BGii 
 
 f\ o^ 
 
 CoEege of ^Jpsiiciang anb burgeons? 
 Hibrarp 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/healthinafricameOOcros 
 
HEALTH IN AFEICA 
 
HEALTH IN AFEICA 
 
 iy ■ 
 
 % McMcal 1banM)ook for :6uropean travellers ant) 
 
 1Rc6it)cnt6f embraciiiG a StuD^ ot /iftalarial 3fe\?er 
 
 as it is tounD in :f8ritisb Central Htrica 
 
 BY 
 
 D. KERR CROSS, M.B., CM, RR.G.S. 
 
 Medical Officer for British Central Africa Protectorate 
 
 WITH AN INTRODUCTION BY 
 
 SIR HARRY JOHNSTON, K.C.B. 
 
 H. B. M.'s Commissioner for British Central Africa Protectorate 
 
 WITH NUMEROUS ILLUSTRATIONS 
 
 ILontion 
 
 JAMES NISBET & CO., LIMITED 
 
 21 BERNERS STREET 
 
 1897 
 
/'=/-//'ro o 
 
 "RCSi 
 CSS 
 
 Printed by Ballanttne, Hanson ^ Co. 
 At the Ballautyne Press 
 
X- ■ 
 
 C 1 
 
 '^ PHEFACE ^ 
 
 The following pages have been written witli tlie desire of helping, 
 in however small a degree, those who live on the outskirts of civi- 
 lisation in Africa. After a residence of fully ten years in British 
 Central Africa as a medical man, I have been impressed with the 
 need for a small handbook on health, written with little attention 
 to technical expression, yet with such acumen and detail as will be 
 appreciated by the intelligent. Surely it is unwise for young men 
 : to go out to malarial countries, like the Central African continent, 
 without the knowledge of the nature of "fever" and allied troubles, 
 and without knowing how best to protect themselves against the 
 same. It is equally unwise to be without the necessary medicines. The 
 majority of those resident in Central Africa are stationed a long way 
 — sometimes a week's journey — from a medical adviser. They are 
 thus, by the exigencies of their position, compelled to acquire some 
 knowledge of medicine. Then, in the eye of the African every 
 European is a doctor, and at any moment may be called upon to 
 minister to a needy native. 
 
 These pages are written in the hope of helping the following : — 
 
 (1) The government official who comes in direct contact with 
 
 the people. 
 
 (2) The non-medical missionary who must be the physician to 
 
 his own community. 
 
 (3) The coffee-planter who is compelled to do something for 
 
 the sick among his employees. 
 
 (4) The merchant trader who may be stricken with fever in 
 
 his store or while travelling in distant places. 
 
 (5) The traveller, the miner, and the engineer. 
 
 Little originality is claimed for the chapters. In writing I have 
 
vi PREFACE 
 
 culled information from every source at my disposal, this only 
 influencing me to accept or reject it : would tlie information be 
 useful for elucidating the subject to those whose mission is in a 
 malarial country. 
 
 Malarial fever has been made the subject of special study. This 
 is the one disease that forces itself on the attention of all, even of 
 the most indifferent. No one escapes fever. This chapter has been 
 written for the intelligent reader who wants to know what " fever " 
 is ; what is going on when the system is convulsed in ague ; what 
 are the varieties of fever found in Africa ; what the sequelse, and, 
 above all, what is the best treatment. One is often surprised at 
 the intelligence manifested on medical themes by those resident in 
 Africa, and can only attribute this to the peculiarities of their 
 situation. 
 
 A full index has been deemed a necessity. 
 
 Is it too much to hope that this little book will become a com- 
 panion to some Europeans in Africa, and that its pages may be 
 consulted with ]3rofit ? 
 
 D. K. C. 
 
 Glasgow, May 1897. 
 
INTRODUCTION 
 
 The man who can teach us Europeans to maintain our health in 
 Central Africa will solve the most important question connected 
 with the Dark Continent. Dr. David Kerr Cross has been for some 
 ten years engaged in medical work at the north end of Lake Nyasa, 
 in the British Central Africa Protectorate, and no medical man of 
 my acquaintance is so fully versed as he is in the study of African 
 diseases. He returns to Central Africa as one of the medical officers 
 in the service of the British Central Africa Protectorate, but, before 
 starting, has, at my suggestion, compiled the most useful and in- 
 teresting manual to which I venture to affix these few words of 
 recommendation. 
 
 Central Africa under present conditions is not healthy. The 
 Highlands are better than the Lowlands, but the land has to be 
 very lofty in altitude to be above the fever zone. Yet the vast 
 countries which lie between the Tropics in Africa are — most of 
 them — richly endowed with sources of wealth. As a rule, the land 
 is fertile and well watered — markedly so compared with Central 
 Australia and many parts of South Amei'ica. The rocks contain 
 precious metals and precious stones. The forests furnish timbers, 
 gums, drugs, and dyes of value. The animal world provides us 
 with beautiful furs, with hides, ivory, and wax. The human 
 population, living mostly in a state of savagery, attracts the atten- 
 tion of missionaries of many forms of Christian doctrine who desire 
 to raise the negro to an appreciation of civilised life and to a 
 definite religion. How are these sources of wealth to be tapped, 
 how are these works to be carried on, if the European pioneer 
 cannot retain his health ? 
 
 Dr. Cross's manual will teach those who study it, how to avoid 
 
viii INTRODUCTION 
 
 disease, and liow to combat it ^vllell it is unavoidalDle. It is not tlie 
 last word on the suljject : men may adopt his remedies and follow 
 his suggestions and yet be vanquished by the African climate. But 
 this manual is, I believe, a step in advance of the few pre-existing 
 works on African Hygiene — mostly written by medical men whose 
 experience of Tropical Africa was much less than that of Dr. Cross. 
 I therefore recommend all Europeans about to settle in Tropical 
 Africa, to read Dr. Cross's manual, and follow as closely as may be 
 the advice therein given — advice with which I wholly concur. 
 
 H. H. JOHNSTON. 
 May 1897. 
 
CONTENTS 
 
 CHAPTER I 
 
 PAGE 
 
 Hygiene ; oe, the Preservation of Health ... 1 
 
 Food — Exercise — Clothing — Mosquito - curtain — The house — 
 Ventilation — Travelling — E-esidence in a warm climate pro- 
 duces changes on the temperature — Blood — Internal organs — 
 Nervous system — Bodily weight. 
 
 CHAPTER II 
 
 Diseases op the Skin . 9 
 
 Structure and functions of the skin — Protection — Nails and hairs 
 — Sweat-glands — Mucous membrane — Erythema — Prickly 
 heat — Eczema — Erysipelas — Urticaria — Boils — Carbuncles — 
 Li ce — House bug — Flea — Chigger — If wingire — Itch — Mos- 
 quitoes — Ticks — Leeches — Ringworm — Affections of the 
 sweat-glands — Excessive perspiration— Sweaty feet. 
 
 CHAPTER III 
 
 Diseases of the Digestive System 23 
 
 Structure and functions of the organs" of digestion — Inflammation 
 of the mouth — Ptyalism, salivation — Sore throat — Quinsy — 
 The teeth — Toothache — Indigestion or dyspepsia — Bilious- 
 ness — Vomiting — Sea-sickness — Gastritis — Diarrhoea — Con- 
 stipation — Colic — Inflammation of the bowels — Dysentery — 
 Tape- worms — Round- worms — Thread- worms — Congestion of 
 the liver — Jaundice — Enlargement of the spleen. 
 
 CHAPTER IV 
 
 Diseases of the Respiratory System 42 
 
 Structure and functions of the respiratory organs — The lungs— 
 Voice-box — Dyspnoea — Cough — Expectoration — A cold — 
 Bleeding at the nose — Laryngitis — Bronchitis — Pneumonia — 
 Pleurisy. 
 
CONTENTS 
 
 CHAPTEE, V 
 
 PAGE 
 
 Diseases of the Cieculatory System and Kidneys . . 51 
 
 Structure and functions — The heart — Dropsy — Palpitation — 
 Angina pectoris — The kidneys — Urine — Hsematuria — 
 Haemoglobinuria. 
 
 CHAPTER yi 
 
 Diseases of the Nervous System 58 
 
 Structure and functions — The brain — Spinal cord - Syncope, 
 fainting, swooning — Apoplexy, cerebral haemorrhage — Epi- 
 lepsy — Convulsions, seizures, fits — Sunstroke, sun-fever, heat 
 apoplexy — Neuralgia — Sciatica — Headache, migraine — Sleep- 
 lessness, insomnia — Chronic alcoholism — Delirium tremens, 
 acute alcoholism — Concussion, collapse, shock — Insensibility, 
 coma — Insanity, mania. 
 
 CHAPTER yil 
 
 Specific Fevers 73 
 
 Fever — The blood — Malarial fever — A typical attack — Apyrexial 
 forms — Malarial, diarrhoea, dysentery, ulcers, paleness, head- 
 ache — Metastatic forms — Intermittent forms with delirium, 
 convulsions, insensibility, excessive shivering, biliousness, 
 fainting — Remittent forms : mild, gastric, bilious, cerebral, 
 algic, typhoid, black-water fever or bilious hamoglobinuric 
 — Sequelse of fever : ansemia, dropsy, red urine, chronic 
 affection of liver and spleen, paralysis, affections of vision, 
 perversion of smell and taste, blood anomalies, perversion of 
 heat-regulating mechanism — Treatment of apyrexial forms, 
 intermittent forms, remittent forms, black- water form — 
 Acclimatisation — Small-pox — Mumps — Whooping-cough — 
 Leprosy — Syphilis. 
 
 CHAPTER VIII 
 
 Bleeding and its Method of Control Ill 
 
 Description of main blood-vessels — Arterial — Venous — Treatment. 
 
CONTENTS xi 
 
 CHAPTER IX 
 
 PAGK 
 
 Wounds, Beuises, Buens, and theie Treatment . . 119 
 
 Antisepticism — Antiseptics — Wounds — Incised wound — Lace- 
 rated wound — Stab — Gunshot wounds — Bruise — Ulcer — 
 Burns and scalds. 
 
 CHAPTER X 
 
 Minor Suegeey 130 
 
 Abscess — Fissure of the anus — Itchiness of the anus — Bubo — 
 Bunion — Chapped hands, chilblains — Corns and callosities — 
 Cramp — Inflammation of the foreskin — Gleet — Gonorrhoea — 
 Haemorrhoids or piles — Hydrocele — Joint-affections — Syno- 
 vitis — Wounds of the lung — Inflammation of the nail, onychia 
 — Necrosis, death of bone — Orchitis or inflammation of the 
 testicle — Prolapsus ani — Retention of the urine — Rupture or 
 hernia — Sprains or strains — Foreign bodies in the throat — 
 Varicose veins — Warts — Whitlow. 
 
 CHAPTER XI 
 
 The Eye, Eae, Theoat, and Nose 144 
 
 Sty — Conjunctivitis — Granular conjunctivitis — Injuries and 
 foreign bodies in the eye — The ear — Inflammation of the 
 meatus of the ear — Wax and foreign bodies in the ear — Acute 
 catarrh of the middle ear — Purulent catarrh or "a running 
 ear" — Polypi — The throat — Sore throat — Ulcerated sore 
 throat — Chronic sore throat — Foreign bodies in the nose — 
 Bleeding at the nose. 
 
 CHAPTER XII 
 
 Emeegency Cases 151 
 
 Cases of poisoning — Cases of drowning — Snake bites — Bites by 
 dogs, hygenas, &c. — Stings — Bites by scorpions — Mosquitoes — 
 Spiders — Insects of all kinds. 
 
 CHAPTER XIII 
 
 Bandages and Bandaging 158 
 
 The roller bandage — Triangular bandage — Applying a sling — 
 Applying a triangular bandage. 
 
xii CONTENTS 
 
 CHAPTER XIV 
 
 PAGE 
 
 Feactures and Dislocations . . . 164 
 
 Fractures — Simple — Compound — Signs of fracture — To set — Frac- 
 ture of collar-bone — Fracture of arm-bone — Fracture of fore- 
 arm — Hand and fingers — The leg — Ribs — Dislocations: 
 Collar-bone — Shoulder — Elbow — Thumb — Hip-joint. 
 
 CHAPTER XV 
 
 Appliances and Hints . .173 
 
 How to take the temperature — To give an enema — Hypodermic 
 injection — How to apply hot fomentations — Counter irrita- 
 tion — Dry and wet cup — Starch and how to make it — 
 Poultices — Warm-water dressing — Baths and packs — Hot, 
 warm, and tepid baths — Graduated cold baths — Cold foot-bath 
 — -Hot foot-bath — Hip-baths — Hot-air baths — Vapour-baths 
 — Mercurial vapour-baths — Cold wet pack — Hot wet pack — 
 Half pack — Cold and tepid sponging — Cold and tepid douche 
 — Medicated suppositories — How to change sheets — How to 
 lift the patient — How to remove the disabled — Water, and a 
 few hints regarding it — Latrines. 
 
 CHAPTER XVI 
 
 Sick Diet and Cooking for Invalids 193 
 
 Serving of food — Milk diet — Water — Oatmeal gruel — Boiled bread 
 and milk — Toast- water — Barley - water — Ri ce -water — Whey 
 with wine — Lemonade — Poached egg — Egg flip — Egg milk — 
 Beef-tea — Chicken-tea — Bouillon — An omelet — Chicken soup 
 — Potato soup — Mutton soup — A chop — A grilled chop — A 
 palatable custard — Tea — Cofifee. 
 
 Appendix I. Weight in Health . . _. . . .199 
 
 Appendix II. Medicines 200 
 
 Appendix III. European Provision Order for one Year 204 
 Appendix IV. General Outfit ...... 208 
 
 INDEX 214 
 
HEALTH IN AFRICA 
 
 CHAPTER I 
 HYGIENE; OR, THE PRESERVATION OF HEALTH 
 
 It is now admitted by every writer on Hygiene, that tlie climate 
 of a country lias a marked effect on the health, spirits, and char- 
 acter of its inhabitants ; it therefore becomes all those brought up 
 in a temperate climate, and who find themselves suddenly trans- 
 ported to tropical heat and life, to carefully study the laws of health, 
 so as to ward off those bodily weaknesses and diseases to Avhich they 
 are exposed. 
 
 In order to maintain health in the tropics, special attention 
 must be paid to — 
 
 Food. — By food is meant everything that is taken into the 
 Bystem to maintain the healthy discharge of its functions. Milk is 
 a perfect food, in that it contains in perfect proportion all that is 
 necessary for the maintenance of health. The food of a healthy 
 person is usually a mixed diet, and contains quite a variety of 
 nutritious ingredients. The different foods may be classified as 
 follows : — 
 
 (1) Proteids or Nitrogenous Foods, such as meat, flour, 
 
 eggs, and cheese. 
 
 (2) Fats, as oils ; animal and vegetable fats. 
 
 (3) Amyloids, which comprise sugar, rice, sago, bread, arrow- 
 
 root, potatoes. 
 
 (4) Salts, as common salt and phosphates. 
 
 In addition to the above, ordinary water, and mineral waters 
 containing various chemical substances, enter largely into the com- 
 position of the food. From 60 to 80 ounces of fluids, in the form 
 of tea, coffee, and water, are taken every day into the system. 
 
 A 
 
2 HEALTH IN AFRICA 
 
 A large part of the solid constituents of the body consists of 
 proteids, which, are alwaj^s undergoing oxidation, and the oxidised 
 products are constantly being excreted in the urine as urea and 
 uric acid. 
 
 Milk from the cow is the most digestible of milks. Goat's milk 
 contains 4*2 per cent, of fat, 4 per cent, of milk-sugar, and 3 per 
 cent, of casein. It is richer in cream, but poorer in proteids than 
 cow's milk. Asses' milk is most nearly allied to the human, and is 
 therefore the most suitable substitute for the mother's milk which 
 can be given to very young infants. 
 
 Meat as an article of diet should only be partaken of in the 
 tropics twice within the twenty-four hours, and then only with 
 moderation, and should always be carefully and well cooked. The 
 digestive organs are more delicate in the tropics than in the tem- 
 perate regions, and are not so resistant to an overstrain. Heavy 
 luncheons should always be avoided. As far as possible discard all 
 tinned meats, and, above all, tinned fish. The flesh of the native goat 
 is infinitely better and cheaper than any form of tinned meat. Should ' 
 one be forced to open a tin of fish, the whole should be partaken of 
 at one meal, and if any is left over, it should be disposed of. Low 
 forms of life germinate in tinned fish with remarkable rapidity. 
 
 Fruits in their season when fully ripe are always good. Oranges, 
 mangoes, ripe bananas, guavas, papaws, and the juice only of the 
 pineapple, can be partaken of freely during the day, but should not 
 be partaken of at night. 
 
 As regards the use of alcohol in the tropics, the question is one 
 that has been fiercely debated, and even now is a vexed question. 
 It is admitted on every hand, that, provided suitable food is pro- 
 curable, the majority of men can maintain perfect health without 
 alcohol in any form. AU admit that the stronger forms of alcohol, 
 unless freely diluted with water, are prejudicial to health. Alcohol 
 dilates the vessels of the skin, so that it lessens bodily heat by 
 radiation. It increases the action of the heart for the time being, 
 but this is quickly followed by a period of depression. Large 
 quantities of spirits paralyse the nerve centres ; while small quan- 
 tities, by increasing the blood supply, stimulate mental activity. 
 In small quantities it induces sleep. This, however, should be 
 clearly stated : in no climate is it necessary for the maintenance of 
 health, and should on no consideration whatever be touched till 
 the work of the day — with its worry and fatigue — is over. Con- 
 sidering, too, the awful hold alcohol has on certain constitutions, 
 slowly undermining every noble trait, it would be well to discard 
 spirits absolutely as a common article of diet. 
 
THE PRESERVATION OF HEALTH 3 
 
 Tea, coffee, and cocoa are excellent drinks in liot climates. It 
 should, however, never be forgotten, that thirst, and the habit of 
 relieving it by imbibing fluids, are largely a matter of education 
 and habit. The drinking of large quantities of water is always in- 
 jurious, especially when one is heated after a long fatiguing journey. 
 Never take a big drink of water from a running stream when you 
 are hot, or you may fall insensible. 
 
 Exercise. — As in temperate climes, so in tropical, the amount 
 of exercise and rest in sleep which are necessary for the mainte- 
 nance of health in the individual, are largely the result of habit. 
 No rule can be laid down, but, speaking generally, it is a fact that 
 the amount of sleep partaken of is in excess of the requirement. 
 It seems also to be true that residents in the tropics require more 
 sleep in hours than those who reside in temperate regions. Sleep 
 should never be indulged in after a hearty meal. 
 
 The best time to take exercise is in the early morning shortly 
 after sunrise. During these hours the air is cool and balmy, the 
 body fresh, and the mind active and susceptible of impressions. 
 
 Most people take a quiet siesta during the day, and this is 
 necessary. Rest is generally taken from 12"30 to 2 p.m. It should 
 be made a rule, that, including the quiet noonday time of rest, nine 
 or ten hours out of the twenty-four should be given to sleep. 
 
 In the tropics it is doubly unwise to turn the night into day. 
 No amount of sleep taken during the day can compensate for the 
 loss of calm rest at night. The unavoidable noises, the heat, the 
 light, rob the nervous system of the tranquillity so necessary to 
 refreshing sleep. 
 
 The tendency in the tropics is to lead a sedentary life, and this 
 is more injurious to the system than in the temperate zone. Every 
 man must fight this tendency, and take a due amount of exercise 
 suitable to his own constitution. Of all exercises an early morning 
 ride before the bath is best. 
 
 Clothing. — We clothe ourselves to protect the body against cold 
 and wet and wind, and to retain the natural bodily heat. Man has 
 this power given him in contrast to all other animals, and it enables 
 him to brave all climates. 
 
 In the tropics, for months at a time, the temperature of the air 
 exceeds that of the body (98-6 E.) ; consequently the circulation in 
 the skin is increased, and there is a balance between the evaporation 
 and radiation, which results in the temperature of the body being 
 maintained. We require clothing, therefore, not as in temperate 
 zones, to retain the natural bodily heat, but to protect the skin 
 from the external heat, and allow a free evaporation from the 
 
4 HEALTH IN AFRICA 
 
 same, A resident in tlie tropics should be always so clothed that 
 he is proof against sudden chills from changes of temperature. 
 Look upon the sun as an enemy, and never go into the direct rays 
 without having the head covered by a pith helmet. If forced to 
 stand for a short time, while bathed with perspiration, throw some 
 extra garment over the shoulders and so avoid a chill. In fact, if 
 you want to preserve your health in a changeable climate like that 
 of Africa, you must to some extent be prepared to coddle yourself. 
 
 The material of the dress is important. — Dress should always be 
 chosen so as to maintain, as nearly as possible, an equable tempera- 
 ture, retaining natural heat, and resisting external heat and cold. 
 Cotton is admirably adapted to warm climates, except when the 
 body is covered with perspiration. Linen, on the other hand, is 
 very cold, does not absorb or retain moisture so freely as cotton, and 
 does not soil so readily. A^ery often in Africa the skin is simply bathed 
 in perspiration, even when the most ordinary duties take up the 
 attention. It is therefore most necessary to guard against chills of 
 every kind. I would therefore recommend that fine flannel be worn 
 next the skin, by day and by night, in order, as far as possible, to 
 maintain an equable temperature. If the wearing of flannel should 
 tend to set up prickly heat, as it does in some constitutions, then a 
 linen garment should be worn underneath the flannel to protect the 
 skin. If one should be travelling on the hills in the cold season, 
 an additional flannel shirt should be worn. This point settled, 
 I would recommend that Avhite cotton suits be worn in addition 
 to the flannel under-garments. Colour influences the absorption 
 of heat, and it is well known that white garments absorb heat least 
 of all. A proper head-dress is an absolute necessity. It should 
 be light in weight and white in colour, should afford shade to 
 the eyes and covering to the back of the neck, and should allow 
 a free current of air to pass over the top of the head. A good 
 helmet is therefore as much as a man's life may be worth when 
 under a tropical sun. 
 
 Suitable foot-gear is also a necessity. When the hot season is 
 upon us, shoes are to be preferred to boots. Boots should be made 
 of soft and pliable leather, and, while large and roomy, should be 
 a good fit. 
 
 In Africa it is important to protect the region of the abdomen 
 from the constant chills. — For this purpose the flannel belt or 
 " Kamarband " is usually worn. It should be made 10 inches 
 broad, 6 feet long, and of the best unshrinkable flannel, and 
 should encase the abdomen, being wound round the waist at least 
 twice. It should be M'orn loose. If it is made narrow, and drawn 
 
THE PRESERVATION OF HEALTH 5 
 
 tightly round the abdomen, perspiration will be retained on its 
 upper edge and under surface, and so will neutralise its good 
 effects. 
 
 All over India " putties " are used as an article of clothing, and 
 might well be adopted in Africa. They are worn over the trousers, 
 give support and protection to the legs, and are most comfortable. 
 They are simpler and better than leather leggings, which are often 
 found to press on the ankles. 
 
 A mosquito curtain is indispensable for Africa. Mosquito bites 
 are sometimes a source of great trouble, especially to all new- 
 comers, giving rise to considerable oedematous inflammation of the 
 eyelids, neck, hands, arms, and ankles. They set up a most violent 
 irritation which leads to scratching, and it may be to tearing and 
 bleeding of the tissues. Look upon mosquitoes as enemies, as 
 they are the intermediate hosts of quite a number of low forms of 
 life that live in the lymphatics and blood of man. This is specially 
 so in some parts of Africa where certain species of mosquitoes 
 abound. It may also yet be proven, that all our malarial troubles 
 are due to these blood- sucking insects. For a single person a 
 mosquito net should be about 7 feet in height, 7 feet in length, and 
 3^ feet in breadth. The top should be made of linen cloth and not 
 netting, and the curtain should be of closely woven hairy netting, 
 so that even the smallest mosquitoes cannot find an entrance. It 
 will save a world of after trouble, to get such a net, to use it from 
 the first day of African life, to be most careful that no stray insect 
 has gained an entrance before you retire, and that you make it a 
 rule never to sleep in Africa witliout a curtain. 
 
 The house. — The selection of a site for a house is a much more 
 important matter in the tropics than in temperate regions, inasmuch 
 as the question of malaria enters so largely into the affair. Most 
 eastern towns are, for obvious reasons, built on the banks of rivers, 
 and built in the worst situations possible. Clay slate rocks usually 
 afford a healthy sita for a house, as they do not retain water. Trap 
 rocks, metamorphic and granite, are also good, as from them water 
 runs off more or less rapidly. Limestone rocks, chalk without clay, 
 are usually good. If, however, chalk has an under-strata of clay, 
 it is likely to be cold, damp, and malarious. Sand, if it is pure, 
 and of considerable depth, is usually healthy, as the water cannot 
 lie and afford a nidus to malarial life. Clay soils, being impervious, 
 usually retain water, and are consequently malarious. 
 
 The lower storey of a dwelling-house should be raised so as to 
 be clear of the ground, unless it is made absolutely impervious to 
 damp by the finest cement. It should be a rule that the sleeping 
 
6 HEALTH IN AFRICA 
 
 room, if not cemented, be at least 10 feet above the soil. The nnder- 
 floor could be utilised for ordinary rooms or stores, but the sleeping 
 apartment should always be raised. To the neglect of this rule, 
 together with the use of sun-dried bricks in building, may be traced 
 much of the fever and some of the deaths, which have occurred in 
 Central Africa. 
 
 Every room in the house should have a fireplace, and a good log 
 fire should burn brightly every day. It is not necessary to have 
 such for the heat, but it dries the air and ventilates the room. If 
 it is not possible to have a fire within the house, then a good fire 
 should burn at night on the verandah, opposite the door of the 
 sleeping room. Eire is the enemy of malaria. Every dwelling 
 should have an eight-feet-in-width verandah all round, and should 
 be well ventilated to keep off' the hot air. Every dwelling, too, 
 should be supplied with pij)es, gutters, and eaves, to convey the 
 rain-water from the foundations of the house. 
 
 Ventilation. — Pure atmosphere is of the utmost importance. 
 It is well known that the native African seldom sufi'ers from chest 
 complaints, and this is largely due to the fact that he lives in the 
 free air and sunshine, and enters his house as seldom as possible. 
 His house is built to sleep in — he lives in his village. Pure air is 
 secured in dwelling-houses by ventilation, that is, a stream of pure 
 oxygenated air is allowed to enter the room, and to replace the 
 vitiated atmosphere, which is loaded with what, to man at least, are 
 impurities. The air we expire is largely devoid of oxygen, and 
 loaded with carbonic acid and organic matters. Then the surface of 
 the skin is constantly giving off a variety of impurities ; there are, 
 too, hosts of microscopic life arising in every room from a thousand 
 sources ; dust is abundant in all atmospheres ; gases are given off 
 from the candles we burn, &c. &c. — all these tend to make the air of 
 a room impure, and demand that a current of fresh atmospheric air 
 be supplied. That the air of a dwelling is impure is not always 
 apparent to the senses of those resident in the room, but is abund- 
 antly so to those who have enjoyed the freshness of the open air. 
 The former have had their senses dulled. Nature has provided us 
 all with the most delicate instruments in the sense of smell and 
 touch. That the air is vitiated is most apparent in the early 
 morning if one is called upon to enter a bedroom which has been 
 occupied for the hours of night by one or more sleepers, and if the 
 doors and windows have been closed. On entering such a room one 
 instinctively wishes to draw back, feeling uncomfortable. 
 
 Ventilation is the means by which this heated, moisture-laden, 
 foul air is removed, and pure air allowed to take its place. If 
 
THE PRESERVATION OF HEALTH 7 
 
 a fire is burning in a fireplace, tlien the currents set up purify 
 the air in a wonderful manner. Nothing ventilates a room better 
 than an open fire with a free chimney ; currents from every corner 
 of the dwelling are constantly in motion firewards, while fresh 
 air enters to fill up the vacuum. This fresh air enters by the 
 doors, the windows, and even through the walls themselves. A 
 continual diffusion of gases is thus going on, causing the air of the 
 room to be constantly changed. 
 
 The one thing here to be avoided in the admission of fresh air in 
 abundance, is draughts. The problem must always be solved with- 
 out any current of air acting injuriously on the system, or playing 
 on any one part of the body, so as to reduce its vitality. In Africa 
 this is sometimes very difficult, and is doubtless that which weakens 
 the body and exposes it to an attack of fever. Fever is often brought 
 about by a cold. In every case study the room, and place the bed 
 in such a position, that no current of air from the door or window 
 will pass over the sleeper. Screens will here come into requisition. 
 The window and door are of course the best means of airing a room. 
 As long as draughts are avoided, too much air cannot enter a room. 
 In the early morning throw wide the doors and windows, air the 
 coverings of the bed, and let nature drive away every impurity. 
 There are two things that low pathological forms of life cannot 
 stand, and these are fresh air and sunlight. 
 
 It is absolutely necessary to study to avoid draughts. — Now, it is 
 obvious that if a window is open at the bottom, it will create a 
 current of air about the level of the sleeper, and if open at the 
 top, this will be lessened. It should be laid down as a rule, that 
 when allowing air to ventilate a room in which there is a sick 
 person or a sleeper, the air should by some means, as by a board, 
 be directed towards the ceiling of the room. The current of air 
 is by this means disseminated throughout the apartment, and 
 draughts are avoided. If this rule is put in force, it is an excellent 
 plan to have the uj)per sash of the window lowered a few inches 
 all night long. 
 
 When travelling in Africa it is wise to make the very most of 
 the early morning hours. All journeys should be begun not later 
 than 6 a.m., and should be completed for the day not later than 
 noon. Before starting in the morning, and if possible before rising 
 from bed, take a warm cup of coffee and a biscuit. On rising put 
 the feet on a rug of some kind. Wash in cold water, sponging the 
 body freely. 
 
 When journeying through malarial districts take 2 grains 
 quinine every morning and evening. Take the drug in tabloid 
 
8 HEALTH IN AFRICA 
 
 form or rolled up in cigarette paper. When forced to pitcli the 
 camp near to a marsh or pool of stagnant water, if possible be to 
 the windward of it, so as to escape the unpleasant effluvia, and have 
 the openings of the tent looking awaj from the swamp. All night 
 long keep large log fires burning a few feet from the door of the 
 tent. It would also be a wise precaution to sprinkle a good quantity 
 of sulphate of iron around the temporary dwelling. 
 
 There is ample proof that long residence in a warm climate 
 produces changes in the constitution. Of late years, elaborate 
 researches have proved that, under ordinary circumstances of life, 
 residence in the tropics has an adverse effect on the bodily frame 
 of the resident. Health in the tropics has greatly improved from 
 what it was 50 or 100 years ago. The most scrupulous care is now 
 given to the study of the laws of health, with the result that the 
 death-rate has gone steadily down and is still on the decrease. In 
 order to attain even approximately to the temperate standard of 
 health the most extraordinary care is necessary in the tropics. If 
 the want of attention to detail in food, exposure to night air, sleep- 
 ing apartments, shown in Britain, were imported to the tropics, the 
 mortality would go up with a bound. 
 
 Residence in the tropics has an appreciable effect on the tem- 
 perature of the individual. Careful research shows that in India 
 the body temperature of the European living in Bengal is about 
 0"41° F. higher than the average of healthy persons in England. It 
 has also an effect on the respirations of the individual and on the 
 pulse. It markedly affects the secretion of urine, as even the most 
 casual observer must have noticed. Residence in a warm climate, 
 owing to the heat, the humidity of the air, &c., causes the amount 
 of urine secreted to be much diminished. The actual amount will 
 depend on the moisture lost by the skin and given oft' by the lungs. 
 
 Every resident in the troj)ics becomes anaemic. This is specially 
 so in women and children. Malaria has a marked deteriorating 
 effect on the number and functions of the red blood corpuscles. 
 All the organs of the body suffer — the blood-forming organs as 
 well as those which carry on the ordinary bodily functions. The 
 nervous system is at first elated, but in the course of months, or a 
 year at the most, it is markedly depressed. SjDeaking generally 
 the actual weight of the frame is lessened by long-continued resi- 
 dence, the muscular system is lessened in tone, and the vitality of 
 the frame lowered. 
 
CHAPTER II 
 
 DISEASES OF THE SKIN 
 
 STRUCTURE AND FUNCTIONS OF THE SKIN 
 
 The skin consists of several strata of cells, wliicli lie mostly in layers 
 flattened out, and are united togetlier by a cementing substance. 
 Its main function is protection to the delicate structures beneatb ; 
 but it is also the seat of the sense of touch, and has great absorbing 
 and excreting capacity. It is indeed one vast network of sensory 
 nerves, the meshes of which are so close that the finest point cannot 
 penetrate without causing pain. The tissues below are much less 
 sensitive, so that when once a needle penetrates the skin the pain 
 is comparatively slight. {See Fig. 1.) 
 
 Nails and hairs are modifications of the horny layer of the skin. 
 The sweat glands secrete a large proportion of the watery and gaseous 
 materials of the body. They are found in almost every part of the 
 skin, in little depressions which abound over the horny layer. The 
 skin covers the entire surface of the body, and changes its character 
 as it enters orifices and canals, such as the mouth and nose and 
 ears, which lead into the inner cavities. In canals such as the 
 mouth and digestive canal it is greatly changed in structure and 
 appearance, and secretes a lubricating substance known as mucus. 
 Here it is named mucous membrane. In these canals it is always 
 red and soft and delicate. 
 
 DISEASES OF THE SKIN 
 
 Erythema. — This is a simple inflammation or redness of the 
 skin, which may be localised or spread over the whole body. 
 
 A chilblain is a local inflammation accompanied by itchiness and 
 heat and swelling. Any irritant, such as an acid secretion of the 
 body, frequently applied to the skin, will set up an erythema. If a 
 person with delicate skin should violently rub the body with coarse 
 
10 
 
 HEALTH IN AFRICA 
 
 flannel, a local inflammation will be broiiglit about. If one sits long 
 before a hot fire, or if tbe arms are exposed to the African sun 
 as in marching, erythema is the result. The redness disappears 
 on being pressed, and the edges of the affected parts are not 
 abrupt, but shade off gradually into the healthy skin. Should the 
 opposed surfaces of tender skin rub each other, as in the hips 
 and armpits, in hot moist weather, a marked form of erythema 
 ensues, and if the irritation is very long-continued, it may become 
 an eczema. 
 
 Treatment. — Look carefully for the cause and remove it. Locally 
 apply a soothing application such as flour, oxide of zinc, or starch 
 
 
 
 Fig. 1.— Diagrammatic Sketch of the Skin. 
 
 powder. Benzoic acid (40 grains to two tablespoonfuls of water) is 
 good. Borax (a tablespoonful of the powder to two tumblers of 
 water) is excellent. Itching may be relieved by washing the 
 surface with lotions of the alkalies, or of lead if the aftection is 
 local. Should a large surface be involved, take a tepid bath of 
 bicarbonate or carbonate of soda (|- lb. to 20 gallons is about the 
 proportion). 
 
 Prickly heat. — This annoying affection is met with extensively 
 among Euro23eans in Africa during the hot moist months. Its 
 presence is due to a congestion at the mouths of the sweat glands, 
 and is accompanied by an innumerable number of little red pap- 
 ules, about the size of a pin-head, all over the body. The skin is 
 
DISEASES OF THE SKIN 11 
 
 unusually rough and dry ; but in a few cases it may be moist, and 
 matter even may form at the moutlis of the glands. The redness 
 is accompanied by an intolerable itching sensation, which, may 
 prevent sleep. Stimulants, over-eating, the wearing of woollen 
 clothing, all aggravate the affection. After a short period the 
 rash may disappear, with a very slight falling off of the upper 
 layers of the skin, only to appear again in a fresh crop of papules. 
 
 Treatment. — Let the sufferer be kept cool. Avoid all stimulants, 
 and let the food be very light. Wear only, for a short time, linen 
 clothing ; but should this be found too cold, wear the ordinary flannel 
 garments over tbe linen clothing. A texture made of silk and wool 
 is admirable. Take a Seidlitz powder or citrate or acetate of potash. 
 "Eno's Fruit Salt" is good. Sponge the body, one limb at a time, 
 Avith strong vinegar, which, should be washed off wuth lukewarm 
 water and thoroughly dried. If there is great irritation, and a 
 tendency to the formation of fluid or matter, let the following be 
 used as a wash. : — 
 
 Carbolic acid ... 2 teaspoonfuls, 
 
 Glycerine . . . _ . 6 ,, 
 
 Piectified spirit ... 3 tablespoonfuls. 
 
 Rose water .... 3 „ 
 
 Let the night clothing consist of light flannel, silk and wool, or, better 
 still, let it be a gauze singlet with thin pyjamas. Remedies are of little 
 avail if the 'patient persists in talcing fluids. Let the folds of the skin 
 be dusted night and morning with the following preparation : — 
 
 Powdered boracic acid . . \ 
 
 Starch. >of equal parts. 
 
 Oxide of zinc . . . j 
 
 Apply the following with a sponge after the morning bath : — 
 
 Sulphate of copper . . 10 grains. 
 Water .... 2 tablespoonfuls. 
 
 The following is also good, and should be gently applied by a wet 
 sponge : — 
 
 Sublimed sulphur .... 80 parts, 
 Oxide of magnesia .... 15 „ 
 Oxide of zinc ..... 5 „ 
 
 Eczema (native name, Penza.). — This is a common disease 
 amongst the natives, and is seen both in its acute and chronic 
 
12 HEALTH IN AFRICA 
 
 forms. It is not contagious, and begins usually as a violent inflam- 
 mation of the skin, passing on to blisters with a clear fluid, and even 
 to blebs of matter. There is a burning heat in the affected area and 
 great itching. The fluids secreted unite with dust and hair and dirt, 
 and form scabs, which cover the inflamed parts. It is slow in its 
 course, and liable to come back. The most frequent cause is some 
 local irritation continuously applied. If a person suffers from the 
 veins of the leg being varicose (enlarged), or is subject to indigestion, 
 he is liable to be troubled with this unpleasant aftection. 
 
 There are many varieties of eczema, but all have the following 
 characteristics : — 
 
 1st. A thickening of the skin, due to the long-continued inflam- 
 mation. It is a common observation amongst coloured races, that 
 if a native gets a cut, and allows it to fester, the skin around 
 becomes infiltrated and thickened. So is it here. 
 
 2nd. The surface weeps. A clear fluid trickles down the sore. 
 
 3rd. Crusts form. 
 
 4th. There is excessive itching. This is most severe when the 
 patient is warm in bed. 
 
 Treatment. — Look carefully for the irritant and remove it. If it 
 is due to scratching, see that such is stopped. Almost invariably 
 the disease needs a local as well as constitutional treatment. Avoid 
 rich foods. In treating locally, first remove the crusts by smearing 
 the surface with oil for twenty-four hours, and afterwards applying 
 a poultice for several hours. Let the poultice be large and soft and 
 moist. On removing the poultice, wash with soap, flannel, and 
 hot water. Weak gruel and milk are admirable for this purpose. 
 Should there be no crusts, but only redness and moisture, apply 
 oxide of zinc or borax. In this stage, that is when the affected 
 area is red and moist, soap and flannel should be avoided. When 
 the inflammation is becoming less, use mercurial ointment (5 grains 
 to the ounce of lard). When the skin is dry and scaly and itchy, 
 use oil of cade. Every ointment should be applied on strijDS of 
 lint, and not rubbed over the affected surface. 
 
 Erysipelas (in Scotland, "the Rose"). — It is an acute, spreading 
 inflammation, with swelling and a tendency to suppuration. It 
 may occur in connection with wounds, or burns, or operations, and 
 is frequently seen on the scalp or on the extremities. It is slightly 
 infectious, and is sometimes epidemic, so that we may say some 
 specific poison, introduced from without, lays hold of the body 
 tissues and weakens them. The glands near the affected part are 
 inflamed, and the patient is feverish. 
 
 The simple form of erysipelas is seen on the face, at the angles 
 
DISEASES OF THE SKIN 13 
 
 of the mouth, nose, eyes, or ears, or indeed wherever the skin and 
 mucous membrane meet. At first the part is rosy red, but in a 
 short time it becomes dusky. The skin is stretched, and conse- 
 quently appears smooth and shiny. The edges are abrupt, so that 
 they can be felt ; but there is a constant tendency to spread in some 
 special direction. The glands in the neighbourhood of the affected 
 part are tender and inflamed. The disease usually runs its course 
 in from ten days to three weeks. 
 
 The more serious form may have little vesicles or blebs con- 
 taining fluid or even pus, on its surface. This form is seen near to 
 a wound and mostly in the extremities. It may set in with shivering 
 and fever. 
 
 Treatment. — As the disease is very contagious to those who are 
 suffering from open wounds, the patient should be removed at once, 
 and the most careful attention given to cleanliness and ventilation. 
 Let the sufferer rest in bed and take good, plain, nourishing food. 
 Five grains of calomel, followed in two hours by a Seidlitz powder, 
 is good. Take 20 to 40 drops of the tincture of the perchloride of 
 iron every two hours, and 3 grains of quinine every four hours. 
 Let the local affection be covered with flour, or starch, or oxide 
 of zinc powder, and protected with a thick layer of cotton wool. 
 Powdered camphor is very soothing. If the extremities are affected, 
 let them be elevated in addition to the above treatment. Wash the 
 parts daily with warm water and renew the dressings. All cast-off 
 dressings should be immediately burned. If the head is affected, 
 let it be shaved and cold water or ice applied. 
 
 Urticaria or "Nettle-rash" (native name, Amawunia). — This 
 disease is common amongst the natives of Africa. It has the 
 appearance of the sting of a nettle, and hence its name. It is a 
 little white circular elevation on a red ground, never larger than 
 the finger-nail. It has an intense burning or stinging sensation. 
 The one thing which characterises this disease from other itching 
 skin diseases is its evanescence. The stinging sensation may be 
 almost intolerable, and in an hour the unpleasantness may have 
 passed away. Its reappearance is equally sudden and mysterious. 
 It has been suggested as a means of diagnosis, that, if we write on 
 the skin with a pencil, or with the nail of the finger, the lines are 
 followed by a nettle-rash tracing. The causes of the affection are 
 some irritation affecting the nerve supply, some mental emotion, the 
 eating of bad food or shell-fish. The natives say that if some indivi- 
 duals eat certain grains, they are sure to suffer from this disease. 
 They liken the sensation in the affection to the sting of hornets. 
 
 Treatment. — Find out and remove the cause. At the beginning 
 
14 HEALTPI IN AFRICA 
 
 of the treatment give a brisk purge, or an emetic of sulphate of 
 zinc. There are various ways in which the itchiness may be 
 relieved. It may be effected by sponging the surface with equal 
 parts of tincture of benzoin and water, or with vinegar and water. 
 Eau de Cologne is also good. The following is excellent : — 
 
 Carbolic acid ... 2 teaspoonfuls, 
 Glycerine .... 6 „ 
 
 Water 6 tablespoonfuls. 
 
 Boils. — These are very common amongst Africans. They are 
 never seen on the palms of the hand or soles of the feet, but are 
 common on the back of the neck, armpits, hips, &c. They often 
 come in crops. They begin in the tissues under the true skin, 
 and generally start in one or other of the glands lodged there. 
 At first there is local itchiness, to give relief to which the part is 
 scratched. This results in a small papule, with a hair coming from 
 the centre. In two days there is an extensive red surface with 
 pus in the centre. This pus dries up, but the scratching being still 
 indulged in, tlie centre is pulled out, and results in a small hole 
 with a hard firm base. More pus is formed and discharged. A 
 sty is such, a boil on the edge of the eyelid. The characteristics 
 of a boil are two in number: it has a central slough, and is not 
 larger than a walnut. 
 
 Treatment. — Eemove the local irritation, such as the friction of 
 the clothing. Sometimes a boil may be aborted by pulling out 
 the central hair, and injecting, by a needle, a drop of pure car- 
 bolic acid. Another method is to moisten with tincture of iodine. 
 Nitrate of silver (1 drachm to 2 tablespoonfuls of water) is also 
 good. In order, however, to be effectual this must be done at 
 the very commencement of the affection. Should it have been 
 neglected at the very beginning, apply hot fomentations or a warm 
 moist poultice. Too frequent poulticing is apt to bring on a fresh 
 crop of boils in the neighbouring parts. In order to avoid this, 
 protect the adjacent skin by oil and glycerine. Tincture of opium, 
 sprinkled over the poultice, will relieve the pain. When the boil 
 is fully ripe, and only then, remove the top and the pus, together 
 with, the indurated centre. After that let the sufferer take rest and 
 light nutritious food. Free purging is good. 
 
 Carbuncle. — In some respects this is an exaggerated boil. It 
 is really a slough of the tissues below the skin, which causes the 
 skin to be red and dusky in appearance. The pain of a carbuncle 
 is always great, and at times is intense. In a boil the top is pointed, 
 in this it is flat. Often it is two inches in diameter or even 
 
DISEASES OF THE SKIN 15 
 
 more. In course of time tlie dark skin over the inflamed area is 
 pierced by a number of small holes and bursts, then the slough 
 escapes — it may be in one whole piece, A raw cavity is now visible 
 with much undermining of the skin. A carbuncle is usually single, 
 a boil multiple. It is most frequently seen on the back of the 
 body, while a boil may appear on any part of the body. 
 
 Treatment. — Attend to the digestive organs, and let the food 
 be nourishing. The sufferer should have plenty of fresh air. 
 If he is strong and healthy, and the carbuncle ripening, make a 
 free cross cut right into the mass, and wash it with carbolic acid 
 1 part, to water 60 ^^arts. After this the carbuncle will disajjpear. 
 The general health of the sufferer must now be attended to by 
 change of air and light nourishing food. 
 
 DISEASES OF THE SKIN DUE TO ANIMAL PARASITES 
 
 The following diseases are contagious but not infectious ; that 
 is to say there must be actual contact before they can be trans- 
 mitted. They usually appear when the system is weakened and run 
 down. They are all accompanied by itching, which leads to scratch- 
 ing and abrading of the skin, and the appearance of drops of fluid, 
 or even blood. Most natives suffer from their ravages, and personal 
 servants are apt to give them to Europeans. 
 
 Lice. — The louse is a wingless insect found on man, which feeds 
 by suction. It produces an eruption of slightly raised papules 
 which has a characteristic itching. There are three varieties — 
 
 (a.) On the tody. — This insect pushes its proboscis into a hair 
 follicle until it reaches the capillary blood-vessels. 
 The bites are seen chiefly on the neck and wrist. The 
 eggs are not found on the body of the host, but in the 
 folds of the clothing, 
 (b.) On the head. — This insect is smaller than the above. The 
 eggs are attached to the hair and not to the scalp. It 
 has long legs, and is able to run among the hairs, 
 (c.) On the pubis. — It is found on all hairy parts of the body 
 except the head. 
 Treatment. — Look carefully for the insects and the eggs. Carbolic 
 acid is the best remedy. The following is a good preparation : — 
 
 Carbolic acid .... 2 teaspoonf uls, 
 Water 12 tablespoonfuls. 
 
 With this sponge over the afi^ected parts morning and evening. 
 
16 HEALTH IN AFRICA 
 
 In the case of the head it is often necessary to remove the liair 
 and to wash with carbolic acid 1 part to 60 parts of water. After- 
 wards Avash the part freely with soap and water. Let all clothing 
 be thoroughly boiled. 
 
 The common house-bug {Acanthia ledularia). — This insect is 
 very common in Africa, especially in old houses. Its red flat body, 
 offensive odour, nocturnal habits, and biting propensities are well 
 known. It is very tenacious of life, being able to exist for a year or 
 more, without nourishment of any kind. Its bite is like a nettle 
 sting, but the actual bite in the centre of the circle is quite visible, 
 and does not disappear on pressure like the redness around. It is 
 said to be killed by " Persian Insect Powder." This powder should 
 be sprinkled on the clothing, and inserted into the crevices of the 
 Avoodwork of the house with care. In order to relieve the itching, 
 rub the bites with Eau de Cologne, or very strong vinegar, or 
 ammonia. The following lotion is good : — 
 
 Dilute hydrocyanic acid . 2 teaspoonfuls, 
 
 Glycerine .... 3 „ 
 
 Water . . . . 12 tablespoonfuls. 
 
 The common flea. — This insect is found all over Africa, and 
 everybody suffers from its ravages. It has remarkable powers of 
 leaping, being able to jump two hundred times the length of its own 
 body. This it does by means of the very remarkable muscles of 
 its legs. The eggs are deposited in dust and sand, and even under 
 the toe and finger-nails of the Africans, The bite is more painful 
 than itchy, and causes a hsemorrhage into the tissues, owing to the 
 injury offered to the blood-vessels. The bites are always surrounded 
 by inflammation and swelling, and are found where the clothing 
 embraces the body. To destroy them use the following : — 
 
 Carbolic acid ... 2 teaspoonfuls, 
 
 Water . . . . 12 tablespoonfuls, 
 
 or the following : — 
 
 Perchloride of mercury . 12 grains, 
 Rectified spirits ... 2 tablespoonfuls, 
 
 Water 10 „ 
 
 Sponge the parts night and morning. 
 
 Chigger or Sand flea (native name, Matehenya). — This remark- 
 able insect was at one time confined to America, but within the 
 
DISEASES OF THE SKIN lY 
 
 last few years it lias crossed the continent of Africa, and is now 
 rapidly penetrating tlie Sondan and South Africa. In a short time 
 we shall hear of its ravages in tropical Asia. 
 
 It lives in sand or on the gronnd, in the grass. It is most 
 common where cows and domestic animals abide. It is smaller 
 than the common flea, but, like it, is reddish brown in colour. It is 
 a true parasite, sucking the blood by piercing the skin. The male 
 insect gives us no further trouble, but the female, when impreg- 
 nated, buries herself in the skin of any warm-blooded animal — and 
 the warmer blooded the kindlier for her. In the case of man, she 
 selects the feet or fingers, and preferably the horny parts of the 
 skin. She goes slantingly under the skin, towards the soft tissues, 
 and there settles and imbibes the blood. Here safely lodged, 
 the abdomen begins to enlarge by the development of the eggs. 
 The skin over the insect rises, until a small tumour is observed 
 about the size of a pea. From the moment she pierces the skin 
 until the end, the part is extremely itchy. If carefully looked at, 
 the small hole of entrance will be seen as a dark spot, with the 
 abdominal appendages occupying the same. The tissues around 
 become inflamed and may suppurate. In time the covering of skin 
 over the insect dies, and the intruder, now having assumed an enor- 
 mous size (comparatively), is ejected. The eggs are fully ripe when 
 this takes place, and the overstrained abdomen bursts, and scatters 
 thousands of eggs on the ground. Soon each egg becomes a larva, 
 and weaves for itself a cocoon, and |)asses through the nympha 
 stage. In a week they emerge as full insects. 
 
 Treatment. — Extract the insect from the horny skin before it 
 ■reaches maturity, and burn it. If it is allowed to rupture the 
 overlying skin, the parts will certainly ulcerate. The insect ex- 
 tracted, bathe the toes with the following : — 
 
 Carbolic acid, 1 part, 
 
 Iodoform 2 „ 
 
 Glycerine 3 „ 
 
 Let the house be daily thoroughly swept, and the floors sprinkled 
 with carbolic acid (1 to 60 of water). 
 
 Solutions of ammonia, hazeline, or eucalyptia will relieve the 
 itchiness. 
 
 Ifwingire. — This is the native name for a disease which is 
 common amongst native Africans, and which also is sometimes seen 
 amongst Europeans. It consists of the presence of maggots in the 
 tissues of the body. These maggots are often seen in the bodies of 
 
 B 
 
18 HEALTH IN AFRICA 
 
 dogs, cats, antelopes, and most animals that frequent the long grass. 
 The eggs of the insects are lodged in meat, milk, blood, or other 
 sulDstances of a fluid nature. They are commonly found on the 
 floors of houses and leaves of bananas. In due time the eggs are 
 hatched, producing a larva, which is white, the size of a small flea, 
 and able to creep about actively. Seeking for a home in the flesh 
 of some warm-blooded animal, they often pierce the flesh of human 
 beings. The natives call them " ifwingire," from " ingira," to enter. 
 In the tissues they continue gi-owing for weeks, but as they are 
 more or less quiescent, they occasion little inconvenience beyond a 
 slight uneasiness. As they reach their maturer stage they are about 
 # in. in length and 1 in. in breadth, and hesiii to wricfcrle about. The 
 stinging sensation produced calls the attention of the host. There 
 is found a large papule or small boil, with the head of the insect in 
 the centre. If the head is touched it is immediately withdrawn. 
 Should the maggot not be extracted by pressure, it sets up a most 
 irritable-looking ulcer, from which a clear or bloody acrid ichor 
 flows. The discharge from the sore is extremely ^i.rulent, for, 
 should it touch even healthy skin, it is a^^t to bring about a spread- 
 ing ulcer. In the European these maggots are usually single, but I 
 have seen the whole side of the bodv of nesrlected African children 
 one mass of ulcer from this cause. African dogs too have them 
 frequently in great numbers. Many animals die from their efFects, 
 Treatment. — On carefully inspecting the angry-looking pajjule, 
 aud the head seen to be protruding, extract the maggot by j)ressure 
 with the nails of both thumbs. T\"ash the ulcer with some degree 
 of care, and dress it with the followino' : — 
 
 Carbolic acid .... 1 teaspoonful, 
 
 Olive oil .... 10 „ 
 
 The itch (native name, Fere). — This is the most common of all 
 African skin diseases. Almost every native suflers in his wrists or 
 hips or thighs. It is highly contagious, and is usually got from dogs 
 and cats. The disease is due to the presence on the body of the 
 itch insect — Aca/ims Scaiiei — and the itchiness is wholly due to the 
 female insect. After the female has been impregnated, she burrows 
 along the layers of the upper skin, often for a considerable distance, 
 and as she crawls she lays her eggs. If this canal be magnified, 
 something like this will be seen. (See Fig. 2.) 
 
 The female insect is at the end of the canal, and the etj^s are in 
 rows behind. The insect having got into this canal, cannot, owing 
 to her many spines, retreat, but must go forward. She usually 
 
I 
 
DISEASES OF THE SKIN 
 
 19 
 
 enters the skin by the side of one of the hairs, and as she crawls 
 she irritates the sujDerficial nerves of the skin most violently. She 
 prefers delicate skin in warm parts of the body. As the sufferer 
 scratches to gain relief, he may set up blisters and sores. The 
 natives very often set up an eczema from this cause, so that the two 
 diseases are frequently found on the one person. 
 
 Treatment. — This resolves itself into the removal of the insect 
 and her eggs. To do this the body must be well soaked, and washed 
 with soap, warm water, and flannel. Let the sutterer lie in warm 
 water for an hour, so as to thoroughly soften tlie skin. The body 
 
 /h^^tC 
 
 Fig. 2.— Female Itch Insect burrowing in the Skin, 
 AND Laying her Eggs, 
 
 then being thoroughly dried, rub vigorously with some prej)aration 
 of sulphur. 
 
 The following is best 
 
 Carbonate of potash 
 Flowers of sulphur 
 Lard or oil . 
 
 1 teaspoon ful, 
 
 2 
 24 tablespoonfuls. 
 
 Let the above treatment be continued for three days in succession. 
 European clothing should be thoroughly boiled and washed, and 
 the rags of the natives should be burned. 
 
 Mosquitoes. — There are many varieties of mosquitoes known 
 to entomologists, and Africa has a goodly proportion. Some people 
 are much less susceptible and sensitive to their bites than others, 
 but all Europeans suffer. In some parts of Africa an additional 
 terror is added to the bite, since some varieties of mosquitoes are 
 the host of the embryonic stage of three varieties of the Filaria 
 Sanguinis Hominis, a parasite belonging to man, and associated 
 with the disease of elephantiasis. Some authorities say they also 
 are the agent for the introduction of another parasite — Bitharzia 
 HcBmatohia — which gives rise to serious trouble in the liver. Again, 
 
20 HEALTH IN AFRICA 
 
 it may vet be shown that they are the direct cause of the great 
 scourge of tropical countries, namely, " malarial fever." It is only 
 the female mosquito that bites, the male being a puny insignificant 
 thing. They are only active at night or during A'ery dull weather. 
 
 Treatment. — Xo European should travel without a mosquito-net, 
 and at no time should he ever sleep without the same. Some re- 
 commend the smearing of the face and exposed parts with carbolic 
 oil, others prefer to wash with a soap made from lanoline and 
 eucalyptia. Burning camphor in the sitting-room keeps them 
 away. Where it is possible, however, a large log fire should be 
 kept burning at the door of the house. To relieve the irritation of 
 the bite, apply strong ammonia, or strong vinegar, or hazeline, or 
 eucalyptia. 
 
 In some countries the natives smear themselves with oil or grease, 
 and even sleep with their bodies buried in sand. Others sleep in 
 thickly woven mats, which they carefully tuck under on retiring 
 for the night. During the height of the wet season in other places 
 the natives sit up most of the night, and sleep by day, in order to 
 escape this enemy. 
 
 Ticks. — These troublesome insects infest dogs, sheep, and cows, 
 and frequently lay hold of human beings. They are found on grass, 
 and are abundant for a month or two before the rains. They have 
 flat bodies, and are suckers. They creep up the clothing and attach 
 themselves to any delicate part of the body. 
 
 Treatment. — Use carbolic soap freely in the daily bath, and 
 during the season anoint the lower limbs with carbolic acid 1 
 part to 10 of olive oil. 
 
 Leeches. — These are found in the water of marshy districts. 
 TVhen wading in such places the leeches may attach themselves to 
 the legs, and extract a considerable quantity of blood. 
 
 Treatmeiit. — Dislodge them by the use of salt and water, and in 
 order to stop the bleeding, apply pressure, or touch the bleeding 
 point with a little nitrate of silver. 
 
 DISEASES OF THE SKIX DUE TO VEGETABLE 
 PARASITES 
 
 Most of the diseases due to vegetable life found in Europe 
 abound in Africa. The heat, moisture, habits of the j^eople, together 
 with constitutional peculiarities all tend to this development. 
 
 Ring-worm. — This disease appears on the body as rings, or parts 
 of rings, enclosing areas which are lighter in colour than the healthy 
 
DISEASES OF THE SKIN 21 
 
 skin. The edge of the patch is reddish, scurfy, itchy, and often 
 appears in the arm-pits, on the breast, abdomen, or back. In hot 
 damp weather the itchiness is so excessive that the sufferer cannot 
 sleep, so lies all night long, indulging in the "delight" of a good 
 scratch. Often by so doing he makes the part weep or even bleed. 
 When cold dry weather sets in, the itchiness is less severe, and tends 
 to disappear, so that only a reddish scurfy spot may remain. The 
 disease is due to a low form of fungus attacking the hairs of the skin. 
 Treatment. — The best remedy for natives is chrysophanic acid 
 in some form or other. The following is excellent : — 
 
 Chrysophanic acid . . .20 grains, 
 Vaseline 2 tablespoonfuls. 
 
 Let this be well rubbed in, twice every day, and it will be cured 
 in about a week. This acid stains linen clothing. 
 
 Another good remedy for the thick-skinned native is the free 
 use of the strongest liniment of iodine, one or two applications of 
 which is sufficient. Some advise the painting of the patches with 
 strong acetic or sulphurous acid. Some forms of ring- worm are 
 very unamenable to treatment, especially if the disease is extensive 
 and long-standing. In such a case use the following : — 
 
 Perchloride of mercury . . 2 grains, 
 Water 2 tablespoonfuls. 
 
 This is applied by painting the part with a small brush every day 
 until a change is apparent. 
 
 If the ring-worm is on the beard, the hairs must be pulled out, 
 in order that the antiparasitic medicine may do its work. After 
 this has been done, apply the above perchloride of mercury solution, 
 or the following ; — 
 
 Hyposulphite of soda . . 1 teaspoonful. 
 Water . . . . . 2 tablespoonfuls. 
 
 DISEASES OF THE SKIN DUE TO ABNORMALITY 
 IN THE SWEAT GLANDS 
 
 Excess of perspiration is the normal state in Africa. It is 
 seen to be greatly in excess in rheumatic fever, malarial fever, &c. 
 It is brought on by the inordinate use of food and spirits. Perspi- 
 ration is abundant in the hot season, and leads to a number of 
 
22 HEALTH IN AFRICA 
 
 troubles. It follows upon excitement and faintness. Then some 
 persons have a constitutional tendency to excess of perspiration, being 
 troubled on the slightest departure from the normal state of life. 
 
 Great sweating is seen in the palms of the hands, soles of the 
 feet, armpits, groins, and genitals. Some suffer greatly from sweaty 
 feet, and especiall}^ from a most disagreeable odour, which accom- 
 panies the same. The excessive perspiration tends to inflame the 
 soles and to make walking difficult. Some say a certain bacterium 
 finds a nidus in this perspiration and sets up the odour. 
 
 Treatment for excessive perspiration of the body. — Tonics are here 
 indicated, such as quinine, strychnia, and arsenic. Easton's syrup, 
 1 teaspoonful half-an-hour before each meal, is best. Dover's powder 
 10 grains every day, or nitrate of pilocarpine -^q of a grain three 
 times a day, will stop it. But the most powerful remedy is atropia 
 injected under the skin. This, however, should only be given by a 
 medical man. It is the following : — 
 
 Sulphate of atropia . 1 grain, 
 
 Water . . . 500 drops — of this inject 5 drops. 
 
 Treatment fm- siveaty feet. — Change the socks twice every day, and 
 when they are taken off let them be soaked in the following solu- 
 tion : Eight tumblers of hot water, having dissolved in it as much 
 boracic acid as the water will contain. After soaking the socks, 
 hang them up to dry, using them again, with a certain amount of 
 the antiseptic boracic acid retained. Cork soles are recommended. 
 If the shoes smell badly, dust them inside with boracic acid. Wash 
 the feet every night with cold water, and rub the soles with zinc 
 ointment. 
 
CHAPTER III 
 DISEASES OF THE DIGESTIVE SYSTEM 
 
 STRUCTURE AND FUNCTIONS OF THE ORGANS OF 
 
 DIGESTION 
 
 Speaking strictly, food as we know it does not go into the body 
 — it passes tlirougli it. During its passage cliemical changes are 
 wrought on the food substances : a certain proportion is absorbed 
 into the body proper, while the effete substances are thrown out. 
 The canal through which the food passes is known as the " alimen- 
 tary canal." It is a musculo-membranous tube about thirty feet in 
 length, and is lined throughout with a delicate membrane which 
 secretes mucus. This canal begins at the mouth and ends at the 
 anus. In its course it has various names. First, there is the mouth, 
 where the food is masticated and mixed with saliva ; then there is 
 the pharynx and gullet, where the act of swallowing takes place ; 
 next is the stomach, where chemical changes are wrought on the 
 food, known as " digestion " proper. The food then passes into the 
 small intestine, where the nutritive substances in it are acted on 
 by the bile coming from the liver, and the pancreatic fluid coming 
 from the pancreas, and are taken into the system as chyle. The 
 next part of the canal is the large intestine, which contains effete 
 substances in large proportion. 
 
 By carefully studying the accompanying sketches, it will not be 
 difficult to follow the course of the food through the mouth, past 
 the entrance to the windpipe, and into the gullet and stomach. 
 (Figs. 3 and 4.) 
 
 During a meal, the various substances of food are torn and 
 ground by the teeth. The tongue rolls the mass from side to side, 
 while the glands, surrounding the mouth, pour the saliva over the 
 food, which becomes thoroughly intermingled with it. Most of the 
 starch of the food substances is converted into sugar right away 
 while it is still in the mouth. The bolus is then swallowed and 
 
 23 
 
24 
 
 HEALTH IN AFRICA 
 
 passed into the stomacli. In this organ tlie gastric juice, wliicli is 
 freely poured out, acts upon the proteids (meat, albumen of egg, 
 cheese, &c.), and changes them into peptones which are very soluble. 
 The stomach contents are now passed into the first part of the bowel 
 — the duodenum — where they are acted on by the secretions of the 
 liver (bile), and the secretions of the pancreas. All fats are converted 
 
 
 Fig. 3.— Diagrammatic Section op the Gullet, Stomach, 
 Small akd Large Ixtestines. 
 
 into emulsions (like milk), that is to say, the fats are broken up 
 into minute particles, and each is covered with a coating of albumen, 
 so that they cannot run together. The pancreatic juice seeks out 
 the remaining starchy substances which have not been acted on by 
 the saliva of the mouth, and changes them so that they can be 
 absorbed. The food is now a milky fluid of the consistency of 
 cream, and is known as chyle. It is forced on by the movements 
 of the bowel, and is brought into contact with the mucous membrane 
 
DISEASES OF THE DIGESTIVE SYSTEM 
 
 25 
 
 of tlie bowel. The very soluble substances are at once taken up 
 by the blood-vessels, and pass into the liver and the venous system ; 
 while the other particles pass into the lacteals, which unite as the 
 lymphatics, and so also reach the veins. 
 
 
 
 Fig. 4. — Vertical Section of the Face and Neck, showing 
 THE Nose, Mouth, Gullet, and Windpipe. 
 
 DISEASES OF THE ORGANS OF DIGESTION 
 
 Inflammation of the mouth. — This is common among young 
 people. It depends, in some cases, on microscopic fungus ]3laiits 
 living in the tissues of the gums and cheeks. The tongue and mouth 
 are covered with flaky white patches, which are somewhat round 
 and elevated, wdiile the rest of the membrane is hot and swollen. 
 Saliva dribbles from the lips. 
 
26 HEALTH IN AFRICA 
 
 Treatment. — In simple cases avoid acids and sweets of all kinds. 
 Milk witli a little lime-water, or milk with a little bicarbonate 
 of soda is good treatment. When there are sores in the mouth use 
 the following : — 
 
 Chlorate of potash ... 1 teaspoonful, 
 Warm water . . . . ] tumbler, 
 Glycerine 1 teaspoonful. 
 
 This is an excellent gargle for the mouth and throat. Borax and 
 honey mixture is good for applying locally. In the parasitic form 
 
 use this : — 
 
 Carbolic acid . . . 12 grains, 
 Glycerine .... 2 teaspoonf uls, 
 
 Water .... 8 tablespoonfuls. 
 
 With a piece of lint apply very freely to the tender spots, three 
 times a day. 
 
 Ptyalism, salivation, or an abnormal floiu of saliva in the mouth. 
 — This is usually a symptom of some other affection, and conse- 
 quently its treatment will de23end on a careful diagnosis of its cause. 
 In children it is often due to delayed dentition or to inflammation 
 of the mouth. 
 
 When mercury, in any of its forms, is pushed too far, it brings 
 on a salivation of the mouth. In such a case the drug should be 
 stopped, as to push the medicine further will do no good, and 
 might do much harm. Locally, wash the mouth with a weak solu- 
 tion of permanganate of potash, and apply chlorate of potash 1 part 
 to 40 parts of water. If, however, the mercury has been pushed so 
 far that the gums are swollen and ulcerated, some astringent will 
 be necessary. Alum (1 to 40 of water), or chloride of zinc (2 grains 
 to 2 tablespoonfuls of water), or tannic acid (1 to 40 of water) are 
 good. Should there be an unpleasant fcetor present, wash the 
 mouth with carbolic lotion (1 to 80 of water) or weak perman- 
 ganate of potash. If the system is down, stimulants may be used, 
 and only liquid foods partaken of. Never give atropine in a case 
 of mercurialism such as the above, for here nature is burdened with 
 the poison and is throwing it off. 
 
 Sore throat. — This may occur by itself, or in conjunction with 
 fever and syphilis. It is also seen in those who are afflicted with 
 acute rheumatism. Exposure of any kind will bring it on. The 
 mucous membrane on the tonsils, soft palate, and back of the 
 throat is red and swollen. There may be fever up to 102° F. The 
 throat is painful, and swallowing is difficult. At first there is a 
 
DISEASES OF THE DIGESTIVE SYSTEM 
 
 27 
 
 dry sensation, but in a short time secretion becomes abundant. 
 The sufferer may speak througb his nose. 
 
 Quinsy is an exaggerated form of the above, and is often seen 
 in young people. The tongue is furred and the bowels are bound. 
 The urine contains albumen. 
 
 Treatment. — Let the sufferer rest in bed* in a warm room, and 
 a]3ply hot fomentations to the throat. Let him also inhale steam, 
 say from a teapot. Owing to the difficulty in swallowing, avoid all 
 solid foods, but keep up the strength by small quantities of nourish- 
 ing soups, given every two hours. Open the bo\^■els freely with the 
 following powder : — 
 
 Calomel 
 
 Jalap 
 
 Some authorities recommend the following to be taken every hour : — 
 
 5 grains, 
 15 „ 
 
 Tincture of aconite . 
 belladonna 
 
 1 drop, 
 1 » 
 
 If no sleep is to be had at night, give 10 grains of Dover's powder ; 
 and should this be vomited, repeat it, and in a short time it will be 
 retained. "When the severe symptoms have subsided, give tonic 
 medicines, and order a change of air. Easton's syrup is on the 
 whole the best tonic. Take one teaspoonful before each meal. 
 
 The teeth. — Before 
 leaving for Africa it is 
 absolutely necessary that 
 the teeth should be at- 
 tended to by a competent 
 dentist. Let all stumps 
 be removed, and all im- 
 perfect teeth stopped. 
 The teeth suffer much 
 from a variety of causes 
 in malarial countries. 
 
 A tooth consists of 
 the parts as sho^^ni in 
 diagram. 
 
 Toothache may 
 come — 
 
 1st. FROii Caries, 
 where there is softening 
 
 and decay of the dentine Fig. 5.— Diagrammatic Section of a 
 or ivory part of the tooth. Tooth. 
 
 
 
 C^^uvu^vi/C 
 
28 HEALTH IN AFRICA 
 
 so tliat the cavity, where the nerves are distributed, is exposed and 
 inflamed. The dentist can treat this in a nnniber of ways. 
 
 2nd. From Inflammation of the Pulp Cavity. — Here food or 
 cold has inflamed the delicate centre of the tooth. An active purge 
 of 5 grains of calomel and 15 grains of jalap will act well in such a 
 case. Wash the mouth \dih. bicarbonate of soda in hot water, dry 
 out the csLvitj of the tooth, and apply a small portion of the fol- 
 lowing mixture upon cotton wool : — 
 
 Llenthol .... 
 
 2 parts. 
 
 Butyl chloral hydrate 
 
 • 1 » 
 
 Carbolic acid 
 
 . 1 „ 
 
 Cocaine hydrochlor. . 
 
 • 1 „ 
 
 Creosote .... 
 
 1 „ 
 
 This is a colourless oily fluid. It is also excellent in preparing 
 teeth for being stopped. It should be remembered, however, that 
 this application is of little use where pain is caused by some 
 inflammatory action at the roots or in the tissues around. 
 
 3rd. From Affection of the Roots of the Tooth. — Here the 
 head of the tooth may be healthy, but the roots diseased. Abscesses 
 in such a case give great annoyance. Get the tooth extracted. 
 
 4th. From Neuralgia. — There is here some affection of the 
 nerves which supply the tooth. Give 5-grain doses of c[uinine twice 
 within twenty-four hours, and it may ward off the attack, when 
 expected. Fifteen grains of antipyrin will do the same. Refer to 
 the article on neuralgia. 
 
 In order to extract a tooth without pain, use the following : 
 
 Cocaine hydrochlor. .... 2 grains, 
 Water (pure) 10 drops. 
 
 H 
 
 By means of a hypodermic syringe, inject at the side of the tooth 
 not more than eight drops, and wait for five minutes. The tooth 
 should then be extracted painlessly. The aneesthesia will last for 
 ten minutes more. This should be done by a medical man. 
 
 DISEASES OF THE STOMACH 
 
 The following are the signs of the stomach being out of order : — 
 
 1st. Pain over the region of the organ. This may simply be 
 
 an uneasiness, like a lump behind the breast-bone, or it may be 
 
 actual pain. It radiates from the stomach to the shoulder-blades 
 
 or the spinal column. It may be caused by gases in the organ, or 
 
DISEASES OF THE DIGESTIVE SYSTEM 29 
 
 indigested food, or excess of acids. If tlie pain is due to disease of 
 the stomach itself, it will come on immediately after a meal, and there 
 will be no relief till the food is parted with ; pressure also applied 
 to the stomach will increase the pain. If the uneasiness is due to 
 indifferent digestion, these two things are reversed — it comes on 
 some time after food is taken, and pressure brings relief. 
 
 2nd. Heartburn. — This is a burning sensation with the regurgi- 
 tation into the mouth of acid fluids. 'Jliere is sometimes, also, what 
 is popularly called water-brash — namely, the regurgitation into the 
 mouth of a clear alkaline fluid. 
 
 3rd. Fulness of the Stomach, — The organ is blown out by 
 gases which have been formed by the fermentation of the foods. 
 
 4th. Nausea and Vomiting.— The vomited substances may be 
 bile or blood. Here we have nature trying to get rid of some 
 injurious substances. 
 
 5th. The Tongue is coated with a yellow fur. 
 
 6th. Headache. 
 
 Indigestion or Dyspepsia. — Here we have only abnormal 
 digestion, and no actual disease of the stomach. The secretions and 
 movements of the organ are unnatural. As a consequence the food 
 is passed on undigested to the bowel. Constipation, &c., is the 
 result. Alcohol, chills, and overwork are at the root of most of 
 these ailments. They are frequent in Africa, being brought on by 
 poor food, imperfectly cooked, and less perfectly masticated. In 
 indigestion most of the above signs of stomach affection are found. 
 
 Treatment. — Look to the diet. Avoid all foods that are difficult 
 to digest, as salt meat, cheese, veal, pork, and tinned meats. Avoid 
 rich dishes of every kind. For a few days take milk only, mixed 
 with barley-water. Cocoa is here to be preferred to tea or coffee, 
 and should be well diluted with milk. 
 
 By way of parenthesis, I would most highly recommend the "poor 
 man's cow," the African goat. She thrives in every part of Africa, 
 even the poorest, and can go with the traveller on every journey ; 
 even the steamers and river boats can carry one or two milch goats. 
 A fairly good supply of fresh milk will thus be available. No one 
 should travel for any long distance without a couple of goats. 
 
 Take gentle exercise in the open air, and partake of very little 
 food at a time. Take a tepid bath every morning, but on no ac- 
 count attempt a cold bath. Wear only fine flannel or silk and wool 
 clothing. Natives suffer much from this form of dyspepsia, and 
 can we wonder when we see the food they eat, and know their 
 manner of cooking? For the relief of the pain take a prompt 
 emetic, such as a large spoonful of mustard in half a cup of water, 
 
30 HEALTH IN AFRICA 
 
 or drink salt and water. Thereafter take small draughts of hot 
 water. For the acidity nothing is better than three tabloids of 
 soda-mint as supplied by Messrs. Burroughs, Wellcome & Co. 
 
 Biliousness.— This is a form of indigestion which is comm.on. 
 In such a case the tongue is furred, there is severe headache, 
 giddiness, and, it may be, a little jaundice. It is purely a case 
 of hepatic dyspepsia. The liver may be enlarged and congested, 
 much the same as when this disease is one of the symptoms of severe 
 malarial fever (which see). 
 
 Treatment. — If the case is mild, give 5 grains calomel and 
 15 grains jalap. When the stomach is irritable, calomel is most 
 useful. Or use the following : — 
 
 Mercurial pill 1 grain, 
 
 Compound rhubarb pill . . . 4 „ 
 
 Take one of these pills every night. Nitro-hydrochloric acid is 
 most useful also. The best way to take it is the following : — 
 
 Dilute nitro-hydrochloric acid , . 2 teaspoonfuls, 
 
 Infusion of quassia . . . . 16 tablespoonfuls. 
 
 Of this take a tablespoonful three times a day in water before food. 
 Drink plenty of soda or potash water. A gasogene is excellent for 
 Africa. Apply mustard poultices or turpentine stupes over the 
 region of the liver. 
 
 Vomiting. — This is not a disease but a symptom, and is often 
 a violent effort of nature to rid the system of something injurious. 
 The mechanism of vomiting is caused by the pyloric or lower end of 
 the stomach closing, and a violent contraction of the walls setting 
 in. {See Fig. 3.) It occurs most readily when the stomach is full, 
 and in order to this, before a dog vomits, it distends the stomach by 
 swallowing air. Should vomiting be very violent, the abdominal 
 muscles also contract, with suddenness, and assist the stomach. 
 Before the act there is nausea, and a great secretion of saliva. The 
 substance ejected often consists of partially digested food, which is 
 sour, the acidity being due to the presence of gastric juice. If the 
 vomiting be continued for any length of time, it will be mixed 
 with bile of a yellow or green colour. Blood may be vomited, 
 and may indicate the presence of an ulcer in the stomach, or con- 
 gestion of the organ from disease of the liver. The blood may be 
 bright red, brown like coffee, or almost black ; the darkness being 
 due to the action of the digestive fluids. 
 
 Treatment. — Sometimes it is necessary to get rid of a nauseous 
 
DISEASES OF THE DIGESTIVE SYSTEM 31 
 
 substance as poison, indigestible food, or bile which has passed 
 back into the stomach. Vomiting may be brought on by tickling 
 the back of the throat with the finger or a feather, by putting 
 three teaspoonfuls of mustard in a cup of water and drinking 
 quickly, or by swallowing 30 grains of sulphate of zinc in water. 
 The following is most effective, need not reach the stomach, and 
 is resorted to in cases of poisoning which demand most prompt 
 action, or where the stomach is sensitive. Inject -^^ grain of 
 aporaorphine hypodermically, and in three seconds vomiting will 
 be brought about. 
 
 7'o stop vomiting. — Put a mustard poultice over the stomach, 
 give ice to suck if this is to be had, and liquor arsenicalis 1 drop 
 before anything is partaken of. Give morphia hypodermically, 
 ^ to "I grain, in more serious cases. 
 
 Sea-sickness. — Certain individuals are martyrs to this truly 
 harassing malady, while others are not affected. This peculiarity 
 is due to the nervous system, and runs in families. It is a 
 mistake, as was advised long ago, to take a hearty meal before 
 setting out on a voyage, as it is a mistake to fast for some hours 
 before embarking. Take a light meal some three hours before 
 experiencing the motion of the sea. Some recommend a warm- 
 water enema. Have the cabin made " shij^-shape " before the 
 journey is undertaken, and on no account remain below — the rock- 
 ing motion in such a case would make even the least susceptible 
 excessively sick. Find a comfortable spot amid-ships, where the 
 motion is least ; wrap the body well ujd in rugs ; if possible j)ut a 
 warm-water bottle to the feet, and a mustard leaf over the region of 
 the stomach. Face the breeze cheerfully, and fight the weakness. 
 The following additions are good : sucking small pieces of ice ; 
 sipping a teaspoonful of dilute hydrocyanic acid in the following 
 proportions — hydrocyanic acid 35 drops, water 4 tablespoonfuls. 
 
 The drugs recommended for sea- sickness are numberless. The 
 best is perha]3s the following, to be taken thus : for a day or two, 
 before embarking, take 20-grain doses of bromide of ammonium 
 three times in the twenty-four hours ; then as soon as the expectant 
 sufferer is on board, he should apply a broad tight bandage to the 
 abdomen and lie in a recumbent position. 
 
 When the vomiting has once been established, relief should be 
 sought in sucking ice, or in sipping champagne in which ice is plenti- 
 ful. Mustard may also be applied to the region of the stomach. 
 
 After two or more days, should the vomiting continue, the 
 sufferer must take food in order to keep up the strength. Cold 
 soups should be tried first. 
 
32 HEALTH IN AFRICA 
 
 Catarrh of the stomach— gastritis. — This affection is very 
 common. It is -u^^ually due to indigestible food, alcoholic excesses, 
 tinned meats, and above all, to tinned fish. There is severe pain over 
 the region of the stomach, which is increased by food and relieved 
 by vomiting. There is a constant desire to vomit, and often only 
 a glairy mucus, stained with bile, is parted with. The tongue is 
 furred. The affection usually begins with a chill, which leads to 
 fever, headache, and sleeplessness. The inner coat of the stomach 
 is congested and swollen, and it may be ulcerated. 
 
 Treatment. — If tinned meat is suspected, give an emetic (jf 
 mustard or 30 grains of sulphate of zinc, and follow up with a 
 brisk purgative. Take no food for twenty-four hours, and then 
 allow small quantities of liquid soups or milk. No solid food 
 should be taken for several days. If the vomiting persists, apply 
 poultices or hot fomentations over the stomach, and give morphia 
 as indicated in the article on vomiting. Effervescing drinks 
 relieve the pain. Leeches over the stomach would be good. The 
 one thing to know is that the inner lining of the stomach is 
 inflamed, and that all treatment should tend to draw blood from 
 that membrane. 
 
 Diarrhoea. — This is not strictly a disease, but a sj^mjDtom. It 
 is analogous to vomiting. The bowel is relaxed, and there is a 
 frequent evacuation of loose liquid stools. In addition there is 
 increased peristaltic (wormlike) motion of the bowels. The inner 
 coating is inflamed by some substance, or the circulatinn through 
 the liver, being impeded, has caused congestion of the bowel. The 
 character of the stools varies greatly. They may contain true feecal 
 matter, or bilious substances of a yellow or green nature. Slimy 
 and bloody substances may also be present. It may even be that 
 the food is passed having undergone little alteration. 
 
 The acute form generally begins suddenly, and is due to a chill 
 setting up a congestion. Bad food or water may also bring it on. 
 With each stool there may be a straining and griping with rumbling 
 within the bowel. The ejected matters may be acid, and so cause 
 the anus to be inflamed. When slimy matter is passed, we are 
 certain that the inner coating of the bowel is highly inflamed ; and 
 when there is a constant straining we know that the lower and 
 larger bowel is affected. 
 
 The affection may become chronic, after repeated attacks of the 
 acute form. Diarrhcea is often set up by more serious affections, 
 as typhoid fever, malarial fever, &c. 
 
 Treatment. — In Africa, if you feel sure that the diarrhcea is 
 due to malaria, do not stop it. If you have occasion to think that 
 
 I 
 
1 
 
DISEASES OF THE DIGESTIVE SYSTEM 33 
 
 indigestible substances are causing irritation, give 3 or 4 tea- 
 spoonfuls of castor oil with. 20 dro]3s of laudanum (tincture of 
 opium). If tlie pain is acute, apply poultices to tbe abdomen. 
 Give non-irritating foods — milk with lime-water, or milk boiled 
 with rice and strained. Give barley-water to drink, or weak tea 
 and toast, leading on to fish and chicken. 
 
 If it is due to cold, keep in bed and take 10 drops of laudanum 
 every three or four hours. Chlorodyne in, full doses is excellent. 
 
 Constipation. — This is habitual costiveness, or a prolonged 
 departure from the normal motion of the bowel. Most people 
 go to stool once in twenty-four hours, but some do so every second 
 or third day. In constipation the functions of the stomach, liver, 
 pancreas, or bowel itself are imperfectly performed. This leads to 
 a variety of troubles. The countenance becomes sallow, the breath 
 foul, the skin dry, and the head aches. Often it is associated with 
 a weak state of health, sedentary employment, want of exercise, 
 and constant disregard of the calls of nature. These lead to all 
 sorts of complications. 
 
 Treatment. — For temporary constipation take 3 teaspoonfuls 
 of castor oil in beef -tea, as recommended on page 176 ; or take 5 
 grains of calomel and 15 grains of jalap. For habitual constipation 
 let the diet be regulated. Brown-bread, oatmeal porridge taken 
 occasionally, together with figs, prunes, &c., are on the right lines. 
 The bread made from the wheat in Africa, introduced by the Arabs, 
 is excellent for this purpose. Vegetables are good. Cultivate a 
 regular habit of defsecation, and to this end go immediately after 
 breakfast every day, whether there is desire or not. Take plenty 
 of exercise in the open air and a tepid bath once every day. 
 Friction over the abdomen is good, especially rubbing downwards on 
 the left side. If the patient can bear it, a dessert spoonful of pure 
 olive oil every morning after breakfast is both a laxative and a food. 
 Of medicines the liquid extract of Gascara Sagrada is good, only 
 first remove the existing constipation, then take every night, 30 drops 
 for two months. By this time the habitual constipation will have 
 quite disappeared. The following is an excellent pill : — 
 
 Extract of nux vomica 
 
 i grain, 
 
 Sulphate of iron 
 
 2 55 
 
 Powder of myrrh 
 
 • i 5, 
 
 Powder of soap . 
 
 • • i ,5 
 
 Aloes ..... 
 
 • • i „ 
 
 Another excellent method, for certain persons, is to inject into 
 the bowel, during the early morning, from 30 drops to a table- 
 
 c 
 
34 HEALTH IN AFRICA 
 
 s2)oonful of glycerine. Tliis lubricates the lower bowel and. sets 
 up normal action. (See Glycerine syringe, ]). 175.) A piece of soap 
 cut like a finger, and inserted into the bowel, is excellent. Enemata 
 of soap and warm water, to which some castor oil may be added, is 
 very efficient. 
 
 Colic. — This is a severe twisting or griping, spasmodic contrac- 
 tion of the bowel. It is generally due to the j^resence of indigestible 
 food. In Europe it is common amongst those who work in lead or 
 copper. The griping begins about the region of the navel and 
 spreads over the whole of the abdomen. These pains change their 
 position frequently, and are always relieved by pressure, and never 
 aggravated by it. In extreme cases the sufferer may be " doubled 
 up," with his abdomen hard and tense. The pain is felt to be 
 "coming on," increases till it reaches a climax, and as gradually 
 passes off. There may be faintness, perspiration, and even nausea, 
 but there is no fever. The face looks pale and anxious, as if some- 
 thing dreadful were impending, and the surface of the body may 
 be cold and covered with sweat. 
 
 Treatment. — If the case is mild give a brisk purge of castor oil, 
 3 teaspoonfuls, laudanum 30 drops. Before this acts put the 
 sufferer in a hot bath of 104° F. ; place a large moist warm 
 poultice over the abdomen and order rest in bed ; or hot turpen- 
 tine stujDes may be used instead of the bath. Relief is afforded by 
 a hot indiarubber bottle being placed over the stomach. The j)ain 
 goes off as soon as a motion is obtained. Should no relief be 
 afforded, a hypodermic injection of morphia should be given, say 
 \ grain of the sul|)hate, along with a glassful of hot punch. Chloro- 
 dyne is a popular and excellent remedy, and should be given in 
 30-drop doses till the pain is relieved. 
 
 Inflammation of the bowels. — This is a catarrh of the bowels. 
 Sometimes the whole length of the bowel is affected, from the 
 stomach to the anus. More commonly part only of this long surface 
 is inflamed. It is brought on by the same causes as inflammation 
 of the stomach, namely, bad foods and bad water. The signs vary 
 according to the seat. Usually there is diarrhoea, but no blood is 
 seen unless an ulcer is present. If the large intestine is affected 
 there are recurring colic-like pains, with soreness on pressure, flatu- 
 lence, rumbling, and distension of the abdomen. If the upper part 
 of the small bowel is inflamed then jaundice is present. If it 
 becomes chronic there is continuous diarrhoea with watery offen- 
 sive stools, or it may even be that the food is passed as it has 
 been swallowed. It is impossible to separate this affection from 
 ordinary diarrhoea ; should, however, slimy mucus be present in 
 
DISEASES OF THE DIGESTIVE SYSTEM . 35 
 
 the stools then we have a sure indication that the large bowel is 
 inflamed, 
 
 Treat7nent. — Give only non-irritating foods, as weak soup free 
 from all solids. It is not wise to at once stop the diarrhcea, as nature 
 is throwing off something injurious to the system. If indigestible 
 food is suspected, give castor oil as indicated above. If there is a 
 tendency to mucus and little streaks of blood, give 15 grains of 
 Dover's powder, repeated, if necessary, every four hours ; or the 
 following : — 
 
 Subnitrate' of bismuth . . 20 grains. 
 
 Tannic acid .... 3 „ 
 
 Dover's powder ... 3 „ every four hours. 
 
 If the tenderness is located to one spot, as over the right side, 
 the sufferer will incline to lie on that side, with the legs drawn up. 
 Poultices and fomentations in such a case will give great relief. 
 
 Dysentery. — Another name for this disease is " bloody flux." 
 It is caused by a specific germ, which sets up a severe inflammation 
 and ulceration of the mucous membrane, and it may be of other 
 tissues of the lower end of the large bowel and rectum. It occurs 
 sometimes in malarious countries as an epidemic. It is very common 
 in Africa, where the sufferer has been exposed to great fatigue, under 
 a blistering sun, together with badly cooked food, worse water, and 
 tinned meats. The disease usually begins in the right groin and 
 works up the bowel. The signs of the disease are, however, most 
 pronounced near the rectum. In mild cases patches only of the 
 bowel are affected, but on the other hand great ulcers may be 
 present. In very severe cases patches of the mucous membrane may 
 die and be discharged. In a typical case there is, for a few days, 
 irregularity of the bowels with pain and lassitude ; then fever sets 
 in with shivering, gripes, and very frequent desires to go to stool. 
 At first fsecal matter is passed in little nodules, but soon the stools 
 are composed of mucus and blood, with shreds of mucous membrane. 
 The fluids in the stools are j)uriform and very offensive. The 
 fever, when this is so, is high and markedly intermittent in type. 
 The features of the sufferer are pinched, and the expression is that 
 of great anxiety. The seriousness of the case is usually estimated 
 by the straining at the bowels. In a severe case stools may be 
 passed every few minutes for days. In less severe cases the tenesmus 
 may occur twenty times a day. The patient strains with great per- 
 sistency, always feeling as if he had something to part with, but 
 passing oftentimes only as much mucus as would cover a shilling 
 piece. In a favourable case improvement sets in in a week. If the 
 
36 HEALTH IN AFRICA 
 
 patient is sinking, great perspiration appears and liiccough harasses 
 tlie weakened frame. In other cases the disease becomes chronic 
 after frequent relapses. 
 
 Treatrtient. — As soon as this disease is apparent let the patient be 
 put in as comfortable a room and on as good a bed as possible, for 
 rest in the recumbent position is absolutely necessary. In mild 
 cases, where little hard lumps are j)assed, begin with a full dose of 
 castor oil (3 teaspoonfuls), and for two days after give 1 teaspoonful 
 of the same oil with 20 drops of laudanum. In severe cases, where 
 only mucus and blood are being passed, do not give the above oil, 
 but apjDly several fomentations, as hot as can be borne, to the abdomen, 
 to relieve the pain and calm the bowel. If the pain is very great, 
 give \ io \ grain of morphia hypodermically. The one recognised 
 specific for dysentery is ipecacuanha. At the beginning of its 
 administration, however, it is almost certain to act on the stomach 
 and set up vomiting. If we try it again and again, we will reach 
 the point when the stomach will tolerate the drug, and then half 
 the battle is over. My treatment is the following : fifteen minutes 
 before administering the ipecacuanha give 30 drops of laudanum, 
 then give a full dose of the pure powder — say 30 grains — keep 
 the patient absolutely still in the recumbent position, and the desire 
 to vomit will be overcome. If vomiting persists, continue the 
 ipecacuanha, but in addition put a mustard poultice over the 
 stomach, and give ^ grain of morphia hypodermically. When this 
 drug has been taken several times, the stomach will tolerate it. The 
 sufferer should seldom rise from the recumbent position, and the 
 hot fomentation cloths or poultices, or turpentine stupes, should be 
 constantly applied. When the stools assume a natural appearance 
 stop the ipecacuanha, and let the diet consist of milk and gruel, 
 weak broth or eggs. {See Sick Diet, p. 193.) Every form of irritable 
 diet should be scrupulously avoided. Spirits, in small quantities, 
 are necessary to keep up the strength. 
 
 Some recommend, instead of ipecacuanha, laxative doses of 
 Epsom salts, with dilute sulphuric acid. Injections of nitrate of 
 silver (20 grains to 2 tablespoonfuls of water) are highly spoken of. 
 They should be given after the patient has had a hypodermic in- 
 jection of morphia. The bowels should be washed out twice every 
 day (say morning and evening) with warm water, and about mid-day 
 an enema of starch and laudanum (say 40 drops) should be given. 
 This free washing should be an accessory to whatever form of treat- 
 ment is adopted. Every discharge from the patient should be dis- 
 infected with Condy's fluid (permanganate of potash), or carbolic 
 acid, or strong solution of sulphate of iron, and immediately buried. 
 
DISEASES OF THE DIGESTIVE SYSTEM 37 
 
 Treatment of chronic dysentery. — In this case all the above acute 
 symptoms are gone, and there is only very irregular action of 
 the bowels, with the passage of mucus. The patient has lost so 
 much flesh during the many months or years of his illness that he 
 is now verily a " walking skeleton." Medicines in such a case do 
 little good. Let him take tonics of quinine and iron in full doses, 
 such as the following, three times every day before meals : — 
 
 Quinine . . . . . .2 grains, 
 
 Ferri redact! 1 53 
 
 Powder of digitalis . . . . 1 „ 
 Extract of gentian, as much as required. 
 
 Use enemata of nitrate of silver every day in the proportion of 2 
 grains to 2 tablespoonfuls of water. A flannel bandage should be 
 worn habitually, and above all the sufferer should leave his present 
 surroundings and go for a change. Let only non-irritating diet be 
 taken. 
 
 There is a form of dysentery which appears in connection ivith 
 fever. In this case ipecacuanha does no good. Give instead small 
 doses of quinine, say 3 grains three times a day, together with 30 
 drops of the perchloride of iron freely diluted in water. 
 
 In the treatment of ordinary dysentery there is a drug named 
 lungili, which has been highly spoken of. It is the powdered bark of 
 a tree which is native to East Africa. It is given in the following 
 way. The bark is ]3owdered and intimately mixed with a little 
 milk. When about to be taken a little fresh milk is poured on the 
 mixture and it is swallowed. It can also be taken in beef-tea, wine, 
 or even water. 
 
 WORMS WHICH INHABIT THE DIGESTIVE ORGANS 
 
 There are about thirty different parasitic worms which have 
 been described as inhabiting the human subject. They reach the 
 tissues in the form of ova, imbedded in imperfectly cooked food 
 or impure water. When they reach a suitable nidus in the 
 bowel or other tissues, they go through another stage of their life 
 history. They live by absorbing fluids. Most of those known to 
 science are found in Africa, and I feel persuaded that there are 
 some in that continent not yet known. They may be divided into 
 three groups : — 
 
 I. Tape- worms. — There are three different kinds of these. It 
 is well to bear in mind that this group has two marked phases of 
 
38 HEALTH IN AFRICA 
 
 existence. Segments of the mature worm, containing eggs, are dis- 
 charged from tlie bowel of the host, and drying np, are blown about 
 in the air, till they reach water or some damp locality. In time 
 an egg reaches the bowel of an animal, which suits it, say a pig, and 
 develops, so that an embryo begins to live, and bores a passage 
 through the intestinal wall into the tissues of the animal. Here it 
 develojDs a head and neck and bladder-like body. In this situation 
 it may lie dormant for years, until the flesh of its host reaches the 
 intestine of another animal, say a human being. Here the second 
 stage of its life begins. The bladder-like body is cast off, and 
 segments grow from the head, until it may attain to many feet in 
 length. 
 
 When these tape- worms are in the human subject the symijtoms 
 are the following. There are pains in the bowel of a colicky nature, 
 and itching at the nose and anus. Sometimes, however, these signs are 
 not well marked, so that they are not to be relied upon. The passage 
 of segments of the worm is the only reliable sign of its presence. 
 
 Treatment. — In the endeavour to expel the parasite from the 
 system it is well to prepare the bowel by taking no food for a day 
 and a night beforehand. Then take four teaspoonfuls of castor 
 oil in beef-tea or other fluid. In the morning, after the oil has 
 operated, take, on an empty stomach, one teaspoonful of the extract 
 of malefern in milk, or give this drug as prepared by Burroughs, 
 Wellcome & Co., which is excellent in its mode of preparation and 
 action. Another good drug is a decoction of pomegranate. Three 
 hours after swallowing either of these drugs, take a dose of castor oil 
 similar to the above, and carefully examine the stools for the head 
 and neck of the worm. If the head is not passed, the worm will 
 develop again in about three months. 
 
 II. Round-worms. — This form of worm is very common in 
 Africa. All in this family are solid and round, and taper at both 
 ends, and may be nine inches or a foot in length. The sexes are 
 distinct. There may only be one in the bowel, but usually there 
 are two or more. They reach the body in the drinking water ; 
 the eggs having very strong envelopes, resist heat and cold. The 
 symptoms of their presence are the same as in the case of the tape- 
 worm, namely, colicky pains, gi*eat appetite, nausea, &c. Unless we 
 actually see the worms we can only surmise that they are present. 
 
 Treatment. — Prepare the patient by fasting and castor oil, as in 
 treating the above. Then give an adult 6 grains of santonine, 
 a child about 3 grains. Let the drug be given for four mornings 
 in succession, and every time on an empty stomach. On the second 
 and fourth afternoons, give a full dose of castor oil in beef-tea. 
 
DISEASES OF THE DIGESTIVE SYSTEM 39 
 
 III. Thread-worms. — These are tlie most common of all the 
 worms, and as they are generally found in those who are poorly 
 clad and fed, they are often seen in Africa. The worms are white 
 and small, and look like little bits of sewing cotton. They infest 
 the rectum, and are always found in great numbers and chiefly in 
 young people. The most characteristic symptom of their presence 
 is the itching at the anus and nose. 
 
 Treatment. — This is the same as for the round-worms, only, in 
 addition, it is well to inject into the bowel a strong infusion of 
 quassia, say to the extent of two cupfuls. The parts should be 
 sponged with Condy's fluid, and dusted with starch or oxide of 
 zinc or flour. Some recommend 3 grains of calomel and 10 of 
 jalap for three successive nights ; thereafter an enema of cold water 
 and common salt. 
 
 In order to p-event the recurrence of these pests, carefully avoid 
 all raw and underdone beef or pork. See that the cook washes 
 thoroughly all vegetables used at table. Boil and filter all water. 
 Keep the bowels freely open. 
 
 Congestion of the liver. {See Fig. 8.)— A slight increase of 
 blood in the liver takes place immediately after a meal, and the 
 digestive act has set in. When, however, food or drink is taken to 
 excess, this congestion is apt to exceed due limits. The sufferer 
 becomes irritable and depressed. He has constant headache and 
 general " out-of-sortness." He has a feeling of dead weight and 
 fulness on the right side underneath the lower ribs. He has a bad 
 taste in his mouth, and no appetite for food. There is constipation, 
 and it may be a dull pain passing up to the right shoulder. There 
 may be vomiting and jaundice. 
 
 The above stage may pass on to acute inflammation of the 
 liver, which is brought about usually after great exposure to fatigue 
 and heat, in a malarial country. The drinking of spirits is usually 
 at the bottom of the illness. Pus may form in the organ. 
 
 Treatment. — Enjoin rest in bed ; give a bland and non-irritating 
 diet, and forbid all stimulants. Act freely on the bowels by giving 
 5 grains of calomel and 15 grains of jalap, or give two of 
 Burroughs, Wellcome & Co.'s cathartic tabloids, which consist of 
 colocynth, jalap, and mercury. Ipecacuanha acts admirably in 
 cases of this kind. Give of it 15 grains, and before doing so put 
 a mustard poultice on the region of the stomach. Don't be dis- 
 couraged if the stomach parts with it once or twice, but try again. 
 Medical men could do much more in severe cases, especially if the 
 case ran on to an abscess, but it is not necessary here to indicate the 
 line of treatment. The local pain can be relieved by fomentations 
 
40 HEALTH IN AFRICA 
 
 or poultices, or even blisters, over tlie region of tlie liver. I liave 
 known of great relief having been given by painting tbe surface 
 of the liver with ordinary blistering fluid. 
 
 Jaundice. — This is not a disease but a symptom, yet it often 
 sets in suddenly, and persons far away from medical aid are called 
 upon to do their best for its treatment. Jaundice denotes a yellow- 
 ness of the skin of the body, and is specially apparent in the white 
 of the eyes. The tissues of the whole body may be stained yellow. 
 The urine in such cases is black and will stain linen. There is 
 a bitter taste in the mouth, constipation is prevalent, while the 
 stools that are passed are clayish or even white. The skin is often 
 very itchy. 
 
 Treatment. — First of all endeavour to find out the cause. If it 
 is due to excessive congestion, then treat for congestion. In Africa 
 jaundice is often seen in the course of the serious forms of malarial 
 fever. In the bilious remittent fever there is a hyper-secretion of 
 bile, as manifested by the bilious vomiting and purging, high 
 coloured urine, and the malarial jaundice. In such a case authori- 
 ties recommend calomel in 20 or 30-grain doses, to be given at 
 the outset of the symptoms, and repeated in the same large doses, 
 or it may be a little less (say 10 to 20 grains), during the illness. 
 The calomel in such cases acts like a purgative. Three hours after 
 the administration of the calomel give a Seidlitz powder. 
 
 As the bile is chiefly passed out of the system by the kidneys, 
 act on them freely. Give the patient large draughts of warm liquids, 
 such as gruel. A skim-milk diet is excellent. Sugar ^ fats, and all 
 alcoholic stimulants should be carefully avoided. Wear warm cloth- 
 ing, and give a hot bath twice every day. Pilocarpine acts well 
 here in relieving the jaundice, and in removing the itchiness of the 
 skin. It can be given in doses of about ^ grain hypodermically. 
 This drug acts most admirably. 
 
 Enlargement of the spleen. {Bee Figs. 8 and 9.) — The normal 
 spleen lies in the left side of the body. In a line drawn from the 
 left armpit down the side it is found to lie from the seventh to the 
 twelfth ribs. It often enlarges enormously, and extends down, and 
 in, towards the navel, and may form a tumour of immense size. It 
 is movable, and shifts its position according to the posture of the 
 body. Congestion of the spleen occurs in connection with malarial 
 fever, and this often repeated leads to chronic enlargement. There 
 is then a sense of weight in the left side, and it may be tenderness. 
 
 Treatment. — Recent enlargement disappears under the influence 
 of the remedies used in malarial fever — quinine, &c. In the older 
 forms, however, the enlargement remains. In such a case, take a 
 
DISEASES OF THE DIGESTIVE SYSTEM 41 
 
 piece of the biniodide of mercury, and sitting before a warm fire, 
 rub tlie drug briskly over the organ as long as possible. By this 
 means the mercury will be absorbed by the skin. Do this every 
 day, and relief will be obtained. This treatment acts admirably 
 upon a hard indurated spleen due to malaria. If there should be 
 localised pain apply a small blister, or paint the part with blister- 
 ing fluid. On the whole, however, the organ is not very responsive 
 to treatment. It is fortunately not a very serious affection. Good 
 food, tonics of iron, such as Easton's syrup, mineral acids, and a 
 change to a healthy locality are indicated. 
 
CHAPTER IV 
 DISEASES OF THE RESPIRATORY SYSTEM 
 
 STRUCTURE AND FUNCTIONS OF THE RESPIRA- 
 TORY ORGANS 
 
 Respiration or breatMng is a part of tlie life of every organism, 
 wlietlier vegetable or animal. It consists of the absorption of 
 certain gases from the air, as oxygen, and the giving off from the 
 system of deleterious substances, as carbonic acid. The mechanism 
 of respiration in mammals consists of the lungs, which are one vast 
 series of air-chambers into which the outer air enters, with a minute 
 network of blood-vessels covering these chambers. There are extremely 
 minute membranes between the circulating blood and the free air, 
 so that gases transfuse freely from one to the other. The blood, as 
 it comes from the right side of the heart and the tissues of the body, 
 is loaded with carbonic-acid, water and urea, and is of a dark-blue 
 tint ; coming into contact with the air it assumes a scarlet red 
 colour. This change of colour takes place when the blood is brought 
 into close contact with the air of the air-chambers of the lungs. 
 The essential structure of all respiratory organs — lungs of a mammal, 
 gills of a fish — are the same, namely, a thin membrane exposed on 
 one side to the oxygen of the air or water, and on the other to the 
 blood flowing in a very fine network of vessels. The gases pass 
 freely through this membrane. The simplest form of lung that we 
 can conceive of is an elastic bag with air inside and blood out- 
 side, having a tube to allow the egi-ess and ingress of air. This is 
 exactly the structure of our lungs, only they are complex, so as to 
 allow an extended area of contact with the air. 
 
 The lungs. — The nose and mouth join the upper part of the 
 gullet in a cavity known as the pharynx. (See Fig. 4, p. 25.) From 
 the jDharynx arises the windpipe or trachea. (See Fig. 6.) 
 
 The voice-box {laryn:c) is at the entrance to the windpipe, 
 and is easily felt in the front upper part of the neck, and is 
 
 42 
 
DISEASES OF THE RESPIRATORY SYSTEM 
 
 43 
 
 popularly known as Adam's apple. In its interior are the cords 
 for the formation of the voice. The windpipe {trachea) is the 
 passage downwards from the voice-box, and is also felt in the 
 neck. Its sides and front are provided with rings of cartilage which 
 keep it open. As soon as it passes from the region of the neck into 
 the chest it divides into two tubes known as the bronchi, one of 
 
 ^/^oj-^At 
 
 -S^^ 
 
 Fig. 6. — Diagrammatic View of the Wind-Pipe and Lungs. 
 (The left bronchi is shown to ramify in the tissue of the lung.) 
 
 which goes to each lung. All the tubular ramifications of the 
 bronchi are lined with a fine mucous membrane, the mucus of 
 which lubricates the passages. The lungs themselves are two huge 
 bellows or spongy structures of a purplish colour, which, together 
 with the heart and the large blood-vessels, fill the cavity of the 
 chest. Each lung is covered with a fine membrane named the pleura, 
 which, after it invests the lung, passes over the inner surface of 
 
44 HEALTH IN AFRICA 
 
 the cavity of the ribs (thorax). There is a fluid secreted in the 
 cavity of the pleura, which allows the bellows-like lungs to expand 
 freely. The bronchi divide over and over, ordinarily into two, until 
 they lose themselves in the air-chambers of the lung. (See Fig. 7.) 
 
 These minute chambers are estimated as being j^th inch in 
 diameter, and to be about 725 millions in number, and that, if 
 spread over a flat surface, they would cover 2000 square feet. The 
 walls of these minute air-chambers are formed of the thin mem- 
 brane in which the blood and lymph capillaries ramify. A very 
 great amount of elastic tissue enters into the structure of these 
 minute membranous walls, and this allows of their elasticity. 
 
 The chest is an air-tight chamber. The walls of the chest are 
 formed of the ribs, backbone, the breast-bone, and muscles. These 
 together form the mechanism of respiration. 
 
 It is estimated that some four hundred cubic feet of air pass 
 through the lungs in one day of twenty-four hours. This air 
 escapes, charged with carbonic acid, watery vapour and other im- 
 purities. What, therefore, is imperative to health is that there 
 be free circulation of air in our homes. 
 
 But there is another respiration going on in the system, 
 namely, the passage of the oxygen of the blood into the tissues, 
 the use that is made of that oxygen by the minute cells result- 
 ing in carbonic acid, and the mode by which this carbonic acid 
 is taken to the lungs and thrown forth. This is often named 
 the " Inner Respiration." 
 
 DISEASES OF THE RESPIRATORY ORGANS. 
 
 As in Africa these organs are seldom seriously involved, it is 
 not necessary to dwell on them at length. The following are 
 general symptoms of the organs being affected : — 
 
 Dyspnoea is applied to any alteration in the regularity of the 
 breathing. It may be rapid or laborious. The depth of the 
 respiratory act is generally in the inverse proportion to its fre- 
 quency. Dyspnoea may be due to nervousness ; or, on the other 
 hand, may be due to an abnormal condition of the blood. It is 
 seen when the blood is overheated, or if there is any obstruction 
 to the passage of the air, as in inflammation of the lungs. A person 
 in fever often pants like a sheep. 
 
 The respiration is very slow in fainting, collapse, and in affec- 
 tions of the brain. 
 
 Cougll is a violent expiration of air after a long-drawn inspira- 
 
DISEASES OF THE RESPIRATORY SYSTEM 
 
 45 
 
 tion. A coiigli may be simple or it may come in paroxysms. It 
 may be dry. The loudest cougli is seldom the most serious. 
 
 Expectoration. — In health it is seldom necessary to spit, but 
 in affections of the air-passages there may be a great deal of mucus 
 secreted, which may be more or less frothy. Pus or blood may be 
 present. Viscid, purulent-looking lumps may come away. 
 
 Z^oi^. ?t^ 
 
 
 Fig. 7. — Bronchial Tube passing into the Air-Cells 
 OF the Lung. 
 
 (The Pleura is shown diagrammatically to be covering the lung. 
 
 A cold {catarrh), — An ordinary cold is an inflammation of the 
 nostril, pharynx, larynx, and upper part of the windpipe lead- 
 ing down to the lungs. {See Fig. 4.) Any sudden change from 
 warmth to cold, even in the most robust, will set up the affection, 
 but in the weakly it is easily brought about. It begins with a 
 feeling of chilliness, perhaps a shiver, and the temperature will be 
 found to be 101" F. or so. There is frontal headache, dryness in the 
 
46 HEALTH IN AFRICA 
 
 nose, followed in a day or two by excessive secretion. The mem- 
 branes are at first red and swollen. The pharynx, larynx, and 
 trachea may all be involved. There may be hoarseness and a 
 tickling cough. A cold may extend down to the bronchial tubes, in 
 the very young or very old, and be serious. 
 
 Treatment. — If taken at its commencement a warm bath is good. 
 Bathe the feet and legs in hot water with a little mustard ; give 5 
 grains quinine, or 15 grains antipyrin, or 10 grains Dover's powder, 
 and retire to bed w*ith an extra blanket. If this is done at the onset 
 of the illness, in all probability the affection will be cut short. 
 The following is an excellent mixture for arresting and curing 
 a cold, relieving influenza and other chest affections : menthol, 
 camphor, and oil of eucalyjDtus in equal proportions apjjlied locally 
 relieves the swelling and irritability of the cold, allievates the pain 
 and fulness of the head, and stops the sneezing. 
 
 For sore throat or hoarseness give inhalations of steam with 
 the compound tincture of benzoin (a teaspoonful to two tumblers 
 of boiling water). Gargles of cold water with chlorate of potash 
 and glycerine of tannic acid is good. Mustard to the chest is good. 
 Chlorodyne, which is always at hand in Africa, is excellent. 
 
 Bleeding at the nose occurs as an important symptom in 
 some diseases. It is readily excited in some constitutions about 
 the period of puberty. It occurs also from local causes, as in con- 
 gestion of the nose and catarrh. In those of an over-full habit, 
 and in those who suffer from congestive headache, bleeding gives 
 relief, and should not be stopped. 
 
 Treatment — Place the subject upon his back with the shoulders 
 and head moderately elevated. Let the arms be raised above the 
 head, and press the bleeding nostril. If this fail, put cold on the 
 temples and mustard to the calves of the legs. Hot foot-baths are 
 good if given when the subject sits in a chair. 
 
 Ozsena. — This word comes from the Greek, meaning a stench. 
 It is applied to all diseased conditions of the nose, accompanied 
 by great foetor of the breath. It may arise from many causes, 
 but usually from an inflammation of the mucous membrane, in 
 which there is a morbid secretion of crusts in the cavity of the 
 nose and an offensive odour. 
 
 Treatment. — Absolute cleanliness is the one essential. ^Ye are 
 very apt to wash with scrupulous care the body itself, and forget 
 the mucous passages, such as the ears, nose, throat, genitals, and 
 bowels. The difficulty in ozeena is to remove the thickened secre- 
 tion. Wash away every crust : so long as these are present in the 
 nose, so long will the surface be kept from healing. Wash the 
 
DISEASES OF THE RESPIRATORY SYSTEM 47 
 
 nose thoroughly by means of the nasal douche and warm water, in 
 which is placed a teaspoonful of coinmon salt, or a teaspoonful of 
 bicarbonate of soda, or a pellet of permanganate of potash. Do this 
 till every trace of crust is removed. In very bad cases use in- 
 halations of steam to assist tlie stream of water. When the cavity 
 is thoroughly cleansed, use on cotton the following antiseptic solu- 
 tion : permanganate of potash (1 grain to 20 tablespoonfuls of water), 
 boracic acid (2 drachms to 20 tablespoonfuls of water), perchloride 
 of mercury (1 or 2 grains to 20 tablespoonfuls of water). Insuf- 
 flation of aristol and iodol in powder is also most useful. 
 
 Laryngitis is an inflammation of the larynx or voice-organ. 
 It usually results from cold, exposure, or from some irritant. The 
 vocal cords are inflamed, and the voice hoarse ; there may also 
 be some difficulty in breathing. Should this latter be present, 
 there is marked distress : the face is flushed, and the lips are blue. 
 The cough is harsh and croaking. 
 
 Treatment. — Keep the temjDerature of the room, if possible, always 
 about 65^ or 70^ F. The treatment in the early stages is the same 
 as in a cold. Ipecacuanha is useful, as it brings about vomiting, 
 which clears the throat. Give the ipecacuanha in teaspoonful doses. 
 The inhalation of a few drops of chloroform will relieve the spasm. 
 Let the diet consist of milk and cooling drinks. If there is great 
 difficulty in breathing, the doctor must be sent for. 
 
 Bronchitis is a catarrhal inflammation of the mucous membrane 
 of part or of the whole of the air passages. It may l)e acute or 
 chronic, and it may be limited to the larger tubes of the bronchi, 
 or it may extend into the smallest ramifications. The clironic form 
 is not often seen in Africa. 
 
 Acute bronchitis is endemic in Britain. It commonly begins 
 as a cold. There is sore throat, nasal discharge, and a cough. Then 
 the pulse becomes quick, wdth thirst and general feverishness. 
 There are symptoms of something obstructing the breathing, with 
 a distressing cough, and pain in the region of the breast-bone. 
 Headache is common. In three days or so there is an abundant 
 secretion, at M^hich stage the greatest part of the discomfort is over. 
 At first the expectoration is watery, then tenacious, and, lastly, 
 somewhat purulent. If the disease is only in the larger divisions 
 of the bronchial tubes, after a lapse of ten days or so the breath- 
 lessness goes, the cough is less, the expectoration free, and the general 
 uneasiness at an end. But if it travels to the smaller tubes of the 
 bronchus, the breathlessness is increased, the cough is more per- 
 sistent, the expectoration more difiicult, and there is a tendency to 
 choke. 
 
48 HEALTH IN AFRICA 
 
 Treatment. — Keep tlie patient in bed. If seen at the beginning 
 give a Seidlitz powder or a fall dose of Epsom salts, with 4 grains 
 of Dover's powder. Put strong mustard poultices on the chest. 
 When the expectoration is free, it is to be looked upon as a good 
 sign, esj)ecially in children. In such a case give an emetic, as the 
 act of vomiting clears the bronchial tubes. Ipecacuanha in any of 
 its forms assists the expectoration. 
 
 Pneumonia. — This is an inflammation of the lung tissue itself, 
 and is due to a low form of diplococcus multiplying in the lung 
 tissue. Like bronchitis, it very frequently is the result of cold, 
 and occurs in Africa very often during the cold season or at the 
 beginning of the rains. When it is acute, and when it attacks 
 a healthy person, it runs a very definite course. Usually, before 
 it sets in, there is a day or two of marked " out-of-sortness," then 
 there is sudden and severe shivering. On taking the temperature, 
 it is 103° F. or more. In a few hours rapid breathing is marked, 
 with cough and pain in the inflamed side. The patient at this stage 
 inclines to lie on the back. The cheeks are flushed, the nostrils 
 dilated, and it may be little dark spots appear on the lips. The 
 breathing is very shallow and frequent, out of all proportion to 
 the pulse. (The normal ratio is one breath to four beats of the 
 heart.) Cough is usually jDresent, and is very harassing, as it aggra- 
 vates the pain. The sputum is sticky, and in colour is reddish- 
 brown or rusty, which is due to the intimate admixture of small 
 particles of blood. The skin is dry and parched, and may have 
 a slightly yellow colour. The urine is dark. The sufferer has a 
 great tendency to tremble all over, and is often delirious at night. 
 
 Improvement generally takes place from the fourth to the ninth 
 day, when the temperature comes down with remarkable sudden- 
 ness. As in malarial fever, perspiration is very profuse, and the 
 relief is immense, delirium and other serious symptoms disap- 
 pearing. The cough may, however, remain, but the exjDectoration 
 changes markedly in colour and in profuseness. 
 
 This disease varies greatly according to the health of the 
 patient, the constitution, and the amount of lung involved in the 
 affection. The danger is greatly increased if the other lung be 
 involved. Death usually ensues from suffocation. 
 
 Treatment. — Rest in bed is absolutely necessary. The treatment 
 is chiefly a matter of nursing. Absolute quiet should be insisted 
 on. The diet should be fluid, and some palatable drink given in 
 teaspoonfuls, as the sufferer is often very thirsty. No drugs can 
 shorten the course of the disease after it has set in. A good purge of 
 calomel 4 grains, jalap 10 grains, will often give relief. (Always use 
 
DISEASES OF THE RESPIRATORY SYSTEM 49 
 
 a bed-pan, as the sufferer cannot get out of bed.) To allay the severe 
 pain apply mustard-poultices for half-an-hour, and cover the in- 
 flamed part most carefully with cotton. Blisters to the affected part, 
 as also hot fomentations, are good. Stimulants are as a rule required, 
 and should be given frequently, and in teaspoonful doses. Delirium 
 should be treated with bromide of ammonium, 20 grains. Maintain 
 the strength of the patient by extract of beef, beef-tea, eggs, and 
 milk, remembering that the crisis comes with the sudden fall of 
 temperature, from the fifth to the tenth day. 
 
 Notice the sputum, and if it is offensive, disinfect it by Condy's 
 fluid, and remove at once. 
 
 After the patient has recovered, be on the look-out for a relapse. 
 See that warm clothing is worn, and as soon as possible let him be 
 removed to a sheltered district. 
 
 Pleurisy. — This is an inflammation of the investing membrane 
 of the lung named the pleura. It is very often associated with disease 
 of the lung tissue itself (pneumonia). In the acute form it begins as 
 a congestion, followed by dryness of the membrane, which has a dull 
 lustre. It is commonly due to exposure to cold and wet, especially 
 when the body is perspiring, or to a blow on the chest wall. It is 
 often secondary to other affections, as typhus fever. The onset is 
 marked by a sudden rise of temperature, say to 100° or 102° F., 
 but it rarely rises as high in this respect as pneumonia (104° F.), 
 and is not so regular in its course. The bowels are usually consti- 
 pated, the tongue coated, and great thirst complained of, as in other 
 fevers. There is breathlessness, the sufi^erer breathing quickly, and 
 in a shallow manner. He complains of a "catching," lancinating 
 pain, or a "stitch," and this is an early and pronounced symptom. 
 There is a cough, but it is not so marked as in pneumonia, and there 
 is no expectoration. The posture of the patient in bed is full of 
 instruction. In the early stage of the disease, when there is great 
 pain, owing to the two coatings of the pleura rubbing together, he 
 seldom lies on the affected side, as the pressure increases the pain. 
 About the fifth day, when fluid has been poured out, the patient 
 has difficulty in breathing, and the pain being less, lies on the 
 side that is affected — doing this to give the other lung full play. 
 The face is anxious, but not flushed as in pneumonia. 
 
 Treatment. — The first thing to do is to secure for the lung that 
 is disabled as much rest as possible ; next, to apply something 
 that will relieve the distress and pain. To this end some apply a 
 plaster of Paris jacket to give rest to the affected side, and relieve 
 the rubbing of the pleura and the pain. When there is severe 
 stabbing pain apply a fly-blister over the spot, and give 20 grains of 
 
 D 
 
50 HEALTH IN AFRICA 
 
 quinine. Dry cupping, after the fashion of the natives, is good. 
 Both of these, the blister and the cupj^ing, draw blood to the super- 
 ficial parts, and so relieve the congestion beneath. To further re- 
 lieve the pain, give ^ grain of morphia hy2)odermically. A Seidlitz 
 powder or Epsom salts is very good at this stage. The common 
 medicine — chlorodyne — is excellent, and is in every African outfit. 
 According to the site of the pleurisy and its stage, turpentine 
 stupes, or the strong liniment of iodine, may be applied. In order 
 to correct the abnormal perspiration, ^ grain of pilocar2:)ine hypo- 
 dermically is excellent. If the pleurisy has a tendency to become 
 chronic, mercurial ointment rubbed on the side of the chest is 
 on the right lines. The diet should be light and very nourishing, 
 but fluids in quantity shoul be discarded. 
 
 Sometimes the fluid poured out into the pleural cavity does not 
 dry up as desired ; in such a case we resort to medicines which cause 
 a great flow of urine, or to those which bring about watery stools. 
 The following is on these lines : sulphate of magnesia, 30 grains. 
 Should, however, breathing be embarrassed, or the heart displaced 
 by fluid in the pleural cavity, or should fluid remain stationary for 
 a considerable period — say two or three weeks — the physician could 
 perform the operation of " tapjjing the chest." This is done by the 
 aspirator needle. 
 
I 
 
 \ 
 
CHAPTER V 
 
 DISEASES OF THE CIRCULATOEY SYSTEM 
 
 STRUCTURE AND FUNCTIONS 
 
 Circulation is tlie term used to designate the course of the blood 
 from the heart, through the arteries, to the minutest capillaries 
 (which supply the tissues with nutriment), from these back throuo-h 
 the veins to the heart. It is a circle of rotation that is ever goinc' 
 on by night and by day. 
 
 The heart is the central organ of the circulatory system, which 
 acts as a force or a suction-pumj). It is simply one of the arteries 
 more highly developed in its muscular coat than its fellows. {See 
 Fig. 8.) The human heart lies in the chest between the two 
 lungs. It has two receiving- chambers or auricles, of which the 
 right receives all the impure blood coming from the head and 
 body, while the left receives the purified blood coming from the 
 lungs. The two auricles pass their contents to the ventricles 
 which are enormously powerful pumping- chambers. The right 
 ventricle pumps, with great force, its blood through the lungs, 
 and the left ventricle, with even greater force, pumps its blood 
 through the whole body. There are thus two circulations. The first 
 is the general circulation, which passes from the left heart through 
 its large vessels to the head, the arms, the viscera, and the lower 
 limbs ; from there the blood returns by the veins to the right heart. 
 The second or lesser circulation carries impure or venous blood, and 
 passes from the right heart to the lungs ; there the fluid is exposed 
 to the free air and is oxygenated ; from thence it j^asses to the left 
 heart and on into the first or greater circulation. 
 
 When the heart is working, the two auricles contract simul- 
 taneously and force their contents onwards. This is followed 
 immediately by a like contraction of the ventricles, also forcing 
 on their contents. A pause ensues, when the heart rests, after which 
 the rhythmic contraction is renewed. 
 
 51 
 
52 
 
 HEALTH IN AFRICA 
 
 AimM^J-^ fi^. 
 
 
 Fig. 8. — Froxt View of the Chest and Abdomen. 
 
 (The ribs and sternum are shown in their relation to the lungs, heart, 
 liver, and stomach. The size of the liver is shown rather dia- 
 grammatically. It is important to remember that the liver is 
 covered by lung down to the lower edge of the sixth rib. Below 
 that, the liver is covered by ribs and intercostal muscles only. ) 
 
DISEASES OF THE CIRCULATORY SYSTEM 53 
 
 There is no passage of the blood from the right side to the left 
 side except through the lungs. It is as if a long tube had received 
 a figure-of-eight twist upon itself. Where the one part overlapped 
 the other, we might conceive of union in the sense that they grew 
 and adhered to one another, but there was no passage for the fluids. 
 
 The heart lies behind the breast-bone, about the level of the 
 nipples. It lies rather to the left side, its apex being in the inter- 
 costal space between the fifth and sixth ribs, and about three inches 
 from the middle line of the breast-bone. Its upper surface is about 
 level with the lower surface of the third rib. In a healthy person 
 it beats about 70 times in a minute. In children it may beat from 
 100 to 120 in a minute ; and in old people may only attain 50. 
 By placing the finger between the fifth and sixth ribs, and about 
 three inches from the middle line of the breast-bone, the beat of the 
 heart can be distinctly felt. When a person is excited, the heart 
 can be seen to beat in this region. What is known as the jmlse, is 
 merely the rhythmic contraction and expansion of the arteries 
 leading off from the heart. The pulse can be felt wherever an 
 artery passes over a hard substance, as a bone, and can be gently 
 comj)ressed between that substance and the finger of the observer. 
 
 Heart affections are not common amongst those who go out to 
 Africa. They are often seen, however, amongst the natives. Heart 
 affection is so vast a subject that a non-professional person cannot 
 hope to do much in the way of treatment. The following notes 
 on general diseases may be of interest. 
 
 Dropsy. — This is more a symptom than a disease of the heart. 
 It is an effusion of watery fluid from the blood, into the skin and 
 connective tissue of the body or its cavities. The fluid part of the 
 blood transudes and fills up the spaces in the connective tissue. It 
 occurs when the blood is watery and the heart unable to force the 
 fluid against gravity, from dependent parts of the body, such as 
 the lower limbs. The dropsical fluid is very much like ordinary 
 blood serum. It is without colour, or somewhat of the tint of straw. 
 Dropsy may be local, in which case it is due to something interfering 
 with the venous circulation leading from the part. This is seen 
 when the abdomen swells from affections of the liver. Or, again, 
 it may be general. It is then due to the heart, and begins in the 
 most dependent parts, as the ankles or insteps, and always comes 
 on about evening. The tissues become swollen and flabby, and 
 pit on pressure. The vitality of the dro]3sical tissues is lowered, so 
 that they are very liable to low forms of inflammation. 
 
 Treatment. — The condition may hinder the subject from getting 
 out of bed, or even moving in bed. In treating it, find out the 
 
54 HEALTH IN AFRICA 
 
 cause, and remove it. The absorj)tioii of tlie fluid may be aided by 
 medicines wliicli cause very watery stools, as 15 grains of jalap, or 
 Epsom salts in very little water, or by medicines wliich cause great 
 persjDiration, as 10 grains of Dover's j^owder. 
 
 A surgeon could drain off tlie fluid. After liaving tliorouglily 
 cleaned and oiled the skin, he could make a prick and allow the 
 fluid to trickle off, or he might insert small silver tubes. 
 
 Where the abdomen is distended with fluid (ascitis), it is some- 
 times absolutely necessary to remove the same, as the pressure inter- 
 feres with breathing. In such a case the fluid may be drawn off. 
 This operation should only, however, be undertaken by a duly 
 qualified j)hysician. 
 
 Palpitation is an increase of the action of the heart, both in 
 frequency and in force, which causes some discomfort. It may arise 
 from some heart affection, but may also be brought on reflexly, by 
 a disorder of another nature. It is seen in affections of the stomach, 
 as indigestion, or over-distension of that organ. It may come on 
 from over-indulgence in tobacco, tea, or alcohol. The onset is some- 
 times sudden, occurring even during sleep, but it more often comes 
 on after excitement or severe exertion. There is a great sense of 
 oi3pression over the region of the heart, Avith breathlessness, giddiness, 
 and a feeling as if the " end " had come. The heart heaves as if under 
 some weight. The sounds of the beating are louder than usual, and 
 the impulse of the heart seems to be conveyed even to the vessels of 
 the neck. These abnormalities of the heart's action last for a few 
 hours, or even days, and often go off as suddenly as they appear. 
 
 Treatment. — Try and find out the cause and remove it. Let the 
 diet be very sparing. If any narcotic is in use, be susj)icious of it 
 and stop it. When the palpitation is present, let the patient recline 
 on a couch of some kind, and give ether to breathe, or apply ammonia 
 to the nostril. 
 
 Angina pectoris — breast pang — cardiac pain. — This is an 
 affection of the heart which is characterised specially by loain in 
 the region of the organ, wtiich occurs in paroxysms. Along with 
 the pain there are cold sweats, and a horror as of impending death. 
 It comes on usually about middle age, and is more common amongst 
 men. The one feature which characterises the disease is the sudden- 
 ness of the onset of the jJain. A person may be hurrying to a train or 
 to an appointment, when suddenly he is arrested. The pain is like a 
 stab in the heart, radiating down the left arm. The patient has all 
 the appearance of having had a shock : the face is pale, anxious, and 
 a picture of distress. He lays hold of whatever is near, lest he should 
 fall to the ground. His legs quake, and a cold, clammy sweat breaks 
 
DISEASES OF THE CIRCULATORY SYSTEM 55 
 
 over the whole frame. There is, however, no fainting and no tend- 
 ency to stupor. There may be irregularity of the heart's action ; 
 but often it beats at the regular rate, as if nothing were abnormal. 
 Death may supervene, but usually after half-an-hour the paroxysm 
 of pain is at an end. The attacks, however, are likely to come 
 back, and at lessening intervals. 
 
 Treatment. — Attend carefully to the general health. Avoid ex- 
 citement and muscular exercise, which throw a strain on the heart ; 
 avoid all stimulants ; make certain that there is no straining at 
 stool. Nitrite of amyl, when it is inhaled in doses of from 2 to 5 
 drops, gives almost instant relief. It does so by relieving the spasm 
 of the superficial arterioles, and so lowers the blood pressure. Those 
 who suffer from the disease should carry about with them a few of 
 the silk-enveloped glass capsules. On the aj)proach of the spasm, 
 break the glass over a handkerchief and inhale the vapour. After 
 a few deep inspirations the pain is at an end. The inhalation of 
 chloroform gives relief, and is often at hand when there is no 
 nitrite of amyl. The chloroform should be inhaled in the usual 
 way from a handkerchief or a towel. Another authority recom- 
 mends a hypodermic injection of -| grain of morphia. Until these 
 drugs can be procured, on the appearance of the paroxysm let 
 all clothing be removed from the neck, apply hot fomentations to 
 the region of the heart, and give hot stimulants, as brandy. In 
 malarial cases quinine in large doses, say 20 grains, gives relief. 
 
 The kidneys. — These organs are two in number, having for 
 their function the secretion of the urine. They are of the shape of 
 a French bean. They are tubular glands, and are the largest of 
 their kind in the human body. They are situated at the back 
 of the abdomen, in the lumbar region. {See Fig. 9.) They lie 
 on either side of the spinal column, extending from the lower 
 edge of the eleventh rib to a little way above the crest of the 
 ilium. The right kidney is a little lower than the left. Each 
 organ is four inches in length, two in breadth, and one in thickness. 
 The substance is of a dark-red colour. They may be compared to 
 the skin, in having enormous numbers of tubes, after the likeness 
 of the sweat glands, abundantly sujDpliecl by capillary blood-vessels. 
 The function of these tubes, which are greatly convoluted, is to 
 secrete from the blood, in a fluid form, the various constituents of 
 the urine. This secretion is collected into a cavity in the kidney, 
 passed on through the ureter to the bladder, and cast out of the 
 system. The ureters are two long muscular tubes leading from the 
 kidneys to the bladder. They descend in the back part of the 
 abdomen. The bladder is a muscular bag which receives the urine 
 
56 
 
 HEALTH IN AFRICA 
 
 droj) by drop as it is secreted. It lies in the pelvis in front of the 
 lowermost j)art of the bowel. 
 
 Fig. 9.— Diagrammatic View of the Back, showing the Spinal 
 Column, Eibs, Spleen, Kidneys, and Bladder. 
 
 The urine. — It is important to have a knowledge of this secre- 
 tion in health. The nrine consists of waste products of the system, 
 
DISEASES OF THE CIRCULATORY SYSTEM 57 
 
 and water. These, should they be retained within the body, act as 
 poisons. The physician, by studying its amount and quality, is 
 guided to a knowledge of the state of the kidneys. The quantity 
 passed in twenty-four hours in health is from two to three pints 
 (four tumblers), but it varies greatly. A healthy person should 
 not be forced to pass urine from the hour of lying down till that 
 of rising in the morning. This also depends on the fluids partaken 
 of, and the state of the skin. Healthy urine is clear and trans- 
 parent when passed, and on standing in a vessel may have a faint 
 cloud of mucus suspended a little way above the bottom of the 
 vessel. It is slightly acid, as is shown by turning blue litmus 
 paper red. Its specific gravity is 1015 to 1020. It may vary 
 greatly from the above and yet not indicate actual disease. 
 
 If mucus be present, the urine has a cloudy whitish colour ; 
 if pus, the urine is thick, heavy, and it may be greenish in tint. 
 If albumen is jDresent, it manifests a grave kidney weakness. In 
 order to test this, boil a little in a test-tube, and, if present, a more 
 or less thick cloud will a^^pear, and this cloud does not pass off", but 
 is rather increased, by adding a few drops of acetic acid. Bile 
 when present makes the urine yellowish or greenish in colour. 
 When such urine is spilt on linen or white clothes, it stains them 
 yellow. Bile is always associated with jaundice. Hcematuria means 
 actual blood in the urine. If the amount of blood is small, the 
 urine will be smoky in appearance ; if great, it may be red or scarlet, 
 or dark brown, as porter. If the blood is diffused throughout the 
 urine when passed, it comes from the kidneys ; but if it is passed 
 in clots, it may come from the ureters, or even the bladder, or 
 other passages. Hcemoglohinuria is a condition of the urine in 
 which blood pigment is present, but very few, if any, blood 
 corpuscles. It may be paroxysmal in form, when there is an 
 occasional passage of dark-coloured urine. The attack may come 
 on after the morning bath, exposure to cold, exhaustion, or an 
 ordinary attack of tertian malarial fever. It may also be due to a 
 toxic poison, such as bile nitrites, or the substances secreted by 
 the parasites of malarial fever. 
 
 There may be actual suppression of the urine. This is very 
 serious, and may indicate that the kidney is unable to eliminate the 
 products of waste. It is seen in actual kidney disease, cholera, 
 malignant malarial fever, &c. It is difterent from retention, when 
 the urine is secreted, but the bladder has not the capacity of 
 discharging the same. 
 
CHAPTER VI 
 DISEASES OF THE NERVOUS SYSTEM 
 
 STRUCTURE AND FUNCTIONS 
 
 The nervous system of vertebrate animals consists of two apparently 
 distinct parts — the brain and the spinal cord. These organs are so 
 extremely delicate and sensitive, that they are contained in very 
 strong bony encasements. The brain is within the skull, and is 
 divided by anatomists into the large brain (cerebrum), the small 
 brain (cerebellum), and a most important part, the medulla oblon- 
 gata. (See Fig. 11.) 
 
 In weight the brain is about fifty ounces, and in proportion to 
 the weight of the human body it is one to fifty. In this respect 
 man is very different from the lower animals. The cerebrum 
 embraces the greater part of the brain substance, and presents an 
 external, an internal, and an inferior surface. The external sur- 
 face is laid out in folds and convolutions, separated by deep 
 furrows. These convolutions consist of nerve substance, or "grey 
 matter," and are different from the deeper substance. This internal 
 or deeper part is white, and encloses cavities, which are connected 
 with other cavities, that are found in the spinal cord below. These 
 in every healthy brain contain a little fluid. From the inferior sur- 
 face there passes off a number of little processes, which go through 
 holes in the bony case. They are known as the cerebral nerves, 
 and some of them are the nerves of sight and smell and hearing. 
 The small brain or cerebellum lies below the larger brain. The 
 medulla oblongata is, in many respects, the most important part of 
 the brain, as here are lodged the centres of action of the most vital 
 organs of the body — the heart and the lungs. Comparatively, it is 
 small, and lies inside the skull, at the top of the canal, in which is 
 lodged the spinal cord. 
 
 The delicate brain has, besides the strong outer bony skull, and 
 the coverings of skin and hair, three other very delicate mem- 
 
 5S 
 
60 
 
 HEALTH IN AFRICA 
 
 OMcryOafs 
 
 herve 
 
 
 Fig. 11.— Diagrammatic Sketch of the Nerve Supply. 
 
DISEASES OF THE NERVOUS SYSTEM 61 
 
 These nerves, when they leave the cord, divide again and again, 
 and finally end in giving nerve power, or motive force, to the muscles 
 of the body, and, above all, sensitiveness to the skin. No part of the 
 body is supplied with sensory nerves so freely as the skin. It is 
 indeed one vast sensory sheet or network, that envelops so minutely 
 every part of the body, that the finest point of the finest glass 
 cannot pass through without doing injury. When, however, this 
 sensory network is penetrated, a needle even can be thrust into the 
 tissues below without pain. 
 
 Before we can understand the action of the spinal cord, it is 
 important to notice, on making a section, that we get an appear- 
 ance like that in Fig. 10. The dark shading indicates the grey 
 matter of the cord, and is found in its centre. The larger part 
 of this grey matter is in front, and from it pass off the fibres 
 of the anterior root. The smaller part passes into the posterior 
 root. Both unite to form the spinal nerve. When a person per- 
 forms a movement, say the moving of an arm, the whole of the 
 nervous system is involved. The desire to do so originates in the 
 grey matter of the brain, goes along the white matter through 
 the medulla, down the spinal cord, and passing out at the anterior 
 root of the spinal nerves, passes to the particular muscle which has 
 to perform the desired action. Now we know that the movements 
 of one side of the body are governed by the brain on the opposite 
 side. There must therefore be a crossing at some part. These 
 crossings take place in the medulla oblongata. Paralysis signifies 
 that the connection between the muscle and the brain is severed 
 in some part of the connection, it may be in the nerve, the 
 spinal cord, or in the brain. If the spinal cord be cut or injured, 
 all the muscles below the injury are paralysed. If there is disease 
 in the brain, the whole of the opposite side of the body is disabled 
 and paralysed. 
 
 Besides this, however, there is another set of nerves which carry 
 sensation. If we prick a finger with a needle, the sensation passes 
 along a sensory nerve into the cord by the posterior root ; it then 
 passes over to the opposite side of the cord, and ascends to the brain. 
 If a sensory nerve is cut, there is loss of all sensation, or ancesthesia. 
 If the spinal cord be injured, the body below the point of injury not 
 only loses its power of motion but its sensation as well. The spinal 
 cord is thus a great conductor of impulses to and from the brain — 
 the centre. 
 
62 HEALTH IN AFRICA 
 
 DISEASES OF THE NERVOUS SYSTEM 
 
 It is beyond the scope of tliis handbook even to enumerate the 
 diseases of the nervous system. The following, however, offered 
 withont any classification, are found frequently in Africa, and a 
 description of their symptoms and management, may not be out 
 of place. 
 
 Syncope — fainting — swooning. — Fainting may be brought about 
 by the want of pro23er food, or weakness ; a copious sudden hsemor- 
 rhage (bleeding); or, by sudden loss of the muscular power of the 
 heart. When the last happens, the heart is gorged with blood in all 
 its cavities. The person suddenly becomes pale and giddy, and 
 may fall to the ground unconscious ; the breathing may be gasping 
 in its nature, w^hile the eyes stare. If the case is extreme, there is 
 total unconsciousness, the pupils of the eyes become largt^, wdiile the 
 urine and the f seces may be passed without the sufferer's knowledge ; 
 the pulse is weak and irregular ; later on there may be vomiting 
 and perspiration. 
 
 ' Treatment.- — Place the sufferer in a horizontal position, wdtli the 
 head lower than the body. Remove the clothing from the neck 
 and chest, and allows fresh air to play on the face. If swallowing 
 is impossible, dash a little cold water on the face, and, immediately 
 after, dash a little hot water also ; this w411 set up a reflex action 
 on the heart and lungs and cause the patient to "gasp." Put a 
 little ammonia, or strong vinegar, or pepper to the nose, and rub 
 the hands with a w^et cloth. This will usually be enough. If the 
 case still resists, rub the limbs upwards, and give a little brandy 
 or ether by the mouth to stimulate the heart. If, however, it is 
 impossible to get the brandy dow'n the throat, then ether or 
 ammonia, in the proportion of 1 to 5 of pure water, may be injected 
 under the skin. Or give an enema of brandy and water by the 
 bowel. This treatment is to keep the heart from stoj)ping. Nitrite 
 of aniyl may be inhaled when the fainting is due to stoj)23ing of 
 the heart from excessive heat. It may even be necessary to set ujj 
 artificial respiration (which see). 
 
 Apoplexy {cerebral hcemorrhage). — This is due to rujDture of a 
 blood-vessel within the substance of the brain, and, as a consecpience, 
 more or less tearing of the delicate tissues. The bursting of the 
 vessel may be due to disease in the wall, or to increased pressure of 
 the blood w^ithin the vessel. The bleeding inside the brain may be 
 very insignificant, and only push the delicate nerves aside, or it may 
 
DISEASES OF THE NERVOUS SYSTEM 63 
 
 lacerate a large portion of the brain tissue. Usually the bleeding is 
 single, but it may be multi]3le. Should the patient survive, the 
 blood will form a clot, and shrink, and undergo changes. 
 
 At times there are impending signs of something being wrong 
 in the brain, as headache, giddiness, mental dulness, or bleeding 
 at the nose. This, however, is not always so. The onset of the 
 disease is always accompanied by an " apo2Jledic stroke," which is 
 characterised by a state of deep sleep, from which the sufferer 
 cannot be roused ; he suddenly loses consciousness and falls down ; 
 the pulse is low, the breathing long drawn out, and accompanied 
 by snoring ; the cheeks are puffed out, the eyelids closed, the 
 eyes, and it may be the head, are turned to the side opposite to the 
 paralysis ; the pupils of the eyes, too, are unequal and contracted. 
 
 Cerebral haemorrhage always results in paralysis, which varies 
 greatly. The paralysis is of the opposite side of the body — say a 
 leg and an arm, together wath the muscles of the lower part of the 
 face, and often of the muscles which 23rotrude the tongue. Yet the 
 eyes are not involved, as they can be closed together. 
 
 The forehead and body are generally bathed in perspiration. 
 At first the temperature falls, and in fatal cases remains low, but 
 almost always in a few hours it rises again. It may reach 107° F. 
 The duration of the stroke lasts from a very few minutes to four- 
 teen days, or even longer. Consciousness may return slowly, but 
 it is seldom that health is perfectly restored. 
 
 Treatment. — If there should be any warning, give a very active 
 purge— give, say, 2 drops of croton oil on sugar, and put it far 
 back on the tongue. Leeches may be put beliind the ears, the 
 object being to relieve the congested brain. When the shock has 
 come, raise the head, and put ice, if it is to be had, or cold cloths 
 to the head, mustard to the abdomen and calves of the legs. 
 Darken the room, and enjoin that the patient be kej)t absolutely 
 quiet. Tincture of aconite should be given in 1-drop doses every 
 ten minutes, to reduce the pressure of the blood in the blood-vessels. 
 When consciousness returns, give bromide of potassium in 20-grain 
 doses ; above all, avoid stimulants, as they tend to increase the 
 bleeding. 
 
 Epilepsy is very common in Africa. It is a disease of the 
 brain, although it is not due to any change that is obvious. There 
 is a temporary loss of consciousness, which sets in with suddenness, 
 and usually with a slight convulsive attack. The sufferer "takes 
 fits." It usually comes on, for the first time, about the age of ten, 
 and lasts till middle life or longer. Intemperance or insanity is 
 frequently in the family, as is ascertained by inquiring after the 
 
64 HEALTH IN AFRICA 
 
 family history. Friglit, overwork, and great excitement are the 
 nsiial immediate causes. Usually it comes on periodically at 
 intervals of some weeks, or even months. 
 
 Treatment. — Inquire carefully into the family and past history 
 of the sufferer. The best medicinal remedy is bromide of potassium 
 in full doses of 30 grains twice a day. This acts like a charm on 
 the natives. Along with it, however, combine some good tonic, 
 as Easton's syrup. During the fit, loosen all clothing and allow a 
 free play of fresh air. 
 
 Convulsions {seizures— ^^ fits"). — These occur as a symptom of 
 something wrong in quite a number of affections. When called on 
 to see such a case, let the patient be put to bed, with the head and 
 shoulders slightly raised. Eemove clothing, and all other constric- 
 tions, from the necl<. Guard the tongue from being bitten, by 
 placing a pencil or a cork between the teeth. If one seizure 
 after another lays holds of the patient, it may be advisable to give 
 nitrite of amyl, or even in very severe cases a little chloroform. In 
 the case of an adult try and find out the cause and treat it. 
 
 Convulsions are very common in Children, and are often 
 due to teething. If the child is about a year old, always examine 
 the gums. Wash the index-finger thoroughly, soak it for a little in 
 1-40 of carbolic acid, pass it into the mouth, and feel for any raised 
 parts over the line of the gums. If a tooth seems to be near the 
 surface, scrape the spot with the finger-nail ; this will set free the 
 troublesome tooth. Rubbing the abdomen for about ten minutes 
 before a fire is good. The best treatment of all is to jDromptly give a 
 warm bath. Let the water be exactly the temperature of the body 
 when the little one is placed in the bath. Keep the head cool 
 by cold water, and gradually add hot water till the whole is a degree 
 or two above that of the body. Give an enema while the child is 
 still in the bath, and so wash out the bowels. Mustard over the 
 back of the neck is good in every case of convulsions. Some recom- 
 mend the constant pouring of cold water over the top of the infant's 
 head. Always relieve the boAvels either by a brisk purgative as 
 castor oil, or by an enema given in the above way. 
 
 Sunstroke — sun - fever — heat - apoplexy. — These are names 
 applied to a class of nervous symptoms which arise from long 
 exposure to the sun or to an artificially high temperature. Of all 
 animals, man j)ossesses the greatest power of adapting himself to 
 changes of climate, and of maintaining health under extremes. He 
 has the inherent power of maintaining and regulating an equable 
 temperature under extreme cold and extreme heat. Strong healthy 
 Europeans can not only tolerate great heat, but thrive in it. The 
 
DISEASES OF THE NERVOUS SYSTEM 65 
 
 temperature of the body is practically constant, an equilibrium 
 being maintained between heat formation and heat loss. If by any 
 means more heat is produced than the system can cope with, there 
 is a sudden elevation of the temperature, and the result is sunstroke. 
 Usually the onset is sudden — the patient falling insensible, with 
 gasping respiration, snorting breathing, extreme feebleness of the 
 ]3ulse, and elevation of the temperature. At other times the onset 
 is less abrupt, and comes on like an attack of malarial fever. Here 
 there is weariness, exhaustion, nausea, restlessness, and a high tem- 
 perature passing on to insensibility. 
 
 On careful inquiry into the past history of such cases, it is 
 usually found that for a short period previous to the attack the 
 sufferer has not been well. He has had a shivering fit, and has not 
 perspired regularly, or the ordinary eliminating functions of the 
 bowels, liver, and kidneys have been blocked. He has thus been 
 less able to resist the abnormal state of heat into Avhich he has 
 been suddenly thrown. 
 
 All who suffer do not necessarily die ; some recover perfectly ; but 
 many are injured for life, and unfit to return to a hot climate. 
 
 Treatment. — Preventive treatment is the best for Africa. Care- 
 fully protect the head and spine from the direct rays of the sun by 
 a good thick pith helmet. Light fine woollen clothing should be 
 worn next the body. Take precaution against over-fatigue, physical 
 or mental. Avoid all excess in animal food and stimulants of 
 . every kind. Carefully attend to the condition of the bowels, and 
 keep them strictly in accordance with nature. In simple heat-ex- 
 haustion, remove the sufferer to a cool place in the shade ; douche 
 cold water on the head and chest ; remove all tight clothing ; 
 apply ammonia to the nostrils, and give a little spirits. 
 
 In severe cases where the temperature is from 106° to 109° F., 
 with complete loss of consciousness, stertorous breathing, passing 
 motions in bed, &c., and this serious state lasting for a week or 
 more, the treatment consists in the following ; apply ice or cold 
 cloths to the head night and day ; wash out the bowels thoroughly 
 with warm enemata ; give hypodermic injections of ether or quinine ; 
 apply a blister to the nape of the neck ; on recovery of conscious- 
 ness, order Easton's syrup three times a day as a tonic. No one 
 who has suffered from severe sunstroke should remain in Africa, but 
 should leave it for a cooler climate. 
 
 Neuralgia. — This is the term applied to pain originating in the 
 course of a nerve. It usually arises from cold, from injury, from a 
 decayed tooth exposing the nerve, or from pressure on the nerve 
 itself. Often,' however, no cause can be discovered. It affects 
 
 E 
 
66 HEALTH IN AFRICA 
 
 those wlio are run down in liealtli, and wlio are of a nervous or 
 hysterical temperament. The one characteristic feature of neuralgia 
 is an aching, boring, shooting pain, which comes on in marked 
 paroxysms. Sometimes the pain is bearable, at other times it is like 
 to drive the sufferer distracted. It has a tendency to shift about, 
 usually, however, these erratic shiftings are in the course of the 
 one affected nerve. 
 
 Neuralgia when it attacks the side of the face is known as 
 douloureux. "When in the hip it is in the course of the sciatic 
 nerve, and is known as sciatica. 
 
 Treatment. — Carefull}^ look for the cause and remove it. If the 
 cause is a decayed tooth, as long as that tooth is there, so long will 
 the neuralgia be liable to affect the subject. When the cause of the 
 trouble is removed, attend to the general health. Let the food be 
 abundant and nutritious, and above all, let it contain a large pro- 
 portion of fatty substances. Apply hot fomentations to the course 
 of the nerve. Friction with camphor, turpentine, belladonna, 
 brandy, and pepper are all good. If these fail, then, in order to 
 relieve the pain, give a hyj^odermic injection of morphia, or 5 to 10 
 drops of pure chloroform. These two latter drugs not only palliate 
 but seem to cure the affection. 
 
 The following drugs are on the right lines : quinine in 5-grain 
 doses twice a day ; antipyrin in 15-grain doses may be taken 
 along with the quinine, and these two together often have a mar- 
 vellous effect ; or begin by taking 10 grains of antij^yrin, and in 
 one hour take another equally large dose. One to 5 drops of liquor 
 arsenicalis, or 15 to 20 drops of the tincture of gelsemium is highly 
 spoken of. Exalgine has lately gained a reputation as a cure for 
 neuralgia. It is best tolerated in the following mixture : — 
 
 Exalgine .... 36 grains. 
 Rectified sj)irit of wine . 4 teaspoonfuls, 
 Water 6 tablespoonfuls. 
 
 Of this take a table spoonful in water every second or third houi'. 
 
 The new drug apolysine is highly spoken of in the treatment 
 of neuralgia. The pain is said to disappear rapidly after one 
 application. 
 
 Sciatica merits a word further. It is one of the most common 
 forms of neuralgia. Here, however, the -paiji is really constant, 
 with severer paroxysms suj)erveniug. These have been described 
 as " lightning " pains darting from the hip to the toes. It is usually 
 confined to one leg, but in severe cases it radiates to the other. The 
 causes of this trying afi^ection are exposure to cold, weakness of 
 
DISEASES OF THE NERVOUS SYSTEM 67 
 
 nutrition, and exhaustion. It is a debility of the nervous system. 
 In some cases great ftecal accumulations in the lower bowel bring 
 on the disease and keep it up. 
 
 Treatment. — All sorts of drugs have been tried, internally and 
 externally. Electricity and galvanism alone, or combined with 
 Turkish baths, and massage are excellent. Very chronic cases 
 seem to have been successfully treated by the deep injection of a 
 1 per cent, solution of osmic acid. The best of all treatment seems 
 to be absolute rest, with a blister applied to the course of the nerve 
 every w^eek, and the deep injection into the tissues of morphia, say 
 ^ grain, or cocaine, ^ to ^ grain. 
 
 Headache— sick headache — migraine— megrim.— These are 
 names given to a peculiar form of headache which is very common 
 in Africa, as well as other places, and which has the peculiar tend- 
 ency of coming on in paroxysms. It affects the system first about 
 the age of puberty, and may continue for years. It seems to be 
 hereditary, being handed down from one generation to another. 
 The causes are too numerous to mention, but mental worry seems 
 to be the leading cause. The attack may come on suddenly, but 
 usually it is insidious, creeping on the system with slow step. At 
 first the sufferer may feel an uneasiness about the stomach, then 
 a gradual feeling of pain in the head. Meantime the eyes become 
 heavy, the face flushed, and the temples throb. In some cases, 
 however, the subject becomes extremely pale ; in others the illness 
 is ushered in with slight shivering, and it may be vomiting. In 
 the majority of cases the attack will go off in about twenty-four 
 hours, but it may hang about the system for four days or aVeek. 
 As a rule it does not affect those wdio are well advanced in life. 
 
 Treatment — This resolves itself into the management of the 
 attack, and in the employment of such measures as w^ill prevent its 
 return. When the headache is at its worst it is useless to fight 
 against it : the sufferer must give up all physical and mental work. 
 Long walks in the open air should be undertaken if the sun is not 
 too hot, or he should go off and have a chat with a friend. Of all 
 drugs, antipyrin, or antifebrine, or phenacetin, and this class of 
 remedies, are the best. In some cases they act like magic. As 
 soon as the attack begins to make its appearance let the sufferer 
 take of antipyrin or phenacetin 10 or 15 grains. If the pain does 
 not go in a quarter of an hour or less, then the patient should 
 rest on a sofa and take half of the above dose every hour for four 
 consecutive hours. Persons suffering from fever or from this 
 nervous affection can take larger doses of the drug than those who 
 are in perfect health. If the patient has reason to fear the drug. 
 
68 HEALTH IN AFRICA 
 
 then lie should take 3 or 4 grains every twenty minutes till relief 
 comes. Every individual must find out what exactly is the dose 
 of any drug which his constitution requires in order to be brought 
 under the jDhysiological action of the same. Constitutions differ 
 in this respect. The doses given in every case are only approxi- 
 mate : in one case it may be a very little less, in another case it 
 may be a very little more. The salicylicate of soda gives relief 
 in a few cases if it is taken in 20-grain doses. 
 
 The following is antipyrin combined with quinine, which is an 
 excellent mode of giving the drug : — 
 
 Phenazone (Antipyrine) ... 10 grains, 
 Citrate of caffein .... 4 „ 
 
 Quiniuce hydrobrom . . . 4 ,, 
 
 Let this be made into two 230wders, and let one be taken every two 
 hours. It is almost certain to remove the nervous headache. 
 
 Sleeplessness or insomnia. — Sleeplessness is very common in 
 Africa, and manifests itself very often as the first symptom of fever. 
 It is due, often, to the presence of malarial fever, to over-exhaustion, 
 to congestive conditions of the brain, to certain drinks injuriously 
 affecting the brain, such as alcohol, tea, coffee, and tobacco. Sleep- 
 lessness is also one of the first signs of a breakdown of the con- 
 stitution. 
 
 Treatment. — Try to find out the cause. Thus, in some, the 
 drinking of strong tea at a late hour of the night is the cause of 
 hours of restless tossing. This being found out must be avoided. A 
 late supper affects some. Late mental work affects others. Before 
 resorting to drugs it is always wise to confine the management to 
 strict attention to the laws of health. This may be the first call of 
 injured nature. Make the diet plain but nutritious ; take gentle 
 open-air exercise ; avoid mental work and worry of all kinds. Cold 
 feet must be warmed and rubbed till they tingle. Before retiring 
 it is wise to bathe the feet in warm water, drying them well with 
 a coarse towel. Cold-water bandages may be applied to the head, 
 but should never be allowed to give discomfort. Make the body 
 as comfortable as possible under the blankets, endeavour to lie abso- 
 lutely still, taking long drawn-out breaths, till one hundred has 
 been counted. A^ery often before fifteen or twenty-five have been 
 reached one or two moments of unconsciousness have intervened. 
 Hot- water bottles to the feet and abdomen prolong the dilatation of 
 the blood-vessels, drawing blood from the brain, and refreshing 
 sleep supervenes. Narcotic medicines should be avoided as long as 
 possible, although it is better to have recourse to them than to pass 
 
DISEASES OF THE NERVOUS SYSTEM 69 
 
 a sleepless niglit and to face a day of wony and work. In all cases 
 tliey should only be resorted to as a temporary measure. 
 
 In mild cases of sleeplessness, after a day of marching in the sun 
 or great mental work or worry, the least harmful narcotics are the 
 bromides of potassium and sodium. Take 30 to 45 grains of the 
 former in 4 tablespoonfuls or more of water. Repeat the dose in 
 an hour or so. The bromides may be taken for many nights in 
 succession without injury to the system. 
 
 Chloral has been extensively used as a sleep-inclucer. It is 
 perhaps the best we have when there is no pain present. The 
 dose is 30 grains, 
 
 Sulphonal is excellent as a drug for producing sleep. It acts 
 well Avhen no j)ain is present. It is colourless, odourless, tasteless, 
 and insoluble, and the dose is from 30 to 45 grains. It is also ex- 
 cellent in preventing the night sweats which are so distressing to the 
 wakeful in the hot season. Dissolve it in boiling water — say half a 
 cup — and drink half-an-hour before lying down. 
 
 There are new drugs highly spoken of, as paraldehyde, urethane 
 hypnone, but these should only be given by the physician. 
 
 Where sleeplessness is due to actual pain the best way is to give 
 a hypodermic injection of | grain of morphia. 
 
 Alcoholism {chronic alcoJiolism). — This affection is really a toxic 
 disease of the nervous system. Alcohol, if taken to excess, acts 
 as an active poison, and if pushed will destroy life. When it 
 is taken in quantity and constantly repeated, it brings about a 
 class of sym23toms which are known by the above names. In some 
 cases the body becomes emaciated, in others there is obesity. The 
 features in time become red, flabby, and " pimpled," The white j^arts 
 of the eyes become bloodshot. The appetite for food is in abeyance, 
 especially in the morning, and there is in the mouth a troublesome 
 regurgitation of sour fluid. The tongue is coated with a thick fur, 
 and the breath is foetid. 
 
 The nervous system is markedly affected, as is manifested by 
 morning tremblings of the hands on the performance of any delicate 
 manipulation. There is loss of memory and judgment, indicating 
 an impairment of the intellectual powers. The "will" to do any- 
 thing is weak. The emotions are susceptible, so- that the sufferer 
 cries or laughs without apparent reason. Headache and swimming 
 of the head are complained of. It may be sleep is broken, and 
 unpleasant dreams rob the still hours of night of their repose. 
 Later on in the affection, ordinary duties are neglected, and the 
 conversation becomes rambling and incoherent. On the other 
 hand, some subjects of chronic alcoholism manifest a peculiarly 
 
70 HEALTH IN AFRICA 
 
 suave and unctuous manner. There is a marked perversion of tlie 
 "moral" sense, in that the subject of the disease, being ashamed of 
 the weakness, seeks to screen himself often behind a lie. Later 
 on there is indifference to all family ties, and, it may be, deception 
 and lying of the meanest kind are resorted to. The " man " is 
 unmanned. Everything in life is subservient to this one unnatural 
 craving — alcoholic drink. 
 
 The liver, kidneys, and nervous system are structurally changed. 
 The sufferer has what is known as the drunkard's liver — a shrunken 
 dried-up apology for the real organ. 
 
 Delirium tremens {acute alcoholism). — This disease is the 
 result of long-continued drinking to excess, together with the 
 neglect of the bodily frame. It is due to acute alcoholic poison- 
 ing, and is characterised by delirium, sleeplessness, and muscular 
 tremors. It is not the result of one or two " bouts " of drink, but 
 is the direct result of long-continued indulgence. For days or 
 weeks before the attack, the person is irritable, uneasy, unable to 
 sleep at night, and readily loses power over himself. He goes 
 from his food, being unable to eat. To get relief, as he fancies, he 
 resorts to the one thing that is slowly undermining the system — 
 alcoholic drink. 
 
 Suddenly he becomes more wakeful than ever, and is seized 
 with an uncontrollable trembling. The mind becomes confused 
 and excited. He is talkative, and, it may be, furious. He sees 
 animals, monsters, and devils in his near neighbourhood, grinning 
 at him, and mocking his misery. Or, it may be, he fancies that he 
 is pursued and must make his escape. He becomes suspicious of 
 those who are around him, being sure that they are the cause of 
 his distress. He has delusions of every sense, which occasion him 
 the acutest pain ; these delusions taking the hideous form, or that 
 of some unpleasant emotion. Some who suffer from this disease 
 become wildly maniacal, and attempt all sorts of mad things ; others 
 are sullen, sour, and gloomy. Usually in the midst of all this 
 mental aberration the afflicted one can be recalled temporarily to 
 himself. Thus, when his physician, or one whose voice he is in the 
 habit of obeying, speaks imperatively, he has moments of lucidity. 
 Usually, on the least attempt at movement, there is a violent shaking 
 of the limbs, upper and lower. The temperature is not much 
 affected, but the face is red and flushed ; the tongue is furred and 
 the breath fcetid. There is an inordinate craving for something to 
 drink, and a distaste of all nutritious foods, while all the ordinary 
 calls of nature are in abeyance. The brain is congested to irritation, 
 and is oedematous. 
 
DISEASES OF THE NERVOUS SYSTEM 71 
 
 This wild state may last from three to ten days, during which 
 time sleep has been quite absent. At last sleep supervenes, and 
 from this he wakes up somewhat like the old " self," but utterly 
 exhausted. 
 
 Treatment — Every form of spirits must be absolutely forbidden. 
 This must be enjoined should force even be necessary. Lic^uid 
 foods, such as beef -tea, should be given in teaspoonfuls. Insist on 
 a brisk purgative being taken, such as 5 grains of calomel and 15 
 of jalap. Sometimes the hypodermic injection of morphia acts 
 admirably. Bromide of potassium in large doses (say 30 to 45 
 grains) acts well in such cases. The drink craving is relieved by 
 strychnine given by the mouth or hypodermically. Liquor strych- 
 ninee in 5 to 10 drop doses in water is the usual form in which it 
 is given. The sufferer must be nursed, and watched night and 
 day. No mechanical restraint should be resorted to, but he should 
 be carefully tended and coaxed. If there is very great excitement, 
 give a wet-sheet pack, which will act quickly and calm the over- 
 taxed nervous system. When the attack is over, perfect quiet and 
 calm must be enjoined, and tonics of quinine and iron given for 
 some months. 
 
 Concussion — collapse — shock. — These three terms relate to a 
 functional depression of the system. It is a shock given to the 
 heart or to the brain which markedly depresses the vital powers. 
 It may be due to a j)oison, a fall, the receipt of bad news, excessive 
 pain, or other like causes. 
 
 The symptoms are first of all a fall of the bodily heat ; the lips 
 become pale, the body cold and clammy ; the pulse is small and 
 feeble ; there may be hiccough and nausea, dimness of sight, or 
 like symptoms. 
 
 Treatment. — Lay the person down in a horizontal jjosition, and 
 apply blankets and hot-water bottles to the extremities. Gently 
 rub the body so as to restore animation. Give a little brandy punch 
 if the sufferer can swallow. Apply mustard in the form of poultice 
 to the nape of the neck, spine, and calves of the legs. In alarming 
 cases give a weak solution of ammonia or sal volatile under the skin. 
 
 Insensibility, or stupor, or coma. — These terms express degrees 
 of incapacity, and may be due to a great variety of causes. If the 
 stupor is due to poisoning, as say from opium, then empty the stomach 
 by some means. Put the finger into the back of the throat, or 
 use a stomach-pump. Give a cup of very strong coffee, shake the 
 man well, and force him to walk about the room. Then give a 
 brisk purge, say one drop of croton oil. This can do no harm. 
 Apply mustard to the neck and warmth to the body. 
 
72 HEALTH IN AFRICA 
 
 Insanity, dementia, mania, melancholia, monomania are 
 
 all terms wliicb. indicate a certain departure from tlie normal mental 
 state. Such cases are rather common amongst the natives, and 
 mental Avorry may bring on a like state amongst Europeans. The 
 treatment must resolve itself into careful nursing and watching of 
 the sufferer. If possible let the surroundings be changed. Attend 
 to the general health by means of good tonics, cod-liver oil, &c. 
 Insure that good sleep is obtained. As regards drugs, hyoscine 
 stands liighest (^^ grain of the jjure drug being given hypodermi- 
 cally). Sulphonal is excellent. 
 
CHAPTER VII 
 SPECIFIC FEVERS 
 
 Fever is characterised by undue elevation of temperature. The 
 average temperature of the human body is 98"4° F. (36*8° C), and 
 in health varies little from this. In fever the state of equilibrium is 
 disturbed, and the temperature falls or rises. It may be as low as 
 95° F., which would be looked upon as a colla23se temjoerature, and 
 it may be as high as 110° F. The production of heat is due wholly 
 to the oxidation of the tissues of the body and the food, which takes 
 place during every form of bodily activity. Heat is, on the other 
 hand, being constantly given off by the lungs and excreta of the 
 body, and above all by the skin. The temperature of the body 
 rei^resents the balance between these two. Both of these are under 
 nervous control, and are constantly being brought into relation one 
 with the other by the circulation of the blood. In the state of 
 fever this balance is lost, and oxidation runs wild. The increased 
 heat, or the loss of heat, is perfectly evident to the hand when laid 
 on the skin of the sufferer. It can only, however, be correctly 
 estimated by the thermometer. {See How to take the Temperature, 
 p. 173.) Besides the change in the temj)erature of the body, there 
 are other evidences of fever. The skin is dry and parched, and it 
 may be rough to the touch (goose-skin), or bathed in perspiration. 
 Headache is usually complained of. There is a sensation as of 
 breaking asunder in the small of the back. There is sleeplessness, 
 and it may be delirium. This change from the normal, usually sets 
 in with a severe shivering fit, which is due to a spasmodic contraction 
 of the blood-vessels in the skin. The pulse and the breathing are 
 similarly affected, and are much more frequent than the normal. 
 There may also be a bad taste in the mouth, loss of appetite, nausea, 
 and vomiting. The urine is scanty, high in colour, and very acid. 
 
 All the specific fevers are due to low forms of microscopic life 
 setting up chemical or fermentative changes in the blood. 
 
 The blood.— In order 'to understand fever it is absolutely 
 
 73 
 
74 HEALTH IN AFRICA 
 
 necessary to know a few things as to tlie nature and functions of 
 blood. The blood is a red fluid, which fills, during life, the arteries 
 and veins and cax^illaries of the body. It is the nutritive fluid of 
 the tissues and the great carrying tissue of the body — a means of 
 exchange within the system. Its functions are complex. It conveys 
 food materials to every tissue, it removes thence all waste products, 
 and its red corpuscles carry oxygen. The blood in the arteries going 
 to the tissues is bright red in colour, whereas the blood coming from 
 the tissues in the veins is of a dark hue. The red corpuscles have 
 great jDOwers of absorbing oxygen, due to the jjresence in them of a 
 colouring matter known as the haemoglobin. This substance, which 
 is one of the most complex in the body, carries oxygen from the 
 lungs in a loose form, and supplies it to the body tissues. 
 
 The circulation of the blood is well seen in the tail of the tad- 
 pole. The following sketch (Fig. 12) represents what is seen when 
 the tip of the tail is put under a low power. Only the smaller 
 vessels are seen. In the larger vessels the blood is going with such 
 rapidity, that whilst you see that there is motion, you do not see the 
 individual corpuscles of the blood. In the smaller vessels towards 
 the outer sides the circulation is clearly seen : a single corpuscle 
 may be sometimes observed winding its circuitous way through the 
 vessel : in others the corpuscles may be seen to be moving back- 
 wards and forwards in a trembling manner.; in others again they 
 appear to be stagnant and to cleave together. The fluid part of 
 the blood is straw-coloured. 
 
 If a little bit of the foregoing is put under a higher f)ower an 
 appearance like that of Fig. 13 will be seen. The vessels, it will 
 be observed, are filled with a thickish-looking fluid. There are 
 very many red blood corpuscles to be seen rolling along, as in the 
 diagram. These corpuscles are very elastic, and change their shape, 
 so as to move through a very narrow vessel. They seem to be some- 
 what spindle-shaped in the tadpole. They often go through vessels 
 singly. The white blood corpuscles are also distinctly seen. They 
 seem to be sticky, and do not go as fast as the red. Many seem to 
 stop, and stick to the wall of the vessel. They often quake, as if 
 shaken by the fluid in which they float, but do not wave back 
 and forward as the red corpuscles do, when in a vessel through 
 which there is no current. 
 
 When the blood alone is examined, it is seen to consist of an 
 almost colourless fluid, the plasma. This fluid is very complex, 
 but has a permanently fluid portion— the serum — and a portion 
 which goes to form the clot of the blood. In the plasma there are 
 an innumerable number of two kinds of blood corpuscles, the red 
 
SPECIFIC FEVERS 
 
 ?47i/->4 
 
 Fig. 12.— The Circulation of the Blood in the Tail of the 
 Tadpole, seen under the Low Power. 
 
 (Drawn from life.) 
 
76 
 
 HEALTH IN AFRICA 
 
 and the wliite. The red are by far the more numerous, being esti- 
 mated at one white to 355 red. (See Fig. 14.) 
 
 It is estimated that, in a healthy person, about 5,000,000 of red 
 corpuscles are found in one small drop of blood. The individual 
 
 Fig. 13.— a Piece of the Tadpole's Tail seen under the 
 High Power. 
 
 (Drawn from life. ) 
 
 corpuscle is not red, but more of a pale straw colour ; when in 
 bulk, however, tfiey look red. They are composed of a colour- 
 less membrane and a coloured fluid, the haemoglobin. On being 
 
SPECIFIC FEVERS 77 
 
 withdrawn from the body they tend to run into heaps, like a pile 
 of coppers or rouleaux. Then the white blood corpuscles or 
 phagocytes are larger than the red, and consist of a jelly-like 
 substance which is sticky. In common with all one-celled bodies 
 they possess the power of altering their shape, that is to say, they 
 can put out a little process of their body and pull themselves 
 along. This is known as the amoeboid action. By this means the 
 white blood corpuscles eat up everything injurious that is found in 
 the blood. They also have the power of wandering outside the 
 
 yjV*^ 
 
 @ d 
 
 
 
 ;^^ 
 
 ^ 
 
 
 ^ i^l® 
 
 "^ ^/e^4M^^^^ 
 
 Cl ^^ 
 
 If-OUx^uM. 
 
 
 Fig. 14.— Blood Corpuscles from the Human Subject. 
 
 very small blood-vessels (capillaries) into the tissues. They are the 
 scavengers or soldiers of the system, and with their own bodies are 
 able to repair all breaches of the tissues. They are wonderful 
 bodies these little phagocytes. When an injury is received, say a 
 cut, these cells appear in great numbers, surrounding the breach, 
 infiltrating the tissues, proliferating rapidly, adhering together' 
 and undergoing changes into connective tissue, until a scar is 
 the result and the breach healed. If the injury should be severe 
 or prolonged, then in the struggle many of tliem lose their lives 
 bemg destroyed by the poisonous secretions of enemies (bacteria)i 
 
78 HEALTH IX AFRICA 
 
 cand tlie outcome is pus. If tlie blood is tlireatened b}^ the 
 presence of injurious particles, such as vermilion or carbon, or the 
 malarial parasite, then the phagocytes lay hold of these, living or 
 dead, and literally eat them up, digesting them, and converting 
 them into soluble substances, to be secreted by the skin or liver 
 or kidneys. 
 
 Malarial fever. — Xo disease is so universally distributed as 
 malarial fever. (In Africa it is always spoken of distinctively as 
 " fever.") It is found in all continents. Owing to the cultivation 
 of the soil, drainage, &c., it is seldom seen in Europe, or only seen 
 in its milder forms. It was only in 1880 that the true nature of 
 this disease was demonstrated. Almost all fevers are due to living 
 organisms attacking the system and going through a life history. 
 Xo infectious disease arises of itself any more than a crop of wheat 
 springs up spontaneously in the farmer's field. All come from seed, 
 and all have been sown in a soil that has suited their peculiarities. 
 The parasite of malarial fever is believed to be a low form of 
 fungus which attacks the red blood corpuscles, consuming them, and 
 so destroying that on which our very life depends. The parasite 
 lives in the interior of the red corpuscle, and absorbing the hsemo- 
 globiu, converts it into a black substance named melanin. 
 
 It has for ages been kno-\\Ti that ordinary malarial fever renewed 
 itself in twenty-four, or thirty-six, or forty-eight hours, and so on. 
 It is now knoAvn that the attack of fever coincides with the bursting 
 and setting free of a crop of these microscopic parasites ; and the time 
 the parasite takes to go through its life cycle determines the type 
 of fever. It is clear that if this should go on uninterruptedly, these 
 enemies would destroy every red corpuscle in the body, and the 
 result would be anaemia, weakness, and death. 'We have, however, 
 a means of defence. Whenevej' fever is set up in the system the 
 w^hite l^lood corpuscles or phagocytes seem to be quickened into 
 activity. Tliey become excitedly active. Assisted by a number 
 of giant white corpuscles (macrocytes), they, like a body of im- 
 passioned soldiers, rush upon the j^arasitic intruders. Both com- 
 batants are ama?boid in their action, but the phagocytes are the 
 larger of the two. By their stickiness they attach the intruders to 
 tlieir l^odies, absorb and digest tliem, so that all that remains of the 
 parasites is the black colouring-matter. This dark matter is named 
 melanin, and is the haemoglobin of the destroyed red blood cor- 
 puscles. It is unexpelled faecal matter. The phagocytes carry 
 this melanin to the liver, kidneys, bowels, and in some cases 
 malarial sores. 
 
 Tiiis process, phagocytosis as it is called, has one of its most 
 
SPECIFIC FEVERS 79 
 
 important seats in the capillaries of the liver : the relatively large 
 size of the blood-vessels there and the slow current, afford a specially- 
 good opportunity for this action taking place. Moreover, some 
 assert that the inner membrane of the capillary blood-vessels (endo- 
 
 « -twx 
 
 w^•*^^^^ 
 
 ^/-^ .>^„^„ 
 
 P^''^^ 
 
 Capillary Blood- Vessel containing Eed Blood Corpuscles 
 AND Malarial Parasites. 
 
 (k^ll^'^t-'-X. 
 
 Crescentic Form of Parasites. 
 
 
 White Blood Corpuscles containing Black Colouring Matter. 
 
 Fig. 15. 
 
 thelium) has also the power of engulfing parasitic intruders and 
 their toxic poison. 
 
 A typical attack of fever. — After a person, coming direct from 
 Euroi3e, has been exposed, in a malarial country, for from seven to 
 twenty-one days, his system having imbibed the poison, a marked 
 series of phenomena are brought into play. For a short period 
 
80 HEALTH IN AFRICA 
 
 previous to the actual attack he is elated, peculiarly Ijright, and 
 cheerful. Then he becomes dogmatic in his manner, boisterous, and 
 perhaps irritable. At a variable hour he is conscious of a feeling 
 of cold creeping over his frame, which may begin in the fingers, 
 toes, or legs. He creeps near the fire or walks in the sun, feels 
 gruesome and shivers. The teeth chatter, and like one stricken 
 he lies down and covers himself. There is sickness, the head 
 aches, and the small of the back is like to break. Feeling very 
 thirsty, he drinks. He craves for blankets and hot bottles. In 
 an hour or two the sufferer is conscious of flashes of heat darting 
 through him. Gradually he ceases to shiver, and the face be- 
 comes red and flushed. The pulse bounds. He may begin to 
 mutter and sing. In young people at this stage there may be con- 
 vulsions. The nose may bleed. The veins on the forehead become 
 prominent. If the temperature is taken, it will be found to be 
 103' or even 105° F. 
 
 This stage may last for four or six hours, when gradually 
 another change sets in. Beads of perspiration apj)ear on the fore- 
 head and temples, and in an hour the body may be bathed in 
 moisture. Gradually the temperature falls, the pulse becomes soft, 
 the head is relieved, and altogether he is calmer and better. Sleep 
 may supervene, and in an hour he wakes — the fever gone. 
 
 The three stages — cold, hot, sweating — ^here referred to vary 
 greatly in different cases : one or other may be absent or, greatly 
 exaggerated. 
 
 In twenty-four, or forty-eight, or seventy-two hours, almost 
 to a minute, there are signs of the return of the above great dis- 
 turbances of the normal state. Again there is the cold, the hot, 
 and the perspiring phenomena. This is typical intermittent 
 fever. These forms of ague, returning with remarkable regu- 
 larity, are found in the south of Euroj^e, and in the less malarial 
 countries ; where the severer forms of malarial poisoning are 
 found, as in the centre of Africa, the fever may not relax its 
 liold of the system for many days. It has also been observed 
 that in those who are strong, and who have come into a malarial 
 country for the first time, the above stages are well marked. The 
 cold stage is severe, the headache intense, the tendency to delirium 
 apparent, and there is bilious vomiting. On the other hand, in 
 those who have been long exposed to the malarial poison, the cold 
 stage is not so marked, nor is perspiration so profuse. There is 
 giddiness, stupor, weakness, and the fever does not tend to abate 
 for many days. 
 
 In the present state of our knowledge, it is impossible to give 
 
SPECIFIC FEVERS 81 
 
 a comj^lete list of tlie various forms of malarial fever, tliey are 
 so numerous, and apparently so different. 
 The following classification may assist : — 
 
 (1) Forms of Malarial Fever without marked Fever, 
 
 OR Apyrexial Forms. 
 
 (2) Forms that relax the Fever at intervals, or 
 
 Intermittent Forms. 
 
 (3) Forms that relax for a little, but do not abate 
 
 altogether, or Remittent Forms. 
 
 I. Apyrexial Forms of Malarial Fever. 
 
 Fever, in the sense of having an increased bodily temperature, 
 accelerated pulse, thirst, and headache is not an absolutely essential 
 accompaniment of malarial poisoning. The poison may be in the 
 system, and do its deteriorating work, without bringing about 
 actual fever. The following are forms of this : — 
 
 Malarial diarrhoea. — Here, instead of an ordinary attack of 
 fever, there is severe diarrhoea. It is a flow, and is attended with 
 little or no pain. It j)roduces a sense of relief rather than of suffering. 
 Before it sets in the patient feels as if he were about to have an 
 ordinary attack of fever. There is tenderness in the spleen and liver, 
 indicating that these organs are congested. The ejecta are bilious. 
 In a couple of days the sufferer feels weak, as if he had suffered 
 from fever. It may be that the temperature has been a little above 
 the normal. Here the usual dose of quinine acts as it would in 
 fever. The poison has been thrown off by the congested bowel. 
 ~ Malarial dysentery. — General experience shows that where 
 malaria is intense there is an absence of dysentery. This disease 
 is looked upon in its ordinary form as being due to a specific virus. 
 In the affection before us we have not regular dysentery, but a dysen- 
 teric form of malarial fever. The fever jjoison has attacked the 
 mucous membrane of the lower bowel, and brought on an affec- 
 tion which similates true dysentery. The stools are dark and fluid, 
 with some mucus. Here ipecacuanha has little influence, but 
 quinine and perchloride of iron have a very marked effect. 
 
 Malarial ulcers. — These appear in some persons as crops of 
 unhealthy looking monstrous pajotdes which come to their maturity in 
 four or five days, form pus of a thin watery nature, dry up, and pass oflP. 
 Some of the papules have a hard base, and when they disappear leave 
 a dark stain behind. They are seen chiefly on the lower limbs and 
 hips. Another class appears as angry-looking, punched-out, irritable 
 ulcers, half an inch in diameter. They are seen usually in the neigh- 
 
 F 
 
82 HEALTH IN AFRICA 
 
 bourhood of tlie ankles, and are constantly giving off unliealtliy 
 matter. They appear first as a crop of papules, but gradually one of 
 tbem takes upon itself a vigorous growth, while the others pass away. 
 It may be that this form of ulcer has started in a mosquito bite or 
 other light abrasion. The sore may exist for many months. A third 
 class appears as sores as hig as the palm of the hand, and always on the 
 loiver limbs. All who suffer from these fever-ulcers assert that, when 
 the sores are open, no fever is present, and when there is typical fever 
 in the system no ulcers are to be seen. Should the ulcers close, the 
 sufferer in a few weeks becomes feverish. The ulcers on closing leave 
 the skin deeply stained a dark brown colour. This dark colouring- 
 matter is related to the melanin of the white blood corpuscles. 
 
 The following may be classified here. A young man, A. B., had 
 only been in Africa for a few weeks/ when he accidentally injured 
 his knee. The joint became extremely swollen and painful. He 
 had no fever, but paroxysms of pain in this one joint. He tried 
 all kinds of treatment with little apparent effect. After five weeks 
 he tried quinine locally, and internally, with very marked effect. 
 The joint perspired, and to his astonishment the pain and swelling 
 abated. In after years when he had an attack of fever he felt the 
 old pain and uneasiness in his knee. 
 
 Malarial paleness. — I have seen several cases of this. After 
 a number of regular attacks of fever the sufferer develops very 
 great anaemia of the body. Pains are felt in the back and limbs, 
 the spleen is enlarged, and there is much neuralgia. The blood 
 on being examined is watery, while the face and feet are dropsical. 
 The nose, gums, lungs, stomach, and bowels may bleed. There is 
 no regular attack of fever, but the system is intoxicated by the 
 malarial poison. 
 
 Malarial headache, neuralgia, and other nervous dis- 
 orders. — These come on instead of an attack of fever. They are 
 periodic in their occurrence. The headaches, sciatica, and neuralgia 
 are very characteristic, and lead us to think that the nervous system 
 is not well nourished. They respond to quinine and antipyrin drugs. 
 
 Metastatic forms of fever. — Sometimes in the course of ordi- 
 nary fever the disease seems to change its seat. Thus, suddenly, 
 without any warning, the testicle becomes violently inflamed, or 
 if the sufferer is a female, the ovaries or the mammary glands are 
 inflamed and painful. When this takes place the regular attack 
 seems to be cut short. I have known of several cases of this kind. 
 When in a feverish state the patient has been injudicious in ex- 
 posing himself, with the result that there has been a marked change 
 of the seat of the disease. 
 
SPECIFIC FEVERS 
 
 83 
 
 II. FoRxMS WHICH RELAX THE FeVER AT INTERVALS, OR 
 
 Intermittent Forms. 
 
 There are three classical forms of intermittent fever which have 
 been long known. They are the quotidian, the tertian, and the 
 quartan. Here we have outbursts of fever at definite intervals 
 (See Fig. 16.) 
 
 'iihta^ fuwouiod lis.jilffL^^ I 
 
 
 
 Fig. 16.— Typical Temperature Charts of the Three Regular 
 Forms of Malarial Fever. (Taken from cases in the country. ) 
 
 If the above chart is studied these forms of fever will be clearly 
 understood. The chart shows that the temijerature has been taken 
 carefully every three hours. In the quotidian the outburst of 
 fever takes place every twenty-four hours. In the tertimi the out- 
 
84 HEALTH IN AFRICA 
 
 burst takes place every second day. In tlie qvartan the outburst 
 takes place every third day. These three types seem to be well 
 marked in temperate regions or where the malaria is less virulent, 
 but they are not so well defined in Africa. All varieties of irregular 
 types appear there. 
 
 To each of these varieties of fever a special form of parasite 
 belongs, which keen observers can define. It is also well known 
 that there may be two sets of parasites running their courses in 
 the weakened system at the same time. This has been made out 
 especially in the case of tertian fever, and it has been shown that 
 they reached their sporulation periods on diff"erent days. We have 
 thus not a quotidian fever, but what is known as a double-tertian. 
 Practitioners in the tropics lay it down as a maxim, that, when the 
 temperature runs up, on consecutive periods, at an hour later than 
 the last paroxysm, the fever is on the decrease, and conversely, when 
 the fever rises at an hour earlier than the last ajDpearance, the fever 
 is on the increase. This serves to confirm the idea of a parasite of 
 increasing and declining virulence. 
 
 The following forms of fever are intermittent, but, during the 
 course of the fever, a something steps in and gives the case a serious 
 turn. The sufferer becomes delirious, or is convulsed, or becomes 
 unconscious. The following types have been seen : — 
 
 Intermittent with, delirium. — Some sufferers are delirious 
 during every attack of fever. The patient sings, and talks, and 
 mutters, tossing the head from side to side. This matters very 
 little, however : even boisterous delirium, occurring at the height of 
 fever, is not very serious. Should, however, the delirium not pass 
 off with the onset of perspiration and fall of temperature, it is apt 
 to develop into complete insensibility or coma. 
 
 Intermittent with convulsions. — Here there are violent and 
 involuntary contractions of the muscles of the body, with alternate 
 relaxations. Usually the sufferer feels excessively sleepy. These 
 attacks pass away readily, but come again when the fever is high. 
 They are most common in young people. 
 
 Intermittent with complete insensibility. — It is when the 
 fever is at its height that insensibility sets in. When the perspira- 
 tion has continued for some time, and the temperature begun to fall, 
 these symptoms may pass off. On the other hand they may con- 
 tinue for days. The patient is so drowsy that he cannot be roused : 
 he snores, his eyes are open, and the pupils dilated. 
 
 Intermittent with excessive shivering. — Here the cold stage 
 is exaggerated ; or suddenly, when the perspiration is expected to 
 break out on the forehead, the pulse becomes so very rapid that 
 
SPECIFIC FEVERS 85 
 
 it can with difficulty be felt. The legs become cold, the lips 
 white, the eyes glassy and sunken, the bridge of the nose hollow 
 and pinched, and the patient shivers most violently. The cold is 
 only apparent, for the thermometer in the axilla registers 103° F., 
 or even higher. This may last for hours or days, although 
 clothes are multiplied and hot bottles ajDplied to every part of 
 the body. 
 
 Intermittent with biliousness. — This form is very common in 
 Africa. There is usually a prolonged cold stage ; then very ex- 
 cessive vomiting of bilious matter. The sufferer has an agonising 
 pain in the pit of the stomach, and it may be suffers from hic- 
 cough ; there may also be spasms of the leg muscles — cramps 
 indeed. There is usually great looseness of the bowels, little secre- 
 tion of urine, and a kind of collapse. Altogether the symptoms 
 are like those of cholera. 
 
 Intermittent with fainting. — Every attack of fever is accom- 
 panied by a tendency to faint. Faintness is also a sequelse of fever. 
 It may accompany all the forms of fever, but is most common where 
 the cold stage is exaggerated. If the patient suddenly turns in bed, 
 or jum23s uj) to stool, all around may become dark, or he may fall 
 like a log. 
 
 III. Forms which relax in Violence for a Little, but 
 
 DO NOT RELAX ALTOGETHER, OR REMITTENT FoRMS. 
 
 Here the fever suffers a decided remission of its violence during 
 the twenty-four hours, but does not entirely abate. The patient 
 feels better, but on taking the temperature it is found to be above 
 the normal. 
 
 Fig. 17 is a chart of tyjoical remittent fever. 
 
 Mild remittent. — In this form we usually get a warning of its 
 approach. For a day or two before the onset of the actual attack 
 there is a feeling of weariness. The cold stage is not marked, being 
 short and in some cases hardly perceptible. The patient fights against 
 the fever, but is at last forced to go to bed. The temperature ranges 
 from 102° to 105° F. There is retching and vomiting. In a few 
 hours free perspiration sets in, and the temperature may go down 
 to 101° F., but does not reach the normal. It is, when examined 
 carefully, seen to be an abortive persjDiration. This variation from 
 cold to heat may go on for a week or more, the patient being unable, 
 as it were, to shake off the fever. Careful observation will reveal 
 the fact that the rise of the temperature, and the feeling of cold, 
 appear at a definite hour each day, or the fever may slip over a day 
 
86 
 
 HEALTH IN AFRICA 
 
 and return in two days. There are many sweating periods, but no 
 typical perspiration. Everything seems abortive. Jaundice seldom 
 appears in tlie ordinary mild remittent, but it may be present in a 
 slight degree. At last, after a week or more, there is a sudden rise 
 
 
 jO^^ 
 
 
 mi 
 
 "4- 
 
 1m 
 
 l''ni''ir|"j'PR'' 
 
 jm 
 
 M 
 
 33235 
 
 lyiMytu 
 
 't 
 
 n 
 
 u 
 
 ~n 
 
 
 m 
 
 
 ....Ld^». 
 
 ^1 
 
 Fig. 17. — Typical Eemittent Fever. (Gastric form.) 
 
 of the temperature, a copious perspiration breaks out all over 
 the body, and on taking the temperature it is found at last to be 
 normal. 
 
 Gastric remittent. — This is the form which attacks most new- 
 comers to Africa. It begins, in the usual way, after a variable period 
 of exposure, with headache, shivering, burning skin, &c. The face 
 is red, and the bowels are constipated. The vomited matter is a 
 
SPECIFIC FEVERS 87 
 
 watery fluid wliicli may contain bile ; the urine, liowever, is not 
 bilious. The sufferer may be slightly delirious ; he may rave about 
 guns and shooting, and often be most desirous to see his guns. 
 Having recently come to the country and been occupied in shooting, 
 the mind seems to take this bent. 
 
 Bilious remittent. — This form is much the same as the above, 
 only very early in the attack the patient begins to vomit dark 
 green bilious matter. The bowels are loose and the stools bilious. 
 Jaundice may be observed in the white of the eye. There may be 
 bile and albumen in the urine. Bile seems to be generated in excess 
 owing to the wholesale destruction of the red blood corpuscles, and 
 nature by every channel is doing her best to cast out the injurious 
 thing. Vomiting may take place every half hour till the patient is 
 completely exhausted. The temperature is usually 103° F. or more, 
 and may run up to this point, or to a higher, every second day. In 
 other cases the symptoms may disappear after four or five days' 
 illness. Suddenly, however, there is a relapse, and the worst 
 symptoms return with renewed vigour. There may be bleeding 
 from the nose, and the legs may swell. Mentally too the sufferer 
 is stupid and dull, and he may even sink into a comatose state. 
 His one cry is "water," and his one complaint "want of sleep." 
 The remarkable feature in this form of fever is the extraordinary 
 secretion of bile, and the marked efforts of the system to throw the 
 bile off. Bile is excreted by the urine, the bowels, the stomach, and 
 even by the skin. There is an abnormally abundant supply of 
 bile, the tissues even, it would seem, taking on this function, as 
 the whole body becomes suddenly yellow. Some hold that the 
 malarial poison (whatever it exactly is) gives rise to a toxic sub- 
 stance which destroys the corpuscles. It is well to know that the 
 skin, when it is yellow from biliary obstruction, is itchy, but when 
 yellow from causes other than biliary obstruction, as in this form 
 of fever, is not at all affected. 
 
 Cerebral remittent. — -The one characteristic of this form is the 
 affection of the brain, manifested by delirium and convulsions, or it 
 may be by a comatose state with deep snoring. It usually has the 
 symptoms of the above bilious form, but on the third or fourth day 
 insensibility sets in, or half the face may be paralysed. There may 
 be distressing hiccough. Every motion may be passed in bed. 
 Complete collapse may take place through failure of the heart. It 
 is always serious if the delirium continues while the temperature 
 is falling. 
 
 Algic remittent. — Here, in addition to the above symptoms, 
 while the body temperature is still very high the legs and arms 
 
88 HEALTH IN AFRICA 
 
 become cold, and a clammy sweat breaks out over tlie whole body. 
 The urine may suddenly stop. The patient may be unable to speak 
 altbougb conscious. 
 
 Typhoid remittent. — Here, in addition to continued high fever, 
 bilious vomiting, &c., in about a week or less the pulse becomes weak 
 and thready. The sufferer is torpid and cannot be roused, and mutters 
 as he tosses his head from side to side. The tongue becomes dry 
 and black, owing to the absence of saliva. The teeth and gums are 
 covered with a foul whitish stuff. The skin is yellow, and dry and 
 parched. The bowels are bound. The temjoerature varies greatly 
 from near the normal to 106° F. {See Fig. 18.) 
 
 Black-water fever, or bilious haemoglobinuria. — This begins 
 as a regular remittent fever. There is severe vomiting of bilious 
 matter, which may take place every half hour, night and day. 
 There are bilious stools, marked jaundice, and delirium. Some- 
 times there is a free discharge of black urine, or it may be of 
 actual blood. Towards the close of a fatal case there may be suppres- 
 sion of urine, resulting in coma and convulsions. Everything in this 
 affection points to the wholesale destruction of the red blood cor- 
 puscles, and to a desperate effort of nature to throw the resulting 
 irritant off. The patient vomits, purges, sweats, and in some cases 
 bleeds. There may be bleeding from the mouth and nose, and even 
 from certain ]3urple spots on the skin. As in yellow fever there may 
 be a bleeding from the mucous membrane of the stomach and bowels, 
 which, acted on by the digestive fluids, may lead to a black vomit. 
 This, however, is not general. A frequently marked feature is, that 
 the attacks are paroxysmal. They come on with a shivering fit, severe 
 pains in the back, retention of the testis, vomiting, and lowered 
 temperature. Two hours after, when the urine is passed, it is dark 
 red, contains albumen, and deposits a sediment. I have heard of a 
 case where the paroxysm came on every time the hands were placed 
 in cold water. The dark urine may continue to be passed for three 
 or four days ; in other cases after a few hours there is a return to 
 the normal state. I have had a case in whom these seizures re- 
 turned every morning about eight o'clock for ten days in succession. 
 Gradually they diminished in severity and passed off. Between the 
 attacks the urine seemed perfectly normal. The j^atient recovered. 
 
 There is another form where ive get actual blood in the urine. Here 
 the urine is like porter, the blood being intimately intermixed with 
 the urinary secretion. We infer in such a case that the kidneys are 
 highly congested, and that there has been actual bleeding in the 
 urinary tract. I have known of one case in which the urine was 
 passed in long streaks of coagulated blood. 
 
SPECIFIC FEVERS * 
 
 89 
 
 -^p^ 
 
 v2^ W 
 
90 HEALTH IN AFRICA 
 
 Then we may get actual su'p'pression of urine. We know that this 
 occurs in the course of other fevers in Europe, as for instance scarlet 
 fever. It is also the case in some forms of cholera, and in severe 
 shock to the system. In all febrile affections the secretion of urine 
 is scanty. Actual suppression leads on to uraemic poisoning, which 
 manifests itself in headache, nausea, vomiting, motes dancing before 
 the eyes, an ammoniacal breath, and convulsions. The patient may 
 fall down insensible, while the muscles of the face twitch. He may 
 foam at the mouth and bite the tongue. No urine being passed, 
 the products of waste and change are retained in the blood. 
 
 These forms of black-water fever, have been proved to be associ- 
 ated, in many cases, with the malarial parasite, but not in every case, 
 so that the consensus of opinion is that it is due to malaria, jjIus 
 something else. It is now known that hsemoglobinuria may arise 
 apart from malaria. It is found in the blood of yellow-fever 
 patients, where it is also due to the destruction of the red blood 
 corpuscles. Glycerine given in large doses dissolves the hcemo- 
 globin, and allows it to float in the blood. From the remarkable 
 tendency heemoglobinuria manifests to come on in paroxysms, and 
 from the suddenness with which it ceases, we infer that the expla- 
 nation is to be found in the study of the neurotic supply of the 
 kidney. Women and weakly persons are seldom affected. It seems 
 to be confined to young healthy individuals, in whom there is great 
 muscular waste. 
 
 Sequels op Fever. 
 
 The following are some of the after consequences of malarial 
 fever : — 
 
 Ansemia. — Extreme pallor of the lips and face' is an invariable 
 accompaniment of fever. Instead of there being 5,000,000 of red 
 blood corpuscles to the drop of blood, there may be 1,000,000, and 
 this, over the body, means an immense loss. Often too the corpuscles 
 that remain are larger or smaller than normal. After bilious 
 remittent fever the patient is very pale. 
 
 Dropsy of the feet and body. — This is always the case when 
 there has been great destruction of the corpuscles. The constitution 
 of the blood is altered, in that it is more watery, and the capillaries, 
 not being nourished, allow the watery constituents to transude into 
 the tissues. 
 
 Brick-red deposit in the urine. — It is a common observation 
 that the urine of some, who have suffered from fever, leaves a brick- 
 red sediment on the bottom or side of the urinary vessel. Here 
 
SPECIFIC FEVERS 91 
 
 tlie red blood corpuscles are not only fewer in number, but the 
 colouring-matter separates from the stroma as a red deposit. Could 
 we peep into the liver, spleen, and kidneys, we would see this red 
 substance in their tissues. 
 
 Chronic affection of the liver and spleen. — After several 
 attacks of fever, these organs, in certain constitutions, become 
 dull and heavy. The spleen may be enormously enlarged. This, 
 however, is no sign of danger. Some think it is a good sign. 
 Native children, in malarial countries, suffer from great enlarge- 
 ment of the spleen. 
 
 Forms of paralysis. — Complete and partial paralysis, together 
 with loss of the sense of pain, have been recorded. Strange to say, 
 too, these abnormalities are often located to certain districts or 
 islands. On the island of Likoma, Lake Nyasa, British Central 
 Africa, there have occurred, within the last few years, several cases. 
 They appeared in those who had been for a short time in the 
 country (all less than a year), and after several attacks of regular 
 intermittent fever. They affected the lower limbs only, one having 
 complete paralysis of the legs together with anaesthesia. A second 
 had a little feeling in the limbs, but complete paralysis. A third 
 was able to walk a little, dragging one leg after another, but there 
 was total loss of all sensations in both legs below the knee. 
 
 Cases of paralysis of one side of the face have been noticed. 
 In the morning the sufferer could not close the right eye and could 
 not whistle. The tissues were described as being "stiff." This 
 inconvenience went off in a couple of weeks. Temporary want of 
 speech is known. 
 
 Affections of vision. — It is a common observation in those 
 who have had much fever, that, when they have been in the re- 
 cumbent position and have suddenly assumed the erect posture, that, 
 for a few seconds, they partially lost the power of vision — every- 
 thing seemed dark, or motes danced before the eyes. This is due 
 to the anaemia and debility affecting the retina. Several cases of 
 complete blindness, which lasted for weeks, have occurred on Lake 
 Tanganyika, and one case to my knowledge on Lake Nyasa. Some 
 suffer from flashes of light in the eyes, or it may be circles dance 
 about the eyes, or yellow circles are seen at the side. 
 
 Perversions of smell and taste. — These senses are often 
 affected. Soup taken at dinner tastes like gooseberries, or another 
 is constantly troubled with bad odours. 
 
 Blood affections. — Very often during the course of a severe 
 fever the blood seems to be changed in such a way that it does not 
 coagulate in a normal fashion. Here we say that the fibrin of the 
 
92 HEALTH IN AFRICA 
 
 blood is lessened. I have known of a patient wlio, after a severe 
 attack of fever, plucked off unwittingly, while falling asleep, a small 
 pimple on the face. Bleeding ensued of a serious nature. Some 
 hours after, he awoke to find the pillow covered with blood, and 
 the bleeding as active as ever. Pressure was applied for hoiu\s 
 before the blood coagulated and the bleeding came to an end. 
 
 Deposits of colouring matter. — The blood j)igment from the 
 destroyed red blood corpuscles is regularly deposited in the different 
 tissues of the system. The spleen and liver are darker in colour 
 than normal, and the skin of those who have suffered from malarial 
 fever has a clayey dirty palor. The scars from malarial ulcers are 
 always markedly dark in colour. 
 
 Perversion of the heat-regulating mechanism. — We are told 
 that the mechanism which regulates the heat of the body is referred 
 to three centres in the brain. There is — 
 
 (1) A heat-jrroducing centre. — This centre in the brain may be 
 affected by bleeding into its substance, or by jDoisonous drugs acting 
 on it. or the toxine of fever may irritate it, and the result is a rise 
 ■of temperature. The source of heat in the body is the consumption 
 of muscular tissue. 
 
 (2) A heat-losing centre. — This regulates the breathing organs, the 
 blood-vessels of the skin (which embraces an enormous area), and 
 the sweat glands. 
 
 (3) A heat-regulating centre. — This keeps the balance between 
 the tAvo former. In every healthy person this centre regulates 
 the whole mechanism, and only allows a range of about 1° F. in 
 the day. The body of a healthy person may be exposed to a 
 temperature much IjeloAv zero, or to a heat much above tlie normal 
 bodily state, and yet the actual temperature of the body remains 
 the same. If, however, this heat-regulating mechanism is dis- 
 organised, it is most difficult for its influence to be renewed. In 
 malarial fever we are forced to think that this has taken place, 
 and the higher controlling influences are impaired. 
 
 Every one who has been in malarial Africa knows liow very 
 easily fever is brought about. A slight exposure to the sun, some 
 indiscretion in eating — and the result is fever. For years after the 
 individual has removed from all malarial influences and resided 
 in Europe the result is the same. There a catarrhal cold ends in 
 fever. A long cold railway journey brings on all the phenomena 
 of fever. Once an old African got his leg broken, and the shock 
 brought on apparently regular malarial fever. In Africa it is the 
 common experience that the excitement of receiving a mail from 
 home brings on fever. When those resident in the country are 
 
SPECIFIC FEVERS 93 
 
 writing despatches tliey frequently do so with a temperature ranging 
 from 102° to 105° F., nay, frequently on such occasions the brain 
 is peculiarly active. We explain these phenomena by saying that 
 the heat-regulating centre has been upset by the malarial poison, 
 and every deviation from the normal state takes the form of a high 
 temperature. Nor is this adjustment of the heat-regulating centre 
 easily restored. For years after — say from four to seven — the system, 
 although we may say it is free from malarial fever, has the tendency, 
 whenever it is upset, to revert to the old course— shivering and 
 perspiration. Such is not malarial fever, but the malarial habit. 
 
 It is impossible to enumerate all the sequelcB of fever. Some 
 suffer from intermittent attacks of neuralgia of the face and eyes. 
 Some suffer from toothache ; others from numbness of the limbS; 
 like a false paralysis. Some have no feeling in toes or fingers ; 
 others are martyi's to sciatica, for the malarial influence is mostly 
 spent on the nervous system. Some suffer from palpitation, from 
 asthma, from indigestion, from bronchitis, &c. These all affect 
 those who are anaemic, and whose health has been reduced by 
 fever. 
 
 The mind naturally asks for an explanation of these various 
 and extraordinary phenomena, and we can only answer in part. 
 The Plasmodium malarice, found in the blood, spleen, liver, &c., 
 are looked upon as the immediate cause. Whether, however, they 
 themselves are the cause, or the toxines which they generate in 
 the blood, it is impossible meantime to determine. Why in some 
 cases the fever should be of the ansemic form, or the ulcerous, 
 or the orthodox oscillation of temperature, can only be partially 
 guessed at. The occurrence of the paroxysm of fever, at definite 
 periods in the twenty-four hours, is probably synchronous with the 
 .escape of the spores. The sudden rise of the temjDerature is due 
 to increased oxidation, and also to a lessened loss of heat, caused 
 by the contraction of the cutaneous arteries. It is a common 
 observation that whilst the body heat is much above the normal 
 at the beginning of the hot stage, the extremities are cold and pale. 
 The abnormally high temperatures that are sometimes met with, 
 may be caused by the irritant in the blood so affecting the heat 
 regulating centres of the brain, that oxidation runs wild. The 
 feeling of a warm glow passing over the body, and the onset of 
 perspiration, is probably due to the relaxation of the arterial spasm. 
 The nervous phenomena, such as headache, are probably due to the 
 blood coursing in the brain with greater force than usual, and also 
 to the presence of the parasite irritating the brain tissues. Then the 
 increase in the colouring-matter of the urine is due to the fact 
 
94 HEALTH IN AFRICA 
 
 tliat tlie watery constituents pass off by the skin, while the solid 
 constituents are retained. 
 
 Within the last few months " Dr. Manson has revived the 
 mosquito theory of the spread of malaria. This theory, which 
 was at one time suggested by Laveran, is no other than that the 
 mosquito sucks the blood of tropical residents, and the corpuscles 
 containing the plasmodium are withdrawn in the process, and gain 
 entrance to the stomach of the mosquito. 
 
 " The Plasmodium, being contained in a corpuscle, is protected 
 from phagocytes while in the human blood ; but whilst protecting 
 it, the parasite, being inter-corpuscular, cannot develop, and it is 
 only by gaining the stomach of the mosquito, and there being 
 exposed to the action of digestive fluids, that it can get rid of its 
 sheath and become free. At the same time that it becomes free the 
 parasite, which while intra-corpuscular was motionless, now develops 
 ' flagellse,' by which it is endowed with motion. The power of move- 
 ment enables it to escape from the digestive juices of the mosquito's 
 stomach and bury itself in the tissues of the mosquito's body. There 
 it will remain possibly in a quiescent state until the death of its 
 host, when it will be deposited in or on the water or the swamp 
 which the animal haunts. From water to the human body is an 
 easy step, and in this way is the cycle kept up." — Medical Annual^ 
 1897, p. 390. 
 
 Treatment of Malarial Fever. 
 
 Every form of life has enemies. In the struggle for existence 
 which has been going on during the ages, every living thing has, 
 developed within itself some antitoxine which gives it the power of 
 defence against enemies. Neither man nor beast, reptile nor fowl, 
 insect nor jjlant, escapes from the ravages of lower pestilential 
 forms of life. What, however, seems to be poison to one has little 
 effect on another. Wlien the rinderpest scourged Africa the ox and 
 the buffalo and certain forms of antelope were stricken down in 
 vast numbers, but sheep and goats were proof against the poison. 
 They had a power within themselves which rendered them immune 
 against that which destroyed the more powerful oxen. Similarly, 
 man sought a weapon of defence against his malarial enemy. That 
 he found in quinine. Quinine is an alkaloid derived from certain 
 plants which have an immunit}'- from malarial poison. These 
 plants belong to a certain genus of the order Cinchonacece, are 
 evergreen, and flourish in those regions where malaria abounds. 
 For long quinine has been known as a medicine of great value in 
 
SPECIFIC FEVERS 96 
 
 the cure of ague, and diseases attended witli febile debility. The 
 oil of eucalyptus trees is of the same nature. Quinine possesses 
 great power over low forms of life. One grain dissolved in one 
 ounce of water (two tablespoonfuls) will kill instantly all infusoria 
 and fungi, while two grains prevents alcoholic fermentation and 
 stops putrefactive decomposition, thus acting like an antiseptic. 
 This is the secret of the action of quinine in all intermittent 
 forms of fever. It is possible that it prevents the growth of the 
 Plasmodium malarice in the blood. It too has some power over the 
 movement of the white blood corpuscles. The sulphate of quinine 
 is the preparation that is most frequently used. It is sparingly 
 soluble in water (1 in 700 parts). In alcohol or dilute sulphuric 
 acid it is very soluble. The hydrochlorate of quinine is much more 
 soluble, dissolving in 1 to 34 of water. Locally applied, a dilute 
 solution, say 4 grains to the 2 tablespoonfuls of water, has a germi- 
 cidal, antiputrefactive, and antifermentative action. It is a marked 
 antipyretic and antiperiodic. It is also a preventative medicine 
 in those who are exposed to the risks of malarial poison. It should 
 be taken with this object in view, in 2-grain doses, every night and 
 morning. The tannate of quinine, being tasteless, is excellent for 
 children, and should be given in milk, in from 1 to 4-grain 
 doses. 
 
 Quinine has a direct action on the parasite of malaria. Laveran, 
 in 1881, said that "it is because it destroys the parasite that quinine 
 causes the disappearance of the manifestations of paludism." He 
 showed that when xo.Voo solution of quinine was allowed to run 
 under the cover-glass, the movements of the parasite were instantly 
 arrested. This sums up the results of almost every observer. On 
 the other hand, most agree that the crescentic bodies which appear 
 in the more dangerous continued fevers, are affected slowly, if at 
 all, by quinine. (See Fig. 15.) 
 
 Golgi, in his paper of 1892, asserts that quinine in tertian and 
 quartan fevers acts most markedly on the young free spores, less 
 markedly on the more advanced forms, where the red blood cor- 
 puscles are almost disintegrated, and least upon the young endo- 
 globular forms. We say, therefore, that if quinine be given freely 
 several hours before a paroxysm occurs, it will not prevent segmenta- 
 tion, but it will destroy the new group of parasites. The segmenta- 
 tion takes place, and the toxic substances are generated, resulting 
 in the chill, but this latter is modified, and, it may be, retarded. 
 Furthermore development of this group of organisms is made 
 impossible. 
 
 The best time, then, to push quinine, and to have the system 
 
96 HEALTH IN AFRICA 
 
 thoroiiglily under the influence of the drug, is two or three hours 
 before the paroxysm of fever is expected, though continued doses, 
 three times a day, may be absolutely necessary to wholly eradicate 
 the parasite and its resultant toxic poison. Quinine best combats 
 the development of the parasite when it is in solution in the blood 
 at the time the spores are being set free, that is, some hours before 
 the onset of the fever. 
 
 There is, however, a percentage of persons who cannot take 
 quinine. In some it seriously irritates the stomach, and may lead 
 to depression ; in others it acts violently on the nervous system, 
 causing dizziness and stupor. It may bring on skin eruptions, 
 swelling of the face, irritation of the bladder and kidneys, and 
 other disagreeable effects. Let such persons take one or two tabloids 
 of -^Q of a grain each of arsenic, or, every three hours, ten drops 
 of Fowler's solution (a preparation of arsenic, also named liquor 
 arsenicalis), gradually increasing the dose. Always take arsenic 
 after a meal, and with a good drink of water. 
 
 Treatment of Apyrexial Forms of Fever. 
 
 Malarial diarrhoea. — Do not stop the diarrhoea unless it is 
 excessive, say over eight stools per day, and lasts for a long time. 
 The diarrhoea is analogous to perspiration. Take 5 grains quinine 
 twice every day. Apply a warm poultice over the whole abdomen, 
 and take complete rest. Let the food be unirritating to the bowel, 
 such as boiled milk, beef-tea, and corn-flour. Should the diarrlioea 
 be excessive, give an enema of thin starch, and 30 drops of laudanum 
 twice a day, together with dilute sulphuric acid (10 drops) twice a 
 day in a glass of water. In such cases it is important at stool not 
 to use paper. Let the anus be washed after every motion v/ith cold 
 water, and mopped with a linen rag. 
 
 Malarial dysentery. — Neither is it wise to stop this. The 
 ailment is a part of the fever, not a complication, and nature is 
 curing herself. Instead of giving ipecacuanha, give small doses of 
 quinine, say 3 grains three times a day, and 30 drops of the per- 
 chloride of iron freely diluted in water at the same rate. Easton's 
 syrup (1 teaspoonful in water thrice daily) acts admirably in 
 such cases. Let the strength be kept up by fluid nourishment. 
 Eight drops of liquor strychninse in water, three times a day, is 
 excellent as a tonic. 
 
 Malarial ulcers. — These are allied to the above forms, and 
 should not be too readily closed. Those who sufler testify that, 
 
 I 
 
\ 
 
SPECIFIC FEVERS 97 
 
 when the ulcers close, feverish symptoms, as languor, disinclination 
 for work, manifest themselves. Let the ulcerous limb be rested, 
 elevated, and dressed with the following : carbolic acid, 1 part ; 
 iodoform, 2 parts ; olive oil, 4 parts. Wash and dress night and 
 morning. Let quinine be taken in its tonic forms, 1 grain three 
 times a day. 
 
 It is important that the large sores be well bound with linen 
 bandages, or, better still, be well supported by an elastic bandage. 
 Let this bandage be kej)t absolutely clean, and let it be applied 
 before rising in the morning, and taken off before retiring at night. 
 When these ulcers heal, they always leave a marked brown stain. 
 This is due to the deposit of blood pigment, and is an exaggerated 
 form of the dusky pallor of the skin peculiar to all who have 
 suffered much from malaria. 
 
 Malarial paleness — Cachexia. — What is needed here is a 
 change to a healthier locality, or, better still, a long sea voyage. 
 Even the natives in Africa are alive to the benefit of a change from 
 one locality to another. Easton's syrup in 1-teaspoonful doses, 
 three times a day, is excellent. Blaud's pills too (4 three times 
 a day), act admirably. The tonic compounds of Burroughs, Well- 
 come & Co. are good. 
 
 Headaches, &c. — Take 10 grains of quinine and 15 grains 
 phenacetin. This, in my experience, acts like magic. 
 
 In the treatment of enlarged spleen^ the result of infection from 
 malaria, the following is excellent : — 
 
 Hydrochlorate of quinine . . 30 grains, 
 Tincture of quassia ... 1 teaspoonful. 
 
 Tincture of chinchona ... 1 „ 
 
 Water 10 tablespoonfuls. 
 
 Let two tablespoonfuls be taken every day before the evening 
 meal. 
 
 When the spleen has been enlarged for a long period, and is hard 
 to the touch, it is well to take, every day, 15 grains of the iodide of 
 potassium. Others again recommend that daily the patient should 
 strip, and have about 40 tumblers (or about one gallon) of cold 
 water poured over the region of the enlarged organ, from the dis- 
 tance of one foot in height. Thereafter the region of the spleen, 
 and the whole abdomen, should be vigorously rubbed by rough 
 warm towels, for at least five minutes, {See Enlargement of the 
 spleen, p. 40.) 
 
98 HEALTH IN AFRICA 
 
 Treatment of the Intermittent Forms of Fever — 
 Ordinary Fever. 
 
 "WTienever fever manifests itself with, coldness and shivering, 
 remove the ordinary wearing apparel as speedily as possible, and go 
 to bed. Put on several pairs of extra blankets ; put hot-water bottles 
 to the feet, abdomen, and back ; and under the clothes briskly rub the 
 legs upwards, from the ankle to the knee. Warm drinks, such as tea, 
 are good, but the inordinate craving for liquids should not be satis- 
 fied. If the patient can keep it down, give 10 grains Dover's powder, 
 and in order to the retention he should lie absolutely still. If 
 liquid is taken sparingly he is not so likely to vomit. If the head- 
 ache is very severe, give 15 grains phenacetin, and it will be relieved. 
 In a variable period perspiration will appear on the forehead, and 
 soon diffuse itself all over the body. In some hours' time the load 
 of blankets, which was so agreeable at the beginning of the attack, 
 will be a burden. Before removing them, however, give the 
 sufferer 5 grains quinine, and having fresh clothing laid out, sj^eedily 
 remove the wet garments, rubbing the body with a rough towel. 
 Thereafter give 5 grains of quinine every three hours, until 20 grains 
 have been taken in the day. Small doses, often administered, are 
 more effectual at this stage than one large dose. 
 
 Should the vomiting he severe it may demand treatment, — In such a 
 case put a mustard poultice over the stomach, and keep it there for 
 half-an-hour. If the sufferer is an adult, and the poultice is not 
 sufficient to allay the vomiting, let 30 drops of laudanum, in some 
 liquid starch, Ije thrown into the rectum, as an enema. If vomiting 
 still persists, give sulj)hate of morphia, | grain, hypodermically (1 
 grain morphine is contained in 10 grains j)Owdered oj)ium). Never 
 give opiates to children. Give ice to suck if it is to be had. If not, 
 prepare lemon drinks {see p. 194). Lemons are found in most parts 
 of Africa. Tlie juice of the lemon, citric acid, and tartaric acid 
 are identical in action, and are most grateful refrigerants. The 
 gases of effervescing drinks soothe the inflamed inner coat of the 
 stomach, and hasten th.e perspiration. When the patient has per- 
 spired freely, it often gives relief to sponge the body witli cool 
 water, or Adnegar and water, bathing the limbs one by one. 
 
 Let it be a rule, that, if the patient is attacked with fever shortly 
 after a meal, and the stomach is loaded with food, the treatment be 
 begun by giving an emetic. Thirty grains of sul23hate of zinc or 
 10 grains of sulphate of copper, in a tumblerful of tepid water are 
 good. Apomorphine, y^^ grain injected hypodermically, acts with, 
 certainty and rapidity, especially when the patient is unable to 
 
SPECIFIC FEVERS 99 
 
 swallow. Mustard in dessert-spoonful doses, in large quantities of 
 tepid water, is very effective. Tickling the back of the throat by 
 the finger or a feather, is a good method. Emptying the stomach 
 freely will relieve the nausea and j)ainful retching. 
 
 I wish to say a good word on behalf of Warburg's tincture. It 
 is not at all a scientific mixture, and savours of the old nostrums, 
 when a dozen drugs were thrown into the compound under the 
 belief that one surely would be effectual. Still, in fever, it has an 
 influence not easily explained. My experience is, that if a person 
 should feel languid, dull, sickish, disinclined for work, as though 
 fever were hanging about the system, and should take a full dose 
 of this tincture and rest in bed, in all probability the fever will 
 be thrown oft'. It acts markedly on the bowels, and seems to cut 
 short an ordinary attack of fever. Messrs. Burroughs, Wellcome and 
 Co. supply this drug, admirably done up in tabloids, six of which 
 are a dose. In using the drug always take the full dose of six 
 tabloids, with a draught of water. 
 
 As a medicine for mitigating fever, the tincture of aconite is 
 superior to Warburg's tincture. Of this drug use 1 drop every ten 
 minutes for an hour, then repeat the dose every hour till the skin 
 acts well and the temperature is reduced. 
 
 The headache can be relieved by cloths wrung out of cold water, 
 laid on the temples. Fifteen grains of antipyrin given by the mouth, 
 or larger doses given by the rectum, act admirably. This drug 
 also reduces the temperature. For my own part I prefer phenacetin 
 to antifebrine or antipyrin : ic has been given daily in quantities 
 of from 15 to 30 grains for months, in all forms of pain with success, 
 and without injurious effect. It influences favourably every form 
 of fever, keeps down the temperature for four or five hours, and 
 brings on a profuse perspiration. Children bear antipyrine well 
 if given in three grain doses every two hours. 
 
 General experience shows that if the bowels have been freely 
 opened, during the course of the fever, quinine acts quickly and 
 powerfully. It is, therefore, good treatment to give a Seidlitz 
 powder when the sufferer calls loudly for something to drink. In 
 all the grave forms of fever, as convulsions, or delirium, give at 
 once 5 grains of calomel and 15 grains powdered jalap. This is 
 specially good when there is bilious vomiting and bilious stools. 
 The calomel acts on the liver, and assists nature to throw off the 
 injurious thing. 
 
 Sleeplessness is often distressing and calls for treatment. (See 
 Article on Sleeplessness.) There is no drug better than sulphonal 
 for the sleeplessness of fever. It is one of the most valuable of the 
 
100 HEALTH IN AFRICA 
 
 recent additions to medicine. It is colourless, odourless, tasteless, 
 and insoluble ; it is a -pure hypnotic, and has no bad effects in 
 ordinary doses. It is, however, slow in its action. Dissolve 40 
 grains in a little hot water one hour before sleep is desired, and let 
 it be taken when little fluid is on the stomach. It acts admirably 
 when sprinkled on bread, or in weak soup, or other warm beverage. 
 It is the best soporific in 7-grain doses for children. 
 
 If delirium and low muttering is present in the course of a fever 
 it need cause little anxiety. Put cold cloths on the head, and 
 sponge the body with vinegar and tepid water, exposing one limb 
 only at a time. 
 
 If severe convulsions^ together with other cerebral symptoms, set 
 in, put the patient in a warm bath at the same temperature as the 
 body, and put cold cloths on the head ; then gradually add cold 
 water to the bath, and thus reduce the temperature. {See Bathing, 
 p. 182.) If you suspect the bowels of being loaded, give while in 
 the bath an enema of warm water and so relieve them. The same 
 treatment applies to a child. Children take convulsive fits much 
 more frequently than grown-up persons. If the stomach of the 
 child is full, give as much Dover's powder as will lie on a threepenny 
 piece. This will relieve the stomach. Then put 2 grains of calomel 
 on the tongue, or while the little one is still in the bath give a 
 warm enema. It is important to relieve the bowels. 
 
 If there is complete insensibility ivith snoring and dilated ijuyils^ 
 and you ascertain it is not due to alcohol, opium, or injury, then 
 you must conclude that there is some pressure on the brain. If the 
 face is red and fiushed, and the arteries of the head throb, give 5 
 grains calomel and 15 grains jalap if he can swallow, if not put 
 2 or 3 drops of croton oil on the back of the tongue. Raise the head, 
 and put powdered ice on it, if it is to be had. Put mustard poul- 
 tices on the legs and arms so as to draw blood from the brain. 
 
 Shivering is sometimes distressing, and may be a serious menace 
 to life. In such a case get blankets and hot bottles, with all pos- 
 sible haste, and put the system under the influence of quinine 
 as speedily as possible. Give 20 grains by the mouth if it can be 
 swallowed ; or give 10 grains by the bowel dissolved in thin gruel 
 or starch. The most speedy means of bringing the system under 
 quinine is by giving it hypodermically. The acid hydrochlorate is 
 the most soluble form of the drug, and dissolves in its ovm weight 
 of water. If this is not to be had, the ordinary sulphate will melt, 
 by adding half its weight of tartaric acid dissolved in water, or 
 indeed a few drops of any acid. If the case is grave, inject into 
 the skin in all about 10 grains of quinine. In giving a hypodei-mic 
 
I 
 
SPECIFIC FEVERS 101 
 
 injection select the skin over tlie outer part of the arm (not the 
 inside), rub the part briskly with a towel, pinch it up firmly, and 
 insert the needle. Little pain will be felt, as by this means you 
 partially aneesthetise the skin, and the tissues below have very 
 little sensory development. Be sure that the needle enters well 
 into the tissues and not into the skin only. 
 
 The following is an admirable means of giving quinine to children. 
 Dissolve 2 grains in thin starch or cod liver oil and inject into 
 the bowel ; or take of the flaky sulphate of quinine (not tabloids) 
 about 3 grains, lay it on the palm of the left hand, pour a few drops 
 of olive or cod liver oil over the drug and rub briskly over the 
 abdomen of the child for half -an -hour. A not inconsiderable 
 amount of quinine will be absorbed by this means. Children bear 
 quinine wonderfully well. The tannate of quinine is a white 
 insoluble powder which is almost tasteless, and given in milk 
 is excellent for children. For a child give 2 grains three times 
 a day. 
 
 Hiccough is often distressing and demands treatment. All sorts 
 of medicines have been tried for it. What I have found most effec- 
 tive is not a drug, but the setting up of other reflexes, say by giving 
 very strong snufl^, which brings about violent sneezing. 
 
 JVhere the temperature is very high, say above 105° F., the follow- 
 ing is most useful : — 
 
 Salicylicate of soda . . .30 grains, 
 Antipyrin. . . . . 30 „ 
 Simple syrup .... 2 tablespoonfuls, 
 Water 6 „ 
 
 Of the above give for an adult a tablespoon ful every hour. For 
 young people about twelve, give a dessert-spoonful, and for children 
 of three, give a teaspoonful every hour. 
 
 Treatment of thk Eemittent Forms op Fever. 
 
 As this form of fever begins in the usual way with shivering, 
 the same treatment must be pursued as in the less serious inter- 
 mittent, namely, blankets, hot-water bottles, drugs, &c. In most 
 cases the remittent seems to be an abortive form of intermittent. 
 We, therefore, as soon as perspiration makes its appearance, push 
 quinine in the usual way. Small doses, say 5 grains, every three 
 hours, are more effectual than one large dose. It is noticed that 
 those who suffer from the mild remittent forms of fever, are apt 
 to have a relapse every seven, or fourteen, or twentj^-one days. 
 
102 HEALTH IN AFRICA 
 
 Special care should be taken on these days, and an extra dose of 
 quinine superadded. - Every form of remittent fever has periods 
 in its course when the fever abates a little and some perspiration 
 ap23ears. When we notice that these remissions are regular, it is 
 good to give, during the remissions, two doses of cjuinine, say of 
 5 grains each. Give the first of these as soon as the fever falls, and 
 the perspiration appears on the brow. If, however, there is no sign 
 of abatement, give c^uinine every seven hours without reference to 
 fluctuations, for practically there are no fluctuations to guide us. 
 Possibly, after a course of this treatment, thei'e will set in a marked 
 fall of the temperature. This may not approach the normal, but 
 it indicates an effort of nature to reach the normal state. In every 
 case it is wise to embrace that fall and assist nature, by giving a 
 large dose of quinine. All experience shows this to be the moment 
 to give the drug. 
 
 If seve7'e bilious symptoms are present they are to be managed as 
 indicated above, where the lines of treatment are laid down. This 
 is precisely a case which should early be brought under the influ- 
 ence of quinine, as the life of the patient is endangered. If we 
 cannot treat by the mouth, we must treat by giving enemata of 
 10 grains of quinine in liquid starch, and hypodermically o^ of a 
 grain of elaterium. 
 
 When in the course of a long-continued fever the arms and legs 
 become cold, with a clammy sweat on the brow, and stoppage of 
 the urine, we must see that free stimulation is applied. In order 
 to restore the circulation, roll the patient in hot blankets, apply 
 mustard to the calves of the legs, nape of the neck, and spine ; or 
 better still, give a hot bath with plenty of mustard in it. Give 
 brandy in beef-tea (either by the mouth or by the bowel), to 
 keep up the action of the heart. Should this treatment not be 
 effectual, give h3^podermically 20 or 30 drops of ether or the same 
 amount of brandy. If convulsions are marked, give 20 or 30 
 grains of the bromide of potassium three or four times a day. {See 
 Fig. 7, p. 45.) 
 
 In the typhoid remittent form, we have symptoms which suggest 
 that the patient is suffering from a hybrid between typhoid fever 
 and malarial fever of a pernicious type. The treatment here resolves 
 itself into the bringing of the system under the influence of quinine, 
 and then most careful nursing. The patient should be kept in a 
 well-ventilated room with a small fire in it. When there is a 
 tendency to coma, apply cold to the head. Nurse night and day, 
 and treat symjjtoms when they arise. 
 
 Black-water fever. — In all the above forms of fever our sheet- 
 
SPECIFIC FEVERS 103 
 
 anclior lias been quinine. Here, however, the best authorities affirm 
 that this drug is not so effectual, and the explanation given is that 
 black- water fever is not purely malarial. The following treatment 
 is on the right lines. Make certain that the bowels have been freely 
 acted upon, then give a full dose of Warburg's tincture (say 6 or 
 8 of the tabloids, as prepared by Burroughs, Wellcome & Co.). If 
 this should be parted with, try again. If not successful, then dis- 
 solve the tabloids and give them in the form of an enema with 
 thin starch. If there is a free flow of urine coloured like porter, 
 the patient should be kept warm and comfortable. If there is the 
 slightest sign of a remission of the fever, give quinine in a full dose 
 by the mouth, or by the bowels (10 grains), and alternately with 
 the quinine give 10 drops, freely diluted with water, of the tincture 
 of the perchloride of iron. The consensus of medical opinion 
 inclines to the belief that quinine is not so active in hsemo- 
 globinuric fever. Some withhold quinine and give 10-drop doses 
 of oil of turpentine every four hours. A blister to the back of the 
 neck is often beneficial. If there is any sign of a suppression of 
 the urine, experience tells us that the kidneys are most relieved 
 by those means which promote perspiration, and by applications to 
 the loins. Baths are to be resorted to. Considering everything, a 
 hot-mustard bath given in the following way is the best : the 
 patient, wrapped in hot blankets, sits for half-an-hour, with his 
 feet and legs fully immersed in water as hot as can be borne, to 
 which a liberal supply of mustard has been added. The blankets 
 are to envelop the patient, so that he is steamed indeed. This 
 relieves the cerebral congestion and headache, and should bring 
 on a free perspiration. The bath may be repeated three or four 
 times in the day. If the head and hands of the patient are bathed 
 with cold water, it will afford great comfort to the already overtaxed 
 sufferer. Hot fomentation cloths could also, every half hour, be 
 applied to the small of the back during the intervals of the hot 
 foot-bath, or a warm pack could be given several times a day. 
 When in spite of all that is done the skin is hot and dry, little 
 urine passed, with a constant pain at the small of the back, 
 indicating congestion of the kidneys, we get the best of results 
 from the hypodermic injection of ^q grain of pilocarpine. This 
 should cause beads of perspiration to break out all over the body. 
 If there is great bilious vomiting, together with suppression of the 
 urine, we must act powerfully on the liver. To this end give 
 oV of a grain of elaterium under the skin. This should produce 
 profuse watery evacuations. Another way is to give 5 grains of 
 the compound powder of elaterium, by putting it on the tongue 
 
104 HEALTH IN AFRICA 
 
 and washing it over witli a little water. Give copious draiights of 
 barley water. To resuscitate the heart and keep up the strength, it 
 is absolutely necessary to give stimulants. When the pulsations of 
 the heart do not exceed 40 or 50 to the minute, there is always a 
 danger of swooning away. This dangerous period may often be 
 tided over by a little cold champagne or brandy, given in teaspoonful 
 doses, at intervals of a quarter of an hour. If possible give the 
 stimulant ice cold. An authority recommends hock in preference 
 to all other stimulants. In order to keep up the strength, give 
 every two hours some egg-flip and milk in a little hock. Later on 
 let arrowroot and chicken soup be resorted to, '\^Tien the patient is 
 recovering, let him take, ten minutes before food, 5 dro23S of liquor 
 strychnine to quicken the digestion and appetite. 
 
 Let it he repeated : — the sheet-anchor in the treatment of fever is 
 quinine. This is specially so in the treatment of the acute affection. 
 Where it is life and death, we must here also cast our anchor, 
 according to our present knowledge. Experiments have abundantly 
 shown that the ylasmodium mcdarice parasite is extremely sensitive 
 to the action of this drug. Indeed, it has been shown, that after a 
 few doses of quinine, this j^arasite seems to disappear from the blood 
 altogether. Some say, too, that quinine stimulates the white blood 
 corpuscles in their soldier-like office of removing the intruders and 
 the melanin from the circulation. It thus has a double action. 
 Children can take comparatively large doses (say Ij grains to a 
 child under one year), but it is wise to watch them with some 
 degree of care. When the system is brought under the influence 
 of quinine there are a series of marked symptoms set up named 
 cinchonism. There is a great buzzing in the ears, with dulness 
 of hearing, a sense of fulness in the head, &c. Wlien these pheno- 
 mena are produced it is not necessary to push the drug further. 
 Quinine is generally looked upon as a prophylactic in that it helps 
 to arm the system against fever. There is no drug which we, 
 with our present knowledge, can say will do this wholly. All 
 new-comers to Africa should take 2 grains of cj^uinine every night 
 and morning, with this object in view. Again, should one be much 
 exposed to the sun or to marshes, 5 grains should certainly be taken 
 before and after the exposure. If, too, one feels weary and dis- 
 inclined for work, with a feeling as if fever were " hanging about " 
 the system, he should take at once a full dose of Warburg's tincture 
 (six of Burroughs, Wellcome & Co.'s tabloids), and in all probability 
 the impending fever will be averted. 
 
 The generation of the specific organism which occasions malarial 
 
SPECIFIC FEVERS 105 
 
 fever is not due to wet and damp, as it has frequently been shown 
 to disa23pear in malarial regions during the height of the rainy 
 season, nor is it altogether due to the decomposition of vegetable 
 life, as we have many middens in countries that are free from 
 malaria. It seems to be dependent on a number of factors, such as 
 damp, porous soil, rank vegetation, a certain degree of temperature, 
 togetlier with want of cultivation. 
 
 Damp, swampy soil, when it has been drained and cultivated, 
 seems to lose its sour properties, and no longer to give off the 
 miasm of malaria ; should it, however, as has been proved over and 
 over again, be allowed to revert back to the primitive state, malaria 
 of a pernicious type again prevails. It has been shown that drainage 
 sometimes increases the malaria, but this is explained by the under- 
 lying vegetation now being brought into contact with heat, it having 
 been previously covered with water. The same explanation is 
 offered when outbreaks of malarial fever result from excavations, 
 digging of wells, trenches, railways, and other disturbances of the 
 soil. 
 
 The poison is, to a great extent, confined to low-lying ground, 
 especially to land running along the foot of mountain ranges, and 
 does not extend to any great altitude. At what elevation it is 
 absent depends on a number of factors. It passes easily along the 
 surface from one region to another, and is often carried up ravines 
 and gullies. It is absorbed by running water, and its dissemination 
 is prevented by trees and vegetable life. It is a mistake to clear all 
 the green grass from the soil, as this is nature sealing up the pores 
 under our feet. 
 
 Acclimatisation, in the sense of being fully habituated to the 
 malarial influences, is not believed in by any authority, but acclima- 
 tisation in the sense of the system acquiring a partial immunity 
 from the disease, by residence in a malarial country, is borne out 
 by facts. The usual experience is, that, when a European enters 
 Africa, he has a great deal of fever, probably of the gastric inter- 
 mittent type. After residence for a year or two, it is found that 
 he takes fever less frequently, and that of a less violent type. 
 Instead of having fever every month, he now has it every year or 
 even less frequently. The system has undergone a kind of acclima- 
 tisation. Again, it is a common experience, that, if a resident in the 
 highlands goes down to the hot plains, he has an attack of fever, 
 and vice versa, if one resident in the lower parts ascends to the colder 
 highlands, he is almost certain to be stricken down with fever. 
 Almost all travellers say, that, while they are on the march they 
 enjoy good health, and a comparative immunity from fever, but 
 
106 HEALTH IN AFRICA 
 
 that, wLen the excitement is over, and the strain removed, they are 
 sure to have a severe attack of fever. The nervous system accounts 
 for a great deal here. In those who have long been resident in 
 malarial countries, there is a kind of acclimatisation going on in 
 the system, not altogether accounted for by the improvement in 
 the cultivation of the soil, house accommodation, mode of life, &c. 
 The system begins to adapt itself to the new environment by 
 bringing about physiological changes. These are found mainly 
 in the circulatory system, the liver, and the spleen. Some of the 
 organs are depressed, some are elevated. To this extent is there 
 a form of acclimatisation. As to the length of time which even 
 this process of being habituated to the new influences takes, it is 
 beyond our power to calculate. Probably it varies greatly in each 
 individual. 
 
 Small-pox. — This is a specific disease due to a poison in the 
 blood. It is infectious and inoculable. We do not know the nature 
 of the virus. The negro races are most highly susceptible to the 
 poison, although with them, as with Europeans, vaccination imparts 
 to the system a certain power of resistance. A second attack is 
 unusual. A typical attack begins with a chill, when the fever may 
 mount up to 104° F. Headache, pains in the back, vomiting are all 
 present as in other cases of fever. As a rule all those symptoms of 
 disturbance remain or increase in severity, till the characteristic 
 eruption is seen on the body. 
 
 This eruption apj)ears first on the face, about the third day of 
 the illness, and in a couple of days more is found all over the body. 
 It is first seen as a small congested pimple with a hard base, and 
 feels like small-shot in the skin. This is the beginning of the 
 " pock." Fluid forms in the true skin and raises up the horny part 
 of the epidermis into a vesicle {see Fig. 1). This takes place about 
 the sixth day. By-and-by this vesicle contains pus which is puru- 
 lent, and is at its height about the ninth day of the disease. Each 
 pustule is surrounded by a red rash. In most cases the fever falls 
 as soon as the eruption is apparent, and remains down. As soon, 
 however, as the pus appears in the "pocks," the fever again rises, 
 and sometimes the skin of tlie whole body becomes swollen, red, 
 and irritable. We must remember that the " pocks " are on the 
 various mucous membranes of the body, such as the mouth, nose, 
 eyes, as well as on the skin. When this swelling and redness 
 appears, the patient complains of sore throat, hoarseness, blindness, 
 deafness, diarrhoea, &c. During this period a foul odour rises from 
 the sufferer — he is " stricken." 
 
 Now begins the drying-up period. The pustules become dark 
 
SPECIFIC FEVERS 107 
 
 scabs and in three weeks are ready to fall off, leaving pits in tlie 
 skin. 
 
 Treatment. — If tlie case is mild, and the pustules few in number, 
 little should be clone beyond isolating the sufferer, giving rest in 
 bed, and careful nursing. At the beginning, if there is delirium 
 and excitement, give bromide of potassium in 30 grain doses or 15 
 grains of Dover's powder. Morphia injected subcutaneously, say two 
 of the ^ grain tabloids, would be in the right direction. If there 
 is low muttering and prostration, small quantities of spirits and 
 good food must be given freely. In order to prevent pitting of the 
 skin, protect the surface of the body from the air and light, by 
 anointing every clay with carbolised or olive oil, after sponging 
 with warm water. Frequent spongings with warm water, and 
 dusting freely with starch or oxide of zinc, allay the great irrita- 
 bility of the skin. When there is great soreness of the throat, give 
 warm bland drinks, and if matter comes from the nose or back of 
 the throat, use a lotion containing boracic acid. Keep the patient 
 clean, attend to the eyes, and if there is irritation of these delicate 
 organs insert a drop of castor oil. When the scabs are black and 
 offensive, a bread or charcoal poultice may be applied to loosen 
 them and allow the pus to escape. It is a matter of nursing. 
 
 Mumps. — This is an acute, specific infectious disease which 
 occurs mostly in epidemics, and is characterised by inflammation of 
 all the glands around the mouth which are engaged in the secretion 
 of saliva. The functions of the various glands are in abeyance, so 
 that no saliva is elaborated. The inflammation of the glands seldom 
 goes on to suppuration. The onset is sudden, marked by shivering, 
 vomiting, and fever up to 103"^ F. or more. In two or three days 
 the glands around the mouth enlarge, become red and painful, so 
 that the mouth can only be opened with difficulty. 
 
 Treatment. — Rest in bed ; if the bowels are confined, give a 
 slight laxative, such as a full dose of castor oil, or a seidlitz powder. 
 Apply hot fomentations to the aft'ected region. If the disease runs 
 on to suppuration, the pus should be removed early. 
 
 Whooping-cough. — This is a specific infectious disease seen 
 mostly in young people, characterised by a cough which comes 
 on in paroxysms of frequent short expiratory efforts, followed by 
 a long inspiration, which produces the characteristic " whoop." 
 Writers on the subject define three stages, (1) catarrhal stage, when 
 the affection is like an ordinary cough, and lasts for ten or twelve 
 days. This leads on to (2) a convulsive stage, when there are great 
 attacks of coughing, characterised by the whoop ; (3) stage of de- 
 cline. It is becoming common amongst young African children. 
 
108 HEALTH IN AFRICA 
 
 Treatment. — There is no special remedy. All sorts of tHngs 
 have been tried with the view of arresting the attack of coughing. 
 Morphia, ^q of a grain, seems to give the best results. It should, 
 however, be carefully watched. Attention to diet is most essential. 
 Give small quantities of food at short intervals. Milk, eggs, and 
 puddings are best for children. 
 
 Leprosy. — This is a specific disease which is endemic to all parts 
 of Africa. Its commencement is marked by inflamed swellings or 
 nodules which arise in the skin or on the course of certain nerves, 
 followed by anesthesia and local death. It affects chiefly grown-up 
 persons, being very rare before the period of puberty. At one time 
 this disease was found all over Europe, and even now is seen in 
 Scandinavia. It prevails at the present day in tropical countries, 
 where there is much marsh, on the banks of great rivers or near 
 the sea. It is specially severe on weaklings who are poorly fed, 
 poorly clothed, and dirty. Fish has been suggested as a predis- 
 posing cause. 
 
 The disease is only, in a very slight degree, contagious, but it is 
 so. It is due to a specific micro-organism. This organism sets up a 
 chronic inflammation, with great increase of the cells of the tissues. 
 The skin and the nerves swell up, and passing through changes, die. 
 It begins very gradually. Patches of red puffy skin appear, with 
 nodules below. In Africa it is usually first seen on the face, as the 
 forehead, nose, and ears, and gives the sufferer an unsightly appear- 
 ance. As these spots pass away others appear. Another form has 
 not only the red patches, but others which come on the hands, feet, 
 or bod}?-, whicli are void of all feeling, paler than the true skin, and 
 shining. The hairs in these white patches become grey and fall 
 out. Little blisters and ulcers form over the joints, and eventually 
 the parts begin to die. A third form appears as swellings in the 
 skin of the face and extremities, producing hideous deformity. The 
 skin over the swellings ulcerates, forming offensive sores, which 
 extend deep into the tissues, causing deatli of the muscles, tendons, 
 and even bones. The eyes and nose may be involved, as well as 
 the mouth and throat. After a horrible existence, death, in from 
 two to sixteen years, ends the scene. 
 
 Treatment — The disease is, according to our present knowledge, 
 incurable. The patient should, if possible, be removed to a healthy 
 locality, and the general health attended to. The pain may be 
 alleviated by hot baths in which anaesthetics are dissolved. By 
 the isolation of leprous persons from healthy individuals, the 
 disease can be stamped out. 
 
 Syphilis. — This disease has all the characteristics of a long 
 
SPECIFIC FEVERS 109 
 
 drawn out fever. It is a specific eruptive disease, wliicli is only 
 contracted by direct inoculation. At the point wliere tlie infec- 
 tious matter has been communicated (usually the genitals), there 
 is a small abrasion or sore, which may seem insignificant. The 
 lymph glands in its neighbourhood are, however, inflamed. Later 
 on in its course, the skin over the body and the mucous mem- 
 branes are affected ; and later still, it may be months or years after, 
 the deeper tissues, as the muscles, bones, and internal viscera, are 
 involved. 
 
 This disease, while it affects all nationalities, ranks, and ages, is 
 chiefly seen in youth, and owing to the larger area of the mucous 
 surfaces of the genitals, is most common in women. Dark races and 
 orientals suffer severely. 
 
 The poison of syphilis enters the blood by some breach in the 
 skin or mucous membrane. It can only do so by actual contact, 
 and is contracted in kissing, suckling, vaccination, circumcision, 
 or coition, and this last is the most common. One attack usually 
 gives protection, but second seizures are known. The disease begins 
 to manifest itself in from thirty to thirty-five days after the actual 
 contact. It is usual for writers to describe the disease as having 
 three stages, but these often overlap one another. 
 
 First, Primary Stage. — From thirty to thirty-five days after 
 exposure to the virus, there ajDpears on the affected spot, usually 
 on the jDrepuce or foreskin, a small dusky-looking pimple, which 
 is not very painful. This pimple sloughs at the to]D, leaving, in 
 six or seven days, a small ulcer surrounded by a hard base. This 
 is the " hard chancre " S23oken of in books. It comes to its height 
 in six weeks or so, and then goes away, leaving a slight scar. 
 During the growth of this pimjDle, the glands in the neighbour- 
 hood have been growing too, accompanied by no great pain, but 
 when the sore goes, they feel like hard kernels under the skin. 
 Something has been going on in these glands, it may be with no 
 great inconvenience, fever, or pain, but something of a serious 
 nature. This hardness may remain for six or eight months. 
 
 Second Stage. — This comes on insidiously at a variable period. 
 At first there is slight fever and " out-of-sortness," accompanied by 
 eruptions on the skin, ulcers on the back of the throat, affections 
 of the eyes, especially of the pupils, &c. Usually there is no itchiness 
 and no desire to scratch. Later on, these ulcers of the throat, &c., 
 increase, and the neighbouring glands become hard. The hair falls 
 out in patches. Pains are felt at night in the bones of the leg 
 and joints. 
 
 Third Stage. — This comes on also at a variable period. It has 
 
110 HEALTH IN AFRICA 
 
 even been known to appear before tbe second stage has disappeared, 
 and it usually continues for years. This stage manifests itself by 
 the presence of tumours, which permanently destroy the parts 
 affected. These tumours may affect the bones, or the muscles, or 
 the viscera. Often the large joints are chronically inflamed. The 
 nervous system, too, may be seriously affected. 
 
 Treatment. — The treatment for syphilis is mercury in one form 
 or other. For the first sore or chancre on the 2Jenis : destroy the little 
 pimple by means of fuming nitric acid or strong sulphuric acid. Let 
 one drop fall on the ulcer. Then wash the parts thoroughly with soap 
 and water and apply the following lotion : calomel 10 grains, lime- 
 water 2 tablespoonfuls. This will produce the famous black wash. 
 Another way would be to dust the sore, after destroying it, with 
 pure iodoform, or iodoform ointment (iodoform 1, oil 8) ; then give 
 blue pill 3 grains, or grey powder (Hydrarg c. creta) 4 grains, or the 
 green iodide of mercury 2 grains, three times every day. The 
 object is to bring the system under the influence of mercury. If 
 there is a tendency to diarrhcea, by which means the mercury will 
 leave the system, give a little opium to stop the diarrhoea. Continue 
 this for two months, unless the gums and mouth become very sore, 
 in which case stop the drug at once. If mercury has been given, 
 there may be no secondary stage. If this second stage has appeared 
 in the form of eruptions, and rashes, and sore throat, then continue 
 the mercury. This drug can be given in many ways, but perhaps 
 the method of rubbing is best. Take a small teaspoonful of the 
 blue ointment and rub it in freely over the inner side of the thighs 
 or over the chest and abdomen. Continue the rubbing for at least 
 half-an-hour. In the morning wash these surfaces with soap and 
 water, to remove the greasiuess. Do this every day. There are 
 many other methods of bringing the system under the influence of 
 mercury, but for Africa* the above is the best. Some give mercury 
 hypodermically ; ^ grain of the bichloride of mercury in 20 drops 
 of water is injected into the buttock. 
 
 In the Third Stage. — Give 5 grains of the iodide of jDotassium 
 with 30 drops of the liquor of the perchloride of mercury three 
 times a day. When a patient is taking mercury, smoking should 
 not be indulged in ; nor should coffee, fruit, or opening medicines 
 be partaken of. Wash with care, twice every day, the teeth, gums, 
 and back of the throat. 
 
 The new drug airol being tasteless, odourless, and insoluble in 
 water, spirits, or glycerine, is very highly spoken of, and by many 
 on these accounts is preferred to iodoform. It is specially useful in 
 the primary syphilitic sore. 
 
CHAPTER VIII 
 BLEEDINa AND ITS METHOD OF CONTROL 
 
 Bleeding, or liaemorrhage, is one of tlie most serious accidents that 
 can befall a human being, and if not controlled will lead to swoon- 
 ing and death. In the body there is but a limited quantity of 
 blood, estimated at about one-tenth of the weight of the frame 
 and as life may be seriously jeopardised in a few minutes, if one of 
 the large blood-vessels be injured, it is imiDerative that all should 
 know what to do in a case of emergency. The heart is the centre 
 of the circulation of the blood, and is a hollow muscular organ, 
 lying behind the centre of the breast-bone towards the left side. 
 {See Fig. 8.) It consists of two chambers, the right and the left. 
 The heart acts as a great suction and force-pump, alternately con- 
 tracting and relaxing. The two parts of the heart beat simul- 
 taneously. The right half forces the blood into the lungs, where 
 it is oxidised, and the left half pumps the same through all 
 the tissues of the body. {See Fig. 19.) The pulse can be felt 
 whenever an artery is compressed against a hard substance, as 
 a bone, and is merely the beat of the heart in the vessel. It is 
 caused by the heart sending forward the blood in jerks, together 
 with the elastic recoil of the vessel. When the blood leaves the 
 left heart it is contained in one large vessel — the aorta. This 
 soon gives off branches, which go to the head, neck, and ujoper 
 arms. The main, vessel then coils abruptly round behind the 
 heart, and descends through the chest and abdomen, sujDj^lying 
 the viscera in its course. Towards the lower part of the abdomen, 
 while it is deeply placed, it divides into two main vessels which 
 supply the lower limbs. As the arteries go further and further 
 from the heart they become smaller in caliber, their various coats 
 becoming less in thickness, until they begin to ramify and lose 
 themselves in what is known as the capillaries. These form a 
 dense network in every part of the body — so dense that it is im- 
 possible to insert the finest needle without lacerating one or more 
 
 111 ' 
 
112 
 
 HEALTH TN AFRICA 
 
 Fig. 19.— Diagrammatical Eepresentation of the Circulation 
 OF THE Blood in the Viscera and Limbs. 
 
 (Venous circulation dark shaded.) 
 
BLEEDING AND ITS METHOD OF CONTROL 113 
 
 and allowing an extravasation of blood. The coats of tlie capillary 
 vessels are so fine tliat nutrient fluids and gases from the blood pass 
 out to the tissues, and waste products pass into the blood. After 
 bathing the tissues, the caj)illaries reunite into larger and larger 
 vessels, and travel upwards from the limbs towards the heart, under 
 the name of veins. As the veins are travelling against gravity 
 many of them are supplied with a wonderful series of valves. The 
 veins, uniting, enter the heart through a large vessel, and pour their 
 contents into the right side. 
 
 The blood in an artery is bright red in colour — this is due to 
 the oxygen of the lungs, whereas the blood in a vein is dark in 
 colour and loaded with impurities. The bleeding of an artery is very 
 characteristic. It comes forth in jets, and may spout a consider- 
 able distance. Bleeding from a vein is of an oozing nature. If a 
 large artery be severed, the first gush of blood may prove fatal. 
 Fortunately the patient usually faints, and this is the best thing 
 that could happen, as in this state the heart relaxes its beating, 
 and the blood pressure is lowered. 
 
 It is most important to have some idea of the course of the main 
 arteries of the body. With this object in view, it will be wise to study 
 the accompanying sketch. (See Fig. 20.) It is not essential to know 
 the arterial names, but it is necessary to know the general course of 
 the largest vessels. Arteries are carefully guarded by nature, and are 
 so placed that they seldom receive a blow. If a person is about to 
 receive a knock on the head he instinctively ducks down, and in so 
 doing protects the main vessels of the neck. All of us instinctively 
 crouch in the presence of danger. When we sleep we roll ourselves 
 up, with the head bent forward, the arms folded, and the lower 
 limbs flexed on the body. By so doing we unwittingly have all the 
 main vessels to the inside, and protected against danger. Look at 
 Fig. 20, and conceive the man in a crouching position, and this will 
 be apparent. If he were rolled up like a ball, the head and shoulders 
 would project, but no main blood-vessels would be exposed. The 
 knees too would project prominently, but here nature has made 
 a wonderful provision. The main vessel (femoral artery), running 
 down the inside of the thigh, dips into the midst of the great muscles 
 of the leg, and comes out at the popliteal space (behind the knee), 
 where the leg is firmly flexed. If a man rolls himself into a ball 
 you can do him comparatively little injury. You can make a con- 
 siderable incision over the shoulder or outer part of the arm, and 
 cause little bleeding, but if you make a cross-cut of an inch, or a stab 
 even of half an inch in depth, into the armpit or inner part of the 
 arm, you might injure fatally. So too with the lower limbs. You 
 
 H 
 
114 
 
 HEALTH IN AFRICA 
 
 
 I 
 
 
 Fig. 20. — Course op Main Arteries in Arms and Legs. 
 
BLEEDING AND ITS METHOD OF CONTROL 115 
 
 might make a cut down tlie hips, and back of the thighs, a foot in 
 length, and do no great harm, whereas if you make a cut an inch or 
 so, on the inner side, you might fatally injure the femoral artery. 
 
 Fig, 21.— Tourniquet applied 
 TO THE Leg. 
 
 Fig. 22.— Tourniquet applied 
 TO the Armpit. 
 
 Treatment— In certain cases, where the injured vessel is no too 
 large, there is a natural arrest of bleeding ; tliat is to say, when the 
 parts are left to nature, there is a cessation of bleeding. If the 
 
116 
 
 HEALTH IN AFRICA 
 
 artery is wholly cut through, it contracts in caliber at the spot 
 M^here it is severed, and also retracts within its sheath. The blood 
 coagulates, layer by layer, until a natural plug is formed and 
 stops the bleeding. If the vessel is large, the clot will be washed 
 away by the pressure of the blood, and the patient will bleed to 
 death. If the vessel is of medium size, the clot may be washed 
 away, but fainting supervenes and reduces the pressure, and allows 
 a clot of large dimensions to form. If the artery is only partially 
 
 divided when it contracts in caliber, and 
 retracts within the sheath, it will be kept 
 open, so that it gapes, and no clot will be 
 formed. 
 
 We cannot depend on the formation of 
 clots, so must adopt some artificial means of 
 restraining the flow of blood, till the cut 
 surfaces adhere together and heal. First, 
 then, we control the bleeding by immediate 
 'pressure ; that is, we grasp the bleeding 
 point and press it freely. If we see a 
 bleeding artery, we grasp the limb above 
 the spot and press with some degree of 
 firmness. Pressure can be kept up by ap- 
 plying a pad of lint, or a coin rolled in 
 cloth, and held firmly by means of ban- 
 dages. Again, pressure can he applied above 
 the artery from whence the blood flows. (See 
 Figs. 21 and 22.) The pressure has to be 
 apj)lied to the inside of the upper arm, 
 where the brachial artery can be grasped by 
 the hand even, and the bleeding controlled. 
 Pressure on the middle of the groin will 
 grasp the femoral artery, and so control 
 bleeding from any part of the leg. The 
 hand can only grasp for a little time, but 
 a handkerchief, always to be had, can be 
 tied tightly, and by means of a stick can be twisted till any desired 
 pressure is attained. (See Fig. 23.) The modern tourniquet is 
 only a long india-rubber cord, with a hook at one end and a chain 
 at the other. (See Fig. 24.) If we stretch this tube and wind 
 it round and round the limb, of course above the bleeding point, 
 and fasten it by placing the hook in one of the chains, we have 
 a most effectual means of controlling bleeding. 
 
 At the best, however, this pressure is only temporary, is very 
 
 Fig. 23, — Handker- 
 chief TIGHTLY TIED 
 TO THE Arm in Case 
 OF Emergency. 
 
BLEEDING AND ITS METHOD OF CONTROL 117 
 
 painful, and if long continued will endanger the life of tlie limb. 
 If a person is healthy, this pressure may be continued for five Or 
 six hours in a case of emergency, but longer pressure would not 
 be free from danger. Permanent 'pressure is applied thus : get a 
 large basin with some clean linen cloths. Let the basin be filled 
 with water 30 parts, and carbolic acid 1 part. Gently remove 
 whatever is tied round the disabled limb, and as you do so, wash 
 the jiarts well with the watery 
 solution. If there is still any 
 bleeding-point on removing the 
 dressings, catch it up by an artery 
 forceps, draw it out from the wound 
 a little, and tie it firmly with cat- 
 gut. Surgeons often seize small 
 bleeding-points by means of such 
 forceps, and twist them round 
 several times, when the bleeding 
 ceases at once. {See Fig. 25.) Cat- 
 gut is the best tying material, as it 
 
 is easily absorbed by the tissues. If silk is used, the two ends must 
 be allowed to hang out of the wound, so that, when the artery is 
 quite healed, it can be removed. When the bleeding is stopped, 
 cleanse the wound thoroughly by washing, and dress it with carbolic 
 oil 1 to 10, or with iodoform ointment. Bandage the limb neatly 
 and firmly from the extremities upwards, and give perfect rest. 
 If the wound is on the scalp, it is only necessary to allow the 
 
 Fjg. 24. —Tourniquet. 
 
 Fig. 25. —Artery Forceps. 
 
 artery to draw itself into the tissues, in order that the bleeding may 
 cease. In such a case it may be necessary to complete the cut. 
 This done, dress in the usual way. 
 
 Venous bleeding is known by its deep colour and its con- 
 tinuous flow. Pressure is generally sufficient to stop the oozing, 
 if it is directed over the wounded part. If pressure is applied 
 above the wound, that is further up the limb, it will do harm, as 
 it will increase the flow of blood. In this form of bleeding pressure 
 
118 HEALTH IN AFRICA 
 
 should be applied to the course of the vein below the seat of injury. 
 When a very large vein is divided, its two ends must be tied. 
 Oozing from a cut surface is generally venous in character. In 
 order to control it, aj)ply a stream of very hot water, as hot as can 
 be borne, and in a short time the oozing will cease. A^Dply pressure 
 over the bleeding part by means of a pad in 1-40 carbolic acid, and 
 bandage tightly. 
 
 Treatment of all kinds of bleeding should be accompanied by 
 rest in the recumbent position, with the head somewhat lower 
 than the body. As the temperature is likely to be low, see that an 
 extra blanket is thrown over the sufferer. Cheer the patient by 
 assuring him that the l)leeding, although it is a great loss, is not 
 serious. When a person faints from loss of blood, allow him to lie 
 until a certain amount of strength has been regained. If he is raised 
 suddenly there might be failure of the heart. Avoid all stimu- 
 lants, unless there is collapse, as these increase the blood pressure, 
 and tend to the continuation of the bleeding. If there is collapse, 
 hastily inject under the skin a teaspoonful of ether or brandy. 
 
 Antipyrin is most powerful and rapid in stopping bleeding. 
 
 Ordinary bleeding from the nose is stopped by ni' dstening a simple 
 plug of wool in a solution of this drug, say 1 to 2 of water. 
 
 In more severe bleedings^ antipyrin may be dusted over the surface, 
 or hot irrigations with a 3 or 5 per cent, of the drug may be used. 
 After the removal of a polypi or the extraction of a tooth, there 
 is often some bleeding. Such may be stopped by antipyrin applied 
 in the above strength. For all forms of bleeding this method of 
 treatment is excellent. 
 
 For the coughing up of blood (haemoptysis), antipyrin in the form 
 of a spray of a 1 or 2 per cent, solution, or by inhalations, has 
 been effectual in stopping the blood, even when in some cases sub- 
 cutaneous injections of ergo tin were not successful. 
 
 When the powder is sjjrinkled over an open wound, it stops 
 bleeding by causing the blood to coagulate. 
 
CHAPTER IX 
 
 WOUNDS, BRUISES, BURNS, AND THEIR 
 TREATMENT 
 
 ANTISEPTICISM 
 
 Before speaking of woimcls, it is absolutely necessary to have a 
 clear grasp of the antiseptic and asejotic treatment of modern days. 
 
 This treatment depends on the fact that the air abounds 
 with micro-organisms, which, being brought into contact with 
 injured tissues of the body, set up putrefactive changes. These 
 organisms vary in number, quality, vital power, and are of infinite 
 variety. Many thrive in dead tissue, aided by moisture and heat 
 such as a wound on the body affords. All the specific fevers, and 
 most of our other ailments, are due to their presence in the air. 
 It is against these lowly, but, in virtue of their number and viru- 
 lence, most seriously destructive organisms, that we have to fight. 
 The skin is an impermeable structure to every form of such life 
 but the moment this outer covering is l^roken, they pour into 
 the tissues, and set up putrefactive changes, generating toxines or 
 poisons by their very existence. All antiseptic treatment aims at 
 rendering to a wound such protection as is afforded hy the natural 
 skin. We have first to destroy the germs that have gained access 
 to the wound, to neutralise the poison they have generated, then 
 to keep the wound in such a state that it will not afford a nidus 
 to the germs, and be enabled to repair itself with all possible haste. 
 We thus reall}^ treat the atmos^^heric surroundings of the breach of 
 skin. Antiseptic dressing is, in fact, an artificial skin. There is 
 another class of low microscopic life, which gains access to the 
 system through some breach in the mucous membrane within the 
 body, or even enters the blood and courses there. Wherever there 
 is a local injury or weakness, they congregate in that spot and set 
 up an internal abscess. Then we might speak of a third set, which, 
 
 119 
 
120 HEALTH IN AFRICA 
 
 finding the body reduced in vigour, enters tlie system, it may be 
 by tlie internal mucous membranes, sets up tlie various fevers, all 
 of which run through their own definite course. 
 
 The system of treatment we are considering, consists in destroy- 
 ing and casting out of the body the dangerous intruders. This is 
 done by means of certain drugs which we know have the power 
 of rendering inert the organisms themselves or the toxines which 
 their presence generates. Thus carbolic acid dissolved in water, or 
 impregnated in gauze or cotton-wool, has this property. Thymol, 
 eucalyptus oil, boracic acid, salicylic acid, iodoform, perchloride 
 of mercury, have this power, and are all specially useful in their 
 own way. 
 
 These drugs are chiefly employed to purify the media surround- 
 ing the wound ; the wound itself is only treated by the drugs when 
 the presence of germs within its tissues is suspected. 
 
 Methods used in the Treatment. 
 
 The methods and material used vary greatly, but the principles 
 are the same in all. Everything surrounding the wound and that 
 which comes in contact with it must be purified. The operator's 
 hands, those of his assistants, his instruments, and dressings are 
 carefully made aseptic with a watery solution of perchloride of 
 mercury, of the strength of one spoonful of the drag to 1000 
 spoonfuls of water. The wound is irrigated with the same anti- 
 septic lotion. "VVlien the operation is over, the wound is closed 
 and covered with a layer of specially prepared gutta-percha tissue 
 or oil-silk " protective," which prevents the constant irritation of 
 the antiseptic. The muslin dressing covering the silk is impreg- 
 nated with carbolic acid, resin, and paraffin. Here the carbolic 
 acid is retained in the muslin at ordinary temperatures, so that 
 the wound is kej)t in an antiseptic state for some days. The first 
 layer is applied to the wound after having been soaked in a solution 
 (carbolic 1, water 40) to destroy all germs adhering to the surface. 
 The remainder of the dressing is applied dry, in order to absorb 
 all discharges that may flow off from the wound. This is covered 
 with cotton wadding, impregnated with a strong antiseptic, at the 
 above strength of perchloride of mercury. The whole is then 
 tightly fixed by bandages. When the wound is an old sore, 
 which has not been so treated, and which has been the seat of the 
 growth of innumerable numbers of septic germs, and of smelling 
 discharges, the surgeon does his best to bring the raw surface irto 
 
WOUNDS, BRUISES, AND BURNS 121 
 
 an aseptic state. The wound is washed with very strong carbolic 
 acid, say 1 part to 20 parts of water, or with corrosive sublimate 
 (perchloride of mercury), of the strength of 1 part to 500 parts 
 of water. The washing is done most thoroughly to the extent of 
 scrubbing, and is afterwards treated like the ordinary antiseptic 
 wound. It is not possible, however, to eradicate altogether the 
 evils of putrefaction, after a wound has been exposed to the air for 
 a period of two days, and suppuration has set in. 
 
 The latest development in this treatment is, with the most 
 scrupulous attention to detail, to thoroughly sterilise all instru- 
 ments, dressings, operators, nurses, and everything indeed that 
 comes in contact with the broken skin, and so carry out the 
 aseptic treatment. 
 
 The following is a description of a few of the best antiseptics 
 used. The list is full with the idea, that, in Africa, should one 
 drug be absent another may be used. 
 
 (1.) Carbolic Acid. — This is, at the present time, the best 
 and the most useful. The crystals (in Africa the pui-e acid is 
 generally a fluid) may be dissolved in water or oil or glycerine. 
 The strong solution is 1 of the acid to 20 of water. The weaker is 
 1 to 40 of water. It is also used, frequently, in the strength of 1 of 
 the acid to 10 of oil or glycerine. The most recent experimenters 
 discard the oil and speak highly of glycerine. 
 
 (2.) Corrosive Sublimate (perchloride of mercury). — This is 
 very cheap and very effective. It however corrodes all instruments 
 and makes them unsightly. The strong solution of 1 of the per- 
 chloride to 500 parts of water is used for the hands of dressers and 
 those who come in contact with a breach of skin. The weaker is 
 1 to 1000, while that used for the irrigation of wounds is 1 in 2000 
 of water. When using this drug for irrigation purposes, always put 
 a little common salt into the solution. 
 
 (3.) Iodoform. — This is a most useful drug, as it has marked 
 deodorising properties. It can be used in a variety of ways, but is 
 often simply dusted on the wound. It is insoluble in water, but 
 mixes well with equal parts of oil or glycerine. Its odour is 
 unpleasant, but it is excellent for natives. 
 
 (4.) Antinosine. — This is a new drug. It is a blue powder 
 which dissolves easily in water, and is a sodium compound contain- 
 ing iodine and phenol. It possesses antiseptic properties equal to 
 those of iodoform. It arrests the growth of all pathogenic microbes. 
 It has no odour, no toxic properties, no irritant eftects, and is conse- 
 quently most excellent for a variety of uses. It is sj^ecially useful 
 in syphilitic chancres. A ^ per cent, watery solution is excellent 
 
122 HEALTH IN AFRICA 
 
 as a gargle for throat affections. It can be used as a powder on 
 external surfaces. 
 
 (5.) BoRACic Acid. — This is a very mild antiseptic, and is 
 specially useful in dressing the wounds of mucous membranes. 
 
 WOUNDS. 
 
 A wound is any breach of continuity of the skin. For the sake 
 of clearness we will divide them into — 
 
 1st. Incised Wounds. 
 
 2nd. Lacerated Wounds. 
 
 3rd. Stabs or Punctured Wounds. 
 
 4th. Gunshot Wounds. 
 
 An incised wound means a clean cut as with a knife. The 
 edges are not ragged or injured in any way, beyond having been 
 severed. There is usually a good deal of bleeding, as the blood- 
 vessels have been freely opened. A stick, however, may give an 
 apparently clean cut, if a hard surface, as a bone, is underneath. If 
 the instrument that inflicted the injury was clean, and the wound 
 looked after and properly treated, it should heal very quickly by 
 what is called immediate union, or union by first intention. 
 
 A lacerated wound is one that has the edges variously cut 
 into irregular segments, and it may be parts of the tissue killed. 
 Such a wound is seen when a "chikote" or a "shambuck" is used 
 freely, and cuts the skin, or when a log falls on the leg and wounds 
 the flesh. The danger here is not so much the cut, as that the 
 tissues are injured, and septic matter is rubbed into the flesh as it 
 were. The edges, being torn, are usually jagged in appearance. 
 
 Stabs are produced by knives or spears, and are always much 
 dee2:)er than they are broad. The first danger is the bleeding, which 
 cannot readily be controlled ; and next comes the absorption of septic 
 poison, as we cannot get into the wound to clean it thoroughly. 
 
 Gunshot wounds may present any possible form. It may be 
 a puncture, or it may be a most seriously contused wound. The 
 ball may be lodged in the tissues, together with cotton, cloth, or 
 wadding ; or it may have escaped, leaving a second hole and a long 
 tunnel. When a bullet passes right through any tissue, the hole by 
 which it enters is usually small, Avhile the hole by which it passes 
 out is large, irregular, and with out-turned edges. Small shot, if 
 fired from a little distance, makes a most serious lacerated wound ; 
 if from a considerable distance the shot scatters, and may lodge in 
 
WOUNDS, BRUISES, AND BURNS 123 
 
 tlie skin without causing great injury or inconvenience. Usually 
 there is very little bleeding. A native round bullet is most easily 
 deflected, and in passing through tissues, may push a tendon, a 
 nerve, or a vessel to one side without cutting it. It is different 
 with a modern Inillet, projected from a rifle, which passes through 
 the tissues, much the same as an augur passes throu;^h wood — it 
 lacerates everything in its passage. 
 
 Treatment. — The first thing to do is to arrest the bleeding by 
 laying the sufferer in a horizontal position, and firmly grasping the 
 bleeding vessel or applying other pressure by means of pads. It may 
 be necessary to apply a tourniquet or a bandage or twisted handker- 
 chief. It may also be necessary at once to tie the bleeding vessel in 
 order to save life. If it is a lacerated ivound, wash it thoroughly with 
 soap and water, taking away all dirt, and then bathe the wound for 
 some five minutes at least in 1-20 carbolic, or 1-1000 corrosive sub- 
 limate. Do not fear to make it bleed. Tie or twist all bleeding 
 points, and if tendons are cut, unite them each to each with cat-gut 
 stitches. If you are dealing with a stab and cannot control the bleed- 
 ing by pressing on the artery above, then you must cut down and tie 
 the bleeding vessel. Watch carefully in the after treatment of a stab 
 for rise of temperature, for if this takes place, be sure there is septic 
 poison in the wound, finding its way into the system, and slowly 
 poisoning the sufferer. Here the treatment is to open the wound 
 freely, and let out the pus by free drainage. If nerves or tendons 
 are cut, tie them carefully each to its fellow. If you are dealing 
 with a gunshot wound, in addition to washing with 1-20 carbolic 
 and removing wadding, powdered fragments of bone, &c., use the 
 fingers of your hand, thoroughly purified in 1-20 carbolic as a means 
 of exploring. It may be necessary to put a finger of each hand 
 into the opposite holes and cause them to meet in the wound. 
 Remove the bullet if it is still within the wound. Syringe the 
 wound with 1-20 carbolic, and treat it in the ordinary antiseptic 
 manner. Although you cannot see the various sides of such a 
 wound, it is quite the same as an open sore, only the lips of the 
 various tissues lie in contact one with the other. Having arrested 
 the bleeding, and washed the wound thoroughly with 1-20 carbolic, 
 with great care bring the lips of the wound together with accuracy. 
 Let muscle come to muscle and skin to skin, and keep them in 
 that position by means of a few stitches or by sticking-plaster. 
 This is an admirable method where the wound is of moderate size. 
 Take care, however, to allow spaces between the straps of sticking- 
 plaster for the discharge of blood, or it may be, of pus. In large 
 wounds plaster is not sufficient, we must have something to grasp 
 
124 HEALTH IN AFRICA 
 
 the lips firmly, and hold them in position. This is done admirably 
 by ordinary cat-gut, which is supplied by all chemists. Sew the 
 wound as you would sew a bad tear in a great bag, only each stitch 
 must be tied for itself. Continuous sewing may be used where the 
 wound is very clean and there is no tension on the lips. Don't tie 
 so tightly that the skin is puckered, but let the lij^s lie easily against 
 one another. In doing so it is necessary to be prepared for drainage, 
 as there is almost a certainty of pus being present later on. If the 
 wound is small, allow the most dependent end to remain open some- 
 what, with this object in vii-w, but in large wounds insert a small 
 piece of india-rubber tubing at the lowermost end. The wound 
 sewn, and the drainage tube inserted, apply a piece of j)rotective 
 over the wound which has been soaked in the carbolic solution. 
 Then apf)ly the pads of dressing and the bandages. 
 
 Should one spot appear to form pus day after day, touch this 
 with nitrate of silver and reapply the antiseptic lotion. 
 
 Remove the tubes and the dressings in twenty-four hours and 
 dress afresh. Take every care to bathe the whole in 1-30 carbolic 
 lotion. If the stitches tend to tear the edges of the wound, or to 
 cut their way out, the tension is too great on the lij^s. Remove 
 them at once and apply straps of plaster, or resew the wound. 
 When the wound begins to heal remove the stitches ; tliey should 
 be removed about the fourth day, and the wound should be quite 
 healed by the seventh or tenth day, if all goes well. 
 
 Bruise. — This is an injury inflicted by a blow or a squeeze, in 
 which the skin is not broken, but the internal tissues are lacerated, 
 and the small vessels so affected that there is an extravasation of 
 blood. The skin not being broken the blood remains in the tissues, 
 but below the skin, and thus not in contact with the air. This injury 
 may range from an ordinary black eye, to the internal crushing of 
 the muscles. In the lesser form, typified b}^ a black eye, there is 
 only a slight injury to the tissues, with the rupture of one or two 
 capillaries, which occasions the discoloration. In the more seriou?, 
 the tissues under the skin, muscles, and blood-vessels are crushed 
 and may die. The amount of blood poured out depends on many 
 things, such as the size of the broken vessels, the laxity of the 
 tissues, &c. If it is under the eye, where the tissues are lax, there 
 is great discoloration ; if the scalp, where the tissues are firm, the 
 discoloration is comparatively slight. 
 
 The symptoms are pain, swelling, and a marked discoloration. 
 Usually there is little shock, but if the testicle is the seat of the 
 blow, or the breast in a woman, or even one of the large joints, there 
 may be faintness, loss of muscular jiower, and vomiting. The pain 
 
WOUNDS, BRUISES, AND BURNS 126 
 
 is numb or dull and aching. The parts rapidly swell, and may 
 remain swollen for a week. At first the discoloration may be dark 
 like blood, but as this undergoes chanf,'e it becomes purple, pink, 
 and then yellow. These changes are said not to come about where 
 the parts are uninfluenced by air and light. 
 
 Treatment. — If the bruise is simple, all that is wanted is rest and 
 a covering of dry cotton-w^ool or boracic lint. It may be necessary, 
 however, to do something to remove the pain and the discoloration 
 of the part. If the pain is great, put on a warm fomentation sprinkled 
 with laudanum. If blisters form, prick them gently to let out the 
 fluid, but on no account tear off the cuticle that forms the blister or 
 break the skiu. Dress with zinc ointment or carbolic oil. 
 
 If the bruise is on the leg, give the j^art absolute rest and use 
 Elliman's embrocation. If the parts tend to mortify and die, apply 
 hot fomentations till the dead tissue sloughs, and dress with car- 
 bolic 1-40. 
 
 Pugilists, who often suffer from bruises and black eyes, use the 
 following rough and ready treatment. The eyes, with them, some- 
 times swell so greatly that it interferes with vision. In such a case 
 they puncture the eyelids to let out the serum, and apply a piece 
 of raw beefsteak as a poultice. Tliis has the eflect of keeping out 
 the air, and is certainly a cooling, moist application. 
 
 It is against all principles to incise the skin, even when the 
 extravasation of blood is extensive. The application of hot fomen- 
 tations and rest, will, even in such a case, do wonders. 
 
 Ulcers of every kind are common in Africa. The natives often 
 suffer for years from unclean sores, which are a tremendous drain 
 to the system. They may appear on any part of the body, but are 
 seen most often on the legs and dependent parts. An ulcer is a 
 " sore," or a degenerate tissue, giving off an unhealthy discharge or 
 " ichor." They may appear on any surface of the body, external or 
 internal. They are common on the mouth, stomach, or bowels ; on 
 the eye, nose, or skin. In the present article they are restricted to 
 the skin. An ulcer may be the direct result of an injury ; or from 
 defective circulation, such as a varicose ulcer ; or from a constitutional 
 cause, such as syphilis, or struma. Careful diagnosis of the cause is 
 the key to successful treatment. 
 
 A common healthy healing sore may be found on any part 
 of the body, but is most often seen on the lower leg or shin. It is 
 a healing, granulating wound, which is "drying up." Usually a 
 little pus is given off, .which is of the consistency of thick cream, 
 and not of an unpleasant odour. It is " sweet." The edges merge 
 gradually into the healthy skin, and are of a purplish blue tint, 
 
126 HEALTH IN AFRICA 
 
 indicating that the ej)idermis (the upper layer of skin) is gradually 
 enclosing the sore. Such a sore may be described as inflamed, 
 if the surface is red and angry-looking, the discharge thin and 
 watery, and the sensation comj^lained of as hot and stinging. It 
 may be described as a weak ulcer, if the granulations (the little 
 raised-up healing parts) are pale and soft and watt-ry-looking. If 
 there is what is popularly called " proud flesh," it may be described 
 as a fungus ulcer. 
 
 A sloughing ulcer is a grey-looking sore, part of which is 
 being cast off in pieces. A chronic or callous ulcer is such as is 
 seen on unhealthy natives. It is generally on the legs, and has been 
 there for months or years. Usually it is oval, with its long dia- 
 meter running along the leg. The margin is pale and hard like 
 gristle. All the tissues around are thickened from long-standing 
 inflammation. 
 
 Treatment. — What is imperatively needed in treating such ulcers 
 is absolute cleanliness. In dealing with an ordinary native sore, wash 
 away thoroughly the dirt and pus of the past months. Then purify 
 its surface by some antiseptic lotion, and keep it free from irritation. 
 Stimulate the part so that more bloo'i will come in to it; look 
 also to the venous circulation, as this is often at the bottom of long- 
 standing sores. This done, treat the constitution by tonics and 
 good food. 
 
 What is required most of all in the treatment of a common healthy 
 sore is rest. If this cannot be given, by allowing the limb to lie in an 
 elevated position, then use an elastic woven bandage. This should 
 be put on before rising in the morning, and taken off after retiring 
 at night. An ordinary sore should be washed and soaked in corrosive 
 sublimate 1-500 for five minutes, then dusted with iodoform and 
 dressed with lint soaked in 1-40 of carbolic acid. Let the lint fit 
 the sore exactly. Over this put a piece of oiled silk, which should 
 overlap the lint by about half-an-inch all round. If the silk tends 
 to irritate the skin, rub the surrounding tissues with vaseline or oil. 
 Over all, bandage the limb from the toes upwards with the above 
 woven elastic bandage, or a bandage of the ordinary texture. 
 
 The following are good lotions for all sores. It may be that 
 one is at hand, while another is not procurable : (1) inire filtered 
 and boiled water; {•!) horacic «aV? dusted over the j)art ; (3) cJdoride 
 of zinc, 2 grains to 2 tablespoonfuls of water ; (4) corrosive sublimate, 
 J grain to 2 tablespoonfuls of water ; (5) hlach and yellow washes are 
 on the same lines as the sublimate ; (6) hydrate of chloral, 3 grains 
 to 2 tablespoonfuls of water ; (7) dilute nitric acid, 5 drops to 2 
 tablespoonfuls of water ; (8) iodine, 1 grain to 20 tablespoonfuls of 
 
WOUNDS, BRUISES, AND BURNS 127 
 
 water ; (9) sulphate of copper, 1 grain to 2 tablesxDoonf uls of water ; 
 (10) nitrate of silver, 5 grains to 2 tablespoonfuls of water ; (11) sul- 
 phate of zinc, 2 grains to 2 tablespoonfuls of water ; (1 2) carbolic 
 acid, 1 part to 40 of water. 
 
 Another very excellent remed}^, for the treatment of ordinary 
 native sores, is to dust the ulcer every day, after washing, with 
 ordinary flowers of sulphur. This is an antiparasiticide, and seems 
 to have marked effect on the low microscopic life of ulcers. It is 
 inexpensive, and is usually at hand. 
 
 If the sore seems weak, in that it looks pale, soft and flabby, 
 it needs stimulation ; in such a case, take an ordinary stick of 
 nitrate of silver and pencil the parts over, dress with dry lint and 
 a bandage. Rubbing the sore with crystals of bluestone (sulphate 
 of copper) is on the same lines. 
 
 In treating a sloughing ulcer, it is necessary that the patient should 
 have good food and good hygienic surroundings. If the slough is 
 spreading up or down the leg, it is well, at once, to apply strong 
 nitric acid to the dead line, and so destroy the poisonous matter 
 that is acting on the weakly tissues. This done, effectively wash 
 with perchloride of mercury (1 in 1000), or carbolic acid (1 in 40), 
 and treat as above. 
 
 In treating an indolent callous ulcer such as is often seen amongst 
 African natives, it is imperative to act effectively. In such a case 
 the edges of the sore are hard like cartilage, which for over a period 
 of years have been laid down in layers, and when seen are capable 
 of being torn off in strips. Blisters may be tried with the object 
 of revivifying the sore, but will do little ultimate good. The follow- 
 ing, however, is effective. Treat the part with this local ansesthetic 
 by means of a spray : — 
 
 Chloroform 10 parts. 
 
 Ether . . . . . • 15 „ 
 Menthol 1 part ; 
 
 the resulting deadness to pain will last for five minutes. This 
 effected, thoroughly scrub the greenish stinking surface with car- 
 bolic (1-40) and soap. Then deeply incise the callous cartilaginous 
 edges thus : — 
 
 Take a sharp bistoury, and beginning at the centre of the sore 
 make a series of cuts outwards through the hard edges. Cut deep 
 into the fascia and through the edges. The wound must gape 
 widely and bleed freely. The bleeding will be controlled easily by 
 pressure. After this operation the wound looks ghastly, but life 
 
128 HEALTH IN AFRICA 
 
 will have been brouglit into it and it will start afresli on healing 
 lines. If this wound is dressed with iodoform and covered for a 
 couple of days a great change will be apparent. 
 
 What might be described as angry-looking, irritable sores are 
 seen amongst the natives, and give a great deal of trouble. There is 
 great pain, redness, and swelling. Begin the treatment of such by 
 giving a brisk purge, as one drop of croton oil on the back of the 
 tongue. To relieve the pain give 30 grains of bromide of sodium 
 with antipyrin 10 grains three times a day. Then treat the sore 
 with carbolic (1-40) as above. If this does not give relief, then 
 make a solution of cocaine 8 parts to water 100 parts, and soaking 
 lint in this, put it on the sore for 15 minutes. This will relieve 
 the pain. Then with a solution of nitrate of silver 35 grains 
 to 1 tablespoonful of water, paint the edges, and wash the inner 
 sore. Thereafter apply cold-water dressing for a fevr days, and let 
 it have absolute rest. 
 
 The new drug airol is highly spoken of as a means of treating 
 ulcers. This is a green powder, tasteless, odourless, and insoluble 
 in water, spirit, or glycerine. It is excellent for ulcers of the leg, 
 which in a short time become painless and dry up. The granula- 
 tions become firm and healthy. This drug is excellent for treating 
 ingrowing toenail, and small wounds of every kind. The fact that 
 it is odourless gives it the preference over iodoform. 
 
 Bums and scalds may be considered together, in that they are 
 both injuries to tlie skin caused by excessive heat, or by a strong 
 chemical agent destroying the same. A bum is caused when a 
 flame, a hot solid, a metal in a liquid state, or a chemical, such 
 as nitric acid, destroys the tissues of the body. A scald is caused 
 by hot water, hot oil, or other liquid injuring the skin. Both 
 present similar features, and require the same care and treatment. 
 In minor surgery these accidents are simple, but severe burns or 
 scalds menace life. 
 
 The skin may simply be reddened or blistered, or the true 
 skin may be destroyecl ; deeper still, the muscles and bones may 
 be killed. 
 
 The danger to life depends on the extent of the surface involved, 
 and this is the more serious in the very young or the very old. It 
 is estimated that if one-sixth part of the surface of the body is 
 destroyed, the injury is likely to be fatal. A burn on the body is 
 more dangerous than the same extent of injury on any of the limbs. 
 The pain is usually intense, and the shock to the system in even a 
 small burn is very great. Shortly after the accident, the pulse 
 bounds, while the body may be cold and the sufferer faint. In 
 
WOUNDS, BRUISES, AND BURNS 129 
 
 twenty-four hours there comes a reaction : fever supervenes, and 
 some internal organ, as the lung, may be congested. 
 
 Treatment. — After receiving a burn, even one of the simplest, 
 as by lifting a red-hot cinder, make at once a paste of bicarbonate 
 of soda and water, apply the doughy stuff to the j)art, and the pain 
 will be relieved. This must be done before the blister forms. The 
 application of ordinary brown soap at this stage is good. 
 
 In a very severe burn, what is called for, first of all, is attention 
 to the swooning patient. The shock may be so great, that there is 
 danger of collapse. Cover the sufferer with blankets, put hot-water 
 bottles to the feet, and give a wine-glassful of hot brandy or whisky 
 to stimulate the heart. If the pain is very great, apply a watery 
 solution of oj)ium to the injured surface, or give a hypodermic 
 injection of morphia, say ^ grain. Then, by means of scissors, 
 most gently remove the clothing, taking one limb at a time, and 
 dress it. Never attempt to take off the clothing in the usual way. 
 Puncture all blisters at the dependent parts, and allow the fluid to 
 drain off, always saving the upraised cuticle. {See Fig. 1.) What is 
 wanted is, as soon as j)ossible, to exclude the air. To this end cover 
 the burn with ordinary flour or starch, or flour and boracic acid, 
 and envelop the limb in cotton- wool and bandages. 
 
 Iodoform dusted over the surface is good. Antinosine is also 
 excellent, being effective and having no smell. Burns from gun- 
 j)owder should be carefully washed and syringed with hot water in 
 order to remove the grains of powder, and treated as above. 
 
 When the burned suriace is literally charred, the best thing to 
 use is the old-fashioned carron oil, or a modification of it, made 
 thus : of an oil made from eucalyptus 10 parts, olive oil 90 parts, 
 take one cupful and mix with a cupful of lime-water. Soak cotton- 
 wool in this, and aj)ply to the burned surface. Keep the dressing 
 on by means of lint and bandages till the patient says it is painful, 
 or until a discharge appears below the dressings. Then take oft" 
 the oily dressings and wash with warm carbolic lotion (1-40), and 
 dust with iodoform or antinosine. It may be that parts of the 
 injured surface will begin to slough, in which case the whole should 
 be enveloped in linseed-meal poultices, and the sloughs washed with 
 the above warm carbolic lotion. 
 
 When extensive burns of this nature heal, there is usually great 
 after-contraction. This should be taken into consideration. If it 
 is in the neighbourhood of a joint, the limb should be put upon a 
 splint. 
 
CHAPTER X 
 MINOR SURGERY 
 
 An abscess is a circumscribed collection of purulent matter formed 
 in tlie superficial tissues of the body or some of tlie deeper organs. 
 In its growtli tlie capillaries of tlie part are first inflamed and 
 gorged with, blood ; tlie delicate vessels are weakened, so tliat a great 
 amount of fluid and white-blood corpuscles exude and become pus. 
 This dead matter dissolves the delicate tissues in which it is diffused 
 and eventually makes for itself a cavity. This pus burrows and 
 works to the surface through the skin or into some natural cavity 
 of the body. The pus may burrow long distances from its place 
 of origin. The cavity containing the pus is surrounded by an 
 inflamed and thickened area which does not contain matter. The 
 pus may in time be dried up if it does not find an outlet, but 
 usually a cure is only eftected after the matter is discharged. In 
 most cases abscesses are due to the presence of micro-organisms. 
 They may be acute or chronic. 
 
 Treatment. — When pus threatens to form give a brisk saline 
 purge, as Epsom salts and of quinine two 5 -grain doses in the day. 
 Apply hot poultices every two hours, which will cause the capillaries 
 to dilate and relieve the congestion. If suppuration has already 
 taken place, warm poultices and hot fomentations hasten the forma- 
 tion of matter. When this is fully formed, then open the cavity by 
 an ordinary bistoury. If the skin above is frozen by means of ether, 
 no pain will be felt in the incision. {See p. 127.) This effected, 
 wash the cavity with carbolic acid 2 tablespoonfuls and water 80 
 tablespoonfuls, or corrosive sublimate 5 grains to water 80 table- 
 spoonfuls. If there is still great pain, apply hot poultices well 
 sprinkled with boracic acid or iodoform. 
 
 Anus, Fissure of the. — This is a crack, or a superficial ulcera- 
 tion, at the verge of the anus, between the skin and the mucous 
 membrane, extending within the bowel. There is intense pain 
 during the act of defeecation and it may be for hours after. 
 
 130 
 
MINOR SURGERY 131 
 
 Treatmeiit. — If of long standing it must be treated by a surgeon ; 
 if not, toucli with nitrate of silver and allow it to heal. But some- 
 thing must be done for the agonising pain that comes on after defee- 
 cation. The following ointment should be rubbed on the fissure 
 twice every day after washing the part with cold water : hydro- 
 chlorate of cocaine 30 grains, water 1 teaspoonful, lanoline ointment 
 2 tablespoonfuls. This preparation paralyses the small nerves in 
 the skin. 
 
 Anus, Itchiness of the. — Find out if it is caused by worms or 
 cracks, or piles, and treat these. It is, however, often due to a morbid 
 state of the nerve-supply, in which case it is necessary to attend to 
 the general health. Give iron tonics, and let the sufferer take a 
 change. An ointment made of carbolic acid 1 teaspoonful, lard 
 4 tablespoonfuls, and camphor 1 teaspoonful is often effectual. Or 
 the parts may be dusted over with carbonate of bismuth. The 
 following too is good : hydrate of chloral 2 teaspoonfuls, water 20 
 tablesjDOonfuls. Avoid all scratching. 
 
 Bubo is an inflammatory swelling of the glands of the groin. 
 Here we will speak of it as a hard and sometimes suppurative 
 state of the glands of the groin, coming on after a venereal sore of 
 the genitals. 
 
 Treatment. — Attend first to the venereal sore on the 23enis. If 
 the gland in the groin is only swollen and sore, with no pus, then, 
 in order to prevent the formation of pus, moisten the skin over the 
 gland with a little water and rub it freely with solid nitrate of 
 silver. Give absolute rest to the part by resting the limb. Another 
 excellent way is to paint the skin over the gland with iodine 2 
 drachms and carbolic acid 4 tablespoonfuls. If the pain is of a 
 stinging character with great redness, we conclude pus is forming. 
 In this case apply a good large warm moist poultice. When the 
 matter has formed, after the application of a few warm poultices, 
 freely open the sore and let out the poisonous pus. Take away 
 every shred of dead matter and skin, and wash thoroughly with 
 perchloride of mercury 1 in 1000 and fill the cavity with warm 
 iodine ointment or the above iodine and carbolic acid. Then treat 
 as an ordinary ulcer. It is sometimes absolutely necessary to attend 
 to the general health. 
 
 Bunion is an enlarged synovial sac situated on any part of the 
 foot, but most commonly at the root of the great toe or of the fifth 
 toe. There is often some distortion of the foot. These enlarged 
 synovial sacs are usually due to badly fitting boots. In some cases 
 a bunion is hereditary, beginning as a tender spot on a prominence 
 that has been exposed to pressure. In course of time the natural 
 
132 HEALTH IX AFRICA 
 
 bursa becomes fuller than normal ; this may suppurate or become 
 the seat of corns. 
 
 Treatment. — Remove the cause, such as badly fitting boots. 
 Paint the inflamed part with liniment of iodine, and it will be 
 followed with good results. 
 
 Chapped hands. — This is a form of inflammation of the back of 
 the hands characterised by a dryness of the skin together with 
 cracks of the same. It is due to cold affecting skin that has not 
 been jjroperly dried, and is often brought on by drying the hands 
 with damp towels and holding them before a fire. 
 
 Treatment. — When washing the hands be careful to dry them 
 thoroughly with a warm towel. Rub the following ointment on 
 the hands night and morning : lanoline 4 tablespoonfuls, hydrarg, 
 amnion, clilor. 25 grains, liquor, carb. deterg. one and a half tea- 
 spoonful. Glycerine 2 parts and eau-de-cologne one part are 
 excellent. 
 
 Chilblains are localised inflammations of the skin, seen in cold 
 weather, mostly on the hands and feet. At first they are red ; but 
 later on they become purple in colour. They are often very painful, 
 especially when they have been chilled and are being heated again. 
 
 Treatiiunt. — Wlien the sore first makes its appearance, rub it 
 well with compound camphor liniment, or the following : liniment 
 of soap 6 tablespoonfuls, chloroform 1 teaspoonf ul, liniment of bella- 
 donna 4 teas^^oonfuls. Oil of eucalyptus is good. If blisters form, 
 puncture so as to allow the water to escape, and dress with the 
 following : zinc ointment 2 tablespoonfuls, compound tincture of 
 benzoin 2 teaspoonfuls, lanoline 2 dessert spoonfuls. If an ulcer 
 forms, dress it like any other ulcer. Take good exercise in the open 
 air and attend to the general health. 
 
 Corns and callosities are due to intermittent pressure produced 
 by tightly fitting, or badly fitting, boots. The corn may be due to 
 too large boots causing the skin of the foot to be intermittently 
 irritated. 
 
 Treatment. — Pare the corn with a sharp knife, and if it cannot 
 be cut out, by means of a straw or a match let a small drop of 
 glacial acetic acid fall on the spot. Salicylic acid, if rubbed into 
 the tissues of the corn, is most effectual. In soft corns between 
 the toes, separate the two opposing surfaces with a very little bit 
 of felt in which a small hole is cut. Into the hollow put a little 
 salicylic acid. 
 
 Cramp means a muscular contraction which is involuntary, 
 irregular, and variable. It affects the muscles of the calves most 
 frequently. 
 
MINOR SURGERY 133 
 
 Writer's cramp. ^In this the sufferer can use the hand in the 
 most delicate manipulation, but as soon as writing is attempted tlie 
 muscles called into jjlay refuse to act, or do so in a sporadic 
 manner. 
 
 Bather's cramp. — In this case the bather is seen suddenly to 
 throw up his arms and sink. This form is believed to be more 
 a failure of action of the heart than of the muscles of the legs. 
 When a swimmer, out of practice, plunges into cold water the strain 
 on the heart is very great, and may prove too great. No one who 
 has not been practising should attempt a long swim in cold water, 
 and those with weak hearts should be most careful to avoid fatigue 
 in swimming. This is the explanation of some serious illnesses 
 that have seized bathers in mountain streams in Africa. No one 
 in Africa should Ijatlie in a lake till the sun is well above the 
 horizon (say eight o'clock), and on no account should one ever bathe 
 in a mountain rivulet, as the temperature of the water in these 
 streams is often very low. 
 
 Treatment of cram]). — Let the limb be rubbed upwards briskly 
 with a towel. By a voluntary action let the muscles be thrown 
 into full jDrolonged play. It is said if an elastic band or a strong 
 cord be tied tightly round the calf, the spasm will cease. If it 
 comes on when the person is lying down, let him immediately 
 endeavour to rise up. 
 
 Foreskin, inflammation of the. — This often occurs in young 
 African boys who have long foreskins, and where the natural secre- 
 tions are not washed away, and ordinary cleanliness observed. 
 
 Treatment. — Draw back the foreskin, and several times a day 
 wash the parts thoroughly with warm water, and dust with equal 
 parts of boracic acid and starch. If the foreskin tends to con- 
 tract so that it cannot be drawn back, then circumcision must be 
 performed. If the inflammation has aftected the prepuce on the 
 surface of the glans penis, then the sores must be touched with 
 nitrate of silver, or nitric acid, or pure carbolic acid, and covered 
 with a piece of dry lint laid between the glans and the foreskin. 
 If the foreskin is contracted in such a way that it cannot readily be 
 drawn back, then take a small syringe with a little warm Condy's 
 fluid, or warm, weak, corrosive sublimate (1 in 1000), or nitrate of 
 silver (1 in 100), and wash the parts thoroughly, putting the nozzle 
 of the syringe under the foreskin, and injecting the fluid so that 
 the skin is stretched gradually ; then by exercising gentle pressure 
 endeavour to draw back the relaxed tissues. If the inflammation 
 is due to a gonorrhoea, then syringe with permanganate of potash 
 1 grain to 4 tablespoonfuls of watefr. If there is much pain apply 
 
134 HEALTH IN AFRICA 
 
 lead and opium. If there is a chancre, or a sore of any kind wliich 
 you cannot get at, do not hesitate to slit up the foreskin on its 
 dorsal aspect, and treat as for chancre or syphilis. 
 
 Gleet is a chronic impure discharge from the mucous mem- 
 brane of the urethra which may last for months or years. It 
 usually has its origin in a gonorrhoea, and is a most troublesome 
 disease to treat. 
 
 Treatment. — Always bogin to treat it as if it were an ordinary 
 gonorrhcea, but if it has lasted for many months the ordinary 
 remedies for gonorrhcea will be useless. First, then, look to the 
 general health. Remove constipation, dyspepsia, anjEuiia. Stop 
 all stimulants, tobacco, spirits, over-eating, and indulgence of every 
 kind. Avoid pickles, beer, &c. Give Easton's syrujD in teaspoonful 
 doses three times a day, with 3 grains of quinine and 15 drops of 
 the tincture of iron at the same rate. In order to act on the urethra, 
 give 10 grains of boracic acid in water every night. 
 
 As a local remedy pass a solid silver or plated sound with a 
 wide curve into the -urethra. Lubricate the instrument well with 
 glycerine, and allow it by its own weight to slip into the canal. 
 Begin with a small instrument, and go on to a No. 12 ; leave it in the 
 canal at first for a few minutes only, but the time should be gradu- 
 ally lengthened. Do this three times a week, and it will stay any 
 tendency to stricture. The following are good lubricants to rub on 
 the sound in order that they may be carried down the canal to the 
 seat of the ulcer : iodofurm, 30 grains, mixed with glycerine, 2 table- 
 spoonfuls. Antinosine, being odourless, may be preferred to the 
 iodoform. All kinds of bougies and injections have been used. 
 Blisters, or counter-irritation to the perineum (the skin in front 
 of the anus), have been used with great effect. 
 
 Gonorrhoea is the name given to a muco-purulent discharge 
 from the urethra or vagina, which is a contagious poison. If this 
 muco-purulent discharge be examined microscopically the diplococ- 
 cus gonorrhoea will be seen in considerable numbers. This is the 
 low form of life which sets up the disease. The affection is usually 
 brought on by the direct communication of the unaffected with 
 those already suffering, and is one of the many penalties attend- 
 ing impure intercourse between the sexes. It is a very acute and 
 painful disea>!e, attended with severe itching, redness of the parts, 
 and swelling. At first the name gonorrhoea was given under the 
 belief that the discharge was really the spermatic fiuid ; it is now 
 known to be a muco-purulent discharge from some inflamed part of 
 the mucous membrane of the urethra. The disease may reach its 
 height in from one to three weeks, and then gradually subsides. An 
 
MINOR SURGERY 135 
 
 old heathen long ngo said, " Truly the gods make scourges out of 
 onr pleasant vices." 
 
 Treatment — In tlie early stages, when pain and uneasiness mani- 
 fest themselves, and there is a history of exposure, begin by giving a 
 mild purge daily, say 4 teaspoonfuls of Epsom salts ; wash out the 
 urethra with warm permanganate of potash 1 grain to 10 tablespoon- 
 fuls of water. Inject most thoroughly, and do it every three hours. 
 Twice a day take a warm bath. When the discharge begins to get less, 
 use double the amount of permanganate to the same amount of water. 
 When using this drug rest in bed if possible ; take only milk and eggs 
 and light corn-flour puddings. Discard for a day or two tobacco and 
 animal food, and on no account imbibe spirits. Give large drinks of 
 potash water with a lemon squeezed in it : this forms citrate of potash 
 in the urine, which acts soothingly on the inflamed mucous membrane. 
 
 When there is great pain and swelling in the penis, and fever 
 in the system, let the sufferer take very hot baths, and while in 
 the bath inject hot water into the urethra. If the penis is pain- 
 fully erected and twisted (chordee), while in the bath take a warm 
 enema and wash out the bowels, and take the following : bromide 
 of potassium 20 grains, chloral 10 grains, camphor 5 grains. 
 
 When the fever and pain have subsided, the stage is reached 
 in which astringents should be pushed. Of all the host of drugs 
 recommended, copaiba, notwithstanding all its disadvantages, is 
 the best. The following is an excellent preparation for Africa : 
 cubebs in powder, 2 ounces, nitrate of potash, 2 drachms, Dover's 
 powder, ^ drachm, balsam of copaiba, as much as rec^uired. Of 
 this take about the size of a small marble in cigarette paper three 
 times a day, two hours after meals. 
 
 Continue all the time the injection of waim permanganate of 
 potash (1 grain to 10 tablespoonfuls of water). It may even be 
 used up to the strength of 1 grain to 2 tablespoonfuls of water. 
 Never use it cold, but about the temperature of the body, 99° F. 
 
 After passing urine wash out the urethra with pure warm water, 
 and inject the warm permanganate. 
 
 Shoidd permanganate of potash not be at hand, then one of the 
 undermentioned should be used in the following proportion : — 
 
 1 grain to 2 tablespoonfuls of warm water, 
 
 Chloride of zinc . 
 
 1 grain t 
 
 Acetate of lead . 
 
 3 grains 
 
 Iodoform . 
 
 10 „ 
 
 Alum . 
 
 3 „ 
 
 Tannin 
 
 ,5 
 
 Boracic acid 
 
 10 „ 
 
136 HEALTH IN AFRICA 
 
 The most recent medical literature points to tlie following treat- 
 ment of tins disease : a 1 or 2 per cent, of iclitliyol is injected into 
 the urethra till the passage is distended. The injection should be 
 used three times a day. This drug is antiseptic, is painless, and 
 keeps down the fever. Creasote, in the strength of 2 to 10 drops 
 to the thousand drops of water, is very highly spoken of also. 
 
 This disease in females should be treated on exactly the same 
 lines, only before using the injection all the canals should be washed 
 out thoroughly with two or three tumblers of warm water, with, say, 
 a tablespoonful of alum, and the same of borax dissolved in it. 
 
 Hsemorrhoids or piles are little tumours found at the very edge 
 of, or just within the anus, where the skin and mucous membrane 
 meet. They originate in the veins of this region, and at their 
 maturity consist of folds of skin or mucous membrane with infil- 
 trated and hardened tissue. Sometimes the knot consists of little 
 clusters of dilated veins which can be easily emptied by pressure. 
 In others the blood coagulates in the veins, forming little hard 
 knots. Some piles bleed profusely, others do not bleed at all, or 
 only to a trifling degree. The patient suffers for a long time from 
 a feeling of heat, and fulness, and dull pain at the anus. He feels 
 as if a something were in that region that should come away. On 
 examining, he feels a little tumour about the size of a marble, 
 which may be soft or hard, and may be inside or outside the anus. 
 In time this grows as large as a walnut, and other tumours grow 
 round it. If it is not inflamed it gives little annoyance, but it is 
 apt to be irritated by the fteces, or stagnation in the blood-flow may 
 be set up. It is exquisitely painful to the touch, and constantly 
 stinging. It is specially acute in women. In severe cases the 
 sufterer can neither stand nor sit, and finds relief only when lying 
 do^m on the flat. 
 
 Piles are brought on by anything which causes a congestion of 
 the lower bowel, as constipation, high living, sedentary life, and 
 affections of the bowel which hinder the return of blood from the 
 fundament and rectum. 
 
 Treatment. — Before treatment for h hemorrhoids is sought, they 
 have usually been present for years, being known as "attacks of 
 piles." The veins have been varicose for years it may be, but consti- 
 pation, excess in food, or a severe wetting has increased the conges- 
 tion and brought on an attack. This is the usual history. In order 
 to prevent piles it is necessary to take plenty of exercise in the open 
 air, to wear warm clothing, and to avoid cold and damp. Constipa- 
 tion is very injurious, and should never be tolerated. In such cases 
 a tablespoonful of pure olive oil every morning after breakfast is 
 
MINOR SURGERY 137 
 
 excellent. Straining at stool, too, is sure to l)e injurious. Whenever 
 the "piles" liave come down after a motion, wash them carefully with 
 cold water and push them up into the bowel. In such a case never 
 use paper but the softest sponge. The muscle which constricts the 
 bowel often tends to strangle the piles and sets up much trouble. 
 Should one have occasion to fear the coming of j^iles he should 
 twice every day inject a teacupful of warm water into the bowel, 
 and before he goes to stool should inject two more teacupfuls. 
 
 When the j)iles are inflamed and stinging, by the jerky contrac- 
 tion of the constrictor muscle of the bowel, let the sufferer sit down 
 on a chamber half filled with very hot water, and let the lips of the 
 anus be steamed thoroughly. Then inject, say, two or three cups of 
 the same hot water into the bowel, and wash it out thoroughly. 
 Then let the suff"erer rest in bed in the horizontal position, and 
 apply hot fomentation cloths with belladonna or opium sprinkled 
 over the same. A 5 per cent, solution of cocaine gives relief. 
 
 When the piles are very much inflamed and indurated they must 
 be removed by a surgeon. 
 
 Hydrocele means a dropsy into the serous membrane which 
 invests the testicle. It is usually a painless, pear-shaped swelling, 
 which only causes uneasiness from its weight. The natives are 
 very subject to it. It may come on as the result of inflammation, or 
 without any apjmrent cause. It is seldom seen before middle life. 
 
 Treatment. — It should be tapped by a moderately sized trocar and 
 canula, and some strong tincture of iodine injected to inflame the 
 membrane and bring about a radical cure. 
 
 Joint affections. — Wherever there is any tendency to affection 
 of the joints, the first thing to do is to attend to the general health. 
 Get healthy surroundings, good food, and improved nutrition by 
 cod-liver oil, malt extract, &c. Tonics, as iron, arsenic, quinine, are 
 on the right lines. 
 
 Let the joint get absolute rest. If it is large, let the sufferer rest 
 in bed till the inflammation — as pain, redness, heat — passes off. 
 If pain is great use warm fomentations, hot poultices, &c.; or make 
 a spirit lotion of rectified spirits 1 part and water 2 parts, soak 
 strips of lint in this and strap the joint. Cover the whole with 
 a thin mackintosh or oiled silk ; this will relieve the pain. If the 
 part is very red and the small vessels throbbing, then a few leeches 
 will do good. If abscesses are present and pointing they should cer- 
 tainly be freely opened as the pus is a poison. Use every anti- 
 septic precaution. 
 
 Synovitis is the inflammation of the synovial membrane, which 
 allows the free gliding of all integuments in or surrounding a joint. 
 
138 HEALTH IN AFRICA 
 
 In the acute affection absolute rest must be secured, and if possible 
 leeches applied to the joint, then to secure continued bleeding 
 apply hot fomentations. Give 4 teaspoonfuls of Epsom salts to 
 act on the bowels. When suppuration occurs only a surgeon can 
 deal with the case. 
 
 Wounds of the lung, as by spears, bullets, &c. Never probe 
 for a bullet. If the spear is broken in the wound pull it out 
 with all possible antiseptic care. Put on a large pad of gauze, and 
 bandage moderately tight, and this will give relief. Order perfect 
 rest, with the sufferer lying upon the wounded side. 
 
 Inflammation of the nail — Onychia. — Tliis affection often 
 gives a great deal of trouble and annoyance. In treating it use 
 carbolic lotion made from 1 teaspoonful carbolic and 8 tablespoon- 
 fuls of water. Let lint be soaked in this, and wrapped round the 
 finger, then envelop in oiled silk or guttapercha tissue, and tie 
 firmly at the distal end to keep tlie moisture within. If the pain is 
 very gr^-at use chloral 1 grains and 2 tablespoonfuls of water ; or 
 iodoform may be dusted over the part. If the nail is destroyed, 
 remove it and dress the matrix. 
 
 Necrosis — death of bone. — This is the death of bone, but is 
 usually restricted to those cases where a piece of the sliaft of a long 
 bone dies, and is enclosed in a layer of new bone. Exfoliation is the 
 death of a thin superficial layer of bone. Caries is the death of 
 the more cancellous or soft bone. 
 
 Treatment. — Endeavour to trace out the cause, as syphilis, and 
 treat it. If struma, then treat it. Wlien abscesses form we must 
 open them, and remove the purient matter. Often matter forms 
 under the periosteum (membrane round the bone), in which case 
 it must be freely and deeply opened. This is about all that can 
 be done — red^ feeding^ opening of abscesses, and special remedies 
 directed against the causes. 
 
 If the exfoliation is seen remove it ; if the dead part is near the 
 surface remove it also, and plug the hole with iodoform, and treat 
 it most carefully with all antiseptic precautions. 
 
 Orchitis, or inflammation of the testicle, may arise from 
 many causes. It is sometimes, by metastatic action, set up in an 
 ordinary course of malarial fever {^ee p. 83). I have known of this 
 taking place on three occasions. 
 
 Treatment. — What is most needed is rest in bed, in the horizontal 
 position, and on the broad of the back. Put a small board between 
 the thighs, and rest the painful enlarged and inflamed testicle on 
 this. It is not always possible to rest, however, in which case 
 the inflamed organ must be supported by bandages. Get a good 
 
MINOR SURGERY 139 
 
 sized handkercliief, and tie it round the waist. Get another, and tie 
 one end to the back of the above girdle, and the other end is brought 
 through between the limbs and tied in front. By this means the 
 testicle will be well supported. At the beginning of the treatment 
 give a full dose of Epsom salts, 4 teaspoonfuls, or other saline purge. 
 Forbid all solid foods, and let the patient take only milk diet. 
 Cold water cloths applied to the organ are good ; but, it may be, 
 that hot fomentations applied every hour, and covered with a thin 
 mackintosh, will give greater relief. 
 
 If the pain is almost unbearable, leeches will give relief, or 
 painting the organ with nitrate of silver 1, to water 6 parts, will 
 alleviate the suffering. 
 
 If suppuration is jjresent, free incision under the most careful 
 antiseptic treatment is indicated. 
 
 Prolapsus ani. — This is a protrusion of the bowel through the 
 anus. Here, obviously, the first thing to do is to push the bowel 
 back within the grasp of the sphincter. This is done by putting 
 the tips of the fingers of one hand together, and pushing the pro- 
 truding mass into its place ; or, it may be necessary to oil the 
 fingers and push them beyond the mass into the bowel, and so slip 
 the whole in. This done put a pad of lint over the anus, and 
 strap the whole firmly. Another very good way, in order to 
 prevent the prolapse (for it usually comes on while at stool), is to 
 inject, previous to a motion, by means of a glycerine syringe, about 
 2 tablespoonfuls of glycerine in a cup of warm water. Let the 
 motion be made while the patient lies on the side, and afterwards 
 inject half a cup of cold water into the bowel. This water may be 
 ejected in a short time. It is absolutely necessary to attend to the 
 general health, and, as it improves, in most cases, the prolapse will 
 gradually become less. 
 
 Retention of the urine. — Here the patient is unable to expel 
 the urine from the bladder. It is due to many causes, as weakness 
 of the system, nervousness, inflammation of the urethra, stone, 
 stricture. There is usually great desire to pass urine, but, notwith- 
 standing all the straining, an inability to do so. In old persons 
 the bladder may be enormously enlarged. 
 
 Treatment. — Let the patient strip, and get into a very hot bath, 
 and, while lounging in the water, endeavour to relieve the distended 
 bladder. Again, if it is due to a stone in the bladder, the urine may 
 flow if the patient lies on his back, or rests on the hands and knees. 
 If this does not occur then a catheter must be passed into the 
 bladder. This instrument is a hollow tube made of silver or rubber 
 or other material. Catheters are known by their numbers, the 
 
140 HEALTH IN AFRICA 
 
 smallest English size being a No. 1, and the largest a No. 12. In 
 passing a catheter the greatest of care and j^atience is absolutely 
 necessary. On the whole the silver instrument is the best. Let the 
 patient lie in a hot bath for about ten minutes, then take a No. 10 
 catheter, rub it briskly by means of a towel and glycerine, so that 
 it is about the temperature of the body ; this done, insert it into 
 the urethra, and gently push it on. When the prostatic region is 
 reached, manipulate perseveringly. 
 
 It may be necessary to tie the catheter into the urethra for a 
 few days, during which time the patient should lie in bed. 
 
 If it is impossil)le to empty the bladder, then, in order to relieve 
 the sufferer, the bladder may be tapped by the aspirator above the 
 pubes. This, however, must be performed by a surgeon. 
 
 Patience, hot baths, a No. 2 gum-elastic catheter, and even 
 chloroform will often work wonders in a case of this kind. 
 
 Rupture or hernia signifies a protrusion of any organ through 
 its natural covering. This may happen in any part of the body. It 
 is, however, usually restricted to a protrusion of any of the abdominal 
 viscera through a natural or forced opening. If we take into account 
 the j)ressure in coughing, &c., to which the organs in the abdomen 
 are subjected, together with the looseness of the various viscera, and 
 the weaknesses of the walls, we can easily see how a hernia may 
 occur. These herniEe may be congenital, from a natural weakness in 
 the walls, or they may arise from the exercise of some abnormal pres- 
 sure. In the projDortion of 1 to 4, men are more subject to rupture 
 than women, although the femoral herniee are most seen in women. 
 Herniae at the umbilicus are very common amongst the Africans, 
 due to the carelessness in attending to the umbilical cord at the 
 period of birth. Every hernia has a covering of skin, then fat, then 
 the lining membrane of the abdomen which is forced on by the boAvel 
 or other Organ. The bowel (usually the small intestine) forms the 
 contents of the sac, but there is usually, along with the bowel, a 
 quantity of secreted fluid. 
 
 Some hernias are reducible, in that they can be pushed back 
 into the abdomen ; others cannot be so reduced, but go on growing 
 larger ; while others again become adherent to the structures over 
 them. Some may be blocked up by indigestible food (as cheese) 
 or hard faeces ; others may become strangulated, by the 02:)ening 
 through which they originally came being closed u]?. 
 
 Treatment. — This is too large a subject for this book, but a word 
 may not be out of keej)ing with the object of our writing. If the 
 hernia is recent, try to reduce it and keep it reduced. Lay the 
 sufferer in a horizontal position in bed, with the head low and the 
 
MINOR SURGERY 141 
 
 hips raised a little, when the hernia may slip in of itself. If not, 
 grasp the tumour by the whole hand and gently roll it, as in a circle, 
 and it may slip in. Then put on a pad, large and firm, with a tight 
 bandage in the figure-of-eight fashion. If a good fitting truss is 
 to be had, it is the best of all. 
 
 If the hernia cannot he reduced, but does not give any great 
 inconvenience, then it must be carefully protected by a bag sus- 
 pender. A bag-truss is best. The bowels must be most carefully 
 studied, and always kept loose. No indigestible food, as cheese, 
 should be taken, as such an irreducible hernia may suddenly 
 manifest signs of the stoppage of the natural motions. The hernia, 
 in such a case, becomes hard and inflamed with twisting pains, 
 sickness, and vomiting. On coughing an impulse can be felt, how- 
 ever. Here let the suff'erer rest with the hips raised on a pillow. 
 Give only cold water to sip. Give a full dose of castor oil to in- 
 crease the natural motion of the organ. After twenty-four hours 
 give a warm water enema, and try if the motion will come. 
 
 If the hernia is hot and inflamed, the patient may have some 
 fever, vomiting, and be generally uneasy, yet on coughing an impulse 
 is felt ; in such a case we conclude the sack itself is all right, but the 
 natural motions through it are stopped. Continue the rest in bed. 
 Give milk only as food. Apply hot fomentations to the part. Give 
 a full dose of castor oil. Give ^ grain morphia to relieve the pain. 
 Try the warm-water enema. As soon as the patient gets a motion 
 a great change will be felt in the tumour, as the pain and inflamma- 
 tion will subside and the .tumour will be soft. By grasping the 
 tumour in the hand try and reduce it as a whole. 
 
 Last of all the boivel may he strangulated. Here the neck of the 
 sac has grasped the protruded bowel and stopped the circulation. 
 This is most dangerous, and can only be touched by a surgeon. 
 
 Sprains or strains designate a violent stretching, and it may 
 be, rupturing of the l)inding fibrous ligaments that are found 
 around joints, together with, it may be, rupture of some of the small 
 blood-vessels, and a consequent extravasation of blood underneath 
 the skin. In severe cases muscles and tendons in the neighbour- 
 hood may be torn asunder. Such sprains are very common in the 
 wrist and the thumb. In the lower extremities the ankle suffers 
 most. A severe sprain of the ankle may be mistaken for a fracture, 
 and in a serious case both may be present. Sometimes the swelling 
 is so great, and the pain so acute, in one or two spots, that it is 
 difficult to say what exactly is wrong. Sprains of the knee are 
 common, and are manifested by great swelling in the knee-joint. 
 Sometimes too the back is seriously strained. The symptoms are 
 
142 HEALTH IN AFRICA 
 
 a sharp stinging pain immediately after a slip or other accident. 
 It may be that a feeling as of something cracking and giving way 
 is felt. Then soon after this sensation there is swelling, and in a 
 few hours the part becomes blue. 
 
 Treatment— -li seen immediately after the accident, and before 
 there is much swelling, put on a bandage somewhat tightly, and con- 
 stantly apply cold water over the Ijandage. If the bandage becomes 
 unbearably tight and unpleasant, take it off, and put the limb into 
 as hot water as can be borne. This is the treatment to apply after 
 the swelling, and other symptoms, have manifested themselves. 
 Absolute rest is a necessity. Put on strips of lint soaked in recti- 
 fied spirit 1 part and warm water 4 parts, and cover it with oiled 
 silk or a thin mackintosh, or hot fomentations continued for a few 
 davs are iroocl. 
 
 Some recommend that sprains should be treated from the very 
 first by pressure. This may be done by strips of plaster being 
 put firmly and neatly lound the whole joint ; or the part may be 
 enveloped in cotton wool, and a bandage firmly applied. The 
 limb must be allowed to rest until the pain and swelling have 
 subsided. If there is a tendency to stiffness, rub the joint twice a 
 da}^ with sweet oil, and exercise the part, manifesting the greatest 
 of care. 
 
 It is well to pay attention to sprains, as they are often the 
 origin of serious after trouble. 
 
 Varicose veins are veins Avhich are preternaturally enlarged 
 Avithout any apparent ]3hysiological reason ; some veins are never so 
 affected, while others are universally involved. Varix is of common 
 occurrence in the sub-mucous veins of the rectum, constituting piles ; 
 others occur in the spermatic veins, giving rise to varicocele ; others 
 in the lower limbs, constituting ordinary varicose veins. 
 
 The affection is seen most in those persons who are of a slow 
 indolent temperament, with weak health, and who also suff'er 
 from the walls of the veins being lax. Some families seem to 
 have a hereditary tendency to this aff'ection. If any member of 
 such a family should have an occuj)ation in which much standing 
 is involved, he is likely to suffer from this affection. If the liver 
 suffers from a disease, in which the organ is contracted, it will im- 
 pede the circulation through it, and cause a stagnation of the veins 
 below. So too with the heart : if it is weak, it will be unable to 
 propel the blood against gravity, and so the circulation in the lower 
 limbs is sluggish. 
 
 Garters compress the veins, so too does the hard faeces in the 
 lower bowel in constipation. 
 
MINOR SURGERY 143 
 
 Treatment. — Support is the treatment called for in affections of 
 the leg. Do this by an elastic webbed bandage. Let this bandage be 
 put on the leg in the morning before rising from bed, and taken off 
 after retiring for the night. Avoid garters, high living, constipation, 
 and long standing in a damp place. The curative treatment by 
 excision or ligature can only be undertaken by a surgeon. 
 
 War.ts are groups of abnormally long papillae of the skin covered 
 by hard dry cuticle. They are horny, and rounded off by friction. 
 They are common on the hands and fingers, and are seldom seen on 
 the face. Very little is known as to their cause. 
 
 Treatment. — Once a day apply, with a straw, a drop of the strong- 
 est glacial acetic acid. What is aimed at is the entire destruction 
 of the growth. When the mass falls off, apply salicylic acid. 
 
 Whitlow is a most painful inflammatory aftection of the fingers 
 which almost always goes on to suppuration. The inflammation 
 may only be in the cellular tissue under the skin or the nail, or it 
 may be in the tendons or sheaths of the tendons, or deeper still, in 
 I he membrane that surrounds the bone. It is an inoculation of 
 septic organisms which have lodged beneath the skin by the medium 
 of some wound. There is a great tenseness and throbbing of the 
 affected finger, and it may be fever and pus. When it aftects the 
 tendons it is very serious, as it may travel up into the arm. 
 
 Treatment. — Immerse the finger in water as hot as can be borne, 
 and put on hot i^oultices covered with boracic acid or carbolic acid. 
 A free and deep incision down to the bone is the only effectual 
 treatment witli the object of allowing the pus under the periosteum 
 to escape. The pain of the incision can be relieved by ether. {See 
 p. 127.) After the incision, dress the wound in the ordinary anti- 
 septic way. 
 
CHAPTER XI 
 THE EYE, EAR, THROAT, AND NOSE 
 
 Sty. — A sty is a small boil on the edge of the eyelid, with a hair 
 coming from its centre. In the very early stages of the ailment, if 
 the eyelash is plucked out, the pus that has formed will be allowed 
 to escape, and the trouble will be at an end. Should, however, 
 matter not have formed, but from the inflamed surface it be evident 
 that pus will form, the following treatment will cut it short. 
 Remove the hair, then dip a needle in pure carbolic acid, and let 
 the smallest drop enter the hole. Never a2Jply poultices to the eye, 
 as they are objectionable, having a tendency to multiply the local 
 collections of pus. If the sty is very painful hot fomentations 
 might be used. When the pus has formed apply a few drops of 
 cocaine, and puncture the little boil, and give free vent to the ]jus. 
 Then apply a little of the yellow oxide of mercury (say 6 grains 
 to 2 tablespoonfuls of lard). This will prevent the return of the 
 local boils. Or make the folh;wing ointment, and three times every 
 day rub it over the lids : cocaine, 4 grains ; red oxide of mercury, 
 3 grains ; vaseline, 6 tablespoonfuls. 
 
 Conjunctivitis is an inflammation of the delicate mucous 
 membrane of the eye. This membrane lines the inner surface of 
 the eyelids, and is reflected over the fore part of the white of the 
 eye (sclerotic), and over the cornea. The part under the lids is thick, 
 white, and very vascular, and is covered with small papillae, which 
 in disease are greatly enlarged, and known as granular lids. On 
 the white of the eye this membrane is loosely attached to the 
 tissue below. It is thinner than that on the lids, and not so 
 vascular. On the cornea it is very thin and very adherent, and 
 in health has no vessels. 
 
 Simple conjunctivitis is a catarrh or a "cold in the eye." 
 The white of the eye is reddish, and there is a secretion of a 
 gummy substance, which makes the eyelids cohere during sleep. 
 The sufferer feels as if sand were in the eyes. 
 
 144 
 
THE EYE, EAR, THROAT, AND NOSE 
 
 145 
 
 Treatment. — Never apply wet cloths or poultices. Any one of the 
 following lotions in their respective strengths is excellent : (1) sul- 
 phate of zinc 5 grains, water 8 tablespoonfuls ; (2) chloride of zinc 
 2 grains, water 8 tablespoonfuls ; (3) boracic acid half a teaspoonful, 
 water 8 tablespoonfuls ; (4) perchloride of mercury 1 grain, water 16 
 tablespoonfuls. These fluids must have access to the surface of the 
 eyeball underneath the lids. Let the patient sit on a chair with 
 the head thrown back, draw down the under lid with the finger 
 and the upper lid with the thumb, and place the drop at the inner 
 angle of the eye near the nose. Then tilt the head over, so 
 that the astringent fluid reaches the whole ball. An eye-dropper 
 {see Fig. 26), or a glass rod, or a camel's-hair brush are all excel- 
 lent for the purpose. The one thing essential is that the fluid 
 bathes the whole ball of the eye. A short course of one of the 
 above astringent medicines applied three times every day is suflS.- 
 cient. When the case does not yield to this mild treatment, evert 
 
 Fig, 26.— Glass Droppee. 
 
 the eyelids and with a camel's-hair brush paint the whole con- 
 junctiva with the following solution : nitrate of silver 10 grains, 
 water 2 tablespoonfuls. Note that the above affection is highly 
 contagious, being usually carried by flies. 
 
 Granular conjunctivitis is an exceedingly chronic and in- 
 tractable disease. It was very prevalent in the French army in 
 Egypt in 1798, and has therefore been called Egyptian ophthalmia. 
 It is due to the overcrowding of dwellings, want of cleanliness, 
 smoky atmosphere in low-lying and damp localities. There are 
 many distinct half-transparent elevations on the conjunctiva, where 
 it envelops the lids, and these are chiefly on the upper lids. It may 
 last for months or for years amongst the Africans. Recently a 
 microbe has been discovered which accounts for its great tendency to 
 spread, and suggests treatment by remedies that are fatal to low life. 
 
 Treatment. — Make a solution of the perchloride of mercury 1 
 grain to 2 tablespoonfuls of water, and apply this freely with a 
 
146 HEALTH IN AFRICA 
 
 camel's-liair brusTi. Put cool compresses to the eyes to keep out tlie 
 light and relieve pain. It is very irresponsive to treatment. 
 
 Injuries to, and foreign bodies in the eye.— There is, in the 
 eye, no proportion between the body that causes the injury and 
 the pain occasioned. A wound that penetrates into the ball may 
 cause less discomfort than the tiniest grain of sand. Lime in the 
 eye is rapidly destructive ; when this, or any other alkali, by 
 accident enters or lodges on the ball, at once insert one or two 
 drojDS of dilute vinegar to neutralise it. If some strong acid, such 
 as sulphuric, enters, then some weak solution of soda should be 
 dropped in, with the same object of neutralisation. After the 
 injury insert a little oil, and cover up the eye from all light. 
 Sometimes guni30wder, as in an explosion, enters the ball ; this 
 should be removed at once by means of a fine camel's-hair brush 
 and warm water, otherwise it will make permanent bluish stains 
 over the white of the ball. Should glass or stone enter the delicate 
 eye, there is little hope of saving it. Other foreign bodies, as dust, 
 soot, sand, flies, grass-seed, cinders, should be washed out with a 
 camel's-hair brush. The expression " into the eye " is in common 
 use, when referring to a mote causing irritation of the eye. By 
 this expression it is not meant that the mote has gained access to 
 the tissues of the eye, but that it is under or between the eye- 
 lids, or on the surface of the ball of the eye. In such a case the 
 eye should never be rubbed by the fingers or knuckles. Rubbing 
 no doubt gives temporary relief, but usually tends to embed the 
 foreign body deeper in the tissues. The best thing to do, until 
 assistance comes, is to completely close the injured eye. This act 
 of closing the eye, in itself, sets up a flow of tears, which may 
 wash the mote away. In washing the eye with a camel's-hair 
 brush we are merely aiding nature, which is always washing the 
 delicate surface with the fluid tears. If dust is not thus removed 
 it lodges under the lid (usually the upper), and rubs the eye every 
 time the lid is lowered in winking ; this causes great pain, as the 
 eye is very highly supplied with sensory nerves. If the dust is not 
 removed it will set up an inflammation. Should this haj)pen, 
 the cause, namely, the particle of dust, is apt to be overlooked. 
 Remove the foreign thing at once, and to do so, catch the eyelash 
 of the lid affected and pull the edge forward ; then by means of 
 a pencil evert the lid and the foreign body will be seen. It can 
 then be removed with a handkerchief or by the camel's-hair brush. 
 Or the sufferer may do the following : Pull forward the upper lid 
 with the finger and thumb of one hand, and with the other hand 
 insert the lower lid under it so as to sweep off the foreign thing. 
 
THE EYE, EAR, THROAT, AND NOSE 147 
 
 Another way is to lift up the iijDper lid and bring it down on the 
 lower lid and rub the eye so as to cause a great flow of tears. At 
 the same time blow the nose very freely. This blowing tends to 
 draw off the great flow of tears by a suction action, which dislodges 
 the irritating mote. 
 
 The ear. — The auricle, or external prominent jiM-t of the ear, 
 often suffers from eczema. So too does the meatus of the organ. The 
 treatment of these in no way differs from treatment of eczema in 
 any other part of the body. For the external ear make an ointment 
 of liquor of lead 60 dro^^s and vaseline 2 tablesj)oonfuls, and apply 
 this twice every day. For the meatus insert a few drops of the 
 lead liquor (say 1 to 40) and this will give relief. Occasionally fill 
 the cavity with warm almond oil, and gently remove all secretions. 
 
 Inflammation of the meatus of the ear is present when little 
 boils or abscesses apjDear in the cavity. These are very common 
 in some persons. Before the little abscess points, and while the 
 pain is very great, counter-irritation is certainly right. Leeches 
 may be j)laced on the auricle, and after they are removed apply 
 hot fomentations to draw off more blood. Or a blister may be 
 applied to the back of the ear. In order to relieve the excessive 
 pain take of cocaine 1 grain, almond oil 25 drops. Of this insert 
 a few droj^s, and it will give relief. An authority recommends in 
 such cases resorcin 5 grains, cocaine 25 grains, in 2 tablespoonfuls 
 of water. Of this a few drops are allowed to fall into the ear and 
 then soaked up on wool. The following is directed against the low 
 form of parasitic life which is believed to be at the bottom of this 
 very troublesome complaint : Take of perch loride of mercury 2 
 grains, rectified spirit (if it is to be had) 6 teaspoonfuls, and 
 water 6 tablespoonfuls, and apply to the inside of the ear on 
 cotton-wool. When the abscess points it should be opened Avith 
 a small abscess knife, and immediate relief will be obtained, then 
 apply dry boracic acid and insert a little cotton- wool. 
 
 Wax and foreign bodies in the ear. — The majority of those 
 who sufter from foreign bodies in the ear are young people, who 
 in their play allow the thing to slip into the external ear. Some 
 of these bodies, as peas, beans, &c., are liable to swell from the heat 
 and moisture, and becoming fixed set up serious trouble. Living 
 things, as insects, irritate the meatus of the ear ; while little things, 
 as beads, buttons, stones, shells, slate-pencil, cause less actual trouble 
 but an ec[ual amount of anxiety. There are certain constitutions 
 which seem more liable to be troubled with wax consolidating than 
 others. Nothing should ever be picked out of the ear by a pin 
 or other hard instrument. A noted specialist says "the point of 
 
148 HEALTH IN AFRICA 
 
 a dagger in the meatus is less likely to do harm than unskilled 
 efforts to remove it." Wax and foreign bodies are removed by 
 syringing with warm water. A good india-rubber enema is best, 
 and should never be introduced within the meatus, but held near. 
 The Huid, too, should be inserted with some force, and continued 
 for a little time. If the auricle is ^^ulled upwards and backwards, 
 the stream will more readily get behind the hardened wax (ceru- 
 men) or foreign body, and so drive it out. Should the wax be very 
 hard and not yield to a moderate amount of syringing, stop the 
 operation for a day, only first insert a little oil or a solution of 
 bicarbonate of soda, say 2 grains to a teaspoonful of water. No 
 endeavour should ever be made to remove a foreign body from 
 the ear which is not seen. All probing in the dark, for the 
 obstructing thing, is highly dangerous. No one should ever 
 "pick" the ear; it may result in the pin or "ear-pick" being 
 driven through the drum membrane. Should the result be bleed- 
 ing, and there be doubt as to whether or not the drum of the ear 
 has been perforated, every care should be taken to i^revent fluid 
 entering the meatus. Should this happen or oil be dropped in, 
 the middle ear is most likely to inflame and cause great trouble. 
 
 Acute catarrh of the middle ear. — This is extremely pain- 
 ful. It is best relieved by a few leeches applied to the auricle of 
 the ear. When the leeches stop sucking, apply hot fomentations 
 and encourage bleeding from the bites. Sometimes, if the case has 
 not gone on very far, the following will give great relief : Put 
 the nozzle of an ordinary enema apparatus well into the nose on 
 the affected side, then with force inject air as the patient is in the 
 act of swallowing a little water. By this means air will go into 
 the middle ear, and mucus may be removed. 
 
 Purulent catarrh (or a "running ear"). — Treat it first as the 
 above, from Avhicli it cannot at the beginning be distinguished. 
 Syringing with weak antiseptic solutions must be done twice or 
 thrice every day. The following is the best : boracic acid 10 grains, 
 water 2 tablespoonfuls. A stronger solution would be carbolic acid 
 1 teaspoonful to water 20 teaspoonfuls. 
 
 Polypi often appear during the course of a "running ear." 
 They should be removed by forceps or a snare. 
 
 The throat. — Simple catarrh of the throat passes by various 
 names, as sore throat, ulcerated sore throat, follicular tonsillitis. It 
 is generally brought on by cold. The mucous membrane in the 
 pharynx {see Fig. 4) is red and swollen. The tonsils, too, may 
 ]3e similarly inflamed, and through the eustachian tubes may affect 
 the ears. Sticky mucus is seen on the inflamed membrane, and 
 
THE EYE, EAR, THROAT, AND NOSE 149 
 
 it may be little patches of blood. When the affection of the 
 throat becomes chronic the redness is less, Init the mucous mem- 
 brane contains pus. In what is known as tonsillitis there is great 
 hypersemia of the tonsils, extending to the roof of the mouth and 
 the uvula. The tonsils are so seriously swollen that they may 
 almost meet in the centre of the throat. Pus may form after a 
 short time. 
 
 The affection usually begins as a cold, with headache and general 
 " out-of-sortness." There is fever up to 103° F. The breath is 
 unpleasant. The voice is muffled in tone, showing that the vocal 
 cords are affected. If there is a severe shivering fit, we know at once 
 that suj)puration has set in. 
 
 Treatment— Qwimne should be given in 5 grain doses every four 
 hours where there is much fever. Antipyrin acts like magic in 
 cases such as this, affecting markedly the pain in the throat, ear, 
 and head. Give a milk diet and strong soups, and if the subject is 
 weak constitutionally, port and claret wines are necessary. Locally 
 use the following gargle, which may be used also as a spray : carbolic 
 acid 1 teaspoonful, hydrochlorate of cocaine 8 grains, glycerine of 
 borax 1 tablespoonful, water 20 tablespoonfuls. This can be painted 
 or sprayed over the sore throat. It is also good where there is 
 hoarseness of speech. 
 
 If the head and throat of the sufferer is steamed in the following 
 manner, great relief in swallowing will be obtained. Procure a large 
 basin of boiling water, and allow the sufferer to lean over the basin 
 and breathe the steam, while the head, shoulders, and basin are 
 covered by a sheet. Cold compresses or warm poultices may be 
 applied to the outside of the throat. 
 
 The chronic sore throat may be painted with glycerine of 
 tannin (this is a teaspoonful of glycerine and a teaspoonful of tannin 
 to a tumbler of water).' 
 
 If abscesses form in the tonsils give a powerful emetic, for the 
 abscess may burst in the. act of vomiting, and so do great good. 
 Sometimes it is imperative to open the abscess by means of a sharp- 
 pointed bistoury. Before making the incision, paint the tonsils 
 with a 6 per cent, solution of cocaine. 
 
 It is imperative to attend to the general health of the patient. 
 Order some preparation of iron, together with cod liver oil. A 
 long sea voyage is often necessary to get up the general health. 
 
 Throat, foreign bodies in the. — Fish bones, coins, and badly 
 masticated meat often cause trouble. A surgeon in such a case 
 would use a horsehair probang, which he would insert into the 
 throat, and as he withdraws it, the instrument expanding, pulls 
 
150 HEALTH IN AFRICA 
 
 out the intruding thing. Swallowing a large piece of bread, with 
 water, sometimes carries the foreign body into the stomach. Where 
 the substance is soft it may be pushed down by an elastic bougie or 
 catheter. If this is not successful, try a smart tap on the back 
 between the shoulders ; then try vomiting, which is most success- 
 ful in dislodging foreign bodies. Vomiting can be set up by tickling 
 the back of the throat, or by giving ^^ grain apomorphia under 
 the skin. Then a ball of thread, about the size of a marble, may 
 be firmly wound, and having attached to it a strong piece of silk 
 cord or string, it can be swallowed in jam and withdrawn. In the 
 process it may dislodge the foreign body that sticks in the gullet. 
 
 If an angular thing is swallowed or a piece of glass, never give 
 a purgative ; rather give dry bread, biscuits, and hard-boiled eggs, 
 the idea being that the glass may be enveloped in the putty-like 
 substance, and be carried gradually along, and not cut the bowel. 
 Coins, glass, spicules of bone, &c., often pass through the bowel 
 without lacerating the same or causing much injury. 
 
 Foreign bodies in the nose. — Children suffer most from 
 foreign bodies in the nose. Often in their play, without thinking, 
 they push such bodies as beads, buttons, nuts, carpet tacks, pieces 
 of stone, sweets, beans, pins, &c., into the cavity of the nostril. 
 The amount of irritation occasioned depends on the article intro- 
 duced. The cavity of the nose, however, is capacious, and allows 
 plenty of room for an ordinary foreign body. 
 
 Treatment. — Try and dislodge the irritant. Tickle the other 
 nostril by a feather, and set up violent sneezing. Snuff may be 
 used with this object in view. If this is not successful syringe 
 the nostril with hot fluid, causing a strong current to play on the 
 back of the foreign body. 
 
 Bleeding at the nose. — In such a case take a small plug of lint 
 and moisten it in a solution of antipyrin 1 to water 2, and insert 
 into the nostril. This drug, antipyrin, is most rapid and powerful 
 in stopping the flow of blood. 
 
CHAPTER XII 
 
 EMERGENCY CASES 
 
 Cases of poisoning. — Poisoning may take place by a person 
 accidentally swallowing a poisonous drug, or eating poisonous food, 
 such as affected tinned meat. It may even be that a poison is 
 taken with the object of destroying life — a suicide. In being 
 called upon to treat such cases, first find out exactly what has been 
 taken, then without loss of time cause the stomach to evacuate its 
 contents. This may be done by tickling the back of the throat 
 with the finger, or by injecting one tabloid of apomorphia hyj)oder- 
 mically. This drug is most useful when the sufferer is unable to 
 swallow. Another means of emptying the stomach is by the 
 " stomach pump," if it is at hand. In using this pump, let the suf- 
 ferer sit on a chair with the head steadied by an assistant ; then 
 by means of the left index finger depress the tongue, and push the 
 tube boldly into the mouth, towards the back of the throat and gullet, 
 till the stomach is reached. Before inserting smear the tube with 
 glycerine, or vaseline, or olive oil. Ask the patient to " swallow " 
 the tube. The tube inserted, pump off the contents of the organ. 
 Eeverse the working of the instrument, and inject a little clean 
 water from time to time, and so wash everything out. If you know 
 the nature of the poison swallowed, mix a little of the antidote in 
 the water, and inject it. If it is a case of poisoning by drink or 
 opium, give one or other of the following emetics : 10 grains of 
 sulphate of copper, or 30 grains of sulphate of zinc ; mustard in 
 3-teaspoonful doses, in large cups of tepid water, is most effective ; 
 also tepid water with plenty of soap, or grease, or salt in it. The 
 idea being to bring on nausea, and so empty the stomach. 
 
 The next thing is, knowing the poison, to neutralise it chenii- 
 cally, as : — 
 
 (1) For all acid poisons, as acetic acid, sulphuric acid, hydro- 
 chloric acid, &c., give plenty of soap and water to drink ; 
 chalk or whitewash (taken from the wall of a house), or 
 magnesia, are on the right lines, 
 
 151 
 
152 HEALTH IN AFRICA 
 
 (2) For all alkali poisons, as caustic soda, ammonia, give 
 
 vinegar and oils. 
 
 (3) Alcohol. — Make tlie sufferer vomit promptly. Give 
 
 strong coffee with a little spirits in it to drink. Put 
 mustard poultices over tlie stomach. In desperate cases 
 the soles of the feet may be plunged in boiling water, 
 so as to cause immediate blistering. Or inject hypo- 
 clermically ^ grain of strychnine. Give hot coffee to 
 the extent of two cuj)s, by the bowel. Rouse by 
 slapping with wet towels, putting cold water on the 
 head, and forcing the unfortunate person to walk. 
 Vermin-hilling powders usually contain strychnine in consider- 
 able quantity. Crayons, and such like substances, contain chromic 
 acid, arsenic, and lead. Fly ^^o^pers generally have some preparation 
 of arsenic, and rat pastes have arsenic too, with the addition of 
 phosphorus. 
 
 If the sufferer has collapsed, that is to say, if he is cold, stupid, or 
 utterly j)rostrate, stimulants must be given either in the form of 
 brandy or whisky, to the extent of 1 to 4 teaspoon fuls, or ammonia 
 (sal- volatile), may be offered. Ether may be given by the mouth, 
 or 1 teaspoonful hypodermically. Strong coffee, Liebig's extract, 
 or bovril may be injected, while hot, into the bowel. If there is 
 very great j^ain, one or two tabloids of morj)hine may be given 
 hypodermically. 
 
 Cases of drowning. — When an apparently drowned person 
 is drawn from the water everything possible should be done 
 immediately to restore the natural breathing. Lay the drowned man 
 on his back, and with a pair of scissors remove the collar from the 
 neck and all clothing about the chest, and by means of a towel dry 
 and rub the skin. If there should be any mud or grass in the 
 mouth let it be removed. Look after the tongue, which will be found 
 lying limp at the back of the throat, and by means of a pair of artery 
 forceps, if these are at hand, draw it forward. Keep the tongue 
 forward with the fingers, or by means of an elastic band bind 
 it to the chin. The idea is so to fix the tongue that it will not 
 fall back and cause choking. Turn the drowned person on his 
 face, with his arm under his forehead, and his jacket (or other 
 hard thing) rolled \\\) under his stomach, press several times 
 with all your weight, for four or five seconds, on the back, and 
 endeavour to let the water run from the stomach and chest. 
 This done, put him on his back again, and j)lace the rolled-up 
 jacket under his back, and at once begin artificial resj^iration after 
 Sylvester's method. Make sure that the tongue is not in the back 
 
EMERGENCY CASES 153 
 
 of the tliroat, but if j)Ossible, hanging out of the mouth. If this 
 method of restoration can be performed on a table with the far-off 
 end tilted uj) so much the better, but if not, let the patient lie on 
 the ground. The operator should kneel at the head of the un- 
 conscious person, and grasping the arms firmly about the elbows 
 (see Fig. 27), bend the arms over the chest, and press firmly 
 
 Arms drawn up as far as possible to bring about Inspiration 
 
 OF Air. 
 
 Arms bent on the Chest. 
 
 (The operator rests on the chest, while an assistant drives the abdominal 
 viscera upwards towards the diaphragm to bring about expiration.) 
 
 Fig. 27. 
 
 the sides of the body. An assistant at this moment drives the 
 viscera of the abdomen upwards nnder the ribs towards the dia- 
 phragm. The idea is to drive the air out of the lungs. Press the 
 sides of the chest very firmly for at least four seconds ; then quickly 
 raise the arms above the head, drawing them out somewhat. The 
 idea here is to draw air into the lungs. Keep the arms drawn out 
 
154 HEALTH IN AFRICA 
 
 for two more seconds. Again bend tlie arms over the chest for two 
 
 seconds, pressing the sides very firmly, and again draw the arms over 
 the head. Continue this operation without interruption about 
 fifteen times in the minute, imitating natural breathing. While 
 this is being done, others may apply a nitrate of amyl tabloid to 
 the nostrils of the unconscious one, or ammonia or burned feathers, 
 if nothing else is to be had. Others, again, may be removing the 
 wet clothing, and drying and rubbing the limbs, applying warm- 
 water bottles, &c. Another good thing is to throw a little hot water 
 on the chest, and immediately after, sprinkle a little cold water, with 
 the idea of setting up reflex ins23iration — gasping. Nothing, how- 
 ever, is to take the place of the regular artificial respiration performed 
 by the operator on the arms of the unconscious person, and hope 
 should not be abandoned for at least an hour or an hour and a half. 
 When natural breathing is set up stop this artificial mode, and 
 continue the rubbing upwards of the limbs. Put on plenty of warm 
 clothing. If possible put the patient in a warm bed, with hot- water 
 bottles or warm bricks around him. If he is able to swallow, put a 
 teaspoonful of brandy and two of water at the back of the tliroat, 
 or on the tongue. When he is becoming warmer, it would be 
 well to hypodermically inject 20 drops of ether, or 10 drops of 
 brandy, at the same time giving jDlenty of hot water to drink. He 
 should be kept perfectly quiet for at least a week, the danger to be 
 guarded against being pneumonia. 
 
 Artificial respiration may be resorted to in cases of fainting, 
 poisoning, suffocation from swallowing or inhalation of poisonous 
 gas, or anything that interferes with natural breathing. 
 
 Snake bites. — In treating the bite of a snake apply, immediately, 
 a ligature of some kind above the bite, and suck the wound vigor- 
 ously for a minute. Spit out the saliva and blood, and wash out the 
 mouth with Condy's fluid or 1-60 of carbolic acid. If the mucous 
 membrane of the mouth is free from any abrasion, this proceeding 
 is harmless; it may be otherwise if there is a wound in the mouth. 
 Cut out the bitten point and destroy the tissues in the wound 
 with juire carbolic acid. In the majority of bites this treatment 
 will be successful. Indians are said, immediately on the receipt of a 
 bite, to pinch the spot up and to bite it out, or should a finger be 
 bitten, to cut it off. This is a wise proceeding, as the venom of some 
 snakes is remarkably absorptive. The method by which snake 
 poison destroys life depends upon the concentration N^-ith which the 
 venom reaches the circulation. When this concentration reaches 
 the blood in a certain state, death may be almost instantaneous. 
 This is often the case when small animals are bitten, or when the 
 
EMERGENCY CASES 155 
 
 undiluted poison is injected directly into the blood of a vein. It 
 is sometimes difficult to be absolutely sure that you are dealing 
 with a snake bite. The following, however, are signs that cannot 
 be mistaken. In a typical hite, there are the marks of the teeth of 
 the lower jaw on the skin in addition to the two distinct punctures 
 of the fangs. In such a case there is always a history of the snake 
 holding on to the limb, as is the case in a bite from another animal, 
 say a dog. The tissues surrounding the bite are slightly swollen, 
 and there is a bleeding or oozing of blood or watery matter from 
 the actual bite. In cm incomplete hite we may get any stage from 
 the above typical bite, with two actual punctures, down to a mere 
 scratching of the upper layers of skin. In recent years strych- 
 nine to the amount of Jy of a grain every hour has been given h3q3o- 
 dermically, so also has permanganate of potash. The medical 
 world, however, hopes the greatest of results from the recent experi- 
 ments of Professor Fraser. He found that, by injecting very small 
 doses of snake poison into an animal (say a rabbit), it did not 
 kill the rabbit, but that the animal gradually acquired a power of 
 resisting the poison of even larger doses than would be injected 
 in an ordinary bite. Not only so, but he i'ound that the serum 
 of this animal which had been operated upon, if injected into 
 the blood of another animal, gave it also the power of resisting 
 the snake poison. Both had acquired an immunity against snake 
 poison. Still further, if the serum was injected into an animal 
 that was likely to die of a bite, it also acquired power of resist- 
 ing the poison. This serum of an animal protected against large 
 poisonous doses of snake virum is named antivenene, and is now 
 being manufactured for the treatment of all snake bites. 
 
 Bites by dogs, hyaenas, &c.— Should a person receive a bite 
 from a dog, he may be haunted by the idea of the dog having 
 been rabid, or of it becoming rabid at some future period, and 
 of his being seized by that awful affliction hydrophobia. When 
 Ave speak of a dog being " rabid," we mean that it is suffering from 
 a disease characterised by a well-known series of nervous phenomena, 
 and known as " rabies." When a dog is seized with this disease it 
 has a peculiar tendency to attack other dogs. The disease is due to 
 a low organism in the blood of the dog, and when this organism 
 appears in the blood of man, it sets up the disease known as hydro- 
 phobia. These two, rabies and hydrojjhohia, are distinct diseases. A 
 dog when it suffers from rabies has no actual fear of water, but a 
 human being has a mysterious dread of the fluid. The very presence 
 of water sets up a series of distressing nervous symptoms. Hydro- 
 phobia is a disease in man due to a specific organism, as the result of 
 
156 HEALTH IN AFRICA 
 
 an animal poison, introduced into his blood usually by a rabid dog. 
 Rabies, however, occurs in other animals besides dogs. It has been 
 seen in wolves, jackals, hysenas, foxes, cats, horses, pigs, goats, sheep, 
 oxen, and antelope, consequently it may be set up by the bites of 
 any of these animals. 
 
 The poison is usually in the saliva of the stricken animal, so that 
 the clothing offers a great means of protection against the bite. It 
 is well to note, too, that very few excited dogs are really rabid — few 
 indeed, and still fewer of those persons bitten really suffer from evil 
 effects. Ordinary dog bites, as everybody knows, are extremely 
 common, but hydrophobia is one of the rarest of diseases. 
 
 Treatment. — If the wound is a bite from an ordinary angry dog, 
 wash it well with warm 1-40 carbolic acid, and dress it in the usual 
 way. It is well here to mention that no subsequent illness of the 
 dog can affect the person who has been bitten, and that consequently 
 there is no need to destroy the unfortunate animal. It is only if the 
 dog is rabid at the moment of inflicting the bite, that any evil after- 
 effect can accrue. 
 
 Should you fear, however, that the dog is rabid, then^rsi do your 
 utmost to prevent the poison from entering the system. Grasp the 
 limb above the bite, and tie on a ligature by means of a handker- 
 chief, twisting it by a piece of stick. Second^ get rid of the local 
 poison. Do so by allowing, if possible, the bitten person to suck 
 the wound, ejecting the saliva. There is no danger here, provided 
 the mucous membrane on the inner surface of the mouth is without 
 abrasion, or the lips not cracked. Wash the wound with Condy's 
 fluid and encourage it to bleed freely. Then burn the wound with 
 nitrate of silver, or if that is not at hand burn it by a red-hot 
 wire or poker. Others advocate the excision of the bite altogether. 
 Sportsmen in India, on being bitten by snakes, put a little gun- 
 powder into the wound and ignite it. This would not be unwise 
 treatment in the present case. 
 
 Stings. — In a country such as Africa, where insect life abounds, 
 not a day passes without people being stung. It is therefore impor- 
 tant to know what to do in such a case. Where wasps or bees have 
 stung, immediately apply some strong liquor ammonia. This will 
 give instant relief. Examine the spot with care, and if the sting has 
 been broken, and left in the tissues, by means of a pair of forceps or a 
 watchkey pressed forcibly over the spot, the sting may be extracted. 
 If liquor ammonia is not at hand, use a strong watery solution of 
 ordinary baking or washing soda, and it will give a measure of relief. 
 Oil of peppermint is also good. Carbolic acid 1 part to 8 parts of 
 water freely applied is also on the right lines. 
 
EMERGENCY CASES 157 
 
 If the parts have been allowed to swell much, apply no ammonia, 
 but a large moist poultice instead. 
 
 In treating a scorpion bite apply the above ammonia and 
 carbolic acid, or a little chloroform laid on the spot will give relief. 
 A recent number of the Lancet recommends the following very 
 highly : Take of camphor and hydrate of chloral equal quantities, 
 and rub them together in a warm mortar ; puncture the sting of 
 the scorpion with a needle, and rub freely with this preparation. 
 This is also recommended to be painted on painful parts in 
 neuralgia and rheumatism. 
 
 Mosquito bites are relieved by the oil of peppermint, or by the 
 above camphor and hydrate of chloral. 
 
 Spider bites are best treated by first making a very small incision 
 over the part, and rubbing in carbolic acid 1 to water 8. An 
 authority has recommended the following in venomous bites of all 
 kinds : ^ grain of strychnine to be injected hypodermically every 
 hour for six successive hours. 
 
 Insect bites are, according to the Lyon Medical for September 
 1896, best treated by a few drops of the following being placed on 
 the bite : — 
 
 Ammonia water .... 40 drops, 
 Salicylic acid ..... 4^ grains, 
 Collodion '''G „ 
 
 Another prescription is the following : — 
 
 Collodion .... 3^ teaspoonfuls, 
 Salicylic acid . . . 15 grains. 
 Benzoin . . . . 15 „ 
 
 Should these remedies not be at hand when the bite is stinging, 
 apply a small ligature to the finger or limb above the sting, and 
 suck the spot with vigour. There is no danger in swallowing the 
 poison, but it would be wise to eject it. 
 
CHAPTER XIII 
 BANDAGES AND BANDAGING 
 
 The reasons for applying bandages to a limb are various. Tbey are 
 applied to keep a part of the body at rest, to support the circulation 
 of parts that are weak, to apply uniform pressure over parts that 
 are swollen, to make compression over points that are bleeding, and 
 to retain the dressings of a wound, or the apparatus on a broken 
 limb. There are really only two varieties of bandages, the ordinary 
 roller, and the handkerchief or triangular. 
 
 The roller bandage is of ordinary calico, but may be made, 
 for special purposes, from flannel or elastic webbing. In length 
 it is usually about 6 yards, and the rule for its breadth is that it be 
 one-fifth of the circumference of the part of the body to which it is 
 to be applied. In ajDplying such a bandage, in order to keep up the 
 circulation, always commence at the extremity of the limb, and 
 bandage from below upwards, towards the body itself. It should 
 cover the whole limb, and be applied with equal pressure through- 
 out. If in a part, such as the lower limb, which is hanging, it 
 be applied firm in one part and slack in another, swelling and 
 pain will be occasioned where the bandage is less firmly applied. 
 This cannot occur where the bandage is bound to the limb with 
 gentle uniform pressure. Never bandage two surfaces of skin 
 together, like two fingers, as the sweat and other secretions of the 
 skin are sure to lead to irritation and discomfort. Bandage each 
 finger separately by means of the |-inch-broad finger bandage ; or 
 if the fingers must be bandaged as one, put a layer of boracic lint 
 between each finger. In some cases, where the material of the 
 bandage is hard and inelastic, and the skin delicate, interpose some 
 soft material, as a closely fitting woollen sock, between the skin and 
 the bandage. In ordinary cases, however, the common bandage 
 may be applied directly to the skin without injury. 
 
 It is absolutely necessary, in order to keep the bandage on the 
 limb without slipping, that both ends be secured firmly. When 
 beginning, be careful first to bandage from below upwards, and 
 
 158 
 
BANDAGES AND BANDAGING 
 
 159 
 
 from witliin outwards ; then fix the lower end of the bandage by 
 making one or two turns above and below the joint (say the ankle), 
 in a figure-of-eight fashion, thus : O. This completed, make one 
 
 more turn over the foot (or limb), and gradually work up. Make 
 it a rule never to go on till the lower end is fixed at the joint, 
 then gradually work up, covering the part to be bandaged by en- 
 .circling it so that each turn covers two-thirds of the previous turn. 
 Always use the bandage so that the frayed edge, and not the selvage 
 falls on the limb. In parts of the limb which get thick rapidly, 
 it is necessary, in following out this rule, to " reverse " the bandage, 
 otherwise it will run \\y> the limb and leave spaces uncovered. 
 Hold the coiled bandage loosely in the hand, while the thumb of 
 
 Fig. 28.— Bandage torn down the Middle and secured by a 
 Half Knot. 
 
 (End of bandage is torn down for 8 inches, and half knotted, so that the two 
 ends can be utilised for tying when the bandaging is completed. ) 
 
 the other hand lies on the turn just made ; then make the turn 
 of the bandage upon itself, and it will lie closely on the skin. 
 By this means no portion of skin is uncovered, even in the most 
 conical parts of the limb. The bandage at the top may be fastened 
 by a safety-pin, or better still by tearing the free end down for 
 about 6 or 8 inches, making a half knot, to save it from tearing 
 down further (see Fig. 28), and by these two tails securing the limb 
 in a loop round the leg. 
 
 A bandage for the fingers should be | in. wide and 1 yard long, 
 arm „ 2^ „ 4 
 
 » leg „ 3 „ 8 
 
 chest „ G „ 6 
 
160 HEALTH IN AFRICA 
 
 In winding up a bandage, crumple up the ends into a small ball, 
 and roll from without inwards. {See Fig. 29.) 
 
 When an arm or a leg is bandaged, the toes and finger tips are 
 always left uncovered. In order to test whether or not the bandage 
 is too tight, look at the nails of the fingers or toes ; if they are 
 dusky or very cold, and the patient complains of excessive numb- 
 ness, press on them so as to drive out the blood ; if the redness 
 comes back at once, the bandage is all right, if not it is too tight, 
 and should be reapjDlied. {See Figs. 30, 31.) 
 
 The triangular bandage.— If we take a sc[uare yard of ordinary 
 calico and cut it dias^onallv from corner to corner, we will get an 
 
 Fig. 29. — Windes^g up a Bandage. 
 
 ordinary triangular bandage. A pocket-handkerchief cut in the 
 same way does admirably. As in the case of the common bandage, 
 this may be used for a variety of purposes. If we desire to fix 
 some flat dressing on a part of the body, and so cover a large sur- 
 face, the bandage may be applied unfolded. If we desire to apply 
 pressure to a spot we can fold it lengthwise, and so gain our 
 object. Then it can be used as a sling, rolled up thus, when it is 
 desired to support the hand only (see Fig. 32) ; or if we desire to 
 support the whole forearm we must apply the triangular bandage 
 fully opened out. {See Fig. 33.) 
 
 In ajyplying a sling to the ujjper liiiib it is necessary to bear in 
 
BANDAGES AND BANDAGING 
 
 161 
 
 Fig. 30. — Bandaging of the Left Arm. 
 
 (The bandage should be 4 yards long and 2| inches wide. 
 Let the patient extend the arm. Hold the bandage 
 in the right hand, allowing the end to run below. 
 Begin by placing the end over the back of the fore- 
 finger. Make a figure-of-eight round the wrist and 
 between the thumb and forefinger. Then work up 
 the limb, making reverses whenever the bandage tends 
 to run off when you keep it closely laid on the arm. 
 At the bend of the elbow make another figure-of- 
 eight so as to allow the arm to bend. Finish off by 
 one or two extra turns, tearing the end into two 
 tails and tying. ) 
 
 Fig. 31. — Bandaging of 
 Left Foot. 
 
 (Extend the patient's foot. 
 Stand in front with the 
 bandage in the right hand. 
 Let the tail of the bandage 
 run from below thus — 
 
 and place it on the ball of 
 the great toe. Make a figure- 
 of-eight on the ankle, and 
 tie when finishing off.) 
 
102 
 
 HEALTH IN AFRICA 
 
 mind one or two details. {See Fig. 33.) The base of the triangle 
 is always applied to the arm that is to be supported. Let the limb 
 lie over the bandage, with the hand well up towards the opposite 
 
 Fig. 32.— Triangular Bandage folded supporting the 
 Hand only. 
 
 Fig. 33.— Triangular Bandage supporting the 
 Right Forearm. 
 
 (The base of the bandage is laid under the arm in the right arm-pit, 
 and the tail over the right shoulder. The other tail is laid over the 
 left shoulder with the arm across the chest, and enclosed by the 
 bandage. The ends are tied behind the neck, and for neatness the 
 loose end is tucked under and secured by a safety-pin. On no account, 
 however, should the pin bear any weight. 
 
BANDAGES AND BANDAGING 163 
 
 shoulder. Let the base be put well into the armpit, while the end 
 lies over the shoulder of the arm to be slung. Eaise the other end 
 of the bandage, laying it over the opposite shoulder, and let the 
 two ends be tied in a " reef " knot, behind the neck, while the limb 
 is raised or pulled up to the desired height. Allow the arm to rest 
 easily, and to improve the appearance of the sling tuck the ends 
 underneath, and secure them by safety-pins. No weight, however, 
 should be put on the pins. 
 
 In applying the triangular bandage to support the elhuw, the base 
 of the bandage is placed in the armpit with the arm laid across the 
 bandage and well up towards the oppo^te shoulder. The other end 
 of the bandage is laid over the opposite shoulder, and as the arm is 
 well drawn forward, the two ends are secured at the back of the 
 neck. The angles and dependent parts are now tucked in and 
 secured by safety-pins. 
 
 Common sense teaches us to fold and apply this bandage to 
 quite a variety of wounds, which it is unnecessary here to enume- 
 rate in detail. 
 
 A surgeon in the exercise of his profession has many bandages 
 besides the above, as the " looped " bandage for the heel, the " T " 
 bandage, the " four- tailed " bandage, the " many- tailed " bandage, 
 &c., but the above two general divisions are sufficient for our 
 purpose. 
 
CHAPTER XIV 
 FRACTURES. AND DISLOCATIONS 
 
 Fractures. — A fracture is a break in a bone made suddenly, 
 either by a blow or a twist. They are among the commonest of 
 injuries. They may be classified as simple when the bone only is 
 broken, the skin and tissues being entire, and compound, when, 
 in addition to the bone being broken, the skin and tissues are 
 ruptured, so that the external air enters to the seat of fracture, 
 and the low forms of life find, in the weakened tissues, a nidus, and 
 set up suppuration. 
 
 The bone may be broken transversely or obliquely, or it may 
 be quite comminuted. On the other hand it may be only cracked, 
 as is often seen in the bones of the skull, or bent after the fashion 
 of a " green stick," as is seen in the bones of very young people ; 
 or, lastly, one part of the hard bone may be driven into the softer 
 bone. Fractures are mostly in the long hones, particularly in the 
 collar-bone and the forearm-bone (radius) above the wrist. 
 
 The causes are usually a straight blow, a violent twist, or great 
 muscular action. 
 
 The signs of fracture are j)ain on movement, unnatural swelling, 
 deformity of some kind, as shortening, or unnatural rotation of the 
 limb. None of these signs are to be absolutely depended upon, as 
 for instance, there is no unnatural movement when only one of 
 the bones of the forearm or leg is broken — the other bone may act 
 as a splint. Usually, however, there is a grating of one bone on 
 another. Then, on running the fingers along the bone, there is 
 felt to be a distinct break. This, however, is only felt when the 
 swelling is absent. 
 
 In addition to some of the above signs you will have a history, 
 with the patient affirming that he felt a "snap" or " break" of the 
 bone of the injured limb. 
 
 It is most important to examine the fracture of a bone as soon 
 after the accident as possible, otherwise swelling will set in and 
 
 164 
 
FRACTURES AND DISLOCATIONS 165 
 
 mask tlie injury. On examining the disabled limb, be careful to 
 have the opjDOsite limb alongside and uncovered, so that at once 
 any difference in the contour may be detected. Move the disabled 
 limb as little as possible, for, apart from the pain, the splinters of 
 bone may tear the tissues, or may even pierce the skin, and make a 
 simple fracture into a compound fracture, — a most serious calamity. 
 If possible examine the limb where the accident has taken place. 
 With scissors cut off the clothes, never attempting, on any considera- 
 tion, to remove them in the ord inary way. Having ascertained that 
 there has been a fracture, support the bones temporarily by means 
 of a walking-stick, the shaft of a spear, bark of a tree, or other 
 unbendable substance. Ordinary reeds would answer the purpose 
 admirably. For tying, use handkerchiefs or bandages, made out 
 of the ordinary calico found in every caravan or house. Common 
 sense must select the best splint and the means of fixing the same. 
 Even the temporary splints should be padded by dry grass, fine 
 leaves, clean native cloth, calico, or other soft substance. Apply 
 two splints well padded, one on the outside and one on the inside 
 of the broken limb, grasping the broken bones above and below 
 the seat of fracture, in such a way as to prevent all unnatural 
 movement. If the injury is in the lower limb, tie the two limbs 
 together, so that the sound one will act as a splint to the disabled 
 member. In the case of the leg, the temporary splint (every splint 
 indeed) should be long enough to reach from the joint above to 
 the joint below. Usually in the case of the leg a long splint is 
 an advantage. If the broken limb is an arm, support it from the 
 shoulder by means of a sling, but if it is the leg the sufferer must 
 on no account attempt to rise from, the recumbent position ; he 
 must be carried on a machilla, a blanket, a native door, or a hurdle, 
 made of long straight poles. 
 
 When arranging to treat the limb 'permanently^ see that the patient 
 lies on a good hard hair bed, if it is to be had. Do not let him 
 fall into a hollow, or he will lie twisted, and so affect the after- 
 healing of the limb. Have the bandages, splints, &c., in readiness. 
 The splints should be lined with padding, so that when bandaged to 
 the limb, they may offer an even pressure all over, and not unduly 
 injure any prominence. Never put the bare s]3lint on the limb, 
 but pad it with cotton wool or other soft material, and with a 
 light bandage attach the cotton to the sjolint. Look out for pro- 
 minences of bone, and adapt the whole accurately. On fixing the 
 limb see that the broken pieces of bone are brought together, and 
 in accurate position. Comj^are it carefully with the opposite limb. 
 The two must be the same in length and contour, making account 
 
166 HEALTH IN AFRICA 
 
 of course for the swelling. Xext keep these iDroken pieces thus 
 accurately together hy the splints and bandages. This is the prin- 
 ciple which underlies the setting of a limb. 
 
 It may be that one is not absolutely sure that there is a frac- 
 ture of the bone. In such a case the rule is to put the limb up 
 as if there had been a break in the bone, and if it turns out after- 
 wards that you have made a mistake, no harm has been done. 
 On the other hand, if there is a fracture, and nothing has been 
 done to keep the bones in accurate position, untold mischief may 
 be the result. 
 
 Common sense must fix the splints so that the bones are accu- 
 rately kept in position. Do so by tying and bandaging the splints 
 to the limb. When putting on a bandage over the splints, do not 
 bind too tight, as this will lead to swelling ; on the other hand, the 
 bones must be kept in accurate position. When the bandaging is 
 complete, put the limb carefully in the position which allows the 
 most complete relaxation of the muscles ; in other words, bend the 
 knee a little, and put the arm in a natui-al position. Let the foot 
 of the bed be raised up, say six inches or so. This completed, the 
 less it is interfered with the better for the limb. 
 
 The healing of a fracture takes place by the broken ends being 
 united by new bone. At first this "new bone" is soft and pliable, 
 but gradually nature, knowing that soft bone is useless, impreg- 
 nates it with bone salts, which it completes in from four to eight 
 weeks. The older the subject of the fracture, and the bigger the 
 bone, the longer is the healing process. If the bones have been 
 kept accurately together, and no movement of them allowed, they 
 will unite without any deformity ; but if not, they may heal in a 
 crooked fashion, or not heal at all. If the health is low, or the 
 splints have failed to keep the parts accurately together, they may 
 be united by a fibrous tissue instead of bone, or if rest is too long 
 continued, the healing process may not only have united the bones, 
 but have fixed the tendons and ligaments around, by fibrous 
 adhesions, so that the joints become stiff. We endeavour, there- 
 fore, to avoid both of these extremes. 
 
 INDIVIDUAL FRACTURES 
 
 Fracture of the collar-bone and its treatment.— This is one 
 
 of the commonest of fractures. The shoulder is displaced usually 
 downwards, inwards, and forwards. The ends of the bones can be 
 
FRACTURES AND DISLOCATIONS 
 
 167 
 
 felt riding one above the other. Take an ordinary cotton triangular 
 bandage, and roll it up somewhat, placing a pad of cotton in the 
 centre. Wash carefully the armpit of the injured side with cold 
 water and soap. Place the pad of cotton wool in the armpit, 
 taking the ends of the bandage over the opposite shoulder, and 
 tying them under the unaffected armpit. This will raise the arm up 
 a little. Then take a triangular bandage, and lay one end over the 
 injured shoulder, with the base of the bandage under the injured 
 arm, and, of course, the upper angle away. Then bend the injured 
 arm in such a way that the fingers touch the opposite shoulder. 
 Raise up the lower angle of the bandage and place it over the sound 
 
 Fig. 34. 
 
 shoulder, and tie behind the neck. Pin up the hanging angle, and 
 the bandage will su^Dport the elbow. Now bind the arm of the 
 injured shoulder tightly to the body with a roller bandage. It 
 would be well to sew on these bandages lest they come off. If 
 there is a great tendency, owing to the exact position of the 
 fracture of the collar-bone, for the shoulder to fall forward, 
 then it would be well to tie back the shoulders by means of two 
 loops of bandage, or two triangular bandages after this fashion. 
 {See Fig. 34.) 
 
 Fracture of the arm-bone — the bone between the shoulder 
 and the elbow (humerus). Here the usual fracture is about the 
 middle third of the shaft of the bone, and the ends are easily recog- 
 nised as riding one on the top of the other. Begin by most care- 
 
168 
 
 HEALTH IN AFRICA 
 
 fully bandaging the forearm from the fingers to the elbow, getting 
 an assistant to hold the disabled arm steady. Then make a short, 
 narrow splint to extend from the armpit to the elbow. This, how- 
 ever, must not go too far into the armpit, or it will inflame the part. 
 Get a second narrow splint to extend from the front of the shoulder 
 to the elbow, and a third from the outer shoulder to the elbow, and 
 it may be a fourth. Let all these be well padded with cotton, and 
 see that they are not too long, or likely to rub on bony prominences. 
 Then adjust the splints, tying them to the arm by means of tapes 
 or small bandages. Place the hand and wrist in a splint, but let 
 the elbow be kept free. To do so let the angle of the triangular 
 bandage be placed over the shoulder opposite to the injured arm, in 
 
 Fig, 35.— Fractuee of the Right Uppee Aem. 
 
 such a way that the base of the triangle lies to the outside, and the 
 upper angle towards the elbow. Then raise the dependent end 
 over the injured shoulder, and tie. It is well also, Avith a broad 
 bandage, to bind the disabled arm to the body with some degree 
 of firmness. (See Fig. 35.) 
 
 Fracture of the forearm bones. — The radius is the outer bone, 
 running from the elbow to the thumb, the ulna is the lower and 
 the weaker bone, running from the elbow to the little finger. Two 
 splints should be used here, rather broader than the arm, the inner 
 one reaching from the bend of the elbow to the wrist, and the 
 outer from the elbow to the tips of the fingers. They are to be 
 fixed in such a position that the thumb is uppermost ; in other 
 
FRACTURES AND DISLOCATIONS 
 
 169 
 
 words, the arm is midway between pronation and supination. Be 
 most careful tliat the splints do not injure the arm at the elbow 
 when it is bent. {See Fig. 36.) The radius is very often broken 
 above the wrist, but this can only be treated by a surgeon. 
 
 Fracture of the hand and fingers.— This often occurs and is 
 usually the result of great force. It is accompanied by much swell- 
 ing and not a little j)ain on the inside of the broken finger. A pply 
 a broad splint from the wrist to beyond the fingers to keej) the 
 whole hand stead}'". 
 
 Fractures of the leg. — These are all so serious that it is im- 
 possible for an unskilled j)erson to attempt to do much for them. 
 
 Fig. 36,— Fracture of the Forearm. 
 
 More harm will be done than good. A surgeon must be called at 
 all hazards. These fractures require skilled treatment in bed, on a 
 mattress, which should be firm, even, and unyielding. Keep the 
 patient absolutely dry, and see that no bread crumbs become lodged 
 on the bed, or bed-sores will be set up. Wash all bony prominences 
 on which the sufferer lies with spirits of wine and corrosive subli- 
 mate 1 part, to water 1000 parts, and dry them thoroughly. Let 
 this be done twice every day at least. 
 
 Fractures of the ribs are very common, and may be occasioned 
 by blows and squeezes. The pain is very severe, and is worse if 
 the patient should cough ; so he endeavours to keep the injured side 
 
170 HEALTH IN AFRICA 
 
 at rest by taking short breatlis. The treatment here is to keep the 
 broken ribs and side at rest, as far as this is possible. Make a 
 number of strips of sticking-plaster, about two inches broad, and as 
 long as from the spine to the breast-bone and three inches beyond. 
 Begin to strap the side four inches below the broken rib, and 
 continue for at least four inches above. Let each strip of plaster 
 overlap the one below for half its breadth. Apply a broad roller 
 bandage round the chest over all. 
 
 DISLOCATIONS 
 
 "Out of joint" is the popular designation of this affection, and 
 is the displacement of the bones which go to form a joint. Gene- 
 rally it is the result of a twist or a blow, but in some cases the 
 direct result of disease. Dislocation is a rare accident in infancy 
 and in old age, and is most common in full manhood, say from 
 twenty to forty. The following symptoms are seen in every dis- 
 location : (1) the shape of the joint is different from the normal ; 
 (2) the joint is disabled — it has no power, the bones being fixed 
 in an unusual manner ; (3) the joint is very painful. The shoulder 
 suffers more than any other joint. The appearance and shape of 
 the joint is always altered, and usually it is greatly increased in 
 circumference. It may be that the limb is increased in length 
 or shortened, according to the manner in which the bones are 
 dis23laced. The joint is always fixed. In a fracture we have pre- 
 ternatural mobility at a part which is normally fixed ; in a dis- 
 location we have preternatural fixity in a part which is normally 
 movable. Moreover, in a fracture we have the grating or rubbing 
 of the broken bones one on the other, whereas in a dislocation 
 there is no such thing, but a "jamming" of the part. There is 
 usually great pain, and in a short time much swelling of the 
 affected limb. 
 
 Treatment. — As soon as possible, by manipulation, replace the 
 bones in their natural positions. If this is not done, the muscles 
 will act reflexly, and hinder the reduction of the accident. In all 
 probability, immediately on the receipt of the accident, the sufferer 
 will feel faint, with a cold sw^eat on the brow, and the whole body 
 lax. This is the moment to seize the bones and put them right. 
 Dislocations are generally treated best of all by what is known as 
 manipulation. Here we relax the tense muscles, and try to make 
 the wandering head of the bone go back to its natural position by 
 
FRACTURES AND DISLOCATIONS 171 
 
 tlie way it came. This is easy when tlie patient is thoroughly under 
 the influence of chloroform. Or it may be treated by long-continued 
 and applied force. By this means the resisting muscles become 
 weary and yield, and the head of the bone slips into its position. 
 If a surgeon is present he may give chloroform or ether, and so 
 overcome the muscular resistance. After the bones are reduced, 
 the joint should be kejDt at perfect rest, otherwise they may again 
 become dislocated. Do this by means of splints and bandages. In 
 ten days take off the splints, and gently move the joints. Then 
 replace the splints again. Do this daily thereafter. The idea is to 
 allow the capsule of the joint to heal, and, at the same time, to save 
 the joint from becoming stiff. 
 
 Dislocation of the collar-bone. — This bone may be dislocated 
 at either of its ends. Let the operator place his knee on the man's 
 back between the shoulders, and with a hand on each shoulder, 
 pull the shoulders back. Put a pad of lint over the dislocated 
 spot, and cause the shoulders to remain back by a figure-of-eight 
 bandage. 
 
 Dislocation of the shoulder. — Here the roundness of the 
 shoulder is gone. The method of reduction by extension is per- 
 formed by the ojDerator placing his foot in the armpit of the dis- 
 located arm, and grasping the arm by the wrist and pulling 
 steadily. If this fails, the arm should be swung gently round the 
 head^ when the humerus may slip into its position. The manipula- 
 tion method consists in flexing the forearm on the upper arm, 
 putting the elbow close to the side, and then twisting the forearm 
 out. By this means the humerus is rotated. After this has been 
 done for ten minutes or so, the arm is raised, and the humerus 
 rotated in towards the body. It may be necessary to give chloro- 
 form in working with this joint. 
 
 Dislocation of the elbow.— Here motion of the bones one 
 upon the other is impeded, and the relations of the various pro- 
 tuberances are abnormal. In treating, straighten the forearm 
 as far as possible, and then bend the arm on the humerus and 
 towards the opposite shoulder with some degree of sharpness, and 
 usually the bones will slip into position. When replaced, bandage 
 from the fingers upwards most neatly, putting a figure-of-eight on 
 the elbow to keej) the bones from slij)ping out again, and place 
 the arm in a sling for two weeks at least. 
 
 Dislocation of the thumb. — This is often difficult to reduce. 
 Tie a bandage very firmly on the displaced thumb, in order to 
 afford power of grasping. Then force the bone of the hand (meta- 
 carpal) towards the palm of the hand. Draw back the injured 
 
172 HEALTH IN AFRICA 
 
 finger, and suddenly flex the thumb forwards. When it is reduced, 
 apply a short splint to the thumb, and keep it at rest for two 
 weeks. 
 
 Dislocation of the hip-joint. — It is usuall}^ impossible to reduce 
 this disj)lacement without chloroform, in which case it is imperative 
 to have a medical man present. 
 
CHAPTER XV 
 
 APPLIANCES AND HINTS 
 
 How to take the temperature. — The 
 
 temperature is taken by tlie ordinary clinical 
 thermometer. There are several varieties 
 of these instruments, but this (Fig. 37) is 
 one of the commonest. It is a thermometer 
 specially made so that the mercury will 
 run up, but will not go down unless it is 
 forced. The scale usually runs from 90° F, 
 to 110° F. The normal temperature of the 
 -body, 98*6° F., is usually marked by an 
 arrow. The degrees are all plainly indi- 
 cated, and the scale registered to the ^q of 
 a degree. In setting the instrument, it is 
 necessary to catch it firmly at the upper 
 part, and to give it a few sharp shakes 
 so as to cause the mercury to go below the 
 normal, say to 95°. The temperature may 
 be taken in any part,^o long as the instru- 
 ment is kept in close contact with the body, 
 say for a period of five minutes. It is 
 usually taken in the armpit, but it may be 
 taken in the mouth, or groin, or bowel. 
 In putting it in the armpit see that the 
 mercurial end goes well into the hollow, and 
 is not kept from the body surface by folds 
 of clothing. In putting it into the mouth 
 it is necessary to know that the mouth is 
 of normal heat, and that no cold or hot 
 fluid has been taken for a considerable time. 
 After the instrument has been in use it 
 should be carefully cleaned and put into its 
 case. As far as possible the temperature 
 
 173 
 
 r^ 
 
 in 
 
 fft- 
 
 'n 
 
 m 
 
 <^ 
 
 fO 
 
 f^S^lf^c^ 
 
 Fig. 37.— Clinical 
 Thermometer. 
 
]74 
 
 HEALTH IN AFRICA 
 
 should be taken at tlie same hour every morning and evening, when 
 the fever extends over a period. It may even be necessary to take 
 the temperature every two or every three hours in some forms of 
 malarial fever. 
 
 How to give an enema. — Enema, clyster, or injection are three 
 terms in common use to designate the introduction of a liquid sub- 
 stance into the lower bowel by the anus. They may 
 be given to promote alvine discharges, to wash the 
 delicate mucous membrane of the bowel, to give 
 nourishment in times of great weakness, or medicine 
 in diarrhoea or dysentery. There are three instru- 
 ments in common use : — 
 
 I. The Vulcanized India-rubber Ball, with 
 bone nozzle. {See Fig. 38.) This is most useful when 
 only about half a cupful of fluid is required to be 
 injected, or when a nutrient soup is about to be 
 introduced. Before injecting squeeze it well, so 
 that the air is expelled, and only the fluid appears 
 at the opening. 
 
 II. The Common Enema Syringe, of which 
 Fig. 39 is the most useful variety. It has a valve 
 in the centre and a lead-sucker, which enters the 
 
 fluid at one end, and a bone nozzle or long vulcanised nose at the 
 other. This latter enters the cavity it is desired to wash. It is 
 
 Fig. 38.— Vul- 
 canised India- 
 rubber Ball 
 with Bone 
 Nozzle. 
 
 Fig. 39.— Common Enema Syringe. 
 
 advisable to get an instrument of the very best quality, and made 
 of one piece of india-rubber. After it has been used hang it up 
 by the lead end and do not coil it up in the box. Along with this 
 
APPLIANCES AND HINTS 
 
 175 
 
 Fig. 40.— Gly- 
 cerine Stkinge. 
 
 instrument there is usu- 
 ally supplied a long tube 
 of about nine inches, 
 which is used in cases 
 where the short nose is 
 not effective, owing to the 
 being impacted in the bowel. In in- 
 troducing it, allow the nozzle to lie in hot water 
 for a few minutes, oil freely and insert slowly 
 along the side of the bowel for at least an inch. 
 If this is not done it will come out again. Push 
 on steadily and firmly, but never force the instru- 
 ment : if resistance is experienced, withdraw it 
 somewhat and try another passage. It is a most 
 useful instrument where the f?eces has been re- 
 tained for a few days, and it is necessary to get 
 above the impacted mass. 
 
 III. The Glycerine Syringe (Fig. 40) is a 
 glass syringe with a long, curved, vulcanite nose. 
 It will hold two or three tablespooiifuls of gly- 
 cerine. The drug lubricates the sides of the 
 bowel, and so sets up a natural action of the same. 
 It can easily be used while the j^atient lies in bed. 
 A71 enema may be given for a variety of pur- 
 poses : — 
 
 (1.) For Washing out the Bowels. — To do 
 this warm water (from 90° to 100° F.) alone, or 
 with soap, is commonly used. But gruels may 
 be employed, or gruel and oil or other lubricant, 
 or even glycerine to the extent of 1 to 2 tea- 
 spoonfuls. Castor oil is excellent, say 1 or 2 
 tablespoonfuls ; so too is sulphate of magnesia, 
 2 tablespoonfuls. For an infant inject about 
 2 tablespoonfuls of warm water. In children of 
 four years inject, say, half a teacupful or more, 
 and for an adult as much as the bowel will con- 
 tain. No harm can possibly be done in washing 
 out this " drain " most thoroughly. On begin- 
 ning, inject very slowly, and wait for a little. 
 At first a feeling as if evacuation must take place 
 will be felt ; this, however, is soon overcome. 
 Inject a little more and wait again : by this 
 means 2 breakfast- cupfuls may be injected into 
 
176 HEALTH IN AFRICA 
 
 the bowel. Sooner or later tlie sphincter is overcome, and evacua- 
 tion takes place. 
 
 The washing out of the bowel may be done by the patient or by 
 an assistant. In such a case cover the bed with a " mackintosh," 
 with a towel over all, let the patient lie at the edge of the bed with 
 the knees drawn up. See that the basin with the fluid is on a chair 
 and at the proper temperature, and that the bed-pan is near. In 
 withdrawing the nozzle of the syringe press on the bowel with a 
 towel, which will assist the sphincter in its contraction. Xo possible 
 harm can be done in such an operation. When injecting oil, set 
 the bottle in a basin of hot water, till it is about the temperature 
 of the body. 
 
 (2.) For applying Soothinq Medicines, as in Diarrhcea or 
 Dysentery. — In both of these diseases the lower bowel is seriously 
 involved, and no treatment is better than that of washing the delicate 
 membrane. If it is desired to wash the mucous membrane only 
 (which it is well to remember may be ulcerated like any open sore), 
 give 12 or 14 tablespoonfuls of warm water, having, it may be, a 
 little Condy's fluid, or chlorate of potash, or boracic acid dissolved 
 in it. In a case of diarrhcea the disease may be treated by injecting 
 12 tablespoonfuls of ordinary housewife's well-made starch, having 
 half a teaspoonful of laudanum (tincture of opium) in it. In 
 dysentery an injection of nitrate of silver 20 grains to warm water 
 4 tablespoonfuls, gives great relief. 
 
 Salt injections are used for destroying thread-worms. One table- 
 spoonful of common salt put into a tumbler of warm water or gruel, 
 is very effective in such cases. 
 
 (3.) For giving Nourishment. — There are many cases where 
 no food can enter the system by the mouth, or where it is necessary 
 to let the stomach and bowels have a com^^lete rest. In such cases we 
 must give nutriment by the bowel. It is well known that the mucous 
 membrane of the bowel cannot, in any way, digest food like the 
 stomach, so everything that is injected must be digested before it 
 is put into the organ. Never give more than 3 tablespoonfuls at 
 a time, and let the fluid be about 100° F., and of the consistency 
 of cream. Beef -tea, gruel, milk, eggs (especially the yolk), extract of 
 meat, or weak spirits may all be given. Prepare the food in a basin 
 to the proper consistency and temperature, and digest it by adding 
 a tablespoonful of Benger's Liquor Pancreaticus. If there has been 
 intense sickness, the sufferer will be very thirsty, and will be greatly 
 relieved if a cupful of warm water is injected into the bowel. 
 
 How to give a hsrpodermic injection. — The instruments 
 necessary are seen in Fig. 41. There is the syringe itself, which 
 
APPLIANCES AND HINTS 
 
 177 
 
 is small and made of glass, with marks on the piston to show 
 the number of drops. The fluid is drawn in by the piston, after 
 which the button needle is screwed on. These instruments are sup- 
 plied by Burroughs, Wellcome & Co., and other makers, together 
 with little tubes of hypodermic drugs. The drugs are made up in 
 
 v^^- 
 
 (^ 
 
 H 
 
 X'^' 
 
 ^ 
 
 >?/• 
 
 f ll I I 
 
 P^^Zfu/glTt 
 
 TTTTrr 
 
 K~T^p7^o7phTa" 
 
 Cc^ 
 
 t.u(Wt 
 
 l llllll l l l ll') 
 
 _i^^..,^,^^ \L>>«« ^«**^^'^ 
 
 Fig. 41. — Hypodermic Needle with Appliances and 
 Tabloid Medicines. 
 
 exact doses, and in soluble substances. All that is necessary is to 
 take one of the little tabloids, put it into the glass mortar supplied, 
 add the number of drops desired, say 5 or 10, and triturate with the 
 pestle. Then draw up the fluid into the syringe and screw on the 
 needle. In order to fill the needle completely and expel all air, 
 drive the fluid through the needle until a few jets escape, then keep 
 
 M 
 
178 HEALTH IN AFRICA 
 
 the needle-point uj) wards. An injection may be made into any tissue 
 of the body where there are no large blood-vessels. Hj^podermic 
 medicines are usually injected on the outer side of the middle of 
 the arm ; but the back of the elbow and the hips are good places. 
 Grasp the skin firmly between the left forefinger and thumb, 
 pinching it slightly, and boldly plunge the needle through the 
 skin into the flesh below. The prick is only felt, and that very 
 slightly, as the needle pierces the skin ; it is not painful as it passes 
 through the tissues. Being inserted at least half an inch, inject the 
 drug ; then lay the forefinger on the pierced spot, gently with- 
 draw the needle, and rub the drug into the neighbouring tissues 
 very gently. No further thought need be given to the puncture. 
 There are two rules to be observed in this little operation. (1) Before 
 using the syringe always run an antiseptic fluid through it, and let 
 it lie in the same {see p. 121) for a few minutes ; (2) after using, 
 wash the syringe and needle with warm water, blowing through the 
 latter, and inserting the tiny wire to kee^o the button needle from 
 being stuffed up. 
 
 How to apply hot fomentations. — These are means for the 
 application of warmth and moisture to a local part of the body. 
 They are very convenient, cleanly, and eflective. A piece of flannel 
 a yard square, or in an emergency a flannel shirt, is put into a basin 
 full of boiling water ; remaining there for a few seconds it is lifted out 
 of the water on to a towel, and two persons wring freely in opposite 
 directions, removing as much of the water as possible. The flannel 
 is then applied to the desired surface, and covered with a towel 
 or a mackintosh. These, in order to be effective, should be applied 
 every half hour, and a second one should be prepared before 
 the first is removed. They are most successful in removing pain 
 when they are medicated with vegetable infusions, such as ojDium, 
 belladonna, turjDentine, camomile, being used in almost all painful 
 local disorders. 
 
 In giving an opium fomentation, prepare it as above, and as 
 soon as it is wrung out of the hot water sj)rinkle the steaming cloth 
 with 2 tablesjDoonfuls of laudanum and aj)ply to the skin. This 
 will cj^uickly relieve pain. 
 
 How to apply counter-irritation. — Counter-irritation means 
 the application of some irritant to the skin which will produce 
 redness, and so somewhat relieve the congestion and pain in deeper 
 parts. It is usually effected by mustard, turpentine stupes, by 
 blisters, or by the actual cautery. 
 
 Mustard leaves are usually supplied in all medicine-chests. The 
 leaf is soaked in water for a few seconds and applied direct to the 
 
APPLIANCES AND HINTS ' 179 
 
 skin, being secured by a broad bandage. It should be kept on for 
 balf-an-hoiir. Ordinary mustard is made by the application of a 
 very little cold water or vinegar, and stirred in a cup till it is of 
 the consistency of jam. It is then spread between two layers of 
 thin muslin cloth, and while cold applied to the skin. It is a 
 powerful counter-irritant. 
 
 Turpentine stupes are used for this purj)ose. Prejmre as an 
 ordinary fomentation cloth, and sprinkle 4 teas]30onfuls of turpen- 
 tine over the hot flannel and apply to the skin. Take great care 
 that the irritation is not such as to raise a blister. 
 
 Blisters are usually very powerful agents. They so irritate the 
 blood-vessels of the skin that a clear, straw-coloured fluid exudes from 
 the blood, and lies between the two layers of the skin, raising the 
 superficial one as the ordinary blister {see Fig. 1). This counter- 
 irritation can be applied as " blistering ointment," or the " ordinary 
 fly-blister," or it can be painted on as a " blistering fluid." If the 
 ordinary cantharidis blister is applied, it should be secured by a 
 bandage and kept on for six or eight hours. The raised-uj) skin, 
 when the counter-irritant is removed, should be snipped at its 
 dependent part and the fluid allowed to drain off, but the cuticle 
 should never be removed, as it acts as a dressing to the part. Dust 
 the affected part well with boracic acid, cover it with boracic lint 
 and a layer of cotton, securing the whole by a bandage. 
 
 Tincture of iodine is a mild counter-irritant which can be 
 painted on the skin. The liniment of iodine is much stronger and 
 very effective. 
 
 How to dry and wet cup.— Cupping is an excellent means of 
 abstracting blood from the deeper tissues which may be congested, 
 and allowing it to remain in the superficial skin, or to flow off in a 
 stream. Dry cupping is that in which the blood is drawn to the 
 surface only ; wet cupping is when the blood is withdrawn from 
 the body altogether. 
 
 In dry cu-pping we can use a cup, a tumbler, or any other hollow 
 vessel — the natives in Africa use a horn. Select a flat surface and 
 sponge it well with warm water ; then heat the interior of the 
 vessel by holding it over a spirit-lamp, or better still by sjorinkling 
 a few drops of whisky or other S23irit in the vessel and lightino- it. 
 While it is still burning apply the cup to the skin and it w^ill stick 
 fast, a vacuum being produced ; the skin and tissues rising up into 
 the cup are deeply congested. 
 
 In wet cupping the same manoeuvres are gone through, only 
 before applying the cup, freely make a few incisions over the skin 
 with a lance, going through the skin only, and not into the deeper 
 
180 HEALTH IX AFRICA 
 
 tissues. The natives do this very frequently when they treat 
 infiamniation. When the surface bleeds, put the spirit into the cup, 
 light it, and apply to the skin. A small stream of blood will flow 
 into the cup and as much blood can be extracted as desired. To 
 remove tiie cup, press the skin on one edge of the cup with the 
 thumb and allow the air to go in. Thereafter sponge the wounds 
 with an antiseptic lotion, say carbolic 1 to 30, and dress it with dry 
 boracic lint. 
 
 If a test tube is taken, and so treated with spirit as to exhaust 
 the air, and applied over a spot that has been scarified, an artificial 
 leech will be the result. As much blood as desired can be withdrawn 
 in this manner. 
 
 Starcli and how to make it. — Place in a basin 1 table- 
 spoonful of ordinary starch and 4 tablespoonfuls of cold water, and 
 mix thoroughly till it is of the consistency of cream. Then add 
 boiling water, and stir briskly till the whole is of the desired 
 consistency. 
 
 Poultices and how to make them. — A poultice is an admirable 
 means of applying heat and moisture to any surface of the body. 
 In hospitals linseed meal is jDreferred to all other substances, 
 but oatmeal, brown-bread, starch, native flour, are all admirable 
 in their own way. Let the poultice be made of well-ground flour 
 free of knots. First wash the bowl and the spoon in warm 
 water. Pour into the bowl as much boiling water as is required for 
 the poultice, then gradually add the flour, stirring briskly all the 
 while. There should be no knots, and it should be neither too dry 
 nor too moist, but such as will turn out off the bowl without 
 sticking to the sides. Spread it on warmed calico or linen to 
 about one inch in thickness, lifting it with a fresh spoon, which 
 should be first put into water, or the substance will stick to it. 
 Cover it over with a layer of very thin cloth or muslin, and apply 
 to the surface. The heat should be such as can be borne on the 
 back of the hand, and not more. Having applied the poultice, cover 
 it with cotton wool or lint to keep in the heat, and over all put a 
 mackintosh or oiled silk, then secure it to the spot by a bandage 
 or napkin. Remove the poultice as soon as it begins to get cold, say 
 in one hour, or two, at the most, and apply a fresh one. Have the 
 new application quite ready before the old one is removed. When 
 it is desired to remove the poultice altogether, it is well to wash the 
 part freely with warm water and soap, and apply a thick layer of 
 cotton wool and a bandage. 
 
 Should there be much discharge from the wound that is being 
 poulticed, sucli as is found in an abscess, then absorbent cotton 
 
APPLIANCES AND HINTS 181 
 
 sliould be aj)23lied in sucli a way that it will cover the poultice and 
 absorb the discharge. 
 
 In making an oatmeal poultice some suggest that the meal should 
 first be boiled, as it is rather hard. 'J"he jDoultice should be moist 
 and soft. 
 
 In viaking a bread poultice, boil some coarse stale bread crumbs 
 in water for eight minutes. Drain off the water to get rid of 
 the alum contained in most breads, and spread the wdiole on a 
 piece of linen. This makes an excellent poultice, as it is soft and 
 well suited for small affections. Brown-bread is good for the 
 purpose as it " drawls better." A mixture of this bread poultice and 
 linseed meal makes an excellent poultice. Before applying, add a 
 few drojDS of warm oil to the surface, and it will prevent the poultice 
 from sticking, and will be a lubricant to the irritated skin. 
 
 In order to give to any of the above poultices antiseptic properties, 
 it is only necessary to add some powdered charcoal, or boracic acid, 
 or iodoform, and stir the mixture well throughout the whole mass ; 
 tliis will keep down all fermentation and smell. It is well also, 
 before applying the poultice, to sprinkle the surface with any of the 
 substances chosen. 
 
 A warm-water dressing is allied to a poultice. It is a most 
 soothing and comfortable application, and is the simplest form in 
 which moisture and warmth can be applied to the body. In order 
 that it may be effectual, it must be so put on the skin that it will 
 retain its heat and moisture as long as possible. Take a piece of 
 lint folded two or three ply, as large as the part it is desired to 
 affect ; put the same into hot water, wring it, and apply to the skin. 
 Cover the lint with a piece of oiled silk or guttapercha tissue, 
 larger than the lint, all round, by about one inch. This prevents 
 the lint from cooling and drying. Secure the lint by a bandage. 
 The dressing should be renewed every four hours or so. If the 
 skin is wdiole, all that is required is to reapply the lint after being 
 dipped afresh in hot water ; but if it is applied to an ulcer a fresh 
 piece of lint should be aj^plied every time. 
 
 Baths and packs, and how to administer them.— Bathing is 
 the application of water in some form or other to the body. It 
 may be indulged in for the jjurposes of cleansing or cooling the 
 frame, but it may also develop into a branch of therapeutics, and 
 become a means of removing stiffness, pains, and fatigue. 
 
 In a country like Africa every person should take a tepid bath 
 at least once a day. Only the robust should bathe in the lakes, and 
 that only wdien the sun has risen somewhat — say about eight in the 
 morning ; and nobody should ever attempt to bathe in mountain 
 
182 HEALTH IN AFRICA 
 
 streams. On entering tlie water, first wet tlie liead and tlie cliest, 
 and go on to the abdomen and limbs. No batli should be taken 
 immediately after a full meal, but may be indulged in after a very 
 slight repast in the morning. A kettle of hot water should 
 always be poured into the cold bath before entering. As long as 
 the bather feels a warm glow on emerging from the water, all is 
 well, but if this is not so, and on leaving the water he trembles, 
 and his limbs have a blue duskiness, then he has over indulged, 
 and in future must reduce the length of the time of the bath. 
 
 Hot, warm, and tepid baths. — In preparing these always test 
 the temperature by the thermometer, as the sensation to the hand 
 is deceptive. A hot bath varies from 97° F. to lOS"" F., and may 
 be indulged in for ten minutes. A warm bath is from 91^ F. to 
 97^ F., and may be indulged in for say a charter of an hour, A 
 tepid bath is from 84° F. to 91° F., and may be indulged in rather 
 longer than any of the others. If any of these baths are given to a 
 patient they should be administered before a fire, and on emerging 
 from the water a warm blanket should envelop the bather. As a 
 rule the body should be under the water up to the neck. In giving 
 a hot bath always remember that the heat is apt to bring on a state 
 of faintness, especially in the weakly and feverish. The patient is 
 apt, in such a case, if not looked after, to be drowned. It should 
 l)e a rule, therefore, never to allow a person in fever to be alone in 
 taking such a bath ; and the moment faintness is complained of, 
 the bather should be taken out of the water. Sponges are not 
 good, as they harbour all sorts of impurities in the interstices : 
 rather use a wet towel or the glove. On emerging from the 
 water rapidly rub the whole body with a wet towel wrung out of 
 the water, then briskly dry the frame. The idea is to quicken the 
 circulation and set up a warm glow throughout the body. Hot 
 baths stimulate and excite the nervous system, and should be used 
 when the system is depressed ; tepid baths calm and soothe the 
 frame, and should be indulged in after great worry and nervous 
 strain. 
 
 Graduated cold baths are most useful means of reducing the 
 temperature in hyperpyrexia. If the temperature is 105'' F., with 
 coma and a burning skin, this form of bath is an excellent means of 
 reducing the severe fever. The bath to be used should be a large 
 one in which the j)atient can lie at full length. In giving the bath 
 let many buckets of cold water be at hand, and let the temperature 
 of the bath be about the same temperature as that of the sufferer. 
 Kemove all wearing apparel and other clothing, and throw a large 
 soft towel over the patient. Let a strong blanket be slipped below, 
 
APPLIANCES AND HINTS 183 
 
 and let liim be lifted from the bed and lowered into the bath. 
 Gradually add cold water along the side so as not to touch the body 
 of the sufferer, till the temperature reaches about 70° F. While 
 the patient is in the water keep a thermometer in his mouth or 
 rectum, and as soon as the body heat is normal let him be lifted 
 out, and thoroughly rubbed and dried. The bath may be con- 
 tinued for half-an-hour, and may be repeated several times. If 
 the slightest sign of shivering appears, or if the patient becomes 
 blue, let the bath be stopped at once. Put the sufferer to bed 
 between hot blankets. Let hot-water bottles be applied to the 
 feet and abdomen, and warm beef-tea, or even brandy, be given by 
 the mouth or rectum. Such a cold bath must be given with the 
 greatest of care, as, while it is most efficacious, it is not without 
 danger. 
 
 A cold foot-bath. — In this form only three or four inches of 
 water should be in the bath, and the soles of the feet only should be 
 immersed. Don't keep the feet in more than from three to five 
 minutes, and all the while let the feet and limbs be briskly rubbed. 
 On removal, dry the feet well with a coarse towel, and continue the 
 friction. These baths are good where the feet are constantly cold. 
 If a little coarse mustard be added the bath is made all the more 
 effective. 
 
 A hot foot-bath. — Here the water in the basin is to be as hot 
 as can be borne, and is of such amount as will immerse the feet. 
 The patient should sit with the feet in the water, and the body and 
 knees covered with a blanket. Keep the feet immersed for about 
 half-an-hour. From time to time add warm water, so as to keep up 
 the temperature. Mustard added makes the bath all the more 
 effective. At times it is desirable to give this bath when the 
 patient is in bed. This can be done by the subject lying with the 
 feet in the bath or with the limbs hanging over the end of the bed. 
 It is very effective in stopping a cold, if the bath is taken at the 
 very outset of the shivering. 
 
 Hip-baths are used where it is desirable to stimulate the hijos 
 and the organs in the abdomen and pelvis, without bathing the 
 whole body, as for instance in piles. Let the bather be covered with 
 a warm blanket, and sit in the bath for a quarter of an hour, with 
 the water as hot as can be borne. See that the legs and feet are 
 not exposed, and that too much water is not j)^^t in the bath, as on 
 sitting down the water may run over. 
 
 The arms and legs may also be bathed separately from the 
 body. Zinc baths are made the shape of the limbs, with loose 
 covers to keep the water warm and protect the blankets of the 
 
184 HEALTH IN AFRICA 
 
 bed. In the treatment of certain skin diseases, tliese batlis are 
 very useful. 
 
 Hot-air baths are used to promote profuse perspiration. The 
 patient is put to bed wearing only flannel sleeping garments, and 
 lying on a blanket instead of a sheet. Over the limbs is placed 
 any form of cradle which will keep the upper blankets from directly 
 enveloping the body by about a foot or so. Over this is placed a 
 blanket or two, and the patient is carefully tucked in at the neck 
 and sides. A lamp is then lit, and by means of an indiarubber 
 tube the hot air is led under the cradle and the blankets. By this 
 means the hot air envelops every part of the body and induces a 
 most copious perspiration. The chest must be covered by a towel 
 wrung out of cold water, another wet towel rolled like a turban 
 should envelop the head, while a mackintosh should be put over the 
 pillow. The patient must not be left alone, and should not be 
 kept in the hot air longer than twenty minutes. 
 
 Vapour-baths are prepared exactly as the above, and are most 
 useful when it is desired to induce free perspiration in malarial fever. 
 They are most applicable for Africa. The patient is put to bed in 
 the usual way between blankets. A cradle is put on the bed with 
 blankets thrown over ; only instead of using a hot lamp use a 
 kettle and lead the steam, by means of an indiarubber tube under 
 the blankets ; or let the patient sit on a cane-bottomed chair and 
 envelop the whole body down to the ground in blankets, and j)ut 
 the kettle, heated by a spirit-lamp, under the chair. A quarter of 
 an hour will suffice to bring about a free perspiration. If the 
 patient drinks cold or hot fluids in profusion, or if he takes pilo- 
 carpine hypodermically, the perspiration will be all the more pro- 
 fuse. The temj)erature under the blankets should not be more than 
 110° F. The head should always be kept cool by cold cloths. 
 
 If the above tubing is not at hand, envelop ordinary hot- 
 water bottles in damp cloths, and put them on a plate under the 
 cradle ; or heat bricks, and envelop them in damp cloths, and put 
 them on plates under the blankets. The vapour bath given by 
 means of a tube led from a kettle is an excellent arrangement in 
 treating black-water fever. 
 
 Mercurial vapour-baths. — This is an excellent means of giving 
 calomel in cases of syphilis. The patient sits on a cane-bottomed 
 chair enveloped in a long blanket, which reaches to the ground 
 and embraces the chair all round. Then under the chair place a 
 spirit-lamp, and in a watch glass or other vessel place 10 grains of 
 calomel, and let the drug be consumed over the spirit-lamp. Accord- 
 ing as it is desired to give a vapour bath or a hot-air bath insert a 
 
APPLIANCES AND HINTS 185 
 
 tube from a kettle. The calomel will be vaporised and enter tlie 
 system by tlie open pores. In lialf-an-hour the calomel will have dis- 
 appeared. Let the patient thereafter take great care against cold. 
 
 The cold, wet pack. — This is an excellent means, in severe 
 fever, of reducing the temperature, removing delirium, moistening 
 the burning skin, bringing about a profuse perspiration, and in- 
 ducing sleep. Prepare the bed by placing a large mackintosh over 
 the whole mattress and a blanket over that. Under the blanket 
 place two strong binders a foot in breadth across the bed, one at the 
 calves and the other at the shoulders, where the patient will lie. 
 Then let the patient, strip^^ed of all clothing, lie under a blanket, 
 occupying the far-off side of the bed. Dip a sheet in cold water 
 and wring it out as completely as possible. Fold it lengthwise, 
 and lay the edges towards the patient. Then, as one edge is lifted 
 up, let the patient roll himself naked on to the sheet. Quickly 
 envelop him in the wet sheet and blankets. Put the hands under the 
 patient's feet, and wrap them in the sheet, and tie them down by the 
 binder. Tuck everything well in round the neck, and tie the binder 
 that is under the shoulders. Put on four or five blankets, and it 
 may be a mackintosh, and see that the neck and body is well tucked 
 in. Let the patient lie for half-an-hour — not more — and a free 
 perspiration will be induced. In that time remove the sheet, and, 
 by means of tepid water, sponge the whole body, rubbing freely and 
 drying thoroughly. Put on warm clothing, and let the patient rest 
 quietly. In all probability the temperature will be greatly reduced, 
 and sleep brought about. If the pack is agreeable to the patient, 
 and the severe fever returns, this procedure may be adopted every 
 three or four hours. Copious draughts of cold or hot water further 
 induce the perspiration. 
 
 The hot, wet pack is given exactly as the above, only, instead 
 of cold water, hot is used at a temperature of 112° F. When the 
 patient is enveloped, three hot- water bottles are placed to the feet 
 and body. In giving these packs the patient must be carefully 
 watched, and if faintness is induced they must be discontinued. 
 Yet given with care they are a means of controlling exhaustion and 
 fever. After half-an-hour in the hot sheet the body should be well 
 sponged, freely rubbed, and rolled in hot blankets. 
 
 The half-pack. — This pack is more easily given than the 
 above, and is s^^ecially applicable to children. Two towels are 
 wrung out of cold water under the blankets, one is placed below the 
 body from the shoulders to the hips, and another above the body 
 from the armpits to the thighs. The limbs are not covered by 
 the wet sheets. Blankets are then well tucked in round the patient, 
 
186 HEALTH IN AFRICA 
 
 and quietness is induced for half-an-hoiir. It may also be a good 
 plan, in less severe cases, to lay only one towel over the chest and 
 abdomen, under several blankets. In removing the wet sheets the 
 body should be sponged and rubbed in the usual way. 
 
 Cold and tepid sponging is most soothing to the fever-stricken 
 jDatient, where there is great restlessness together with a hot burning 
 skin. Let some hot water, about 116° F., be poured into a basin to 
 which some toilet or aromatic vinegar is added. Then take a piece 
 of mackintosh the size of a large towel, cover it with a warm towel, 
 and lay it under the limb to be sj)ongecl. Expose an arm, washing 
 it thoroughly with the tepid water and drying briskly. Do the 
 same to the various limbs and the body, taking care not to expose 
 a great part of the skin at once. Then cover the patient, putting a 
 hot-water bottle to the feet and a cold cloth to the head. The 
 result will be a great reduction of the temperature and a calming 
 of the nervous system, which may lead to sleep. 
 
 The above may be varied by sponging the limbs with strong 
 vinegar or acetic acid, and washing the acid off with hot water, 
 drying and rubbing thoroughly. 
 
 Cold and tepid douche. — This means the applying of cold or 
 hot water, in a continuous stream, to any j)art of the body, in order 
 to reduce inflammation or relieve j)ain. It is most applicable where 
 a joint is affected, or where it is necessary to wash out a cavity 
 of the body, as the nose or rectum. The water, cold or hot, is 
 put into a basin at some distance above the level of the patient, 
 and an india-rubber tube is placed in it. By sucking the tube, or 
 drawing the fingers along to exhaust it of air, the stream of water 
 will fioAv, and can be directed to the desired spot. Common sense 
 will direct the patient in washing out the rectum, &c., by cover- 
 ing the bed with mackintoshes and receiving -pans. It is an 
 excellent mode of washing out the rectum, in the treatment of 
 dysentery. 
 
 Medicated suppositories are most useful means of introducing 
 various medicines into the rectum. They are made from some 
 fatty material which is of considerable consistency at the temjDera- 
 ture of the atmosphere — as cacao butter — but soluble within the 
 bowel. Intimately mixed with the fatty material is the drug to be 
 administered. They are always shaped like cones, and can easily 
 be introduced within the anus by the j)atient. 
 
 How to change the sheets, and bed-side hints. — Every morn- 
 ing the face and hands of the patient should be washed with soap 
 and warm water, and as often as need be the hands should be 
 washed through the day. If the illness is prolonged, a warm bath 
 
APPLIANCES AND HINTS 187 
 
 should be given once a week ; or if tliis is not convenient, the whole 
 body should be sponged once a week, taking one part at a time. 
 The teeth should be washed every morning with camphorated chalk 
 or common salt. If the patient is too weak to do this alone, the 
 person who nurses should wash the mouth and teeth Avith a little 
 flannel, tied on a stick, dipped in Condy's fluid. Attend to the skin 
 on the back and hips, or wherever the bones protrude. Every day, 
 after washinn:, dust all red spots on the back with starch and oxide 
 of zinc, in equal quantities. Boracic acid is also excellent for this 
 jjurpose. Remove all wrinkles in the sheets, and crumbs of bread 
 should on no account be allowed to gather about the bed. If 
 the skin becomes very red over any of the bones, most carefully, 
 by means of a piece of flannel, rub in a little spirit of wine or 
 whisky or other spirits ; this is admirable for hardening the skin, 
 and preventing it from breaking and forming a bed-sore. 
 
 In some cases it is necessary to change the sheets without dis- 
 turbing the occupant of the bed. Do this by folding up the soiled 
 sheet while the patient lies to one side of the bed. While the 
 soiled sheet is being rolled the clean sheet, rolled in the same way, 
 can be spread on the bed. The patient can then gently turn from 
 one side to the other over the two sheets. The soiled one is then 
 removed and the clean sheet spread out. Or the sheet can be re- 
 moved from the top of the bed to the bottom. The fresh sheet is 
 tirst rolled up in its length ; then the patient's head is raised, and 
 the soiled sheet taken from the pillows and the clean one adjusted. 
 The patient is then gently raised, and the sheet rolled out until 
 it is spread under the limbs and the soiled one removed. 
 
 How to lift and move the patient. — It is necessary at times, 
 although the patient cannot actually leave the bed, that he be lifted, 
 as in changing the bed and in using the bed-pan. This may be 
 done, if the strength is suflicient, by one person passing one arm 
 under the knees and the other below the shoulders, while a second 
 adjusts the bed. In other cases it may be done by the patient 
 moving or rolling from side to side. 
 
 If the patient is very helpless, it will require three persons to lift 
 with due care. Two persons stand on either side of the patient and 
 under him join bauds. One pair of hands is placed on the back, 
 about the region of the shoulders ; or the arms of those lifting may 
 cross one another, the hands being placed on the opposite shoulders. 
 The other pair of hands are laid below the hams of the patient. 
 As he is lifted the third person attends to the broken limb, &c. 
 
 No bed-pan or urinals should, after use, be allowed to remain in 
 the room or hidden under the bed, but should be covered, placed 
 
188 HEALTH IN AFRICA 
 
 in an Ntanga or large native basket, carried out of the room, and 
 the contents buried. After being emptied, get the native attendant 
 to wash thoroughly with hot water, to rinse out with carbolic acid 
 (1-20), wash again, and take into the room. This is imjportant. 
 
 How to remove the disabled.— The assistance required will 
 vary with the nature of the case, and very often calls for an exercise 
 of tact and ingenuity. 
 
 Where a 'person is weak from loss of blood ar from- an ivjtiry, hut is 
 still able to ivalk, stand at the disabled person's side, pass your arm 
 behind his back, putting your hand on his distant hip. A sk him 
 to put his arm round your neck and over your shoulder. Then 
 with your free hand grasp firmly the hand laid on your shoulder, 
 and keeping step together, move slowly along. 
 
 Where a person is unable to icalk through the limb being broken or 
 other accident. — If the patient is a child or very light in weight, the 
 best way is to carry him in your arms. Place your right arm under 
 the thighs, and the left round the body under the shoulders. Ask 
 the i^atient to grasp you round the neck and to endeavour to raise 
 the body. When two j)ersons are about to help a patient who is 
 disabled, let them form a kind of "hand chair:" let the two 
 bearers stand face to face, and join the front pair of hands, allowing 
 the fingers of the right hand of the one person to interlace with 
 the fingers of the left hand of the other ; let the hands so inter- 
 laced form a seat ; then let the other arms cross each other so that 
 each has a hand on the shoulder of his fellow ; this will form the 
 back of the seat. The disabled person now sits on this seat, and 
 may put his arms round the necks of the bearers. 
 
 Another very good plan, applicable for carrying wounded persons, 
 or for crossing rivers on the arms of natives, is to use what is known 
 as the " four-handed seat." It is very comfortable for the p)erson 
 who is being borne, and is less of a strain to those who are 
 bearing. Let the bearers stand facing each other ; let each man 
 grasp with his right hand his own left wrist ; then each grasping 
 the right wrist of his fellow, a four-handed seat will be formed. 
 {See Fig. 42.) 
 
 Water and a few hints regarding it. — In a new country 
 such as Africa, it is absolutely essential, if we wish to enjoy even a 
 measure of health, and be saved a world of trouble, to pay most 
 careful attention to the water supply. Water, both in its liquid 
 and solid state, contains a variable number of micro-organisms, 
 which have been named loater bacteria, and which do not grow at 
 the higher degrees of temperature. Some of these low forms of 
 life, in their growth on water, set up an ammoniacal fermentation, 
 
APPLIANCES AND HINTS 
 
 189 
 
 which accounts for the stench of some stagnant pools. The 
 cholera bacillus was discovered by Koch in the drinking water of 
 Calcutta. The bacillus of typhoid fever also grows in the water 
 of stagnant pools. Many of these water bacteria in their growth 
 form pigment of red, or green, or bluish tint which covers the 
 stagnant pool as by a coloured scum. Others, again, exhibit a phos- 
 phorescence which is brilliant. These bacteria of water find an 
 ideally suitable nidus only when the water has been stagnant for 
 some time. In fresh spring water the life is said to sink to the 
 bottom of the sjoring and attach itself to the decaying leaves and 
 
 Fiu. 42.— Four-Handed Seat. (Right over left.) 
 
 roots found there. The life is seldom carried to the spring by 
 water which percolates through strata, but comes from the damp 
 surface of the ground or from the superficial layers of soil. 
 
 Water bacteria are removed from water by good filtration. Per- 
 haps the Kaolin filter made on the Chamberland-Pasteur principle 
 is the best. 
 
 It is impossible in Africa to carry a huge filter with one at all 
 times, and as pure water is so essential to health it is wise, while 
 travelling, to know how to secure even moderately good water. 
 The following hints are so excellent that I venture to quote them 
 
190 
 
 HEALTH IN AFRICA 
 
 in full. They are taken from " The Surgeon's Pocket-Book," by- 
 Surgeon- Major Porter. 
 
 " When the halting-ground is reached it may be necessary to 
 filter the water. A common plan is to carry a cask, charred inside, 
 and pierced with small holes at the bottom ; it is sunk in a small 
 stream, and the water rises through the holes. A better plan still 
 is to have two casks, one inside the other ; the outer pierced with 
 holes at the bottom, and the inner near the top ; the space between 
 is filled with sand, gravel, or charcoal if j^i ocurable ; the water rises 
 through the gravel between the barrels and fl.ows into the inner 
 barrel. {See Fig. 43.) 
 
 f f I 
 
 Fig. 43. 
 
 " It is advisable to heat sand or gravel to redness before using ; 
 the same applies to charcoal, if there be any question of its purity. 
 All these media must be changed frequently. 
 
 " Arrangements (must be made) for the different places of supply. 
 Men and cattle should be watered at different points ; places should 
 be assigned for washing ; and if removal of excreta by water be 
 attempted, the excreta should flow in far below any possible spring. 
 In case of a spring, several reservoirs of wood should be made, and 
 water allowed to flow from one to another — the highest for men, 
 the second for cattle. If it is a running stream, localities should 
 be fixed for the special purpose ; that for the men's drinking water 
 should be highest up the stream, for animals below, washing 
 lowest." 
 
APPLIANCES AND HINTS 191 
 
 Where drinking water is taken direct from tlie river, which is 
 generally very muddy, a lump of alum is moved rapidly through it 
 with satisfactory results, in proportion of 6 grains to a gallon. 
 
 " In the Ashanti campaign of 1873 the water was purified by 
 Surgeon-Major Gouldsbury's direction in the following way, in the 
 absence of proper filters : alum was added to precipitate suspended 
 matter ; the water was passed through a rough filter consisting of 
 (1) sponge, (2) sand, (3) charcoal in pieces ; it was then boiled, 
 and a few drops of solution of potassium permanganate added. 
 Water even taken from a hole in a, marsh was innocuous after 
 this treatment. 
 
 " As it is unlikely that any organic poison will resist the tem- 
 perature of boiling, it is of the greatest importance that all sus- 
 picious water should be boiled before use. During epidemics this 
 is essential. It may even be advisable to try and supply the men 
 with distilled water at such times ; any sort of rough still would 
 answer. One great advantage would be that impure water could 
 not be substituted for it, as a few drops of solution of nitrate of 
 silver would at once detect the presence of chlorides, which are 
 present in all except distilled water. 
 
 '■ The Russian soldiers abstain from drinking water on the line 
 of march in their Turkestan routes until the end of the day's 
 journey, when they at once make tea and then assuage their thirst. 
 
 " In judging of water a few rough qualitative tests may be 
 useful. 1st. Try, as far as possible, to get water that is clear, free 
 from sediment, and colourless. 2nd. Test it with a little nitrate of 
 silver solution and a few drops of dilute nitric acid ; good water 
 should give only a faint haze. 3rd. Add a few drops of Nessler's 
 solution ; good water should give no colour ; a yellow tinge makes 
 the water suspicious. 4th. Add a little permanganate of potash 
 solution ; good water should remain pink for about ten or fifteen 
 minutes ; if the colour fades rapidly, or becomes brown, the water 
 is to be suspected. 5th. Add some solution of starch, a little iodide 
 of potassium solution, and a few drops of dilute sulphuric acid ; if 
 a blue colour appears at once, or within a minute or two, the water 
 is suspicious. Other tests may be added ; but these are generally 
 sufficient for practical purposes, while they entail the use of no 
 special aj)paratus." 
 
 Latrines, and the attention they demand. — In making a 
 latrine for natives, it is essential that the trench should be made as 
 narrow as possible, say two feet, and about four feet deep. It 
 should be so situated that it is impossible for any infiltration in the 
 soil to reach the drinking water. An enclosure of reeds should be 
 
192 HEALTH IN AFRICA 
 
 run up so as to hide tlie place from view ; or, if possible, the trench 
 should be dug in a wooded enclosure, and a goodly distance from 
 the dwelling-house. Daily at least the bottom of the trench should 
 be covered to the depth of three or four inches with mould or good 
 earth. Sand, being porous, is not so good for this purpose. The 
 ashes from the kitchen fires, especially the wood ashes, may with 
 great advantage be daily spread in the neighbourhood of the latrine. 
 Carbolic acid and permanganate of potash should, at stated periods, 
 be freely sprinkled about. 
 
 It is impossible to denounce in too strong language the native 
 ]3ractice of "going to the bush." Where influence can be brought 
 to bear on them, it should be directed to this particular. Suitable 
 retreats should be built for the men themselves, and the strictest 
 orders issued. 
 
 For Europeans in the tropics the "earth-closet" is excellent. 
 It should be attended to by the native servants once every day, and 
 carbolic acid freely used. 
 
CHAPTER XVI 
 SICK DIET AND COOKING FOR INVALIDS 
 
 The quantity and quality, as well as the frequency, witli whicli food 
 should be given are in every case to be determined by the person 
 who is nursing the sick. 
 
 Serving of food. — If fluid only can be taken, it should be given 
 frequently and in small quantity. Give a stated amount every two 
 hours, but in certain cases it may be given every hour or every half- 
 hour. If the patient can take solid food, it should be given not 
 oftener than every four hours. Whatever the interval may be, it 
 should be given with great punctuality. Let the food for the sick 
 always be served in small quantity, and with scrupulous attention 
 to cleanliness and taste. Encourage the seeking for a second supply, 
 rather than the discarding of a quantity of food. Whenever the 
 meal is over, take everything away at once ; a sick person comes 
 to loathe the very idea of food when the remains of the former 
 meal are perpetually before the eyes. Moreover, it is very bad for 
 a sick person to be constantly nibbling at food, however tempting, 
 as the stomach is weak, and needs rest as well as other organs. 
 
 Milk diet. — It is a good plan to set aside night and morning 
 a vessel which contains a certain known quantity of milk, and this 
 should be kept for the sole use of the invalid. So many low forms 
 of life grow on milk, it is wise, knowing that the resisting power of 
 the mucous membrane of the stomach is weakened, in every case to 
 boil the milk before it is used. Boiling for a few minutes destroys 
 every form of germ that may have lodged on the milk. Milk is the 
 food to be relied on in fever. Milk and albumen of egg are perfect 
 foods, in that everything necessary for life are present in perfect 
 proportion. 
 
 Water, if possible, should always be filtered in a Kaolin filter 
 on the Chamberland-Pasteur system. If not, it should be boiled, and 
 cooled, and exposed to the air to be aerated. It should be kept as 
 cold as possible. Ice should be sucked if this is to be had. 
 
 193 N 
 
194 HEALTH IN AFRICA 
 
 Oatmeal gruel. — Take two tablespoonf uls of fine ground oatmeal, 
 and mix well with two tablespoonfuls of water. Then put a tumbler 
 of cold water in an enamelled pan, and add the oatmeal while the 
 water is on the fire. Keep constantly stirring, and let it boil for at 
 least half-an-hour. Add salt or sugar according to taste. If the 
 gruel is prescribed for a cold, add a piece of butter as large as a 
 walnut, and two tablespoonfuls of spirits, if it is desired to stimulate. 
 Boiled bread and milk. — Wash out a large-sized bowl most 
 thoroughly with boiling water ; then take stale or dry bread, and 
 break it into small pieces, each about the size of a marble, and put 
 them into the bowl. Boil a tumbler of fresh milk, and as soon as 
 it rises in boiling, pour it over the bread ; with a plate cover the 
 bowl for a quarter of an hour, and serve. 
 
 Toast water. — Thoroughly brown a slice of dry bread before 
 a fire ; break it into a bowl, pouring tw^o tumblers of boiling water 
 over the bread till all is covered. Set it aside for an hour. Strain, 
 and salt according to taste. 
 
 Barley water. — Take four tablespoonfuls of good barley and 
 wash it several times in cold water. Throw these various waters 
 away. Put the barley into a jug ; add the rind of half a lemon cut 
 into three or four j)ieces, and two teaspoonfuls of good sugar. Then 
 pour two tumblers of boiling water over the whole, and set it beside 
 the fire to simmer. In an hour add the juice of the half lemon, 
 and set aside to cool. When cool, strain and serve. 
 
 Rice water. — Take two tablespoonfuls of rice, wash it well ; 
 then take six large raisins and cut them into fine pieces, allowing 
 the stones to remain. Put the rice and raisins into a pan, with 
 three tumblers of water, and allow the whole to boil for fully an 
 hour. As the boiling continues, it may be necessary to skim occa- 
 sionally. Strain through muslin, and allow the whole to cool. If 
 the patient requires to be stimulated, it may be necessary to add 
 a teaspoonful of brandy or rum. 
 
 Whey with wine. — Take one tumbler of fresh milk and heat 
 it in a goblet ; before it boils pour in one wineglassf ul of sherry 
 or port wine ; stir vigorously while it is curdling. Then through 
 a fine linen cloth strain the whole. Add a little sugar, and it is 
 ready for use. 
 
 Lemonade. — Take three yellow lemons and skin them. Put four 
 tablespoonfuls of sugar into a large bowl, together with the yellow 
 rind of the lemons. Then squeeze the four lemons in a linen cloth, 
 allowing the juice to go into the bowl, but keeping back the fibres 
 and the pips ; pour on the juice one tumbler of boiling water ; 
 cover the same with a plate, and let it stand for six hours or until 
 
SICK DIET AND COOKING FOR INV^ALIDS 195 
 
 it is quite cold. Strain throiigli a linen cloth, and bottle. Do not 
 keep longer than two days. Two tablespoonfuls of this mixture 
 in a tumbler of water, and it may be with a little soda, makes a 
 refreshing drink. 
 
 Banana wine. — Take twelve large ripe bananas (the plantain 
 named Ingheyho is considered best) and macerate them well in a 
 basin ; add twelve breakfast-cupfuls of cold filtered water, cover 
 and allow to stand for twenty-four hours. Strain and bottle the 
 liquid for other twenty-four hours, when it will be ready for use. 
 This is a most refreshing drink. 
 
 Poached egg. — Into a small enamelled pan or other shallow 
 cooking vessel, i3ut one tumbler of water, half teaspoonful of salt, 
 and half teasjDOonful of vinegar. Put the pan on the lire to boil. 
 Meantime break an egg into a cup, and as soon as the water in 
 the pan boils vigorously, drop the egg into the water, and cook 
 for one and a half minutes. Have a slice of warm buttered toast 
 ready, and put the poached egg on the same, and set before the 
 patient while hot. 
 
 Egg-flip. — Put the yolks of two eggs into a cup, together with 
 one tablespoonful (or less) of fine sugar, and if desired to stimulate, 
 add two teaspoonfuls of brandy, and flip the whole together. Or, if 
 desired, this might be dropped into a tumbler and filled up with 
 gasogene water or milk. 
 
 Egg-milk. — Take the white of two eggs and whip them in a 
 cup till they are beaten into a stiff froth ; then stir into the cup half 
 a tumbler of fresh milk. This is very good for those who are recover- 
 ing from a severe illness. 
 
 Beef- tea. — Take about 1 lb. fresh lean beef, with all fat 
 removed, and cut it up into small pieces ; sprinkle a saltspoonful 
 of salt and a little pepper over the same, and put it into a cooking 
 pot with a tumbler of cold water. It is very important that the 
 water should be cold. Put it on the fire, and as soon as it boils 
 set the pot to the side and let it simmer for six hours or more 
 with the lid on. Do not let the "tea" boil again after the first 
 boilJUL^, but merely "infuse," so to speak, at the side of the fire. 
 After six hours pour off the tea, skimming all fat, and let it be 
 served hot or cold as desired. 
 
 Beef-tea quickly made. — Prepare the same quantity of beef as 
 the above, let it boil for seven minutes only, and serve. It is not so 
 nutritions, but is good in an emergency. 
 
 CMcken-tea. — Take one young chicken, remove its skin, and 
 cut the meat off the bones. Mince the meat into small pieces, 
 removing all fat. Allow it to stand for half-an-hour, in as much 
 
196 HEALTH IN AFRICA 
 
 cold water as will cover it. Then put in two tumblers of cold 
 water, salt, pepper, &c., and let it boil for ten minutes. Stop the 
 boiling, but let it simmer beside the fire for three hours. Now 
 add the yolks of two eggs, and carefully remove every particle 
 of fat. Stir over the fire, but do not let it boil, or it will spoil. 
 Strain and serve. 
 
 Essence of beef— bouillon.— Take 1 lb. of lean beef finely 
 minced, and to it add two tumblers of water. Stir thoroughly, and 
 allow it to stand under cover for six hours in a cool place. Strain 
 the red-looking water through linen, pressing out, with the washed 
 hands, the last portion of meat juice. Then put on the fire a 
 goblet half full of water ; when boiling, place the above juice in a 
 jar, and put the jar in the boiling water and boil for one hour. 
 Then strain, or filter if possible, and the result will be a clean straw- 
 coloured fluid. Season this to taste. This is excellent for weak 
 persons. If it is desired to feed by the bowel, take four tablespoonf uls 
 of this essence, add a little salt, and half a teaspoonful of peptone. 
 1 )issolve the whole, and by means of a syringe inject slowly into 
 the bowel. {See page 176.) 
 
 An omelet. — Beat up three eggs in a cup, adding a little pepper 
 and salt. Take a piece of butter the size of one of the eggs, put 
 the butter into a pan over the fire and melt it, then pour in the 
 flipped eggs, and constantly keep the pan revolving. Do so till 
 the whole looks like cream. Then stop revolving, and let it 
 remain on the fire for about one minute. Slip a knife under one 
 half of the omelet and turn it over on the top of the other half, so 
 as to make it oval in shape. "When the under side is golden in 
 colour it is ready. Have a hot plate at hand, and over this reverse 
 the omelet quickly, with the brownish golden side uppermost. The 
 omelet should be creamy inside, but golden brown outside, when it 
 is served to the patient. 
 
 Chicken soup for an invalid. — Prepare a young chicken by 
 skinning it and cutting the limbs and body into small pieces, and 
 put it into a bowl with as much water as will cover it fully. In the 
 course of a quarter of an hour throw away the water, in which 
 the fat will be floating. Wash again, and jDut into the cooking 
 goblet, with four tumblers of cold water, salt, &c. Put the whole on 
 the fire, and allow it to boil for five minutes. Then set by the side 
 of the fire and allow it to simmer for four hours. By this time the 
 meat will have been separated from the bones, and the gelatinous 
 substances of the tissues dissolved into the fluid parts of the soup. 
 Take the solid parts of the muscles that remain and pound them in 
 a mortar, adding the whites of three eggs and a tumbler of good milk. 
 
SICK DIET AND COOKING FOR INVALIDS 197 
 
 Then add tlie whole again to the soup in the goblet. Stir the soup 
 on the fire, but be careful that it does not boil, or the boiling will 
 cause the milk to coagulate. Strain and serve. It may be set 
 before the patient with or without little squares of toast. 
 
 Potato soup. — Take fully 1 lb. of native or European potatoes 
 and cut them into slices, along with a good-sized onion, or half-a- 
 dozen shelots, and one teaspoonful of butter. Put all into a stew- 
 pan and add two tumblers of water, and let the whole boil till 
 the potatoes are reduced to pulp. Then into a second pan put one 
 tumbler of fresh milk and heat it, taking care that it does not 
 boil. Then take the contents of the first stew-pan and pass them 
 through an ordinary kitchen strainer, adding the heated milk in 
 the second pan. Put beside the fire for a short time, add salt and 
 pepper, and allow the soup to come slowly to the boil. When it 
 boils the soup is ready. 
 
 Mutton soup. — Take 1 lb, of good mutton free from fat, chop it 
 very fine, and put it into a goblet with two tumblers of water ; cover, 
 and allow to come slowly to the boil. Then, if necessary, it can be 
 carefully skimmed, so that all froth, fat, &c., are removed. Let it go 
 on simmering for two and a half hours. Then take one tablespoon- 
 ful of rice, or the same quantity of fine barley, and let it be washed 
 in several waters. Add this rice to the soup, together with an 
 additional half- tumbler of water. Let this simmer beside the fire 
 for another hour. This can now be strained and served hot, or it 
 can be strained and set aside till cold, or can be kept till next day. 
 It should, however, be served hot if possible, and always with little 
 squares of brown toast. 
 
 A chop. — If possible let the chop be taken from the loin. 
 Prepare a saucepan, or other flat dish, by having it well buttered 
 over a hot fire. Turn the pan from side to side so that it does 
 not burn, and yet is well heated all over. Let the chop be well 
 salted and peppered, with a piece of butter the size of a walnut 
 on its upper surface, and let it be laid on the hot saucepan. 
 Put the pan, if possible, in a hot oven, and let it cook for five 
 minutes. If not, cover it by means of a plate, and let it lie over 
 a hot fire. Take it off and turn the chop, and again give it five 
 minutes. Then place the chop on a hot plate : pour into the sauce 
 that is now in the saucepan two tablespoonfuls of the cream of 
 milk, if it is to be had, and make a sauce by stirring briskly and 
 allowing it to boil over the fire. Pour this sauce over the chop, and 
 serve in a tempting way to the patient. 
 
 A grilled chop. — As in the above, let the chop, if possible, be 
 taken from the loin. See that the firB is a white heat and that no 
 
198 HEALTH IN AFRICA 
 
 smoke is about. Then put the gridiron on the fire till every wire is 
 hot. Take it off and rub both sides with fat, so that the chop may not 
 stick. Place the chop upon the gridiron and cook for ten minutes, 
 all the while turning the chop round from side to side. Do not 
 keep one side down longer than say eight seconds. By this means 
 you secure that the chop is well browned, with all the fluid substance 
 inside. The hot fire coagulates the superficial albumen, and keeps 
 the juice within. 
 
 A palatable custard. — Take four eggs and the white of an 
 additional egg, and beat them very briskly in a bowl, adding one 
 teaspoonful of sugar and one tumbler of fresh milk. Then take an 
 ordinary pie or custard dish, and butter it well inside ; pour the 
 whijDped-up contents into the same, and place it in an oven fairly 
 well heated. There let it remain for a quarter of an hour, without 
 being moved, when it will be ready for serving. If it is moved 
 while inside the oven, the custard will be curdled and not set. 
 
 Tea. — Sir Andrew Clark tells lis that the best tea is made with 
 boiling milk instead of boiling water, and that it should be allowed 
 to stand for four minutes exactly. 
 
 There are two or three secrets in the art of making tea, which 
 are so insignificant that they are apt to be put down as fads. They 
 go, however, to the infusing of an " excellent cup of tea." Fijst, the 
 water should be fresh ; second, the tea should be infused the moment 
 the water boils ; third, the teapot should be very hot before the tea 
 and boiling water are added ; and fourth, the teapot should be dry. 
 Then, allowing two cups of tea for each 2:)ersonj put into the teapot 
 one teas2JOonfiil of tea for every drinker, and one teaspoonful for the 
 teapot. Pour the boiling water on the tea, and let the tea stand for 
 four minutes under a tea-cosy. Do not allow it to stand longer, but 
 pour off the tea into a second teapot or jug. If the tea-leaves remain 
 longer in the infusion, they tend to make the tea bitter. 
 
 Coffee. — Coffee in its preparation should never be boiled, and 
 should always be served very hot. Let the coffee-pot or jug be 
 heated by boiling water and dried. Then for every cup add one 
 tablespoonful of coffee, and pour in one cupful of boiling water. 
 Cover and let it " mask " beside the fire for five minutes. It should 
 never boil. Some recommend that, in order to stir the contents 
 gently, it is well to pour off a little of the coffee into a cup and 
 pour it back again. Do this three times, and at the end of ten 
 minutes, serve. Add two-thirds of a cup of such prepared coffee 
 to one-third of a cup of boiled milk. It is important that the milk 
 should be boiled. 
 
APPENDIX I 
 
 199 
 
 o w 
 
 ^ M 
 
 I— I 
 
 
 /-^ 
 
 
 
 -t^ 
 
 
 n 
 
 ^ 
 
 
 
 .SP 
 
 Jmi-HCCOtHOCCCOOOCO 
 
 
 j^ tH r-H 
 
 |3 
 
 w 
 
 
 o 
 
 CO 
 
 ^^•(MCOCCCCTt^TtlrJIlOOt^t- 
 
 >> 
 
 ^ 
 
 M 
 
 g 
 
 s 
 
 
 eS 
 
 
 
 w 
 
 
 
 
 
 ei-i 
 
 
 
 O 
 
 
 ,aoO(MiH'!t<OiCCCOOiOCOlO 
 
 1 
 
 _^ 
 
 +3 
 
 .-; iH rH 
 
 s 
 
 ^'ccco'^-^-^^ioiococot^ 
 
 P 
 
 
 
 
 03 
 
 OJ 
 
 V 
 
 o 
 
 fefJlO COt-OOCSOT-l(MCO-*lO 
 
 > 
 
 pp 
 
 <5 iH iH rH T-i tH tH 
 
 . 
 
 
 
 oj 
 
 
 
 s 
 
 
 
 f 
 
 >> 
 
 -1-5 
 
 ^0-*t>.(M(NCl(MC5COCO-*i 
 
 .§ 
 
 J rt rH 
 
 s 
 
 53 
 
 
 s 
 
 ^ 
 
 -u:t^i>.b-i>.ooooc50ioi0i-i 
 
 ^ 
 
 
 02 i-ir-{ 
 
 « 
 
 
 
 w 
 
 
 
 d 
 
 tw 
 
 
 
 
 
 o 
 
 
 
 -i-> 
 
 
 
 ,f3 
 
 
 
 ha 
 
 
 
 '3 
 
 -w 
 
 52 0THOrHC<lCO'^lOCCt-00 
 
 To 
 
 •l-H 
 
 -rH,-l 
 
 « 
 
 a> 
 
 
 bo 
 
 K 
 
 g-^Tt^lOlOlOlOlOOlOlOlO 
 
 u 
 
 
 
 > 
 
 
 
 < 
 
 
 
 d 
 
 
 
 i5 
 
 
 
 S 
 
 
 Sot^CC(?<JK500rH(XirHOO 
 
 ^ 
 
 
 3 rH ,^ 
 
 ^ 
 
 
 -ti0505C5000THrH(M(?q(M 
 
 0) 
 
 
 OQ r-l 1-1 T-H rH tH tH r-( iH 
 
 
 
 <4H 
 
 
 
 o 
 
 
 
 ■^ 
 
 
 
 ^ 
 
 
 
 6J> 
 
 
 
 •fH 
 
 
 
 4> 
 
 -tJ 
 
 a(?qccTjHio?ot^GociOi-io 
 
 M T-lrH 
 
 a> 
 
 |3) 
 
 
 60 
 
 '3 
 
 
 2 
 
 K 
 
 ^loioioioiooioiciioio':© 
 
 > 
 
 
 
 < 
 
 
 
 CI 
 
 a2 
 -(J 
 w 
 
 ci.-S 
 
 1 j3 
 
 w 
 
 o S 
 ^ o 
 
 O M 
 
 rH >> 
 
 ^^ 
 
 if ts 
 
 MH O 
 
 M iJD 
 
 © fe 
 be 
 
 <D > 
 > cS 
 
 ^ o 
 
 O 
 
 a, 
 
 © 
 
 13 
 c3 
 
 3 ^^ 
 
 O 
 
 pq 
 
 © 
 
 s 
 
 o 
 
 'c3 
 © 
 
 ,=3 
 '© 
 
 © 
 bo 
 
 © 
 © 
 
 -^^'-f? 
 
 ^^ai 
 
 ft 
 © 
 
 r!4 
 
 ;3 
 02 
 
 
 bo 
 
 •S 
 
 pi 
 
 -1-3 
 
 ,bfl 
 '© 
 
 2 
 
 -1-3 
 PI 
 
 o 
 
 a 
 
 rt 
 
 ' b 
 © ^ © © . 
 
 © © s 
 
 O Q 
 
 ^ > § > a 
 g_§ o o o 
 
 c3 <^ ^ cS O 
 © ©'rf ©ffl 
 
 rG ^ _0 ^ , 
 
 H Eh "bflH !» 
 
 O Kl 
 
 ft § 
 
 o o ^ 
 
APPENDIX NO. 11. 
 
 MEDICINES 
 
 As far as possible, they should be supplied in tabloid form, as 
 tlius they are accurately administered witbout tbe use of scales, 
 are easily swallowed, and breaking up readily in tbe stomacb, 
 are sj)eedily absorbed into tbe system. Weight in carriage is also 
 minimised. Those supplied by Burroughs, W'ellcome & Co., Snow 
 Hill Buildings, London, E.G., are excellent, as this firm pays special 
 attention to foreign export. Their hypodermic medicines are all 
 that could be desired. 
 
 The following list embraces medicines that are necessary 
 for the treatment of malarial fever in its various forms. No 
 one should go to Africa without these. They can be suj)plied in a 
 j)ortable medicine-chest, and the majority are in bottles containing 
 100 tabloids. 
 
 Bisulphate of quinine, 2-grain and 5-grain tabloids. 
 
 Tannate of quinine, 2 grains. Excellent for children when 
 
 given in milk. 
 Hydrochlorate of quinine (muriate of quinine) : dose, 1 to 10 
 
 grains. 
 Quinine, iron, arsenic, and strychnine pills : dose, 1 before food 
 
 three times a day. 
 Arsenious acid — white arsenic : dose, ^q grain. 
 Liquor arsenicalis (Fowlei-'s solution) : dose, 2 to 8 drops in 
 
 water after food. 
 Liquor strychnine : dose, 5 to 10 drops. 
 Phenacetin : dose, 10 to 15 grains. 
 Antipyrin : dose, 10 to 15 grains. 
 Calomel : dose, ;| to 5 grains. 
 
 Jalap — "pulvis jalapce compositus : dose, 20 to 60 grains. 
 Dover's powder — ipecacuanha and opium : dose, 10 grains. 
 Ipecacuanha powder, as an expectorant, | to 2 grains ; as an 
 
 emetic, 15 to 30 grains. 
 
 200 
 
APPENDIX II 201 
 
 Laudanum — tincture of opium : dose, 10 to 30 drops. 
 
 Dilute sulphuric acid : dose, 5 to 30 drops. 
 
 Tincture of tlie per chloride of iron : dose, 10 to 30 drops. 
 
 Easton's syrup : dose, 1 teaspoonful. 
 
 Warburg's tincture : dose, 6 to 8 tabloids. 
 
 Tincture of aconite : dose, 1 drop every hour. 
 
 Sulphonal : dose, 15 to 40 grains, given an hour before sleep is 
 desired, and followed by a drink of hot fluid. 
 
 Sulphate of zinc, as an emetic, 10 to 30 grains. 
 
 Salicylicate of soda : dose, 10 to 30 grains. 
 
 Croton oil : dose, -g^ to 1 drop. 
 
 Compound powder of elaterium : dose, ^ to 5 grains. 
 
 Carbolic acid. Pure it is a caustic. Used in the strength of 
 1 to 20 or 40 of water. Applied locally it has an anaes- 
 thetic action similar but inferior to that of cocaine. 
 
 Iodoform — pulvis iodoformi. 
 
 The following are hypodermic medicines. It is necessary to 
 be provided with a good hypodermic syringe and three sets of 
 needles, &c. {See Eig. 41.) 
 
 Sulphate of morphia : dose, -/xr to \ grain. To relieve pain. 
 
 Apomorphine : dose, 2V ^^ 6 grain. A powerful emetic. 
 
 Elaterium : dose, tV to \ grain. Acts powerfully on the liver. 
 
 Ether, hypodermically, 20 drops. In a case of collapse a tea- 
 spoonful may be given. 
 
 Pilocarpine : dose, tV grain. Brings on profuse perspiration. 
 
 Cocaine : dose, ^ grain. A local ansesthetic, &c. 
 
 In addition, the following are useful medicines : — 
 
 Ammonium bromide : dose, 2 to 20 grains, in spasmodic affections 
 of the throat and loss of voice. 
 
 Anti-constipation tabloids. 
 
 Subnitrate of bismuth : dose, 5 to 30 grains. Used for fermen- 
 tative disorders of the stomach and for worms. 
 
 Bismuth and soda, that is bismuth subnitrate, and soda bicar- 
 bonate, of each 3 grains. 
 
 Blue pill : dose, 3 grains. 
 
 Perchloride of mercury (corrosive sublimate), used in lotions of 
 1 in 2000 to 4000 of water. This is the most powerful 
 antiseptic. It is soluble 1 in 16 of water. It is also 
 extensively used in dressings for wounds. 
 
 Hydrarg. cum creta. — mercury with chalk : dose, ^ to 1 
 grain. 
 
202 APPENDIX II 
 
 Hydrarg. iodidnm rubriim (Red Iodide of mercury) : dose, -^ 
 
 to ^ grain. 
 Cascara sagrada composita, a good laxative : dose, one before 
 
 dinner or at bedtime. 
 Cathartic compoimd, strongly purgative. 
 Cbloral hydrate : dose, 5 to 30 grains, A sleep-prodiicer, but is 
 
 incompatible with quinine. 
 Lead and opium pills : dose, 4 grains. 
 Male fern, usually in capsules. 
 Citrate of iron and quinine : dose, 3 grains. 
 Pepsin : dose, 2 to 5 grains. Has digestive properties. 
 Peptonitic : dose, 3 grains. This contains pepsin, pancreatin, 
 
 lacto-phosj)hate, and lime in equal quantities. Is a power- 
 ful digestive. 
 Potassium permanganate : dose, 1 to 5 grains. Has marked 
 
 deoxidising and disinfecting proj)erties. 
 Bromide of j)otas.^ium : dose, 5 to 30 grains. 
 Chlorate of potassium : dose, 10 to 30 grains. 
 Iodide of potassium : dose, 2 to 20 grains. 
 Compound rhubarb j)Owder (Gregory powder) : dose, 20 to 60 
 
 grains. 
 Santonin : dose, 2 to 6 grains, in sugar or milk. An anthelmintic 
 
 for round and thread- worms. 
 Soda-mint, or neutralising tabloids. 
 Tannin. 
 Tonic tabloids. 
 
 Voice tabloids of potash, borax, and cocaine. 
 Chlorodyne, 
 Toothache mixture — menthol 2 parts, butyl chloral hydrate 1 
 
 part, carbolic acid 1 part, cocaine hydrochlor 1 part. 
 Glycerine. 
 Sulphate of copper. 
 Nitrate of silver. 
 Flowers of sulphur. 
 Camphor. 
 Liquor ammonise. 
 Chrysophanic acid. 
 Vaseline. 
 
 For surgical purposes the following are necessary : — 
 Bandages of various sizes. 
 Boracic acid. 
 Lanolin. 
 
APPENDIX II 203 
 
 Sterilized catgut ligatures. 
 
 Surgeon's lint. 
 
 Sterilized gauze. 
 
 Oiled silk protective. 
 
 Tape adhesive plaster. 
 
 A few sticks of nitrate of silver or lunar caustic. 
 
 Mustard leaves. 
 
 Small dresser's pocket-case, containing scissors, director, catlieter, 
 surgical needles, clinical thermometer, bistoury, artery- 
 forceps. 
 
 Tourniquet. 
 
 Tooth instruments. 
 
 Vaccine lymph in tubes. 
 
 Brandy or whisky — should be taken in cases of emergency 
 
 only. 
 Champagne — useful in treatment of black-water fever. 
 Wincarnis — useful in cases of great nervous debility and 
 
 prostration. 
 
APPENDIX NO. III. 
 
 EUROPEAN PROVISION ORDER FOR ONE YEAR 
 
 The following is a suggestive list of provisions suitable for 
 
 tropical Africa. They may be supplied by Messrs. Crosse and 
 Blackwell, Soho Square, London ; J. T. Morton, 107 Leadenliall 
 Street, London ; Messrs. Moir & Son, 145 Leadenball Street, London. 
 A few delicacies have been added for invalids. It lias been tboufdit 
 advisable not to add quantities in every case. 
 Beverages. 
 
 Tea. This is a common beverage, owing to the bad water : 
 20 lbs. in 5-lb. tins. Tea pellets are useful when 
 travelling. 
 Coffee : that grown in the country, if obtainable, is the best. 
 Ground coffee is preferable to all forms of essence of 
 coffee. 
 Cocoa or chocolate, useful for its nutritious properties. 
 Cadbury's preparation is the best, as it contains no 
 soda. 
 Easpberry vinegar, 3 |-pint bottles. 
 
 Lime-juice, or lime-juice cordial, or lemon squash — never to 
 be used if fresh lemons can be obtained, 3 -|-pint bottles. 
 Granular effervescent citrate of magnesia, 2 l^-piiit bottles. 
 Soda-water, lime-water, or sherbet, 4 ^-Vo. bottles. 
 Soups. — Such as julienne, vegetable, ox-tail, hare-soup, 3 of 
 
 each in 1-lb. tins. 
 Fish. — Such as salmon, 6 1-lb. tins, herrings a la sardine 3 1-lb. 
 tins, oysters 6 |-lb. tins, sardines 6 j-lb. tins. Fresh fish, 
 even if coarse in fibre and of indifferent flavour, is to 
 be preferred to tinned fish. 
 Meats. — Various, in 1-lb. tins. 
 Chicago compressed beef or ham. 
 Smoked breakfast bacon or whole hams. 
 Paysandu ox tongues, lunch tongues, or sheep's tongues, 
 
 204 
 
APPENDIX III 205 
 
 potted ham and tongue, potted ham and chicken, in 
 3-oz. tins, 3 of each. 
 
 Anchovy paste, 2 in 3-oz. tins. 
 
 Liebig's extract of meat, 6 1-oz. jjots. Bovril. 
 
 Essence of mutton, beef, or chicken jelly, 3 in 2|^-oz. tins. 
 Vegetables. — Various. Only to be used if fresh vegetables 
 are not to be had. Chollet's compressed mixed vegetables 
 for soup. 
 Cheese. — If desired. 
 Condiments and relishes. 
 
 Curry powder, 3 ^-Ib. bottles. 
 
 Madras chutney, 3 1-pint bottles. 
 
 Colman's mustard, 6 |^-lb. tins — may be required for 
 poultices. 
 
 Ground white pepper, 3 small tins. 
 
 Cayenne pepper, 3 1-oz. castors. 
 
 Lea & Perrins' Worcester sauce, 6 small bottles. 
 
 White table vinegar, 3 ^-pint bottles. 
 
 Salad oil, 1 ^-pint bottle. 
 
 Sweet almond oil, 1 -^-pint bottle. 
 
 Salt, 20 1-lb. packets in hermetically sealed tins. 
 Fruits in syrup. — Various, such as — 
 
 Pears, in 2j-lb. tins. 
 
 Peaches, in 2^-lb. tins. 
 
 Easpberries, in 1-lb. tins. 
 
 Strawberries, „ „ 
 Dried fruits. 
 
 Imperial French plums. 
 
 Elme figs. 
 
 Dates. 
 
 Crystallised ginger. 
 Jams. — Various. 
 
 Bottled fruits for tarts. — Various. 
 Gelatine. 
 
 Portable table jellies. 
 Biscuits. — Various — Huntley & Palmer's are the best. 
 
 Plain biscuits, such as " water," and " soda," often take 
 the place of bread on the march. 
 Baking and cooking. 
 
 Flour, say 126 lbs. in 9 14-lb. tins. 
 
 Sugar, say 70 lbs. „ 10 7-lb. „ 
 
 Oatmeal, 21 lbs. „ 6 4-lb. „ 
 
 Marrow fat, 16 lbs. „ 8 2-lb. „ Of the above, together with 
 
206 APPENDIX III 
 
 tea, the largest supply of all the provisions is neces- 
 sary. 
 Butter — if desired. 
 Condensed milk — if desired. 
 Sago, taj)ioca, vermicelli. 
 
 Eice — may frequently be bought in the country. 
 Arrowroot or corn-flour — 6 1-lb. tins. 
 Bcirley, 10 lbs. in 5 2-lb. tins. 
 Split lentils, 4 lbs. in 4 1-lb. tins. 
 Hops, 4 ^-Ib. packets in sealed tins. 
 Baking-powder, 6 1-lb. bottles ; bicarbonate of soda, 3 ^-Ib. 
 
 bottles ; tartaric acid, 3 ^-Ib. bottles. 
 Cloves, 1 ^-Ib. tin. 
 Mixed spice, nutmeg, orange peel, senna leaves, sultana 
 
 raisins, currants. 
 Dried mint, 1 j-pint bottle. 
 Dried parsley, 1 j-pint bottle. 
 Golden syrup, 6 1-lb. tins. 
 Saltpetre for pickling beef or pork, -| lb. 
 Miscellaneous. 
 
 Soap, brown soap, say 20 lbs. 
 Carbolic. 
 Toilet. 
 Soft soap. 
 
 Blue. 
 
 Starch. 
 
 Borax, beeswax. 
 
 Candles, 30 lbs. 
 
 Matches, 1 gross. 
 
 Blue black ink, 2 bottles. 
 
 Gum. 
 
 Nubian blacking. 
 
 Knife polish. 
 
 Washing soda. 
 
 Keating's insect powder, 3-lb. tins. 
 
 Lump camphor, 1 lb. 
 
 Glycerine, 1 small bottle. 
 
 Linseed meal, 2 1-lb. tins. 
 
 Carbonate of ammonia, 1 bottle 
 
 Spirits of wine, small quantity 
 
 2 provision-opening knifes. 
 
 Nail-puller. 
 
 2 corkscrews. 
 
APPENDIX III 207 
 
 The following native and fresh food stuffs are to be found 
 in most parts of the continent, and are, when well cooked, to be 
 preferred to tinned provisions. 
 
 Meats. — Beef, mutton, kid are frequently to be had, and 
 fowls are always obtainable. The Africa nkuku (fowl), 
 while small in size, is most delicate. Ducks, guinea-fowl, 
 jjigeons, partridges, as well as venison, are to be had 
 occasionally. Pigs do remarkably well on the hills. 
 Eiver and lake fish are plentiful at certain seasons. 
 Vegetables. — Sweet jjotatoes, yams, beans, peas, and pumpkins 
 are in abundance. European potatoes should be culti- 
 vated by every settler, and do well. Green Indian-corn, 
 boiled with milk or roasted in the ashes, is excellent 
 and most nutritious ; casava in its season, when boiled in 
 several waters and fried, resembles European potatoes. 
 
 Green bananas, of varieties well known to the natives, are 
 excellent when roasted in the ashes. They may also be 
 boiled. The fruit of the j)apaw (Carica Papaya), when 
 green, is an excellent vegetable, and resembles vegetable 
 marrow. 
 
 The native mtaka (a kind of spinnage) is excellent. 
 
 Tomatoes grow everywhere. 
 Fruits. — Native and foreign fruits in their season are good. 
 Lemons, pine-apples, melons, papaws. Cape gooseberries, 
 bananas (of which there are thirty varieties) form an 
 excellent variety. 
 
 The banana and plantain may be used as a vegetable, as a 
 fruit, as flour, or as a wine. 
 Flour. — Indian-corn flour can be used in the hot season 
 instead of oat-meal. It should always be cooked with 
 milk. It is good also for puddings and fritters, and 
 resembles ground rice. Banana flour is excellent for 
 porridge and for thin gruel. 
 
 Bean flour cooked with milk makes a most nutritious food. 
 
 Pea-flour is also excellent. 
 
APPENDIX NO. IV. 
 
 GENERAL OUTFIT 
 
 The following is a suggestive list of clothing, hoiiseliold utensils, 
 and furniture. Africa is a continent, and embraces hot plains, 
 undulating cool plateaux, and cold highland country. Every resi- 
 dent or traveller must therefore select according to the require- 
 ments of the country about to be visited. The goods may be 
 supplied by Messrs. Silver & Co., Cornhill, London, or the Army 
 and Navy Stores, London. The india-rubber material may be 
 supplied by the Argyle .Rubber Co., 64 Gordon Street, Glasgow. 
 
 PERSONAL CLOTHING. 
 
 Suits. — One dozen white drill, such as are made at Zanzibar 
 (C. R. de Souza, Portuguese Street, Zanzibar). Flannel 
 tennis suits may be selected by some. Two light tweed 
 suits, such as are worn in Europe during the spring and 
 autumn. Some prefer knickerbockers of woollen material. 
 All clothing for the tropics should be unlined. 
 
 Sleeping garments or pyjamas. — It is often so hot in the 
 tropics, that in the early hours of the night the bed- 
 clothing cannot be borne, whereas about four in the 
 morning the temperature falls, and exposure may result 
 in a chill. Silk and wool, or grey shrunk flannel, is 
 the best material. 
 
 Shirts may be made of Jaeger's fine flannel, silk and wool, 
 or white union shirting. The last named is a mixture 
 of cotton and wool ; it is inexpensive, unshrinkable, and 
 washes well. White cellular garments for hot weather 
 may be selected by some in preference. White dress 
 shirts may be required in certain localities. 
 
 Drawers may be made of calico or light woollen material. 
 They should be short and loose. 
 
 Waistcoat. — Those who do much hunting will require one 
 
 208 
 
APPENDIX IV 209 
 
 which, should be made of chamois leather. A sleeved 
 waistcoat may be preferred. 
 
 Stockings. — Several pairs of knitted woollen material should 
 be taken for the march. Socks of cotton, cashmere, or 
 silk are excellent for the hot season. 
 
 Handkerchiefs — of white linen or red silk. 
 
 Towels. — Six bath, and six hand towels. 
 
 K3,marb^nd. — A few of silk may be preferred by some ; 
 for ordinary wear two yards of fine cloth or flannel 
 wound round the waist afford an excellent protection to 
 the abdomen. 
 
 Braces. — A few pairs. 
 
 Helmets. — This is a very important item. They should be 
 light in weight, with a broad brim, and made so that 
 they afford shade to the back of the neck. The Terai 
 hat is excellent, and should be of double felt. Smaller 
 hats of soft material should be chosen, and at least two 
 caps for knock-about wear. 
 
 Boots. — Brown shooting-boots for heavy wear. Have them 
 made to order, of the best russet leather, and a little 
 larger in size than those worn in Europe, as an allow- 
 ance for the heat. Shoes are excellent for lighter wear. 
 Veldtschoons are useful for knock-about use. Spare 
 laces and dubbin should not be overlooked. White 
 cloth or leather slippers are chosen by some. 
 
 Leggings may be selected according to taste, so too may 
 light cloth gaiters. 
 
 Putties are usually of light woollen material, and grey in 
 colour. 
 
 A light woollen dressing-gown is most necessary. 
 
 Overcoat of light tweed is useful for the cold chilly weather 
 of the highlands ; or a light, sleeveless, Inverness cloak 
 may be the choice of some. 
 
 Waterproof- coat should be made of the best of mackintosh, 
 and of light texture. It should be sewn, and not put 
 together by adhesive material. 
 
 India-rubber bath is excellent for the march. 
 
 Hot- water bottles. — These are an absolute necessity for 
 Africa. They are indispensable in the treatment of 
 malarial fever. Three at least should be taken. Make 
 certain that the screw at the neck will not become 
 loose and lead to leaking, in which case the bottle is 
 useless. 
 
 o 
 
210 APPENDIX IV 
 
 Housewife, containing needles of various sizes, thread, 
 
 buttons, a bodkin, palm and sail needles, tapes, &c. 
 Holdall, or dressing-case, containing brusbes for the hair, 
 
 nails, and teeth ; scissors, comb, hand-glass, soap, and 
 
 sponges. 
 Shaving instruments, as two razors, soap-brush, strop, &c. 
 Traveller's pocket-knife, containing cork-screw, tin-opener, 
 
 screw-driver, &c. 
 Mackintosh sheeting of the best quality, and yet not 
 
 heavy. Let it be 2 yards square. 
 India-rubber tubing, |-inch diameter and 2 yards long, for 
 
 giving a hot-air bath and inducing free perspiration in 
 
 fever. 
 Umbrellas. — White, lined with green. A few spare covers 
 
 should be taken. 
 Lump camphor. — Sewn in cloth and placed in boxes to 
 
 keep away moths. 
 
 TRAVELLING AND HOUSEHOLD UTENSILS 
 
 The following is a suggestive list of articles necessary for travel- 
 ling. All residents and planters should surround themselves with 
 as many household comforts as possible. A good library stocked 
 with choice literature, favourite authors, and a few of the best 
 novels is invaluable to health. 
 
 Tent. — If there is much travelling in the interior a tent is 
 a necessity. Those of Edgington, London, are by uni- 
 versal consent the best. It should have a fly and a 
 ground sheet, and should be of the very best material 
 Only the best of everything can stand the tear and wear 
 of a rough country like Africa. 
 Canteen. — This should contain all the necessaries for a 
 kitchen in the shape of cooking-pots, goblets, gridirons, 
 knives, &c. It should contain everything suitable for 
 a table, as enamelled plates, cups, saucers, table-knives, 
 forks, spoons. It should contain a teapot, coffee-pot, 
 and dishes for salt, pepper, mustard, &c. 
 
 A canteen is a necessity for all travellers in the 
 country ; if, however, residence (as in coffee-planting) 
 is contemplated, then the ordinary kitchen furnishings 
 should be procured, together with a stove, such as the 
 " Victoress." Tea services, dinner services, &c., must be 
 
APPENDIX IV 211 
 
 selected according to requirements and taste. Enamelled 
 ware is the best for ordinary purposes. 
 
 Bedstead. — Some prefer the ordinary folding iron bedstead 
 for the march. My experience, however, is that the 
 natives, not understanding joints, bring the whole thing 
 to grief in a few weeks. It is better to get a cross-legged 
 bedstead made at home of good 2-|-inch pine wood, which 
 should be 6^ feet long, with the crossed legs made to 
 fit in below. It should be covered with the strongest 
 sailors' canvas, and when stretched should be 2 feet 
 8 inches broad. It is beyond the power of the native to 
 break this, and is an ordinary load for a carrier. 
 
 Valise or " bed." — This is a giant hold-all. It should be 
 made of strong waterproof canvas, and not of water- 
 proofing only, as the perspiration of the native in 
 carrying affects the mackintosh. It should be 6^ feet 
 long and 3 feet broad, with flaps at the sides of thinner 
 waterproof material 2^ feet broad each. There should 
 also be end flaps of the same thin material, and also 
 2^ feet broad. It should be sewn throughout. This 
 valise should contain all bedding furnishings, such as — 
 
 (1) A hair mattress to suit the bedstead. It should be 
 1-| inches thick, as when laid on the canvas stretcher 
 this will be enough. If the mattress is of the ordinary 
 thickness, the " bed," when rolled up, will be bulky and 
 cumbersome. 
 
 (2) A mosquito-curtain. — This may be bell shaped, so 
 that the apex can be suspended from a hook. The 
 
 ; r ' square pattern is most useful. 
 
 (3) Two of the best Austrian or Jaeger blankets. In 
 cold districts more may be required. 
 
 (4) Two white sheets. 
 
 (5) Two small hair-pillows with pillow-slips. Down 
 pillows are too hot. 
 
 (6) A valise pillow for holding clothes and sleeping 
 garments. 
 
 (7) A waterproof ground sheet, 6 feet long by 5 feet broad. 
 
 (8) An india-rubber basin. 
 
 The whole valise should weigh not more than 55 lbs. 
 
 Folding Amer table, table-cloths, and table-napkins. 
 Folding-chairs, for household purposes. The bent wood 
 
 furniture is excellent for Africa. 
 Machilla, or hammock, made of the strongest canvas, with 
 
212 APPENDIX IV 
 
 rope at either end, which can be utilised for slinging on 
 
 a pole or for sleeping purposes. 
 Water-bottle, for the journey. Usually made of ebonite and 
 
 covered with felt. 
 Lantern. — The best that is made, and suitable for oil or candles. 
 A table-lamp. — Those of the Hitchcock or Wandzer patterns 
 
 are best, as they need no glass funnels (oil is to be had 
 
 at most of the European stores in the country). 
 Candle lamps. 
 Zinc baths are most useful. 
 Filter. The pocket-filters are of little use. " Every resident 
 
 should have a large kaolin filter on the Chamberland- 
 
 Pasteur principle, which consists of porous tubes of 
 
 porcelain. 
 The Colonial leather waist-belt may be necessary for hunt- 
 ing. It has a strap to go on the right shoulder, a means 
 
 of holding a light revolver, a knife, and ammunition. In 
 
 this connection the following are necessary accessories : 
 
 flint and steel, bi-convex burning-glass, whistle, &c. 
 Miscellaneous. — The following may be found useful : — 
 
 Field-glasses. 
 
 Compass. 
 
 Clinical thermometer, for taking the temperature in fever. 
 
 Ordinary thermometer. 
 
 Blue-coloured glasses. 
 
 Spring balance. 
 
 Letter weights. 
 
 Tape-measure. 
 
 Small handcase of tools, with screws, nails, tacks, and a 
 small hammer. 
 
 Eish-hooks, chess, &c. 
 
 A few tricks for amusing the natives. Street toys amuse 
 and break down the fear and prejudices of the 
 people. 
 A tin japanned despatch-case, containing — 
 
 Journals. 
 
 Diaries. 
 
 Writing-paper, &c. 
 
 Envelopes. 
 
 Pens. 
 
 Pencils. 
 
 Maps. 
 
 Ink-bottle. 
 
APPENDIX IV 213 
 
 Ink in pellets. 
 Ink erasure, 
 Stylographic pen. 
 Sketching materials. 
 Drawing paper and utensils. 
 Travelling trunks. — As most of tlie transport in Africa has 
 to be done by native carriers, the boxes should not 
 exceed, when jDacked, more than 50 or 60 lbs. All 
 personal clothing should be packed in tin japanned air- 
 and water-tight boxes, with the lock outside. For 
 convenience, all the boxes should have the same lock, 
 so that one key fits all. Those supplied by Messrs. 
 Silver & Co., Cornhill, London, are excellent, and 
 the most convenient size for general purposes is 
 32x14x10. 
 
INDEX 
 
 Antipyrin 
 
 46, 66, 67, 99, 118, 200 
 
 Antiseptic poultice 
 
 Antisepticism 
 
 Antitoxine . 
 
 Antivenene — against snake-bites 
 
 Anus, fissure of the 
 
 , , itchiness of the . 
 
 , , prolapse of the . 
 Apomorphine . . 31, 
 
 Apoplectic stroke 
 Apoplexy 
 Apyrexial forms of fever 
 
 PAGE 
 
 Abscess . . . 119, 130, 180 
 Absorption of fluids . -54 
 
 Acclimatisation .... 105 
 Acid, chrysophanic . , .21 
 ,, poisons .... 151 
 ,, sulphuric .... 36 
 Acidity of the stomach . . 30 
 
 Aconite, tincture of . . 63, 99 
 
 After-contraction in a burn . . 129 
 
 Ague 80 
 
 Airol 128 
 
 Albumen in the urine . . 57, 89 
 
 Alcoholism . . . . 69, T52 
 ,, acute. ... 70 
 
 Alcohol, use of . . . . 2 
 Algic form of fever ... 87 
 Alkali poisons .... 151 
 Ammonia ..... 54 
 Ammoniacal fermentation . . 189 
 Amoeboid action .,..']'] 
 Amyloids ..... i 
 Anaemia — due to fever . 82, 90 
 
 Anaesthesia ..... 61 
 Anaesthetic, local . . . 127, 130 
 Angina pectoris .... 54 
 Antinosine ..... 121 
 
 . 181 
 
 • 119 
 
 • 94 
 
 • 155 
 
 • 130 
 
 • 131 
 
 • 139 
 18, 201 
 . 63 
 62, 64 
 . 81 
 
 PAGE 
 
 Arm-bone, fracture of the . , 167 
 
 Arrest of bleeding — from a vein . 117 
 
 ,, natural . . 115 
 
 Arsenic in fever .... 96 
 Arteries, and how nature guards 
 
 them 113 
 
 Ascitis, dropsy of the abdomen . 54 
 
 Aseptic treatment . . 119, 120 
 
 Astringent injections . . . 135 
 
 B 
 
 80, 89 
 77 
 
 ■ 193 
 , 188 
 
 ■ 195 
 
 Back, pains in the 
 Bacteria 
 
 ,, in milk . 
 , , in vi^ater . 
 Banana w^ine 
 Bandaging, and the reason for 
 
 bandaging . . . .158 
 Barley-vi^ater . . . .194 
 
 Bath, hip 183 
 
 ,, hot air ... . 184 
 
 ,, hot mustard . . . 103 
 ,, hot, warm, and tepid. 46, 182 
 ,, vapour .... 184 
 
 Bather's cramp . . . -133 
 Bathing in mountain streams 133, 181 
 ,, to reduce the tempera- 
 ture ..... 100 
 
 Baths, and how to take them , i8i 
 Bed-pans ... . . . 187 
 
 Bedside hints .... 186 
 
 Beef essence . . . .196 
 
 ,, tea 19s 
 
 Bile and its generation . . 87 
 
 , , in the urine ... 57, 87 
 
 Bilious fever . . 85, 87, 102 
 
 ,, hasmoglobinuria . . 88 
 
 214 
 
INDEX 
 
 215 
 
 
 
 
 PAGE 
 
 
 
 
 Bilious vomiting . 
 
 
 103 
 
 C 
 
 
 
 Biliousness . 
 
 
 
 3C 
 
 >, 85 
 
 
 PAGE 
 
 Bismuth 
 
 
 
 
 201 
 
 Callosities 
 
 . 
 
 132 
 
 Bites by dogs 
 
 
 
 
 iSS 
 
 Callous ulcer 
 
 
 126 
 
 ,, scorpions 
 
 
 
 
 157 
 
 Calomel, and jalap 27, 30, 39 
 
 48, 
 
 100 
 
 Black eye . 
 
 
 
 
 124 
 
 ,, means of giving 40, 
 
 185, 
 
 200 
 
 ,, wash . 
 
 
 
 
 no 
 
 Capillary circulation of the blood 
 
 113 
 
 , , water fever 
 
 
 
 88, 
 
 103 
 
 Carbolic acid as an antiseptic 
 
 121, 
 
 201 
 
 Bladder, the 
 
 
 
 
 55 
 
 Carbuncle .... 
 
 
 14 
 
 ,, how to empty 
 
 
 139. 
 
 140 
 
 Cardiac pain 
 
 
 54 
 
 Bleeding and how to control 
 
 
 Caries of bone 
 
 
 138 
 
 it . . . . Ill, 
 
 116, 
 
 123 
 
 Carron oil . 
 
 
 129 
 
 Bleeding at the nose . 
 
 46, 
 
 150 
 
 Carrying a disabled person . 
 
 
 188 
 
 ,, from an artery 
 
 
 "3 
 
 Cascara Sagrada 
 
 33. 
 
 202 
 
 , , from a vein . 
 
 . 
 
 117 
 
 Castor oil and how to take it 
 
 
 38 
 
 , , ■ from the nose 87 
 
 89, 
 
 118 
 
 ,, ,, and opium . 33 
 
 .36, 
 
 107 
 
 , , in fever . 
 
 
 91 
 
 Catarrh, an ordinary cold . 
 
 
 45 
 
 into the brain tissues 
 
 
 62 
 
 , , of the bowel . 
 
 
 34 
 
 ,, resulting in fainting 
 
 
 62 
 
 of the eye 
 
 
 144 
 
 Blindness .... 
 
 
 91 
 
 of the middle ear . 
 
 
 148 
 
 Blisters, fly, blistering ointment 
 
 50. 
 
 179 
 
 , , of the stomach 
 
 
 32 
 
 Blood, affections in fever 
 
 
 91 
 
 , , of the throat . 
 
 
 148 
 
 ,, circulation of the 51 
 
 74. 
 
 112 
 
 Catheter, how to pass . 
 
 134. 
 
 139 
 
 ,, in the urine . 57 
 
 88, 
 
 103 
 
 Cerebral form of fever 
 
 
 87 
 
 , , its nature and functions 73, 74 
 
 III 
 
 haemorrhage . 
 
 
 62 
 
 ,, when vomited , 
 
 
 30 
 
 Chair made from the hands 
 
 188, 
 
 189 
 
 Boiled bread 
 
 
 194 
 
 Chancre .... 
 
 T09, 
 
 134 
 
 Boils 
 
 
 14 
 
 Change and its benefits 
 
 
 97 
 
 ,, in the ear . 
 
 
 147 
 
 Chapped hands , . 
 
 
 132 
 
 Bone, death of . 
 
 
 138 
 
 Chest, the . 
 
 
 44 
 
 Boracic acid as an antiseptic 
 
 47, 
 
 122 
 
 Chicken soup 
 
 
 196 
 
 Bouillon .... 
 
 
 196 
 
 ,, tea. 
 
 
 195 
 
 Bowel, how to feed by the . 
 
 , 
 
 176 
 
 Chigger .... 
 
 
 16 
 
 , , how to wash out the 174, 
 
 175 
 
 ,186 
 
 Chilblain . 
 
 9, 
 
 132 
 
 Brain, the . 
 
 . 
 
 58 
 
 Children, and how to give qui- 
 
 
 Brandy as an enema . 
 
 . 
 
 62 
 
 nine .... 
 
 95. 
 
 lOI 
 
 Brandy, how to give it hypod 
 
 er- 
 
 
 Children with convulsions . 
 
 64, 
 
 100 
 
 mically .... 
 
 
 102 
 
 Chloral hydrate . . 28 
 
 ,69, 
 
 202 
 
 Bread poultice 
 
 
 181 
 
 Chlorodyne. 
 
 34, 50 
 
 Breast pang .... 
 
 
 54 
 
 Chloroform and its uses 47, 5' 
 
 ;.66 
 
 Breath, foetor of the 
 
 
 46 
 
 Chop, a . . . . 
 
 
 197 
 
 Breathlessness 
 
 44, 54 
 
 Chordee, .... 
 
 
 13s 
 
 Bromide of potassium 64, 69, 
 
 107, 
 
 202 
 
 Chrysophanic acid 
 
 
 21 
 
 Bronchitis, acute . 
 
 
 47 
 
 Circulation of the blood 51 
 
 , 74. 
 
 1X2 
 
 Bruises and their treatment 
 
 119. 
 
 124 
 
 Classification of fever . 
 
 
 81 
 
 Bubo 
 
 
 131 
 
 Closets .... 
 
 
 192 
 
 Bugs 
 
 . 
 
 16 
 
 Clothing .... 
 
 
 3 
 
 Bunion .... 
 
 . 
 
 131 
 
 Clyster, how to give a 
 
 
 174 
 
 Burns . 
 
 
 
 
 128 
 
 Cocaine, to avoid pain 28, 67, 
 
 137, 
 
 201 
 
216 
 
 INDEX 
 
 PAGE 
 3 
 
 3. 198 
 
 45. 149 
 . 182 
 
 • 144 
 
 Cocoa as a beverage 
 Coffee . 
 Cold, a 
 
 ,, baths . 
 
 ,, in the eye . 
 Coldness of the body 
 Colic ...... 34 
 
 Collapse 71 
 
 Collar-bone and its fractures . 166 
 Colouring matter, deposits of . 91 
 Comatose state . . .71, 87, 88 
 Compresses of the eye . . . 146 
 Concussion of the brain . . 71 
 Congestion of the liver . . 39 
 Conjunctivitis .... 144 
 Constipation and its treatment . 33 
 Convulsions in children 64, 84,87, 88, 100 
 Cooking for invalids . . . 193 
 
 Corns 132 
 
 Corrosive sublimate . . . 121 
 Cough, a . . . . 44, 140 
 Coughing of blood . . . 118 
 Counter irritation, how to apply . 178 
 Crack at the anus . . . 130 
 Cracks on the back of the hand . 132 
 Cramp .... 85, 132 
 Croton oil . . . 63, 100, 201 
 Cupping, dry and wet . . 179 
 Custard, a 198 
 
 70, 84, 
 
 D 
 
 Death of bone . 
 Delirium 
 Delirium tremens 
 Delusions . 
 Dementia . 
 Diarrhoea , 
 
 ,, due to malaria 
 
 Digestion 
 Disabled person, and how 
 
 move such . 
 Dislocations 
 Dog bites . 
 Douche, cold and tepid 
 Dover's powder 27, 35, 46, 
 Draughts 
 
 Drink acting as a poison 
 Dropsy 
 
 . 138 
 87, 100 
 
 • 70 
 70 
 72 
 
 32, 176 
 81, 96 
 
 2q 
 
 to re- 
 
 . 188 
 . 170 
 
 • 155 
 . 186 
 
 107, 200 
 7 
 
 • 151 
 53. 90 
 
 PAGE 
 
 Drowning 152 
 
 Drowsiness ..... 84 
 Drunkard . . . . .69 
 Dry cup, how to . . . . 179 
 Dysentery and its treatment 35, 176 
 
 ,, as seen in malarial fever 
 
 37. 81, 96 
 
 ,, chronic • • • 37 
 
 Dyspepsia . , = . . -29 
 
 Ear . 
 Earth closets 
 Easton's syrup 
 Eczema 
 Egg flip 
 
 , , milk 
 
 , , poached 
 Elastic bandage . 
 Elaterium acting 
 
 liver 
 Emetics and when 
 them 
 
 to 
 
 • 147 
 . 192 
 
 64, 96, 201 
 II, 147 
 
 • 19s 
 
 • 19s 
 
 • 195 
 97, 126, 143 
 
 the 
 
 102, 103, 201 
 give 
 . 29 
 
 32, 98 
 
 Endothelium and its functions . 79 
 
 Enema and how to give it . . 174 
 
 ,, in children ... 64 
 
 of starch, brandy, &c. 62, 96 
 
 syringe .... 174 
 
 Epilepsy . . . . -63 
 
 Epsom salts . . . 36, 48, 54 
 
 Erysipelas . . . . .12 
 
 Erythema ..... 9 
 
 Essence of beef .... 196 
 
 Ether . . . . 54, 62, 201 
 
 Eucalyptus 132 
 
 Exercise . . . . . 3 
 
 Exfoliation of bone . • . . 138 
 Expectoration .... 45 
 
 Extract of male fern ... 38 
 Extravasation of blood . . 124 
 Eye . . . . . . 144 
 
 ,, lotions 145 
 
 Fainting . . . . 62, 85 
 
 ,, from loss of blood . 118 
 
 Fats ...... I 
 
INDEX 
 
 217 
 
 PAGE 
 
 Feet, cold 68 
 
 Fermentation . , . • i88 
 
 Fever 73. 120 
 
 and its evidences . . 73 
 
 a typical attack of malarial 79 
 black-water . . 88, 103 
 
 how easily brought on . 92 
 how it is generated . . 105 
 treatment of ordinary . 98 
 
 ulcers ..... 82 
 Filtration and filters . . 189, 193 
 Fires in dwelling-houses . . 6 
 Fissures of the anus . . . 130 
 
 Fits 64 
 
 Fleas 16 
 
 ,, of the sand-chigger. . . 16 
 
 Flip, egg 19s 
 
 Fluid foods .... 193 
 
 Fly-papers 152 
 
 Follicular tonsillitis . . . 148 
 Fomentations, and how to apply 
 
 them .... 103, 178 
 
 Food 
 
 Foot-baths — cold and hot . 
 Fore- arm bone, fracture of the 
 Foreign bodies in the ear 
 
 ,, ,, eye . 
 
 ,, ,, ,, nose . 
 
 ,, ,, ,, throat 
 Foreskin, inflammation of the 
 Fractures .... 
 Fraser and his experiments 
 
 snakes .... 
 
 I 
 
 183 
 168 
 
 147 
 146 
 
 150 
 149 
 
 133 
 
 164 
 
 155 
 
 Gargle for the throat 
 
 , 
 
 149 
 
 Garters .... 
 
 
 142 
 
 Gasogene for Africa . 
 
 
 30 
 
 Gasping as a reflex action . 
 
 
 62 
 
 Gastric remittent fever 
 
 
 86 
 
 Gastritis, or catarrh of 
 
 the 
 
 
 stomach 
 
 . 
 
 32 
 
 Generation of the organism 
 
 in 
 
 
 fever .... 
 
 
 104 
 
 Giddiness .... 
 
 . 
 
 54 
 
 Glands of the groin 
 
 
 131 
 
 Glass in the eye . 
 
 
 146 
 
 Gleet 
 
 . 
 
 134 
 
 PAGE 
 134. 139 
 
 34. 175 
 
 29 
 
 95 
 
 133. 134 
 
 182 
 
 • 14s 
 144 
 202 
 
 197 
 34 
 
 194 
 129, 156 
 122, 123 
 
 Glycerine . 
 
 , , syringe 
 Goat of Africa . 
 Golgi on quinine 
 Gonorrhoea 
 Graduated cold baths 
 Granular conjunctivitis 
 
 , , lids of the eye 
 Gregory powder 
 Grilled chop 
 Griping pains 
 Gruel of oatmeal 
 Gunpowder burn 
 Gunshot wounds 
 
 H' 
 
 HEMATURIA .... 57 
 
 Haemoglobin . . -74. 7^> 7^ 
 Hsemoglobinuria . • 57. 88, 89 
 Haemoptysis .... 
 
 Haemorrhage in the brain . 
 
 , , resulting in swoon- 
 
 ing . . . ... 62, 
 
 Haemorrhoids .... 
 
 Hand-chair . . . 188, 
 Headache, and how to relieve it 
 
 47. 67. 99 
 82, 97, 99 
 
 118 
 
 62 
 
 III 
 136 
 
 189 
 45. 
 
 ,, due to malaria 
 
 ,, in fever ... 73 
 
 Healing by immediate union . 122 
 
 ,, sore .... 125 
 
 Heartburn 29 
 
 Heart, the . . 51, 104, iii, 133 
 
 Heat-apoplexy .... 64 
 
 Heat-exhaustion ... 65 
 
 Heat, regulating mechanism . 91 
 
 ,, the production of . . 73 
 
 Helmet 4 
 
 Hepatic dyspepsia . . • 3° 
 
 Hernia ..... 14° 
 Hiccough . . . .85, 87, loi 
 
 Hints for securing good water . 190 
 
 the bed-side . . 186 
 
 Hip-baths 183 
 
 Hoarseness of speech . 46, 149 
 
 Hot-air baths .... 184 
 
 Hot fomentations, how to apply 178 
 
 House, the selection of a . . S 
 
218 
 
 INDEX 
 
 Hydrocele . . , , 
 
 PAGE 
 
 . 137 
 
 Hydrophobia 
 
 • ^55 
 
 Hygiene .... 
 
 I 
 
 Hyperpyrexia . 
 
 . 182 
 
 Hypnotic .... 
 
 100 
 
 Hypodermic injection, how 
 
 to 
 
 give a . . . 66, 
 
 loi, 176 
 
 Hypodermic injection, of ether 
 
 or brandy . 
 
 . 118 
 
 Ifwingire .... 
 Inability to pass urine . 
 Indigestion .... 
 Indolent callous ulcer . 
 Inflammation of the air passages 
 , , , , bowels 
 
 ,, ,, larynx (voice 
 
 box) .... 
 Inflammation of the liver 
 
 ,, ,, lung tissue 
 
 (pneumonia) . 
 
 Inflammation of the meatus of the 
 
 Inflammation of the mouth . 
 nail . 
 ,, ,, nostril and 
 
 pharynx .... 45 
 Inflammation of the pleura 
 
 (pleurisy) .... 49 
 Injection, how to give an . 174 
 
 ,, hypodermic . . loi 
 
 , , of nitrate of silver . 36 
 Injuries to the eye . . . 146 
 Insanity .... 63, 72 
 
 Insect bites ..... 157 
 Insensibility . . 65, 71, 84, 100 
 
 Insomnia 68 
 
 Intemperance .... 63 
 Intermittent forms of fever . 81, 83 
 
 Iodide of potassium . 97, no, 202 
 Iodoform as an antiseptic 97, no, 121 
 Ipecacuanha, and how to give 
 
 it . . . .36, 39, 47, 200 
 
 Itch 18 
 
 Itchiness of the anus . . . 131 
 
 ,, ,, skin ... 87 
 
 17 
 
 139 
 29 
 
 127 
 47 
 34 
 
 47 
 39 
 
 48 
 
 147 
 
 25 
 
 138 
 
 J 
 
 Jalap, for removing fluids 27, 39, 48, 54 
 Jaundice ..... 40 
 ,, in malarial fever . 40, 86, 87 
 Joint-affections .... 137 
 Joint, out of ... . 170 
 
 K 
 
 Kamarband 
 
 Kidneys 
 
 Knee affected in fever 
 
 Lacerated wound 
 Laryngitis . 
 Larynx 
 Latrines 
 Laudanum . 
 Laveran on quinine 
 Lead and opium . 
 Leeches, artificial 
 Lemonade . 
 Leprosy 
 Lice 
 
 Lifting and moving the patient 
 Lime in the eye . 
 Liquor arsenicalis 
 ,, strychninae 
 
 4 
 
 55. 103 
 . 82 
 
 122 
 
 • 47 
 ■ 42 
 . 191 
 
 14, 32, 201 
 
 • 95 
 . 202 
 
 20, 180 
 . 194 
 . 108 
 
 . 15 
 187 
 
 . 146 
 
 66, 95, 2CO 
 
 71, 96, 104, 200 
 
 Liver, congestion of the . . 39 
 
 Local anaesthesia . . 127, 130 
 
 Lotions for sores and wounds . 126 
 
 Lungili in the treatment of 
 
 dysentery . . • • 37 
 
 Lungs, wounds of the . 42, 138 
 
 M 
 
 Macrocytes 
 
 78 
 
 17 
 
 78 
 
 92 
 
 Malarial fever .... 
 
 habit .... 
 
 Male fern extract, and how to 
 
 give it 38 
 
 Mammary glands . . 82, 124 
 Mania 72 
 
INDEX 
 
 219 
 
 Maniacal ., . . . 
 Manipulation of dislocations 
 Matekenya .... 
 Meat, and tinned meat 
 Medicated suppositories 
 Medicines and their doses . 
 Medulla oblongata 
 Megrim .... 
 Melancholia 
 
 Menthol .... 
 Mercurial vapour-baths 
 Mercuric perchloride . 
 Mercury for syphilis . 
 
 ,, given hypodermically 
 Metastatic forms of fever 
 Migraine .... 
 Milk as a food . . i, 2, 
 Milk egg .... 
 Monomania 
 
 Morphia for relieving pain 31 
 55. 66, 71, 
 Morphia for relieving vomiting 
 Mosquitoes and their effects 5, 
 
 ,, curtain 
 
 , , theory of fever . 
 
 Mote in the eye . 
 Mouth, inflammation of the 
 Moving a patient in bed 
 Mucus in the urine 
 Mumps .... 
 Mustard and mustard leaves 
 Mutton soup 
 
 PAGE 
 
 70 
 . 170 
 
 . 16 
 
 2 
 . 186 
 
 68, 200 
 . 58 
 . 67 
 
 • 72 
 28, 46 
 . 184 
 . 121 
 
 no 
 . no 
 
 . 82 
 
 . 67 
 
 193. 194 
 . 195 
 
 • 72 
 
 , 34- 36, 
 141, 201 
 
 19. 157 
 5. 20 
 
 93 
 146 
 
 25 
 187 
 
 57 
 107 
 178 
 197 
 
 N 
 
 Narcotics . . . . 
 Natural breathing, how to restore 
 Necrosis 
 Nervous system 
 
 Nettle-rash . 
 Neuralgia . 
 Night sweats 
 Nitrate of amyl 
 Nitrate of silver 
 Nitrogenous foods 
 Nose, bleeding at the 
 
 ,, how to wash out the 
 Nourishment, how to g^ve 
 
 69 
 
 152 
 
 . 138 
 
 . 58 
 
 • 13 
 
 28, 65, 82 
 
 . 69 
 
 55. 62, 154 
 
 • 36 
 
 I 
 . 46 
 . 186 
 . 176 
 
 O 
 
 
 PACK 
 
 Oatmeal gruel . 
 
 194 
 
 ,, poultice 
 
 181 
 
 Omelet .... 
 
 196 
 
 Onychia .... 
 
 138 
 
 Ophthalmia 
 
 14s 
 
 Opium acting as a poison . 
 
 151 
 
 ,, fomentation 
 
 178 
 
 Oppression over the heart . 
 
 54 
 
 Orchitis .... 
 
 138 
 
 Ovaries affected in fever 
 
 82 
 
 Over-exhaustion . 
 
 68 
 
 Ozaena 
 
 46 
 
 Pack, and how to administer . 181 
 
 Pack, cold wet . . . .185 
 
 ,, hot wet .... 185 
 
 ,, the half . . . .185, 
 
 Pain after defsecation . . -131 
 
 in a joint . . . • i37 
 
 in a bruise . . . . 125 
 
 in a tooth .... 28 
 
 how to relieve . . • 178 
 
 ,, in a burn . 129 
 
 ,, in a sore . 128 
 
 ,, when making 
 
 an incision . . . 127, 130 
 
 Pain, sudden onset over the heart 54 
 
 Paleness, malarial . . 82, 97 
 
 Palpitation ..... 54 
 
 Papules leading to malarial ulcers 81 
 
 Paralysis . . . 61, 63, 87, 90 
 
 Parasite of malarial fever . . 78 
 
 Paroxysmal black-water fever . 89 
 
 Penis, when painful and swollen 135 
 
 Pepsin and peptonitic . . 176, 202 
 
 Perchloride of iron . . 37. 96 
 
 ,, mercury 47, 121, 201 
 
 Per6, the itch .... 18 
 
 Perineum i34 
 
 Permanganate of potash 47, 135, 202 
 Perspiration, and how to bring it 
 
 on . . 21, 48, 73, 103, 185 
 Phagocytes and their functions . 77 
 Phenacetin . . • 67, 97, 98, 200 
 
220 
 
 INDEX 
 
 PAGE 
 
 Piles ..... 136, 142 
 Pilocarpine acting on the kidney 103 
 ,1 .. liver 40, 50, 
 
 103, 201 
 Plasma of the blood ... 74 
 Pleurisy ..... 49 
 Pneumonia ..... 48 
 Poached egg .... 195 
 Poisoning ..... 151 
 
 Polypi 148 
 
 Pomegranate, decoction of . . 38 
 Potato soup ..... 197 
 Poultices, and how to make them 180 
 Poulticing and its evils . . 14 
 
 Prickly heat .... 10 
 
 Prolapsus ani . . . • 139 
 Proteids ..... i 
 Protrusion of the bowel . . 140 
 Pugilists, and how they treat black 
 
 eyes ..... 125 
 Pulse, the .... S3, m 
 Pupils of the eyes . , .84 
 
 Purge, a brisk . . 27, 30, 34 
 
 Pus, signs of it forming . 78, 130 
 Putties ..... 5 
 
 Purulent catarrh of the ear . . 148 
 
 Q 
 
 Quartan fever .... 83 
 
 Quinine . . 46, 94, 104, 200 
 
 , , as a prophylactic . . 104 
 
 ,, how best to bring the 
 
 system under it . . . 100 
 
 Quinine, how to give it hypoder- 
 
 mically ..... 100 
 
 Quinine, how to give it to children loi, 
 
 104 
 
 ,, in its action on low forms 
 
 of life • .... 95 
 
 Quinine, when best to give it . 95 
 
 Quinsy, a form of sore throat . 27 
 
 Quotidian fever . . . . 83 
 
 R 
 
 Rabid dog and rabies . . 155 
 
 Rectum, how to wash out the 174, 186 
 Red blood corpuscles ... 77 
 
 PAGE 
 
 Red deposit in the urine -. . . 90 
 Remittent forms of fever . 81,85 
 
 , , and their 
 
 treatment 
 Removing the disabled 
 Residence in the tropics and its 
 
 effects . 
 Respiration, artificial 
 ,, inner 
 
 , , ordinary 
 
 Respiratory organs 
 Restlessness, great 
 Retention of the urine . . 57, 
 Ribs, fracture of the 
 Rice water . 
 Ring^vorm . 
 Round-worms 
 Running ear 
 Rupture 
 
 lOI 
 
 188 
 
 62 
 
 44 
 
 42 
 
 42 
 
 186 
 
 139 
 169 
 194 
 20 
 38 
 148 
 140 
 
 Salicylic acid . . . 132, 201 
 
 Salivation 26 
 
 Santonine . . . .38, 202 
 Scald, and how to treat . .128 
 Scars due to fever sores . . 91 
 Sciatica .... 66, 82 
 Scorpion bites .... 157 
 Sea-sickness and its treatment . 31 
 Seat, a four-handed . . . 188 
 Seizures ..... 64 
 Sequelae of fever . . . - . 90 
 Serum of the blood ... 74 
 Serving of food .... 193 
 Sewing of a wound . . . 124 
 Sheets, how to change the . .186 
 Shivering and its treatment 73,84, 100 
 Shock ...... 71 
 
 Sick diet 193 
 
 Siesta . . . . . . 3 
 
 Side, pain in the .... 49 
 
 Skin and its nervous supply . 61 
 
 ,, ,, structure . . 9, 119 
 
 Sleep, amount to be partaken of. 3 
 
 , , how to encourage . . 68 
 
 , , want of . . . -87 
 
 Sleeplessness . , • 68, 73, 99 
 
 Sling, how to apply a . . . 160 
 
INDEX 
 
 221 
 
 
 PAGE 
 
 
 
 
 PAGE 
 
 Sloughing ulcer . 
 
 
 126 
 
 Suppositories, medicated 
 
 
 . 186 
 
 Small-pox .... 
 
 
 106 
 
 Suppression of the urine 
 
 57. 88, 89 
 
 Smell, perversions of . 
 
 
 91 
 
 Sweat, a cold clammy . 
 
 
 • 54 
 
 Smoking .... 
 
 
 no 
 
 ,, glands 
 
 
 9, 21 
 
 Snake bites .... 
 
 
 154 
 
 Sweating and how to bring 
 
 it 
 
 Snuff in the treatment of hiccough 
 
 lOI 
 
 on . . 21, 48, 
 
 73. 
 
 103, 184 
 
 Soda used in the rehef of a burn . 
 
 129 
 
 Sweaty feet . 
 
 
 22 
 
 Sores on the foreskin . 
 
 
 133 
 
 Swooning 
 
 
 . 62 
 
 ,, ulcers 
 
 
 125 
 
 Syncope, fainting 
 
 
 62, 104 
 
 Sore throat . . 26, 46, 
 
 148, 
 
 149 
 
 Synovitis 
 
 
 • 137 
 
 Soup of chicken . 
 
 
 196 
 
 Syphilis 
 
 
 . 108 
 
 ,, ,, mutton . 
 
 
 197 
 
 Syringing out the ear . 
 
 
 . 148 
 
 ,, ,, potato . 
 
 
 197 
 
 
 
 
 Spasm of the heart 
 
 
 54 
 
 - T 
 
 
 
 leg 
 
 
 8S 
 
 
 
 Spider bites .... 
 
 
 157 
 
 Tannate of quinine for children 
 
 Spinal cord . . . 
 
 . 
 
 58 
 
 
 95. 
 
 loi, 201 
 
 ,, nerves 
 
 
 58 
 
 Tapeworm . . . 
 
 
 • 37 
 
 Spirits and stimulants 36, 49 
 
 62, 
 
 104 
 
 Tapping the abdomen 
 
 
 
 54 
 
 Spleen, congestion of the . 40, 9] 
 
 c, 97 
 
 Taste, perversion of . 
 
 
 
 91 
 
 Splints for fractures 
 
 165, 
 
 168 
 
 Tea as a beverage 
 
 
 
 3.68 
 
 Sponging, cold and tepid . 
 
 98, 
 
 186 
 
 ,, beef 
 
 
 
 19s 
 
 Sprains .... 
 
 
 141 
 
 ,, chicken 
 
 
 
 195 
 
 Sputum in pneumonia . 
 
 
 49 
 
 , , how to infuse 
 
 
 
 198 
 
 Stabs, and how to treat them 
 
 122, 
 
 123 
 
 Tearing of stitches 
 
 
 
 124 
 
 Starch and how to make it . 
 
 
 180 
 
 Teeth, decayed . 
 
 27 
 
 , 66, 187 
 
 Stench as in ozaena 
 
 
 46 
 
 Temperature, how to take the 
 
 • 173 
 
 ,, in stagnant water 
 
 
 189 
 
 ,, natural . 
 
 
 65. 73 
 
 Stimulants, how and when 
 
 to 
 
 
 , , when very hi 
 
 ?h 
 
 loi, 185 
 
 give . . . 104, 
 
 152, 
 
 154 
 
 Tertian fever 
 
 
 • 83 
 
 Stings 
 
 
 156 
 
 ■ Test for tight bandaging 
 
 
 . 160 
 
 Stomach, catarrh of the 
 
 
 32 
 
 Testicle, inflammation of the 
 
 82, 89, 
 
 , , disease of the 
 
 . 
 
 28 
 
 
 
 124, 138 
 
 , , how affected in fever 
 
 
 86 
 
 Thermometer, clinical . 
 
 
 • 173 
 
 ,, how to empty 
 
 
 71 
 
 Thread-worms 
 
 
 39. 176 
 
 ,, pump . 
 
 71, 
 
 151 
 
 Throat, sore 
 
 26 
 
 46, 148 
 
 Stools in dysentery- 
 
 
 35 
 
 Ticks .... 
 
 
 20 
 
 Strains . . 
 
 
 141 
 
 Tincture of aconite . 27 
 
 ,63 
 
 99, 201 
 
 Strychnine, liquor . 71 
 
 96. 
 
 104 
 
 belladonna 
 
 
 • 27 
 
 Stupes, turpentine 
 
 
 179 
 
 ,, iodine 
 
 
 14. 179 
 
 Sty 
 
 14, 
 
 144 
 
 ,, iron . 
 
 . 
 
 134, 2or 
 
 Suicide .... 
 
 
 151 
 
 ,, opium 
 
 
 14. 32 
 
 Sulphate of magnesia . 
 
 
 SO 
 
 Tinned meat, affected . 
 
 
 • 151 
 
 ,, zinc . . 31 
 
 32, 
 
 201 
 
 Toast water 
 
 
 • 194 
 
 Sulphonal and how to take it 69 
 
 99. 
 
 201 
 
 Tonic medicines . 
 
 
 . 64 
 
 Sulphur in the treatment 
 
 of 
 
 
 Tonsillitis . 
 
 
 . 148 
 
 wounds 
 
 
 127 
 
 Toothache mixture 
 
 27 
 
 28, 202 
 
 Sulphuric acid 
 
 36 
 
 , 96 
 
 Tourniquet . 
 
 
 . 116 
 
 Sunstroke or sun-fever 
 
 
 64 
 
 Toxine in fever . . 87, 
 
 93. 
 
 II 
 
 9, 120 
 
9-'>-7 
 
 INDEX 
 
 PAGE 
 
 Travelling, precautions when . 7 
 Treatmentof bleeding and wounds 123 
 , , malarial fever . . 94 
 
 Trembling of the body . 69, 70 
 
 Turpentine stupes . . . 179 
 Typhoid form of fever . . 88, 102 
 
 U 
 
 Ulcer due to malaria 
 ,, in the bowel . 
 ,, ,, stomach 
 
 , , ordinary native sores 
 Umbilical hernia . 
 Unconsciousness . 
 Uraemic poisoning 
 Urinals 
 Urine, black 
 
 ,, its constituents , 
 ,, retention of the 
 , , secretion of 
 ,, stoppage of the 
 Urticaria 
 
 :^A 
 
 € 
 
 V 
 
 Vapour-baths 
 Varicocele . 
 Varicose veins 
 Varix . 
 Veins . 
 Venereal sore 
 Venomous bites 
 Venous bleeding 
 Ventilation . 
 Vermin-killing poisons 
 Vision, affections of , 
 
 81, 96 
 
 • 34 
 
 ■ 30 
 125, 132 
 
 . 140 
 . 65 
 . 89 
 
 . 187 
 88, 89 
 56, 57 
 
 • 139 
 
 • S5 
 88 
 
 • 13 
 
 184 
 142 
 142 
 142 
 142 
 131 
 157 
 117 
 6 
 152 
 91 
 
 PAGE 
 
 Voice-box .... 42, 47 
 
 Vomit, black, as in yellow fever . 89 
 
 Vomiting . . . 30, 85, 86, 87 
 
 ,, how to set it up 31, 98,150, 155 
 
 ,, how to stop it . 31.98 
 
 ,, mechanism of . -30 
 
 W 
 
 Wakefulness .... 70 
 Warburg's tincture . 99, 103, 201 
 
 Warm bath ..... 46 
 
 Warm-water dressing . . . 181 
 
 Warts 143 
 
 Washing out the bowel . . 175 
 
 Wasp sting ..... 156 
 
 Water and hints regarding it. 188, 
 
 193. 194 
 ,, bacteria .... 189 
 ,, in camp .... 190 
 Watery effusion ■ • • ■ 53 
 Wax in the ears .... 147 
 Wet cup, how to . . . . 179 
 Whey with wine .... 194 
 White blood corpuscles . -77 
 
 Whitlow 143 
 
 Whooping-cough . -. . 107 
 Windpipe ..... 43 
 Wine from bananas . . . " 195 
 Worms in the bowel ... 37 
 Wounds . . . .119, 122 
 ,, of the lung . . . 138 
 Writer's cramp .... 133 
 
 Zinc sulphate 
 
 32, 98, 201 
 
 Printed by Ballantyne, Hanson &= Co. 
 Edinburgh &= London 
 
COLUMBIA UNIVERSITY LIBRARIES 
 
 This book is due on the date indicated below, or, at the 
 expiration of a definite period after the date of borrowing, as 
 provided by the rules of the Library or by special arrange- 
 ment with the Librarian in charge. . 
 
 DATE BORROWED 
 
 DATE DUE 
 
 DATE BORROWED 
 
 DATE DUE 
 
 
 
 
 
 
 
 
 
 
 
 ' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 C2B(n4l)MIOO 
 
 
 
 1 
 

 Cross 
 
 :88 
 
 iifii^Lin Africa. 
 
 H.H.G.GRAT'l 
 
 DISCOUNT BOOKSELLER, 
 TABARD BOOK STORE, 
 
 17, THE BdROOGH, 
 
''^* 
 
 w 
 
 
 
 ■HP 
 
 '» ►'»"iV, ' »