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SOME AFRICAN DISEASES
This is the season of blackwater fever, the pestilence that stalks in the noontide and the terror of tropical campaigning. Hitherto with the exception of the Rhodesians who have had this disease previously in their northern territory, or men who have come from the Congo or the shores of the Great Lakes, our army has been fairly free from this dread visitation. The campaigning area of the coast and the railway line of British East Africa that gave our men malaria in plenty during the first two years of war, had not provided many of those focal areas in which this disease is distributed. The Loyal North Lancashires and the 25th Royal Fusiliers had been but little affected. The Usambara Valley along the Tanga-Moschi railway was also fairly free. On the big trek from Kilimanjaro to Morogoro the blackwater cases were almost entirely confined to Rhodesians and to the Kashmiris, who suffer in this way in their native mountains of Nepal. But once we struck the Central Railway and penetrated south towards the delta of the Rufigi the tale was different. British and South African troops began to arrive in the grip of this fell malady. It was written on their faces as they were lifted from ambulance or mule waggon. There was no need to seek the cause in the scrap of paper that was the sick report. All who ran could read it in the blanched lips, the grey-green pallor of their faces, the jaundiced eye, the hurried breathing. Thereupon came three days' struggle with Azrael's pale shape before the blackwater gave place to the natural colour again, or until the secreting mechanism gave up the contest altogether and the Destroying Angel settled firmly on his prey. At first, if there was no vomiting, it was easy to ply the hourly drinks of tea and water and medicine. But once deadly and exhausting vomiting had begun, one could no longer feed the victim by the mouth. Then came the keener struggle for life, for fluid was essential and had to be given by other ways and means. Into the soft folds of the skin of the arm-pits, breast and flanks we ran in salt solution by the pint. The veins of the arms we brought into service, that we might pour in this vitalising fluid. Day and night the fight goes on for three days, until it is won or lost. Here again, as in tick fever, we use the preparation 606, for which we are indebted to the great Ehrlich. Champagne is a great stand-by. So well recognised is the latter remedy that all old hands at tropical travel take with them a case of "bubbly water" for such occasions as these. Blessed morphia, too, brings ease of vomiting and is a priceless boon.
You ask me the cause of this disease, and I have to admit that among the authorities themselves there are no settled convictions. Some hold--and for my part I am with them--that the attack is caused by quinine given in too large a dose to a subject who is rotten with malaria. But there are others who maintain that it is a malarial manifestation only, and that the big dose of quinine, which seems to some to precipitate the attack, is only a coincidence. Be that as it may, there is little difference in the treatment adopted by either school. Death achieves his victory as frequently with one as with another. Certain it is that, to the common mind, quinine is the reputed cause and is avoided in large doses by men who have once had blackwater, or who are in that low rotten state that predisposes to it. In one point all agree, that one must be saturated with malaria before blackwater can develop. So great is the aversion shown by some men to the big doses of quinine as laid down by regulations, that men have often refused to take their quinine. Others, too, who have protested at first, take their quinine ration only to find themselves in the grip of this disease within twelve hours. Such a case was a Frenchman named Canarie (and the colour of his face, upon admission, did not belie his name), who had been treated for blackwater fever by the great Koch in Uganda many years before, and had been warned by him against big doses of quinine. That evening he was on my hands, fortunately soon to recover, and to win a prolonged convalescent leave out of this rain to the sunny and non-malarial slopes of Wynberg.
Seldom do the rumbling ambulances roll in but among their human freight is some poor wretch snoring into unconsciousness or in the throes of epileptiform convulsions. Custom has sharpened our clinical instinct, and where, in civil life, we would look for meningitis, now we only write cerebral malaria, and search the senseless soldier's pay-book for the name that we may put upon the "dangerous list." As this name is flashed 12,000 miles to England, I sometimes wonder what conception of malaria his anxious relatives can have.
For there is no aspect of brain diseases that cerebral malaria cannot simulate; deep coma or frantic struggling delirium. A drop of blood from the lobe of the ear and the microscope reveals the deadly "crescents"--the form the subtertian parasite assumes in this condition. No time this for waiting or expectant treatment. Quinine must be given in huge doses, regardless of the danger of blackwater, and into the muscles or, dissolved in salt solution, into the veins. The Germans have left me some fine hollow needles that practice makes easy to pass into the distended swollen veins. Through this needle large doses of quinine are injected, and in six hours usually no crescent remains to be seen. As a rule, conscious life returns to these senseless bodies after some hours; but, unhappily, such success does not always crown our efforts. Then it is the padre's turn, and in the cool of the following afternoon the firing party, with arms reversed, toils behind our sky-pilot to that graveyard on the sunlit slopes of Mount Uluguru, where our surgical failures are put to rest.
One can always tell, you know, the onset of such a complication as this; for when one finds the victim of malaria hazy and stupid after his fever has abated; and, more especially, if he develops wandering tendencies, leaving his stretcher at night to choose another bed in the ward, often to the protesting consternation of its present occupant, then one passes the word to Sister Elizabeth to get the transfusion apparatus ready. I shall not readily forget one stout fellow, a white company sergeant-major in the Gold Coast Regiment, who was lost in the bush and discovered after many days in the grip of this fell disease. Him they bore swiftly to me at Handeni, and after many injections and convulsions innumerable, he was restored to conscious life again. Sent back by me eventually to Korogwe with a letter advising his invaliding out of the country, he opened and read my report upon the way. But he was of those who do not take kindly to invaliding. Who would run his machine-gun section, if he were away, and his battalion in action? Who like he could know the language and the little failings of his dusky machine-gun crew that he had trained so long and so carefully in the Cameroon? So he appeared in the books of the Stationary Hospital at Korogwe as an ordinary case of convalescent malaria on his own statement. And when they would send him still further back to M'buyuni he broke out from hospital one night, and, with his native orderly, boarded the train to Railhead and marched the other 200 miles to Morogoro. Here I met him on the road starting out on the next long trek of 125 miles to Kissaki. For news had come to him that the Gold Coast Regiment had been in action and their impetuous courage rewarded by captured enemy guns and a long casualty list. But he was determined and unrepentant, one of his beloved machine-guns had been put out of action. How could I hold him back? So joining forces with another white sergeant of his regiment, who was hardly recovered from a wound, these two good fellows set out with a note that, this time, was not to be destroyed, for the instruction of their regimental doctor.
A third scourge responsible for frequent admissions into hospital is "tick-fever." Rather an unpleasant name, isn't it? And in its course and effect it fully acts up to its reputation. More commonly known as "relapsing fever," this illness attacks men who have been sleeping on the floor of native huts, which in this country are swarming with these parasites. Once in seven days for five or seven weeks these men burn with high fever--higher and more violent even than malaria--but sooner over. As you may imagine, it leaves them very debilitated; for no sooner does the victim recover from one attack than another is due. The ticks that are the host of the spirillum, the actual cause of the disease, live in the soft earth on the floor of native huts at the junction of the vertical cane rods and the soil. Here, by scraping, you may discover hundreds of these loathsome beasts in every foot of wall. But they are fortunately different from the grass ticks that, though unpleasant, are not dangerous to man. For the tick that carries the spirillum is blind and cannot climb any smooth surface. So to one sleeping on a bed or even a native "machela" above the ground, he is harmless. But woe betide the tired soldier who attempts to escape the tropical rain by taking refuge on the floor. In sleep he is attacked, and when his blind assailant is full of blood he drops off; so the soldier may never know that he has been bitten. I got twelve cases alone from one company of the Rhodesians, who sheltered in a native village near Kissaki. Of course, not every tick is infected, and for that we have to be very grateful. At the height of the fever the spirillum appears in the blood as an attenuated, worm-like creature, actively struggling and squirming among the blood corpuscles. A drop of blood taken from the ear shows hundreds of these young snakes beneath the microscope. For the cure we are again indebted to that excellent Hun bacteriologist Ehrlich, who gave us .606--a strong arsenical preparation that we dissolve in a pint of salt solution, and inject into the veins at the height of the paroxysm of fever. This definitely destroys the spirillum, and no further attacks of fever result; but this injection, once its work is done, does not confer immunity from other attacks. It is typical of the Hun and his anti-Semitic feelings that Ehrlich, the most distinguished of German scientists, perhaps, after Koch, has never received the due reward of all the distinction he has conferred on German medicine, for the offence that he was a Jew. We should have honoured him, as we have done Jenner or Lister.
Relapsing, or Rückfall fever, as the Germans call it, was one of the common dodges used by them to deceive the ingenuous British doctor. For the subtle Hun prisoner knew that, if he pretended to this disease, it would win him at least a week in the grateful comfort of a hospital, and perchance the ministering joys conferred by German nursing sisters, until the expected relapse did not occur; then the British doctor, realising the extent of his deception, would thrust these shameless malingerers to the cold comfort of the prison camp.
How is it, you might ask me, that there are any natives left, if tropical Africa is so full of such beastly diseases as this? Is it that the native is naturally immune, or is it that the white man is of such a precious quality that he alone is attacked by these parasites and poisonous biting flies? The fact is that the native is affected also, and in childhood chiefly, so that the infant mortality in many native tribes is very high. And there is little doubt that repeated attacks of malaria in youth, if recovered from, do confer a kind of protection against attacks in adult life. But this is not the case with newly introduced disease; for the sleeping sickness that came to Uganda along the caravan routes from the Congo, has swept away fully a million of the natives along the shores of Lake Victoria Nyanza.
But the native has a sure sense of the unhealthiness of any locality, and one must be prepared for trouble when one notices that the native villages are built up on the hillsides. This was specially remarked by us on our long trek down the Pangani, and thus we were warned of the fever that lurked in the bright green lush meadows beside the water, and the "fly" that soon overtook our transport mules and cattle and the horses of General Brits' 2nd Mounted Brigade. At first we thought the columns of smoke along the mountain-sides beside the Pangani were signal fires for the enemy; but before long, when the roads were choked with victims of "fly" and horse-sickness, we realised the wisdom that induced the simple native to take his sheep and cattle up the hillsides and above the danger zone. When one spends only a short time in some native huts, it is quite clear how he escapes infection. For the floor is covered with a layer of wood ashes that is usually deadly to bugs and fleas and ticks and other crawling beasts; and the atmosphere is so full of wood smoke that the most enterprising mosquito or tsetse-fly would flee, as we do, choking from the acrid smoke. So the native fire that burns within his hut day and night not only serves to cook his food and to keep wild beasts away, but also supplies him with an excellent form of Keating's Powder for the floor and smoke to drive the winged insects from the grateful warmth of his fireside.
