573
PUBLIC RECORD OFFICE
Reference :-
PELTICO.885
7
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO
22
recupera-
21. Unfortunately malarial fever is not the only evil to guard against in West Africa and other tropical malarious climates. Dysentery is equally formidable, and perhaps more serious in its after effects, and there is no safeguard in temperance, though it is needless to say that the careful man when attacked has greater power of tion. In West Africa, too, there is a peculiar mental deterioration, which more or less affects every individual who spends many years there. Memory, nerve, energy, all fail, and often these are accompanied by a diminution of physical vitality which renders the sufferer a pitiable object indeed. Fortunately in these days when a different stamp of man is attracted to the West African Service than formerly, and a liberal leave system affords constant opportunity for change, such cases as I have described are not so frequently observed; nevertheless the death rate is still high, and the percentage of invalids is often large enough to seriously handicap administration.
22. I fear, even if the anopheles could be abolished, the last word will not have been said in regard to malarial fever, for I feel confident that malarial germs can be absorbed into the system by other means than by inoculation. Many observers have noticed the coincidence of fever with the disturbance of fresh soil or that which has lain fallow for a long time, and there can be little doubt that this disturbance liberates germs which find their way into the human body, either through the skin or by inhalation.
23. It is at any rate difficult for the non-expert to understand why the so-called malarial germ should require to be introduced by mechanical means any more than the germ of typhoid or influenza. Indeed, these diseases in certain stages appear to be indistinguishable from malarial fever. To cite my own experience once more; in February, 1895, I was seized in London with symptoms which to me appeared to indicate a sharp attack of malarial fever; the doctor who attended me, however, diagnosed influenza, and I was treated for this complaint for some days. Eventually unmistakable signs of typhoid appeared, and this disease ran its normal course.
K
24. It frequently happens that malarial fever in West Africa exhibits typhoid symptoms, and, in fact, becomes true typhoid, though usually in a modified form, and epidemics of influenza have appeared in all the West African Colonies. The question, therefore, arises, what is the exact relation of these two well-known forms of blood-poisoning to malarial fever and can it be held that the anopheles is re- sponsible for the developments which sometimes follow upon the original diseases? 25. There can be little doubt that the symptom known as blackwater" is one of the sequelae of malarial fever, although during this stage it has been observed that parasites are often absent from the blood, due, it is supposed, to the administra- tion of quinine previously. If the parasites have been killed off by this drug, would be interesting to know why there should be this distressing and dangerous manifes- tation of evil. It is difficult to resist the conclusion that there must be some other agency besides that of the action of parasites in the blood to account for the severity of the symptoms in certain types of fever.
+
26. The illness which caused the severance of my own connection with West Africa occurred in Lagos, and was primarily held to be influenza, then epidemic in the place, and exhibiting in certain cases grave symptoms. The fever stage in my case lasted only a short time, but subsequently other symptoms appeared pointing to the type of malarial fever known as "dengue," and the further developments were of so serious a character that invaliding followed. I had previously spent a term of 20 months in Lagos, and another term of 12 months with practically no illness due to climatic causes, and I attribute my later disastrous experience to the fact that on my third term I was not in a physical condition to undertake the onerous duties devolving upon a Governor of Lagos, owing to the fact that my constitution had been impaired by the attack of typhoid from which I had suffered during my leave in England. I mention this only to accentuate my belief that neither the anopheles nor the climate was specially responsible for my breakdown.
27. It is with some reluctance that I enter into these personal details in this despatch, but I think they will be interesting as bearing upon the origin and effect of malaria in a specific case, though not from the point of view of an expert, but from which it might be useful to generalize. It is far from my wish to minimise the valuable work done by Dr. Ross, Dr. Manson, and others, not only in demonstrating the part which certain species of mosquitoes take in communicating malarial poison to the human subject, but in the impetus which their action has given to the study of
23
general questions bearing upon the best means of minimising the effects of malaria, and in preserving health in malarious climates. It is fortunate that this activity has been coincident with the presence of a sympathetic Secretary of State, who has given every encouragement possible to the cause.
28. Whatever part the mosquito may take in contributing to malarial diseases, the point I desire to insist upon is that it is still more important to pay attention to general hygienic rules, than to rest in the serene belief that if one can avoid con- tamination through the medium of the mosquito, the abolition of fever follows as a natural consequence. I was very much struck with the remarks of Mr. H. G. Howse, Senior Vice-President of the Royal College of Surgeons, during the discussion upon Dr. Manson's valuable paper, read before the Royal Colonial Institute in March, 1900, and entitled "A School of Tropical Medicine." In addition to the doubts which he expressed as to whether we were yet at the bottom of the cause of malarial in fection, he pointed out the great difficulty of abolishing the mosquito on a vast con- tinent, and of the possibility of this insect finding other sources of poison besides that which may be extracted from an infected human being, the ape, for instance; but with anyone who has made acquaintance with the ubiquitous West African pig, this animal will at once occur to the mind as a suitable and highly probable medium for the acquisition of all that the mosquito requires to furnish its armoury.
29. There is little doubt that the horse suffers from malarial fever, and would, therefore, be available as a source of supply of the requisite poison. Mr. Howse also sounds a note of warning in regard to the administration of quinine, which, although apparently an antidote to the malarial parasite, produces counter-balancing evils, which ought not to be ignored. If, as appears to be sometimes the case, after destroying the parasite, the condition known as blackwater " supervenes, it is to 30. In case it should be supposed from any remarks I have made in this report that I desire to bring a charge of general intemperance against West African officials, I wish to state definitely that this is far from being my intention. The majority of men who first come to West Africa are, I think, careless, and do not realize how necessary it is to be specially cautious in regard to the consumption of stimulants. Although I have no fanatical views about the use of alcohol, I am one of those who would taboo the more potent forms of it as a luxury altogether, except plentifully diluted with water at meal times. Most men unfortunately take it at odd times during the day, ostensibly to quench thirst, and although the quantity consumed in the majority of cases may not be sufficient to produce immediate ill effects, yet, taken on an empty stomach, as it frequently is, the practice unquestionably lays the foundation for those digestive troubles to which I have previously alluded, and which personally I believe have more to do with the effective action of malaria than all the species of mosquitoes put together. Other forms of imprudence sometimes assist the process of deterioration, but I feel sure that a healthy man in West Africa, who keeps his digestion in good order, ought not to come to any serious harm during the 12 months he spends on duty, except under very exceptional circumstances. As, however, the climate itself has a tendency to induce a habit of constipation in most persons, I cannot do better than close this despatch with a prescription which I have found invaluable in correcting this tendency, without prejudice to any organ or organs, and which, I may add, I have made use of daily for the last 15 years, when in my usual health.
he hoped that a safer germicide may be eventually found.
Aloin, 1/5 grain.
Strychnine, 1/60 grain.
Ex. Bella Donna, 1/8 grain. Ipecacuanha, 1/16 grain.
This is made up in tabloid form by Messrs. Burroughs and Wellcome, the well known chemists, and, in my opinion, a supply of these should be in the hands of every official who goes to West Africa. The dose is one taken with the last meal of the day.
31. Although this was not prescribed to me by a physician, it is a well known preparation, and since I discovered this admirable combination, I can only say that life has assumed a different complexion to me.
I have, &c.,
G. T. CARTER,
Governor.
25673
24