the neat little town of palime—the market—the breakfast—a luxury for the well-to-do—mount klutow—the german sleeping sickness camp—the german's consideration for the hammock-boys—misahohe, a beautiful road, well-shaded—a kindly welcome—the little boys that were cured—dr von raven, a devotee to science—the town of the sleeping sickness patients—“last year strong man, this year finish”—extreme poverty and self-denial—a ghastly, horrible, lingering and insidious disease—dr von raven's message to the english people.

palime is the neatest of little towns, set at the foot of some softly rounded hills. not hills clothed with dense bush such as i had come across farther west, but hills covered with grass, emerald in the brilliant sunshine, with just here and there a tree to give it a park-like appearance. and the town, it is hardly necessary to say, was spotlessly neat and tidy. all the streets were swept and garnished, and all the fences were whole, for if a german puts up a picket fence, he intends it for a permanency, and not for a fuel supply for the nearest huts. that the streets were neat was perhaps a little surprising, for every morning, beginning at dawn, in those streets there was held a market in which all manner of goods, native and european, were exposed for sale, spread out on the ground or on stalls. i looked with interest to see if i could notice any difference between the native under english and under german rule in the markets, and i came to the conclusion that there was none whatever. here, at rail-head, both native and european goods were bought and sold, and here too the people took their alfresco meals. the native of west africa usually starts the morning with a little porridge, made of cassada, which is really the same root from which comes our tapioca, but his tapioca is so thin you can drink it, and it looks and smells rather like water starch. it was being made and served out “all hot” at a copper a gourd, the customer providing his own gourd, and the porridge being in a goodsized earthen pot fixed on three stones over a little fire of sticks, or else the fire was built inside another pot out of which one side and the top had been knocked. porridge of course is not very staying, so a little later on good ladies make their appearance who fry maize-meal balls in palm oil, and sell them for two a “copper,” the local name for a pfennig, which is not copper at all, but nickel. very appetising indeed look these balls. the little flat earthenware pan on the fire is full of boiling palm oil, and the seller mixes very carefully the maize meal, water, a little salt, and some native pepper, till it is smooth like batter, such as a cook would make a pancake of, then it is dropped into the boiling oil, and the result, in a minute or so, is a round, brown ball, which looks and smells delicious. sometimes trade is brisk, and they are bought straight out of the pan, but when it slacks they are taken out and heaped up on a calabash. i conclude that it is only the aristocracy who indulge in such luxuries, for i am told that the average wage of a labourer in palime here is ninepence a day, but judging by what i saw, there must have been a good many of the aristocracy in palime. after all, the woman from the time she is a tiny child is always self-supporting, so in a community where every man and woman is self-supporting, i conclude that many luxuries are attainable that would not be possible when one man has to provide for many.

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the butchers' shops presided over as they are on the gold coast by hausas are not inviting, and tend to induce strong vegetarian views in anyone who looks upon them, and the amount of very highly smelling stink-fish makes the vegetarian regime very narrow. but there are other things beside food-stuffs for sale; from every railing flutter gay cloths from manchester, or its rival on the coast, keta, and there were several women selling very nice earthenware pots, that attracted me very much. they were the commonest household utensils of the native woman; she uses the smaller ones as plates and dishes, and the larger ones for water, for washing, or for storage. the big ones were terribly expensive and cost a whole sixpence, while a penny brought me a big store of small ones. i thought how very quaint and pretty my balcony at home would look with plants growing in these pots from such a far corner of the earth, and so i bought largely, even though i knew i should have to engage a couple of extra carriers for them, and my host applauded my taste.

that young german was very kindly. i showed him my telegram, but he laughed at it, and gave me to understand that of course i was welcome anyhow, though again i can certainly see no of course about it. why should he, in the kindness of his heart, put himself out for me, a total stranger, who did not even belong to his nation? still he did.

i was bent on going on to mount klutow, the german sleeping sickness camp, and he said he had never seen it, though it was only a short distance away, so he would get carriers and come with me. accordingly we got carriers, paying them threepence extra because it was sunday, and went up to mount klutow. they were very good carriers, but since i have heard so much about the german's inconsiderateness to the native, i must put it on record that when we came to a steep part of the road, and it was very steep, though a most excellent road, that german not only got out and walked himself, but expected me to do the same. i did of course, but many and many a time have i made my men carry me over far worse places, and many an englishman have i seen doing likewise.

again i must put it on record that these german roads are most excellent. they are smooth and wide, well-rolled and hard, and they are shady, a great boon in such a climate. every native tree that is suitable has been allowed to stand, and others have been planted, shapely, dark-green mangoes and broad-leaved teak, and since all undergrowth has been cleared away, the road seems winding through a beautiful park, while there is absolutely no mosquito. during all my stay in german territory i never slept under a mosquito curtain, and i never saw that abomination, a mosquito-proof room. the germans evidently think it is easier to do away with the mosquito.

misahohe is a little government station, set on the side of the mountain up which we were climbing. it looks from a distance something like a swiss chalet, and the view from there is as magnificent as that from anum mountain itself, only here there are white men connected, i think, with the german medical station to see and appreciate its beauties. on and on went the beautiful road; but even the germans have not yet succeeded in getting rid of the tsetse fly, and so though the roads are good, there are as yet no horses. we met great carts of trade goods going to kpando, fifteen miles away, and they were drawn and pushed their slow, slow journey by panting, struggling kroo boys. strongly as i should object to carrying a load on my head, i really think it would be worse to turn the wheels of a laden cart, spoke by spoke, while you slowly worked it up-hill.

at mount klutow, the german sleeping sickness camp, there is no timber, and the first impression is of barrenness. we went up and up, and i, who had not yet recovered from my long day's journey to palime, was exceedingly thankful when my escort allowed me to lie in my hammock till we arrived at a plateau surrounded by low hills. it was really the top of the mountain. there was a poor-looking european bungalow, a very german wooden kiosk on the other side of the road, and a winding road, with on either side of it little brown native huts built of clay, and thatched. it is just a poor-looking native village, with the huts built rather farther apart than the native seems to like his huts when he can choose, and none of the usual shelter trees which he likes about his village. after the magnificent tropical scenery we had just passed through it looked dreary in the extreme, but the young man who came out of the bungalow and made us most kindly welcome, dr von raven, the doctor in charge, explained that this barrenness was the very reason of its existence. they wanted a place that the cool winds swept, and they wanted a place that gave no harbour to the glossina pal palis, the tsetse fly that conveys the disease. mount klutow was ideal.

i had hesitated a little about visiting a doctor and asking him for information. i had no claim, no letters of introduction, and i should not have been surprised if he had paid no attention to me, but, on the contrary, dr von raven was kindness itself. he took us to the little kiosk and sent for wine and cakes and beer, so that we might be refreshed after our hot journey, though it was hardly hot here. the good things were brought by two small boys, and the doctor put his hand first on one shoulder and then on the other, and turned the little laughing black faces for me to see.

“sleeping sickness,” said he. “cured,” and he gave them a friendly cuff and let them go. he knew very little english, and i knew no german, and mr fesen's, even though he was agent for an english firm, was of the scantiest; so that it was a process of difficulty to collect information, and it was only done by the infinite kindness and patience of the two germans. dr von raven produced papers and showed me statistics, and so by degrees i learned all there is to be known, and then he took me round and showed me the patients.

many men in africa count themselves exiles, but never saw i more clearly the attributes of exile than in dr von raven. comforts he had none, and his house was bare almost to poverty. here he had lived for two and a half years without going home, and here he intended to live till some experiments he had in hand were complete. a devotee to science truly, but a cheerful, intensely interested one, with nothing of the martyr about him. very few white people he must have seen, and he said himself he had only been down to the nearest town of palime three times in two years, but he looked far better in health than many a man i have seen who has been on the coast only as many months.

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from the doctor's house there curves a road about a kilometre in length, and off this are the houses of the sleeping sickness patients. two and two they are built, facing each other, two rooms in each house and plenty of space between. they are built of mud, with holes for doors and windows, and the roofs are of grass—native huts of the most primitive description. each patient has a room, and each is allowed one relative to attend him. thus a husband may have a wife, a mother her daughter, and between them they have an allowance of sevenpence a day for food, ample in a country where the usual wage for a day labourer is ninepence. there are one hundred and fifty-five patients in all, and besides them there are a few soldiers for dignity, because the neighbouring chiefs would think very lightly of a man who had not evidences of power behind him, and so whenever the doctor passes they come tumbling out of the guard-room to salute him. there are also a certain number of labourers, because though many of the sick are quite capable of waiting on themselves, it would never do for them to go beyond the confines of the camp, and possibly, or probably, infect the flies that abound just where wood and water are to be had.

of course there is a market where the women meet and chat and buy their provisions; there are cookhouses and all the attributes of a rather poor native village, but a village where the people are among the surroundings to which they have been accustomed all their lives and in which they are more thoroughly at home than in a hospital. part of the bareness may be attributed to economy, but the effect is greatly heightened by the absence of all vegetation. anything that might afford shelter for the flies or shut out the strong, health-giving breezes that blow right across the plateau is strictly forbidden. and here were people in all stages of the disease—those who had just come in, who to the ordinary eye appeared to have nothing wrong with them, great, strong, healthy-looking men, men of thews and sinews who had been completely cured, and those who were past all help and were lying waiting for death.

“you would like to see them?” asked the doctor.

i said i would, and i would like to take a photograph or two if i might. my stock of plates was getting woefully scarce.

“yes,” he said, and we went down the roadway.

a man was borne out of one of the huts and laid on the ground in the brilliant sunshine. he was wasted to skin and bone, his eyes were sunken and half-open, showing the whites, his skeleton limbs lay helpless, and his head fell forward like a baby's. the doctor pointed to him pitifully.

“last year,” he said, “strong man like this,” indicating the men who bore him; “this year—finish.”

“he will die?”

“oh, he will die—soon.”

0379

and the great brawny savages who carried the stretcher, stark but for a loin cloth and a necklace, with their hair cut into cock's combs, had come there with sleeping sickness and were cured. they brought them out of all the huts to show the visitor—women in the last stages after epilepsy had set in, with weary eyes, worn faces, and contracted limbs, happy little children with swollen glands, a woman with atoxyl blindness who was cured, a man with atoxyl blindness who, in spite of all, will die. they were there in all stages of the disease, in all stages of recovery. some looked as if there was nothing the matter with them, but the enlarged glands in the neck could always be felt. the doctor did not seem very hopeful. “we could cure it,” he said; “it is quite curable if we could only get the cases early enough. not 2 per cent, of the flies are infected, and of course every man who is bitten by an infected fly does not necessarily contract the disease.”

it comes on very insidiously. three weeks it takes to develop, and then the patient has a little fever every evening. in the morning his temperature is down again, only to rise once more in the evening. sometimes he will have a day without a rise, sometimes three or four, but you would find, were you to look, the parasites in the blood. after three or four months the glands of the neck begin to swell, and this is the time when the natives recognise the danger and excise the glands. but swollen glands are not always caused by sleeping sickness, and, in that case, if the wounds heal properly, the patient recovers; but if the parasites are in the blood then such rough surgery only causes unnecessary suffering without in any way retarding the progress of the disease. slowly it progresses, very slowly. sometimes it takes three or four months before nervous symptoms come on, sometimes it may be twelve months, and after that the case is hopeless. not all the physicians in the world in the present state of medical knowledge could cure it. in europeans—and something like sixty europeans are known to have contracted the disease—very often immediately after the bite of the fly, symptoms have been noticed on the skin, red swellings, but in the black man apparently the skin is not affected.

the treatment is of the simplest, but the doctor only arrived at it after careful experiment. after having ascertained by examination of the blood that the patient has sleeping sickness he weighs the patient and gives him five centigrams per kilogram of his own weight of arsenophenylycin. this is divided into two portions and given on two consecutive days, and the treatment is finished. of course the patient is carefully watched and his blood tested, and if at the end of ten days the parasites are still found, the dose is repeated. sometimes it is found that the toxin has no effect, and then the doctor resorts to atoxyl, which he administers the same way every two days, with ten days between the doses. this has one grave drawback, for sometimes in conjunction with sleeping sickness it causes blindness. out of eighty-five cases that have taken atoxyl since 1908 five have gone blind. i saw there one young man cured and stone-blind, and one woman also cured and but just able to see men “as trees walking.” apparently there was nothing wrong with their eyes, but the blank look of the blind told that they could not see.

at first this camp here up among the hills was looked upon with suspicion by the natives, and they resisted all efforts to bring them to it. they feared, as they have always feared, all german thoroughgoing methods. but gradually, as is only natural, a good thing makes its own reputation, and the natives who were before so fearful come long distances to seek help where they know only help can be found.

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after we had walked all round the camp and got well soaked with the ordinary togo afternoon shower, of which none of us took any notice, we went back to the kiosk for more refreshment, and here we found waiting us one of the roman catholic fathers from palime. he was a fair-bearded man in a white helmet and a long, white-cotton soutane, which somehow, even in this country of few clothes, gave the appear-ence of extreme poverty and self-denial. he had come up on a bicycle and had a great deal to say about the sleeping sickness. a day or two before he had been travelling two days west of palime and he was asked by a native if he could speak english, and, when he assented, was taken to see a sick man. the man was a stranger to the people round and could only make himself understood in pigeon english. he told the father he lived six days away, in british territory, and as he talked he perpetually took snuff. “why,” asked the father, “do you take snuff when you talk to me?” because, the man explained, he had the sickness, and unless he took the strong, pungent snuff into his nostrils he could not talk, his head would fall forward, and he would become drowsy at once. this, he went on to say, was his reason for being here, so far from his home. he had heard there was a doctor here who could cure the sickness, and he was journeying to him as fast as he could. it is sad to think after such faith that he had probably left it too late.

“it is very difficult, indeed,” said the doctor, “to be sure of a cure.” the patient is discharged as cured and bound over to come back every six months for examination, and if each time his blood is examined it is free from parasites, all is well. he is certainly cured. but he has gone back to his home in an infected district, and if after six months or twelve months the parasite is again found, who is to say whether he has been re-infected or whether there has been a recrudescence of the old disorder? occasionally, says the doctor, it is impossible to find the parasite in the blood, while the patient undoubtedly dies of sleeping sickness; the parasite is in the brain.

since 1908 there have been four hundred cases through the doctor's hands. of these 19 per cent, have died of sleeping sickness, 67 per cent, have been sent away as cured, and about 3 per cent, have died of other causes. only ten of those sent away as cured have failed to present themselves for re-examination, and in this land where every journey must be made on foot, and food probably carried for the journey, it speaks very well, i think, for both doctor and patients that so many have come back to him. he is far kinder, probably, than the natives would be to each other—too kind for his own convenience, for the natives fear his laboratory, and will not come there at night, because when a patient is dying and past all other help he has him brought there to die. “why?” i asked. “i may be able to help a little,” he said. “but how kind!” he shrugged his shoulders with a little smile. “it is nothing, it is doctor,” and he waved the thought aside as if i were making too much of it.

the disease comes, so says dr von raven, from west to east, and was first noticed in the gambia in 1901. as long ago as 1802 a dr winterbottom described the sleeping sickness, and in 1850 a slavetrader noticed the swelling of the glands and refused to take slaves so afflicted. undoubtedly cases of sleeping sickness must have been imported to the west indies or america, but owing to the absence of the glossina palpalis to act as host the disease did not spread. that it is a ghastly, horrible, lingering, and insidious disease, that every man who has it where the glossina palpalis abounds is a danger to the community among whom he dwells, no one can doubt. they say that after a certain time the natives of a district may acquire immunity, but as this immunity comes only after severe suffering, it is perhaps better to stop the spread of the disease. the germans have no hesitation in restricting the movements of the native if he is likely to become a public danger, but the british government is very loath to interfere with a man's rights, even though it be the right to spread disease and death. dr von raven and the english dr horne met in conference a few months ago with the object of urging upon their respective governments the absolute necessity for allowing no man to cross the volta unless he have a certificate from a medical man that he is free from sleeping sickness. they contend, probably rightly, that a little trouble now would ensure the non-spread of the disease and assist materially in stamping it out. the volta is a natural barrier; there are only two or three well-known crossing places where the people pass to and fro; and here they think a man might well be called upon to present his certificate. against this is urged the undoubted fact that large numbers of the people are at no time affected, and, therefore, it would be going to a great deal of trouble and expense to effect a small thing. but is it a small thing?

“you write,” said the doctor as he bid me farewell; “you write?”

i said i did a little.

“then tell the english people,” said he, “how necessary it is to stamp out this disease while it is yet small.”

and so to the best of my ability i give his message, the message of a man who is denying himself all things that go to make life pleasant, for the sake of curing this disease, and if that sacrifice is worth while, and he says it is well worth while, then i think it should be well worth the while of us people, who are responsible for these dark children we govern, to put upon them, even at cost to themselves and us, such restrictions as may help to save in the future even 2 per cent, of the population from a ghastly and lingering death.