MALIGNANT FEVER.

373 of course, with the severity of the attack; but even in very mild cases several days are required to re-establish the patient's health.

The disease I have described is the common and mild form of coast-fever, the simplest and least dangerous of all. Often, however, other symptoms appear with these, and cause a complicated intermittent, which is much more serious, because more difficult to treat when it has once become chronic.

This is occasioned by inflammation of the spleen and liver. The spleen is subject to a chronic enlargement where patients have suffered from intermittent fever, and persons suffering from such enlargement should not remain on the coast. Affections of the spleen can not always be known without percussion; but affections of the liver are easily recognized by their effect upon the complexion. The white of the eyes becomes yellow, and the whole complexion is sallowed.

Intermittent fever often approaches very insidiously, the first chills being so light as to be almost invariably neglected, until finally a decided chill proclaims that the fever-demon has gained possession.

But the most dangerous form of fever in Africa is that known as malignant or pernicious fever. To this violent disease stout and full-blooded men are much more subject than lean and thin persons. It is noticeable that the African climate is much more fatal to full-blooded, robust, hearty people, than to those who are lank and thin. No length of residence or completeness of acclimation exempts a man from this last-mentioned form of fever. The oldest residents are sometimes carried off with a speed which is truly frightful. The disease not unfrequently runs its course in twenty-four to thirty-six hours.

The approach of malignant fever is very insidious. An attack begins mostly with an ordinary chill, attended by no unusual or marked symptoms. Sometimes the patient has had a light chill a day or two before this, which he has neglected. Sometimes he has felt slightly unwell for ten or fourteen days; has complained of loss of appetite and general weariness; but, as these symptoms are not very marked, they are very apt to be overlooked, especially with new-comers. It requires one fully on his guard and familiar with all the symptoms to detect its approach.

The real attack may begin with a chill or with a fever, but its effects are, in either case, at once evident in a peculiarly yellow

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TREATMENT OF MALIGNANT FEVER.

skin and haggard countenance. In fever there is profuse perspiration, a rush of blood to the head, high and irregular pulse, and general prostration. Sometimes the body is hot, but dry. Thirst is urgent, but the stomach rejects whatever is swallowed.

Now is the time to give quinine in large doses. In such cases I have stopped the attack by taking this medicine at the rate of 60 grains per day, 20 grains at a dose; and if I were suffering from a severe attack, I should not hesitate to take in one day 150 grains.

If the paroxysm of fever returns, it is with renewed force, and the third attack is commonly fatal. Before death the patient becomes insensible; there is violent vomiting, which is, in fact, but a regurgitation of the ingesta, mixed with green and yellow fluids. Immediately after the chill, and even before this has passed off, the urine becomes dark red or black. The pulse is very irregular, the breathing slow, and finally the patient sinks away into a state of coma, and dies without a struggle.

There is another form of attack which ends even more quickly than the one just described. In this there is no yellowness. The countenance is pale, and has a peculiar ghastliness and wildness of expression. The skin is cold to the touch, though the patient does not complain of cold. The whole surface is almost insensible to stimulants. The pulse is generally small and very frequent, particularly in the beginning. Under these symptoms sometimes a patient sinks away, reaction never occurring. The treatment here must be stimulating. In the last stages there is sometimes blindness and deafness; in others there is not only entire prostration of the intellect, but raving delirium; and the patient must be held in bed by force. This soon ends in stupor and death.

The natives sometimes suffer from fever, though by no means as frequently as the whites. With them the chills return sometimes every third or seventh day for some weeks, and finally wear out of themselves. I have known a few-four or five-instances where natives died of malignant fever, but this does not happen often. In the cases I saw they had first, for a few days, the usual chills, which then turned into malignant fever, under which they sank.

In cases of malignant fever, inflammatory complications of the liver, spleen, or brain greatly aggravate the attack, and almost al ways give the disease a fatal turn.

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If the chills are broken by medicine they are apt to return at longer but regular intervals, mostly in seven, fourteen, or twentyone days, and precautions should be used against such returns. It is well to take quinine twelve or twenty-four hours before the periodical return of the chill.

Persons residing permanently in any fever district are more liable to attacks than those who are moving about, and in this I had an advantage, though on several occasions a return to the coast from the interior brought on a fever which probably I should have escaped had I remained all the time on the coast. Where a fever is not broken readily by medicine, it is prudent to try a temporary change of locality.

I will conclude this chapter by a summary account of my course of treatment of myself in a fever attack. When the chill was felt I covered myself heavily to induce perspiration. Then my extremities were severely rubbed with pepper and mustard to restore their temperature. The thirst of fever was quenched with cold lemonade. Costiveness was averted by cathartics. For headache cold water was applied, and when this was without effect, leeches, which are very abundant almost every where in this region. If my liver was affected I took calomel, and also applied leeches. Meantime quinine was taken in doses of from 4 to 12 grains, and at the rate of from 12 to 60 grains per day, according to the violence of the attack. And when the fever was broken I continued to take four or five grain doses daily for some weeks, as a preventive.

The treatment must be energetic. Delays are most dangerous; and I have found it well to meet every individual symptom, so far as possible, with a remedy. In intermittent chills, where the paroxysm returns generally after seven days, I was very careful to take quinine the day before and on the day of the chill a few hours before it came on. Patients should not be frightened by the slight deafness and ringing in the ears, which is one of the immediate effects of quinine. These effects go off presently, and they are useful as evidence that the drug has taken effect.

In my ten years' residence in Africa I paid much and close attention to the phases of fever; but it was not till after some years of careful study of my own symptoms that I became able to detect its insidious approach with any degree of certainty, and thus, by timely preventives and care, ward off many attacks.

In justice to myself, my readers, and particularly the medical profession, I must say, in conclusion, that I have never studied medicine, and know nothing of diseases or their remedies beyond what my necessities, as a traveler in a barbarous and sickly country, have compelled me to learn experimentally. But necessity is an able teacher.

SUBDIVISIONS OF THE TRIBES.

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CHAPTER XIX.

Politics: the Government, Superstitions, and Slave System of Equatorial Africa.

I HAVE found it most convenient to consider these three subjects together, because each is intimately affected by the other; and to treat of them separately would be almost impossible.

Among the tribes which I visited in my explorations I found but one form of government, which may be called the patriarchal. There is not sufficient national unity in any of the tribes to give occasion for such a despotism as prevails in Dahomey, and in other of the African nationalities. I found the tribes of Equatorial Africa greatly dispersed, and, in general, no bond of union between parts of the same tribe. A tribe is divided up into numerous clans, and these again into numberless little villages, each of which last possesses an independent chief. The villages are scattered; are often moved for death or witchcraft, as I have already explained in the narrative; and not unfrequently are engaged in war with each other.

The chieftainship is, to a certain extent, hereditary, the right of succession vesting in the brother of the reigning chief or king. The people, however, and particularly the elders of the village, have a veto power, and can, for sufficient cause, deprive the lineal heir of his succession, and put in over him some one thought of more worth. In such cases the question is put to the vote of the village; and where parties are equally divided as to strength, there ensue sometimes long and serious palavers before all can unite in a choice. The chief is mostly a man of great influence prior to his accession, and generally an old man when he gains power.

His authority, though greater than one would think, judging from the little personal deference paid to him, is final only in matters of every-day use. In cases of importance, such as war, or any important removal, the elders of the village meet together and deliberate in the presence of the whole population, which last finally decide the question.