Popular Science Monthly/Volume 28/February 1886/Medical Practice in Damaraland

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MEDICAL PRACTICE IN DAMARALAND.
By C. G. BÜTTNER.

THE missionary in Damaraland has also to be a physician. The stations in that country being cut off from regular intercourse with European civilization, the missionary societies have been obliged to give their agents a medical education, in order, if for no other purpose, that they may be able to doctor themselves and their families. From my own station of Otimbingue, which is well situated as compared with some of the others, I would have had to go at least a month's journey to find a regularly graduated physician. Of course, the natives are glad to avail themselves of the benefit of what medical skill we may have, the more especially as they have learned that we will never intentionally do them any harm, while they are always suspicious of their own doctors and sorcerers. Hardly a day passed during my residence in the country that I was not called upon by some sick person; so that I am able to speak from the results of a seven years' busy practice. As I could converse with the natives with perfect freedom in their own language, I had frequent opportunities to consult with their professionals, and was able to learn more of their notions than usually falls to the lot of the ordinary explorer; so that, though not a physician by profession, I believe I can make some interesting contributions to medical lore.

One of the most curious results of my observations is that the climate of Damaraland possesses what we might call an antiseptic character for several months of every year. The quality is an attendant of the long annual drought. Every living thing suffers during that period from the excessive heat, and much comfort is impossible, even in the shade, while, in places exposed to the warm winds, the thermometer has risen to 129°; and the sand, unmoistened for six months, becomes so hot that I have seen eggs hardened in it. This arid heat is opposed to the propagation of ferment, for it dries up everything that is exposed to the wind before it has time to sour. No manifestations of tuberculosis are known. Wounds of every kind heal remarkably quickly and well, without enough suppuration taking place to make the bandages stick. The manner in which large, neglected wounds heal of themselves would form an interesting study for a professional surgeon. I observed a case of a Herero whose right lower arm had been shattered in battle by a musket-ball. The healing process had worked itself out in such a way that the whole lower arm with all its muscles had become withered and useless, while the upper-arm bone was whole and covered at its lower end only with the brown skin. All the muscles and ligaments of the elbow-joint had vanished, while the shoulder-muscles remained, so that the unpleasant spectacle was presented of the man appearing to gesticulate with his bones. A woman lived at our station whose feet had been barbarously cut off in some war several years before, so that her captors might more easily get off the iron ornament which the Herero women wear on their ankles. Although the woman had to lie helpless for a long time, her wounds eventually healed up, and now she has been hopping around on her knees for thirty years.

We soon remarked, however, when the rains fell, a genius epidemicus coming over the country and demanding offerings. We could also see how those of the natives who lived on the ridges were much less troubled by illness than those whose houses were situated on the moister alluvial ground and in the river-bottoms. Those who have once had fever are more readily exposed to attack than those who have never been ill. My wife, who appeared to have wholly recovered from a recent illness, only required a stay of ten minutes in a river-bottom, where I and several other persons received no injury, to be put in bed for months. The influence of malaria is manifested in many persons in other ways than by fever-and-ague. Thus, I never had that disease; but, when others of the family had fever, I had rheumatic pains in my joints, and I knew of other persons who were similarly affected. Occasionally a severe and almost universal influenza would prevail instead of the fever; and, while few died from it, it was very painful, and sometimes laid entire households low, so that no one was left to attend to the daily duties.

One of the most prevalent diseases is a running inflammation of the eyes, which few natives escape suffering from one or more times during their lives. Europeans also are usually attacked by it, and it was a great wonder to the natives that I and my family escaped it. We avoided it by the observance of the most scrupulous cleanliness and the use of prophylactics.

Venereal disorders are quite widely spread, but the Hereros have no name of their own for them, and call them the "Hottentot disease."

A peculiar skin-disease, called otiyndimba, causes much inconvenience. It is connected with the hot weather, and is characterized by little sores that appear upon different parts of the body, lasting for two or three weeks, to be succeeded by others till the cold weather. They develop pus, in quantity which appears to be very scanty in proportion to the pain they cause, and leave no scar. The only disturbance they produce in the general system appears to be to make the sufferer very uncomfortable.

Two cases of snake-bites were brought to me, one of which was without consequences, while the other only resulted in a trifling sore. Yet cattle are frequently killed by snakes. I had several cases of men who had been spit in the eyes by the spitting-snake, or ongoroka. Some persons regard this serpent as a myth; but I have conversed, not only with natives, but also with trustworthy Europeans, who have seen it spit. The attack produces a running inflammation in the eyes, which lasts for about a fortnight.

The various behavior of the natives toward surgical and internal disorders is curious to the European. No one can be more indifferent than they are to external injuries and the pains they occasion. Except in the rarest cases, they never utter a sound or move a limb, whatever may be done to them. A thoroughgoing surgeon could not want better subjects; and only when the question is directly asked them will they admit that they suffer any pain. An illustration of this power of endurance is given by the poorer mountain Damaras, whose clothing, for summer and winter, is reduced to a mere loin-cloth. Their only way of warming themselves in cold weather is to hover over the fire as closely as possible. They thereby become blistered nearly from head to foot, and acquire a rather mottled appearance; yet they never seem to mind the smart of the burns. But let them suffer from any slight internal disorder, if it be no more than a common cold, no one can touch them, and it is very hard to make them submit to a medical examination. It was common in our school when one asked a person suffering from such a disorder, "Where do you suffer the most pain?" for him to return the answer, "In my arms, neck, head, back, stomach, all over my body." These imaginary sick gave us a great deal of trouble, and it became necessary to keep them as much out of the way as possible. I found an effectual means to accomplish this, and one that was characteristic of the people. I ordered calf-soup for the sick man. To kill one of their calves was more than the Hereros were willing to do just to make a sick man well; and no one to whom I made this prescription ever came to me a second time.

Massage plays an important part in native therapeutics, and is applied upon the whole of the lower part of the body and the bowels. I can not deny that this operation is quite thoroughly and in a manner scientifically performed. It is a circumstance favorable to this process that the skin over the abdomens of the natives is stretched and flabby on account of their custom—which arises from their necessities—of overeating at times, and at other times having to endure long hunger. The operator, first with a slow, light, but continuous movement of his oiled finger-tip draws the bowels clear over to one side till he can plainly feel the inner part of the hip-bone with its muscles and vessels on the other side; then the bowels are slowly pushed back, with a movement so executed that every knot and every induration is rubbed as thoroughly as possible between the fingers. A number of the unpleasant symptoms that may arise from costiveness, uterine disorders, or the troubles of pregnancy, are removed by this operation, and it can not be denied that the effect of the kneading on the circulation is beneficial. The whole process lasts from an hour to an hour and a half, and in serious cases is repeated every two or three days. The men who perform massage have by repeated practice acquired a fair knowledge of the normal condition of the abdomen, and of the more usual irregularities that take place there; and they have also, by practice in cutting up slaughtered animals, gained some knowledge of the anatomical relations of the parts. I have satisfied myself, by close observation of the procedure, that every part can be so fully separated from the others as to permit the whole to be plainly felt by the finger.

The skill attained in this art is particularly serviceable in midwifery cases, and makes up in a great measure for the lack of instruments. By it faults in the position of the fœtus are soon discovered, and much skill is displayed in remedying them. Even the white women are not afraid to call in the native midwives; and they can really be recommended without peril. As a rule they are women of the higher social ranks. The art of massage is handed down from mother to daughter, or to other relatives of the younger generation. Occasionally men practice at it.

Chest-diseases and pains in the extremities are treated by cupping and the moxa. Cupping is done with a horn. The skin having been scratched with a knife, the larger end of the horn, which has an opening at the point, is placed over the wound, and the operator sucks out the air and as much blood as he can, making of himself a kind of an artificial leech.

Moxas are preferred for diseases of the lungs and liver, and are applied in the simplest imaginable manner, by burning the end of a stick and putting the glowing coal upon the skin. Some ten or fifteen points are thus burned in succession, the scars of which afterward look like a kind of tattooing. When I first saw these scars on the breasts and backs of the Hereros, I thought they had been made for decoration, but was soon set right in the matter.

For internal remedies the people have a considerable number of simples. Every one knows of a few plants that are good as laxatives, emetics, sudorifics, or quietives. Among the heathen natives, supernatural help appears to be regarded as more important, and to be more approved. It is invoked, I observed, in two forms: One kind seems to be a traditional survival of the old patriarchal sacrifice; and the other embraces a kind of combination of secret knowledge with jugglery. A very obvious distinction is made between the two kinds of invocation, in the fact that some honorable member of the family is chosen to officiate in the former, while the latter is left to some wretched charlatan, or juggler, who sometimes has to suffer death as a penalty for his practice. In the former kind of invocation a beast is always slain, with whose meat and fat certain ceremonies are performed and formulas uttered over the patient, in a way that has been handed down by tradition.

One of the simpler features in the practice of the juggler-doctors consists in the practitioner sucking at the afflicted part of the patient till he brings out the thing that has produced the sickness. So long as these things are beans, pumpkin-seeds, and the like—and these are what the doctor generally finds—there is nothing about the matter that passes our comprehension. But when I saw one of these performers, entirely naked except for a little skin-apron, who was closely watched by many curious persons, at last draw out a living snake, a foot and a half long, I was somewhat astonished. It was a real snake, for the by-standers hastened to kill it. If the sick man failed to get well after this kind of procedure, the burning coal was applied to him. Hottentot quacks generally give the patient to drink of a kind of tea which they compound from plants known to them, and which should cause him to vomit. For the cure to succeed they must find the object by which the man was bewitched and made sick, in the vomited matter. These objects are things which can not usually be found in the stomach nor come out of it. Thus my friends were shown, among the things that bad been in this way taken from patients, large pins with glass heads, neatly tied together, crosswise, with a red thread, a piece of wood with several twigs forking from it, and almost as large as the hand, and other things equally curious. So far as I could learn, this process is usually applied to a St. Vitus's dance, which is supposed to be caused by enchantment.

I close with the relation of an incident in which I was made to play the part of the magic doctor, because it exhibits one of the characteristics of the people. A Hottentot came to me with a story of his nephew being bewitched, and said that he had sought me out after several other white men had declined to help him, because they knew nothing about witchcraft. His nephew, he told me, had been quite well till he had been bewitched by a rival in a love-affair, and nothing could now be done with him, for his convulsions and running around. As this condition had come about all of a sudden, the suggestion of some external cause for it was obvious, and I was satisfied that it was a case of poisoning. For the quacks are adepts in the management of snake and plant-poisons, and produce all their enchantments, when they amount to anything, by some means of the kind. I was glad to have the opportunity of dealing with one of these cases by a remedy of my own. I gave the man a bottle of camphor, with directions for using it, and told him to come back and report the result in a fortnight. He came three weeks afterward, with the empty bottle, and told me joyfully that the sick man was well; he had vomited up the lion's hairs in which the enchantment was lodged!—Translated for the Popular Science Monthly from Das Ausland.