West African studies Part 10

Mainly from the point of view of the native apothecary, to which is added some account of the sleep disease and the malignant melancholy.

There is, as is in all things West African, a great deal of fetish ceremonial mixed up with West African medical methods. Underlying them throughout there is the fetish form of thought; but it is erroneous to believe that all West African native doctors are witch doctors, because they are not. One of my Efik friends, for example, would no more think of calling in a witch doctor for a simple case of rheumatism than you would think of calling in a curate or a barrister; he would just call in the equivalent to our general pract.i.tioner, the abiabok. If he grew worse instead of better, he would then call in his equivalent to our consulting physician, the witch doctor, the abiadiong. But if he started being ill with something exhibiting cerebral symptoms he would have in the witch doctor at once.

This arises from the ground principle of all West African physic.

Everything works by spirit on spirit, therefore the spirit of the medicine works on the spirit of the disease. Certain diseases are combatable by certain spirits in certain herbs. Other diseases are caused by spirits not amenable to herb-dwelling spirits; they must be tackled by spirits of a more powerful grade. The witch doctor who belongs to the school of Nkissism will become more profound on this matter still, and will tell you all herbs, indeed everything that comes out of the Earth, have in them some of the power of the Earth, Nkissi nisi; but the general view is the less concrete one--that it is a matter of only certain herbs having power. This I have been told over and over again in various West Coast tongues by various West African physicians, and in it lies the key to their treatment of disease--a key without which many of their methods are incomprehensible, but which shows up most clearly in the methods of the witch doctor himself. In the practice of the general pract.i.tioner, or, more properly speaking, the apothecary, it is merely a theory, just as a village chemist here may prescribe blue pill without worrying himself about its therapeutic action from a scientific point of view.

Before I pa.s.s on to the great witch doctor, the physician, I must detain you with a brief account of the neglected-by-traveller-because-less-showy African village apothecary, a really worthy person, who exists in every West African district I know of; often, as in the Calabar and Bonny region, a doctor whose practice extends over a fair-sized district, wherein he travels from village to village. If he comes across a case, he sits down and does his best with it, may be for a fortnight or a month at a time, and when he has finished with it and got his fee, off he goes again. Big towns, of course, have a resident apothecary, but I never came across a town that had two apothecaries. It may be professional etiquette, but, though I never like to think evil of the Profession whatever colour its complexion may be, it may somehow be connected with a knowledge of the properties of herbs, for I observed when at Corisco that an apothecary from the mainland who was over there for a visit shrank from dining with the local medico.

These apothecaries are, as aforesaid, learned in the properties of herbs, and they are the surgeons, in so far as surgery is ventured on. A witch doctor would not dream of performing an operation. Amongst these apothecaries there are lady doctors, who, though a bit dangerous in pharmacy, yet, as they do not venture on surgery, are, on the whole, safer than their _confreres_, for African surgery is heroic.

Many of the apothecaries' medical methods are fairly sound, however. The Dualla pract.i.tioner is truly great on poultices for extracting foreign substances from wounds, such as bits of old iron cooking pot, a very frequent foreign substance for a man to get into him in West Africa, owing to pots being broken up and used as bullets. Almost incredible stories are told by black men and white in Cameroons concerning the efficiency of these poultices; one I heard from a very reliable white authority there of a man who had been shot with bits of iron pot in the thigh. The white doctor extracted several pieces, and declared he had got them all out; but the man went on suffering and could not walk, so finally a country doctor was called in, and he applied his poultice. In a few minutes he removed it, and on its face lay two pieces of iron pot.

The white doctor said they had been in the poultice all the time, but he did not carry public opinion with him, for the patient recovered rapidly.

The Negroes do not seem to me to go in for baths in medical treatment quite so much as the Bantu; they hold more with making many little incisions in the skin round a swollen joint, then encasing it with clay and keeping a carefully tended fire going under it. But the Bantu is given greatly to baths, accompanied by ma.s.sage, particularly in the treatment of that great West African affliction, rheumatism. The Mpongwe make a bath for the treatment of this disease by digging a suitably sized hole in the ground and putting into it seven herbs--whereof I know the native names only, not the scientific--and in addition in go cardamoms and peppers. Boiling water is then plentifully poured over these, and the patient is laid on and covered with the parboiled green stuff. Next a framework of twigs is placed over him, and he is hastily clayed up to keep the steam in, only his head remaining above ground. In this bath he is sometimes kept a few hours, sometimes a day and a half.

He is liable to give the traveller who may happen suddenly on him while under treatment the idea that he is an atrocity; but he is not; and when he is taken out of the bath-poultice he is rubbed and kneaded all over, plenty more hot water being used in the process, this indeed being the palladium of West Coast physic.

The Fjort tribe do not bury their rheumatic patients until they are dead and all their debts paid, but they employ the vapour bath. My friend, Mr. R. E. Dennet, who has for the past eighteen years lived amongst the Fjort, and knows them as no other white man does, and knows also my insatiable thirst for any form of West African information, has kindly sent me some details of Fjort medical methods, which I give in his own words--"The Fjort have names for many diseases; aches are generally described as _tanta ki tanta_; they say the head suffers _Ntu tanta ki tanta_, the chest suffers _Mtima tanta ki tanta_, and so on. Rheumatism that keeps to the joints of the bones and cripples the sufferer is called _Ngoyo_, while ordinary rheumatism is called _Macongo_. They generally try to cure this disease by giving the sufferers vapour baths.

They put the leaves of the _Nvuka_ into a pot of boiling water, and place the pot between the legs of the patient, who is made to sit up.

They then cover up the patient and the pot with coverings.

"They try to relieve the local pain by spluttering the affected part with chalk, pepper, and logwood, and the leaves of certain plants that have the power of blistering.

"Small-pox they try to cure by smearing the body of the patient over with the pulped leaves of the mzeuzil. Palm oil is also used. These patients are taken to the woods, where a hut is built for them, or not, according to the wealth and desire of their relations. If poor they are often allowed to die of starvation. A kind of long thin worm that creeps about under the eyelid is called _Loyia_, and is skilfully extracted by many of the natives by means of a needle or piece of wood cut to a sharp point.

"Blind boils they call _Fvuma_, and they cure them by splintering over them the pulped root _Nchechi_, mixed with red and white earth. Leprosy they call _Boisi_, ague _Chiosi_, matter from the ear _Mafina_, rupture _Sangafulla_. But diseases of the lungs, heart, liver, and spleen seem to puzzle the native leeches and many natives die from these terrible ills. Cupping and bleeding, which they do with the hollow horns of the goat and the sharpened horn of a kid, are the remedies usually resorted to.

"All persons are supposed to have the power to give their enemies these different sicknesses. Amulets, frontlets, bracelets, and waistbands charged with medicines are also used as either charms or cures.

"A woman who was stung by a scorpion went nearly mad, and, rus.h.i.+ng into the river, tried to drown herself. I tried my best to calm her and cure her by the application of a few simple remedies, but she kept us awake all night, and we had to hold her down nearly the whole time. I called in a native surgeon to see if he could do anything, and he spluttered some medicine over her, and, placing himself opposite to her, shouted at her and the evil spirit that was in her. She became calmer, and the surgeon left us. As I was afraid of a relapse, I sent the woman to be cured in a town close by. The Princess of the town picked out the sting of the scorpion with a needle, and gave the woman some herbs, which acted as a strong purge, and cured her. As the Nganga bilongo (apothecary) is busy curing the patient, he generally has a white fowl tied to a string fastened to a peg in the ground close to him. I have described this in _Seven Years among the Fjort_."

I think this communication of Mr. Dennett's is of much interest, and I hastily beg to remark that, if you have not got a devoted friend to hold you down all night, call in an apothecary in the morning time, and then hand you over to a Princess--things that are not always handy even in West Africa when you have been stung by a scorpion--things that, on the other hand, are always handy in West Africa--carbonate of soda applied promptly to the affected part will save you from wanting to drown yourself and much other inconvenience. The sting should be extracted regardless of the shedding of blood, carbonate of soda in hot water washed over the place, and then a poultice faced with carbonate of soda put on.

Although I do not say these West African doctors possess any specific for rheumatism, it is an undoubted fact that the South-west Coast tribes, with their poultices and vapour baths, are very successful in treating it, more so than the true Negroes, with their clay plaster and baking method. Rheumatism is a disease the Africans seem especially liable to, whatever may be the local climate, whether it be that of the reeking Niger Delta, or the dry delightful climate of Cabinda; moreover, my friends who go whaling tell me the Bermuda negroes also suffer from rheumatism severely, and are "a perfect cuss," wanting to come and sit in the blood and blubber of fresh-killed whales. Small-pox is a vile scourge to Africa. The common treatment is to smear the body of the patient with the pulped leaves of the mzeuzil palm and with palm oil; but I cannot say the method is successful, save in preventing pitting, which it certainly does. The mortality from this disease, particularly among the South-west Coast tribes, is simply appalling. But it is extremely difficult to make the bush African realise that it is infectious, for he regards it as a curse from a great Nature spirit, sent in consequence of some sin, such as a man marrying within the restricted degree, or something of that kind. Mr. Dennett mentions small-pox patients being sent into the bush with more or less accommodation provided. Mr. Du Chaillu gave Mr. Fraser the idea that the Bakele tribe habitually drove their small-pox sick into the bush and neglected them, which certainly, from my knowledge of the tribe, I must say is not their constant habit by any means. I venture to think that this rough attempt at isolation among the Fjort is a remnant of the influence of the great Portuguese domination of the kingdom of Congo in the fifteenth, sixteenth, and seventeenth centuries, when the Roman Catholic missionaries got hold of the Fjort as no other West African has since been got hold of. Nevertheless the keeping of the sick in huts you will find in almost all districts in places--_i.e._ round the house of a great doctor. My friend Miss Mary Slessor, of Okon, has the bush round her compound fairly studded with little temporary huts, each with a patient in. You see, distinguished doctors everywhere are a little uppish, and so their patients have to come to them. Such doctors are usually specialists, noted for a cure of some particular disease, and often patients will come to such a man from towns and villages a week's journey or more away, and then build their little shantie near his residence, and remain there while undergoing the cure.

There is a prevalent Coast notion that white men do not catch small-pox from black, but I do not think this is, at any rate, completely true. I was informed when in Loanda that during an epidemic of it amongst the natives, every white man had had a more or less severe touch, and I have known of cases of white men having small-pox in other West Coast places, small-pox they must either have caught from natives or have made themselves, which is improbable. I fancy it is a matter connected with the vaccination state of the white, although there seem to be some diseases prevalent among natives from which whites are immune--the Yaws, for example.

Less terrible in its ravages than small-pox, because it is far more limited in the number of its victims, is leprosy; still you will always find a case or so in a district. You will find the victims outcasts from society, not from a sense of its being an infectious disease, but because it is confounded with another disease, held to be a curse from an aggrieved Nature spirit. There was at Okon when I was there a leper who lived in a regular house of his own, not a temporary hospital hut, but a house with a plantation. He led a lonely life, having no wife or family or slave; he was himself a slave, but not called on for service--it was just a lonely life. People would drop in on him and chat, and so on, but he did not live in town. There was also another one there, who had his own people round him, and to whom people would send their slaves, because he was regarded as a good doctor; but he also had his house in the bush, and not in town.

Undoubtedly the diseases that play the greatest continuous havoc with black life in West Africa are small-pox, divers forms of pneumonia, heart-disease, and teta.n.u.s, the latter being largely responsible for the terrible mortality among children; but the two West African native diseases most interesting to the European on account of their strangeness, are the malignant melancholy and the sleep sickness, and strangely enough both these diseases seem to have their head centre in one region--the lower Congo. They occur elsewhere, but in this region they are constantly present, and now and again seem to take an epidemic form. Regarding the first-named, I am still collecting information, for I cannot tell whether the malignant melancholy of the lower Congo is one and the same with the hystero-hypochondria, the home-sickness of the true Negro. In the lower Congo I was informed that this malignant melancholy had the native name signifying throwing backwards, from its being the habit of the afflicted to throw themselves backwards into water when they attempted a drowning form of suicide.[24] They do not, however, confine themselves to attempts to drown themselves only, but are equally given to hanging, the constant thing about all their attempts being a lack of enthusiasm about getting the thing definitely done: the patient seems to potter at it, not much caring whether he does successfully hang or drown himself or no, but just keeps on, as if he could not help doing it. This has probably given rise to the native method of treating this disease--namely, holding a meeting of the patient's responsible relations, who point out elaborately to him the advantages of life over death, and enquire of him his reasons for hankering after the latter. If in spite of these representations he persists in a course of habitual suicide, he is knocked on the head and thrown into the river; for it is a nuisance to have a person about who is continually hanging himself to the house ridge pole and pulling the roof half off, or requiring a course of sensational rescues from drowning.

The sleep disease[25] is also a strange thing. When I first arrived in Africa in 1893 there had just been a dreadful epidemic of it in the Kakongo and lower Congo region, and I saw a good many cases, and became much interested in it, and have ever since been trying to gather further information regarding it.

Dr. Patrick Manson in his important paper[26] states that it has never been known to affect any one who has not at one time or another been resident within this area, and observes on its distribution that "it seems probable that as our knowledge of Africa extends, this disease will be found endemic here and there throughout the basins of the Senegal, the Niger, the Congo, and their affluents. We have no information of its existence in the districts drained by the Nile and the Zambesi, nor anywhere on the eastern side of the continent." As far as my own knowledge goes the centres of this disease are the Senegal and the Congo. I never saw a case in the Oil Rivers, nor could I hear of any, though I made every inquiry; the cases I heard of from Lagos and the Oil Rivers were among people who had been down as labourers, &c., to the Congo. What is the reason of this I do not know, but certainly the people of the lower Congo are much given to all kinds of diseases, far more so than those inhabiting the dense forest regions of Congo Francais, or the much-abused mangrove swamps of the Niger Delta.

Dr. Manson says, "The sleeping sickness has been attributed to such things as sunstroke, beriberi, malaria, poison, peculiar foods, such as raw bitter manioc, and diseased grain; it is evident, however, that none of these things explains all the facts." In regard to this I may say I have often heard it ascribed to the manioc when in Kakongo, the idea being that when manioc was soaked in water surcharged with the poisonous extract, it had a bad effect. Certainly in Kakongo this was frequently the case in many districts where water was comparatively scarce. The pools used for soaking the root in stank, and the prepared root stank, in the peculiar way it can, something like sour paste, with a dash of acetic acid, and thereby the villages stank and the market-places ditto, in a way that could be of no use to any one except a person anxious to find his homestead in the dark; but Dr. Manson's suggestion is far more likely to be the correct one. Against it I can only urge that in some districts where I am informed by my medical friends that _Filaria perstans_ is very prevalent, such as Calabar, the Niger, and the Ogowe, sleeping sickness is not prevalent. Dr. Manson says "the fact that the disease can be acquired only in a comparatively limited area, suggests that the cause is similarly limited; and the fact that the disease may develop years after the endemic area has been quitted, suggests that the cause is of such a nature that it may be carried away from the endemic area and remain latent, as regards its disease-producing qualities for a considerable period; even for years." He then goes on to say, "_Filaria perstans_, so far as is known, is limited in its geographical distribution to Western Equatorial Africa--that is to say, it can be acquired there only--and it may continue in active life for many years after its human host has left the country in which alone it can be acquired. We also know that similar entozoa in their wanderings in the tissues by accident of location, or by disease, or injury of their organs, not infrequently give rise to grave lesions in their hosts. I therefore suggest that possibly _Filiaria perstans_ may in some way be responsible for the sleeping sickness. I know that this parasite is extremely common in certain sleeping sickness districts, and moreover, I have found it in the blood of a considerable number of cases of this disease--in six out of ten--including that described by Mackenzie. There are many difficulties in the way of establis.h.i.+ng this hypothesis, but there is a sufficient inherent probability about it to make it well worth following up."

The most important statement that I have been able to get regarding it so far, has been one sent me by Mr. R. E. Dennett; who says "The sleeping sickness though prevalent throughout Kakongo and Loango is most common in the north of Loango and the south of Kakongo, that is north of the river Quillou and among the Mussorongo.

"What the cause of the sickness is, it is hard to say, but it is one of those scourges which is ever with us. The natives say any one may get it, that it is not hereditary, and only infectious in certain stages.

They avoid the _dejecta_ of affected persons, but they do not force the native to live in the bush as they do a person affected by small-pox.

"Pains in the head chiefly just above the nose are first experienced, and should these continue for a month or so it is to be expected that the disease is _Madotchila_, or the first stage of the sleeping sickness.

"In the word _Madotchila_ we have the idea of a state of being poisoned or bewitched. At this stage the sickness is curable, but as the sick man will never admit that he has the sickness and will suffer excruciating pain rather than complain, and as it is criminal to suggest to the invalid or others that he is suffering from the dreadful disease, it often happens that it gets great hold of the afflicted and from time to time he falls down overcome by drowsiness.

"Then he swells up and has the appearance of one suffering from dropsy, and this stage of the disease is called _Malazi_, literally meaning thousands (_Kulazi_ = one thousand, the verb _Koula_ to become great and _zi_ the productive fly.)

"This appears to be the acute stage of the disease and death often occurs within eight days from the beginning of the swelling.

"Then comes the stage _Ntolotolo_, meaning sleep or mock death.

"The next stage is called _Tchela nxela nbela_, that is the knife cutting stage, referring to the operation of bleeding as part of the cure; and the last stage of the disease is called _Nlemba Ngombo_.

_Lemba_ means to cease. The rites of _Lemba_ are those which refer to the marriage of a woman who swears to die with her husband or rather to cease to live at the same time as he does. _Ngombo_ is the name of the native gra.s.s cloth in which, before the _Nlele_ or cotton cloth of the white man appeared, the dead were wrapped previous to burial. Thus in the name _Nlemba Ngombo_ we have the meaning of marriage to the deathly winding sheet or shroud.

"I remember how poor Sanda (a favourite servant of Mr. Dennett's, a mussorong boy) was taken sick with pains in his head which I at first mistook for simple headache. As he was of great service to me I kept him in the factory instead of sending him to town (the custom with invalids in Kakongo is that they should go to their town to be doctored). I purged him and gave him strong and continued doses of quinine and he got better; but from time to time he suffered from recurring headache and drowsiness, and on one occasion when I was vexed at finding him asleep and suspecting him of dissipation, was going to punish him, I was informed by another servant that the poor fellow was suffering from the sleeping sickness. I at once sent him to town with sufficient goods to pay his doctor's bill, and his relations did all in their power to have him properly cured, taking him many miles to visit certain Ngangas famed for the cure of this fell disease.

"He came back to me well and happy. The next year however, the malady returned, and he went to town and gradually wasted away. They told me that sores upon one of his arms had caused him to lose a hand, which he lived to see buried before him. Sanda was of royal blood, so his body was taken across from the north bank to San Antonio or Sonio, on the south bank of the Congo, and there he was buried with his fathers.

"Another sad case was that of a woman who lived in the factory.

"As a child, it appeared afterwards, she had suffered from the disease, and had been cured by the good French doctor then resident in Landana (Dr. Lucan). I knew nothing of this at the time, and put her sickness down to drink, but got a doctor to see her. He could not make out what was the matter, but thought it might possibly be some nervous disease; altogether we were completely puzzled.

"On one occasion during my absence she nearly tortured one of her children to death by stabbing her with a needle. On my return, and when I heard what she had done, I was very angry with her, and turned her out of the factory, and shortly afterwards the poor creature died in the swelling state of the disease.

"Joa (a more or less civilised native) tells me that one of his wives was cured of this sleeping sickness. She was living with him in a white man's factory when she had it, and on one occasion fell upon a demijohn and cut her back open rather seriously--the white man cured her so far as the wound was concerned. A native doctor, a Nganga or Kakamucka, later on cured the sleeping sickness. He first gave her an emetic, then each day he gave her a kind of Turkish bath; that is, having boiled certain herbs in water, he placed her within the boiling decoction under a covering of cloth, making her perspire freely. Towards nightfall he poured some medicine up her nostrils and into her eyes, so that in the morning when she awoke, her eyes and nose were full of matter; at the same time he cupped and bled her in the locality of the pain in the head. What the medicines were I cannot say, neither will the Nganga tell any one save the man he means shall succeed him in his office.

"The native doctors appear to know when the disease has become incurable and the life of the patient is merely a question of a few days, for once while I was at Chemongoanleo, on the lower Congo I heard the village carpenter hammering nails into planks, and asked my servant what they were doing. 'Building Buite's coffin,' he said. 'What, is he dead?' said I. 'No, but he must die soon,' he answered. This statement was confirmed by the relations of Buite who came to me for rum as my share towards his funeral expenses. Imagine my feelings when shortly after this Buite, swollen out of all likeness to his former self, crawled along to the shop and asked me for a gallon of rum to help him pay his doctor's bill.

"A doctor of the Congo Free State began to take an interest in the sickness and asked me to persuade some one suffering from the disease to come and place himself under his care, promising that he would have a place apart made for him at the station, so that he could study the sickness and try to cure the poor fellow. After a good deal of trouble I got him a patient willing to remain with him, but owing to some red tape difficulty as to the supply of food for the sick man this doctor's good intentions came to nought. A Portuguese doctor here also gave his serious attention to the sleeping sickness, and it was reported that he had found a cure for it in some part of a fresh billy-goat. This good man wanted a special hospital to be built for him and a subsidy so that he might devote himself to the task he had undertaken. His Government, however, although its hospitals are far in advance of those of its neighbours on the Coast, could not see its way to erect such a place."

All I need add to this is that I was informed that the disease when it had once definitely set in ran its fatal course in a year, but that when it came as an epidemic it was more rapidly fatal, sometimes only a matter of a few weeks, and it was this more acute form that was accompanied by wild delirium. Another native informant told me when it was bad it usually lasted only from twenty to forty days.

Monteiro says the sleep disease was unknown south of the Congo until it suddenly attacked the town of Musserra, where he was told by the natives as many as 200 died of it in a few months. This was in 1870, and curious to say it did not spread to the neighbouring towns. Monteiro induced the natives to remove from the old town and the mortality decreased till the disease died out. "There was nothing in the old town to account for this sudden singular epidemic. It was beautifully clean and well-built on high dry ground, surrounded by mandioca plantations, the last place to all appearance to expect such a curious outbreak."[27]

Monteiro also observes that "there is no cure known for it," but he is speaking for Angola, and I think this strengthens his statement that it is a comparatively recent importation there. For certainly there are cures, if not known, at any rate believed in, for the sleeping sickness in its own home Kakongo and Loango. There is a great difference in the diseases, flora and fauna, of the north and south banks of the Congo--whether owing to the difficulty of crossing the terrifically rapid and powerful stream of the great river I do not know. Still there was--more in former times than now--much intercourse between the natives of the two banks when the Portuguese discovered the Congo in 1487. The town called now San Antonio was the throne town of the kingdom of Kongo, and had nominally as provinces the two districts Kakongo and Loango, these provinces that are now the head centres of the sleep disease. Yet in the early accounts given of Kongo by the Catholic missionaries, who lived in Kongo among the natives, I have so far found no mention of the sleep disease. It is impossible to believe that Merolla, for example, could have avoided mentioning it if he had seen or heard of it.

Merolla's style of giving information was, like my own, diffuse.

Certainly we must remember that these Catholic missionaries were not much in Loango and Kakongo as those provinces had broken almost entirely away from the Kongo throne prior to the Portuguese arrival, so perhaps all we can safely say is that in the 15-17th centuries there was no sleep disease in the districts on the south bank of the Congo, and it was not anything like so notoriously bad in the districts on the north bank.

Before quitting the apothecary part of this affair, I may just remark that if you, being white, of a nervous disposition, and merely in possession of an ordinary amount of medical knowledge, find yourself called in to doctor an African friend or acquaintance, you must be careful about hot poultices. I should say, _never_ prescribe hot poultices. An esteemed medical friend, since dead, told me that when he first commenced practice in West Africa he said to a civilised native who was looking after his brother--the patient--"Give him a linseed poultice made like this"--demonstration--"and mind he has it hot." The man came back shortly afterwards to say his brother had been very sick, but was no better, though every bit of the stuff had been swallowed so hot it had burnt his mouth. But swallowing the poultice is a minor danger to its exhibition. Even if you yourself see it put on outside, carefully, exactly where that poultice ought to be, the moment your back is turned the patient feeling hot gets into the most awful draught he can find, or into cold water, and the consequences are inflammation of the lungs and death, and you get the credit of it. The natives themselves you will find are very clever at doctoring in their own way, by no means entirely depending on magic and spells; and you will also find they have a strong predilection for blisters, cupping and bleeding, hot water and emetics; in all their ailments and on the whole it suits them very well. Therefore I pray you add your medical knowledge and your special drugs to theirs and for outside applications stick to blisters in place of hot poultices.

FOOTNOTES:

[24] An experienced medical man from West Africa informs me that he considers the Africans very liable to hysterical disease, and he attributes the throwing backwards to the patient's desire not to spoil his or her face, a thing ladies are especially careful of, and says that turning a lady face downwards on the sand is as efficacious in breaking up the hysterical fit as throwing water over their clothes is with us.

[25] Negro lethargy; Maladie du sommeil; Enfermedad del sueno; Nelavane (Oulof); Dadane (Sereres); Toruahebue (Mendi); Ntolo (Fjort).

[26] _System of Medicine._ Volume II. Edited by Dr. Clifford Allb.u.t.t.