DR. SCHWEITZER AND HIS WORK

[To the Editor of THE SPECTATOR.]

SIR)—It has occurred to me that some of your readers might be interested in a few notes on our recent work here at Lambarene. A grateful white patient has given us a big Petroleum lamp with an incandescent mantle which gives a splendidly bright light, and renders us great service in the °Perating room. For we frequently have to undertake urgent operations in the night. In the third week in March it was necessary to operate three nights in succession. Because of the danger of fire it is of course impossible to employ ether as an anaesthetic when the incandescent petroleum lamp is in use. But as a rule we use a local anaesthetic in any case. How grateful we colonial surgeons ought to be to Charles Louis Schleich, who discovered local anaesthesia in 1892 and thus so enormously simplified surgical work ! In special cases We also use spinal analgesia, which is produced by the injec- tion of Novocain solution into the cerebro-spinal fluid. We only have recourse to ether and chloroform when their use is unavoidable.

The ward constructed two years ago for excitable, noisy

Mental patients renders good service. But in spite of all Precautions the ground round this building is covered with Cement and is strewn with fresh ashes every morning, for the inhabitants of this ward, which lies a little apart, are threatened by warrior-ants. If the ashes become damp in the night air, and so of firmer consistency, the insects no longer sink into them

but can march across the surface. Several times during these past weeks night attacks by armies of ants, before which,

,a8 is Well known, even an elephant takes to flight, have had to be repulsed. Fortunately, the nurse who had the supervision Of these patients always became aware of the danger in time. If the warrior ants have once crossed the barrage of ashes and penetrated into the building, there is no alternative but to take the mental patients out of their cells and flush the whole place from floor to ceiling with a solution of Lysol. Even the excited patients keep relatively quiet when this situation arises, as if they realise the danger from which it is necessary ta deliver 'them.

Influenza has arrived at Lambarene. When I landed at

Port Genti on February 25th, it was just appearing there; It took a month to come up the river. It has not taken nearly' so bad a form as in the epidemic of 1919, but nevertheless we have lost several patients from pneumonia in combination With influenza. A fatal end to an ' attack of influenza is altogether far more frequent here than in Europe. Unfor- tunately pneumonia cases are generally brought to us so late that we have scarcely any opportunity of trying the new early treatment which has such good results in Europe.

For months past the hospital has been quite full. More

than thirty patients are waiting their turn for operation. On March 28th, between 1 and 1.30 p.m., there arrived from different directions three patients with strangulated hernia On whom operations had to be performed forthwith, after the whole morning had been devoted to similar work. Recently, when Dr. Goldschmid, following the usual praise- worthy custom of surgeons, began a friendly conversation With a woman who lay on the operating table receiving the injections for local anaesthesia, in order to divert her attention and cheer her, he received the answer: "This is no time for gossip ; get on with the cutting." In the year 1934, 622 major operations were performed.

Accident cases are constantly brought to us from the lumber camps. Many have been injured while felling trees ; others,have been run over by and they are in the majority,

'wagons of one of the light railways by which the logs are Conveyed from the camp to the nearest stream. These Primitive people lack understanding of the danger threatened by the engine. A timber-cutter told me that one of his newly- recruited labourers remained standing on the rails without any misgiving as a wagon was coming down a steep hill, and h_ ad to be snatched aside at the last moment. He simply could

not imagine that the wagon would have gone over him, but

he he could have stopped it with his hand, simply because ne had never before seen a heavy mass in motion. And it happens again and again that new men jump off a wagon when it is going at full speed without being able to imagine that they will fall. They lack experience of speed. We frequently also have under treatment wounds caused by gorillas, hippo- potami, alligators, buffaloes and wild boars. We are now experimenting with a new method of treating elephantiasis of the foot: • This monstrous thickening of the feet, which truly makes them look like elephants' feet, comes from the presence of micro-fllariae (larvae of Filaria lianerofti) in the lymph-ducts. These worm-like larvae, which cause obstructions in the lymphatic circulation, are about 1 milli- metres long. Formerly operations were performed on elephan- tiasis feet by cutting wedge-shaped strips out of the thickened tissue. But the results were not very satisfactory. Some time ago, Dr. Goldschmid read in a medical journal of attempts to treat this disease with intravenous injections of Lugol's solution (gin 1 of Iodine and gm 2 of Potassium Iodide in 300 gin distilled water). Thereupon he combined this with our previous treatment. Every fourth day he gave an injec- tion, in doses ranging from 1 to 2 cern. Of the twelve feet treated in this way up to now, all have shown a fairly rapid and, considerable improvement. People who could hardly drag themselves about on' heavy misshapen feet have again become capable of work. It still remains to prove whether the improvement is lasting.

At the beginning of April Boulinghi, one of my earliest native assistants, returned to his home some 200. miles to the south. He was in my service for ten years. For years he patienti, and he helped ter

supervised the ward for operated

observing the pulse,, save many a human life by

breathing and general appearance of those in his care by day or by night, and immediately reporting to us any suspicious change in their condition. He has been ailing for three Years add only occupied with light work, and now he has no longer been able to resist the longing to see his native village once' more. Sorrowfully we gazed after the boat which bore away our faithful old helper.L-I am,

&c., ALBERT SCHWEITZER.

Lambarene, French Equatortal Africa.