Chapter IX: Section 3

Climate continued—Notes on the Nosology of Zanzibar—Effects on Strangers.

The climate of Zanzibar Island is better than that of the adjacent continent. Here many white residents have escaped severe fever; but upon the coast the disastrous fate of Captain Owen’s surveyors, the loss of life on board our cruisers, and the many deaths of the ‘Mombas Mission,’ even though, finding the sea-board dangerous, they built houses on the hills which lead to the mountain region of Usumbara, prove that malaria is as active in eastern as in western Africa. Colonel Hamerton once visited the Pangani river during the month of August: of his 19 men, three died, and all but one suffered severely. Perhaps we should not find a similar mortality in the present day, when the lancet has been laid aside for the preventive treatment by quinine and tonics. It has, however, been asserted that the prophylactic use of the alkaloid, which was such a success in western Africa, did not prove equally valuable on the eastern coast.

Yet Zanzibar, with its double seasons and its uniformly heated and humid atmosphere, accords ill, even where healthiest, with the irritable temperament of northern races. Here, contrary to the rule of Madagascar, the lowlands over which the fresh sea-breeze plays are the only parts where the white stranger can land and live; the interior is non habitabilis æstu. Lieut.-Colonel Hamerton, called upon in March, 1844, by Sir George Arthur, governor of Bombay, to report upon the island, wrote in September of the same year, ‘The climate of the [insular] coast is not unhealthy for Europeans, but it is impossible for white men to live in the interior of the island, the vegetation being rank and appearing always to be going on; and generally fever contracted in the interior is fatal to Europeans.’ Colonel Sykes (loco cit.) questions this assertion as being ‘contrary to all other testimony.’ Every traveller, however, knows it to be correct. As in the lovely climates of the Congo River and the South Sea Islands, corporal lassitude leads to indolence, languor, and decline of mental energy, which can be recovered only by the bracing influence of the northern winter. Many new arrivals complain of depressing insomnia, with alternations of lethargic sleep: I never enjoyed at Zanzibar the light refreshing rest of the desert. Yet the island is a favourable place for the young African traveller to undergo the inevitable ‘seasoning fever’, which upon the coast or in the interior might prove fatal. The highlands, or the borders of the great central basin, are tolerably healthy, but an invalid would find no comforts there—hardly a waterproof roof. He should not, however, risk after recovery a second attack, but at once push on to his goal; otherwise he will expend in preparation the strength and bottom required to carry out his explorations. With a fresh, sound constitution, he may work hard for three years, and even if driven home by ill health he may return in comparative safety within a reasonable time.

No European, unless thoroughly free from organic disease, should venture to remain longer than three or four years at Zanzibar: the same has been observed of Baghdad, and of the Euphrates valley generally. Lurking maladies will be brought to a crisis, and severe functional derangements are liable to return. The stranger is compelled to take troublesome precautions. He may bathe in cold water, sweet or salt, but he must eschew the refreshment of the morning walk: during the rains, when noxious mists overhang the land, the unpleasant afternoon is the only safe time for exercise. Flannel must always be worn despite the irritability of the ever-perspiring skin: even in the hottest weather the white cotton jackets and overalls of British India are discarded for tweeds, and for an American stuff of mixed cotton and wool. Extra warm clothing is considered necessary as long as the ‘mugginess’ of ‘msika- weather’ lasts. Sudden exposure to the sun is considered dangerous, and the carotid, jugular, and temporal arteries must be carefully protected from cold as well as from heat. Hard work, either of mind or body, is said to produce fever as surely as sitting in draughts or as wearing insufficient clothing. The charming half-hour following sunset is held dangerous, especially in hot weather; yet most tantalizing is the cool delicious interval between the burning day and the breathless night. Natives of the country rarely venture out after dark: a man found in the streets may safely be determined to be either a slave or a thief— probably both.

Directions for diet are minute and vexatious. The stranger is popularly condemned to ‘lodging-house hours’—breakfast at 9 A.M., dinner at 3 P.M., tea at 8 P.M., bed at 10 P.M. He is told also to live temperately but not abstemiously, and never to leave the stomach too long empty. I should prescribe for him, contrary to the usual plan, an abnormal amount of stimulants, port and porter, not claret nor Rhine-wine. It is evident that where appetite is wanting, and where nourishing food is not to be obtained, the ‘patient’ must imbibe as much nutriment as he safely can. In these lands a drunkard outlives a water-drinker, despite Theodoret, ‘vinum bibere non est malum, sed intemperanter bibere perniciosum est’; and here Bacchus, even ‘Bacchus uncivil,’ is still ‘Bacchus the healer.’ As usual old stagers will advise a stranger recovering from fever to strengthen himself with sundry bottles of port, and yet they do not adopt it as a preventive—‘experto crede Ricardo.’ The said port may be Lisbon wine fortified with cheap spirits, liquorice, and logwood—in fact, what is regimentally called ‘strong military ditto;’ yet I have seen wonders worked by the much-debased mixture. Again, Europeans are told to use purgatives, especially after sudden and strong exercise, when the ‘bile is stirred up.’ As an amateur chronothermalist—thanks to my kind old master, the late Dr Dickson—I should suggest tonics and bitters, which often bring relief when the nauseous salts and senna aggravate the evil. Also, in all debilitating countries, when the blood is ‘thin,’ laxatives must be mild, otherwise they cause instead of curing fever; in fact, double tonics and half purgatives should be the rule. Above all things convalescents should be aided by change of air, if only from the house of sickness to that of a neighbour, or to a ship in port. The most long-lived of white races are the citizens of the United States: they are superior to others in mental (or cerebral) energy; they are men of spare, compact fibre, and of regular habits; they also rarely reside more than two or three years at a time on the island. On the other hand, the small French colony has lost in 15 years 26 men: they lived imprudently, they drank sour Bordeaux, and when attacked with fever they killed themselves by the abuse of quinine. Swallowing large doses upon an empty stomach, they irritated the digestive organs, and they brought on cerebral congestion by ‘heroic practice’ when constipated.

According to the Arabs and Hindus of Zanzibar, ague and fever are to be avoided only by perspiring during sleep under a blanket in a closed room—a purgatory for a healthy hot-blooded man in this damp tepid region. I found the cure-almost-as-bad-as-the-disease precaution adopted by the Spanish colonists at my salubrious residence—Fernando Po, West Africa. Only two officers escaped ‘chills,’ and they both courageously carried out the preventive system: on the other hand, it was remarked that they looked more aged, and they appeared to have suffered more from the climate, than those who shook once a month with ‘rigors.’ There is certainly no better prescription for catching ague than a coolth of skin during sleep: having purchased experience at a heavy price, it is my invariable practice when awaking with a chilly epiderm to drink a glass of water ‘cold without,’ and to bury myself for an hour under a pile of blankets. Every slave-hut has a cartel or cot, and the savages of the coast, like those of the Upper Nile, carry about wooden stools for fear of dysentery. I have mentioned how our sailors dig their graves.

So much for the male sex. European women here, as in the Gulf of Guinea, rarely resist the melancholy isolation, the want of society, and the Nostalgia—Heimweh or Home-sickness—so common, yet so little regarded in tropical countries. Under normal circumstances Equatorial Africa is certain death to the Engländerin. I am surprised at the combined folly and brutality of civilized husbands who, anxious to be widowers, poison, cut the throats, or smash the skulls of their better-halves. The thing can be as neatly and quietly, safely and respectably, effected by a few months of African air at Zanzibar or Fernando Po, as by the climate of the Maremma to which the enlightened Italian noble condemned his spouse.

The nosology of Zanzibar is remarkable for the prevalence of urinary and genital diseases; these have been roughly estimated at 75 per cent. Syphilis spreads wide, and where promiscuous intercourse is permitted to the slaves it presents formidable symptoms. The ‘black lion,’ as it is popularly called—in Arabic El Tayr or El Faranj; in Kisawahili, Bubeh, Kiswendi, or T’hego—will destroy the part affected in three weeks: secondaries are to be feared; noses disappear, the hair falls off, and rheumatism and spreading ulcers result. Gonorrhœa is so common that it is hardly considered a disease. Few strangers live long here without suffering from irritation of the bladder, the result, it is said, of hard lime-water: and the common effect of a cold or of stricture is severe vesical catarrh. Sarcocele and hydrocele, especially of the left testis, according to the Arabs, attack all classes, and are attributed to the relaxing climate, to unrestrained sexual indulgence, and sometimes to external injury. These diseases do not always induce impotence or impede procreation. The tunica vaginalis is believed to fill three times: as in elephantiasis the member is but a mass of flesh, a small meatus only remaining. The deposition of serum is enormous; I have heard of six quarts being drawn off. The natives punctuate with a heated copper needle, and sometimes thus induce tetanus: Europeans add injections of red wine and iodine. The latter is also applied with benefit in the early stage to sarcocele; and both complaints have yielded, it is said, to the galvanic current. Strangers are advised at all times to wear suspensory bandages.

Elephantiasis of the legs and arms, and especially of the scrotum, afflicts, it is calculated, 20 per cent. of the inhabitants: Arabs and Hindus, Indian Moslems and Africans, however dissimilar in their habits and diet, all suffer alike. It is remarked that the malady has never attacked a pure white, European or American: perhaps the short residence of the small number accounts for the apparent immunity. Similarly, in the Brazil I have never seen a European stranger subject to the leprosy, or to the goître, so prevalent in the great provinces of São Paulo and Minas Geraes. The Banyans declare that a journey home removes the incipient disease, or at least retards its progress: it recurs, however, on return to Zanzibar. The scrotum will often reach the knees; I heard of one case measuring in circumference 41 inches, more than the patient’s body, whilst its length (33 inches) touched the ground. There is no cure, and the cause is unknown. The people attribute it to the water, and possibly it may spring from the same source which produces goître and bronchocele.

Syphilitic and scorbutic taints appear in ulcers and abscesses. The helcoma resembles that of Aden: it generally attacks the legs and feet, the parts most distant from the centre of circulation; the toes fall of, and the limb becomes distorted. Phagædenic sores are most common amongst the poor and the slaves, who live on manioc, fruit, and salt shark often putrid. Large and painful phlegemonous abscesses, attacking the muscular tissue, occasion great constitutional disturbance: they heal, however, readily after suppuration. Scabies, yaws (Frambæsia), psoriasis, and ‘craw-craw,’ inveterate as that of Malabar or the Congo River, commonly result from personal uncleanliness, unwholesome food, and insufficient shelter and clothing. That frightful malady Lupus presents pitiable objects.

The indigenous diseases which require mention are fevers, bowel- complaints, and pulmonary affections.

Fevers at Zanzibar have been compared with Aaron’s rod; at times they seem to swallow up every other disease, and generally they cause the greatest amount of mortality. As at Muhamreh, and on the swampy margins of the Shat el Arab (Persian Gulf), the constitution worn out, and the equilibrium of the functions deranged by moist heat and sleeplessness, especially during and after the heavy rains of the S. West monsoon, thus relieve themselves. Persians and northern Asiatics are even more liable to attacks than Europeans; and, as in Egypt, rude health is rare. Some Indian Moslems have fled the country, believing themselves bewitched. Arabs born on the island, and the Banyans, who seldom suffer much from the fever, greatly dread its secondary symptoms. The ‘hummeh,’ or intermittent type, is remarkable for the virulence and persistency of the sequelæ, which the Arabs call ‘Nazlah’ (metastasis), or defluxion of humours—‘dropping into the hoofs’ as the grooms say. Cerebral and visceral complications, with derangements of the liver and spleen, produce obstinate diarrhœas, dysenteries, and a long dire cohort of diseases. Men of strong nervous diathesis escape with slight consequences in the shape of white hair, boils, bad toothaches, neuralgias, and sore tongues. The weak lose memory, or virility, or the use of a limb, the finger-joints especially being liable to stiffen; many become deaf or dim-sighted, not a few are subject to paralysis in its various forms, whilst others, tormented by hepatitis, constipation, and disorders of the bowels and of the digestive organs, never completely recover health. In this country all attribute to the moon at the ‘springs’ what we explain by coincidence and by the periodicity of disease. For months, and possibly for years, the symptoms recur so regularly that even Europeans will use evacuants and quinine two or three days before the new and full moons. In such cases, I repeat, change of climate is the best aid to natura curatrix.

The malignant typhus is rare at Zanzibar: it raged, however, amongst the crew of a French ship wrecked on the northern end of the island, when the men were long exposed to privations and over-fatigue. Intermittents (ague and fever) are common as colds in England. They are mild and easily treated;[47] but they leave behind during convalescence a dejection and a debility wholly incommensurate with the apparent insignificance of the attack, and often a periodical neuralgia, which must be treated with tonics, quinine, and chiretta.

The bilious remittent is, par excellence, the fever of the country, and every stranger must expect a ‘seasoning’ attack. It was inordinately fatal in the days when, the lancet being used to combat inflammation, the action of the heart was never restored. Our grandfathers, however, bled every one for everything, and for nothing: there were old ladies who showed great skill in ‘blooding’ cats. In 1857 men had escaped this scientific form of sudden death, but the preventive treatment so ably used on the West coast of Africa had not been tried. The cure at Zanzibar was an aperient of calomel and jalap. Castor oil was avoided as apt to cause nausea. Quinine was administered, but often in quantities not sufficient to induce the necessary chinchonization, and the inexperienced awaited too long the period of remission, administering the drug only during the intervals. Diaphoretics of nitrate of potash, camphor mixture, and the liquor acet. ammon. were used to reduce the temperature of the skin. The most distressing symptom, ejection of bile, was opposed by saline drinks, effervescing draughts, diluted prussic acid, a mustard plaister, or a blister. The hair was shaved or closely cut, and evaporating lotions were applied to the head. The extreme restlessness of the patient often called for a timid narcotic; in these days, however, the invaluable hydrate of chloral, Sumbul and chlorodyne were unknown, and soporifics were used, as it were under protest, being believed to cause constipation. Extreme exhaustion was not vigorously attacked with medical and other stimulants; and thus many sank under the want of ammonia and wine. I have since remarked the same errors of treatment in the West African coast; the patient was often restricted to the acidity-breeding rice water, arrowroot, and similar ‘slops.’ When he pined for brandy and beef-tea, the safe plan of consulting his instincts was carefully ignored.

In strong constitutions the initiatory attack of remittents is followed after a time by the normal intermittent, and the traveller may then consider himself tolerably safe. In some Indian cases ague and fever have recurred regularly for a whole year after the bilious remittent.

The bilious remittent of Zanzibar is preceded by general languor and listlessness, with lassitude of limbs and heaviness of head, with chills and dull pains in the body and extremities, and with a frigid sensation creeping up the spine. Then comes a mild cold fit, succeeded by flushed face, full veins, an extensive thirst, dry, burning heat of skin, a splitting headache, and nausea, and by unusual restlessness, or by remarkable torpor and drowsiness. The patient is unable to stand; the pulse is generally full and frequent, sometimes thready, small, and quick; the bowels are constipated, and the tongue is furred and discoloured; appetite is wholly wanting. During my first attack, I ate nothing for seven days; and despite the perpetual craving thirst, no liquid will remain upon the stomach. Throughout the day extreme weakness causes anxiety and depression; the nights are worse, for restlessness is aggravated by want of sleep. Delirium is common in the nervous-bilious temperament. These symptoms are sometimes present several days before the attack, which is in fact their exacerbation. A slight but distinctly marked remission often occurs after the 4th or 5th hour—in my own case they recurred regularly between 2 and 3 A.M. and P.M.—followed by a corresponding reaction. When an unfavourable phase sets in, all the evils are aggravated; great anxiety, restlessness, and delirium wear out the patient; the mind wanders, the body loses all power, the ejecta become offensive; the pulse is almost imperceptible; the skin changes its dry heat for a clammy cold; the respiration grows loaded, the evacuations pass involuntarily; and after perhaps a short apparent improvement, stupor, insensibility, and sinking usher in death. On the other hand, if the fever intends yielding to treatment, it presents after the 7th day marked signs of abatement; the tongue is clearer, pain leaves the head and eyes, the face is no longer flushed; nausea ceases after profuse emesis of bile, and a faint appetite returns.

After the mildest attacks of the Zanzibar remittent, the liver acts with excessive energy: sudden exercise causes a gush or overflow of bile, which is sufficient to bring on a second attack. The debility, which is inordinate, may last for months. It is often increased by boils, which follow one another in rapid succession, and which sometimes may be counted by scores. Besides the wet cloth, the usual remedy to cause granulation, and to prevent the sore leaving a head, is to stuff it with camphor and Peruvian bark. When boils appear behind the head, the brain is sometimes affected by them, and patients have even sunk under their sufferings. The recovery, indeed, as in the case of the intermittent type, is always slow and dubious, relapses are feared, and for six weeks there is little change for the better; the stomach is liable to severe indigestion; the body is emaciated, and the appetite is excessive, or sickly and uncertain. The patient suffers from toothaches and swelled face, catarrh, hepatitis, emesis, and vertigo, with alternations of costiveness and the reverse. As I have already said, change of air and scene is at this stage more beneficial than all the tonics and preventives in the pharmacopœia. Often a patient lying apparently on his death-bed recovers on hearing that a ship has arrived, and after a few days on board he feels well.

Diarrhœa and dysentery are mostly sporadic; the former, however, has at times attacked simultaneously almost every European on the Island. It is generally the result of drinking bad water or sour wine, of eating acescent or unripe fruit, and of imprudent exposure. Dysentery is especially fatal during the damp and rainy weather. It was often imprudently treated with mere astringents, and without due regard to the periods of remission, and to the low form which inevitably accompanies it. As in remittents, the patient was weakened, and his stomach was deranged, with ‘slops,’ when essence of meat was required. The anti- diarrhœa or anti-cholera pill of opium, chalk, and catechu has been fatal wherever English medicine has extended; witness the Crimean campaign, where the bolus killed many more than did the bullet. A complication, rarely sufficiently considered, is the hepatic derangement, from which almost all strangers must suffer after a long residence in the Tropics. At Zanzibar some Europeans were compelled to give up breakfasting, to the manifest loss of bulk, stamina, and muscular strength—vomiting after the early meal, especially when eaten with a good appetite, was the cause. Yet it was a mere momentary nausea, and when the mouth had been washed no inconvenience was felt.

Catarrh and bronchitis are common in February and in the colder months of July and August. Of endemic pulmonary diseases, pneumonia, asthma, and consumption—the latter aggravated by the humid atmosphere—are frequent amongst the higher classes, especially the Arab women debilitated by over-seclusion. The incidental maladies are tropical rheumatisms, colics, hæmorrhoids, and rare attacks of ophthalmia, simple, acute, and purulent. Hæmorrhoids are very common both on the Island and the coast; the people suffer as much as the Turks in Egypt without wearing the enormous bag-trowsers which have been so severely blamed.

Of the epidemics, the small-pox, a gift of Inner Africa to the world, is fatal as at Goa or Madagascar. Apparently propagated without contact or fomites, it disfigures half the population, and it is especially dangerous to full-blooded Africans. About three years ago (1857) a Maskat vessel imported a more virulent type. Shortly before my arrival, numbers had died of the confluent and common forms, and isolated cases were reported till we left the Island. All classes were equally prejudiced against vaccination. The lymph sent from Aden and the Mauritius was so deteriorated by the journey that it probably never produced a single vesicle (1857).

Until 1859 cholera was unknown even by name. Col. Hamerton, however, declared that in 1835 hundreds were swept off by an epidemic, whose principal symptoms were giddiness, vomiting and purging, the peculiar anxious look, collapse, and death. It did not re-appear for some years; but in a future chapter I shall notice the frightful ravages which it made on the East African coast at the time of my return from the interior.

Hard water charged with lime and various salts, combined with want of vegetables, renders constipation a common ailment at Zanzibar. Amongst the rich it mostly arises from indolence, and from the fact that all are greatly addicted to aphrodisiacs. The favourite is a pill composed of 3 grains of ambergris, and 1 grain of opium, the latter ingredient in the case of an ‘Afímí’ (opium-eater) must be proportioned to his wants.

‘Doctors’ in my day were unknown at Zanzibar. Formerly, two Indians practised; since their departure the people killed and cured themselves. Amongst Arabs, and indeed Moslems generally, every educated man has a smattering of the healing art. H. H. the late Sayyid was a ‘hakím’ of great celebrity. A physician is valuable on the Island; throughout the African interior he is valueless in a pecuniary sense, as every patient expects to be kept and fed. The midwives are usually from Cutch; Arabs, however, rarely consent to professional assistance. The Prince kept in his establishment two sages femmes from Maskat.