-V,    :< : . "

-■' ?-:v-r--.tr:'^    & &

■ ■ !‘    ’VS-S r> #35 » '

.    :.    :: . Vv. ■; W '■    '    ■    ,


Vi


VV,;


ij-


me? ' %•'•■ i'M- E'^'


n


TERRITORY OF PAPUA.


«


UNIVE

m sjfc

RS

0676505 6


Handbook on the

TREATMENT AND PREVENTION OF DISEASE I PAPUA

when medical advice unobtainable.


BY


WALTER MERSH STRONG,


M.A., M.D., B.Ch., D.T.M. & H.,Camb., Eng.; M.R.C.S., Eng., L.R.C.P., Lond.; Chief Medical Otlicer, Government Anthropologist and late Resident Magistrate for North-Eastern Division, Territory of Papua, Australia.


BY AUTHORITY.


102<>.


Port Moresby :

Edward Gkorgk Bakkk. Government Printer.


Y L



BRARY

\x< V


f iíq-oxums

ir / Hot

l9Vo


(./i


o


\    ' “i o

*    * *- i. ** i w    i 1 U i


DATE DUE

TERRITORY OF PAPUA.

Handbook on the

TREATMENT AND P R E V E N TIO N 0 F DISEASE IN PAPUA

when medical advice is unobtainable.

J!Y

WALTER MERSH STRONG,

M.A., M.D., B.Cli., D/r.M. & H., Camb., Eng.; M.R.C.S., Eng., L.R.C.P., bond.; Chief Medical Officer, Government Anthropologist and late Resident Magistrate for North-Eastern Division, Territory of Papua, Australia

BY AUTHORITY.

1026.

Port Moresby:

Edward George Baker. Government Printer.

FIRST EDITION OF THE HANDBOOK.

The circumstances of Papua are quite peculiar. It is a Territory of about ninety thousand square miles with a population of about a thousand Europeans and a quarter of a million natives. The number of qualified medical men to attend to the wants of this immense Territory and large population has never exceeded four and has often been limited to two. As a result of this relative scarcity of medical men the partially qualified and the unqualified layman has had to help in the matter of the prevention and treatment of disease and, up to a certain point, I have always encouraged such assistance. This handbook has been written mainly with a view to assisting those in Papua who have to deal with the treatment and prevention of disease in absence of trained medical advice. It is not intended as a scientific treatise of Papuan diseases, nor as an account of Papuan diseases to be read by qualified medical men, but it is also hoped that it will he of some assistance to any such who may be coming to practise in the Territory, and who have little or no knowledge of what is becoming a very specialized subject, viz., Tropical Medicine, and who have no knowledge of the special circumstances of the country and of the difficulties to be met with in the treatment and prevention of disease amongst a native population only just emerging from the Stone Age.

The present work is an extension of a pamphlet entitled “ Hints on the Medical Treatment of Natives and Others in Papua, when medical advice is not obtainable.” The first edition of these hints was published by the Papuan Government in 1908. The work was revised and a second edition was published in 1909. The present work is considerably larger and in several respects has been modified in the light of seven more years’ experience of the country.

This work, like the Hints on Treatment mentioned above, is primarily intended for the use of officers in the Government Service. Some of these are in charge of large tracts of country with thousands of natives under their control and without medical advice of any kind being available. It is also hoped that the book will be of use to those owners and managers of plantations and mines who are sufficiently far-seeing to understand that attention to the treatment and prevention of disease amongst their employees pays in the long run, even if expenses for the time being may have to be incurred. The amount of time lost by employees on account of actual sickness must be considerable. Apart from actual sickness, the healthier an employee the more work he will do. It is also hoped that this work will be useful to the thousand Europeans

who have to live in the country and who commonly suffer from sickness simply because they do not understand the few simple precautions which have to he taken to maintain health in a tropical country where malaria is indigenous. Being primarily written for Government officers, the work contains one or two chapters not altogether applicable to others. Yet the list of drugs which are supplied to various Government officers (See Chapter III) should be of use to anyone in the country who employs much native labour. Further information on this point will be found in Chapter I.

SECOND EDITION OF THE HANDBOOK.

There is very little alteration, except in matter of detail, between tiie second and iirst edition of this handbook. The present edition as regards general plan is the same as the 1917 edition, but the work has been modified and expanded in the light of eight further years' experience of medical work in Papua.

The method of requisitioning for drugs lias been brought into accord with the present practice (See page 13).

The visit of the Hookworm Commission has led to the extensive use of drugs with a view to the lessening of infection in the country. The drugs used are mentioned on page 11 and the method of using them on page 67.

In this edition the use of Cinchona Febrifuge is recommended as a treatment for malaria (See Appendix, p. 82).

CONTEXTS.

Preface ...    ...    ...    ...    ...    ...    •••    ••• ni, v

CHAPTER I.

Introduction ...    ...    ...    •••    •••    •••

CHAPTER II.

List of Drugs for Outstations Use—

(1)    Tablets and Tabloids    ...    ...    ...    ...    •••    3

(2)    Lotions ...    ...    ...    ...    ...    ...    •*    1 2

(3)    Dusting Powders...    ...    ...    ...    •••    6

(4)    Ointments    ...    ...    ...    ...    •••    •••    8

(5)    Liniments,    etc.    ...    ...    ...    ...    •••    •••    7

(6)    Liquid Medicines...    ...    ...    ...    ...    •••

(7)    Dressings and Sundries ...    ...    ...    ...

CHAPTER III.

Requisitioning for Drugs—

(1)    Rules to be observed by Government Officers when Requisition

ing for Drugs ...    ...    ...    ...    •••    13

(2)    Schedule A (Magisterial Outstations)    ...    ...    • ••    14

(3)    ScheduleJB (Government Plantations, etc.) ...    ...    ...

(4)    Schedule C (Patrol)    ...    ...    ...    •••    •••

CHAPTER IV.

Treatment of Disease and Injury—

(1)    Minor Injuries, Ulcers and Abscesses—

(а)    Cuts and Wounds    ...    ...    ...    ...    ...    18

(б)    Ulcers ...    ...    ...    ...    ...    •••    18

(c)    Leech Bites, Scrub Itch, etc.    ...    ...    ...    21

(d)    Abscesses and Boils...    ...    ...    ...    ...    22

(0)    Burns ...    ...    ...    ...    •••    •••    23

(/) Sprains and Strains...    ...    ...    ...    ...    23

({7) Pain and its Treatment ...    ...    ...    ...    24

(2)    Serious Injuries—

(а)    Qeneral Principles of Treatment    ...    ...    ...    24

(б)    Serious Bleeding    ...    ...    ...    ...    ...    25

(c)    Fractures and    Dislocations ...    ...    ...    ...    26

(d)    Snake Bites, etc.    ...    ...    ...    •••    ...    28

(e)    Wounds due to Arrows, Spears and Firearms    ...    ...    29

CHAPTER IV.—continued.

(4) More Serious Medical Troubles—

(u) Fever (and the method of using the Clinical Thermometer)

(b)    Malarial Fever    ...    ...    ...    ...    ...

(c)    Black water Fever    ...    ...    ...    ...    ...

(d)    Sunstroke ...    ...    ...    ...    ...    ...

(e) Bacillary Dysentery    ...    ...    ...    ...

(/) Beriberi ...    ...    ...    ...    ...    ...

(g)    Ulcerated Mouth Disease    ...    ...    ...    ...

(h)    Venereal Diseases    ...    ...    ...    ...    ...

CHAPTER V.

Prevention of Disease—

(1)    The Maintenance of Good Health in the Tropics    ...    ...

(2)    The Introduction of Disease into the Body ...    ...    ...

(3)    Prevention of Malarial Fever (and of Mosquitoes)    ...    ...

(4)    Prevention of Dysentery (and of diseases carried in a similar

manner)    ...    ...    ...    ...    ...    ...

(5)    Diseases clue to Defective Food (Beriberi and Ulcerated Mouth

Disease)    ...    ...    ...    ...    ...    ...

(G) Prevention of Hookworm (Agchylostomiasis) and other Intestinal Worms    ...    ...    ...    ...    ...    ...

(7)    Infectious Diseases in Native Villages (Epidemics) ...    ...

(8)    Prevention of Ulcers    ...    ...    ...    ...    ...

CHAPTER VI.

The Medical Laws of the Country—

(1)    Quarantine    ...    ...    ...    ...    ...    ...

(2)    Health Ordinance    ...    ...    ...    ...    ...

(3)    Native Labour Regulations (Native Labour Ordinance, Î911-1920)

(4)    Regulations Dealing with Native Matters (The Native Regula

tion Ordinance of 1908)...    ...    ...    ...    ...

(5)    Communicable Diseases Occurring on Bçats ...    ...    ...

CHAPTER VII.

Miscellaneous—

(1)    Weights and Measures    ...    ...    ...    ...    ...

(2)    Doses for Children    ...    ...    ...    ...    ...

APPENDIX.

Cinchona Febrifuge    ...    ...    ...    ...    ...    ...

Venereal Disease ...    ...    ...    ...    ...    ...    ...

INTRODUCTION.

In Chapter II a complete list is given of the drugs, dressings and instruments which will he supplied to Government officers in charge of out -stations. Such drugs, if wanted, must he requisitioned for in accordance with the rules and regulations which are applicable to requisitions in general. Requisitions should he sent direct to the Head of the officer's own department at Port Moresby. Reasonable quantities only of drugs will be supplied ; and some consideration may have to be given to the amount of money available for outstation drugs.

The full name and description of each article is given so that anyone outside the Government Service can order the exact article. With each article a brief description is given of how it is to be used, and of the particular trouble or disease it is intended to relieve or cure.

In Chapter III the same list of drugs is given with the quantities mentioned which would usually he considered reasonable for a Government officer to have for each six or nine months provided he knows the use of such drugs.

The list given in Schedule A, Chapter III, will also he of use to those Europeans, such as missionaries or plantation managers, who wish to keep a fairly complete supply of drugs without getting anything unnecessary or fanciful.

The list given in Schedule B should be of use to anyone living away from medical aid and in charge of natives who wishes to keep a minimum of drugs to meet ordinary common complaints.

The list given in Schedule C will he found of use by Europeans who have to travel about the country and who wish to take with them a reasonable supply of medicines in a portable form.

Chapter IV is the longest in the book. In it various symptoms, diseases and accidents are described, and their appropriate treatment is given. Such have been selected either because they are affections which are common in parts of the country where medical aid is not available, or because they are serious conditions which may occur away from medical aid and which may he greatly benefited by simple treatment along correct lines.

Chapter V deals with the prevention of disease, i regard this as the most important part of the book, and, in spite of the seeming difficulty of the subject at first sight, I hope there will be some who will read it with care and grasp the underlying principles. The second section of this chapter, dealing with the prevention of malaria, should be carefully read and acted upon by all who suffer from malaria, and by all who live in malarial parts of the country away from medical aid.

Sections three, four, five and six should he read carefully by those who are in charge of any considerable number of native labourers or prisoners.

In Chapter VI a few brief indications as to the medical laws of the Territory are given. In Section 3 the medical regulations made under the ‘ Native Labour Regulations ” are briefly described. They will he of use both to newlv-appointed Government officers and to those employers of native labour who wish to comply in a reasonable manner with regulations, the meaning and purpose of which may not be apparent without some explanation. In Section 4 a similar brief outline of the regulations made under The Native Regulation Ordinance of 1908 is given, and will be of use to officers of the Government who have to assume control of native villages in face of an epidemic. Such officers should also read Sections 3, 4 and 6 of Chapter V. In the absence of a Government officer a missionary could do useful work by being guided in the matter of giving advice by the same sections.

In Chapter VII a list of weights and measures is given, together with the value of ordinary domestic measures. The proportional doses which should usually he given to children are also mentioned.

LIST OF DRUGS, Etc,, FOR OUTSTATION USE.

I.—* Tablets and Tabloids.

1.    tQuinine Bisulphate Tablets.—These are supplied in bottles of one hundred. Each bottle contains one hundred tablets and each tablet contains live grains of Quinine Bisulpluite and is not sugar coated. The usual dose is one or two tablets three times a day after meals for malarial fever. For severe cases two tablets should he given, or an extra single tablet once or twice during the day. For preventing malarial fever it is recommended that one tablet he taken three times a day after each meal on the 9th and 10th, 19th and 20th, and 29th and 30th of each month. When Quinine is being taken the bowels should be kept well open and a dose of salts for this purpose is often advisable. If preferred, the tablet can be dissolved in water or broken up into powder before being taken.

2.    Smaller tablets, each containing only two grains of Quinine, will also be supplied, but are intended mainly for children or for use as a mild tonic.

3.    Dover s Powder Tablets.—These are supplied either in bottles of one hundred or in bottles of twenty-live tablets. Each tablet contains five grains of the Dover’s Powder. One or two tablets taken at night during an attack of malaria or other febrile trouble will often secure a comfortable night free from sleeplessness. But there may be some headache and drowsiness next day if two are taken. Dover’s Powder tends to cause constipation so it is advisable to take a purgative, either at the same time or soon after. Dover’s Powders should be used cautiously and not too often. The tablet may be powdered and drunk with a little water to secure more rapid action.

4.    Opium Tablets.—These are supplied in bottles of one hundred. One or two of these can be taken to allay pain arising from an injury. They must not he used to relieve sleeplessness nor to relieve frequently-recurring pain. The danger of contracting the serious Opium habit should be remembered as well as the constipating effects of Opium, and a purgative should he taken at the same time. The maximum dose of Opium is two grains for an adult and less for children [See Chapter V I I (2)]. Tt is not advisable to give Opium to young children.

Occasionally these Opium tablets are called “Tincture of Opium.” For all practical purposes the article is the same. A two-grain dose of Opium is about equivalent to a dose of twenty drops of the tincture.

‘ Tablet is the term for a drug made up into a disc-like pill. The word tabloid is a trade designation and is properly applied only to the products of a particular firm which was a pioneer in the making and popularizing of medicines in a tablet form.

t In place of Quinine a new preparation. Cinchona Febrifuge, will often be supplied in tablet form, It is used just the same as Quinine {See Appendix).

5. Potassium Chlorate Tablets.—These tablets are supplied either in bottles of one hundred or in boxes of forty tablets. They are for use in cases of sore throat or in early cases of 1 colds.’ One is placed in the mouth and allowed to dissolve slowly three or four times a day, or one may be used in a similar manner just before going to sleep at night time.

G. Phenacetin Compound Tablets.—These are supplied either in bottles of one hundred or in bottles of twenty-five. One or two tablets are useful in cases of headache due to overwork, the heat of the sun, or fever. They are also useful sometimes to relieve pain in the joints and in the limbs, or to relieve sleeplessness due to overwork, over-anxiety or other nervous cause. Apart from relieving symptoms they have little or no curative value and should not be used too frequently. In larger doses they may, like all similar preparations, cause serious symptoms in specially susceptible people. It is seldom, if ever, necessary to give Phenacetin to natives.

The action of Phenacetin is quite similar to a drug often known under the name of Asperin. Neither drug should he used when the patient is seriously ill.

7.    Casco ra Sagrada Tablets.—These are usually supplied in bottles of one hundred or in bottles of twenty-five tablets, and each tablet contains two grains of the active constituent. One tablet taken at night acts as a mild purgative, or taken after a heavy meal is a good “ digestive.” If more active purgation is desired it is better to take one tabloid with a Quinine and Rhubarb tablet (8)" rather than to take large doses of the Cascara.

8.    Quinine and Rhubarb Tablets.- These tablets are supplied either in bottles of one hundred or in bottles of twenty-five. One tablet is usually sufficient when a moderately active purgative is required, either alone or combined with a Cascara Sagrada tablet (7).T

9.    Tonic Compound Tablets.—These are usually supplied either in bottles of one hundred or in bottles of twenty-five tablets. They contain highly active and poisonous drugs and care must be taken in using them. If one tablet is taken three times a day after each meal recovery from illness is hastened. It is only harmful or useless to take them while the temperature is raised or while active disease is present. Their use should not be continued for more than a week or ten days.

2.Lotions.

10.    Lysol and Lysol Lotion (ami Lysol Substitutes).— “ Lysol” is a word “ made in Germany.” Before the war no one had the right to use the word except a particular German firm, although Australian firms could supply exactly the same article under another name. The name “ Lysol ” became popular partly because it was well advertised and partly because it was an efficient preparation put up in convenient bottles at a cheap rate. When the war broke out Lysol made by the

German firm became unobtainable and Australian preparations were put on the market under other names such as Serscol. Now the Australian article is usually labelled “ Lysol. All such preparations are practically identical.

Lysol and its substitutes are conveniently kept for use as a two per cent, lotion. The two per cent, lotion can be made by either adding three drams (three teaspoonfuls) of Lysol to a pint of water, or by adding two ounces (four tablespoonfuls) of Lysol to a Win Chester quart (five pints) of water. For actual use the lotion is again diluted as a rule with from one to three parts of water. In this strength Lysol Lotion is very commonly used to wash ulcers or injuries before other treatment is applied.

11. Copper Sulphate (Bluestone) Lotion.—Copper Sulphate will be supplied in the form of powder for making up into a lotion. The powder will be sent out in 200-grain packets or tins, and if the contents of a packet are dissolved in a Winchester quart (five pints) of water a lotion containing two grains to the ounce will be made. Care must be taken to see that all the powder dissolves before the lotion is used. The powder will the more readily dissolve if the bottle is frequently shaken.

The lotion is used as a wash for ulcers when they have begun to heal up. Healing is then often accelerated by its use.

12. Zinc Sulphate Lotion.—Zinc Sulphate is supplied in bottles of ten-grain tablets or soloids. Each bottle contains one hundred tablets or soloids. The usual strength to use the lotion is two grains to the ounce. A lotion of this strength is made by dissolving one ten-grain tablet in five ounces (a quarter of a pint) of water, or by dissolving four of the tablets in a pint of water.

t The lotion is usually used as eye drops or as an eye wash in cases of sore eyes. Immediately after an attack of sore eyes begins, Boracic Acid Lotion (15) is preferable ; but after the trouble has lasted a day or two the Zinc Sulphate Lotion is the better.

13. Corrosive Sublimate Lotion.—Corrosive Sublimate or Perchloride of Mercury is supplied in the form of tablets or soloids containing 8i grains of Corrosive Sublimate to the tabloid. These tablets are supplied in bottles of twenty-five. The lotion in a strength of one part in two thousand is made by dissolving one tabloid in two pints of wafer. In this strength it is very useful in cases of scurvy, often called “ sore mouth ” or New Guinea mouth.” It is poisonous and must not be swallowed.

14. Potassium Permanqanate Lotion.—Potassium Permanganate is usually supplied in the form of one-grain tablets or soloids. A bottle of the tablets usually contains one hundred tablets. The lotion should be used in a strength of one part in four thousand to one part in eight thousand. One of the one-grain tablets dissolved in half a pint of water makes a lotion of very convenient strength (one in 4,800). Potassium Permanganate is a very favourite lotion to wash ulcers with, and also as a mouth wash. If used in the above strength if is very beneficial and no harm can be done, but I have known it do serious harm when used as a strong solution or as a powder. The great advantage of Potassium Permanganate is that a few tablets are very portable, and from one small tablet a large quantity of lotion can he made.

15. Boric Acid Lotion.—For the purpose of making up into a lotion Boric Acid is supplied in the form of tablets or soloids, each tablet containing fifteen grains of Boric Acid. The tablets are put up in bottles of one hundred. The lotion is made by dissolving one tablet in two ounces (four tablespoonfuls) of water, and is intended for use as eye drops or as an eye wash. It is especially useful at the very beginning of an attack of “ sore eyes.”;

are sometimes written respectively. They are


Lotion ’ Lotion ”


“Boric Acid ” and “ Boric Acid “ Boracic Acid ’’ and “ Boracic Acid t he same thing.

3.—Dusting Powders.

16.    Compound Iodoform Powder.—This is sent out in tins containing approximately half a pound. This powder is especially useful in treating the ordinary native ulcer after preliminary washing with Lysol Lotion as will he described in further detail later. It is applied by means of a powder sprinkler (37).'

If asked for, the plain Boric Acid Powder will also be sent out in half-pound tins. It is used in just the same way as the Compound Iodoform Powder. For many cases it is not so effective but is without the Iodoform smell of the compound powder.

4.Ointments.

17.    Sulphur Ointment.— This is a very useful preparation for the trouble called by the native kuhi-kuhi and for most other forms of superficial small ulceration of the skin, especially if accompanied by marked itching. In such cases the affected skin should be washed with Lysol Potion and kept covered with Sulphur Ointment for three days before any attempt is made to heal up the ulcer. In some cases it is sufficient to apply the ointment at night and to wash it off in the morning so that an individual can do his work without being covered over with a greasy mess. Subsequent treatment with Copper Sulphate (11)F generally causes such small superficial ulcers to heal rapidly.

Sulphur Ointment is usually supplied in 4-oz. tins.

18.    Borofax.—This is a refined Boric Acid Ointment preparation and is put up in collapsible tubes. It is intended for use in cases of sunburn, and it may be used in place of the ordinary Boric Acid, Zinc or Carbolic Ointments, or in place of Vaseline, by those who prefer an ointment lor trivial cuts and abrasions, it is not intended to be used

■ \ few six-grain tablets are on band and may occasionally bo sent out.

I The figures in parentheses refer to the numbered paragraphs in this part of the book.

for treating the ordinary simple ulcers which natives are so liable to get, and which heal better when treated with the Compound Iodoform Powder.

19.    Other Ointment.—The treatment of the ordinary native ulcer by means of the Compound Iodoform Powder (16)'*: is advised as a routine treatment. Small quantities of Boric Acid, Zinc or Carbolic Ointment will usually be sent out to officers who specially ask for the same.

5.Liniments, Etc.

20.    Turpentine Liniment.—This is sent out in half-pound bottles. It is a popular remedy for various ill-defined aches and pains. It is rubbed on the part which is painful. It is not for use when the skin is broken.

21. Tincture of Iodine.—This is now usually supplied in 8-oz. bottles. Wide-mouth bottles holding one or two ounces and paint brushes are also supplied for using the same as a “ paint." Corks may require removing from time to time as the corks deteriorate under the influence of the drug in course'of time and the drug itself then begins to deteriorate.

It is not intended for use when the skin is broken or ulcerated. Like the Turpentine Liniment it is useful in cases of ill-defined aches and pains when the skin is not affected. It is applied to the skin by means of a brush, not rubbed on by the hand.

It is also a very satisfactory cure for limited small areas of the common skin diseases (ringworms). Care must be taken in its application, especially where the skin is thin, and it must not be applied over too large an area. It must be kept away from the neighbourhood of the eyes, nose and mouth.

22. Friar's Balsam (Compound Tincture of Benzoin).—This is supplied in 4-oz. bottles. Wide-mouth bottles holding one or two ounces and paint brushes are also supplied for using the same as a

* i y>

paint.

It is intended for use in the case of minor cuts and injuries. The cut is carefully cleaned with soap and water, or with Lysol Solution, and then painted over with the balsam. A little cotton wool is next placed on the cut and a little more balsam added to form a complete covering to the cut. The balsam soon dries up and with the cotton wool forms a protecting layer under which the cut will in favourable cases heal up without further trouble.    •

In cases of more serious cuts and tears of the skin it is also a useful application as a dressing in the absence of skilled assistance or dui’ing the transport of the case to skilled assistance.

In doses up to a dram, i.e., a teaspoonful, in a little water the balsam makes a very satisfactory cough mixture which can be used at any time without danger.

23.    Compound Tincture of Resorcin.—This is now supplied in 8-oz. bottles for use in cases of “ skin disease" or Tineia Imbricata. It should be used in conjunction with the wide-mouthed bottles mentioned under Tincture of Iodine and under Friar's Balsam.

24.    Paint Brushes or Gum Brushes.—These are useful for applying either the Tincture of Iodine (21),:,: Friar’s Balsam (22)'" or Compound Tincture of Resorcin (23)."

6.—L i(j u id Med icities.

25.    Compound Tincture of Chloroform and Morphine.—This is sent out in 2-oz. bottles. It is very similar to the proprietary preparations known as Chlorodyne, although these latter may not be made up to the same strength as the official preparation. The dose of the official preparation is up to fifteen drops. It is a popular and favourite remedy for diarrhoea and pains in the stomach. It should not be used at the beginning of an attack of diarrhoea or within twenty-four hours of the beginning of the attack, and only after a preliminary dose of Epsom Salts. If the Epsom Salts are taken at once it will often be found that this alone is sufficient and that the Chlorodyne is not required at all. It should never be used in dysentery cases.

26.    Concentrated Cough Mixture.- - This is usually sent out in 8-oz. bottles and made up to teaspoonful doses. It is a popular remedy and in t hese doses can do little harm. It is useless or even harmful if given to a patient who is going out into the wet and cold at once. When on patrol, if used at all, it should be given only when camp is made and everyone has settled down for the night. A double dose will then do no harm (See also 22).*

27.    Tincture of Ginger.—This is usually sent out in 4-oz. bottles. It is intended for use with Epsom Salts in treating dysentery. One dram (one teaspoonful) is given with each half packet of Epsom Salts (31). At other times a dram or two of it will sometimes relieve indigestion.

28.    Quinine Mixture.—This is sent out in 8-oz. bottles and is made up to tablespoonful doses, i.e., 5 grains to the half ounce. It is used in the same way as the Quinine tablets (l).:,:

29.    Tonic Syrup.—A modified Easton’s Syrup is now usually supplied labelled “ Easton’s Syrup Co." (Compound Easton’s Syrup). It is sent out in 8-oz. bottles. It contains a highly active and poisonous drug and great care must be taken in its use. The usual dose is from half to one teaspoonful with water three times a day after each meal. It is useless or even harmful to take this drug while the patient’s temperature is raised or while any active disease is present. If taken after an acute illness recovery to ordinary strength is more rapid. Its use should not be continued for more than a week or ten days at the most.

30.    Gonorrhoea Pills.—These are usually sent out in bottles of a hundred pills, one to he taken three times a day after meals.

31.    Epsom Salts.—The use of this drug in doses of about half a packet as a purgative is so well known as to hardly need mention. A dose of an entire packet given at the beginning of an attack of dysentery does much to secure a mild attack. In dysentery it is continued in smaller doses until symptoms subside.

It is usually supplied in 1-oz. packets in boxes of 7 lb. There will, therefore, be one hundred and twelve packets in a box.

7.—Dressings cnid Sundries.

32.    Blucstonc Crystals (Copper Sulphate Crystals). A very chronic ulcer is sometimes greatly benefited if a crystal is dipped in water and rubbed over the ulcer. But this method of treatment requires care and caution and should not be carried on as a routine practice or more than a few times at intervals of two or three days. Powdered Copper Sulphate must never be sprinkled over an ulcer.

33.    Lint.—This is sent out in 4-lb. packets. It is t he usual covering for an ulcer. A few packets of specially compressed lint will also be sent out for patrol purposes if asked for.

34.    Cotton Wool.—This is also sent out in i-lb. packets. A small quantity of it may he used as a sponge to wash ulcers. It is also of use as a pad to protect injuries on the foot or elsewhere, or to pad splints, but it is not intended to he placed on the common simple ulcer. A few packets specially compressed will be sent out for patrol use if asked for.

35. Bandages, 24-inch.—There is a very general tendency to use too much bandage. A bandage is used for the purpose of keeping dressings in position, and, if more than is necessary for t his purpose is used, it is an extravagance, or, at best, a concession to neatness and tidiness.

30. Adhesive Plaster, J-inch wide.—This can he used in at least three distinct ways.

In the case of small cuts it can be used to cover up the cut completely if the cut is first carefully washed and cleaned. Should, however, the cut not heal up satisfactorily owing to pus or discharges collecting under the plaster, the plaster must be taken off and the cut kept covered with lint and powder.

It is very diflicult to keep dressings on certain parts, such as the face. If such a part is injured a strip or two of plaster is often a convenient way of keeping a piece of lint over the injury.

The plaster is also of use in the case of more serious cuts where there is a difficulty in keeping the cut or injured surfaces together. In such case the edges should be brought together with the plaster and covered with a dry powder dressing; the entire cut should not be covered, but a small space allowed between two neighbouring strips of

plaster for any discharges to come away. Cuts should not be sewn up except by a medical man or trained individual.    *

The adhesive plaster is also of use in padding splints and for keeping them in position.

*17. Pou'der Sprinkler (Dredge)*).—This is intended for use with the Compound Iodoform Powder or other powder (16).:,: It is used like a pepper-pot for sprinkling the powder over ulcers and skin injuries.

38.    Clinical Thermometer.—The use of this instrument must be learnt practically by seeing one used ; still, a few hints may be useful. The thermometer dose not "go down ” unless shaken, and it goes down best when shaken with a jerk. Before being used, care.should be taken to see that the mercury is down. I have received more than one alarming message because this was not done. Do not let an ignorant native have it in his mouth without his understanding that he must not bite it. If you cannot make the native understand this, put the thermometer in the axilla, or, in the case of a child, in the groin ; and make certain that no part of the bulb of the thermometer is exposed to the air.

39.    Scissors.— These are hardly a necessity. Still, a pair is useful for cutting up lint and bandages.

10. Dissecting Forceps.—These again are hardly a necessity. Still, they are useful for remvoing dirty dressings, etc.

41.    Medicine Droppers. These are used either for measuring out a few drops of very active medicines or for applying lotions lo the eyes.

42.    Class Measures. - If required a pint glass measure and one or two ounce measures will be supplied.

43.    Bottles and Corks.—If required, the following bottles will be supplied if available : a limited number of Winchester quart bottles not exceeding one for each lotion kept made up on the station, a few dispensing bottles either 8 oz. (large) or 2 oz. (small), and a few bottles of similar size for liniments.

Ordinary lotions, if issued in quantity to patients, should be given out in ordinary beer or similar bottles.

A few corks will also be sent out to fit any of the above bottles.

44.    Ointment Tins and Pill Boxes.—Upon application a dozen or so ointment tins will he supplied for giving out ointments, and a dozen or two nests of pill boxes for giving out tablets.

45.    Class Syringes.— The male” syringe is made in two sizes and is useful for washing ulcers or wounds with lotion. It is not advisable for officers to use syringes for urethral injection or to use female syringes without special instruction.

46. Wide-Mouthed Glass Bottles.—These are now supplied with corks for use with liniments, etc., which are used as paints,’’ viz., Iodine Liniment, Compound Tincture of Resorcin and Friar’s Balsam.

17 & 48. Enamel Basins.—Small enamel basins are now supplied for use when ulcers are dressed, etc. If required a smaller size can he asked for for use on patrol and, subject to suitable supplies being available, will he sent out.

49. Crude Disin fectants.—These are generally supplied in one-gallon tins— often with instructions as to use on the tins. These disinfectants are mainly of use for disinfecting dysentery fusees. For this purpose a two per cent, solution is made up, made up in a similar way to t he Lysol Lotion (10),* and the fieces are covered over with the same. Badly-infected flooring may also he scrubbed over with the same strength of disinfectant, and blankets or clothing soaked for a couple of hours in the same solution before being washed.

50. Disinfecting Powder.—In spite of the name it must not be supposed that ficces, ground or flooring is really going to he disinfected and to have ail harmful bacteria killed by the powder. But this powder has a real value if properly used If sprinkled over soiled flooring, soiled ground or in latrines, it helps to keep ilies away and so prevents the flies carrying the harmful bacteria on to food or into milk or tea. Under ordinary circumstances it does not take long for harmless bacteria and other organisms to destroy disease-producing bacteria outside the body. These disease-producing bacteria are harmless so long as they remain in or upon the ground. It is only when they get inside the body that they cause disease.

51. Defecation Tins for Dysentery.—A few of these tins are useful in case of dysentery or in suspected cases of dysentery. They have a lid for keeping flies away.

5‘2. Patrol Cases.— Small wooden boxes are now supplied fitted with the articles mentioned in the list in Schedule C, pages 16 and 17.

JJntf/s for Hookworm (.Agcliylostomiasis) Treatment.

53. iCarbon Tetrachloride Co.—This is for use in treating hookworm (See Chapter V, Section 6). It will he sent out in 4-oz. bottles. Each bottle will then contain enough to give sixty-four adult treatments if a dose of 30 minims (half a teaspoonful) is given. A purgative is combined with if before being sent out.

54. Minim Measures.—These are supplied for use in measuring out doses of Oil of Chenopodium and Carbon Tetrachloride. They can also he conveniently used for measuring out Chlorodyne, Friar’s Balsam, Tincture of Ginger, Easton’s Syrup and Concentrated Cough Mixture, especially when small doses for children are wanted.

The figures in parentheses refer to the numbered paragraphs in this part of the hook.

! The treatment of hookworm by Oil of Chenopodium has now been superseded by the use of Carbon Tetrachloride.

NOTE.—The following articles are liable to deteriorate if kept on hand for long periods :—

(7)    Cascara Sagrada Tablets.    (29)    Easton’s Syrup Co.

(20)    Turpentine Liniment.    (36)    Adhesive Plaster.

(21)    Tincture of Iodine.    (11)    Medicine Droppers.

Especial care should be taken to see that not more of these are ordered than is likely to be required during the six-monthly period the requisition is intended to cover.

It is recommended that the corks in the Liniment of Iodine bottles be tightened from time to time or fresh corks put in if they have deteriorated. It is also recommended that the bottles of Easton’s Syrup and Turpentine Liniment be kept lying down. The Liniment of Turpentine also keeps better if shaken up once every month or two.

The corks in bottles or tins of Lysol and Crude Disinfectant are liable to deteriorate on keeping.

CHAPTER 111.

REQUISITIONS FOR DRUGS.

I.—* Rules to be observed bij Government Officers tvlien

liequisitiomny for Drugs.

Government officers who are away from medical assistance are supplied by the Government with a reasonable amount of drugs. In this Chapter will he found various lists of drugs. From these, officers are expected to select such drugs as they may know the use of and require.

The list given in Schedule A is the longest of the lists. It is intended primarily for officers of the Magisterial Department who may come in contact with sickness amongst police, prisoners and carriers, and who are expected to take charge of venereal cases until an opportunity arises to send them in to a medical officer in accordance with the “ Native Regulations/’

The list given in Schedule B is a list which officers in charge of Government plantations, road camps, survey parties, etc., are advised to learn the use of and to keep available. The quantities may have to he varied according to the number of natives employed.

The list in Schedule C contains such drugs as patrol officers will find it profitable to learn the use of and to carry about with them on patrol.

The directions to he observed in making out requisitions (supply notes) for drugs and dressings will be found on the back of the requisition form. The chief alterations which have been made since the pr evious edition of the handbook was published are as follows

There is a special requisition form now for use by all officers of the Service not being definitely attached to the Medical Department. Such requisition forms are in triplicate. The officer requisitioning keeps the third (station) copy and sends the two other copies to the Head of his own department. When the goods are despatched the second copy is sent hack to the officer requisitioning for the goods. On this copy (on the hack of it) is noted any alterations in the requisition which have been made. This copy of the requisition has at the foot of it a receipt form. The officer on receipt of the goods is required to sign the receipt form and return it to the Chief Medical Officer, making any notes he may desire with

' Those who are not Government officers should refer to Paragraphs :j-.r) of Chapter 1, page 1, before reading this chapter.

These rules an* not intended to apply to members of the Medical Department unless special instruction to that oiTect is given by the Chief Medical Officer.

regard to shortages, breakages, etc. The quantities on hand must be entered on the requisition, the items must he clearly written and sufficient description for the articles to he identified with certainty, must lie given. Requisitions should he sent in as a rule to cover a period of one year. The year should coincide with the yearly requisition which they send in for non-medical supplies.

The drugs mentioned in the schedules are being ordered in quantity and, as far as the stock on hand and the money voted for the purposes allows, reasonable quantities of the same will he approved for issue by tiie Chief Medical Officer. The maximum quantity ordinarily allowed at any one time is mentioned in the schedules. The maximum quantity includes the quantity on hand at the station (or held by the officer) and the quantity which will be supplied on the requisition. For instance, three bottles of Cascara Sagrada are allowed ; if one is on hand at the station, only two more will ordinarily lie sent. If the requisition covers a period of a year an increase in these quantities would usually he allowed.

All unopened bottles and packets must be counted as " on hand.” An opened bottle or packet need only be counted as a half-bottle or packet, irrespective of the amount used, if care is taken to use up one bottle or packet before another one of the same or similar kind is opened. Thus when a bottle is opened it is to be counted as a half-bottle until it is all used up, and a roll of lint counted as half a roll until it is all used up.

The schedules are not intended to represent drugs which an officer must always have. It is useless for officers to get drugs they do not know the use of. It is also impossible for the Government to stock every possible variety of drug which an officer desires even if he does think he knows how to use the drug asked for. The schedules indicate the drugs which an officer who is away from medical assistance may with advantage learn the use of.

A fuller description of each drug mentioned is given in Chapter II, together with some indication of the circumstances under which the drug should he used. In Chapter IV will he found a list of the diseases and troubles which these drugs are intended to relieve or cure.

(2) Schedule A.

MAGISTERIAL OUTSTATIONS.

The drugs in this Schedule are intended for use on Magisterial outstations where medical assistance is not procurable. The quantities mentioned are the maximum quantities ordinarily allowed. When a requisition is sent in the quantities on hand must always be stated. Opened bottles and packages need not be counted if care is taken to use up a bottle or package before another one of the same or similar kind is opened. If the requisition covers a period of a year an increase in these quantities would usually be allowed.

The numbers placed before each item are the same as placed before the same item in Chapter II. In Chapter II further details concerning these drugs will be found, together with some account of how they are intended to be used. Every drug mentioned in Chapters IV and V will be found mentioned in this list.

1.    9 bottles ’Quinine Tablets, 5-gr.

2.    2 bottles Quinine Tablets. 2-gr.

3.    1 bottle Dover’s Powders.

4.    1 bottle Opium Tablets.

5.    2 bottles Potassium Chlorate Tablets. f>. 2 bottles Phenacetin Tablets.

7. 2 bottles Cascara Sagrada Tablets, 2-gr.

S. 1 bottle Quinine and Rhubarb Tablets.

9. 1 bottle Tonic Compound Tablets.

10.    3 tins (or bottles) Lysol (or similar preparation).

11.    ¿-doz. packets Copper Sulphate Powder (for making lotion). Phis is usually

sent out in tins containing 200 grains.

12.    2 bottles Zinc Sulphate Tablets (for making lotion).

13.    1 bottle Corrosive Sublimate Tablets.

14.    2 bottles Potassium Permanganate Tablets (for making lotion).

15.    1 bottle Boracic Acid Tablets (for making lotion).

16.    4 tins Compound Iodoform Powder.

17.    6 tins Sulphur Ointment.

18.    3 tubes Borofax (Refined Boracic Acid Ointment).

19.    2 tins Boracic Acid, Carbolic Acid or Zinc Ointments.

20.    4 bottles Turpentine Liniment.

21.    2 bottles Tincture of Iodine.

22.    2 bottles Friar’s Balsam.

23.    4 bottles Compound Tincture of Resorcin.

24.    ¿-doz. Paint Brushes.

25.    2 bottles Compound Tincture of Chloroform and Morphine (Ohlorodyne).

26.    4 bottles Cough Mixture (compound).

27.    2 bottles Tincture of Ginger.

28.    3 bottles Quinine Mixture.

29.    2 bottles Easton’s Syrup.

30.    2 bottles Gonorrhoea Pills.

31.    4 boxes Epsom Salts.

32.    ¿-lb. of Bluestone Crystals.

33.    3 lb. Lint.

34.    2 lb. Cotton Wool.

35.    6 doz. 24-inch Bandages.

36.    1 spool 4-inch Adhesive Plaster.

37.    ¿-doz. Powder Sprinklers.

38.    4 Clinical Thermometers.

39.    1 Pair Scissors.

40.    1 Pair Dissecting Forceps.

41.    ¿-doz. Medicine Droppers.    .

42.    3 Glass Measures.

43.    Empty Bottles (4 Winchester Quarts, ¿-doz. 8-oz. dispensing bottles, ¿-doz.

2-oz. dispensing bottles, ¿-doz. 2-oz. liniment bottles). Corks will be supplied with the above.

44.    1 doz. Ointment Tins; 1 doz. Pill Boxes.

45.    ¿-doz. Syringes.

46.    4 Wide-Mouthed Bottles.

47.    3 Enamel Basins.

48.    1 small Enamel Basin for patrol use.

49.    2 gals. Crude Disinfectant.

50.    2 tins Disinfecting Powder.

51.    ¿-doz. Defecation Tins (for dysentery).

52.    Patrol Case.

53 and 54. Drugs for Hookworm Treatment as may be required.

Articles 3, 4, 6, 9, 10, 11, 12, 14, 20, 23, 25, 26, 29, 32, 49, 53 and 55 are harmful or poisonous if used improperly. No dru« should be used unless the proper way of using it has been carefully ascertained.

In place of Quinine a new preparation, Cinchona Febrifuge, will often be supplied in tablet form. It is used just the same as Quinine (See Appendix),

(5) Schedule

GOVERNMENT PLANTATIONS, ETC.

The drugs in this Schedule are intended for use on Government plantations, road camps, survey parties, etc., when medical assistance is not procurable. When a requisition is sent in the quantities on hand must always be stated. Opened bottles and packages need not be counted if care is taken to use up a bottle or package before another one of the same or similar kind is opened.

The numbers placed before each item are the same as placed before the same item in Chapter II. In Chapter II further details concerning these drugs will be found, together with some account of how they are intended to be used.

The quantities mentioned are the maximum quantities ordinarily allowed for a period of six months.

1. 4 bottles *Quinine Tablets.

5. 2 bottles Potassium Chlorate Tablets.

7. 1 bottle Cascara Sagrada Tablets.

10. 3 bottles Lysol (or some similar preparation).

14. 2 bottles Potassium Permanganate Tablets.

1G. 2 tins Compound Iodoform Powder.

17. G tins Sulphur Ointment.

19.    2 tins Boracic Acid Ointment.

20.    3 bottles Turpentine Liniment.

21.    1 bottle Tincture of Iodine.

22.    1 bottle Friar’s Balsam.

24. 3 Paint Brushes.

2G. 2 bottles Cough Mixture (concentrated).

27.    2 bottles Tincture of Ginger.

28.    2 bottles Quinine Mixture.

31. 3 boxes of Epsom Salts.

33.    3 lb. Lint.

34.    2 lb. Cotton Wool.

35.    4 doz. Bandages.

3G. 1 Spool Adhesive Plaster.

37.    3 Powder Sprinklers.

38.    2 Clinical Thermometers.

45. 4-doz. Syringes.

4G. 3 Wide-Mouthed Bottles.

47. 2 Enamel Basins.

49. 2 gals. Crude Disinfectant.

51. 3 Defecation Tins.

Articles 10, 20, 21, 25 and 49 are poisonous or harmful if used improperly. No drug should be used unless the proper way of using it has been carefully ascertained.

If further articles are required for special purposes they should be selected from the list in Schedule A.

(4) Schedule, G.

PATROL.

The articles mentioned in this Schedule are intended for the use of officers on patrol. When requisitioning for such drugs the requisition should be clearly marked “ required for patrol use.” In some instances the same drug occurs in this Schedule as in Schedule A. but they are sometimes put up in a more portable form.

The numbers in front of each article are the same as placed before the same article in Chapter II. In Chapter II further details concerning these drugs will be found, together with some account of how they are intended to be used.

The quantities mentioned are the maximum quantities ordinarily allowed for a period of six months.

1. 1 bottle *Quinine Tablets.

4. 1 bottle Opium Tablets.

‘ In place of Quinine a new preparation. Cinchona Febrifuge, will often be supplied in tablet form. It is used just the same as Quinine (,SV<° Appendix).

5. 1 bottle Potassium Chlorate Tablets (or small box of same).

0. 1 bottle Phenacetin Tablets.

7.    1 bottle Cascara Sagrada Tablets, 2-gr.

8.    1 bottle Quinine and Rhubarb Tablets.

14. 1 bottle Potassium Permanganate Tablets.

1G. 1 Sprinkler with Compound Iodoform Powder.

17.    1 tin Sulphur Ointment (1- or 2-oz. tin).

18.    1 tube of Borofax.

*20. 1 bottle of Turpentine Liniment.

88. 3 packets Compressed Lint.

35.    4 Bandages.

36.    1 small spool Adhesive Plaster.

38. 1 Clinical Thermometer.

48. 1 small Enamel Basin.

52. 1 Camphorwood or other case can generally be supplied to contain the above if due notice is given.

Articles 4, 6, 14 and 20 are poisonous or harmful if used improperly. No drug should be used unless the proper way of using it has been carefully ascertained.

If further articles are required for special purposes they should be selected from the list given in Schedule A.

CHAPTER IV.

TREATMENT OF DISEASE AND INJURY.

1.—Minor Injuries, Ulcers and Abscesses.

(a) Cuts and Wounds.—Cuts and minor wounds may be treated in a variety of ways. In all cases the first essential is to keep the injury clean. If it lias become dirty it must be carefully cleaned and washed, preferably with some antiseptic. An ordinary wound heals up readily unless bacteria have been introduced into the wound, which is a favourable place for them to grow. The latter point must not he forgotten. In all cases of moderate injury the patient must be kept in the best of health if the wound is to have the best possible chance of healing rapidly. For this purpose a dose of some purgative, e.g., Epsom Salts, is always advisable, and moderation in eating and drinking must be exercised until the wound heals. Frequent movement will also tend to prevent a wound from healing. If the wound is on the leg the less the patient walks about the better. Wounds near joints are especially liable to delayed healing from this cause, and in wounds of moderate severity the joint is best kept at rest by means of a splint.

If the wound is at all severe it must be washed with some form of disinfectant. Lysol Lotion {See Ch. II) in about one per cent, strength is very suitable. Not only is it a disinfectant, but it also dissolves out and removes fatty material and dirt in the same way that soap does. Idle next essential in all cuts and wounds on the outside of the body is to protect them from dirt and the entry of bacteria. The various ways of treating such injuries are mainly the different ways of keeping dirt and bacteria away.

The simplest way of protecting small cuts is to cover them with adhesive plaster (See Ch. II). Another way is to paint the cut with Friar’s Balsam with or without a little cotton wool. The balsam dries up and forms a protective covering for the cut; and, being an antiseptic, helps to discourage the growth of bacteria in the wound.

The treatment of a cut with the Compound Iodoform Powder is a very good way of treating more serious cuts, especially if the edges are ragged. After bleeding has ceased, the powder is sprinkled very lightly over the injury and covered with a piece of lint and a bandage. Unless the part becomes hot or painful, or unless blood or discharges come through the lint, or unless the wound becomes offensive, the lint need not be disturbed for several days. If, however, the part gets hot or painful, if blood or discharges come through the lint or if the wound becomes offensive, it must be dressed twice or more times a day and treated just like an ulcer {See Sec. {b) of this Chapter).

Another way of affording some protection to a cut is to cover it with Borofax or some form of ointment or vaseline. The ointment forms a greasy covering to the wound and helps to keep bacteria and dirt away from actual contact with the injured part.

Even without any special treatment, except cleanliness and dryness, the cut will often “scab over" and itself form a protective covering. This is the most favourable course which a cut can take; and the application of the adhesive plaster, Friar’s Balsam or Compound Iodoform Powder helps to secure healing in this way. Such a cut, when the scab has formed, will usually go on healing by itself, provided the scab is not injured or kept moist.

With any form of treatment it may, however, happen that cleanliness and disinfection has failed, and that the wound or cut becomes hot and painful, or it may discharge a whitish or blood-stained fluid. At the same time, if the wound is of any size, the patient may become obviously ill and suffer from headache, constipation, loss of appetite, and with a raised temperature. This is due to bacteria having entered the wound and to their having found the conditions there favourable to their growth and multiplication. The first line of treatment, to exclude bacteria and to prevent their growth in the wound, has failed. The second line of treatment is to afford the bacteria, and t he discharges they cause, every possible opportunity of getting away. Consequently, when the wound gets iiot and painful, or when there is any appreciable discharge from the wound—apart from a little blood or clear yellowish fluid soon after the injury—adhesive plaster must he removed, any covering of Friar’s Balsam and cotton wool stripped off', and the wound carefully washed twice or more times a day and dressed with the Compound Iodoform Powder.

it is not advisable for anyone without special training to sew up cuts or wounds ; the liability of such wound to become infected, amongst other reasons, renders such a course inadvisable. In the case of superficial wounds when the skin has contracted and left a raw space, something can he done towards getting the skin hack into position by means of the adhesive plaster by putting up a limb in splints in such a way that there is the least possible tension on the torn skin, and b\ keeping the patient at rest.

(/;) Ulcers.—Ulcers should he washed with By sol Lotion (See Ch. II) as a preliminary to treatment. In the case of neglected ulcers or injuries which are offensive the undiluted two per cent. Lysol Lotion should he used. For ordinary ulcers which are not particularly had or offensive it is advisable to mix the two per cent, lotion with an equal quantity of water before use. For ulcers which are progressing favourably it is advisable to mix the two per cent, lotion with three times the quantity of water. In the latter case the strength of the Lysol Lotion is of course a half per cent, and in the previous case one per cent. It is an advantage if hot water is used to dilute the lotion and for the lotion to be used warm.

After washing with Lysol Lotion the ulcer should be lightly sprinkled with the Compound Iodoform Powder. Only a little powder and the minimum quantity of dressing and bandage used in ordinary cases. The ulcer is not then so likely to get sodden with perspiration. If the patient has to travel afterwards through mud, dust or wet grass, as on patrol, rather more dressing and bandage may be used sometimes with advantage. But under these circumstances no one can expect the ulcer to heal up, one should be quite satisfied if it gets no worse.

It is a common mistake to use too much powder with the result that the ulcer gets irritated and does not heal up as quickly as it should. The powder •should be always sprinkled on with a powder sprinkler.

If a number of cases of ulcers are under treatment at the same time, care must be taken that two or more cases do not use the same piece of cotton wool or lint to wash their ulcers. Each should be given a separate bowl, or else the ulcer should lie washed with the aid of a syringe.

This treatment should be carried out twice a day, morning and evening. If for any reason treatment twice a dry is impossible, the treatment should be carried out in the evenings. If done then the patient, whether European or native, soon goes to bed and the dressing remains clean and in correct position until the morning, so that the patient gets at least twelve hours’ satisfactory treatment every twenty-four hours. Tf the dressing is done in the mornings only, the individual goes to work or walks about; and the dressing soon gets displaced and dirty, sweat runs down into the wound, and perhaps the dressings saturated by the patient walking through the wet grass, etc. In such case the morning dressing does little or no good, and may even do harm. Unless dressed properly an ulcer is best left to itself. An ulcer is dressed to keep it clean ; but if the dressings get dirty the only effect they can have is to keep the ulcer dirty.

After the ulcer has once begun to heal it will often progress more rapidly if washed over with Copper or Zinc Sulphate Lotion. The Copper or Zinc Lotion is applied after the ulcer has been washed with the Lysol Lotion and before the powder is applied. It must be remembered that the Lysol and Copper or Zinc Lotion are incompatible, consequently the Lysol Lotion must not be mixed with either the Zinc or Copper Lotion, they must he applied separately. When the ulcer is healing satisfactorily soap is quite a satisfactory substitute for the Lysol Lotion. The Copper or Zinc Sulphate Lotion is also to be used if the ulcer instead of healing up forms projecting masses of soft red tissue, sometimes called proud flesh. A crystal of Copper Sulphate moistened with water and rubbed over the red projections will often act more rapidly. If such is used, it must be remembered that if the crystal is used after the surface of the ulcer no longer projects above the rest of the skin only harm will be done.

In the case of a very chronic ulcer, and especially if the ulcer is surrounded with a hard ring of thickened skin, the Bluestone Crystal used as above is often very beneficial. This should not be done often. As a rule only one application is necessary, but in very obstinate cases, with thickened skin, an application once a day for a few days may be required. This use of Bluestone Crystals is especially valuable in the case of chronic ulcers on the sole of the foot.

Multiple small ulcers or any skin trouble which itches badly are usually benefited by three days’ treatment with Sulphur Ointment before other treatment is begun. The affected part is washed morning and night with soap and water or with the Lysol Lotion and the ointment is afterwards applied. Before fresh ointment is applied the old is washed off. There is also a type of long-standing ulceration found in this country which heals up readily after a preliminary treatment with Sulphur Ointment. Such cases are seen from time to time in the villages of the Papuan Gulf. They can he recognized by extensive superficial scars and ulcerations without any of the ulceration being at all deep or with well-defined margins.

All ulcers heal up better if the part affected is kept at rest. It is impossible to expect ulcers of any appreciable size on the legs or feet of native labourers to heal up if the labourer is kept doing his ordinary work.

(c) ijcech Bites and Send) Itch.—Leech bites sometimes give rise to ulcers, but as a rule they heal up without much trouble if the leech is allowed to drop off by itself or if it is removed gently with the blade of a knife. If the leech is forcibly removed, the teeth are sometimes broken off in the wounds and a small painful ulcer forms. Such an ulcer, if it is neglected, may increase in size.

I have never heard of serious loss of blood following leech bites in this country. Occasionally a leech may get up the nose or down the throat and cause serious trouble. In the only case I have come across in this country no serious results ensued. A leech remained up the nose for a fortnight—at first with symptoms resembling an ordinary cold in the head, and with symptoms resembling hay fever afterwards finally it was sneezed out of the nose, before which event its presence in the nose was not suspected.

Scrub Itch, etc.—Every one who has travelled much in the bush knows of scrub itch. It is caused by a minute red insect just visible to the naked eye. The insect burrows just into the skin. The presence of the insect causes the itching.

The treatment of scrub itch is not very satisfactory. I have found benefit to follow the application of either Sulphur Ointment or of hot water. But the treatment must be carried out within a few hours of the trouble beginning. When on patrol this can he done by using the ointment or the hot water during the midday halt and in the evening.

If the Sulphur Ointment is used, it must he well rubbed in ; and some ointment seems to act better than other. If hot water is used it must he quite as hot as can he borne and hotter than the insect in the skin can hear.

Treatment being so unsatisfactory, it is fortunate that the trouble cures itself in a few days as a rule. As a result of scratching, combined with dirt, ulcers occasionally form, especially if the individual affected is in bad general health or is suffering from any deficiency as regards food. The insects cannot go on living in the skin, but have to spend the next stage oi their existence in the damp decaying vegetation of the bush again.

Il the feet and legs were kept covered with Sulphur Ointment all day, J do not suppose that the insect would ever cause trouble, but enough ointment would have to be used to keep the feet and legs in a greasy mess.

Although scrub itch comes to an end within a few days—providing fresh infections are not contracted by further walking about in the bush—yet there are other very similar affections, where the insect can go on living in the skin. Such cases tend to be very chronic if not efficiently treated with Sulphur Ointment. These cases can usually be recognized by the great itching and multiple scratch marks with perhaps small ulcers.

The commonest is called by the natives kuhi-kuhi. Tins “ itch” will spread from one native to another if the quarters are at all crowded, i f is readily cured with Sulphur Ointment; Europeans occasionally get it. II it should attack a group of natives, all clothing, bedding, etc., should be well washed and exposed to the sun.

(d) A bscesses and Boils.—An abscess is a collection of more or less fluid material of a whitish or yellowish colour, and caused by the growth of bacteria in the body. The material forming the abscess may be more or less blood stained. There is not much likelihood of relief coming until the skin breaks, and there is a free passage for the discharge of this material from the abscess. Still it is safer for those who have had no surgical training to leave the abscess alone, and for them not to cut into the abscess, or supposed abscess, with a view to hastening the cure. If the abscess is superficial enough for them to do this with safety they can rely on its being sufficiently superficial to soon break and discharge without this assistance.

When an abscess threatens to form, some form of counter irritant may at times abort it, especially if a purgative is given at the same time. Some paint a threatening abscess with Tincture of Iodine. The treatment which I prefer is to use hot water to bathe the part. The part is bathed with hot water, as hot as can be borne, three or four times a day and for ten minutes to half an hour each time. Such treatment can hardly do any harm at any time, and is very useful in all kinds of vague pains and swellings.

When the abscess has really begun to form, the hot water treatment will hasten the breaking and curing of the abscess.

Instead of hot water, poultices are used by some. A poultice is a very efficient way of applying heat, but it tends to cause further boils or abscesses around the first one.

After the abscess has broken, it is still an advantage to bathe it with hot water, but it will require subsequent dressing with Lysol Lotion and Compound Iodoform Powder just like an ordinary ulcer (See Section I (b) of this Chapter).

When the abscess has once broken, especially if it lias been opened with the help of a knife, care has to be taken that the opening does not close up again. Usually, if the abscess is gently squeezed every time it is dressed, the opening remains until the abscess has healed up. The squeezing must not lie done with any violence or else the abscess may be caused to increase in size. Natives realize the value of this treatment and are quite adepts at carrying it out.

A boil is very similar to an abscess, except that its contents are more solid. It requires just the same treatment as an abscess. A boil is very liable to be followed by other boils if careful treatment is not carried out, or if poultices are used.

(,c) Burns.—In cases of burns all blisters should be pricked if of any size, but the skin over them should be preserved if possible. The burn may be dressed either with an ointment, Borofax, i.e., Boracic Acid Ointment, or Zinc Ointment, or a powder dressing may be used, either the Compound Iodoform Powder or plain Boracic Acid Powder. Generally speaking the powder is better for deeper burns and the ointment treatment for more superficial ones. The dressing is often very painful and once a day is enough unless the burn is very deep or becomes offensive. Before being dressed for the first time, the burn and the skin around should he carefully washed with soap and water or with weak Lysol Lotion, provided the latter does not cause too much pain.

In the case of a severe burn the patient’s general condition requires treatment. He may be faint and collapsed, and this condition may be severe enough to cause death. In such case he requires to be kept-warm, and a dose of spirits is an advantage; not enough should be given to cause him to become drunk. Such a condition of collapse can be recognized by the patient becoming cold to the touch, by the pulse weakening so that it cannot he felt at the wrist or is only just perceptible, and by the patient becoming quiet and only semiconscious.

Pain is another symptom which often requires treating in the case of a burn. A dose of Opium should then be given either at night to secure sleep, or in extreme cases, three times a day.

A deep burn of limited area becomes practically an ulcer and requires similar treatment to an ulcer.

The danger of burns depends rather on their superficial extent than on their depth. In the case of extensive superficial burns, care must be taken to keep the patient warm and comfortable. There is always the danger of death from shock or from lung or other complications.

(/) Sprains ami Strains.—These are usually obvious because they are due to violence applied by someone else, by a fall, or by an undue muscular exertion such as lifting too heavy a weight. There is usually no marked pain except on movement. When a limb is affected there may be some loss of power or loss of power of making particular movements or perhaps only on active movement. There may be some swelling, especially marked if the trouble is around a joint. In such cases the possibility of gonorrhoea should he remembered. (See Chapter fV, Section 4 (h).

As a rule such injuries are of a trivial nature and require little or no treatment except rest. The feeling of stiffness experienced by those who being out of training take violent exercise is a very similar condition. The great essential in more severe forms of these troubles is rest of the part affected with the help of a splint or otherwise. For the first twenty-four hours water if used at all should be used cold and the part kept quite quiet and not irritated by liniments or rubbing. After forty-eight hours hot water may be of benefit combined later on with Turpentine Liniment, massage, and gradually increasing movement of the part.

((/) Pain and its Treatment.—Turpentine Liniment is supplied for use in the case of vague pains without ascertainable cause. It may also he used for stiffness and pain after severe physical exercise. It is to be rubbed on the part affected, and is for external application only. It must not be used for pain in the eyes.

In cases of vague pains about the limbs, in the hack, or on the left side, the possibility of malaria should be remembered and the effect of Quinine tried.

Pain in the stomach may he the first symptom of dysentery. In such cases it is wise to avoid preparations of Opium, including the popular preparation called pain killer. A good dose of a purgative, preferably Epsom Salts, will often effect a complete cure in a short time, even ii not so quickly as Opium, and the cure will he more lasting.

Pain in the chest, especially if associated with a cough, is often the first symptom of pleurisy or other lung trouble. (See Sec. 3 (a) of this Chapter.)

Both influenza and dengue may begin with acute pain in the back and limbs. (See Sec. 4 (a) of this Chapter.)

Headache will be dealt with further on. (See Sec. 3 (d) of this Chapter.)

2.—Serious Injuries.

(a) General Principles of Treatment.—In the case of all injuries the essential line of treatment is to keep the injured part at rest, and to keep any wound clean and free from dirt with its accompanying bacteria. Then, unless a vital part has been put out of action by the injury, repair of the injury will usually take place with rapid recovery. If necessary, the patient must be kept at rest with the aid of Opium. If the injury has been really severe, there may he internal bleeding, and this is increased if the patient moves about.

In the case of a serious injury, it is usually a mistake to give brandy or other stimulants. The great immediate danger of all injuries, especially of the head, is bleeding either externally or internally. Fainting is caused by the heart propelling the blood less forcibly than usual and, in case of severe bleeding, this reduces the amount of blood lost.

Stimulants may cause more lapid recovery from the fainting condition hy reason of their stimulating the heart, but at the same time this only increases the loss of blood.

If the chest is injured a rib is often broken. This is by no means dangerous, unless the lung has been injured at the same time by the broken rib. If injury to the lung has taken place, it will usually be apparent by the patient spitting up blood. A broken rib is often very painful. The pain can be relieved by strapping the injured side and by Opium, hut care 1ms to he taken in the use of Opium if the injury is really severe. In such severe cases, which are usually apparent by the patient quite obviously breathing very rapidly, one or even both lungs may have been put almost out of action by internal bleeding, and then Opium only increases the risk of death from lung failure. So too in such cases the entire chest should not he strapped or bandaged, even if some relief from pain is secured thereby. The injured side is strapped by means of strips of adhesive plaster passing from the middle line in front over the injured or painful side to the middle line of the back.

The strips overlap each other until the area injured and painful is covered with the strapping.

Blows on the stomach may cause death from rupture of an internal organ and the consequent bleeding. In this country many natives as well as Europeans have spleens enlarged hy reason of malaria. Even a slight blow on such a spleen or a slight degree of violence may cause rupture of the spleen and death. In cases of severe blows on the stomach, purgatives should not be given and food should he reduced to a minimum for a few days. Constipation can be relieved by an injection into the lower bowel by means of the large glass syringe refilled several times. About a pint to a pint and a half of warm soapy water should be used.

It should not be forgotten that a kick may have fatal consequences if the kicker is shod with heavy boots, especially if the individual kicked is a native stooping down with little or no clothing on.

The information given in this Chapter in Sec. 1 (a) (Cuts and Wounds) is also applicable to the treatment of serious injuries.

(b) Serious Blec&inq.—A good deal of blood may be lost without any harm resulting.

When a limb is wounded, it may he at times noticed that considerable quantities of bright red blood is being lost, and that the blood is coming out in jerks. In such cases a ligature must be put on the limb above, i.e., nearer the body than the wound, and tied or twisted tightly enough to stop the bleeding. The ligature may consist of a handkerchief or stout cord tied around the entire limb, and may be conveniently tightened up by passing a short stick through it and twisting the stick round until the handkerchief or cord is tight enough to stop the bleeding. Such a ligature must be put on above the elbow or the knee. Below the elbow or knee there are two bones in the limb, and the two bones may prevent the requisite amount of pressure being distributed over the entire limb. The ligature should be left, on eight hours. It is then taken off» hut should he re-applied if bleeding begins again.

In other cases the blood may be dark coloured, and come out in a steady stream. In these cases, a ligature above the wound should never be applied. The bleeding is best stopped by applying a firm pad to the wound and by bandaging it on firmly. A certain amount of oozing may go on for some time, and fresh pads may have to be applied, but serious harm is not likely to ensue. If this should fail, a ligature below the wound should be tried, combined with a firm pad.

The bleeding part should be kept elevated as much as possible, in the case of the foot, the patient should lie down and his leg should be raised by placing it on a chair or box. Serious bleeding from the hand can often be stopped by forcibly bending the elbow, bandaging it bent, and lifting it above the head.

In all cases of serious bleeding both the injured part and the patient himself must be kept, absolutely at rest for fear lest the bleeding may begin again. If this cannot be effected otherwise, Opium tablets must be given {See Chapter 11). Not more than two tablets may be given at first and afterwards a single tablet given every two hours until the patient becomes quiet. The administration of the Opium must then be stopped, and only begun again if the patient becomes restless. After twenty-four hours the risk of further serious bleeding greatly diminishes, and gets still less at the end of forty-eight hours. If a serious wound becomes inflamed and suppurates (discharges a white or discoloured fluid), serious bleeding may occur at the time of such suppuration.

After severe bleeding a patient has to make up for the fluid he has lost, lie becomes very thirsty and should be allowed to drink plenty of wafer, or, if preferred, soda and milk or weak tea. in extreme cases it is advisable to give frequent injections of water into the lower part of the bowel. A preliminary larger injection may be given with the idea of washing out the lower bowel, and then two ounces given every half-hour.

The administration of alcohol is very inadvisable, so long as the bleeding still continues, and so long as there is any possibility of it starting again.

(c) Fractures and Dislocations.— In the case of fractures or dislocations, every effort should be made to obtain medical advice as soon as possible. In the case of fractures, the principles of treatment are to place the limb in as natural a position as possible without using much force, and to retain it there with splints and bandages. Splints may be improvised from suitable pieces of wood. Care must be taken not to move the limb about much, nor to let the patient move it. If the limb is moved much, the broken ends of the bone may do serious mischief.

If a hone of the leg is broken, the patient must not on any account be allowed to walk or stand on the injured limb. In the case of a compound fracture, i.e., when the broken bone has penetrated the skin, the skin wound should he carefully washed with Lysol Lotion, all dirt removed, and the wound treated with Compound Iodoform Powder. In the case of a compound fracture, medical help must be obtained as soon as possible at all costs.

Dislocations are generally readily recognized. There is obvious deformity, and inability to move the joint affected. Not only is the patient unable to move the joint freely, but the attendant cannot either. Although attempts to move the joint may cause pain, still the pain produced is not the cause of the lack of mobility of the joint. Fractures, on the other hand, cause increased mobility in the limb affected, but when the limb is moved there is much pain, and the grating of the ends of the broken bone may be felt as they rub against each other. This grating may he felt both by the patient and by the attendant when he places Ins hand over the place of the fracture. In the case of the arm below the elbow, and in the case of leg below the knee, a very sugges-1 ive sign of fracture is pain felt persistently over one spot when the limb is compressed at some distance from this spot. Below the elbow and the knee there are two bones, and if either or both of these are broken compression made on the limb even away from t he place of injury will cause pain owing to the broken ends of the bone or hones being moved by t he compression. Such compression should he made from side to side, not from before back.

In some cases the alteration in the form of the limb may be so marked that the existence of a fracture is quite obvious; in other cases a medical man may he in doubt. The hardest cases to diagnose are those where there is great swelling near an injured joint. An attempt should be made to reduce the swelling by using cold water to bathe the part for forty-eight hours after the injury, and hot water afterwards, in all cases of doubt it is better to assume that there is a fracture, and to act accordingly, i.e., keep the limb at rest and in a splint. Possibly the patient may get well in a few days, when the diagnosis can be revised, but no harm will have resulted. The rest will have done the injured part good in any case, but if a fracture is treated as a simple injury considerable harm may follow.

If the existence of a fracture or a dislocation ol a limb is really in doubt, a very useful test is to measure the distance between corresponding points on the two sides of the body. If there is either a fracture or a dislocation, the distance will usually he less on the fractured or dislocated side. Actual measurements in inches need not be made; the distances can he compared with a piece of string. The distances are usually the same on the two sides, apart from a recent fracture or dislocation. If there is any congenital difference in size between the limbs on the two sides, it is generally pretty obvious that the limbs on the two sides are unequally developed. It should he remembered that even after a fracture has healed, or if an old dislocation has remained unreduced, there is usually shortening of the affected limb. Inquiry should therefore be.made as to the existence of old injuries.

(d) Snake Bites, etc.—If the bite is on a limb, a tight ligature should be applied above the wound, i.e.. nearer the body than the wound. The skin should be cut through just above the wound by a cut transversely across the limb. The region of the bite and the cut should be washed with Potassium Permanganate Lotion.

After an hour, if the patient appears well, the ligature may be taken off for a minute or two and than re-applied again. If the patient appears well, treatment may he left off after twelve hours, but the ligature must be re-applied if the patient becomes ill in any way.

If the bite is on the body or the face—quite an unusual occurrence —the ligature cannot he applied, hut the bite can be scarified and the place washed with the Potassium Permanganate Lotion. Before any heroic treatment is carried out, it is as well to make quite certain that the patient has really been bitten by a poisonous snake. Any ordinary and reasonably clean knife can he used for purposes of scarifying the lute.

In a few cases, symptoms of collapse may appear; if such does occur, the patient becomes unable to stand, his limbs and body become cold, the thermometer shows that his temperature becomes below normal, and his pulse becomes feeble or imperceptible. These are dangerous symptoms. The patient must he kept warm, and a bottle filled with hot water wrapped in a cloth applied to his feel. Two tablespoonfuls of whisky should be given with a little water every few hours until the patient improves.

In the case of Europeans, puttees and hoots are a great protection against snakes. During the twenty-two years 1 have been in Papua, I have not seen a case where a European has been bitten by a snake, and in all the native cases I have seen the bites have been on the leg or foot.

Even natives, when bitten by a reputed 1\ poisonous snake, commonly recover without poisonous symptoms, especially if the above treatment is carried out. If a medical man is within reach, the undamaged head of the snake should, if possible, be brought to him for examination. From it some opinion can be formed as to whether the snake is really poisonous or not.

Natives often refer to a centipede as a “gaigai” or snake, and needless alarm may be caused in consequence.

Besides snakes, there are certain fish which produce very similar kinds of injuries. In such cases the poison is introduced into the body by a spine on the fish. Severe symptoms arise and the patient appears seriously ill, but I do not know that death ever occurs. Pain is generally the most prominent symptom of such injuries, and is best relieved by doses of Opium. The injury itself generally bleeds sufficiently to make it hardly necessary to further scarify or cut the part, but the injured part should be squeezed and made to bleed as much as possible. If the part is bathed in very hot water, coloured if preferred with Potassium Permanganate Lotion, this bleeding is encouraged and pain is also relieved. In some cases sucb wounds inflame and, after some days, a portion of tbe skin becomes greenish and dead. The injury then has to be treated with Lysol Lotion and Compound Iodoform Powder just like an ulcer.

Centipede bites and scorpion stings are often very painful and severe symptoms may be experienced. For these and for wasp stings, hot water fomentation, with or without Potassium Permanganate, and the use of Opium for pain is all that is usually required.

Severe injuries are sometimes seen due to wild pigs and to crocodiles. Such cases have to be treated along the lines already explained. Torn skin has to be replaced as far as possible in its normal position, the injuries kept clean and covered up, and treated like an ulcer with Lysol Lotion and Compound Iodoform Powder.

Injuries due to sisal hemp spikes always seem to inflame and to take a long time to get well. Likewise an injury which has become contaminated with the juice of the sisal hemp always seems to inflame and to take a long time to get well.

(e) Wounds due to Arrows, Spears and Firearms.—If the arrow or spear is not barbed it is usually withdrawn easily. Should it pierce a bone it may require to be rocked to and fro before it can be withdrawn.

If barbed there may be great difficulty in withdrawal, if the point can be felt through the skin on the opposite side of a limb, an arrow is often best pushed through the skin. There is no harm in getting the patient into a drowsy condition with Opium first, so that pain is reduced, hut care has to he taken not to give an overdose. If the arrow or spear is barbed and has penetrated deeply and cannot be withdrawn, the best course is to cut or saw it off nearly level with the skin, and to send the case to the nearest medical man. Enough of the arrow should be left for him to grasp the end of it with forceps ; and care must be taken when cutting or sawing the arrow off, not to cause further damage by rocking the point of it about. Of course if there is a medical man available, the less the wound is interfered with before he sees it the better. The surrounding skin should be washed clean of dirt and blood with the Lysol Lotion, powdered with the Compound Boracic Acid Powder, and dressed like any other wound.

Penetrating wounds of the lower part of the body are likely to lead to subsequent serious trouble, so also may penetrating wounds of the chest.

In the case of bullet wounds, really serious bleeding is not altogether unlikely. If such bleeding takes place from the body, neck or head, little can he done for it. In the case of really serious bleeding from the limbs a ligature or tourniquet may be effectual [ See Section 2 (I>) j. The compound fracture of a bone, due to the bullet striking the bone, is also another serious danger. Such a case woidd have to be treated like an ordinary fracture [S<?e Section 2 (c)], i.e., the limb put in as natural position as possible and kept so with splints, and at the same time treated like any other severe injury, i.e., the wound or wounds kept as clean as possible, washed with Lysol Lotion and dressed with the Compound Iodoform Powder. No probing or syringing deep into the wound should be attempted.

A shot gun is not likely to produce a dangerous wound unless fired at very close quarters, when the shot may enter the body in one solid mass and do extensive injury, if possible the shot should he picked out and the wound treated with Lysol Lotion and the Compound Iodoform Powder.

3.—Mi nor Medical Troubles.

(a) Coughs and Colds.—In the case of coughs and colds, reliance should he placed on general hygienic measures rather than on special drugs. This also applies to the more serious lung conditions which may be the real cause of a cough, or which may follow a cough or a cold. The patient should he kept warm and comfortable out of draughts, and, at the same time not in an overheated iron house. If freedom from draughts cannot he secured, it is advisable to bandage a layer of lint or cotton wool over the whole chest. This is the routine practice at the Port Moresby Native Hospital in all cases where lung trouble threatens.

At the beginning of an attack a purgative, e.g., Epsom Salts, should he given. If a cough is really troublesome a dose of the Concentrated Cough Mixture can he given three or four times a da> or a double dose may he given at night time. It is not much good giving a cough mixture if the patient is at once going out into the cold and wet, and it must he remembered that coughing is often only a sign that there is something “on the chest" which has to he brought up by coughing. Hence it is hardly advisable to always try and stop the coughing, the aim should he rather to render the coughing easier and less painful. In the early stage of a cold, cough, sore throat or lung trouble, a dose of from five to ten grains of Dover’s Powder given at night time may secure a comfortable night for the patient and lessen the severity of the attack. This should not he given in case of serious lung disease, i.e., if the patient is too ill to walk about or if he is breathing with difficulty or breathing very rapidly.

If the cough is accompanied by pain or discomfort in the chest, especial care should he taken in the treatment and cold and wet avoided. Some relief is often experienced if the chest is rubbed with liniment, e.g., Turpentine Liniment. In more severe cases of lung troubles the patient can only be allowed light and liquid foods, and regular doses of brandy or whisky are then a help, up to three ounces a day taken diluted with water ; but in such cases natives often crave for their accustomed native food, and often do well when it is allowed them.

Ln the case of a sore throat (or a cold with a sore throat threatening) the Potassium Chlorate tablets are often a great help. One of these is taken in the mouth and allowed to dissolve slowly three or four times a day.

Cases of chronic cough with expectoration in younger people should always arouse a suspicion of tubercle, especially if the cough lasts for weeks or months without intermission and if the patient is getting thinner or coughs up blood. Little can be done for such cases beyond giving them dry and comfortable quarters with plenty of food. Owing to the danger of the trouble spreading to others, it is not advisable for such cases to live in crowded and dark gaols, and it is all the better if they can he kept out of the more commodious quarters of police and native labourers. Still the average native living in his normal way and under Ins natural conditions does not readily acquire tubercle, and there is no sufficient reason for insisting on any form of rigid isolation. Advanced cases, however, should he kept in a room by themselves. Such cases occasionally occur in the native villages, and every effort should he made to put them in a house by themselves with one or perhaps two relatives to look after them. It would he a great advantage if all the larger villages would build small houses quite a short distance outside the village so that sick cases could he put there if there is any suspicion of their being liable to infect others.

After frequent attacks of malaria, people are very liable to “take cold on the liver.” Anyone who has suffered from malaria should take especial care not to “catch cold.” Bathing in a strong wind after the sun has gone down should he especially avoided. It is also wise to avoid getting wet and remaining in wet clothes as far as possible.

(/;) Constipation.— It is very important to keep the bowels working regularly, especially in the Tropics. If one regular motion can be secured daily, much is done towards securing good general health, freedom from sickness, and a lit condition both physically and mentally. Whenever a course of Quinine is taken a preliminary clearing out of the bowels should he effected.

The number of purgative pills and other preparations which have been used is almost infinite. It is not of very much importance which one is selected provided the desired result is secured. For ordinary purposes, where a good clear out is required by a European, a Quinine and Rhubarb tablet combined with a two- or three-grain Cascara tablet, and taken at night time, is as good as any. As with all other purgatives, a dose of a saline purgative should be given in the morning if there is any doubt as to the efficacy of the tablets taken the night before. A packet or half a packet of Epsom Salts is recommended in the case of natives.

Saline purgatives are especially useful in the morning. Their action is rapid and they are especially indicated when constipation is noticed the first thing on getting up in the morning, Epsom Salts is very generally used. From a half to an entire packet is the amount usually required. Various proprietary preparations act in the same way and are perhaps more pleasant to take, but they are no more efficacious and are far more expensive. The effervescing preparations moreover readily deteriorate in this climate. Cascara Sagrada in the form of two- or three-grain tablets is a very good purgative to use in cases of chronic constipation or as a digestive after a heavy meal. In cases of chronic constipation, the value of fresh or even tinned fruit and green vegetables should be remembered. Young sweet-potato tops make an excellent substitute for spinach.

In all ordinary cases of sickness, including boils, ulcers and fever, it is a good plan to begin treatment with a purgative, and to keep the bowels working regularly throughout the illness.

(c) Diarrh&a.—It may seem a paradox that purgatives should be the first line of treatment in cases of diarrhoea, yet it is a fact. Diarrhoea is more a symptom that there is something inside which should not he there, rather than a disease of itself. Consequently the first line of treatment is to give something which will clear out the bowels. Nothing is for this purpose quite so satisfactory as Epsom Salts. To the salts dissolved in water a dose of Tincture of Ginger may be added. Ginger is an example of a large group of drugs which diminish the griping caused by purgatives. It should not be forgotten that diarrhoea may be the first symptom of dysentery, and that in such cases early treatment with salts is all important.

Hardly less important than the medical treatment of diarrhoea is the dietetic. In cases of diarrhoea which are at all severe no solid food should be taken. Every ordinary individual has sufficient reserve material in him to suffer a few days’ starvation without serious harm resulting, whereas solid food taken when the digestive organs are out of order may only increase the trouble of which the diarrhoea is a symptom, may upset the stomach, cause vomiting and headache, or even precipitate an attack of dysentery.

ft is very generally known among laymen that Opium preparations will “ stop diarrhoea.’' As explained above, the first line of treatment should be to secure a good clearing out of the bowel and to put as little food into it as possible. I have gradually come to rely more and more on this line of treatment. Still there may be times when the symptom of diarrhoea itself is sufficiently severe to require treatment. Such cases are, more especially long-standing cases, improperly treated in the early stages, where the patient is really becoming dangerously thin and exhausted, and where all food given passes at once through the body without having time to be digested and absorbed. In such cases the administration of Opium (a one-grain tabloid before each meal) may ensure that the food remains long enough in the intestine for some of it to be absorbed. Such doses should be given some twenty minutes before food. But such cases must be carefully watched and no Opium in any form given when the diarrhoea shows signs of stopping. Not uncommonly such cases are succeeded by constipation, which requires prompt treatment with Epsom Salts or other purgative.

The dieting of these cases of long-standing chronic diarrhoea is most important. In severe cases only milk and water, weak tea, clear meat extracts, and a little weak lime-juice (siporo) drink should be allowed. In less severe cases, or during recovery, arrowroot, cornflour oi* sago may be allowed. In the case of natives, twice-boiled rice is useful at this stage. As the patient improves, minced meats, minced fish and mashed potatoes are allowed, and a return to ordinary diet is made gradually. In chronic cases a small quantity of brandy or whisky is generally beneficial.

It should not be forgotten that defective teeth are often the cause of chronic digestive trouble, constipation, diarrhoea, stomach-ache, headache, irritability, sleeplessness and perhaps vomiting.

(d)    Headache.—Headache may he due to several very different causes. One of these is constipation, which has already been considered [Section 3 (b)]. Headache may also be due to malaria and other fevers. This will be considered later [Section I (a) and (i)j. Another frequent cause is over eating or over drinking. In such cases the line of treatment required is a good purgative and abstinence from food and strong drink for a while.

There are other cases where headache is due to nervous causes, excessive mental work or anxiety, or to the action of the sun. In such cases the underlying cause should be dealt with, but sometimes the headache itself may require treatment. But 1 would, however, here make a strong protest against the habit of flying to drugs on the least provocation. If such is done, drug habits may ensue and imperceptibly secure control of the patient so that “ he cannot do without them” and they may themselves produce alarming symptoms, chronic ill-health, or worse. Still there are cases where it is quite legitimate to treat the headache itself. For this purpose one or two of the Compound Phenacetin tablets are as good treatment as any other. But it must be remembered that Phenacetin, and all similar drugs, depress the heart, and that excessive doses must be carefully avoided when the heart is already overtaxed by a severe illness. If two of the five-grain tablets do not remove the headache, no more should be taken for some six hours. In the meantime, a purgative should be taken, work given up, and rest taken in a shady and cool place. Even when important work has to be done, it may be preferable to postpone it until recovery takes place, rather than to do it badly when not in a proper condition for work. Bathing the head with cold water, iced water, or vinegar and water will sometimes relieve such headaches.

(e)    Vomiting.—This may be symptomatic of malaria or other fevers, or it may be due to excessive eating or drinking, or to over exposure to the sun. The underlying cause should be treated. If this is malaria, Quinine should be taken. Purgatives are very useful also, e.g., a Quinine and Rhubarb tabloid with a Cascara tabloid.

Vomiting is usually only a symptom that the stomach is out of order and cannot digest anything. Hence nothing at all in the way of food should be given in acute attacks' until the vomiting is ceasing, and in the more chronic attacks only the most easily digested food possible should be given. Small doses of Compound Tincture of Chloroform and Morphine (Chlorodyne) given twenty minutes before a light meal of soda and milk, cornflour, arrowroot, etc., may enable the meal to be retained. In these conditions, as well as in others, the patient’s own feelings are often the best guide as to whether the stomach is in a condition to digest food or not. The patient’s likes and dislikes should be considered, and, if at all suitable, he should be given what he fancies. It is in such cases where the utility of a good nurse is most marked. She will try the patient with one suitable article after another, noting which the patient fancies, and will prepare plain dishes suitably flavoured.

(/) Sleeplessness.—Sleeplessness often accompanies and is caused by constipation, indigestion, and by malaria or other fevers. It may also be due to nervous causes such as an undue amount of mental work, worry and annoyance.

The treatment of sleeplessness caused by constipation or indigestion is obvious. A purgative must be taken and heavy indigestible meals avoided. The last meal at night should be especially light and easily digested.

Sleeplessness is often a symptom of an on-coming attack of malaria, influenza or other general fever. In such cases one or two five-grain tablets of Dover’s Powder taken at night will often secure a comfortable night and may benefit the fever.

In the case of sleeplessness due to nervous causes, the best preventative is to take an occasional long walk, to avoid late heavy meals and excessive mental work. A short rest should be taken after meals. Drugs are best avoided in most cases. Opium especially should be avoided owing to the very real danger of contracting the Opium habit. It drugs are taken at all, one or two five-grain tablets of Phenacetin Compound may secure relief. More than this should not be taken at one time owing to the depressing effect of drugs of this character on the heart.

A very distressing and intractable type of sleeplessness often follows the excessive drinking of alcohol, it is a case of prevention being easier than cure. Phenacetin may secure some relief.

in cases of persistent sleeplessness an out-door occupation should be secured if possible, or a change taken away from the country or from the patient’s usual routine employment.

(n) Sore Eues.—Mild cases should be bathed with cold water and a few drops of undiluted Boracic Acid Lotion or Zinc Sulphate Lotion (two grains to the ounce) dropped into the outer angle of the eye by means of a medicine dropper. The lotion used for this purpose should be either filtered through blotting-paper, or else carefully poured off* from any sediment there may be in the bottle. For recent cases the Boracic Acid Lotion is the better, and for more chronic cases the Zinc Sulphate Lotion. In the more severe case§ it is often advisable to well wash the eye out with the above lotions and with the aid of a small glass syringe. The treatment should be carried out three times a day, or more often if much white discharge collects under the eyelids.

A very severe form of inflamed eyes occasionally occurs in the course of gonorrhoea. Some of the infective material gets on to the fingers and from there into the eye. There it may set up a severe inflammation with swelling of the eyelids and much discharge. Attendants as well as patients should he warned of this possibility and cautioned to wash their hands after attending to such cases.

In place of the above lotions either the Permanganate Lotion (1 in 8,000) oi* the Corrosive Sublimate Lotion (1 in 4,000) may be used.

form strong light


In all cases where the eyes are painful they should lie protected For mild cases it is sufficient if the patient is kept

in a darkened room, but in severe cases, the eye or eyes should be covered by a pad of lint kept in position by a bandage, or dark glasses used.

(h) Skin Disease (Ringworm).—There are several varieties of skin disease generally called “ ringworm.” The commonest form is unfortunately very obstinate and difficult to cure permanently. 1 have tried many lines of treatment, hut have never satisfied myself that a permanent cure has been effected in an old standing case of the common obstinate type of the disease. With considerable trouble it is possible by several distinct lines of treatment to effect an apparent cure, but in casos which I have been able to follow for any considerable time, the trouble has always recurred. The more effective lines of treatment are moreover expensive, tedious and painful; and some of them not altogether free from danger. I would not recommend anyone to take in hand an old case of the more common form of the disease with a view to effecting a permanent cure. However unsightly the common skin disease may be to our eyes, yet it causes little inconvenience as a rule to the native affected, and little if any damage to the general health of the native or to his working capacity.

The intractable common form of the disease is recognized in the early stages by the concentric character of the affection, and in later stages by the skin being uniformly covered with a silvery white coating of scales. It is certainly worth while trying to cure an early case, where there are only one or two small concentric patches. For this purpose,

1 have found nothing better than Tincture of Iodine applied freely by means of a paint or gum brush. The tincture is painted over the patches on two or more consecutive days. In the course of a week or ten days the patch will usually peel off. A second application should then be made and, in another week or ten days, when the skin peels off again, a careful watch should be kept for any recurrence. If recurrence takes place, the treatment must be begun again. Care should be taken to paint the edges of the patches well. It is at the edges that the trouble is extending. Especial care has to be taken where the skin is thin. The tincture must of course never be allowed to enter the eyes. Sulphur in various forms has some reputation as a cure. It does produce some benefit and is moreover quite a harmless remedy. The ointment is the most convenient form in which to apply it. A very satisfactory method is to make a native well rub the ointment over the whole area of skin affected every night and to wash it off with soap and water in the morning. The ointment made from the Precipitated Sulphur appears more effective than the ointment made from the Sublimed Sulphur.

Chrysarobin (Chrysophanic Acid) has also some reputation, but is no better than the Tincture of Iodine. It is not altogether free from danger when used over large areas and I have known serious and permanent injury to the eyes follow its use on natives.

The leaves of a certain plant, Cassia Alata, have a marked curative effect in some cases I have tried it on. This plant has been introduced into Papua and can be recognized by its bunches of brilliant flowers growing on bushes up to eight or ten feet high. It grows readily in this country. The leaves are simply well rubbed on the parts affected, and I have never known any harm follow their use. The planting of this bush around native villages is, I believe, the most promising practical means of keeping the trouble in check in Papua. If planted in the villages, it will be available as soon as a case begins and, I feel certain, the natives would readily use it if informed that it was “ skin medicine,*' and that it made the skin good.*’ The plant grows readily from the black seeds which are produced in abundance.

The treatment recommended now for the severe form of ringworm (T inea Imbricata) is a Compound Resorcin Tincture (See Chapter II, Section 23). it is used just the same as is the Tincture of Iodine (See below).

A well-known Ceylon authority says of it that very good results are obtained with it and that it is the routine treatment in Ceylon. Ele points out that the treatment must be continued for three or four weeks and that although symptoms of absorption are rare yet it is well to proceed at first with care, i.e., begin on a comparatively small area, not on the whole body or even half the body, and if ill effects are complained of or noticed proceed with caution. My own experience of this preparation coincides with the above. I have never known it to produce ill effects.

Chrysoplninic Acid or Chrysarobin, for they are practically identical, can be used with effect in the form of an ointment; but it is too dangerous. Apart from the danger to the eyes mentioned on page 35 there are other dangers. 1 will again quote the above-mentioned Ceylon authority who says “Chrysarobin is a very toxic medicament; the patient must be watched and the urine regularly examined. In one of our cases symptoms of absorption appeared after a single application.” Another authority says “it should not be allowed to touch the healthy skin.”    •

11 the seeds of the Cassia A lata, mentioned at the bottom of page 35, are desired, and are asked for on a requisition, an effort will be made to supply the same.

The above-described variety of ringworm was formerly most common along the South Coast of Papua, but appears to be now spreading. Certain cases from the Western Division appear to he a little different—the scales being less silvery and more papery—but for practical purposes it may be regarded as the same disease and included in the native term “levu.” I noticed quite a distinct form on the North-East Coast some eight years ago, and this Northern form is now soon at times on the South Coast, ft is not so markedly concentric, it tends to disappear in one part of the body while extending in another, the skin is sometimes inflamed and raised at the edges, and it never covers very large areas on the body. It is readily cured by one or two applications of Tincture of Iodine. It is cases of this kind which have given rise to popular accounts of the permanent cure of the “ native skin disease.”

Various other forms of somewhat similar skin diseases occur in the tropics—some difficult to cure and others not so. For all of them Sulphur Ointment is a mild cure while Tincture of Iodine is often more effective. Some forms are confined to the crutch, the axilla, or between the toes, i.e., to parts of the body where the skin is kept moist and warm, while others are more extensive. Some forms, at least in some instances, cause little or no trouble or inconvenience, and are to be regarded as blemishes rather than as true diseases : others cause chronic itching and are liable at times to become inflamed and painful.

There is one form in this country which tends to be confined to patches on the arms and legs of natives, especially to parts which suffer from constant friction. The skin after a while often assumes a white colour. Another form may be often seen as inconspicuous yellowish spots on the skin of natives.

(i) Malingering.—Malingering is not common among natives. I believe that there are far more complaints of sickness neglected than there are cases of malingering. The thermometer is a very valuable means of showing that a native is really sick, and every one in charge of natives should learn the simple method of using it. 1 have known more than one native learn the use of it. If a native has a temperature of over 99° F., we may reasonably accept it that he is unwell. Tn some cases the temperature only rises at a particlar time of the day, so in doubtful cases it is advisable to take the temperature three times in the day. The most likely time for the temperature to rise is in the evening. It the temperature is only taken once in the day, if should be in the evening.

Some cases of malingering may puzzle a medical man, still, if the following points are noted, mistakes will be uncommon. If a native appears well, is not getting thin, has no obvious lumps or swellings anywhere, eats well, and has no temperature in the evenings, he is probably not really ill.

Cases of limping may give rise to some difficulty. A malingerer will usually lose his limp when he thinks he is unobserved. It is quite possible for a native to limp owing to disease, and for there to be no sign of anything wrong with the legs or feet; but in most cases some lump or swelling can be found, or else some part of the foot will feel obviously hot to the touch, or the native may have a temperature in the evenings.

In doubtful cases of malingering, i.e., when no sign of disease is discoverable, it is best to make a native take a packet of salts every morning, and some unpleasant mixture (such as the Quinine Mixture or half-doses of Easton’s Syrup) three times a day, and to keep the native rigidly confined to his quarters. If he is only malingering, he will soon get tired of doing so.

4.—More Serious Medical Troubles.

(a) Fever (and the method of using the Clinical Thermometer).—In this section I am using the word “fever” in its more strict medical sense, and not in the more popular sense of malarial fever. Malaria is the commonest cause of fever in Papua, and it will be fully dealt with in the next section—4 (6).

Besides malaria, dengue fever and influenza are by no means uncommon. Fever also accompanies many other complaints, e.g., the more serious lung affections, the formation of abscesses, severe constipation, and a host of other conditions.

The most important sign of fever is a raised temperature, and the non-medical attendant will not often go wrong if he assumes that a temperature above 99 F. means that the patient has fever in the sense the word is used in this section.

Accompanying the raised temperature, certain signs are usually found. The patient has a furred tongue, perhaps with foul breath, the appetite is usually lost; if food is taken it is not digested properly, and causes vomiting; the mental faculties are dulled, and there may be a condition of mental irritability produced, resulting in loss of temper for quite trivial reasons. Constipation is usually present, and the urine is scanty and highly coloured.

Certain practical lines of treatment are obvious directly the above symptoms are understood. The food taken should be light and only in smally quantity. In severe cases nothing but liquid food should he taken. Mental work reqiring careful discrimination should not be attempted. Mistakes are liable to be made even in comparatively simple and unimportant routine work, whilst serious disaster may occur if an attempt is made to carry on really important work.

At these times needlessly acrimonious disputes are likely to arise between Europeans, and between Europeans and their native employees, and may result in Court cases.

As regards drug treatment, a purgative is always beneficial at the beginning of the attack, and the bowels should be kept working once a day during the attack. Five or ten grains of Dover's Powder given at night may secure a comfortable night’s rest, but may add to the constipation. Phenacetin in doses up to ten grains is sometimes useful if there is much headache. The method of drug treatment of malarial fever is given in rather fuller detail in the next section, under the heading of malaria.

Needless anxiety is sometimes caused by the deeply-coloured orange urine of simple fever being mistaken for the blood-stained urine of blackwater fever.

The method of using the Clinical Thermometer.—In the tropics every one beyond the reach of medical help should learn the use of the clinical thermometer. This should be learnt practically from someone who knows the use of if, but a few hints will be given below

Before using the thermometer it should be washed in cold water, and examined to see that the mercury has been shaken down. After carrying the thermometer in the pocket in the sun it may go up to 110 F. or more, and, if such a thermometer is used without the mercury being shaken down, it will appear to register an abnormally high temperature, and may cause needless alarm and quite unnecessary treatment.

The thermometer may be placed either in the mout h or in the axilla or armpit. If placed in the mouth it must be placed under the tongue and the mouth kept closed. A native must be made to understand that he is not expected to eat the instrument, and care must be taken that he keeps the thermometer under the tongue with the mouth closed. If the end of the thermometer which is outside the mouth is gently pressed down with the linger, it will be found to offer considerable resistance when the other end of the thermometer is really under t he tongue. A few trials will be of more use than pages of description. If the thermometer is placed in the armpit, care must be taken that it does not project behind—it should not be visible at the back at all. Care must also be taken that the thermometer is placed between the skin of the arm on the one side and the skin of the body on the other and not between the skin on the one side and the clothing on the other.

Some thermometers require half a minute to reach the temperature of the body ; others require one, two or even three minutes. If the time required for any special thermometer is not known, it can be found by placing the thermometer for a half, one, two and three minutes in the attendant’s own mouth. The shortest time the thermometer takes to reach its final temperature can then be found.

(6) Malarial Fever.—Malarial fever often is spoken of simply as “fever,” but, as has been explained in the previous section, the symptoms of fever occur in the course of many diseases. Fever in Papua is very commonly due to malaria.

Drug treatment is all-important in the treatment of malaria. The routine treatment for a mild attack is to take five grains of Quinine or of Cinchona Febrifuge3 three times a day after meals. When more severe malarial fever occurs the same treatment is usually very effective, but an extra five grains given at night, or just before an expected rise of temperature, is an advantage.- In really severe cases of malaria, or if it is important that a complete cure be effected as soon as possible, ten grains should be taken in place of the five grains. A rapid cure is effected with more certainty, but, for the time being, headache, deafness and noises in the ears may be produced by the Quinine. People vary ms regards their susceptibility to these troubles from Quinine Compounds. Natives usually take tablets quite readily, but, in cases where they cannot be trusted to take it without supervision, ten grains of the tablet may be given at night instead of five grains three times a day.

There is one question which I have not yet discussed, and that is the form in which the Quinine is to be given. Under nearly all circumstances I prefer non-sugar-coated tablets. They are soluble enough to dissolve under ordinary circumstances, if, however, it is feared that tablets may not dissolve, Quinine in liquid form can be taken ; or the tablets powdered up or dissolved in water, with or without the aid of the juice of a lime (locally known as siporo). Some people prefer to swallow the powder with the aid of a little water and this method is quite satisfactory if the taste is not objected to provided the dose is accurately weighed out and not simply guessed at. Others prefer the gelatine-coated capsules, but these have no advantage over well-made tablets and the capsules do not keep well in the tropics. The great advantages of the tablets are portability and the ease with which a known dose can be taken without trouble.

Attention is directed to the fact that many patients do not always swallow the Quinine or Cinchona Febrifuge prescribed. Perhaps the attendants keep the tablets and sell them ; perhaps the patients think it is only “ a fad of the doctor’s ” and throw them away into the bed pan or otherwise. A systematic examination of patients in hospitals in the Malay Peninsula has shown that about a quarter really are not swallowing the Quinine prescribed. The moral of this is that if a patient seems to have fever in spite of Quinine, or of Cinchona Febrifuge, the officer in charge (or a reliable assistant) should see that the drug prescribed is actually swallowed.

As regard other drugs, 1 will mention purgatives, Dover's Powder and Phenacetin.

At the beginning of an attack the bowels should he well cleared out. The particular purgative used is not very material provided the desired result is secured. A tablet of the “ Quinine and Ehubarb" (often called a Livingstone Houser) combined with a two- or three-grain Cascara tablet is as good as any. It is best taken at night, and followed by about half a packet of salts early in the morning if action is delayed. During the attack t he bowels should be kept moving about once a day. Two or three grains of Cascara, given from time to time as may be required, will usually help to do this.

One or two five-grain tablets of Dover's Powder given at night time often secure a good night’s rest in comfort, but they have no curative value and increase constipation.

Phenacetin and similar drugs are of use sometimes for relieving headaches and rheumatic-like pains. They are harmless in moderation and in mild cases ; but in larger doses, or if given in severe cases where the heart is already overtaxed by the malaria, they become dangerous. Not more than ten grains of the Phenacetin Compound should he given at one time, and the dose should not be repeated more often than every six hours. In severe cases, or where the patient is already unconscious, these drugs should never he given.

Malarial Cachexia.—After repeated attacks of fever a condition of ill-health, called “ malarial cachexia” develops. This is recognized by the patient becoming thin and pale. The complexion acquires a distinct yellowish tinge, and the patient is obviously out of health. In such a condition the patient requires some form of tonic treatment in addition to Quinine. Medical help should be obtained if possible and a change to a more temperate climate may be advisable. If such medical help cannot be obtained, a tonic, such as Easton’s Syrup, should be taken between the attacks of actual fever.

Malarial cachexia is nothing like so common in Papua as it used to be. This is due to the more general use of Quinine, both as a preventative and as a cure of malarial fever.

(c) Blackwater Fever.—This is recognized by the patient passing dee]) red or black urine, by his skin and the whites of his eyes acquiring yellow colour, and by his having a temperature. There is usually also headache, nausea, vomiting and a feeling of weakness. The disease is a dangerous one and medical help should be obtained if possible, even if the patient does not feel very ill.

The treatment of blackwater fever lias given rise to a great deal of difference of opinion in the past. The prevailing opinion now is that Quinine should not be given as a routine practice without medical control, if Quinine ever is given, the amount should not exceed two grains three times a day. A purgative at the beginning of the attack is very necessary, but otherwise medicines have liltle, if any, influence on the disease. It is pretty generally agreed that the most important thing to do is to give the patient plenty of fluid, in order that the kidneys may he washed out and the suppression of urine may not occur—death, if it ensues, is very frequently caused by suppression of urine. If the patient is conscious he must be given plenty of simple fluids to drink. Such fluid may consist of wafer, weak tea, sodawater, soda and milk or weak lemonade. At least three pints in the day should be given, and the more the better, especially if much of it is vomited up at once. If the patient is unconscious, or if he cannot be persuaded to drink fluid in quantity, it must be injected into the lower bowel by means of a large glass syringe. Plain water may be used, but it is better to dissolve about a teaspoonful of common salt in a pint of the water. About three pints should be given in the twenty-four hours, or four ounces—two large syringefuls—every hour, or one syringeful every half-hour. This is especially necessary if the patient is unconscious and has not been passing urine for some time.

During the attack only quite light food should he given, milk, custards and the fluids above-mentioned. After the attack care should still be taken for some time, since a relapse may occur. The case should come under medical care if it is at all possible, and a change of climate is advisable afterwards. Cold has to he guarded against both during the attack and afterwards. After a severe attack great caution should be used in letting the patient get up, or even sit up in bed. There is always great blood destruction, and cases are by no means uncommon of very severe anaemia. If a patient in this condition gets up, or even sits up in bed, he may fall down dead.

Natives of Papua do not appear to suffer from this disease and attacks among Samoans and Raratongans have, in my experience, always been uniformly mild; but to Europeans blackwater fever is a serious disease.

(d)    Sunstroke.—Cases of sunstroke are not so easy to diagnose as the general public is inclined to assume, and more than one condition is included in the popular term.

In ail cases of prostration or loss of consciousness, the patient should be placed in a cool shady place, not exposed to the direct rays of the sun. If the temperature of the patient exceeds 104 F., the head and limbs (or, in extreme cases, the whole body) should he sponged with cold water until the temperature falls to 101° F., but it is most essential for the non-medical attendant to assure himself that the temperature is really above 104 F. before carrying out this treatment. While this treatment is being carried out the temperature of the patient should be taken every few yninutes, and treatment discontinued when the temperature falls to the neighbourhood of 101 F. Temperature above 106 F. must be reduced at all costs, even if it means placing the patient in a cold bath. Similar treatment is effective if the high temperature is due to causes other than malaria.

There are other cases of sunstroke, more properly called heat exhaustion, where collapse symptoms occur, and where the patient will appear almost lifeless, although usually quite conscious, with a temperature below 98° F., and with cold clammy extremities and little or no pulse. In cases of this kind, whether due to sunstroke or not, the patient requires to be kept warm ; and unless the temperature of the air is obviously high, he should be covered up with a blanket. A hot-water bottle to the feet is also very useful. Hot drinks, especially an ounce of whisky, are very beneficial; but the attendant must first assure himself that the condition itself has not been brought about by the excessive drinking of alcohol, and must also assure himself that the condition is not due to some infernal injury caused by an accident.

(e)    Bacillary Dysentery.—This is the form of dysentery found in Papua. There is hardly any other disease where proper treatment makes so must difference to the patient as it does in bacillary dysentery ; by treatment, I do not mean drug treatment only, but I include the food he is given, the way he is housed and his whole surroundings. T remember one epidemic where, on a plantation, under quite simple treatment, there were only three deaths in seventy-two cases. At the same time, in the surrounding native villages, the death rate varied from thirty to sixty per cent., being in the neighbourhood of sixty per cent, where the natives were left quite to themselves, and in the neighbourhood of thirty per cent, where certain mission teachers did their best, with quite inadequate resources and knowledge, to carry out some form of treatment.

To laymen, dysentery is almost equivalent to the passage of blood by the rectum or lower bowel. While this may not always be quite accurate, yet in the circumstances of this country, it is a very good rule to treat every case which passes blood as a case of dysentery, until reason is shown to the contrary. Moreover, during an epidemic every case should be regarded with suspicion where slime or mucus is passed, or where there is stomach-ache or diarrhoea not to be explained by the patient having taken purgative medicines like Epsom Salts.

As soon as a case of dysentery is suspected, the patient should he given an ounce packet oi Epsom Salts dissolved in water. If available, a double dose of Tincture of Ginger, i.e., two teaspoonfuls, should be added to the dissolved salt. Not uncommonly this initial dose of salts is sufficient to put an end to the attack. A large quantity of fences is then usually passed and the individual promptly recovers, and perhaps doubt is felt as to whether tlie attack was one of true dysentery.

Some degree of isolation is necessary in the case of natives. A native case should be placed in a house or room by himself, and no one allowed in the room except his attendant or attendants without special reason and under reliable supervision. The room or house should he comfortable, dry and neither over hot nor cold, and there should be no draught.v

Having given the native his first dose of medicine, isolated and housed him, the next thing to do is, in medical parlance, to confirm the diagnosis, or in other words to make certain that he really has dysentery. If there is dysentery about, the passage of blood, either actually seen or reported by a reliable native, is pretty conclusive. But the witness must he reliable. A tired prisoner, or over-worked native labourer, may discover that, if he reports the passage of blood, lie gets a fortnight’s holiday. A doubtful case should, if possible, lie kept apart. If he should lie put in the same room as dysentery cases, it is risky sending him back to work without first keeping him isolated and under observation for a fortnight. Although not sick when first seen, he may become infected if placed in close contact with those already sick, and may develop the disease at any time within the next fortnight.

If the case is one of ordinary severity, it will be found that the patient is passing mucus or slime in addition to blood, and that he has some stomach-ache. If for several days nothing but blood mixed with ordinary heees is being passed, and if the patient has no stomach-ache, the case can hardly be one of dysentery ; possibly it is a case of piles. In dysentery, pus is often passed as well as mucus and blood. Mucus is a clear, almost transparent, slimy material, whilst pus is an opaque, white, milky material, more or less fluid.

Treatment during the Disease.—The general lino of treatment is to give no solid food while the disease is at all acute, and to give enough Epsom Salts to ensure at least one normally-coloured liquid motion being passed every twenty-four hours.

Dysentery is often confused with diarrhoea, and people arc sometimes surprised that dysentery should be treated wit h a drug like Epsom Salts, which itself produces temporary diarrhoea. In point of fact diarrhoea and dysentery are very different. In diarrhoea there is a rapid passage of normally coloured liquid material from one end of the

1'extbooks usually advise that a dysenteric patient be put to bed and not allowed to yet up at all. This is usually impracticable in the case of natives. Experience in this country does not show that any very unfavourable vosult ensues if natives are allowed to walk about a little intestine to the other. In dysentery, ulcers or sores soon form at the lower end of the intestine or bowel. As a result of the ulcers, the food eaten (together with bile and other material secreted into the intestines) tends to collect and to stagnate in the upper part of the intestine, and it is this stagnation which does much of the damage in dysentery. Consequently it is the aim of successful treatment to prevent this stagnation.

With a view to prevent this stagnation in the upper part of the intestine, the quantity of food eaten should be reduced to a minimum. There is then less food to stagnate, and less food to pass down the intestine and irritate the ulcers lower down. The native is inclined to argue as follows:—‘ When a man eats, lie is well; when a man does not eat, he is ill. This man is sick because he does not eat. Therefore let us persuade him to eat, when he will recover.” This is a most fallacious line of argument, hut honestly believed in by many. Hence a native with dysentery and his attendant must not only he told that the patient must not eat such things as roast taro or other solid food, hut the supervision must be such that it is impossible for the patient to get roast taro and such like food. For this reason it is generally an advantage if the attendant is not a friend or relation of the patient. Such food as is allowed should lie given in a liquid form, and should he of such a character that as little residue as possible is left after it has been digested and absorbed in the stomach. But to whatever extent the food is reduced, the liver and other organs are busy excreting bile and other materials into the intestine, which tend to stagnate in the upper part of the intestine, and give to faeces their ordinary yellow-brown colour. These materials must be got rid of once a day at least, by passing out of the body as yellowish coloured faeces. For this reason Epsom Salts and other purgatives are given in cases of dysentery."

For the proper treatment of a case of dysentery it is essential for the individual in charge to inspect the motions which are passed, and all faeces must therefore be kept for his inspection without being mixed first with any disinfectant. The theory of the treatment has been given above, and the practical method of carrying out this theory will now be given.

Every morning and evening the motions passed must be inspected and the following points noted:—

1.    The presence or absence of blood.

2.    The presence or absence of slime (mucus).

3.    The presence or absence of pus.

4.    The presence or absence of yellow or brown teces.

5.    The presence or absence of lumps of yellow or brown fasces.

Then treatment is carried out as the result of each morning and evening’s examination as follows :

i. If either blood, slime or pus (or any combination of blood, slime oi- pus) is present without yellow or brown material, give one ounce of Epsom Salts together with two teaspoon-

' Anti bodies in the exuded serum are probably not without their effect also.

fuls of Tincture of Ginger (if the latter is available) and restrict the diet to milk and water, or to rice water (the water in which a little rice has been boiled and the rice strained off), for the next twelve hours. In place of the milk and water, weak tea with or without milk and sugar, clear soups such as Bovril, heef tea, or soups made from meat extracts, may be given.

II. If either blood, slime or pus (or any combination of them) is present, together with normally yellow or brown coloured liquid faeces, give half a packet of salts and one teaspoonful of the Tincture of (linger. In addition to the food allowed in the first case, weak cornflour, arrowroot, or sago and water may he allowed. No medicine should be given if the blood, slime or pus amounts to mere streaks, unless solid faeces are passed at the same time. In the latter event the half-packet of salts and a teaspoonful of the Tincture of Ginger should he given, as above.

III.    If there is no blood, slime or pus, or only mere traces of

them, while at the same time yellowish coloured liquid fieces have been passed, no medicines should he given but rather stronger cornflour, arrowroot or sago allowed.

IV.    If nothing at all has been passed, or only a few lumps of

solid faeces, give the half-doses of Epsom Salts (half-packet) with a teaspoonful of Tincture of Ginger, and the stronger arrowroot, cornflour or sago can he allowed.

V. If solid faeces is passed together with blood, mucus or pus, full doses of salts (a packet) are given with the ginger, and the diet is restricted to liquids and to weak cornflour, arrowroot and sago.

VI. After two or three days without any appreciable quantity of blood, mucus or pus being passed, no more medicine should be given, and well-boiled or twice-boiled rice may be allowed. After another two or three days without signs of blood, slime or pus, potatoes, taro, yams, bananas, fish and meat may be allowed. Care must he taken that the patient does not at this stage become constipated. If there are signs of this a packet of salts must be given. Constipation sometimes brings on a relapse. Hard coconuts, mangoes and other stringy fruit should be forbidden until the patient has quite recovered.

For the proper treatment of such cases, it is advisable for the attendant to keep careful notes, and to record every morning and evening the presence or absence of blood, slime, pus, liquid faeces or solid fieces, also the amount of salts given each time. If in doubt it is better to give no salts, or the smaller dose in the evening and the larger dose in the morning.

Everyone who is responsible for the well being of natives, or who wishes to benefit them, should explain as far as possible the above method of treatment to the natives themselves. Quite recently no difficulty was exj>erienced in teaching a Y.C. to carry out treatment on the above lines. In this case a village epidemic occurred and was not reported until fourteen deaths had resulted, and fifteen cases had recovered. When reported, there were eighteen cases still sick. Of these fifteen recovered and three died. Subsequently twenty-nine other cases occurred with one death only. Apart from a visit by a medical officer on the 9th, 11th, 13th, loth, 18th, 22nd, 26th and 29th of one month, and on the 9th, 16th, 23rd and 30th of the following month, the treatment was carried out by a Y.C. The cases, moreover, occurred mostly amongst children who are more difficult to treat and with whom the disease is more often fatal.

Exceptional Cases.—Occasionally the stools of a dysenteric patient become green. This is an unfavourable sign, hut it does not indicate any difference in the treatment.

At other times the stools become very watery and are passed in large quantity. This is also an unfavourable sign. If this occurs the Epsom Salts should he discontinued for the time being. Care must, however, he taken not to mistake urine for these watery stools.

At other times blood is passed in large quantity. It is an unfavourable sign, and an indication that the patient should be kept quiet and not allowed to walk about at all.

At other times the motions become black in colour. This indicates bleeding high up in the intestine. It is not necessarily of grave import. As regards treatment, these black faeces are only to be regarded as a variety of the ordinary yellow-brown faeces mixed with blood, and the half-doses (half a packet) of Epsom Salts given.

In the case of children, the dose of Epsom Saits must he less than is advised above. The doses for children will he explained in detail in Chapter VII.    '

In place of Epsom Salts, either Castor Oil, or another salt called Sodium Sulphate, may be used. Children sometimes take the Castor Oil better. At the beginning of an attack, two teaspoonfuls of Castor Oil may be given to a very young child ; an adult should he given two ounces (four tablespoonfuls).

The question of the prevention of dysentery will be more fully dealt with in Chapter V. Here it is only necessary to say that a native can usually be considered free from infection fourteen days after the passage of blood, or appreciable quantities of mucus and pus, have ceased.

if) Beriberi.—This is a disease which has caused many deaths in this country amongst signed on labour and prisoners.

A few years ago the most divergent views were held by medical men with regard to its causation and treatment. Now all are agreed as to the most essential factor as regards both causation and treatment, and the older theories do little more than haunt the subject like ghosts of their former selves.

It is agreed that the essential factor in the production of beriberi is the eating of a rigid ration deficient in certain necessary food constituents. The eating of such ration must be continued over a prolonged period, two to three months or more, and usually occurs only amongst those who have no opportunity of supplementing this rigid ration with extras. In this country beriberi is not uncommon in gaols and on plantations and mining fields where no regular ration of native food is sowed out. Apart from the sago-eating districts of the West beriberi is practically unknown in the villages of British Papua. In the West, signs of it exist in villages where much sago is eaten, and where the less fortunate or less enterprising section of the community eat little else.

It is much to be regretted that means cannot be found for gradually introducing into this country the less-highly-polished varieties of rice. Such varieties prevent beriberi. Bice of tins character should be cheaper, since the labour and loss during polishing has not to be paid for. The natives might not like such rice at first, but would probably get used to it with a little judicious persuasion. Bven if cheaper than the ordinary standard highly-polished white rice, it would not be charged a higher Customs duty by the Government if clean and otherwise in satisfactory condition. The efficiency of plantation and prison labour would be increased if such rice were used or if a third of the ordinary rice ration were replaced hy peas, beans or potatoes properly cooked ; moreover, beriberi would be practically banished from the country.

Among.signed on labourers and prisoners a diet consisting mainly of highly-polished rice with a little biscuit is the essential factor in producing it. I can only remember amongst the police force one case which occurred at Abau some years ago. This is rather the exception which proves the rule. In places like Port Moresby the police get monthly salary, and they can supplement their rice ration with extras, which they buy or barter, and on most outstations native food is plentiful. I have, however, seen cases amongst natives living in the police barracks, who get no salary and could not supplement their rice ration.

I have also seen one or two cases in the Port Moresby villages at a time when native vegetable food was exceptionally scarce.

Beriberi is primarily a disease of the nerves, and, since the nerves are found all over the body, very different symptoms may arise, depending on the nerves which are most affected.

There are two chief forms commonly seen in this country. In one form the nerves of the legs are chiefly affected ; in the other form, the nerves of the heart or the heart muscle itself.

W hen the nerves of the legs are mainly affected there is at first some general ill-health with pains in the limbs which may be severe. The legs become weak, and the patient may he unable to walk on this account, or he may become obviously unsteady on his legs. If proper treatment is not at once applied the weakness increases, and later on the legs waste.

When the heart is affected, the onset may be Very sudden. I have known a prisoner, sent to me in a large group for mere routine inspection, drop down outside the hospital and die in a matter of a few minutes. Death is not usually so rapid, but 1 have known of numerous deaths within two or three days. These rapid cases often occur amongst natives who look quite healthy. More commonly the native affected complains for a week or two of not being able to work and is not uncommonly thought to be malingering. On one occasion a plantation manager brought me a couple of natives whom he said had been malingering. There was nothing to be found wrong with them except a rapid heart; 1 suggested beriberi, but am afraid the plantation manager remained somewhat sceptical. However, I learnt that one native died about a fortnight later. From this it will be correctly guessed that a rapid pulse in a native complaining of sickness, and with no other sign of sickness, should give rise to a suspicion of beriberi, if the native has been living on a ration consisting mainly of rice, sago and biscuits. If such a native complains of sickness and his pulse rate remains over 90 per minute after half an hour’s rest, be had better be given the benefit of the doubt; if the pulse rate remains over 100, he should be considered definitely ill; if the rate remains over 120 or 140 he should lie considered very dangerously ill. In this form of the disease, pain is frequently felt in the chest, and there may be pain in the stomach and legs as well; the ordinary symptoms of weakness in the legs may exist at the same time as the heart symptoms.

Another form of the disease is caused by the nerves of the stomach and intestines being affected. In these cases the pain is felt in the stomach. Severe vomiting and hiccoughing may rapidly follow and are very grave symptoms.    '

A form of beriberi, very rarely seen in this country, is the so-called wet type. In these cases the legs swell up and “pit on pressure,” i.e., if the finger is pressed steadily on the swollen legs for a minute or two, the mark of the finger will be found to be left on the leg in the form of a pit oi’ depression.

Very commonly two or three of the above forms may occur in the one case.

Treatment.— It will be obvious that if beriberi is caused by a food deficiency, the best treatment will be a complete change of diet. Fresh native vegetable food should be procured, e.g., sweet potato, taro, yams or bananas; or dried peas or beans may be added to the diet. It is much to be regretted that people in this country seem unable or unwilling to supply their natives with either peas or beans when native vegetable food is scarce. If available, unsweetened milk and fresh fish or meat are excellent for these cases.

The feeding is the essential part of the treatment of beriberi. In chronic cases tonics may perhaps help, and a liniment well rubbed in may sometimes prevent the limbs from wasting while the nerves are regaining their power. The rapidly fatal case mentioned above owed his sudden attack and death to the hospital lull at Port Moresby, which he had just negotiated in line with other healthy prisoners.

Beriberi patients should not be allowed to undertake active exercise while in the acute stage of the disease. Heavy work appears to favour the onset of the disease. Perhaps the rapid onset of heart symptoms so commonly seen in apparently healthy and strong natives is due to their being capable of working, and to their doing more work than their physically weaker companions.

One of the older theories of beriberi was that it was due in some way to dampness. It is possible that dampness favours the onset and the continuance of the disease. The quarters of natives attacked with beriberi should be dry and warm.

The disease is such a serious one, and is so likely to recur if the conditions which produced it in the first instance are reverted to, that the diagnosis of beriberi always justifies a recommendation that a Contract of Service under the ** Native Labour Ordinance be cancelled.

The disease is practically unknown amongst Europeans living in this country.

(g) Ulcerated Mouth Disease.—This is also known as “ sore mouth,” and New Guinea mouth disease.” It appears to be a form of scurvy.

Like beriberi, it is often seen in this country amongst natives who live mainly on rice and biscuits, and is pretty well known to most who have had much to do with prison or indentured labour in parts where the ration usually supplied to natives consists principally of rice and biscuits.

The mildest cases show only some slight ulceration around the teeth. Later on this extends further over the gums, and the teeth become loose. In more severe cases the ulceration extends to the inner surface of the cheek and to the tongue. In extreme untreated cases the ulceration may eat through to the face, and cause extensive destruction of the face, and death.

The treatment of such cases is to give an appropriate mouth wash, to supply lime-juice, fresh limes or fresh green food and to prevent the disease being transmitted to others.

Potassium Permanganate in a strength of about 1 in 8,000 makes a very satisfactory mouth wash. This is generally supplied to outstation officers in the form of one-grain tablets." One of these dissolved in a half-pint of water will form a solution of a convenient strength. The tablet will take some little time to dissolve. Such mouth washes should not be made up haphazard from the crystals of Potassium Permanganate. I f so made up they are likely to be made too strong, and I have known natives get the highly caustic crystals themselves in their mouth.

Another suitable mouth wash is a 1 in 2,000 solution of Corrosive Sublimate. Care has to be taken that an ignorant native does not swallow large quantities of it. It is a poison, and, if swallowed, may itself cause ulceration of the gums and loosening of the teeth.

‘ If eight-grain tablets are supplied one is dissolved in four pints of water (a Winchester quart bottle holds five pints).

When this disease occurs amongst a group of natives they should all, both sick and well, be put on a ration of lime-juice. For every ten natives, a half-pint of lime-juice should be mixed with six pints of water and ten ounces of sugar, and the same should be drunk daily.

Although natives seldom if ever suffer from this disease if they are well supplied with fresh food, still the disease is more or less infectious amongst those who are not quite properly fed. It is rather to be regarded as a disease to which ordinary well-fed people are immune. Consequently, when the disease does occur, natives should not be allowed to smoke each others baubaus, nor to use the same spoon or pannican.

(h) Venereal Diseases.—These are often serious diseases and should be sent to a medical man for treatment if it is at all possible. Venereal disease can be divided into two forms—t hose where the main symptom is a white discharge, with or without pain on micturition, and those where the chief symptom is an ulcer or sore. Each form can, for practical purposes, be divided into a form readily cured and a form not readily cured by ordinary treatment.

Natives not uncommonly have a slight white discharge due to lack of cleanliness. Such cases can be readily cured by having the foreskin drawn back, and by washing with soap and water or by the use of one per cent. Lysol Lotion. Even where there is a definite discharge from inside “ the pipe,” some cases may clear up rapidly under simple treatment. For this purpose a concentrated “ Gonorrhoea Mixture ” is sent out. Like all similar preparations it is very nasty. However, a teaspoonful three times a day in a little water and after food often may have apparently a distinctly beneficial action. Pills may be supplied and taken for the same purpose, but the modern tendency is to place less and less reliance on this treatment by the mouth.

Internal treatment is not without danger in the hands of laymen. However, with medical men so scarce in this country, there are occasions when 1 regard it as quite justifiable, provided care is taken to learn the precautions necessary.

Internal treatment is carried out two or three times a day in the following manner : The patient passes some water for the purpose of cleaning out the passage. A dram or two of the injection is then inserted into the pipe by means of a small syringe. The injection is to he retained for some five or ten minutes. Finally some more water is passed to again wash out the passage.

For the injection a Potassium Permanganate Lotion (1 in 4,800 to 9,GOO) can be used, and in recent, years is the one most favoured by those who make a special study of this disease. For chronic cases a solution of Zinc Sulphate, of a strength of two grains to the ounce, or Corrosive Sublimate Lotion, of a strength of 1 in 2,000, is also suitable.

The diet in such cases is a matter of considerable importance, and the bowels should be kept well opened. Alcohol, condiments (pepper, chutney, chillies, etc.) and coconut water should be avoided, and, especially in severe cases, active exercise given up. Certain more serious complications seem to be common in this country in the case of those Europeans who persist in leading active lives in spite of an attack.

It is important in all cases to warn the patient and his attendant that strict cleanliness must be observed, and the hands washed after treatment or examination. The great danger is that a particle of the discharge may get transferred to the fingers and from there into the eye. If this occurs, a very severe and dangerous form of ophthalmia may follow.

No case should he considered cured unless it has been found free from all symptoms of a discharge on three consecutive examinations. These examinations should he conducted at intervals of not less than three or four days from each other. In the case of male natives, care should be taken that the patient does not conceal the disease by passing water just before examination. A recurrence is always possible.

Severe or chronic native cases should always he sent in for treatment to a medical officer.

Associated with or following on gonorrhoea inflammation with pain may occur around the joints and tendon sheaths. Such affections are commonly called rheumatism. The symptoms resemble those of sprains and strains [See description of these, Chapter IV, Section 1 (/)] ; hut there is no history of an injury as a rule. Still it may happen that the symptoms are tirst noticed when some trivial accident occurs or when some extra muscular exertion is made. In case of troubles of this kind the possibility of gonorrhoea should he kept in mind, and if a genital discharge is found the case considered as probably of gonorrhoeal origin. There is no very special line of treatment available. If there is a genital discharge, it should he treated as well as the rheumatic-like sprains. When the pains and stiffness clear up it is quite possible that the genital discharge may show up even when not present when the rheumatism was bad.

ft should not be forgotten that venereal diseases are not the easy things to diagnose off-hand in the way which the layman sometimes imagines. Even a medical man may well be in doubt on occasions. Experience in this country has shown that on the average only about a third oi the cases sent in to medical men by laymen as cases of venereal disease are so considered as such by the medical man who received them. This applies both to cases of supposed gonorrhoea and to cases of genital ulceration.

Females. The treatment ol females by officers without medical training is to be deprecated, but, as such treatment has to he carried on sometimes by partially-trained women under the supervision of the officer in charge, the method of carrying out the treatment will he indicated.

Cases showing a discharge are syringed out with a special female glass syringe twice a day. The more profuse the discharge the more syringing will be required. For ordinary cases two or three syringefuls each time will he enough. The solutions used may he Potassium Permanganate in a strength oi about 1 in 4,800 to 9,600 (especially7 useful in evil-smelling cases); half per cent. Lysol Solution (especially useful in cases accompanied by ulceration) ; Zinc Sulphate Solution in a strength of 2 grains to the ounce; or Corrosive Sublimate Solution in a strength of 1 in 2,000. Either of the last two are especially useful in old chronic cases.

Cases not rapidly clearing up should he sent in to a medical officer, and no case should he considered to he cured unless found free from all discharge on three consecutive examinations made at intervals oi three or four days. A recurrence is always possible.

In the case of women no internal treatment, beyond an occasional purgative, is required.

In female as well as in male cases the danger of the discharge getting into the attendant’s or the patient’s eyes should be remembered, and the patient and attendant carefully cautioned.

Venereal Ulceration.—These cases can be divided into two groups, those easily getting well under simple treatment, and those not getting well under simple treatment. By simple treatment is meant the treatment described in Chapter IV, Section 1 (b) for the treatment of simple ulcers, viz., one per cent. Lysol Lotion, Compound Iodoform Powder, with the occasional use of Copper Sulphate Lotion. If on applying sucli treatment the case does not rapidly improve, it should be sent in to a medical officer. Such cases, if not properly treated, may give rise to severe and even fatal disease.

The prevention of the spread of venereal disease amongst the natives of Papua is most important. Every case should be kept under control until a cure appears to have been effected ; but it is practically impossible to be certain that a recurrence will not take place later unless the case is kept under observation for a longtime and occasionally inspected.

PREVENTION OF DISEASE.

1.—Maintenance of Good Health in the Tropics.

Nearly all diseases depend on the introduction and growth of microscopic living germs into the body and their growth and multiplication there. There are thus two chief lines of defence: (l) the microscopic living germs of disease may he kept out of or away from the body—in short by isolation ; and (2) by the rendering of the body an unsuitable place for the growth and multiplication of these germs—in other words by rendering the body immune.

An ordinary healthy body possesses a high degree of immunity to many diseases, and, if a person keeps in good general health, his body is not a very suitable place for the growth and multiplication of the disease germs which are commonly met with. It is this aspect of prevention which 1 am going to consider in this section, or, in other words, how to keep in good general health.

First of all, for good general health to bo maintained the food eaten must be of a suitable kind, in suflicient quantity, but not in too great excess. If too much is eaten it fails to be digested, microscopic germs flourish in the undigested residue, and indigestion follows, with symptoms of headache, stomach-ache, vomiting and diarrhoea or constipation. A similar result follows if the food is eaten without being sufficiently chewed up and mixed with saliva.

We may dismiss the possibility of starvation or of semi-starvation in the case of Europeans. Certain forms of partial starvation in the case of natives will be dealt with in Section 5 of this Chapter (Beriberi and Scurvy).

The first result of eating food improperly, i.e., food in great excess, food not sufficiently chewed up, or unsuitable food, is an attack of indigestion. Indigestion itself is a weakening of the body to such disease-producing germs as commonly enter by the mouth. Cholera germs do little harm if they enter a healthy stomach. If this is in proper working order the germicidal or antiseptic juices produced in the stomach kill the germs which do get into the stomach, and so they are unable to pass on to the intestine and cause the disease cholera. Very much the same occurs in the case of dysentery.

The importance of sufficient teeth cannot be too strongly emphasized. All those seriously deficient in teeth should have them replaced by artificial ones.

The food should also be prepared so as to be liked by the eater. The expression “it makes my mouth water” is by no means entirely

imaginary, and well-flavoured food encourages the secretion of other digestive juices besides the saliva. 1 quite believe that a very considerable part of the ill-health experienced in the more remote parts of the Territory is due to the unappetising tin of meat, which is turned out of its tin daily by a native cook until his master gets so tired of it that he can hardly eat it. For good health, therefore, some care should betaken in the preparation of food, and some variety in the matter of food should be obtained.

The question of natives being fed on food which is unsuitable by reason of the absence of certain necessary constituents will be dealt with later. Europeans seldom suffer seriously in this way, but the health of Europeans in the Territory would improve if fresh vegetables or fruit were more easy to obtain.

Closely allied with the question of food is the question of alcohol. The drinking of alcohol in strict moderation does little, if any, harm. The effect of drinking alcohol in great excess is unfortunately too well known to need description. Taken over a long time in less excess serious harm is eventually done in the great majority of cases, although it may be years before the kidneys, liver or heart show definite signs of giving way. Generally speaking the taking of alcohol in anything more than strict moderation tends to lower the resistance of the body to disease, especially when combined with excess in the matter of food. On the other hand, under certain circumstances, its use in medicinal doses is very valuable.

A generation or so ago the most common explanation of almost all diseases was cold. Cold alone dose little harm, but it does at times render an individual less resistant to disease, a fact recognized by the term cold” for the invasion of the nose and throat by microscopic germs. Moreover, it is not so much cold which does the harm, as cold applied to a special limited area of the body—in other words, by a draught. Cold, however, can undoubtedly cause an attack of malaria when the requisite germs are already latent in the body.

In Papua, excessive heat is of more importance than excessive cold. Heat is well known to be injurious, especially if applied to the head. When working or walking in the sun, a good thick helmet or hat should be worn. Even if the sun is clouded over, a European should not remain out of doors without some covering over the head.

The houses so fa)* built in this country for Europeans are, unfortunately, very unsuitable for the tropics, and are seldom ventilated on scientific principles. I am convinced that some of the chronic minor ill-health of the country is due to living and working in over-heated rooms often with a hot iron roof above the head.

It is quite a mistake to suppose that a native is capable of working in the hottest sun without some head protection but the harm done to a native is not so great as in the case of a European. In his natural condition, the native wears a thick mass of hair, and seldom works in the sun during the hottest hours of the day. As far as possible, all patives working in the sun should not have their hair cut too short, or

they should be supplied with some head covering. I have known a native, under quite exceptional circumstances, to die from the effects of exposure to the sun.

Lack of outdoor exercise is another cause of minor ill-health amongst Europeans, and everyone should get some outdoor exercise several times a week. Generally speaking, it is t hose who have active, outdoor employment, who keep their health best in this country.

Another requisite for good health is some form of mental relaxation and change.

2.—The Introduction of Disease into the Body.

The importance of keeping in good general health has been emphasized in the preceding section. But however perfect the general health may be, there are certain living germs which, if once int roduced into the body in sufficient numbers, can, and sometimes do, go on living and multiplying there, with the production of definite disease. It is this aspect of the prevention of disease which I will consider in this section.

Such germs may be introduced through three main channels: (l) with the air we breathe; (2) with the food we eat or drink; and (3) through the skin, generally by means of a biting insect, e.g., a mosquito.

Diseases like influenza, measles and smallpox are introduced into the body by means of the air. People have to breathe, and there is no practical way of sterilizing the air we breathe, hence our main defence against this group of diseases is to keep away from people who are affected. Fortunately a matter of a few yards is a sufficient- distance under ordinary circumstances. It is equally fortunate that, when these germs are once introduced, the body at once begins to react to the introduction in such a way that if soon becomes immune, and no longer suitable for the growth and multiplication of these special germs which have entered it. Hence these diseases tend to run a definite course, and recovery can be expected within a defined time provided the patient keeps up his strength, and no special complication arises. If is again fortunate that this immunity, when once acquired, usually lasts for many years, or for life ; and, when a second attack of the same disease does occur, it is usually a mild one. It is also fortunate that in the case of smallpox we have a means of rendering a person immune to it by vaccination. If this is properly and effectively performed, the person remains immune to smallpox for some years ; and even if ho

should afterwards get an attack, it will be a mild one.

• ■*.**••*,

It might seem at first sight that all we have to do to avoid these diseases is to keep away from people suffering from them. But most unfortunately it is possible for people to carry some of these disease germs about with them, without showing signs of illness. It is advisable, therefore, to avoid, as far as possible, close contact with other people (or with animals) and with any of the discharges from their bodies. Under special circumstances the saliva, the urine, the ficces, the hair, and scales of skin may carry infection. Hence the necessity for cleanliness as regards the body, the clothing and all drinking and eating utensils, and tor the proper disposal of faeces and urine.

The second great source of infection is the food which is eaten and the fluid which is drunk. Here the matter is entirely under our own control. Food should either he kept free from all possible source of contamination, or else cooked before being eaten. Efficient cooking kills all germs which are on the outside of the food, and go a very long way to kill all germs inside.

Decomposed food should not be eaten. This is partly because the living germs which have caused the decomposition may have already manufactured poisons while they have been causing the decomposition, and partly because actual disease germs may have got into the interior of the meat where they are difficult to kill by cooking.

Dust contains all sorts of objectionable and dangerous material, including, possibly, dried saliva, dried faeces of animalsor even of human beings, and dried urine. Any of these may contain active disease germs, which, if they get on to food, may reproduce their corresponding disease in anyone who is unfortunate enough to eat such food. I say “may reproduce ” such disease, not that they will always necessarily reproduce such disease, for two reasons. Almost all these disease germs are as a rule killed off sooner or later—it may be by drying, by sunlight, or by being crowded out by harmless living germs which are not disease producing. Moreover, if living disease germs do reach the stomach, an ordinary healthy stomach contains a substance which acts as an antiseptic and will kill many kinds of them. When the stomach is out of order this antiseptic may not be produced, and, as has already been pointed out in the preceding section, diseases like cholera and dysentery may more readily occur.

Flies are equally as dangerous as dust. They breed in and live on all kinds of refuse and filth, and they may carry disease germs on or inside their bodies and on their legs. The flies afterwards may get on to food, oi* drown themselves in milk or tea, and the germs are thus conveyed to food or drink.

Particular care should be taken with regard to milk and water, for they are specially liable to contamination.

Milk is a very favourable medium for the growth of certain germs, and it is liable to contamination with germs from several sources—the cow, the milker of the cow, the vessel it is put into, the water possibly used to dilute it, the dust blown into it, and the Hies which drown themselves in it. Hence, unless obtained from cows in perfect heath, and, unless kept the whole time under reliable supervision, it is best boiled before being drunk. Boiling sterilizes it, or, in other words, kills all the living microscopic germs in the milk.

Water is also liable to many sources of contamination ; and water, unlike most foods, does not stimulate the stomach to produce its own special antiseptic. In the case of shallow springs, dangerous material may be washed into the water or soak through the ground. Water is also liable to be contaminated by dirty vessels, and by dust and Hies. Therefore, it is best boiled, and a very good way of making certain that it has been boiled is to make it into and to drink it as tea.

Dysentery is a disease not uncommon in this country and usually enters the body by the mouth with food or drink. The method of the prevention of dysentery will be fully dealt with in Section 4 of this chapter. Broadly speaking, the precautions which are required in the case of dysentery are the same as are required for other diseases which are transmitted in a similar way. Such diseases are typhoid fever, cholera, and various forms of diarrhoea.

The third means by which disease germs enter the body is by the skin. This is more especially liable to occur when the skin is damaged. Hence the importance of keeping all wounds clean and free from contamination with germs, and of treating them with unirritating antiseptics of the right strength.

The human race is, unfortunately, plagued with a variety of insects, which not only make life miserable by a series of * pin pricks,” but also introduce germs into the body which may cause serious disease. The commonest disease so caused is malaria. This is transmitted from one person to another l>v the bite of a special kind of mosquito. It is a wise precaution—not perhaps always possible in this country- to keep all biting insects (mosquitoes, fleas, bugs and lice) away, since they are all possible carries of disease.

The question of the prevention of malaria will be carefully considered in detail in Section 3 of this chapter. Apart from the use of Quinine, the methods used for the prevention of malaria are just the same as are required for the prevention of yellow fever and dengue fever, the special kind of mosquito being different in these cases. Plague is carried by fleas in a very similar way, especially by the rat flea. Plague prevention therefore mainly consists in the avoidance of rats and the fleas they carry.

o.—Prevention of Malarial .Fever (and of Mosquitoes).

The method of preventing malarial fever will be at once apparent when the method of transmission of this disease from one person to another is understood. No excuse is therefore needed for describing the method of transmission in some detail.

Malaria is caused by a living germ which lives in the blood of a person who has or who has had malaria. Signs of ill-health are not usually experienced until there are some two or three hundred of these germs to each drop of blood. Even when the blood is free from these germs and the individual may appear and may really be quite well, some of these germs may be latent in the spleen and in other parts of the body. If the resistance of such a person is lowered by cold, by another illness, by a severe injury, or by alcoholic excess, these latent germs may become active again and give rise to symptoms of malarial fever. Hence, in this country, it is a very good general rule to always give Quinine to anyone who is in any way sick or badly injured. I f the

patient is not actually suffering from malaria at the time he is being given the Quinine, lie very likely will soon get an attack if the Quinine is not given.    .

If a mosquito bites a person who has the malarial germ or parasite in his blood, the mosquito gets a drop of the person’s blood, together with two or three hundred parasites. These parasites at a particular stage of their growth, and in the case of a particular kind of mosquito, go on living and multiplying in the body of the mosquito for some eight or ten days. When a mosquito bites, it begins by injecting a drop of fluid to keep the blood fluid while it is sucking. It is this drop of fluid which causes the wheal and the itching after a mosquito has bitten. If such a mosquito has bitten a malarial patient some eight or ten days before, a number of the malarial germs or parasites are introduced into the blood of the person bitten, if such a person is not immune, the parasites go on multiplying and increasing in his blood until, at the end of eight or ten days, they may be numerous enough to produce an actual attack of malarial fever with a rise of temperature.

Native children very commonly have malarial parasites in their blood, even if they do not suffer from malaria. Hence if malariacarrying mosquitoes exist, as they often do, in the neighbourhood of native villages, such mosquitoes will very likely have already bitten native children, and will inoculate anyone afterwards bitten by them with malaria. Hence it is not advisable to camp in or very near native villages, if it can be avoided. It is also inadvisable for the quarters of Europeans to be built near the quarters of married natives with children.

Although it is true that almost everyone living in Papua, except those living in special places like Port Moresby (and then in Granville West only), must become inoculated with malaria ; still repeated inoculations probably do more harm than occasional inoculations, so precautions as regards sleeping away from native villages and away from native children should not be altogether neglected. To prevent malaria the malaria-carrying mosquito must be got rid of. If this is impracticable something can be done sometimes by preventing the mosquito biting a person ill with malarial fever and afterwards biting a healthy person. If malarial mosquitoes are about, anyone ill with malaria should be kept under a mosquito-net. Healthy people should also keep under mosquito-nets as far as possible when malarial mosquitoes are about. Such mosquitoes are especially active about and just after sunset. They are also often fairly active about sunrise and during the whole evening. It is therefore at such times that especial precautions should be taken not to be bitten by them. At all times they prefer darkness, and very commonly bite peoples’ ankles as they sit with their feet under a table at their evening meal. In such cases a great deal of protection is afforded by wearing two pairs of socks, through which the mosquito will hardly bite. The use of preparations smeared over the body for the purpose of keeping mosquitoes away is hardly practicable. Such preparations are hardly effective for more than about half an hour, and repeated applications get almost as annoying as the mosquitoes themselves. It is quite a hopeless business to try and kill oh’ the millions of mosquitoes by catching them with a net, hut something can be done by burning smoky sandalwood. Smoke of all kinds tends to drive them away, and the smoke from sandalwood is especially effective.

The recognition of these malaria-carrying mosquitoes is usually easy, when they are once seen. Unlike most mosquitoes they' rest on a surface with their head and body in one straight line, and generally almost at right angles to the surface they are resting on. The ordinary mosquito rests with his head and body almost at a right angle. The malaria-carrying mosquito does not make much if any noise, while the ordinary mosquito is distinctly audible. The wing ot the malariacarrying mosquito, moreover, usually is far more mottled than the nonmalarial ones. Even when present, the malaria-carrying mosquito is often difficult to see. It keeps to dark places and makes no noise. In such cases, if the hand is placed under the table for a few minutes, one of these mosquitoes will often settle on it. if the hand is gently withdrawn as soon as the bite is felt the mosquito can be examined at leisure.

Mosquitoes tend to keep near the ground, and houses built on high piles have fewer mosquitoes in them than those built on the ground.

The most hopeful way of dealing with mosquitoes is by attacking them when they are in the larval stage. The mosquito lays its. two or three hundred eggs at a time in water. Each of the main varieties of mosquitoes utilizes water of a particular character as a rule. The malaria-carrying mosquito almost always selects shallow clean water in which grass and weeds are growing, which is exposed to the sun, and sheltered from strong wind. If malaria is to he driven out of a district, the most hopeful thing to do is to attack possible breeding places of this kind. There are two methods of attack. One method is by draining the land where such shallow collections of water exist, the other method is by sprinkling kerosene on such collections of water. About a quarter of an ounce or rather more per square yard is required. The kerosene should be sprinkled at the coolest and calmest part of the twenty-four hours. If applied during the heat of the day or while the wind is blowing, the kerosene tends to evaporate too quickly. A mixture of equal parts of kerosene and oil is often used. The oil alone does not spread readily enough, but it has the advantage over kerosene that it does not evaporate quickly.

The oil and kerosene act by forming a film over the water. The larvae have to come frequently up to the surface to breathe, the kerosene then poisons them and prevents them from breathing.

However satisfactory such methods of mosquito extermination may be under special conditions with unlimited money available, still, at best, they can only he applied to limited areas ; and Europans living in Papua away from Port Moresby and Samarai have, for the most part, to submit to repeated inoculation with malaria by mosquitoes.

The next problem then which has to he considered is how this inoculation can be rendered harmless. It is very fortunate for Europeans

living in Papua, and the tropics generally, that there is a comparatively simple and harmless method of rendering the body for the time being immune to malaria. 1 refer, of course, to the taking of Quinine.It is very strange that while the public will often accept quack advertisements at the value put on them by the advertiser, yet the three lines of medical treatment which act with more certain success than almost any other line of treatment are received by many cranks with the greatest possible amount of suspicion. I refer to vaccination as a preventative of smallpox, to the treatment of diphtheria with Antitoxin, and to the prevention of malaria by Quinine. Not only are the benefits of such treatment denied by a few faddists, but the comparatively slight inconvenience and harm which may occasionally arise from such treatment is greatly exaggerated. It is quite certain that whatever inconvenience may, in a few susceptible people, be caused by moderate and reasonable doses of Quinine, yet malaria without Quinine does far more harm. It is not too much to say that life for the average European in Papua would be quite impossible without Quinine.

The exact method of taking the Quinine is not of very much importance provided it is done systematically and continuously. Some authorities recommend five grains every day ; others fifteen grains every Saturday and Sunday ; others the same dose on two consecutive days every ten days. By the first method 150 grains are taken per month, by the second 130 grains and by the third 90 grains. Fifteen grains in one dose by the second and third methods gives rise in the case of some people to headache and deafness.

The method I prefer is as follows : On the 9th and 10th, the 19th and 20th, and the 29th and 30th ol each month, five grains of Quinine are taken three times a day after each meal. It is a method I have followed myself during some twenty-two years’ residence in Papua, often in the most malarious parts of it, and it is a method which has been most successful.

Anyone who gets malaria once should continue such treatment for some months afterwards, and they should resume treatment and continue it for some months if they should ever get malaria again. In addition, if such a person should ever get out of health in any way, should he got seriously over-tired, or seriously cold or wet, he should take the Quinine in five-grain doses three times a day for the next two or three days, if this is done I think there are very few Europeans who could not maintain good health in Papua. On the other hand if Quinine is never taken, one attack after another of malaria will be experienced, each attack leaving the patient a little worse off than he was before ; and, in the course of a few years, about one individual in every three will be dead, one in every three will become a chronic invalid, and, perhaps, the lucky one oi the three will become, after a longer or shorter period ol ill-health, immune to malaria, and maintain general good health without taking Quinine. Even such an individual will be liable to it again should he get out of health in any way.

' In place of Quinine Cinchona Febrifuge may be used.

So fur I have not specified the form in which the Quinine4 should he taken for the purpose of preventing malaria. The question of the form in which Quinine should be taken for the purpose of curing an actual attack of malaria has been full discussed in Chapter IV, Section 4 (b) (page 39), and here I will only say that the best form in which to take Quinine for prophylactic purposes, i.e., for the purpose of preventing malarial fever, is in the form of a tablet, and the form of tablet which I prefer is the non-sugar-coated tablet of Quinine Bisulphate.

The method of avoiding malaria by taking regular doses of Quinine is so important that 1 will summarize all that has been said above.

Method of preventing malaria by taking regular doses of Quinine.

Get from one of the stores a bottle of Quinine Bisulphate tablets, not sugar coated, 5 grains, 100 tabloids to the bottle.

On the 9th and 10th, 19th and 20th, 29th and 30th of each month, take one of the above tabloids three times a day after meals. If the bowels are at all constipated, take a purgative on tin1 evening of the 8th, 18th and 28th of the month.

In addition, if you feel unwell at any time, get over-tired or sutler from excessive cold, take the tabloids for two or three days one tabloid after each meal.

If there is anyone who thinks he will not he able to remember the dates, let him take the tabloids—one after each of the three chief meals —on every Saturday and Sunday. If he does this he will keep malaria away, and the extra amount of Quinine taken will do no appreciable harm.

Tt will have been noticed that I have said that the malarial mosquito breeds in shallow pools. If this is so, it may he asked why trouble should he taken to keep water-tanks and guttering mosquito-proof. The annoyance caused by mosquito bites supplies a ready answer, but there are others. Dengue fever may he carried by mosquitoes which commonly breed in tanks. This is another reason for keeping water-tanks and guttering mosquito-proof. Yellow fever is a very serious disease, and it is just possible that it might someday be brought into an Australian or Papuan port. If it were ever so brought it is the tank-breeding mosquitoes which would act as carriers of the disease.

While it is true that mosquitoes only breed in water, it does not follow that mosquitoes will necessarily breed if water is provided. The water must contain enough food of the right kind for the larvae to eat; it must he free from the numerous insects and fish which eat mosquito larvae, and also from microscopic germs which cause disease amongst mosquito larvae. Moreover the mosquito must be able to find the water for the purpose of egg laying. There is some evidence to show that it does this by means of sight. The surface of water in which mosquitoes are breeding must be kept free from ripples. Some varieties seem to require that the water shall he freely exposed to the sun, probably because the larvae live on microscopic vegetable material which only flourishes in sunlight. This seems to he true of the malaria-carrying mosquitoes. Perhaps it explains why it is that malaria is said to he specially bad when ground is first cleared and dug up. The harmless forest-breeding mosquitoes then become replaced by the sunlight-breeding and dangerous malarial mosquitoes. Later on, when drainage is rendered more perfect, the malarial mosquitoes are driven away again.

The distance a mosquito will travel is often a matter of dispute. It is clear that usually they do not travel far, and this is especially true of the malaria-carrying kind. In Port Moresby the tank-breeding kind—black mosquitoes with white streaks on them—are usually confined to one special part of the town around a defective tank. At other times the entire town becomes troubled with another form, similar to the mosquito which is found on the opposite side of the harbour. It would appear that, under special circumstances, such as a moist atmosphere with just enough wind to carry them along and not enough to harm them, these mosquitoes may be carried for a matter of two or three miles. Such conditions would be all the more likely to cause mosquitoes in the township if they occurred at a time when the mosquito was normally most active, that is about sundown. It is, however, quite well recognized that mosquitoes will hide away and aestivate, as it is called, in sheltered places during hot and dry weather. Such sheltered places may be dense undergrowth, behind pictures, in ceiling spaces or in any dark and sheltered place where they are not likely to be disturbed. When conditions become favourable, i.e., on a calm and moist day, they become active again.

4.—Prevention of Dysentery (and of diseases carried

in a sim ilar vianner).

Dysentery is caused by the growth of a microscopic living germ in the lower part of the intestine. This living germ can only reach the intestine by way of the mouth, or rarely perhaps by way of the nose in the form of dust; hence the whole question of preventing dysentery consists in stopping these living germs from passing from the intestine of one individual to another in sufficient numbers, and in a sufficiently vigorous state, to go on living and multiplying in the intestine of the second individual. The germs only flourish in the lower part of the intestine, and are only given out with the faeces (or rarely, perhaps, with the urine), hence the prevention of dysentery depends on the proper disposal of faecal matter without contaminating food, drink or dust. As soon as this simple principle is grasped the method of preventing dysentery becomes quite evident.

Having understood that the prevention of dysentery consists in preventing faecal matter from contaminating food, drink and dust, I will now trace out the channels by which food, drink and dust may be contaminated.

Faecal matter may be deposited on the ground near a waterhole, and be afterwards washed by rain into the hole and drunk with the water. Hence faecal matter should not be deposited near waterholes ;

TREATMENT AND PREVENTION OF DISEASE IN PAPPA

waterholes should he protected from surface drainage by a low embankment around them. Waterholes should not be contaminated by natives standing in them (possibly their feet may have been contaminated with dried faecal matter), and dirty buckets, etc., should not he put into the waterholes. It is best to supply each waterhole with its own special bailer on the end of a stick. Likewise animals must he kept out of the waterholes. Apart from other possible dangers, they may carry human faecal matter on their feet. Waterholes should not be near latrines, especially if the pit system is used.

A waterhole which is going to be used by any considerable population should be covered up and fitted with a pump. It should he protected from surface water, not too near latrines, and it should not he necessary for anyone drawing water to walk over the cover of the well. The fact should always be remembered that feet or boots may be contaminated with (hist derived from dried human fæcal material, and that, if such material is rubbed off on the cover of the well, the next shower of rain may wash it into the well.

The contamination of streams and rivers in a lightly-populated place like Papua is not of so much importance as in more densely-populated countries. Such contaminating matter very quickly gets diluted to the vanishing point, and the competing growth of harmless germs soon destroys the harmful ones.

There is one further danger as regards water supply, which is especially likely in the dry districts of the Central Division. A hush camp is not uncommonly made around a waterhole, and unless care is taken as to where the natives deposit their excreta, they are not unlikely to deposit it in the neighbourhood of the waterhole. It is quite possible that the next shower of rain will dissolve out and sweep much of this excreta into the waterhole. The remedies are obvious. The camp should be made below the waterhole, or care taken to see that the natives do not deposit their fæcal excreta where it can possibly he carried into the waterhole. Such waterholes not unusually occur in the beds of small streams. It is safer not to use such natural water-boles, but to dig another hole not far off and out of the line of the stream. This hole will then become filled by filtration through the ground ; and, when the stream first begins to flow again, there will be no chance of offensive matter being washed into the hole from which water is drawn. Another plan, sometimes easier to carry out, is to protect the naturally occurring waterhole from water coming down the stream bed, and to dig a channel around the waterhole for any drainage which may trickle down the stream bed.

It there is any doubt at all about the water supply it should always he boiled before being drunk, and a very good way of making certain that water has been boiled is to drink it in the form of tea. Care should also he taken in the matter of water which is used to clean the teeth, to wash eating or drinking utensils, or to wash fruit which is going to be eaten uncooked.

It has already been explained that the prevention of dysentery consists in preventing fæcal matter from contaminating food, drink

and dust. 1 have already described the various ways in which the water supply may become dangerous by contamination with faecal material, and will now go on to describe how food and dust may become contaminated.

Fcecal material may be deposited on the ground and get into food, drink and dust in various ways, it may be blown as dust direct into peoples’ mouths or noses, it may be blown on to food or drink, or on to the roof, whence it finds rts way into water-tanks. It is clear, therefore, that food and drink should be protected from dust. Cooking or boiling food removes any danger on this account, apart from the possibility of dust getting on to the food after it has been cooked.

Flies habitually breed in and live on all kinds of filth and faecal material. It has been abundantly proved that the flies in so doing may become contaminated with dysentery and other, dangerous germs. If such flies then get on to food, or drown themselves in milk or tea, the germs may be carried on to the food or drink, and dysentery may result from the eating of such food or drink. Hence it is important to keep Hies away from all food and drink, including fruit or vegetables which are to be eaten uncooked, and food after it has been cooked.

Another medium by which food may become contaminated with faecal matter is the fingers. An attendant on a dysentery case can hardly avoid getting his fingers occasionally soiled with some of the dicharges and some of the living germs derived from the patient. Such an accident is quite harmless if the attendant washes his hands immediately after, but, ii he does not, he may convey such germs to food eaten by himself or by other people. The fingers may also be contaminated by digging about in ground, e.g., digging for sweet potatoes, which has been defecated on, or which has been contaminated by water draining out of latrines.

The prevention of infection from these sources is by washing the hands after attending to a dysenteric patient, or after having touched anything in his immediate neighbourhood, by washing the hands before eating or preparing food for others, and washing after the hands have become soiled with earth or dirt. Infection from these sources is more likely to take place in the case of young children, who defecate anywhere, crawl about everywhere, rub their hands on all sorts of ground, and are always putting their fingers in their mouths.

Another very unfortunate and important factor in the spread of such diseases as dysentery, typhoid fever and cholera, is that an individual can carry these germs about with him in his inside without being himself at all ill. The individual himself is immune, although his intestine may be swarming with germs highly dangerous to many other people. Hence it is not enough to take the above precautions with regard to people known to he sfick. Similar precautions must be taken even in the case of people apparently well. In short, the prevention of dysentery reduces itself down to cleanliness and the proper disposal of fecal excreta.

The methods of faecal disposal are very numerous. The various methods will be briefly indicated here, and one or two common in this country will be described in rather more detail.

The best and most satisfactory way of disposing of facal excreta is by a water-closet with a proper drainage and sewerage system. This is practically an impossibility as a rule in Papua.

Another system of disposing of faecal material is by using buckets, which are afterwards emptied out at sea or into deep pits or trenches. This is a satisfactory method in the absence of flies, provided t he faecal material is at once covered over with dry earth, sand or ashes, to prevent such flies as may be present from alighting on to fa'cal material and afterwards getting on to food, and if the pans are properly cleaned or tarred.

Another method of disposing of faecal material is to have it deposited direct into deep pits or latrines. This is quite satisfactory if the pits are dug deep enough (16 to 20ft.) ; and if the pits are kept well away from waterholes. The pits should be kept dark and about a cupful of kerosene poured in once a week to discourage flies and to prevent mosquitoes breeding in any water which may collect in the pits. Such pits require to he protected from surface water, otherwise they get full and overflow and contaminate all the surrounding ground. After they have been in use for a while the pits become full of spiders' webs which act as a further safeguard against flies. The use of such pits is impossible in flat country where the level of the ground water is very close to the surface.

If ordinary household refuse is kept out of such pits they practically last for ever. The solid portion of the material rapidly decomposes and disappears and the water drains away.

Another method of disposing of faecal material is to have it deposited direct into shallow pits or trenches. These are not altogether satisfactory. The faeces have to be covered at once with earth, or else flies are attracted, and this requires more supervision than is usually given to latrines in Papua, especially on plantations. Usually such pits become highly offensive and objectionable, and I am not surprised that the natives often prefer to relieve themselves anywhere rather than go into the highly-offensive latrine. Doubtless if fresh pits were dug frequently, a sufficient number being kept available and adequate supervision exercised, such pits could be made to work satisfactorily. But in practice such systems have not up to now been satisfactory in Papua. Neither this nor any other system is satisfactory if there is an offensive smell always around the latrine, and if flies are obviously attracted to the latrine, or if they breed there. Another danger of shallow pits is hookworm (agehylostomiasis) (See Section 6 of this chapter). This danger could be obviated by the use of lime.

Another method which has been used to get rid of faecal material is the septic tank method. 1 do not know of its ever having been tried in this country. The system requires supervision, and even then does not always work well on the small scale.

Another very good method of disposing of fecal material in the case of natives is for them to deposit their feces direct into the sea, or well below high-water mark. In place of the sea a fair sized stream may be used without real risk in this sparsely-populated country.

It must not he assumed that a person necessarily gets dysentery, typhoid fever or cholera merely because he or she may swallow a few million of the corresponding living germs. Such germs may be killed by the disinfecting action which goes on in a healthy stomach, or the intestine may not provide a suitable place for the particular germs to live and multiply in, or the person may be in some way immune to the evil effects which the growth of such bacteria would produce in the case of other people.

5.—Diseases due to Defective Food (Beriberi and

Sore Mouth Disease).

I have grouped beriberi and the trouble called in this country 11 sore mouth disease ” or “ New Guinea mouth disease ” together, since the essential factor in the causation of both is the same, viz., a lack of variety in a rigid ration served out to those natives who cannot supplement their ration with extras.

The deficiency may broadly be stated to be the absence of fresh vegetable food and of fresh green food. As regards the sore mouth disease the method of prevention has been given in detail in describing the treatment of the condition in Section 4 ((/) of Chapter IV, viz., by providing green vegetable food, lime-juice or fresh limes, and by restricting the use of each pannican, spoon and baubau to one individual only. Precautions as regards pannicans, spoons and baubaus only become of importance when the disease lias already begun among a group of natives owing to lack of care in the matter of providing green vegetables or limes.

Beriberi is a far more serious disease, and, now that the method of preventing it is quite well known to students of tropical medicine, it is a pity that so many cases of it are still allowed to occur. Were one-third of the rice or sago ration usually allowed to natives working in this country replaced by peas or beans, I am certain that these cases would cease to occur, the same result would be obtained if fresh vegetable food (roots or bananas) were substituted for one-third of the rice ration, in about the proportion of 2 lb. of vegetable to 4-lb. of rice or sago. The real trouble appears to he that rice is the cheapest article of food obtainable, and those who have to find the money do not like to use the expensive foods in its place (I am aware that native food is sometimes impossible to obtain and that peas or beans require proper preparation and cooking). Moreover, beriberi cases do not begin to occur until the natives have been fed on the unsatisfactory ration for two or three months, by which time, possibly, their overseer has become satisfied that the ration is all right. Further, such natives in the acute and earlier stages of the disease look perfectly healthy and well fed. it would he a great gain to the country if someone would find a variety of pea or bean which coidd be grown and sold in the country at about

the same price as rice. The extra boiling which imported dried peas or beans require, as compared with rice, unfortunately renders them unpopular with those who have to cook them, and with those who have to eat them if the cook neglects to boil them properly. The imported bean—usually called Java peas requires three hours boiling. The substitution of maize meal or wheatmeal for some of the rice would probably be beneficial, although the value of these foods as preventatives of beriberi has not been proved. There does not seem to be any advantage gained by the substitution of ordinary white flour for a portion of the rice. Apart from the actual production of cases of beriberi, I am convinced that the health of, and the work done by, natives would be appreciably increased ii more care were taken to vary their diet; and that the slight extra expense involved would be more than repaid, even if the financial side of the question only is deemed to be worthy of consideration. The ordinary ration supplied to working natives is also deficient as regards fruits and green vegetables. Oranges, limes, pawpaws, custard apples, and tomatoes, grow well in this country ; the health of native labourers on plantations would be improved if a few acres were always kept under cultivation with these, and the produce supplied to the labourers. The tomatoes become small when grown from seed raised in this country, but they are none the worse on that account. Modern research is tending more and more to show the necessity for a varied diet. In addition to the remarks made above and which appeared in the last edition of this book, the importance of a certain constituent which is usually found in green food and in the fat of animals fed on fresh green food is becoming more and more recognized. This constituent is also found very generally in the liver of fishes and to a smaller extent in many fishes apart from the liver. It is due to this constituent that cod liver oil owes its reputation for preventing and curing tuberculosis and rickets. Tomatoes are worth mentioning since they contain considerable quantities of all the three well defined vitamines as the accessory food substances are called. The vitamin last mentioned (usually called the fat soluble vitamin) is liable to be very deficient in many native dietries. Modern research is also emphasizing the value of exposure to sunlight. In absence of sunlight a greater quantity of the fat soluble vitamin is required for good health than is the case il the person is exposed to ordinary sunlight as is the case during open air exercise.

.    \ f

G.—Prevention and Treatvient of Hookworm '

{A<jc hy los to miasis)    and of ot Intestinal Worms.

A variety of worms are liable to get into the intestine of human beings, and usually do no very serious harm there. Still, if present in any numbers, they reduce the health and resisting power of the individual affected.

The microscopic eggs of many of these worms are passed with the faeces, and are liable to reinfect other, individuals by being introduced into their mouths in the same way as dysentery germs are introduced. The method of their accidental and undesired introduction into the mouth has, in the case of dysentery, been fully described in Section 4 of this chapter. The precautions which keep the dysentery germs away will also keep most of these intestinal worms away.

There is, however, another variety of worm, “ the hookworm,” quite small even when fully grown, which has a peculiar mode of entering the body, and which is generally held to be specially harmful if it exists in the body in at all large numbers. It is, moreover, so common that its method of spread and its prevention will be described in some detail. The eggs pass out of the body of the affected individual with the faeces, and in very large numbers. When supplied with warmth and moisture for a few days each egg hatches out a microscopic worm. After a few more days the young worm, or, as it is usually called, the embryo, becomes inactive (encysts) and lies in wait until a suitable individual comes along, when it passes into his body in a very curious way. If an individual with bare feet walks into mud or water containing tjhese microscopic worms, they will penetrate the skin and wander about in the body until they come to rest in the intestine. Here they do little harm for a long time, but if numbers of these worms continually enter, the individual becomes a chronic invalid and may eventually die. Treatment is now comparatively easy and it is recommended that natives receive treatment as a general rule every six months (See Paragraph 6, page 69).

The prevention of this infection (hookworm) is very simple and easy, the difficulty is to get the known methods of prevention carried out. For prevention nothing more is required than the proper disposal of all excreta in a satisfactory and sanitary manner. Everyone who knows the conditions of native life, both in the villages and on plantations, must realize how difficult a question this is. Still, much would be effected if more care and attention were paid to latrines.

Some few years ago it was shown that the condition of plantation labourers was very considerably worse than in the native villages (See Annual Report for 1914-15, page 154, et seq.), but in recent years there appears to have been a distinct improvement in this respect.

However, as in other parts of the moist tropics, the bulk of native Papuans are carriers of hookworm. It is by no means an easy matter to distinquish between the many who do carry hookworm and the few who do not without spending more time on the work than is at all possible. This being so it is recognized that in a country like Papua it is advisable to treat as many natives as possible without specially examining each one and it is this method I would advise in this country, both in the villages and in places where native labourers are employed in any numbers. The method of treatment has also been improved in the last few years.

There have been two lines of treatment recognized, based on Oil of Chenopodium and Carbon Tetrachloride respectively. Both are reasonably safe for use by laymen if instructions are carried out.

When the Hookworm Commission was in Papua a few years ago Oil of Chenopodium was the basis of treatment used. But since then

the treatment by Carbon Tretrachloride has superseded the treatment by Oil of Chenopodium. The method of treatment is recited below:—

1.    Dose.—The dose for an adult is half a dram, i.e., thirty min

ims or drops. Anyone about twelve years of age should got about half this, and anyone about six years of age a quarter. Intermediate ages about in proportion. One can safely judge the age by the apparent size or age of the patient. It is really size rather than age which counts. Thirty minims is a sale dose for any ordinary native not exceedingly small and not in obvious bad health. Very young children under about six years should not be treated. Minim measures are supplied for measuring out these very small doses.

2.    Purgative.—The medicine as sent out has a purgative incor

porated with it. Therefore no purgative is needed.

3.    Method of Administration.—The drug is most conveniently

given in a tablespoonful of water followed by a drink of water. Thus given, and if the dose is restricted to thirty minims, vomiting seldom occurs. No particular harm is done if it does.

4.    Precautions.—Persons obviously acutely ill from other dis

eases should not be treated for hookworm infection until they have recovered. Persons severely sick with chronic ailments should be treated only under the immediate direction of a physician, preferably in a hospital. \\ omen in advanced stages of pregnancy should not be treated, at all events by laymen.

A second treatment should not under any circumstances be given within three weeks of the first. The drug is inflammable and care should be taken in the matter of bringing it near a naked light, etc. It also evaporates readily if not kept securely corked or stoppered. The cork or stopper should always be put back in the bottle at once. It is said at times to cause headache, nausea or vomiting even as late as two days after. It is best given more or less on an empty stomach, e.g., in the morning, and probably it would be rather more effective if food is not given immediately after. But this does not seem to be a matter of great importance.

5.    Records and Reports.—The number of persons treated and tho

dates of treatment should be regularly recorded together with remarks on any important observations or unusual occurrences.

6.    Treatment every Six Months.—'It is suggested that treatment

be carried out once every six months.

7.    Prisoners and Crown Servants.—In the case of prisoners and

Crown servants it is suggested that a first treatment be given on committal or when the natives begin to work and that

they he afterwards treated soon after the day on which the six-monthly stores are received. Any natives treated during the previous two or three months need not be treated again. However, no harm will be done if a second treatment is given at a shorter interval provided a month elapses between the two treatments.

8. Native Labourers.—In the case of plantation and mining centres it is suggested that all new arrivals be treated and . that two dates be selected, six months apart, and that on these dates every native on the plantation or mining centre be treated unless he has been treated within the previous two or three months. No harm will be done if a second treatment is given at a shorter interval, provided a month elapses between the two treatments.

7.—Infectious Diseases in    Na

In the course of a report on a recent epidemic the Chief Medical Officer made the following suggestions, and His Excellency the Lieutenant-Governor has directed that they be circulated for the information and attention of all officers who have control of villages:—

“ During the course of this epidemic 1 have carefully considered the action which should be taken in native villages when epidemics occur or threaten. I do not think it possible to lay down a series of hard-and-fast rules which must be observed on all occasions—some consideration lias always to be given to special local circumstances—but I have considered that the following suggestions would he a guide to Magistrates and Patrol Officers in dealing with such epidemics and would recommend that they be circulated amongst them. More particularly, I would emphasize the importance of gradually educating the natives and the Village Constables up to a knowledge of the general principles which have to be observed in the matter of dealing with epidemics. I can assert from my own experience that this is by no means an impossible feat. Moreover, the Village Constables should be encouraged to act upon their own initiative ; and if their reasonable orders are not obeyed, disobedience should be punished, if possible. It is more especially at the very beginning of an epidemic when no European officer is present that prompt action may make all the difference. Moreover, I know of more than one instance where prompt action by a Village Constable has served to prevent the spread of an infectious disease.

1. If possible, everyone from an infected house, i.e., a house in which one or more of the inhabitants are sick with an infectious disease, should he sent to live in their garden houses, fishing shelters, hunting shelters or similar places ; but care must be taken that the sick people have someone to look after them.

*2. Before the inhabitants depart, the house should, if possible, be washed out by the inhabitants without the assistance of other inhabitants of the village.

3.    The house is then to be shut up, no one is to enter it and, when the sick have fully recovered, the house is to be again washed out by the inhabitants.

4.    In presence of an epidemic, no one is to enter any house (not being the house he is living in) except fora necessary purpose.

5.    No one is to enter a house where there is a case of infectious disease except such people as are living there permanently.

6.    \\ hether the inhabitants of an infected house remain in the village or whether they go to a garden or other house as recommended under Paragraph 1, the actual patients and one or two attendants should if possible live in a partitioned-off portion of the house (unless it is possible to put the sick and attendants in a house by themselves and other occupants of the originally infected house in another house by themselves).

7.    No one from a house where there is a case of infectious disease is to enter any other house for any purpose whatever. There is no objection to them walking about the village for necessary purposes or going to their gardens; but they must not accompany other people on canoes.

8.    If visitors are in a house when a case of infectious disease occurs, they must not return to their own houses, but must either continue to live in the same house or accompany the people they are visiting to the garden or other similar houses (fishing shelters, hunting shelters, etc.).

9.    No one from a house in which there is a case of infectious disease must visit another village or go away from the lands occupied by his own village people.

10.    In presence of an epidemic, no one is to go away from the lands of his own village except for a necessary purpose and is for no purpose whatever to enter any house outside the boundary of his own village lands.

11.    No child from a house where there is a case of infectious disease shall be sent to school.

12.    In presence of an epidemic, no school is to be held and no dances held.

13.    A house where there is a case of infectious disease should be washed out once or even twice a day. (This is more especially important in cases of dysentery and particularly when children are affected.)

11. Individuals living in houses where there are cases of infectious disease (especially dysentery) should wash at least once a day.

15.    Attendants on sick cases of an infectious nature should wash their hands after attending on the sick, before meals, before getting water, and before going to sleep at night.

16.    In the presence of an epidemic of dysentery, especial

care should be taken to see that the waterholes are protected from surface water and that the defecation ground is to leeward of the village, especially if it is dusty and if wind is to be expected regularly in a particular direction.    .

17.    It would be a great safeguard if a house for sick natives was built a hundred yards or more from the village and if sick cases were put there.

18.    In cases of chronic cough, natives should be cautioned as to the danger of spitting on the floor inside houses.

19.    In presence of an actual or threatened epidemic the Village Constable should remain and take charge of the village and, if it is necessary to communicate with a Magistrate, should send a reliable messenger rather than go himself to the Magistrate and let the village take care of itself. Such messenger must enter no house outside his own and not stay in any other village or native encampment and not smoke with or come into intimate contact with other natives.

20.    If it does appear that an epidemic is prevalent in any particular district, neither the Magistrate nor anyone acting for him should enter the infected district unless he is prepared to stay there till the epidemic is over. The same of course applies to all police and Magistrates’ messengers.

21.    I am aware that it is impossible to expect Magistrates to accurately diagnose cases, still, the following table, indicating the longest incubation period likely to be met with and the length of time it would usually be necessary for laymen to isolate sick cases, may be of use :—

Disease.

Time of Isolation of Intimate Contacts.

Time of Isolation of Patient.

* Influenza ...

Not more than a few days

A few days after recovery.

Diphtheria ...

Seven days ... ...

For three weeks after recovery.

Scarlet Fever ...

Seven days ... ...

For six weeks after appearance of rash and as long as any nasal discharge continues.

It is not usually practicable to isolate for influenza. Diphtheria, scarlet fever, smallpox and clilorea are not likely to occur in Papua in extensive epidemics.

Disease.

Time of Isolation of Intimate Contacts.

Time of Isolation of Patient.

Whooping Cough

Fifteen days ... ...

Till all cough ceases.

Measles ...

Twenty-one days ...

Twenty-one days from first appear-

Small-pox ...

Twenty-one days ...

ance of rash proyided recovery has taken place.

Until all scabs come off.

German Measles

Twenty-one davs ...

Twenty-one days from first appear-

Dysentery, Typhoid, and Cholera ...

Fourteen days ...

ance of rash prov ided recovery has taken place.

Fourteen days after recovery.

Chicken-pox ...

Twenty-one days ...

Till all scabs separate.

Mumps ...

Twenty-six days ...

Twenty-one days from onset.

As before mentioned the above rules are not meant to be invariable and to be rigidly followed in every instance—in some instances some of them may be quite impossible; but they are intended as a guide to Government officers, and, perhaps, to missionaries who may have influence in a village. When an epidemic does occur, or when one threatens, anyone with influence in a village should go through the rules and decide on a general policy throughout the epidemic ; also as to those he will try to enforce, and those he considers impracticable or unnecessary in the special case of the epidemic. More particularly 1 would urge on Government officers to carefully explain methods of prevention of infectious disease to village police and the more intelligent natives. This is by no means an impossible task. The more intelligent natives very readily grasp the ideas which underlie the prevention of disease, and are generally quite anxious to carry the ideas out in practice whenever serious sickness threatens. 1 have, moreover, known several cases where prompt action by a Village Constable has served to cut short epidemics at the very beginning ; and l have known other cases where the Village Constable gave the requisite orders, but where neglect of such orders by one or two self-willed families led to the spread of disease in the village. Unfortunately it is very difficult to punish breaches of such orders ; whenever possible it should he done. It is more especially at the very beginning of an epidemic, when the village policeman has to rely on himself only, that prompt action is likely to he most effective in the matter of stopping an epidemic.

In the case of dysentery, all faecal matter should he buried, unless it can be disposed of in the sea or a large river." "

Influenza.—Since the handbook was written in 1917, Papua like every other country in the world has suffered from epidemics of an influenzal character. The country should now he sufficiently immune to influenza to escape severe types of epidemics for many years —at least one may so hope. It is a disease which spreads so readily that— as the whole world has recently found very little can he done to limit 5 the spread of it. II measures of quarantine are taken they must he of the most thorough nature to prevent infection and as such amount pretty well to the paralysing of all intercourse and business or work of any kind in the districts threatened. It is easy to specify how to prevent the epidemic spreading—viz., to let no one from a district suffering from the epidemic in any way come into intimate contact with anyone from a healthy district; but in practice such attempts usually fail. However, 1 know of one small plantation which escaped completely while an epidemic was raging in the districts around. It is fortunate that influenza is usually only a relatively mild complaint. But it is liable to be followed by lung affections so that the percentage mortality of the population has in many districts approached two and a-half per cent. There is little to be done for actual cases in the way of drug treatment. A purgative, e.g., a dose of salts is beneficial at the beginning of the attack ; and Quinine is at least useful in that it prevents malaria. In common with at least a fair proportion of other medical men, I believe that it has some beneficial influence on the influenza itself. It is the drug to be used ii any is. Influenza is of course a “fever" although quite distinct from malarial fever. As such, the general lines of “fever” treatment should be carried out (See page 37). But the matter of prime importance is that the patients both while really sick and when getting better should be kept out of the cold and wet. This is a matter of great difficulty in the case of natives. When they suffer from malaria they go and bathe or lie out in the cool with apparently little or no harm ensuing—often perhaps with benefit. When they are affected with influenza the symptoms from their point of view are sufficiently similar for them to carry out the same treatment; but with disastrous results. This quite likely has far more to do with the susceptibility of native races to lung troubles than has the lower resistance of such natives to these troubles, and accounts for the high mortality (2 A percent.) in some districts in Papua due to pulmonary troubles following on the influenza. The great thing therefore is to persuade the native to keep out of the cold and wet until recovery is fairly complete. One difficulty which may occur is that the native has no one to fetch him food from the distant gardens; and that if he does not risk the cold and wet he may starve. During an epidemic the native, especially the native women, should always be cautioned not to take young children out to the gardens and into the cold and wet until they have fully recovered. This again I know may not always be quite easy to have carried out. It may be necessary to go to the gardens for food and there may be no one to look after the young children at home.

8.—Prevention of Ulcers.

Both in the tropics and in more temperate climates the skin is liable to many kinds of trouble leading to “ a breach of the surface," as it may be called. In temperate climates the tendency of all such troubles (minor cuts, other small injuries accompanied by removal of skin, boils and small superficial abscesses) is to heal up. In the tropics

TREATMENT AND PREVENTION OF DISEASE IN PAPUA.

75


the tendency is often for such troubles to go on spreading until chronic ulcers result. Such troubles are especially likely to occur amongst natives who commonly walk about in rough country without boots, and who sutler from all kinds of injuries through their feet and legs being pierced by thorns and sharp sticks, bruised by stones, plastered with mud, and attacked with leeches and scrub itch. Moreover, such injuries on the feet and legs are just those which are likely to heal up with greatest difficulty, because of the mud and dirt with which they are continually being brought in contact. Such injuries tend to become chronic in this country mainly because they are continually being irritated by sweat, and the dirt which sweat carries into them.

Prevention of ulcers consists essentially in keeping the skin clean, and treating carefully every trivial injury or affection of the skin, where the skin is pierced or removed, as soon as the trouble begins. No such injury should be thought so trivial in the tropics as not to merit some care and attention. The requisite treatment is fully described in Section 1 (b) of Chapter IV.

In the case of natives it is also of some importance to see that they are properly fed. If the body is ill-nourished, or if the food is deficient in any respect, wounds and ulcers will not heal up readily. The manner in which native rations are most likely to be deficient has already been described in Section 5 of this chapter.

THE MEDICAL LAWS OF THE COUNTRY.6

1.Quarantine.

Before any boat from any place outside the Territory of Papua is allowed to land passengers or cargo, or to communicate in any way with the shore, a Quarantine Officer has to go on board and assure himself that there is no likelihood of the boat, its passengers or its cargo bringing into the country certain diseases, which it is feared might cause considerable trouble if they were once introduced and not kept fully under control.

Such disease are smallpox, cholera, plague, yellow fever and measles-There are also very special powers for dealing with these diseases should they ever occur on shore, and the use of such special powers be deemed necessary.

Oversea boats are obliged to fly the special quarantine flag, or to hoist the quarantine lights, until the Quarantine Officer has assured himself that there is no danger. Anyone boarding a vessel with the quarantine signal hoisted, or in any way communicating with such a vessel, is liable to very severe penalties.

2.—Health Ordinance.

As far as the public are concerned, Part V of this Ordinance, dealing with insanitary conditions and their removal, is the more important part of the Ordinance, if the Health Officer (or Sanitary Board) is satisfied that any condition exists which, in the opinion of such Health Officer, is an insanitary condition, and if the Health Officer is satisfied that it is proper so to do, such Plealth Officer may serve a notice requiring the responsible party to remove or amend the insanitary condition. There is a penalty of Twenty pounds (£20), for disobedience ot the notice, and the Health Officer may then arrange for the work to be carried out and for the responsible party to be charged for the same.

The most likely insanitary conditions to arise are such as will give rise to the breeding of mosquitoes or flies.

Mosquitoes may breed in water-tanks which have not been rendered mosquito proof, in roof guttering which has sagged so much as to hold water, and in tins or other vessels scattered about on waste ground. Trouble with flies is most likely to arise from the keeping of horses, the depositing of rubbish and waste material on waste ground, or by burying it too near the surface.

By Section 92 ol the Health Ordinance, 1912-1924, a house must have such drains, means ol ventilation, and sanitary requirements as the Health Officer (or Sanitary Board) may prescribe. Plans and specifications have to he submitted and approved before the house can be occupied.

The provisions of Part VIII apply to certain infectious diseases, including dysentery. It such a disease occurs, anyone in charge of the sick person is hound to report such disease to the Chief Health Officer at Port Moresby. Notification to any Health Officer is usually accepted as sufficient and, in the case of native labourers, the notification to the Magistrate, which is required under the Native Labour Regulations, is usually accepted as sufficient.

Anyone suffering from, or not completely recovered from, one of these infectious diseases may not expose himself in a public place without taking reasonable precautions to prevent danger to others. There is also power for the Health Officer to compulsorily remove and to detain anyone suffering from one of these infectious diseases under certain circumstances.

3.—Native Labour Regulations.

{Native Labour Ordinance, 1911-1920.)

The employer, or his European employee, is called upon to inspect the premises of his natives daily if he employs more than ten natives. The employer must also provide suitable latrine accommodation ; and, if he employs many natives, a hospital for the accommodation of sick natives. He must also supply liis native employees with a suitable dwelling and with a blanket.

At the main centres of European population the Government provides native hospitals. Native labourers are admitted to these. There is also power for a Government officer to order that a native labourer be sent to one of these (Regulation No. 16). The employer pays a fee of from Is. to 2s. per day for any of his employees while in hospital until the time when his agreement with such native expires (Regulations Nos. 17-21). The employer is also compelled to keep a few simple drugs if he employs more than ten natives (Regulation No. 22).

The employer is also bound to supply his native labourers with sufficient and with properly prepared food (Regulations Nos. 23-25 and Section 47 of the Native Labour Ordinance, 1911-1920. Minimum ration scales are prescribed, hut any employer who wishes to keep his employees in good health and to get the best work possible out of them will be liberal in the matter of diet, and will not keep rigidly to the minimum enforceable by law.

There are also numerous regulations dealing with infectious disease and with dysentery in particular. These regulations have been made, for the most part, during times of special anxiety as regards dysentery, and have not so far been rearranged. Consequently it is a little difficult to grasp them as a whole. The fundamental regulation is No. 48 which enacts that whenever a case of dysentery occurs amongst native labour-era, the labourers’ quarters shall become an infected centre, and shall remain so for two months after the last case has recovered. All natives irom such quarters have to be taken to a Government Medical Officer before they can be taken elsewhere in the Territory (Regulation No. 49). The medical officer has wide discretionary powers as regards detaining them, and as regards letting them depart to other parts of the Territory (Regulations Nos. 50-53).

By Regulation No. 54, every case of dysentery which occurs amongst native labourers must be reported to the nearest Magistrate, and the employer is bound to either properly isolate and treat the sick, or else to send them to a Government hospital and to see that no undue risk of the disease being transmitted to others is taken on the way (Regulation No. 55). Disobedience on the part of the native is also punishable (Regulation No. 56). There are also provisions for seeing that blankets, bedding and ramis are kept clean (Regulations Nos. 57 and 58).

It should be noticed that in the regulations the term employer includes any agent of the employer and anyone who has charge of native labourers before or after they are signed off.

Regulations Nos. 32-40 also place further restrictions on natives who come from any place where there has been dysentery. More particularly, the master of a vessel on which a case of dysentery occurs or which has received natives from any native labourers’ quarters where there has been dysentery (Regulation No. 33), must at once take the native labourers to a Government Medical Officer. The medical officer has wide discretionary powers of isolation and detention, and the employer is liable for the housing and feeding of such natives.

Regulations Nos. 40-45 enacts that the employer must, in specially proclaimed areas, get a permit from a medical officer before he removes any native labourers or time-expired native labourers to any other place. The employer is also bound to supply the medical officer with such information as may be required for him to determine whether such permit can properly be granted. The medical officer may also grant the permit subject to the employer undertaking to observe such reasonable precautions as he may think advisable.

Regulation No. 46 enacts that an employer may forbid natives to visit places if there is reasonable grounds for believing that they might contract dysentery by so doing. If there is dysentery amongst his labourers an employer may order other natives not to visit his labourers’ quarters (Regulation No. 47).

4.— Regulations Dealing with Native Matters.

(The Native Regulation Ordinance of 1908.)

Regulation No. 91 deals with venereal disease. It is enacted that if a native has venereal disease he is bound to report to a Village Constable, who is then bound to take him to a Magistrate. In the meantime the native must refrain from spreading the disease. The Magistrate can order detention. A breach of any part of the regulation is punishable.

Generally speaking the sick native is sent to a medical officer if one is available, if one is not available the Magistrate treats the native to the best oi his knowledge and resources until a cure is effected or until an opportunity occurs to send him to a medical man. Unless a Magistrate has special knowledge and training as regards treating these cases, he should send them to a medical officer at the first reasonable opportunity.

Regulation No. 90 provides for the keeping of villages and waterholes clean, and for a space of fifty feet being kept clean around the village.

Regulation No. 92 enacts that when sickness occurs, the Village Constable may order removal to a place of isolation. A Magistrate may also fordid communication between a house where there is sickness and other houses. This regulation is of course only intended to be applied in the case of infectious disease. When infectious disease (dysentery for example) occurs the Village Constable should, as far as possible, keep the people from communicating with houses where the disease is. An amendment of this regulation, made in Executive Council on 15th March, 1911, places special restrictions on natives entering Port Moresby if there is dysentery either at Port Moresby or the place from which the natives came.

By Regulation No. 92 (8) (9), a Magistrate (subject to the concurrence of a medical officer if one is available) may forbid or restrict communication between one native village and another, between a village and a township, and between villages and canoes, for the purpose of preventing the spread of infectious disease. In the absence of a Magistrate a Village Constable should use his influence with the same end in view.

5.—Communicable Diseases Occurring on, Boats.

When such diseases occur on board any boat a Quarantine Officer has certain special powers irrespective of whether the boat is an oversea boat or otherwise.

Under Section 21 of the Quarantine Ordinance, 1913-1922, the master of any boat is bound to hoist the quarantine signal, *' not only when a case of quarantinable disease* occurs on board, but also when any eruptive disease occurs. Eruptive disease would include chickenpox, German measles and scarlet fever. The master of such a boat is also required to keep the quarantine flag hoisted until a Quarantine Officer gives him permission to take it down ; and, in the meantime, to refrain from communication with the shore.

Under Section 36 of the Ordinance a Quarantine Officer may if he thinks it necessary order the disinfection of a boat or any part of it on which a case of communicable disease has occurred ; and he may order the removal to a quarantine station of anyone suffering from such disease.

' The Quarantine signal is given in Statutory Rules No. 1 of 1023, made under the Quarantine Ordinance. 1913-192*2. In absence of the proper flags any yellow flag could he used.

1 In addition to the quarantinable diseases plague, cholera, typhus and yellow fever mentioned in the Quarantine Ordinance, 1913-19*22, the following diseases has been proclaimed as Quarantinable in Papua, viz., measles, German measles, Spanish influenza and diphtheria.

MISCELLANEOUS.


1.— Weights and Measures.



1 dram 1 ounce 1 pound


Fluid Measure.


GO minims 8 Huid drams


1 fluid dram (often written “ 1 dram ”)

1 fluid ounce (often written 1 ounce j


20 ounces    ...    ...    1 pint

480 minims    ...    ...    1 fluid ounce

1 cubic foot of water equals 1,000 fluid ounces or Gi gallons.


Domestic Measure.



1    fluid dram (approximately)

2    fluid drams    ,,

4 fluid drams

or Lounce    „

i-pint    ,,


It is better to measure out medicines in proper medicine glasses; spoons often differ appreciably in size.


2.—Doses for Children.


Children do not require as much medicine as adults ; and disasters may occur if powerful medicines, e.g., Easton’s Syrup and Opium preparations, are given to them in anything like the same doses as are given to adults with safety.


The following table will give an indication as to the proportional doses of drugs which can usually be given to children, with reasonable safety:—


Child of 1G years requires two-thirds of


J J

12

> >

if

6

i >

» >

4

» i

f i

3

y i


an adult dose.


one-half one-third one-quarter one-sixth

Child of 2 years requires one-eighth of an adult dose.

„    1 year or less one-twelfth    „    ,,

Nevertheless, children under one year can he given up to two teaspoonfuls of Castor Oil or one dram of Epsom Salts for dysentery, or one grain of Quinine for malaria.

APPENDIX.

('inchona Febrifuge.

In place of Quinine, a preparation (Cinchona Febrifuge) is coming into use. It is composed of the total crystallizable alkaloids of the Cinchona bark. As such it consists very largely of Quinine. In Cinchona Febrifuge the Quinine is mixed with the other alkaloids. These other alkaloids have a precisely similar action on malaria to that of Quinine itself. In fact, one of them in some cases appears to act rather better than Quinine itself. For all ordinary practical purposes the Cinchona Febrifuge can he considered as good as Quinine: it is much cheaper, it is made up into tablets just like Quinine and is used in just the same way. The tablets are dark coloured. Its cheapness renders it particularly valuable for use on the large scale for natives; hut there is no reason why Europeans should not use it also. I am using it myself at the present time. When circumstances indicate, it will he supplied in place of the Quinine tablets.

Venereal Disease.

Circular by Chief Medical Officer dated 11th October, 1923 :—

“ l. In course of a letter to me a medical officer says that there seems to he much confusion in the lay mind between syphilis and yaws. 1 have come across the same confusion and am therefore taking this opportunity of stating that they are different diseases although in the later stages of the two diseases it is not always easy to he certain which it is. However, syphilis is so very rare amongst natives in the country and yaws relatively so very common that doubtful cases when they occur can, by laymen at all events, he regarded as yaws. Further, yaws ’ is not a venereal disease and should not he so classed. It is not ordinarily speaking transmitted by sexual intercourse although like smallpox, measles, influenza, mumps, etc., it may on occasion he so transmitted.

2. A sore or swelling in the genital region is not necessarily * venereal disease nor is every discharge, even if opaque, necessarily so. But a Magistrate is I think justified, if he is prepared to do so, in treating such cases himself for a while as such ; and if they do not clear up in a few weeks in sending them to a doctor. If a doctor is available the Magistrate would also I think he justified in sending such cases to a doctor without preliminary treatment, hut I do not think he would be justified in expecting a medical officer

TREATMENT AND PREVENTION OF DISEASE IN PAPUA.

So


or assistant to disarrange his plans and wait for such cases. Unless arrangements are previously made with a travelling officer, cases should be sent only to the permanent native hospitals at Port Moresby, Samarai and the Trobriand Islands. The time of travelling medical officers and of medical assistants is too valuable for them to sit down and watch a couple or so of gonorrhoea cases for six or seven weeks while they gradually clear up, and, in the absence of a medical officer or a European assistant, such cases are best on a Magisterial station.

3. No case is properly called venereal unless it is a case of an infective disease commonly transmitted as a direct result of sexual intercourse. It is usually impossible for a layman to be certain on this point so care should he taken in making public such a diagnosis. In ordinary cases I suppose there is little harm done if a native is accused of having venereal disease—and presumably therefore either himself or his wife guilty of immorality—but in mission cases as well as others this may not always be so. In European countries such accusations have led to libel actions and heavy damages.”

ADDITIONAL.

List of    Ordinances, Regulations or

Restricting or Amending the Contents of this Book.

INDEX.

3

14

Cinchona Febrifuge ... ...

82

required in Papua ...

1

Chenopodium Oil ... ...

11

requisitioning for, rules

Children, doses for ... ...

80

to be observed by

Quinine tablets for ...

3

Government officers

Opium not advisable for

3

when ... ...

13

Chlorodyne. See Compound Tincture of Chloroform and Mor

Schedule A, for Magisterial Outstations ...

14

phine.

Clirysarobin ... ... ...

35

Schedule B, for Government Plantations,

Chrysophanic Acid and Ointment

36

etc. ... ...

16


PAGK

Abscess    ...    ...    ...    ‘2*2

Adhesive Plaster    ...    ...    9

Agchylostomiasis    ...    ...    67

prevention of ...    67

Alcohol, the taking of, in the tropics    ...    ...    ...    54

Ankylostomiasis. See Agchylostomiasis.

Arrow Wounds    ...    ...    29

Bacillary Dysentery    ...    ...    42

Bandages    ...    ...    ...    9

Basins, Enamel    ...    ...    9

Beriberi    ...    ...    ...    46

prevention of...    ...    66

treatment of    ...    ...    48

Bites, centipede    ...    ...    29

leech    ...    ...    ...    21

snake    ...    ...    ...    28

Blackwater Fever    ...    ...    41

Bleeding (serious)    ...    ...    25

Bluestone. See Copper Sulphate.

Boats, quarantine of over-sea ...    76

communicable disease on

board    ...    ...    79

Boils    ...    ...    ...    22

Boric Acid lotion    ...    ...    6

powder    ...    ...    6

tablets    ...    ...    6

ointment    ...    ...    6

Borofax    ...    ...    ...    6

Bottles    ...    ...    ...    10

Boxes, pill    ...    ...    ...    10

patrol, for medicines ...    17

Brushes, paint    ...    ...    8

Bugs, a possible source of disease 57 Bullet Wounds    ...    ...    29

Burns    ...    ...    ...    23

Calomel. See Quinine and Rhubarb tablets.

Carbon Tretrachloride    ...    ...    11

Cascara Sagrada tablets    ...    4

Cassia Alata ...    ...    ...    36

Centipede Bites    ...    ...    29

Clinical Thermometer ...    ...

method of using..

Cold, a cause of    sickness    ..

Colds    ...    ...    ..

Compound Iodoform Powder ..

Ipecacuanha Powder See Dover’s Powder tablets.

Tincture of Benzoin... Tincture of Chloroform and Morphine Concentrated Cough Mixture Constipation ...    ...

Copper Sulphate    ...

crystals    ..

lotion...    ..

powder. See Lo tion.

Corks    ...    ...

Corrosive Sublimate lotion

tablets

Cotton Wool ...    ...

compressed for patrol Cough Mixture Coughs    ...

Crude Disinfectant Cuts    ...

Defecation Tins Defective Food, diseases due to Diarrhoea    ...

Disinfectants, crude Dislocations ...

Dissecting Forceps Domestic Measure Doses for Children Dover’s Powder tablets Dram Dredgers

Dressings (see also Drugs) Droppers, Medicine ...

Drugs, brief descriptoin anc method of using list of, for outstations

PAGK.

10

37

57

30

6


8

8

31

9

9


10

5

5

9

9

8

30

I    I 18

II 66 32 11 26 10 80 80

8

SO

10

9

10


Drugs, Schedule C, for Patrol

PAGE

16

Dust, a source of infection

• • •

56

Dusting Powders ...

• • •

6

Dwellings. See Houses. Dvsenterv, bacillary ...

42

exceptional cases of...

46

prevention of

• . •

62

treatment of

43

tins ...

• • •

11

Easton’s Syrup ...

...

8

Epidemics in native villages

...

70

Epsom Salts ... ...

• • •

9

Excreta, disposal of ... Exercise, lack of, a cause of

ill-

65

health ... ...

...

55

Eyes, sore ... ...

. . .

34

Fever ... ...

• • •

37

Black water ... See Malarial Fever.

...

41

Firearms, wounds due to

...

29

Fleas, a source of disease

...

57

Flies, a source of dysentery

...

64

infection

. • •

56

Food, in relation to health

• • •

53

a source of infection

...

56

Forceps, dissecting ...

...

10

Fracture ... ...

...

26

Friar’s Balsam (See also Com

pound Tincture of Benzoin)

r7

i

Ginger, Tincture of ...

...

8

Glass measures ...

...

10

syringes ...

...

10

Gonorrhoea ... ...

...

50

pills ...

. . »

9

Headache ... ... Health, maintenance of in

the

33

tropics ... ...

...

53

Health Ordinance and Regulations

53

Heat, avoidance of excessive,

on

the head ... ...

...

54

Hookworm Drugs ...

...

11

Houses in the tropics ...

• • •

54

Infection, introduction of disease

into body ...

...

55

Infectious Diseases in native

vii-

lages ... ...

,,,

70

Injuries due to arrows ...

...

29

bullets ...

...

29

crocodiles

...

29

firearms

. . .

29

pigs ...

»»»

29

sisal hemp

• . .

29

spears ...

...

29

minor ...

...

18

serious ...

...

24

Instruments. See Drugs. Introduction ... ...

1

of disease into

the

body

...

55

Insects, carriers of disease

...

57

Iodine, Tincture of ...

7

Iodoform, Compound Powder

of

6


PAGE

Iodoform, Compound, for treating


ulcers    ...    ...    ...    19

Isolation, time required in infective disease    ...    ...    72

Itch, Scrub    ...    ...    ...    21

Latrines    ...    ...    ...    65, G8

Laudanum. See Opium and Tincture of Opium.

Laws and Ordinances ...    ...    76

Leech Bites    ...    ...    ...    *21

Levu. See Skin Disease.

Lice, a possible source of disease... 57 Liniments    ...    ...    ...    7

Lint    ...    ...    ...    9

compressed for patrol    ...    9

Liquid Medicines ...    ...    8

Livingstone Housers, tablets.    See

Quinine and Rhubarb    tab

lets.

Lotions    ...    ...    ...    4

Lvsol    ...    ...    ...    4

Lotion    ...    ...    ...    4

Substitutes    ...    ...    4

Malaria. See Malarial Fever.

Malarial Fever, chronic.    See

Malarial Cachexia.

Malarial Cachexia    ...    ...    40

Fever    ...    ...    39

prevention of ...    57

prevention of, by

Quinine ...    61

treatment of ...    39

Malingering ...    ...    ...    37

Materia Medica    ...    ...    3

Measures, domestic    ...    ...    80

glass    ...    ...    10

Weights and    ...    80

Medical Troubles, minor    ...    30

more serious...    37

Medicine Cases for patrol    ...    11

Droppers    ...    ...    10

Medicines, liquid    ...    ...    8

Mental relaxation, need for ...    55

Mercury Percliloride. See Corrosive Sublimate.

Milk, a source of infection ...    56

Minor Injuries    ...    ...    IS

Medical troubles    ...    30

Mixtures. See Medicine, liquid. Mosquitoes, prevention of ...    57

and malaria    ...    57

Mouth Disease, prevention of ...    66

treatment of ...    49

Native Labour Regulations, medical    ...    ...    77

Villages, prevention of epidemics ...    70

Health Regulations under Native Regulation Ordinance of 1908    78

PAGE


PAGE


Ointments ...    ...    ...    0

Boric Acid ...    ...    6

Carbolic ...    ...    6

Chrvsophanic    ...    85

Tins    ...    ...    10

Zinc    ...    ...    6

Opium, not advisable    for children    3

tablets    ...    ...    3

Ordinance, medical    ...    ...    70

Ounce    ...    ...    ...    80

Pain, treatment of    ...    ...    24

Paint Brushes    ...    ...    8

Patrol Cases    ...    ...    11

Patrol, list of drugs for    ...    16

Perchloride of Mercury. See Corrosive Sublimate.

Phenacetin Compound tablets ...    4

Pill Boxes ...    ...    ...    10

Potossium Chlorate tablets ...    4

Permanganate Lotion    5

tablets    5

Poultices not advisable    ...    22

Powder, Boric Acid    ...    ...    6

Compound Iodoform ...    0

disinfecting    ...    ...    11

sprinkler    ... ,    ...    10

Preface ...    ...    ...    3

Prevention of disease (See under

the special disease)    ...    53

Prevention of mosquitoes ...    57

Quarantine, oversea    ...    ...    70

boats in general ...    79

Quinine and Rhubarb tablets ...    4

Cinchona Febrifuge a substitute for ... doses for children ...    3

method of taking ...    39

mixture    ...    ...    8

for preventing malaria...    01

for treating malaria ...    39

tablets    ...    ...    3

for children    ...    ...    3

Regulations, medical, native labour ...    ...    ...    77

Regulations, medical, native ...    78

Requisitioning for drugs    ...    13

Resorcin, Tinct. Co.    ...    ...    8

Rhubarb. See Livingstone Rou-ser tablets.

Ringworm ...    ...    ...    35

Rules to be observed by Government officers when Requisitioning for Drugs ...    ...    13

Salts, Epsom...    ...    ...    9

Schedule of Drugs, A    ...    ...    14

B    ...    ...    10

C    ...    ...    10

Serious injuries    ...    ...    24

. medical troubles    ...    37

Scissors ...    ...    ...    10

Scorpion stings    ...    ...    29

Scrub Itch ...    ...    ...    21

Scurvy, prevention of ...    ...    00

treatment of ...    ...    49

Serious bleeding ...    ...    25

injuries    ...    ...    24

Sickness. See Vomiting.

Sipoma. See Skin Disease.

Sisal Hemp, injuries by    ...    29

Skin, infection through the ...    57

Skin Disease ...    ...    ...    35

Sleeplessness ...    ...    ...    34

Snake Bite ...    ...    ...    28

So re s. Nee Vice rs.

Sore Eyes ...    ...    ...    84

Spear Wounds    ...    ...    29

Spoons, measurement of doses by    80

Sprains ...    ...    ...    23

Sprinklers, powder ...    ...    10

Stings    ...    ...    ...    29

Strains ...    ...    ...    23

Sulphur Ointment ...    ...    0

Sunstroke ...    ...    ...    42

and the wearing of    a

helmet ...    ...    54

and the exposure    of    .

native to    ...    54

Syringes, glass    ...    ...    10

Tablets ...    ....    ...    3

Tabloids ...    ...    ...    3

Thermometers    ...    ...    10

method of using...    38

Tincture, Compound, of Benzoin.

See Friar’s Balsam.

Tincture, Compound, of Chloroform    and Morphine    ...    8

Tincture, Ginger ...    ...    8

Iodine ...    ...    7

Resorcin Co____    ...    8

Tins, defecation, for dysentery ...    11

ointment    ...    ...    10

Tonic Compound tablets    ...    4

Syrup ...    ...    ...    8

Treatment of disease and injury...    18

Turpentine Liniment ...    ...    7

Ulcers    ...    ...    ...    19

prevention of ...    ...    74

treatment of ...    ...    19

Ulcerated Mouth Disease—

prevention of ...    ...    00

treatment of ...    ...    49

Vaccination, a    preventative    of

smallpox...    ...    ...    55

Venereal Disease ...    ...    50

females    ...    51

ulcerated    ...    52

Villages,    inadvisability of camping in ...    ...    58

prevention of epidemics

in ...    ...    70

Vomiting ...    ...    ...    33

Water, a source    of    infection    ...    62

Waterholes, danger of improper...    63

Weights and Measures... ...    80

PAGE

Worms, prevention of intestinal... 07 See Agchylostomiasis.

... ...    ...    18

due to arrows, spears and

firearms ...    ...    *29

PAGE

Zinc Lotion. See Zinc Sulphate Lotion.

Sulphate Lotion ...    ...    5

tablets ...    ...    5

1926.

Port Moresby :

Edward George Baker, Government Printer.—8721/1.26.

/


■&}


1

   Minor Medical Troubles—

(a)    Coughs and Colds    ...    ...    ...    •••    •••    30

(b)    Constipation    ...    ...    ...    ...    •••    31

(c)    Diarrhoea ...    ...    ...    ...    •••    •••    32

2

(d)    Headache ...    ...    ...    ...    ...    ••*    33

(e)    Vomiting ...    ...    ...    ...    •••    ...    33

(/) Sleeplessness    ...    ...    ...    ...    ...    34

(<7) Sore Eyes ...    ...    ...    ...    ...    34

(h) Skin Disease (Ringworm) ...    ...    ...    ...    35

(1)    Malingering    ...    ...    ...    ...    ...    37

3

In place of Quinine a new preparation. Cinchona Febrifuge, will often be supplied in tablet form. It is used just the same as Quinine (See Appendix).

4

In place of Quinine Cinchona Febrifuge may be used.

5

Treatment: Purgative at first; Quinine. Keep in dry house, out of cold and wet. Little or no food and that light food ; and that strange articles of diet he not forced on the native. I Quite approve of native sago.

6

Since the previous edition of the handbook was written the formal part of some of the Quarantine and Health Regulations of the Ferri tor y have been altered and a few minor additions to the regulations and laws made ; but such have not been of sufficient importance to justify their bointf mentioned here.