90 
V. JANUARY TO JUNE. 1914 
every one of them should from time to time have fever 
with shivering fits, but children are the worst sufferers. 
As a result of this fever the spleen, as is well known, 
swells and becomes hard and painful, but with them it 
sometimes projects into the body like a hard stone from 
under the left ribs, not seldom reaching as far as the navel. 
If I place one of these children on the table to examine 
him, he instinctively covers the region of the spleen 
with his arms and hands for fear I should inadvertently 
touch the painful stone. The negro who has malaria 
is a poor, broken-down creature who is always tired and 
constantly plagued with headache, and finds even light 
work a heavy task. Chronic malaria is known to be 
always accompanied by anaemia. The drugs available 
for its treatment are arsenic and quinine, and our cook, 
our washerman, and our boy each take 7 to 8 grains 
(half a gram) of the latter twice a week. There is 
a preparation of arsenic called “ Arrhenal,” which 
enormously enhances the effect of the quinine, and I give 
it freely to white and black alike in subcutaneous 
injections. 
Among the plagues of Africa tropical dysentery must 
not be forgotten. This disease, also, is caused by a 
special kind of amoeba, which settles in the large 
intestine and injures the membrane. The pain is 
dreadful, and day and night alike, without inter- 
mission, the sufferer is constantly wanting to empty the 
bowels, and yet passes nothing but blood. Formerly 
the treatment of this dysentery, which is very common 
here, was a tedious process and not really very success- 
ful. The drug used was powdered ipecacuanha root, 
but it could seldom be administered in sufficient 
quantities to act effectively, because when taken 
