The condltion a under which a Medical Officer in
the West African Medical Service carries out his
duties, are not such as permit of his performing a
detailed and prolonged investigation of disease,
unless h© happens to be stationed in one of the larger
towns, where work is more domiciliary, and where
laboratory equipment and material for investigation
are readily available, and even then medical duties
may be so exacting as to preclude any chance of
confining his attention to special work.
In the administration of the Service, Medical
Officers are appointed to districts with residence at
central stations, and sudden calls to outlying parts
are frequent, either to attend an urgent case of
illness, or to investigate an outbreak of disease,
already epidemic or liable to become so. This lack
of continuity in service was accentuated during the
war when quite one third of the staff was on Military
duties in other countries, and, with no new arrivals
to replace the vacancies caused either by death or
other factors, the work of the remaining individual
members was greatly increased, and the service was
only maintained by a general prolongation of tours
and a curtailment of furloughs.
I do not put this forward as an excuse for this
Thesis, but merely as an illustration of the difficulties under which this Service has laboured since
its inception, and of the disadvantages, which it has
overcome and is overcoming, in its mission of carrying
into the heart of West Africa the benefits of European
science.
In the smaller outlying stations, the only instrument of precis© investigation available is a microscope,
but stains deteriorate at such a rapid rate that their
use is restricted, and results obtained are often
unreliable.
During my first tour I was sent to one of these
stations in the Northern Territories of the Gold Coast,
end the microscope I found there was an excellent
instrument, but there was no suitable place to use it,
except upon the rough table in that part of the
mudhouse used as a dining room, where it was exposed
to the tornadoes of the rainy season, which came on
with startling suddenness and frequently swept the
microscope and all the surrounding impedimenta Into
the compound, and to the heat and dust storms of
the Harmaitan season, which penetrated into the barrel
of the instrument and obscured the lenses.
With the aid of Labour from the Prison, I set
about building a small laboratory of mudwalls and
thatched roof, with rough-hewn wooden benches and
shelves. A small compact soldering set was a somewhat lucky inclusion among my kit when I left England,
and with this I fashioned a rough still cut of
Kerosene tins, which provided me with abundant distilled water, more reliable than that received by
the irregular supply from headquarters. I was also
able to make a rough incubator, but the only medium I
could make was a simple broth and my supply of test
tubes was extremely limited.
For staining purposes I prepared a stain with
Methylene Blue and Eosin powders according to the
proportions used in Wright's formula, and used the
hobs of the mud stove in the kitchen for ths heating
part of the operation. With this improvised stain,
which had frequently to be dried in the sun before
making a fresh supply with Methyl alcohol, I got
better results in blood work, than with any of the
other prepared stains kept in bottles or supplied
in tablet form.
Investigation of Malaria could not go much beyond
the examination of blood slides, and one conclusion
I came to was that it was extremely difficult to find
parasites in smears from the peripheral blood, either
in the young growing forms or as crescents, even when
the subjects, from which the smears were taken, showed
all the characteristic signs and symptoms of Malarial
infection. Out of close upon two hundred and fifty
examinations made during this tour I only found
crescents in three cases.
Work under such difficulties could not be productive of much result, but it afforded infinite
pleasure in a lonely life, where one's ordinary duties
engrossed only a small portion of the day.
Laboratories are however doing good work in the
larger towns under trained observers, but they have
to depend almost entirely upon the material available
in the towns, in which they are located, and upon
occasional specimens from the more accessible of the
stations.
