natural treatment for the disease elephantiasis

[drumming and music] [drumming] [narrator #1:] any practice of medicine and research in the tropics requires a new examination into the cause and nature of disease, and in terms of treatment, a different concept regarding the indigenous people and the application of medicine to their specific needs. more often than not, the freshly-recruited medical worker learns that he must reexamine the relations between people

and the relations to their environment that he had grown to accept as constants. the climate, in all its aspects, creates conditions often completely different from those known to the uninitiated worker. the important issue of malnutrition and its direct and indirect relationships to disease may lead him to an analysis of agricultural problems. the way of life of the indigenous people may be so foreign to him, that he must virtually become psychologist, anthropologist, and social worker. on the other hand, the prevalence of insert-borne parasitic diseases makes imperative a knowledge of the basic biological sciences.

thus, any study of tropical medicine must be prefaced by an emphasis on both the ecological nature of the region and the way of life of the people. in this instance, we will examine the practice of medicine and medical research in the republic of liberia. liberia lies in the tropic zone on the west coast of africa, stretching from a point 280 miles north of the equator to a point 650 miles north. the land level rises from the coastline to 4000 feet in the mountain foothills some 150 miles inland.

liberia has been aptly characterized as a watershed area. the annual rainfall ranges from a maximum of 200 inches along the coast to 70 inches up country. the numerous rivers and their tributaries overflow during the rainy season, when the temperature will fall to a low of 50 degrees. the annual mean maximum temperature is 86 degrees, the mean minimum is 71 degrees, and the average annual humidity is 82 percent. in the dry season when the harmattan winds redden the sky with the sands of the north african deserts,

the shade temperature rises to the high 90s. under these conditions, mycotic infections of the skin are highly prevalent. most of liberia was originally covered by tropical rain forests. large areas have been cut over to meet the needs of a primitive agriculture. yet the resultant sporadic cultivation has allowed second growth forests to repossess the land. the temperature range and high humidity are determinant factors in the development of insect vectors of disease. on the other hand, the life economy of some insect species is such an intricate complex of physiological requirements,

that any slight environmental change can upset the delicate equilibrium on which survival depends. such are the risks attending extreme specialization, as is the case with the female tsetse fly. in the reproductive cycle, the most specific of conditions are required: a permanent stream of water, a sandy bank into which she inserts the larvae, a fairly constant temperature, and a low canopy of vegetation producing nearly 100 percent humidity. in those areas of liberia where the heavy jungle growth has been replaced by commercially-productive rubber trees

with their high branches and thin foliage, the tsetse fly has disappeared. many of the people's daily functions of survival constitute mechanisms by which they are exposed to parasitic infection. a single body of water is often the village's source for fishing, bathing, and drinking. thus, they come in contact with many of the insect and snail vectors. [music] life in africa may appear to be lackadaisical to foreign eyes. much infection seems due to an absence of precaution and a lack of interest in bettering their lives,

but the land and the climate are determinant factors conditioning concepts of hygiene. life is far from easy, not to be plucked from the nearest tree. the currents keep the fish away from liberia's coast, and often a successful catch is made no closer than 80 miles off shore. the torrential rainfall in the wet season leaches the soil. the high soil temperature and the photoperiodic constancy, 12 hours night and 12 hours day, curtail the growth of most grains and vegetables that come from cooler climates. when rice and casaba are to be planted,

the heavy forest must be cut down. without fertilization, each crop of rice exhausts the already weakened soil. as it must lie fallow for six years, new jungle areas must be cleared. then, at the end of the six year period, the original plot is covered with scrub. the cycle begins anew, and the laborious cutting back of the jungle never ceases. the dearth of protein is compounded by the unsuitability

of the soil to support forage crops, and the presence of various livestock diseases, including trypanosomiasis. with arrow or gun, the hunter finds little success, or as small as the liberian population is, it has grown beyond the limit of its diminishing forests to support wild game. with this limited diet, the shortage of protein, and the mother's insufficient supply of milk, the child's defense against infection is critically impaired. tools are primitive, and no matter how greatly we may admire the skill of the metal craftsman,

long and tedious hours of labor are required to fashion the most simple implements and objects. a division of labor is obvious and clearly defined, but both sexes find the fruits of their labor minimal and uncertain. in such primitive societies, superstition exists to conjure up answers to daily and seasonal mysteries. in place of procedures born of an orderly appraisal of data, the necessary understanding of nature is absent. because there is no knowledge of the cause of disease,

the full disposal of sewage beyond the limits of water source contamination is not practiced. because rivers are everywhere accessible, wells are seldom sunk. in the unobjective terms of what is observable, conclusions have been drawn that well water is stale. in a noble attempt to relate tropical cause and effect, it is often believed that the degree of coldness of well water is the cause of colds. thus, the existence of superstition is not due to an unwillingness to learn,

and a parting with ancient ways begins when the process and the result become predictable. until generations of individuals have learned from experience, the mystical authority of the witch doctor will prevail. clay will continue to be used as both a cosmetic and a skin ointment. disease will fester in isolation until it is sought out, and no matter how friendly is the image of the friendly devil dancer, he will for some time continue to represent the equation between primitive man's lack of knowledge and nature's apparent caprice-like behavior.

against this background of primal need, research and medical organizations and agencies are at work in liberia, scraping away the surface of myth, building anew on the solid ground of need, an objective understanding of scientific process. emanating from the government of liberia, and led by its energetic president, the honorable william v.s. tubman, there exists a program of ever-increasing medical facilities and public health projects. the national public health services under the direction of dr. jay n. togba

provides and operates hospitals, dispensaries, and conducts training programs for nurses, technicians, and sanitarians. as this trained force grows, and the resultant education creates a new demand for modern medicine, an increasing number of liberian students will take up the study of medicine in the schools of europe and america. the endeavor of the national public health services is furthered through cooperation with various international agencies. in cooperation with the world health organization, they have inaugurated a campaign to eliminate malaria and yaws

and with the united states international cooperation administration, they are conducting a program of technical training, in addition to an anti-malaria campaign. among the first medical efforts in liberia were those of the various denominational missions. in the almost completely isolated villages, long before the penetration of roads, they set up their hospitals and dispensaries, and the personal histories of these medical pioneers constitute a saga of man's faith, ingenuity, and unfaltering energy; a saga seldom equaled in the history of human dedication. operating on another level of motive are the two large commercial operations in liberia.

the firestone plantations company has been growing and processing rubber since 1926. in recent years, the liberia mining company has found success in the extraction of high-grade iron ore. these two companies employ close to 30,000 liberians, and provide them and their families with housing, community, and medical facilities. such medical programs extend beyond the direct results of treating and immunizing the employees and their families. viewed only negatively, an epidemic among this labor force could cause havoc to the economy

of the country. but, as the first step lies in the protection of the body of men, an even more emphatic contribution is born in the mind of men. they are operating the vehicles and machine tools of the industrial world. they are learning the agricultural science of plant breeding and grafting, and they are maintaining the chemistry of rubber processing. it is this skilled labor force that represents the population that is liberia's future. analyzed positively in the light of these occupational developments, the liberians' increasing dependence on and knowledge of the world of medicine

becomes an attendant factor in liberia's social and economic growth. serving as the fulcrum of health and sanitation of the firestone plantations, two hospitals maintain over 200 beds, staffed by 11 physicians and 75 nurses, lab technicians, and orderlies. due to the high level of mechanization in the mining process and the consequently-limited labor force, the bomi hills hospital is smaller, but its facilities and services are equal to the best to be found in africa.

bomi is especially plagued with a heavily silted water supply, and as a check on its modern filtration system, a bacteria count is maintained at all major distributive points. in both operations, prevention takes precedence over treatment. sanitation and hygiene in the company villages constitute the basis of prevention, but the education and vigilance of the villagers themselves is a prerequisite to that goal. under the guidance of directives developed by the medical staff, each of the plantation villages possesses a trained sanitarian who is periodically checked and upgraded through examinations.

the sanitarian maintains a continuity in the method and effectiveness of sewage disposal, and in general, is custodian to the health needs of his community. the new pattern of symmetrically-designed villages takes hold with the residents. seeing the benefits of drainages, planned and maintained thoroughfares, and recreation areas, they also come to accept new and improved types of housing that radically depart from the traditional and inadequate hut. as the changing seasons bring changes in the density and species of insect vectors, insecticide spraying teams move through the villages, and even with new residents who have had little experience with medicine

and no knowledge of the relationship between insect vectors and disease, the very elimination of the pests from the houses represents a newfound peace. thus, the fullest performance of these medical programs is obtained by bringing prevention and treatment to the local working and living areas. in addition to maintaining nurses at the hiring centers, and clinics in the heavily-populated factory area, the plantation doctors conduct regular frequent clinics at 36 dispensaries, strategically located across the 100,000 acres of the plantation. with such a program, illness is identified early. guidance in the diet and care of the newborn is provided,

and the people learn that the practice of modern medicine is a methodical procedure, composed of objective knowledge, and requiring only their understanding and cooperation. they learn that the results of modern medicine tend to be orderly and stable, and nonviolent and non-dramatic in contrast to the life or death prescription of the country medicine man. basic to all this activity, on both the public and private level, is research. in that singular interest, the liberian institute of the american foundation for tropical medicine was, in 1946, incorporated in the state of new york as a private nonprofit organization. in 1951, on a land grant from the government of liberia, the present structures were completed with funds provided by

harvey s. firestone, jr. as a memorial to his father. support of the institute comes from annual gifts made by american business corporations operating in the various tropical areas, including liberia, and by research grant funds provided by the united states public health service. the institute's basic goal is to contribute to the more successful prevention and treatment of topical disease. in such terms, it has successfully endeavored to fulfill a four-point program. attracted to this opportunity from all over the world, scientists study the insect vectors and methods of control.

while an outpatient clinic is maintained by the institute, the nearby plantation hospital sets aside beds for institute case studies requiring hospitalization. numerous villages serve as laboratories of treatment and control, and throughout liberia, the institute carries out collaborative projects with such groups as american universities, the world health organization, and the united states public health service. in view of the variety and density of tropical disease, all of liberia is available for medical study. [narrator #2:] neural leprosy has two manifestations, macula-anesthetic leprosy;

a depigmentation of skin patches and mutilization with loss of digits. nodular leprosy is often referred to as lion face. in liberia, there are several leprosaria, supported by the national public health services and various missions. here, at the ganta methodist mission, under the direction of dr. george w. harley, the discharge rate has been greatly accelerated, with the use of the new therapeutic agents. the incidence of leprosy in liberia is not known.

until more extensive studies are carried out, there can be no certainty of existing data. while the few agencies in this field are contributing a valuable service, the impression must remain that no progress in control. [inaudible] ...made. however, the cooperative reaction of the patients, their obvious desire for the drugs, and the attendant growth of an interest in and understanding of disease, reveals that given data and facilities, the disease can be eradicated.

yaws is widely prevalent among the liberian population. in the early stages, it is essentially a disease of the skin. later, it becomes systemic, and the most troublesome late lesions are those of the bones, joints, and plantar surfaces of the feet. goundou, an exostosis of the facial bones. it is considered by most authorities to be a tertiary lesion of yaws. plantar or crab yaws. this condition, which is characterized by the development of papillomata under the thick skin of the sole, is very painful. eventually, the overlying skin breaks down, and ulcers form. because it is highly contagious, the disease is one of the most difficult to eradicate, and the incapacitating degree of pain causes a heavy loss

to the manpower of the country. osteitis results in saber shins and deformities of the arms and fingers. collaborative projects on the treatment of yaws are being conducted by the national public health services of liberia, the world health organization, and the united nations international children's emergency fund. the filarial worm is transmitted by a species of fly of the genus simulium, commonly called the black fly, which breeds in rapidly flowing streams. infection causes onchocercal dermatitis;

shown here with a superimposed pyogenic infection. and fibrous nodules. and in some instances, eye lesions. here, a nodule in the pelvic region is being removed. onchocercosis is now considered by the world health organization to be the most urgent medical problems in africa. bancroft's filariasis is due to a filarial worm parasite, wuchereria bancrofti, which invades the lymphatic system. it is transmitted by a number of mosquito species very prevalent in liberia. it is this parasite that gives rise to elephantiasis.

also, lymphangitis, adenitis, and other clinical conditions. without the aid of a survey, which would be difficult, the prevalence of tb is not known. it is recognized as widespread in liberia, as in most underdeveloped countries. isolation hospitals are provided by the national public health services, utilizing specific chemotherapy. the well-known tendency of the african to develop keloid growths is well exemplified here. part of the growth was surgically removed,

and it can be seen as recurring around the edges of the excision. ainhum is a disease characterized by spontaneous amputation of the fifth and occasionally the fourth toe. it is brought about by constricting fibrous bands developing at the base of the toes. the disease is most prevalent in west africa and brazil. the cause is unknown. ulcerative processes of the skin, especially on the legs, are very common and in some instances, difficult to cure. african sleeping sickness is caused by the protozoan parasite trypanosoma gambiense,

which is transmitted by the tsetse fly, glossina palpalis. in its late stages, the disease is characterized by disorders of the central nervous system, usually resulting in lethargy and a stuporous condition. however, the hyper-reactivity shown by this patient can also occur. smallpox has recurred in liberia periodically in devastating epidemics. although there has been some vaccination, the entire population is by no means protected. until there is 100 percent vaccination, the threat of a recurrence exists. [narrator#1:] the research work of the liberian institute of the american foundation for tropical medicine extends beyond its 15 labs,

lab animal houses, and workshops; all liberia is its laboratory. liberians eager to improve their country's strength take their own individual first step, and train as technicians. as the scientists possesses two methods of control where a carrier is involved: to destroy the transmitting vector, and to treat and prevent the effects of the parasite in the host, so too does he depend on the problem being attacked on more than one front. the basic conditions that weaken the body and cause susceptibility must also be eradicated. the institute recognizes that one problem basic to treatment is the malnutrition of the people;

a lack of protein in the diet. to help combat this scarcity, the liberian government, the united states international cooperation administration, and firestone, are establishing fish ponds. the creation of such a supply of protein for each inland village is the final goal. with liberia's climate ideally suited for tree crops, it is only natural that the work of the many rubber, coffee, and cocoa botanists is leaving a deep mark. taking advantage of this profound cultural wedge,

an ica agronomist shows a tribal chief the increased resistance and productivity of a new variety of palm nut tree, the oil of which is an important food source. the move is on to educate a change from the growing of dry rice to the less toilsome and higher-yielding swamp rice, and the growing presence on the plantation and demonstration farms of mechanical tools, is producing an interest, which promises far-reaching results. on the medical side of health by drug and surgery,

the stories of scientific treatment emanate from the plantation hospitals to display a folklore of magic; a tale spellbinding with its facets of sleep-producing aromas, painless incisions, and quick recovery. with such an enviable social position, the physician gains an opportunity to begin at the beginning, and the expectant mothers look forward to the scheduled prenatal clinics. but to the continued progress of this activity,

research is always fundamental. in the malaria work of the liberian institute, a complete knowledge of the life habits of mosquito vectors and their relation to malaria, is an essential prerequisite to the establishment of a control program. in the laboratory, thousands upon thousands of mosquitoes are annually reared and used in a variety of studies, including experimental infections and the determination of the genetic factors

in acquired tolerance to insecticides. to determine the fluctuations in specie population and density throughout the year, collecting trips are made daily to numerous localities over extended periods. to attract and capture the mosquitoes, teams of collectors set up portable hut traps, in which they spend rather fitful nights. by their growing understanding of the methodology of science, these technicians gain some added strength in resisting the normal desire to swat the little pests.

schistosomiasis or bilharzias is prevalent in large areas of liberia. institute surveys have shown close to 100 percent infection in some regions. the two species of schistosomes in liberia, haematobium and mansoni, are carried by snails. work is in progress to test methods of destroying the snail vectors, and to determine the effects of various drugs on the parasite. across country at the mines, an institute staff member examines a group of children for enlargement of the spleen, to determine the effectiveness of a residual insecticide spraying program

in the eradication of the insect carrier. incidentally, umbilical hernias, such as this one, are very common among african children. however, a large proportion of the incidence disappears in adult life. trypanosomiasis, sleeping sickness, is another disease prevalent in liberia. the incidence, however, is not known. on a tour upcountry, the institute's director, dr. max miller, pays a visit to the clan chief of a group of villages to secure his cooperation and permission in locating cases of the disease. old acquaintances exchange gossip,

news of local crop conditions traded for a report on a local youngster, working as an institute technician. then, with the ease of established trust, the chief leads the doctor to a nearby case, and the excited retinue, eager for a demonstration, follows. african sleeping disease is a disease of major importance to the health of liberia. the institute's work at the present time is mainly restricted to the testing of drugs and a limited surveying of the incidence of infection. as additional funds become available, research can be extended to a degree commensurate with the need.

this case is an advanced one. the stage of infection is demonstrated by extreme lethargy. walks only with the greatest difficulty and assistance. if left alone, he would show no interest in food, and die of starvation. the extreme emaciation obviously reveals that the case is rapidly progressing to the last stages. because he is unable to perform the most elementary personal hygiene, he is covered with a skin infection, and is irritable when disturbed. an experiment in administering a malarial drug

and the consequent blood surveys, moves into its ninth month. two groups of villages serve the investigation. all the population of one-half the villages have been given monthly suppressive doses of anti-malarial drugs, while the population of the other half have taken placeboes, sugar pills. at the time of drug administration, a survey is made to determine the malaria parasite rate in the entire population group. in the light of the growing interdependence of nations, the necessary trading of energy for skills, skills for resources,

and resources for a participation in all the wealth of man's achievement, there can be seen a kinship between the smallest, most unconscious endeavor, and the greatest need. although the success of the survey is dependent on the village receiving the suppressives, it is no less indebted to the people taking placeboes. if the development of backward areas has become fundamental to the growing needs of all people, the eradication of tropical disease lies in the category of first things first. as evidence of the liberian institute's function, facility, and opportunity to this end,

scientists from all over the world are drawn to it. they work in a country that is friendly to our concept of human dignity. for the institute's very existence provides the example of american business abroad contributing to the health of man. by its ready acceptance of change when the benefits are clear, the population reveals its desire to progress, and the government, too, is anxious to make a dynamic contribution, because it recognizes that it cannot increase its voice among the nations by only clipping the coupons

of the country's growing wealth. with this wealth of opportunity and cooperation, it is easy to see the pattern necessary in the development of the backward areas. there is a great prevalence of disease, an absence of proper foods, and a lack of knowledge concerning the realities of the world the people live in. cure the disease. free the people for productive enterprise,

and the indigenous people will eagerly seek the knowledge necessary to further enrich their lives. the liberian institute's dedication to seek inexpensive methods of treatment and prevention attacks the core of the problem. to this end, the institute should receive widespread support. with the new intercourse of trade, the dark continent's resources of soil and climate are only available as the health of the people is secure. in point of fact, the health of the world can benefit by so small,

so unknowing a contribution as that being made by the liberian people in both the test village and the control village. in one of the blood samples held against the african light, the image of all the world's well-being can be seen.