CHAPTER IX. “me Cuttim Wind, Me Cuttim Gut!”

“ME CUTTIM WIND, ME CUTTIM GUT!”

The conquest of pidgin cheered me up mightily; and I needed cheering. Toward the close of the New Guinea campaign (October, 1921) I began to realize more and more, through daily practice, that oil of chenopodium was inadequate for the mighty job cut out for it. To do it justice, it did remove worms, quantities of them. The standard method of administering chenopodium was to starve the patient the night before and give him a purge in preparation for next morning’s treatment, which was 15 minims, given at two-hour intervals, at 6 A.M., 8 A.M. and 10 A.M. This was followed by another purge at noon, and he was not permitted to eat until the purge had taken effect.

In North Queensland I had found that even these heroic measures had not reduced the rate of infection, because the people were not taking the drug. Then I decreed that no treatment would count unless inspectors stood by and saw the medicine swallowed. In the early morning hours one could get track of a treatment unit by the sight and sound of front doors bursting open and children running wildly down the street. So I decided to modify the dose by one half, followed by a purge. Re-examination showed somewhat better results.

Old-timers who ran the standard chenopodium campaigns were unsung heroes, and the grinding disappointments drove many good men out of public health work. Examination, treatment, re-examination and retreatment--repeated half a dozen times in any given area--made up a method so extremely slow that by the time work in one region was completed the unremoved female worms had again laid eggs inside our patients; eggs which fell with the excreta to infect the soil once more and permit another horde of larvae to crawl back to the human intestine.

When Colonel Honman at last drafted my services and put me in charge of the native hospital at Rabaul, I was given an ideal chance to experiment and observe. Groups of native patients were chosen and locked behind barbed wire; each was given his dose and a gasoline can for his stools. The latter were washed every twenty-four hours for three days, and the worms counted. After an interval each man would be given a very large dose to remove the remaining worms, so that a percentage of effectiveness of the first dose could be estimated. We tried various combinations of chenopodium: thymol, betanaphthol, even betel-nut (which has a certain degree of vermifuge action). We studied the relation of purge and drug, to find out on what ratio they could be given. At best chenopodium was nauseous and produced many severe symptoms like tingling toes, temporary deafness, vomiting; and there was always the danger of profound poisoning inherent in the powerful drug,--untrained dispensers might grow careless and omit the purge,--and that might prove fatal.

To sum up chenopodium, it was about as popular as the Hammer and Sickle at a Republican rally.

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Taking charge of the native hospital, although it was added to my duties in the field, was the job I liked best of all I had--new things turning up every day, and plenty to swing to.

I swung to Colonel Honman with ever increasing faith, for he was my mainstay when it came to an argument with Governor Wisdom. The Governor’s troubles were piling up on him, and I never blamed him for his stubborn spells. If Wisdom’s moods interfered with urgent medical work, it was the Colonel’s delight to set his artificial teeth firmly and jump into the scrimmage. He wasn’t afraid to go to the mat with the Governor, and at the finish he usually came out winner. I cannot forget his loyalty to me any more than I can forget a set of eccentricities peculiarly his own.

Here is one of my favorite pictures of the Colonel in action. I was in charge of quarantine while he was away, and always on the qui vive for any alarm that might come in. Early one morning a disturbing cable came: bubonic plague had broken out in Brisbane, and we must keep a strict lookout for ships from that port. The Colonel was away, making a trip around the group, so when the regular boat from Brisbane pulled in I went aboard and talked it over with a worried skipper. How was he to unload her? Certainly it would be inconvenient if he had to dump his cargo on lighters and move it piecemeal to the dock. I saw his point, and was wondering if I should take chances and let her come in before dark, when I saw the Medical Chiefs ship poking around the heads. I went over to it and found the Colonel in his pajamas. I asked him what we were supposed to do about the caller from Brisbane. He hadn’t put in his false teeth yet, and his mouth was sunken like a dead crater. “Keep her out in the thtream,” he lisped. So I carried the orders back to the Australian skipper, and went home to breakfast. But I said to my wife, “Eloisa, I’ll bet that ship will be alongside the wharf before noon.” It was; and I knew why. Down in the Australian’s hold there was a new Ford sedan for the Colonel, and he wasn’t going to risk having it unloaded on a lighter, away out in the stream.

Colonel Honman had his faults, but I grew to love and admire them, with the firm belief that “even his failings leaned to virtue’s side.”

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We had more and more cases of yaws sent in and were administering intravenous arsenicals. The natives called these injections “needla,” and it became a popular craze with them--a craze which spread over the South Pacific. It was better than magic; a native would gladly have anything poked under his skin through a needle, no matter what. In Rabaul the native orderlies were always there on injection days; their tongues hung out with eagerness to get a shot of any salvarsan solution that happened to be left over. I have heard them arguing, “Why waste that bully stuff on a lot of ignorant bush fellows who are no good to anyone?” White men were queer in their preferences.

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The primitive Melanesians have a holy horror of mutilation--except when they mutilate their noses for decorative purposes, or their foreskins from custom. The man who has lost an arm or leg is damned eternally, for he must go to the local heaven armless or legless and be the laughingstock of the gods. This belief is a nuisance to the surgeon down there. A native with a gangrenous limb will fight against the knife, tooth and claw. Slow and painful death by blood poisoning is far preferable. Die with both your legs on and you can walk into Paradise, a true man....

When a white man has anything artificial, like a glass eye, a realistic wooden leg, or a set of false teeth, the back-country fellow looks upon him as a miracle worker. One of the oldest stories along this line originated in Papua--how the plantation manager took out his glass eye and put it on a stump to glare at his lazy field hands while he was absent; it kept the crew busy until a native genius thought of just the right thing--he put a hat over the magic eye, and they all went back to sleep.

Toward the end of my term in New Guinea a situation arose in a native ward which compelled me to take advantage of this popular dread of mutilation. Influenza had flared up on the plantations. The plague that laid our soldiers low in American training camps had visited the South Pacific also, in 1918-1919, and played havoc with these non-resistant people. Since then, it had broken out sporadically; but health officers had learned more about it and were holding it down better than before.

I had returned from the field and found the native hospital filled with flu cases; many were dying in the collapse from pneumonia. The sudden deaths among seemingly mild cases puzzled me, until I probed into the cause. Our native attendants hated to lose sleep; as soon as they were snoring, the sick men, hot with fever, would sneak out of a side door and go down to lie in the sea and cool off under the stars. Then they would sneak back to bed and die of shock.

I put a stop to all that. Native attendants had told them how I slit open dead men’s bellies. (I had performed thirty-three postmortems to determine the average native content of whipworms.) My ogreish fame had spread among a simple folk who would far rather lose a life than a leg. To them I was master of life and death--and the postmortem table.

Therefore I profited by my foul reputation and marched through the ward brandishing a large amputation knife, and as I passed along rows of quaking cots I shouted: “Suppose you no stop along bed, you sons of bitches, suppose you no takim medicine good feller, now you die finish, me cuttim bell’ belong altogether, me cuttim heart, me cuttim wind, me cuttim gut belong you feller. But suppose you good feller altogether, now you die finish, me no cuttim you.”

Dark faces turned green. If they died in a state of disobedience their bodies would go to butchery on the postmortem table; what chance would their gutted souls have in a heaven where true men walk high, wide and handsome?... After my threat they turned into completely docile patients, and we had hardly a case of pneumonia when they were dying of it elsewhere, all over Rabaul.

Twenty men in this ward had been rounded up and jailed for cannibalism. I went to Colonel Honman and described an experiment I wished to make. We all knew of Dr. Heiser’s brilliant success in the treatment of leprosy. Chaulmoogra oil was no new thing; lepers had been given it by mouth for a couple of thousand years. When Heiser experimented with it in the Philippines he didn’t change the remedy--he changed the method. He tried chaulmoogra oil in intramuscular injections, with tremendously improved results.

I didn’t expect to obtain any such startling effects. What I wanted to know mainly was whether chenopodium acted directly on hookworms in the bowel, or whether it was absorbed into the blood stream first and was then ingested by bloodsucking.

The twenty cannibals were on the road to recovery from influenza, and for experimentation Colonel Honman selected six who were heavily infected with hookworm. They had already been condemned to hang as an example to their outlaw village, so it didn’t matter whether the poor devils died in bed or at a rope’s end. My plan was to try intramuscular and intravenous injections of chenopodium.

The result proved harmless to the patients and surprising to the rest of us. In our tests on three of the patients chenopodium was mixed with camphorated oil and resorcin, following Heiser’s formula for preparing chaulmoogra oil. These three men were given intramuscular injections in this form, followed by purgatives, and their stools were examined for a period of six days. From Case Number 1 we got only four hookworms in five days; from Case Number 2 two hookworms and one Ascaris. But Case Number 3 offered the main interest. To him we gave an intravenous injection of chenopodium undiluted. After six days we had recovered twenty-two whipworms and only three hookworms, although this patient, like the other two, was heavily infected with hookworm. In Case 3, then, injections of unmixed chenopodium had a far greater effect on whipworms than on hookworms.

In the three who were given intravenous injections results were:

Case 1:--Hookworms: None. Trichuris: 11. Case 2:--Hookworms: None. Trichuris: 19. Ascaris: 2. Case 3:--Hookworms: None. Trichuris: 30. Ascaris: 2.

Our experiences with all six cases showed that injections of chenopodium have little effect intramuscularly on hookworm, and no effect on that parasite when given intravenously. But in both ways it had a marked effect on trichuris.

Why was this? Obviously the answer must be in the habits of the two parasites. The hookworm is a superficial feeder, sucking blood from the surface of the gut. The whipworm has a very long head which he buries half an inch into the intestinal wall; possibly he fed only on lymph, which may have taken up a heavier charge of the chenopodium. Ordinarily the whipworm is very resistant to chenopodium, as to all vermifuges. Yet here he showed a high mortality to the drug when it was administered through a new route. Whereas the hookworm, which is affected by chenopodium given in the usual way, showed a high resistance to it in the new method.

I had no time to continue experiments, which were interesting because they were the first attempt to give anthelmintics by intramuscular or intravenous injections, a new route for treating intestinal parasites. Superficially at least, I had settled an argument which had arisen among investigators with more claims to learning than my own. I had established that the action of chenopodium is by direct contact with the hookworm in the gut, not by absorption in the blood stream and subsequent absorption by the parasite. The experimental cases showed that fact clearly, and still more clearly revealed that chenopodium in intramuscular and intravenous injections has a decided effect on whipworm. For the latter there is no other satisfactory treatment. I made these tests without the sanction of the Rockefeller Foundation, whose letterhead should bear the motto, “We Do Not Experiment with Human Beings.” When 61 Broadway learned of what I had been doing there might have been trouble for me, but Dr. Maurice C. Hall, chief of the Bureau of Animal Industry at Washington, became my advocate. In a later