Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Medical Adventures in the Nigerian Bush
Table 2. Total number of deaths during our stay: 75
Pneumonia 9
Tetanus 7
Anemia 7
Heart failure 7
Tuberculosis 6
Malnutrition 5
Infantile dehydration 5
Liver failure and ascites (“Drank native medicine”) 4
Abdominal neoplasms 3
Prematurity 3
Hepatitis 3
Ruptured uterus 2
Encephalitis 2
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One death was casued by each of the following: Rabies, snakebite, burn, hemorrhage,
pyelonephritis, skull fracture, bladder neoplasm, tracheal stricture, carcinoma of cervix,
postpartum septicemia, fractured neck, dissecting abscess of thigh
redundant skin heavy with swollen inguinal lymph nodes from O.V. infestation.
Skin on the legs often is depigmented in patches where the Simulium fly bit the
patient. Treatment O.V. infestation is hazardous and uncomfortable, since many
patients develop reactions to the allergenic parasites when they are treated. Treatment
is most often futile even if it were pushed for cure, since the patient becomes
rapidly repopulated with O.V. So the risk of blindness, extensive elephantiasis, and
some of the common afflictions that may be related to O.V. Keeps increasing the
longer the host and parasite cohabit.
An example of one affliction that may be related to filariasis that abounds is
tropical pyomyositis. It seems that all protoplasm, living and dead, festers under the
tropical sun. Many patients suffer from multiple deep abscesses that seem to be
confined to major muscle groups of the trunk and limb girdles, not found distal to
elbows, knees or neck. This distribution has led to some speculation that the abscesses
result from filarial plugging of vessels of a caliber found only in the muscle
sin which the disease is found. Regardless of the etiology, patients frequently present
with hot painful abscesses that are near to bursting. On a particularly “pussy” day in
the outpatient clinic, one can knife a dozen such abscesses. Before these closed space
infections open sinus tracts to the surface, they dissect and do much damage to soft
tissue and bone, resulting sometimes in multiple pyarthroses. One woman who
looked very debilitated and elderly at age 26 had an ulceration at her knee and a
small sinus at her hip. After probing each with the suspicion that they might be
connected, I unroofed the sinus. The hip to knee incision revealed an anatomic
dissection with shiny bone and muscles individually hanging in free air—all the
fascial connective tissues had been dissolved away by the dissecting purulence.
To point out other examples of the morbidity secondary to infectious diseases,
we reviewed the inpatient and outpatient diagnoses which were summarized in Table
3. It can be seen that preventable parasitic diseases constitute the bulk of the disability
in this part of the Nigerian bush.
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