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MEDICAL RESEARCH AT NAIROBI

(FROM A CORRESPONDENT)

THE Kenya Medical Department had the goodfortune to get the estimates and plans of its medicalresearch laboratory passed, and building operationsactually begun, before the financial crisis put astop to further developments in the colony. Thoughthe laboratories have been in use for some time theirformal opening, or at any rate their introductionto the notice of the public, took place in October last,when Sir Joseph Byrne, the Governor of Kenya,inaugurated the centenary celebration of the BritishMedical Association in which all the East Africanbranches cooperated.The idea underlying the scheme of the institute

is that the problems presented by the more importantdiseases of East Africa can best be worked out byselected teams either chosen from the various govern-ment services or by specially qualified research workersfrom elsewhere. Ample space has, therefore, beenallotted for the accommodation of workers who mayhave scholarships or fellowships which will allowthem to live in Nairobi. Money which may be availablefor the investigation of any special problem may beutilised to the best advantage in the provision ofpersonnel and equipment.

These more ambitious ideals are, of course,independent of the provision of facilities for carryingout the routine work required by the governmentand by private practitioners.The laboratory is situated on the outskirts of

Nairobi, on the Hill, at an elevation of about 5600feet, 200 feet above the general level of the town.It is thus free from the dust and noise which werecharacteristic of the older very limited accommodation.The buildings face east-south-east and look out overan immense plain. They are constructed of brick.

The main block is in the form of the letter E. Ithas two floors but is only one room deep throughout.On each floor there is a verandah all round the innerside, and the doors open thereon. Each room iswell lighted by large windows on two sides, and thusa maximum of illumination is provided for micro-scopical work, while there is ample space on the otherwalls for shelves and cupboards. On the groundfloor, on the left of the entrance, is a small waitingroom and the general offices. Then come the largelibrary, the reading room, and the museum. At theend of the south wing are found the sterilising andmedia rooms of the bacteriological section. Thegovernment analyst has his rooms on the right ofthe entrance hall, and in the north wing is the bio-chemical department. On the first floor opposite thetop of the main staircase are found the office andlaboratory of the deputy director of laboratory services,and the office of the laboratory superintendentadjoins. Special accommodation is allotted in thisblock for malaria investigation, while the south wingis occupied by the pathological and bacteriologicalsections. The latter lies immediately over thesterilising and media rooms which are in communicaltion by a lift. The medical entomologist occupiesrooms on the north side of the first floor in front,and the north wing of the same floor houses themedical biologist, whose accommodation includes ananimal room. At the back of the main block are

the dark room and a microphotographic room andstores. The whole building is lighted by electricityand there are two complete Silverlite petrol plantsfor the provision of gas.

Separate from the main building are single-storeybuildings, one of which is devoted to the productionof calf lymph and antirabic vaccine, and attachedto this are the calf-shed, the operating room, andaccommodation for experimental animals. Up to1919 calves were vaccinated and lymph collectedunder a tree in the old laboratory compound, and untilthe present building was erected this work was donein a temporary wood and iron shelter. It speakswell for the care with which the delicate operationswere carried out in such surroundings that no singleaccident has occurred.The African attendants are housed in a separate

building of one storey. It may be noticed here thatconsiderable time is taken with the training ofdressers and laboratory attendants and some of thesewhen sufficiently versed in technique are drafted tooutlying hospitals.As indicating the magnitude of the routine work

done in the laboratory it may be mentioned that thereis a yearly output of about half a million doses ofcalf lymph for vaccination against small-pox. In a.similar period 2,000,000 doses of plague prophylactichave been issued, and the biochemical section hasproduced 80,000 doses of the bismuth preparation usedin the treatment of yaws and syphilis. A largenumber of serological examinations and agglutininreactions are made yearly, and stock vaccines forgeneral use and autogenous ones for special cases

are prepared. Some thousands of blood examinationsare performed for malaria, &c.

Research work is continually going on and recentlymuch attention has been paid to the various aspectsof malaria, plague, dysentery, and trypanosomiasis.Among other items of interest may be noted thediscovery of the tick vector of African typhus, andthe special investigations made for the past two yearsinto the structure of the cerebral cortex of the African.A visitor accustomed to the often cramped conditionsunder which the clinical investigator works at home isagreeably surprised by the spacious accommodationin the Nairobi laboratories. The absence of over-

crowding, ample light, and a healthy atmo?phereafford highly favourable conditions for work. More-over, the concentration of these services in one

institute enables the staff to avail themselves ofmutual consultation and assistance.The proximity of the African Hospital, from which

most of the material is drawn, is an additionaladvantage. As soon as the finances of the Colonypermit, the European Hospital will be replaced by anup-to-date building close to the laboratory, and thefull scheme also provides a hospital for Asiatics, ofwhom there are many thousands in the Colony..When this combination of European, Asiatic, andAfrican hospitals grouped round the central laboratorycomes into being there will be unique conditions forthe study not only of tropical diseases but of manyother problems which await solution under excep-tionally good circumstances.

It is not perhaps too much to hope that in the nearfuture young research workers may be attracted fromEurope to this centre. If such there be, it may bepointed out that besides the opportunities for work,

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all kinds of exercise are available, and week-endholidays may be filled by fishing and other sportswithin easy reach. Living is not expensive and theclimate is excellent.The laboratory has been established and maintained

under the directorship of Dr. W. H. Kauntze, whowas appointed bacteriologist and pathologist to theEast African Protectorate in 1919. Dr. Kauntze hasnow, however, left Kenya to take up the office ofdirector of medical and sanitary services in Uganda.

THE DOCTOR’S DAY

" Come, tell me how you live," I cried," And what it is you do I

"

XXII.—IN THE ROYAL AIR FORCE

SUNLIGHT flooding the mess room shows breakfastwell advanced. Most of us have consumed porridgeand fish and sausages, and reach with fading appetitefor marmalade and toast. A few stragglers fromearly duty on the station saunter in and start the ballrolling again. Members of the territorial searchlightcompany, with us for a week of night flying andspotting, mix cheerily with the regular members.Conversation is general, for the majority are youthsfresh from the flying training schools, and have notyet reached the stage in a service career when con-versation at breakfast and high treason share equalTank as offences " punishable by death or such...."A junior territorial officer expresses loudly his desireto have a flight in the Hinaidi, the big bombingmachine attached for night exercises. It is no concern-of his how air sick were certain of his colleagues thenight before, for has he not crossed the channel sixtimes in rough seas with never a suggestion... ?" Does he know he must sign a blood chit ? " " What’sthat ? " " Oh simply a form to say it’s his own faultif he spins into the ground." " Certainly he will signthe thing. Machines don’t crash these days."

SICK PARADE

Then someone asks me how fares his friend, a flightcommander, operated on a few days ago for appendi-citis at the general hospital, and will I fly over withhim for more recent news after lunch ? Yes, I will,if no machines are up while we are away, as myassistant is having the afternoon off and I am onduty for dusk and night flying. I rise, pass from themess across the compound to sick quarters and tothe matter of sick parade. It is 8.30 A.M. A mildmeasles epidemic has added one or two lesser com-plications to the situation,’ particularly as so many.airmen seem never to have had the disease. Myassistant is handed the duty of inspection parades andisolations. He is also allotted care of families andelementary child welfare lectures because of a

oonfessed leaning to peadiatrics. All the better. Atsick parades one is rarely faced with emergency. Theseriously ill man may drop off duty at any hour,after a stolid endeavour to carry on. Pneumonia,appendicitis, spreading cellulitis, acute influenza-they more often come in during the morning break.I see an acute tonsillitis, and, thoughtful of diphtheria,take a swab. The swab can go over with me by airthis afternoon to save time, as the general hospitaland the central laboratory are on the same station.Next comes an airman with a damaged internalcartilage. His medical documents show that this ishis third attack of knee trouble. I arrange hisadmission to the hospital. The next case presents aproblem more or less confined to the Air Force. Asergeant pilot comes forward with a history from hisflight commander of rather indifferent landingsbecoming progressively worse. The sergeant pilotstates that he is doubtful quite where the ground isin the last few feet of descent, he usually flattens outtoo soon, and tends to stall. Now the " last few feet"with a machine that must for proper safety be landed.at 65-75 miles an hour is a matter of no small import-ance. I consult his medical documents from hishistory envelope, and pay particular attention to hiseye condition when up at the central medical boardin London for his fitness-for-flying examination.Vision is normal, I find, but a certain ocular muscleweakness is suggested. He was passed " borderline

eyes." I repeat some of the tests and find him worsethan he was then. I take him off flying temporarily,and arrange for an examination by the ophthalmicconsultant, telling the sergeant pilot that he may haveto undergo a course of eye training, after which hewill be fit again for full flying duties.

WARD ROUNDS

It is now time to do ward rounds. The modernstation sick quarters are like little cottage hospitals.The design and equipment are excellent. There aretwo small wards and an isolation room, a waitingroom, consulting room, treatment room, and dis-pensary. There is a useful operating theatre so placedthat the crash ambulance can be brought to withina corridor width of it, with ample stretcher space-apoint of great importance for cases of severe

injury requiring immediate help. The ambulancein daytime waits at the sick quarters, fully equippednot only with all first-aid materials, but also withhacksaws, pliers, asbestos gloves, and so forth, forbreaking quickly through wreckage. In the case ofmishap in the air, the alarm bell rings and the telephonegives one details of position.

After rounds the morning correspondence isexamined and answered, and then an inoculationparty is paraded for their T.A.B.C. vaccine as apreliminary to going overseas. By this time mycolleague is back with the results of his work, and Isend him to do sanitary rounds so that he can beclear for the afternoon. As I prepare to leave sickquarters to report to the officer commanding, one ofthe flying officers confronts me nervously in thepassage: " I wonder, sir, could I ... " "Youcertainly could-come in." "Well, sir, I’m notfeeling quite fit. I’m a little worried in the air. Lookslike ’ wind up,’ but it’s not really. I’m just, some-how, always listening to the engine and the flyingwires on turns..." " Go on." " And I think Iought to say something before they spot it in theflight." " So do I." " It’s not really funk." No,I know that ; it’s the feeling that comes on slowly,unaccountably at times, with many fast scout pilots ;the feeling that something is going to snap somewhere,and of always waiting and waiting, till the will snapsfirst. He continues : " It’s worse, of course, nightflying. I’ve tried to make myself fly through it, soto speak, but now I hate walking out on the tarmac."" How much leave have you had ? "

" Fourteendays, so far." " I see. Probably another 14 will putthings right. Take it, and make it a completechange. I leave that to you. I’ll drop the hint tothe C.O. Let’s see you as soon as you are back-anddon’t worry."When he has gone I run through the contents of

his medical history envelope. He has had two slightcrashes-undercarriage damaged in one, and lowerplane written off in another. No loss of consciousness,no injuries. The crashes happened in pretty quicksuccession five months ago. His annual medicalexaminations are up to the average, with the exceptionof a tendency to brisk knee-jerks and eyelid tremorsin a rather marked degree. Nothing in his eyes tosuggest a reason for his two crashes. A firm but humancommanding officer can help these borderline casesto a considerable extent. Sometimes they have tobe put up for a medical board ; at others, they recoverwith a spell of leave and a sympathetic gesture. The’medical officer has to use his judgment. The pilotwho has taxed his nervous control too far becauseof an inherent distaste for expressing his feelingsand getting it off his chest may never regain his’confidence in the air. This has happened to pilots