Tuesday, 28 January 2014

"Our Son Hasn't Started Menstruating Yet."

When I asked what she had come for I got the rather injured and indignant reply, "Are you not the man who makes women pregnant?"
     No, it's not what you think. The white doctor immediately understood that she required treatment for infertility. Werner Junge had come to Liberia in 1930, and pretty soon discovered that, what with infertile women, dying children, and adults suffering from all the horrible diseases the tropical jungle could throw at them, he had his hands full. But he was flummoxed when a boy of about twelve was brought to him with the complaint that his periods had not yet started.
    It took a lot of questioning for the truth to come out. One of the most common debilitating diseases for which west Africa is notorious is biharzia, or schistosomiasis. The parasite's complex life cycle commences when it enters a fresh water snail. From this primary host emerge a whole lot of tiny larvae, which spread out and pierce the skin of anyone bathing nearby. The immediate sign of infection is a rash, but gradually the larvae develop into tiny flatworms which consume the victim's red blood corpuscles. Eventually, they migrate to the capillaries in the victim's lower regions, next to the intestine or, in the case of Schistosoma haematobium, his bladder, where they lay their eggs in the countless thousands. These extraordinarily tiny eggs come equipped with a pointed barb at one end. This allows them, under the pressure of blood in the capillaries, to pierce the lining of the blood vessels and force themselves into the bladder or intestine. If the victim's faeces or urine then enter the water, the eggs are picked up by the snail, thus completing the cycle.
     Sounds gruesome, doesn't it? The upshot is that, eventually, the walls of the bladder become extensively perforated. In this boy's village, the disease was so widespread that every boy contracted it when he began working in the rice fields at puberty. Haematuria, or blood in the urine, was thus assumed to be a normal part of growing up. This boy's "problem" was that he was apprenticed to his father, the village blacksmith, and never went near the fields. He was perfectly healthy! Presumably, his father had contracted it some other way, but the son himself was uninfected.
     Of course, there would be no point in trying to explain this to the "patient" and his father. The doctor gave him some harmless medicine to mimic the symptoms, and that was that.

Reference: Werner Junge (1952), African Jungle Doctor, George G. Harrop & Co. (p 31 of the 1956 Panther edition)

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