The Medical Visitor.

A MEDICAL NEWSPAPER.

No. 2.

FEBRUARY, 1893.

VOL. IX.

THE AFRICAN PAW-PAW IN SURGERY.

BY R. ST. JOHN PERRY, M. D., LINCOLN, NEB.

Quite recently numerous short articles have appeared giving the results of some experiments in using the preparations of the African paw-paw (carica papaver) in certain surgical cases. Having had no little experience in the use of this plant, I venture to detail some of my personal observations in that direction. Soon after entering upon my duties some years ago as a missionary surgeon in western Central Africa, on the Guinea coast, I took up the study of the local medical and surgical methods of practice as seen among the various tribes of natives in that region. With many other indigenous plants I soon became acquainted with the fruit of the paw-paw tree, first, as an article of food in the shape of pie, then as a culinary adjunct in the kitchen where small pieces of the fruit were boiled with the meat to render it tender; and finally it came to me as a drug. It was used to aid the over-distended glutton in securing relief from the pains which always followed his semi-occasional stuffings. Then, as I advanced in my acquaintanceship, I found it used with the plantain as an application to ulcers and open wounds. The native methods were exceedingly crude; the required amounts of plantain leaf and paw-paw fruit, about equal parts of each, were thoroughly masticated until reduced to a fine pulp, and then bound upon the lesion, a piece of plantain leaf serving as a covering with bamboo grass tied around it to retain the dressing in place. These applications were renewed daily. Not withstanding the recommendations of my native friends, I continued

to use my imported petroleum, iodoform and other vulnerary and antiseptic remedies, disdaining as a member of the superior Caucasian race to adopt barbaric Ethiopian methods, much less to serve a surgical apprenticeship under an African devil-doctor. But pride had a fall, said fall following immediately after the loss of my small stock of iodoform, and I saw it was necessary to adopt the native remedy. Collecting a lot of the fruit, I had it reduced to a pulp in a large mortar-one of those large wooden ones used to make rice flour-and mixing it with similarly prepared plantain leaves, I applied it to some of my cases. At that time there were upon the Episcopal Mission station some 250 children and fully four-fifths of these were afflicted with "jigger sores," that is ulcers following the invasion of the chigoe parasite into the skin. These ulcers are of a most intractable form, early assuming a chronic type and breaking down and sloughing upon the slightest provocation. Everything that could be had been done to check the ulceration, but apparently to no effect. The only substance which seemed to have any reparative influence was iodoform; but the drug was scarce and expensive, the source of supply thousands of miles and two months' time away, and it was out of the question to use our small store upon these ulcers when graver and greater cases demanded the drug. In this extremity it was determined to utilize the paw-paw; and with this end in view the ulcerated limbs were divided off into squads of fifty ulcers each to be treated every other day. This treatment consisted of touching up the indolent granulations with a stick of silver nitrate "No. 2 Caustic" and then applying a dressing of the paw-paw and plantain mixture. I might state here that the plantain was added more to give the mixture a body or bulk and to act as a vehicle, than because of any vulnerary virtue it may possess. With the help of my assistant we used to treat about 100 of these cases every morning, and in the course of a few treatments there was noticed a marked improvement in the granulations-they took on a healthy appearance and spread more rapidly. In two weeks I had the satisfaction of knowing that for the first time in five years there were less than a dozen sore legs on the Mission. This experience encouraged me to further trials. Soon after I had a case come to me which was supposed to be cancer of the