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neurology
FOR GENERAL PRACTITIONERS
This page intentionally left blank
neurologyFOR GENERAL PRACTITIONERS
Roy G Beran
Sydney Edinburgh London New York Philadelphia St Louis Toronto

Churchill Livingstone
is an imprint of Elsevier
Elsevier Australia. ACN 001 002 357

(a division of Reed International Books Australia Pty Ltd)
Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067
This edition © 2012 Elsevier Australia
This publication is copyright. Except as expressly provided in the Copyright Act

1968 and the Copyright Amendment (Digital Agenda) Act 2000, no part of this
publication may be reproduced, stored in any retrieval system or transmitted by any
means (including electronic, mechanical, microcopying, photocopying, recording or
otherwise) without prior written permission from the publisher.
Every attempt has been made to trace and acknowledge copyright, but in some
cases this may not have been possible. The publisher apologises for any accidental
infringement and would welcome any information to redress the situation.
This publication has been carefully reviewed and checked to ensure that the content
is as accurate and current as possible at time of publication. We would recommend,
however, that the reader verify any procedures, treatments, drug dosages or legal
content described in this book. Neither the author, the contributors, nor the
publisher assume any liability for injury and/or damage to persons or property
arising from any error in or omission from this publication.
National Library of Australia Cataloguing-in-Publication Data
Author: Beran, Roy G. (Roy Gary)

Title: Neurology for general practitioners / Roy Beran.
ISBN: 9780729540803 (pbk.)
Subjects: Neurological examination.
Neurology.
Dewey Number: 616.8075
Publisher: Sophie Kaliniecki

Developmental Editor: Neli Bryant
Publishing Services Manager: Helena Klijn
Project Coordinator: Geraldine Minto
Edited by Brenda Hamilton
Proofread and indexed by Forsyth Publishing Services
Illustrations by Toppan Best-set Premedia Limited
Cover and internal design by Darben Design
Typeset by Toppan Best-set Premedia Limited
Printed by 1010 Printing International Ltd, China
Contents
Foreword vii
Preface ix
The author x
Reviewers x
Acknowledgements xi
1 The neurological diagnostic consultation 1

2 The neurological examination: higher centres 5
3 The neurological examination: cranial nerves 11
4 The neurological examination: peripheral
nervous system 26
5 Non-organic neurological diseases 37
6 Headache 46
7 Epilepsy 56
8 Vertigo 72
9 Parkinson’s disease 81
10 Multiple sclerosis 95
11 Peripheral neuropathy 109
12 The neurology of sleep 126
13 Pain 136
v
vi CONTENTS
14 Stroke 149
15 Dementia 160
16 Muscles 171
Index 187
Foreword
In this creative book, Neurology for General Practitioners, written by the

eminent neurologist and educator, Roy Beran, we have a text presented at a
most appropriate level for general practitioners. The author’s stated objective
was to demystify a complex discipline and avoid ‘an overly complicated and
patronising cookbook of neurological conditions’. He has certainly achieved
this, yet at the same time presents a scholarly text with the imprimatur of an
authoritative specialist.
This back-to-basics approach has undoubtedly been influenced by the
author’s past experience as a coalface general practitioner in suburban Sydney.
This surprising fact would certainly allow the author to identify with and
understand the general practice perspective, and it shows! During my long
term as medical editor of Australian Family Physician I came to know and
admire Roy for his ability to swathe through the esoteric verbiage and get to
the core issues. Practitioners will be familiar with his neurology series in
Medical Observer. He is committed to general practice education. I was
subsequently delighted with his positive response to my request to act as a
reviewer and mentor for the neurological component of Murtagh’s General
Practice.
In this text Roy Beran has simplified many of the complexities without
sacrificing excellence.
The choice of content is particularly pleasing to the general practitioner.
Many of the recognisable brain-teasing issues are addressed and this includes
the common presenting problems of headache, vertigo, seizures, peripheral
neuropathy and muscular disorders; not in great detail but in an economy of
words and concepts. As one would expect, the author challenges the practi-
tioner to achieve excellence in diagnostic methodology by adhering to the
traditional values of good history taking and physical examination. This
emphasis is reflected in the excellent chapters on neurological examination
vii
viii FOREWORD
of higher centres, cranial nerves and the peripheral nervous system. To facili-
tate our understanding the text is enhanced with first-class simplified illustra-
tions. We are also challenged to think laterally as exemplified by the chapter
on ‘non-organic neurological disease’ and other relevant nuances throughout
the text, including sections on pain, sleep and lifestyle.
At last we have a commendable, user friendly, but subtly scholarly, text
for the general practitioner, who is treated with respect and understanding by
an experienced author. The book would be equally appropriate and valuable
for students, registrars and other clinicians. It has been my privilege to be
invited to write the Foreword, and I can recommend this book with sincere
enthusiasm to my colleagues.
Professor John Murtagh AM, MBBS, MD, BSc, BEd, FRACGP,

DipObstRCOG
Emeritus Professor, Monash University; Professorial Fellow, Department
of General Practice, University of Melbourne, Victoria; Guest Professor,
Peking University, Beijing; Adjunct Clinical Professor, Graduate School of
Medicine, University of Notre Dame, Western Australia; Senior
Examiner-Australian Medical Council and Patron of General Practitioners
Registrars Association
Preface
The writing of this book was a labour of love. It began with my writing an
article for the medical broadsheet, The Medical Observer. This led from
article to article to result in a compilation that reflects my overview of neurol-
ogy for General Practitioners (GPs).
The last thing GPs needed was an overly complicated and patronising
‘cookbook’ of neurological conditions. They did not need another set of
meaningless lists, which included minutiae they would never encounter. Some
of my happiest time in medicine was when I was working as a GP in the inner
western suburbs of Sydney. It was then that I learnt to respect the role played
by GPs in the delivery of healthcare. I learnt to understand that GPs were the
vanguard in medicine.
My objective in writing Neurology for General Practitioners was to offer
these frontline doctors some insight into my approach to neurology. I am
reminded of the saying that if one gives a man a meal he is fed for a short
time, but if one teaches him how to feed himself he might be fed for life.
This book was conceived as a way of repaying some of the debt that I owe
to general practice. I believe it was my FRACGP that allowed me to enter
neurological training more than 30 years ago. General practice taught me to
accept my responsibility as a doctor, to think laterally and to deal with medi-
cine from first principles rather than from a ‘recipe book’. Lists are necessary
to pass exams but medicine is more than rote learning of mindless lists. It is
an intellectual challenge, which should be enriching and invigorating.
My hope is that Neurology for General Practitioners provides food for
thought. My goal is to encourage colleagues to think for themselves. My
ambition was to open a few windows or doors for others to pass through so
that they may be equally affected by the joy that medicine has to offer.
Throughout my writings I reiterated that this book reflects the idiosyncratic
approach of a single doctor. Not everyone will agree with some of my
ix
x PREFACE
dogmatic concepts. All I can say in my defence is that these concepts have
served me well throughout my years as a clinician. I offer them to those who
choose to read this book to accept, reject or modify. If I encourage just a few
colleagues to renew their love of learning, which motivated them to be coal-
face clinicians, then I have written a successful book.
I thank you for taking the time to read my offering and sincerely ask for
feedback. I truly hope that at least some of you find this book worthwhile and
that I can benefit from your insights to improve it into the future.
Roy G Beran
THE AUTHOR
Roy Beran MBBS, MD, FRACP, FRACGP, GradDip Tertiary Ed, GradDip
Further Ed, FAFPHM, FACLM, FRCP, FACBS, BLegS, MHL and
FFFLM(Hon)
Neurologist; Professor, School of Medicine, Griffith University,
Queensland; Conjoint Associate Professor, South-Western Clinical School,
University of New South Wales, Sydney, New South Wales
REVIEWERS
Anne Kleinitz MBBS, MPH TM, DRANZCOG
GP Registrar with Victorian Metropolitan Alliance, Northern Territory GP
Training Program, Registrar Liaison Officer Senior Lecturer at Flinders
University, Northern Territory
Bronwyn Knight MBBS

GP Registrar, Sturt Fleurieu General Practice Education and Training,
South Australia
Stephen A Margolis MBBS, MFM, MD, DRANZCOG, FRACGP,

FACRRM, GEM
Associate Professor, School of Medicine and Dentistry, James Cook
University, Cairns, Queensland
Jason Pak MBBS, FRACGP

General Practitioner, Drysdale, Victoria
Nyoli Valentine MBBS, GradCert

Health General Practice Registrar Research and Development Officer,
General Practice Education and Training Limited
Acknowledgements
This book has been many years in evolution, dating back to my time in general
practice with Ewen Loxton and Roger Davidson in Enmore, Sydney. Ewen
and Roger had a well-established practice that taught me to appreciate family
medicine. During this time Ric Day and Don Frommer from St Vincent’s
Hospital, Sydney tutored me, for which I will be eternally grateful.
I moved to Adelaide where people like Dick Rischbeith, Andrew Black,
Paul Hicks, Jim Manson and Jeremy Hallpike helped train me in neurology.
Graham Schapel introduced me to clinical pharmacology, which led into
clinical trials. I returned to Sydney to undertake my doctorate with Professor
Ian Webster, the founding Professor of Community Medicine at the University
of New South Wales (UNSW), and Professor James W Lance, the first UNSW
Professor of Neurology. Having a combined appointment in community medi-
cine and neurology is a very rare opportunity, which should not be underval-
ued. Professor Lance taught me never to accept anything unless its rationale
made sense, and Professor Webster taught me that a commitment to com-
munity service was mandatory. I hope this book reinforces those views,
although my teachers may not endorse all my hypotheses. An enduring friend
from this time is Paul Spira, with our latest collaboration published in 2011.
Another friend from this time is Rod Mackenzie, who introduced me to sleep
medicine.
I was an intern at Liverpool Hospital, Sydney in 1973, and I am still there
almost four decades later. From one neurologist, Tony Broe, who came as
needed and later became a foundation Professor of Geriatrics, it grew to two,
namely David Rail and myself. David always questioned what others took
for granted, with most interest in chaos theory. What could be more chaotic
than the road I have travelled in preparation for this book? The Department
expanded, with some good friends moving on, to now claim eleven neurolo-
gists. I thank all these colleagues for their encouragement and collegial
xi
xii ACKNOWLEDGEMENTS
friendship. I was dubbed ‘Uncle Roy’ and I hope this book reflects the views
of an elderly uncle for my friends in general practice. One person who has
been like an ‘uncle’ to me is Frank Vajda, who was always ready to advise
and criticise. I know that I have omitted names of very important friends and
colleagues who helped my career and I beg their forgiveness for the
oversight.
The most important recognition must go to my beautiful, devoted, intel-
ligent and wonderful wife, Maureen, who steadfastly stood by me since my
last year as a medical student. She supported me as a GP, while preparing for
the RACP exams, during my neurological training, while working for my
doctorate and later as my practice manager. Her intellect, enthusiasm and
support are unique, and without her I could not have achieved half of what I
consider a very proud and worthwhile career. I must also acknowledge my
four beautiful children, their partners and my grandchildren, who helped make
all of this worthwhile.
Having acknowledged those doctors and family members who contributed
to my career, an acknowledgement also must go to the wonderful team who
has worked with me, be it in my private rooms or within the hospital. They
are like family to me.
Final acknowledgement must go to the thousands of patients who
allowed me to be their doctor—be it as a GP, in my younger years, or as a
neurologist.
1
The neurological
diagnostic consultation
INTRODUCTION
The neurological examination is really no different to any other medical
examination except that it appears more impressive for the novice. There is
a formula that allows maximal yield from the process.
This chapter will offer discussion of more than just the examination and
will cover how to conduct the neurological diagnostic consultation.
HISTORY
The most important component of the neurological consultation is a detailed
history. Many neurological illnesses lack absolute diagnostic tests and may
rely exclusively on the history. It follows that the history must be as compre-
hensive and searching as possible.
While it is important to listen to what the patient offers as the main
presenting complaint, it is equally important not to take this at ‘face value’.
Patients can believe all bad headaches are migraines, all disequilibrium is
vertigo and all loss of consciousness is a seizure. Nothing could be further
from the truth. Patients should be advised to avoid jargon and diagnostic
terminology, as far as possible. Severe tension-type headache is far more
common than is migraine; loss of balance due to upper respiratory tract
infection and blocked Eustachian tube is more common than is true vertigo;
and syncope is far more common than is seizure.
Concurrent with overuse of jargon is the use of ambiguous and ill-defined
terminology, such as dizziness, giddiness, numbness, blackout or even double
vision. It is imperative to ensure that message sent is the same as message
received. It follows that if a term can have multiple meanings, both the patient
1
2 NEUROLOGY FOR GENERAL PRACTITIONERS
and clinician must agree on the meaning to be adopted. An example of this

may be ‘dizziness’, which may mean true vertigo but could also mean light-
headedness, loss of balance, disequilibrium, failure to think clearly, or even
having a ‘flu-like’ heavy headedness. ‘Numbness’ can mean loss of sensation,
a feeling of heaviness of a limb, pins and needles dysaesthesia, impaired
movement of a limb or digits with loss of dexterity, or something quite dif-
ferent. It follows that the doctor must interrogate the patient to be sure that
both are ‘reading from the same text’. Patients may complain that the doctor
doesn’t believe them so it is important to be reassuring. It helps to explain
the need for clarity and for avoidance of ambiguity.
Patients often misinterpret symptoms, such as reporting loss of vision in
one eye, when what has happened is loss of vision in a visual field, such as
homonymous hemianopia. The distinction is very important as monocular
loss of vision may be amaurosis fugax, caused by impaired vascular supply
to the eye as may occur with temporal (giant cell) arteritis. Monocular loss
of vision is rostral, distal to the optic chiasm, while hemianopia is caudal,
proximal to the chiasm. When a patient reports loss of vision in one eye it is
important to ask if they have tested each eye individually, namely if covering
one eye caused total loss of vision while covering the other eye allowed clear
vision. This implies that covering the good eye caused binocular loss of
vision, while uncovering it allowed the unaffected eye to see normally. Many
patients believe left vision comes from the left eye and right vision from the
right. With hemianopia it doesn’t matter which eye is covered as the visual
loss is the same.
With any symptom, it is important to get a clear description of what actu-
ally happened without any ambiguity. Much of this is covered in individual
chapters on specific topics. Once one understands the true nature of the actual
symptom, ‘What is the problem’ (the first ‘W’), it is time to explore the other
three ‘W’s—Where, When and Why. ‘Where’ is ‘where in the body’ (such as
focal, unilateral or bilateral) and whether the demarcation is anatomically
sound. ‘When’ asks in what situations does the symptom occur; for instance,
provocative factors. An example of this is the use of alcohol, which differenti-
ates between tension-type headaches that may be relieved by alcohol, and
migraines, which may be provoked or exacerbated by alcohol. It seeks causes,
such as stress, which is also important in tension-type headaches and other
conditions such as benign essential tremors. ‘Flashing lights’ are a hallmark
of photically induced seizures, and benign paroxysmal positional vertigo is
provoked by rolling over in bed. ‘Why’ may include auxillary factors that
might be important, such as exposure to toxic agents, trauma or genetic pre-
disposition with positive family history.
Diagnosis is much easier if one knows which questions to ask. The first
symptoms of Parkinson’s disease may be difficulty getting out of a low chair
or a low car seat, such as a sports car, or trouble turning over in bed at night.
Much of this subtlety in history taking comes with experience but just asking
the patient ‘What did you first notice wrong?’ or ‘When did you first notice
1 • The neurological diagnostic consultation 3
TABLE 1.1 The formal approach to taking a history

History Area covered
Presenting What caused the patient to seek medical attention?
symptom
History of present Detailed history of events leading up to the presenting
illness (the 4 ‘W’s) symptom
i What (presenting complaint) is causing the patient
to go to the doctor? (description of the symptoms
and their evaluation)
ii Where in the body?
• focal, generalised, unilateral or bilateral
• radiation
• is it anatomically sound?
iii When?
• provocative factors
• possible causes
• situations in which symptoms occur
iv Why?
• auxiliary factors often found in past and personal
history
Personal history i History of smoking
ii Alcohol consumption
iii Medications: name, strength, dosage
iv Medical past history
v Surgical past history
vi Psychosocial history as may be relevant to the
complaint
Symptom review History covering symptoms relevant to other organs
things were not right?’ will help. Given a chance and forced to describe
symptoms in simple words rather than using jargon, which is often misunder-
stood by the patient, the description in plain language will greatly improve
the diagnostic process.
Before leaving the discussion of history, it is important to set out the formal
approach to the taking of an adequate history (see Table 1.1).
EXAMINATION
The examination starts long before the patient reaches the consultation room.
An observant receptionist may diagnose sleep apnoea, with excessive daytime
sleepiness, before the patient has seen the doctor. An experienced receptionist
will usually identify patients with behaviour disorder in the waiting room. A
good receptionist will share these thoughts with the doctor.
As already stated, difficulty getting out of a chair may alert the doctor for
Parkinson’s disease. A wide-based gait, looking like a drunken sailor, may
suggest cerebellar disease. A white stick is self-evident for visual impairment
and a hearing aid may be important for the patient complaining of ‘vertigo’.
There are many diagnostic gaits, such as the stooped, shuffling, unsteady gait
of the Parkinsonian; the hemiparetic gait of the stroke patient; or even the
flamboyant, brazen gait of the patient with a psychological disorder.
Similarly language, facial expression or facial asymmetry, ptosis, dystonic
posturing or the way in which a walking aid is used (which should be different
for balance problems or pain support) all provide diagnostic tools. These
provide direction for the consultation. They should alert the doctor if the
patient fails to mention something that is important. An example of this is the
patient who complains of an unprovoked fall but shows Parkinsonian gait,
expressionless face, softly spoken voice, appears younger than the stated age
and is moving slowly. The astute doctor will have made the diagnosis before
the consultation has commenced: the cause of the fall probably will be ‘failed
righting reflexes’. The consultation will then focus on this diagnosis and try
to exclude the potential differential diagnoses.
In the majority of neurological cases the diagnosis is obvious once the
history has been taken. This is especially so if the clinician has been observant
both before the consultation (as the patient moves from the waiting area to
the consultation room) and during history taking. In most cases the physical
examination is largely unnecessary other than to reassure the patient that the
doctor is both competent and diligent. If there is not a strong suspicion of the
provisional diagnosis prior to commencing physical examination, it is unlikely
that the examination will provide the answer and the missing clue. The exami-
nation should confirm the expected findings. The competent neurologist will
have anticipated the findings before examining the patient. This translates into
students being very impressed because the doctor can afford to be flamboyant
in demonstrating the signs and even suggesting additional techniques that the
doctor knows will be positive. Concurrently, patients are impressed when the
doctor can predict clinical findings, thereby reassuring patients that they are
in good hands.
Despite dismissing the need for physical examination, only a foolish doctor
would not carry it out. It is part of patient expectation and, hence, part of the
mystique that is medicine. It may also uncover other problems unrelated to
the presenting complaints, such as goitre, cardiac murmur or skin lesions.
2
The neurological
examination:
higher centres
The neurological examination is broken down into three components:

1 higher centres
2 cranial nerves
3 peripheral neurological examination.
Each comes with its own tricks and shortcuts, and each will be explored
in separate following chapters.
HIGHER CENTRE FUNCTION TESTING

Many people use tools such as the Mini Mental State Examination (MMSE)
or a variety of other tests such as The Rowland Universal Dementia Assess-
ment Scale (RUDAS) developed by a team at Liverpool Hospital in Sydney.
Over the years I have developed my own tool, which I will now share. This
tool takes less than ten minutes to administer and offers fairly specific answers
as discussed below. Higher centre function testing is usually only necessary
if cognitive impairment is the presenting complaint.
As a general rule, higher centre function testing is adequately tested in the
routine consultation, taking the history and assessing patient participation and
cooperation. Clinicians will form a fairly accurate assessment of higher centre
function by this alone.
Where further testing of cognition is needed, as with assessment of demen-
tia, the MMSE is mandated by the government to underwrite appropriate
medication. Personally, I believe that the MMSE is an extremely blunt instru-
ment and should only be used if so mandated to allow prescription. My
alternative tool is as follows.
5
1 The patient is given a six-item name and address (for example, William
Bourke, 61 Griffith Avenue, Waverley) and asked to repeat it correctly
on three consecutive attempts and until it is correctly repeated three times.
The number of times the initial material needs to be offered should be
scored. The average person should not require more than ten repetitions
of the data to repeat it three times correctly. This tests immediate recall
and allows transfer from the metaphoric RAM (random accessed memory)
to hard drive. Once the material is correctly repeated three times, the
patient is advised that an alarm has been set and they will be asked why
it was set when it goes off in five minutes. The reason will be to see if
the patient can remember that the alarm was set for a reason, what that
reason was, and then repeat the six-item name and address. Most people
can remember why the alarm was set, and personal experience suggests
the average patient will recall three or four out of the six items. This tests
immediate memory, five-minute recall, compliance and cooperation. It
does contain a cultural element as the name and address is Australian
based, but the recall of why the alarm was set does not reflect cultural
bias.
2 Once Step 1 has been completed and the backwards timer is set, the
remainder of the higher centre function testing can take place. This dis-
tracts the patient to allow proper five-minute recall rather than the patient
practising and thus only testing immediate recall rather than five-minute
recall.
3 Within the Australian context the patient is asked the name of the prime
minister, state premier, day and date. This tests orientation in time and
place as well as awareness of current affairs with an element of memory
testing. Most will know at least day and date, and many will offer politi-
cians’ family names if prompted with given names.
4 The next test is ‘Serial 7s’. Patients are asked to sequentially deduct 7
from 100, 7 from the response (i.e. 93) and 7 from that—until asked to
stop. Once the patient reaches ‘30’ the sequence recurs, thus if the patient
correctly states 100, 93, 86, 79, 72, 65, 58, 51, 44, 37, 30, it is my practice
to stop at 30. The average person loses concentration when the answer is
‘44’. The most common error is 100, 93, 84 but this still shows good
arithmetic skills: (a) the patient correctly subtracts 100 – 7 to achieve 93;
(b) then subtracts 3 from 93 to achieve the 80s; (c) then subtracts 3 from
7 to get 4; (d) but rather than subtracting 4 from 90 the patient adds 4 to
80, hence the answer 84. This demonstrates anxiety rather than dyscal-
culia. Serial 7s test calculation (eloquent dominant hemisphere function),
visual spatial orientation (spatial non-dominant hemisphere function) and
the connections between the hemispheres to coordinate both hemispheres
(corpus callosum). It also assesses concentration and anxiety levels. It is
important to determine which of these factors has provoked an error if
one occurs, as demonstrated above with the ‘84’ response.
2 • The neurological examination: higher centres 7
5 The patient is then asked to manipulate 29 × 3 to achieve 87. Once the

correct answer is given the patient is asked for the method used. The
intelligent, sophisticated calculation is 30 × 3 = 90 – 3 = 87. This dem-
onstrates capacity for lateral thinking and equates to proverb testing. The
traditional method of long multiplication 9 × 3 = 27; 20 × 3 = 60; 60 +
27 = 87 demonstrates a degree of concrete thinking.
6 Next in higher centre testing is 5-digit repeat and reverse. The patient is
given a 5-digit number and asked to repeat the number in the sequence
given and then to recite it in reverse order. As part of the instructions the
patient is provided the example of 1, 2, 3, 4, 5 followed by 5, 4, 3, 2, 1
to demonstrate what is expected. The average patient should be able to
complete the process with no more than ten attempts. Should the patient
have trouble giving the number in its correct forward order, the number
should be repeated for the patient before the next attempt. The failure to
perform the task is recorded as one of the attempts, and the attempt after
the repetition of the number constitutes the next attempt. The number of
times the base number is provided should also be recorded but does not
constitute one of the ten attempts. This tests immediate recall, visual
spatial orientation, concentration and may also provide the best indicator
of organic pathology if there is a perseverative error; for example, the
reverse of 1, 2, 3, 4, 5 is repeatedly given incorrectly as 4, 3, 5, 2, 1
despite being advised that this was incorrect. If the patient successfully
completes the 5-digit repeat and reverse sequence then a 7-digit number
is provided. The average patient can repeat the 7-digit number but cannot
correctly reverse it, even after ten attempts.
7 The next step is to test dominant parietal lobe function by asking the
patient to name: a watch, strap, clasp and hands of a wristwatch. Other
questions include the lapel of a jacket and the cuff of a sleeve. These test
for nominal dysphasia, but such items as the lapel of a jacket may be
culturally and socio-economically reflective so this needs to be
considered.
8 Receptive dysphasia and right/left dissociation is tested by asking the
patient to place the right hand over the left ear and then the left hand over
the right eye.
9 Finger agnosia and right/left dissociation is tested by asking the patient
to indicate the right index finger, the left middle finger and so on. This
also further tests receptive dysphasia.
10 Constructional dyspraxia and visual/spatial orientation is tested by asking
the patient to draw a clock face (analogue) with the hands set at 10:45
hours (Fig 2.1). The reason for selecting this time is because it further
tests receptive dysphasia as it is somewhat more complex and further it
requires both the hands to be set on the left-hand half of the clock face,
thereby further testing non-dominant hemisphere function due to the
Both hands
on left side 11 12 1
of clock
10 little hand 2
Patient is asked to draw
a clock with hands set at
9 3
big hand
8 4
10:45 or
a quarter to eleven
(I prefer the latter
as it tests
reception better)
7 6 5
FIGURE 2.1 Clock.
potential for left-sided neglect. Clock drawing tests constructional dys-

praxia as well as left-sided neglect.
11 Within the Australian context, the final test is to ask the patient to draw
a map of Australia with a capital letter identifying each capital city at an
appropriate spot on the map. This tests educational standard, visual/
spatial orientation and constructional dyspraxia (Fig 2.2).
Dressing and undressing, as part of the physical examination, is also part
of higher centre function testing. Inability to dress is known as dressing dys-
praxia and is further evidence of non-dominant hemisphere dysfunction.
It is not enough to know which tests to perform as it is equally important
to appreciate what is being tested and what the results mean. The above tool
describes both the test and the modality tested. It also offers suggested limits
of normality based on experience of the average patient (see Box 2.1 on p.
10). A patient achieving below average for a test has demonstrated a localised
problem, such as memory problem with possible temporal lobe dysfunction.
This helps direct further investigations.
2 • The neurological examination: higher centres 9
D Captial cities:
A = Adelaide
B = Brisbane
C = Canberra
D = Darwin
H = Hobart
M = Melbourne
P = Perth
S = Sydney
B
S
A C
Patient is asked to draw a map of Australia

with the capital letter of each capital city
placed at approximately the correct position on the map
FIGURE 2.2 Map of Australia.

BOX 2.1 Testing cognition: summary

A Memory testing (a) immediate recall and (b) five-minute recall
a The patient is given a six-item name and address and asked to repeat
it correctly three times without error.
Abnormal: Most can do this with less than ten repetitions of the six
items.
b After three correct repetitions, an alarm is set to sound in five minutes,
and the patient told to remember:
i why the alarm was set
ii to recall the six-item name and address.
Abnormal: Most know:
i why the alarm was set
ii can recall at least three of the six items.
B Orientation in time and place and current affairs
Patients are asked to name the prime minister, state premier, day and
date.
Abnormal: Most will know:
i day and date
ii only politically aware will know politicians.
C Calculation, visual spatial orientation, concentration and
interhemispheric connections
Serial sevens: 100 – 7 = 93 – 7 = 86 – 7 = 79 …
Abnormal: Most people retain concentration to 44.
D Calculation and lateral thinking
29 × 3 = 87. The method adopted to achieve the result tests lateral versus
concrete thinking, which is important.
8 × 3 = 27, 20 × 3 = 60, 60 + 27 = 87 (concrete/traditional thinking)
30 × 3 = 90 – 3 = 87 (lateral thinking)
Abnormal: Most can do this but how it is done is important.
E Immediate recall, visual spatial orientation concentration and
perseveration
i Patients are asked to repeat and reverse the sequence of a five-digit
number.
Abnormal: Most can do this within ten attempts.
ii Once achieved (i), repeat with a seven-digit number.
Abnormal: Most cannot do this even after ten attempts.
F Dominant hemisphere function
The patient is asked to: name common objects (looking for nominal
dysphasia); perform complex tasks (place right hand over left eye—
looking for receptive dysphasia plus right/left dissociation); and name
fingers on right or left hand (looking for finger agnosia and right/left
dissociation).
G Non-dominant hemisphere function
The patient is asked to draw common objects (such as a clock face) to
test for constructional ability.
3
The neurological
examination:
cranial nerves
CN I (OLFACTORY NERVE)
Smell, if tested, requires soft musks, floral and ketone smells rather than
astringents, such as ammonia or cloves. The reason for this is that astringents
are also noxious. They may stimulate trigeminal (CN V) nerve endings in the
nose, causing perception of the stimulus even with completely severed CN 1.
Each nostril is tested individually and not necessarily with a different scent,
so that the patient is asked if the test scent is the same or different in each
nostril. Often the patient will say they are different when they are the same,
making interpretation difficult.
A CN 1 palsy should alert the GP to the possibility of a meningioma of
the olfactory groove. This is a slow growing tumour that may be ignored
because its effects come on slowly. The patient may not be aware that they
have lost the sense of smell. Loss of smell, associated with the flu, may be
permanent. Sensation of smell and taste are intertwined so a patient complain-
ing of altered taste may be identifying problems with smell.
CN II (OPTIC NERVE)
This requires four separate tests: field, fundi, acuity and pupils.
Fields are tested by confrontation, by standing in front of the patient and
randomly wiggling fingers in each of the four quadrants of the visual fields
(Fig 3.1).
The patient is asked to point at the wiggling fingers, and at times it is worth
wiggling fingers in more than one quadrant to encourage the patient to pay
extra attention. If this test suggests abnormality, then each eye should be
tested individually by covering the other eye. The crude test has the doctor
11
1 The patient fixates on the doctor’s eye

2 The patient points to the moving fingers
3 It is often good to test in different quadrants at the same time
Note: Students were taught that the doctor and patient must
be seated at the same level but it is more important that both
work from the same planes, which are perpendicular to each other
FIGURE 3.1 Testing visual fields.
wiggle the finger in each of the four quadrants of the visual field and the
patient must identify the wiggling finger. More sophisticated testing has the
doctor move the fingers in on the diagonal in each quadrant (see Fig 3.2).
The patient is asked to indicate as soon as the finger is seen, and the doctor
compares this to their own perception of the finger to see if there is parity
between doctor and patient. Use of a red object, such as a red pin, produces
a more precise definition of the field of vision. The patient is asked to nomi-
nate when the pin is clearly perceived as red, thereby relying on colour vision,
rather than a relatively large moving object. Loss of vision must respect the
horizontal and vertical meridians to be anatomically sound (see Fig 3.2).
When the patient is uncooperative and will not point to the moving finger
or object, an alternative method for testing visual fields is to use ‘menace’.
Menace employs a motion as if the examiner is going to poke the patient in
the eye, either with a fist or flattened hand, stopping just short of the point of
contact. If the patient has preserved vision within the quadrant being tested,
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offspring and his property, or to die in the attempt. At first he
appeared anxious for our assistance; but, on mature consideration,
he generously refused any interference on our part in his behalf.
“For,” said he, “when once the war begins, there is no saying when
or where it will end. The whole country will be in an uproar; much
blood will be shed; and it would involve you in endless difficulties
and dangers.” He, moreover, strongly endeavored to persuade us
from proceeding northward at all, but in that matter he of course
failed.
We had only been a short time at Kotjiamkombè when it was
discovered that four of our best draft-oxen were stolen by some
stranger Damaras. On being informed of this theft, Kahichenè
became exceedingly annoyed, and even distressed, as he considered
us under his special protection. He immediately dispatched men on
their tracks, with strict orders to recover the oxen, and, if possible,
to bring back the thieves. They succeeded in recapturing all the
beasts but one, which the natives had slain and eaten. With regard
to the fate of the rogues, we could never ascertain any thing with
certainty. We were, however, strongly inclined to think they were all
killed, the more so as Kahichenè himself told us that, in case of their
capture, they ought to be punished with death, and coolly suggested
hanging as the most eligible way of ridding the world of such
scoundrels. We, of course, took the liberty to remonstrate with the
chief upon the severity of this measure, but with little or no effect.
Indeed, one man was accidentally found at a distance from our
camp in a horribly mangled state, and, on being brought to us, he
stated that he himself, together with several of his friends, were
driving away the cattle, when they were overtaken by Kahichenè’s
men, who immediately attacked them with their kieries, and only left
them when they thought life was extinct. He had, however, partially
recovered, but was completely naked, having, as is usual on similar
occasions, been stripped of every article of dress. The exterior of his
body was nearly covered with blood. The head was almost double its
natural size; indeed, it resembled rather a lump of mashed flesh; no
particular feature could be distinguished, and his eyes were
effectually hidden from view. The sight altogether was hideous.
Instead of proceeding due north, as was originally proposed, it
was found necessary, in order to avoid Omugundè, to make a
considerable détour to the westward. As Kahichenè, with his tribe,
was encamped in that direction, he invited us to take his werft by
the way, to which we cordially assented. On the day of our departure
from Kotjiamkombè, the chief led the way. A branch of a particular
kind of wood (having a small, red, bitter berry, not unlike that of the
mountain-ash) was trailed before him—a superstitious act, thought
to be essential in insuring success during the pending attack against
his mortal enemy.
Before reaching the chief’s kraal, we passed the foot of a very
conspicuous mountain called Ombotodthu. This elevation is
remarkable for its peculiar red stone, which is eagerly sought after
by the natives. Having reduced it to powder, they mix it with fat,
when it is used as an ointment. I was at first struck by its great
resemblance to quicksilver ore, and was led to believe that we had
really discovered a mine of that valuable mineral. However, on
considering the harmless effect it had on the natives, and that, had
it been quicksilver, its use would have produced an opposite result, I
came to the conclusion that it was simply oxide of iron, which has
since been confirmed by analysis.
On arriving at Kahichenè’s werft we were well received by our host
and his tribe, from whom we obtained by barter a few head of
cattle. Indeed, we might here have sold all our articles of exchange
to great advantage; but this was not thought advisable, as, in case
of the cattle being lost or stolen, we should have been in a state of
complete destitution. Could we, however, have foreseen the future,
our tactics would have been different; for, as it afterward turned out,
this was almost the last opportunity we had of providing ourselves
with live-stock.
By a strange chance, I accidentally became the owner of a
percussion rifle, which had at one time belonged to Hans, but who,
years previously, had disposed of it to a Damara. The latter,
however, finding that he could not obtain a regular supply of caps,
offered to exchange it for a common flint-lock musket. The rifle was
a very indifferent and clumsy-looking concern, and had, if I
remember rightly, been manufactured by Powell, of London. In
justice to the maker, however, I must confess that a man could not
possibly wish for a better. While in my possession, many hundred
head of large game, to say nothing of a host of bustards, geese,
ducks, Guinea-fowl, &c., fell to this piece.
Game was abundant in the neighborhood of Kahichenè’s kraal,
and Hans made several successful shots. Very little, however, of
what was killed reached us, for the portion not immediately
appropriated by the Damaras ultimately found its way to them
through the medium of our native servants. In Damara-land the
carcasses of all animals, whether wild or domesticated, are
considered public property; therefore, unless the natives should
share their allowances with every stranger that might choose to
intrude himself into their company, a withering “curse” was
supposed to befall them. I have seen the flesh of four zebras, that
had been shot by our party, brought to the camp in a single day, and
the next morning we could not obtain a steak for our breakfast.
The Damaras are the most voracious and improvident creatures in
the world. When they have flesh they gorge upon it night and day,
and in the most disgusting manner, until not a particle is left; and, as
a consequence, they not unfrequently starve for several days
together; but they are so accustomed to this mode of living that it
has no injurious effect on them.
In this hot climate, unless preventives of some kind were adopted,
flesh would, of course, soon become tainted; and as salt, from the
difficulty of conveyance, is exceedingly scarce in Damara-land, the
following expedient is adopted. As soon as the animal is killed,
lumps are indiscriminately cut from the carcass; a knife is plunged
into an edge of one of these lumps, and passed round in a spiral
manner, till it arrives at the middle, when a string of meat, often ten
to twenty feet long, is produced, which is then suspended like
festoons to the branches of the surrounding trees. By cutting the
flesh very thin it soon dries, and may in that state be carried about
any length of time. There is considerable waste in this process, as
fully one third of the meat thus jerked is lost. On such occasions, the
natives take care not to forget their own stomachs. Besides large
pots filled with the most delicate morsels, immense coils may be
seen frizzling on the coals in every direction. When half roasted, they
seize one end with their hands, and, applying it to their mouth, they
tug away voraciously, not being over particular as to mastication. In
this way they soon manage to get through a yard or two, the place
of pepper and salt being supplied by ashes attached to the flesh,
which ashes are, moreover, found to be an excellent remedy against
bad digestion.
I frequently observed the daughter of Kahichenè’s favorite wife
sprinkling water over the large oxen as they returned to the werft
about noon to quench their thirst. On such occasions she made use
of a small branch of some kind of berry-tree, such as that which
Kahichenè caused to be trailed after him when wishing to be
successful in his attack on Omugundè. In this instance (as they
somewhat poetically expressed themselves), the aspersion was
supposed, should the cattle be stolen, to have the power of
scattering them like drops of water, in order to confuse their
pursuers, and to facilitate their return to the owners.
On the 18th of March we were again en route. It was with regret
that we parted with our friendly and hospitable host. Poor Kahichenè
we were doomed never to meet again! A few months after our
departure he made an attack on Omugundè; but, at the very
commencement of the fight, and when every thing promised
success, his dastardly followers (as he always had predicted) left
him. But too proud himself to fly, he fell, mortally wounded, pierced
with a shower of arrows.
Being in advance of the wagons, I suddenly came upon an animal
which, though considerably smaller, much resembled a lion in
appearance. Under ordinary circumstances I should certainly have
taken it for a young lion; but I had been formerly given to
understand that in this part of Africa there exists a quadruped which,
in regard to shape and color, is like a lion, but in most other respects
totally distinct from it. The beast in question is said to be nocturnal
in its habits, to be timid and harmless, and to prey, for the most
part, on the small species of antelopes. In the native language it is
called Onguirira, and would, as far as I could see, have answered
the description of a puma. As it was going straight away from me, I
did not think it prudent to fire.
Immense quantities of game were now observed, but the country
was open and ill adapted for stalking, and, having no horses, it was
difficult to get within range. A few springboks, however, were killed.
I also shot a hartebeest; but, having been obliged to leave it for
about an hour, I found, on my return, that it had been entirely
devoured by vultures; but as they could not manage to eat the
bones, our men consoled themselves by sucking them. The flesh of
the hartebeest is considered extremely palatable.
The next day we rounded the cones of Omatako; but, to my great
astonishment, the river of that name, although running breast-high
on my visit to it about a fortnight previously, was now perfectly dry.
Fortunately, a pool still remained on its left bank.
The estimate of the Damaras as to the distance between the
mountains Omatako and Omuvereoom, of which mention was
recently made, was now reduced from ten to three long days’
journey. These men still said that the intervening country was
destitute of water. We dared no longer trust to their conflicting and
unsatisfactory accounts; but, in order to enable us to judge in a
measure for ourselves, Galton rode to the neighboring mountain,
Eshuameno, whence, from its advanced and isolated position, a
good view of the country was likely to be obtained. After the
absence of a day and a night, he returned with favorable news. By
means of a rough triangulation, he had ascertained that
Omuvereoom could not possibly be distant above twelve or fourteen
hours’ traveling. To the north and west of Omuvereoom the country
appeared as one unbounded plain, only covered by brushwood.
Eastward grass and trees were abundant. This, together with a
timely fall of rain, at once determined us to make the attempt.
On the morning of our departure a bitterly cold wind swept over
the dreary wastes, and suddenly reminded us of the approach of the
winter season. Hitherto a shirt and a pair of trowsers had been
enough to protect our bodies, but this day an addition of thick
flannel and a warm pea-jacket was found to be insufficient.
One evening, as Hans and myself were giving chase to a troop of
giraffes, we were overtaken by darkness, and, in the heat of pursuit,
had completely lost our way. Hans being the most experienced of
the two, I blindly abandoned myself to his instinct and guidance.
After a while, however, it struck me we were actually retracing our
steps to Omatako, and I told him so, but he only laughed at my
apprehensions. Still, the more I considered the matter, the more I
became convinced that we were pursuing a wrong course. In order,
therefore, to split the difference, I proposed to Hans that if in about
an hour he did not find any indications of our whereabouts, he
should permit me to act as “pilot” for the same space of time, and
that if I were equally unsuccessful as himself, we should quietly wait
for the return of daylight. Hans was skeptical, and, shaking his head,
grudgingly gave his consent. His hour having elapsed without
gaining the object of our search, I wheeled right round, to his great
disapproval, and walked as hard as I could in an exactly opposite
direction. Singularly enough, only two or three minutes were
wanting in completing my hour when I was suddenly and agreeably
surprised to find my foot in the deep track made by the wheels of
the wagons. Nothing could have been more fortunate, for I struck it
precisely at a right angle. Another half an hour’s walk brought us
safe back to our bivouac, where, over a substantial dinner, we joked
Hans on his singular obstinacy. His pride as a skillful woodsman had
received a severe blow, and he would at intervals shrug his
shoulders and repeat broken sentences of, “Well, I am sure! It’s too
bad!” and so forth.
The day after this little adventure we continued our journey, and
in the afternoon found ourselves safe at the foot of the southern
extremity of Omuvereoom, and its sister hill, Ia Kabaka, from which
it is only separated by a narrow valley. We “outspanned” at a small
vley, where, for the first time, I observed the willow-tree—an
agreeable reminiscence of my native land. The water, however, was
of the most abominable quality, being apparently much frequented
by wild animals, who had converted the pool into something like
what we see in a farm-yard.
At this place we had a striking instance of the fearful ravages
which termites are capable of committing in an incredibly short time.
In the early part of the day after our arrival, Mr. Galton and Hans
started on foot, with the intention of ascending Omuvereoom. In
consequence of a sudden and distressing pain in my side, I was
unable to accompany them, and, in the hope of obtaining a little
ease, made a sort of extempore couch on the ground, covering it
with a plaid. On rising after a while, I discovered, to my dismay and
astonishment, that my bedding had been completely cut to pieces by
the destructive insects, and yet, when I first laid down, not one was
visible.
Early the next morning we pushed on to a large vley, upward of a
mile in length, the finest sheet of standing water we had yet seen in
Damara-land. It was swarming with geese and ducks. The
vegetation had a very tropical appearance; several—to us—new
trees and plants, without thorns, presented themselves, and we
began to flatter ourselves that we had at last passed the boundary-
line of those thorny woods which had so long and pertinaciously
harassed us. In this, however, we were disappointed. The very next
day we entered a region far worse than any we had yet seen, which,
indeed, bade fair to stop us altogether. Our poor cattle were cruelly
lacerated, and it was with the utmost difficulty we succeeded in
getting the wagons through. I counted no less than seven distinct
species of thorny trees and bushes, each of which was a perfect
“Wacht-een-bigte,” or “Wait a little,” as the Dutch colonists very
properly call these tormentors. Few individuals have ever traveled in
the more northerly parts of Southern Africa without being greeted
with a friendly salutation of ‘Stop a little, if you please;’ and fewer
still, who have disregarded this gentle hint, ever came away without
first paying a forfeit of some part or other of their dress. Indeed, the
fish-hook principle on which most of the thorns are shaped, and the
strength of each, make them most formidable enemies. At an
average, each prickle will sustain a weight of seven pounds. Now, if
the reader will be pleased to conceive a few scores of these to lay
hold of a man at once, I think it will not be difficult to imagine the
consequences. Indeed, on our return to Barmen, after a few months’
absence, I possessed hardly a decent article of clothing; and, had
not Mr. Hahn kindly taken pity on my forlorn condition, I am afraid
there would soon have been little difference between me and the
savages.
In the course of the day we arrived at a magnificent fountain,
called Otjironjuba—the Calabash—on the side of Omuvereoom. Its
source was situated fully two hundred feet above the base of the
mountain, and took its rise from different spots; but, soon uniting,
the stream danced merrily down the cliffs. These cascades, falling to
the plain below, flowed over a bed of red gravel. A gigantic fig-tree
had entwined its roots round the scattered blocks of stone by the
side of Otjironjuba fountain, its wide and shady branches affording a
delicious retreat during the heat of the noonday sun. It bore an
abundance of fruit; but it was not yet the season for figs. Several
half-ripe ones that I opened contained a large quantity of small ants,
and even wasps. Great caution, therefore, is necessary in eating
them.
Otjironjuba was to us a perfect paradise. We enjoyed it the more
on account of the marked contrast it presented to the country we
had previously traversed.
At the foot of the mountain we discovered the remains of a large
Hill-Damara kraal. A considerable extent of land had at one time
been carefully cultivated, and a few young calabashes and pumpkins
were still seen springing up from the parent stock of the preceding
season. The day after our arrival one or two natives came to visit us,
and no doubt, also, for the purpose of ascertaining who and what
we were. We of course entertained them well, and at parting gave
them a few trifling presents, with a request that they would soon
return with the remainder of their tribe, in order that we might buy
from them some goats, which, from the surrounding evidences, they
must have possessed in great numbers. The fresh tracks of a few
horned cattle were also to be seen. However, our friends never came
back, nor did we encounter any more of the natives.
While sauntering about the place we stumbled upon several
deserted Damara villages, and our native servants now told us that,
after the late attack on Schmelen’s Hope by Jonker, Kahichenè and
his tribe had fled with the remainder of their cattle to this secluded
spot; and yet, a short time previously, they had positively asserted
that the country was impassable for man and beast! They, moreover,
informed us that several bloody fights, or rather massacres, had at
that time taken place between the contending parties; and that
whenever a man, woman, or child was met, and the deed could be
perpetrated with impunity, they were cruelly murdered. These
sanguinary outrages were sometimes inflicted, they said, by the
Damaras, and at others by the Hill-Damaras.
I climbed to the top of the Omuvereoom, whence I had a very
extensive view of the country to the eastward; but, excepting a few
periodical water-courses which originated in the sides of the
mountain, nothing but an immense unbroken bush was to be seen.
It was in vain that I strained my eyes to catch a glimpse of
Omanbondè, which we were told lay only about five days’ journey
hence, and at the northern extremity of Omuvereoom.
Elephants occasionally visited this neighborhood, and even breed
near a fountain somewhat farther to the northward.
After having spent a couple of days very pleasantly at Otjironjuba
fountain, we for a short time followed the course of the rivulet which
has its rise there; but it was soon lost in a marsh.
On the second day of our departure we came, unobserved, upon a
few Bushmen, engaged in digging for wild roots, and succeeded in
capturing a man and woman, whom, with some difficulty, we
persuaded to show us the water. The dialect of these people was so
different to any we had yet heard, that, notwithstanding our two
excellent interpreters, we could with difficulty understand them.
However, by a good deal of cross-questioning, we managed to make
out that they had both been to Omanbondè, which they called
Saresab; that the “water was as large as the sky,” and that
hippopotami existed there. The man, moreover, said that he would
conduct us to the lake; but this was only a ruse, for in the course of
the night both he and his wife absconded.
Our doubts and anxiety increased as we approached nearer and
nearer the inland sea, and all our thoughts were concentrated in the
single idea of the lake. The Bushman’s story of the water being “as
large as the sky” wrought greatly on our expectation.
“Well, Andersson, what should you suppose this lake’s greatest
length to be, eh?” said Galton. “Surely it can not cover less than
fifteen miles anyhow; and as for its breadth, it is, no doubt, very
considerable, for the Hottentots declare that if you look at a man
from the opposite shore he appears no bigger than a crow.”
It would have been well for us had we been less sanguine.
As we journeyed on a course somewhat parallel with
Omuvereoom, we fell in with a sort of vley river—if river it could be
called, since it consisted alternately of dry, open spaces and deep
gulleys. Both banks of this peculiar water-course were hemmed in by
one vast thorn-jungle, which seemed to defy the passage of man or
beast. It was doubly fortunate, therefore, that we met this river, as
its sides served as a good and open road, while a plentiful supply of
water was afforded by the occasional pools. It was here, at last, that
we arrived at some Damara villages, on the fifth day after leaving
Otjironjuba. At first the natives tried to run away; but we captured a
few women, which soon induced the men to return. These people
had never before seen a white man; and our sudden appearance,
therefore, created no small astonishment, not to say consternation.
But of all our property, nothing amused them more than the sight of
a looking-glass. On finding that the mirror faithfully reflected the
smallest of their motions or gesticulations, they became convulsed
with laughter; and some of them were so excited as to throw
themselves on the ground, pressing their hands against their
stomachs. Others would approach with their faces to the glass as
close as they could, then suddenly turn it round, fully expecting
somebody at its back. It is a great pity that the Damaras are such
unmitigated scoundrels, for they are full of fun and merriment. Give
them a “yard of meat” and a bucket of water, and they are the
happiest creatures on the face of the earth.
After some parleying, a man agreed to guide us to the lake. An
afternoon’s farther traveling brought us to a second werft, the
captain of which was the jolliest and the most amusing Damara that
we ever saw before or since. He mimicked the figure and the actions
of the hippopotamus so admirably that we should never have
mistaken the animal, even had we not known a word of the
language. He also gave us an amusing and laughable account of the
people to the north.
One day more, and the goal of our hopes and anxieties would be
realized! We carefully examined our Mackintosh punt to see that it
was sound, as we fully purposed to spend a few weeks on the
shores of Omanbondè, in order to enjoy some fishing and shooting.
By this time we had lost sight of Omuvereoom, which gradually
dwindled into a mere sand-ridge, and was now identified with the
plain. The vley river just mentioned, which had so long befriended
us, we also left behind, and were now traveling across a very sandy
tract of country. Fortunately, though the bushes were very thick, only
a few were thorny. Moreover, their wood, which was quite new to us,
was of so brittle a nature that, although trees from five to six inches
in diameter repeatedly obstructed our path, our ponderous vehicles
crushed them to the ground like so many rotten sticks. A European
can form no conception of the impracticable country one has to
travel over in these parts, and the immense difficulties that must be
surmounted. To give a faint idea of the obstructions of this kind of
traveling, we will suppose a person suddenly placed at the entrance
of a primeval forest of unknown extent, never trodden by the foot of
man, the haunt of savage beasts, and with soil as yielding as that of
an English sand-down; to this must be added a couple of ponderous
vehicles, as large as the coal-vans met with in the streets of London,
only a great deal stouter, to each of which are yoked sixteen or
twenty refractory, half-trained oxen. Let him then be told, “Through
yonder wood lies your road; nothing is known of it. Make your way
as well as you can; but remember, your cattle will perish if they do
not get water in the course of two or three days.”
No greater calamity could possibly befall us than the breaking of
an axle-tree at a distance from water. Therefore, every time the
wagons struck against a tree, or when the wheels mounted on a
stone several feet in height, from which they descended with a crash
like thunder, I would pull up abruptly, and hold my breath till all
danger was over, when a weight like that of the nightmare fell from
my mind. However, in the course of time, we became tolerably
accustomed to the hazards that beset us, and looked almost with
indifference on the dangers which constantly threatened destruction
to our conveyances.
About noon on the 5th of April we were rapidly approaching
Omanbondè, but oh, how were we disappointed! My heart beat
violently with excitement. The sleepy motion of the oxen, as they
toiled through the heavy sand, being far too slow for my eagerness
and excited imagination, I proceeded considerably in advance of the
wagons, with about half a dozen Damaras, when all at once the
country became open, and I found myself on some rising ground,
gently sloping toward the bed of what I thought to be a dry water-
course.
“There,” suddenly exclaimed one of the natives—“there is
Omanbondè!”
“Omanbondè!” I echoed, almost in despair; “but where, in the
name of heaven, is the water?”
I could say no more, for my heart failed me, and I sat down till
the wagons came up; when, pointing to the dry river-bed, I told
Galton that he saw the lake before him.
“Nonsense!” he replied; “it is only the end or tail of it which you
see there.”
After having descended into the bed, we continued to travel, at a
rapid pace, about a mile in a westerly direction, when, at a bend, we
discovered a large patch of green reeds. At this sight a momentary
ray of hope brightened up every countenance; but the next instant it
vanished, for we found that the natives were actually searching for
water among the rushes!
The truth at last dawned upon us. We were indeed at Omanbondè
—the lake of hippopotami! We all felt utter prostration of heart. For
a long while we were unable to give utterance to our feelings. We
first looked at the reeds before us, then at each other in mute
dismay and astonishment. A dried-up vley, very little more than a
mile in extent, and a patch of reeds, was the only reward for months
of toil and anxiety!
CHAPTER XIV.
Omanbondè visited by Hippopotami.—Vegetation, &c., described.—Game
somewhat scarce.—Combat between Elephant and Rhinoceros.—
Advance or Retreat.—Favorable reports of the Ovambo-land.—
Resolve to proceed there.—Reconnoitre the Country.—Depart from
Omanbondè.—Author shoots a Giraffe.—Splendid Mirage.—The Fan-
palm.—The Guide absconds.—Commotion among the Natives.—Arrive
at Okamabuti.—Unsuccessful Elephant-hunt.—Vegetation.—Accident
to Wagon.—Obliged to proceed on Ox-back.—The Party go astray.—
Baboon Fountain.—Meeting with the Ovambo; their personal
Appearance, &c.—Return to Encampment.—An Elephant killed.—
Discover a curious Plant.—Immorality.—Reflections.
Dry as the basin of Omanbondè then was, it nevertheless

appeared evident that, at no distant period, it had contained a good
deal of water. Moreover, there could be but little doubt as to
hippopotami having also, at one time, existed there.
On becoming better acquainted with the geography of these
regions, we thought we were able to explain the phenomenon
satisfactorily. Thus, for instance, from (or to?) the deep, trough-
shaped basin of Omanbondè leads a peculiar water-course, in an
easterly direction, called Omuramba-[21]k’Omanbondè, consisting of
a succession of immense gulleys, very similar to Omanbondè itself.
These (after being in a short time joined by the Omuramba-
k’Omatako) we supposed to be connected with some large
permanent water, abounding with hippopotami. In seasons when
rains are plentiful, these troughs or gulleys fill, and, no doubt, retain
the water from one rainy period to another, which enables the
animals to travel at their ease to Omanbondè. Indeed, by similar
omurambas they have found their way even as far south as
Schmelen’s Hope. According to Jonker Afrikaner’s account, a
hippopotamus had taken up its abode at this place, but was at last
killed by a sudden inundation of the Swakop. The carcass was
washed up at the mouth of the Tjobis, where he saw its remains.
On a first look at Damara-land, an inexperienced person would “as
soon expect,” as Mr. Galton says, “a hippopotamus to have traveled
across the great Sahara as from Omanbondè to Tjobis.” The fact,
however, is, that this country, after heavy rains, differs as much from
its normal state as a sea-beach when dry and when at spring-tide.
Little or no rain had fallen this year at Omanbondè, and,
consequently, it presented a very dreary and uninteresting
appearance. In its bed, however, we discovered several wells, which,
together with numerous remains of Damara villages, clearly
indicated that the so-called lake was, at times, largely resorted to by
the natives.
The vegetation remained precisely as hitherto, but the thorn
coppices were, if possible, thicker and more harassing. The
monotony of the scene was somewhat relieved by clumps of very
fine kameel thorn-trees.
Game was rather scarce, yet I managed to bag a few red bucks
(pallahs) and koodoos. Tracks of giraffes, rhinoceroses, and
elephants were by no means uncommon, but I never had the good
fortune to fall in with any of these animals.
Furious battles are said to take place occasionally between the
two last-named; and though, of course, strength in the elephant is
infinitely superior to the rhinoceros, the latter, on account of his
swiftness and sudden movements, is by no means a despicable
antagonist. Indeed, instances are known where they have perished
together. At Omanbondè, we were told that a combat of this kind
occurred not long before our arrival. A rhinoceros, having
encountered an elephant, made a furious dash at him, striking his
long sharp horn into the belly of his antagonist with such force as to
be unable to extricate himself, and in his fall the elephant crushed
his assailant to death.
In sauntering one day about the neighborhood of Omanbondè,
Galton suddenly found himself confronted by a lion, which seems
terribly to have terrified him; and he candidly tells us that, being
only armed with a small rifle, he would “much rather have viewed
him at a telescopic distance.”
As soon as we had somewhat recovered from our bitter
disappointment, we began seriously to consider our situation, and to
consult on our future plans. Once more we were without a definite
object. Should we return, or push boldly forward? At one time my
friend entertained thoughts of going no farther; in which case,
though it was probable we might reach home in safety, it was very
certain we should reap but little credit for what had been done. On
the other hand, by continuing to travel northward, we exposed
ourselves to much risk and danger. From experience, we were aware
that, to accomplish even a comparatively short distance in our very
slow mode of traveling, months would elapse. In that time, all the
pools and vleys which now contained water would probably be dried
up. This would be certain destruction to ourselves and cattle.
Besides this, our men were disheartened, and wished to return.
However, in that respect there would be less difficulty, as they were
now nearly as much dependent on us as we on them, inasmuch as a
broad tract of wild, inhospitable country separated us from the
nearest point of civilization.
From Jonker Afrikaner and various other sources of information,
we had already learned that at a considerable distance to the north
there lived a nation called Ovambo, who had much intercourse with
the Damaras, with whom they bartered cattle for iron-ware. They
were a people, moreover, of agricultural habits, having permanent
dwellings, and were reported to be industrious and strictly honest.
The Damaras spoke in raptures of their hospitality and friendliness
toward strangers, and represented them as a very numerous and
powerful nation, ruled by a single chief or king named Nangoro,
who, to their notions, was a perfect giant in size. With regard to the
distance to this country, they gave us the same wild, conflicting, and
unsatisfactory accounts as those we received about the position of
Omanbondè. A variety of circumstances at last induced us, let the
consequence be whatever it might, to attempt to reach this
interesting land.
As, however, no reliance could possibly be placed on the accounts
of the natives with regard to water, character of the country, and so
forth, it was deemed advisable, before moving from our present
encampment, to make a short exploratory excursion in order to see
and judge for ourselves.
Mr. Galton, accompanied by a few of the men, therefore rode
northward, in order to ascertain if the route we purposed taking was
traversable with wagons. On the evening of the third day he
returned, being assured of its practicability. He had met with several
native villages, and, though his reception there had by no means
been very flattering, we determined to proceed without a moment’s
delay.
None of the Damaras whom we had brought with us from Barmen
professed to know any thing of the country we were about to
explore. The guide, however, whom we had procured a short
distance south of Omanbondè, said that he was well acquainted with
it, and volunteered to show us the way to the Ovambo provided his
services should be rewarded with a cow-calf. Mr. Galton gladly
agreed to his terms, but, unfortunately, as the event proved, paid
him his wages in advance.
Early in the morning of the 12th of April we bade farewell to the
inhospitable shores of Omanbondè. For a few hours we kept parallel
with the Omuramba, when we struck into a more easterly course.
During the day we saw vast troops of camelopards, and just at
nightfall I had the good fortune to kill a fine, full-grown male, which
was an acceptable addition to our larder. Before the carcass had
time to cool, twenty or thirty men were busy in tearing it to pieces.
As usual on such occasions, the Damaras dispensed with sleep, and
devoted the night entirely to the enjoyment of the banquet.
The next morning we witnessed a magnificent mirage. Lakes,
forests, hills, &c., burst on the eye and disappeared in rapid
succession.
Later in the day we were gratified by the sight of a large number
of palm-trees. This harbinger of a better land was an agreeable
surprise, bringing an involuntary smile of satisfaction to every face.
We were astonished at the cheerful and refreshing effect a very
slight improvement in the landscape had on our spirits. In the
distance these palms seemed to us to form an extensive and
compact wood, but on nearer approach we found the trees grew at
long intervals from each other. They were very tall and graceful,
each branch having the appearance of a beautiful fan, and, when
gently waved by the wind, the effect produced was indescribably
pleasing.
This species of palm is, I believe, new to science.[22] It produces
fruit about the size of an apple, of a deep brown color, with a kernel
as hard as a stone, and not unlike vegetable ivory. The fruit is said
to have a bitter taste, but farther north (where, as will be presently
seen, we found the tree very plentiful) it was very palatable. On
account of the great height and straightness of the trunk, the fruit
was very difficult of access. The story our guide told us previously to
leaving Barmen about a tree, the fruit of which was obtainable only
by means of “knob-kieries thrown up at it,” was now easily
comprehended. But we experienced greater difficulty in realizing his
other tales, such as the existence of a people who make trees their
sole dwellings, while others were found without joints to their limbs,
who nevertheless were able to indulge in the refined custom of
feeding each other by means of their toes.
FAN-PALM.[23]
In the afternoon of this day we reached a Damara village which

had already been visited by Mr. Galton, and camped near to it.
Previously to our arrival here our guide absconded, taking with him,
besides the calf my friend had given him as payment, a horse-rug
which he had borrowed from Timbo.
The next morning, just as I was returning to the village from a
successful hunt, I observed an unusual commotion among the
natives, accompanied by the most terrific yelling, passionate
vociferations, and brandishing of assegais. The cause of this uproar
was at first thought to be an attack by the Bushmen on one of the
cattle-posts of the Damaras. However, on investigating the matter
more closely, we ascertained that the apprehensions of the Damaras
arose from the arrival of some inhabitants of a neighboring kraal,
who had come forcibly to recover a flock of sheep which the chief
had taken possession of under the pretext of “hunger.”
The news of our arrival had by this time spread far and wide, and
the Damaras were flocking together from all parts to see the white
strangers. Some of them promised to conduct us to their great chief
Tjopopa, who resided at a place called Okamabuti, which was on our
way to the Ovambo.
In the course of our journey to Tjopopa I learned the history of
the father of one of our visitors, who, it would appear, had been a
thorough rogue. He professed great friendship toward the Ovambo,
whom he allowed freely and peaceably to pass through his territory;
but when, on one occasion, they were returning home with a
numerous herd of cattle obtained by barter, he fell suddenly upon
them, and deprived them of all their hard-earned gains. When,
however, his treacherous conduct became known to Nangoro, he
instantly dispatched a party in order to punish him, and this was
done so effectually that, since that day, no one has ventured to
molest the Ovambo in their peaceable and industrious vocation.
Indeed, this tribe now commanded a large share of the good-will
and respect of the Damaras.
Elephants were said to be numerous to the northward, and the
Damaras pointed to some wooded knolls, where they said these
animals walked “as thick as cattle.” At times they would suddenly
make their appearance in the night in the midst of a village, and
drive the inhabitants precipitately from their dwellings.
On the 15th of April we were again moving, and the very next day
we entirely lost sight of the palms, which we did not again see till
nearly a whole month’s travel had been accomplished.
On the 17th we reached Tjopopa’s werft. It was reported that
through the instrumentality of his friend Nangoro this man became a
chief of the first order. Be that as it may, he was now living in very
great abundance, though, like many who are well off with regard to
worldly possessions, he was avaricious in the extreme. A miser’s
parsimony always increases in proportion to the enlargement of his
property.
Okamabuti may be said to be the northern limit of Damara-land. It
is situated at the foot of those wooded knolls already pointed out to
us by the natives as the resort of elephants; indeed, the ground
round about bore ample testimony to the destructive propensities of
these animals. The place was well supplied with water by a fountain
springing from a limestone bottom.
The morning after our arrival at Okamabuti, we started off on a
shooting excursion, in a northeast direction, in search of elephants;
but, though we discovered their fresh tracks, and followed these for
a whole day, we were unable to overtake the beasts.
Notwithstanding our failure, we enjoyed the trip extremely. The
scenery was novel and highly interesting. At times we crossed
savannas where the grass reached above our heads as we sat on the
oxen, and at others we passed through magnificent forests of
straight-stemmed and dark-foliaged timber-trees,[24] fit abodes for
the most wonderful creatures of animated nature.
A day or two afterward a calamity befell us which we had long
dreaded. In order to be near the elephants, that we might hunt
them at our leisure, we had determined to move our camp to a
fountain a few hours further to the northeast, that was much
frequented by these animals. On the morning of our departure,
however, before we had proceeded many hundred paces, our largest
wagon came in contact with a stump of a tree, which entirely
demolished the foremost axle-tree. Unfortunate as this circumstance
could not fail to be, we had, nevertheless, every reason to feel
thankful it occurred where it did. The natives hereabout had shown
themselves well disposed toward us. Water and pasturage were
abundant; and even suitable wood for repairing the damage was to
be found in the immediate neighborhood.
A few days would, perhaps, have sufficed to make a temporary
repair; but, as we had a journey of several months’ duration before
us, it was necessary to make the work as permanent as possible,
and the seasoning of the wood alone, in such a case, would occupy
several weeks. None of us had much experience in carpentry; but
Hans was by far the most practical hand, and he boldly undertook
the task. To postpone our journey to the Ovambo till our wagons
were in order was now, indeed, out of the question. The season
being advanced, every day became of the greatest importance; and
therefore, to save time, it was resolved that we should leave the
vehicles behind, and that Galton and myself should prosecute the
journey without farther delay by means of pack-and-ride oxen.
Having come to this determination, our first care was to obtain
accurate information of the distance, number of watering-places,
and so forth; but the Damaras proved true to their nature; for, after
having spent several days in cross-questioning them, we were just
as far from our object as ever. Tjopopa himself was very reserved,
and would neither provide us with guides nor give us the least
information. He said, however, that he was just expecting a trading
caravan from Ovambo-land, and that, if we remained with him till its
arrival, he doubted not that we should, by the assistance of the
individuals composing it, be enabled to reach that country. But no
reliance could be placed in a Damara.
While in this dilemma, a man unexpectedly came to offer his
services as guide. Without, perhaps, inquiring sufficiently as to
whether he was well acquainted with the road, we accepted with
eagerness the proposal, and did not lose a moment in making
preparations for the journey. To shorten a long story, suffice it to say
that we set out; but our guide almost immediately lost himself; and
after we had wandered about the hills for several days, suffering the
greatest anxiety of mind, to say nothing of physical privations, we
were about to retrace our steps to Okamabuti, when we fortunately
fell in with some Bushmen. We had left both our Hottentot
interpreters behind, but we managed to explain to them our wants
and wishes. With much persuasion, two of them agreed to
accompany us to a certain large water in advance, of which the
Damaras had made repeated mention. These men desired to spend
the night at their own werft; but we had been so often deceived,
that, in order to secure their services, we determined that only one
of them should be allowed to absent himself. The other was to sleep
near us; and, as a further security, Galton and myself agreed
alternately to keep watch on the fellow through the night.
During our wanderings in the mountains we stumbled upon a
series of wells which we christened “Baboon Fountain,” on account
of the number of baboons which frequented the place. Its real name
was Otjikango.
It was from this point that on the morning of the 2d of May we
took our fresh departure under the guidance of our Bushmen
friends. We had not, however, been long on the road before we were
overtaken by three or four men whom our Damaras at once
recognized as natives of Ovambo-land, coming from the very quarter
we had just left. They were part of the expected caravan, and I need
hardly say that we were delighted at this opportune meeting.
Contrary to custom, the men had made a short cut across the hills,
and thus we had missed each other. On the Ovambos reaching our
encampment, however, and finding strange tracks, and our bivouac
fire still burning, their curiosity was greatly aroused, and they had
detached the men whom we now encountered in order to bring us
back. We did not much like the idea; yet, in hope of obtaining from
them a guide, we acquiesced, intending presently to pursue our
journey.
The caravan was composed of twenty-three individuals, of a very
dark complexion, tall and robust, but remarkably ugly, and scantily
attired. Their looks bespoke determination and independence. On
acquainting them with our object, and our wish to obtain a guide to
conduct us to their country, they not only refused, but became very
reserved in their manner. They promised, however, that if we would
return with them to Tjopopa’s werft, and there wait until they had
disposed of their articles of exchange, we were welcome to
accompany them home. They assured us, moreover, that any
attempt on our part to accomplish the journey alone would be
attended with certain destruction; for, even supposing we should
find the waters—which were few and far between—their chief,
unless previously apprised of our approach, would never receive us.
We thought their language bold, and at first laughed at them; but
they remained inflexible. Remonstrances were of no avail, and we
soon saw that they were a very different style of natives from those
with whom we had been accustomed to deal. Moreover, on mature
consideration, we thought it only just that they should know
something of our character before taking us into the heart of the
country. We accordingly made necessity a law, and agreed to their
proposal. No sooner had we done so than they threw off their
reserve, and in a very short time we became the best of friends.
Mr. Galton made them a present of some meat, which they greatly
prized. Their sole diet, on these occasions, was apparently a kind of
grain resembling Caffre-corn (holcus Caffrorum), which they carried
in small skin-bags. This grain was either half boiled, simply steeped
in water, or, more commonly, partially crushed, and then converted
into a coarse stir-about. They kindly gave us a liberal supply of their
homely fare, which we eagerly partook of, being quite tired with the
everlasting flesh-diet. Our Damaras were also treated with a dish of
soaked corn; but, before they were allowed to taste it, they were
obliged to undergo the ceremony (why or wherefore I know not) of
having a quantity of water spirted into their faces from the mouth of
one of the Ovambo. These people invariably made use of salt with
their food, a thing never seen among the Damaras. As soon as their
plain meal was finished, pipes—of their own manufacture—were
produced, and, after a few whiffs, a song was struck up. One man
began to chant, and the whole party joined occasionally in chorus.
Though somewhat monotonous, the music was not unpleasing.
PIPE.
They were armed with bow and arrows, the assegai and the knob
kierie; but the two first-named weapons were of smaller dimensions
than those used by the Damaras. Their bows, moreover, were
constructed from a kind of wood called mohama, which, in its
natural state, is flat on one side, and thus, in a degree, of the
required form.
The arrows are generally tipped with bone or iron; but they do not
often poison them. They carry their quivers under the left arm by
means of a strap across the right shoulder. In addition to the
weapons mentioned, they have a dagger, protected by a leather
sheath tastefully ornamented with thin copper wire.
DAGGER AND SHEATH.

HATCHET.
Carpenter’s work is not much practiced among the Ovambo. The

rude hatchet here represented is nearly the only mechanic’s tool I
remember to have seen in their possession.
Their articles of barter were spear-heads, knives, rings, copper
and iron beads, &c., but of exceedingly rude workmanship. Indeed,
it was to me a constant wonder how they could persuade their
neighbors to buy such trash. Yet all these things were very dear; an
unfinished assegai-blade or a yard of beads being the regular price
for an ox.
Their merchandise was packed in small square baskets made out
of palm-leaves: these were suspended to both ends of the long,
smooth, and elastic pole (of palm wood) that each man bore poised
on his shoulder. What with their merchandise, provisions, water, &c.,
the weight was often very considerable, yet they traveled much
faster than ourselves.
They have no idea of making use of oxen for draft, or, perhaps it
would be more correct to say, they value these animals too highly to
make use of them for such purposes.
On the 4th of May we returned to our encampment. Hans and
Phillippus had killed an elephant during our absence, which highly
delighted the Damaras, who had flocked to the neighborhood of
Okamabuti in very great numbers. We were sorry to find that our
cattle, instead of improving in condition by
their rest, were fast losing flesh. This was
attributed to the grass hereabout, which
was bitter tasted, and to change of
pasturage in general. The cattle of the
natives were accustomed to every variety of
herbage, and did not suffer. Sheep,
however, failed to thrive here.
While waiting for the return of the
BASKET FOR Ovambo traders, who, with the exception of
MERCHANDISE. their head man, Chikor’onkombè, had now
dispersed over the neighborhood in small
bands of two and three, I employed the
time in diligently exploring the surrounding country and ascertaining
its natural productions, and was fortunate enough to add many an
interesting specimen of insect and bird to my collection.
The natives were unable to comprehend why I thus collected birds
and other specimens of natural history, and on an evening, when I
returned home, were convulsed with laughter on seeing the contents
of my game-bag. This passion of mine (coupled with my name being
unpronounceable) caused them to rechristen me “Karabontera,” or
the bird-killer, by which designation I am now universally known
throughout the country.
The vegetation at Okamabuti was very rank and luxuriant, but the
thorn-jungles still continued to haunt us. The hills were covered with
a profusion of creepers, low shrubs, and aromatic herbs. The
euphorbia candelabrum was particularly abundant.
I discovered a peculiar plant growing on a very large succulent
root, protruding about a foot above the soil. It produced two or
three immense leaves, with a fruit so closely resembling grapes that,
when I first brought some bunches to our encampment, they were
mistaken for such; but they were not eatable—nay, the natives
pronounced them to be poisonous.
There was also a tree, yielding an acid fruit somewhat like an
apple, but with a hard kernel similar to that of a plum. In hot
weather this fruit was very refreshing, and not unpalatable.
During our stay at Okamabuti, Tjopopa’s aged mother died. The
women of the place, according to custom, howled most dismally for
a whole day. Great numbers of cattle were killed or sacrificed on this
occasion.
Tjopopa would spend whole days at our camp in the most
absolute idleness and apathy, teasing us with begging for every
thing he saw. Like all Damaras, he had a perfect mania for tobacco,
and considered no degradation too deep provided he could obtain a
few inches of the narcotic weed. He was of an easy and mild
disposition, but excessively stingy. We stood greatly in need of live-
stock, and took every opportunity to display our most tempting
articles of barter in the hope of inducing him to purchase. Brass or
gilt ornaments he almost spurned, but cast longing eyes on articles
of iron or copper. At last he selected goods to the value of four oxen,
with which he quietly walked off. On asking him for payment the
following day, he smilingly replied, “Why, between us there must be
no talk of buying and selling. You are going to stop here a long time,
and you want plenty of food: this I will give you.”
Knowing the truth of the adage that “a bird in the hand is worth
two in the bush,” we should infinitely have preferred an immediate
settlement to any vague promises. And the end justified our
apprehensions. The old rogue took good care neither to pay his
debt, nor make us any presents of cattle, of which we stood so
much in need. Nay, he even went further. Under pretext of supplying
our wants, he induced his people to contribute oxen and sheep,
which he was mean enough to keep for his own use.
Our friend Tjopopa was rather a sensual man: he was supposed to
have no less than twenty wives, two of whom I found, to my
astonishment, were mother and daughter! I have since ascertained
that this is by no means an unusual practice among this demoralized
nation. Moreover, when a chief dies, his surviving wives are
transferred to his brother or to his nearest relation.
It is in vain that poets and philanthropists endeavor to persuade
us that savage nations who have had no previous intercourse with
Europeans are living in a state of the most enviable happiness and
purity, where ignorance is virtuous simplicity; poverty, frugality and
temperance; and indolence, laudable contempt for wealth. One
single day among such people will be sufficient to repudiate these
idle notions.
CHAPTER XV.
Depart from Okamabuti.—Visit from a Lion.—Amulets.—Revisit Baboon
Fountain.—Otjikoto; a wonderful Freak of Nature; Remarkable
Cavern.—Natives unacquainted with the Art of Swimming.—Fish
abundant in Otjikoto; frequented by immense Flocks of Doves.—
Panic of the Ovambo on seeing Birds shot on the Wing.—Arrive at
Omutjamatunda.—A greasy Welcome.—Ducks and Grouse numerous.
—Author finds himself somewhat “overdone.”—“Salt-pans.”—All “look
Blue.”—A second Paradise.—Hospitable Reception.—Vegetation.—
People live in Patriarchal Style.—Population.—Enormous Hogs.—
Arrive at the Residence of the redoubtable Nangoro.
In conversation with the Ovambo, we learned that Nangoro’s werft

was distant at least a fortnight’s steady travel. We therefore felt
anxious for the speedy return of the trading parties, in order that we
might prosecute or journey; but they tarried longer than we had
expected. By degrees, however, they reassembled at Tjopopa’s
werft, having brought about two hundred head of cattle, the result
of their trade.
On the 22d of May Chikor’onkombè, their leader, announced that
every thing was in readiness for a start; and, as we ourselves had
long been prepared, the caravan set out that very afternoon.
We bivouacked at one of Tjopopa’s cattle-posts, only a few hours’
journey from Okamabuti, and had just finished dinner, when all at
once our people rushed toward the fire with cries of “Ongeama!
ongeama!”
And so it was. A lion had, it seems, been crouched in the bush
within twenty paces of our camp, in readiness to spring on the cattle
that were scattered about; but as one of the men who was in search
of fuel had fortunately discovered him, the beast retreated. He was
evidently much displeased at being thus foiled, and kept growling in
the distance during the remainder of the night. The following

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Sydney Edinburgh London New York Philadelphia St Louis Toronto

Elsevier Australia. ACN 001 002 357

This edition © 2012 Elsevier Australia

This publication is copyright. Except as expressly provided in the Copyright Act

National Library of Australia Cataloguing-in-Publication Data

Author: Beran, Roy G. (Roy Gary)

Publisher: Sophie Kaliniecki

1 The neurological diagnostic consultation 1

In this creative book, Neurology for General Practitioners, written by the

Professor John Murtagh AM, MBBS, MD, BSc, BEd, FRACGP,

Bronwyn Knight MBBS

Stephen A Margolis MBBS, MFM, MD, DRANZCOG, FRACGP,

Jason Pak MBBS, FRACGP

Nyoli Valentine MBBS, GradCert

and clinician must agree on the meaning to be adopted. An example of this

TABLE 1.1 The formal approach to taking a history

The neurological examination is broken down into three components:

HIGHER CENTRE FUNCTION TESTING

5 The patient is then asked to manipulate 29 × 3 to achieve 87. Once the

potential for left-sided neglect. Clock drawing tests constructional dys-

Patient is asked to draw a map of Australia

FIGURE 2.2 Map of Australia.

BOX 2.1 Testing cognition: summary

1 The patient fixates on the doctor’s eye

FIGURE 3.1 Testing visual fields.

Dry as the basin of Omanbondè then was, it nevertheless

In the afternoon of this day we reached a Damara village which

DAGGER AND SHEATH.

Carpenter’s work is not much practiced among the Ovambo. The

In conversation with the Ovambo, we learned that Nangoro’s werft

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