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Section 6 Problems of Oxygenation: Transport

29 Assessment of Hematologic System

30 Hematologic Problems

Section 7 Problems of Oxygenation: Perfusion

31 Assessment of Cardiovascular System

32 Hypertension

33 Coronary Artery Disease and Acute Coronary Syndrome

34 Heart Failure

35 Dysrhythmias

36 Inflammatory and Structural Heart Disorders

37 Vascular Disorders

Section 8 Problems of Ingestion, Digestion, Absorption, and

Elimination

38 Assessment of Gastrointestinal System

39 Nutritional Problems

40 Obesity

41 Upper Gastrointestinal Problems

42 Lower Gastrointestinal Problems

43 Liver, Pancreas, and Biliary Tract Problems

Section 9 Problems of Urinary Function

8
44 Assessment of Urinary System

45 Renal and Urologic Problems

46 Acute Kidney Injury and Chronic Kidney Disease

Section 10 Problems Related to Regulatory and Reproductive

Mechanisms

47 Assessment of Endocrine System

48 Diabetes Mellitus

49 Endocrine Problems

50 Assessment of Reproductive System

51 Breast Disorders

52 Sexually Transmitted Infections

53 Female Reproductive and Genital Problems

54 Male Reproductive and Genital Problems

Section 11 Problems Related to Movement and Coordination

55 Assessment of Nervous System

56 Acute Intracranial Problems

57 Stroke

58 Chronic Neurologic Problems

59 Dementia and Delirium

60 Spinal Cord and Peripheral Nerve Problems

61 Assessment of Musculoskeletal System

9
62 Musculoskeletal Trauma and Orthopedic Surgery

63 Musculoskeletal Problems

64 Arthritis and Connective Tissue Diseases

Section 12 Nursing Care in Specialized Settings

65 Critical Care

66 Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

67 Acute Respiratory Failure and Acute Respiratory Distress Syndrome

68 Emergency and Disaster Nursing

Answer Key for Study Guide

IBC
Tips to Prepare for Exams

Tips for Taking an Exam

10
List of Case Studies in This Study Guide
Abdominal Aortic Aneurysm (Chapter 37), p. 162

Acute Decompensated Heart Failure (Chapter 34), p. 144

Acute Pancreatitis (Chapter 43), p. 193

Acute Pelvic Inflammatory Disease (Chapter 53), p. 239

Acute Respiratory Failure (Chapter 67), p. 305

Allergy (Chapter 13), p. 47

Alzheimer's Disease (Chapter 59), p. 266

Asthma (Chapter 28), p. 114

Bladder Cancer (Chapter 45), p. 202

Burn Patient in Rehabilitation Phase (Chapter 24), p. 93

Cancer (Chapter 15), p. 56

Cancer of the Rectum (Chapter 42), p. 186

Cellulitis (Chapter 23), p. 88

Chronic Open-Angle Glaucoma (Chapter 21), p. 81

Cocaine Toxicity (Chapter 10), p. 36

Coronary Artery Disease (Chapter 33), p. 140

Critically Ill Patient (Chapter 65), p. 296

Cushing Syndrome (Chapter 49), p. 223

Disseminated Intravascular Coagulation (DIC) (Chapter 30), p. 124

Dysrhythmia (Chapter 35), p. 151

End-of-Life Palliative Care (Chapter 9), p. 32

Extreme Obesity (Chapter 40), p. 174

Fluid and Electrolyte Imbalance (Chapter 16), p. 62

Fracture (Chapter 62), p. 282

Gastric Cancer (Chapter 41), p. 180

Genetics (Chapter 12), p. 43

Gonorrhea (Chapter 52), p. 234

11
Head Injury (Chapter 56), p. 253

Heatstroke (Chapter 68), p. 285

Herniated Intervertebral Disc (Chapter 63), p. 285

HIV Infection (Chapter 14), p. 51

Hypoglycemia (Chapter 48), p. 218

Infective Endocarditis (Chapter 36), p. 156

Inflammation (Chapter 11), p. 40

Intraoperative Patient (Chapter 18), p. 68

Isolated Systolic Hypertension (Chapter 32), p. 134

Kidney Transplant (Chapter 46), p. 208

Malnutrition (Chapter 39), p. 140

Metastatic Breast Cancer (Chapter 51), p. 231

Multiple Sclerosis (Chapter 58), p. 262

Pain (Chapter 8), p. 29

Postoperative Patient (Chapter 19), p. 71

Preoperative Patient (Chapter 17), p. 65

Pulmonary Hypertension (Chapter 27), p. 108

Rheumatoid Arthritis (Chapter 64), p. 290

Rhinoplasty (Chapter 26), p. 102

Septic Shock (Chapter 66), p. 300

Sleep Disturbance (Chapter 7), p. 25

Spinal Cord Injury (Chapter 60), p. 271

Stress (Chapter 6), p. 22

Stroke (Chapter 57), p. 257

Testicular Cancer (Chapter 54), p. 243

12
Copyright

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STUDY GUIDE FOR MEDICAL-SURGICAL NURSING; ASSESSMENT AND MANAGEMENT OF

CLINICAL PROBLEMS, 10th EDITION
ISBN: 978-0-323-37148-3

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14
SECTION 1
Concepts in Nursing Practice
OUTLINE
1 Professional Nursing Practice
2 Health Disparities and Culturally Competent Care
3 Health History and Physical Examination
4 Patient and Caregiver Teaching
5 Chronic Illness and Older Adults
6 Stress and Stress Management
7 Sleep and Sleep Disorders
8 Pain
9 Palliative Care at End of Life
10 Substance Use Disorders

15
1

Professional Nursing Practice

1. Using the American Nurses Association's definition of nursing, which activities are within the
domain of nursing (select all that apply)?
_____ a. Implementing intake and output for a patient who is vomiting
_____ b. Establishing and implementing a stress management program for family caregivers of
patients with Alzheimer's disease
_____ c. Explaining the risks associated with the planned surgical procedure when a preoperative
patient inquires about risks
_____ d. Developing and performing a study to compare the health status of older patients who
live alone with the status of older patients who live with family members
_____ e. Identifying the effect of an investigational drug on patients' hemoglobin levels
_____ f. Using a biofeedback machine to teach a patient with cancer how to manage chronic pain
_____ g. Preventing pneumonia in an immobile patient by implementing frequent turning,
coughing, and deep breathing
_____ h. Determining and administering fluid replacement therapy needed for a patient with
serious burns
_____ i. Testifying to legislative bodies regarding the effect of health policies on culturally,
socially, and economically diverse populations
2. A nurse who has worked on an orthopedic unit for several years is encouraged by the nurse
manager to become certified in orthopedic nursing. What will certification in nursing require
and/or provide (select all that apply)?
a. A certain amount of clinical experience
b. Successful completion of an examination
c. Membership in specialty nursing organizations
d. Professional recognition of expertise in a specialty area
e. An advanced practice role that requires graduate education
3. What accurately describes the health care system in which future nurses will be employed?
a. With improvements in medicine there will be fewer patients with chronic illnesses.
b. Rapidly changing technology and expanding knowledge will simplify the health care
environment.
c. Simplifying data collection and information infrastructure will provide more effective planning
and policy making.
d. The Joint Commission establishes National Patient Safety Goals and evidence-based solutions
for nurses to promote meeting these goals by all caring for the patient.
4. What are the six competencies from Quality and Safety Education for Nurses (QSEN) that are
expected of new nursing graduates?
a.
b.
c.
d.
e.
f.
5. Place the steps of the evidence-based practice (EBP) process in order (0 being the first step; 6
being the last step).

16
 _____ Make recommendations for practice or generate data
_____ Ask a clinical question
_____ Critically analyze the evidence
_____ Find and collect the evidence
_____ Evaluate the outcomes in the clinical setting
_____ Create a spirit of inquiry
_____ Use evidence, clinical expertise, and patient preferences to determine care
6. The following is an example of an evidence-based practice (EBP) clinical question. “In adult
seizure patients, is restraint or medication more effective in protecting them from injury during a
seizure?” Which word(s) in the question identify(ies) the C part of the PICOT format?
a. Restraint
b. Or medication
c. During a seizure
d. Adult seizure patients
e. Protecting them from injury
7. Two nurses are establishing a smoking cessation program to assist patients with chronic lung
disease to stop smoking. To offer the most effective program with the best outcomes, the nurses
should initially
a. search for an article that describes nursing interventions that are effective for smoking
cessation.
b. develop a clinical question that will allow patients to compare different cessation methods
during the program.
c. keep comprehensive records that detail each patient's progress and ultimate outcomes from
participation in the program.
d. use evidence-based clinical practice guidelines developed from randomized controlled trials of
smoking cessation methods.
8. Which standardized nursing terminologies specifically relate to the steps of the nursing process
(select all that apply)?
a. Omaha System
b. Nursing Minimum Data Set (NMDS)
c. PeriOperative Nursing Data Set (PNDS)
d. Nursing Outcomes Classification (NOC)
e. Nursing Interventions Classification (NIC)
f. NANDA International Nursing Diagnoses
9. The nurse working in a health care facility where uniform electronic health records are used
explains to the patient that the primary purpose of such a record is to
a. reduce the cost of health care by eliminating paper records.
b. keep the patient's medical information more private than handwritten records.
c. efficiently improve clinical decision making, patient safety, and quality of patient care.
d. provide a single record, making the patient's medical information accessible to any care givers
in any health system.
10. Match the phases of the nursing process with the descriptions (phases may be used more than
once).
_____ a. Analysis of data 1. Assessment
_____ b. Priority setting 2. Diagnosis
_____ c. Nursing interventions 3. Planning
_____ d. Data collection 4. Implementation
_____ e. Identifying patient strengths 5. Evaluation
_____ f. Measuring patient achievement of goals
_____ g. Setting goals
_____ h. Identifying health problems
_____ i. Modifying the plan of care
_____ j. Documenting care provided

17
11. During the diagnosis phase of the nursing process, both nursing diagnoses and collaborative
problems are identified. Which statements are collaborative problems (select all that apply)?
a. Fatigue related to sleep deprivation
b. Infection related to immunosuppression
c. Excess fluid volume related to high sodium intake
d. Constipation related to irregular defecation habits
e. Hypoxia related to chronic obstructive pulmonary disease
f. Risk for cardiac dysrhythmias related to potassium deficiency
12. For the nursing diagnoses and written patient outcomes listed below, use the Nursing
Interventions Classification (NIC) to identify a specific nursing intervention to help the patient
reach the outcome.
a. Nursing diagnosis: Risk for impaired skin integrity related to immobility
Patient outcome: Patient will demonstrate skin integrity free of pressure ulcers.
b. Nursing diagnosis: Constipation related to inadequate fluid and fiber intake
Patient outcome: Patient will have daily soft bowel movements in 1 week.
13. A patient with a seizure disorder is admitted to the hospital after a sustained seizure. When she
tells the nurse that she has not taken her medication regularly, the nurse makes a nursing
diagnosis of Ineffective health management related to lack of knowledge regarding medication regimen
and identifies the Nursing Outcomes Classification (NOC) outcome of Compliance behavior:
prescribed medications, with the indicator Takes medication at intervals prescribed, at a target rate of 3
(sometimes demonstrated). When the nurse tries to teach the patient about the medication regimen,
the patient tells the nurse that she knows about the medication but does not always have the
money to refill the prescription. Where was the mistake made in the nursing process with this
patient?
a. Planning
b. Diagnosis
c. Evaluation
d. Assessment
e. Implementation
14. Identify the five rights of delegating nursing care (select all that apply).
a. Right time
b. Right task
c. Right patient
d. Right person
e. Right dosage
f. Right circumstance
g. Right supervision and evaluation
h. Right directions and communication
15. Delegation is a process used by the RN to provide safe and effective care in an efficient manner.
Which nursing interventions should not be delegated to unlicensed assistive personnel (UAP) but
should be performed by the RN (select all that apply)?
a. Administering patient medications
b. Ambulating stable patients
c. Performing patient assessment
d. Evaluating the effectiveness of patient care
e. Feeding patients at mealtime
f. Performing sterile procedures
g. Providing patient teaching
h. Obtaining vital signs on a stable patient

18
 i. Assisting with patient bathing
16. Match the following care planning tools to the description statement(s). There may be more than
one tool per statement, and the tools will be used more than once.
Tools Description Statements
1. Nursing Care Plan _____ A plan that directs an entire health care team
2. Concept Maps _____ Used as guides for routine nursing care
_____ Used in nursing education to teach the nursing process and care planning
3. Clinical Pathway
_____ A description of patient care required at specific times during treatment
_____ Should be personalized and specific to each patient
_____ A visual diagram representing relationships among patient problems, interventions, and data
_____ Used for high-volume or high-risk and predictable case types

17. Which nursing actions are in response to the National Patient Safety Goals (select all that apply)?
a. Use restraints to prevent patient falls.
b. Administer all medications ordered by physicians.
c. Wash hands before and after every patient contact.
d. Conduct a “time-out” when too tired to provide care.
e. Quickly communicate test results to the right staff person.
f. Evaluate the initial existence of pressure ulcers before patient dismissal.
18. Which quality of care measures influence the payment for health care services by third-party
payers (select all that apply)?
a. Clinical outcomes
b. Cultural awareness
c. Use of evidence-based practice
d. Adoption of information technology
e. Occurrence of a serious reportable event
19. The Affordable Care Act (ACA) encourages groups of doctors, hospitals, and other health care
providers to unite to coordinate care for Medicare patients. What are these groups called?
a. National Quality Forum (NQF)
b. Preferred Provider Organization (PPO)
c. Accountable Care Organization (ACO)
d. Health Maintenance Organization (HMO)

19
2

Health Disparities and Culturally Competent

Care
1. A 62-yr-old African American man has been diagnosed with lung cancer and has been scheduled
for surgery. The nurse recognizes what as the most likely major determinant of this patient's
health?
a. He is African American.
b. He chose to smoke all of his adult life.
c. His father died of lung cancer at about the same age.
d. His lack of experience limits his ability to understand and act on health information.
2. A 73-yr-old white woman is brought to the emergency department by a neighbor who found the
woman experiencing severe abdominal and lower back pain for 2 days and nausea and vomiting
for the last 24 hours. She has always refused medical care of any kind and lives by herself “up the
mountain” off a dirt road in rural West Virginia. She gave birth to two children with the help of a
midwife, but both of her children left for the West Coast years ago and she rarely sees them. She
was not married to the father of her children, and she has not seen him in years. She has barely
made a living by sewing for a doll company and receives a small amount of public assistance. As
ill as she is, she is insisting that she will return home after she sees the doctor. List at least four
factors in this situation that contribute to health disparities.
a.
b.
c.
d.
3. Limited health literacy may be associated with which individual conditions that lead to health
disparities (select all that apply)?
a. Age
b. Place
c. Gender
d. Race/ethnicity
e. Language barrier
f. Income/education
4. Cultural safety describes care that prevents cultural imposition. The nurse must be aware of and
include the knowledge of which factors in providing safe cultural care for the patient (select all
that apply)?
a. Values
b. Culture
c. Ethnicity
d. Stereotyping
e. Acculturation
f. Ethnocentrism
5. What are four basic characteristics of culture?
a. Ever present, shared by all members, expected by all members, adapted to individuals
b. Dynamic, shared values, provides a baseline for judging other cultures, learned from parents
c. Ever present, not always shared by all members, not accepted by the group, learned at school

20
 d. Dynamic, not always shared by all members, adapted to specific conditions, learned by
communication and imitation
6. Identify the specific component of acquiring cultural competence that is reflected in creating a
safe environment in which collection of relevant cultural data can be obtained during the health
history and physical examination.
a. Cultural skill
b. Cultural encounter
c. Cultural awareness
d. Cultural knowledge
7. Identify one example of how each of the following cultural factors may affect the nursing care of a
patient of a different culture and one example of the functioning of a health care team made up of
individuals from different cultures.
Cultural Factor Effect on Nursing Care Health Care Team
Time orientation
Economic factors
Nutrition
Personal space
Beliefs and practices

8. When admitting a woman experiencing a spontaneous abortion at the ambulatory care center, the
nurse notes that the admission form identifies the patient's religion as Islam. What should the
nurse understand about this patient?
a. She should not receive any pork-derived products.
b. She does not believe in using contraception or abortion.
c. She probably will not have purchased any health insurance.
d. She will not be able to receive blood or blood products if an emergency develops.
9. A hospitalized Native American patient tells the nurse that later in the day a medicine man from
his tribe is coming to perform a healing ceremony to return his world to balance. What should the
nurse recognize about this situation?
a. The patient does not adhere to an organized, formal religion.
b. The patient's spiritual needs may be met by traditional rituals.
c. The patient may be putting his health in jeopardy by relying on rituals.
d. Native American medicine cannot alter the progression of the patient's physical illness.
10. In a Hispanic patient who claims to have empacho, what assessment findings would the nurse
expect?
a. Abdominal pain and cramping
b. Anxiety, insomnia, anorexia, and social isolation
c. Nightmares, weakness, and a sense of suffocation
d. Headaches, stomach problems, and loss of consciousness
11. When the nurse takes a surgical consent form to an Asian woman for a signature after the
surgeon has provided the information about the recommended surgery, the patient refuses to
sign the consent form. What is the best response by the nurse?
a. “Didn't you understand what the doctor told you about the surgery?”
b. “Are there others with whom you want to talk before making this decision?”
c. “Why won't you sign this form? Do you want to do what the doctor recommended?”
d. “I'll have to call the surgeon and have your surgery cancelled until you can make a decision.”
12. A male nurse would be providing culturally competent care by requesting that a female nurse
provide care for which patient?
a. Arab male
b. Latino male
c. Arab female
d. African American female

21
13. Identify the drug class that has a different response in African Americans when compared with
the usual response of European Americans (select all that apply).
a. Analgesics
b. Anticoagulants
c. Benzodiazepines
d. Antihypertensive agents
14. Several cultural groups avoid direct eye contact and consider it disrespectful or aggressive.
Which cultural group(s) may not return a direct gaze (select all that apply)?
a. Arab
b. Asian
c. Hispanic
d. Native American
e. African American
15. To communicate with a patient who does not speak the dominant language, the nurse should
(select all that apply)
a. pantomime words while verbalizing the specific words.
b. speak slowly and enunciate clearly in a slightly louder voice.
c. use family members rather than strangers as interpreters to increase the patient's feeling of
comfort.
d. use a website or phrase books that translate from both the nurse's language and the patient's
language.
e. avoid the use of any words known in the patient's language because the grammar and
pronunciation may be incorrect.
16. Identify measures that the nurse should use to reduce health care disparities (select all that apply).
a. Use cultural competency guidelines.
b. Use a family member as the interpreter.
c. Use standardized, evidence-based care guidelines.
d. Complete the health history as rapidly as possible.
e. Include racial cultural differences in planning care.

22
3

Health History and Physical Examination

1. During the day, while being admitted to the nursing unit from the emergency department, a
patient tells the nurse that she is short of breath and has pain in her chest when she breathes. Her
respiratory rate is 28, and she is coughing up yellow sputum. Her skin is hot and moist, and her
temperature is 102.2° F (39° C). The laboratory results show white blood cell count elevation and
the sputum result is pending. The patient says that coughing makes her head hurt, and she aches
all over. Identify the subjective and objective assessment findings for this patient.
Subjective Objective

2. Priority Decision: For the patient described in Question 1, the data will lead the night shift nurse
to complete a focused nursing assessment of which body part(s)?
a. Abdomen
b. Arms and legs
c. Head and neck
d. Anterior and posterior chest
3. Give an example of a sensitive way to ask a patient each of the following questions.
a. Is the patient on antihypertensive medication having a side effect of impotence?
b. Has the patient with a history of alcoholism had recent alcohol intake?
c. Who are the sexual contacts of a patient with gonorrhea?
d. Does the patient skip taking medications because they cost too much?
4. Priority Decision: The nurse prepares to interview a patient for a nursing history but finds the
patient in obvious pain. Which action by the nurse is the best at this time?
a. Delay the interview until the patient is free of pain.
b. Administer pain medication before initiating the interview.
c. Gather as much information as quickly as possible by using closed-ended questions that require
brief answers.
d. Ask only those questions pertinent to the specific problem and complete the interview when
the patient is more comfortable.
5. Priority Decision: While the nurse is obtaining a health history, the patient tells the nurse, “I am
so tired, I can hardly function.” What is the nurse's best action at this time?
a. Stop the interview and leave the patient alone to be able to rest.
b. Arrange another time with the patient to complete the interview.
c. Question the patient further about the characteristics of the symptoms.
d. Reassure the patient that the symptoms will improve when treatment has had time to be
effective.
6. Rewrite each of the following questions asked by the nurse so that it is an open-ended question
designed to gather information about the patient's functional health patterns.
a. Are you having any pain?
b. Do you have a good relationship with your spouse?
c. How long have you been ill?
d. Do you exercise regularly?
7. A patient has come to the health clinic and reports having diarrhea for 3 days. He says the stools
occur five or six times per day and are very watery. Every time he eats or drinks something, he
has an urgent diarrhea stool. He denies being out of the country but did attend a large family

23
 reunion held at a campground in the mountains about a week ago. Identify the areas of symptom
investigation using PQRST that still must be addressed to provide additional important
information (select all that apply).
a. Timing
b. Quality
c. Severity
d. Palliative
e. Radiation
f. Precipitating factors
8. The following data are obtained from a patient during a nursing history. Organize these data
according to Gordon's functional health patterns. Patterns may be used more than once, and
some data may apply to more than one pattern.
_____ a. 78-yr-old woman 1. Demographic data
_____ b. Married, three grown children who all live out of town 2. Important health information
_____ c. Cares for invalid husband in home with help of daily homemaker 3. Health-perception/health-management pattern
_____ d. Vision corrected with glasses; hearing normal 4. Nutrition-metabolic pattern
_____ e. Height 5 ft, 8 in; weight 170 lb 5. Elimination pattern
_____ f. Considers herself a stress eater; eats when stressed 6. Activity-exercise pattern
_____ g. 5-year history of adult-onset asthma; smokes two or three cigarettes a day 7. Sleep-rest pattern
_____ h. Coughing, wheezing, with stated shortness of breath 8. Cognitive-perceptual pattern
_____ i. Moderate light-yellow sputum 9. Self-perception/self-concept pattern
_____ j. Says she now has no energy to care for husband 10. Role-relationship pattern
_____ k. Awakens three or four times per night and has to use a bronchodilator inhaler 11. Sexuality-reproductive pattern
_____ l. Uses a laxative twice a week for bowel function; no urinary problems 12. Coping–stress tolerance pattern
_____ m. Feels her health is good for her age 13. Value-belief pattern
_____ n. Allergic to codeine and aspirin
_____ o. Has esophageal reflux and eats bland foods
_____ p. Can usually handle the stress of caring for her husband but if she becomes overwhelmed, asthma worsens
_____ q. Has been menopausal for 26 years; no sexual activity
_____ r. Takes medications for asthma, hypertension, and hypothyroidism and uses diazepam (Valium) PRN for anxiety
_____ s. Goes out to lunch with friends weekly
_____ t. Says she misses going to church with her husband but watches religious services with him on TV

9. What is an example of a pertinent negative finding during a physical examination?

a. Chest pain that does not radiate to the arm
b. Elevated blood pressure in a patient with hypertension
c. Pupils that are equal and react to light and accommodation
d. Clear and full lung sounds in a patient with chronic bronchitis
10. Match the following data with the assessment technique used to obtain the information.
a. Normal blood flow through arteries 1. Inspection
b. Abnormal blood flow in carotid artery 2. Palpation
c. Tympany of the abdomen 3. Percussion
d. Pitting edema 4. Auscultation
e. Cyanosis of the lips
f. Hyperactive peristalsis
g. Bruising of the lateral left thigh
h. Cool, clammy skin

11. What is the correct sequence of examination techniques that should be used when assessing the
patient's abdomen?
a. Inspection, palpation, auscultation, percussion
b. Palpation, percussion, auscultation, inspection
c. Auscultation, inspection, percussion, palpation
d. Inspection, auscultation, percussion, palpation
12. When performing a physical examination, what approach is most important for the nurse to
use?
a. A head-to-toe approach to avoid missing an important area
b. The same systematic, efficient sequence for all examinations
c. A sequence that is least revealing and embarrassing for the patient
d. An approach that allows time to collect the nursing history data while performing the
examination

24
13. The nurse is performing a physical examination on a 90-yr-old male patient who has been
bedridden for the past year. Which adaptations for performing the examination would be
appropriate for the patient (select all that apply)?
a. Make sure that a family member is with him.
b. Handle the skin with care because of potential fragility.
c. Keep the patient warm and comfortable during the assessment.
d. Allow the patient to watch TV to distract him from any painful assessments.
e. Place the patient in a position of comfort and avoid unnecessary changes in position.
14. In what patient situations would a comprehensive assessment be performed (select all that apply)?
a. Complaints of chest pain
b. On initial admission to the telemetry unit
c. On initial evaluation by the home health nurse
d. Found lying on the floor, unresponsive, with moist skin
e. On arrival in the surgery holding area of the operating room
15. Which assessment tools can be used to assess the cardiac system (select all that apply)?
a. Watch
b. Stethoscope
c. Reflex hammer
d. Ophthalmoscope
e. Blood pressure cuff
16. What is the term used for assessment data that the patient tells you about?
a. Focused
b. Objective
c. Subjective
d. Comprehensive
17. On the first encounter with the patient, the nurse will complete a general survey. Which features
are included (select all that apply)?
a. Mental state and behavior
b. Lung sounds and bowel tones
c. Body temperature and pulses
d. Speech and body movements
e. Body features and obvious physical signs
f. Abnormal heart murmur and limited mobility

25
4

Patient and Caregiver Teaching

1. In each of the nursing situations described below, identify the general goal of the patient and
caregiver teaching.
Nursing Situation Goal
Teaching a new mother about the recommended infant immunization schedule a.
Discussing recommended lifestyle changes with a patient with newly diagnosed heart disease b.
Counseling a patient with a breast biopsy that is positive for cancer c.
Demonstrating the proper condom application to sexually active teenagers d.

2. What is meant by this statement: “Every interaction with a patient or caregiver is potentially a
teachable moment”?
3. Which statements characterize the teaching-learning process (select all that apply)?
a. Learning can occur without teaching.
b. Teaching may make learning more efficient.
c. Teaching must be well planned to be effective.
d. Learning has not occurred when there is no change in behavior.
e. Teaching uses a variety of methods to influence knowledge and behavior.
4. From the list of principles of adult learning below, identify which one(s) is (are) used in the
following examples of patient teaching. Principles may be used more than once, and more than
one principle may be used for each example of patient teaching.
Examples of Patient Teaching Principles
_____ a. The nurse explains why it is important for a patient with Parkinson's disease to walk with wide placement of the feet. 1. Learner's need to
_____ b. The nurse asks a patient what is most important to her to learn about managing a new colostomy. know
_____ c. The nurse teaches a patient how to reduce the risks for stroke after the patient has had a transient ischemic attack. 2. Learner's readiness
to learn
_____ d. The nurse provides a variety of printed materials and Internet resources for a patient with impaired kidney function to use to learn about the
disorder. 3. Learner's prior
experiences
_____ e. When caring for a patient with newly diagnosed asthma, the nurse explains that asthma is a disorder the patient can control and allows the patient to
decide when teaching should be done and who else should be included. 4. Learner's motivation
_____ f. The patient diagnosed with diabetes mellitus requests to try performing self-monitoring of blood glucose and insulin administration while being to learn
taught by the nurse. 5. Learner's orientation
_____ g. During preoperative teaching of a patient scheduled for a total hip replacement, the nurse compares the postoperative care with that of the patient's to learning
prior back surgery. 6. Learner's self-
concept

5. When a patient with diabetes tells the nurse that he cannot see any reason to change his eating
habits because he is not overweight, what action does the nurse determine as the most
appropriate at this stage of the Transtheoretical Model of behavior change?
a. Help the patient set priorities for managing his diabetes.
b. Arrange for the dietitian to describe what dietary changes are needed.
c. Explain that dietary changes can help prevent long-term complications of diabetes.
d. Emphasize that he must change behaviors if he is going to control his blood glucose levels.
6. Put the following medical terms into phrases that a patient with limited health literacy would be
able to understand.
a. Acute myocardial infarction
b. Intravenous pyelogram
c. Diabetic retinopathy
7. What demonstrates an empathetic approach to patient teaching by the nurse?
a. Assesses the patient's needs before developing the teaching plan
b. Provides positive nonverbal messages that promote communication
c. Reads and reviews educational materials before distributing them to patients and families
d. Overcomes personal frustration when patients are discharged before teaching is complete

26
8. Describe one strategy that could be used to overcome the common barriers to teaching patients
and caregivers.
Barrier Strategy
Lack of time
Your feeling as a teacher
Nurse-patient differences

9. The nurse assesses a 48-yr-old male patient and his family for learning needs related to the
myocardial infarction the patient experienced 2 days ago. While doing her assessment, she finds
out that the patient's father died at age 52 from a myocardial infarction. Which assessment area
will influence the teaching plan for this patient and family?
a. Learner characteristics
b. Physical characteristics
c. Psychologic characteristics
d. Sociocultural characteristics
10. To promote the patient's self-efficacy during the teaching-learning process, the nurse should use
which strategy?
a. Emphasize the relevancy of the teaching to the patient's life.
b. Begin with concepts and tasks that are easily learned to promote success.
c. Provide stimulating learning activities that encourage motivation to learn.
d. Encourage the patient to learn independently without instruction from others.
11. Identify the teaching interventions that are indicated when the following patient characteristics
are found.
Patient Characteristic Teaching Intervention
Impaired hearing
Patient refuses to see a need for a change in health behaviors
Drowsiness caused by use of sedatives
Presence of pain
Uncertain of reading ability
Visual learning style
Primary language is not English

12. On assessment of a patient's learning needs, the nurse determines that a patient taking
potassium-wasting diuretics does not know what foods are high in potassium. What is an
appropriate nursing diagnosis for this patient?
a. Risk for cardiac dysrhythmias related to low potassium intake
b. Deficient knowledge related to not knowing what foods are high in potassium
c. Imbalanced nutrition: less than body requirements related to lack of intake of potassium-rich
foods
d. Deficient knowledge related to lack of interest regarding dietary requirements when taking
diuretics
13. Write a learning goal for the patient taking potassium-wasting diuretics who does not know
what foods are high in potassium.
14. Which teaching strategies should be used when it is difficult to reach the desired goals of the
session (select all that apply)?
a. DVD
b. Role play
c. Discussion
d. Printed material
e. Lecture-discussion
f. Web-based programs
15. When selecting audiovisual and written materials as teaching strategies, what is important for
the nurse to do?
a. Provide the patient with these materials before the planned learning experience.
b. Ensure that the materials include all the information the patient will need to learn.

27
 c. Review the materials before use for accuracy and appropriateness to learning needs and goals.
d. Assess the patient's auditory and visual ability because these functions are necessary for these
strategies to be effective.
16. A patient with a breast biopsy positive for cancer tells the nurse that she has been using
information from the Internet to try to make a decision about her treatment choices. In counseling
the patient, the nurse knows that (select all that apply)
a. the patient should be taught how to identify reliable and accurate information available online.
b. all sites used by the patient should be evaluated by the nurse for accuracy and appropriateness
of the information.
c. most information from the Internet is incomplete and inaccurate and should not be used to
make important decisions regarding treatment.
d. the Internet is an excellent source of health information, and online education programs can
provide patients with better instruction than is available at clinics.
e. the patient should be encouraged to use sites established by universities, the government, or
reputable health organizations, such as the American Cancer Society, to access reliable
information.
17. Identify what short-term evaluation technique is appropriate to assess whether the patient has
met the following learning goals.
Learning Goal Evaluation Technique
The patient will demonstrate to the nurse the preparation and administration of a subcutaneous insulin injection to himself with correct technique before discharge.
Before discharge, the patient will identify five serious side effects of Coumadin that should be reported to the health care provider.
The patient's wife will select the foods highest in potassium for each meal from the hospital menu with 80% accuracy.
The patient will verbalize “no shortness of breath” when ambulating unassisted with the walker each of three times a day.
The patient's caregiver will state that he or she is ready to change the patient's dressing today.

18. What is the best example of documentation of patient teaching regarding wound care?
a. “The patient was instructed about care of wound and dressing changes.”
b. “The patient demonstrated correct technique of wound care following instruction.”
c. “The patient and caregiver verbalize that they understand the purposes of wound care.”
d. “Written instructions regarding wound care and dressing changes were given to the patient.”
19. Which teaching strategies should the nurse plan to use for a baby boomer patient (select all that
apply)?
a. Podcast
b. Role playing
c. Group teaching
d. Lecture-discussion
e. A game or game system
f. Patient education TV channels
20. An 88-yr-old male patient with dementia and a fractured hip is admitted to the clinical unit
accompanied by his daughter who is his caregiver. She looks tired and disheveled. About 6
months ago she moved in with her father to keep him safe when he started wandering away from
his home. She has no money as a result of her inability to work. She has inadequate information
and is concerned about what will happen to her father after this hospitalization. Her brother calls
on the phone to tell her what to do but does not come to visit or help out. There is conflict in the
family related to decisions about caregiving. She has no respite from caregiving responsibilities
and is socially isolated with loss of friends from an inability to have time for herself. What are the
best coping strategies to teach this daughter (select all that apply)?
a. Keep a journal.
b. Get regular exercise.
c. Join a support group.
d. Go on a weight-loss diet.
e. Use humor to relieve stress.
f. Take time to read more books.

28
21. A 68-yr-old female patient was admitted with a stroke 3 days ago. She has weakness on her right
side. She states, “I will never be able to take care of myself. I don't want to go to therapy this
afternoon.” After listening to her, which statement would be included as part of a motivational
interview?
a. “Why not?”
b. “If you go to therapy, I'll give you a back rub when you get back.”
c. “I know you are tired, but look how much easier walking was today than it was last week.”
d. “Well, with that attitude, you will have trouble. The doctor ordered therapy because he
thought it would help.”

29
5

Chronic Illness and Older Adults

1. A 78-yr-old female patient is admitted with nausea, vomiting, anorexia, diarrhea, and
dehydration. She has a history of diabetes mellitus and 2 years ago had a stroke with residual
right-sided weakness. Identify which characteristics of chronic illness the nurse will probably find
in this patient (select all that apply).
a. Self-limiting
b. Residual disability
c. Permanent impairments
d. Infrequent complications
e. Need for long-term management
f. Nonreversible pathologic changes
2. Seven tasks required for daily living with chronic illness have been identified. From Table 5-4,
select at least one of these tasks that would specifically apply to the following common chronic
conditions in older adults.
Chronic Condition Task
Diabetes mellitus
Visual impairment
Heart disease
Hearing impairment
Alzheimer's disease
Arthritis
Orthopedic impairment

3. Consider the differences between primary and secondary prevention. Fill in the blanks.
a. Actions aimed at early detection of disease and interventions to prevent progression of disease
are considered __________ prevention.
b. Following a proper diet, getting appropriate exercise, and receiving immunizations against
specific diseases are considered __________ prevention.
4. What is the leading cause of death in the United States?
a. Cancer
b. Diabetes mellitus
c. Coronary artery disease
d. Cerebrovascular accident
e. Chronic obstructive pulmonary disease
5. According to the Corbin and Strauss chronic illness trajectory, which statement describes a
patient with an unstable condition?
a. Life-threatening situation
b. Increasing disability and symptoms
c. Gradual return to acceptable way of life
d. Loss of control over symptoms and disease course
6. Which statement(s) about older people are only myths and illustrate the concept of ageism (select
all that apply)?
a. You can't teach an old dog new tricks.
b. Old people are not sexually active.
c. Most old people live independently.
d. Most older adults can no longer synthesize new information.
e. Most older people lose interest in life and wish they would die.

30
7. For each of the nursing diagnoses listed, identify at least two normal expected physiologic
changes related to aging that could be etiologic factors of the diagnosis. Changes related to aging
are found in the chapters identified in Table 5-5.
a. Imbalanced nutrition: less than body requirements (see Table 38-5, p. 840)
Change:
Change:
b. Activity intolerance (see Table 61-1, p. 1451)
Change:
Change:
c. Risk for injury (see Table 55-4, p. [1305]; Table 20-1, p. 353)
Change:
Change:
d. Urge urinary incontinence (see Table 44-2, p. 1020)
Change:
Change:
e. Ineffective airway clearance (see Table 25-4, p. 459)
Change:
Change:
f. Risk for impaired skin integrity (see Table 22-1, p. 397.)
Change:
Change:
g. Ineffective peripheral tissue perfusion (see Table 31-1, p. 663.)
Change:
Change:
h. Constipation (see Table 38-5, p. 840.)
Change:
Change:
8. The nurse identifies the presence of age-associated memory impairment in the older adult who
states
a. “I just can't seem to remember the name of my granddaughter.”
b. “I make out lists to help me remember what I need to do, but I can't seem to use them.”
c. “I forgot that I went to the grocery store this morning and didn't realize it until I went again this
afternoon.”
d. “I forget movie stars' names more often now, but I can remember them later after the
conversation is over.”
9. Indicate what the acronym SCALES stands for in assessment of nutrition indicators in frail older
adults.
S
C
A
L
E
S

10. When working with older patients who identify with a specific ethnic group, the nurse
recognizes that health care problems may occur in these patients because they
a. live with extended families who isolate the patient.
b. live in rural areas where services are not readily available.
c. eat ethnic foods that do not provide all essential nutrients.
d. have less income to spend for medications and health care services.
11. An 83-yr-old woman is being discharged from the hospital following stabilization of her
international normalized ratio (INR) levels (used to assess effectiveness of warfarin therapy). She
has chronic atrial fibrillation and has been on warfarin (Coumadin) for several years. Discharge
instructions include returning to the clinic weekly for INR testing. Which statement by the patient
indicates that she may be unable to have the testing done?

31
 a. “When I have the energy, I have taken the bus to get this test done.”
b. “I will need to ask my son to bring me into town every week for the test.”
c. “Should I just keep taking the same pill every day until I can get a ride to town?”
d. “It is very important to have this test every week. I have several church friends who can bring
me.”
12. The old-old population (85 years and older) has an increased risk for frailty. However, old age is
just one element of frailty. Identify at least three other assessment findings that are considered
criteria for frailty.
a.
b.
c.
13. An 80-yr-old woman is brought to the emergency department by her daughter, who says her
mother has refused to eat for 6 days. The mother says she stays in her room all of the time
because the family is mean to her when she eats or watches TV with them. She says her daughter
brings her only one meal a day, and that meal is cold leftovers from the family's meals days
before.
a. What types of elder mistreatment may be present in this situation?
b. How would the nurse assess the situation to determine whether abuse is present?
The daughter says her mother is too demanding and she just cannot cope with caring for her
mother 24 hours a day.
c. What may be an appropriate nursing diagnosis for the daughter?
d. What resources can the nurse suggest to the daughter?
14. What are three common factors known to precipitate placement in a long-term care facility?
a.
b.
c.
15. An 88-yr-old woman is brought to the health clinic for the first time by her 64-yr-old daughter.
During the initial comprehensive nursing assessment of the patient, what should the nurse do?
a. Ask the daughter whether the patient has any urgent needs or problems.
b. Interview the patient and daughter together so that pertinent information can be confirmed.
c. Refer the patient for an interprofessional comprehensive geriatric assessment because at her age
she will have multiple needs.
d. Obtain a comprehensive health history using physical, psychologic, functional, developmental,
socioeconomic, and cultural assessments.
16. What is a mental status assessment of the older adult especially important in determining?
a. Potential for independent living
b. Eligibility for federal health programs
c. Service and placement needs of the individual
d. Whether the person should be classified as frail
17. What is the most important nursing measure in the rehabilitation of an older adult to prevent
loss of function from inactivity and immobility?
a. Using assistive devices such as walkers and canes
b. Teaching good nutrition to prevent loss of muscle mass
c. Performance of active and passive range-of-motion (ROM) exercises
d. Performance of risk appraisals and assessments related to immobility
18. In view of the fact that most older adults take at least six prescription drugs, what are four
nursing interventions that can specifically help prevent problems caused by multiple drug use in
older patients?
a.

32
 b.
c.
d.
19. Which nursing actions would demonstrate the nurse's understanding of the concept of
providing safe care without using restraints (select all that apply)?
a. Placing patients with fall risk in low beds
b. Asking simple yes-or-no questions to clarify patient needs
c. Making hourly rounds on patients to assess for pain and toileting needs
d. Placing a disruptive patient near the nurses' station in a chair with a seat belt
e. Applying a jacket vest loosely so that the patient can turn but cannot climb out of bed
20. When teaching a 69-yr-old patient about self-care, what will promote health (select all that apply)?
a. Proper diet
b. Immunizations
c. Teaching chair yoga
d. Demonstrating balancing techniques
e. Participation in health promotion activities
21. The 58-yr-old male patient will be transferred from the acute care clinical unit of the hospital to
another care area. The patient requires complicated dressing changes for several months. To
which practice setting(s) could the patient be transitioned (select all that apply)?
a. Acute rehabilitation
b. Long-term acute care
c. Intermediate care facility
d. Transitional subacute care
e. Programs for All-Inclusive Care for the Elderly (PACE)

33
6

Stress and Stress Management

1. When a patient at the clinic is informed that testing indicates the presence of gonorrhea, the
patient sighs and says, “That, I can handle.” What does the nurse understand about the patient in
this situation?
a. The patient is in denial about the possible complications of gonorrhea.
b. The patient does not perceive the gonorrhea infection as a threatening stressor.
c. The patient does not have other current stressors that require adaptation or coping
mechanisms.
d. The patient knows how to cope with gonorrhea from dealing with previous gonorrhea
infections.
2. The student nurse is depressed. He is trying to study for an important exam but cannot focus.
Yesterday he received news that his mother was diagnosed with metastatic breast cancer. What
effect could the stress on the student's mind and spirit most likely have on the student's body?
a. The student's stress will cause failure of the exam.
b. The student's stress will contribute to physical illness.
c. The student's worry will affect his driving to see his mother.
d. The student's emotional stress will cause bad feelings about the exam.
3. Identify four key personal characteristics that promote adaptation to stressors.
a.
b.
c.
d.
4. Using the words and phrases list below, fill in the boxes below with the numbers of the words or
phrases that illustrate the physiologic responses to stress.

34
Word and Phrase List
1. Interpretation of event
2. ↑ ADH (antidiuretic hormone)
3. Cortisol
4. ↑ Blood volume
5. ↑ HR and stroke volume
6. ↑ Water retention
7. Wakefulness and alertness
8. ↑ Sympathetic response
9. β-Endorphin
10. Self-preservation behaviors
11. ↑ Cardiac output
12. Corticotropin-releasing hormone
13. Aldosterone
14. ACTH (adrenocorticotropic hormone)
15. Blunted pain perception
16. ↑ Gluconeogenesis
17. ↑ Epinephrine and norepinephrine
18. ↓ Digestion
19. ↑ Proopiomelanocortin (POMC)

35
Another random document with
no related content on Scribd:
 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN