and deficient water, there is no very In the hot great amount of fever. The amount of drunkenness and delirium tremens in Canada used to be great. In 1863 no less than 9 out of 96 deaths, or nearly one-tenth, were caused by delirium tremens. Violent deaths also are usually large, drowning giving the largest proportion. The sickness and mortality of Nova Scotia and Newfoundland are almost identical with Canada, and they are now included in the returns under the one head of "Dominion of Canada." Both stations have always been considered very healthy. There is some typhoid fever at Halifax, and at both places there was formerly much drinking, but that is now less. In British Columbia, where there is a small garrison of 100 to 150, the health is also extremely good. SECTION V. AFRICAN STATIONS. SUB-SECTION I.-ST. HELENA. Garrison, 200. In 1880 only 194. Civil population (in 1881), 5,059. Until comparatively recently this small island was garrisoned by a local corps (St. Helena Regiment), which has now been disbanded. The island has always been healthy; seated in the trade-winds, there is a tolerably constant breeze from southeast. The average mortality in the years 1859-66 was 9.75, or without violent deaths, 7.85. In 1867 the mortality from disease was only 5.24. In 1875 almost the same, viz., 5.41. There is very little malarious disease (about 50 to 60 admissions per 1,000 of strength), but there has frequently been a good many cases of "continued fever," and dysentery and diarrhoea are usual diseases. merly there appears to have been much phthisis, but this is now much less, giving another instance of the decline of this disease, as in so many other stations. For In the years 1837-46, the admissions from tubercular diseases averaged 21 per 1,000 per annum, and the deaths 5.45. In the years 1859-66 the admissions from tubercular diseases were 6.6; and the deaths 1.66 per 1,000. In 1867 there were no admissions. The health of the troops would have been even better if the causes of the continued fever and dysentery could have been discovered and removed, and if the amount of drunkenness had been less. The returns from St. Helena are now combined with those from the Cape of Good Hope. SUB-SECTION II.-WEST COAST OF AFRICA.' The principal stations are Sierra Leone and Cape-Coast Castle. The station of Gambia has now been given up, and troops are no longer stationed regularly at Lagos (500 miles from Cape-Coast Castle, and occupied in 1861). In 1875 Sierra Leone, Cape-Coast, and Accra were occupied, and Elmina for a short time, and since then the two first stations have been 1 For a very good account of the topography of the Gold Coast, see Dr. R. Clarke's paper in the Transactions Epid. Society, vol. i. VOL. II.-21 alone garrisoned. No white troops are employed, except during war-time, as in the Ashanti campaign of 1873. Sierra Leone. Strength of garrison, 300 to 500 black troops, with a few European officers and non-commissioned officers. Civil population (in 1872), 37,089. Hot season from May to the middle of November; Harmattan wind in December; soil, red sandstone and clay, very ferruginous. There are extensive mangrove swamps to N. and S. Water very pure. The spring in the barrack square contains only 3 to 4 grains per gallon of solids. This station had formerly the reputation of the most unhealthy station of the army. Nor was this undeserved. From 1817 to 1837 (twenty years) there were yearly among the troops— At the same time, about 17 per cent. of the whole white population died annually. The chief diseases were malarious fevers, which caused much sickness, but no great mortality; and yellow fever, which caused an immense mortality. Dysentery, chiefly scorbutic, was also very fatal. The causes of this great mortality were simple enough. The station was looked upon as a place of punishment, and disorderly men, men sentenced for crimes, or whom it was wished to get rid of, were drafted to Sierra Leone. They were there very much overcrowded in barracks, which were placed in the lower part of the town. They were fed largely on salt meat; and being for the most part men of desperate character, and without hope, they were highly intemperate, and led, in all ways, lives of the utmost disorder. They considered themselves, in fact, under sentence of death, and did their best to rapidly carry out the sentence: Eventually, all the white troops were removed, and the place has since been garrisoned by one of the West Indian regiments. Of late years, the total white population of Sierra Leone (civil and military) has not been more than from 100 to 200 persons. The great sickness and mortality being attributable, as in so many other cases, chiefly to local causes and individual faults, of late years Europeans have been comparatively healthy; although from time to time fatal epidemics of yellow fever occur. They are, however, less frequent and less fatal than formerly. The position of the barracks has been altered, and the food is much better. One measure which is supposed to have improved the health of the place, is allowing a species of grass (Bahama grass) to grow in the streets. The occupiers of the adjacent houses are obliged to keep it cut short, and in good order. During the four years, 1863-66, there died 8 white non-commissioned officers, in the whole command of the West Coast, out of an average strength of 25, or at an annual rate of 80 per 1,000 of strength. Three of the 8 deaths were from liver disease, two from delirium tremens, two from fevers, and one from dysentery. In 1867 two sergeants died, out of 15 white men-one from apoplexy, one from delirium tremens. Among the black troops serving in Sierra Leone and the Gold Coast, the returns of the ten years (1861-70) give 1,283 admissions and 22.49 deaths per 1,000. In 1871 the deaths were 15.63 per 1,000 from disease. In ten years (1870-79) the admissions were 1640.5 and the deaths 25.07 per 1,000. 1873 was the year of the last Ashanti war. In 1880 the admissions were 1565.7 and the deaths 22.47, of which 20.86 were from disease. These numbers are for the whole West African command. Among the causes of death, tubercular diseases hold the first place, amounting to 7.05 per 1,000 of strength. In 1862 phthisis amounted to no less than 12.6 per 1,000 of strength, and constituted 43.7 per cent. of all deaths from disease. There were also 9.46 per 1,000 of strength deaths from pneumonia. In 1863 the deaths from phthisis were 9.3 per 1,000 of strength, and made up 36.3 per cent. of the total deaths. In 1867 the tubercular deaths per 1,000 of strength were 17.71 in Sierra Leone, 15.87 at the Gambia, and 12.58 at the Gold Coast and Lagos together. In 1880 the total rate for the command was 11.23 per 1,000. It seems clear, indeed, that in all the stations of the West Indian corps (black troops), the amount of phthisis is great; in fact, the state of health generally of these regiments requires looking into, as in the West Indies. In 1862 there were only five cases of intermittent, and eighteen of remittent fever among 317 negroes. In 1880 the number was 404 out of 623. In 1861 some of the troops from Sierra Leone and the Gambia were employed up the Gambia against the Mandingoes, and also against the chiefs of Quiat. În 1863 and 1864, and again in 1873, Ashanti wars prevailed. All these wars added to the sickness and mortality, so that these years are not fair examples of the influence of the climate. Gambia. No troops have been quartered here of late years, and it has been in contemplation to abandon the station. It is much more malarious than any of the others. The drinking water is bad; all barrack and sewage arrangements are imperfect. Yellow fever from time to time is very destructive. In 1859 two out of four European sergeants, and in 1860 three medical officers, died of yellow fever. Among the black troops in 1859-65,the admissions were 1169.8 and the deaths 29.97 per 1,000 of strength. As at Sierra Leone, phthisis and other diseases of the lungs caused a large mortality among the negroes. In 1861 phthisis gave five deaths out of a strength of 421, or at the rate of 11.6 per 1,000 strength; and pneumonia gave four deaths, and acute bronchitis three, or (together) at the rate of 16.24 per 1,000 of strength. Phthisis, pneumonia, and bronchitis gave nearly 60 per cent. of all deaths from disease. This was higher than in previous years; but in 1862 phthisis gave 14.35 deaths per 1,000 of strength, and constituted 75 per cent. of the whole number of deaths. There was, however, no pneumonia or bronchitis in that year. In 1856 the tubercular class gave 9.53 deaths per 1,000. In 1863, however, there were no deaths from phthisis. Although the period of observation is short, it can hardly be doubted that here, as elsewhere in the stations occupied by the West Indian regiments, some causes influencing the lungs prejudicially are everywhere in action. It is probably to be found in bad ventilation of the barracks. Among the few white residents at the Gambia, diarrhoea, dysentery, and dyspepsia appear to be common. These, in part, arise from the bad water; in part from dietetic errors (especially excess in quantity), and want of exercise and attention to ordinary hygienic rules. Cape-Coast Castle (Gold Coast). Garrison, 300 to 400 (black troops). This station has always been considered the most healthy of the three principal places. It is not so malarious as even Sierra Leone, and much less so than the Gambia, and has been much less frequently attacked with yellow fever. Dysentery and dyspepsia are common diseases among the white residents. Among the black troops the prevalence of phthisis, pneumonia, and bronchitis is marked, though less so, perhaps, than at the other two stations. One peculiarity of the station was the prevalence of dracunculus. This was much less common at Sierra Leone, and at the Gambia. It appears to have lessened considerably in later years, but there is no definite information now to be obtained from the A. M. D. Reports. Hygiene on the West Coast. There is no doubt that attention to hygienic rules will do much to lessen the sickness and mortality of this dreaded climate. In fact, here as elsewhere, men have been contented to lay their own misdeeds on the climate. Malaria has, of course, to be met by the constant use of quinine during the whole period of service. The other rules are summed up in the following quotation from Dr. Robert Clarke's paper,' and when we reflect that this extract expresses the opinion of a most competent judge on the effect of climate, we must allow that, not only for the West Coast, but for the West Indies, and for India, Dr. Clarke's opinions on the exaggeration of the effect of the sun's rays and exposure to night air, and his statement of the necessity of exercise, are full of instruction : "Good health may generally be enjoyed by judicious attention to a few simple rules. In the foremost rank should be put temperance, with regular and industrious habits. European residents on the Gold Coast are too often satisfied with wearing apparel suited to the climate, overlooking the fact that exercise in the open air is just as necessary to preserve health there as it is in Europe. Many of them likewise entertain an impression that the sun's rays are hurtful, whereas in nine cases of ten the mischief is done, not by the sun's rays, but by habits of personal economy. Feeling sadly the wearisome sameness of life on this part of the coast, recourse is too frequently had to stimulants, instead of resorting to inexhausting employments, the only safe and effectual remedy against an evil fraught with such lamentable consequences. Europeans also bestow too little attention on ventilation, far more harm being done by close and impure air during the night than is ever brought about by exposure to the night air. "Much of the suffering is occasioned by over-feeding." 1 Trans. of the Epidem. Soc., vol. i., pp. 123, 124. 2 Considerable interest in this part of the work was roused by the occurrence of the Ashanti war of 1873, for an admirable account of which see the Army Medical Reports, vol. xv., where Sir Anthony D. Home gives a full medical history of the operations carried on. The excellent hygienic arrangements enabled the arduous work of the expedition to be accomplished with a comparatively small loss. But the few casualties in action, compared with the deaths by disease, show by contrast how much more deadly were the forces of nature than those of the enemy: 26 officers died, of whom only five were killed or died of wounds; 13 men were killed (white troops), while 40 died of disease; of the West Indian troops (black) only 1 was killed, while 41 died of disease. For analysis of soil of Gold Coast, see Army Med. Reports, vol. xiv., p. 264; and for some account of the drinking-water, see paper by Dr. J. D. Fleming, in vols. xiv. and XV. SUB-SECTION III.-CAPE OF GOOD HOPE Garrison, about 3,000 men. The chief stations are Cape Town (about 45,000 inhabitants), Graham's Town, King William's Town, Port Elizabeth, Algoa Bay, and several small frontier stations. At Natal there is also a small force. The climate is almost everywhere good; the temperature is neither extreme nor very variable; the movement of air is considerable. At Cape Town the mean annual temperature is 67°, with a mean annual range of about 38°. Elim The statistics of later years are complicated by the casualities of war, included killed and wounded in action and a great excess of fever. inating these, we have the following ratios per 1,000: As regards the admissions, which in total number appear little if at all influenced by war, it is clear that the diminution which might have been expected in consequence of sanitary improvements was chiefly arrested by the great number of cases of continued fever, which occurred during the period of hostilities. In times of peace there is but little fever, and a small and decreasing mortality. Thus, in 1856-66, the death-rate was 1.25 per 1,000, in 1870-77 only 0.50,-while in 1878-80 it was no less than 11.16; in all these cases the deaths are almost invariably enteric. Paroxysmal fevers, arising in the station itself, are very uncommon, the worst year in the period 1870-77 being 1874, when these diseases appeared among troops 1 Including the detachment at St. Helena. |