BARBADOES.

Strength of garrison, 300 to 400 men. 172,000.

Civil population (in 1881),

Geology.-Limestone (coralline); sandstone (tertiary); beds of bituminous matter and coal (tertiary), clay in parts (especially in the hilly district called "Scotland ").

An open country, well cultivated, no marshes except a small one at Græme Hall, one mile to the east of St. Ann's Barracks.

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The country is divided into two parts: a mountainous district termed Scotland," and a lower country consisting of a series of five gigantic terraces, rising with some regularity one above the other. The highest hill is 1,100 feet.

Climate of the Plain.-Temperature: Mean of year, 80°; hottest month (October), 83°; coldest month (January), 78°; mean yearly fluctuation, 5. Climate equable and limited. Relative humidity, 70 per cent.

Wind.--N.E., trade, strongest in February to May; weak in September to November inclusive; hurricane month, August.

Rain.-About 56 to 58 inches, on an average, but varying a good deal in the autumn chiefly, though there is rain in all months, but much less. The dry season is from December to May.

At

Water. Formerly supplied from wells; it was highly calcareous. present good water is supplied by a water company. Rain-water is also collected in tanks.

Sanitary Condition.-St. Ann's Barracks are placed above one and a half mile from Bridgetown, on the sea; the locality and the construction of the barracks have been much complained of, and a position in the hills advised. Arrangements for sewering and the water supply were both formerly bad; considerable improvements have been made, and, since 1862, 30,000 gallons are supplied daily to St. Ann's Barracks. It is a limestone water, containing carbonate of lime, but no sulphate of lime, and is remarkably free from organic matter. The total solids are 18.72 grains per gallon. The troops are still too much crowded in barracks, the allowance being under 600 cubic feet. Since 1872 new latrines (Jennings' pattern) have been provided and the old ones closed.

Formerly vegetables were very deficient in Barbadoes, and even now there is some difficulty in procuring them. They are often imported from other islands.

Diseases among Civil Population.-Yellow fever has appeared frequently, although the island is not marshy. It is not so frequent as formerly; it used to be expected every four years.

Barbadoes and Trinidad contrast greatly in the freedom from marshes of the one, and the existence of marshes and malarious diseases in the other; yet Barbadoes has had as much yellow fever as Trinidad.

Dysentery was common formerly, partly from bad water; influenza has been epidemic several times. Barbadoes leg, or Elephantiasis of the Arabs, is frequently seen. Leprosy, or Elephantiasis Græcorum, is also not very uncommon. Variola and Pertussis have from time to time been

Hillary, in 1766, described a "slow nervous fever," under which term

For an extremely good and concise account of Barbadoes, see Dr. Jameson's Report in the Army Medical Report for 1861, p. 261.

our typhoid fever appears to have been indicated by most writers of that period. His description is not quite clear, but resembles typhoid fever more than any other. He also speaks of "diarrhoea febrilis." Can this

have been typhoid ?

Dracunculus was formerly very frequent, and Hillary attributes it to the drinking-water, and states that there were some ponds the water of which was known to "generate the worm if washed in or drank."

Yaws used to be common.

Colica pictonum was formerly frequent.

Diseases of Troops.-Yellow fever has several times been very fatal. Scorbutic dysentery, arising from the wretched food, was formerly very frequent, and appears from Sir Andrew Halliday's work to have been very bad even in his time (1823 to 1832).

From 1817 to 1836 (20 years)—

Average mortality (white troops), 58.5 per 1,000 of strength.

In 1817 there were 1,654 men on the island, and yellow fever broke out. In 1823 there were only 791.

Of late years, as in all the other islands, the sickness and mortality has been comparatively trifling.

In 1859-65 the total deaths were 6.98 per 1,000, and in 1866 they fell to 3.28 per 1,000, which is only one-third the mortality of home service. The highest mortality of late years was in 1862, viz., 16.77; the average number of admissions is about 1,200.

In 1864 there was an outbreak of a mild fever, termed "remittent;" the nature is unknown; no case was fatal.

The increased mortality of 1862 was owing to yellow fever. It appeared first among the civil population in Bridgetown, and afterward attacked the troops in the (stone) barracks. As it continued to spread, the men were moved out and placed under canvas, with the best effects. A remarkable feature of this epidemic was that the officers suffered in attacks six-fold more than the men, and had a mortality more than twenty-fold. The women also suffered three-fold more than the men. Formerly the case would have been reversed. In 1861 there were only two deaths out of 787 men, one from phthisis and one from apoplexy; and in 1864 there were also only two deaths (diarrhoea and phthisis) among 930 men.

Dysentery is now uncommon.

The great improvement to be made at Barbadoes is decidedly a complete change of barracks. The persistent recurrence of yellow fever in these old barracks, with their imperfect arrangements, shows them to be the main cause of the appearance of the disease. The saving in the cost of a single epidemic would amply repay the outlay.

As in the other islands, the black troops are now much more unhealthy than the white, and the sanitary condition of their barracks and their food evidently require looking into. Phthisis and chronic dysentery are the chief diseases causing mortality. The average of 1859-64 gave 1,015 admissions and 20.46 deaths per 1,000 of strength. In 1865 there were 22.64 deaths per 1,000 of strength, or, excluding violent deaths, 20.49; of these phthisis caused 14.34, or no less than 70 per cent. of total deaths.

No separate information is now available from the "Army Medical Department Reports."

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ST. LUCIA.

Strength of garrison 100 men, now usually black troops. Civil population (in 1871), 36,610.

St. Lucia is divided into two parts: Basseterre, the lowest and most cultivated part, is very swampy; Capisterre, hilly, with deep narrow ravines, full of vegetation. The climate is similar to that of the other islands, but is more rainy and humid.

Diseases of the White Troops.-From 1817-36; average strength, 241 ; average deaths, 30= 122.8 per 1,000 of strength. Of the 122.8 deaths, 63.1 were from fevers, 39.3 from bowel disease, and 12.5 from lung disease.

Pigeon Island (a few miles from St. Lucia) was formerly so unhealthy that on one occasion 22 men out of 55 died of dysentery in one year, and of the whole 55 men not one escaped sickness. The cause is supposed to have been bad water. Now Pigeon Island is considered healthy.

Although the mortality was formerly so great, St. Lucia has been very healthy for some years.

In 1859, mean strength of white troops, 96; admissions, 113, and there was not a single death, although, if the mortality had been at the rate of the twenty years ending 1836, 12 men would have died.

Better food, some improvement in barracks, and the use of rain- instead of well-water, have been the causes of this extraordinary change.

Twenty two men were admitted with "continued fever," 18 with ophthalmia, and only 2 with venereal.

In 1860 there was no case of dysentery and only two of diarrhoea among 100 men in this island, where formerly there would have been not only many cases, but 4 deaths. One man died from phthisis, or at the rate of 10 per 1,000.

In 1861, out of 94 men, there was one death from jaundice, or at the rate of 10.6 per 1,000.

In 1862 there were 88 men on the island; one man was drowned; there was no death from disease. No case of jaundice was admitted.

In 1863 there were 55 men, and one death from accident; there were 64 admissions, of which 15 were accidents.

The total death rate among the white troops in the West Indian Command was, in 1880, 8.68 per 1,000, of which 5.79 only were due to disease ; invalids sent home, 42.43 per 1,000, of whom 12.54 were finally discharged.

BRITISH GUIANA (252,000 inhabitants in 1881).

No white troops are at present stationed at Demerara.

This station in the West Indian Command is on the mainland, extending from the equator (nearly) to 10° N., 200 to 300 miles, and inland to an uncertain distance.

It is a flat alluvial soil of clay and sand, covered with vegetation.

The water of Georgetown is not good; it is drawn from a fresh-water lake and an artesian well; the water from this well contains a good deal of iron.

Trade-winds from N.E. an E. for nine months. In July, August, and September, S.E. and S. and land-winds. This is the unhealthy season. Two wet seasons, January and June; the last is the longest. Temperature of summer, 86°; of winter, 82°. Rain, about 100 inches. Formerly there was an enormous mortality among the troops from

yellow fever and scorbutic dysentery. The men used to have salt meat five times a week.

The climate is most highly malarious, but this does not cause much mortality.

Yellow fever has prevailed here several times. On one occasion (1861) the troops were moved out and encamped at some distance from Georgetown; they escaped (7 mild cases only), although they were on a swampy plain.

In 1817-36 the average deaths were 74 per 1,000 of strength.

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In 1859, out of a mean strength of 143, there were 156 admissions 1,091 per 1,000 of strength; 2 deaths 13.9 per 1,000 of strength. One death from apoplexy, one from drowning. The deaths from disease were only 6.9 per 1,000. Of the 156 admissions, no less than 81 were from malarious disease, or at the rate of 519 per 1,000 of strength, or nearly onehalf the total admissions.

In 1860, 1861, and 1862, the admissions from malarious disease continued high (673, 1,380, and 1,104 per 1,000 of strength), the mortality was very small, being only 6.6 per 1,000 in each year; in fact, the single death in 1860 and in 1861 was in the one year from "acute hepatitis,” and in the other from accident. In 1862, in spite of the immense malarious disease, there was no death.

Subsequently to 1861 it appears that scattered cases of yellow fever occurred among the shipping and in the town every year; in 1866 there was an outbreak among the white troops. In eight weeks 16 deaths occurred among 72 men, or 22 per cent.1

Some important lessons are drawn from the medical history of this station. It has been shown that even in a highly malarious country yellow fever may be evaded by change of ground, although the men are obliged to encamp on a swamp. Another remarkable point is the very small mortality attending the paroxysmal fevers. It would be very interesting to know the future history of such men, but it cannot be doubted that the lessened mortality since former years must be owing to better treatment.

The extent of malarious disease shows how desirable it is to avoid sending white troops to Demerara.

In French Guiana, Dr. Laure, besides malarious fevers, describes typhoid fever to have occurred for some short time after the arrival of French political prisoners after the coup d'état of 1851. It then disappeared.

1 A full inquiry was made into this outbreak; it was, as so frequently happens, localized, for the troops were suffering severely, while the health officer for the port (Dr. Scott) states in his evidence (Report of the Commissioners appointed to Inquire into the Outbreak of Yellow Fever at Demerara in 1866, p. 25) that the cases in town were "very few" at the time. The barracks were badly circumstanced in various ways, particularly in having removal of sewage on a trench system, into which the latrines opened, and which trenches were intended to be kept clean by flushing; they were, however, in a very foul state, and were merely open cesspools; and the evidence of Surgeon-Major Hutton (Report, p. 37) clearly points out that a thoroughly good system of dry removal is the proper plan for this colony. Whether this and the other unsanitary conditions gave its local development to the yellow fever, was a matter of doubt in the colony; but they are precisely the same conditions which have been so frequently seen in West Indian outbreaks - a foul soil, and, in addition, open cesspools exposed to the intense heat of a tropical sun, and to the influence of a moist atmosphere and a moist soil. On this occasion the troops were not removed from the barracks until too late.

BAHAMAS AND HONDURAS.

The black troops garrison both those places, and show a degree of mortality nearly the same as in the other stations, the amount of phthisis being very great. In 1862, at the Bahamas, there were no less than 4 deaths from phthisis out of a strength of 439, or at the rate of 9.1 per 1,000 of strength; there were also 3 deaths from pneumonia and 1 from pleurisy. In the years 1859-66 the average deaths from tubercular diseases per 1,000 men were 11.04 yearly, and from other diseases of the lungs, 5.86; out of 100 deaths, 60 were from diseases of the lungs. is evidently a matter for careful inquiry.

This

At Honduras, among the black troops, the deaths from tubercular disease, in 1859-66, were 4.04 per 1,007 of strength.

SECTION III.

BERMUDA.

Usual strength of garrison, about 1,900 men. 1881), 13,948.

Civil population (in

Climate.-Hot, equable, and rather limited. Temperature.-Mean of year, 74°; hottest month (July), 83.5°; coldest month (February), 64.5°; amplitude of yearly fluctuation, 19°. Relative humidity about 74 per cent.

The sanitary condition was formerly very bad; there were no sewers, and no efficient dry method of removal. Now matters are much improved, and in 1875 the health of the troops was reported excellent. Rain-water

is used for drinking.

Diseases of the Troops.

Loss of Strength per 1,000 per annum. Loss of Service per 1,000 per annum.

This history of the West Indies may be applied to Bermuda, though, with the exception of yellow fever years, it never showed the great mortality of the West Indies. There is no great amount of paroxysmal fevers ; in ten years (1837-46) there were only 29 admissions out of an aggregate strength of 11,224 men. In ten years (1870-79) there were only 15 admissions out of 18,974, or at the rate of 0.8 per 1,000.

Yellow fever has prevailed seven times in this country-viz., in 1819, 1837, 1843, 1847, 1853, 1856, and 1864.