largely supplementing, and even supplanting, the methods of what may be
termed chemical therapeutics, the question of suitable health resorts is
one which must engage the attention of every medical man who is anxious
to do his best for his patient. The opening up of South Africa by the
success of British arms will be followed shortly, it is to be hoped, by
a vigorous development of the country through colonisation and the
investment of capital. Thus will be afforded a new and more extended
field for the employment of the natural therapeutics of climate, soil,
and environment, by which to combat the advance of many insidious
diseases. We English people are too prone to bend the knee to foreign
Baals, who but mock us as we worship. It should be an additional
pleasure to every enlightened Imperialist to think that within the
borders of our own empire, in lands peopled by those who speak our own
kindly mother-tongue, we may find physical conditions in every way
superior to those of foreign health-resorts, which have hitherto waxed
fat and become insolent in their fancied monopoly. I write with the hope
that many who are ignorant of these superior advantages possessed by
South Africa may be guided by these pages to make their choice of a
recreation-ground more intelligently, and consequently with better
results, than is at present usually the case. It is true that at the
moment invalids should be dissuaded from going to South Africa while the
difficulties exist of transport and maintenance of so large and so
sudden an increase of population. Supposing that our railway companies
had not been able to run any extra trains for the last Coronation
procession in London, we should have had a picture of congestion and
discomfort not unlike what is happening in South Africa at the present
time. But these difficulties are but of the moment and are passing
hourly. When once things have settled down a little, normal methods will
prevail; and it may confidently be predicted that travelling in South
Africa will become increasingly comfortable and easy as the flow of
population and wealth create a demand for increased facilities. Already
far nearer approximation to our standards of comfort has been made than
is dreamt of by stay-at-home Englishmen. The ox-waggon is not now the
usual means of covering the distance between Wynberg and Kimberley, as
was apparently thought by a medical lecturer not many years ago, since
he gravely advised his audience to adopt that method of transit. We have
only within the last few months seen in London electric trams as good as
those that have been running for some years from Cape Town to Sea Point.
The voyage to South Africa is one of the pleasantest and most healthful
in the world. It is in itself a powerful factor in the restoration of
mind and body. There are two routes by which one can travel, the East
and the West Coast routes. The East Coast route, by which Mr.
Chamberlain travelled, is of recent development, and the principal
steamers running on it are German (the German East Africa Company).
Passengers may join the boat at Hamburg, Antwerp, Marseilles, or Naples,
and the voyage is broken at Port Said, Suez, Aden, Zanzibar, Delagoa,
and is terminated at Durban. It is thus an interesting itinerary, and
for those who fear sea-sickness may be recommended, as the vessel is
never longer than five days continuously at sea. The pleasantest months
in which to travel by this route are February, March, and April. At
other times it is apt to be oppressively hot. The personnel of the fleet
is very obliging and anxious to promote the comfort of passengers, but
the German cooking is not to the taste of all English palates. The
steamers carry a German medical officer. The time occupied is about six
weeks, and the fares are from £48 for first-class, from £33 for second,
and from £21 for third. The West Coast service is at present practically
a monopoly of the Union-Castle Company, formed by the amalgamation of
the Union and Castle lines, which formerly competed for the passenger
traffic. The time occupied by this service, which carries the royal
mails, is much shorter, being usually about sixteen days. The fares
range from 35 guineas for first, from 23 guineas for second, and from 10
guineas for third class. The voyage is exceedingly pleasant at any time
of the year, and but little rough weather is met with, the worst part of
the buffeting being often in the English Channel and Bay of Biscay.
After leaving Madeira, which is about four days out from England, the
sea is usually smooth and the weather gloriously fine. The feeding and
accommodation on these steamers are comparable with those of a European
first-class hotel, and all of them carry a well-qualified medical man.
Latterly, some competition with these lines has been introduced, and is
to be welcomed. Messrs. Bucknall Brothers, Messrs. Rennie, the White
Star Company, the German East Africa line, the Shaw-Savill Company, and
others are now running frequent steamers to the Cape and Natal, and
their fares are lower than those of the Union-Castle line, and the
comfort and speed are not much less than obtain with this service.
Where, however, time and not money is the important consideration, the
Union-Castle steamers must be preferred. These steamers start from
London and Southampton, and call at Madeira, Teneriffe, Grand Canary,
and St. Helena (not more than two of these places on each voyage). The
steamers remain three or four days at Cape Town, and proceed up the east
coast, calling at Port Elizabeth, East London, and finally Durban, which
is the end of the voyage.
For many cases of nervous break-down, so common a feature of our
over-strained civilisation, I regard the Cape trip as an invaluable
restorative. Persons who have had a severe attack of influenza would
regain their strength more surely in a holiday spent in going and
returning from the Cape than in any other way. I particularise influenza
for its frequency, but the benefit is equally great in many other
affections in which the nervous system especially suffers. Thus I have
seen extraordinarily good results follow in a case of persistent
insomnia of many months' duration. The patient completely conquered his
sleeplessness during the voyage out, and was perfectly free from it on
his return, and has remained exempt for years. In another instance a
gentleman whose symptoms pointed to the early nervous break-down of
general paralysis, recovered his faculties of mental concentration and
memory as a result of a visit of a few weeks' duration. In the case of
phthisical patients, whose special desiderata I shall discuss throughout
this paper, it would be well for the companies to arrange, where
possible, for facilities for their sleeping under cover on deck, in
order to avoid the unavoidable closeness of cabins during the night.
This would be a matter of no difficulty or discomfort for three-quarters
of the voyage. The wants of delicate infants are met by the carriage in
most of the mail steamers of a cow, so that fresh milk can be obtained
throughout the voyage; but a store of milk, adequately sterilised before
leaving England, may with advantage be taken with them by anxious
mothers to ensure proper supplies for their infants. The milk keeps
perfectly, and a couple of dozen pint-bottles will last out the voyage,
and be a security against lacking this essential nourishment.
The ports of arrival in South Africa are usually Durban for the East
Coast routes and Cape Town for the West Coast. The health-characteristics
of these ports will be discussed after a general survey of the climatic
conditions of the country has been made.
It is a common mistake to send patients to South Africa with no
detailed instructions as to the localities best suited for individual
cases, and regardless of the fact that the physiography of the country
is so varied that no general statement as to the climate is possible.
Two broad features, however, may be immediately distinguished, if we
regard South Africa as consisting of interior highlands surrounded by a
narrow, low-lying coast belt, the width of the latter varying much, but
seldom exceeding fifty miles. The largest towns, with the exception of
Johannesburg, are comprised in the coast-belt, the uplands being for the
most part sparsely inhabited. The climate of the seaboard is further
conditioned by the prevalence of currents and winds, so that towns on
the east coast have a materially different atmosphere from those of the
west. It will, of course, be remembered that the seasons in the southern
hemisphere are exactly reversed with respect to those of the northern.
For the Cape the division of the year may be made as follows:--
_Spring_--September, October, November.
_Summer_--December, January, February.
_Autumn_--March, April, May.
_Winter_--June, July, August.
In South Africa, however, the matter is complicated by the fact that the
rains occur, in some parts, mostly in the winter, as in England and
northern countries generally, and in other parts are strictly confined
to the summer. The humidity of the air is probably the most important
factor in the healthiness or otherwise of a climate for many diseases,
and this point must therefore be most carefully considered. For phthisis
in particular moist warmth has long been condemned as only less harmful
than moist cold. Madeira and the Riviera have consequently lost much of
their former vogue as suitable resorts for phthisis, on account of their
high degree of humidity. It is to be earnestly desired that the claims
of the highlands of South Africa to be considered the most advantageous
country in the world for all but the latest stages of this disease,
should become more widely known, alike to patients and physicians. A
further consideration, of the highest importance to non-wealthy
consumptives, is that South Africa is a new and progressive country, in
which there are good prospects that the change of environment will lead,
not only to restored health, but to the means of earning a livelihood as
well.
[Illustration: BLOEMFONTEIN
Drawing by Donald E. M'Cracken]
It will be necessary now to examine more in detail the special
characteristics of the several regions of South Africa and their
relative fitness for receiving patients and visitors. Besides the
question of climate many other factors must be considered, such as the
accommodation for invalids, the possibility of obtaining comfort and
suitable food, and the social conditions which form, from a
psychological standpoint, an important element in the treatment. To
take the last point first, I would earnestly deprecate the focal
accumulation of a large number of invalids, especially of tubercular
invalids, in one centre; not so much because of the infectivity of such
an accumulation, but because of the deplorable mental depression which
results from the constant contemplation of other sufferers from this
disease. Any one who has had experience of large hospitals or sanatoria
for phthisis must have been struck with the undesirability, from this
point of view, of the aggregation of patients. Mind and body are so
inextricably mingled that the intelligent physician will attach not less
importance to factors concerning the first than to those affecting the
second. Let the sick man, therefore, avoid his sick fellows, when this
is possible, and mix by preference with the healthy and robust. Health,
like ill-health, is contagious. But when the patient's forces are too
far shattered to allow of this, sanatoria become necessary. I contend
still that these should be small and disseminated, rather than central
and on a colossal scale. This subject will be discussed in greater
detail later.
Accommodation and the obtaining of creature comforts for invalids are,
of course, more practicable in the towns than in the sparsely-populated
country districts, but, unhappily, the towns are mostly confined to the
coast-belt, which is not the healthiest part of South Africa. The
variations of climate within this coast-belt are great, and are
influenced, as has been said, by the prevalence of winds and rains, and
sea-currents. The eastern and south-eastern parts of the seaboard have
heavy summer rains; the southern and south-western parts have in the
first a rainfall somewhat evenly distributed through the year, with
winter rains as one approaches the west. The imaginary approximate line
between the summer and winter rains would divide the southern coast in
the longitude of Grahamstown. West of this line the rainfall may be said
to vary between ten and twenty-five inches; east of this line it is
uniformly above the latter figure. The mean humidity of the coast-line
is about 75 per cent. It may be said at once that for this reason none
of the coast districts, as regards climate, is an advantageous resort
for all-the-year-round residence for phthisical patients, but that the
seaboard having winter rains is _ipso facto_ less suitable than that in
which the rainfall is chiefly in the summer months. It is unfortunate
that hitherto many circumstances have conspired to make the English
visitor in search of health reluctant to live out of the towns, though
these are often by no means the most suitable places for him. Political
dissension between the two great occupying races has been the bane of
South Africa and especially of the Cape Colony. It has come about that
the progressive English have settled in the towns, while the
unprogressive Dutch have kept tenaciously to the country. As a corollary
from this, it is still the reproach of South Africa that, outside of a
few towns, it is impossible to obtain good accommodation for the
traveller, and still less for the invalid. It is earnestly to be hoped
that the wider knowledge of the country, consequent upon the attention
which has been concentrated upon it during the war, will lead to a large
immigration of settlers who, eschewing the goldfields, will be content
with the securer, if less considerable, competence to be obtained from
agriculture, and will thus develop the country. It was a very wise and
far-seeing plan of the late Mr. Rhodes to settle energetic English
farmers in the midst of a stagnant Dutch district, and it is desirable
in every way to break up the hard-and-fast racial division which has
made so permanent an impress on the land. But this must be a matter of
time, and for many years it must remain true that in the precious search
for health the English invalid must be content to live in the midst of
an alien majority, sometimes bitterly antipathetic to all things
English. An even more important reason for keeping to the towns is that
owing to the devastation of cattle caused by rinderpest and red-water,
food, especially fresh meat, milk, and butter, has become dear and
difficult to procure. To sum up, it may therefore be said that to the
seriously ill, who are incapable of roughing it in any sense, the coast
lands, though as regards climate not so satisfactory as the upper
plateaux, are the only possible resource; but the sick man who is not
yet so sick as to be laid up, is urged to quit the coast as soon as
possible, and to take up his abode in the higher plains.
HEALTH RESORTS IN THE COAST-BELT
Cape Town, the capital of the Cape Colony, is the usual terminus of the
voyage from England. It lies at the foot of Table Mountain, on the
shores of Table Bay. Though an ugly town, it has natural surroundings of
great beauty, and its suburbs are picturesque in the extreme. It has an
excellent water-supply derived from Table Mountain, but its drainage is
bad and the death-rate excessively high for a position of such natural
advantage. Living is dear and at the present time exorbitant, owing to
the large influx of persons wishing to go up to the goldfields, and
unable to proceed on their way by reason of the congestion of the
railway and the impossibility of finding house-room at their ultimate
destination. The hotels are for the most part expensive, and leave much
to be desired as regards cleanliness and comfort to the traveller fresh
from Europe. There are numerous boarding-houses which are often
comfortable and well managed, and in which the charges are about £12 per
month for each person. The city itself, however, is not a pleasant
place to live in, and most of the business community have houses in the
suburbs, retaining only offices and shops in the town. The pleasantest
residential district within the metropolis itself is the part called
"the Gardens," at the top of Government Avenue, a fine shady walk not
open to wheeled traffic, with a double row of oak trees on each side,
some of them planted by Governor Van der Stell, between 1679 and 1699.
The magnificent Parliament buildings, Government House (the residence of
the High Commissioner), many of the Government offices, the Public
Library and Museum, the South African College, are all in close
proximity to this part of the town. The library contains the most
notable collection of books to be found in any of our colonies,
including, as it does, the great Grey collection and the Dessinian
bequest. It is particularly rich in literature dealing with South
African history.
There is a large native quarter where the Malays congregate. It is
overcrowded and insanitary to a degree, and contributes conspicuously to
the high death-rate.
The residential suburbs, which are very healthy, stretch east and west
of the town, and are connected with it by rail and electric car. The
former are the more fashionable, and have become familiar to English
readers during the past three years. Rondebosch, in which is Mr.
Rhodes's house, Groot Schuur (bequeathed to the High Commissioner), is
five miles out. Claremont, a couple of miles eastward, has a large and
excellent sanatorium which was of great value to the military. Wynberg,
a mile further east, has a military hospital, and is a particularly
healthy and pleasant district. It has an excellent independent
water-supply. The Government wine-farm, Constantia, which gives the name
to the well-known Cape liqueur, is situated in the neighbourhood. The
suburban railway is continued to the east, passing by Muizenberg and
Kalk Bay, favourite seaside resorts for holiday-makers, and terminating
at Simonstown, the headquarters of the Cape and West Coast Imperial
naval squadrons. To the west of the bay lie the suburbs of Green and Sea
Point, separated from the town by a large expanse of flat open land
adjoining the sea, and called "the Common," upon which a large military
camp was located during the war. The fresh Atlantic breezes blow
directly across the Point, and this is one of the healthiest spots on
the coast-belt. A magnificent new road, the Victoria Road, has been made
along the sides of the precipitous slope forming the western edge of the
Cape peninsula, as far as Houts Bay. From this there is an inland
carriage-drive to Wynberg. The Victoria road a little resembles, but is
far more magnificent than, the celebrated Corniche road in the French
Riviera. The late Lord Carnarvon, when he visited South Africa in 1887,
called this "the finest drive in the world." January, February, and
March are the hottest months of the year in Cape Town. The mean maximum
temperature for these three months is 80°. June, July, and August are
the coldest, with a mean maximum of 62°, and a mean minimum of 49°.
Clothing as for the English summer and winter respectively is
recommended, but it must be remembered that even in summer the nights
are cool, a drop of over 20° between midday and evening temperatures
being common. The mean humidity is 79.
Fruit in the Cape peninsula is plentiful and good--grapes, oranges,
tangerines, peaches, apricots, nectarines, strawberries, plums, apples,
quinces, melons, pears, pomegranates, grenadillas, loquats, figs,
guavas, tomatoes, are all procurable in season. The flora of the Cape
peninsula is one of the most interesting in the world. Over 10,000
varieties of heath have been described as occurring in this small area.
Mr. Chamberlain should be interested in the _Disa grandiflora_, the
celebrated orchid to be found only on the summit of Table Mountain.
It is well to give a caution as to the prevalence of venomous snakes
which abound in the Cape peninsula and South Africa generally. The cobra
and the puff-adder are the most dangerous of these fearsome things. A
celebrated South African authoress has confided to me that her habit of
looking at her feet when walking, a habit upon which she received much
banter in Europe, was derived from her early timidity of snakes.
Cautious observation of one's tread in tramping across the Cape plains
is very necessary, and many fatal accidents have been due to
carelessness in this respect. The visitor is strongly urged to carry
with him on any such expedition a hypodermic syringe and a supply of
Calmette's "Antivenene," which may be obtained from the British
Institute of Preventive Medicine. Calmette's experiments go to show that
the venom of all species of snakes and of scorpions is of a similar
nature. His serum is obtained by the inoculation of horses with the
poison of the cobra. The remedial injection should be made immediately
upon the occurrence of the bite. The serum keeps well for months if
retained in a cool dark place. The dose is about five cubic centimetres
of the serum, to be injected hypodermically.
It is curious that this late observation of modern science should have
been in a measure anticipated by the natives, who have been accustomed
for many years to eat snakes and swallow their venom, with a view to
render themselves immune to the bites of these reptiles.
An infective sore, occurring mostly on the hands and feet, is often
contracted in walking on the veldt in South Africa, and it has been
called veldt-sore. Its bacteriology has lately been thoroughly worked
out, and it appears to be due to a specific micro-organism, though
Professor Wright, of Netley, claims it to be the ordinary microbe of
suppuration. I have had personal experience of this small ailment, and
can vouch for the discomfort and intractability of the sore thus
produced. Free drainage of the wound and antiseptic dressings are
recommended.
Another note of warning may be fitly included here. Domestic service
being performed almost entirely by natives, it is often necessary to
entrust young children to their care. Unhappily, venereal diseases are
exceedingly common among the coloured population. I have seen deplorable
instances of the infection of young children with gonorrhoea and
syphilis derived from their native nurses. These should, therefore, be
selected with the utmost circumspection.
Durban, the second most usual termination of the voyage from Europe, is
the seaport of the Colony of Natal. Cape Town and Durban have the
distinction of being the only ports in South Africa at which landing can
be effected direct from the ocean-steamers. The hottest months are
January, February, and March, with a mean maximum of 84°, and a mean
humidity of 76 per cent. Its dry season is the winter, and it is at its
best then, and is a favourite winter resort for residents of
Johannesburg, from which it is only twenty-four hours by rail. From
April to September, bright, clear, sunny weather may be expected, and
the climate is exceedingly enjoyable. The town is one of the most
English in South Africa, and its hotels, boarding-houses, &c., are good,
but woefully deficient in number for the present influx of settlers.
Houses are extremely difficult to procure, and building is very
expensive. The recent working of important coalfields near Durban has
increased its value as a port and coaling station. The water-supply is
ample and excellent, being derived from rivers several miles from the
town, and being passed through filter-beds before distribution. A modern
drainage system is approaching completion, and the town is being
supplied with electric lighting. Mangoes, pine-apples, bananas, and
custard apples are plentiful, in addition to many of the fruits
previously enumerated as growing in the Cape Colony. There are large
sugar and tea plantations in the vicinity, and rice, coffee, pepper, and
tobacco are cultivated with success. To sum up, it may be said that
although the summer humidity and heat make it not well suited for
phthisical patients, the town is in the winter months one of the
healthiest in South Africa, and one of the most progressive and pleasant
to live in.