Amongst the Sierra Leone children there is only one death from
consumption and one from scrofula reported out of a total of 190
deaths. In the West Australian schools two of the nine deaths arose
from consumption. In the Natal schools there was one death from
consumption and one from scrofula out of 16 deaths. But there died
seven children of other chest diseases besides consumption. The Ceylon
schools yielded seven deaths from consumption, five from other chest
diseases, and one from scrofula, out of a total mortality of 341.
[Sidenote: Table S, p. 47.]
These figures, so far as they go, show comparatively little liability
to consumptive diseases among children in these colonies. But there is
a native training institution in South Australia, in which a very large
proportion of the mortality is due to tubercular diseases. Scrofula,
phthisis, and hæmoptysis are returned as having occasioned 69·6 per
cent. of the total mortality in the institution, among males, and 61·9
per cent. among females. When we cross over to Canada we find that, out
of a total mortality of 27, 16 deaths arose from consumption and five
from scrofula. Indeed all the specified deaths arose from tubercular
disease except one solitary death from fever.
I will next describe shortly the method of the school education, with
its probable influence on the children’s health.
[Sidenote: pp. 30 to 39.]
The facts under this head are given in the form of notes to each school
return. I have had them thrown together, for the sake of comparison, in
Table H., the general results of which are as follow.
Many of the school houses are described in the returns as of bad
construction, and ill situated for health, and the ventilation very
insufficient. Some of them are unfavourably situated for free external
ventilation, or their local position is damp and subject to malaria,
the results of which, as well as the results of general defective
sanitary condition in their vicinity are evidenced by the great
prevalence of miasmatic diseases, such as fevers, diarrhœa, dysentery,
and even cholera, among the children.
The period of tuition varies considerably, from two up to ten or more
years. The school instruction is generally five; in a few cases, six
days a week. At a few stations {7} nearly half the year is allowed for
holidays. But generally the holidays are from two to six or eight weeks.
In most of the schools there seem to be no play hours on school days.
When play hours are allowed these are from half an hour to two hours.
At about a dozen schools only is there any out-door work combined with
instruction. The largest amount of this work is given in the Natal
and Canadian schools. Out of the whole number there are only nine
schools at which there is any attempt made at combining the elements of
physical education with the school instruction, and even where this is
done the measure is partial and inefficient, being confined to a few
exercises or simply to bathing. The obvious physiological necessity of
engrafting civilized habits on uncivilized races gradually through the
means of systematic physical training appears to be nowhere recognized,
except at New Norcia (Benedictine) school, Western Australia,
on the return from which there is the following very important
statement:―Gymnastics are stated to be necessary to prevent sickness,
and the reporter proceeds, “The idea of bringing savages from their
wild state at once to an advanced civilization serves no other purpose
than that of murdering them.” And the result of the out-door training
practised at this school is said to have been hitherto successful “in
preventing the destructive effects of this error.”
[Sidenote: Appendix II. p. 62.]
Confinement appears to be peculiarly injurious to the aborigines of
South Australia, for the Governor states that he “almost always finds
it necessary to release prisoners before the expiration of their
sentences, as death is apt to ensue from any prolonged confinement.”
Even partial confinement in schools, he thinks, injuriously affects the
native constitution.
Another very important observation bearing on the necessity of careful
consideration of habits is recorded on the return from one of the Natal
schools. It might be supposed that one of the most obvious duties
in bringing native children to school would be to clothe them, but
nevertheless clothing an uncivilized child requires care.† In their
natural state they expose themselves to torrents of rain which, runs
off them, and they are easily warmed {8} and dried at the hut fire.
But it is stated that, when clothed in flannel and jersey, they get
chilled by the rain, and that pulmonary diseases ensue as a consequence.
† People have been asked to assist in making
clothing for the Kaffir
tribes whom missionaries were going out to address,
that the feeling of decency might not be offended in
addressing the naked.
The method of conducting colonial schools appears to be based on our
home system, without reference to physical training or other local
conditions affecting health. This fact, together with the high rate of
mortality, is the most prominent result of our inquiry. And although
there is not sufficient evidence to show to what extent the school
education increases the mortality, there is strong reason to believe
that it is a cause. By far the greater part of the mortality is the
direct result of mitigable or preventible diseases.
In all the schools within or near the tropics the miasmatic class of
diseases occasions most of the mortality at the earlier periods of
life. A considerable proportion arises from small-pox, showing bad
management of children, and that vaccination is either neglected or
imperfectly performed. The other fatal diseases are mainly those which
in this country are connected with bad drainage, deficient and bad
water supply, overcrowding, and want of sufficient house accommodation
and cleanliness. In the Canadian schools consumption and scrofula
appear to occupy the place of miasmatic diseases. But there is nothing
in the school education, as described in the returns, sufficient to
account for their special prevalence in these schools. The causes must
probably be looked for in the close foul atmosphere of the native
dwellings in a climate where warmth is more likely to be sought by
closing every opening capable of admitting fresh air than would be the
case in warmer latitudes, together with exposure and other conditions
depressing to the general health.
Although these returns show the necessity of making systematic physical
training and bodily labour at useful occupations an element absolutely
essential and never to be neglected in the training of uncivilized and
half civilized children in civilized habits and trains of thought,
there is nothing to show that education properly conducted tends to the
destruction and disappearance of native tribes.
The general result may be summed up in the following words: “Educate
by all means, but look carefully at the problem with which you have
to deal, and above all things never forget that education everywhere,
but more {9} especially with uncivilized tribes, must always include
physical training and useful work.”
* * * * *
Colonial hospital returns.
Besides this statistical inquiry into the condition of schools, I had
forms prepared for colonial hospitals into which natives are received
for treatment, in order to compare the school diseases with those
prevailing among the adult population. They were sent to the colonies,
also by the great kindness of the Duke of Newcastle. And returns have
been received from the following hospitals:―Free Town, Sierra Leone,
Cape Coast, Natal, Mauritius, Colombo and Malabar, King William’s Town,
Kaffraria, and from two native hospitals in Canada.
[Sidenote: pp. 40 to 53.]
These returns were applied for as affording the only means of arriving
at a knowledge of the prevailing classes of diseases among natives and
of the relative mortality from each class. Abstracts of the returns,
showing the mortality on the admissions for different sexes and ages,
and the relative per-centages of mortality from each disease, are
appended. (Forms I. to Y.) Of course the results can be relied on
only so far as they represent the proportions admitted and dead from
each disease, taken on numbers often hardly sufficiently large for
statistical purposes. On account of the smallness of these numbers, I
consider the results as only approximations, which I give because there
is nothing better to be had. The tables do not enable us to ascertain
directly the state of health or rate of mortality of the native
population; but they afford us in an indirect manner a considerable
amount of important information as to the diseases from which natives
suffer. The hospital statistics appear to be very much in the same
unsatisfactory condition as they are in many of our home hospitals.
With these reservations the mortality statistics of these hospitals
show a very high death rate upon the numbers treated.
[Sidenote: Table L, p. 41.]
Thus, in Free Town Hospital, the mortality to admissions among males
is upwards of 20 per cent., and among females 18·6 per cent. of the
admissions.†
† The admissions are obtained by adding the
deaths to the recoveries, in the absence of more definite
information.
[Sidenote: Table T, p. 48.]
At the Civil Hospital, Port Louis, Mauritius, the mortality is 21·3 per
cent. for males, and 38·8 per cent. for females. {10}
[Sidenote: Table V, p. 50.]
In the Ceylon hospitals it is 20·7 per cent. for males, and 18·1 per
cent. for females.
[Sidenote: Table P, p. 44.]
At Natal the mortality is much lower, being 12·8 per cent. for males
and 6·6 per cent. for females.
[Sidenote: Table N, p. 43.]
In Kaffraria the mortality for males and females is 21·8 per cent.
[Sidenote: Table X, p. 52.]
In the Canadian hospitals it is 12·3 per cent. for males and 14 per
cent. for females.
These high death rates can be attributed only to one or more of
the following causes:―Defective stamina in the population, delay
in applying for medical relief, bad and insufficient hospital
accommodation, or defective medical treatment and management of the
sick. The exact influence of each of these elements could hardly be
appreciated without local inquiry. But the tables enable us to obtain
some insight into the matter.
[Sidenote: Table M, p. 42.]
We find, _e. g._, that in the tropical districts the miasmatic class
of diseases occasions a large proportion of the mortality, _e. g._,
at Sierra Leone 20·4 per cent. of the total mortality among males and
6·8 per cent. of that among females is due to small-pox; that 34 per
cent. of the mortality among females is due to dysentery; and that 19
per cent. of the mortality among males is due to periodic fevers. The
mortality from miasmatic disease in this hospital is no less than 43·9
per cent. of the total mortality among men, and 43·1 per cent. of the
total mortality among women.
[Sidenote: Table K, p. 40.]
At Cape Coast Hospital the admissions from miasmatic diseases, at
least those recorded, amounted only to 9 1/2 per cent. of the total
admissions, and no deaths are attributed to this class of diseases.
This is quite sufficient to show the imperfection of the hospital
records at this station.
[Sidenote: Table U, p. 49.]
At Port Louis Hospital, Mauritius, the miasmatic deaths from dysentery,
diarrhœa, cholera, continued fevers, and rheumatism amounted to 54·9
per cent. of the total mortality for men, and 47·9 per cent. of the
total female mortality.
[Sidenote: Table W, p. 51.]
Dysentery appears to be particularly severe and fatal amongst the
natives in Ceylon, for the returns show that 43·6 per cent. of the
men’s mortality and 30·1 per cent. of the women’s were due to this one
disease. The miasmatic class generally gave rise in these hospitals to
64·3 per cent. of the total deaths of men, and 60·1 per cent. of those
of women. {11}
[Sidenote: Table Q, p. 45.]
In D’Urban Hospital and Grey’s Hospital, Natal, 41·1 per cent. of
the men’s mortality arose from continued fever, and 6 per cent. from
dysentery. This latter disease occasioned all the deaths in hospital
among women. These two diseases are the only ones of the miasmatic
class which proved fatal.
[Sidenote: Table O, p. 43.]
Miasmatic diseases appear to be rare among the native patients at King
William’s Town, Kaffraria. Only one of them, dysentery, produced a
fatal result, and it gave rise to no more than 6 per cent. of the total
deaths of men and women conjointly.
[Sidenote: Table Y, p. 53.]
The same diseases appear to be rare also in the Canadian hospitals,
where they occasioned 12·3 per cent. of the men’s mortality and 17·3
per cent. of the women’s. The prevailing types were diarrhœa, periodic
fevers, and rheumatism.
[Sidenote: Table M.]
If we take the other points of comparison, supplied by tubercular
diseases, we find a remarkable difference in the proportion of
mortality in different colonies. Thus, the death rate from scrofula,
phthisis, and hæmoptysis, at Free Town, Sierra Leone, amounts to 3·2
per cent. of the total deaths from all causes among men, and 2·3 per
cent. among women. In this hospital other chest diseases give rise to a
mortality of 2·4 per cent. for men.
[Sidenote: Table K.]
At Cape Coast Hospital no deaths are registered from any class of
tubercular or chest affections.
[Sidenote: Table Q.]
At D’Urban Hospital and Grey’s Hospital, Natal, there was a similar
absence of mortality from these diseases.
[Sidenote: Table W, p. 51.]
The Ceylon hospitals afforded also only a small mortality, 0·7 per
cent. for men, and 1·1 per cent. for women. There was, however, a
mortality of 1·3 per cent. for other chest diseases, among men, and
1·7 per cent. among women. In striking contrast with this comparative
exemption from a class of diseases to which the disappearance of the
native races has been to a large extent attributed, we find a very
considerable increase in the other hospitals.
[Sidenote: Table U.]
At Mauritius the mortality from scrofula, phthisis, and hæmoptysis, was
8·7 per cent. of the total mortality among men, and 3·7 per cent. among
women. Other chest diseases furnish a mortality of 3·6 and 1·8 per
cent. among men and women respectively.
[Sidenote: Table O.]
At King William’s Town Hospital, Kaffraria, the mortality from
tubercular diseases, for men and women {12} conjointly, was no less
than 70·6 per cent. of the total deaths, and from chest diseases 11·7
per cent.
[Sidenote: Table Y.]
Both classes of disease afford a high death rate in the Canadian
hospitals. For the tubercular forms this amounts to 44·9 per cent. for
men, and 41·3 per cent. for women. The other chest diseases give rise
to 30·6 per cent. of the total hospital mortality for men, and 24·4 per
cent. for women. Three-fourths of the whole hospital mortality among
men, and two-thirds among women, were thus due to some form or other of
chest disease.
Much has been said and written on the pernicious effects of the use
of intoxicating liquors by uncivilized races. Diseases of the brain
and nervous system, and liver diseases, are those which, at home,
are generally supposed to indicate the greater or less prevalence
of habits of intoxication among the people. Let us inquire to what
extent admissions and deaths from these classes prevail in the various
colonies.
[Sidenote: Table M.]
At Sierra Leone brain and nervous diseases occasion 5·7 per cent. of
the total admissions, and 12·7 per cent. of the total deaths among
men, and 9·2 per cent. of the admissions, with 21·6 per cent. of the
deaths, among women. Liver diseases afford only 0·1 per cent. of the
admissions, and no deaths.
[Sidenote: Table K.]
Cape Coast Hospital affords an extraordinary contrast to this, for
there we find that, although brain and nervous diseases and liver
diseases occasion no more than 4·8 per cent., and 2·4 per cent.,
respectively, of the admissions, all the deaths arose from them.
[Sidenote: Table Q.]
The Natal hospitals show a proportion of admissions from brain and
nervous diseases, of 5·7 per cent. of men, and 8·3 per cent. of women.
But no deaths and no admissions from liver disease.
[Sidenote: Table O.]
The King William’s Town Hospitals, Kaffraria, show no admissions from
either class.
[Sidenote: Table U.]
At Mauritius the admissions from brain and nervous diseases were 3·5
per cent. for men, and 2·7 per cent. for women, and the deaths 6·1 per
cent. for men, and 1·9 per cent. for women. Liver disease is so rare as
to be scarcely appreciable.
[Sidenote: Table W.]
A similar remark applies to the infrequency of liver disease in the
Ceylon hospitals. In these hospitals, the admissions from brain and
nervous diseases are 1·6 per cent. for men, and 3·2 per cent. for
women. And the deaths 1·5 per cent. and 3·1 per cent. respectively.
{13}
[Sidenote: Table Y.]
No liver diseases were admitted into the Canadian hospitals. And the
brain and nervous diseases afforded 6·5 per cent. admissions, and 2 per
cent. deaths for men, with 5·2 per cent. admissions and no deaths for
women.
* * * * *
Results.
These are the statistical results of this inquiry. To the extent to
which the data are imperfect, the results are of course unreliable. The
numbers are often much smaller than are required for such purposes. I
have used them because the best obtainable, even with the assistance
of the colonial governments; and the first lesson they teach is
the necessity for assimilating the colonial registration and vital
statistics to those at home. But, with all their defects, when these
statistics are examined, they bring clearly into light certain great
general facts.
As regards the schools, they show us that the educational idea in the
colonies is just as deficient as it is at home, and that it is attended
with worse physical consequences.
No account appears to be taken of the past history of the races on
whom it is desired to confer the inestimable blessings of Christian
civilization. Our teachers go among them just as they would into
English villages. They collect the children who, together with their
ancestors, have spent most of their existence in active out-door
habits, into all classes of structures, good, bad, and indifferent,
apparently without regard to the effect of local conditions on their
health. In all probability the children are set together as close
as they are placed in one of our Home “Model Schools,” without any
reference to children’s epidemics or other fevers. This is not done
without great risk, even with children of English birth. But to do
this with children taken from their open air habits in uncivilized or
semi-civilized communities is to incur the immediate danger of losing
the most hopeful pupils by diseases, which, under a more rational
system, might in all probability be avoided.
The education appears to be confined simply to head-work, and no
provision is made for sustaining the health by physical training, while
it is in danger of exhaustion by a cerebral stimulus, perhaps applied
for the first time in the history of the family from which the child
has sprung. It is true that cerebral disease forms only a small part
of the school mortality; but the diseases from which the mortality
proceeds in the tropical schools are {14} the result of overcrowding,
defective ventilation, and other local sanitary evils, all of which are
augmented by sedentary occupation.
The remedy for this is obviously to improve the school-houses, to give
more attention to space, to ventilation, and to the locality where the
school is placed, and above all to make physical training an essential
and important part of the school system, never forgetting that the
habits of generations cannot be suddenly broken through without danger
to health and life.
In as far as concerns the effect of the schools on the disappearance of
native races, the returns contain no appreciable evidence. Education,
if properly conducted, together with the improved personal, physical,
and moral habits consequent on it, ought everywhere to be conservative
and not destructive; but to be so it should be conducted, as already
stated, with a full knowledge of the physiological effects of altered
habits and the influence of these on health.
The hospital returns, so far as they can be relied on, show in the
tropical colonies a large mortality from diseases arising from bad
drainage, bad water, imperfect agriculture, want of cleanliness, and
from other bad habits. Bad, overcrowded, unventilated dwellings must
also in these colonies, as at home, bear their proportion of the
blame. Thus mortality arising from mitigable or preventible causes of
an external nature occasions in all the colonies by far the greatest
part of the death rate in hospitals. Incivilization with its inherent
diseases, when brought into contact with civilization without adopting
specific precautions for preserving health, will always carry with it a
large increase of mortality on account of the greater susceptibility of
its subjects to those causes of disease which can to a certain extent
be endured without as great a risk by civilized communities born among
them.
The hospital returns throw little light on the causes of the
disappearance of native races, unless these are to be found in the
great prevalence of tubercular and chest diseases in certain of
the colonies. This is especially remarkable in the returns from
Australia, Kaffraria, and Canada. But why this class of affections
should be so much more prevalent in the temperate than in the tropical
colonies could only be ascertained by careful local inquiry. One
thing is certain that, in those colonies from which complaints of the
disappearance of native races have come, {15} tubercular and chest
diseases appear to occasion the largest amount of hospital mortality.
The discovery of the causes of this must be referred back to the
colonies. Anything which exhausts the constitution; above all
things, foul air during sleep, will engender these diseases. Open
locality, healthy winds, active daily occupation, are by themselves no
safeguards, if the nights be spent in unventilated cabins. The Alpine
climates of Europe are known to be the most free of any climates from
this tribe of diseases. But even on their healthy mountain slopes
scrofula in all its forms prevails among the peasants, engaged during
summer on the high pastures, when they pass their nights in the close
unhealthy chalets there.
It is possible that a tubercular taint so engendered may be the cause
of the whole evil, and it is to this point that the inquiry has brought
us.
* * * * *
Appended to the school and hospital returns from each colony, there
are very interesting notes, giving generally the impression of the
reporters on the nature and causes of disease among the aboriginal
population. These notes, the chief portions of which I have appended,
confirm the statistical evidence; but they afford little additional
light on the causation.
The decaying races are chiefly in Australia, New Zealand, Canada,
and perhaps in certain parts of South Africa. They appear to consist
chiefly of tribes which have never been civilized enough or had force
of character enough to form fixed settlements or to build towns. Such
tribes have few fixed habits or none. But the papers show that they are
naturally, in their uncivilized condition, possessed of far stronger
stamina, and that they resist the effects of frightful wounds and
injuries far better than civilized men. This latter fact tells strongly
against any natural proclivity to diseased action. But we nevertheless
see that when they come in contact with civilized men, and are, as
a necessary consequence, obliged to conform themselves to a certain
extent to the vices and customs of their _civilized_ (_!_) neighbours,
they perish from disease.
[Sidenote: Appendix II., pp. 62–3.]
The evidence contained in these notes unfortunately proves that the
pioneers of British civilization are not always the best of the
British people. Many of them, it is to be feared, leave their own
country, stained with vice and vicious habits, ready for any act of
oppression, ready {16} to take any advantage of the simplicity of the
poor aborigines. Such people have introduced everywhere the use of
intoxicating drinks, together with the diseases as well as the vices of
their own depraved standard of civilization. Where the races are found
most rapidly decaying, there the married women are found living in a
state of prostitution and exposed to its diseases. And we know where
such is the case, decline and extinction are inevitable.
This appears to be a main cause of the falling off in births; while the
other evil habits introduced by Europeans destroy the stamina of the
adult population and raise its rate of mortality. With the facts before
us, imperfect as they are, we need feel no surprise at the gradual
extinction of these unhappy races. But we should draw from them an
argument for doing all that can be done to lessen these evils, and to
remove, as far as practicable, any causes of disease and death which it
may be in our power to remove.
Complaint of such things, in some form or other, runs through the whole
of the evidence regarding these aboriginal populations, who appear to
be far more susceptible of the operation of causes of disease arising
out of imperfect civilization, than are civilized† men; how much more
so must they be to such dreadful causes as those indicated above!
† Meaning by “civilized,” men who can live together in a city or
village without cutting each other’s throats.
There is a strong presumption that, if aboriginal races are left
undisturbed in their own country to follow their own customs and even
their own vices, they will continue to exist as they have hitherto
done, in a slowly increasing or stationary condition. But there is no
reason to doubt the evidence contained in these papers that certain
races require very little disturbance in their primeval habits to pass
into a state of decline.
The great question at issue is, how this is to be arrested.