Andrew Davidson.

Hygiene and diseases of warm climates online

. (page 1 of 116)
Online LibraryAndrew DavidsonHygiene and diseases of warm climates → online text (page 1 of 116)
Font size
QR-code for this ebook


THE LIBRARY

OF

THE UNIVERSITY

OF CALIFORNIA



PRESENTED BY

PROF. CHARLES A. KOFOID AND

MRS. PRUDENCE W. KOFOID




HYGIENE AN!) DISEASES OF
WAEM CLIMATES.




NUNQUAM ALIUD NATURA, ALIUD SAPIENTIA DIGIT.



/I/ -






«• «



HYGIENE & DISEASES



WARM CLIMATES.



EDITED BY



ANDEEW DAVIDSON, M.D., F.K.C.P.Ed.,

LATE VISITING AND SUPERINTENDING SURGEON, CIVIL HOSPITAL, AND PROFESSOR OF CHEMISTRY,
ROYAL COLLEGE, MAURITIUS; AUTHOR OF "GEOGRAPHICAL PATHOLOGY,"



ILLUSTRATED WITH ENGRAVINGS AND FULL-PAGE PLATES,



EDINBURGH AND LONDON:
YOUNG J. PENTLAND.

18 93.



EDINBURGH : PRINTED FOR YOUNG J. PENTLAND, 11 TEVIOT PLACE,
AND 38 WEST SMITHFIELD, LONDON, E.G., BY MORRISON AND GIBB,



[All Bights Reserved.]






PREFACE.



The design of this work is expressed in its title. The need for it
is proved by the fact that no work professing to cover the whole
field of tropical hygiene and pathology has hitherto appeared in our
language. The classical treatises of Annesley, Morehead, Martin,
and Chevers remain of permanent value, but they do not adequately
represent the science and practice of the present day.

How far I have succeeded in filling up the blank that exists in
this department of medicine, must be left to the judgment of the
profession ; but the co-operation of so many distinguished men,
recognised as authorities on the subjects which they have undertaken,
justifies the hope that this work will not disappoint the expectations
of the teacher, student, or practitioner.

In selecting the subjects, and deciding upon the space to be
allotted to each, I have been guided by their relative importance to
the medical practitioner, rather than by considerations of their
scientific interest, although these have not been ignored. The three
dominating endemic maladies of warm climates — malarial fever,
dysentery (including tropical diarrhoea), and hepatitis, — and the
three great pestilences — cholera, yellow fever, and plague — have been
treated in that detail which their importance demands. Leprosy
and beriberi have also seemed to require particular attention ; the
former from its wide diffusion in the East ; and the latter, not only
on account of its gravity, but from the numerous interestxng and, as
yet, unsolved problems connected with its etiology, pathology, and
treatment. All of these diseases are more or less unfamiliar to
those educated at home, and most of them will probably be seen for
the first time by the medical officer when he commences to practise
in the tropics, and it may be safely said that they will form more
than three-fourths of the cases he will be called upon to treat.

It is only within recent years that the role of parasitic diseases in
tropical pathology has been fully understood. The responsibility for



i^35^0G9



vi PREFACE.

this important class of diseases has been devolved on Professor
Sonsino of Pisa and l)r. Manson of London. Those who read the
articles on filaria disease, Bilharzia disease, and anchylostomiasis, will
require no apology for the space which has been allotted to them.

I have gratefully to acknowledge my obligations to those who
have rendered nie their invaluable assistance in this undertaking.
Some of them have done so under the pressure of other duties, in
order to place their experience- at the service of their younger pro-
fessional brethren. The heavy labours devolving on an editor have
been lightened by the uniform courtesy and consideration I have
received from the contributors.

ANDREW DAVIDSON.
Lass WADE, Oc^ofter 1893.



LIST OF CONTEIBUTOES,



Birch, Edward A., M.D., F.RC.R, Principal of Medical College, and Professor
of Medicine, Calcutta.

Bruce, David, M.B., Surgeon-Captain, Army Medical Staff, Netley.

Cayley, Henry, F.RC.S., Professor of Clinical and Military Medicine, Army
Medical School, Netley.

CoppiNGER, R. W., M.D., Fleet-Surgeon, Royal Navy, Haslar.

Davidson, Andrew, M.D., F.R.C.P.Ed., late Visiting and Superintending
Surgeon, Civil Hospital, and Professor of Chemistry, Royal College, Mauritius.

Davidson, D. M., M.B., CM., Surgeon-Captain, Indian Medical Service.

Fayrer, Sir Joseph, K.C.S.I., LL.D., M.D., Q.H.P., F.R.SS. (Lond. & Edin.),
Associate of the Academy of Medicine of Paris.

Lubbock, Montagu, M.D., F.R.C.P., Assistant Physician, Hospital for Children,
Great Ormond Street, London.

Macnamara, F. N., M.D., formerly Professor of Chemistry, Medical College,
Calcutta.

Macnamara, N. C, F.R.C.S., Surgeon, and Lecturer on Clinical Surgery, West-
minster Hospital.

Manson, Patrick, M.D., M.R.C.P., LL.D., Physician, Seamen's Hospital, Green-
wich.

NoTTER, J- Lane, M.A., M.D., Professor of Military Hygiene, Army Medical
School, Netley.

Prout, William T., M.B., CM., Government Medical Officer, Gambia.

Sonsino, Prospero, M.D., Libero Docente, University of Pisa.

Sternberg, George M., M.D., Surgeon-General, United States Army.

Whitehead, H. R., F.R.C.S., Surgeon-Captain, Army Medical Staff.



CONTENTS.



HYGIENE.

CHAPTER I.

INFLUENCE OF WARM CLIMATES ON THE CONSTITUTION.
By Edward A. Birch, M.D., F.RC.R

PAGE

Evidences of tlie Influence of Warm Climates on the Constitution — Influ-
ence of Warm Climates on the Physiological Functions — Theor}' of
Acclimatisation — Influence of Warm Climates on the Pathological
Processes, ........ 1

CHAPTER II.

HYGIENE OF THE TROPICS.
By J. Lane Notter, M.A., M.D.

General Hygiene— Clothing — Food — Exercise — The Dwelling— Water
Supply — Hygiene of Troops in Peace and War — Selection of Sites,
Barracks, Tents, and Camps — Diet — Peace Ration — Clothing and
Kit — War Ration — Marching and Bivouacking — Disposal of the Dead
in War — Change of Climate, . . . . . .25

CHAPTER III.

TROPICAL NAVAL HYGIENE.
By R. W. Coppinger, M.D.

General Considerations— Accommodation of Crew and Passengers-
Ventilation of Ships— Dietary on Board Ship in the Tropics —
Water Supply of Ships— Clothing and Personal Cleanliness — Latrines
and Bilges — Exercise on Board Ship — Isolation of Infectious Diseases
—Disinfection — Tropical Ship Diseases, . . . .81



113



CONTENTS.



GENERAL DISEASES.

CHAPTER IV.

MALARIAL DISEASES.

By Andrew Davidson, M.D., F.RC.REd.

Nomenclature and Synonyms — Nature of the Malarial Infection— Etiology
of Malaria — Climatic and Non-Malarial Fevers of Warm Climates —
Symptomatology of Malarial Fever — Complications and Sequelae —
Pathological Anatomy— Diagnosis — Prognosis — Prophylaxis — Treat-
ment, .........

CHAPTER V.

TROPICAL TYPHOID FEVER.

By H. R Whitehead, F.R.C.S.

Definition — Geographical and Racial Relations — Etiology— Symptom-
atology — Treatment — Diagnosis — Prognosis — Bacteriology — Morbid
Anatomy — Prophylaxis, . . . . . .217

*

CHAPTER VI.

MALTA FEVER.
By David Bruce, M.B.

Synonyms — Definition — Geographical Distribution — Etiology — Clinical
Description — Principal Symptoms in Detail — Diagnosis — Pathological
Anatomy — Treatment, . . . .... 265

CHAPTER VIL

YELLOW FEVER.

By George M. Sternberg, M.D.

Definition — Etiology — History and Geographical Distribution— Patho-
logical Anatomy and Histology — Prophylaxis and Incubation —
Clinical History — Prognosis and Mortality — Treatment — Illustrative
Cases, . . . . . . . . . 283

chaptp:r VIII.

DENGUE.
By Andrew Davidson, M.D., F.RC.P.Ed.

Definition — Synonyjns — Etiology — Symptomatology — Prognosis and

Morljid Anatomy — Diagnosis— Treatment, .... 323



CONTENTS. xi

CHAPTER IX.

PLAGUE.

By Montagu Lubbock, M.D., F.R.C.P.

PAGE

Synonyms — Definition — History — Symptoms — Forms — Morbid Anatomy
— Etiology — Diagnosis — Prognosis — Treatment — Prophylaxis —
Bibliography, . . . . . ... 334

CHAPTER X.

CHOLERA.
By N. C. Macnamara, F.R.C.S.

Epidemic History — Bacteriology — Inoculation Experiments — Etiology —
Mode of Dissemination— Prophylaxis — Pathology — Symptoms — Treat-
ment, ......... 352

\

CHAPTER XI.

LEPROSY.

By N. C. Macnamara, F.R.C.S.

History — Present Distribution — Bacteriology — Pathology — Etiology —

Symptoms — Treatment, . . . ... . . 426

CHAPTER XII.

BERIBERL
By Patrick Manson, M.D., M.R.C.P, LL.D.

History — Definition — Geographical Distribution — Sym23toms — Analysis of
Symptoms — Mode of Death — Pathological Anatomy — Etiology —
Prognosis — Mortality — Sequelae — Diagnosis — Prophylaxis — Treat-
ment, , . . . . . . , . 452

CHAPTER XIII.

NEGRO LETHARGY.
By Patrick Manson, M.D., M.R.C.P, LL.D.

Geographical Distribution — Age, Sex, Occupation, Race — Symptoms —
Duration — Pathological Anatomy — Cause — Mortality — Diagnosis —
Treatment, .....,,, 503

CHAPTER XIV.

frambcesia or yaws.

By William T. Prout, M.B., CM.

Definition — Synonyms — Geogi'aphical Distribution — History — Clinical
History — Etiology — Pathology — Diagnosis — Prophylaxis — Treat-
ment, ......... 511



xii CONTENTS.

LOCAL DISEASES.

CHAPTER XV.

TROPICAL DIARRHCEA.

By Sir Joseph Fayrer, K.aS.L, LL.D., M.D. Q.H.P, F.R.S.

PAGE

Etiology and Natural History— Semeiolog}'— Morbid Anatomy and Bac-
teriology—Treatment — Illustrative Cases, . . . .521

CHAPTER XVI.

DYSENTERY.

By D. M. Davidson, M.B., CM., and Andrew Davidson, M.D., F.R.C.P.Ed.

Synonyms — Definition — History — Etiology — Nature of the Disease —
Morbid Anatomy — Symptomatology — Modifications — Complications,
Relapses, and Sequela)— Diagnosis— Mortality and Prognosis— Pro-
phylaxis — Treatment, ....... 546

CHAPTER XA^II.

TROPICAL DISEASES OF THE LIVER.

By Henry Cayley, F.R.CS.

General Considerations — Hepatitis : Etiology — Pathology and Symptoms
— Treatment. — Tropical Abscess — Pysemic Abscess — Cases of Liver
Abscess — Treatment. — Chronic Congestion: Etiology — Symptoms —
Treatment. — Other Forms of Enlargement. — Functional Liver Affec-
tions, ......... 612

CHAPTER XVIII.

TROPICAL LIVER ABSCESS.

By Sir Joseph Fayrer, K.C.S.I., LL.D., M.D., Q.H.P., F.R.S.

Natural History and Etiology — Semeiology — Morbid Anatomy — Treat-
ment — Illustrative Cases, ...... 641

CHAPTER XIX.

SUNSTROKE.

By Sir Joseph Fayrer, K.C.S.L, LL.D., M.D., Q.H.P., F.R.S.

Natural History and Etiology — Semeiology and Pathology — Morbid

Anatomy — Treatment — Illustrative Cases, .... 693



CONTENTS. xiii

CHAPTER XX.

GOITRE.

By Francis Nottidge Macnamara, M.D.

PAGE

Prevalence and Character — Distribution in India, and Conditions under

which it occurs — Conclusion — Treatment, . . . . .717



PARASITIC DISEASES.

CHAPTER XXI.

THE FILAEIM SyLNGUINIS HOMINIS AND FILARIA DISEASE.

By Patrick Manson, M.D., M.R.CP., LL.D.

Nomenclature — Description of the FilaricB sanguinis hominis — Filarial
Periodicity — Diagnosis of Embryo Filariae — F. sanguinis hominis
diurna — F. sanguinis hominis nodurna — Natural History and Geo-
graphical Distribution of F. nodurna — Classification of Diseases
associated with F. 7iodurna (Filariasis). — Elephantoid Disease :
Forms of Abscess — Lymphangitis — Dermatitis — Cellulitis — Forms of
Erysipelas — Orchitis — Chyluria — Chylous Dropsy of Peritoneum —
Chylous Dropsy of Tunica Vaginalis — Varicose Groin Glands — Lymph
Scrotum — other Lymphatic Varices. — Elephantiasis Arabum : Geo-
graphical Distribution — Age — Sex — Occupation and Race — Regions of
Body affected — Incidence and Progress — Symptoms, Morbid Anatomy
and Histology — Pathology of Elephantoid Disease — Pathology of
Elephantiasis arabum — Prophylaxis — Treatment — F. sanguinis hominis
perstans — Demonstration of F. sanguinis, .... 738

CHAPTER XXII.

DISTOMUM RINGERI VEL PULMONALE.

By Patrick Manson, M.D., M.R.CP, LL.D.

History — Geographical Distribution — Description of Parasite — The Embryo
— Prophylaxis. — Endemic Haemoptysis or Pulmonary Distomiasis :
Symptoms — Prognosis — Pathological Anatomy — Treatment. — Cerebral
Distomiasis : Description — Treatment, ..... 852

CHAPTER XXIIL

INTESTINAL, HEPATIC, AND PORTAL ENTOZOA, AND
ASSOCIATED DISEASES.

By Prospero Sonsino, M.D., Pisa.

Intestinal Entozoa, their Importance — Synopsis of Zooparasites — Diagnosis
of Ova. — Rarer Intestinal Parasites : Distomum heterophyes — D.
crassum — Amphistomum hominis — Tcenia Madagascariensis. — Anchy-



xiv CONTENTS.



APPENDIX.



PAGE



L08TOMIA8IS : History and Geographical Distribution of Arwhylostoma
duodenale — Characters of the Parasite and its Natural History-
Symptoms — Post-Mortem Examination and Pathological Anatomy—
Pathogenesis and Nature of Anchylostomiasis — Diagnosis — Prognosis
— Treatment — Prevention.— Rhabdonemiasis : History and Descrip-
tion of Rhahdonema mtestinale {Anguillula intestinalis) — Pathogenetic
Imijortance — Treatnient. — Liver Parasites : Pentastomum constrid-
um — Fasdola hepatica and Distomum lanceolatum — D. sinense and D.

C07ljunctum. — BlhB.ARZIA HiGMATOBIA AND BiLHARZIA DISEASE:

History and Geographical Distribution — Characters of the Worm
and its Life History — Post-Mortem Examination and Pathological
Anatomy — Symptoms, Course, and Issue — Diagnosis — Prognosis —
Treatment — Prevention — Description of Plates, . . . 861



SKIN DISEASES.

CHAPTER XXIV.

DISEASES OF THE SKIN IN TROPICAL CLIMATES.
By Patrick Maxson, M.D., M.R.C.P., LL.D.

General Remarks. — Epiphytic Skin Diseases : Tropical Ringworm —
Tinea circinata — Tinea tmJricato —Characters — Distribution — Treat-
ment. — Pinta : Geographical Distribution — Symptoms — Pathology —
Treatment. — Skin Affections caused by Animal Parasites : Craw-
Craw. — Guinea- Worm : Geographical Distribution — Natural History
— Symptoms — Prophylaxis — Treatment. — Filaria loa : Symptoms
— Anatomical Characters — Life History — Geographical Distribution
— Treatment. — Filaria volvulus. — Chigger or Sand -Flea (Pulex
penetrans). — Cutaneous Myiasis : Lucilia macellaria — Dermatohia
noxialis — Ochromyia anthropophaga. — Leeches : Hcemopis sanguisuga
— Hcemadipsa Ceylonica. — Skin Diseases caused by Micro-Organ-
I8M8 : Boils — Pathology — Treatment. — Tropical Sloughing Phag-
edsena : Pathology — Treatment. — Oriental Sore : Symptoms — Inocu-
lation — Histology — Bacteriology — Etiology — Treatment.— ^Pemphigus
Contagiosus : Symptoms — Treatment. — Verruga : Symptoms — Patho-
logical Anatomy — Mortality — Treatment. — Unclassed Skin Dis-
eases : Prickly Heat : Symptoms — Treatment. — Keloid. — Ainhum, . 928



Medium of Malarial Infection — Epidemy of Dysentery at Futuna — Life

History of BilJiarzia hcematobia^ ..... 997

Index of Subjects, ........ 1003

Index op Authors, . . . . ioi5



LIST OF ILLUSTRATIONS



I. PLATES.

PAGE

I. Life Cycle of the Quartan and Tertian Parasites, . , .126

II. Typhoid Bacilli, their Morphology and Culture, . . . 255

III. Multiple Abscesses and Sloughing of the Liver, . . . 631

IV. Ova of Parasites found in Faeces, ..... 866
V Intestinal Flukes and Anchylostoma, .... 869-873

VI. Ehabdonema mtestinale, Eggs, Embryo and Adult Forms, . . 899

VII. Liver Flukes and Bilharzia, ...... 905



II. FIGURES IN TEXT.



1. Daily Range of Temperature of Europeans living in. Bengal, and of

the Natives of India, ...... 8

2. Age at which Menstruation appears in India, . . . .17

3. Do, do. .... 17

4. Schematic Representation of Parasites of Malaria, . . .118

5. Chart illustrating Relation of Malarial Fever to Rainfall in Rome, . 139

6. Do, do, do. Algeria, . 139

7. Do. do. do. Mauritius, 140

8. . Do. . do. do. Meerut and
Rohilkljand, .. . . . . . . . 140

9. Relation of the Fever Reason in Ceylon to the Season of Rainfall,

, Western Province. . . . . . . . .141

10. Relation .of the Fever Season 'in Ceylon to the Season of Rainfall,

Eastern Province, . . . . . . .141

11. Chart illustrating Bilious Remittent Fever (Grave), . . . 155
J2. Do. . do. ^ Typhp-Malarial Fever, . . . .157

13. J)o. . do. ^ Quotidian Type (so-called), terminating in Double

Tertian Remittent, . . , . . . .162

14. Chart illijstrating Tertian Intermittent, . . . . .162

15. Do. do. Double Tertian Intermittent, . . .163

16. Do. . do. , Quartan with. Abortive Paroxysms on third day, . 163
VJ. Do. , do. . Gastric Remittent, Recovery, . . . - 175



XVI



LIST OF ILLUSTRATIONS.



PAGE



18. Chart illustrating Bilious Remittent, Delirium and Coma, . . 178

19. Do. do. Bilious Hsemoglobinuric Fever, . . .182

20. Do. do. Primary Febrile Malarial Cachexia, . . 186

21. Do. do. Relapses of Chronic Malarial Fever, not treated

with Quinine, .....•• 187

22. Section of the Liver in a Case of Pernicious Fever. X 170, .195

23. Cerebral Vessels, Parasite-Bearing Corpuscles, and Free Pigment, . 197
24-29. Cliarts illustrating the Peculiarities of the Thermometric Course of

Tropical Typhoid, . . . . . . . 238

30. Diagram representing the Various Stages of the Typhoid Lesion in

Peyer's Patches, ....... 258

31. Chart representing Admissions for Malta Fever for Eleven Years

from a garrison of 3000 Soldiers, ..... 270

32. Chart illustrating the long Course of, and the Relapses which

occur in, Malta Fever, ...... 275

33. Chart illustrating Secondary Waves or Relapses in Malta Fever, . 276

34. Do. do. an Irregular Case of Malta Fever, . . 277

35. Do. do. High Temperature in a Fatal Case of Malta Fever, 278

36. Charts illustrating the Febrile Course of Yellow Fever, . . 305

37. Cholera Bacilli from a pure Culture, x 1000, . , .389

38. Gelatine Plate Cultivation of Cholera Bacilli, x 50, . . 391

39. Do. do. do. X 50, . . 392

40. Gelatine Culture of the Cholera Bacillus, . . . .393

41. The "Dry "and "Wet" Types of Beriberi (after Pekelharing and

Winkler), 457

42. Beriberi Atrophia (Simmons), ...... 460

43. Beriberi Hydrops. Appearance presented Two Days before Death

(Simmons), ....... 461

44. Areas of Anaesthesia in both Forms of Beriberi, according to

Simmons, ........ 465

45. Position sometimes assumed in Walking after partial Recovery from

Beriberi Atrophia (Simmons), . . . . . . 496

46. The Eruption of Yaws, from a Photograph by Prout, . . 514

47. Section of Gangrenous Ulcer in Dysentery, .... 566

48. Section of Ulcer caused by the Dry Eschar in Dysentery, . . 567

49. Chronic Dysenteric Ulcer, x 20, . . . . . 574

50. Grooved Trocar and Cannula ; dilating Forceps for Liver Abscess, . 663

51. Filaria sanguinis hominis diurna. x 160, . . . . 739

52. Do. do. do. mcturnxi. x 160, . . , . 740

53. Do. do. do. perstans. x 160, . . . . 740

54. Filaria nodurna^ showing Sheath (Lewis), .... 744

55. The cast Sheath of Filaria noctuma in chilled Blood, , . 745

56. Filaria nodurna in chilled Blood casting its Sheath, . . . 746

57. Filaria nodurna in chilled Blood casting its Sheath. Preparation

about Thirty Hours old, . . . . . . 746

68. Filaria nodurna, stained so as to show the Nuclei, . . . 748

69. Cephalic End of Filaria perstans (somewhat diagrammatic) ;

Cephalic End of Filaria nodurna, .... 749

60. Chart illustrating filarial Periodicity in a Case of Filaria nodurna

Infection, ........ 754

61. Filaria sanguinis hominis diurna^ ..... 769



LIST OF ILLUSTRATIONS,



xvu



PAGE

62. Filaria sanguinis hominis nocturna (Filaria Bancrofti), . . 762

63. Filaria Bancrofti. Mature Female Form of Filaria nocturna (after

Cobbold), ........ 764

64. Stretching of the Chorional Envelope to form the Sheath of the

Free Embryo Filaria corvus torquatus, .... 765

65. Caudal Extremity, showing Spicules and Papillae of Magalhaes Filaria

(after Magalhaes), ....... 768

66. Metamorphosis of Filaria nocturna in the Mosquito, . . .773

67. Chart showing the Temperature and Pulse Curves in a Case of

Elephantoid Fever and Filarial Orchitis, .... 780

68. Varicose Groin Glands, ... . . 792

69. Lymph Scrotum, . . ..... 795

70. Lymph Scrotum and Varicose Groin Glands, .... 796

71. Elephantiasis of the Legs, ...... 805

72. Do. of the Scrotum, . . . . . .806

73. Diagrammatic Sketch of Elephantiasis of the Scrotum, . . 807

74. Dissection of the Lymphatics in a Case of Chyluria, . . . 813

75. Method of applying Ligature in Operation for Elephantiasis of

the Scrotum (after M'Leod), . . . . .838

76. Filaria sanguinis hominis perstan^. x 160, . . . . 841

77. Filaria nocturna. x 60, . . . . . . 848

78. Filaria diurna and Filaria perstans. x 60, . . . . 849

79. Distomum pulmonale, ....... 854

80. Tinea imbricata, ....... 933

81. Do. do. ....... 934

82. Female Guinea-Worm (after Leuckart), .... 949

83. Do. do. head end (after Leuckart), . . . 950

84. Do. do. Uterus stuffed with Embryos (after Leuckart), 950

85. Do. do. Embryos (after Bastian), . . . 954

86. Fresh- water Cyclops, the Intermediary Host of Guinea- Worm, . 955

87. Metamorphosis of Guinea-Worm in Cyclops, .... 956

88. The Chigger or Sand-Flea, . . . . . .964

89. Do. do. ...... 965

90. Verruga (after Dounon), ...... 986

91. Do. do. ...... 986

92. Do. do. ...... 986

93. Section of Verrucous Tumour (after Dounon), . . . 988

94. Keloid Growths, . . . . . . .992

95. Do. do. ....... 992

96. Artificial Keloid in a Congo Negro, ..... 993

97. Ainhum, . . . . . . . . 994



I



HYG-IENE AND DISEASES OF
WAEM CLIMATES.



HYGIENE AND DISEASES



OF



WARM CLIMATES



CHAPTEK I.



THE INFLUENCE OF WARM CLIMATES ON THE
CONSTITUTION.

BY EDWARD A. BIRCH, M.D., F.R.C.P.

Evidences of the Influence of Warm Climates on the
Constitution. — The evidence that residence in warm climates
produces very appreciable effects upon the human constitution is
ample. A study of the comparative mortality which prevails in
temperate and tropical climates renders it certain that residence in
the tropics has an adverse effect upon Europeans, under the con-
ditions of ordinary life. Guy's oft-quoted table of the death-rate at
the soldiers' age brings this out very prominently. Selecting men
of various occupations, he showed that while only 7 per 1000 of
the members of the London Fire Brigade succumbed annually, the
British soldier in Bengal died at the frightful rate of 63 per 1000.
He also instituted a number of intermediate comparisons ; for instance,
the London Police force yielded 7*6, and agricultural labourers of
similar age in England, 8-0 deaths per 1000. It is unnecessary to
quote all his figures, especially as they apply to a bygone time,
when the mortahty of the soldier, and, indeed, of all classes in
India, was very much higher than it now is. Since Guy wrote,
the Indian death-rate has declined by quite two-thirds ; yet this
enormous reduction still leaves a balance against India of more
than double as regards the soldier. This point is shown very
plainly by a study of the statistics of later periods.^ Thus, taking

1 Parkes and Notter, Practical Hygiene, Wa. ed.

I



2 HYGIENE OF WARM CLIM4TES.

the ten years ending 1880, the gross male civil mortality at the
soldiers' age in England was —

From 20 to 25 years = 7*32 pro mille.
„ 25 „ 35 „ = 9-30 „ „

If we confine ourselves to the still later year 1888 alone, these
rates are altered to 5-4 and 7*2 respectively; further, we find that
the soldiers' ratios in England stood in that year at 4*70 and 8*1 1
for these ages, thus presenting a favourable comparison. Turning
next to the soldiers' death-rate in India for 1888, the mortality
was as follows in Bengal : —

20 to 25 years = 14*75 ) or, excluding f 11*32
25 „ 35 „ = 16-07 J cholera, ) 9*74

The mortaUty among the women of British regiments is even
greater than that of the men, especially from fevers, dysentery,
cholera, and phthisis. It has not been found possible to discover
any method by which the mortality or sickness of the civil
European population of India can be compared with that of
England. It may, however, be remarked that the general health
among the indigo planters of Tirhoot, which is a dry, though at
times very hot, climate, is good. They expose themselves at all
seasons ; and, although they take a great deal of exercise in the sun,
they retain more of their healthy European appearance than the
settlers in other parts of India. On the other hand, the tea planters
of Bengal (excepting those resident in the hills) can but be charac-



Online LibraryAndrew DavidsonHygiene and diseases of warm climates → online text (page 1 of 116)