Chapter IV (7)

In these days, when the physical methods of treating disease are so 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.

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.

Port Elizabeth, the third most important of the coast-towns, is not to be recommended as a permanent residence for invalids. Its rainfall is more evenly distributed through the year, and the humidity, which is remarkably constant, is about 75 per cent. The variations in summer and winter heat are also within a small range; the highest mean temperature for summer being 75°; the lowest mean for winter 48°. But the winds are trying, and render it unsuitable for invalids. Uitenhage, a small village three-quarters of an hour's run from Port Elizabeth, is far healthier, and is rapidly becoming a favourite suburb. It has an exceptionally good water-supply. In the near neighbourhood are the largest vineyards in the Eastern Province.

These three towns may serve as types of the climatic conditions to be met with on the south-western, southern, and south-eastern coast-line respectively. It must be again emphasised that climatically none of the coast resorts are as beneficial for phthisis and chest affections generally as the uplands; but that other factors render them at the present time, and for the immediate future, the most suitable resorts for the seriously ill. And though climatically they are not the best that South Africa can afford, they are, nevertheless, better than most of the European resorts that have hitherto been frequented. For they all afford more prolonged sunshine, and purer air, and are more exempt from the infectivity of overcrowding than is the case with the fashionable recruiting places of Europe. But it is to the highlands of South Africa that we eventually look with confidence as promising the maximum of benefit, which will be available as soon as the difficulties of food and accommodation and social environment are adjusted. From the coast-line a series of terraces rise to the northward, with extreme regularity on the western three-fourths, with less uniformity on the eastern fourth of the southern continent, as far as the Zambesi. Four terraces may thus be distinguished, and are divided as follows:--

1. The coast plateau comprising the land within fifty miles of
the coast, and reaching a level below 1000 feet.

2. The Southern Karroo, the plateau between the Outeniqua and
Langenbergen mountains to the south, and the Zwaartebergen to
the north. Level from 1000 to 1500 feet.

3. The Great or Central Karroo, the plateau between the
Zwaartebergen range to the south, and the Nieuwveld and
Roggeveld to the north. Height between 2000 and 3000 feet.

4. The Northern Karroo, stretching north to the Orange River at
a level of 4000 feet and over. The Transvaal and Rhodesia,
though not commonly included as within the Karroo districts,
are high tablelands with similar altitudes, and may be
described under this heading.

The climate of the coast plateau is similar to that of the seaboard, and much need not be added to the description given under that heading. Visitors to the higher plains of South Africa must be warned to go not unprovided with warm clothing, and to be careful of evening chills. The fall of temperature as night comes is very great. It has been observed that chills which in England usually result in nasal catarrh, in South Africa take the form of intestinal catarrh, and most visitors experience this discomfort soon after arrival.

In the Southern Karroo is situated the important health-resort of Ceres, much frequented by the residents of Cape Town, from which it is distant only 84 miles. It is a pretty little Dutch town, 1700 feet above sea-level, with picturesque surroundings. It has a small sanatorium under very competent medical supervision. The water-supply is derived from mountain springs, and is very pure. The climate is drier than that of the coast plateau, and its ease of access from Cape Town enables supplies to be readily brought up. Being within the line of winter rains it is not recommended for phthisical patients in other than summer months, but during the latter, which may be taken as extending from October to March, the phthisical patient could live and sleep in the open air in properly-constructed sanatoria. It is much to be desired that further accommodation of this kind should be supplied, as Ceres forms a comfortable halting-place, where the phthisical patient may with advantage spend a few weeks on his road to the higher plateaux, and it would be an invaluable resort for delicate persons whom physicians are obliged to send out of England during the English winter, a time at which Ceres would be at its best.

Grahamstown, though not properly in the Southern Karroo, is at nearly the same level, 1700 feet, as Ceres, and may be considered here. Its rains occur mostly in the summer, and it is consequently more to be recommended as a winter resort. It is one of the prettiest towns in South Africa and one of the most English, and it vies with the capital in educational facilities. It is best reached from Port Elizabeth, from which it is 100 miles by rail, but the journey occupies nine hours. Its climate is remarkably equable but somewhat damp. It has a public library, second only to that of Cape Town, and a magnificent museum. Sport is still to be procured in the neighbourhood, and the society is more cultured and intellectual than is the case in many colonial towns. It has long enjoyed the sobriquet of the "City of the Saints," and is a pleasant and healthy place for family settlement, the schools being numerous and excellent. It is not, however, so well adapted for the presence of sanatoria for phthisis as many other districts in South Africa, owing to its humidity.

The Great or Central Karroo and the Northern Karroo may be considered together, as they have very similar climates, differing only in the greater height of the northern plateau with the consequent influences on temperature and dryness. It may be said to offer a crescendo of advantage as the elevation increases. Here is probably to be found one of the most perfect climates in the world for tuberculosis, and one of the most healthy and invigorating. I would defy the most miserable hypochondriac alive to remain uncheerful on a bright sunny day on these glorious uplands. His struggle to remain lugubrious would be as hopeless as Mr. Thompson's after his second glass of port, even when that gentleman's deference for Sir Austin Feverel urgently required the effort. Something of the same exhilaration may be felt in the higher Swiss altitudes, but unaccompanied by the vivifying influences of the sun. Sunshine and pure air, it must be remembered, are the strongest bactericidal agents known. Mr. Clinton Dent, lecturing at St. George's Hospital, gave expression to his astonishment at the surgical triumphs of healing, which he attributed to pure air, achieved under his observation during the war. The dryness, and consequent clearness, of the air are remarkable, and indeed incredible to the northern European. This feature explains the inferior shooting of our soldiers on their first arrival in South Africa; they would invariably sight their rifles too low, their targets being, in fact, far more distant than seemed possible by reason of the clearness. And this dryness makes it possible to tolerate extremes both of heat and cold which without this factor would mean serious discomfort.

Photo by Wilson, Aberdeen]

In fact, the moist warmth of our English summers is infinitely more oppressive and less easily borne than the far higher temperatures, but tempered by comparative absence of moisture, which prevail in the Karroo. The rarity of sunstroke throughout South Africa is a clinical observation which establishes the truth of the statements just made. In the records of a military hospital in the Northern Karroo during the months from August to April, including therefore the hottest time of the year, out of 3000 medical cases not a single instance of sunstroke was noted. The experience gained in this hospital has an additional value from the circumstance that the gifted physician, the late Dr. Washbourn, was the observer, and some of the results he records may be more eloquent than many pages of description. Of the medical cases (nearly 3000), 546 were enteric, 379 dysentery, 296 muscular rheumatism, 258 malaria, 187 "continued fever," 152 diarrhoea, 93 jaundice, 70 tonsilitis, 71 influenza, and only 43 bronchitis and chest affections. Dr. Washbourn acutely remarks, "From this list it may be roughly concluded that the air in South Africa is good; the food bad." It will be noticed that intestinal diseases form more than a third of the total. The dysentery was probably due to faulty ingesta and not to the specific organism usually associated with dysentery, since amoebæ coli could not be found in the stools. Malaria occurs only in limited areas in the northern Transvaal and parts of Rhodesia; the Karroo proper and the coast-belt are entirely free. The causation of malaria is now so well understood that it must yearly become a more and more preventable disease. But the great outstanding features of the list, the prevalence of intestinal diseases, the absence of respiratory troubles, merit closer examination. The intestinal diseases, under which the muscular rheumatism, (caused by toxines), the jaundice, and much of the continued fever, must be included, are due to ingesta, _i.e._ food and water. The difficulty of obtaining good food, and the absence of sanitation which is the main cause of the impurity of the water, are the obstacles which must speedily be overcome in order to make the second feature assume its proper value in the treatment of disease. The rainfall is everywhere adequate for the supply of pure water, but this must be properly stored and kept from contagia. The interesting experiments which Dr. Vivian Poore has made on the subject of rural hygiene are convincing as to the possibility of disposing of excreta with complete security to health, and material profit to the community, without the necessity of abundant water. He has found that in the dry-earth system of closets, followed by the application of the excreta to the soil and their superficial burial in the humus, with subsequent tillage, a perfectly successful system of drainage is obtainable. In an acre and a half of ground he has for many years disposed of the excreta of a hundred persons, and the crops he has raised upon this land have yielded a profit of £50 per annum per acre. It appears to me fortunate therefore that most of the South African towns (except on the coast) have not yet adopted the costly and wasteful methods of destruction of sewage which are the fashion of the moment and which entail an immense loss of water. An intelligent application of very simple methods, within the reach of the smallest community or of the largest town, will ensure proper destruction of excreta, increased fertility of soil, and security against contamination of water--the latter being by far the greatest danger in South Africa. The supplying of food is intimately bound up with the conservation of water. The soil of the Karroo is astonishingly fertile when watered, and irrigation should be widely adopted. In places where this has been done the most satisfactory results have been obtained. At Matjesfontein, for example, a small oasis in the midst of the dry Karroo has been created within recent years by intelligent methods of irrigation. It is to be hoped that more energetic and progressive settlers will ultimately, as farms change hands under the financial stress of the war, tackle these difficulties with modern methods of agriculture. When it becomes possible to obtain fresh food-stuffs at moderate cost, the country will be ripe for the multiplication of sanatoria and places of reception for invalids and visitors. The type of sanatorium to be recommended for phthisical patients is still much debated. The essay of Dr. Latham and Mr. West, of St. George's Hospital, who have lately won the King's prize, offered for the best solution of this question, will be published within a few weeks, and may go some way towards settling the model to be adopted. At the present time only a few sanatoria exist in South Africa, and it will be well to devote a few words to the localities in which they are to be found.

Beaufort West, on the northern main line from Cape Town, and Cradock, on the northern main line from Port Elizabeth, are old-established health-resorts which offer fair accommodation for invalids. They are of nearly equal altitude, some 2800 feet, and are both in possession of a good water-supply. Their moderate elevation and ease of access from the coast render them particularly suitable for advanced cases of phthisis who are too ill to travel farther north, and for asthma and cardiac affections.

Howick, on the main north line to the Transvaal from Durban, altitude 3500 feet, was much used as a convalescent military base during the war, and is a popular health-resort with adequate invalid accommodation. It has a good all-the-year-round climate, but is particularly recommended for the winter, which is its rainless season. Estcourt, a little farther north on the same line, is some 300 feet higher, with much the same climate. It has a sanatorium. Standerton, 5000 feet, near the Natal-Transvaal border, and on the Durban line, has a bracing winter climate, and is then much frequented by Johannesburg residents, anxious to escape the dust-storms of the Rand. Wakkerstroom, 6000 feet, a few miles east of Standerton, is an advancing health-resort, which has a sanatorium. It is best adapted for cases of early phthisis. Its altitude contra-indicates it for persons with heart affections.

Middelburg, 4000 feet, in the Great Karroo, on the Port Elizabeth line, has a sanatorium, and opportunities of accommodation in farms in the neighbourhood. It has a summer rainfall, and is therefore more especially to be recommended as a winter resort.

Kimberley, altitude 4000 feet, on the Great Northern Plateau, is the fourth largest city in South Africa, and is entirely unique in this, that it may be described as being run by a benevolent despotism, that of the De Beers Company, who own the diamond mines. This company has built at its own cost the best sanatorium in South Africa. The fierce heat and the dust-storms render it somewhat trying as a permanent residence.

Bloemfontein, 4500 feet, in the Northern Karroo, the capital of the Orange River Colony, has long been a favourite resort for phthisical patients, and has a well-deserved reputation for the extreme dryness of its climate. It has summer rains of short duration but very heavy while they last. Its mean humidity is 58. December, January, and February are the hottest months, with a mean maximum of 85.° It has very fair hotel-accommodation at prices much lower than those ruling in Johannesburg, and has sanatorium establishments. It is on the main line of railway from Cape Town, from Port Elizabeth, and from East London. It has a good water-supply, and should become a most successful centre for the treatment of many pulmonary affections. The principal drawback to its healthiness is the prevalence of dust-storms in the late winter months.

Johannesburg, 5700 feet, in the great northern plateau of the Transvaal, is the largest and busiest town in South Africa, and cannot, for these reasons, be recommended as a health-resort; moreover, for some time to come the scramble for accommodation and the general roughing that results must keep away all but the most active and robust. But it is in a very healthy position, and enjoys a splendid climate for ten months of the year. The later winter months (July and August) are spoilt by the severe dust-storms, and the wealthier Johannesburg residents usually leave it during these months. It is the centre towards which all railways converge, and may be reached from Cape Town (in 45 hours by mail train, once a week; in 60 hours by the ordinary daily service), from Port Elizabeth in 43 hours; from Durban in 24 hours. It has summer rains in heavy downpours, with clear, fine weather between the showers. The healthiest parts of Johannesburg are the Hill and Parktown, which are fashionable suburbs. There are numerous hotels, which at the present time are very expensive; a single room with board cannot be had under 25s. a day; servants' wages are high, from £6 to £10 per month; food-stuffs are dear and difficult to procure; fresh meat is unobtainable, all supplies being imported frozen; eggs are 11s. a dozen; milk 1s. a pint; house-rent, for a six-roomed house, averages from £20 to £30 a month. These details are mentioned to give the intending visitor warning what he may expect at the present moment; and the great rush which is continuing will doubtless keep up the prices and lack of accommodation, so that for a considerable time to come Johannesburg is a place for the delicate and the ill to avoid.

Pretoria, the official capital of the Transvaal colony, is 30 miles north of Johannesburg, but it is 1760 feet lower, and is sheltered and shut in by mountains, which render it a pleasant resort from Johannesburg in its windy months. The winter climate is delightful. The sanitation, both of Johannesburg and Pretoria, is very imperfect and bad, and enteric and dysentery are in consequence very prevalent. Pneumonia is one of the scourges of Johannesburg, probably owing to the frequency of chills, the variation in temperature from the heat of the day to the cool of the evening being very great--as much as 70° at times. Water is not too plentiful, and there are seasons of scarcity which increase epidemic disease.

Basutoland has been called the Switzerland of South Africa from its beautiful mountain-scenery. It is, however, not open to invalids, or indeed to travellers, owing to its being still a native reserve.

Harrismith, 5250 feet, in the Orange River Colony, is probably the nearest available health-resort to Basutoland, and is an excellent place for consumption in earlier stages. A sanatorium is being provided. It is easily reached from Durban. I have known a case of phthisis with repeated hæmoptysis to be arrested by a visit of six months to Harrismith.

Rhodesia is, as has been said, a continuation of the elevated tableland of the great northern plateau, and its climate is very similar to that of the higher Karroo, with the exception that malaria is found in some parts of the country, and is not present in the Karroo. The country is on the whole healthy, but is as yet too undeveloped to receive invalids.

THE SPAS OF SOUTH AFRICA

There are numerous mineral-springs in the country, but they remain for the most part but little used, and there is here an excellent opportunity for future development. A few words upon some of the better known of these may be useful.

Caledon, altitude 900 feet, 80 miles from Cape Town, is the best known and most developed watering-place in South Africa. A line of railway, connecting it directly with the Cape main-trunk line, has just been completed. Its reputation dates from the times of the earliest Dutch occupation. It has ferruginous springs, both hot and cold, which offer a most successful treatment for gout, rheumatism, anæmia, and cardiac diseases and renal insufficiency. There is excellent and increasing accommodation in connection with the springs. The climate is very pleasant, and especially to be recommended in summer, as being drier than the coast towns, though within such a short distance of Cape Town. The rains are in the winter.

Brandvlei, near Worcester, 100 miles from Cape Town, has some very hot sulphur-springs which have not yet been much used.

Montagu, altitude 750 feet, near Robertson (140 miles by rail from Cape Town), has some hot mineral-springs which have been used with success in rheumatism and skin diseases, and there is an "établissement des bains" under progressive management.

Aliwal North, 4500 feet, on the Orange River, best reached from East London, may be compared to the Swiss watering-place, Loêche, in the combination of hot sulphur-springs with a great altitude. The baths are excellent for rheumatism and skin diseases, and good accommodation is procurable. The climate is a delightful one, with short summer rains and bright dry winter. The altitude is unfavourable for cardiac affections, but good for phthisis, and this has long been a much commended resort for the latter disease.

Warmbaths, altitude about 5000 feet, a thermal spring, connected by rail with Johannesburg and Pretoria (from the latter of which it is distant 70 miles), is rapidly becoming an important spa. The water issues at a very high temperature. It is ferruginous, sulphurous, and alkaline. Increased accommodation here is very desirable, and will no doubt be rapidly supplied. Rheumatic affections, anæmia, and skin diseases are benefited by this treatment, but heart disorders are aggravated by the high elevation.

It is impossible within the limits assigned to me to go into further details about the magnificent opportunities for the health-seeker which this great country must offer in the near future. To those who have been bred under those kindly skies, and who have left them permanently, an incurable nostalgia often comes, when the burden of this murk-laden atmosphere of London seems indeed intolerable. I hope that these few pages may lead many a sufferer to find new vigour and new courage in that sunnier air. May it prove to them in very fact a land of Good Hope and pleasant memories, whether they remain in the country or whether they make but a fleeting visit.[15]

FOOTNOTES:

[15] I have obtained much help, for which I wish to make due acknowledgment, from the following works on South Africa, which I would commend to the inquirer on the subject:--

"John Noble's Hand-Book," published in 1887 by the Cape Government.

"Health Resorts of South Africa." Dr. Arthur Fuller, 1898.

Messrs. Brown's "Guide to South Africa," published by the Union-Castle Company, 1902.

"South African Studies." Dr. Alfred Hillier.

"The New South Africa." Bleloch.

COMMERCIAL PROSPECTS

BY WILLIAM EGLINGTON

_Editor and Proprietor of "The British and South African Export Gazette"_

It is somewhat of an anomaly that of the scores of books which have been published of late years in connection with South Africa, not one has contained any direct reference to its commerce. This is the more remarkable when it is remembered how little is known, outside the circle of those associated with the trade, of its actual extent and importance. It is true that here and there in the daily press statements, more or less accurate, from time to time appear as to its trend, and of late quite a number of technical journals, somewhat tardily, appear to have only just awakened to the fact that the huge demands made upon British industries by South Africa's consumptive requirements are worthy of further investigation. But however admirable their intentions, the process of enlightening the public to which they set themselves would seem to have failed of its object, for the reason that, while each has done its best in its own particular groove, collectively they reveal nothing but what interests their own immediate circle of readers.

In view of the wide publicity given to South African affairs in recent times, the ignorance of the average man as to the remarkable expansion which has taken place in South African trade since the Majuba scuttle is not a little astonishing. He doubtless has a hazy idea that it runs well into millions, but there his knowledge ceases. He has had it dinned into his ears that British manufacturers have been asleep and sacrificed the trade to the greater activities of their rivals, and while he may deplore this fact, and bewail the decadence of our erstwhile commercial supremacy in oversea markets, there his interest ceases. It is with the view of enlightening a wider public as to the extent and scope of our present trade with South Africa, together with its future prospects, that this article has reference, and it will also serve to show, despite erroneous assertions to the contrary, that we have nothing to fear from foreign competition. However lax our manufacturers may have been in the past in allowing their rivals to secure so firm a footing in a market where, until a few years ago, they were supreme, after a perusal of the facts herein adduced it will be conceded that their present position is one from which it will be a matter of extreme difficulty to dislodge them.

Strange as it may appear, South African trade first began to show signs of expansion after the events which followed upon the retrocession of the Transvaal to the Boers in 1881. Until that year it was practically insignificant in its proportions and almost stationary in its volume, being mainly assisted by the activity shown in the diamond industry, gold not then having become a factor in quickening the commercial pulse. In the year named, the total imports into the country from all sources amounted to £11,140,027, of which the Cape Colony took, in round figures, all but two millions. After 1881, however, the imports steadily, if slowly, increased in bulk, which was due less to active developments in South Africa itself than to the gradual opening up of the country after the first Boer war. In 1891, in which year it may be said the fabulous wealth of the Witwatersrand first began to attract the attention of the civilised world, the value of the imports stood at £12,230,270, of which the Cape Colony took practically the same amount of goods as in 1881, while Natal had improved her position by taking about one-fourth of the total. After 1891 the imports increased with extraordinary rapidity in proportion as the gold industry made headway, until in 1901 they touched the high-water mark with £31,595,332, or practically three times what they stood at twenty years before.

In 1881, the quantity of goods imported from countries other than England was so insignificant as not to be worth including in the official returns, and so far as the United States was concerned absolutely no trade with South Africa was done at all, and but very little with the European Continent. In 1892, however, Germany and America began to pay greater attention to the possibilities of what then showed signs of becoming an exceedingly promising market, the share of the former country in that year being only £231,172, while that of the latter was £418,126. How successful they were in their efforts is seen by the fact that with each succeeding year the value of the goods entering South Africa from those countries grew by leaps and bounds, until in 1901 the German share had increased to £1,118,010, and that of the United States to £2,640,193. Neither of these amounts was, however, the highest point reached by either Germany or America, their record years being 1896 and 1898 respectively. It is unquestionable that had British manufacturers paid sufficient attention to the possibilities of the South African trade in the period from 1881-91, and had realised how rapidly the country was developing, thereby quickening them to action, the foreigner would not have got the hold upon its commerce which he now has, the combined share of all the countries competing with Great Britain amounting in 1901 to £4,590,681, or 14.9 per cent. of the total imports. Although the purely British share was as much as 65.6 per cent., the balance being made up by the shares of our Colonies and non-competing countries (i.e. goods imported from countries that Great Britain cannot supply), much remains to be done to retain even that percental share; but it is satisfactory to note that the lessons of the past have not been lost upon us, and that with the general awakening to the foreign menace there is every likelihood that we shall more than hold our own in the future, provided our manufacturers are not handicapped by the exactions of labour, the excessive cost of which, and the general disinclination of the Trades Unions to adopt modern labour-saving machinery, being the two principal factors in determining whether competition with other countries shall be effective or not.

Photo by Barnett & Co., Johannesburg]

It may not be without interest to put on record the values of the principal articles imported into South Africa in 1901 from all sources. They were as follow:--

Animals, Live £71,771 Articles of Food and Drink 9,641,809 Articles of Personal Use 6,120,903 Builders' Materials 1,245,609 Drugs and Chemicals 437,610 Electrical Goods 136,964 Explosives and Weapons 119,379 Hardware, Cutlery, and Ironmongery 1,276,041 Household Requisites 1,969,724 Iron and Steel 596,928 Leather and Manufactures 394,525 Machinery, &c. 859,685 Paper, Books, &c. 689,216 Textile Manufactures 2,104,245 Vehicles and Vehicular Material 968,210 Other Articles 1,943,465 Goods by Parcels Post 520,265 Stores for Government 2,498,983 ----------- Total £31,595,332 ===========

The purely British (_i.e._ the United Kingdom's) share in this trade was as follows:

Animals, Living £29,306 Arms, Ammunition, &c. 143,697 Articles of Food and Drink 2,533,163 Articles of Personal Use 3,528,907 Builders' Materials, &c. 175,078 Drugs and Chemicals 423,190 Household Requisites 1,600,763 Ironmongery and Hardware 275,245 Leather and Manufactures 1,762,438 Machinery, Millwork, &c. 1,210,151 Metals and Manufactures 1,762,438 Oils, other than Essential 55,076 Paper and Stationery 577,228 Textile Manufactures 2,387,666 Vehicles and Parts 635,153 Vessels (Ships and Boats) 23,214 Wood and Timber 108,034 Miscellaneous Articles 965,655 ----------- Total £20,648,529