Introduction.
In the following pages the chief emphasis has been laid upon the care of the health in the tropics; but it must be remembered, that whilst by far the greater proportion of travellers go to the tropics, most of these hints for the preservation of health apply equally well for all climates.
Though many subjects have been briefly dealt with, certain matters have been rather more fully written up, such as the treatment of wounds. It is, in the author’s opinion, so important that the traveller should thoroughly understand what is meant by ‘surgical cleanliness’ that the usual methods observed by surgeons to ensure it have been plainly set forth. The author, of course, understands that in many cases it would be quite impossible to carry out the instructions in every detail, but it is hoped that a thorough knowledge of the principles underlying the correct treatment of wounds will assist the traveller in doing the best possible for his patient in any emergency, and under even the most unfavourable circumstances.
It is hardly necessary to observe that travellers in remote regions, and especially in tropical climates, are much more exposed to physical ills and diseases than most residents at home, and that they are more likely to be placed beyond the reach of skilled medical and surgical aid when it is most required. It is chiefly for the use of the non-professional traveller that the following pages have been written, and with this aim in view the symptoms and general treatment of the diseases and injuries with which he is most likely to be brought in contact are dealt with in simple, non-technical language.
Every traveller should supply himself with either Bernard Myer’s ‘Atlas of First Aid Treatment’ or Hastings Young’s ‘First Aid to the Sick,’ books of general utility. Travellers visiting countries with hot climates will find Garry’s ‘Some Factors Influencing Health in Tropical and Sub-tropical Climates’ a useful book, despite a few errors, while the small ‘Primer of Tropical Hygiene’ by Colonel R. J. Blackham, is a valuable guide to things hygienic as is Professor Simpson’s ‘Maintenance of Health in the Tropics.’
A few books may be mentioned as specially suitable for those travelling in the countries with which they deal, such as ‘Hints for Residents and Travellers in Persia’ by A. R. Neligan, ‘Health Preservation in West Africa’ by J. C. Ryan, ‘Hygiene and Disease in Palestine’ by Masterman, and ‘The Epidemics of Mauritius’ by Anderson.
Those who read German will find the ‘Gesundheitlicher Ratgeber für Auswanderer,’ issued under the auspices of the Institut für Schiffs- und Tropenkrankheiten in Hamburg, of considerable service, and if they intend visiting South America it is worth noting that from the same source a series of small books to guide the traveller in different parts of that continent will soon be forthcoming. This series will also include works on Mexico, Angola and Siberia. These German guides are obtainable from L. Friederichsen & Co., Hamburg.
Persons who intend to travel should undergo a thorough medical examination, in order to ascertain if they are likely to be able to stand the fatigues, exposures and privations to which they will probably be subjected.
Fig. 1.—Diagram showing some of the Principal Organs of The Body, and the Course of the Main Blood-vessels.
Most people of good constitutions and regular temperate habits can, with care, maintain a good state of health in the tropics, and many of those who have been by no means strong at home are able with some extra caution to do well even in the hottest climates.
The intending traveller should attend a course of ambulance lectures in order to prepare himself for the responsibilities which he will have to undertake. As much time as possible should be devoted to discussing with some professional friend the uses, correct doses, and proper methods of prescribing and combining the drugs which are to be taken on the journey, and in becoming familiar with the position of the principal bones, vessels and other important structures of the human body.
A traveller should understand how to use the clinical thermometer, how to twist or tie a bleeding vessel, how to use the hypodermic syringe and the syphon stomach tube. He should learn how to cleanse a wound, how to treat a case of snake-bite, and should know the best way in which to set a broken limb. Such things are not easily learnt from books, and experience alone will give the necessary skill and confidence. Many valuable lives have been saved by travellers who have fairly mastered the rudiments of medical and surgical treatment, and who have been able in an emergency to give the necessary drugs, administer an antidote, or to stop severe bleeding.
The ideal traveller is a temperate man, with a sound constitution, a digestion like an ostrich, a good temper, and no race prejudices. He is capable of looking after details, e.g., seeing that drinking water has really been boiled, and is willing to take advice from those who have made journeys in countries similar to the one in which he is about to travel.
A traveller should be supplied with suitable housing, food and clothing, and should have a proper supply of medicines, dressings, and medical comforts.
In selecting the drugs with which the traveller should be provided before leaving home care should be taken to see that only reliable products be purchased. In the tropics, and in exploration generally, the medical outfit is subjected to very severe tests, and it is a mistaken policy to economise on medicines. The latter should be as portable as possible and be properly packed.
Risks to Health in a Tropical Climate.
Seeing that these hints will be chiefly required by travellers in tropical or sub-tropical climates, it may be well to indicate some of the chief risks which are to be met with in warm climates, and the best methods of meeting them.
It will be noted that any detailed reference to questions of outfit, such as the supply of proper food or clothing, is omitted, as these matters have been fully dealt with in ‘Hints on Outfit,’ published by the Royal Geographical Society uniformly with this ‘Hints to Travellers,’ and it is understood that this work will be consulted by all who read these hints.
Chill.—The most prominent feature of a tropical climate is undoubtedly heat, and yet the greatest risk arises not so much from excessive high temperature as from a risk of chill, which is due mainly to the excessive perspiration which takes place. This must be guarded against by the use of proper clothing, the most important point being that the underclothing should be partly of absorbent material. For general use cotton is best, and the vest or undershirt should in the tropics be of the Aertex Cellular type. It is a mistake to wear wool next the skin in hot countries, for it soon gets sodden with perspiration and is irritating. A light flannel shirt worn over the open cotton mesh is probably the best arrangement though a mixture of wool and cotton may be employed for the shirting. This question is fully dealt with in ‘Hints on Outfit.’ It is particularly important to avoid sudden changes of temperature, and if exposed to the cooling sea breeze, special care must be taken as to proper clothing. Parke laid great stress on the importance of avoiding chills, draughts, or wettings. He remarked “In crossing Equatorial Africa the Relief Expedition found that every wetting meant an attack of fever.” The sea breeze, which is so refreshing and cool, by checking the perspiration, frequently acts as the exciting cause of an attack of fever. There is special liability to chill and subsequent fever when ascending an eminence, as the exertion causes profuse perspiration, and the cool breeze encountered on arrival at the top is very likely to produce ill effects.
On completing a day’s journey, the underclothing, at least, should be changed without delay, and the skin should be well dried by the free use of a rough towel. If at all possible a warm bath should be taken.
The cummerbund is a useful article of clothing, especially for men in the evening. It does away with the need for a waistcoat, which often proves hot and uncomfortable, and yet provides the necessary safeguard against chill to the abdominal organs.
A word as to the use of a flannel cholera belt, about which opinions differ. Experience in many tropical countries leads the writer to recommend its use at night, and at night only. Even so, it is unnecessary and uncomfortable in places where the nights are invariably hot and steamy, and is chiefly of value in dry, desert climates where there is a great difference between the day and night temperatures.
Effects of the Sun.—It is difficult to overestimate the importance of the protection of the head from the direct rays of the sun. It is best, where possible, to avoid going out in the heat of the day, but where this is necessary the head should be protected by a suitable helmet, which should be light in weight and colour, which should be ventilated, and which should have a good protection for the back of the head. A large green leaf inside the helmet might be an additional protection, and a sun umbrella should also be used wherever practicable. A helmet should as a rule be worn when going out during the day-time in the tropics. Sometimes, however, the helmet is found very troublesome, as, for example, by the sportsman in the bush. He may then have recourse to a double Terai hat, or even to an ordinary wide-brimmed felt hat provided he inserts a crumpled-up handkerchief in its crown. This will usually afford a reasonable protection.
Errors of Diet.—The lassitude which is often so much felt by Europeans resident in the tropics too frequently tempts them to the abuse of alcoholic stimulants and highly-spiced foods. The habit is a most pernicious one, for such indulgence is one of the most fruitful causes of the permanent ill-health so often wrongly attributed to the mere residence in a hot climate. There is no doubt that food should be taken with greater moderation in hot than in cold climates; heat-producing articles of diet, such as fat, should be taken in far smaller quantity, but an ample supply of vegetables is essential. The meals should never be heavy, especially during the heat of the day, and intervals of about four hours should always separate consecutive meals.
Cooking should always be conducted with great care in the tropics, for the stomach and liver are less able to bear any extra strain, such as would be induced by the attempt to digest imperfectly-cooked food. Parasites are often introduced into the system by insufficiently cooked food.
Natural milk must be boiled; condensed milk should be mixed with boiled water.
Excess in the use of alcoholic stimulants is one of the most fatal errors into which the tropical resident can fall, and their habitual use as beverages is totally unnecessary, tea, coffee and cocoa being the best beverages for ordinary use. A small supply of brandy, champagne, and port wine may be of service in certain cases of illness, but they are better regarded as belonging strictly to the medical equipment.
Avoid native drinks, as they will probably have been diluted with dirty water, or prepared in unclean vessels.
Great moderation in the use of alcohol is quite as necessary in arctic as in tropical climates. In the latter no alcohol should be taken till the sun has set, and even then the quantity should be strictly limited. There is no reason why a glass of light beer, a whisky and soda, or a little light wine should not be drunk with the evening meal. Alcohol taken at this time often promotes appetite and aids digestion, but alcohol between meals is bad, chiefly perhaps because the habit of exceeding the daily allowance is thereby apt to be engendered. It is largely a question of self-control, and it must be remembered that in the tropics self-control, so far as drinks are concerned, is very apt to weaken. Apart from the question of its habitual use alcohol is often of great service as a restorative, as, for example, after a fatiguing march, and especially if one has got wet and chilled. Champagne is possibly the best form to take on such occasions and it should be used as an apéritif or drunk along with food.
Risks due to Drinking Water.—The use of water for drinking purposes must be attended with great care in all tropical climates. As the water of the lakes, streams and pools of these countries usually contains a large proportion of impurities, and the germs or parasites of many diseases, it should be strained and subsequently boiled before being used.
As, however, it is not always possible or convenient to incur the delay of boiling the drinking water and allowing it to cool, it is advisable that a reliable filter should be taken.
Most filters—charcoal or otherwise—are merely death-traps, as the accumulation of germs and injurious matter within the filtering substance soon renders the water more dangerous than if unfiltered. There are, however, a few filters which, with ordinary care in cleansing, are in themselves efficient safeguards. The most highly recommended of these are the Pasteur Chamberland and the Doulton filters. In any case, spare filtering candles should be taken, and these should be cleaned and boiled at least every three days. It is recommended that the filter-makers should be consulted immediately the probable requirements of any expedition are known. It should be remembered that no filter combines rapid delivery of water with efficient sterilization. A mistake commonly made is to boil water and then filter it. This should never be done.
The drinking of very cold water, to which there is great temptation when one is exhausted by prolonged heat and copious perspiration, should be carefully avoided; thirst often induces tropical residents to have recourse to iced water, which is always apt to be dangerous if taken when one is heated. The drinking of copious draughts of water is also a habit to be deprecated; it certainly weakens the muscular energy, and as the water is rapidly lost by perspiration, the feeling of exhaustion is increased. Hot or cold weak tea, without milk or sugar, is one of the least injurious of all beverages.
Precautions on the Voyage.
The traveller should endeavour to land in a perfectly healthy condition, and to this end he should on the voyage out take plenty of exercise, drink little or no alcohol, be moderate as to diet, and avoid much meat and rich dishes. Neglect of these obvious rules frequently ends in the traveller arriving in a flabby, bilious condition, in which state he is predisposed to attacks of malaria, dysentery, and other diseases.
Constipation is frequent at sea, and a seidlitz powder, a dose of fruit salt, or one or two cascara tabloids may be necessary. If constipation is severe, then one or two four-grain blue pills should be taken at bedtime, followed in the early morning by a seidlitz powder or some other saline aperient.
In order to avoid chill the traveller should be properly clothed during the evening or when there is a cool breeze, and should not stand in draughty doorways and passages on board. If he is proceeding to a country where there is endemic malaria he should begin his course of prophylactic quinine on ship-board, because even a single night spent ashore in a malarious locality may result in his acquiring infection. It is therefore advisable to begin taking quinine in the manner described on [p. 207] at least two days before arrival at the place of disembarkation.
What is true of the journey out is of even greater importance on the voyage home. There is a serious danger of illness owing to chills contracted on board ship when leaving a hot climate. Quinine should be systematically taken as recommended on [p. 208].