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 gonorrhœa 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.
THE MORNING MARKET AT KIMBERLEY
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 diarrhœa, 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 amœbæ 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.