HEALTH RESORTS OF SOUTH AFRICA

By ERNEST GRAHAM LITTLE

B.A., formerly Porter Scholar, of the Cape University; M.D. University of London; Member of the Royal College of Physicians; Physician, with charge of the Skin Department, at St. Mary’s Hospital; Senior Assistant Physician to the East London Hospital for Children and Dispensary for Women, Shadwell; late House Physician at St. George’s Hospital and at the City of London Hospital for Diseases of the Chest

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:—

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.