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.