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Source: Edinburgh Medical and Surgical Journal. 1832, pp. [342?]-349.
X.—Sketch of the Geographical Distribution of Diseases. By Henry Marshall, Esq. Deputy-Inspector-General of Army Hospitals.
The leading distinction between the diseases of temperate and intertropical climates appears to be, that, in the former the viscera of the head and thorax, or the nervous and respiratory systems, are chiefly affected, while in the latter the abdominal viscera, or the organs of assimilation, principally suffer Fevers in warm climates seem chiefly to affect the stomach, as is seen in the black vomit of yellow fever. In cold climates the brain and spinal marrow are commonly principally implicated, while the stomach more rarely suffers. Tropical diseases differ also from those of temperate climates by their violence or great proportionate fatality, and the extreme rapidity of their progress.
Independently of the difference of latitude and the difference of temperature resulting therefrom, other causes more or less connected with the difference of longitude, modify the prevalence of diseases inasmuch as those which prevail in one hemisphere are often not of frequent occurrence in another, although in the same latitude.
My object in this sketch is to give a brief notice of those diseases and affections which are considered peculiar, or chiefly restricted to particular regions or spots of the earth’s surface. For the sake of convenience, I will arrange them in alphabetical order. There are two leading objects which require to be kept in view.
1st, To point out in a general way the geographical distribution of each affection.
2d, To endeavour to ascertain in some measure the degree to which each affection prevails in a particular range of country. This object can often be but very imperfectly attained, in consequence of the want of specific information.
Should the following catalogue of diseases, which are alleged to be much more frequent in some parts of the world than in others, have any influence in exciting some person, who has better opportunities than I have for investigations of this kind, to examine the subject carefully, and to publish the result of his inquiries, my object shall have been attained. It is not my intention in this paper to attempt to account for the causes of diseases. I purpose chiefly to state simply where certain affections are remarkably prevalent, without reference to their occasional causes, or to their artificial multiplication.
I. Albino Skin—Examples of a deficiency of the natural pigment of the skin, hair, and eyes, occur much more frequently among the inhabitants of intertropical climates than in temperate latitudes. Albinoes seem to be relatively more numerous in Africa than in Asia or America. The king of Ashiantee collected nearly 100 white negroes. Dubois says, they are not uncommon in India; and I have seen a few in Ceylon; but they are not numerous in that island. It is remarkable that the few Albinoes which have been born in Europe have been generally males. Dr Mason Good states that they have been all of this sex; an assertion which is not, however, strictly correct.
When Albinoes are matched with blacks, the progeny is either white or black, not brown-coloured like a mulatto. A similar result takes place in this country. I am informed that an Albino male parent, who resides at in the north of England, has a numerous family of children, some of which are pure Albinoes, while the others have the natural pigment of the skin, hair, and eyes, and resemble the mother. There are several Albino females in this gentleman’s family.
In the’ oriental Archipelago, Albinoes arc not rare among quadrupeds. Mr Finlayson informs us, in his account of the Mission to Siam and Hue that he saw several Albino elephants, buffaloes, and monkeys, in Siam.
2. Barbiers.—This disease is very generally confounded with beriberi, although the nature and progress of their symptoms are materially different. The former is a chronic, the latter is commonly an acute, disease. The leading symptoms of barbiers are, numbness, pain, and partial loss of power of the muscles of the inferior or superior extremities. Sometimes the muscles of the back become similarly affected. The progress of the disease is often protracted for several months before either recovery or death supervenes. Horses and dogs are liable to barbiers, from the effects of which they seldom if ever recover.
Barbiers occurs, according to Bontius, in Java; and the translator of his work, with Dr Lind, states, that it is violent and frequent on the Malabar coast. I have seen it in the island of Ceylon; but except in the places enumerated, I am not aware of its having been observed and described.
3. Beriberi—The leading symptoms of this disease are numbness, wderna, sometimes loss of power of the lower extremities, general anasarca, dyspnea, great uneasiness at the precordia, spasms, feeble pulse, livid countenance, and coldness of the extremities. The progress of the symptoms is commonly rapid. The female sex are not liable to beriberi.
Beriberi was very prevalent among the various classes of troops employed in Ceylon about the end of the last and commencement of the present century. The troops employed in the Kandyan country, during the year 1803, suffered much by it. Since that period this disease has been comparatively little known in Ceylon. Lascars, or Indian seamen, are occasionally liable to beriberi. It sometimes also affects the inhabitants of the peninsula of India, particularly the Malabar coast, and that part of the Coromandel coast which extends from Madras to Ganjam, but it is seldom observed above forty miles inland. I am not aware that beriberi has been observed in any other parts of the world. The pathognomic symptoms of barbiers and beriberi have been mentioned for the purpose of preventing them from being confounded.
4. Bronchocele; Goitre.—This affection is common among the inhabitants of the vallies of the Alps, Apennines, and Pyrenees. In Savoy, Switzerland, the Tyrol, and Carinthia, there are villages in which the greater number of the inhabitants, more particularly of the female population, have some swelling of the neck. About two-thirds of the inmates of the Lunatic Asylum at Milan, when it was visited lately by a friend, suffered under this affection. Professor Barton learned that bronchoceles are not uncommon among the North American Indians. Bronchocele is said to be especially frequent in Lower Canada, and, according to Bonpland, it is endemic in New Grenada. This disease occurs frequently in Derbyshire, and occasionally in Norfolk: in Scotland it is seldom seen, except in Perthshire. Sporadic cases of bronchiocele occur perhaps all over the world; but, except in the places mentioned, I am not aware that it is endemic to any considerable extent.
5. Bulimia.—In the frozen regions of the north, the appetite for food and the power of digestion are commonly excessive. Captain Cochran, in his account of a Journey through Russia and Siberian Tartary, gives some remarkable illustrations of this fact. Admiral Saritchief states, that a Yakuti informed him” one of their men was accustomed to consume at home, in the space of a day or twenty-four hours, the hind quarter of a large ox, twenty pounds of fat, and a proportionate quantity of melted butter for his drink. The appearance of the man not justifying the assertion, the Admiral had a mind to try his gormandizing powers, and for this purpose lie had a thick porridge of rice boiled down with three pounds of butter, weighing together twenty-eight pounds; and although the glutton had already breakfasted, yet did he sit down to it with the greatest eagerness, and consume the whole without stirring from the spot.” Captain Cochran says, “ I have repeatedly seen a Yakut, or a Tongouse, devour forty pounds of meat in a day ;” and “I have seen three of these gluttons consume a rein-deer at one meal.” He adds,” I myself have finished a whole fish in a frozen state, which might have weighed two or three pounds, and, with black biscuit and a glass of rye brandy, have defied either nature or art to prepare a better meal.”
6. Cacabay.—This is the negro name of a disease which Dr Hunter informs us affects negroes in Jamaica, but not persons born in Europe. Hillary asserts that cacabay (leprosy of the joints) affects both negroes and creole whites in Barbadoes. He says that from six to twelve negroes are sometimes suffering from this disease upon one estate. Cacabay occurs frequently among the indigenous inhabitants of Ceylon and the Peninsula of India. Many of the mendicants at Colombo, Amblamgoddy, and Point de Galle, in Ceylon, are disabled by this disease.
Cacabay is frequently confounded with tubercular leprosy, although they are very different affections. In cacabay the disease commences by the skin of the extremities becoming speckled, followed by diminished sensibility and enlargement of the toes or fingers. The flexor muscles of the wrist and fingers become contracted, and the patient soon loses the power of extending his hands. The flexor muscles of the feet become similarly affected, when the unhappy victim is obliged to walk upon his heels. Ulcerations at the joints next follow, which are succeeded by a separation of some of the phalanges of the fingers or toes. The ulcers cicatrize, but eventually other joints become affected, followed by a successive separation of some of the remaining bones. Cacabay often makes great progress before the general health appears to suffer. Indeed it is not uncommon in this distressing complaint to witness great mutilation of the extremities, accompanied with a plump healthy frame. Cacabay has not, I believe, been observed in a temperate climate.
7. Calculus Vesicae.—The geographical distribution of this disease seems to be in a great measure limited to the temperate latitudes. But even in temperate climates it is much more frequent in one place than in another a very short way distant. The relative proportion of eases of stone to patients admitted on account of other diseases in the following hospitals evince considerable variety.
Norwich, 1 case in 35 patients; La Charite (Paris), 1 in 238
Guy’s Hospital, I in 300; Glasgow Infirmary, 1 in 344.
(1830.) Hopital Des Enfans Malades (Paris), 1 in 500;
St Thomas’s Hospital, 1 in 528;
Infirmary. Edinburgh, 1 in 1000;
Civil hospital Establishment, Gibraltar, 1 in 1481.
(Period 110 years.)
Dr Dancer states that calculus never occurs in Jamaica. Dr Scott makes a similar statement in regard to Bombay. He says that during his long residence there lie never met with a case. Dr Ainshie, who was for more than thirty years on the peninsula of India, says, “ I have had occasion to attend both Hindoos and Mussehuanus suffering for gravel or stone; but I cannot say that they are maladies of common occurrence in Hindostan; on the contrary, they are very rare; and as for confirmed stone in the European habit, I never knew a case of it.
8. Cancer.—This disease is in a great measure confined to the temperate latitudes. During a period of ten years, 16,283 patients were treated by the medical officer attached to the Civil Hospital, Gibraltar; and of this number eight are returned under the head of cancer. This is presumed to be a much smaller relative Proportion of the disease than occurs in higher latitudes. In Jamaica Dr Dancer states, that “cancer seldom occurs, and it is peculiar to water drinkers.” I recollect of having seen one case, and one only, of open cancer in Ceylon, although I had extensive opportunities of observing the natives under disease.
9. Consumption, Pectoral Disease.—Thoracic disorganization is a frequent or prevailing disease from the 30th degree of north latitude to Nova Zembla. In so far as information has been received, it may be presumed that pectoral disease is pretty uniformly prevalent in the respective parallels of latitude within the above range. The mean annual mortality of all ages in Great Britain has been found, by the census of I 821, to be about 1 in 58; but in round numbers I shall assume that it is 1 in 50, or 2 per cent. Now, according to the London bills of mortality since 1808, it appears that one-fourth, or 25 per cent. of the deaths, is occasioned by consumption. If the proportion of consumption to general mortality be admitted to be as 1 to 4, and if it be granted that the annual mortality is to the population as 1 to 50, while by the census of 1821 it is ascertained that the inhabitants of Great Britain amount to 14,391,631, it will be found that the annual number of victims to consumption in this island amounts to 71,958. Perhaps this estimate is rather below than above the real number. Sir James M’Grigor informs us, that “in England this disease (consumption) is as frequent in the army as it is irm civil life under ordinary circumstances; and when no epidemic or contagious diseases prevailed, I found the deaths from consumption to amount to one-fifth, one-fourth, and in some regiments even as high as one-half of the mortality.” According to an abstract of the returns of the sick of the troops employed in Scotland from 1816 to 1 822, the deaths amounted to 230, and of this number 107 died from diseases of the thorax, being equal to 46.5 per cent. of the general mortality.
At New York consumption seems to engross one-sixth and sometimes a fifth of all the deaths. As the mortality of the inhabitants of New York is 1 in 40, one-fifth of the general mortahity by consumption is exactly the same ratio of deaths in the population by this disease as in London, namely, one-fourth.
10. Philadelphia, which is 160 south of Edinburgh, the relative number of deaths by phthmisis is said to be as high as in Great Britain. I am not aware of the existence of any documents by which we can estimate the degree of the prevalence of consumption in British America.
The annual mortality in France is about 11 in 40, and the relative proportion of deaths by consumption to the general niortahity is 23 per cent., or nearly one-fourth. The frequency of consumption among the natives of Madeira, Naples, and Sicily, is remarked by various authors; but I do not know that any comparative statements have been published on the subject. The general mortality of the garrison of Gibraltar during the eight years ending 20th December 1822 amounted to 379; of this number 107 or 28.4 per cent. of the whole mortality, died of diseases of the chest, and during the above period 227 men were discharged from the service in consequence of “ chronic affection of the chest, under the head pulmonic.”
Mr Marshall’s Sketch of the
According to Krafft, pleurisies destroy one-fourth of the whole population of Petersburgh, fevers one-third, and consumption one-sixth, being five-sevenths of all the deaths. We have no data to enable us to estimate to what extent consumption adds to the general mortality of the inhabitants of Tartary or China.
Within the tropics Europeans suffer much less by consumption than in temperate latitudes. By Dr Strachan’s annual returns of the troops employed in the Bombay Presidency for the year 1826, it appears that the mortality by “pulmonary consumption” amounted to 2 per cent. of the general mortality; and, according to Dr Adolphius’s annual returns of the troops serving in the Island of Jamaica, from the years 1823 to 1823, both inclusive, the deaths by “pulmonic disease” amounted to 4 per cent. of the total mortality.
Dr Dancer, physician to the public hospital at Kingston, published a report of this establishment, from the 1st November 1807 to the 31st October 1808, by which it appears that the ratio of the mortality by thoracic diseases, including “asthma,” “pneumonia,” and “ phthisis,” amounted to 4.5 per cent. of the general mortality.
To what extent consumption exists among the aborigines of South America we are uninformed. On the continent of Africa it seems to be a rare disease. Dr Winterbottom, who was physician to the colony of Sierra Leone, for a number of years, says in regard to consumption, “ as an idiopathic disease, I do not recollect to have seen a single case.”
The indigenous inhabitants of the peninsula of India and Ceylon are but little liable to consumption. It occurs, however, more frequently among the Malay than among the Gentoo or the Singhalese inhabitants of Ceylon.
Although the natives of Africa are, according to Dr Winterbottom, remarkably free from consumption in their own country, they are very liable to it in other climates. Even in Ceylon, where the mean temperature of the coast is 81 degrees—82 degrees Fahrenheit four-fifths if not nine-tenths of the mortality of Africans is occasioned by pectoral disease, and chiefly by tubercular consumption. The general mortality of Africans out of their own country has therefore an intimate relation with the ratio of the prevalence of consumption among this class of people in particular portions of tile world. During the period Ceylon was under the sway of the Portuguese government, there was a constant importation of African slaves, of which not a trace remains. Mr Bartolocci, in his work upon the commerce of Ceylon, says, “ it is a very remarkable fact, that of about 9000 Caffries, at different times imported into Ceylon by the Dutch government, and formed into regiments, no descendants are remaining, at least they are in no way to be distinguished among the present inhabitants.” In 1803, the British government embodied a regiment of Africans, which were chiefly procured at Mozambique, and in 1810, a similar corps was raised. The number of men required to form and recruit these corps must have amounted to from 3000 to 4000. In December 1820, only 440 individuals, which comprehended the remains of both corps, and their male progeny, were in existence.
In the West Indies, also, Africans are very liable to diseases of the chest; but chiefly to tubercular consumption, and to an effusion of serum into the pleura, the result of inflammation of the lungs. It is the latter affection which has been denominated by authors Anasarca Americana, and Cachexia Africana. The average annual mortality among the African corps employed on the windward and leeward islands, and Jamaica, during a period of 19 years, or from 1810 to 1828, inclusive, was 5.5 per cent. This is very nearly four times the ratio of the mortality of the troops employed in Great Britain and Ireland, which is 1.5 per cent.
A similar ratio of mortality seems to occur among Africans in temperate climates ; for in New York and Philadelphia, the annual average amount is 5.2. per cent. whereas it is 2.5. per cent. among the whites.
Except at Bourbon, I am not acquainted with any account of the average annual mortality which occurs among free blacks. In that island, according to Mr Thomas, it is annually 1.5. per cent. Among the slave population, the deaths exceed the births on an average of 3 per cent.
An interesting question may here be asked, namely, what is the relative proportion of the inhabitants of temperate climates, who are commonly suffering under consumption? Accurate and comprehensive returns from hospitals and dispensaries might furnish materials from which to deduce the relative, but not the absolute, prevalence of this disease. It would be impossible to estimate the average sickness in a whole community. This may, however, be easily effected in certain classes of people, such as friendly societies, but particularly in the army, where accurate returns are preserved. For example, it may be deduced from the following returns, that the average proportion of men in hospitals belonging to the army in this country is about from 4 to 5 per cent.
Return of the mean annual strength of the troops employed in Ireland, from the 31st December 1796, till the 1st January 1829, the proportion of sick per cent. the average number of deaths, and the proportion of deaths to the mean strength.
33( Mr Marshall’s Sketch of the
According to Krafft, pleurisies destroy one-fourth of the whole population of Petersburghi, fevers one-third, and consumption one-sixth, being five-sevenths of all tim deaths. We have no data to enable us to estimate to what extent consumption adds to the general mortality of the inhabitants of Tartary or China.
Within the tropics Europeans suffer much less by consumption than in temperate latitudes. By Dr Strachan’s annual returns of the troops employed in die Bombay Presidency for the year 1826, it appears that the mortality by “pulmonary consumption” amounted to 2 per cent. of the general mortality and, according to Dr Adohphus’s annual returns of the troops serving in the Island of Jamaica, from the years 1823 to 1825, both inclusive, the deaths by “ pulmonic disease” amounted to 4 per cent. of the total mortality.
Dr Dancer, physician to the public hospital at Kingston, published a report of this establishment, from the 1st November 1807 to the 31st October 1808, by which it appears that the ratio of the mortality by thoracic diseases, including “asthma,” pneumonia,” and “phthisis,” amounted to 4.5 per cent. of the general mortality.
To what extent consumption exists among the aborigines of 4 South America we are uninformed. On the continent of Africa it seems to be a rare disease. Dr Winterbottom, who was physician to the colony of Sierra Leone, for a number of years, says in regard to consumption, “as an idiopathic disease, I do not recollect to have seen a single case.”
The indigenous inhabitants of the peninsula of India and Ceylon are but little liable to consumption. It occurs, however, more frequently among the Malay than among the Gentoo or the Singhahese inhabitants of Ceylon.
Although the natives of Africa are, according to Dr WTinterbottom, remarkably free from consumption in their own country, they are very liable to it in other climates. Even in Ceylon, where the mean temperature of the coast is 8l~82~ Fahr. four-fifths if not nine-tenths of the mortality of Africans is occasioned by pectoral disease, and chiefly by tubercular consumption. The general mortality of Africans out of their own country has therefore an intimate relation with the ratio of the prevalence of consumption among this class of people in particular portions of the world. During the period Ceylon was under the sway of the Portuguese government, there was a constant importation of African slaves, of which not a trace remains. Mr Bartolocci, in his work upon the commerce of Ceylon, says, “ it is a very remarkable fact, that of about 9000 Caffries, at different times imported into Ceylon by the Dutch government, and formed into regiments,
Number of Mean Mean proportion Mean annual Mean ratio
years. strength. of sick per cent. number of deaths. of deaths
32 36,921 5.1 576 1.5
The following is a similar return of the troops employed in Scotland from 1816 to 1822, inclusive.
Number of Mean Proportion of sick Number of Ratio of
years. strength. per cent. deaths. deaths
7 2975 3.6 33 1.1
From the official returns at the Adjutant-General’s oflice, it appears that in 24 monthly musters of different corps in this country, forming an aggregate of 313,695, there were 14,049 on the sick list, and disqualified for duty, being at the rate of 4. It per cent.
Taking a very general view of the subject, it may be assumed that 2 per cent. of the army serving in this country are unfit for duty, on account of pectoral affections, and that one-half per cent. die annually in consequence of this class of diseases.
10. Cholera.—This disease in a severe form seems to have been epidemic in Europe during the 14th century. In 1817 it became epidemic in Bengal, and since that period it has appeared in a southern direction, in the island of Timor, New Holland, and the Mauritius. Eastward, it has seemed to travel as far as Kuku Chaton, a town in China. To the north it has extended to the frontiers of Siberia, and in a north-western direction it has spread over great part of Europe; and lately it has reached the eastern shores of North America, where it is now raging.
11. Convulsions.—Leaping ague is the colloquial denomination of a convulsive disease which is nearly peculiar to a few of the parishes of Forfarshire in Scotland. The disease has not lately been as frequent as formerly, but eases still occasionally occur, particularly in the parish of Kirryrnuir.
A similar affection was epidemic among the inhabitants of the Orkney and Shetland Islands about the year 1774. At one time leaping ague was so prevalent in a parish in the Orkneys, that from fifty to sixty persons were on sacramental occasions attacked with it in church. “ The extraordinary work at Cambuslang,” which commenced in February 1742, was perhaps a kindred affection, “the subjects of it being strangely agitated by strong convulsions, fearful contortions, loud out-cryings, imaginary sights, visionary representations, great swoonings, foamings, fainting, &e.”—Vide “ Faith no Fancy, or a Treatise on Mental Images,” by the late Reverend Ralph Erskine, minister in Dunfermline.
12. Deformities of the Body.—.The following varieties of this class of diseases or disabilities are not unfrequent in temperate climates, more especially among the civilized communities of Europe. In India, and in tropical Africa and America, they are extremely rare, so much so that many a person has resided in one or other of these countries for several years without observing a single example of one of them.
Enormously large head; strabismus; hare-lip; disproportioned length of the superior or inferior extremities; hump-back; knock-kneed; bow legged; club feet; superfluous organs, as toes or fingers; diminutive organization in general, (dwarfs,) or the reverse, (giants.)
13. Dysentery, Bowel Complaint.—This may be considered a tropical disease; but it is much more prevalent within certain ranges of longitude than in others. In the West Indies it is the cause of comparatively only a small portion of the mortality; but in the peninsula of India and the oriental islands, it is perennially endemic among all classes of the inhabitants, both indigenous and imported, and carries off a large portion of those who die of general disease. Dysentery is often combined with inflammation and consequent abscess of the liver. In some stations in India it has been ascertained by dissection that the liver evinces traces of disease in one-half of those who seem to have died of bowel complaint. The following remarks, therefore, in regard to the prevalence of dysentery, will, to a certain extent, apply to hepatitis. Dysentery affects Europeans, Africans, Singhalese, Malays, Gentoos, and Mussehmanns indiscriminately. The ratio of sick in European military hospitals in India commonly averages from ten to twelve per cent., and of this number one-half of the important cases generally suffer from dysentery. In many stations this affection is the cause of a moiety of the mortality. Sir George Ballingall, in the fifth appendix to his Practical Observations on the Diseases of India, has given a general statement of the sickness and mortality of the European troops at the principal stations under the Madras establishment, from 1st January 1807 to 31st October 1808, by which it appears that the number of deaths during the above period amounted to 1116, and in the following proportion of the several diseases:
Dysentery, . 575 51.5 per cent.
Fever, . 237 21.1
Other diseases, 206 18.4
Hepatitis, . 98 8.
Loss, . 1.
Under the head “Other Diseases,” are included 20 deaths on
voL. xxxviii. No. 113. z
account of ulcers, 21 in consequence of dropsy, and 34 on account of venereal ! A similar degree of mortality by dysentery took place in the Indo-Egyptian army, as will appear by the following statement of the number of deaths which occurred among the Europeans belonging to the Indian army in Egypt, from the time of embarkation to the return to India, and the relative proportion of deaths per cent. by particular diseases, to the general mortality:
Dysentery, 148 = 47.8
Liver complaint, . 64 = 20.6
Diseases unknown, 41 13.2
Plague, . 38 = 12.3
Fever, . 18 = 5.8
Diseases of the lungs, 4 – 1.2
Stroke of the sun, . — .6
Total deaths, - 315 100
The deaths which occur by this disease are more numerous than commonly appears on the returns; for in many instances, although men are admitted into hospital under the head fever, they finally sink from a bowel complaint. With the view, therefore, of estimating the extent of the mortality occasioned by dysentery in India, I shall assume that on an average one-half of the absolute mortality is caused by it. In the prosecution of this investigation, the first question to be decided is, what is the ordinary ratio of mortality? I am not aware that there has been said before the public a sufficiently extensive suite of returns of the absolute and relative mortality of the indigenous inhabitants of India by particular diseases, so as to convey a correct estimate of the degree of the prevalence of bowel complaint among that class of society. Recourse must therefore be had to returns of the troops employed in India, by which means we shall arrive at a close approximation of the truth. The following return is compiled from extensive data, and is intended to show the average ratmo of mortality among European troops employed in our possessions in Asia.
Return of the ratio of mortality among eighteen regiments while they were serving in India, the island of Ceylon, or Java.
Number of years compre- Mean mortality
Regiments. hended in the mean ratio per cent. per
of deaths. annum.
16th dragoons, 2 10.2
17th do. . 14 7.8
1st Royals, . 6 9.1
13th Regiment, - 7 19.5
19th do. . 24 7.4
20th Regiment. 7 6.
34th do . 20 7.7
47th do . 2 2.1
53d do. 6 6.4
59th do. 14 7.9
65th do. 22 6.8
69th do. 15 8.5
73d do. 3 28.1
78th do 19 11.3
83d do. 3 8.9
87th do. 12 11.6
89th do. 7 4.
Madras European Regt. 7 11.
General mean 9.6 per cent
The following returns corroborate the conclusions which have been drawn from the foregoing statement.
Abstract of Mr Annesley’s general returns of the sick of the Madras army for the year 1821.
Number of Deaths per cent of
Strength. deaths. the whole strength.
Europeans, 9553 604 6.3
Natives, 82046 1929 2.3
If, from the whole number of deaths which took place among the natives, the number who died of cholera, which was epidemic in 1821, namely, 830, be deducted, we shall find that the ratio of mortality is exactly 1.4 per cent. or about the same proportion that occurs among European troops in Great Britain.
The ordinary annual ratio of mortality among the native inhabitants of the peninsula of India may be inferred from the following statement of the population and deaths in two districts for one year to be about 1.5 per cent.
Ratio of deaths
Population. Deaths, per cent.
Madura, 245,654 3933 1.595
Dindigul, 295,654 3438 1.163
(Vide Medical, Geographical, and Agricultural Report of a Committee appointed by the Madras Government, &c. &c. &c. of which Dr Ainslie was president.)
In estimating the extent of the prevalence of disease among troops, not only the ratio of sick and the ratio of mortality should be considered, but also the ratio of men disabled thereby, and rendered unfit for the service. For this purpose, I have sub-joined an abstract of Dr. Burke’s annual numerical return of the European troops serving in the presidency of Bengal during the year 1826, and Dr Strachan’s return of the troops serving in the presidency of Bombay for the same year.
Ratio of deaths Number Ratio and loss
Presidency. Strength. Deaths, per cent. invalided. by invaliding.
Bengal, 7976 774 9.7 379 5.2
Bombay, 2793 305 10.9 185 7.3
Mean, 5384 539 10. 282 5.8
Assuming that one-half of the mortality and invaliding which appear in the above return was occasioned by dysentery, either simple, or combined with liver disease, 1 conclude that the army serving in Bengal and Bombay loses annually, on account of dysentery, 5 per cent. by death, and nearly 3 per cent. by invaliding. The same data warrant us in inferring, that the annual loss by disease and disabilities is about 14 or 15 per cent. per annum.
With the view of showing the ratio of deaths and discharges in the Madras presidency, I have added an abstract of the mean annual loss of the European force in the presidency by deaths and discharges, for a period of seven years, or from 1815 to 1821, inclusive, from Mr Annesley’s Sketches of the Diseases in India.
Mean Mean Ratio of deaths Dicharges. of discharges
strength. deaths. per cent. per rent.
Madras, 12592 794 6.3 514 4
Total annual loss, 10.3
It is worthy of remark, that the loss by invaliding in India, according to these returns, amounts to about one-half of the mortality, whereas the loss by invaliding among the troops in Gibraltar for a period of eight years was exactly three times that of the mortality, as will appear by tIme following statement.
Return of the mean strength of the troops employed in Gibraltar; the mean annual number of deaths, invalided, &c. from 21st December 1814, till the 20th December 1822.
Period. Mean Mean Mean deaths Mean number Discharged
Years. strength. deaths. per cent. invalided. per cent.
8 4000 47 1.1 148 3.3
14. Elephant leg, Barbadoes leg, Galle leg, or Cochin leg.
These terms are intended to denominate a specific disease which seems to be a result of some form of inflammation recurring periodically. A quantity of albuminous or seroalbuminous fluid is effused from. the exhalents into the cellular tissue of a limb, which is not removed by adequate absorption. The limb or other parts of the body which are affected becomes tumid, hard, and mis-shapen. Elephant leg is very rarely observed, except in the islands of Barbadoes and Ceylon, at Coelmin on the Malabar coast, in the Polynesian isles, where it takes the name of Yava, in Abyssinia, Arabia, and in the provinces of Castile, and the Asturias in Spain. According to Dr Hendy, elephant leg is a disease of recent occurrence in Barbadoes. He says it was first described about the commencement of the eighteenth century. In that island the disease affects white, as well as the black, inhabitants; the latter class most frequently. All ages and both sexes are liable to it. No part of the body is exempted from becoming morbidly enlarged, but the scrotum and inferior extremities are much more frequently implicated than any other. Dr Hendy states, that horses are liable to elephant leg in Barbadoes, and that it had been reported to him, dogs, horned-cattle, and poultry, were sometimes affected with it.
In Ceylon the elephant or Galle leg is almost exclusively restricted to the indigenous inhabitants of eighty miles, or about one-ninth of tIme coast of the whole island. That part of the coast where the disease occurs has a south-west aspect, and extends from Colombo to Matura. Galle, or Point de Galle, whence the disease derives its Ceylon name, is situated on a part of this coast. Galle leg does not extend inland. Creoles, Moors, and the native Singhalese, are liable to this affection, but imported Europeans, Africans, Malays, and even the inhabitants of the Peninsula of India, appear to be exempted from it. In Point de Galle, which is the principal village or garrison upon that part of the coast where the disease occurs, morbid enlargements are very frequent among all ages; perhaps one-third, if not one-half of the susceptible inhabitants are more or less affected with them. The upper and lower extremities and the scrotum are the parts of the body most frequently enlarged. In general, one limb only is affected in an individual, although sometimes two or more are diseased. None of time brute creation are liable to morbid enlargements of this kind in Ceylon. I have known persons who suffered under the regular paroxysms of fever which accompany the progressive increase of elephant leg, who escaped these paroxysms by changing their place of residence, from Galle to the northern part of the island. The disease recurred, however, when the individuals in question returned to Point de Galle. Elephant leg occurs sporadically in Ireland, and sometimes in Caithness and Ross-shire in Scotland. According to Dr Graves, the enlargement is most frequent in the upper extremity in Ireland.
15. Fever, Endemic, Yellow, or Remittent.—Yellow fever prevails chiefly in tropical climates, where the mean temperature of the atmosphere ranges from 70 to 80 or 81. It has never, I believe, been known to appear in temperate latitudes, unless the atmospheric beat has for some time been equal to the mean temperature within the tropics. When the fever has become epidemic in North America, the coast of Spain, or the Greek Archipelago, it has invariably disappeared on the approach of winter. Yellow fever seems frequently to be intimately connected with other less obvious, and indeed wholly unknown causes, the range of the disease being often limited to a confined space. Under similar circumstances, in regard to temperature, it is much more prevalent in certain degrees of longitude than in others; and it is more apt to spread among the inhabitants of crowded communities than where the population is less dense.
Endemic fever prevails to a much greater degree in the West than in the East Indies. In the West Indies, perhaps, from 70 to 90 per cent. of the mortality which occurs among Europeans is the result of fever. From a statement furnished by Dr Dancer of the patients admitted into the Public Hospital, Kingston, Jamaica, from the 1st of November 1807 to the 31st of October 1808, we learn that 266 died; and the following table is calculated to show the relative proportion of mortality by each disease
Number. Per cent.
Fever, – 200 = 75.1
Pectoral diseases, - 12 = 4.5
Dysentery, - 17 = 6.4
Thirteen other diseases, 14 = 5.2
Surgical diseases, - 23 8.6
Loss, – - .2
The predominance of fever over every other fatal disease in the West Indies is strikingly illustrated by the following abstract of Dr Adolphus’s return of the strength and mortality of the troops serving in Jamaica from the years 1823 to 1825, both years included.
Period Mean Mean Ratio of deaths
years. Strength. deaths. per cent. per an.
2677 371 13.9
Causes of death Number. of deaths by each
Fever, – - 341 90.1
Pulmonic diseases, 15 4.
Bowel complaint, - 12
Hepatitis, - 3 .8
Loss, - 1.9
Total, - 371 100.
According to Dr Adolphus’s quarterly return of the year 1825, including the months of October, November, and December, 300 deaths occurred during that period, of which 295 were in consequence of fever.
If we assume that 90 per cent. of the deaths which happen in the army in the West Indies is occasioned by fever, the following returns will enable us to estimate the mean loss among the troops by this disease.
By Bohingbroke’s “ Table of Deaths by Disease in the British Army serving in the West Indies,” during a period of seven years, or from 1796 to 1802, inclusive, the mean annual ratio of mortality amounted to 22.3 per cent.
According to materials published by Dr Robert Jackson, it appears that the mean annual ratio of the mortality which took place among the troops serving in the windward and leeward islands, and the British colonies, or time coast of America, for a period of twelve years, or from 1803 to 1814 inclusive, was 12.6 per cent.
Return of the mean strength and mortality of the European troops employed in the West Indies and British colonies, America, from 1810 to 1828 inclusive, from data furnished by order of the Honourable the House of Commons.
Windward and Lee-years. Strength. Deaths. Ratio of deaths
per cent. per an.
Ward Island stations, 19 5768 657 11.3
Jamaica, - 19 2528 392 15.5
I have not been able to obtain an extensive series of returns of the mortality of the troops employed by the French government in the West Indies; but, according to the materials furnished by Monsieur Moreau de Jonnes, it appears that during the period included between the years 1802 and 1807, the mean annual mortality amounted to 30.2 per cent. of the whole strength. Subjoined is an abstract of the returns for these years.
Return of the mean annual strength of the French army employ.. ed in the islands of Martinique and Guadeloupe, the number of deaths, and proportion of deaths per cent. from the year 1802 to 1807 inclusive, compiled from returns published by M. Moreau de Jonnes
Years. Strength Deaths. Proportion of
deaths per cent.
1802 4010 2394 57.
1803 4686 1674 35.7
1804 3421 1005 29.3
1805 5169 2090 40.4
1806 5102 463 9.
1807 4959 622 12.8
Mean of 6 years, 4558 1374 30.2
346 Mr Marshall’s Sketch of the
16. Female Precocity.—Dr Mason Good asserts, that “menstruation has sometimes, under the influence of a tropical sun, shown itself as early as eight or nine years of age ;“ and he adds, “ we have numerous and well-authenticated instances of pregnancy itself occurring at the early age of nine.” It ma y be doubted whether tIme precocity here noticed was materially promoted by a tropical sun. In Ceylon time menses seldom appear before thirteen or fourteen years of age; amid I do not recollect of hearing of an instance of pregnancy under fourteen. Persons who have resided in the oriental islands are enabled to speak with some confidence on this subject, because the first appearance of the menses among the females of the half-caste is frequently celebrated by a feast; so that, instead of considering this process of nature a delicate topic, they adopt various means to make it public. In some parts of India the event here alluded to is regularly promulgated in the public bazaar or market-place.
It is not unusual in India for children of eight or nine years of age to be betrothed; but we are not thereby warranted in supposing that the circumstance is to be attributed to a “fore march of nature.” The betrothed children have no sexual intercourse until the female is a woman.
17. Filaria Medinensis, Guinea Worm.—This disease occurs chiefly in tropical climates. It has been observed in Africa, India, Arabia, the West Indies, and South America, and, according to some authors, it has occurred in the southern parts of Europe; but I am not aware that it has been recently noticed in this quarter of the world.
Guinea worm seems to be occasionally epidemic as well as endemic. So prevalent is it in some seasons in the west Indies, that 300 out of 500 negroes have been laid up with it at the same time in one of the Grenadines; and in Grenada, it often happens that 50 negroes out of 300 are in the sick list on account of it. During a voyage from Calcutta to Judda, in the Red Sea, Sir James M’Grigor informs us, that 199 cases of Guinea worm appeared out of’ 360 men of the 88th regiment; and several cases occurred among time ship’s crew.
18. Framboesia, Yaws—This disease is said to be endemic on the west coast of Africa. Since our intercourse with Guinea, the disease has appeared in the West Indies, “ where no habit, age, sex, or country, is proof against the contagion of yaws once in his lifetime.”—(Dr Wright.) In healthy subjects the disorder will arrive at its height in about a month but in persons that are sickly, not sooner than three or four months. Dr Adams thought he saw a case of yaws in Madeira, in a gentleman who had lately left the West Indies; but his conclusion respecting the diagnosis of the disease has been doubted. rfhe yaws seem never to have been observed in a temperate climate.
19. Fungus Haematodes.—A case of this disease has lately l)een observed in India; but, so far as I know, it is extremely rare in tropical climates.
20. Gout is chiefly a disease of temperate climates. It is rare in China and Arabia, which is not the case in Persia, where, among those who do not follow the rules of the Koran in regard to temperance, it is by no means uncommon. Dr Ainshie, who resided more than thirty years in India, says, “ I do not think that I ever knew but one Hindoo who had a well-marked gout: the Mahometans are not so fortunate in this respect. Those Europeans who are subject to the attacks of it have, for the most part, long intervals betwixt the fits and when they do come, they are generally slight.” Dr Dancer makes a similar report in regard to Jamaica. The gout,” he says, though it sometimes occurs, is not so severe as in northern countries.”
21. Hemeralopia, Day-Sight, Night Blindness, Tropical Nyctalopia, are all names which characterize an affection of the eyes, by which vision is rendered more imperfect in moderate light, such as during moonlight, than in health. Night blindness not unfrequently affects troops upon arriving in a tropical climate. European sailors, when employed between the tropics, are very liable to it; so are Lascars (Indian seamen.) Sometimes as many as one in twenty British sailors are thereby rendered unfit for duty. The natives of India are occasionally liable to this affection. Hemeralopia is said to be frequent in the British West Indies and Poland. Poultry, and indeed almost all day birds, seem to be naturally hemeralopic.
22. Hepatitis—This disease, which frequently terminates in abscess, is more prevalent in tropical than in temperate climates, especially in the peninsula of India and the oriental islands. Inflammation of the liver affects especially Europeans, but the indigenous inhabitants of these countries are by no means exempted from it. Hepatitis is often combined with inflammation and ulceration of the mucous membrane of the colon, which constitutes the dysentery of tropical climates. Of the numbers who die apparently of dysentery, the liver is, in all probability, obviously disorganized in about one-half. The influence of climate in changing the character of the diseases to which troops are liable in this country, and on board ship during a voyage to India, becomes soon evident after their arrival. I have seen tropical dysentery, combined with abscess of the liver, occur among troops in less than ten days after they had landed.
23. Hernia umbilicalis.—The natives of the central region of Africa are almost universally liable, in a greater or less degree, to this affection. They are rarely if ever incapacitated for labour by it.
24. Hydrophobia.—This disease has been chiefly observed in Europe. It has, however, never been described as occurring beyond the Arctic Circle, and indeed, according to some authors, it is seldom, if ever heard of, at Archangel, Tobolsk, or in the country north of St Petersburghi. It has never been observed at Constantinople, Syria, or Egypt. Hihlary states that he saw some cases of the disease in Barbadoes. It is, however, a disease which is extremely rare in the West Indies; I believe that in many of the Islands it has never been noticed. Valentin asserts that it is extremely rare in the warm regions of America, but common in the northern part of that continent. Rabies occurs in India but not often. According to B arrow the dogs in time vicinity of the Cape of Good Hope very rarely go mad.
25. Hydrocele.—This disease is certainly more frequent in tropical climates than in temperate latitudes.
26. Influenza, Djluence; Catarrhus Epidemicus.—This disease has appeared as an epidemic in Europe about fourteen times during the last three centuries. We know nothing of the country whence influenza has at any time taken its rise. The epidemic of 1781 and 11782 was, however, supposed to have originated in China. the disease travelled through Asia into Europe, whence it crossed the Atlantic and arrived in America the following year. In this instance the epidemic travelled from east to west; it has frequently, however, seemed to proceed from north to south, and sometimes from west to east. Has influenza ever visited the Indian Archipelago, Africa, or South America?
27. Insanity, Mental aberration.—This affection occurs in all parts of the world, but it is particularly prevalent among the imported inhabitants of low latitudes where the temperature of the atmosphere is high. Pinel, Cox, and Dr Arnold, authors who have devoted much attention to the pathology of mental derangement, consider inordinate heat a powerfully exciting cause. Examples in proof of this opinion are of frequent occurrence.
28. Intestinal Concretions.—One variety of this class of calculi is peculiar to Scotland. Dr Wollaston discovered that it is chiefly composed of a portion of the grain of oats.—(Vide Dr Marcet’s Essay on Calculous Diseases.)
29. Itch, Scabies.—This “ is an almost universal complaint in Iceland, appearing indiscriminately among all classes of the inhabitants; no discredit is attached to it, nor does it seem that any means of cure are attempted.” (l)r Holland.) A similar statement may be made in regard to the prevalence of itch among the inhabitants of the Malabar coast of the peninsula of
Geographical Distribution of Diseases. 349
India. All over India and the oriental Archipelago the scabies purulenta is known by the term “ Malabar,” probably from the almost universality of the affection among the inhabitants of that coast. It is scarcely possible to conceive two classes of people, situated under equally different circumstances, as the inhabitants of Iceland and India; not only in food and temperature of the climate, but in habits so far as regards ablution, &c. &c.
According to Dr Schotte, the “ itch is annually during the rainy season (at Senegal) endemic among the blacks, but particularly among the young ones.”—” The disease yields to the external use of sulphur; but the blacks seldom take any thing for it, as it commonly disappears spontaneously after the rainy season is over.” The inhabitants of Senegal, like the natives of tropical climates in general,” are constantly bathing and washing themselves.”
30. Kriebel Krankheit, the Raphania of Linnaeus, Vogel, Cullen, and Dr Good, and which the latter authors define a “ spastic contraction of the joints with trembling and periodical pains.” This disease is supposed to be restricted to the shores of the Baltic and a few other places on the continent of Europe. In 1595 and 1672, it appeared in Westphalia and the countries bordering on the Rhine; and about the year 1770, it became epidemic in the neighbourhood of Cologne and the Hartz. The heading symptoms of the epidemic of 1770 were paroxysms of insensibility, which sometimes lasted for a quarter of an hour, and occurred several times in a day, convulsions, headach, and during the intermission, tile patient had, a remarkable craving appetite. Gangrene happened in some cases.
31. Tubercular Leprosy.—The diagnosis of this disease is frequently not sufficiently attended to by authors, and by that means their account of the affection is often not specific or satisfactory. The tubercular leprosy of the Arabians occurs in Iceland; but Dr Holland, who is the chief authority on this subject, does not say how far it may be called a prevalent disease. “ With the exception of three hospitals, in which a few incurable lepers receive gratuitous support,” he tells us, that “ no medical institution exists on the island.” Pallas informs us that the inhabitants of the Crimea, Astrakan, and the Ural Mountains are liable to leprosy. This affection seems to be particularly prevalent in Madeira, and along the south coast of the Mediterranean. It would seem to be a very rare disease in Gibraltar, for, of 16,293 patients treated by the officers of the Civil Hospital, not one case of leprosy appears on the returns.
Leprosy occurs among the indigenous inhabitants of India and oriental islands; but it does not seem to be so frequent as cacabay, with which it is often confounded. Europeans are almost never affected with leprosy in India, but Creole whites are liable to it. In 1825, a soldier belonging to a regiment in India was admitted into Fort Pitt General Hospital, Chatham, on account of well marked tubercular leprosy. According to his own statement, the affection appeared during his passage from India. Perhaps this is the only case of leprosy which stands on the books of’ the Fort Pitt HospitaL Leprosy is extremely rare in Great Britain. Dr Bateman tells us, lie never saw but two cases of it.
32. Ophthalmia.—This disease is said to be very common in the frozen regions of’ the north,—a circumstance which may depend rather upon reflected light than upon sublunary or terrestrial agents. Inflammation of the eyes is constantly endemic in Egypt, and the affection is not limited to men; for dogs, asses, camels, oxen, and horses, are liable to it. (Journal of Cairo, year viii.)
Ophthalmia is also said to be very prevalent on the Cordilleras and the mountains of Peru. (Le Blond.)
33. Pellagra, Italian Leprosy.—In this disease the skin is scaly ; and, during the progress of’ the affection, vertigo and mental alienation supervene. Pellagra is endemic in the Milanese and Venetian territories, but beyond the boundaries of these countries it is scarcely ever seen.
34. Plague.—This disease appeared last in Scotland in 1645, in England as an epidemic in 1665, in France in 1 720, in Moscow in 1771. Ever since it has been restricted to the islands and neighbourhood of the Mediterranean sea. Plague seems to be perennially endemic in a certain extent of country, the centre of which is the eastern boundary of the Mediterrainean. The disease commonly begins in November in Egypt, and continues its ravages during the winter and spring. As the summer approaches its symptoms become milder; and on the 24th June the Turkish government announces to the public, by a discharge of cannon, that the epidemic has ceased. In Constantinople it prevails chiefly in summer, and, unlike the Egyptian plague, it ceases during winter.
85. Plica Polonica.—” Hairs vascularly thickened and matted by the secretion of’ a glutinous fluid.” This disease is said to be endemic in Poland, Lithuania, Hungary, and Transylvania, from the source of the Vistula to the Carpathian Mountains. It occurs also in Prussia, Russia, Switzerland, and in some parts of the low countries.
36. Pyebald skin.—Pyebald skin is not an uncommon affection in India among the indigenous inhabitants, and among the black inhabitants of tropical climates in general. The absorption of the pigment is sometimes sudden, as during a paroxysm of’ disease; commonly, however, it is progressive, and continues during life. A priest who lately belonged to one of the Buddhist temples in Ceylon had become completely white, except a small black spot near to the right eye. The white patches of pychald skin have an albino whiteness, resembling the nose of a white horse.
37. Puerperal Peritonitis.—T his disease is, I believe, chiefly confined to temperate latitudes. I d0 not know that it has been observed in a tropical climate.
38. Radesyge, Northern Leprosy.—This affection of the skin is nearly allied to the Arabian or tubercular leprosy. It has been chiefly observed in the Feroe Islands, Scandinavia, and the Duchy of Holstein.—(Edinburgh Medical and Surgical Journal, viii. 116.)
39. Rickets, Cretinism.—Rickets. This disease was first described by Glisson in the seventeenth century, when it was observed in the western counties of England, and it is therefore presumed that the word has a Saxon origin,—probably hreac, ricq, a heap or hump,—and hence the term humpbacked. Rickets is not much known except in Great Britain, Holland, the northern parts of Italy, and the north of France.
Cretinism, which is generally combined with goitre, seems to be a variety of rickets. It has been chiefly observed in the vallies of the Alps, the Pyrennees, and some of the mountainous parts of Germany and Spain. Sir George Staunton saw it in Chinese Tartary. Cretinism has been supposed to be a consequence of indigence and poverty. It is, however, remarkable that privations and impure air often exist to an extreme degree without producing the disease in other parts of the world. I have lately learned that Cretinism and goitre are prevalent in a small sheltered village on the coast of the Island of Arran.
40. Trismus; Tetanus.—Trismus is much more common among infants in hot climates than in temperate latitudes, more especially in the settlements of Demerara and Essequibo, where, according to Dr Hancock, one-half of the new-born children die of this disease. I am not, however, convinced that the tetanus which originates from wounds is more frequent in warm than in cold climates. At the capture of the Isle of France a number of men were wounded, but not a case of tetanus followed. When Java was captured, a great number of the troops were severely wounded, and only one case of tetanus took place. During the insurrection of the Kandyans in 1817 and 1818, only three cases of the disease occurred, although a great number were wounded. Tetanus is not very frequent on the peninsula of India, and it is said not to be known at the Cape of Good Hope.
Horses are very liable to traumatic tetanus in Ceylon, Java, and the peninsula of India; and many die from time disease, which occurs after the operation of docking.
41. Varix.—Varicose veins of the legs is very rare in India, except among the Palanquin-bearers, who are “ fired” for the cure of the affection by the native doctors. Perhaps this mode of treatment may have given rise to the recent plan of employing caustic.
42. Worms (intestinal.) The long round worm (Ascaris lumbricoides) is much more frequent among the inhabitants of india than those of temperate climates. Europeans and Africans are likewise very liable to worms in India. I have seen an African who in one day passed 40 worms, and 200 in a week. Purgatives frequently expel worms where their existence had not been suspected. Worms are said to be frequent among Africans in the ‘West Indies. When a body is inspected within ten or eleven hours after death the worms are generally found alive. The tape worm is occasionally met with in India, but not frequently. One variety of this worm, the Taenia Solium, is common in Italy, and, according to report, in Egypt also. The Taenia lata is very frequent in France, Switzerland, and Poland, probably much more so than in any other part of the world.
In this article the term Disease has been employed in a very widely extended sense, for which I hope to be excused.
I am well aware that this is a very imperfect sketch of the geographical distribution of diseases; a circumstance which may in no small degree be attributed to the deficiency of available materials. Were an abstract of the “ valuable records,” now in the public offices, regarding the health concerns of the troops employed in the different stations under the British government, published, so as to render the facts accessible to the medical profession at large, and an abstract of the subsequent reports made public at regular intervals, a body of information would soon be collected which would afford excellent data to illustrate this highly interesting and useful branch of medical science. When military returns are compiled with care and accuracy, the information they convey is more correct and satisfactory than that obtained from any other source.