EPIDEMICS OF YELLOW FEVER 325 



lation of India was 13 per thousand. With improved methods of living and 

 more skillful treatment this has been reduced to 7 per thousand ; but the native, 

 who is slow to change his ways, and usually averse to modem methods of treat- 

 ment, still retains a very high fever death-rate — over 18 per thousand. . . . 



" Apart from the mortality due to this disease, the amount of suffering and 

 the decline in human power and activity which it entails deserve careful atten- 

 tion. Compared with the number of patients, the number of deaths is by no 

 means large. In round numbers, out of every thousand soldiers in the British 

 army in India in 1897, 420 men were attacked by malaria, but only one in a 

 thousand died ; even in the ' most malarious ' districts the death-rate only 

 amounted to 6 per thousand. In Sierra Leone, a district much more fatal than 

 any in India, the average death-rate of the white troops, based on hospital records 

 extending from 1892 to 1898, is estimated by Major L. M. Wilson at 42.9 per 

 thousand, whilst that of the coloured troops is 5.9 per thousand. On the other 

 hand, the European troops show an annual number of cases of 2134 per thou- 

 sand, and the non-European troops one of 1056 per thousand. These figures 

 probably under-estimate the amount of fever amongst the troops. It must be 

 remembered that many soldiers who have slight attacks of fever do not present 

 themselves at the hospital, whilst of those who do a considerable number are 

 only detained for slight treatment, and are never entered on the hospital books, 

 and so are not recorded on the returns. 



" From the statistics quoted above, it appears that of our soldiers in India 

 three out of every seven suffer from an annual attack of malaria sufficiently pro- 

 nounced to be recorded on the medical books, whilst our soldiers on the west 

 coast of Africa have an average of at least two attacks a year, and a considerable 

 number of them die. There is no reason to believe that the civil population of 

 India or West Africa is in any degree more exempt from the disease than the 

 military, but the statistics in the latter case are more readily accessible. 



" Malarial fever, when it does not kill, leaves great weakness behind; and all 

 who have watched malaria patients, or patients who are already recovering from 

 an attack, cannot fail to have noticed the listlessness and want of interest in 

 their surroundings and the lack of inclination to work that they all show. Apart 

 from the mortality, the disease probably levies a heavier tribute on the capacity 

 of the officers and officials who administer the British Empire than does any 

 other single agency." 



LOSS FROM YELLOW FEVER. 



In the publication already mentioned the senior author has discussed the effect 

 of yellow fever on the welfare of the United States as follows : 



" Yellow fever has prevailed endemically throughout the West Indies and in 

 certain regions on the Spanish Main virtually since the discovery of America. 

 Barbados, Jamaica, and Cuba suffered epidemics before the middle of the 

 seventeenth century. There were outbreaks in Philadelphia, Charleston, and 

 Boston as early as 1692, and for a hundred years there were occasional outbreaks, 

 culminating in the great Philadelphia epidemic of 1793. Northern cities were 

 able, by rigid quarantine measures, to prevent great epidemics after the early 

 part of the nineteenth century, but from the West Indies the disease was 

 occasionally introduced and prevailed from time to time epidemically in the 

 Southern States. In 1853 it raged throughout this region, New Orleans alone 

 having a mortality of 8000. The last widespread epidemic occurred in 1878, 

 chiefly in Louisiana, Alabama and Mississippi, but spreading up the Mississippi 

 Valley as far as Cairo, 111., and attacking with virulence the city of Memphis, 

 Tenn. In this year there were 125,000 cases and 12,000 deaths. In 1882 there 



