HEALTH AND POPULATION 587 



medical services, and there are not many stations now which do 

 not either have a resident medical officer or receive frequent visits 

 from one, while private practice and nursing homes are well 

 established in all urbanized, industrial, and closely settled agri- 

 cultural areas. In the principal towns, where white population 

 is large, hospitals reserved for Europeans are as good, or nearly 

 as good, as anywhere in the tropics, and subsidiary European 

 hospitals are established in nearly every township in the settled 

 areas. 



On the much-debated question of deterioration in health under 

 tropical conditions, a few figures may be quoted from H. E. Rayne 

 (1930), showing the enormous improvement which has come about 

 during the last forty years. The most accurate data are for civil 

 servants in the Gold Coast and Nigeria: in 1881-97 the annual 

 death rate per 1,000 was 75-8 in the Gold Coast, and 53-6 in Lagos. 

 Since then there has been a steady and rapid decline, only inter- 

 rupted during the war years as a result of overwork and lengthened 

 tours. In 1925-8 the death rate was 6'5/i,ooo per year at the age 

 of 25, 1 2' I at the age of 45, and 9-3 at ages over 50 (the last figure 

 is perhaps misleading since many officers retire before 50 years of 

 age). Similar figures could be quoted for other tropical depen- 

 dencies, but the improvement is not so striking because the initial 

 mortality rate in East and Central Africa was not so high as on 

 the West Coast. Of course all classes of the European community 

 do not enjoy the same health; for example, missionaries as a group 

 have a comparatively high mortality and invalid rate. This is 

 sometimes interpreted as the result of a low standard of comfort, 

 but may equally well be due to the greater risk of infection 

 for persons in close contact with the native population. Figures 

 show that in recent years the mortality rate for retired officials 

 is not appreciably higher than the normal for Great Britain for 

 similar age periods. Mortality rates in the Belgian Congo remain 

 somewhat higher than in British Africa. This must be partly, 

 perhaps wholly, a result of the larger proportion of European 

 children in the Belgian territory, since children in the tropics have 

 always a higher mortality than adults. 



The great improvement of health in Africa among Euro can 

 has clearly resulted from an all round improvement in the stan- 



