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 modern 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-Huropean 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, Ill., and attacking with virulence the city of Memphis, 
Tenn. In this year there were 125,000 cases and 12,000 deaths. In 1882 there 
