30 Medical Report on the causes 



left to the assiduity of the Medical Officer : but all his effects will be 

 nullified, his energies frustrated, and he himself will experience the 

 mortification of a failure in a good and benevolent cause, if his varied 

 efforts are not warmly and energetically seconded by the executive. 



1 1 . The following are amongst the principal causes which produce 

 Endemic disease : — Geographical and relative position ; imperfect 

 drainage, and diseased vegetation with their united effects ; impure 

 water and food, combined with an imperfect ventilation and crowded 

 population. The operations of the mind, which in a civilized country 

 exert so powerful an influence on the inhabitants in predisposing to 

 disease, is of so little importance, and the effects are so slight in a bar- 

 barous people, that its consideration does not require any prominent 

 attention in a local report like the present. The other causes of disease, 

 however, previously mentioned, will be considered with reference to 

 Akyab ; and the importance of this consideration is considerably in- 

 creased, when it is mentioned, that the same causes which induce 

 Endemic disease, exert a very material influence in propagating the 

 Epidemic form, not only in number but severity. 



12. The geographical and relative position of Akyab, is peculiarly 

 adopted for the development and propagation of disease, being ex- 

 posed to all the violent and sudden changes of heat and rain, which is 

 only experienced in a tropical climate situated on a loose, sandy soil, 

 with an elevation but little beyond high-water mark ; bounded on 

 three sides by jungle, jheel and marsh, and on the fourth, by an 

 estuary ; with the wind blowing for nearly half the year over hundreds 

 of miles of unexplored jungle, previous to reaching the station ; and 

 marsh miasma and noxious gases of every description, the result of 

 animal and vegetable putrefaction rising in every direction. All these 

 considerations point out the situation as being highly detrimental to 

 health ; but at the same time demand the most active measures to 

 endeavour to counteract the evil influence of a position which cannot 

 be remedied, but which has been, and still can be, much improved by 

 human exertion and perseverance. 



13. In alluding to diseased vegetation and imperfect drainage, it 

 will not be irrelevant to the question, to consider, that healthy vegeta- 

 tion in the exercise of its functions, exerts a beneficial influence over 



