Addenda. 
naturally expect to find that malarial infection was comparatively a rare event there. And this is precisely 
what we do find. All my enquiries from local medical men and colonial surgeons led me to believe that 
there had been no case of "original infection" for two and a half months before I arrived. During 
this time there had of course been " recurrent cases," though these had not been numerous — only thirteen 
among Europeans. These, I venture to say, are important points ; but I do not wish to lay too much 
stress on them, for I full}- realize that it would be rash to draw too rigid conclusions from observations 
carried on o\'er so limited a time ; but it is, in conjunction with facts observed elsewhere, at least 
significant of the influence of the mosquito in the propagation of malaria. 
It should be noted in this connection that all authorities, in each of the three Colonies that I 
had the opportunity of visiting, agreed that 1899 had been an exceptionally healthy }ear ; so that 
probably the number of fever cases was below the average. 
Thanks to the efforts of the present Governor — Sir Frederick Hodgcson— the official population 
is now better housed : spacious and well-ventilated bungalow s have been provided, and these have 
been removed nearly a mile eastward, so that the native town ^vith its squalor and overcrowding is 
no longer the menace that it \vas {I'ide Map III.). On the other hand, many of the habitations of 
the commercial population arc badly built and badly ventilated ; some are still in close proximity to 
the native huts, and some to that part of the sea-shore which I shall refer to again as practicallj- a 
public latrine. To improve the sanitary condition of the native town much has recently been done 
in some districts. A fire in 1896 burnt down many of the huts in one part, and afforded an opportunity 
of opening up the maze of squalor that previously existed. Broad streets were laid down, a partial 
system of drainage started, a stinking pool in the market place filled up and better houses built — \vith 
the result that disease of all kinds in this district diminished. Several districts remain in all their 
primitiveness, and similar treatment could not fail to bring about a marked improvement. But the 
Government, though alive to its responsibilities in this matter, are handicapped b\- a want of 
money for the purpose, and also not a little by restrictions imposed at home by a mistaken and 
sentimental regard for what arc called " native rights." Alread}- so much has been done with 
good results that, in my opinion, advanced \vith the greatest diffidence, Accra is not the death-trap 
its reputation would warrant one to believe. This reputation has been built up parti)- by the many 
cases of sickness imported from the hinterland ; and to get a right conception of the general health 
of Accra it is necessary to draw a distinct line between the seat of government and the northern 
territories of the colony. I do not mean to say that it will ever become a health resort, nor do I 
think it would be wise to extend (as has been by some suggested, including the late Governor, Sir 
William Maxwell) the length of the "tour" of service. I'he climate, quite apart from any specific 
disease which may there exist, has a definite reducing and depressing effect on European constitutions. 
However healthy a man may be on his arrival on the Gold Coast, sooner or later he becomes ana:mic 
or dyspeptic, and often his nervous s)'stem is so affected that a condition of extreme irritability is 
induced ; insomnia often follows, and he becomes totall) unfit for \\ork. 
It should not be overlooked that the difficulty — often impossibilit}- — of procuring fresh meat and 
vegetables is after a time a serious tax on any constitution, however strong. There is a \videspread belief 
that alcoholism is rampant on the West Coast ; I may say here that, though I had good opportunities of 
judging, I did not find it so in any of the three Colonies I visited. 
That part of Accra known as the "native town" (rvV/r Map III.) needs further consideration here, 
in order to make it clear that what I have already said ma)- not seem exaggerated, and that it is in fact a 
standing menace to the health of the community at large. 
In this part of the town there are no streets. Winding allc\s, unpavcd, and so narro\\- that t\vo 
persons cannot stand abreast, do dut)' for streets. These alle}-s luave interminable ramifications, and form 
so complex a maze that it was found impossible b)- the survc) ing authorities to chart them. Numberless 
naked children disport themselves in these gutters, and man)- mang)- dogs arc seen wandering about under 
no control. In addition to these, sheep and goats of a more or less unhealthy appearance roam the 
byeways. Filth of all sorts is found lying broadcast in the alle)-s ; stinking garbage, decaying vegetables, 
