SANITARY AND MEDICAL CONDITIONS: PREVAILING DISEASES 199 
attacks of the disease — a greater tolerance or immunity to the malady so prev- 
alent and fatal at Mesurado at that time, than those coming from the northern 
part of the United States. 
Undoubtedly many among the population of Liberia of today have through 
long residence either become more or less immune both to malaria and to yellow 
fever, or have acquired greater tolerance to these and certain other infectious 
diseases prevalent in tropical countries, for otherwise there would be a higher 
morbidity and higher mortality among them from such affections. 
The situation in the matter of sanitation is perhaps unique. There is among 
the Liberian people no health organization of any sort anywhere in the country, 
no public health laboratory of any description, and no adequately trained sani- 
tarian or physician. The Government had selected a two-storied house formerly 
used as a residence in Monrovia, as a hospital while we were there, and had placed 
in it a few beds, several of which were occupied by patients in charge of a poorly 
qualified Liberian physician and a Liberian nurse.!' This apparently is the only 
gesture that the Liberians have made with reference to the question of hospi- 
talization and the care of the sick. In Monrovia there is no general system of 
sewage, disposal or drainage, no running water in the houses, and no general 
water supply. The drinking water is derived from wells and cisterns, and in the 
porous soil of the same back yards are both the well or cistern and the latrine. 
The latrines are not protected from flies. Anopheles, Stegomyia, and Culex 
(fatigans) mosquitoes were found breeding plentifully in many parts of the town 
and on its outskirts, particularly in the gutters at the sides of the streets, in the 
water in the back yards, and in the wells or cisterns in the yards. Food, both 
raw and cooked, is commonly exposed for sale in the open-air restaurants along 
the main business street, and is never protected from flies. Only in several 
houses of the whole town has any screening against insects been done, and mos- 
quito nets are not in general use at night. That more residents are not actually 
ill, and that there is not a higher morbidity and mortality from dysentery, ty- 
phoid fever, malaria and filariasis is obviously due in part to tolerance and im- 
munity. There are, of course, no public health statistics, no records of illness, 
births or deaths. However, our examination of the Kru children at Monrovia 
gave evidence of the high rate of infection with malaria among them, as no less 
than eighty-seven per cent were found to have malarial parasites in their blood. 
Since the majority of the children were not confined to bed, but were up and 
about, and showed little evidence of disease, it would appear that many of them 
had already acquired more or less immunity to the action of the malarial parasite. 
Medical Conditions in Liberia. 'The medical and sanitary responsibilities 
in Monrovia for some years past have fallen upon two European doctors residing 
in that city, — Dr. G. Bouet, who has also acted as Chargé d’ Affaires and French 
Consul for Liberia, and Dr. Fuszek, an Hungarian physician practicing in Mon- 
rovia. Fortunately both of these gentlemen have special knowledge of tropical 
1 Since the above was written, and as a result of considerable pressure, I am informed a Government 
hospital has been established in the building of the abandoned German cable station at Monrovia, 
containing about twenty beds, and with fairly modern equipment but still without a properly qualified 
physician. 
