CHAPTER XVIII

SANITARY AFFAIRS IN WEST AFRICA

(By Major RONALD ROSS, F.R.C.S., F.R.S., C.B., Liverpool School of Tropical Medicine.)

The first question which any one who has studied the history of West Africa will ask, is this—Why has the country developed so slowly? It is actually nearer to Europe and more accessible than several tropical countries, which have certainly progressed far more towards civilisation—such as the West and East Indies, Central America and the seaboard of China; it is, generally speaking, a rich country; with a fertile soil, sufficient rainfall, large rivers, good harbours, fine, well-watered plains, a vast population, and a climate not excessively hot. One would expect to find here flourishing settlements, large cities, a prosperous agriculture and a great commerce; but what we really have is a series of second-rate, if not third-rate, settlements which are just able to hold their own in the midst of the forests and marshes which surround them; and a native population which can scarcely be considered other than barbarous beyond a short distance from the settlements referred to. The discrepancy between the expectation and the fact is remarkable. India, for example, with her vast tracts of well-cultivated lands, her cities, her ports, her universities, her thousands of miles of railway, her society, and her well-organised Government is far indeed above West Africa. If the best West African province could be transferred bodily to the East and placed alongside even such outlying parts of India as Assam and Burma it would look very shabby in comparison. The principal West African towns seen by me, Lagos, Accra, and Freetown, cannot for a moment be compared with the great Indian capitals and stations such as Calcutta, Bombay, Madras, Rangoon, Secunderabad, Allahabad, Delhi, Benares, Pindi, Lahore. In general appearance, construction, and style of living they are on a level with such “benighted” spots as Moulmein in Burma, Nowgong in Assam, or Masulipatam in Southern India. West Africa possesses no Simla, Bangalore, Darjeeling or Ootacamund.

The whole country reminds one chiefly of the derelict Coromandel Coast minus its principal city. Yet it may perhaps be doubted whether in extent, fertility and natural resources West Africa is really far below India. Europe has been trading with West Africa for centuries; it has long drawn from it many valuable commodities; it has explored it and made settlements in it which have lasted for hundreds of years. Why has not Europe done more for it, then? The question is really one of great importance in the philosophical history of civilisation, especially in these days when civilisation tends so strongly to overflow from the temperate climates into the tropical ones. Here we have two countries equally gifted with natural resources and equally exposed to the civilising irradiance of Europe. Yet, while India is of itself already one of the great Powers of the world, the other still remains in the condition of a newly discovered continent, to be opened up in the future.

Of the three reasons usually assigned for this curious fact, the first generally given is that in India Europe found a certain degree of civilisation already existing before her advent; while in West Africa she started to work upon a completely barbarous country. No doubt this has much to do with the result; but we must remember that many countries now far ahead of West Africa were little or no less barbarous than West Africa a few centuries ago—such as many portions of tropical America, Burma, and the Islands of the Pacific. It can scarcely be said that the antecedent semi-civilisation of India and China has been always favourable to progress, nor that a basis of complete barbarism is always fatal to it. Another reason, perhaps more frequently given, is that the natives of West Africa are incorrigibly indolent. Yet it is by the labours of these very people, controlled by Europeans, that the prosperity of the Southern States of America has been established. In my humble opinion the West African should be very good material for civilisation. Compared with the East Indian, he is perhaps not so patient, laborious, or thrifty; but, on the other hand, he is much more vivacious and virile; he is not hampered by the restrictions of caste; he is physically strong and healthy; he is capable of producing men who are intellectually not a whit inferior to the average European; and above all, instead of adhering obstinately to his own customs as the Indian so often does, he always shows a remarkable desire for the customs and culture of Europe. In fact, I personally feel, though I may be wrong, that these people are better material for civilisation than East Indians, and I do not think that the backwardness of West Africa can be wholly or even largely assigned to defects in their character.

To many of us the real reason for this backwardness appears to be undoubtedly the so-called unhealthiness of the West African “climate” for Europeans. It is impossible to deny the fact that the European cannot live on the West African Coast in the same security against disease as he enjoys in the East and West Indies; and in my opinion it is this fact, and not the original barbarism of the natives, or their indolence, which retards progress here. The agent of civilisation dies on the threshold of the country which he comes to develop.

It would require a large volume to deal adequately with this important subject, and I can only attempt an outline here. We shall first ask what is the cause of this unhealthiness, and secondly, what is the remedy.

I shall not attempt to give any statistics of mortality among Europeans or natives, because what statistics exist are not at all reliable. But the fact that the country is extremely unhealthy for Europeans is universally accepted; and is, moreover, demonstrated by the high rates for life-insurance, by the large amount of leave which Government grants to its employés, and by the difficulty which all employers experience in obtaining European agents for West African work, even for high pay. In fact, the country is so notorious in this respect that it is unnecessary to labour the point farther.

What are the causes of the unhealthiness of West Africa for Europeans? The first series of causes are undoubtedly a group of infectious diseases, certainly or probably due to parasitic invasion of the body. These are principally what is known as malarial or intermittent fever, with its most dangerous variety, blackwater fever; various other fevers, dysentery, and according to many physicians, yellow fever. The first attacks the European with greater force than it attacks the habituated native, but nevertheless produces great havoc among native children. It is so prevalent that new-comers frequently succumb within a few weeks after arrival, while old residents often suffer from relapses during the whole of their stay in the country. In addition, epidemics either of this fever, yellow fever, or some allied disease, sweep through the settlements, causing great mortality among the Europeans; dysentery and bowel complaints are scarcely less to be feared in some parts. The records of West Africa are blackened by these terrible plagues, which time after time have blotted out the names of the most daring travellers, the most capable governors, and the most enterprising traders; which mutilate the lives of those whom they do not kill; and which hamper every political or commercial enterprise by striking down or intimidating the agents who are sent out to execute it.

But we must not imagine that these are the only factors of the total result. The heat and moisture of the climate are most enervating to Europeans. The general absence of good food—good meat, bread, vegetables, and milk—tends to produce dyspepsia and melancholy. The absence of most of the comforts and amenities to which Europeans are accustomed in their own home—good houses, good servants, society and exercise, not to mention the absence of wives and children—depress the mind; and when this general outline is filled in by such details as the ever-present dread of serious sickness, the constant stings of insects, the unsavoury surroundings of a squalid native population, it must be confessed that the colonist has much to depress him. What wonder if, in such circumstances, alcoholism and debauchery sometimes complete the sketch! The fact is, that what we call the “unhealthiness” of West Africa is a complex due to many causes which assist each other. People are apt to fall into a vicious circle from which it is hard to escape. I may say, indeed, that the whole of West Africa has fallen into this vicious circle and has not yet escaped from it. Let us consider the point farther.

When we find much sickness in a given country we are too inclined to think that the sickness is entirely due to certain natural conditions which are present in that country and which render it unhealthy. We forget that the sickness may be due, not to the country itself, but to the fact that the inhabitants do not take proper precautions against the diseases which persecute them. Now the whole trend of sanitary science has been to show in a convincing manner that the great infectious diseases are preventable, if only the proper precautions are taken. Time after time we have witnessed the entire disappearance, or at least the partial disappearance, of such diseases from whole countries. For example, small-pox and typhus have almost vanished from the great States of Europe—at least we may say so when we compare their prevalence in the past with their prevalence at the present day. Typhoid and diphtheria are diminishing daily. Malarial fever and dysentery, which were formerly scourges of parts of Britain, have almost entirely gone from the country. Even in the tropics we shall find numerous instances of the same kind. Calcutta was once a hot-bed of fever and cholera, and was probably as fatal to Europeans as West Africa is now said to be. Rangoon was deadly when the British first went there. A century ago cholera often swept away whole regiments in India. We now look in vain for this state of things. As a whole, India is perhaps as healthy for Europeans as England is—at least if we exclude the enervating effects of mere heat; and, indeed, I think that in some respects, in the absence of colds and chest complaints and in the benefits of open-air life and exercise, Europeans in India are more fortunate than their brothers at home.

Such facts alone clearly demonstrate that many diseases are not dependent upon natural factors beyond human control; but science has reinforced the argument by showing that a number of infectious diseases are due to microorganisms which spring from previously diseased persons and not from the air, soil, or water of localities. When, therefore, we speak of a given place being unhealthy, we merely mean that from some cause or other infectious disease is readily propagated from the sick to the healthy in that place. This may in part be due to the local conditions as regards heat, moisture, and so on being especially favourable to the transmission of the disease germs; but it may also be due to the fact that no precautions are taken to check this transmission.

Thus in the case of West Africa we may ask, Is the local sickness really due to the climate being specially favourable to the transmission of disease; or is it due to the neglect of proper precautions? I would not be prepared to say that as regards heat, moisture, and profuse vegetation—conditions long known to be particularly favourable to malaria—West Africa differs much from Calcutta or Rangoon. So far as nature goes I can see little difference between West Africa and other tropical regions which I have visited. On the other hand, I see the greatest difference in the mode of life adopted by Europeans in West Africa and in India; and I am convinced that the excessive mortality amongst them is due largely, if not principally, to this cause, added to the imperfect condition of public sanitation in the country.

My own visits to West Africa have been short and limited. I have thrice lived in Freetown for brief periods, and have paid flying visits to Bathurst, Accra, Lagos, and Ibadan. But though my experiences of the country were thus brief enough, I was always in a position to see a good deal in the time at my disposal, and my powers of sanitary observation, so to speak, were previously exercised by eighteen years’ employment in the Indian Medical Service. Moreover, for the last three years I have been in constant communication with many old residents on the Coast, and I have also learned much from the members of several expeditions sent there by the Liverpool School of Tropical Medicine, and by reading numerous reports on the sanitation of the country. I state these facts simply in order to enable the reader to judge of the value of my testimony on the points under consideration. I do not pretend that a greater experience would not have increased that value; but at the same time it should be remarked that a sanitarian of any experience, like a trained physician, can often make a correct diagnosis in a comparatively short time; and that it is not necessary to examine every town in a country in order to arrive at a general conception of its sanitary condition. Moreover, the towns which I have seen are the capitals of four out of the six British Colonies on the Coast.

In my experience, such as it is, the mode of life of Europeans in West Africa is not suited to the tropics.

Take the houses to begin with. They are not generally good. It is absolutely essential in the tropics to have good roofs and large airy rooms. Our wise forefathers recognised this early in India, and built the great solid structures which are such a prominent feature of Calcutta and Madras and many Indian stations. I have seen nothing of the kind in West Africa. Even in Lagos and Accra the houses can be described only as second-rate. In Freetown they are simply execrable; and it is monstrous that Englishmen, much more ladies, should be compelled to live in them. It should be remembered that many of these West African hovels are built by Government. In Ibadan I saw a magnificent iron house which I was told cost the Government £6000, but which is so ill-designed and ill-placed that in the heat of the day the inmates are compelled to go outside and sit under leaf shelters! Then again, in India the Europeans and some of the better class natives live in a separate quarter; but in West Africa this seems to be the case only to a limited extent; while in Freetown the Europeans often live over native shops. Remembering that infectious diseases are communicated from the sick, we shall easily understand why the absence of a separate quarter is so dangerous to health. Those absolute essentials to comfort in the tropics, punkahs and mosquito-nets, which are invariably used in India, are often the exception in West Africa, or were so until quite recently.

As regards food, we find little efforts made to help the African colonists to obtain good provisions. Fresh milk and butter often cannot be got at all, even where cattle exist in plenty. Government sometimes maintains, at considerable cost, botanical gardens for various economical purposes. I was told that these gardens used to grow vegetables for the Europeans until stopped by a mandate from England, on the ground that a Government botanist is not a vegetable gardener!—a type of the hopelessly unpractical spirit which has crept into all British administration. As a result the colonist has to fall back upon native vegetables, to which he is not accustomed. The meat is generally poor and coarse, and no proper effort is made to improve it. Ice—another essential in the tropics—cannot generally be obtained. I was gravely informed that ice-machines will not work in West Africa. It is difficult to see why this is the case, because they will certainly work in the hottest and dampest parts of India. Aerated waters have to be imported and cost about sixpence a bottle; I suppose that they, too, “cannot be made” in West Africa. In India they are made everywhere and cost about a penny a bottle. Singular effect of the West African climate!

What are more necessary anywhere than exercise, recreation, and society? In India the smallest station has its gymkana; its polo, tennis, cricket, and even football; its dinners, its afternoon parties, its balls; its shooting and riding. As for West Africa, though, owing to the intelligent encouragement of the Governors, much attention is now being given to this subject, things are very different. A resident of Sekondi told me that their “only amusement is to drink.” So it seemed. In many places horses do not exist, because it is said they do not live there. So far as I know, Government has never attempted the slightest scientific inquiry into this most important matter, although probably the disability is due merely to some easily preventable parasitic disease. In Freetown many people take no exercise at all and are carried about even for short distances in hammocks. In up-country places, I hear, the dulness of life, owing to the absence of recreation and exercise, is often intolerable and heart-breaking.

Turning now to affairs of state sanitation, let us first ask, what would have been the logical and business-like course for adoption by Government from the earliest days of these Colonies? Seeing the obvious fact that all development of the country was being retarded by the sickness and mortality among the European Officials and traders, a practical Government would from the first have strained every nerve to remedy this state of things. It would have spent every available penny in the sanitation of the coast towns, which are, in fact, the portals of the continent. It would have kept these scrupulously clean, swept and drained. It would have housed its employés thoroughly well in quarters removed from the infectious vicinity of the poorer native locations. It would have encouraged the traders to do the same for their agents. It would have organised farms for the purpose of producing good fresh food—meat, milk, butter and vegetables. It would have created or endowed places of exercise and recreation. It would have attempted to add in every possible way to the comfort of the Europeans, who are the backbone of the Colonies, knowing that reasonable comfort is half the way to health and happiness, and that senseless and unnecessary discomfort is more than half the way in the other direction. It would have taken scrupulous care of the water supply; of the conservancy; of the drainage of swamps. It would have insisted on the adequate sanitation of native locations near European locations, in the interests both of natives and Europeans. It would have maintained an up-to-date medical and sanitary department, provided with sufficient powers and funds for its work. It would have kept accurate statistics of sickness and mortality, especially among the Europeans. It would have ordered numerous scientific investigations into the causes of the most disastrous West African diseases, both among men and domestic animals. Above all, it would have put the direction of sanitary affairs into the hands of the ablest scientific men it could procure.

Now I do not wish to take the _rôle_ of the fault finder; but I must say, so far as I know—and I hope I may be mistaken—the Colonial Office and the West African Governments and municipalities can scarcely be said to have given adequate attention to a single one of the items in this programme—at least until quite recently. Consider the question of surface drainage for instance. It has been well known, since the time of the Romans, that surface-drainage removes malaria; and malaria is the principal enemy of the West African Colonies. Surely, then, the most obvious considerations should have induced Government to reclaim the large marshes existing in the vicinity of the principal settlements. A small annual expenditure, if persisted in, would have gradually done the work; and, as Sir William MacGregor once observed, the local Governments have had at their disposal for years large gangs of gaol prisoners who could, with advantage, have been employed on such useful labours instead of shot-drill. But no; the marshes have been allowed to exist as they were. It is only quite recently that the swamps of Lagos and Bathurst have been touched. In Freetown the swamps existed in almost every street in the native quarters during the rains, and were, in fact, actually made by incompetent engineering efforts and maintained by the grossest sanitary neglect—the roadside drains being generally nothing but series of deep pools full of stagnant water seething with insect life. Yet this town was called the white-man’s grave; and Heaven was blamed for causing a disease which man could easily have prevented if the most elementary teaching of sanitary science had been attended to. Even after the connection between stagnant water and malaria was fully verified and explained by the discovery (completed in 1899) that the disease is carried from the sick to the healthy by certain kinds of mosquitoes which breed in stagnant puddles, no spontaneous effort was made by Government to improve the surface-drainage in Freetown.

In 1899 the Liverpool School took the trouble to send out an expedition which made a complete map of the mosquito-breeding puddles in the town; and next year the Commission of the Royal Society extended our observations. Two years later, however, another expedition of the Liverpool School found that everything had been left in exactly the same old state, except that the salary of the chief sanitary official had been largely increased. Not a puddle, not a ditch had been drained; not a single effort worth mention had been made, to act upon the new discovery which was of such importance to these Colonies; and it was not until the advent of the new Governor, Sir Charles King-Harman, assisted by the Liverpool School, that any adequate attempt was made to clear and drain Freetown. In the other Colonies progress was equally slow, until Sir William MacGregor and Dr. Strachan commenced their anti-malarial campaign in Lagos. The central authority, the Colonial Office, instead of forcing on measures in a brisk, business-like way, contented itself with publishing good advice which every one had heard a dozen times before. The Governments of the Gold Coast (Sir Matthew Nathan), of the Gambia (Sir George Denton), are now pushing on in this direction; and we can only hope that the progress will be maintained in the future in all the Colonies.

The other items of the programme mentioned above have also received little attention. The medical and sanitary services have not been kept in an up-to-date condition.

For instance, in 1880, Laveran discovered the parasite which causes malarial fever; but even twenty years later there were few doctors who used the discovery for the proper diagnosis and treatment of the fevers prevalent on the Coast. In most cases they were not even provided with microscopes for the work. In these respects the West African medical services were only on a par with the other State medical services; which, while they often contain exceedingly smart men, are generally wanting as a whole in scientific ability and push, and in the influence which they should exercise in the government of the countries to which they belong. A high official once informed me that of all the men under his orders the doctors had the least sense of duty. This is little to be wondered at, since, in my experience, efficiency does not lead to advancement in these services, and the most perfunctory men reach promotion as readily as the most meritorious. I have noticed a dozen instances of the almost complete indifference to science shown in these public medical services. For example, when the first Liverpool expedition reached Sierra Leone in 1899, the principal medical officer of the R.A.M.C. forbade us to feed mosquitoes upon his cases of malarial fever for experiment, though neither he nor his subordinates took the smallest trouble to prevent their men from being bitten night and day by the insects in the barracks and hospitals. We were convinced that this order was given simply out of wilful desire to obstruct us. Similarly in India a military doctor once forbade me even to prick the fingers of his patients in order to study their blood. The manner in which the R.A.M.C. authorities interrupted the researches of Colonel Bruce, F.R.S., on tsetse-fly disease and horse sickness in South Africa, and in which the Madras Government persecuted Dr. King for his small-pox work, is well known. It would be folly to expect that services administered in this manner could ever take a leading part in organising great campaigns against disease in the colonies; and I fear that, until Sir William MacGregor led the way in Lagos, the West African medical services, even though they have possessed many able men, have done little to improve sanitation in that country. The fault is entirely with the chief offices of Government, which too often appoint and retain as heads of their medical departments men who have no scientific status or even scientific knowledge, and at the same time take no trouble to promote the deserving. I have known many instances of this. It would be much better, in my opinion, to fill such offices from the ranks of able civil practitioners or scientists at home, rather than to select men who have no other claim to the post than long official service.

One of the greatest defects in the sanitary administration of West Africa has lain in the constant refusal of Government to investigate the causes of sickness by making use of the services of experts. Government argues that it is not its duty to investigate disease; but is it not? It admits the duty of maintaining expensive medical services, but not that of helping those services to increase their knowledge of their business! A logical position truly! In my own humble opinion the Colonial Office ought to have spent at least £5000 per annum during the last fifty years for investigation of the causes of sickness in West Africa alone. Do not talk to me of want of funds. There are plenty of funds, but they are thrown away on military expeditions; on the salaries of useless legal officials—chief justices and attorney-generals of little villages; and on building houses such as the one I referred to at Ibadan, which cost £6000, enough to pay for sanitary researches for years, and is uninhabitable! It is a case illustrating that peculiar form of mind which looks upon all research and investigation as idling and waste of time and money, a frame of mind which seems to be specially a British one. We have yet to learn the obvious fact that, if we wish to get a thing done, we must first make suitable inquiry as to how it should be done. Disease cannot be removed from a continent merely by establishing a medical service; we must also help the service to perfect its knowledge. The hand is not the same thing as the brain. In West Africa we have long possessed the hand, but the brain has been wanting.

The truth is that the defects of the West African sanitation are really due to the fact that the colonial councils are almost entirely in the hands of certain castes which are not scientific castes, and which care little for sanitary matters. I mean the politicians, soldiers, tax-collectors and legal people. To these it is a matter of little moment to cleanse streets, to purify towns, to banish disease from thousands of homes. It is not given to them to stand powerless by the side of death-beds and to hear the cries of the bereaved at the moment of bereavement. If they have money to spend, do they spend it for the purposes for which it was really chiefly taken from the tax-payer—for conservancy and hygiene? The filthy condition of most native towns in the British tropical possessions gives the answer. No, it is a finer thing to build a grand new post-office or law-court, or to conduct a forward military policy which will find its place in the home papers and delight the heart of the British greengrocer (and voter) at his breakfast table. Well, after all, it is human nature—each man for his own caste. As for me, I have been too long an official myself not to understand these little matters.

I have said that West Africa has fallen into a vicious circle, and the nature of this vicious circle will now be apparent. The unhealthiness of the Coast for Europeans tends to check their activities in all directions; and in return this detrimental effect on their activities tends to check their efforts towards ameliorating sanitary affairs. The two conditions work hand in hand. It is impossible to remain blind to the disastrous economical effect of the unhealthiness. It leads to a constant change in the working staff of the country, not only in consequence of death and sickness, but also in consequence of the frequent furlough which is rendered necessary. From the highest to the lowest, few Europeans remain in West Africa for more than two or three years at a stretch; and many Government officials are entitled to leave after one year. This has the effect of rendering all business discontinuous. As soon as a man has started a piece of work he is called away from his efforts, and is obliged to leave everything to a successor. In India the period of residence in the country before furlough can be demanded is five years at least, and even then the break in the business which occurs during the furlough is often very mischievous. How much more so must be the interruption which occurs in West Africa every year or two! The same thing prevents people in West Africa from taking sufficient interest in the homes of their exile. Many of them have told me that all the time they are in the country they are indifferent to what happens, that they simply live from hand to mouth, careless of their surroundings and longing only for the day when, if fate spares them, they can escape once more for a brief interval to Europe. It is this feeling which makes them indifferent to the houses in which they live, to the food they eat, to their surroundings—and sometimes, I fear, to their duties. The danger, discomfort and _ennui_ of life are so great that a chronic condition of callousness inimical to all serious effort is frequently arrived at. We must remember these facts when we are inclined to blame them. What wonder then that a matter like sanitation, which requires such constant endeavours, is apt to be neglected. Thus the circle comes “full round” again; and the neglect of sanitation leads to the paralysing unhealthiness which leads to the neglect of sanitation. I have observed the same thing elsewhere—notably in the unhealthy planting districts of India.

What must we do to mend this state of affairs? Well, the vicious circle must be broken at all costs.

But how? I think that there is really only one way in which it can be done, and that is by the introduction of a new force into the vortex. I mean public opinion and public effort at home in Europe. These must be roused for the sake of our countrymen in West Africa. This country should be made to understand that it has something more to do than to watch processions of colonial troops and to brag of its Empire. It is its duty to see that the Empire which it boasts of is properly administered, and that our countrymen who are sent to carry on the affairs, both official and commercial, of that Empire are not left to die there unnecessarily. This duty has certainly been most grossly neglected in the past. It should be the work of all of us, especially of those who govern the country, of the wealthy merchants who trade with it, of the rich people who do not know what to do with their money, and of men like myself, who are hired to study and teach tropical sanitation—it should be the work of all of us to see that it is not neglected in the future.

As every one knows, this new force has already come into being. Every day sees some notice of West African affairs in the Press. The able Governors of the Colonies are, I think, doing all for the cause which their limited means allow. The merchants of Liverpool and London have come forward most handsomely with their tropical schools, which I make bold to say are doing well also. A single philanthropist has actually drained and cleaned the houses in Freetown _pro tempore_, at his own expense, and last, but by no means least, many young pathologists have given their time and risked their health for the cause.

But what are the exact steps which should be taken? I have already indicated these above. It is the duty of the Government to see that the principal settlements are kept scrupulously clean and drained; to construct and publish proper statistics of sickness and mortality among the Europeans; to appoint whole-time health officers; to enforce sanitary laws; and to encourage the building of good houses and the establishment of dairies, settlement farms, gymkanas and other institutions or trades which are likely to conduce to the comfort and health of the colonists. Thus Government has a great deal to do. It has only begun as yet.

But it is not Government alone which must act. Sir William MacGregor recently pointed out to the Liverpool Chamber of Commerce that men who carry on business on the Coast have much to do for their employés—to give them good houses, to force them to take proper precautions against malaria, and to add to their comfort in every possible way.

Then there is the philanthropist millionaire. I wish that we could get hold of him in earnest. Sir Charles King-Harman once told me that £100,000 would reform the West Coast if presented as a free gift, by enabling Government to start gymkanas, dairies, and such like for the Europeans. So it would; and the money ought to be obtained.

Lastly, the Colonial Office ought to do one thing—a thing which was recommended by a deputation which waited upon the Colonial Secretary some time ago. That is, it ought to appoint a Sanitary Commissioner on the Indian model, to make constant inspections of sanitary matters in the West African Colonies, and to report directly to the Colonial Office. We were told, however, that the scheme was too costly, and otherwise impossible. But shortly afterwards a gentleman with a large salary was appointed in order to inspect the knapsacks, &c., of the black troops—a much more important matter than any sanitary business!

I may mention here an opinion which I frequently heard expressed on the Coast, namely, that the West African Colonies have now outgrown the present system of control by small detached Governments placed under an office in London. It is contended that the whole country should be administered by a Governor-General on the Indian lines. I fancy that sanitation would not lose by the change.

Such are my humble opinions on sanitary matters in West Africa. They are given in response to an invitation from the author of this book; and, of course, exigencies of space have prevented my dealing with many points which should be dealt with in a complete survey of the subject—which would require a book for itself. I have thought it best to say exactly what I think without much reservation; but, of course, my views may, perhaps, not be so sound as I imagine. It would be the grandest thing in the world if sanitary science could give to civilisation such a glorious gift as West Africa; and I believe that it will. But the thing will be done only by straight speaking, hard hitting, and the most indomitable action.