Epilogue: the place of sanitation in tropical colonization

The problem of sanitation in the tropics, like most problems in the tropics and elsewhere, is primarily one of ways and means. That the sanitarian is trained primarily as a medical man is, in one respect, a handicap which he rarely overcomes; indeed, of its very existence he is seldom conscious. Yet this seems to me to be the source of many of his difficulties and failures, and lest this book should prove more a cause of stumbling than a help, in this closing chapter I invite the sanitarian to take a broad view of Life—Life as it really is to those whom he would serve; because I am confident that if he does so, he will avoid the chief dangers that beset his path.

The medical man is trained to look on the preservation of the life of his patient as an end to which everything is subordinate, and to attain which the cost need not be counted. His patient tells him that to gain the whole world is nothing, if he loses his life. It is true, too, that while there is life there is hope. Every medical man can recall how the spark of life has blazed up afresh in those on whose faces had already fallen that dread grey—the shadow of the valley of death.

Such things as these, striking a full measure of sympathy from the richest chords of the human heart, graven so deeply at a time when life is most impressionable, must influence the attitude of a medical man to human suffering and pain, surely as long as his life lasts. Indeed, were it not so, it seems to me he would be less than human. So it comes about that the sanitarian does not usually count the cost of his recommendation. One, indeed, bluntly said, “When I give an order, I don’t bother about the cost.” And when you ask him why the cost may be disregarded, he tells you it is because his order will lead to the saving of life, and nothing could be more important or beneficial. It has never occurred to him that sanitation has no monopoly of life-saving; yet it is so. And if the sanitarian wishes to do the maximum good and to avoid unnecessary friction, he must know something of the true proportions of life, and the real place of sanitation in it. And if he finds that sanitation is not the chief aim in life, he will also find that he has yet an honourable place in the scheme of things, and his work may become actually more interesting to himself, because more helpful to others, when properly attuned to life as it really is.

If, then, he would learn the true place of sanitation, I will ask him to follow me as I trace some lessons from the history of tropical colonization. Situated in a belt stretching roughly for 30 degrees of latitude north and south of the equator, bathed in sunshine and showers, the tropics are more abundantly provided with life than any other portion of the globe. Vegetation flourishes with a profusion that the inhabitant of the more temperate regions can hardly imagine, and only by the most strenuous exertions can it be kept from swallowing up the habitations of man. Only [a little] less thriving is animal life, man excepted; for in the tropics the human race does not progress. It is a strange fact, but one beyond dispute, that the tropics have not produced in the last three hundred years, if indeed ever, a single great painter, sculptor, inventor, engineer, or philosopher. Of government and civilisation, as understood by the Greeks, the Romans, and their European descendants for the last two thousand years, there is hardly a trace. Tropical history consists simply of inter-tribal war, barbarity, cruelty, and wanton disregard for property and life.

It would, indeed, not be unfair to assume that this has always been its record; tribe has fought with tribe until one or other has been exterminated, the victor in turn to be overcome by a hardier race from the north. For just as the polar winds are drawn to the tropics by the genial warmth of the sun, so there seems to be a similar flow of the human race. Of tropical invasions by the more virile races from colder zones, the best known is that by the Spanish conquistadores who four hundred years ago founded the first world-wide empire. The expense of his wars in the Netherlands, and the hope of glory and riches were forces that acted as powerfully on the King of Spain and on his subjects, and took them to the tropics, as any that drew the Goths on Rome; while to the conquered races the results were even more destructive. In searching for castles of gold, and in mining for precious metals, the Spaniards employed the natives of the West Indies, who “perished out of the islands of the Caribbean Sea with a rapidity which startled the conquerors.”92 Hardly less fatal was the work on the plantations. We understand clearly now that just as the tropical diseases were fatal to the Spaniards, so the European diseases decimated the Caribs: smallpox was one of these.

Lust of gold, sordid greed lubricated by religious fanaticism, utterly destroying a whole nation, casts a lurid light on the Christianity of the leading European people of the sixteenth century. Yet, to the everlasting glory of the Church, the self-sacrificing lives of many of the Fathers are among the noblest records of missionary work, and they never ceased an eloquent remonstrance against this racial murder. At the instance of the Dominicans, led by Bishop Las Casas, a commission came from Spain to enquire into the system of slavery. “They conducted the inquiry in a very dispassionate manner, but, after long deliberation, came to a conclusion most unfavourable to the demands of Las Casas, who insisted on the entire freedom of the natives.”93 All hope of saving the remnant of the race from extinction now seemed to disappear, until it occurred to the bishop to introduce a race which would not only domesticate, but improve in the white man’s company. “It struck Las Casas that if negroes could be introduced into the West Indian Islands, the Indians might be left alone; the negroes themselves would have a chance to rise out of their wretchedness, could be made into Christians, and could be saved at the worst from the horrid fate which awaited many of them in their own country;”94 for those who were brought over as slaves were prisoners of war for whom the alternative was that, if not eaten by their captors, they should be sacrificed on the blood-stained altars of their idols.

The experiment was a great success at the time, and little did the good bishop dream of the trouble he was making for future generations. Nearly two centuries passed. Spain had shrunk as a world power, Holland and England were the great Colonial powers, with England rapidly taking first place, for she commanded the sea. No longer did colonies pour a stream of crude gold into the mother country; they had long before been stripped bare of that. Their value now consisted of their power to grow spices and other products which could not thrive in colder climates. So merchants established trading stations to barter with the natives; and the native, after his custom, slew the merchant, because he was weak and could easily be killed and spoiled. This led to reprisals, the native had to be taught to respect the white man; his country was conquered. Then the home governments found they were burdened with the charge of governing colonies, for they could not abandon them without inviting a repetition of what they had come to punish.

Few colonies produced sufficient revenue to pay for the necessary civil and military establishments, and still less to send to the treasury at home the contributions which were regarded as the sole justification for their existence. So colonies came to be looked at askance, and were abandoned on any, and even without any, excuse. It was not in the West Indies alone that the local inhabitant would or could not work. Elsewhere the colonist found that the native died if made to work as a slave; money could not induce him to work as a freeman, and to double his pay reduced his output by half. So the colonist came to rely more and more on slaves imported from the few countries where natives were found who could work. Gradually the colonies became more prosperous, became not only self-supporting, but also a source of riches to the motherland.

They had at last justified their existence. Their future seemed assured, when suddenly two great forces strangely affected their even course. One force was new, the other old; one benevolent, the other apparently destructive; one physical, the other spiritual. Neither could be eluded, both were all-pervading.

At last the Christian Church had realized the fatal error she had made in approving of slavery two centuries before, even for so benevolent an object as that of saving the Indians. The Dominicans had never approved of it; even Cortes in his will made the remarkable declaration:95

It has long been a question, whether one can conscientiously hold property in Indian slaves. Since this point has not been determined, I enjoin it on my son Martin and his heirs, that they spare no pains to come to an exact knowledge of the truth; as a matter which deeply concerns the conscience of each of them, no less than mine.

Deep-thinking Christians had “come to an exact knowledge of the truth,” and those in Britain had decided that in the British Empire no man should remain a slave—cost what it might. It was a decision from which even now some colonies have not recovered; but none can doubt it was the right one, for even if not fully realized at the time, it is a fact that the best work comes from the free and the willing worker. In Java the brilliant administration of Sir Stamford Raffles, which in five short years turned hopeless bankruptcy into bounding prosperity by giving the native a secure title to the fruits of his labour, proved for all time that the Christian ideal, however impracticable it might appear, was in truth the real path of progress; and we in British Malaya pride ourselves that our prosperity is in no small degree due to the touch of that vanished hand.

If the spiritual force, in promoting peace and prosperity throughout the world, seemed for a time rather to destroy what had been so laboriously built up, such was not the effect of the great physical force which now appeared; the first throb of the steam engine sent a pulse beat round the world, and stimulated the whole earth to increased life and activity. A hundred years ago the population of England and Europe was gathered into a large number of small villages, with a marketplace in the middle to act as the receiving and distributing centre; the difficulty and cost of transport were too great to permit of produce being taken far from where it was grown. The steam engine has changed all that, and today the wheat of Canada and Russia is sold in London before it is harvested. As the power to manufacture became multiplied by the engine, so arose a greater demand for the raw products of the tropics, and again for markets in which to sell the manufactured goods.

Once again the North hungered for the South, and steamships made communication with distant lands a simple matter; but it was no longer necessary for the northern races to invade the tropics to enjoy their fruits; indeed, for them life there was still very precarious. Just as four hundred years ago both the Spaniard and the Indian suffered in a special degree from diseases to which they were not accustomed, so in later days progress has been greatly retarded by disease, and freer communications have led to national calamities; for by no other name can we call the importation of plague from China to India in 1896 and the steady progress of sleeping sickness across Africa pari passu with the step of the white man.

But if these things have to be set against the benefits he confers, there is much on the other side; and no impartial observer can doubt that the end will be gain, although the goal is still far off. It is true that good water supplies had practically abolished cholera; yet in almost every other respect sanitation appeared a failure, especially so in its utter inability to control the disease “which maims as well as kills, and causes more sickness, misery, and death than any other single disease.”96

The cause of malaria seemed an inexplicable mystery. It was indeed one of the most cunningly hidden of nature’s secrets. Men searched the heavens, the earth, and the waters that cover the earth; and if they did not at first find it, the steps by which Laveran, Golgi, and Manson gradually helped to track it down are among the most brilliant in the annals of medicine. They had many difficulties to overcome; malaria was known to be connected with swamps, and to be reduced by drainage and cultivation. Against that they found in some places that flooding a swamp actually improved health, while in other places drainage and turning up the soil produced serious outbreaks of the disease. And yet again, malaria was not found in swamps, but in hills and dry sandy deserts. The whole subject was full of difficulties that seemed to upset every theory; and the only immediate result of his adhesion to, and elaboration of the mosquito malaria hypothesis was to earn for Manson, as he tells us, the suspicion that he was not quite right in the head. Certainly no one would have been foolish enough in those days to spend money on eradicating mosquitoes in order to prevent malaria.

When at length the genius of Ross, after long and difficult research, proved the guilt of the mosquito and traced all the stages of the parasite’s complicated life in the insect, everyone connected with the tropics realized the importance of the discovery. Our own Government in conjunction with the Royal Society at once sent a Commission to India and Africa; the German Government sent Koch, its greatest medical scientist, to the East Indies; Schools of Tropical Medicine were founded. Tropical research entered on a new path hitherto almost completely neglected, with the result that a series of brilliant discoveries, showing how yellow fever, plague, relapsing fever, sleeping sickness, and other diseases were conveyed from one person to another by insects, lifted the clouds of mystery that had so long hung over tropical diseases—the miasma that had been so fatal to the colonist.

It is in giving the benefits of these discoveries to those amongst whom he lives that the sanitarian finds his opportunity. Yet if he has not already learned that in most places other things have claims on revenue before sanitation, I have written in vain. Without peace, the colony will surely be attacked, lives will be lost; so a rifle brigade is more important than a mosquito brigade; and in India one-third of the revenue is spent on the army in order to preserve peace. Without roads and railways the country’s produce cannot be taken to market, the land remains valueless, its proprietor must move or starve. In countries like India, railways and irrigation works come next to the army, for India still largely consists of isolated villages. “If we had a complete record of the fortunes of an Indian village during the last three hundred years, we should probably find that its population has ever and anon been blotted out by some terrible drought.”97 Railways and canals have driven these awful famines from India; in the last thirty years the population has increased by more than fifty millions, who get a better livelihood than their fathers; and the market is no longer local, for India now exports one hundred million pounds sterling worth of goods, her products every year.

Without mosquito brigades, the tropical inhabitant has quite a good chance of surviving: without rifles, railways, and canals he will almost certainly die before reaching the allotted span. In the face of these facts, can the sanitarian still maintain that he has a monopoly of the saving of life?

If we look further into this matter, we will find that human life depends ultimately and entirely on the fruitfulness of the soil—Mother Earth indeed. The sower sows a grain; it multiplies several fold. Some of the increase feeds the soldier, some pays for the railways and canals, and some goes as the tax that supports those employed in what is called “government;” some the peasant keeps to plant in the following season. If the taxes leave him no seed, he dies; if one seed, he lives just as he was. If there remain two or more seeds, he lives better; he becomes more prosperous; the whole country becomes more prosperous; the same taxes do not bear so heavily upon him, old age and poverty are feared less.

The sanitarian should ever remember he is one who eats the grain he did not plant, and that, if he wastes what is given to him to benefit health, he impoverishes the peasant and the whole country; he is indeed false to his trust. He should ever remember, too, that he is only one of many, each of whom may not agree with him in what he thinks is best for the country. Life has many aspects. On the administrator falls the burden of seeing life as a whole, and it is no light one. That he never fails, he would be the last to claim; but the wiser his expert advisers on sanitary and other matters are, the less often will he err. Of the difficulties of the administrator, one of the greatest tells us something:98

When it became known that the Egyptian Treasury was in possession of a surplus, all the various interests concerned clamoured for the redress of long-standing and often very legitimate grievances. The inhabitant of the country pleaded that his land tax was too high, and pointed with justice to the fall in price of agricultural produce as reason for affording him relief The inhabitant of the town complained of the oppressive nature of the octroi duty. The population in general urged that the price of salt was excessive. The possessor of livestock asked why he should pay a tax for every sheep or goat on his farm. The seller of produce at every market or fair dwelt on the fact that his goods had to be weighed by a Government official, who charged a fee for the Treasury and another fee for himself. Why, again, it was urged, should railway, postal, and telegraph rates be higher in Egypt than elsewhere? Why should a boat passing under a bridge pay a toll, whilst a passenger going over the bridge paid nothing? These and a hundred other arguments and proposals were put forward by the advocates of fiscal reform.

On the other hand, each zealous official, anxious to improve the administration of his own department, hurled in demands for money on a poverty-stricken Treasury. The soldier wanted more troops, and painted in gloomy colours the dangers to which the frontier was exposed by reason of the proximity of the Dervishes. The police officer wanted more policemen to assist in the capture of brigands. The jurist urged that without well-paid judges it was impossible to establish a pure system of justice. The educationalist pointed out with great truth, that unless the sums placed at the disposal of the Department of Public Instruction were greatly increased, the execution of the policy of employing Egyptian rather than European agency in the administration of the country would have to be indefinitely postponed. The soldier, the policeman, the jurist, the director of prisons, and the schoolmaster all joined in asking for construction of expensive buildings. The medical authorities clamoured for hospitals, and pointed out that, without improved sanitation, which was a bottomless financial abyss, there could be no guarantee against epidemic disease. The engineer showed it was false economy not to extend the system of irrigation, to drain the fields, to make roads, and to develop railway communication.

Following on the larger demands came every species of minor proposal. Would it not be an attraction to the tourists, who spent so much money in Egypt, if a theatrical company visited Cairo in the winter? How could this be managed unless the Government gave a subvention to the theatre? Was it not a scandal, now that a civilised power was virtually governing Egypt, that more was not done to protect the ancient monuments of the country from injury? What report would the winter visitors to Egypt make when they returned to Europe, if, in driving to the Pyramids, they were bumped over a road which had not been repaired since the Empress Eugenic drove over it some twenty years previously? These and scores of other questions were asked in tones of more or less indignant remonstrance, by individuals who realized the desirability of paying attention to some one or other subject in which they were interested, but who had no clear preception of the financial situation considered as a whole. … The main facts relating to Egyptian finance, when once the thread of the international labyrinth had been found, were, in fact, very simple; when they were understood, they were not uninteresting.

“Nothing,” as Lord Milner truly says, “in this strange land is commonplace.” The subject surely cannot be devoid of interest when it is remembered that the difference between the magic words surplus and deficit meant whether the Egyptian cultivator was, or was not, to be allowed to reap the results of his labour; whether after supplying the wants of the State, he was to be left with barely enough to keep body and soul together, or whether he was to enjoy some degree of rustic ease; whether he was to be eternally condemned to live in a wretched mud hut, or whether he might have an opportunity given to him of improving his dwelling house; whether he should or should not have water supplied to his fields in due season; whether his disputes with his neighbours should be settled by a judge who decided them on principles of law, or whether, he should be left to the callous caprice of some individual ignorant of law and cognisant only of “baksheesh;” whether, if he were ill, he should be able to go to a well-kept hospital, or whether he should be unable to obtain any better medical assistance than that which could be given to his watchdog or his donkey; whether a school in which something useful could be learnt should be provided for his children, or whether they should be left in the hands of teachers whose highest knowledge consisted in being able to intone a few texts, which they themselves only half understood, from the Koran; whether, if he suffered from mental aberration, he should be properly treated in a well-kept lunatic asylum, or whether he should be chained to a post and undergo the treatment of a wild beast; whether he could travel from one part of the country to another, or communicate with his friends by post or telegraph, at a reasonable or only at a prohibitive cost; in fact, whether he and the ten millions of Egyptians who were like him, were or were not to have a chance afforded to them of taking a few steps upwards on the ladder of moral and material improvement.

This, and much more, is implied when it is stated that the British and Egyptian financiers arrested bankruptcy, turned a deficit into a surplus, relieved taxation, increased the revenue, controlled the expenditure, and raised Egyptian credit to a level only second to that of France and England. All the other reforms which were effected flow from this one fact, that the financial administration of Egypt has been honest, and that the country, being endowed by nature with great recuperative power and being inhabited by an industrious population, responded to the honesty of its rulers. It may be doubted whether in any other country such a remarkable transformation has been made in so short a time.

I invite the sanitarian to ponder deeply on this picture of human existence; to strive to realise what the difference between surplus and deficit really is; and to remember that, since sanitation is primarily a question of ways and means, he must cut his coat according to his cloth. Let the sanitarian grasp the distinction between wisdom and knowledge to which Tennyson alludes in the line:

Knowledge comes, but wisdom lingers, …

and the role of the sanitarian in the tropics will be found of unrivalled interest and opportunity.