542 NOTES FROM SINGAPORE.

Jlyiiig visits every year or two, are amongst the chief reasonsaccountable for the slow progress of civilisation in theprovinces of Spain. A notable exception, however, may befound in some of the northern provinces, such as Galicia,where the more equable distribution of land tends to producenot only greater personal freedom, coupled with more satis-factory social intercourse, but also a much higher intellectualaverage. It therefore follows that in most of the provincesthe medical man has to fall back upon one or two equals ineducation in the villages and perhaps half a dozen to ten inthe more important townships, and of these probably half are,through no desire of his own, political adversaries andtherefore just barely civil. It is hardly to be wondered at,then, if in the course of years he drifts down to the in-tellectual level of his patients, loses the enthusiasm of

early days, gradually forgets what he knew, and getscompletely behind the age.In my introductory remarks I have referred to bleeding as

being still practised in Spain. It is only fair, however, togay that the present generation of medical men there are inevery way equal to the average practitioners of other countriesand have set their faces against this practice, which, bysome of the older men, is still considered the panacea forall the ills that flesh is heir to. I have known a patient insiston being bled by his medical attendant, who, however, onlycomplied under protest and in the conviction that a littlejudicious blood-letting by himself would be preferableto handing his patient over to the village barber,whose discretion in the matter might not be so great.This worthy is a recognised though uncertified minor surgeon.Besides his razors, brushes, and scissors he provides himselfwith lancet, leeches, corn knife, and a variety of surgicaland dental instruments. Occasionally, also, he does a littlebone-setting, though this is, strictly speaking, within theprovince of the curandero, or bone-setter, to whom I shall

shortly refer. On the barber’s shelves may sometimes befound a work on anatomy and occasionally a treatise on thevirtues of herbs in the cure of ailments. His lack, however,of a good elementary education, to say nothing of the rudi-ments of medical science, renders these works worse thanuseless to him, except inasmuch as they enable him to securea good vocabulary of technical phrases, which, howevermisapplied to the case in point, have the desired effectof confusing and impressing his already too credulouspatrons.Whilst being shaved in a small town I have had some

startlingly new ideas propounded on the theory and practiceof medicine. I am afraid, however, that they producedmore amusement than instruction, and though careful notto contradict one who, with a razor to my throat, might justlybe considered the arbiter of my destiny, I can hardly refrainfrom hoping that the practice thereof may be strictly confinedto the confiding patrons of’ each village Figaro. The art and

mysteries of a curandero are handed down from father to soil.He devotes himself to setting bones and repairing injuriesgenerally, and his attentions are not confined to man, his fieldof operations extending to all such members of the animalworld as have a master willing to pay the recognised fee,and on the whole his work seems to be fairly well done.Attempts have at various times been made to suppresscitranderos, but the ’Cox populi is with them, and thus farthey have been able to maintain their own even in some ofthe larger towns. I have heard of a noble family sendingmiles for a celebrated curandero when they had the servicesef two really good surgeons within easy reach. The reasonsfor their continued prestige are complex and somewhat I

curious. In the first place, the bone-setter has generally a Itown and some four to six villages as his field of operations,and in each he, with characteristic modesty, details the mar- ]

vellous cures he has achieved in the others ; secondly, the imedical man is an accepted fact, his remedies are supposedto be known quantities, and a knowledge of them open to all iwho may have the inclination or the means to study them. (

With the enrandero, on the other hand, things are differently fviewed. His art is a secret one possessed by few, and is 1looked upon as something like a special gift from Heaven, on (

the principle of Omne ignotu’ln pro mirabile. If we add to rthis the fact that he has, as a, rule, the simpler cases to deal 7

with, and can therefore often show a greater percentage of 1cures than the certified surgeon, who would be invariably rcalled in to attend a badly fractured limb, it becomes 1easier to understand how it is that bone-setters still tHour ish in a country too long deprived of just educational ifacilities. 1

NOTES FROM SINGAPORE.(FROM A CORRESPONDENT.)

Tile Influenza Epidemic.THE influenza epidemic of 1895 has not been limited to

the "home" countries. During the past three months theStraits Settlements and the adjoining native states havesuffered severely from this well-known scourge. The generalcharacteristics of the disease have in no way differed fromthose which have been noted in Europe. The native Malay,the Eurasian, the immigrant European, Chinaman, Indian,and Arab have all fallen victims to the disease. AmongstEuropeans severe or fatal cases have been rare, but the death-rate in the case of Asiatics has been exceptionally high.We have seen the gastro-intestinal, the cerebro-spinal, andthe pulmonary forms in great frequency, the last being byfar the most common. Pneumonia, broncho-pneumonia, andother forms of pulmonary affections have carried off many ofthe natives. In a large proportion of these cases the durationof sickness was extremely short. Heart complications havebeen far from uncommon, and the writer of these notes hasmet with at least a dozen well-marked examples. Themajority have shown acute dilatation of the left ventricle,slow pulse or else a very rapid and feeble one, with frequentirregularity in rhythm, and death from cardiac asthenia infrom twenty-four to forty-eight hours. When life in thesecases is prolonged various murmurs are to be noted, chiefamong which are those showing mitral and aortic insufficiency.Irregularity of pulse has persisted in some cases for monthsafter the initial attack, and attacks of angina are frequentlymet with. As at home, patients who already suffer fromheart disease stand a bad chance when struck down by "thegrip," and die from cardiac syncope or from a low form ofpneumonia. More especially is this the case in beri-beri, forin patients suffering from this disease influenza is exceedinglyfatal. When "the grip" occurs in an acute attack little elsethan cardiac collapse, without appreciable fever or the charac-teristic pains, the resemblance to an acute attack of beri.beriis most marked. This resemblance is rendered greater incases, two of which came under my notice, where peripheralneuritis follows close upon influenza as a complication. Bothof my cases made perfect recoveries, although one was accom-panied by dilatation of the ventricles. Malaria as a sequelahas been frequently noted, and in a few cases has been fatal.Amongst Europeans especially I have seen a number of casesof acute phthisis arising as a rule out of unresolved pneu-monia, and in these a fatal termination usually ensues in oneor two months. Some cases linger on, however, for a longerperiod. Finally, although I have not the exact figuresbefore me, the death-rate during the last two months ormore has greatly exceeded that for the corresponding monthsof last year.

Epidemic Asiatic Oholera.Unfortunately, influenza has not been the sole cause of our

present high rate of mortality. Asiatic cholera in an

epidemic form is a rarity in Singapore, and we have hitherto.congratulated ourselves on our immunity from its ravages.Jur excellent municipal water-supply has been long held upM the main agent in preventing epidemics of cholera, but;hat a good water-supply is not a sine q1lâ non in this respectlias now been demonstrated to us in a very emphatic manner.Dther factors have been at play, such as back-to-back houses,>vercrowding, want of proper drainage, and the filthy habitsvhich are a characteristic of most Asiatics. These haveinally led to consequences which were sooner or laternevitable. At a meeting of the Municipal Commission onrune 19th the medical officer of health, Dr. Middleton,:tated that "the death-rate began to rise about the beginning)f April, but no cases of cholera were reported. Still it wasuspected that there was some epidemic going about theown, though they were unable to get hold of it. Since then,luring the last week, the death-rate had risen to 75 per 1000.[’he first indication of cholera they had was on Monday, the.Oth of this month [’June], and since then forty cases had)een reported, of which thirty-six’ had proved fatal......._’here was considerable difficulty in dealing with these cases,)ecause the Chinese and natives concealed them in ordero prevent patients being sent to hospital, nor were theylsually called in until after death had taken place." Theoeans adopted to check the spread of’ the disease are, in

543. SLAVERY IN ZANZIBAR AND PEMBA.

Dr. Middleton’s own words, these : "’Whenever a case was dis-,covered the man was sent to hospital at once, his mats andbedding burnt, and his drinking vessels broken, compensa-tion being given where such articles were destroyed." In allcases, too, the infected house is thoroughly cleansed and,disinfected by the municipal authorities.

The Governrnent and the Mnnicipality.The following letter, received by the President of the

1’lunicipal Commission from the Colonial Secretary, was readat a meeting of the Commission on June 19th :-

"Colonial Secretary’s Office, Singapore, June 14th, 1895." SlR,—I am directed by the Governor to direct the attention of the

’Commissioners to the exceptionally high death-rate in Singapore forthe month of April last, as shown in the Registrar-General’s return, acopy of which was sent to you on the lst inst. (2) It will be seen thatthe number of deaths in that month recorded was no less than 770, ascompared with 477 in the corresponding month of last year, and.exceeded by 172 the highest number previously recorded for the month.of April during the last ten years. (3) His Excellency is of opinionthat the abnormal figures appear to indicate the prevalence in Singapore4uring the month referred to of some cause of death intentionally or.carelessly kept back by the natives from fear of consequences whichmight result if it were reported, and I am to request that the Com-’missioners will give their consideration to a matter which would appearat first sight to indicate that much closer attention and supervision onthe part of their medical officer may be desirable.

" I have, &c.,--’ &I Jf.’ A. SWETTENH9Ii, Colonial Secretary.’

The irony of this letter is evident when one notes that thedeath return for April was delivered by the Government tothe municipal authorities so late as June lst, that this wasthe first official indication to the medical officer of healththat the death-rate in April was so unusually high, and thatthe entire onus of such a lax state of affairs rests with theGovernment by reason of the present erroneous and inefficientsystem of death registration. Such a wanton censure of anable and energetic medical officer, such an attempt on thepart of the Government to make the Municipal Commission ascapegoat for its failings, have led to universal expressions ofindignation from the public of Singapore, who now call

emphatically for an immediate and radical change in themethods by which vital statistics are at present obtained.

The Preseott System of Registration of Deaths in the Colony.The present law makes it the duty of the occupier of a

ouse, in which a death happens to take place, to notify thedeath within twenty-four hours to the deputy registrar of thedistrict, who is in all cases a police-constable. These are

usually Malays or Tamils. Failing a medical certificate, theoonstable fills up a form and states the cause of death, eitherfollowing the notifier’s statements or giving his own diagnosisfrom inspection of the corpse or otherwise. In many cases,as was described by Dr. Dumbleton, a retired municipalmedical officer, in a paper read before the Straits MedicalAssociation, a medical certificate is by no means a guaranteeof correct registration, but is often altered according to thefancy of the deputy registrar. These registers, usually madeout in Tamil or Malay, are translated into English at the endof the month and are then forwarded to the Registrar-general. The latter tabulates them, and finally, well on inthe following month-in the specific case referred to in theColonial Secretary’s letter fully a month later-they are

transmitted to the municipal medical officer. In thisway this official is kept in total ignorance of the- death-rate in the district which. is his special care, and hecan have no guide or indication which might lead him tosuspect the presence of any unusual fatal element until someweeks later. It might be argued that the Infectious DiseasesNotification Act is a help to him in this direction, but thepresent epidemic shows the fallacy of this. Almost all thecases have occurred amongst the poorest class of natives,who either do not by preference or cannot afford to call inuropean general practitioners. That the system calls forimmediate alteration at the hands of the Government must beevident to everyone who has the welfare of the Settlement atheart. Deputy registrars should be no longer ignorant police-constables. The posts should either be given to trainedapothecaries or something akin to the parochial systemshould be instituted, so that, failing a certificate from thedeceased’s medical attendant, a proper medical certificatemay in. all cases be obtained. All such certificates, too,should be made out in duplicate, one copy going to themedical officer of health within twenty-four hours of thedeath and. the other being sent, as heretofore, to the Registrar-General.

SLAVERY IN ZANZIBAR AND PEMBA.

ZANZIBAR has for many years been known to the publicas the starting point of exploring expeditions about to enterEquatorial Africa from the eastern side, and the recent

extension of a British Protectorate over the territories of itsruler causes us to regard it with an increased feeling ofinterest and responsibility. The upper classes are Moham-medan Arabs; they have been slave-traders and slave-owners from time immemorial, and a special investigation ofthe condition of the negroes has just been made at theinstance of the British and Foreign Anti-Slavery Society. Thesociety’s commissioner, Mr. Donald Mackenzie, is acquaintedwith the Arabic language and has had long experienceof Mohammedan customs and slavery among the Arabs inNorth-West Africa. He arrived in Zanzibar on March 2nd,1895, and devoted about six weeks to his inquiry. The terri-tories of Zanzibar consist of the coral islands of Zanzibar andPemba, lying about twenty-two miles apart, between 5° and7° S. latitude ; the former island is less than twenty-five andthe latter less than thirty-five miles from the African main-land. There are no precise data as to the population, butthe late Sultan, who died in 1888, estimated the inhabitantsof the two islands at 400,000, of whom 200 were Europeans(merchants) and Goanese (shopkeepers and servants), 8500were natives of British India (moneylenders and merchants),10,000 or 15,000 were Arabs (the ruling class), 266,000 were

slaves, and the balance were aborigines and slaves who hadbeen set free. The slaves may be classified as domestics

(including concubines and eunuchs), plantation workers,chiefly occupied in the cultivation of cloves, and townlabourers. These last work under entirely different con-ditions from the domestic and plantation slaves. They areemployed : (1) in the loading and discharging of vessels andin general warehouse and town labour, women being largelyengaged in this work and especially in the coaling of

steamers, including British men-of-war ; (2) as porters whocarry goods or stores into the interior of Africa ; and (3) asdomestic servants to Europeans, natives of British India, andGoanese, who not being themselves allowed to possess slaveshave to hire them from their owners. All British subjectsdeal with the slaves directly and not with the master, or theymay hire them from a contractor, who need not necessarily bea slaveholder, but who knows where to get them. Employerspay wages to the slaves, who, in turn, hand to theirmasters half of their earnings, and with the remainder haveto buy their own food and clothes ; in the case of porters thehirer has to provide them with food. The pay of porters andharbour labourers is usually ten rupees per month ; womenlabourers receive less. The regulation load of porters is70 lb. each, but beyond that they have to carry food, water,and cooking utensils, which may bring the load up to 100 lb.or more. They have to march about twelve miles a day.These slave porters are the only means of transport for ourGovernment and for missionaries and merchants betweenthe interior of Africa and the coast. If any of them aretaken ill they are left by the path-side to die. theirloads are distributed among the others, and the caravanproceeds on its march without any further notice beingtaken of those who drop by the way. The mortalityamongst them was given to Mr. Mackenzie on the veryhighest authority at 30 per cent. Domestic servants are

generally men, and they receive about seven rupees per month;the women are water-carriers and are paid five rupees permonth. They all receive their wages directly from theiremployers, but each hands to the master one-half. A slaveis told by his master to seek employment, and if he cannotfind it he is punished. The masters have hardly anyresponsibility as regards the slaves and only provide themwith food when they are out of employment. None of theslaves possess any civil rights except that they can com-plain against their masters to the British Consul-General, butat present very few know of the Consul-General, and underexisting circumstances freedom would be no benefit to them,for they would be outcasts, and their masters would havemany ways of getting rid of them by poison and other-wise. Many of the slaves who have been set free by theConsul-General have afterwards been kidnapped and all’ traceof them has been lost. Mr. Mackenzie was much impressedby the fact that very few children are born to slaves, owing,it is said, to the manner in which very young girls are treated