Florence Nightingale

“ Thus mortality arising from mitigable or preventible causes of an external nature occasions in all the colonies by far the greatest part of the death rate in hospitals. Incivilization with its inherent diseases, when brought into contact with civilization without adopting specific precautions for preserving health, will always carry with it a large increase of mortality on account of the greater susceptibility of its subjects to those causes of disease which can to a certain extent be endured without as great a risk by civilized communities born among them. ”

“ The most fatal disease that has come under my notice is the venereal, contracted by contact with the Europeans. Males and females suffer alike from it, and die generally of secondary effects.
As a race the aborigines are dying off and disappearing before a more highly civilized people, and must eventually disappear altogether. The venereal disease on the one hand, and the fact that the women are apt to become prostitutes, and in consequence cease to bear children, on the other, are reducing them at a very rapid rate. ”

“ Such people have introduced everywhere the use of intoxicating drinks, together with the diseases as well as the vices of their own depraved standard of civilization. Where the races are found most rapidly decaying, there the married women are found living in a state of prostitution and exposed to its diseases. And we know where such is the case, decline and extinction are inevitable.
This appears to be a main cause of the falling off in births; while the other evil habits introduced by Europeans destroy the stamina of the adult population and raise its rate of mortality. ”

“ Time would seem to be a great element in the education of these children. There should be as little interference as possible with their born habits and customs. And that interference should take place gradually and wisely. The probability is that if children could leave school in health, with sufficient training to enable them to enter the pale of civilization, their children would be the more able to bear the required development of the mental faculties. In any case, physical training, and a large amount of out-door work, are essentially necessary to success. ”

“ It is to show that statistics, capable of affording complete practical results when wanted, have scarcely made a beginning in the colonies. It is to show that when the Colonial Office, with great labour and no little cost, has collected, and I, with the same, have reduced these materials, they are incapable of giving all the beneficial information expected. ”

“ In most of the schools there seem to be no play hours on school days. When play hours are allowed these are from half an hour to two hours. At about a dozen schools only is there any out-door work combined with instruction. The largest amount of this work is given in the Natal and Canadian schools. Out of the whole number there are only nine schools at which there is any attempt made at combining the elements of physical education with the school instruction, and even where this is done the measure is partial and inefficient, being confined to a few exercises or simply to bathing. ”

“ Our home experience hence teaches us the extreme importance of favourable sanitary conditions, whenever an {18} attempt is made to bring the uncivilized within the pale of civilization.
Every society which has been formed has had to sacrifice large proportions of its earlier generations to the new conditions of life arising out of the mere fact of change. Only by the greatest care and by the adoption of every requisite improvement can London itself bear the rapid increase of its population without danger from pestilence. ”

“ The method of conducting colonial schools appears to be based on our home system, without reference to physical training or other local conditions affecting health. This fact, together with the high rate of mortality, is the most prominent result of our inquiry. And although there is not sufficient evidence to show to what extent the school education increases the mortality, there is strong reason to believe that it is a cause. By far the greater part of the mortality is the direct result of mitigable or preventible diseases. ”

“ The lung disease, called lung sickness, in cattle, does not, with regard to the organ attacked, affect human beings, but the tendency of the present race of mankind is to anemic rather than acutely inflammatory diseases. ”

“ In the Canadian schools consumption and scrofula appear to occupy the place of miasmatic diseases. But there is nothing in the school education, as described in the returns, sufficient to account for their special prevalence in these schools. The causes must probably be looked for in the close foul atmosphere of the native dwellings in a climate where warmth is more likely to be sought by closing every opening capable of admitting fresh air than would be the case in warmer latitudes, together with exposure and other conditions depressing to the general health. ”

“ And it is possible that by educating outcast native children, these tribes, with whatever mental constitution endowed, may be spared to contribute their quota to human knowledge and advancement.
4. The school diseases, however, indicate that education should be conducted in a very different manner from what it is in England. Physiology would teach us that it is not safe to take the child of uncivilized parents, and to submit it all at once to the restraints of civilization. What is wanted is a careful study of what can and what cannot be done with safety. ”

“ With the facts before us, imperfect as they are, we need feel no surprise at the gradual extinction of these unhappy races. But we should draw from them an argument for doing all that can be done to lessen these evils, and to remove, as far as practicable, any causes of disease and death which it may be in our power to remove. ”

“ Your Committee are of opinion that great injustice has been perpetrated upon the Aborigines—that, when the Government of the colony found it necessary to take from them their hunting grounds and their means of living, proper provision should have been made for them. Had they been a strong race, like the New Zealanders, they would have forced the new occupiers of their country to provide for them; but being weak and ignorant, even for savages, they have been treated with almost utter neglect. ”

“ Christian civilization is doing much for them; and the only hope we have of raising the people from that state of moral degradation in which they are found throughout the country is by imparting to them the knowledge of Christian truth, which never fails to produce the happiest effects on their habits of life in general, though it may occasionally happen, that by intercourse with foreigners, vices inimical to longevity are learnt by the aborigines. ”

“ One thing is certain that, in those colonies from which complaints of the disappearance of native races have come, {15} tubercular and chest diseases appear to occasion the largest amount of hospital mortality.
The discovery of the causes of this must be referred back to the colonies. Anything which exhausts the constitution; above all things, foul air during sleep, will engender these diseases. Open locality, healthy winds, active daily occupation, are by themselves no safeguards, if the nights be spent in unventilated cabins. ”

“ Fever occurs, but not frequently, as they have no confined badly ventilated dwellings.
Diarrhœa and dysentery make their appearance in the hot weather, and from five to ten per cent. of the cases prove fatal; these attacks occur most frequently during dentition, as with the Europeans.
The brain and nervous system are seldom attacked primarily. In their native state they indulge in no stimulants, and are not guilty of overtaxing their mental powers.
Consumption is common amongst them; and in every death that I have seen in the school children, there have been tubercular deposits in the lungs. ”

“ Physical prostration, in fact, seems to follow the attempt to imitate the customs of civilized society; and, as I had abundant opportunity of observing in British Guiana among the Indians, the wearing of clothes and adoption of a more settled mode of life detracts from skill in hunting or fishing without imparting sufficient knowledge of or taste for agricultural pursuits to afford a livelihood in exchange. ”

“ If we take the other points of comparison, supplied by tubercular diseases, we find a remarkable difference in the proportion of mortality in different colonies. Thus, the death rate from scrofula, phthisis, and hæmoptysis, at Free Town, Sierra Leone, amounts to 3·2 per cent. of the total deaths from all causes among men, and 2·3 per cent. among women. In this hospital other chest diseases give rise to a mortality of 2·4 per cent. for men. ”

“ The remedy for this is obviously to improve the school-houses, to give more attention to space, to ventilation, and to the locality where the school is placed, and above all to make physical training an essential and important part of the school system, never forgetting that the habits of generations cannot be suddenly broken through without danger to health and life. ”

“ In illustration of this, I may mention the comparatively few births, while from the census it will be seen that a greater equality of the sexes prevails than was generally believed to be the case throughout the entire districts; and perhaps, therefore, the most favourable conclusion to form is, that the native population is not increasing, or, in other words, that, taking the deaths and births into account, it is likely to remain stationary for some time to come, unless swept off by some unusual and fatal disease. ”

“ Wounds of whatever kind which do not affect a vital part are more readily cured than in white people. I have seen most desperate wounds inflicted by their weapons, that would have kept Europeans for months invalids, healed in an incredibly short time, and to the astonishment of medical men. ”

“ Amongst the Sierra Leone children there is only one death from consumption and one from scrofula reported out of a total of 190 deaths. In the West Australian schools two of the nine deaths arose from consumption. In the Natal schools there was one death from consumption and one from scrofula out of 16 deaths. But there died seven children of other chest diseases besides consumption. The Ceylon schools yielded seven deaths from consumption, five from other chest diseases, and one from scrofula, out of a total mortality of 341. ”

“ Civilization increases the proneness to Disease and the facility to succumb to its Power.―Skin diseases are more prevalent among the natives than the settlers. Phthisis carries off a great number; exposure to extremes is the cause. ”

“ A good government which really understood its responsibilities would put down with any force requisite that most accursed of all British habits, the sale of intoxicating drinks to those who never knew them before. On the heads of these traffickers rests the blood of thousands of their fellow men.
3. Although a large proportion of children have died while under school instruction, there is no proof that education, if properly conducted, tends to extinguish races. ”

“ The decaying races are chiefly in Australia, New Zealand, Canada, and perhaps in certain parts of South Africa. They appear to consist chiefly of tribes which have never been civilized enough or had force of character enough to form fixed settlements or to build towns. Such tribes have few fixed habits or none. But the papers show that they are naturally, in their uncivilized condition, possessed of far stronger stamina, and that they resist the effects of frightful wounds and injuries far better than civilized men. ”

“ The Alpine climates of Europe are known to be the most free of any climates from this tribe of diseases. But even on their healthy mountain slopes scrofula in all its forms prevails among the peasants, engaged during summer on the high pastures, when they pass their nights in the close unhealthy chalets there. ”

“ It is purely a disease of the brain and nervous system, generally fatal, except when seen in the very early stages. As it is generally met with, the patient sleeps continually, even when standing up, and becomes perfectly incapable of any exertion; the sufferer will even fall asleep while being fed. ”

“ In all the schools within or near the tropics the miasmatic class of diseases occasions most of the mortality at the earlier periods of life. A considerable proportion arises from small-pox, showing bad management of children, and that vaccination is either neglected or imperfectly performed. The other fatal diseases are mainly those which in this country are connected with bad drainage, deficient and bad water supply, overcrowding, and want of sufficient house accommodation and cleanliness. ”

“ Rheumatism.―Their general remedy is friction. If very severe about legs or thighs, the doctor gets a good mound prepared of ashes, excavating the ground 18 inches, made solely from bark, which never has any grit, but mere ash. If lumbago, the patient is laid on his stomach, the doctor rubs most unmercifully the hot ashes on the part affected, as a butcher would in salting meat; if in thighs or legs, the patient’s feet are put into the mound of heated ashes, about half way up his legs, where he sits whilst the doctor is rubbing the hot ashes on the parts affected. ”

“ How little can any single school do! In the Annesfield Government Institution it has been the aim to prove that the natives are capable of being made useful members of society, and, what is more, that they are capable of understanding and embracing the great truths of salvation ”

“ To the extent to which the data are imperfect, the results are of course unreliable. The numbers are often much smaller than are required for such purposes. I have used them because the best obtainable, even with the assistance of the colonial governments; and the first lesson they teach is the necessity for assimilating the colonial registration and vital statistics to those at home. ”

“ The death rate, it will be observed, varies considerably in different colonies. It is least among the native children at Natal, where a little more than five males per 1,000 and three females per 1,000 die annually. The Ceylon schools give a death rate of 14 1⁄2 per 1,000 per {5} annum for boys and about 3 per 1,000 per annum for girls. But, including deaths among children who leave school to die at home, this rate would be nearly doubled. ”

“ Disorders of the Lungs, Spitting of Blood, &c.―The blacks study much the colour of the spittle in those affected in the lungs, and know well its stages. When the patient begins to spit blood, there is much attention paid to him; should this increase, which generally is the case, the native doctors have a consultation. When once the black doctors hold a consultation, they will not let the patient take any more medicine from the whites. ”

“ The Indian schools in Canada afford a total annual death rate of 12 1⁄2 per 1,000 for both sexes; but the mortality of girls is nearly double that of boys.
The Sierra Leone schools afford a very high rate of mortality, viz., 20 per 1,000 for males, and 35 per 1,000 for females. ”

“ This destroying principle is now at work in the colonies where races are decaying. And its results can only be diminished by assimilating the new conditions, involved in the change, as nearly as possible, so far as healthiness is concerned, to the open air activity to which the people have been for generations accustomed. ”