Health Resorts for Tropical Invalids in India, at home, and abroad

Front matter

HEALTH RESORTS FOR TROPICAL INVALIDS By the same Author. A MANUAL OF THE DISEASES OF INDIA. HEALTH IN THE TROPICS; or Sanitary Art applied to Europeans in India. 8vo. cloth, 9^. A MANUAL OF FAMILY MEDICINE FOR INDIA. Third Ediliun. Crown Svo. cloth, 12j. HEALTH RESORTS FOR TROPICAL INVALIDS IN IXDIA, AT HOME, AND ABROAD BY W. J. MOOEE LICENTIATE OF THE ROYAL COLLEGE OF* PHYSICIANS, EDINBURGH MEMBER OF THE ROYAL COLLEGE /OF BURGEONS. LONDON DEPUTY SURGEON-GENERAO, HER MAJESTY'S FORCES, PRESIDENCY DIVISION, BOMBAY LONDON J. & A. CHURCHILL, NEW BURLINGTON .STREET 1881 All righls reserved

Preface

. Much of the following Notes was compiled for insertion in a fourth edition of the author's ' Manual of Family Medicine for India ; ' but it was found the bulk of that work would thereby be too much increased. The original Notes have, therefore, been somewhat ampli fied, and are now published as a separate volume. There is not, it is believed, any other publication affording even a bird's-eye view of the sanitary stations of India. While all have been reported on officially, and while handbooks and guides have been prepared for some localities, no previous attempt has been made to give the principal characteristics of each place under one cover. Similarly, although numerous books have been written on one or other, or on one or other group, of the Health Kesorts of Europe, there is no one work affording the information to be found in the following pages. VI

PREFACE.

. Several hill stations in India, which are purely military and not public resorts, have not been included. Many small continental and British resorts are also not referred to. The idea has been to give such cursory accounts of the principal sanitaria at home and abroad as will, if not always enabling the reader to determine on a suitable position, yet indicate that locality concerning which more information is desirable — information only to be procured from more expensive and often local publications. Lastly, it is remarked that the volume is not in tended as a handbook excepting in its relation to climate. W. J. M. Bombay : July 1881. CONTENTS. CHAPTER PAGE I. Health Resorts in India 1 II. Tropical Marine Sanitaria 70 III. Health Resorts Abroad 74 IV. Health Resorts at Home 144 Index HEALTH RESORTS.

Chapter I. Health Resorts In India

The principal Hill Stations in India (not including some purely military hill cantonments) are Abbottabad, Almorah, Dalhousie, Darjeeling, Dharmsala, Cashmir, Kusowli, Murree, Mussooree, Naini Tal, Simla. Then there is Pachmarhi in the Central Provinces ; Mount Abu in Southern Eajpootana ; the Nilgherry Hills in Madras ; and Mahableswar, Matheran, and Khandalla, in the Bombay Presidency. The whole may be divided, sanitarily, into extra tropical and -wzira-tropical mountain climates, the stations in the Himmalayas belonging to the former class, the remainder to the latter. All hill climates, except Cashmir, whether within or without the tropical line, are characterised by a summer season from ten to twenty degrees cooler than that of the plains ; by heavy monsoon rains accompanied by much mist and damp (rendering Mahableswar and Matheran in the Bombay Presidency uninhabitable during this period) ; by glo rious autumnal weather; and in the eæ.- a-tropical stations by a winter season much colder than that of B the plains, with usually heavy falls of snow about the month of January.

On the .?_£. a-tropical ranges of hills, the cold season is not so severe, and the changes of temperature are much less than on the Himmalayas, where the thermometer is influenced by cold winds from the snowy regions of the north. The Nilgherry hills especially, from their altitude, their proximity to the equator, and their nearness to the sea, offer a cool climate, famed for evenness of temperature, and con sequent salubrity. The climate of all hill stations is, however, modified by neighbouring physical conditions, and the same mountains or even the same station may afford localities differing much in climatic characteristics. All have excellencies and defects, and many invalids have something special or peculiar in their ailments or constitution demanding special consideration and medical advice with respect to the choice of a suitable climate.

But the very common error of expecting Indian hill climates to cure all kinds of disease should not be entertained. As a rule it is only those cases of ill health when no specific disease exists, which are benefited by the change to the hills. Unfortunately there is no model climate capable of curing all kinds of disease, and no country or locality can boast of perfec tion in this respect. In India the one great thing desirable from change of climate, is to get away from a heated, debilitating atmosphere ; and an easterly wind even, so that it lowers the temperature, is not un frequently regarded by healthy persons with satisfaction ! Climates in Em-ope are spoken of as relaxing, sedative, exciting, or bracing, according as the locality presents certain characteristics of dryness, humidity, and tem perature ; but in India, the two great distinctions of hot and cool, and the paramount necessity of coolness VALUE OF INDIAN HILL RANGES. 3 scarcely admit of much attention to those more subtle variations, to be considered with regard to the more changeable European climates.

Thus the value of Indian hill ranges is limited to those conditions, in which simply a cooler atmosphere may be expected to be beneficial. When there is specific disease, as of the liver, or bowels, or spleen, contracted in the tropics, a more radical change is necessary than to a tropical mountain climate. When there is tendency to such specific diseases, or to chest affection, and a more radi cal change cannot be taken, mira-tropical stations are preferable, although not always advisable. But when the ailment is simply debility from heat, or from con tinued work, or convalescence from some malady which has merely left debility as a result, or when the com plaints are of lassitude, loss of appetite, exhaustion after little exertion, and loss of energy and inclination for the daily occupation, any hill climate almost at any time will prove beneficial.

By such change the spirits are exhilarated, the appetite and digestion are improved, the vital powers are stimulated, and the physical vigour is regained. Eesidence in the hills may moreover be regarded not only as exciting a sanitary effect on the body, but also on the mind; the freedom from the harass of daily work, and the change of scene and society, tending to raise and exhilarate the spirits, depressed by the continued influence of the heated plains. Here a few words are ventured as protest against writers who have portrayed the climate of India as not inimical to Europeans generally, and as even favourable to European children, and who have even advised life assurance at European rates. Without reference to those tropical epidemic diseases which so often < strew B with sudden carcases the land,' and to the dangers from which all Europeans are liable, it is asserted that the Indian climate solely from the exposure to pro longed heat which it entails is inimical to the European constitution.

Subjection to continued heat has a direct impairing influence over and above the in ertia consequent on such conditions of life. In several different manners (well known to medical men) continued heat injures the digestion, debilitates the system, and degenerates the blood. This deterioration, although sometimes slow, is certain, and commences in the majority of instances from the date the European enters the tropical plains. Men with a large amount of vital force and strength withstand the enervating influences longer than others not so endowed, but the time at length arrives when deterioration does occur. As a general rule, during the hot weather of the plains of India the Briton is not himself at all. The Indian climate throws its net over him, and struggle as he may he must yield to its embrace.

Nature seems then in conspiracy to dull energy, weary the brain, and weaken the body; in short, to render both men and women idle and to demoralise them, for a jaded mind soon attends a jaded body. It is only by a periodical escape from the influence of the plains that the majority of Euro peans can retain both mental and physical health and vigour. Every mile the traveller advances from the plains into the hill ranges is eloquent of that change of climate which will so soon produce a change of health. Vegetation, animal Use, and even the appearance of human beings alter gradually, but distinctly. As ele vation is attained, the air feels first lighter, then crisp, then exhilarating as champagne, the immediate relief experienced being a foretaste of the improvement soon DANGERS FROM CHANGE OF CLIMATE. to replace the waning colour, depression of spirits, and deterioration of health occurring to so many residents on the plains.

Much care, however, is necessary to guard against the effects of chill consequent on the change to the lower temperature of the hills. The sudden impres sion of the colder air checks the action of the skin, and the blood being driven within on internal organs^ any weak part suffers from the strain. It should be recog nised that although there is a comparative immunity from liability to cholera, dysentery, sunstroke, and mala rious disease in the hills, there is usually a greater tendency to chest and throat affection, to neuralgic maladies, and rheumatism, and on some hill ranges to diarrhœa. Children taken to hill climates without special regard to clothing, are very liable to throat or chest affection, or to diarrhœa, from which they may never have suffered on the plains. Warmer clothing should be put on before completing the ascent of a mountain — or directly altitude affords a change of temperature— and not after the ascent is made.

However warm the hill climate may appear to persons fresh from the plains (who frequently declare it to be ' as hot as below,' although never reversing the declaration when they go down), the change of temperature involved if made without care is fraught with danger. A very frequent effect of the colder climate of the hills is an increased amount of urine, and when this occurs it should be accepted as a warning that too great impres sion is being made on the skin, which requires warmer clothing. On the other hand, precautions against exposure to the sun must not be neglected. It should be remembered that the low temperature of the Indian hill ranges is due more to elevation than to latitude. HEALTH RESORTS IN INDIA. The rays of the sun shining with great fierceness through a rarefied air, are at some seasons of the year nearly as powerful as experienced on the plains ; and especially so at the intra-tropical stations, where the latitude is less northerly, and the sun's rays more vertical than at the Himmalayas.

To obtain the same mean temperature as in Eng land it would be necessary that about 9,500 feet should be ascended in places south of lat. 20° ; between 20° and 26°, 9,000 feet ; between 26° and 30°, 8,700 feet ; and north of lat. 30°, 8,500 feet. Speaking generally, however, an elevation of 5,000 to 6,000 feet will afford over the whole of India a mean annual temperature about 10° higher than that of England, and about 12° lower than that of the Indian plains. The hill cli mates may thus be regarded as both semi-tropical and semi-temperate, and are therefore climates in which the diseases of both tropical and temperate zones meet and may flourish. On the other hand, the hill climates, owing to the pure atmosphere, are so excellent, that attention to ordinary general sanitary measures, and to individual hygiene, will suffice to reduce the prevalence of both classes of disease to a minimum not obtainable in the tropical low countries, or scarcely even in the temperate zones.

Lastly, a word of caution is desirable on another point. Whatever change of climate is taken, the change alone should not be trusted to. Medical management should be continued, and personal and general hygiene should be still studied. It is from discarding such means that many do not obtain that relief from change which they expected to result. The principal hill stations of India are now briefly described, in their capacity as health resorts. ABBOTTABAD. 7 Abbottabad. — The locality is a small, irregularly shaped valley of the Western Himmalayas, having an area of about thirty square miles. It is almost sur rounded by mountains covered with pine forests, the summit of one called Thundiani, about fourteen miles distant from the station, being nearly 9,000 feet high. The height of the valley of Abbottabad itself is about 4,000 feet, that of the inhabited part being 100 feet higher.

The station of Abbottabad is forty miles from Murree, and the road passes over ranges of hills known as ' The Gullies,' on which there are some private bun galovs. The soil is alluvial clay overlying a stratum of pebbles. The station is situated on elevated sloping ground, and is well drained. It is divided into a civil and military portion. In the latter there are barracks for two infantry regiments and two batteries. In the civil station there are about a dozen bungalows. The climate is very cold from December till the end of February, snow falling every year with a northerly wind. In the summer the temperature may reach 90° in the shade ; but it is frequently moderated by a northerly breeze which sets in at 10 a.m. and con tinues during the day. In spring and autumn the climate is described as a fine English summer.

July and August are the rainy months, but the annual rain fall seldom exceeds 46 inches, and there are showers every month, except October and November. Vegeta tion is very abundant, fruit trees, roses, and flowers of many kinds growing in profusion. The water supply is from wells, good and abundant. Owing to sudden changes of temperature, which occur more or less at all seasons, and to northerly winds, Abbottabad is trying to weakly persons, especially if delicate about the chest, or if subject to any form of rheumatism or neuralgia. HEALTH RESORTS IN INDIA. The summer temperature is also too high for persons who need a bracing climate, although affording great relief from the heat of the plains to those affected with slight or functional forms of bowel or liver complaint, for whom the colder climates of more elevated regions would be unsuitable.

With attention to diet and clothing, such cases, as also most instances of debility, either arising from fever or other causes, do well. Abu. — Mount Abu is a mountain in the native state of Serohi Rajpootana, detached from the great Araveilis range, from which it is separated by the valley of the Western Banass river. In shape the mountain is long and narrow, being about 20 miles in extent at the base and 14 at the summit, the breadth of the latter being from 2 to 4 miles. Abu is the head-quarters of the Rajpootana Political Agency, the site of one of the Lawrence Asylums for European children, and a sanitarium for European soldiers. It is 45 miles from Deesa, and 420 by rail from Bombay. The last sixteen miles from the Abu road station, which is eight miles from the foot of the hill, may be accomplished on horseback or by janpan, but a carriage road is now under construction.

The Abu mountain is composed of igneous granitic rocks, with occasional veins of blue slate and quartz. The highest point, called ' Guru Sikr,' or ' the Priest's Pinnacle,' consists of a vast mass of darkling granite, and is 5,700 feet about the sea; but the station has only an average elevation of 4,000 feet above sea-level, and some 3,200 feet above the plains below. The ele vation of the western aspect especially is very abrupt. There are two roads up the mountain, one on the abrupt western face of the hill from the village of Anadra, entailing four miles of very steep ascent, as the ABU 9 path is constructed in a succession of zigzag turns on the precipitous hill side. The other road, already men tioned, on the south-eastern declivity, is less steep, but longer from the railway station.

The traveller when ascending the mountain can hardly fail to be impressed with the grand and beautiful scenery. The gigantic blocks of granite rock towering on the crest are especially striking, worn into fantastic shapes by the weather, or hollowed into caves in which birds of prey take their abode. The summit of the mountain over looks in places an absolute precipice of four or five hundred feet descent; while on the western side are the plains of Serohi and Marwar stretching off to the Runn of Kutch, only broken towards the north by a range of hills on the Marwar border. On the eastern side there is the Banas Valley separating also from the Araveilis range, in which direction, on a clear day, a vast expanse of mountainous country is visible. The inhabited part of Abu is a wide hollow or basin perforated by ravines, studded with hills, and surrounded on all sides at a distance of two or three miles from the centre with much higher eminences, from the bases of which several gorges descend precipitously to the plains.

The numerous hills, valleys, ravines, bold and grotesquely shaped granite rocks, with here and there large trees, as jambool, burr, pepal, mango, and in some places date palm, afford very picturesque and changing scenery. The delights of the landscape are furthermore enhanced at some seasons by magnificent cloud masses, and by the notes of the cuckoo, or by the singing of the so-called Abu ' thrush,' which birds precede the first monsoon mists ; also by the luxuriance of the jasmine, the dog rose, and numerous other flowers and creepers characterising the local flora. At the close of HEALTH RESORTS IN INDIA. the rains the place is gay with many-coloured butter flies ; while during the rains fire-flies abound. It is indeed at the commencement and termination of the monsoon that Abu appears in its most charming aspect, everything being delightfully green, flowers abounding, and every valley having its running waters, which are more or less dry during the hot weather.

On the western side of the station is a lake nearly two miles in circumference, formed by a bund built across a ravine leading to the plains. The charming view of this lake from various points presents islands and palm trees, high mountains more or less thickly wooded rising on both sides, and a glimpse over the bund and across the plains of other distant hills. The mean annual temperature is 70° ; the extreme summer heat in the shade is 98° ; but this is compara tively seldom recorded, 92° being the usual excess. In the winter, water left outside in a dish freezes, and hoar frost covers the ground. But the daily temperature is very equable, and the station is in some degree protected from the winter easterly winds. The rainfall is variable, but averaged during ten years 64 inches. During August, the most rainy period, the hill may be for days enveloped in clouds ; but this does not prove unhealthy, provided care is taken in drying clothing and bedding.

The summer is certainly warm ; unless in comparison with the burning sandy plains below, as the elevation is only just sufficient to convey the resident above the hot winds, although not always above the fine dust they raise. Abu, however, affords a most agreeable change from the furnace-like hot weather heat of the Rajpootana and Guzerat plains. For, although hot in the sun, the heat is generally tempered in the summer season by a refreshing breeze ; ABU, 11 there is a lightness and elasticity in the atmosphere never enjoyed at such time on the plains, and the nights are cool. Bowel complaints do not occur as on some of the Himmalayan stations, and bronchial com plaints are rare ; but from the middle of October to the end of the year the climate is malarious. This probably arises from the numerous basin-like depressions in the impervious granite rock, some of large extent, and all more or less filled with alluvial soil, and from which there can be no escape of moisture except by evaporation.

Persons at all subject to fever should avoid Abu at this time, which is the period of the year when there is most change between the temperature of the day and night; and when frequently easterly winds prevail, both exciting causes of fever. At other seasons almost any malady, excepting confirmed forms of bowel and liver complaint, will be benefited. Other drawbacks to Abu are the water supply, and the impossi bility of procuring fresh beef. The water, although of good quality, is uncertain in quantity, many of the station wells running dry in the hot weather, when people have to send long distances to other sources in the neighbouring valleys. Cattle are not allowed to be slaughtered in any part of the native State of Sirohi, in which Abu is situated ; killing kine being contrary to the tenets of modern Hinduism, so that residents are confined to mutton and fowl diets, both indifferent and expensive unless home-fed.

With the opening of the railway the excellences of Abu will doubtless be come more appreciated by those requiring a dry, tonic climate, without great cold or vicissitudes of temperature. The railroad may also be expected to diminish that passive opposition on the part of the Serohi Durbar authorities to the development of Abu, who cannot much longer, in the face of advancing civilisation, con sider the hill so holy as to be desecrated by the customs of Europeans. For the convalescent there is not much amusement at Abu. There is a small club ; and sambur, jungle fowl and spur fowl are to be found on the mountain sides, but the pursuit involves great labour. Bears, sometimes tigers, and panthers often, have been shot near the station. The places of interest are the Jain temples near the barracks, the ' Gai Mukh ' half-way down the hill and reached by a long flight of difficult steps ; Achilgurh and its temples, four miles distant ; and the highest point of the mountain ' Guru Sikr,' about eight miles from Abu.

At present there is little accommodation for visitors, the number of houses being limited. Almorah. — The station of Almorah in the Kumaon district is on a rocky ridge sloping down east and west to two mountain streams, the Kosi and the Sawul. Almorah is 30 miles north of Naini Tal, from which it is easily reached. Otherwise the railway brings pas sengers to Bareilly, whence a dak gharry runs a distance of sixty-five miles in nine or ten hours to Ram bagh at the foot of the hills. From Rambagh to Almorah is about forty miles, which may be ridden or travelled in palkee. There are comfortable dak bunga lows at every ten or twelve miles. For sick officers and their families there are at Almorah several Govern ment bungalows (under the charge of the Commis sioner of Kumaon) at a small rental. There is also a public travellers' bungalow ; while in and around Almorah there are numbers of good houses moderately priced.

Almorah is the head-quarters of one of the Goorkha regiments. ALMORAH. 13 The surface of the ground consists of coarse mica ceous rock with veins of quartz cropping out. The elevation varies from 5,300 to 5,500 feet. The average rainfall does not exceed 30 inches, and there is much less fog and damp than at the neighbouring station of Naini Tal. The highest recorded temperature is 88° in May, and the lowest 36° in January, but usually the extremes are not so great. In January and February snow often falls in the station, and always on the neighbouring higher mountains. The drainage, from the physical formation, is excellent, and the sanitary condition is satisfactory. Water supply is good from springs. Edible vegetables are somewhat scarce, but other supplies plentiful and cheap. Some of the neighbouring hills are well wooded, but there are not many trees on the ridge on which the station is situated, owing to its bare rocky character, although the number has been increased during recent years.

From the comparative want of shade the surface vegetation be comes burnt up in the hot weather, and the rocks re flecting the heat raise the temperature of the air above that of localities of similar altitude where there is less rock and more shade. If the rains are late in com mencing, the station becomes unhealthy from continued heat, and especially so for European children, who are liable to bilious fevers and bowel complaints. Those finding Almorah unpleasant at the height of the hot season may visit Binsur, a hill about twelve miles to the north, which is 2,000 feet higher, richly wooded, the temperature being from six to twelve degrees lower, and where there are several houses. After the rains set in, Almorah becomes cool and generally remarkably healthy. The cold weather is bracing and healthy ; but occasionally, when much rain falls, the damp and cold give rise to bronchial and rheumatic affections.

Ex cepting in the cold weather, chest complaints, neuralgia, and rheumatism are very uncommon, and at all times patients recover rapidly from weakened conditions, the result of prolonged residence on the plains. Chronic forms of indigestion are usually benefited. Excepting at the period and under the contingency of late rains, as referred to above, children thrive especially well. Cashmir. — The following rules for the guidance of travellers visiting the dominions of his Highness the Maharaja of Jummoo and Cashmir, having received the sanction of his Excellency the Governor-General in Council, were published for general information in the < Punjab Gazette ' of March 28, 1878 :— 1. The Punjab Government no longer issues passes for visitors to Cashmir. The number of military officers in Cashmir at one time is restricted to 200.

The disposal of passes for this number, less a certain number reserved for the Punjab Frontier Force, is with his Excellency the Commander-in-Chief. Frontier Force officers desiring to visit Cashmir must apply to the Brigadier-General commanding. CiviUans and military officers in civil employ, but a small proportion of whom under the leave rules can visit Cashmir the same season, do not require any passes ; but they should report their intention to travel in Cashmir to the Assistant-Secretary, Lahore, and can obtain at the Secretariat Office, Lahore, a copy of the rules to which they must conform. 2. There are four authorised routes for European visitors to Cashmir : — First.— The principal road from the plains by Bhimbar and Rajaori, over the Pir Panjal range. This CASHMIR. 15 route may be varied by leaving the main road at Thana Mandi and proceeding via Punch and over the Haji Pir Pass to Uri.

The route just mentioned is 147 miles, and there are twelve rest-houses on the road at intervals of 8 to 12 miles, where mules and coolies may be obtained. The second route is 187 miles, also made in twelve marches, the first five marches to Thana Mandi being the same. In ordinary seasons the Pir Panjal route is impracticable until May, and is closed by snow in November. The Haji Pir route is generally open in April. Second. — The road from the plains by Kotli, Punch, Uri and Baramula. The distance is about 240 miles, the last five stages being the same as via the Haji Pir Pass. This route is open in April, but it is difficult and not recommended. Third. — The road from Murree by Kohala and Baramula. Sirinagar is distant from Murree 163 miles, usually performed in thirteen stages. Between the second and third stages, the Jhelum river is crossed by a bridge.

This road is good for laden ponies, and is always, or nearly always, open. The scenery is in many parts very lovely, and there are bungalows at all the stages. Fourth. — The road from Rawul Pindee and Abbott abad by Muzaffarabad, and Baramula. From Pindee to Abbottabad is 61 miles, and from Abbottabad to Sirinagar 156 miles, or eleven stages. This is an easy route from the Punjab to Cashmir. Laden ponies go over it without difficulty, and it is never stopped by snow. The last two stages are usually done by water. Along all the principal routes in Cashmir territory special officers or ' Kotwalls ' are appointed to supply the wants of travellers. Unless travellers encamp at the fixed stages, and encamping grounds where these men are stationed, there is no certainty that supplies will be obtainable.

At many of the stages European liquors and stores are procurable, but this should not be depended upon, and the traveller should take with him both servants and all that he requires in the way of stores. The valley of Cashmir is a tract surrounded by lofty mountains on all sides excepting where a gorge at the north-west extremity permits the escape of the Jhelum river. The central part of the valley is a level expanse, but in some other districts it presents a very uneven surface formed by numerous ridges and ravines, extending from the plain to the surrounding highlands. The shape of the valley is irregularly oval. The plain forming the centre of the valley is about 75 miles long by 40 broad. But the actual area within the ring of hill summits is much larger. The narrowest part is the southern extremity, and the widest is north of Sirinagar, where large portions consist of flooded land or marshes.