Popular Science Monthly/Volume 38/April 1891/Race Influence and Disease

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IT has been my lot to deal professionally for some years with people of divers colors and races, nations and languages in many different parts of the world, and in varied and constantly changing climates. I have thus had exceptional opportunities and sufficient leisure to ponder over racial variations as they present themselves to the medical eye.

Perhaps the most interesting races with whom I have been thrown into contact are the African, and I will consider them first. I have more especially had to do with the natives of East Africa, who are Mohammedans of a somewhat lax and unorthodox type, and yet, owing to their implicit acceptance of Mohammed's fatalistic doctrines, their submission to kismet is so complete as distinctly to influence the course of their illnesses.

Indirectly it does so in the following way: When a Sidi-boy incurs, for instance, a wound on his leg, he thinks that if Allah wills that this should get well its healing is certain, but, if the divine wish is otherwise, no human skill or care can do one iota of good; on this account details of simple dressing and protection are quite neglected by this poor fellow, or as much so as the surgeon will allow. If under discipline, he is willing to have his name on the sick list for the privileges which belong to it; but in his heart he despises surgical treatment. Clearly, then, the prognosis with such a case is much worse than it would be in other subjects.

The same argument applies with much greater force to medical cases, on account of the childlike ignorance which exists among such people as to what disease actually means.

This extreme and apathetic dependence on fate forms the greatest difficulty with which the physician has to contend. It speaks well for the blind religious faith of these races, and puts to shame many professing Christians on their sick-beds; but it costs many lives, and entails much extra work on medical attendants, who have perhaps to administer remedies with their own hands, and that often under great difficulties and at much personal sacrifice.

Another more direct point, and one which adds to the gravity of the prognosis, is that these men are not at all anxious to recover; their idea of the value of life is very low, their present existence is usually a hard one, while their religion promises them better times in their heaven, so that if Allah wills to take them they are in luck, and by no means to be pitied.

Now, we all know what it is in the crisis of a severe illness for a patient to have pluck, and a sufficient supply of doggedness to be capable of making a continued effort; to make up his mind in his saner moments not to yield to the sinking feelings that will come over him, to fight against his illness as against an attacking enemy, to feel that he is determined to pull through, if only to please his friends, to spite his rivals, to foil his foes, or to accomplish some non-completed task. I remember to have had somewhat similar ideas in my own maladies, and I feel sure they were of much assistance to my recovery.

Such impulses as these from the organs of thought and will must of necessity have a distinct effect upon the rest of the nervous system, and thus over the heart and other organs, if only through the emotions, and that a beneficial and stimulating effect; these impulses may therefore make all the difference in tiding over a crisis, and during early convalescence. But of course the influence of the mental state upon disease is unquestioned. The absence in these races of this important factor, and the presence of the stagnating fatalism above mentioned, are, I feel sure, the causes of many a death.

One of my first cases, and it taught me a great lesson, was that of a stalwart East African who complained of feeling ill; on examination nothing could be found amiss but slight febrile symptoms and a small patch of pleuritic friction. To my surprise, the poor negro began by saying he was going to die; he went to his bunk, and next day I found him much the same, except that the heart's action was rather enfeebled, though no physical signs of cardiac disease could be detected. He was, however, utterly uninterested in his condition, and only took food under compulsion. In the evening he suddenly expired, more as it seemed for I was unfortunately unable to make a post-mortem investigation—from what I might call inertia than from his actual disease. Later experience told me that had I bullied the man, and given him brandy with my own hand, and stirred him out of his apathy, I might have saved his life. But it was often noticed among us that if, on becoming ill, these men predict that they are sick unto death, they will, if left to themselves, simply go and lie down and quietly die, refusing all assistance.

Confirmation of this view is found in the following words of Hume Nisbet, when speaking of similar races:

When hope ceases to glow in their breasts, or a superstitious omen tells them that they are to die—it may be the word of the magician, or the bone pointed at them, as among the Queenslanders, or the lizard running over them, as with the Maori, or the utter weariness of life taking possession, as with the Sidi-boys—they can lie down and give up life as easily and methodically as they fall asleep.

"This will-power is utterly beyond the comprehension of us Westerns, nor can doctors give the complaint a name; sailors say they die out of 'pure cussedness.' A Maori will count up the days he has to live, inform his friends of the fact, and die up to time; he calmly lies down and dies without an effort."

So much as regards the course of diseases; now as to treatment. The most successful means of treating such cases lies in the use of alcohol, and so unaccustomed are most of these people to its action that very small doses are required to produce a good effect. It acts partly by a kind of intoxicating influence, putting a little energy, or even "devilment" into them. If administered with cautious judgment, this support may be kept up until convalescence is fairly established, when with returning strength they realize that destiny means them to survive; here the ordinary good effects of stimulant treatment are much enhanced by the previous abstinence.

It is well known how very excitable are these woolly-haired, thick-lipped, flat-nosed races, the excitement representing the opposite mental condition to the extreme languid depression of which I have already spoken. For instance, at the great Mohurram festival at Bombay, which I once witnessed, I noticed that all the noise and mad dancing and boisterous fanaticism of the night processions were manifested, not by the natives of India, who were in a large majority, but by the negroes, their religious fervor and the frenzy born of bhang conspiring to excite them. It is this sensitiveness to rapid mental change that gives alcohol such potent virtues with them in sickness.

The natives of our Eastern empire, always excepting the fine Sikh races, and those living near the northern frontier, than whom I have never seen finer or braver specimens of mankind, are people of poor stamina, and are easily prostrated. Timid and feeble, they dread the pain of illness, and dislike the thought of death mostly on account of the ordeal of the dying process. They are therefore ready, nay, over-anxious for medical treatment, and are fond of both liniments and physic. But in spite of this they fare worse than the Europeans in all ordinary diseases; symptoms are more severe if less sthenic, prognosis is graver. Some explanation may be found in their habitually poor diet, which leaves little balance to the credit account in the nutrition of the tissues, and consequently small resisting power to disease, but more, I think, belongs to a want of "real grit" among them, a characteristic racial failing.

For example, a catarrhal condition of the alimentary canal will pull such a patient down with alarming rapidity, out of all proportion to the other symptoms, and indeed often to a fatal ending. Stimulants in such cases are, of course, of great use, but not to the same extent with our Aryan brother as with the Africans. With small abrasions and ulcers healthy granulations are the exception, lymphatic abscesses are a frequent result, and belong to a low phlegmonous type, pyæmia often supervening. Perforating ulcers of the feet and gangrene about the toes bear evidence to a poorness of local nutrition, and a low vital tone of some of the tissues, also shown by the fact that necrosis of bone is a much more frequent sequela to blows than with hardier nations.

Another point that I have noticed is that minor ailments, such as coryza, etc., take a much more severe course than that with which we are acquainted.

Both the Indians and Africans are much less subject to ill effects from changes of temperature than are Europeans. This is perhaps to be expected in tropical climates, and may be due to the excellent way in which their sweat-glands respond to an extra call upon them, consequent probably on their scantier clothing and less constant interference with the natural skin-functions. Also, in spite of their thin cotton garments, sudden and temporary exposure to a winter climate produces a very small percentage of sickness among them, though those who do suffer become really ill. True, they grow torpid and incapable of much work; but, if Europeans were exposed as much as I have seen these darker races, I feel sure a very much larger proportion of them would soon be on the sick-list.

Chinese and Japanese make much better patients. They have faith, want to recover, and endeavor to do so. They are fairly tractable and obedient, their average constitution is more robust, and they are not destitute of moral courage; consequently treatment yields in their case better results.

Among European nations I have been much struck with the difference in the course of sickness between the Teutonic and the French people. For instance, I have witnessed the effects of extreme heat in the Red Sea, through which I passed seven times in a single year. The phlegmatic German, from sheer stolidity, stays exposed to the sun until he feels queer, then comes below and takes a large draught of beer, which, of course, makes him much worse. His condition soon becomes one of typhoid delirium bordering on stupor, but he is easily treated, and soon recovers. Now, look upon the other picture. The fussy Frenchman, from rank obstinacy, exposes himself to a high temperature, and on feeling ill becomes at once fearfully alarmed, wants to try every remedy at once and nothing long, blames every one but himself, grows noisily delirious, and finally works himself into a state of extreme exhaustion which materially adds to the gravity of his case.

The above personal observations have led me to search out evidence to support my views on the subject, and I now append a very brief account of what I have found in reference to particular diseases, specific and otherwise.

Influenza.—Isolation for long periods from other races, as in the case of insular populations, causes influenza and similar epidemics to run a more severe and dangerous course; witness the cases of St. Kilda and the Society Islands. An epidemic takes place when the infecting visitors are afflicted with apparently only the slightest of colds, while less recent arrivals, if attacked, suffer far more lightly than do the older inhabitants, though more so than the visitors themselves. During my stay at Ascension Island I was told by a resident official that a cold introduced from a passing vessel runs through the island as a severe epidemic, necessitating rest in bed and active treatment for several days. This effect is still more virulent, leading even to fatal results, in the island of Tristan d'Acunha, where the isolation is much more complete, and the people are of British origin.

Now, sea-water is by no means the only method of isolation, and in earlier ages, situation, feuds, and scanty means of locomotion were efficient causes. When a tendency to a particular complaint becomes increased by long periods of isolation, so that heredity is able to accentuate any special proneness, one possible explanation of the origin of pathological racial idiosyncrasies is afforded.

Dengue.—African races incur this disease much less frequently than do others, and with them it takes a very mild form, being highly amenable to expectant treatment and simple care. On the other hand, the natives of India suffer in greater numbers and much more severely than do Europeans even, and show a much higher death-rate from it. Now, there are many African immigrants in India, and vice versa, yet this racial law still holds good among them, even after some generations.

Small-pox.—Both the negro and the Arab tribes in the Nile regions of Africa, and also the Aryan races of central Asia, have from time immemorial suffered cruelly from variola. Vaccination has lessened the value of comparative statistics on this point, but the mortality from the disease has been and is positively awful, complete depopulation sometimes resulting in particular valleys or islands.

Measles as an epidemic has caused terrible devastation among insular races, especially in warm climates, assuming a far more virulent type than that known to Europe, among people less capable of resisting a panic-creating disease.

Malaria.—Here occur the best instances of acclimatization of races. Ethiopians are affected less frequently than are other peoples, and with diminished severity. Blonde and blue-eyed Europeans, as with gonorrhœa and some other complaints, furnish the worst victims. As regards its treatment, quinine has far less efficacy with them than with us, and arsenic is more of a specific remedy to them, though this depends on the actual variety of the fever. With the negro, after-effects upon the constitution are quite exceptional.

Yellow Fever.—Special liability and increased mortality belong to the light-haired Europeans, and acclimatization is by no means absolute; yet pure-blooded negroes possess congenital immunity, which is certainly absent from Redskins, or Hindoo coolies, though the Chinese are almost exempt.

Cholera.—The African races incur the greatest danger from this dread disease, dying off without an effort at resistance and with the greatest rapidity, giving little opportunity for treatment. Europeans and Hindoos, however, provided the latter are under fair hygienic conditions as to food, etc., suffer very similarly. After a famine the Indians, deprived of all resisting power, fall ready victims.

Typhoid Fever gives a typical instance of acclimatization of race through heredity, for in tropical regions the disease is often completely limited to strangers. During my visit to Jinjeera, off the Malabar coast, I was informed that the foul water of the large "tank" is certain death to a European through this fever, and yet it forms the ordinary drinking-water supply of the crowded inhabitants. Among such people mild cases, due probably to the same poison exerting a much mitigated action, are, however, not infrequent. In this instance time has apparently produced a modified form of the disease by a general protective process of natural infection, similar in its effects to inoculation, as well as by the allpervading action of natural selection and accommodation to environment.

Leprosy is well known specially to select tropical races, and to run a more rapid course with them.

Syphilis punishes negroes of the coast of Africa often and very viciously. Phagedæna forms an ordinary complication, as also does bone-disease; and specific treatment has to be pushed with perseverance. On the other hand, the central Africans are remarkably exempt, as are also Icelanders and Greenlanders. In Chinese ports Europeans suffer extremely when compared with the natives, as if the poison, like other living species, had its varieties. Perhaps, too, an inherited natural inoculation becomes a protection to particular races.

Bronchial Catarrh for some reason, it may be carelessness as to clothing and dwelling, inflicts greater punishment on indigenous dark races than on strangers among them, runs a much more trying course, and is more resistant to therapeutic influence. Pneumonia.—Natives of the tropics, and more especially negroes, whether at home or abroad, are peculiarly subject to this acute fever. The death-rate and average of severe cases are among them exceptionally high.

Phthisis is also remarkably rapid and frequent with these races when sojourning for many months in cold climates, but less so with the southern Asiatic.—The Practitioner.