Napier, as a Health Resort For Pulmonary Invalids.

By W. I. Spencer, M.R.C.S., Lond.

In 1875 I wrote a short paper for Dr. Dobell on "Napier as a Health Resort," which was published in the volume of his "Reports on Diseases of the Chest" for 1876. Since that time, New Zealand has become a favorite resort for pulmonary invalids in England. Ten years' further experience and observation have still more confirmed me in the statements I then advanced, and have added conviction to my opinion as to the pre-eminent suitability of the climate of Napier for those cases of incipient lung disease in which residence in a warm, dry, and tolerably equable climate, together with moderate elevation above the sea-level, is indicated—such for instance as chronic bronchitis and the earlier stages of phthisis. And I have not arrived at this conclusion hastily, but after a residence of twenty-one years in the colony, seventeen of which have been passed in Napier, and during which period I have had extensive opportunities of seeing and studying cases of phthisis which have arrived here in search of that health which is forbidden them by the cold sunless climate of the British Isles.

And here I would once more direct the attention both of patients and their medical advisers to a point of much importance—and that is the want of knowledge that appeals to exist as to the geography and the conditions of this country. The usual advice to patients in England is "Go to New Zealand," without particularising the special locality. Hence many invalids come out, and by-and-by return home, page 4 having derived no benefit from their sojourn here, and disgusted with the climate in general. The writer of the article on Climate in Quain's Dictionary of Medicine, p. 267, recommends Wellington as the place to seek. A more unfortunate selection could scarcely have been made. Situated in Cook's Strait, one of the stormiest parts of the Southern Hemisphere, the climate of Wellington is notoriously one of the most disagreeable, windy, and rainy in the country, and certainly the most so in the North Island. Indeed, the climate in different parts of New Zealand varies as much as it does in Great Britain—and this might be anticipated from the fact that the distance between the North Cape in New Zealand and Stewart's Island is nearly 2° greater than that between Unst, one of the Shetland Islands, and the Lizard point in Cornwall: the respective latitudes being, Unst, 60° 45′, the Lizard 49° 57′N.; and Stewart's Island 47°, North Cape, 34° 25′S. Therefore, to send a patient to New Zealand indiscriminately for the benefit of its climate, is equivalent to sending him to Great Britain for the same purpose. In each he will find extremes of heat and cold, wet and dryness, sunshine and cloud, wind and calm, land elevation and depression, barometrical range, geological formation of soil, water supply, hygienic arrangements, and in fact all those conditions which are comprehended under the general term "climate," within pretty much the same range of latitude.

In a very brief attempt to discuss the merits of Napier as a health resort, there are a few points which it may be well to lay before those who, having believed in New Zealand as a whole, have been disappointed in their experience of the country; or, having decided to give the climate a trial, are uncertain which locality to select as the best adapted to their case. I propose to say a few words, therefore, with respect to its Geography, Climatology, Local Products, Means of Communication, and some other questions which, although apparently of minor importance, go far in the aggregate to determine whether any particular place is desirable or otherwise as a residence for invalids.

Scinde Island, on which the town of Napier is situated, is on the East Coast of the North Island of New Zealand, near the southern extremity of Hawke's Bay.

Hawke's Bay, so named by Captain Cook, is a large inlet of the South Pacific Ocean, in length, from N. to s., about 50 miles, and with a depth, from E. to w., of about 30. On the north and south the bay is bordered by ranges of hills of no great elevation; on the west, however, these ranges extend inland to a distance of about 50 miles, and attain an elevation of 2000 or 3000 feet. These ranges have undoubtedly much influence in modifying the climate of Napier. The cold damp ocean breezes which prevail on the West Coast are, in their passage through and over the hills, deprived of the greater part of their moisture, and raised to a considerably higher temperature, and thus reach us as warm, dry, and at times somewhat enervating winds. At the same time their violence is greatly diminished.

Scinde Island or Napier is situated about 14 miles from Cape Kidnappers, the southernmost extremity of Hawke's Bay. The Cape received its name from Captain Cook, from an incident which occurred there during his visit to this country, the son of his interpreter having been kidnapped by the natives and only recovered after some bloodshed.

Scinde Island is an outlyer from the coast of New Zealand. It is about 2 miles in length by an average of ¾ in width, in height it varies from 350 to 200 feet, its borders are on all sides precipitous, but easy access is gained to all parts through the many ravines by which it is intersected, and which have been utilised by the Engineer for the formation of well-paved roads, mostly of gentle gradient. The geographical position of Napier is peculiar. Situated in the southern bight of the bay, it evidently at one period was joined to the mainland, from which it has been separated by the action of the sea, and possibly might ere this have been completely swept away but for the action of a mountain stream which, flowing through a gravel-bearing district, has brought down shingle in such quantities as to form a spit 4 miles in length and 200 yards or so in breadth, thereby connecting the island with the mainland on the south side and by cutting off the wave-flow and tidal influence forming a barrier of protection for the island. By the continual drift of the shingle round the eastern side of the island, another spit 5 miles in length and about ¼ in breadth, extends in a westerly direction, and also joining the main- page 6 land. These two long arms enclose a tidal lagoon of considerable area, through which a small mountain stream finds its way to the sea.

Situated in S. latitude 39° it might be expected that the climate of Napier would bear some resemblance to that of Madeira—and so I believe it does although it is probably not quite so hot, nor is it obnoxious to any winds, having the characteristics of the "Leste" which at times prevails in the latter island—nor, as I learn from patients who have had experience of both places, is the climate so enervating.

From which it is apparent that Napier holds an intermediate position, and that although a greater depth of rain descends during the year than at Torquay, yet it falls on fewer days in the proportion of nearly 2 to 8.

As to the force, prevalence, and nature of winds I have not been able to find any reliable basis for comparative statistics. In summer and autumn the prevailing winds are easterly sea breezes during the day and off the land at night. N.W. winds not unfrequently occur, they are often hot and enervating, and blow with considerable force. Severe storms which are of unfrequent occurrence commence with N.E. gale, after a few hours heavy rain comes on and the wind veers to S. or S.E.; this lasts usually two days, the wind then changes to S.W., is cold and showery, and so the storm terminates.

Thunder-storms, although common enough amongst the mountain ranges inland, rarely visit Napier.

The geological formation of the island consists of a series of limestone, clay, and sandy beds, covered by a thin layer of loam, the beds varying in proportion from pure clay, limestone, or sand, to various proportional mixtures. The fossiliferous deposits, which are all tertiary, Captain Hutton, Professor of Geology at Canterbury College, refers to the miocene period. The soil is porous, and dries quickly after rain. Systematic drainage of the town has been carried out by the Municipal Council, and although not yet extended to every part of the island, is believed to be as perfect as is possible at present.

The water supply is from artesian wells; it is excellent in quality and practicably inexhaustable in quantity.

Almost all plants that flourish in the South of England grow here, besides many that find that climate too cold. The Poplar and Weeping Willow are almost evergreen, the latter being rarely out of leaf more than 4 to 6 weeks in the year. The geranium and fuchsia are in flower all winter. The Eucalyptus globulus and the Norfolk Island Pine form conspicuous objects. Lemons, oranges, and grapes come to perfection in sheltered situations. The camelia and mangolia thrive well. The banana grows out of doors, but does not fruit.

Houses to let are scarce, and rent is high. Otherwise living is cheap. Best joints of beef and steaks are 6d. per lb; mutton, a large quantity of which is now being frozen and exported, 4½d. to 6d. per lb; it is of first-rate quality, quite equal to Welsh mutton. Poultry of all kinds and fish are abundant and cheap. Garden and Orchard products, asparagus, seakale, spinach, and all the ordinary vegetables; fruits of many kinds, apples, pears, plums, grapes, mulberries, figs, strawberries, medlars, almonds, peaches, nectarines, quinces, tomatoes, apricots, and many others, all of local growth, are cheap and abundant. Tropical fruits, such as pine-apples, bananas, &c., are imported from the Pacific Islands, and in the season are plentiful.

Communication with other parts of the world is frequent and easy. With England by four routes. (1) Through San Francisco monthly. (2) By direct steamer monthly at alternate fortnights with the American route, through Australia weekly by steamers which meet either (3) the P. & O. or (4) the Orient steamers. The time occupied in the voyage between England and New Zealand is now so short that the journey is almost reduced to a holiday trip. In Quain's Diet. Med. p. 266, the voyage to Australia is stated to average 90 days—the fact Ls that the double journey does not take quite so long, the advertised time being, by direct steamer, Plymouth to New Zealand 45 days and, the return, calling at at Rio de Janeiro, 42 (has been done in 37). The San Francisco route, although somewhat shorter, is not to be recommended for invalids, in consequence of the long railway journey across the continent of America.

In endeavoring to form an estimate of the value of a place as a residence for an invalid, two questions of the first importance are What amount of time can he spend in the open air? and What attractions and facilities does the locality offer to induce him to be out of doors? In this climate there are not many days in the year of which the greater part may not be passed out of doors, and still fewer when some portion may not be so spent, as, from whatever point of the compass the wind blows, shelter can be found in some of the roads which are formed in the various ravines by which the island is intersected in all directions. For the purpose of driving, riding, or cycling, page 9 level and well-paved roads lead in different directions to the mainland. No hunting is to be had, but in the season a fair amount of shooting, chiefly wild ducks and pheasants, is available. There are no fish here that take the fly, but boating, yachting, and sea fishing may be indulged in in fine weather.

In the hottest part of the year, when the weather in Napier is relaxing and enervating, facilities offer for visiting numerous places of interest, the virgin forest, which still covers a large area of the central portion of the north Island of New Zealand, with its magnificent pine trees, palms, and ferns; the Manawatu Gorge, with its wild and beautiful scenery, distant 8 hours,—5 by railway, and about 3 by coach. Taupo, with the only active volcano in the Colony, it's wonderful system of hot springs, fumaroles and geysers—90 miles distant—can be reached in two days by coach, and one day's journey further takes the traveller to the hot lakes Rotorua and Rotomahana with their indescribable white and pink terraces, boiling cauldrons, and weird scenery,—the "Wonderland of the Antipodes."

In addition to these trips, the Union Steamship Company every summer organise excursions in one of their large steamers to the bays and sounds of the middle island, many of which are unapproachable except by sea, and to the islands of the South Pacific, Fiji, Norfolk Island, Tahiti, Tonga, Samoa, &c.

Unfortunately official statistics as to the causes of death in the Colony are highly untrustworthy, the local registrar of deaths being authorised to receive certificates from any sot disant doctor, irrespective of the fact of his possessing any or no medical or surgical qualification. A counterbalance to this regulation, however, exists in a law that every case of highly infectious or contagious disease must be reported by the medical attendant to the local board of health under a severe penalty, and speaking from personal knowledge, as chairman of the local board of health, I can say that no reports are received except from duly qualified practitioners. This fact therefore affords some reliable basis upon which to form an estimate of the general healthiness of the town. Of that class of diseases which are now usually attributed to page 10 the presence of microzoids in the air or food we see very little. It is two years since a case of diphtheria was reported. It was fatal.

Typhoid fever was ten years ago not uncommon, especially in the hot months of the year—Christmas to the end of March—but since the system of drainage and water supply has been carried out, and a large stagnant swamp that existed nearly in the centre of the town has been obliterated, this affection has almost disappeared. During the last five months—commencement of January to end of May—only two cases amongst the adult population have been reported. A case of cholera, so far as I am aware, has never occurred in Napier. Malarial affections are extremely rare. Occasionally an old shaker will have a modified attack, or a case of neuralgia will assume a periodic phase; but even these are almost phenomenal. On the other hand, I have seen imported cases of violent malarial fever recover permanently and with great celerity. Sunstroke is almost unknown; still it is very necessary not to expose the unprotected head to solar heat.

On the health charts of the world, such as that in Aitken's Science and Practice of Medicine, Australia and New Zealand appear to be generally included in the rheumatism zone. Speaking for New Zealand I believe this bit of medical geography will have to be altered. Without going into statistics, which I have not at hand, I should say that acute articular rheumatism is by no means a frequent affection in New Zealand. The so termed muscular rheumatism—a very different affection, in etiology, treatment, and prognosis—was at one time common enough; and this was nothing more than might have been predicated from the habits and mode of living of the pioneers of settlement. When people take up their abode in an uncultivated country, live in slightly thatched huts, are exposed to weather by day and night whatever it may be, have no comforts, not even a lighted fire on their return home after 12 or more hours in the saddle, sleep in fern because they cannot obtain dry straw to make a bed; it is scarcely fair to attribute their rheumatic pains to the climate. And certainly since ordinary home comforts have been more obtainable, one hears very much less of rheumatic affections.

Doubtless the climate of Napier is at certain seasons of the year depressing and enervating, and induces a considerable amount of atonic dyspepsia amongst the residents. This, however, is in summer, a time which the invalid should utilise to visit the many places of interest in not only the country, but also the other South Pacific Colonies in the adjacent islands.

Pulmonary affections, bronchitis, pneumonia pleuritis, are rare. Phthisis is not so uncommon as might have been expected, the proportion of deaths from consumption being, so nearly as I can ascertain, to deaths from all causes, about 6½ per cent., but it must not be forgotten that many of these cases occur in people who have acquired the disease elsewhere, or whose parents have come here suffering from tubercular affections, and who are therefore congenitally predisposed. Of the actual benefit derived by some of those who have arrived in Napier in various stages of the disease, I can speak from observation. One young gentleman, a medical student, had been obliged to discontinue his studies. On his arrival here he was somewhat emaciated, had cough with copious expectoration, night sweats, the physical signs pointed to vomicæ in the upper lobe of one lung and some solidification on the opposite side. He remained here two years, spending his life out of doors, and when he left for home, had lost the cough and perspiration and gained nearly two stone in weight. There were no signs of any advance of the pulmonary lesion. I have since heard from him that the improvement in his condition continues. He subsequently paid a visit to Madeira, not on his own account, but with his father, who was ill, and he writes to me from there that he prefers the climate of Napier to that of the Atlantic Island, and that a comparison of the two places would be highly in favor of the South Pacific. Another case which came under my notice 8 years ago, on arrival from England, in the last stage, apparently, of emaciation and debility, and with extensive mischief in both lungs, is still here in fail health, in regular and daily employment as clerk in a lawyer's office, and walks up the steep hills with ease and comparative comfort. It is not expected that every case should derive the same benefit from residence here as those mentioned, for various reasons. In some people the con- page 12 stitutional tendency to consumption would appear to be so pronounced, that no sooner does the local affection manifest itself, than the whole system gives way; there appears to be neither power nor inclination to resist the disease, and medicines and all remedial measures are alike inefficient to arrest its progress. Another class of cases defer all thought of climatic assistance until too late; their state is beyond hope, and they arrive at the end of their journey merely to die. It cannot be too strongly insisted upon that it is the earlier stage of phthisis in which the remedial effects of change of climate are to be sought if sought at all. Perhaps to no other disease is the advice of Ovid more applicable than to this:

Principiis obsta: sero medicina paratur,
Quum mala per longas convaluere moras.