Some case histories from Ascension Island.

THE physician of today is aware of the numerous adverse effects and potential hazards of modern drug therapy, and it is both refreshing and instructive to look back to the days when the physician's 'armentarium' of therapeutic agents was of 'narrow spectrum', and when many of the 'drugs' available were basically only of 'nutritive' value. Such retrospective views, even though they are often brief, can be useful in encouraging the modern medical practitioner to be more discriminating in his prescribing habits. Several years ago I was able to spend some nine months on Ascension Island in the role of Medical Officer, and although the island was amazingly healthy, even though it was only some eight degrees south of the equator, it had many compensations in the way of medical interest. Situated in the South Atlantic, it was discovered in 1501 by the Portuguese Joao da Nova and was 'neglected' until it saw the British flag in 1815. Essentially a 'barren' island, Ascension consists mainly of volcanic rocks, and several of the craters carry exotic names. The island has had some distinguished visitors including Halley, Darwin and Dampier (a rather colourful character who combined the roles of navigator and buccaneer, and was wrecked off the island in 1701). Darwin visited in the Beagle in 1836 and thought that Ascension was 'like a huge ship kept in first rate order'. The volcanic rocks aroused his geological interest: 'I clambered over the mountains with a bounding step and made the volcanic rock resound with my hammer'. No doubt, he was somewhat disappointed by the paucity of wild life on the island, but may have found some consolation in the vast hordes of land crabs that abound there. Whilst on Ascension I was able to peruse some of the medical case histories dating back to 1878. Ascension has always been a relatively 'healthy' island and thus these early medical histories are of interest as they are an index of imported diseases, and give some idea of the illnesses that were to be seen in the crews of the passing 'East India' ships and warships. The health risks of modem jet-age travel have been well emphasized by Maegraith and others, but even in the mid-eighteenth century, islands were at special risk from imported illness. It should be pointed out that Ascension has no 'endogenous' population, and no significant endemic disease is associated with the island. …