Skip to main content

Full text of "The influence of tropical climates on European constitutions : being a treatise on the principal diseases incidental to Europeans in the East and West Indies, Mediterranean, and coast of Africa"

See other formats 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 
MRS.  PRUDENCE  W.  KOFOID 


University  of  California  •  Berkeley 


,  A  <y 

L  j  - 


7  °. 


THE 

.^ 

INFLUENCED? 

iicemvy  of  ;.-  . 


TROPICAL  CLIMATES 


ON 


23u<roj)c#u  Constitutions : 

B£ING  A 

TREATISE  ON  THE  PRINCIPAL  DISEASES  INCIDENTAL  TO 
EUROPEANS  IN  THE 

EAST  AND  WEST  INDIES,  MEDITERRANEAN, 
AND  COAST  OF  AFRICA. 


BY  JAMES  JOHNSON,  Xtt.B, 

OF  THE  ROYAL  COLLEGE  OF  PHYSICIANS,  LONDON. 


FROM  THE  THIRD  LONDON  EDITION, 

GREATLY  ENLARGED. 


NEW- YORK : 

W.  E.  Dean,  Printer,  JVb.  3  Wall-Street. 

PUBLISHED  BY  EVERT  DUYCKINCK,  GEORGE  LONG,  COLLINS  &  CO. 

COLLINS  &  HANNAY,  O.  A.  ROORBACK,  AND 

JOHN  GREGG,  PHILADELPHIA. 

*  1826. 

[Pnce  Three  Dollars,} 


I       *     *—  f     1~r     f 


<r  7 


TO 


HEADS  OF  NAVAL  AND  MILITARY  MEDICINE, 

DR.  JOHN  WEIR, 


AND 


SIR  JAMES  Me.  GREGOR,  M.  D.,  &c. 


AND  TO 

HIS  MEDICAL  BRETHREN 

IN  FLEETS,  ARMIES,  AND  COLONIES, 

THIS 

THIRD  EDITION 

IS  RESPECTFULLY  INSCRIBED, 

BY  THEIR  SINCERE  FRIENB, 

The  Author. 


* 


• 


PREFACE 

TO  THE  THIRD  LONDON  EDITION. 


THE  First  Edition  of  the  following  Work  was  published  in 
1813,  chiefly  at  the  Author's  own  risk  and  expense,  for  he  could 
find  no  Bookseller  to  undertake  it.  The  Second,  consisting,  as 
the  First,  of  1000  copies,  was  published  in  1818,  and  has  been 
more  than  six  months  out  of  print.  In  the  present  Edition  the 
Author  has  endeavoured  to  render  the  work  more  extensively 
useful  than  ever,  by  placing  before  the  reader  a  series  of  Analy- 
tical Reviews  of  the  best  modern  Works,  embracing  the  Diseases 
of  Tropical  and  other  sultry  Climates.  Whoever  has  seen  the 
diversified  maladies  produced  by  climate,  season,  constitution, 
and  co-existing  circumstances,  will  easily  appreciate  the  utility 
of  thus  concentrating  the  experience,  observations,  and  sentiments 
of  many  individuals,  as  multiplied  resources  in  exigencies  for  ever 
varying. 

The  Author  has  the  satisfaction  of  knowing  that  the  former 
Editions  of  this  Work  have  proved  serviceable,  not  only  to  his 
junior  Professional  Brethren,  serving  in  sultry  climates  ;  but  also 
to  a  very  considerable  proportion  of  Naval,  Military,  and  Civil 
Officers  sojourning  between  the  Tropics.  In  the  Eastern  Hem- 
isphere a  Work  of  this  description  was  imperiously  called  for. 
where  many  of  the  Company's  Officers,  as  Dr.  Balfour  has  justly 
remarked — "  being  constantly  employed  durhrg  the  first  years  of 
"  their  service,  in  the  most  unhealthy  corners  of  country,  remote 
"  from  medical  assistance,  their  success,  reputation,  health,  and 
"  lives,  and  the  lives  of  all  around  them,  depend  often  on  the 
"  medical  skill  which  they  may  have  acquired."* 

To  the  last  and  present  editions  of  this  Work,  a  new  feature 
has  been  added — the  consideration  of  Climates  bordering  on  the 
Tropics,  the  diseases  of  which,  at  particular  periods,  resemble 
those  of  equatorial  regions.  The  Author  is  convinced  that  this  is 
an  essential  requisite  in  every  Work  on  diseases  of  the  Torrid  Zone. 
These  diseases  acknowledge  no  cancer  or  Capricorn  boundaries. 
The  same  class  sallies  occasionally  from  La  Plata  to  the  Scheldt 
— sweeping  the  Banks  of  the  Ganges,  the  Euphrates,  the  Nile, 
the  Tiber,  the  Guadalquiver,  the  Chesapeake,  the  Mississippi, 
the  Oronoco,  and  every  sinuosity  of  the  great  Western  Archipe- 
He  then  who  studies  the  influence  of  Tropical  Climates  on 

*  Preface  to  Treatise  on  Sol-Lunar  Influence,  p.  xiii. 


VI  PREFACE. 

European  Constitutions,  by  parallels  of  latitude,  will  do  so  inef- 
ficiently. It  is  like  studying  the  physiology  of  the  stomach  or 
liver,  without  regarding  the  functions  of  the  surrounding  viscera. 
An  appeal  may  be  made  to  the  parallel  between  the  Valley  of 
Egypt  and  the  Coast  of  Coromandel,  for  the  truth  of  this  remark. 
It  will  there  be  seen  that  the  climate  and  diseases  of  the  one 
elucidate  those  of  the  other,  and  that  this  comparison  has  solved 
a  problem  in  Etiology  which  has  hitherto  proved  a  stumbling 
block  to  Physicians — namely,  the  question  of  an  indigenous  poison 
existing  in  India,  and  occasioning  the  prevalence  of  Hepatitis 
there. 

During  the  last  few  years,  the  Author  has  had  extensive  com- 
munication, personal  and  epistolary,  with  a  very  great  number  of 
his  professional  Brethren,  on  their  return  from  various  Climates  of 
the  Globe,  and  he  can  conscientiously  aver  that  their  reports  have 
not  given  the  slightest  encouragement  to  change  any  of  the  senti- 
ments or  opinions  broached  in  the  former  Editions  of  the  Work. 
This  is  a  source  of  great  gratification  to  him — and  on  this  fact  he 
may  reasonably  ground  a  hope  of  the  permanent  utility  of  the 
publication  to  those  for  whom  it  is  designed. 

To  the  present  Edition  there  is  an  addition  of  at  least  250  pages 
of  important  matter,  as  will  be  readily  seen  on  a  comparison 
with  the  Second  Edition.  A  few  articles  have  been  omitted,  and 
others  curtailed,  in  order  that  the  new  matter  might  not  swell 
the  Work  beyond  a  single  volume.  And  here  the  Author  is  injus- 
tice beyond  to  acknowledge  the  able  and  valuable  assistance 
which  he  has  received  from  Dr.  Dickson  and  Mr.  Sheppard,  in 
the  arrangement  and  composition  of  an  important  division  of  the 
Work. 

The  Author  does  not  consider  it  necessary  to  make  any  further 
prefatory  remarks,  as  the  Work  must  rest  on  its  own  merits, 
whatever  they  may  be,  in  its  way  through  the  World.  He  is 
very  conscious,  at  the  same  time,  that  numerous  imperfections 
and  deficiencies  may  be  readily  detected  in  it  by  those  who  find 
it  easier  to  judge  than  act — and  whose  trade  is  to  point  out  the 
failings  of  others,  without  correcting  their  own.  To  the  Cri- 
ticisms of  this  class  Author  is  perfectly  callous — while  to  the  judg- 
ment and  opinions  of  the  good  and  the  wise,  he  acknowledges 
himself  to  be  tremblingly  sensible.  On  the  liberality  and  indul- 
gence of  these  he  confides — convinced  that  the  well-intentioned 
effort  to  be  useful  to  his  junior  Brethren  will  be  rewarded  with 
the  approbation  of  all  tbose  in  whose  esteem  it  is  desirable  to 
stand. 


ANALYTICAL  TABLE  OF  CONTENTS. 


Page 

Preliminary  remarks  on  the  Human  Constitution  .    '           10 

Degeneracy  of  the  Portuguese  in  India        .  .        ib. 

African  children  brought  to  Europe                                       .  .                 ib. 

Fool-hardy  Europeans  in  India      .               .               .  .               .11 

PART  I. 

Primary  Effects  of  Hot  Climates  on  European  Constitutions  .               13 

1.  Transitions  from  Cold  to  Hot  Climates,  effects  of  on  the  skin  .               .        ib, 
Refrigerating  Process  of  Perspiration  exemplified 

Bad  Effects  of  Stimulation 

2.  Sympathies  between  the  Skin  and  internal  organs 

3.  Considerations  on  the  Physiology  of  the  Liver 

Effects  of  a  High  Temperature  on  Biliary  Secretion          .  19 

Sympathy  between  the  Skin  and  Liver                      .  ib. 
Vitiation  of  the  Biliary  Secretion 

4.  Lichen  Tropicus,  or  Prickly  Heat 

PART  II— Specific  Diseases. 

EASTERN  HEMISPHERE. 

.  I.  Fever  in  General      ....  24 

Human  Effluvium,  or  Contagion                ,  '.'    '  25 

Contagious  Fever  in  Sir  John  Moore's  Army         .               .  .               ib. 

Laws  of  Contagion        .                / "            .                 .            .  •, .   '            .26 

Marsh  Miasma    .  .27 

Ratio  Symptomatum  in  Fever     V'          -''  <•.  •*:        ,.  •  .        28 

Remedies  in  Fever— Venesection       •'.               .      *•••'••  •               34 

Purgatives                  .                .  .     •            .        35 

Cold  and  Tepid  Affusion    .               .  37 

Mercury     .                .                .  .                        ib. 

Emetics  and  Diaphoretics    ...  38 

Tonics  and  Stimulants                 .  .                .39 

II.  Endemic  Fever  of  Bengal,  or  Marsh  Remittent    ...  41 

Medical  Topography  of  the  Course  of  the  Ganges     .  .        ib. 

Dr.  Clarke's  Description  of  the  Bengal  Fever     .  .45 

Dr.  Lind's  Remarks  on  this  Fever              .  ib. 

Dr.  Clarke's  Mode  of  Treatment,  ineffectual        ...  46 

The  Author's  Bad  Success                           .                .  .47 

Depletive  and  Mercurial  Treatment    .  48 

Dr.  Balfour'a  Plan  of  Treatment                 .  .52 

Treatment  by  the  Natives     ......  54 

Etiology  of  the  Bengal  Fever       ...  .55 

Marsh  Miasmata  profusely  extricated                   .  56 

Mr.  NeUTs  Remarks  on  Miasmal  Fevers     .  .60 

Insalubrity  of  Diamond  Harbour          .            '.  .  ;             .  61 

Modus  Operandi  of  Miasmata      •  .62 

Predisposing  Causes  of  Fever               .                .  64 

Scheldt  Expedition,  Remarks  on                  .  .        65 

Mental  Despondency  and  Intemperance              .  .                67 

SoUunar  Influence      .                .                .  .69 

Difference  between  East  and  West  India  Fevers  70 

The  Question  of  Contagion           .                .               .  .  ••'                     72 

Intermittent  Forms  of  the  Fever       .--.                .                .  .'               73 

III.  Analytical  Review  of  a  Medical  Report  on  the  Epidemic  Fever  of  Coimba- 

TW   »/rt0re.'  drawn  UP  bv  Drs-  Ainsley,  Smith,  and  Christie  .                .         76 

IV.  Mr.  Gibson's  Observations  on  the  Guzerat  Fever,  with  General  Remarks 

on  the  Action  of  Mercury  in  the  Diseases  of  India  82 
V.  Dr.  A.  Nicoll  on  the  Fevers  of  Seringapatam 

VI.  Bilious  Fever        .                .                              -  ,\  gjj 

Exemplification  of  this  Fever  in  the  Centurion            .  .                .92 

EXvkPin  1800n  °f  ^  Bataviaa  Endemic  «*  a  Squadron  blockading  Bata-' 

Cases  of  the  Batavian  Fever       .  U3 

General  Observations  on  the  Batavian  Endemic  122 

VI II.  Disorders  of  the  Hepatic  System  J26 

Climates  of  Madras,  Bengal,  and  West  Indies  compared  .  127- 


Till  CONTENTS. 

Page 

Ratio  Symptomatutn  of  Hepatic  Diseases 

Symptoms  of  Indian  Hepatitis          .  .  138 

Treatment  of  Indian  Hepatitis  .  .        142 

Sympathetic  Connection  between  the  Mental  and  Hepatic  Functions  considered  152 

IX.  Dysentery  .  .  .  .  .  .  155 

Ratio  Symptomatum  .....        157 

Treatment          i  .....  164 

Analysis  of  Mr.  Bampfield's  Treatise  on  Tropical  Dysentery 
Analytical  Review  of  Dr  BallingaFs  Observations  on  Indian  Dysentery  181 

1    Colonitis,  a  form  of  Dysentery  .  .  .  .        ib. 

X.  Cholera  Morbus,  Mort  de  Chien,  and  Spasmodic  Cholera  of  India    .  189 

Analytical  Review  of  the  Bombay  Medical  Board's  Report  on  the  Epidemic 
Cholera  of  India  .....  197 

Review  of  the  Bengal  Reports  on  Cholera  .  .        205 

Review  of  Sir  G.  Blane's  Paper  on  Cholera      ...  ib. 

XI.  Beriberi  .  .  .  .211 

XII.  Dracunculus,  or  Guinea  Worm          ...  .  .  213 

XIII.  Elephantiasis  .  .  .  .  .215 

XIV.  Mr.  Johnson's  Observations  on  Indigenous  Customs  in  India          .  217 

MEDITERRANEAN. 

SECT.  I.  General  Observations  on  the  Climate  of  the  Mediterranean      .  .        223 

Dr.  Sinclair  on  Mediterranean  Phthisis  .  .  .  225 

II.  Analytical  Reviews  of  Dr.  Burnett's  Work  on  the  Bilious  Remittent  Fever 

of  the  Mediterranean  ...  .  227 

HI.  Review  of  Dr.  Boyd's  TJhesis  on  the  Fever  of  Minorca     .  .  236 

IV.  Drs.  Irvine  and  Boyle  on  the  Climate  and  Fevers  of  Sicily       .  .  .      241 

V.  Observations  on  the  Climate  and  Diseases  of  Egypt         .  .  247 

VI.  Loimologia;  or  Observations  on  Plague  .  .  .251 

COAST  OF  AFRICA. 

An  Account  of  the  Climate  and  Medical  Topography  of  the  West  Coast 

of  Africa                .                .                .                .                .  .261 

St.  Mary,  on  the  River  Gambia          .               .               ...  262 

Bulam,  in  the  Rio  Grande          .....        264 

Sierra  Leone     .                                                 ...  266 

Grain  Coas                .               .                .                .                .  .        270 

Ivory  Coast        .  ib. 

Gold  Coast                                               -  .                .                .  .271 

Apollonia           .  ib. 

Dix'Cove                   .                .              "...                .                .  .        272 

St.  George  del  Mina           ...'.,,                .               .               .  273 

Cape  Coast  Castle      .  ib. 

Accrah  Country                 ....  274 

Slave  Coast    ...                .                .                .  .276 

Fevers  and  Dysenteries     .               .                           <    .               .  277, 278 

WESTERN  HEMISPHERE. 

SECT.  I.  Analytical  Review  of  Dr.  Bancroft's  First  Essay  on  Yellow  Fever          .        279 
II.  Review  of  Dr.  Bancroft's  Sequel  to  the  above    .  .  .  280 

III.  Dr.  Dickson's  Topographical  Observations  on  the  Causes  and  Prevention 

of  the  Tropical  Endemic        .  .  .  .        328 

IV.  Observations  on  the  Locale  of  Yellow  Fever,  by  Dr.  Fergusson ;  with  Ob- 

servations on  the  Mariegalante  Fever,  by  Drs.  Dickson  and  Mortimer        346 

V.  Account  of  the  Causus,  or  Yellow  Fever  of  the  West  Indies,  by  Dr.  Me. 

Arthur  ......  356 

VI.  On  the  Inflammatory  Endemic  of  New  comers  to  the  West  Indies,  from 

Temperate  Climates,  by  Nodes  Dickinson,  Esq.    .  .  .365 

VII.  Tetanus  ......  369 

VIII.  On  the  Dysentery  of  New  Orleans,  by  Archibald  Robertson,  M.  D.         .        375 

PART  III. 

TROPICAL  HYGIENE. 
Preliminary  Observations  .....  388 

SECT.  I.  Dress  .....  .390 

II.  Food    .....  .394 

III.  Drink  ...  ...        400 

IV.  Exercise  ...  .405 

V.  Bathing      ....  .409 

VI.  Sleep    ....  412 

VII.  The  Passions  .  415 


THE 

INFLUENCE  OF  TROPICAL  CLIMATES 

ON 

EUROPEAN  CONSTITUTIONS. 


I  BELIEVE  it  is  a  general  opinion  among  philosophers,  that  the 
constitution  of  man  is  better  adapted  to  bear  those  changes  of  tempe- 
rature, &c.  experienced  in  migrating  from  a  northern  to  a  tropical 
region,  and  vice  versa,  than  that  of  any  other  animal.  They  proudly 
observe,  that  this  power  of  accommodating  itself  to  all  climates,  is  a 
distinctive  characteristic  of  the  human  species,  since  no  other  animal 
can  endure  transplantation  with  equal  impunity.  But  I  think  it  would 
not  be  difficult  to  show,  that  for  this  boasted  prerogative,  man  is  more 
indebted  to  the  ingenuity  of  his  mind,  than  to  the  pliability  of  his 
body. 

To  me,  indeed,  it  appears,  that  he  and  other  animals  start  on  very 
unequal  terms,  in  their  emigrations.  Man,  by  the  exertion  of  his 
mental  faculties,  can  raise  up  a  thousand  barriers  round  him,  to  obvi- 
ate the  deleterious  effects  of  climate  on  his  constitution  ;  while  the 
poor  animal,  tied  down  by  instinct  to  a  few  simple  modes  of  life,  is 
quite  defenceless.  Nature  must  do  all  for  the  latter  ;  and,  in  fact, 
it  is  evident  that  this  indulgent  mother  does  compensate,  in  some  de- 
gree, for  the  want  of  reason,  by  producing  such  corporeal  changes,  as 
are  necessary  for  the  animal's  subsistence  under  a  foreign  sky,  in  a 
shorter  space  of  time  than  is  necessary  for  effecting  correspondent 
changes  in  man.  One  example  may  suffice.  The  tender  and  inno- 
cent sheep,  when  transported  from  the  inclemency  of  the  north  to 
pant  under  a  vertical  sun  on  the  equator,  will,  in  a  few  generations, 
exchange  its  warm  fleece  of  woo/,  for  a  much  more  convenient  coat  of 
hair.  '*  Can  the  Ethiopian  change  his  hue,"  in  the  same  period,  by 
shifting  his  habitation  from  the  interior  of  Africa  to  the  shores  of  the 
Baltic  ?  Or  will  it  be  said,  that  the  fair  complexion  of  Europeans,  may, 
in  two  or  three  generations,  acquire  the  sable  tinct  of  the  inter-tro- 
phical  natives,  by  exchanging  situations  ?  Assuredly  not.  Where 
then  is  the  superior  pliancy  of  the  human  constitution  ?  The  truth  is, 
that  the  tender  frame  of  man  is  incapable  of  sustaining  that  degree 
of  exposure  to  the  whole  range  of  causes  and  affects  incident  to,  or 
arising  from  vicissitude  of  climate,  which  so  speedily  operates  a  change 
in  the  structure,  or  at  least,  the  exterior,  of  unprotected  animals. 

2 


10  MIGRATION. 

But  it  is  observed,  that  of  those  animals  translated  from  a  temper- 
ate to  a  torrid  zone,  "  many  die  suddenly ,  others  droop,  and  all  de- 
generate." This  is  not  to  be  wondered  at,  considering  the  disadvan- 
tages under  which  they  labour.  Man  would  not  fare  better,  if  plac- 
ed in  similar  circumstances.  Even  as  it  is,  the  parallel  in  not  far 
from  applying.  Of  those  Europeans  who  arrive  on  the  banks  of  the 
Ganges,  many  fall  early  victims  to  the  climate,  as  will  be  shown  here- 
after. That  others  droop,  and  are  forced,  in  a  very  few  years,  to 
seek  their  native  air,  is  also  well  known.  And  that  the  successors 
of  all  would  gradually  degenerate,  if  they  remained  permanently  in 
the  country,  cannot  easily  be  disproved  ;  while  a  very  striking  in- 
stance, corroborative  of  the  supposition,  may  be  here  adduced. 

Whoever  has  attentively  examined  the  posterity  of  De  Gama,  and 
Albuquerque,  now  scattered  over  the  coast  of  Malabar,  the  plains  of 
Bengal,  and  the  Island  of  Macao,  once  the  theatres  of  Lusitanian 
pre  eminence,  will  be  tempted  to  exclaim  : — 

'Twas  not  the  sires  of  such  as  these, 
Who  dared  the  elements  and  pathless  seas  ; 
Who  made  proud  Asian  monarchs  feel 
How  weak  their  gold  was  against  Europe's  steel- 
But  beings  of  another  mould, — 
Rough,  hardy,  vigorous,  manly,  bold  ! 

• 

In  answer  to  this  it  will  be  alleged,  "  that  they  have  married  and 
blended  with  the  natives  until  all  shade  of  distinction  is  obliterated." 
But  it  is  well  known  to  those  who  have  resided  long  in  India,  that  the 
two  great  prevailing  classes  of  society  in  that  country,  the  Hindoos 
and  Mahomedans,  hold  these  descendants  of  the  Portuguese,  in  the  most 
marked  and  sovereign  contempt  ;  while  the  latter,  still  retaining  a 
remnant  of  the  religion,  and  all  the  prejudice  of  their  progenitors, 
entertain  an  equal  abhorrence  to  their  idolatrous  and  infidel  neigh- 
bours. This  being  the  case,  we  may  fairly  presume,  that  the  inter- 
mixture has  been  much  less  extensive  than'is  generally  supposed  ;  an 
inference  strongly  supported,  if  not  confirmed,  by  the  well  known 
fact,  that,  while  the  people  in  question  have  forfeited  all  pretentions 
to  the  European  complexion,  their  more  stubborn  features  still  evince 
a  descent,  and  establish  their  claim  to  an  ancestry,  of  which  they  are 
superlatively  proud.  Let  those  who  deny  one  common  origin  of  man- 
kind, and  that  climate  is  the  sole  cause  of  complexion,  explain  this 
phenomenon  if  they  can. 

On  the  other  hand,  if  we  look  at  inter-tropical  natives  approach- 
ing our  own  latitudes,  the  picture  is  not  more  cheering.  The  African 
children  brought  over  by  the  Sierra  Leone  Company  for  education, 
seldom  survived  the  third  year  in  this  country.  "  They  bear  the 
first  winter,  (says  Dr.  Pearson,)  tolerably  well,  but  droop  during  the 
second,  and  the  third  generally  proves  fatal  to  them." 

The  object  of  these  remarks,  which,  at  first  sight,  might  seem  irrele- 
vant, will  now  appear.  Since  it  is  evident  that  nature  does  not  operate 
more  powerfully  in  counteracting  the  ill  effects  of  climate  on  man, 
than  on  other  animals,  it  follows  that  we  should  not  implicitly  confide, 


PLAN  OF    THE  WORK.  1  1 

as  too  many  do,  in  the  spontaneous  efforts  of  the  constitution,  but  on 
the  contrary,  call  in  to  its  aid,  those  artificial  means  of  prevention 
and  melioration,  which  reason  may  dictate  and  experience  confirm. 
In  short,  that  we  should,  as  my  motto  expresses  it : — 

"  Study  well  the  clime, 

Mould  to  its  manners  our  obsequious  frames, 
And  mitigate  those  ills  we  cannot  shun." 

That  these  salutary  precautions  are  too  often  despised  or  neglect- 
ed, a  single  quotation  from  a  gentleman,  who  has  resided  more  than 
twenty  years  in  India,  and  whose  talent  for  observation  is,  in  rny  opin- 
ion, unequalled,  will  put  beyond  a  doubt.  '*  Nothing  can  he  more 
preposterous,  (saysCapt  Williamson*,)  than  the  significant  sneers  of 
gentleman  on  their  first  arrival  in  India  ;  meaning  thereby  to  ridicule, 
or  to  despise  what  they  consider  effeminacy  or  luxury.  Thus  se- 
Teral  may  be  seen  walking  about  without  chattahs,  (i.  e.  umbrellas,) 
during  the  greatest  heats.  They  affV-et  to  be  ashamed  of  requiring 
aid,  and  endeavour  to  uphold,  by  such  a  display  of  indifference,  the 
great  reliance,  placed  on  strength  of  constitution.  This  unhappy  in- 
fatuation rarely  exceeds  a  few  dayw  ;  >it  the  end  of  that  time,  we  are 
too  often  called  upon  to  attend  the  funeral  of  the  self-deluded  vic- 
tim."'! 

I  shall  be  my  endeavour  in  this  essay,  after  tracing  the  causes, 
and  pourtraying  the  effects  of  tropical  diseases,  in  such  a  manner  as 
must  impress  the  most  heedless  European  with  the  necessity  of  cir- 
cumspection»on  approaching  the  scene  of  danger,  to  furnish  a  code 
of  instructions  deduced  from  principle  and  experience,  that  cannot 
fail  to  prove  a  usefiil  companion  to  every  one  who  regards  health  as 
the  grand  source  of  happiness,  and  the  most  invaluable  blessing 
which  heaven  can  bestow.  Many  a  day's  anxiety  and  personal  suf- 
fering should  I  have  escaped,  had  I  been  furnished  with  so  friendly 
a  monitor ! 

Without  any  very  fastidious  regard  to  arrangement,  it  will  still  be 
necessary,  for  the  sake  of  perspicuity,  to  observe  some  order.  I 
shall  therefore  divide  the  *utject  into  three  principal  heads,  viz  : — 

1. — The  Primary  or  General  Effects  of  a  Tropical  Climate  on  the 
European  Constitution. 

2. — The  Specific  or  Actual  Diseases. 

3 — Prophylaxis;  or  the  Means  of  Counteracting  the  Influence  of 
Climate  and  Preserving  Health. 

*  Author  of  "  Oriental  Field  Sports,"  '«  East  India  Vade  Mecum,"  £c- 
t  East  India  Vade  Mecuin,  vol-  2.  page  ii. 


PART  I. 

PRIMARY  OR  GENERAL  EFFECTS, 


UNDER  this  head,  I  shall  consider  some  of  those  gradual  and  pro- 
gressive changes  in  the  constitution,  and  deviations  from  previous 
health  and  habits,  which,  though  predisposing,  and  verging,  as  it 
were,  towards,  yet  fall  short  of  actual  disease. 

These  are  consequences  which  all  must  expect,  more  or  less,  to 
feel,  on  leaving  their  native  soil,  and,  of  course,  in  which  all  are  di- 
rectly interested.  For  although  a  few  individuals  may  occasionally 
return  from  even  a  long  residence  in  hot  climates,  without  having 
suffered  any  violent  illness,  or  much  deterioration  of  constitution, 
yet  the  great  mass  of  Europeans  will  certainly  experience  the  effects 
developed  under  this  head,  and  many  others  of  minor  consequence, 
which  will  be  taken  notice  of  in  different  parts  of  the  work. 

It  is,  however,  by  the  most  scrupulous  attention  to  these  incipient 
deviations  from  health,  by  early  arresting  their  growth,  or  at  least  re- 
tarding, as  much  as  possible,  their  progress,  that  we  can  at  all  ex- 
pect to  evade  those  dangerous  diseases,  to  which  they  inevitably, 
though  often  imperceptibly,  tend. 

Sect.  1. — The  transition  from  a  climate,  whose  medium  heat  is 
52°  of  Fahrenheit,  to  one  where  the  thermometer  ranges  from  80° 
to  100°  and  sometimes  higher,  might  be  supposed,  a  priori,  to  occa- 
sion the  most  serious  consequences.  Indeed,  4he  celebrated  Boer- 
haave,  from  some  experiments  on  animals,  concluded,  that  the  blood 
would  coagulate  in  our  veins,  at  a  temperature  very  little  exceeding 
100°.  More  modern  trials,  however,  have  proved  that  the  human 
frame  can  bear,  for  a  short  time  at  least,  more  than  double  the  above 
degree  of  atmospherical  heat,  and  that  too  without  greatly  increasing 
the  natural  temperature  of  the  body. 

The  benevolent  Author  of  our  existence  has  endowed  man,  as  well 
as  other  animals,  with  the  power  not  only  of  generating  heat,  and 
preserving  their  temperature,  in  the  coldest  regions  of  the  earth  ; 
but  has  also  provided  an  apparatus  for  carrying  off  any  superabun- 
dance of  it  that  might  accumulate  where  the  temperature  of  the  at- 
mosphere approaches  to  or  exceeds  that  of  the  body.  With  the  for- 
mer process,  which  is  supposed  to  be  carried  on  in  the  lungs,  we  have, 


14  PERSPIRATION. 

at  present,  nothing  to  do  ;  the  latter  is  one  which  deserves  great  at- 
tention, and  which  will  meet  with  ample  consideration  in  various 
parts  of  this  essay.  9 

We  are  no  sooner  beneath  a  vertical  sun,  than  we  begin,  as  may 
naturally  he  supposed,  to  experience  the  disagreeable  sensation  of 
unaccustomed  warmth  ;  and  as  the  temperature  of  the  atmosphere, 
even  in  the  shade,  now  advances  within  tenor  twelve  degrees  to  that 
of  the  blood,  and  in  the  sun  very  generally  exceeds  it,  the  heat  per- 
petually generated  in  the  body,  cannot  be  so  rapidly  abstracted,  as 
hitherto,  by  the  surrounding  air,  and  would,  of  course,  soon  accumu- 
late so  as  to  destroy  the  functions  of  life  itself,  did  not  Nature  imme- 
diately open  the  sluices  of  the  skin,  and  by  a  flow  of  perspiration,  re- 
duce the  temperature  of  the  body  to  its  original  standard. 

Whether  the  superabundant  animal  heat  combines  with  the  perspir- 
able fluid,  an<  thus  escapes;  or  whether  the  refrigeration  takes 
place  on  the  principle  of  evaporation,  is  more  a  matter  of  specula- 
tion than  practical  importance  to  ascertain.  We  know  the  fact,  that 
perspiration  is  a  cooling  process.  The  modus  operandi — 

"  Let  sages  versed  in  Nature's  lore  explain.' ' 

• 

When  we  contemplate  this  admirable  provision  of  nature,  against 
what  might  appear  to  us  an  unforeseen  event ;  when  we  survey  the 
resources  and  expedients  which  she  can  command  on  all  emergen- 
cies— her  power  of  supplying  every  waste,  and  restraining  every 
aberration  of  the  constitution,  we  would  be  almost  tempted  to  con- 
clude, that  man  was  calculated  for  immortality  !  But,  alas  ! 


«  There  is  a  point, 

"  By  nature  fixed,  whence  life  must  downward  tend," 

'Till  at  length,  this  wonderful  machine,  exhausted  by  its  own  ef- 
forts at  preservation,  and  deserted  by  its  immaterial  tenant,  sinks, 
and  is  resolved  into  its  constituent  elements  ! 

Nasceotes  morimur,  finisque  ab  origine  pendet. 

But,  to  return.  We  must  not  conclude  that  this  refrigerating  pro- 
cess, adopted  by  nature  to  prevent  more  serious  mischief,  is,  in  itself, 
unproductive  of  anjr  detriment  to  the  constitution — far  otherwise. 
«'  If,  (says  Dr.  Currie,)  the  orifices  do  not  pour  out  a  proportionate 
quantity  of  perspiration,  disease  must  ensue  from  the  direct  stimulus 
of  heat  ;  and  if  the  necessary  quantity  of  perspiration  takes  place, 
the  system  is  enfeebled  by  the  evacuation."* 

Here,  then,  we  have  Scylla  on  one  side,  and  Charybdis  on  the 
other  :  morbid  accumulation  of  heat  if  we  do  not  perspire  enough 
— debility  if  we  do.  How  are  we  to  direct  our  course  through  this 
intricate  and  dangerous  navigation  ? 

*  Medical  Reports,  Philadelphia  edition,  p.  192. 


PERSPIRATION.  16 


Dr.  CURRIE. 

"  Europeans  who  go  to  the  West  Indies  are  more  healthy,  in  pro- 
portion, as  they  perspire  freely,  especially  if  they  support  the  dis- 
charge by  a  moderate  use  of  gently  stimulating  liquids,  stopping  short 
of  intoxication .  * ' — ib. 

Dr.  MOSELEY. 

"  I  aver  from  my  own  knowledge  and  custom,  as  well  as  from 
the  custom  and  observations  of  others,  that  those  who  drink  nothing 
but  water,  are  but  little  affected  by  the  climate,  and  can  undergo  the 
greatest  fatigue  without  inconvenience." — Tropical  Diseases,  p.  57. 

Who  shall  decide  when  doctors  disagree  ? 

Without  meaning  to  set  up  the  judgment  of  a  Moseley  in  compe- 
tition with  that  of  a  Currie,  on  other  subjects,  candour  obliges  me  to 
confirm,  by  personal  observation  and  experience,  the  truth  of  Dr. 
Moseley's  remark.,  Dr.  Currie  never  was  in  a  tropical  climate,  there- 
fore had  the  above  piece  of  information  from  others  ;  and  it  is  one 
of  the  very  few  erroneous  positions  in  his  invaluable  work.  Never- 
theless, these  apparently  opposite  directions  are  not  so  contradictory 
in  fact  as  in  terms.  The  principle  on  which  both  act,  is  the  same, 
though  the  means  are  different.  Dr.  Currie's  plan  of  supplying  the 
stomach  with  "  gently  stimulating  liquids,"  will  undoubtedly  keep  the 
morbid  heat  from  accumulating,  by  driving  out  a  copious  perspiration  ; 
but  it  will,  at  the  same  time,  lead  to  debility,  by  carrying  off  much 
more  of  that  fluid  than  is  necessary  ;  by  which  means  the  thirst,  in- 
stead of  being  allayed,  will  be  increased  ;  and  what  is  still  worse, 
the  body  will  be  rendered  more  susceptible  of  the  subsequent  impres- 
sions of  cold,  the  deleterious  effects  of  which,  at  these  times,  are 
much  more  extensive  than  is  generally  believed,  as  will  be  shown 
in  another  part  of  the  work. 

Dr.  Moseley's  plan,  on  the  other  hand,  far  from  preventing:  perspi- 
ration, will  be  found,  in  general,  to  promote  it,  but  at  the  same  time 
restrain  its  excess. —  A  familiar  example  or  two  will  elucidate  this 
subject. 

We  will  suppose  two  gentlemen  to  be  sitting  in  a  room,  at  Madras 
or  in  Jamaica,  just  before  the  sea-breeze  sets  in,  both  complaining 
of  thirst,  their  skin  hot,  and  the  temperature  ot  their  bodies  100°,  or 
two  degrees  above  the  natural  standard. 

One  of  them,  pursuant  to  Dr.  Currie's  instructions,  applies  to  the 
sangaree  bowl,  or  porter  cup,  and  after  a  draught  or  two,  brings  out 
a  copious  perspiration,  which  soon  reduces  the  temperature  to  98°. 
It  will  not  stop  here,  however,  nor  indeed  will  the  gentleman,  ac- 
cording to  the  plan  proposed  ;  for  instead  of  putting  the  bulb  of  the 
thermometer  under  his  tongue,  to  see  if  the  mercury  is  low  enough, 
he,  feeling  his  thirst  increased  by  the  perspiration,  very  naturally 
prefers  a  glass  or  two  more  of  the  sangaree — "  to  support  the  dis- 


16  PERSPIRATION. 

charge" — still,  however,  "  stopping  short  of  intoxication."  Now, 
by  these  means,  the  temperature  is  reduced  to  &7°  or  96^°,  in  which 
state,  even  the  slight  and  otherwise  refreshing  chill  of  the  sea-breeze, 
checks  more  or  less  the  cuticular  discharge,  and  paves  the  way  for 
future  maladies. 

Whether  this  is,  or  is  not  a  true  representation  of  the  case,  let  Dr. 
Currie's  own  worJs  decide. 

"  If,"  say*  he,  ut  supra,  ««  the  necessary  quantity  of  perspiration 
takes  place,  (viz.  by  the  use  of  gently  simulating  liquids,)  the  system 
is  enfeebled  by  the  evacuation,  and  the  extreme  vessels  losing  tone 
continue  to  transmit  the  perspirable  matter,  after  the  heat  is  reduced  to 
itsnatural  standard,  or,  perhaps,  lower ;  in  which'situation,  we  can  ea- 
sily suppose  that  even  a  slight  degree  of  external  cold,  may  become 
dangerous." — Vol.  I.  p.  278. 

Let  us  now  turn  to  the  other  gentleman,  who  pursues  a  different 
line  of  conduct.  Instead  of  tfie  more  palatable  potation  of^angaree, 
he  takes  a  draught  of  plain  cold  water.  This  is  hardly  swallowed  be- 
fore the  temperature  of  his  body  loses  by  abstraction  alone, one  degree, 
at  leant,  of  its  heat.  It  is'now  we  will  suppose' at  99°.  But  the  ex- 
ternal surface  of  the  body  immediately  sympathizing  with  the  internal 
surface  of  the  stomach,  relaxes,  and  a  mild  perspiration  breaks  out, 
which  reduces  the  temperature  to  its  natural  standard,  98W.  Further, 
this  simultaneous  relaxation  of  the  two  surfaces,  completely  removes 
the  disagreeable  sensation  of  thirst  ;  and,  xs  the  simple  "antediluvian 
beverage"  does  not  possess  many  Circean  charms  for  modern  palates, 
there  will  not  be  the  slightest  danger  of  its  being  abused  in  quantity, 
or  the  perspiratory  process  carried  beyond  its  salutary  limits.  Nor 
need  we,  on  the  other  hand,  apprehend  its  being  neglected  ;  since,  from 
the  moment  thai  the  skin  begins  to  be  constricted,  or  morbid  heat  to  ac- 
cumulate, the  sympathizing  stomach  and  fauces  will  not  fail  to  warn  us 
of  our  danger,  by  craving  the  proper  remedy.  T-iken  therefore  as 
a  general  rule,  the  advantages  of  the  latter  plan  are  numerous— the 
objections  few.  It  possesses  all  the  requisites  of  the  former,  in  pro- 
curing a  reduction  of  temperature,  (the  only  legitimate  object  which 
the  admirers  of  sangaree  and  copious  perspiration  can  have  in  view,) 
without  any  danger  of  bringing  it  below  the  proper  level,  or  wasting 
the  strength,  by  the  profuseness  of  the  discharge. 

It  is  true,  there  is  no  general  rule  without  exception  ;  and  there 
may  be  instances,  wherein  the  use  of  "  gently  stimulating  liquids"  is 
preferable  to  that  of  cold  drink. 

For  example  : — during  or  subsequent  to  violent  exertion,  under 
a  powerful  sun  ;  or  in  any  other  situation  in  a  tropical  climate,  when 
profuse  perspiration  is  rapidly  carrying;  off  the  animal  heat,  and  espe- 
cially when  fatigue  or  exhaustion  has  tak;  n  place,  or  is  impending — 
then  cold  drink  would  be  dangerous,  on  the  same  principle  as  exter- 
nal cold.  But  these  cases  rarely  happen  through  necessity  to  Euro- 
peans, particularly  in  the  east  ;  and  they  will  be  duly  considered  in 
the  prophylactic  part  of  this  essay. 

I  have  been  more  prolix  on  this  point,  than  may  have  seemed  ne- 
cessary to  the  medical  reader  ;  but  considering  that  this  is  generally  the 


ANORF.XIA.  17 

first  erroneous  step  which  Europeans  take,  on  entering  the  tropics, 
and  that  the  function  in  question,  (perspiration,)  is  more  intimately 
connected  with  another  very  important  one  in  the  human  frame,  than 
is  commonly  supposed  ;  I  thought  it  proper  to  set  them  right,  m  limine, 
The  probability  of  future  suffering  will  rarely  deter  the  European 
from  indulging  in  present  gratifications  ;  but  vvhere  these  last,  i.  e. 
the  stimulating  liquids,  are  represented,  from  high  authority,  as  not 
only  innocent  but  salutary,  it  will  require  some  strength  01  argument 
to  persuade  young  men  to  relicquisn  their  use,  or  to  check  the  wide- 
spreading  evil. 

Sect.  2. — In  attempting  to  delineate  the  influence  of  hot  climates 
on  the  European  constitution,  although  we  may  endeavour — 

41  To  chain  the  events  in  regular  array  ;" 

yet,  it  must  be  confessed,  that  nature  spurns  all  «uch  artificial  ar- 
rangements ;  since  simultaneous  impressions  on  several  organs,  must 
produce  cotemporary  and  combined  effect*,  which  our  limited  fa- 
culties are  scarcely  capable  of  embracing  in  thought,  much  less  of  de- 
scribing in  the  fetters*  of  language. 

Taking  facts,  however,  and  personal  observation  for  land-marks, 
I  shall  pursue  the  investigation,  as  nearly  as  possible,  in  the  order  of 
nature  and  of  events. 

There  exists  between  different,  and  often  distant  parts  of  the  body, 
a  certain  connection  or  relation,  which  in  medical  language,  is  call- 
ed "  consent  of  parts  :" — that  is,  when  one  is  affected  by  particular 
impressions,  the  other  sympathizes,  as  it  were,  and  takes  on  a  kind  of 
analogous  action. 

This  sympathy,  or  consent  of  parts,  has  never  been  satisfactorily  ac- 
counted for,  by  the  ablest  of  our  physiologists,  nor.— (mirabile  dictu  !) 
by  the  most  ingenious  of  our  theorists.  As  all,  however,  are  agreed 
in  respect  to  the  fact,  we  may  allow  the  cause  to  remain  locked  up 
in  nature's  strong  box,  in  company  with  many  other  arcana,  which  she 
does  not  seem  disposed  to  reveal.* 

Of  these  sympathies,  none  is  more  universally  remarked,  or  fami- 
liarly known,  than  that  which  subsists  between  the  external  surface  of 
the  body,  and  the  internal  surface  of  the  alimentary  canal  This  in- 
deed, seems  less  incomprehensible  than  many  others,  since  the  latter 
appears  tQ  be  a  continuation  ot  ttie/ormcr,  with  the  exception  of  the 
cuticle.  In  the  first  section,  I  gave  an  instance  of  the  skin  sympa- 
thizing with  the  stomach,  where  the  cold  drink  was  applied  to  the 
latter  organ.  Had  the  water  been  applied  to  the  external  surface  of 
the  body,  on  the  other  hand,  the  stomach  would  have  sympathized, 
and  the  thirst  been  assuaged. 

The  loss  of  tone,  then,  in  the  extreme  vessels  of  the  surface,  in 
consequence  of  excessive,  or  long-continued  perspiration  is,  on  this 
principle,  necessarily  accompanied,  or  soon  succeeded  by,  a  consen- 

*  I  do  not  see  that  Dr.  Park's  laboured  discussion  on  this  subject  in  the  Jour- 
nal of  Science,  has  brought  us  a  whit  nearer  the  knowledge  of  sympathetic  ac- 
tion. 


1  BlLlAfcY  SECKETION. 

taneous  loss  of  tone  in  the  stomach,  and  fully  accounts  for  that  ano- 
rexia, or  diminution  of  appetite,  which  we  seldom  fail  to  experience 
on  entering  the  tropics,  or,  indeed,  during  hot  weather  in  England. 
Now  this,  although  but  a  link  in  the  chain  of  effects,  seems  to  me  a 
most  wise  precaution  of  nature,  to  lower  and  adapt  the  irritable, 
plethoric  European  constitution,  to  a  burning  climate,  by  guarding 
very  effectually  against  the  dangerous  consequences  of  repletion. 
This  view  of  the  subject  will  set  in  a  clear  light,  the  pernicious  ef- 
fects of  stimulating  liquids,  operating  on  an  organ  already  debilitated, 
(probably  for  salutary  purposes,)  and  goading  it  thereby  to  exertions 
beyond  its  natural  power,  producing  a  temporary  plethora,  with  a 
great  increase  of  subsequent  atony. 

A  remark,  which  every  person  of  observation  must  have  made, 
even  in  this  country,  during  the  summer,  but  particularly  in  equatorial 
regions,  will  furthur  elucidate  this  subject.  If  by  walking,  for  in- 
stance, or  any  other  bodily  exercise,  in  the  heat  of  the  sun,  during 
the  forenoon,  especialty  near  dinner  hour,  the  perspiration  be  much 
increased,  and  the  extreme  vessels  relaxed,  we  find,  on  sitting  down 
to  table,  our  appetites  entirely  gone,  until  we  take  a  glass  of  wine, 
or  other  stimulating  fluid,  to  excite  the  energy  of  the  stomach.  Un- 
der such  circumstances  of  artificial  or  forced  relish  for  food,  it  is  not 
to  be  wondered  at,  that  the  digestion  should  be  incomplete,  and  that  the 
intestines  should  suffer  from  the  passage  of  badly  concocted  aliment. 
Observation  and  personal  feeling  have  taught  me  this, — that  in  hot 
climates,  perhaps  during  hot  weather  in  all  climates,  an  hour's  cool 
repose  before  dinner  is  highly  salutary  ;  and  if  on  commencing  our 
repast,  we  find  we  cannot  eat  without  drinking,  we  may  be  assured 
that  it  is  nature's  caveat, — to  beware  of  eating  at  all.  This  will  be 
deemed  hard  doctrine  by  some,  and  visionary  by  others  ;  but  I  know 
it  is  neither  one  nor  the  other :  and  those  who  shall  neglect  or  de- 
piseiit,  may  feel  the  bad  consequences  when  it  is  too  late  to  repair 
the  error. 

There  are  several  other  causes,  however,  which  operate  in  con- 
junction with  the  above,  to  impair  the  appetite  :— one  of  which  is,  the 
want  of  rest  at  night.  After  disturbed  and  unrefreshing  sleep,  (but  too 
common  in  tropical  climates,)  the  whole  frame  languishes  next  day, 
and  the  stomach  participates  in  the  general  relaxation.  The  means 
of  managing  and  obviating  these  effects,  will  be  pointed  out  in  the 
prophylactic  part  of  this  essay. 

Sect.  3 — We  now  take  a  wider  range,  and  come  to  a  subject  more 
intricate  in  its  nature,  extensive  in  its  bearings,  and  important  in  its 
consequences.  It  will  readily  be  understood,  that  I  allude  to  the  in- 
fluence of  a  tropical  climate  on  the  liver  and  its  functions. 

This  immense  gland  is  the  largest  organ  in  the  human  frame  ;  for 
neither  the  brain,  heart,  spleen,  nor  kidnies,  can  be  at  all  compared 
with  it  ;  and  the  lungs,  though  occupying  a  larger  extent  when  inflat- 
ed, yet  if  condensed  to  equal  solidity,  would  fall  short  in  size  and 
weight. 

Now,  since  nature,  throughout  her  works,  has  seldom  been  accu- 
ed  of  supererogation,  we  may  safely  conclude  that  the  importance  of 


BILIARY*  SBCilSlON.  19 


this  organ's  function,  in  the  animal  economy,  is  commensurate  with 
its  magnitude.  The  structure  of  the  liver  has  been  explored  by  the 
anatomist,  and  the  bile  secreted  in  it  analysed.  But,  although  the 
chymist  has  separated  this  fluid  into  its  constituent  parts  ;  yet  phy- 
siologists are  not  exactly  agreed  in  regard  to  the  purposes  which  it 
answers  in  the  system.  It  is  proved  to  beantiputrescent,  and  in  con- 
junction with  the  pancreatic  juice,  it  probably  assists  in  animalizing 
and  eliminating  the  chyle  from  the  chyme. 

It  is  supposed  not  to  enter  the  circulation  naturally,  at  least  in  an 
unchanged  state  along  with  the  chyle  ;  but,  there  can  be  little  doubt 
of  its  preventing  the  putrefactive  or  fermentative  process  from  taking 
place  in  the  excrementitious  part,  which  is,  ultimately,  to  be  expel- 
led the  body.  Another,  and  a  principal  use  of  this  important  fluid, 
appears  to  consist  in  stimulating  the  intestines  into  their  peculiar  per- 
istaltic motion,  and  thus  propelling  their  contents  continually  forward, 
to  give  the  lacteals  an  opportunity  of  drinking  up  and  conveying  to 
the  blood  the  nourishment  by  which  our  frames  are  supported. 

In  this  point  of  view,  it  is  the  natural  tonic  of  the  intestines,  and  also 
the  purgative  which  frees  them  from  all  fecal  matter,  the  retention 
of  which  is  productive  of  so  much  inconvenience,  not  to  say  disease. 

The  first  effect  of  a  tropical  climate  on  the  function  of  the  liver,  is 
universally  allowed  to  be  an  increase  of  the  biliary  secretion.  This  is 
so  evident  in  our  own  country,  where  the  summer  and  autumn  are 
distinguished  by  diseases  arising  from  superabundant  secretion  of  bile, 
that  it  would  be  waste  of  time  to  adduce  any  arguments  in  proof  of 
of  the  assertion.  But  why  an  increase  of  the  atmospherical  tempera- 
ture should  so  invariably  augment  the  hepatic  secretion  in  all  climates, 
and  all  classes  of  people,  is  totally  unaccounted  for.  When  Dr. 
Saunders  conjectures  that  richness  of  blood,  tenseness  of  fibre,  gross- 
ness  of  diet,  and  rapidity  of  circulation,  are  the  causes  of  Europeans 
being  at  first  more  afflicted  with  bilious  redundancy  in  India  than  the 
native  Hindoos,  he  gives  us  only  a  comparative  view  of  things,  and 
leaves  us  completely  in  the  dark  with  respect  to  the  modus  operandi 
of  heat,  as  a  general  and  universal  spur  on  the  secretory  vessels  of 
the  liver. 

Were  this  a  question  of  mere  curiosity,  or  theoretical  speculation, 
I  should  pass  it  by  unnoticed  :  but  from  long  and  attentive  observation, 
as  well  as  mature  reflection,  I  believe  that  I  have  discovered  a  con- 
nection between  two  important  functions  in  the  animal  economy, 
which  will  let  in  some  light  on  this  subject,  and  lead  to  practical  in- 
ferences of  considerable  importance. 

The  arguments  and  facts  adduced  in  support  of  this  connection  will 
be  found  under  the  heads  Hepatitis,  Dysentery,  and  in  other  parts  of 
this  essay.  In  the  meanwhile,  I  shall  merely  state  in  a  few  words 
the  result  of  my  observations,  leaving  the  reader  to  give  credit  to  it, 
or  not  as  he  may  feel  inclined. 

There  exists  then  between  the  extreme  vessels  of  the  vena  porta- 
rumio  the  liver,  and  the  extreme  vessels  on  the  surface  of  the  body 
—  in  other  xvords,  between  biliary  secretion  and  perspiration,  one  of 
the  strongest  sympathies  in  the  human  frame  ;  although  entirely  un- 
noticed hitherto,  as  far  as  I  am  acquainted.  That  these  two  functions 


•' '  I  • 
20  CUTANEt-HEPATIC  SYMPATHY. 

are  regularly,  and  to  appearance,  equally  increased,  or  at  least  in* 
flueyced  by  one  particular  agent,  (atmospherical  heat,)  from  the  cra- 
dle to  the  grave — from  the  pole  to  the  equator,  will  be  readily  grant- 
ed by  every  observer  :  and  that  this  synchronous  action  alone,  inde- 
pendent of  any  other  original  connection,  should  soon  grow  up  into 
a  powerful  sympathy,  manifesting;  itself  when  either  of  these  func- 
tions came  under  the  influence  of  other  agents,  is  a  legitimate  con- 
clusion in  theory,  and  what  I  hope  to  prove  by  a  fair  appeal  to  facts. 
This  last  consideration  is  the  great  practical  one  ;  for  it  is  of  little 
consequence  whether  this  sympathy  was  originally  implanted  by  the 
hand  of  nature  at  our  first  formation,  or  sprung  up  gradually  in  the 
manner  alluded  to,  provided  we  know  that  it  actually  exists,  and  that 
by  directing  our  operations  towards  any  one  of  the  functions  in  ques- 
tion, we  can  decisively  influence  the  other.  This  is  what  I  maintain  ; 
but  here  I  only  offer  assertions  ;  in  a  future  part  of  the  work  I  shall 
bring  forward  facts  and  cogent  argument?  in  proof  of  them.  At  pre- 
sent let  this  "  consent  of  parts"  between  the  skin  and  the  liver,  which 
I  shall  beg  leave  to  denominate  the  «*  Cutaneo -hepatic  Sympathy  "  ac- 
count for  the  augmented  secretion  of  bile,  which  we  observe  on  ar- 
riving in  hot  climates,  corresponding  lo  the  increased  cuticular  dis- 
charge. I  shall  here  offer  one  practical  remark,  resulting  from  this 
view  of  the  subject,  and  which  will  be  found  deserving  of  every 
European's  attention  on  his  emigration  to  Southern  regions.  Namely, 
that  as  the  state  of  the  perspiratory  process  is  a  visible  and  certain 
index  to  that  of  the  biliary,  so  every  precautionary  measure,  which 
keeps  in  check,  or  moderates  the  profusion  of  the  former  discharge, 
will  invariably  have  the  same  effect  on  the  latter,  and  thus  tend  to 
obviate  the  inconvenience,  not  to  say  the  disorders,  arising  from  re- 
dundancy of  the  hepatic  secretion.  To  this  rule  I  do  not  know  a  sin- 
gle exception  ;  consequently  its  universal  application  can  never  lead 
astray  in  any  instance.  But  this  subject  will  be  better  elucidated, 
and  more  clearly  explained  hereafter. 

To  proceed.  It  is  well  known,  without  having  recourse  to  Bruno- 
nian  doctrines,  that  if  any  organ  be  stimulated  to  inordinate-  action, 
one  of  two  things  must  in  general  ensue.  If  ihe  cause  applied,  be 
constant  and  sufficient  to  keep  up.  for  any  length  of  time,  this  inor- 
dinate action,  serious  injury  is  likely  to  accrue  to  the  organ  itself, 
even  so  far  as  structural  alteration.  But  if  the  cause  be  only  tempo- 
rary, or  the  force  not  in  any  great  degree,  then  an  occasional  torpor, 
or  exhaustion,  as  it  were,  of  the  organ,  takes  place,  during  which 
period  it?  function  falls  short  of  the  natural  range.  To  give  a  fami- 
liar example,  of  which  too  many  of  us  are  quite  competent  to  judge  : 
•—thus,  if  the  stomach  be  goaded  to  immoderate  exertion  to-day,  by 
a  provocative  variety  of  savoury  dishes  and  stimulating  liquors,  we 
all  know  the  atony  which  will  succeed  to-morrow,  and  how  incapable 
it  then  will  be  of  performing  its  accumtomml  office.  It  is  the  same 
with  respect  to  the  liver.  After  great  excitement,  by  excessive  heat, 
violent  exercise  in  the  sun,  &c.  a  torpor  succeeds,  which  will  be  more 
or  less,  according  to  the  degree  of  previous  excitement,  and  the 
length  of  time  which  the  stimulating  causes  have  been  habitually  ap- 
plied. For  instance,  when  Europeans  first  arrive  between  the  tro- 


VITIATED  BILIARY  SECRETION.  21 

pics,  the  degree  of  torpor  bears  so  small  a  proportion  to  that  of  pre- 
ceding excitement,  in  the  liver,  that  it  is  scarcely  noticed  ;  particu- 
larly as  the  debilitated  vessels  in  this  organ,  continue,  (similar  to  the 
perspiratory  vessels  on  the  surface,)  to  secrete  a  depraved  fluid  for 
some  time  after  the  exciting  cause  had  ceased  ;  hence,  the  increase  of 
the  biliary  secretion  occupies  our  principal  attention.  But  these  tor- 
pid periods,  however  short  at  first,  gradually  and  progressively  in- 
crease, till  at  length  they  far  exceed  the  periods  of  excitement  ;  and 
then  a  deficiency  of  the  biliary  secretion  becomes  evident.  This  is 
not  only  consonant  to  experience,  but  to  analogy.  Thus  when  a  man 
first  betakes  himself  to  inebriety,  the  excitement  occasioned  by  spi- 
rits, or  wine,  on  the  stomach  and  nervous  s>siem,  far  exceeds  the 
subsequent  atony,  and  we  are  astonished  to  see  him  go  on  for  some 
time  without,  apparently,  suffering  much  detriment  in  his  constitu- 
tion. But  the  period  of  excitement  is  gradually  curtailed,  while  that 
of  atony  increases,  which  soon  forces  him  not  only  to  augment  the 
dose,  but  to  repeat  it  oftener  and  oftener,  till  the  organ  and  life  are 
destroyed ! 

Now  it  is  somewhat  singular,  that  this  alteration  of  redundancy 
and  deficiency,  or  in  other  words  irregular  secretion  in  the  biliary  or- 
gans, should  pass  unnoticed  by  writers  on  hot  climates.  They,  one 
and  all,  represent  the  liver  as  a  colossal  apparatus,  of  the  most  Her- 
culean power,  that  goes  on  for  years,  performing  prodigies  in  the  se- 
creting way,  without  ever  being  exhausted  for  a  moment,  or  falling 
below  the  range  of  ordinary  action,  till  structural  derangement,  such 
as  scirrhosity,  incapacitates  it  for  its  duty  ! 

A  very  attentive  observation  of  what  passed  in  my  own  frame,  and 
those  of  others,  has  led  me  to  form  a  very  different  conclusion,  and 
the  foregoing  statement  will,  1  think,  be  found  a  true  and  natural  re- 
presentation of  the  case.  1  shall  afterwards  show  that  the  secretion 
in  question  is  frequently  below  par,  in  quantity,  at  the  very  time 
when  it  is  considered  to  be  redundant — all  arising  from  irregularity 
and  vitiation. 

Here*then,  we  have  two  very  opposite  states  of  the  liver  and  its 
functions.  1st,  inordinate  action,  with  increased  secretion — the  pe- 
riods generally  shortening.  2nd,  Torpor  of  the  vessels  in  the  liver, 
with  deficient  secretion — the  periods  progressively  lengthening.  In 
both  cases,  the  bile  itself  is  vitiated. 

We  may  readily  enough  conceive  how  this  last  comes  to  pass,  by 
an  analogical  comparison  with  what  takes  place  in  the  stomach  during, 
and  subsequent  to,  a  debauch.  In  both  instances,  we  may  conclude, 
that  the  chyme  passes  through  the  pylorus  into  the  duodenum,  in  a 
stateless  fit  for  chylification,  than  during  a  season  of  temperance  and 
regularity.  So  during  the  increased  secretion,  and  subsequent  inactivi- 
ty in  the  liver,  the  bile  passes  out  into  the  intestines  deteriorated  in 
quality,  as  well  as  superabundant  or  deficient  in  quantity. 

In  what  this  vitiation  consists,  it  is  certainly  not  easy  to  say.  In 
high  degrees  of  it,  attendant  on  hurried  secretion,  both  the  colour 
and  taste  are  surprisingly  altered  ;  since  it  occasionally  assumes  all 
the  shades  between  a  deep  bottle  green  and  jet  biack  ;  possessing, 


PRICKLY  HEAT. 


at  one  time,  an  acidity  that  sets  the  teeth  on  edge  ;  at  other  times, 
and  indeed  more  frequently,  an  acrimony  that  seems  absolutely  to 
corrode  the  stomach  and  fauces,  as  it  passes  off  by  vomiting,  and 
when  directed  downwards,  can  be  compared  to  nothing  more  appro- 
priate than  the  sensation  which  one  would  expect  from  boiling  lead 
flowing  through  the  intestines.  Many  a  time  have  I  experienced 
this,  and  many  a  time  have  my  patients  expressed  themselves  in  simi- 
lar language.  But  these  are  extremes  that  will  be  considered  un- 
der Cholera  Morbus,  Bilious  Fever,  Dysentery,  &c.  The  slightly 
disordered  state  of  the  hepatic  functions,  which  we  are  now  consider- 
ing as  primary  effects  of  climate,  and  within  the  range  of  health,  may 
be  known  by  the  following  symptoms  :  —  Irregularity  in  the  bowels  ; 
general  languor  of  body  and  mind  ;  slight  nausea,  especially  in  the 
morning,  when  we  attempt  to  brush  our  teeth  ;  a  yellowish  fur  about 
the  back  part  of  the  tongue  ;  unpleasant  taste  in  the  mouth,  on  g  Ci- 
ting out  of  bed  ;  a  tinge  in  the  eyes  and  complexion,  from  absorp- 
tion of  bile  ;  the  urine  high  coloured,  and  a  slight  irritation  in  passing 
it  ;  the  appetite  impaired,  and  easily  turned  against  fat  or  oily  vic- 
tuals. These  are  the  fir«t  effects,  then,  of  increased  and  irregular 
secretion  of  bile,  and  will  appear  in  all  degrees,  according  as  we  are 
less  or  more  cautious  in  avoiding  the  numerous  causes  that  give  ad- 
ditional force  to  the  influence  of  climate.  For  example  :  if  I  use 
more  than  ordinary  exercise  —  expose  myself  to  the  beat  of  the  sun 
—  or  drink  stimulating  liquids  to-day,  an  increased  and  vitiated  flow 
of  bile  takes  place,  and  to-morrow  produces  either  nausea  and  sick- 
ness at  the  stomach,  or  a  diarrhoea,  with  gripings  and  twitchings  in 
my  bowels.  But  a  slight  degree  of  inaction  or  torpor  succeeding, 
both  in  the  liver  and  intestines,  there  will  probably  be  no  alvine 
evacuation  at  all  the  ensuing  day,  till  a  fresh  flow  of  bile  sets  all  in 
motion  once  more.  These  irregularities,  although  they  may  con- 
tinue a  longtime  without  producing  much  inconvenience,  especially 
if  they  be  not  aggravated  by  excesses,  yet  they  should  never  be  des- 
pised, since  they  inevitably,  though  insensibly,  pave  the  way  for  se- 
rious derangement  in  the  biliary  and  digestive  organs,  unless  coun- 
teracted by  the  most  rigid  temperance,  and^he  prophylactic  measures 
which  I  shall  carefully  detail  in  their  place.  The  reciprocal  influence 
and  effects  which  the  hepatic  and  mental  functions  exercise  on  each 
other,  will  form  an  interesting  inquirj',  under  the  article  Hepatitis. 

Sect.  4.  —  Among  the  primary  effects  of  a  hot  climate,  (for  it  can 
hardly  be  called  a  disease,)  we  may  notice  the  prickly  heat,  (Lichen 
tropicus,)  a  very  troublesome  visitor,  which  few  Europeans  escape. 

This  is  one  of  the  miseries  of  a  tropical  life,  and  a  most  unma- 
nageable one  it  is.  From  mosquitoes,  cockroaches,  ants,  and  the  nu- 
merous other  trioes  of  depredators  on  our  personal  properity,  we 
have  some  defence  by  night,  and  in  general,  a  respite  by  day  ;  but 
this  unwelcome  guest  assails  us  at  all,  and  particularly  the  most 
unseasonable  hours.  Many  a  time  have  I  been  forced  to  spring  from 
table  and  abandon  the  repast  which  1  had  scarcely  touched,  to  writhe 
about  in  the  open  air,  for  a  quarter  of  an  hour  :  and  often  have  I 
returned  to  the  charge,  with  no  better  success,  against  my  ignoble 


PRICKLY  HEAT  23 

opponent !  The  night  affords  no  asylum.  For  some  weeks  after 
arriving  in  India,  I  seldom  could  obtain  more  than  an  hour's  sleep 
at  one  time  before  1  was  compelled  to  quit  my  couch,  with  no  small 
precipitation,  and  if  there  were  any  water  at  hand,  to  sluice  it  over  me, 
for  the  purpose  of  allaying  the  inexpressible  irritation  !  But  this 
\vasproductive  of  temporary  relief  only;  and  u  hat  was  worse,  a 
more  violent  paroxysm  frequently  succeeded. 

The  sensations  arising  from  prickly  heat  are  perfectly  indescriba- 
ble ;  being  compounded  of  pricking,  itching,  tingling,  and  many  other 
feelings,  for  which  1  have  no  appropiate  appellation. 

It  is  usually,  but  not  invariably  accompanied  by  an  eruption  of 
vivid,  red  pimples,  not  larger  in  general,  than  a  pin's  head,  which 
spread  over  the  breast,  arm?,  thighs,  neck,  arid  occasionally  along 
the  forehead,  close  to  the  hair.  This  eruption  often  disappears,  in 
a  great  measure,  when  we  are  sitting  quiet,  and  the  skin  is  cool ; 
but  no  sooner  do  we  use  any  exercise  that  brings  out  a  perspiration, 
or  swallow  any  warm,  or  stimulating  fluid,  such  as  tea,  soup,  or  wine, 
than  the  pimples  become  elevated,  so  as  to  be  very  distinctly  seen, 
and  but  too  sensibly  felt. 

Prickly  heat,  being  merely  a  symptom,  not  a  cause  of  good  health, 
its  disappearance  has  been  erroneously  accused  of  producing  much 
mischief ;  hence,  the  early  writers  on  tropical  diseases,  harping  ou 
the  old  string  of  '^humoral  pathology,"  speak  very  seriously  of  the 
danger  of  repelling,  and  the  advantage  of"  encouraging  the  eruption, 
by  taking  small  warm  liquors,  as  tea,  coffee,  wine  whey,  broth,  and 
norishing  meats." — Hillary. 

Even  Dr.  Moseley  retails  the  puerile  and  exaggerated  dangers  of 
his  predecessor.  "  There  is  great  danger,"  (says  he,)  "  in  repelling 
the  prickly  heat  ;  therefore  cold  bathing,  and  washing  the  body  with 
cold  water,  at  the  time  it  is  out,  is  always  to  be  avoided."  Every 
naval  surgeon,  however,  who  has  been  a  few  months  in  a  hot  climate, 
must  have  seen  hundreds,  if  not  thousands,  plunging  into  the  water, 
for  days  and  weeks  in  succession,  covered  with  prickly  heat,  yet  with- 
out bad  consequences  ensuing.  * 

Indeed,  I  never  saw  it  even  repelled  by  the  cold  bath,  and  in  my 
own  case,  as  well  as  in  many  others,  it  rather  seemed  to  aggravate  the 
eruption  arid  disagreeable  sensations,  especially  during  the  glow  which 
succeeded  the  immersion.  It  certainly  disappears  suddenly  some- 
times on  the  accession  of  other  diseases,  but  I  never  had  reason  to 
suppose,  that  its  disappearance  occasioned  them.  I  have  tried  lime 
juice,  hair  powder,  and  a  variety  of  external  applications,  with  little 
or  no  benefit.  In  short,  the  only  means,  which  I  ever  saw  productive 
of  any  good  effect  in  mitigating  its  violence,  till  the  constitution  got 
assimilated  to  the  climate,  were — light  clothing — temperance  in  eat- 
ing and  drinking — avoiding  all  exercises  in  the  heat  of  the  day — open 
bowels — and  last,  not  least,  a  determined  resolution  to  resist  with 
stoical  apathy  its  first  attacks.  To  sit  quiet  and  unmoved  under  its 
pressure  is  undoubtedly  no  easy  task,  but  if  we  can  only  muster  up 
fortitude  enough  to  bear  with  patience  the  first  few  minutes  of  the 
assault,  without  being  roused  into  motion,  the  enemy,  like  the  foiled 
tiger,  will  generally  sneak  off,  and  leave  us  victorious  for  the  time.  - 


PART  II. 

SPECIFIC    DISEASES 

EASTERN  HEMISPHERE. 


Sect  1. — Fever  in  General. — It  is  not  my  intention  to  include  in  this 
section  what  is  called  Symptomatic  fevers.  It  is  to  the  subject  of  FE- 
VER, strictly  so  called,  that  I  shall  confine  my  observations  ;  and  trite 
and  exhausted  as  the  theme  may  appear,  I  hope  still  to  render  it,  in 
some  measure  interesting.  If  I  have  omited  the  adjective  "idiopathic" 
it  is  not  because  I  consider  fever  as  in  all  cases  dependent  on  topi- 
cal inflammation  or  congestion  ;  but  because  I  wish  to  avoid  a 
"  war  of  words"  about  an  abstract  term.  Some  late  writings,  and  par- 
ticularly Dr.  Clutterbuck's  Essay,  have  divided  the  medical  world  in 
opinion,  a  very  considerable  portion  subscribing  to  the  Doctor's  theo- 
ry. There  is  still,  however,  as  far  as  I  can  learn,  a  majority  in  fa- 
vour of  the  old  doctrine  that  fever  may  originate,  and  even  proceed 
some  way  in  its  course,  without  local  inflammation — -or  those  topical 
affections  which  may  be  considered  analogous  to,  or  synonymous 
with,  local  inflammation. 

Contrary  to  the  usual  mode  of  proceeding,  before  entering  on  the 
nature  of  fever  itself,  I  shall  take  a  rapid  survey  of  the  causes  of  this 
wonderful  disease.  By  systematic  writers  these  have  been  divided 
into  remote  and  proximate  ;  but  the  latter  being  the  actual  state  of  the 
disease,  will  not  yet  come  under  consideration.  The  remote  causes 
are  subdivided  into  predisponent  and  exciting.  The  predi«ponent, 
however,  often  become  the  exciting,  and  the  exr  iting  the  predispo- 
nent causes,  as  the  following  example  will  illustrate.  Two  labourers 
set  out  from  London,  in  the  summer  or  autumn,  to  work  in  the  fens 
in  Lincolnshire.  The  one  is  a  sober  man,  the  other  a  drunkard. 
The  latter  is  attacked  with  intermittent  fever,  while  the  former, 
thongh  equally  exposed,  escapes.  Here  inebriety  is  evidently  the 
predisposing,  and  marsh  miasma  the  excitiug  cause  of  fhe  disease. 
But  the  sober  man  having  returned  to  London  in  the  winter,  com- 
mits a  debauch,  and  immediately  afterwads  he  is  seized  with  ague. 
Here,  on  the  other  hand,  the  latent  miasma  becomes,  the  predisposing, 
and  drunkenness  the  exciting  cause  of  the  fever.  Let  this  be  borne 
in  mind,  for  it  may  help  to  explain  more  than  at  first  sight  might  be 
expected. 

Speaking  generally,  however,  the  two  great  exciting  causes  of  fever 
are  human  and  marsh  effluvia  ;  while  the  predisposing  causes  are  al- 
most innumerable.  The  more  prominent,  however,  are,  plethora — 


FETER.  25 

inanition  from  excessive  evacuations — the  depressing  passions — ex- 
cess, whether  in  eating,  drinking,  gratification  of  the  sensual  pas- 
sions— mental  or  corporeal  exertions — extremes  of  atmospheric  heat 
and  cold,  especially  alternations  ol  these  or  of  heat  and  moisture — sol- 
lunar  influence. 

Now  experience  has  determined,  that  of  the  foregoing  and  many 
other  predisponent  causes,  any  one,  (excepting  the  last.)  will,  when 
in  a  very  high  degree,  induce  fever  without  the  assistance  of  any 
other.  If  this  be  the  case,  then,  it  is  a  natural  and  just  inference 
that  the  operation  of  marsh  and  human  effluvium  on  the  human  frame 
bears  a  very  considerable  analogy  to  the  operation  of  tho?e  causes 
enumerated  as  generally  predisposing  to,  but  sometimes  actually  ex- 
citing fever.  This  may  give  us  a  clue  to  assist  in  unravelling  the 
ratio  symptomatum  hereafter  ;  but  before  entering  on  the  effects,  we 
shall  gay  something  of  the  causes  themselves. 

Human  Effluvium  or  Contagion. — The  existence  of  this  febrific 
miasm  as  the  cause  of  fever  does  not  appear  to  have  been  known  to 
the  ancients,  since  Hippocrates  makes  no  mention  of  it,  and  the  strict 
prohibitions  against  contact  with  unclean  or  diseased  persons  recorded 
in  the  Mosaic  code,  do  not  seem  directed  against  febrile,  but  chro- 
nic or  local  infection — probably  against  cutaneous  or  genital  defla- 
tions. It  is  curious,  however,  that  Plin)s  when  describing  the  pro- 
gress of  an  endemic  fever,  apparently  solves  a  question  which  to  this 
moment,  gives  rise  to  the  most  violent  altercations—  namely,  whether 
endemic  fevers  ever  become  contagious  1  **  Et  primo  temporis  ac  loci 
vitio,  et  aegri  rant,  et  moriebantur  ;  postea,  curatio  ipsa  et  contactus 
aegrorum  vulgabat  morbos."  Lib.  xxv.  ch.  26.  But  more  of  this 
hereafter. 

Notwithstanding  the  exertions  of  Dr.  Bancroft  and  some  others  to 
invalidate  certain  testimonies  respecting  the  generation  of  contagious 
effluvium,  facts  too  stubborn  tobe  swept  away  by  the  brush  of  sophistry, 
attest  that  the  effluvium  issuing  from  the  bodies  of  a  number  of  hu- 
man being?  confined  too  closely,  whether  in  a  state  of  health  or  dis- 
ease, will  occasionally  produce  a- contagion  whic  h  is  capable  not  on- 
ly of  exciting  fever  among  those  so  confined,  but  of  propagating  itself 
afterwards  from  them  to  others. 

Setting  aside  the  testimonies  of  Bacon,  Lind,  Pringle,  and  others, 
the  transports  which  received  and  conveyed  home  the  wretched 
remnant  of  Sir  John  Moore's  army,  after  the  battle  of  Corunna,  afford- 
ed the  most  decisive  and  melancholy  proofs  that  bodies  of  men  con- 
fined close  together  bet  .veen  the  decks  of  a  ship  in  stormy  weather, 
will  soon  become  sickly,  and  that  their  diseases  may  be  communicat- 
ed to  nurses  and  others,  after  they  are  landed,  washed,  and  placed 
in  the  most  clean  and  airy  hospitals.  It  will  hardly  be  contended  that 
these  men  could  have  carried  any  infection  on  board,  either  in  their 
persons  or  clothes,  after  a  rapid  retreat,  during  which,  almost  every 
stitch  of  garment  was  washed  from  their  backs  by  the  incessant  rains. 
A  dreadful  and  sanguinary  battle  at  the  water's  edge,  gave  them  no 
time  to  contract  infection  or  even  clothe  themselves  at  Corunna.  They 
precipitated  themselves  tumultuously,  naked,  exhausted,  and  wound- 

4 


26  FEVER. 

ed,  into  the  first  vessels  that  came  in  their  way,  and  were  there  crowd- 
ed from  choice  or  necessity  during  a  cold,  wet,  and  tempestuous  passage 
across  the  Bay  of  Biscay.  On  this  passage  a  most  fatal  typhoid  fever 
broke  out,  which  spread  far  and  wide  among  the  nurses  and  medical 
attendants  of  the  hospitals  in  England  where  they  were  landed. 
They  embarked  indeed  with  an  unusual  degree  of  predisposition  to 
disease,  arising  from  excessive  fatigue — chagrin — exposure  to  the 
elements  by  day  and  night — nakedness— -want — occasional  inebri- 
ety— insubordination  ;  and  last  of  all— exhaustion  after  a  tremendous 
conflict  that  closed  this  disastrous  retreat.  It  was  utterly  impossi- 
ble, however,  that  a  particle  of  fomites  or  the  matter  of  contagion 
could  exist  among  them  at  the  moment  of  their  embarkation  ;  and  it 
was  too  fatally  proved  that  every  transport  exhibited  a  most  destruc- 
tive focus  of  infectious  fever  before  they  reached  England.  I  have 
dwelt  the  longer  on  this  point,  because  it  bears  upon  questions  that 
are  now  agitating  the  public  mind  ;  and  because  Time's  telescope 
cannot  be  inverted  here  as  it  has  been  on  other  occasions,  nor  facts  be 
denied  that  are  so  recent  in  the  memory  of  thousands  now  alive. 
Within  a  few  yards  of  the  spot  where  I  now  write,  the  greater  part  of 
a  family  fell  sacrifices  to  the  effects  of  fomites  that  lurked  in  a  blanket 
purchased  from  one  of  these  soldiers  after  their  return  from  Corun- 
na! 

It  is  not  so  well  ascertained  that  the  effluvia  from  fead  animal  mat- 
ters alone  will  generate  a  contagious  disease  ;  at  least  it  has  been  fa- 
shionable to  deny  such  an  occurrence  since  Dr.  Bancroft's  publication. 
But  there  are  not  wanting  respectable  testimonies  in  the  affirmative; 
and  it  does  not  seem  very  incredible  that  offensive  exhalations  from 
large  masses  of  putrifying  animal  matters  should,  under  certain 
circumstances,  produce  fever,  as  related  by  Forestus  and  Senac.  The 
late  fatal  fever  at  Cambridge  appears  to  have  been  of  local  origin  at 
first,  but  propagated  by  infection  afterwards. 

Of  what  this  contagious  matter  consists,  we  are  totally  ignorant,  as 
it  is  perfectly  incognizable  by  the  senses,  and  incapable  of  being 
submitted  to  chemical  analysis.  Many  people  have  declared  that  they 
felt  an  indescribable  taste  in  their  mouths,  and  sensation  over  their 
frames,  together  with  a  peculiar  odour  impressed  on  their  olfactories, 
at  the  moment  of  imbibing  the  poison  ;  but  it  cannot  be  ascertained 
whether  these  were  produced  by  the  contagion  itself,  or  by  any  efflu- 
vium accompanying  or  conveying  it. 

With  the  laws  which  govern  contagion,  we  are  fortunately  better 
acquainted.  It  does  not  appear  to  be  much  under  the  control  of  the 
seasons,  since  a  full  dose  of  it  will  produce  the  specific  effect  at  any 
time  of  the  year.  As  warm  air  causes  a  greater  exhalation  from 
bodies,  it  might,  a  priori,  have  been  expected  that  this  contagion 
would  spread  most  in  the  summer  ;  and  the  popular  opinion  to  this  day 
is,  that  hot  weather  is  prejudicial  to  patients  labouring  under  typhoid 
fevers.  We  find,  however,  that  it  is  in  winter  that  these  diseases  are 
most  prevalent.  The  reason  appears  to  be  simply  this  : — the  freer 
ventilation  of  summer  dilutes  and  dissipates  the  exhalations  from  the 
sick,  rendering  them  innocuous  ;  while  the  , confined  air  of  small 


FEVER.  •    27 

apartments  among  the  poor,  in  winter,  tends  to  condense,  as  it  werea 
the  febrific  effluvia,  and  embue  the  bedding,  &c.  of  the  sick  with  the 
same  ;  forming  a  fruitful  source  for  the  dissemination  of  the  disease 
by  means  offomites,  a  form  in  which  the  mutter  of  contagion  is  emi- 
nently powerful.  Experiments  have  proved  that  this  contagion, 
when  diluted  with  pure  atmospheric  air,  becomes  harmless  at  the  dis- 
tance of  a  few  yards — perhaps  of  a  few  feet  ;  and  hence  the  surest 
means  of  preventing  its  dissemination  are,  cleanliness  and  ventilation. 
Indeed  it  is  only  where  these  cannot  be  procured,  that  the  juggling 
process  of  fumigation  need  ever  be  resorted  to  ;  and  I  firmly  believe 
that  if  the  latter  ever  checked  the  spread  of  contagion,  it  was  more 
by  its  effects  on  mind  than  on  matter.  The  history  of  animal  magne- 
tism alone  will  teach  us  how  far  imagination  may  go  in  actually  arrest- 
ing the  progress  of  disease  in  its  full  career  ;  and  in  no  case  have 
mental  impressions  more  decided  effects  than  in  checking  or  facilitat- 
ing the  operation  of  contagion  on  the  human  body. 

The  next  thing  to  be  observed  is,  that  from  idiosyncrasy  of  consti- 
tution, some  individuals  are  infinitely  less  susceptible  of  the  contagion 
than  others  ;  and  also,  that  habitual  exposure  to  it,  renders  us  more 
capable  of  resisting  it,  as  is  exemplified   among    nurses    and   medical 
men.  This  circumstance  appears  explicable  on  the  principle  of  habit, 
which  renders  us  able  to  bear  a  larger  dose  of  any  other  poison,  as  of 
arsenic,  opium,  &c.   v  Dr.  Haygarth  affirms  that  he  has  been    in    the 
habit  of  breathing,  almost  daily,  air   strongly  impregnated   with  the 
infectious  miasms  of  fever,  during  a  space  of  more  than   50  years,  and 
yet  never  but  once  caught  a  fever  in  all  that  time.  Some  periods  of  life, 
however,  render  the  body  more  susceptible  than   others — the   very 
young  and  very  old  are  more  exempt  than  those  of  intermediate  ages. 
Ulcers   and  other  chronic  diseases,  also,  seem  occasionally  to  confer 
an  insusceptibility  on   the    constitution.   The  latent  period,  or   that 
which  elapses  between  the  reception  and  manifestation  of  the  conta- 
gion differs  exceedingly,  according  to  the   degree  of  concentration  in 
the  poison  and  the  predisposition  of  the  subject.    There  is  no    doubt 
but  that  many  doses  of  the  poison  are  received  which  produce  the  fe- 
ver or  not  according  as  the  various  predisposing  causes  are  applied. 
It  is,  however,  seldom    less  than   fourteen,  or  more  than  sixty  days 
between  the  receipt  of  the  infection  and  the  unfolding  of  the  fever. 
Marsh  Miasma.  —  The  febrific  effluvia  of  marshes,  as  well  as  human 
contagion,  seem  to  have  escaped  the  notice  of  Hippocrates.     This  is 
the  more  to  be  wondered  at,  as  many  of  the  fevers  which  he  des- 
cribes are  clearly  the  bilious  remittent  fevers  of  the  present  day,  [see% 
for  instance,  Popularium  i.JEgrotus  octavus,]  and  produced,  of  course, 
by  the  same  causes.     Lancisius  was  the  first  who  drew  the  attention 
of  medical  men  to  the  subject,  since  which,  march  effluvium  has  been 
traced  as  the  cause  of  some  of  the  most  destructive  endemics  that 
occur  both  within  and  without  the  tropics.     The  fevers  of  Cadiz, 
Carthagena,  Gibraltar,  and  Zealand,  may  compete,  in  respect  to  vi- 
rulenee  and  fatality,  with  those  of  Batavia,  Bengal,  St.  Domingo,  and 
Philadelphia.     The  term  marsh,  is  not   so  proper  as  v  eg e  to  -animal 
effluvium  or  miasma  ;  since  experience  and  observation  have  proved 


28  FEVER. 

that  these  febrific  exhalations  arise  from  the  summits  of  mountains  as 
well  as  from  the  surfaces  of  swamps.  The  mountains  of  Ceylon, 
covered  with  woods  and  jungle,  and  the  vast  ghauts  themselves,  give 
origin  to  miasmata  that  occasion  precisely  the  same  fever  as  we  wit- 
ness on  the  marshy  plains  of  Bengal. — But  the  subject  of  Miasmata 
will  again  come  under  consideration,  in  the  Section  on  Endemic  of 
Bengal. 

Ratio  Symptomatum. — We  now  proceed  to  trace  the  action  of  these 
febrific  causes  on  the  human  frame — or  in  other  words,  the  ratio  symp- 
tomatum  of  fever  -itself ;  for  in  nature  and  in  truth,  there  is  no  such 
thing  as  a  proximate  cause  of  this  disease,  the  whole  train  of  symp- 
toms being  a  series  of  causes  and  effects,  extremely  difficult  to  deli- 
neate or  comprehend.  If  any  thing  could  deserve  the  name  of  proxi- 
mate cuusey  it  would  be  some  peculiar  state  or  phenomenon  invariably 
present  at  the  beginning  of  fever,  and  without  which,  the  disease 
could  not  be  said  to  exist.  But  all  writers  agree  that  there  is  no  one 
symptom,  state,  or  phenomenon  which  is  constantly  observable  in  fe- 
ver. Neither  quickness  of  pulse — increased  heat — thirst  nor  head- 
ache can  be  laid  down  as  pathognomonic  ;  for  although  some  of  these 
are  always  present,  no  one  of  them  is  invariably  so. 

If  an  appeal,  however,  be  made  to  accurate  clinical  observation, 
it  will  probably  be  found  that  from  the  first  till  the  last  moment  offe- 
rer, two  phenomena  are  constantly  present — a  derangement  in  the 
balance  of  the  circulation,  and  of  the  excitability.  If  the  calibre  of  the 
radial  artery,  or  the  strength  and  velocity  of  its  pulsations  show  nothing 
preternatural,  (which  by  the  bye  will  be  a  rare  occurrence,)  yet,  the 
experienced  physician  can  instantly  detect  the  unequal  distribution 
of  the  vital  fluid,  as  well  by  the  torpid  state  of  the  extreme  vessels  on 
the  surface,  and  throughout  the  glandular  system,  as  by  the  turgidi- 
ty  of  the  primary  trunks.  The  imperfect  perspiration  and  secretions 
will  point  out  the  one  ;  the  peculiar  febrile  anxiety — huwied  respi- 
ration on  attempting  to  sit  up  or  move — fullness  of  the  praecordia,  and 
heaviness  about  the  head,  will  clearly  demonstrate  the  other.  In  no 
one  instance,  during  a  long  acquaintance  with  fever,  have  I  failed  to 
notice  these  indications  of  a  deranged  balance  of  the  circulation. 

The  proofs  of  broken  balance  in  the  excitability  are  equally  mani- 
fest. It  is  now  well  known  how  much  the  functions  of  the  glandular 
system^are  dependant  on  the  nervous.  In  fever,  the  secretions  are  ne- 
ver perfectly  natural.  They  are  in  general  scanty — sometimes  pre- 
ternaturally  copious  ;  but  always  depraved.  While  this  torpor  or  ir- 
regularity is  going  on  in  the  glandular  system,  the  nerves  of  sense 
show  plain  marks  of  inequilibrium  of  excitability.  The  same  degrees 
of  light  and  sound  that  in  health  would  be  pleasing,  will,  in  fe- 
ver, be  either  distracting,  or  incapable  of  making  any  impression  at 
all.  The  stomach  will  be  in  a  state  of  morbid  irritability,  and  the 
intestinal  canal  completely  torpid.  Speaking  generally,  however,  the 
glandular  or  secreting  system  is  irregularly  torpid — the  nervous  or 
sentient  system,  irregularly  irritable  and  debilitated. 

Now  if  we  find  that  the  general  operation  of  the  various  predispos- 
ing causes  of  fever,  is  to  disturb  more  less,  according  to  the  force  and 
condition  of  the  subject,  the  balance  of  the  circulation  and  exci- 


FEVER.  29 

lability,  we  advance  one  step  nearer  to  a  knowledge  of  this  proximate 
cause  in  fever,  because  we  find  in  it  the  same  ratio  symptomalum  as 
in  all  the  phlegmasiae-,  modified  only  by  the  exciting  cause.  For  ex- 
ample :  one  man  is  exposed  to  a  rapid  atmospherical  transition,  or  a 
current  of  cold  air  when  the  body  is  heated  ;  another  man  is  exposed 
to  the  effluvium  issuing  from  the  body  of  a  typhous  patient  ;  a  third 
commits  a  great  and  unaccustomed  debauch  in  spirituous  or  ferment- 
ed liquors  : — a  fourth  is  overhelmed  with  a  series  of  losses  and  mis- 
fortunes ;  a  fifth  is  exposed  to  the  exhalations  arising  from  a  fen  ; 
•while  a  sixth  performs  a  rapid  and  toilsome  march  under  an  ardent 
sun.  These  six  men,  (and  the  list  might  be  far  extended,)  will  have 
six  different  kinds  of  fever— all  agreeing,  however,  in  the  two  points 
under  discussion,  [a  derangement  of  balance  in  the  circulation  and  in 
the  excitability,]  but  each  offering  peculiar  traits  and  phenomena,  in 
consequence  of  the  peculiarity  of  cause. 

Thus  thejirst  patient  will  in  all  probability,  have  a  fever  remarkable 
for  great  vascular  action,  or  derangement  of  the  circulation,  with  a 
determination  to  some  internal  organ,  most  likely  the  lungs,  in  which 
determination  or  inflammation  consists  the  chief  danger. 

The  second  man  will  have  a  fever  at  a  much  longer  interval  from 
the  application  of  the  cause,  and  which,  contrary  to  the  former  case, 
will  show  greater  marks  of  derangement  in  the  balance  of  the  excita- 
bility, than  of  the  circulation.  In  this  instance,  the  functions  of  all  the 
organs  will  be  more  or  less  affected  ;  the  fever  sometimes  running  its 
whole  course  without  producing  morbid  alteration  of  structure  ;  at 
other  times,  giving  origin  to  congestion  or  inflammation  in  the  brain, 
liver,  stomach,  &c.  destroying  the  patient  at  various  and  uncertain 
stadia  of  the  disease.  To  these  peculiarities  may  be  added  the  pow- 
er of  propagating  itself  by  reproduction  in  other  subjects. 

The  third  man  will  have  high  vascular  action,  with  considerable 
determination  to  the  head,  stomach,  alimentary  canal,  &c.  or  probaly 
that  peculiar  affection  denominated  "  delirium  tremens." 

The  fourth  will  have  whaj;  is  called  a  slow  nervous  fever  so  admi- 
rably described  by  Pringle. 

The  fifth  will  have  a  fever  differing  from  all  the  preceding,  inas- 
much as  it  will  show  great  remissions,  or  even  intermissions,  on  al- 
ternate days,  with  determinations,  if  long  continued,  to  the  liver  and 
spleen. 

The  sixth  man's  fever  will  evince  great  violence  at  beginning,  with 
little  or  no  remission  ;  and  end  in  a  sudden  determination  to  an  inter- 
nal organ — generally  the  liver  ;  or  change  into  a  long  and  dangerous 
typhoid  type. 

Now  the  only  symptoms  or  circumstances  that  are  invariably  pre- 
sent in  all  these  cases,  are  the  ine^iu/^roVy  above-mentioned  ;  the  other 
varieties  appearing  to  depend  on  the  difference  of  cause,  and  idiosyn- 
crasy of  constitution.  Need  we  then  seek  further  for  a  proximate 
cause  of  fever  1 

All  the  causes  then  of  fever,  from  the  most  remote  and  predispos- 
ing, to  the  most  immediate  and  exciting,  however  varied  may  be  their 
mode  of  action,  tend  constantly  to  one  point,  and  directly  or  indirectly  to 


30  FEVER. 

induce  derangement  in  the  balance  of  the  circulation  and  excitability. 
Some  of  these  appear  to  produce  their  first  effects  on  the  vascular, 
others  on  the  nervous  system.  Thus  atmospherical  vicissitudes  evident- 
ly give  rise  to  violent  oscillations  of  the  circulation;  yet  these  transitions, 
and  still  more  the  oscillations  must  secondarily  affect  the  nervous  sys- 
tem. On  the  other  hand,  human  and  marsh  effluvia  seem  to  make  their 
first  impression  on  the  nervous  system,  the  circulation  apparently  be- 
coming deranged  consecutively  Of  the  two  febrific  causes,  however, 
human  contagion  shows  its  effects  most  on  the  nervous — marsh  miasma, 
on  the  circulation  system.  Debauches  and  excesses  operate  on  both 
systems,  hurrying  the  circulation,  exhausting  the  excitability,  and 
producing  fever,  with  or  without  local  inflammation.  The  depressing 
passions,  like  human  and  marsh  poison  seem  also  to  affect  primarily 
the  nervous  system,  which  through  every  stage  of  the  fever  bears  the 
onus  of  disease.  Excessive  muscular  action  and  an  ardent  sun  so 
much  derange  the  circulation  and  the  functions  of  certain  internal  or- 
gans, as  to  induce  great  fever  with  determination  to  the  biliary  or- 
gans, in  particular. 

The  manner  how,  and  the  reason  why  these  various  causes,  preds- 
ponent  and  exciting,  act  on  the  human  frame  producing  the  phenome- 
na of  fever,  are  equally  inscrutable  as  the  manner  how,  and  reason 
why  tartrite  of  antimony  should  have  a  tendency  to  act  on  thew/yjoer, 
and  aloes  on  the  lower  portion  of  the  alimentary  canal.  Let  any  per- 
son demonstrate  the  modus  operandi  of  these  two  simple  substance,  and 
then  I  shall  engage  to  demonstrate  the  modus  operandi  of  human  and 
marsh  effluvia.  The  nature  or  essence  of  many  of  these  causes  them- 
selves, is  also  totally  beyond  our  comprehension.  Some  of  them  are 
even  ideal,  as  the  various  depressing  passions,  &c.  Yet  we  must  not 
cease  to  investigate  the  effects,  though  we  are  ignorant  of  the  nature 
and  mode  of  action  of  the  causes. 

We  shall  now  select  one  cause,  and  trace  its  operations  on  the  hu- 
man frame,  as  a  sufficient  specimen  and  explanation  of  the  ratio  symp- 
tomatum  in  all.  The  varieties  and  peculiarities  from  this  specimen 
being,  as  I  have  stated  before,  ascribable  to  variety  of  cause  and 
peculiarity  of  constitution. 

A  man  after  exposure  to  the  miasmata  of  marshes,  begins  to  exhibit 
symptoms  of  diminished  energy  in  the  nervous  system,  evinced  by  the 
various  feelings  and  phenomena  which  usher  in  the  cold  stage  of 
fever. 

The  power  of  the  heart  and  arteries  appears  evidently  to  be  weak- 
ened, the  consequence  of  which  is  an  inability  to  propel  the  blood  to 
the  surface  and  throughout  the  secretory  organs  ;  and  from  the  dimi- 
nished excitability  of  the  system,  we  observe  a  quiescence  of  the  capil- 
laries, and  a  shrinking  and  coldness  of  all  external  parts,  without  the 
intervention  or  necessity  of  spasm.  In  this  state  it  follows,  of  course, 
and  is  allowed  by  all,  that  the  great  volume  of  blood  is  confined  to  the 
heart,  and  large  internal  trunks  of  vessels.  But  this  appears  an  inade- 
quate explanation  of  the  swelling,  tension,  oppression,  and  even  pain 
about  the  hypochondria,  as  well  as  of  many  other  of  the  symptoms  at- 
tendant on  the  cold  stage  of  fever  in  particular.  If,  during  the  lat- 
ter, I  place  my  hand  on  the  radial  artery  and  endeavour  to  estimate 


FEVER.  31 

its  calibre,  and  the  quantum  of  blood  transmitted  through  it  in  a'given 
time,  compared  with  what  takes  place  in  the  hot  stage,  or  even  in 
health,  I  shall  conclude  that  the  artery  is  not  then  above  one-third 
the  size,  nor  the  quantity  of  blood  passing  through  it,  more  in  pro- 
portion. Such  being  the  ca^e,  it  is  difficult  to  conceive  how  the  whole 
mass  of  blood  can  be  in  actual  circulation  at  this  time.  Besides, 
therefore,  the  confinement  of  a  large  share  of  it  to  the  heart  and 
large  vessels,  where  its  motions  must  be  slow,  I  venture  to  affirm  that 
another  considerable  portion  of  it  is  arPested,  as  it  were,  and  accu- 
mulated in  certain  situations,  where  it  remains  pro  tempore,  out  of 
the  course  of  actual  circulation.  This  congestion  or  complete 
quiescence,  takes  place  in  the  portal  circle,  where  the  blood  is,  at 
all  times,  languid  in  its  current,  there  being  only  a  slight  vis  a  tergo, 
and  but  little  muscular  propulsion.  The  consequence  of  this  must 
be,  that  not  only  the  liver  and  the  various  branches  of  the  vena 
portarum  will  become  turgid,  but  also  the  spleen,  (which  returns 
its  blood  to  the  heart  through  this  channel,)  the  stomach,  pancreas, 
and  intestines,  will  participate  in  this  turgescence. 

If  it  be  asked  why  the  blood  should  cease  to  circulate  in  these 
parts  during  the  cold  stage  of  fever  sooner  than  in  others  ;  I  answer 
that  the  portal  is  the  only  circle  or  set  of  vessels  in  the  sanguiferous 
system,  originating  and  terminating  in  capillary  tubes,  or  inoscu- 
lations with  other  vessels.  They  begin  by  the'minutest  threads  from 
the  stomach,  spleen,  pancreas,  and  intestines  ;  these  enlarge  as  they 
approach  the  liver  ;  there  they  diverge,  and  finally  dwindle  again 
into  the  same  diminution  with  which  they  commenced.  All  other 
veins  dilate  as  they  approximate  to  the  heart,  thereby  affording  more 
and  more  facility  to  the  return  of  the  blood,  which  is  in  most  places 
assisted  by  the  action  of  circumjacent  muscles.  The  temporary  qui- 
escence or  torpor,  then,  of  the  extreme  branches  of  the  vena  portae 
in  the  liver,  from  sympathy  with  the  extreme  vessels  on  the  surface, 
(before  elucidated,  and  I  hope  satisfactorily  proved  )  must  complete- 
ly check  and  arrest  the  reflux  of  blood  from  the  whole  of  the  vis- 
cera above-mentioned.  This  state  of  things  at  once  explains  the  ten- 
sion, elevation,  pain,  weight,  and  anxiety  about  the  praecordia.  It 
shows  why  the  biliary  and  pancreatic  secretions  are  in  common  with, 
and  still  more  particularly  than  others  entirely  checked  for  the  time, 
while  the  gradual  accumulation  and  temporary  abstraction,  as  it  were, 
of  so  great  a  proportion  of  the  vital  fluid  from  actual  circulation, 
will  readily  account  for  most,  if  not  all  the  phenomena  of  the  cold 
stage,  many  of  which  were  inexplicable  on  other  principles.  It  ap- 
pears to  me,  indeed,  that  this  temporary  arrest  of  so  much  blood  in 
the  liver  and  portal  circle,  (including  the  spleen,)  is  one  of  the  most 
admirable  of  nature's  expedients  to  obviate  more  dangerous  effects. 
When  the  balance  of  the  circulation  is  broken,  and  the  blood  is  de- 
termined from  the  surface  upon  the  internal  parts,  were  it  all  to  ac- 
cumulate in  the  large  vessels  about  the  heart,  and  in  the  lungs,  im- 
mediate death  would  be  the  cossequence  ;  but  the  local  abstraction 
of  so  large  a  proportion  of  it,  from  actual  circulation,  by  its  quiescence 
in  the  circle  above-mentioned,  (where  plethora  is  not  so  immediate- 


2  FEVER. 

ly  detrimental.) -preserves  the  heart  and  lungs  from  being  over- 
powered and  suffocated .  till  reaction  restores  the  equilibrium  be- 
tween the  surface  and  the  interior.  From  this  view  of  the  affair 
the  utility  of  the  spleen,  as  an  organ  of  preservation,  is  no  longer 
doubtful.*  But  this  accumulation  of  bloqd  in  the  portal  circle  and 
viscera,  must,  of  necessity,  produr.e  a  corresponding  plethora  in  the 
branches  of  the  caeliac  and  mesentenc  arteries  leading  to  them  ;  and 
since  ^uch  large  and  important  exits  for  the  blood  from  the  descending 
aorta,  are,  as  it  were,  blocked  up,  a  greater  share  of  the  circulating 
mass  will  be  thrown  in  consequence  through  the  carotids  and  verte- 
brals  on  the  brain,  occasioning  or  increasing  the  headach  and  con- 
gestion in  that  organ.  This,  and  the  congestion  in  the  lungs,  howe- 
ver, will  be  principally  caused  by  the  difficulty,  indeed  the  inabi- 
lity of  the  heart  to  propel  the  blood  from  the  ventricles  as  fast  as  it 
returns  to  the  auricles  from  the  brain  and  lungs  ;  hence  the  venous 
turgescence  in  both  these  organs,  occasioning  the  headache,  stupor, 
laborious  respiration,  and  febrile  anxiety  attendant  on  the  collapse  or 
cold  stage. 

The  effects  of  sympathy  are  likewise  to  l^e  taken  into  considera- 
tion. I  have  mentioned  that  which  exists  between  the  extreme  ves- 
sels on  the  surface,  and  those  of  the  vena  portae.  The  lungs  too  will 
sympathize  with  the  skin,  while  the  stomach  and  liver  will  sympa- 
thize with  the  brain,  atid  vice  versa. 

This  state  of  things,  however,  lasts  not  long.  Reaction  at  length 
takes  place  Whether  it  be  from  "  the  stimulus  of  the  blood  itself" — 
from  that  of  the  "  retained  secretion" — from"  accumulated  excitabili- 
ty"— from  the  "  vis  medicatrix  naturae"— or  from  all  combined,  we 
need  not  stop  to  inquire,  (becausej^wa/  causes  can  never  be  discover- 
ed, and  because  we  are  rather  tracing  the  quo  than  the  quomodo  in  fe- 
ver,) but  so  it  is,  that  the  brain,  the  heart,  and  the  arteries  re-acquire 
vigour — the  two  1  ist  drivingthe  blood  to  the  surface, with  great  increase 
of  heat,  and  a  more  rapid  circulation  of  the  vital  fluid,  all  of  which, 
nevertheless,  does  not  appear  to  come  into  motion,  till  the  sweating 
stage  For  this  preternatural  heat  or  febrile  stricture,  seems  to  have 
the  same  effect,  for  a  time,  as  the  previous  coldness  or  collapse,  in  pre- 
venting perspiration  externally,  and  secretion  internally;  since  we 
find  the  load  and  uneasiness  at  the  praecordia  and  epigastrium  con- 
tinue tilHhe  extreme  vessels  on  the  surface  relax,  and  a  sweat  breaks 
out,  when  a  simultaneous  relaxation  in  the  extreme  vessels  of  the  liv- 
er, lungs.  &c.  allows  the  blood  to  pass  on  freely  to  the  heart,  and 
the  various  secretions  to  flow,  relieving  the  internal  congestions. 
This  last  effect,  so  much  accelerated  by  the  cold  affusion,  in  the  hot 
stage  of  fever,  seems  to  have  escaped  the  notice  of  Cuirie  and  Clut- 
terbuck. 

As  the  headache  of  the  cold  stage^  from  venous  plethora,  is  con- 
tinued it  the  hot,  from  arterial  detention,  (with  a  corresponding 
difference  in  sensation,  as  noticed  by  Fordyce,)  so  the  nausea 
and  sickness  at  stomach,«arising  apparently  in  the  cold  tit  from  sympa- 
thy with  the  brain  and  liver,  perhaps  the  skin,  in  continued  in  the 

*  Vide  Dr:  Armstrong's  query  ;  Essay  on  Typhus,  p.  .78. 


FEVER.  33 

hot,  from  the  same  causes,  (these  organs  being  still  affected,  though 
in  a  somewhat  different  manner,)  and  the  vomiting  is  often  brought  on 
and  kept  up,  by  the  sudden  augmentation  of  gastric,  biliary,  and 
other  secretions  of  a  depraved  quality,  which  are  poured  out  towards 
the  commencement  of  the  sweating  stage,  particularly  in  hot  climates, 
and  in  the  hot  seasons  of  temperate"  climates.  In  general,  however, 
the  irritability  of  the  stomach  subsides  pari  passu,  as  perspiration  and 
secretion  commence,  with  relief  to  the  brain,  lungs,  liver,  &c. 

If,  as  some  suppose,  the  cold  be  the  cause  of  the  succeeding  hot 
stage,  so  in  the  latter,  the  violence  of  the  reaction,  or  rather  oyerac- 
tion  of  the  sanguiferous  system,  with  the  morbidly  increased  excite- 
ment of  the  nervous  system,  must  predispose  to  a  repetition  of  the 
fits,  from  the  subsequent  atony  produced  thereby.  If  there  be  sen- 
sorial  energy  enough  to  enable  the  heart  and  arteries  to  clear  the 
viscera  and  brain  of  the  load  of  blood  with  which  they  were  oppres- 
sed, and  to  set  the  secreting  organs  in  action,  then  an  intermission  takes 
place  ;  but  if  these  circumstances  be  incomplete,  a  remission  only. 
In  what  is  called  continued  fever,  it  appears  from  the  affection  of  the 
head,  the  load  on  the  praecordia,  the  confined  pulse,  the  dry,  hot,  and 
constricted  skin,  with  a  corresponding  diminished  biliary  secretion, 
and  costive  bowels,  that  the  constitution  is  called  upon  for  almost 
constant,  or  at  least  frequently  reiterated  exertions  to  relieve  the 
internal  congestions,  and  restore  the  secretions  aqd  excretions,  mark- 
ed by  more  or  less  of  diurnal  remission  and  evening  exacerbation,  till 
it  either  becomes  habituated  to  the  original  cause,  and  restores  the 
balance  of  the  circulation  and  excitability,  or  sinks,  unequal  to  the 
task,  most  commonly  with  the  destruction,  (from  inflammation  or  san- 
guineous determination,)  of  an  organ  essential  to  life.  Dissection 
has  so  repeatedly  detected  the  existence  of  these  inflammations,  con- 
gestions, and  effusions,  in  all  fevers  of  violence,  that  it  is  not  necessary 
here  to  quote  any  passages  from  particular  authors  on  the  subject. 
But  it  may  be  remarked,  en  passant,  that  no  one  organ,  not  even  the 
brain,  is  so  invariably  the  seat  of  lesion  as  to  enable  us  to  build  any 
theory  on  the  subject,  and  hence  Dr.  Clutterbuck  has  overshot  the 
mark  by  confining  the  cause  of  fever  within  the  cranial  parietes. 

We  now  come  to  try  the  theory  by  a  direct  application  of  its  prin- 
ciples to  practice,  the  grand  and  only  legitimate  criterion  of  its  truth. 
If  we  can  show  that  it  is  consonant^  with,  and  elucidates  the  operation 
ofthose  remedial  measures  which  either  ancient  or  modern  experi- 
ence has  employed  in  fever,  it  is  no  trifling  corroboration  of  its 
solid  foundation.  And,  even  if  it  points  to  the  most  successful  plans 
of  treatment  which  modern  investigation  has  devised,  in  must  be  aj- 
lowed  to  be  a  useful,  though  perhaps  only  a  visionary  theory. 

It  will  not  be  necessary,  however,  to  examine  the  whole  farrago 
of  remedies  which  ignorance,  superstition,  or  prejudice  had  at  vari- 
ous periods,  introduced  for  the  treatment  of  fever  ;  it  will  oe  suffici- 
ent to  notice  those  which  have  stood  the  test  of  time. 


34  JETER, 

1st. — VENESECTION. 

Blood-letting  is  as  ancient  as  the  wars  of  Troy,  and  the  practice  of 
Podalirius,  If  Hippocrates  neglected  it,  Areteus,  Celsus,  and  Galen, 
made  ample  use  of  this  important  measure.  It  is  true,  that  even  in 
our  own  times,  the  dogmas  of  the  schools  had  nearly  proscribed  for 
awhile,  what  nature  and  observation  had  pointed  out  from  the  earliest 
dawn  of  medicine  to  the  present  time,  in  every  climate  from  the  banks 
ofthe  Scamander  to  the  vales  of  Otaheite. 

The  bounding  pulse,  the  fever-flushed  cheek,  the  throbbing  tem- 
ples, and  aching  head,  must  indeed  have  vindicated  the  propriety  of 
blood- letting  in  every  aera,  and  in  every  mind  not  warped  by  the  bias 
of  some  fashionable  doctrine. 

In  these  scrutenizing  days  of  investigation  and  experiment,  the 
lancet  has  dispelled  the  mists  of  prejudice,  the  phantoms  of  debility 
and  putrescency,  with  the  delusions  of  the  Brunonian  school  ;  and 
bleeding  is  justly  regarded  as  the  paramount  remedy,  not  only  in 
symptomatic,  but  in  all  the  more  violent  and  fatal  idiopathic  fevers. 

The  consonance  of  this  measure  with  the  principles  1  have  laid 
down,  is  so  evident  as  scarcely  to  need  comment.  When  the  balance 
ofthe  circulation  is  broken,  and  determinations  take  place  to  one  or 
more  organs,  the  most  effectual  means  of  restoring  the  balance,  and 
of  relieving  these  organs  or  parts  from  their  overplus  of  blood,  will 
be  found  either  in  local  or  general  abstraction  ofthe  vital  fluid.  It  is 
not  from  there  being  less  than  usual  of  blood,  in  some  parts,  but  from 
there  being  too  much  in  others,  that  the  danger  consists,  and  that  we 
are  called  upon  to  reduce  the  whole  mass  below  par.  Nature  her- 
self invariably  points  out  this  indication,  and  in  perhaps  a  majority  of 
instances,  fulfils  it  in  her  own  way.  Thus  we  find  that  every  pa- 
roxysm of  fever  is  terminated  by  some  evacuation  from  the  system, 
whether  by  perspiration,  urine,  increased  secretions,  or  some  local 
haemorrhage.  In  what  is  called  continued  fever,  the  nocturnal  exacer- 
bations are  terminated  in  the  morning  by  some  slight  modifications 
of  the  foregoing  evacuations  ;  and  in  all  fevers  and  all  stages  of  fe- 
ver, nature  effects  depletion  by  preventing  repletion  ;  and  hence  that 
invariable  attendant  on  fever  anorexia  is  one  of  the  wisest  and  most 
salutary  measures  which  nature  can  put  in  force  to  finally  overcome 
the  disease  ;  though  she  is  too  frequently  baffled  in  her  attempts  by 
the  officious  interference  of  the  cook,  the  nurse,  or  perhaps  the  medi- 
cal prescriber. 

I  shall  now  make  a  few  remarks  on  the  most  judicious  manner  of 
employing  this  remedy  in  fever  ;  for  on  this,  in  a  great  measure,  de- 
pends its  success  ;  and  to  the  contrary,  I  believe,  may  be  attributed 
not  only  its  failure,  but  its  disgrace. 

In  the  first  place,  the  time  for  blood-letting  in  fever  should  be  an 
object  of  great  attention.  It  should  not  only  be  early  in  respect 
to  the  accession  ofthe  fever,  but  the  acme  of  the  paroxysm  or  the 
height  of  the  exacerbation  should  be  selected  as  the  proper  periods 
for  making  the  abstraction.  At  these  times  the  evacuation  will  pro- 
duce an  alleviation  of  symptoms,  and  often  a  solution  of  the  paroxysm 


FEVER.  35 

or  exacerbation  ;  whereas  if  taken  during  the  remission  of  the  fever, 
when  the  system  is,  as  it  were,  in  a  state  of  collapse,  deliquium  ani- 
mi  is  often  the  consequence,  followed  by  a  train  of  nervous  symptoms 
and  debility  that  are  charged  on  the  measure,  when  they  ought  to 
be  placed  to  the  account  of  the  ill-judged  period  of  its  application. 

The  manner  in  which  blood  is  drawn  ought  not  to  be  neglected. 
When  any  strong  determination  to  the  head,  or  other  organs  exists, 
the  vascular  system  so  accomodates  itself  to  the  loss  of  blood  from  a 
thready  stream  that  little  or  no  relief  is  obtained  for  the  suffering  vis- 
cus,  while  the  general  strength  is  unnecessarily  reduced  by  the  quan« 
turn  lost. 

Although  we  are  to  be  much  less  guided  by  the  appearance  of  the 
blood  drawn,  than  by  the  order  and  violence  of  the  symptoms  ;  yet  as 
a  certain  coat  or  crust  of  fibrine  very  generally,  though  not  invariably, 
covers  the  coagulum  when  there  is  any  local  inflammation  going  on,  we 
should  attend  to  those  circumstances  in  the  abstraction  that  are  favour- 
able to  the  development  of  this  criterion.  Thus  the  stream  of  blood 
should  be  free  and  of  a  good  size  ;  and  it  should  be  received  into  the 
centre,  not  impinged  against  the  side  of,  a  narrow  and  rather  deep 
basin,  with  a  polished  internal  surface.  If  the  reverse  of  these  direc- 
tions be  observed,  as  is  too  often  the  case,  the  blood  will  not  exhibit 
any  inflammatory  buff,  though  inflammation  be  actually  present  at  the 
time.* 

As  in  fevers  as  well  as  some  inflammations,  it  is  not  so  much  the 
general  plethora  of  the  vascular  system,  as  the  broken  balance  of  the 
circulation  that  is  to  be  corrected,  so  local  abstractions  of  blood  from 
the  vicinity  of  those  parts  where  the  congestion  or  determination  ex- 
ists, are  often  of  more  importance  than  general  blood  letting; 

It  is  to  be  regretted  that,  whether  from  the  prejudices  of  the  pa- 
tient or  the  inattention  of  the  practitioner,  the  seat  of  the  determi- 
nations in  the  fever  is  rarely  ascertained  and  relieved  by  topical 
bleedings.  The  violent  headache,  indeed,  and  arterial  pulsation  at  the 
temples,  frequently  draw  the  practitioner's  attention  to  that  part,  and 
leeches  are  accordingly  applied  ;  but  the  epigastric  region,  where 
there  is  always  more  or  less  fulness,  and  to  which  the  vital  fluid 
seems  in  most  fevers  to  gravitate,  is  too  much  neglected.  Leeches 
or  scarifications  should  long  precede  the  necessity  for  blisters  in  these 
parts. 

2nd. — PURGATIVES. 

The  ancient  physicians  had  a  very  limited  range,  and  a  very  rough 
list  of  purgative  medicines.  They  made,  however,  a  considerable 
use  of  them.  Of  late  they  were  almost  neglected  by  Cullen,  and 
proscribed  by  Brown,  in  the  fevers  of  this  country,  unaccompanied 
with  topical  inflammation.  Dr.  Hamilton  and  the  greater  number  of 
modern  practitioners  employ  purgatives  freely,  without  fear  of  that 
far-famed,  and  much  dreaded  debility.  The  principle  on  which 

*  Vide  the  inestimable  work  of  Dr.  Armstrong;  on  Typhus.  Also  Dr-  Dick- 
son's  writings  on  Tropical  Fever. 


36  FEVER. 

these  act,  in  fever,  are  by  no  means  generally  understood  ;  and  the 
practice  itself  is  inefficient  from  this  cause.  Even  Dr.  Hamilton 
seems  to  attribute  most  of  the  good  effects  of  purgatives  in  fever  to 
the  removal  of  irritating  fecal  remains.  But  if  this  were  the  case, 
the  glisters  of  Cullen  would  have  answered  the  same  end,  which, 
however,  they,  did  not.  The  removal  of  fecal  accumulations,  from 
the  small  intestines  particularly,  gives  a  more  free  descent  to  the 
blood  through  the  abdominal  aorta  and  its  branches,  and  thus  me- 
chanically assists  in  the  restoration  of  balance  ;  the  increased  secre- 
tion from  the  mucuous  membrane  of  the  alimentary  canal,  must  also 
powerfully  deplete  the  caeliac  vascular  system  ;  but  a  ve^ry  salutary 
modus  operandi  of  purgatives  id  fever,  has,  I  believe,  escaped  the 
notice  of  physicians,  althongh  I  conceive  it  to  be  an  important  one  ; 
I  mean  the  change  from  torpor  of  the  intestines  to  a  brisk  peristaltic 
motion,  whereby  the  blood  which  has  been  shown  to  accumulate,  and 
as  it  were  stagnate,  in  the  portal  circle,  is  propelled  forward,  and  the 
biliary  secretion  increased.  Another  salutary  effect  is  produced  by 
the  sympathetic  influence  which  the  internal  surface  of  the  alimen- 
tary canal  exerts  on  the  cutaneous  surface  of  the  body  ;  for  although 
drastic  purging  will  check  profuse  perspiration,  yet  where  torpor 
pervades  both  the  internal  and  external  surfaces  of  the  body,  a  re- 
storation of  the  functions  of  the  former  contributes  to  the  same  event 
in  the  latter  ;  a  fact,  of  which  any  one  may  convince  himself  at  the 
bed-side  of  sickness  by  an  attention  to  the  circumstances  under  con- 
sideration. 

When  therefore  the  peristaltic  motion,  the  gastric,  and  intestinal 
secretions  are  roused  by  purgatives,  the  head  which,  from  the  pecu- 
liarity of  its  circulation,  must  suffer  sanguineous  congestion,  is  almost 
immediately  relieved  by  the  change  of  balance,  thereby  induced. 
From  these  considerations  it  will  not  appear  a  matter  of  indifference, 
what  purgative  medicine  we  use.  Experience  has  taught  us  that 
some,  (for  instance  castor  oil,)  do  little  more  than  clear  the  intes- 
tinal canal  of  what  already  exists  there  ;  that  others,  (for  instance 
the  neutral  salts,  jalap,  &c.)  produce  copious  watery  secretions  into 
the  alimentary  tube,  during  their  operation  ; — and  that  others  still, 
(for  instance  the  submuriate  of  quicksilver,)  besides  acting  as  a  com- 
mon purgative,  increase  particular  secretions,  as  of  the  bile,  and 
carry  them  off,  whether  in  a  healthy  or  morbid  state. 

From  the  importance  of  .the  hepatic  function  in  the  animal  econo- 
my, and  bad  effects  which  result  from  any  derangement  or  obstruc- 
tion of  it  in  febrile  commotion,  it  is  evident,  and  experience  proves 
it,  that  into  the  combination  of  purgative  medicines  in  fever,  those 
of  a  cholagogue  power  should  almost  always  enter.  Hence  it  has 
been  found  both  in  this  and  other  countries,  that  powdered  jalap  and 
submuriate  of  quicksilver  formed  a  composition  most  admirably 
adapted  to  the  purposes  above  mentioned,  as  may  be  seen  by  the 
writings  of  Rush,  Jackson,  Hamilton,  Armstrong,  Dickson,  &c. 

Hence  also,  we  see  how  purging,  by  rousing  the  torpid  circulation 
and   excitability  of  the  abdominal  viscera,  determining  the  blood 
through  the  various  branches  of  the  aorta  which  were  before  choak- 
f 


FEVER.  37 

ed  up,  and  thereby  removing  the  congestion  in  the  head,  restores 
strength,  by  relieving  the  sensorium,  instead  of  adding  to  the  pre- 
existent  Debility,  as  was  dreaded  by  the  Brunonians  and  Cullenians, 
and  which  dread  still  fetters  the  hands  of  numerous  practitioners  even 
in  this  country.  The  operation  of  purgatives  then,  is  perfectly  con- 
sonant with,  and  elucidates  the  fundamental  principle,  to  be  kept  in 
view  in  fever — '"  a  restoration  of  equilibrium  in  •  the  balance  of  the 
circulation  and  excitability.'** 

3d. — COLD  AND   TEPID  AFFUSION. 

The  operation  of  these  apparently  different  measures,  in  mitigating 
or  even  arresting  fever,  is  in  perfect  consonance  with  the  principle 
laid  down. 

Leaving  out  the  effect  of  sensation  on  the  nervous  system,  during 
the  affusion  of  cold  water  on  the  febrile  surface  of  a  patient,  it  is 
evident  that  the  violence  of  reaction,  (at  which  time  alone  it  ought  to 
be  applied.)  is  mitigated  by  the  cold,  while  the  febrile  irritation  of 
a  strictured  surface  is  taken  off. 

That  these  objects  tend  to  a  restoration  of  balance  in  the  circula- 
tion and  excitability,  need  not  be  insisted  on  ;  the  other  effect  of  cold 
affusion,  namely,  a  subsequent  perspiration,  will  also  be  found  to 
have  a  similar  tendency. 

The  effects  of  tepid  affusion  during  reaction,  or  the  hot  stage  of 
fever,  is  precisely  analogous  to  that  of  the  cold,  only  less  forcible  in 
degree  ;  for  it  must  be  remembered  that  the  tepid  bath  is,  or  ought 
to  be  of  a  much  lower  temperature  than  the  surface  of  the  body, 
when  applied  in  the  hot  stages  of  fever,  and  consequently  acts  in 
reality  as  a  cold  bath,  only  in  a  much  more  gentle  manner. 

When  it  is  applied  in  the  cold  stage  of  fever,  its  operation  in  draw- 
ing the  blood  to  the  periphery,  and  thus  restoring  the  balance  of  the 
circulation,  is  direct  and  obvious  ;  while  in  restoring  sensibility  to 
the  torpid  skin,  the  balance  of  excitability,  is,  of  course,  equipoised. 
The  action  of  cool  air  in  fevers  is  easily  explicable  on  the  same  prin- 
ciples. 

4th. MERCURY. 

Various  have  been  the  disputes  respecting  the  operation  of  mer- 
cury on  the  human  system.  A  stimulant  property  has  been  very  ge- 
nerally attributed  to  this  mineral,  apparently  from  its  quickening  the 
vascular  action,  and  ««  exciting  an  artificial  fever."|  **  Hence,"  says 
the  Enquirer  [loco  citato]  "  its  efficacy  in  remittent  and  continued 
fevers  is  very  equivocal.  At  the  commencement  of  those  diseases  I 
believe  that  it  does  mischief,  if  exhibited  in  any  form  to  exert  its 
power  on  the  salivary  glands  alone."  It  would  be  difficult  to  select 

*  Vide  Dr.  Dickson's  admirable  papers  ia  various  numbers  of  the  Edinburgh 
Medical  and  Surgical  Journal. 
t  Ed.  Journal,  vol.  yi,  p.  181. 


58  FEVER. 

a  passage  in  any  medical  work  which  contains  so  much  error  and  so 
much  want  of  knowledge,  in  so  small  a  space,  as  the  above  para- 
graph. In  the  first  place,- those  who  condemn  the  use  of  mercury 
most,  condemn  it  on  this  principle,  that  in  some  very  concentrated 
forms  of  inflammatory  fever,  as  the  endemic  of  the  West  Indies,  it 
cannot  be  brought  to  exert  its  influence  on  the  system  in  time,  and 
therefore  there  is  danger  in  trusting  to  its  operation.  Mr.  Sheppard, 
of  Witney,  one  of  the  ablest  of  the  anti-mercurial  party,  expresses 
himself  thus  : — "  The  co-existence  of  febrile  and  mercurial  action 
is  generally  admitted  to  be  incompatible  ;  if,  therefore,  the  action 
could  be  superinduced  in  violent  fever,  we  should  be  possessed  of 
an  invaluable  remedy." — Ed.  Journal,  October,  1817. 

In  the  second  place,  who  ever  saw  mercury  atfect  the  salivary 
glands  alone  ?  Narrow  indeed,  is  that  view  of  the  mercurial  action 
which  stops  short  at  its  quickening  the  pulse,  "and  exciting  an  artifi- 
cial fever."  The  fact  is,  that  ptyalism  is  merely  a  symptom  that 
the  salivary  glands  are  affected,  in  common  with  every  other  gland, 
and  every  secreting  and  excreting  vessel  in  the  system.  Thus  flood- 
gates are  opened  in  all  directions,  and  every  part  of  the  human  fa- 
bric experiences  a  rapid  diminution — in  short,  mercury  is  never 
more  an  evacuant  than  when  it  produces  ptyalism.  This  general  de- 
pletion is  still  further  increased  by  the  ptyalism  preventing  any  supply 
of  nutriment  which  the  patient  or  friends  might  wish  to  introduce. 

I  am  ready  to  grant,  indeed,  that  in  certain  high  grades  of  the  wes- 
.tern  endemic,  or  yellow  fever,  we  cannot  bring  on  this  much  desired 
effect  of  mercury  ;  anct  why  ?  Let  Mr.  Sheppard  himself  answer  the 
question.  "  From  the  experience  of  many  years  within  the  tropics," 
says  this  judicious  observer,  "  I  am  disposed  to  coincide  with  those 
who  believe  that  the  disease,  in  the  highest  degree  of  concentration, 
is  irremediable  by  any  known  means  in  medicine  ;  for  I  have  re- 
marked, in  this  extreme  case,  that  whatever  plan  of  cure  may  be 
adopted,  the  rate  of  mortality  remained  unaffected  by  variety  of 
treatment."  Loco  citato.  Now  if  mercury  fails  in  these  cases,  so 
does  depletion  ;  but  I  most  solemnly  protest  against  the  inference 
that,  because  pyrexia  ceases  when  ptyalism  appears,  the  latter  is 
merely  an  effect  or  consequence  of  the  former. 

In  the  inflammatory  forms  of  West  India  fevers  where  hepatic 
congestions  are  comparatively  rare,  I  conceive  that  depletion  alone  is 
the  best  mode  of  treatment  ;  but  to  draw  a  sweeping  conclusion  from 
this  circumstance  that  mercury  is  totally  useless,  if  not  injurious,  in 
all  febrile  states  of  the  system,  and  in  all  climates,  is  most  erroneous 
in  principle,  and  injurious  in  practice.  The  ensuing  pages  of  this 
essay  will  afford  ample  illustrations  of  the  febrifuge  powers  of  mer- 
cury ;  while  its  modus  agendi,  as  an  equalizer  of  the  circulation  and 
excitability,  will  be  found  to  be  in  exact  consonance  with  the  princi- 
ples here  laid  down. 


Oin. EMETICS. 

The  gastric  irritability  which  accompanies  most  fevers  might  have 
d  to  the  suspicion  that  nature  aimed  at  relief  by  unloading  the 


FRYER.  39 

stomach,  and  hence  the  early  use  of  emetics.— They  are  now  much 
less  frequently  employed  ;  though  it  is  certain  that  they  produce 
other  salutary  effects  beyond  the  mere  evacuation  of  the  stomach. 
They  determine  to  the  surface,  in  common  with  diaphoretics,  and 
produce  a  relaxation  there,  which  generally  ends  in  perspiration. 
Their  utility  therefore,  in  certain  states  and  kinds  of  fever,  is  un- 
questionable, and  consonant  too  with  the  principle  which  I  have  en- 
deavoured to  establish  ;  but  their  violence,  in  certain  fevers  and 
climates  where  unusual  irritability  of  stomach  too  often  prevails,  has 
brought  them  much  into  disuse,  even  in  opposite  circumstances.  The 
debility  also  which  they  induce  gave  the  Brunonians  a  dislike  to 
their  employment. 

6th. DIAPHORETICS. 

These  have  a  close  affinity  to  the  last  mentioned  remedies,  but  are 
of  milder  operation.  In  all  fevers  of  a  marked  periodical  type,  there 
is  such  an  evident  remission,  or  solution  of  the  paroxysm  in  the 
sweating  stage,  that  physicians  must  have  very  early  endeavoured  to 
imitate  this  salutary  process  of  nature  by  artificial  means.  This, 
however,  has  often  led  to  disastrous  results  ;  for  observing  that  heat- 
ed rooms,  multiplicity  of  clothing,  warm  liquors,  &c.  induced  per- 
spiration in  health,  the  same  means  were  resorted  to  in  disease,  and 
too  often  with  the  most  pernicious  consequences.  They  knew  not 
till  lately,  that  the  strictured  surface  of  a  febrile  patient  will  seldom 
relax  into  a  perspirable  state,  till  its  temperature  is  reduced  below 
the  fever  heat,  and  consequently  when  they  failed  in  their  object, 
they  did  much  mischief,  and  when  they  succeeded  in  forcing  out  a 
perspiration,  the  temporary  relief  obtained,  by  no  means  counterua- 
lanced  the  previous  increase  of  febrile  excitement. 

Now  that  the  principles  which  govern  the  perspiratory  process 
are  better  understood,  the  long  and  endless  farrago  of  sweating  me- 
dicines is  reduced  to  a  few  neutral  salts,  as  the  citrate  of  potash,  or 
acetate  of  ammonia,  accompanied  occasionally  with  small  doses  of 
antimony.  These,  with  cool  diluent  drinks,  are  the  only  safe  or  sa- 
lutary diaphoretics  in  fever  ;  and  probably  act  on  the  surface  from 
its  sympathy  with  the  stomach. 

It  is  needless  to  state  that  the  operation  of  this  class  of  remedies  is 
in  perfect  consonance  with  the  principles  I  have  endeavoured  to 
maintain. 

7th. TONICS  AND  STIMULANTS,  INCLUDING  BARK,  WINE,  OPIUM,  &C. 

it  may  seem  a  little  strange,  that  the  most  diametrically  opposite 
plans  have  succeeded  in  fever,  and  been  lauded  to  the  skies  by  their 
supporters  as  infallible.  Hence,  many  have  supposed  that  were 
fevers  left  entirely  in  the  hands  of  nature,  as  many  would  recover  as 
under  the  most  skilful  treatment. 

Whatever  truth  there  may  be  in  this,  it  is  not  equally  correct  that 
nearly  the  same  proportion  recover  under  all  kinds  of  treatment. 


40  FEVER* 

There  is  very  little  doubt  but  that  under  judicious  modern  measures, 
not  only  a  greater  proportion  recover  from  the  graver  types  of  fever, 
but  a  vast  number  of  fevers  are  prevented  from  assuming  the  more 
dangerous  forms. 

Neither  need  it  be  wondered  at,  that  both  stimulants  and  sedatives 
should  occasionally  prove  useful  in  fever.  We  have  shown  that 
when  the  excitability  and  vascular  action  are  too  great  in  one  part  of 
the  system,  they  are  deficient  in  others  ;  hence  the  diffusive  stimuli 
have  the  effect  of  rousing  the  torpid  parts  into  action,  but  too  often  at 
the  expense  of  the  over-excited  organs  ;  and  this  has  been  the  dis- 
tinguishing feature  of  the  Brunonian  practice.  Tonics  and  stimulants 
were  also  frequently  necessary  in  the  ultimate  stages  of  fever,  where 
early  evacuations  were  not  premised  ;  because  the  system  was  ex- 
hausted by  its  own  efforts,  or  by  injudicious  remedies,  and  nature  re- 
quired a  stimulus  at  the  close  of  the  disease.  But,  now  it  is  found, 
after  fatal  experience,  that  by  lessening  reaction  at  the  beginning,  we 
preserve  the  powers  of  the  constitution  tor  ulterior  efforts,  and  there- 
by obviate  the  necessity  of  stimulation  at  almost  any  period  of  fe- 
ver.* 

To  show  how  dangerous  it  was  to  draw  conclusions  respecting  de- 
bility from  the  salutary  operation  of  stimulants  in  fever,  the  follow, 
ing  example  may  suffice.  From  deranged  balance  of  excitability  the 
heart  and  arteries  become  incapable  of  performing  their  office  in  a 
proper  manner. — If  their  excitability  be  too  great,  they  drive  the 
blood  with  an  impetus  to  the  brain  that  may  cause  delirium  :  if  their 
excitability  be  defective,  the  heart  is  incapable  of  unloading  the 
venous  system,  and  distention  of  the  veins  and  sinuses  of  the  head 
produce  the  same  effect.  Now,  wine,  if  given  judiciously,  and  to  a 
certain  extent,  in  the  latter  case,  will  impart  such  vigour  to  the 
heart  as  will  enable  it  to  unload  the  venous  system  of  the  brain,  and 
thereby  remove  the  delirium,  without  giving  too  much  impetus  to  the 
arterial  system  ;  but  if  the  same  medicine  be  exhibited  in  the  former 
case,  it  will  evidently  increase  the  symptom  it  was  intended  to  re- 
lieve !  — In  other  words,  some  parts  of  the  system  being  in  a  state  of 
torpor,  and  others  in  a  state  of  irritability,  if  stimulants  be  applied 
to  the  former,  they  may  do  good,  but  if  to  the  latter,  they  must  do 
harm.  Hence  the  value  and  the  necessity  of  discrimination  in  the 
practitioner  ;  and  the  fatal  effects  of  a  routine  'practice. 

In  some  of  the  more  protracted  fevers  of  this  climate,  assuming 
the  typhoid  and  nervous  type,  the  proper  time  for  exhibiting  the  sti- 
mulating class  of  remedies  requires  the  clearest  judgment  of  the  prac- 
titioner, and  it  is  at  these  critical  and  decisive  moments,  that  real 
ability  unfolds  its  acuteness  of  discrimination,  and  snatches  the  pati- 
ent from  the  jaws  of  death  ;  while  the  blundering  routinist  uncon- 
sciously signs  his  quietus  ! 

Little  need  be  said  of  the  minor  or  subordinate  remedies,  as  blis- 
ters, sinapisms,  &c.  as  their  operation  is  evidently  to  restore  the 

*  Vide  Dr.  Armstrong's  work  on  Typhus,  where  the  subject  is  handled  with 
infinite  skill. 


ENDEMIC  OF   BENGAL.  41 

balance  of  the  circulation  and  excitability  by  soliciting  artificial  de- 
terminations to  superficial  parts,  with  the  view  of  relieving  internal 
congestions  or  inflammations. 


ENDEMIC  FEVER  OF  BENGAL, 

Commonly  called  the  Marsh.  Remittent  Fever. 

SEC.  II. — The  importance  of  this  disease  will  not  be  questioned, 
when  it  is  considered,  that  in  the  small  portion  of  the  Hoogly,  run- 
ning between  Calcutta  and  Kedgeree,  full  three  hundred  European 
sailors,  (better  than  a  fourth  of  the  ships'  crews,)  fall  annual  victims 
to  its  ravages  !*  The  subject  therefore  is  highly  interesting,  and 
must  receive  a  considerable  share  of  our  attention. 

There  is  no  unmixed  good  in  this  world.  The  inundations  of  the 
Nile  and  the  Ganges,  while  they  scatter  fertility  over  the  valley  of 
Egypt,  and  the  plains  of  Bengal,  sow  with  a  liberal  hand,  at  the  same 
time,  the  seeds  of  dreadful  diseases  l*Hence,  Cairo  and  Calcutta  have 
severely  suffered  from  the  overflowings  of  their  respective  rivers. 

These  consequences  are  not  confined  to  tropical  countries  alone. 
Swamps  and  marshes,  in  all  latitudes,  give  rise  to  intermittents  and 
remittents,  varying  in  degree  and  danger,  according  to  the  heat, 
rains,  and  other  circumstances  of  the  season.  The  deleterious  in- 
fluence of  an  atmosphere,  impregnated  with  marsh  effluvia,  on  the 
human  frame,  is  in  some  places  astonishing.  In  the  lower  districts  of 
Georgia,  life  is  curtailed  to  forty  or  fifty  years. 

I  have  myself,  in  rambling  through  the  villages  of  Beveiand  and 
Walcheren,  been  struck  with  the  conspicuous  marks  of  premature 
old  age,  which  all,  beyond  maturity,  exhibited  ;  particularly  among 
the  peasantry.  On  inquiring  the  ages  of  decrepid  wretches,  wither- 
ed, sallow,  and  apparently  on  the  borders  of  fourscore,  I  was  sur- 
prised to  find  that  fifty-five  or  sixty  years  were  all  they  had  number- 
ed in  these  noxious  fens.  Often  have  1  been  asked  by  inattentive 
observers,  why  so  unhealthy  a  country  should  present  so  great  a 
number  of  very  old  people  ?  But  to  return  to  the  Ganges. 

This  immense  river,  originating  in  the  mountains  of  Tibet,  and 
winding  in  a  south-eastern  direction,  collecting  its  tributary  streams 
from  all  quarters  as  it  proceeds,  after  a  course  of  more  than  a  thou- 
sand miles,  bursts  its  boundaries,  in  the  rainy  season,  and  covers  the 
plains  of  Bengal  with  an  expansive  sheet  of  turbid  water.  But  the 
ground  springing  a  little,  as  it  approaches  the  coast,  prevents  the  in- 
undation from  rushing  at  once  into  the  ocean  :  it  therefore  dis- 
embogues itself  slowly  through  a  multiplicity  of  channels,  that  inter- 
sect the  great  Indian  Delta,  or  Sunderbunds,  in  every  possible  di- 
rection. 

.  This  check  keeps  the  plains  of  Bengal  overflowed  from  ,the  latter 
end  of  July  till  the  middle  of  October  ;  during  which  period,  noted 
cities,  populous  villages,  exalted  mosqu-es,  and  stupendous  pagodas, 

*  Vide  Captain  Williamson's  East  India  Vade  Mecum 
6 


42  EASTERN  HEMISPHERE. 

are  seen  just  above  the  level  of  this  temporary  ocean,  surrounded  by 
innumerable  boats,  now  the  habitations  of  domesticated  animals. 

At  this  time,  vessels  even  of  an  hundred  tons  are  beheld  traversing 
the  country  in  various  route?,  wafted  by  a  breeze  that  seldom  shifts 
more  than  a  point  or  two  from  south — The  depth  of  water  during 
the  inundation,  varies  from  ten  to  thirty  feet,  according  to  the  undu- 
lations of  the  ground.  The  original  course  of  livers  is  now  known 
only  by  their  currents,  which  miy  have  a  velocity  of  four  miles  an 
hour,  on  an  average,  whib*  the  great  body  of  water,  spread  over  the 
plains,  moves  at  the  rate  of  half  a  mile  or  a  mile,  in  the  same  space 
of  time. 

A  chemical  .analysis  of  the  various  impregnations  and  impurities 
which  the  Ganges  and  its  contributory  streams  sweep  down  to  Bengal, 
and  which  either  subside  in  feculence  on  the  soil,  or  are  carried  on  to 
the  sea,  would  form  an  interesting  memoir  ; — It  will  be  sufficient  in 
this  place  to  glance  at  a  few  of  them. 

The  Western  bank  of  the  Ganges  itself,  between  Hurdvvar  and  Be- 
nares, consists  in  general  of  lime,  concreted  in  irregular  masses  ;  and 
all  the  rivers  which  issue  from  the  Western  bank  are  more  or  less 
impregnated  with  the  same  substance  ;  while  on  the  opposite  bank  the 
waters  partake  of  a  stro.ig  solution  of  nitre,  with  which  the  plains  of 
Oude,  Fyzabda,  andGazeepoor,  abound.  The  country  lying  be- 
tween the  Ganges  and  the  Goomty,  on  the  Eastern  bank,  is  replete 
with  fossil  alkali,  named  "  seedgy?'  giving  rise  to  severe  bowel  com- 
plaints among  the  natives  ;  while  the  swamps  of  Sasserani  are  annually 
in  a  state  of  partial  corruption,  sufficient  to  occasion  the  most  malig- 
nant diseases  in  the  month  of  Novt'tnber,  when  the  sun's  power  pro- 
motes an  astonishing  evaporation,  tilling  the  air  with  miasmata,  and 
spreading  destruction  among  all  the  living  tribes. 

The  Mahana^  the  Mutwalla,  and  various  other  mountain  rivers, 
that  rush  into  the  Ganges  between  Pains  and  Boglepore,  are  frequent- 
ly tinged  with  copper.  The  12th  Battalion  of  Native  Infantry  were 
nearly  poisoned  by  drinking  at  one  of  these  streams. 

But  it  would  be  endless  to  trace  all  the  sources  of  pollution  in  the 
vegetable  and  mineral  kingdoms  ;  one  or  two  only  in  the  animal  king- 
dom will  be  selected  as  specimens  in  that  extensive  depaitrnent. 

The  Hindoo  religion  enacts,  that  as  soon  as  the  spirit  has  taken  its 
departure,  the  body  shall  be  burnt  on  the  banks  of  the  Ganges,  and 
that  the  ashes,  together  with  every  fragment  of  the  funeral  pile,  be 
committed  to  the  sacred  stream.  In  a  country  where  dissolution  and 
putrefaction  are  nearly  simultaneous,  the  utility  of  such  a  measure  is 
sell  evident ;  but  either  from  indolence  or  penury,  the  body  is  now  ge- 
nerally placed  on  a  small  hurdle,  and  when  little  more  than  scorched,  is 
pushed  off  from  the  shore  with  a  bamboo,  there  to  float  until  it  ar- 
rives at  the  ocean,  unless  it  be  previously  picked  up  by  a  shark  or 
alligator  ;  or,  which  is  frequently  the  case,  dragged  ashore  by  Pari- 
ar  dogs  and  devoured  by  them,  in  company  with  a  numerous  train  of 
carrion  birds  of  various  descriptions.  From  one  hundred  to  one  hun- 
dred and  fifty  of  these  disgusting  objects  may  be  counted  passing  one 
point  in  the  cour&e  of  a  day  ;  and  in  some  places  where  eddies  prevail, 


ENDEMIC  OP  BENGAL.  3 

a  whole  vortex  of  putrid  corses  may  be  seen  circling  about  for  hours 
together  !  It  was  very  common  for  us  lobe  obliged  to  "  clear  tbe  ca- 
ble" occasionally  of  a  human  body,  speckled  over  by  tbe  partial  se- 
paration of  the  cuticle  and  rete  mucosum  from  putrefaction. 

Each  contributory  stream  brings  down  its  full  proportion  of  these 
ingredients  to  the  general  reservoir  ;  since  the  inland  inhabitants  have 
always  recourse  to  that  which  is  most  contiguous  to  their  village  ; 
and  strange  as  it  may  appear,  where  no  stream  is  at  hand,  the  near- 
est tank,  or  jeel,  performs  the  vicarious  office  of  the  sacred  Ganges, 
supplying  drink  for  the  living,  and  a  final  receptacle  for  the  dead  ! 
We  may  add,  that  the  banks  of  this  river  present,  particularly  about 
the  rising  and  setting  of  the  sun,  a  molly  group  of  all  classes,  and  some- 
times both  sexes,  sacrificing  to  the  Goddess  Oloacina,  in  colloquial 
association  ;  not  indeed  offering  their  gifts  in  temples,  but  commit- 
ting them  to  the  passing  current. 

So  born  and  fed  mid  Tauran's  mountain  snow?, 

Pure  as  his  source,  awhile  young  Ganges  flows  ; 

Through  flow'ry  meaiJs  his  loit'ring  way  pursues, 

And  quaffs  with  gentle  lip  the  nectar'd  dews  ; 

Then  broad  and  rough,  through  wilds  unknown  today, 

Through  woods  and  swamps,  where  tigers  prowl  for  prey, 

He  roams  along  ;  and  rushing  to  main, 

Drinks  deep  pollution  from  each  tainted  plain. 

I  have  remarked,  that  the  ground  springs  a  little  near  the  sea,  and  by 
resisting  the  progress  of  the  inundation,  lays  the  more  inland  plains  un- 
der water.  This  is  an  important  circumstance  in  the  medical  topogra- 
phy of  the  country  :  since  the  more  complete  the  inundation  the  more 
healthy  are  the  inhabitants,  till  the  fall  of  the  waters  in  November  and 
December  exposes  a  number  of  miry  and  slimy  marshes  to  the  action  of 
a  still  powerful  sun,  when  those  who  are  in  their  neighbourhood,  are 
sure  to  come  in  for  a  share  of  remittents  and  intermittents. 

It  is  worthy  of  remark  here,  that  in  those  years,  when  the  rains  are 
late  in  setting  in,  many  people  are  suddenly  cut  off  by  the  intense 
heat  of  the  sun  in  June  and  July.  But  this  is  nothing  compared  to 
the  havoc  produced  by  a  sudden  and  premature  cessation  of  the  rains 
or  Bursautty,  as  they  are  called.  In  this  last  case  an  immense  sur- 
face of  slima  and  feculence  is  all  at  once  exposed  to  the  rays  of  a  ver- 
tical sun,  that  has  lost  nothing  of  his  power  by  a  Southern  declination. 
The  consequence  is,  that  the  profuse  exhalation  of  miasmata  spreads 
pestilence  and  death  in  every  direction  ;  while  famine,  from  the  rice 
being  left  dry  before  it  has  attained  maturity,  completes  the  dreadful 
catastrophe  ! 

But  the  sunderbunds,  and  the  country  for  some  way  round  Calcut- 
ta, being  in  most  places  rather  above  the  level  of  high  water  mark, 
become,  during  the  rainy  season,  an  immense  woody  and  jungly 
marsh,  neither  perfectly  overflowed,  nor  yet  quite  dry — in  a  word, 
presenting  a  surface  as  well  supplied  with  animal  and  vegetable  mat- 
ters in  a  state  of  decomposition,  and  combining  all  the  other  circum- 
stances necessary  for  giving  miasmata  their  full  influence  on  the  human 
body,  viz.  intense  heat,  moisture,  calms,  &c.  as  perhaps  any  spot  of 
equal  extent  on  the  face  of  the  globe. 


44  EASTERN    HEMISPHERE. 

These  sunderbunds  form  a  belt  between  the  Hoogly  and  the  Megna 
of  about  180  miles  in  length,  by  50  in  depth,  completely  overrun 
with  forests,  underwood,  and  jungle  ;  and  inhabited  by  animals  of 
various  species,  who  are  left  to  the  uninterrupted  possession  of  this 
frightful  territory  ! 

The  rainy  season  commences  about  the  middle  of  June,  and  lasts 
till  the  middle  or  latter  end  of  October,  though  the  waters  are  not 
drained  off  low  situations  til!  December.  During  this  period,  the  de- 
luges of  rain  that  appear  to  come  down  occasionally  "'  en  masse" 
from  the  heavens,  would  almost  stagger  the  belief  of  any  one  who 
had  not  witnessed  them. 

The  inhabitants  and  domestic  nnimals  of  inundated  districts  are  all 
this  time  cooped  up  in  a  state  of  ennui  or  torpor,  which  to  an  active 
European  would  be  dreadful,  had  he  not  a  number  of  mental,  as  well 
as  corporeal  resources  for  beguiling  the  tedious  hours.  But  at  Cal- 
cutta and  Diamond  harbour  it  is  far  otherwise.  There  the  Euro- 
peans are  not  confined,  and  business  must  be  attended  to,  as  much  as 
during  the  dry,  or  the  cool  and  healthy  season.  It  will  not,  therefore, 
appear  extraordinary,  that  under  all  circumstances  related,  the  marsh 
remittent  fever  should  make  such  ravages  among  all  classes,  but  more 
particularly  among  those  who  are  exposed  to  the  sultry  heat  of  the 
day — the  rains,  the  dews,  and  intemperance. 

Having  sufficiently  explored  the  sources  from  whence  vegeto-ani- 
mal  miasmata  take  their  rise,  I  shall  defer  the  investigation  of  their 
nature,  or  operation  on  the  human  frame,  till  the  fever  which  they 
occasion  is  considered. 

There  can  scarcely  be  conceived  a  situation  of  greater  anxiety  and 
distress,  than  that  in  which  a  young  medical  man  of  any  sensibility  is 
placed,  on  arriving  at  an  unhealthy  spot  in  a  foreign  climate,  unfor- 
tified by  experience,  unaided  by  advice,  and,  as  is  too  frequently  the 
case,  but  scantily  supplied  with  books,  containing  local  accounts  of  the 
country  and  its  prevailing  diseases. 

In  such  cases,  he  is  forced  to  explore  bis  way  in  the  dark,  agitated 
and  alarmed  by  the  mortality  around  him  ;  a  great  share  of  which 
he  attributes,  perhaps  with  more  remorse  than  justice,  to  his  own 
misconduct,  or  ignorance  of  the  proper  treatment ! 

We  arrived  in  the  Hoogly  in  the  month  of  September,  after  a  short 
run  of  little  more  than  three  months  from  England  ;  which  place  we 
left  without  the  least  knowledge  of  our  ultimate  destination.  The 
fever  in  question  was  then  making  prodigious  havoc  among  the  ships' 
crews  at  Diamond  harbour,  and  other  parts  of  the  river  ;  nor  were 
we  long  exempted  from  its  visitation.  All  circumstances  considered, 
I  thought  myself  fortunate  in  having  in  my  possession  the  works  of 
two  celebrated  authors,  (Clarke  and  Lin-1.)  containing  a  full  account 
of  this  fever,  drawn  from  personal  observation  on  the  spot.  I  ac- 
cordingly— 

"  Read  them  by  day  and  studied  them  by  night.'' 

In  short,  I  was  quite  anxious  to  grapple  with  this  Hydra  disease, 
and  show  the  power  of  medicine  over  this  scourge  of  Europeans. 


ENDEMIC  OF  BEXGAL.  45 

Many  days  did  not  elapse  before  I  had  an  opportunity  of  trying  my 
strength  against  so  formidable  an  opponent,  and  a  very  few  trials  con- 
vinced me  I  had  calculated  without  my  host,  and  that  I  must  use  other 
weapons  than  those  furnished  me  by  Drs.  Lind  and  Clarke,  if  I  meant 
to  be  victorious  in  the  contest. 

Dr.  Clarke's  description  of  this  fever,  however,  is  so  singularly 
chaste  and  correct,  that  were  1  to  draw  the  picture  myself,  I  must 
either  use  his  own  words,  or  give  a  false  poi  trait.  1  shall  therefore 
only  add  a  few  observations  of  my  own  in  a  note,  and  recommend  Dr. 
C's  description  to  be  carefully  compared  with  that  of  the  yellow  fever 
in  another  part  of  the  work. 

"  This  fever  attacked  in  various  ways,  but  commonly  began  with 
rigors,  pain  and  sickness  at  stomach  ;  vomiting,  headache,  oppression 
on  the  prcecordia,  and  great  dejection  of  spirits.  Sometimes,  without 
any  previous  indisposition,  the  patients  fell  down  in  a  deliquium,  dur- 
ing the  continuance  of  which  the  countenance  was  very  pale  and 
gloomy  ;  as  they  began  to  recover  from  the  fit,  they  expressed  the 
pain  they  suffered  by  applying  their  hands  to  the  stomach  and  head; 
and  after  vomiting  a  considerable  quantity  of  bile,  they  soon  returned 
to  their  senses.  Sometimes  the  attack  was  so  sudden,  and  attended 
with  such  excruciating  pain  at  the  stomach^  that  I  have  been  obliged  to 
give  an  opiate  immediately.* 

*'  In  whatever  form  the  disease  appeared  at  first,  the  pulse  was 
small,  feeble,  and  quick, — the  pain  at  the  stomach  increased,  and  the 
vomiting  continued.  As  the  paroxysm  advanced,  the  countenance  be- 
came flushed — th*>  pulse  quick  and  full — the  eyes  red — tongue  furred 
—thirst  intense — headache  violent,  delirium  succeeded,  and  the  pa- 
tient became  unmanageable  ;  but  a  profuse  sweat  breaking  out  in 
twelve  or  fourteen  hours,  generally  mitigated  all  the  symptoms. 

"  In  the  remissions,  the  pulse,  which  before  was  frequently  130,  fell 
to  90.  The  patient  returned  to  his  senses,  but  complained  of  great  de- 
bility ;  sickness  at  stomach,  and  bitter  taste  in  the  mouth.  This  interval, 

*  It  is  a  little  singular,  that  Dr.  Lind,  of  Windsor,  in  his  inaugural  disserta- 
tion on  this  fever,  never  once  mentions  *•'  oppression  on  the  praecordia," — "  pain 
at  the  stomach," — or  "  fullness  and  tenderness  iu  the  epigastric  region."  I  can 
safely  assert,  that  I  seldom  saw  an  instance  in  which  all  of  these  were  wanting — 
seldom,  indeed,  an  instance  iu  which  they  were  not  all  present.  It  is  true,  that 
this  endemic  is  not  always  arrayed  in  the  same  colours;  but  the  abovementioned 
symptoms  are  so  constantly  attendant  on  fevers,  in  all  hot  climates  particularly, 
that  the  omission  of  them  is  rather  remarkable. 

Dr.  Lind  mentions  a  symptom  not  noticed  by  Dr.  Clarke,  and  which  I  have 
often  observed.  After  remarking  that  bile  was  frequently  ejected  both  upwards 
nnd  dowa wards,  he  says — u  Vomitus  et  dejectiones  t&meQ pleritmque  albi  coloris 
cran/calcis  aqure  commistae,  vel  lactis  illius  quod  lactentes  evouiunt/'  Neither  of 
them  has  mentioned  delirium,  as  often  the  Jirsl  indication  of  the  fever.  Many  a 
time  have  I  been  called  to  see  men,  whom  their  messmates  represented  as  "  mad  ;" 
not  in  the  least  suspecting  that  it  was  the  fever  which  they  were  seized  with. 
This  symptom  generally  happened  among  young  men  who  were  employed  in 
boats,  and  who  were  not  onlj"  more  exposed  than  others  to  marsh  effluvia,  but  to 
the  fervency  of  the  sun  by  day,  and  often  to  the  dews  and  night  air.  A  few  in- 
stances likewise  occurred  where  the  patient  attempted  to  jump  over-board. 
This  symptom  is  not  very  rare  in  bilious  and  other  fevers,  where  there  is  great 
congestion  or  determination  to  the  brain. 


4tf 


EASTEBN  HEMISPHERE 


which  was  very  short,  xvas  succeeded  by  another  paroxysm,  in  which 
all  the  former  symptoms  were  aggravated,  particularly  the  thirst,  deli- 
rium, pain  at  the  stomach,  and  vomiting  of  bile.  If  the  disease  wag 
neglected  in  the  beginning,  the  remissions  totally  disappeared,  and  the 
skin  now  became  moist  and  clammy,  the  pulse  was  small  and  irregu- 
lar, the  tongue  black  and  crusted,  and  the  pain  at  the  stomach  and  vo- 
miting of  bile  become  more  violent."  It  is  m?edless  to  say,  that  from 
this  period  till  death  closed  the  scene,  the  features  of  this  fever  were 
such  as  characterize  the  last  moments  of  all  viohnt  and  fatal  fevers. 

The  unfavourable  terminations  were  generally  between  the  third 
and  seventh  day,  though  in  some  cases  1  have  seen  it  go  on  to  the 
fifteenth  or  twentieth  day  ;  but  visceral  obstructions  were  almost  al- 
ways the  consequence  ;  and  hepatitis  or  dysentery  completed  what 
the  fever  failed  to  accomplish.  I  may  add  that  several  cases  occurred 
under  my  own  inspection  where  there  was  a  yellowish  suffusion  on 
the  skin,  as  in  the  endemic  of  the  West,  with  vomiting  of  matter  bear- 
ing a  considerable  similarity  to  the  grounds  of  coffee.  This  suffusion 
of  bile,  or  yellow  colour  on  tha  skin,  is  by  no  means  an  uncommon 
symptom  in  the  fevers  of  the  East,  as  will  be  shown  hereafter.  The 
natives  themselves  frequently  exhibit  this  appearance,  when  exten- 
sive epidemics  prevail  in  the  lower  situations  of  Bengal,  as  appears 
by  the  following  quotation  from  Captain  Williamson,  "  Certainly, 
(say  this  intelligent  officer,)  it  is  common  to  see  whole  villages  in  a 
state  of  jaundice  ;  and  in  some  years  the  ravages  of  the  disease,  (marsh 
remittent,)  are  truly  formidable."  A  torpid,  or,  at  least,  irregular 
state  of  the  bowels,  almost  invariably  precedes  this  fever  ;  unless  in 
cases  where  the  effects  of  the  paludal  effluvia  are  suddenly  brought 
out,  by  exposure  to  the  intense  heat  of  the  sun  by  day,  and  the  chill- 
ing dews  and  fogs  of  the  nights,  among;  boals'  crews.  In  these,  of 
course,  there  were  few  premonitory  symptoms.  In  respect  to  the  cure, 
Dr.  Clarke  asserts,  that  "  nothing  is  more  indispensably  necessary  in 
the  beginning  than  to  cleanse  the  intestinal  tubes  by  gentle  vomits  and 
purges  "  *  *  *  *  "  As  soon  as  the  intestinal  tubes  have  been 
thoroughly  cleansed,  the  cure  must  entirely  depend  upon  giving  the  Pe- 
ruvian bark,  in  as  large  doses  as  the  patient's  stomach  will  bear,  with- 
out paying  any  regard  to  the  remissions,  or  exacerbations  of  the  fever." 
Such  are  the  plain  and  easy  instructions  which  Drs.  Clarke  and  Lind 
have  left  for  our  guidance  in  this  fearful  endemic.  They  certainly  are 
not,  apparently,  difficult  to  follow  ;  and  heaven  knows  I  endeavour- 
ed, most  religiously,  to  fulfil  every  iota  of  their  injunctions  ;  but  with 
what  success  a  single  ra^e  will  show. 

A  young  man,  of  a  good  constitution,  in  the  prime  of  life  and  health, 
had  been  assisting  with  several  others,  to  navigate  an  Indiaman  through 
the  Hoogly.  The  day  aft^r  he  returned,  he  was  seized  with  the 
usual  symptoms  of  this  fover.  I  did  not  see  him  till  the  cold  stage  was 
past ;  but  the  reaction  was  violent — the  headache  intense —  skin  burn- 
ing hot — great  oppression  about  the  praxordia,  with  quick,  hard  pulse 
— Jhirst,  and  nausea.  An  emetic  was  prescribed,  and  towards  the 
close  of  its  operation  discharged  a  quantity  of  ill-conditioned  bile,  both 
upwards  and  downwards  ;  soon  after  which,  a  perspiration  broke  out. 


ENDEMIC  OF    BENGAL.  41' 

the  febrile  symptoms  subsided,  and  a  remission,  almost  amounting  to  an 
intermission,  followed.  I  now,  with  an  air  of  confidence,  began  to 
"  throw  in"  the  bark  :  quite  sanguine  in  my  expectations  of  soon 
checking  this  formidable  disease.  But,  alas  !  my  triumph  was  of 
very  short  duration  ;  for  in  a  lew  hours  the  fever  returned  within- 
creased  violence,  and  attended  with  such  obstinate  vomiting,  that  al- 
though I  tried  to  push  on  the  bark  through  the  paroxysm,  by  the  aid 
of  opium,  effervescing  draughts,  Sac.  it  was  all  fruitless  ;  for  every 
dose  was  rejected  the  moment  it  was  swallowed,  and  I  was  forced  to 
abandon  the  only  means  by  which  1  had  hoped  to  curb  the  fury  of  the 
disease. 

The  other  methods  which  1  tried  need  not  to  be  enumerated  ; 
they  were  temporizing  shifts,  calculated  in  medical  language,  *'. to  ob- 
viate occasional  symptoms." 

The  plain  truth  was,  that  I  knexv  not  what  to  do  ;  for  the  sudden 
and  unexpected  failure  of  that  medicine  on  which  1  was  taught  to  de- 
pend, completely  embarrassed  me  ;  and  before  1  could  make  up  my 
mind  to  any  feasible  plan  of  treatment,  my  patient  died,  on  the  third 
day  of  his  illness,  perfectly  yellow— vomiting  to  the  last,  a  dark  fluid 
resembling  vitiated  bile,  and  exhibiting  an  awful  specimen  of  the  ef- 
fects which  a  Bengal  fever  is  capable  of  producing,  in  so  short  a  peri- 
od, on  a  European  in  the  vigour  of  manhood  ! 

With  feelings  more  easily  conceived  than  described,  I  had  the  body 
conveyed  to  a  convenient  place,  in  hopes  that  dissection  might  afford 
some  clue  to  my  future  efforts.  On  laying  open  the  abdomen  I  was 
surprised  to  find  the  liver  so  gorged,  as  it  were,  with  blood,  that  it 
actually  fell  to  pieces  on  handling  it.  Indeed,  it  appeared  as  if  the 
greater  number  of  the  vessels  had  been  broken  down,  and  almost  the 
\vhole  of  the  interior  structure  converted  into  a  mass  of  extravasa- 
tion. The  gall  bladder  contained  a  small  quantity  of  bile,  in  colour 
and  consistence  resembling  tar,  and  the  ductus  communis  choledochus 
was  so  thickened  in  its  coats,  and  contracted  in  its  diameter,  that  a 
probe  could  scarcely  be  passed  into  it.  Marks  of  incipient  inflamma- 
tion were  visible  in  some  parts  of  the  small  intestines,  and  the  in- 
ternal surface  of  the  stomach  exhibited  similar  appearances.  The 
thorax  was  not  examined,  on  account  of  the  time  taken  up  in  get- 
ting at  the  brain.  Marks  of  turgescence,  in  the  venous  system  of 
vessels  particularly,  were  there  quite  evident,  and  more  than  the 
usual  quantity  of  lymph  was  found  in  the  ventricles,  but  no  appear- 
ance of  actual  inflammation. 

This  case  requires  little  comment.  It  is  pretty  clear  that  it  would 
have  required  some  ingenuity  to  devise  a  more  injudicious  mode  of 
treatment,  than  that  which  I  pursued.  But  it  taught  me  an  import- 
ant lesson — it  opened  my  eyes  to  my  own  folly,  and.  pace  tantorum, 
virorum,  to  the  oversight  of  my  teachers.  It  is  but  too  true,  that 
we  are  nearly  as  reluctant  in  acknowledging  our  failures,  as  we  are 
forward  in  blazoning  our  successes.  In  so  uncertain  a  science  as 
that  of  medicine,  this  has  always  been  a  considerable  obstacle  to  its 
progress  and  improvement  ;  since,  while  we  read  of  the  great  good 
fortune  of  others,  and  the  surprising  cures  they  have  performed,  and 


•48  EASTERN  HEMISPHERE. 

then  find  our  own  so  far  deficient  in  that  respect,  even  when  we  are 
carefully  treading  their  steps,  we  despond,  and  become  exceedingly 
sceptical  in  regard  to  the  truth  of  those  statements.  These  reflec~ 
tions  are  not  meant  to  bear  on  the  veracity  or  candour  of  Dr  Clarke, 
both  of  which  I  highly  respect : — but  as  he  has  only  published  two 
unsuccessful  cases — '*  in  the  most  malignant  fever  he  had  ever  seen 
in  any  part  of  the  East  Indies," — viz.  the  Bengal  fever,  it  may  justly 
be  questioned  whether  he  would  nut  have  done  more  good,  by  de- 
tailing a  greater  proportion  of  the  fatal  terminations,  than  by  confin- 
ing himself  to  two  solitary  instances,  without  a  single  dissection.  A 
careful  perusal  of  the  first  of  these  that  occur  on  the  list,  (Henry 
Pope,  case  6,)  will  probably  convince  the  reader  that  I  was  not  the 
only  person  who  had  mistaken  the  nature  of  the  disease,  and  that — 

"  Aliquandodormitat  bonus  Homerus." 

In  fact,  the  determination  to  the  liver  and  the  brain,  is  perfectly 
evident,  from  the  beginning  to  the  end  of  this  case  ;  and  although  no 
dissection  took  place,  we  cannot  for  a  moment,  doubt  the  appearances 
which  it  would  have  exhibited. 

The  impression  made  on  my  mind,  by  the  dissection  on  one  hand, 
and  the  perusal  of  Dr.  Clarke's  case,  (Henry  Pope,)  on  the  other, 
determined  me  to  try  venesection,  notwithstanding  the  dreadful  ac- 
counts which  Dr.  C.  himself  gives  of  its  fatal  effects.  I  had  now  se- 
veral down  with  the  fever  ;  and  must  confess  it  was  with  a  trembling 
arm  and  palpitating  heart,  that  1  first  opened  a  vein,  expecting  every 
instant  to  see  my  patient  die  under  my  hands. 

He  did  not  die,  however ;  nay,  he  seemed  evidently  relieved,  but 
the  bad  symptoms  soon  returned,  and  the  bleeding  was  repeated,  with 
brisk  evacuations.  He  recovered. 

I  now  carried  the  evacuating  plan  with  a  high  hand,  and  with 
much  better  success  than  I  expected.  Fortunately  for  my  patients, 
a  great  majority  of  them  were  fresh  from  Europe  and  high  in  health 
and  strength  ;  these  recovered  wonderfully,  after  bleeding  and  eva- 
cuation?, though  not  always. 

But  there  was  on  board  a  class  of  men  whom  we  had  pressed  out 
of  ships  on  their  return  from  India,  who  had  experienced,  not  only 
the  influence  of  the  climate,  but  of  depressing  passions,  arising  from 
*'  hope  deferred,"  and  the  galling  disappointment  they  must  have  felt, 
while  treading  back  their  steps  to  a  distant  country,  after  they  had 
been  on  the  very  point  of  mingling  with  their  friends  and  relations  at 
home ! 

These  required  a  more  discriminated  mode  of  treatment.  Evacu- 
ations at  the  very  beginning  were  necessary  ;  but  something  more 
was  requisite,  to  clear  the  congestions  iroui  the  head  and  liver.  The 
fluids  here,  to  use  a  simile,  were  too  stagnant  to  drain  off,  of  their 
own  accord,  even  when  a  sluice  was  opened — they  required  propul- 
sion. 

It  would  be  humiliating  to  myself,  and  perhaps  uninteresting  to  my 
readers,  to  enumerate  the  many  glaring  blunders  which  I  committed, 
and  the  false  conclusions  which  1  drew,  before  1  arrived  at  any  thing 


ENDEMIC   OF    BENGAL-.  49 

like  a  steady  and  successful  method  of  checking  this  Herculean  ende- 
mic. Let  those  whose  eagle  eye  and  towering  intellect  can  penetrate, 
at  a  single  glance,  the  secrets  of  nature,  and  curb  with  ease  the  reins 
of  impetuous  disease,  place  their  hands  on  their  breasts,  (if  some- 
thing within  does  not  prevent  them,)  and  thank  their  God  that  "  they 
are  not  like  other  men." 

But  to  return  to  our  subject.  The  first  symptom  that  claims  our 
most  serious  attention  in  this  disease,  is  that  irritability  of  the  sto- 
mach, accompanied  by  a  distressing  vomiting.  Till  this  is  allayed, 
nothing  can  he  done  towards  the  cure,  by  way  of  medicine.  Now 
venesection  has  considerable  effect  in  procuring  alleviation,  even  of 
this  symptom.  But  the  trifling  manner  in  which  it  is  too  often  per- 
formed, when  it  is  ventured  on  at  all,  does  more  harm  than  good. 
Bleed  boldly  and  decisively  till  the  head  and  pr&cordia  are  relieved,  or 
draw  no  blood  whatever* 

While  this  is  doing,  a  scruple  of  calpmel,  with  half  a  grain  or  a 
grain  of  opium,  should  be  immediately  given  ;  this  will  act  like  a 
charm  on  the  stomach.  I  shall  prove,  in  the  course  of  this  essay, 
what,  indeed,  is  well  known  to  many  of  my  brother  officers  who 
have  served  in  India,  that  twenty  grains  of  calomel  will  act  as  a  seda- 
tive, and  so  far  from  griping  and  producing  hypercatharsis,  it  will 
sooth  uneasiness,  and  rather  constipate  than  purge.  On  this  account, 
in  the  course  of  a  few  hours,  when  the  vomiting  is  assuaged,  some 
purgative  must  be  given,  as  cathartic  extract,  with  calomel,  castor 
oil,  or  even  salts,  which  will  seldom  fail  to  bring  away  a  most  co- 
pious discharge  of  intolerably  foetid,  bilious,  and  feculent  matter,  to 
the  unspeakable  relief  of  the  head  and  epigastrium.  To  facilitate 
and  accelerate  this  most  desirable  object,  purgative  glysters  should 
be  thrown  up.  The  more  copious  the  catharsis,  the  less  danger  there 
will  be  of  the  return  of  vomiting. 

If  there  be  now  a  return  of  any  of  those  dangerous  symptoms,  in- 
tense headache,  delirium,  or  pain  in  the  epigrastric  region,  no  ap- 
prehension need  be  entertained  of  the  lancet  once  more.*  Those 
bugbears,  debility  and  putrescency,  still  paralize  the  arms  of  medical 
men  in  hot  climates,  notwithstanding  the  clearest  evidence  in  favour 
of  venesection,  particularly  where  the  subject  is  lately  from  Europe, 
and  not  broken  down  by  the  climate. 

Immediately  after  the  operation  of  the  cathartic,  the  main-spring 
of  the  cure  must  be  acted  on.  For  this  purpose,  from  five  to  ten 
grains  of  calomel,  according  to  the  urgency  of  the  symptoms,  corn- 
biried  or  not  with  half  a  grain  of  opium,  should  be  exhibited  every 
four  or  six  hours,  till  ptyalism  is  well  raised  ;  when,  in  nineteen 
cases  out  of  twenty,  (I  might  say  forty -nine  out  of  fifty,)  there  will 
be  a  remission  of  all  the  febrile  symptoms,  and  safety  secured.  This 
is  undoubtedly  the  sine  qua  non,  in  the  medical  treatment  of  this 
fever,  as  well  as  many  other  fevers  in  the  East. 

It  is  hardly  necessary  to  remark,  that  emetics  are  exceedingly 
doubtful,  jf  not  prejudicial  medicines  in  this  endemic,  since  gastric 
irritability  is  one  of  the  most  distressing  and  difficult  symptoms  with 

*  The  jugular  vein,  where  the  head  i3oppressed,will  be  the  best  exit  for  the  blo&d 

7 


50  EAfcTEKN  HEMISPHERE. 

which  we  have  to  contend.  Yet  many  judicious  practitioners,  in  the 
navy  especially,  still  employ  them,  as  will  be  seen  hereafter  ;  my  own 
experience,  however,  and  observations  are  decidedly  against  them. 

But,  on  the  other  hand,  cathartics  are  eminently  useful.  There 
is,  in  this  fever,  either  an  obstinate  costiveness,  or  dysenteric  purg- 
ing ;  no  such  thing  as  natural  feces,  tinged  with  healthy  bile,  will 
ever  be  seen  :  when  such  can  be  obtained  by  purgatives,  a  great  and 
evident  advantage  is  gained.  It  may  seem  strange  that  I  should  re- 
commend calomel  and  opium  anterior  to  the  administration  of  laxa- 
tives ;  but,  independent  of  the  necessity  which  there  is  of  allaying 
the  irritability  of  the  stomach,  whoever  will  compare  the  discharge 
procured  by  cathartics  given  previously  to  the  calomel  and  opium, 
with  that  which  follows  the  subsequent  exhibition  of  them,  will  decide 
in  favour  of  the  latter  plan. 

Once  every  day  then,  the  do«e  of  calomel,  usually  given  every 
four  or  six  hours,  should  be  conjoined  with  ten  or  fifteen  grains  of 
ex.  colcynth.  com.  jalap,  or  an  ounce  of  castor  oil,  omitting  the 
opium  for  that  time.  These  will  be  sure  to  bring  down  a  copious 
alvine  evacuation,  composed  of  highly  vitiated  bile  and  fecal  sordes, 
that  had  been  lurking  in  the  convolutions  of  the  intestines  and  cells  of 
ihe  colon,  during  that  torpid  state  of  the  bowels  which  generally  pre- 
cedes the  attack  of  fever. 

This  will  greatly  relieve  the  oppression  and  tension  of  the  epigas- 
trium, as  well  as  the  headache ;  indeed,  so  striking  is  the  ameliora- 
tion of  symptoms,  after  these  intestinal  evacuations,  that  in  two  or 
three  instances  1  was  tempted  to  follow  them  up,  and  try  if  they 
might  not  supersede  the  necessity  of  impregnating  the  system  with 
mercury.  I  trode  here  on  tender  ground  ;  I  was  forced  to  measure 
back  my  steps,  and  have  recourse  in  the  end  to  that  powerful  and  in- 
valuable medicine,  but  in  one  case  it  was  too  late  !  Warned  by  this, 
whenever  I  combined  a  purgative,  with  the  calomel  afterwards,  1  di- 
rected a  mercurial  friction  or  two  to  be  employed  during  their  opera- 
tion, to  prevent  a  halt  in  the  pursuit  of  my  ulterior  and  principal  ob- 
ject— ptyalism. 

In  the  mean  time,  while  things  are  in  this  train,  there  are  several 
objects  which,  though  of  a  secondary  consideration,  the  prudent 
practitioner  will  do  well  to  keep  in  view.  In  the  first  place,  the  pa- 
tient should  be  removed  to  the  most  airy  and  cool  part  of  the  ship  or 
house  ;  he  should  be  made  perfectly  clean  ;  and  as  there  is,  in  nine 
cases  out  often,  a  great  determination  to  the  brain,  his  feet  may  be 
immersed  occasionally  in  warm  \vater.  His  head  should  be  elevated, 
shaved,  and  numerous  folds  of  linen  or  cotton,  moistened  with  vine- 
gar and  water  artificially  cooled,  kept  constant^  applied  to  it. 

Sir  James  Me.  Griper  remarks  in  his  Medical  Sketches,  that  the 
cold  bath  did  not  succeed  in  the  fevers  of  India.  "  On  my  arrival 
there,  (says  he,)  I  tried  it  in  several  cases,  but  it  failed.  This  fever 
is  commonly  of  the  remittent  type,  there  is  much  reaction  ;  it  seems 
in  most  cases  symptomatic  of  liver  affection,  and  often  terminates  in  he- 
patitis." There  is  some  obscurity  in  the  latter  part  of  this  passage  ; 
but  at  all  events,  Sir  Jaraes  Me.  Grigor  cannot  allude  to  the  fever 


ENDEMIC    OF    BENGAL.  51 

under  consideration  ;  for  although  the*  liver,  a.s  I  shall  hereafter  en- 
deavour to  prove,  is  in  this,  and  perhaps  in  all  other  fe?ers,  affected  ; 
yet  it  would  be  carrying  a  theory  to  extremes  to  assert,  that  the  Ben- 
gal Marsh  Remittent,  confessedly  produced  by  paludal  effluvia,  in 
conjunction  with  heat  and  moisture,  was,  "  in  most  cases  symptomatic 
of  liver  affection."  It  is  probable  that  Sir  James  Me.  Grigor  had 
not  an  opportunity  of  seeing  this  fever  ;  as  his  observation,  in  regard 
to  "  liver  affection,"  applies  more  strictly  to  those  fevers  denominat- 
ed **  Bilious,"  which  are  prevalent  at  Bombay,  the  coast  of  Coro- 
mandel,  and  other  elevated  parts  of  India,  in  which  Sir  James  Me. 
Grigor  served — Vide  Sec.  7. 

How  far  the  cold  affusion  in  these  last  fevers  may  be  applicable, 
this  is  not  the  place  to  inquire  ;  but  in  the  Bengal  Remittent,  it  has 
been  practiced,  time  immemorial,  among  the  natives  themselves,  many 
a  century  before  a  Jackson,  a  Wright,  or  a  Currie,  ever  thought  or 
wrote  on  the  subject,  as  the  following  quotation  from  a  gentleman 
out  of  the  profession,  and  who,  of  course,  has  no  other  object  than 
truth  in  view,  will  prove. — "  We  must,  however,"  says  Capt.  Wil- 
liamson, author  of  Oriental  Field  Sports,  &c.  "  do  the  natives  the  jus- 
tice to  allow,  that  the  refrigerating  principle,  lately  adopted  by  some 
of  our  leading  physicians,  owes  its  origin  solely  to  the  ancient  prac- 
tice of  the  Brahmans,  or  Hindoo  priests,  of  whom  the  generality  af- 
fect to  be  deeply  skilled  in  pharmacy.  I  believe  that,  if  taken  in 
time,  few  fevers  would  be  found  to  degenerate  into  typhus,  and  that 
very  seldom  any  determination  towards  the  liver,  in  acute  cases, 
would  occur,  where  the  refrigerating  course  to  be  adopted.  Often 
have  I  known  my  servants,  when  attacked  with  fever,  to  drink  cold 
water  in  abundance,  and  to  apply  wetted  cloths  to  their  heads ,  with 
great  success.  The/ormer  has  generally  lowered  the  pulse  conside- 
rably, by  throwing  out  a  strong  perspiration,  while  the  latter^  has 
given  immediate  local  relief." —  Vol.  2.  p.  308. 

I  can  confirm  the  truth  of  this,  by  experience,  acquired  long  be- 
fore I  knew  any  thing  of  this  native  practice,  and  to  which  I  was  led 
by  the  unconquerable  headache,  heat,  and  throbbing  of  the  temples, 
which  nothing  but  venesection  and  the  cold  ablutions  above-mentioned, 
would  completely  allay. 

Mr.  Bruce  describes  a  somewhat  similar  practice  among  the  natives 
of  Massuah,  a  very  unhealthy  island  on  the  borders  of  Abyssinia. 

"  Violent  fevers  called  the  Nedad,  make  the  principal  figure  in  this 
fatal  list,  and  generally  terminate  the  third  day  in  death.  If  the  pa- 
tient survives  till  the  fifth  day,  he  very  often  recovers,  by  drinking 
water  only,  and  throwing  a  great  quantity  upon  him,  even  in  his  bed, 
where  he  is  permitted  to  lie  without  attempting  to  make  him  dry,  or 
change  his  bed,  till  another  deluge  adds  to  the  first."  Shaw's  Abridg- 
ment, p.  156.  Cold  water,  cold  cungee  water,  or  either  of  these  aci- 
dulated with  tamarinds,  chrystals  of  tartar,  or  nitrous  acid,  will  be 
found  the  most  grateful  beverage.  But  it  is  necessary  to  remark, 
that,  till  the  irritability  of  the  stomach  is  allayed,  however  urgent 
may  be  the  thirst,  the  patient  should  be  restrained  from  drink,  espe- 
cially in  any  large  quantities.  The  cold  ablution  over  the  surface  of 


02  EASTERN    HEMISPHERE. 

the  body  will  help  to  mitigate 'the  thirst,  till  the  stomach  is  tranquil- 
ized. 

Leeches  succeeded  by  large  and  repeated  blisters  to  the  epigastric 
region,  will  be  found  a  most  valuable  auxiliary  to  the  above  plan  of 
treatment  ;  and  where  torpor  in  the  lymphatic  system  of  the  abdomen 
is  evinced  by  difficulty  in  affecting  the  mouth  with  mercury,  the  de- 
nuded surface  should  be  dressed  with  mercurial  ointment.  With 
these  means  in  use,  I  have  generally  awaited,  with  a  kind  of  patient 
anxiety,  the  first  symptoms  of  ptyalism  ;  and  on  the  third  morning  I 
could  frequently  perceive  a  certain  odour  on  the  breath,  prelusive 
of  salivation.  When  this  last  came  on  free,  I  pronounced  my  patient 
to  be  secure. 

But  if  no  symptoms  of  saturation  appeared,  I  have  then,  or  indeed, 
if  things  wore  an  alarming  aspect,  I  have  sooner  than  this,  either  in- 
creased the  doses  of  calomel,  exhibited  them  at  shorter  intervals,  or 
conjoined  with  them  mercurial  frictions.  For  if  relief  could  not  be 
procured  on  the  third,  fourth,  or  fifth  day,  the  chance  of  recovery 
became  smaller  and  smaller  in  proportion. 

This  relief  sometimes  preceded,  sometimes  succeeded  ;  but  was 
generally  synchronous  with  the  visible  or  sensible  effects  of  mercury 
on  the  constitution,  as  evinced  by  the  gums  or  breath.  A  mild  and 
uniform  diaphoresis,  a  refreshing  sleep,  and  the  appearance  of  natu- 
ral stools,  were  the  usual  indications  of  this  happy  change  ;  after 
which,  as  the  ptyalism  advanced,  the  train  of  morbid  symptoms  pro- 
portionally subsided,  till  at  length  the  inability  to  eat,  in  consequence 
of  the  soreness  of  the  mouth,  became  the  principal  complaint  of  the  pa- 
tient. Were  I  to  go  over  the  same  ground  ag^in,  I  should  be  inclin- 
ed to  try  a  still  more  decisive  system  of  depletion  by  blood-letting 
and  purging,  so  as  thereby  to  arrest  the  progress  of  the  (ever,  even  be- 
fore the  development  of  the  mercurial  action.  But  time  and  circum- 
stances will  so  vary  the  features  of  this  and  other  fevers,  that  differ- 
ent, and  sometimes  opposite  modes  of  treatment  must  be  adopted. 

That  there  may  be  cases,  wherein  the  use  of  wine,  and  even  bark, 
is  indispensable,  1  shall  not  attempt  to  deny.  But  the  latter,  in  par- 
ticular, I  seldom  had  occasion  to  emplov,  except  in  cases  of  protract- 
ed convalescence  ;  or  to  prevent  relapses  at  the  full  and  change  of 
the  moon,  when  such  accidents  are  very  liable  to  happen. 

I  have  only  to  remark  further,  that  when  this  fever  was  combined 
with  dysentery,  an  occurrence  by  no  means  unusual,  the  same  treat- 
ment, with  the  exception  of  cold  external  applications,  conducted 
equally  to  a  happy  termination. 

As  the  object  of  this  essay  is  unity,  and  its  design,  to  convey  as 
much  information  on  each  subject,  in  a  srnsll  space  as  possible,  it  be- 
comes a  duty  to  notice  in  this  place  the  opinions  and  practice  of  a  ve- 
ry high  medical  authority  in  India — Dr.  Balfour,  whose  abilities  and 
experience  entitle  him  to  every  respect.  1  shall  endeavour  to  con- 
dense his  doctrine  and  directions  into  as  few  pages  as  I  can,  referring 
to  his  second  Treatise  on  Sol- lunar  influence,  (Kdin.  1790,)  where 
these  are  more  explicitly  developed  than  in  any  of  bis  other  publi- 
cations. 


ENDEMIC  OF  BENGAL.  53 

Dr.  B.  considers  the  mild  and  regular  intermittent,  as  well  as  the 
more  violent  and  continued  Bengal  fevers,  together  with  dysentery, 
as  so  many  grades  of  the  ««  putrid  intestinal  remitting  /puer,"  all  of 
which  he  pronounces  to  be  infectious.  He  conceives  that  the  conta- 
gion proceeds  from  putrefying  or  putrid  bodies,  and  which,  passing 
down  with  the  saliva,  corrupts  the  mucus  of  the  stomach  and  intes- 
tines. That  this  putrid  matter  being  absorbed,  and  carried  into  the 
circulation,  gives  rise  to,  ind  accounts  fur,  the  whole  train  of  tebrile 
symptoms.  This  is  his  theory,  independent  of  "  Sol-lunar  Influence," 
which  will  be  noticed  hereafter. 

Wilh  respect  to  the  cure,  he  thinks  that  copious  and  continued 
purging  would,  in  general,  be  suffi-  ient  to  conduct  mild  cases  to  a 
successful  issue  ;  but  as  we  are  liable  to  much  deception,  he  advises 
that  in  these,  as  well  as  in  the  most  violent  fevers  of  Bengal,  after 
two  days  purging  with  calomel  arid  other  cathartics,  to  begin,  on  the 
third  morning,  to  "throw  in"  the  bark  in  substance,  so  as  to  adminis- 
ter two  ounces  in  the  course  of  forty-ei<>ht  hours.  At  the  expiration 
of  this  period,  the  calomel  is  to  be  again  repeated  at  night,  and  a 
laxative  the  next  morning  ;  immediately  after  the  operation  of  which, 
the  bark  is  to  be  again  reiterated  for  two  days,  and  in  the  same  man- 
ner as  before.  The  purges  and  bark  are  thus  to  be  alternated  in  ex- 
actly the  above  routine,  till  the  disease  is  finally  subdued.  To  give 
efficacy  to  this  practice,  a  liberal  use  is  to  be  made  of  opium,  not  only 
to  keep  the  bark  on  the  stomach,  but  to  ease  pain  and  procure  rest. 

With  respect  to  those  cases  where  there  is  local  affection,  Dr.  B. 
only  directs  a  superior  degree  of  attention  to  be  paid  in  guarding  the 
body  against  cold,  with  occasional  blisters  and  diaphoretics.  In  some 
rare  cases,  where  the  local  affection  is  violent,  he  admits  of  bleeding, 
both  general  and  local ;  but  all  the  other  plans  are  to  be  pursued  in 
the  manner  prescribed,  without  any  regard  to  paroxysms,  remissions, 
or  exacerbations,  whatever. — Fifteen  years  afterwards,  however, 
Dr.  B.  appears  to  have  remodelled  his  plan  of  treatment,  as  the  fol- 
lowing passage  evinces — 

'*  Considering."  says  he,  "  that  obstructions  of  the  liver  very  fre- 
quently show  themselves,  in  the  common  fevers  of  this  country,  and 
may  with  great  reason  be  suspected,  in  a  certain  degree,  in  all,  we 
cannot  hesitate  to  admit,  as  an  essential  and  valuable  principle,  in  the 
cure  of  fevers,  the  introduction  of  mercury  into  the  system,  so  as  to  af- 
fect the  mouth  in  a  moderate  degree,  with  the  view  of  removing  ob- 
struction, or  other  morbid  affections  of  the  liver  ;  of1  obtaining  natu- 
ral secretions,  and  of  its  thus  contributing,  "with  the  other  means  that 
have  been  described,  to  a  speedy  and  permanent  cure."  Preface  to 
CL  collection  of  Treatises 

I  have  thus  given  a  fair  view  of  two  very  different  modes  of  treat- 
ment, (and  likewise  their  combination,)  in  this  dangerous  disease.  I 
have  shown  my  own  preference  for  one  of  them,  and  I  think  substan- 
tial reasons  for  such  :  but  I  do  not  wish  to  blindly  condemn  the  others, 
because  I  did  not  find  them  successful, 

He  who  treads  o?er  the  same  ground  which  I  have  done,  will,  in 
every  probability,  have  ample  opportunities  of  putting  them  all  to  the 


54  EASTERN7    HEMISPHERE 

trial,  and  then  he  may  decide  on  their  merits.  But  I  would  recom- 
mend him  not  to  be  too  sanguine,  nor  condemn  a  practice  from  a  few 
failures.  It  has  not  been  my  lot  to  find  intertropical  fevers  so  very 
tractable  as  some  medical  officers  have,  or  say  they  have,  found  them. 
Those  indeed  who  are  most  conversant  with  disease  at  the  bed-side 
of  sickness  are  well  aware  that-too  fixed  rules  or  general  plan  of  treat- 
ment are  applicable  at  all  times  in  fever,  or  in  almost  any  other  dis- 
ease. But  although  the  means  must  vary,  the  indications  may  be  al- 
ways the  same.  Thus  I  conceive  that  in  those  times  and  places 
where  bark  and  stimulants  proved  more  successful  than  depletion  in 
tropical  fever,  there  was  equally  as  great  a  derangement  in  the  balance 
of  the  circulation  and  excitability  as  where  venesection  and  purgatives 
were  carried  to  the  greatest  extent.  The  great  art  indeed  is  to  early 
ascertain  the  prevailing  diathesis  both  of  constitution  and  climate,  and 
promptly  apply  the  most  appropriate  Methodus  Medendi. 

I  should  be  sorry  to  suspect,  much  less  accuse,  any  of  my  profes- 
sional brethren  of  wilful  misrepresentation  ;  but  when  young  medi- 
cal men  are  setting  forth  their  cures  by  a  new  remedy,  we  may  at 
least  be  allowed  to  enter  that  remarkably  significant,  though  apparent- 
ly paradoxical  caveat  of  Hippocrates,  EXPERIENTIA  FALLAX. 

As  the  cold  season  approaches,  the  fever  changes  from  an  almost 
continued  to  a  plainly  remittent,  and  finally,  in  December,  to  an  in- 
termittent form.  From  this  time,  for  two  or  three  months,  the  cli- 
mate of  Bengal  is  cool  and  delightful  ;  the  only  diseases  being  visce- 
ral obstructions,  the  sequels  of  the  preceding  endemic. 

It  has  already  been  remarked,  that  this  fever,  when  epidemic 
among  the  natives,  occasionally  commits  the  most  destructive  ravages. 
But  the  assimilation  of  their  constitutions  to  the  climate,  their  singu- 
larly abstemious  habits,  and  various  other  causes,  concur  to  shield 
them,  in  general,  from  its  violence,  so  that  it  appears,  for  the  most 
part,  among  this  class,  as  an  intermittent,  but  often  of  great  obsti- 
nacy. 

I  have  alluded  to  the  Refrigerating  practice,  which  they  have  em- 
ployed time  out  of  mind,  in  acute  fevers  :  I  shall  now  advert  to  some 
very  efficacious  native  medicines,  which  they  apply  to  the  cure  of 
this  disease,  especially  when  it  manifests  itself  in  the  form  of  agues, 
which  prove  exceedingly  troublesome  to  the  inhabitants  of  villages 
scattered  among  the  marshy,  as  well  as  hilly  and  jungly  districts. 
Their  first  object  is  the  complete  evacuation  of  all  bilious  and  sordid 
colluvies  from  the  stomach  and  bowels.  For  this  purpose  they  have 
recourse  to  a  black  purging  salt — Bit-J\oben,  or  Cala  Neemuck,  a  so- 
lution of  which  in  water  is  certainly  one  of  the  most  nauseous  pota- 
tions that  can  well  be  conceived,  having  an  abominable  taste,  and  a 
flavour  resembling  rotten  eggs,  or  sulphuretted  hydrogen  gas.  This 
medicine  proves  eminently  cathartic,  and  powerfully  emulges  the 
liver  and  its  ducts,  carrying  off  vast  quantities  of  vitiated  bile,  and 
other  offensive  fecal  matter  from  the  intestinal  canal.  This  being  ef- 
fected, the  kernel  of  a  seed,  produced  by  a  low,  creeping  kind  of 
cow;itch,  (Cossalpina  Bonducella,)  called  by  the  natives,  Kaut-Kulla- 
gee,  or  Catcaranja  Niit,  is  taken  to  complete  the  cure. 


ENDEMIC  OF  BENGAL.  55 

The  kernel  is  intensely  bitter,  and  possesses  the  tonic  or  febrifuge 
powers  of  Peruvian  bark,  in  a  very  high  degree.  But  it  has  a  mani- 
fest advantage  over  the  latter  ;  for,  instead  of  producing  any  consti- 
pating effects  in  the  bowels,  it,  on  the  contrary,  proves  mildly  laxa- 
tive. It  may  be  easily  conceived  that,  in  a  tropical  country,  where 
the  biliary  system  is  so  commonly  deranged,  such  a  qualification  is  of 
incalculable  utility*  One  of  the  kernels  pounded  into  a  paste,  with 
three  or  four  corns  of  pepper,  and  taken  three,  four,  or  five  times  a 
day,  in  conjunction  with  the  decoction  of  Cherettah,  [Gentiana  Che- 
rayita,]  is  found  so  generally  successful  in  curing  intermittents,  that 
it  is  adopted  by  many  European  practitioners  ;  and  will  probably,  at 
no  distant  period,  supersede  entirely  the  bark,  to  which  it  seems  in- 
finitely preferable  in  a  hot  climate,  on  account  of  the  aforesaid  ape- 
rient quality. 

The  Cheretiah  is  a  species  of  gentian,  indigenous  in  the  mountain- 
ous ^countries  north  of  the  Ganges,  and  is  to  be  procured  in  every 
bazar  throughout  Bengal.  It  possesses  all  the  properties  ascribed  to 
the  gentiana  lutea,  and  in  a  greater  degree  than  are  to  be  found  in  the 
latter  root  as  it  comes  to  us.  The  decoction  of  this  herb  forms  a 
powerful  auxiliary  to  the  caranja  nut,  and  their  united  efficacy  in  cur- 
ing intermittents  is  undisputed. 

CAUSES  OF  THE  FEVER. 

Drs.  L{nd  and  Clarke  dwell  much  on  the  putrefying  animal  and 
vegetable  substances  left  on  the  miry  shores  of  the  Hoogly  by  each 
retiring  tide  ;  attributing  a  considerable  share  of  malignity  to  the 
noxious  exhalations  arising  from  this  source,  during  the  intervals  of 
high  water,  both  by  day  and  night.  The  argument  is  more  specious 
than  solid  ;  and  perhaps  it  is  not  founded  on  accurate  or  discriminat- 
ing observation. 

During  the  months  of  August  and  September,  for  instance,  when  fe- 
vers rage  with  their  greatest  violence,  the  rivers  are  swelled  to  the 
summits  of  their  banks  by  the  inundation,  and  the  volume  of  water 
disgorged  into  the  ocean  is  so  immense,  that  the  stream  is  perfectly 
fresh,  and  the  flood-tide  scarcely  felt  at  Calcutta  ;  consequently,  the 
rise  and  fall  are  comparatively  insignificant.  But  in  May  and  the  be- 
ginning of  June,  on  the  other  hand,  when  the  rivers  are  shrunk  far 
within  their  autumnal  boundaries  ;  when  the  heat  is  excessive  ;  and 
when  the  tides  are  so  rapid,  that  the  bore,  as  it  is  called,  rushes  up 
past  Calcutta,  sometimes  with  the  amazing  velocity  of  twenty  miles  an 
hour,  not  entirely  stopping  till  it  reaches  Nia-serai,  thirty  five-miles 
above  the  capital  ;  then,  indeed,  at  low  water,  each  side  of  the  river 
presents  a  broad  shelving  slope  of  mud  and  mire  covered  with  vege- 
to-animal  remains  in  all  stages  of  putrefaction,  and  disengaging  the 
most  abominable  stench, — yet  no  ill  effects  whatever  are  produced 
by  such  exhalations. 

For  the  solution  of  this  phenomenon,  we  must  look  to  the  tides 
themselves,  which,  sweeping  along  these  shores,  every  flood  and  ebb, 
never  allow  sufficient  time  for  the  extrication  of  that  noxious  efflu- 


56  EASTERN  HEMISPHERE. 

vium  which  arises  from  the  stagnant  surface  of  marshes,  either 
partially  covered,  or  just  deserted  by  annual  not  diurnal  inundations. 
Such  marshes,  [and  jungles  which  produce  a  similar  effect,]  spread 
far  and  wide  in  every  direction  along  the  hanks  of  this  river,  during, 
and  for  some  time  subsequent  to  the  rainy  season  ;  to  these,  therefore, 
and  not  to  daily  overflowed  places,  are  we  indebted  for  all  the  sickness 
and  mortality  we  so  fatally  experience. 

Another  circumstance  may  probably  contribute  its  share  in  correct- 
ing these  exhalations  at  the  period  alluded  to.  During  the  inunda- 
tion, the  waters  of  this  riyer  are  quite/res/i,  though  turbid  ;  whereas, 
in  the  dry  season,  when  the  tides  are  strong,  a  considerable  propor- 
tion of  saltwater  comes  up  every  flood,  and  renders  the  stream,  even 
at  Calcutta,  so  brackish,  as  to  occasion  smart  bowel  complaints  among 
those  who  drink  of  it  at  this  time.  A  mixture  of  salt  water,  with 
fresh,  therefore,  does  not,  as  was  supposed  by  Sir  John  Priogle,  in- 
crease the  noxiousness  of  marshy  exhalations  ;  on  the  contrary,  we 
find,  in  this  instance,  that  they  are  quite  harmless,  while  rising  from 
these  extensive  shores,  when  the  water  is  considerably  impregnated 
with  marine  salt.  In  respect  to  the  marshes  that  run  back  from  the 
river,  they  cannot  during  the  inundation,  be  more  subject  to  flux  and 
reflux  than  the  river  itself.  The  shores  of  all  inlets  and  minor 
streams  are  under  exactly  similar  circumstances  to  those  I  have  stat- 
ed of  the  Hoogly  ;  and  finally,  I  may  add,  that  it  is  the  water  of  inun- 
dations alone,  not  tides,  that  ever  bursts  over  the  banks  of  the  Gan- 
ges, to  cover  the  adjoining  plains  ;  consequently  the  marshes  are  not 
subject  to  diurnal  flux  and  reflux.  I  have  been  the  more  particular 
on  this  point,  in  order  to  set  in  a  clear  light  the  validity  of  these  rea- 
sons which  induced  Dr.  Lind,  of  Windsor,  to  read  the  recantation  of 
his  medical  fairh  in  lun>ir  influence ,  in  favour  of  "  the  increased  effluvia 
disengaged  from  the  shores  and  neighbouring  marshes  at  each  retiring 
spring  tide."  Never  <as  the  fable  of  "  dropping  the  substance  to  grasp 
at  the  shadow"  more  completely  exemplified  than  in  this  instance, 
which  shows  that  "  second  thoughts  are  not  always  best."  1  much  won- 
der that  the  ingenious  Dr.  B  ilfour,  while  lamenting  the  defection  of 
of  his  quondam  supporter,  did  not  adduce  this  unanswerable  refuta- 
tion, among  others,  of  Dr.  Lind's  hypothesis; 

In  so  luxuriant  a  climate  as  that  of  Bengal,  and  on  so  fertile  an  al- 
luvion as  the  Delta  of  the  Ganges,  we  may  well  suppose,  that  every 
spot,  almost  every  particle  of  matter,  teems  with  animal  as  well  as 
vegetable  life.  As  the  scale  of  existence  descends,  in  the  animal 
kingdoms,  the  amazing  circle  of  reproduction  and  decay  is  perpetual- 
ly trodden  by  myriad-  of  animated  beings,  whose  ephemeral  vitality 
has  scarcely  commenced,  before  it  closes  again  in  death  !  No  sooner 
has  the  etherial  spark  — the  •*  divinaB  particula  aurae,"  deserted  its 
tenement,  than  the  latter  is  resolved,  by  the  heat  and  moisture  of  the 
climate,  into  its  constituent  materials,  and  formed  without  delay  into 
other  compounds  : — 

*'  With  ceaseless  change  the  restless  atoms  pass 
"  From  life  to  life,  a  transmigrating  mas?. 


ENBEMIC  OF  BENGAL.  57 

It  is  during  this  dissolution  of  animal  and  vegetable  remains,  pre- 
paratory to  new  combinations  and  successive  reproduction,  that  a 
certain  inexplicable  something  is  extricated,  which  operates  with  such 
powerful  and  baleful  influence  on  the  functions  of  the  human  frame. 

This  exhalation  is  capable  of  concentration,  or  rather  accumula- 
tion ;  for  when  it  is  detained  amid  woods  and  jungles,  as  at  this  place, 
and  especially  during  the  rainy  season,  when  there  are  no  regular 
breezes  to  dissipate  it,  and  when  the  beams  of  the  sun  are  obscured, 
except  at  intervals,  by  dense  cl  >uds,  it  becomes  exceedingly  powerful, 
as  the  annual  mortality  too  plainly  proves. 

That  the  exhalation  of  these  miasmata,  and  their  diffusion  in  the  at- 
mosphere  should  be  greater  during  ttie  heat  of  the  day  than  at  night, 
when  the  air  is  raw  and  cold,  appears  more  than  probable  ;  and  yet 
an  idea  seems  to  prevail,  that  they  arise  from  fens  and  marshes  prin- 
cipally in  the  night.  "  The  nature  of  an  unhealthy,  swampy  soil," 
says  Dr.  Lind,  "  is  such,  that  no  sooner  the  sun-beams  are  with- 
drawn, than  the  vapour  emitted  from  it  renders  the  air  raw,  damp, 
and  chilling  in  the  most  sultry  climates."  It  is  difficult  to  imagine 
how  dews  descend  and  vapours  me  at  the  same  time. — Nevertheless, 
it  is  certainly  true,  that  the  stench  emitted  immediately  after  sunset, 
is  much  more  perceptible  to  the  senses  than  at  any  other  period  of 
the  day.  The  reason  of  this  is,  that  the  shores  and  marshes  retain 
their  heat  for  some  time  after  the  rays  of  the  sun  are  withdrawn,  and 
consequently  continue  to  emit  vapours,  which  are  not  exhaled  and 
diffused  through  the  atmosphere,  as  by  the  sun  and  high  temperature 
of  the  day  ;  they  therefore  meet  the  descending  dews  and  cool  air, 
condensing  and  forming  a  thick  fog,  which  hovers  over  the  swamps, 
accompained  by  a  noxious  and  disagreeable  odour.  To  this  we  must 
add,  that  the  miasmata  exhaled  during  the  day,  in  all  probability 
descend  with  the  dews  of  the  evening,  and  by  meeting  and  combining 
with  those  that  continue  to  be  disengaged  from  their  source,  must  form 
a  concentration  highly  capable  of  affecting  the  constitution.  We 
accordingly  find,  that  four  out  of  five  ot  those  who  suffer,  are  attacked, 
or  receive  the  deleterious  principle,  at  the  period  above-mentioned. 

Experience  has  shown  that  marsh  effluvium,  though  by  co  means 
so  limited  as  human,  does  not  occupy  a  wide  range  ;  at  least,  it  be- 
comes innoxious  ajt  a  certain  distance  from  its  source,  in  consequence 
of  dilution.  Thq  circumstance  mentioned  by  Dr.  J.  Hunter,  and 
confirmed  tjjrsrrbsequent  observations — namely,  that  "  the  difference 
of  a  few  feet  in  height  gives  a  comparative  security  to  poldiers  quar- 
tered in  the  same  building,"  will  be  accounted  for  by  the  supposition 
which  I  have  already  stated,  viz.  That  as  the  miasi/u  exhaled  during 
the  day  descend  in  the  evenings,  they  become  more  and  more  concen- 
trated ;  till,  meeting  the  exhalations  from  the  still  reeking  marshes  ^  a 
dense  stratum  of  highly  impregnated  atmosphere  is  formed  close  10  tha 
surface  of  the  earth.  Hence  the  superior  degree  of  salubrity  in  (be 
upper  ranges  of  buildings  ;  and,  on  the  contrary,  the  extreme  dan- 
ger of  sleeping  on  the  ground  in  such  places  ;  many  instances  of 
which  are  recorded  in  the  writings  of  Lind,  Bontius,  fcc. 

I  am  the  more  inclined  (o  believe  that  vegeto-animal  miasmata  del 

8 


68  EASJEHN    HEMISPHERE. 

cend  tvith  the  dews,  and  are  then  more  formidable  than  in  their  as- 
cent by  day,  from  a  circumstance  that  occurred  to  myself  in  October, 
J805. 

Having  occasion  to  take  a  passage  from  Madras  to  Calcutta,  in  a 
foreign  merchantman,  at  that  time,  1  sat  late  on  deck,  one  evening 
after  our  arrival  in  the  Ganges,  the  vessel  being  at  anchor  a  mile 
from  the  shore,  and  not  a  breath  of  wind  moving  in  any  direction. 
As  the  dews  began  to  fall,  1  perceived,  all  at  once,  a  faint,  heavy 
odour,  to  account  for  which  1  was  much  'puzzled,  as  there  was  no 
breeze  to  waft  any  exhalation  from  the  adjacent  shores.  My  reflec- 
tions were  soon  interrupted,  however,  by  a  sense  of  faintness,  gid- 
diness, and  at  length,  nausea,  with  which  1  was  suddenly  affected. 
I  immediately  went  below,  not  a  little  alarmed,  and  fully  persuaded 
that  1  was  seized  with  the  fever,  whose  effects  I  had  so  much  reason 
to  dread.  On  drinking  some  warm  water,  to  clear  my  stomach,  I 
took  a  dose  of  calomel  and  opium,  and  next  morning,  castor  oil. 
Although  no  further  symptoms  of  fever  occurred,  yet  1  felt  an  unu- 
sual degree  of  lassitude  and  depression  of  spirits  for  some  days  after 
I  got  to  Calcutta. 

The  same  is  often  felt  on  crossing  the  pontine  marshes  in  Italy  ; 
and  Dr.  Moseley  remarks,  that  he  has  felt  a  shiver,  while  passing  the 
swamps  to  the  west  of  Kingston,  especially  near  the  ferry,  before  the 
sun  bad  dispersed  the  vapours. 

The  following  remark  of  Dr.  Lind's  is  favourable  to  the  supposi- 
tion of  miasmata  descending  with  the  dews  :  "  The  first  rains  that 
fall  in  Guinea,  are  commonly  supposed  to  be  the  most  unhealthy  ; 
they  have  been  known  in  forty-eight  hours,  to  render  the  leather  of 
shoes  quite  mouldy  and  rotten."  "  It  has  been  further  observed, 
tbat  woollen  cloths  wet  in  those  rains,  and  afterwards  hung  up  to  dry 
in  the  sun,  have  sometimes  become  full  of  maggots  in  a  few  hours." 
It  is  natural  to  suppose,  that  whatever  exhalations  arose,  and  were 
floating  in  the  atmosphere,  previous  to  the  rainy  season,  would  des- 
cend with  the  first  showers,  on  the  same  principle  as  the  miasmata 
exhaled  during  the  day  descend  with  the  dews  of  the  night. 

In  the  months  of  September  and  October,  1799,  while  the  Leo- 
pard and  Centurion,  two  of  Admiral  Blankett's  squadron,  were 
\\orkingupfrom  Mocha  to  Juddah,  along  the  Arabian  coast,  they 
were  considerably  harassed,  (the  Leopard  in  particular,)  with  a  low 
fever,  not  of  the  remittent  type,  accompanied  with  great  headache, 
weak,  small,  and  quick  pulse,  pain  at  the  stomach,  and  over  the  epi- 
gastric region,  frequent  bilious  vomiting  and  purging,  with  uncom- 
mon debility  and  dejection  of  spirits.  The  days  at  tbis  time  were 
oppresively  hot ;  the  thermometer  generally  at  97  u  ;  the  nights  cool. 
But  what  was  most  singular,  a  copious  fall  of  dew  took  place  every 
night,  perfectly  salt  and  bitter  to  the  taste.  To  this  the  fever  was  as- 
cribed ;  and  what  corroborated  the  suspicion  was,  that  the  Leopard's 
crew  slept  exposed  to  the  nocturnal  vapours,  and  suffered  ten  times 
the  sickness  which  occurred  in  the  Centuriou. 

In  the  latter  ship  no  medicine  was  found  to  check  the  bilious  purg- 
ing and  vomiting  so  well  as  calomel  and  opium.  The  addition  of  an- 


ENDEMIC  OF    BENGAL.  o9 

timonial  powder  was  afterwards  made.  When  debility  only  remained, 
decoction  of  bark  with  nitrous  acid,  was  found  useful.  In  some 
cases,  attended  with  great  febrile  stricture  on  the  skin,  the  cold  ab- 
lutions were  used  with  success.  In  the  Leopard  some  mortality 
prevailed. 

This  view  of  the  subject  leads  to  a  practical  inference  of  con- 
siderable utility,  viz.  that  when  necessity  compels  us  to  penetrate 
through  those  insalubrious  woods,  jungles,  or  marshes,  we  should  se- 
lect that  point  of  time  at  which  we  are  least  likely  to  meet  those  mi- 
asms,  whether  in  their  ascending  or  descending  state.  This  period 
seems  to  extend  from  three  to  six  o'c/dtfe  in  the  afternoon  ;  that  is,  af- 
ter the  greatest  heat  of  the  earth  and  air,  and,  consequently,  the 
greatest  evaporation  ;  and  before  th^condensation  and  return  of  such 
exhalations  as  rose  during  the  day,  and  which  combine  with  those 
still  issuing  from  the  heated  soil,  for  some  time  after  sunset.  It  is 
but  too  well  known,  that  the  cool  of  the  morning,  of  the  evening, 
nay,  in  many  instances,  of  the  night,  is  generally  pitched  upon  for 
wooding,  watering,  and  other  duties  on  shore,  to  the  great  risk  of 
those  concerned  in  such  dangerous  occupations. 

An  attention  to  the  above  rule,  {"founded  on  facts  as  well  as  reason- 
ing,] would  certainly  be  productive  of  much  good  ;  particularly  when 
it  is  considered,  that  the  human  frame  during  the  portion  of  time 
above  alluded  to,  is,  perph'aps,  better  fortified  against  the  impression 
of  marsh  effluvium,  or  other  debilitating  causes,  than  at  any  previous 
or  subsequent  period  in  the  twenty-four  hours.     The  seaman  makes 
his  principal  meal   at  mid-day  ;  he  is  then  served  his  allowance  of 
wine  or  spirits,  and  if  a  couple  of  hours  rest  is  allowed  at  dinner,  his 
energy  and  strength  are  much  greater  at  three  o'clock,  than  early  in 
the  morning  or  late  at  night.     The  European  may  object  to  this,  by 
observing  that  the  body  and  mind,  recruited  by  sleep,  are  most  vigo- 
rous in  the  morning.     But  I   well  know,  from  personal  experience^ 
that  in  tropical  climates,  and  particularly  during  the  rainy  season, 
which  compels  all  classes  to  pass  the  night  between  decks,  the  rest 
obtained  from  interrupted,  I  might  say,  stifled  sleep,  is  very  trifling. 
Indeed,  a  general  languor,  lassitude,  and  want  of  appetite  prevail  till 
towards  noon,  when  dinner,  wine,  and  an  hour  or  two  of  repose,  give 
a  tone  and  activity  to  the  system,  which  continue  till  the  evening.  This 
is  the  time,  therefore,  when  we  can  resist  the  agency  of  marih  efflu- 
vium better  than  at  any  other,  and  of  course  should  be  selected,  es- 
pecially since  it  is  at  this  period  that  the  miasmata  are  most  diffused 
through  the  higher  regions  of  the  atmosphere,  and  consequently  less 
potent  in  themselves.     The  next  three  or  four  hours,  viz.  from  six 
till  nine  or  ten  o'clock,  appear  to  be  pregnant  with  danger  to  those 
on  shore.     Within  the  tropics  there  is  little  or  no  twilight ;  imme- 
diately the  sun  withdraws  his  beams,  [six  o'clock,]  every  thing  is  in- 
volved in  darkness  ;  dews  and  vapours  fall  from  the  upper  regions  of 
the  air,  and  exhalations  still  continue  to  spring  from  the  tepid  marshes 
to  meet  them.     At  this  juncture,  therefore,  in  the  places  and  seasons 
alluded  to,  the  stratum  of  atmosphere  in  immediate  contact  with  the 
surface  of  the  earth,  must  be  highly  saturated  with  a  principle  but 


*>0  EASTERN  HEMISPHERE. 

too  destructive  to  human  health  and  life  ;  and  the  system  is  then,  too 
disposed  to  its  reception,  in  consequence  of  the  exhaustion  produced 
by  the  heat  and  labours  of  the  day,  and  the  torpor  induced  by  the 
coldness  of  the  evenings. 

This  reasoning  will  be  illustrated  and  confirmed  by  the  following 
authentic  particulars.  In  the  month  of  November,  1804,  two  par- 
ties of  man,  belonging  to  his  Majesty's  ship  Tremendous,  were  em- 
ployed on  shore,  at  the  Island  of  Madagascar  ;  one  party,  during  the 
night,  tilling  water,  the  other  cutting  wood  during  the  day.  Four  of 
the  night  party  were  attacked  with  the  endemic  fever  of  the  country, 
and  three  of  them  died.  The  whole  of  the  day  party  escaped  the 
fever,  though  exposed  to  an  intei^e  sun,  in  the  laborious  occupation 
of  wood-cutting* 

About  two  years  after  this,  his  Majesty's  ship  Sceptre  in  the  same 
place,  and  upon  a  similar  occasion,  experienced  a  still  greater  dis- 
aster among  her  watering  or  night  party,  to  whom  the  mortality  was 
confined.  Some  interesting  particulars  respecting  this  fatal  occur- 
rence, I  shall  give  in  the  words  of  the  surgeon,  Mr.  Neill. 

"The  fever  which  attacked  our  watering  parties  at  the  Island  of  Ma- 
dagascar, bears  a  striking  resemblance  to  the  endemic  fever  of  the 
west  ; — like  that  too,  it  was  not  a  contagious  disease,  of  which  we  had 
the  most  cogent  proofs,  and  corroborated  what  we  witnessed  at  a  for- 
mer period.  I  believe  that  the  exciting  cause  of  this  disease  was 
confined  to  the  site  of  the  watering  place,  as  no  person  was  affected 
upon  the  wooding  party,  though  constantly  exposed  through  the  day. 
The  deleterious  effects  of  nocturnal  exposure  were  particularly  ex- 
emplified her«,  by  the  disease  raging  most  violently  among  the  marines, 
who  were  on  shore  at  night  for  the  protection  of  the  casks,  and  to 
whom  the  mortality  was  confined.  The  fever  made  its  appearance 
among  some  of  the  same  party  who  did  not  pass  the  night  on  shore, 
but  in  them  it  was  infinitely  milder,  though  similar  in  type  and  gene- 
ral symptom?.  The  watering  place  was  encompassed  from  the  sea 
by  an  amphitheatre  of  hills  ;  and  in  nearly  the  centre  of  this  ran  the 
rivulet  from  which  we  filled,  situated  in  a  marshy  plain,  surrounded 
with  some  trees  of  the  palm  kind,  and  a  thicket  of  jungle.  The 
wooding  place,  on  the  other  hand,  was  a  dry  sandy  soil,  though  stand- 
ing equally  low,  and  covered  with  brush-wood,  jungle,  &c.  in  the 
same  manner  as  the  other.  As  the  more  minute  features  of  the  dis- 
ease are  described  in  the  journal,  I  shall  only  remark,  that  it  exhibit- 
ed something;' of  the  remittent  type,  inasmuch  as  the  paroxysms  were 
more  conspicuous  and  violent  on  alternate  days  ;  and  on  the  interme* 
diate,  the  system  seemed  less  oppressed  and  more  tranquil,  with  a 
different  cast  of  features  in  the  countenance  ;  but  there  never  was 
any  thing  like  an  apyrexia.  The  general  treatment  adopted  in  these 
cases,  and  which  the  journey  developes,  consisted  ia  blood-letting, 
purging,  and  exciting  ptyalism  ;  the  pre-eminence  of  which  practice, 
several  years  experience  in  this  country  has  amply  confirmed.  My 
sentiments  have  been  so  often  expressed  on  venesection,  that  I  need 

not  repeat  thtm.     With  respect  to  purgatives,  I  have  always  observ- 
ed the  greatest  relief  to  follow,  when  they  took  full  effect.     That 


ENDEMIC  OF  BKNGAt.  6l 

they  are  beneficial  in  every  stage  of  the  disease,  I  infer  from  this  ; — 
that  the  pulse,  from  being  depressed,  weak,  and  void  of  energy,  be- 
comes open,  energetic,  and  bounding  to  the  surface  with  a  correspond- 
ing animation  in  the  countenance,  alter  copious  catharsis,  even  in  the 
last  stage  of  debility* 

The  next  and  only  remedy,  where  blood-letting  and  purging  do  not 
check  the  disease  at  once,  in  its  infancy,  is  mercury  to  excite  ptyal- 
ism.  I  say  ptyalism,  for  soreness  of  the  mouth  will  not  secure  the  pa- 
tient in  this  endemic.  In  many  of  the  fatal  terminations,  the  mouth 
was  slightly  affected  ;  but  we  never  were  able  to  excite  ptyalism. 
Wherever  this  last  could  be  induced,  a  revolution,  as  it  were,  in  the 
whole  train  of  morbid  symptoms  instantly  succeeded,  and  a  healthy 
train  supplied  their  place  !  This  revolution  was  most  strikingly 
evinced  in  the  functions  of  the  bowels,  by  the  evacuations  becoming, 
all  at  once,  copious  and  feculent  :  a  circumstance,  which  previous  to 
ptyalism,  no  purgative,  even  of  the  most  drastic  nature,  could  effect." 

Although  the  latter  part  of  this  document  is  foreign  to  the  subject 
for  which  it  was  introduced,  yet  I  trust  it  will  be  considered  interest- 
ing. It  is  satisfactory  to  me,  since  it  strongly  corroborates  what  I 
have  advanced  lately  on  the  treatment  of  the  Bengal  endemic,  both 
in  respect  to  bleeding  and  ptyalism  ;  the  former  being  rather  hetero- 
dox in  India.  I  have  only  to  remark,  in  reference  to  the  striking 
coincidence  of  our  practical  views,  that  the  above  document  was  ne- 
ver penned  for  my  inspection,  nor  that  of  the  public.  The  sensible 
and  well  informed  author  of  it,  (Mr.  Neill,)  is  alive,  and  can  contra- 
dict any  misrepresentation  of  his  sentiments. 

I  shall  here  observe,  once  for  all,  that  the  foregoing  remarks  will 
equally  apply  to  all  other  documents  and  narratives  introduced  into 
this  essay,  in  addition  to  my  own  personal  observations.  They  are 
strictly  authentic  ;  being  the  spontaneous  records  of  facts,  comme- 
morated without  preconceived  theory  or  preconcerted  design.  I 
need  not  say  how  much  their  value  is  enhanced  by  this  consideration. 

In  the  account  of  the  Batavian  endemic,  some  other  striking  in- 
stances, corroborative  of  the  opinions  here  advanced,  will  be  related. 
In  the  mean  time,  the  above  examples  will  be  sufficient  to  justify  the 
rules  I  have  laid  down,  and  put  future  navigators  on  their  guard, 
where  disease  and  danger  lurk  in  concealment. 

And  here  I  cannot  help  noticing  the  apathy  or  impolicy,  which  still 
allows  Diamond  Harbour,  the  principal  anchorage  of  our  Indiamen, 
to  continue  backed  and  flanked  by  woods,  jungles,  and  marshes,  to 
the  annual  destruction  of  one-fourth  of  the  crews  of  such  ships  as 
load  and  unload  at  this  place  !  The  objection  to  clearing  the  Sun- 
derbunds,  has  been  founded  on  the  idea  of  their  presenting  an  impe- 
netrable barrier  to  the  incursions  of  an  enemy  from  that  quarter ; 
but  the  government  does  not  seem  to  be  aware,  that  to  secure  us  from 
a  domestic  foe,  it  is  by  no  means  necessary,  in  this  instance,  to  throw 
open  the  way  to  a  foreign.  A  semicircle  of  cleared  and  drained 
ground,  even  of  six  miles  in  radius,  [not  a  thirtieth  part  of  the  Sun- 
derbunds,  and  scooped  as  it  were,  out  of  their  centre,]  would  suffi- 
ciently protect  the  anchorage  and  warehouses  of  Diamond  Harbour, 


62  EASTERN  HEMISPHERE. 

from  the  baleful- influence  of  those  exhalations  we  have  beea  des- 
cribing. 

That  the  woods  and  jungles  might  be  cleared,  admits  of  no  doubt ; 
and  that  the  country  round  Diamond  Point  might  either  be  drained, 
overflowed,  or  submitted  to  the  flux  and  reflux  of  the  tides,  any  one 
of  which  measures  would  afford  comparative  security,  can  hardly  be 
denied.  To  add  to  this  security,  one  or  two  narrow  semicircular  belts 
of  wood  might  be  interposed  between  Diamond  Harbour  and  the  con- 
fines of  the  cleared  space,  to  arrest  ;:ny  effluvium  disengaged  from 
the  surrounding  wilds  or  marshes,  and  conveyed  by  the  breezes  to- 
wards the  aforesaid  anchorage.  All  writers  agree,  that  marsh  mias- 
mata, although  much  less  limited  in  their  rage  than  the  matter  of  con- 
tagion, would  be  perfectly  harmless  after  traversing  a  much  shorter 
route  than  that  proposed  ;  but  where  native  labour  can  be  so  easily 
procured  ;  indeed,  where  the  convicts  alone  would  be  equal  to  the 
undertaking  in  a  very  few  years  ;  and  finally,  when  it  is  considered, 
that  this  salutary  step  opens  not  any  facility  to  the  irruption  of  an 
enemy  on  the  southern  frontier  of  Bengal,  we  can  hardly  doubt  that 
the  attention  of  the  company  will,  ere  long,  be  directed  to  so  import- 
ant a  measure.  Till  then  we  can  only  remark,  that  the  further 
from  shore,  and  the  lower  down  the  river  ships  lie,  so  much  more 
healthy  will  be  the  crews.  On  this  account  Saugur  Road  is  more 
eligible,  in  regard  to  salubrity,  than  Kedgeree  ;  and  the  latter  much 
less  dangerous  than  Culpee  or  Diamnod  Harbour.  This  was  amply 
proved  by  the  comparative  mortality  in  the  Caroline,  Howe,  and 
Medusa  frigates.  The  two  latter,  by  anchoring  higher  up  than  the 
former,  lost  at  least  six  times  as  many  men,  from  fevers  and  fluxes. 
Indeed,  one  was  obliged  to  take  a  cruise  to  sea,  and  the  other  to  re- 
treat back  to  Saugur  Roads,  to  avoid  depopulation  !  Some  suggestions 
will  be  given  hereafter  in  regard  to  the  means  of  obviating  the 
effects  of  marsh  effluvium,  even  at  Diamond  Harbour,  the  focus  of 
this  destructive  principle. 

In  what  manner,  or  through  what  channel  it  is  conveyed  to  the 
sensorium,  so  as  to  produce  its  effects  on  the  constitution,  we  are 
nearly  ignorant.  A  general  idea  prevails,  that  the  stomach  is  the 
medium  through  which  the  matter  of  contagion  acts  ;  and,  by  analo- 
.  gy,  that  marsh  miasmata  take  the  same  course.  But  when  we  con- 
sider, that  at  each  inspiration,  the  atmosphere  impregnated  with  this 
principle  is  largely  applied  to  the  delicate  texture  of  the  lungs,  it  is 
not  difficult  to  conceive,  that  it  may  pass  into  the  blood,  [if  it  is  in 
any  case  absorbed,]  as  readily  as  oxygen.  There  are,  besides,  the 
schneiderian,  and  other  membranes  of  the  nares  and  fauces,  to  which 
it  must  have  constant  access,  while  there  is  but  one  way  for  it  to  pass 
into  the  stomach,  viz.  along  with  the  saliva  or  food.  Further,  when 
we  see  this  principle,  in  a  concentrated  state,  produce  fever  in  a 
very  few  hours,  with  high  delirium,  can  we  suppose  that  it  enters 
the  system  by  the  circuitous  route  of  the  alimentary  canal  and  lacte- 
als  ?  If  it  be  said  that  it  acts  through  the  medium  of  the  nerves  of 
the  stomach,  why  not  through  that  of  the  olfactory,  which  is  a  shorter 
road  ?  Indeed,  from  a  near  view  of  its  effects,  there  is  every  reason 


KNDKM1C   OF   BENGAL.  63 

-jog  ??'        -;  ^ 

to  suppose  that  the  brain  and  nervous  system  suffer  the  tirst  impres- 
sion and  shock.  To  those  effects,  then,  we  are  to  direct  our  atten- 
tion. 

I  believe  it  is  nearly  an  unanimous  opinion,  at  present,  that  both 
marsh  and  human  effluvia  are  directly  sedative  or  debilitating  in  their 
nature.  Dr.  Hush,  indeed,  uses  the  term,"  stimulus  of  contagion," 
in  almost  every  page  of  his  work  on  Yellow  Fever  ;  but  like  the 
more  celebrated  '» stimulus  of  necessity,"  it  may  be  quietly  laid 
in  the  "  tomb  of  all  the  Capulets."  By  Dr.  Jackson,  the  cause  of 
fever  is  compared  to  electricity.  "  It  seems  to  accumulate  in  the 
system  by  a  regular  but  unknown  process  :  in  a  certain  state  of  ac- 
cumulation, it  seems  to  explode  in  a  manner  similar  to  the  explosions 
of  electricity."*  The  delirium  and  violent  action  early  apparent 
in  the  jungle  fever,  might  countenance  the  idea  of  a  stimulus,  and 
that  the  subsequent  debility  was  of  the  indirect  kind.  I  have  heard 
this  opinion  maintained  on  the  spot,  by  medical  gentlemen ;  but  if 
\ve  narrowly  inspect  the  train  of  morbid  symptoms,  we  find  more  of 
irregular  than  increased  action  ;  more  of  apparent  than  real  strength. 
If  we  carefully  observe  the  delirious  patient  writhing  and  struggling 
under  the  first  impression  of  this  cause,  we  find  the  efforts  not  only 
momentary  and  less  effective  than  healthy  exertions,  but  accompa- 
nied even  at  the  instant,  and  immediately  succeeded  by  tremor  and 
other  marks  of  debility.  The  premonitory  symptoms  too,  are  all 
indicative  of  decreased  sensorial  energy.  The  mind  is  wavering 
and  unsteady  ;  the  appetite  languid  ;  the  secretions,  particularly  the 
biliary,  diminished  ;  and  the  bowels  torpid.  Notwithstanding  the 
determined  phraseology  of  Dr.  Rush,  therefore,  we  may  still  adhere 
to  the  opinion  of  the  venerable  Cullen,  that  marsh,  as  well  as  hu- 
man effluvium,  is  sedative.  Dr.  Jackson,  indeed,  will  not  allow  it  to 
be  either  stimulant  or  sedative,  but  a  kind  of  irritant ;  yet  he  gradu- 
ally slides  into  the  admission  of  its  sedative  nature  :  "  It  however 
appears,  from  tho  most  general  view  of  things,  that  the  febrile  cause 
is  a  cause  of  irritation,  disturbing,  but  not  increasing  in  a  natural 
manner,  the  action  of  the  moving  fibre.  On  the  contrary,  inter- 
rupting, impeding,  and  as  it  were,  suspending  the  operations  essential 
to  health  and  life  ;  by  which  means  the  expression  of  its  effects 
principally  consists  in  debility  and  impaired  energy. "t 

The  space  of  time  which  intervenes  between  the  application  of 
this  poison  to  the  system  and  its  ostensible  operation  in  the  form  of 
fever,  depends  on  the  degree  of  its  concentration,  and  the  predispo- 
sition of  the  patient.  It  will,  for  instance,  be  found  in  some  places 
so  powerful,  that  a  man  in  perfect  health,  by  remaining  on  shore  dur- 
ing the  night,  in  marshy  situations,  and  wet  or  autumnal  seasons, 
shall  have  the  fever  violently  the  next  day,  and  die  on  the  third  or 
fourth.  On  the  other  hand,  it  may  be  applied  in  so  dilute  a  state,  as 
to  require  eighteen,  twenty,  or  even  thirty  days,{  to  bring  on  fever  ; 
and  even  then,  perhaps,  only  in  consequence  of  some  of  the  nurae- 

*  Outlines  of  Fever,  p.  247. 
t  Outlined  of  Fever,  p.  253. 
t  Dr.  Jackson  says  two  months,  and  Dr.  Bancroft  aiae  or  ten 


€4  EASTERN  HEMISPHERE. 

rous  predisposing  or  auxiliary  causes  concurring  to  enable  the  origi- 
nal to  develope  itself.  If  we  take  the  medium  of  these  two  extremes, 
we  shall  have  the  ordinary  period,  viz.  twelve  or  fourteen  days, 
which  elapses  between  the  reception  of  vegeto-animal  miasmata  into 
the  body,  and  their  manifestation,  in  the  shape  of  actual  disease. 

We  see,  then,  this  important  ageut  greatly  varying;  in  force  ;  an  d 
from  standing  occasionally  the  unaided  principal,  — the  '*  instar  om- 
nium," in  the  production  of  fever,  dwindle  away  till  it  can  scarcely 
be  distinguished,  at  least  not  prominently  so,  among  the  train  of  aux- 
iliaries. 

Such  being  the  case,  is  it  not  probable  that  where  the  latter  are 
numerous  or  powerful,  they  may,  in  some  instances  induce  the  afore- 
said disease,  without  the  assistance  of  marsh  exhalation  ? — See  a  va- 
luable train  of  observations  on  this  subject,  in  the  Section  on  Yellow 
Fever  of  the  West  Indies,  in  a  subsequent  part  of  this  work. 

PREDISPOSING  CAUSES. 

We  now  come  to  the  predisposing  causes,  which  are  entitled  to  an 
equal  degree  of  attention  with  that  which  has  been  bestowed  on  the 
remote,  or  exciting. 

These  may  be  divided  into  mental  and  corporeal.  Of  the  former, 
none  are  so  conspicuous  as  the  depressing  passions  ;  and  of  these 
Dr.  Clarke  informs  us  that  FEAR  produced  the  most  striking  and  sud- 
den effects,  in  aiding  the  remote  cause  of  fever.  This  may,  in  some 
measure,  account  for  the  ravages  which  the  yellow  fever  commits 
among  those  newly  arrived  Europeans,  who  are  prepossessed  with 
the  idea  and  dread  of  this  terrible  scourge. 

1  have,  indeed,  remarked  that  most  of  those,  who  were  of  a  timid 
disposition,  and  easily  alarmed  at  the  prevalence  of  the  endemic  dis- 
eases of  the  country,  fell  under  their  influence  sooner  than  those  of 
a  contrary  temperament.  But  grief,  disappointment,  and  chagrin 
were  the  depressing  passions  which  universally  induced  the  most  de- 
cided and  unequivocal  predisposition  to  disease.  I  saw  many  strong 
and  melancholy  instances  of  this  among  that  part  of  our  crew,  which 
we  impressed  within  sight  of  their  own  shores,  and  probably  of  their 
own  habitations,  when  we  were  commencing  our  voyage  to  India. 
They  were  among  the  first  and  worst  cases  which  1  had  under  my 
care,  and  afforded  ample  proofs,  that  mental  despondency  can  acce- 
lerate the  attack,  and  render  difficult  the  cure  of  intertropical  fevers 
in  particular.  I  have  since  seen  the  influence  of  this  predisposing 
cause  on  a  large  scale  ; — not  on  the  banks  of  the  Ganges,  but  much 
nearer  home— on  the  banks  of  the  Scheldt. 

When  our  artny  lay  entrenched  under  the  walls  of  Flushing,  with- 
out any  other  defence  from  the  sun,  the  rains,  and  the  dews,  than 
some  brushwood  or  straw  ; — generally,  indeed,  with  the  humid  earth 
for  their  beds  dnd  the  canopy  of  heaven  for  their  curtains  ;  still, 
with  all  these  disadvantages,  the  animating  prospect  of  success,  the 
mental  energy  inspired  by  hope,  united  with  corporeal  activity,  kept 
the  whole  army  in  health.  When  Flushing  surrendered,  however, 


OF    BENGAL.  65 

and  another  object  was  not  instantly  held  out  for  pursuit  or  attain- 
ment, a  fatal  pause  took  place,  and  a  kind  of  torpor,  or  rather  ex- 
haustion ensued,  during  which,  the  remote  cause  of  fever,  viz. 
vegeto-animal  miasmata,  began  to  make  «ome  impression.  But  when 
from  the  ramparts  of  Batz,  we  clearly  discover  with  our  glasses  a 
strong  boom  crossing  the  Scheldt  from  Fort  Lillo, — the  surrounding 
country  in  a  state  of  inundation,  and  various  other  insuperable  obsta- 
cles between  us  and  the  "  ulterior  objects"  of  the  expedition; — then, 
indeed,  the  depressing  passions,  and  some  other  predisposing;  or  ex- 
citing causes  communicated  a  fearful  activity  to  marsh  effluvium, 
which  rivalled  in  its  effects,  any  thing  that  has  been  seen  in  tropical 
climates  ! 

It  is  an  old  complaint,  that  the  medical  topography,  and  healthy  or 
unhealthy  seasons  of  a  country,  are  too  often  neglected  in  military  and 
naval  operations.  Yet  one  would  suppose  that  within  sixteen  or 
eighteen  hours'  communication  of  London,  every  medical  and  politi- 
cal expedient  would  have  been  speedily  devised  and  applied,  on  such 
an  emergency  as  this.  But  certain  it  is,  that  the  army  did  not  avail 
itself  of  some  local  advantages  that  presented  themselves  among  these 
noxious  islands.  Walcheren,  for  instance,  is  bounded  all  the  way 
round  from  Flushing  by  West  Chapel,  nearly  to  camp  Vere — two- 
thirds  of  its  circumference,  by  a  chain  of  sand  hills,  from  twenty  to 
thirty  feet  in  elevation  above  the  level  of  the  interjacent  plains. 
These  hills  were.not  only  dry,  but  open  to  the  westernly  winds  which 
blew  from  the  sea,  and  were  then  very  prevalent.  On  these,  there- 
fore, had  the  soldiers,  who  continued  in  Walcheren  after  the  fall  of 
Flushing,  been  tented,  the  elevated  site,  combining  with  other  local 
peculiarities,  would  in  all  probability,  have  kept  them  entirely  out 
of  the  range  of  those  exhalations  which  covered  the  country  below. 

On  the  other  hand,  although  Beveland  did  not  present  such  a  fa- 
vourable situation  to  the  rest  of  the  army,  yet  had  they  been  provided 
with  tentst  the  numerous  mounds  or  embankments,  which  not  only  de- 
fend the  island  from  the  highest  rise  of  the  Scheldt,  but  intersect  the 
country  in  every  possible  direction,  frequently  planted  on  each  side 
with  trees,  and  raised  twelve  or  fourteen  feet  above  the  surface  of  the 
soil,  would  have  afforded  excellent  encampments,  where  the  men  un- 
der the  immediate  inspection  of  their  officers,  would  have  been  se- 
cured from  intemperance  and  other  irregularities,  the  inevitable  con- 
sequences of  being  quartered  in  towns  and  villages,  often  in  churches, 
barns,  and  other  damp,  unhealthy  habitations  throughout  Walcheren 
and  Beveland.  But  unfortunately,  tents  were  not  considered  a  ne- 
cessary part  of  the  haggage  on  this  expedition.  The  French  gene- 
ral, too,  having  opened  the  sluices,  and  partially  inundated  the  coun- 
try round  Flushing,  increased  the  force  of  the  en4erilic.  Indeed,  the 
road  leading  from  the  last  mentioned  place  to  Middleburgh,  might  at 
this  time  vie,  in  respect  to  insalubrity,  with  any  through  the  pontine 
fens  of  Italy.  Lenity  towards  the  inhabitants  arrested  the  progress 
of  the  inundation  before  it  was  complete  ;  policy  in  guarding  the 
health  of  our  own  army,  would  perhaps  have  suffered  it  to  continue 

9 


66  EASTERN  HEMISPHERE. 

till  the  cessation  of  the  autumnal  heats,  and  the  commencement  of 
cold  weather  and  frost. 

Nothing  could  more  clearly  prove  the  limited  range  of  marsh  efflu- 
vium, than  the  contrast  between  the  health  of  the  navy  and  that  of  the 
army.  Although  the  ships  were  distributed  all  along  the  shores  of 
Walcheren  and  Bcveland,  from  Pushing  to  Batz,  most  of  them  with- 
in a  cable's  length  of  the  banks,  yet  no  sickness  occurred,  except 
among  such  parts  of  the  crews  as  were  much  employed  on  shore,  and 
remained  there  during  the  nights.  Most  officers  of  ships,  and  many 
of  the  men,  were  in  the  habit  of  making  excursions  through 
all  parts  of  the  islands  by  day,  wish  complete  immunity  from  fever. 
The  night  was  here,  as  in  sultry  climates,  the  period  of  danger. 

One  more  remark  shil!  close  this  digression.  We  all  remember 
the  popular,  or  rather  political  outcry,  that  was  made  about  the 
scarcity  of  bark  :  had  the  lancet,  aided  by  calomel,  and  occasionally 
by  jalap,  been  judiciously,  but  boldly  and  decisively  employed,  the 
physicians  of  London  and  Edinburgh  would  not  perhaps,  since  that 
period,  have  been  so  often  consulted  for  infarctions  and  obstructions 
in  the  liver  and  spleen,  with  many  other  melancholy  sequelae  of  that 
destructive  fever ! 

But  to  return.  One  would  suppose  that  in  a  tropical  climate, 
tvhere  nature  is  ever  arrayed  in  her  gayest  livery,  the  cloudless  skies 
above,  and  exuberant  fertility  around,  would  conspire  to  impart  a 
degree  of  elasticity,  (if  I  am  allowed  the  term,)  and  exhilaration  to 
the  mind,  similar  to  what  we  feel  in  Europe,  at  the  approach  of  spring 
or  summer.  The  reverse  of  this  is  the  case.  The  animal  spirits 
are  in  general,  below  par  ;  and  the  same  cause  of  grief  or  disappoint- 
ment, which  in  England  would  be  borne  with  philosophical  resignation, 
or  perhaps  indifference,  will,  in  India,  greatly  predispose  to  all  the 
diseases  of  the  country,  and  very  probably  terminate  the  mortal  ca- 
reer of  the  unhappy  object. 

The  following  melancholy  facts  are  strikingly  illustrative  of  this 
remark.  His  Majesty's  ship  P.ussel,  (74,)  sailed  from  Madras  on  the 
2'2d  October,  1806,  and  arrived  at  Batavia  on  the  27th  November  ; 
the  crew  healthy,  and  their  minds  highly  elated  with  the  sanguine 
expectations  of  surprising  the  Dutch  squadron  there.  Such,  how- 
ever, was  their  sudden  disappointment,  and  concomitant  mental  de- 
jection, -on  missing  the  object  of  their  hopes,  that  they  began  imme- 
diately to  fall  ill,  ten,  twelve,  or  fourteen,  per  day,  till  pearly  200 
men  were  laid  up  with  scurvy,  scorbutic  fluxes,  and  hepatic  com  - 
plaints  !  Of  these,  upwards  of  30  died  before  they  got  back  to 
Bombay,  and  more  than  50  were  sent  to  the  hospital  there.  The 
Albion  did  not  fare  better — the  Powerful  fared  worse  :  so  that,  in 
these  three  ship*  only,  in  the  short  space  of  a  few  months,  full  one 
hundred  wen  died  on  board,  and  double  that  number  were  sent  to 
hospitals,  many  of  whom  afterwards  fell  victims  to  the  diseases  spe- 
cified ;  aggravated,  and  in  a  great  measure  engendered,  by  mental 
despondency. 

Numerous  are  the  instances  of  a  similar  nature,  though  on  a  smaller 
scale,  which  I  could  relate  ;  but  the  above  specimen  is  sufficient. 


ENDEMIC    OF    BENGAL.  67 

The  converse  of  this  position  is  equally  surprising  :  thus,  success  or 
good  fortune  will  as  forcibly  counteract,  as  the  contrary  will  predis- 
pose to,  the  malignant  effects  of  climate.  A  familiar  example  will 
elucidate  this. — Two  ships,  under  equal  circumstances,  sail  from 
Bombay,  on  a  five  months'  cruise  off  the  Isle  of  France,  One  of 
them  takes  a  valuable  prize,  while  the  other,  with  every  effort  and 
vigilance,  is  quite  unsuccessful.  The  minds  of  the  former  crew  are 
now  perpetually  employed  in  "  building  castles  in  the  air,"  and  form- 
ing the  most  extravagant  anticipations  of  enjoyment  on  their  return  to 
port.  The  ship's  company,  without  the  ;iid  of  a  single  bottle  of  lime 
juice,  or  pot  of  spruce,  will  couie  back  to  Bombay  at  the  end  of  the 
cruise  in  health.  Not  so  (he  other  :  chagrin,  envy,  (for,  after  all  the 
poetical  portraits  that  are  drawn  of  our  noble  tars,  they  are  both  en- 
vious and  jealous  at  times,  like  other  folks,)  and  various  depressing 
passions,  show  themselves  here,  in  the  ugly  »hapes  of  scurvy,  ulcers, 
and  fluxes  ;  so  that,  in  spite  of  all  the  artificial  checks  from  lemon 
juice,  sugar,  porter,  and  even  NOPAL  itself,  they  are  forced  to  Mada- 
gascar for  refreshments,  or  else  return  with  the  other  ship  to  Bom- 
bay, in  a  deplorable  condition. 

Here,  however,  the  scene  shifts  again  ;  for  Hygeia  is  as  fickle  as 
Fortuna.  The  crew  of  the  successful  ship  having  shared  their 
prize-money, 

«  Balnea— Vina— Venus," 

become  the  order  of  the  day  ;  and,  for  a  short  time,  they  are  at  the 
summit  of  human  happiness  !  But  in  a  few  weeks,  on  leaving  port, 
this  ship's  company  will  exhibit  as  long  a  list  of  fevers,  dysenteries, 
and  venereals,  as  the  other  did  of  scurvies,  ulcers,  and  fluxes,  on  ar- 
riving.  Thus  prize-money,  or  rather  the  hope  of  prize-money,  is 
one  of  the  most  potent  antidotes  to  disease  among  sailors  at  sea,  but 
the  most  certain  bane  of  their  health  on  shore. 

To  return.  This  mental  despondency  may  be  attributed  part- 
ly to  physical,  and  partly  to  moral  causes.  1  have  already  hinted 
that  derangements  in  tho  hepatic  and  digestive,  very  soon  affect  the 
menial  functions  ;  so,  on  the  other  hand,  the  depressing  passions 
speedily  derange  the  biliary  secretion,  digestion,  and  peristaltic  mo- 
tion of  the  intestines,  consequently  disposing  the  liver,  stomach,  and 
alimentary  canal,  to  disease,  as  well  as  inducing  general  debility 
throughout  the  system.  This  sufficiently  accounts  for  the  phenome- 
non ;  but  it  is  also  to  be  consid^ed,  tint  grief  and  disappointment 
mustgbe.  cuzteris  paribus,  more  poignant  in  India  than  in  England  ; 
since  the  loss  of  friends  or  relatives  are  more  felt  in  proportion  to 
the  small  number  we  possess  ;  and  frustrated  expectations  will,  of 
course,  be  more  galling  on  account  of  the  previous  sanguine  hopes 
which  always  accompany  a  foreign,  and  particularly  an  Indian  spe- 
culation. We  may  therefore  lay  it  down  as  an  axiom,  that  in  a  tro- 
pical climate,  the  depressing  passions  above  alluded  to  operate  more 
immediately  on  those  organs  which,  under  all  circumstances,  are  the 
principal  sufferers  in  the  diseases  of  the  .country  ;  viz.  that  they  di- 
minish the  mental  energies,  or  sensorial  power,  and  impair  the  func- 
tions of  the  liver,  stomach,  and  intestinal  canal. 

^^F 


£8  EASTERN    HEMISPHERE. 

Within  the  torrid  zone,  philosophy  seems  to  direct  her  influence, 
and  reason  its  arguments,  in  vain,  against  these  powerful  disorders 
of  the  mind !  Their  frigid  tenets  are  more  efficacious  beneath  the 
gloomy  skies  of  Europe.  Religion,  indeed,  frequently  asserts  her 
superiority  here,  as  wellaselsewhe  n.  '  d  in  conjunction  with  some 
pursuit  or  employment,  mental  or  corporeal,  will  be  found  the  best 
shield  against  the  demon  of  despair,  and,  ultimately,  the  pangs  of 
disease. 

The  destructive  effects  of  intemperance,  as  a  predisposing  cause, 
are  equally  conspicuous,  and  1  might  say  peculiar,  in  a  tropical  cli- 
mate ;  for  the  injuries  it  occasions  in  Europe,  great  as  they  are,  bt,ar 
no  proportion  to  those  which  we  witness  in  the  East  or  West  Indies. 
Whether  spiritous  and  vinous  potations  act  as  stimulants  or  sedatives, 
or  both  in  succession,  we  need  not  stop  to  inquire,  since  the  final  re- 
sult is  universally  allowed  to  be  debility.  From  the  temporary  in- 
crease of  excitement  in  the  system,  and  energy  in  the  circulation,  it 
is  not  impossible  that  the  biliary  secretion  is  for  a  short  time  aug- 
mented, and  of  course  vitiated,  by  strong  drink.  This  supposition  is 
strengthened  by  the  diarrhosa  crapulosa  which  we  frequently  observe 
succeeding  a  debauch.  But  the  great  mischief  seems  to  arise  from 
the  torpor  communicated  to  the  liver,  through  paralysis  of  its  ducts, 
by  which  the  secretion  of  healthy  bile  is  not  only  greatly  diminish- 
ed in  quantity,  as  well  as  obstructed,  but  deteriorated  in  quality  : 
and  hence  the  way  is  paved  for  fever,  dysentery,  and  hepatitis. 
fr  The  debility  of  the  stomach,  too,  occasioned  by  the  climate,  is 
further  increased  by  inebriety  ;  and  this  atony  is  readily  communi- 
cated to  the  liver,  which  bears  the  onus  of  disease  in  all  hot  climates. 

The  truth  of  these  observations  is  amply  exemplified  among  the 
crews  of  ships,  when  they  have  liberty  to  spend  a  few  days  at  Cal- 
cutta, or  go  ashore,  indeed,  in  any  part  of  India,  where  intoxicating 
liquors  are  to  be  procured.  During  the  indirect  debility  succeeding 
these  debauches,  the  endemic  of  the  country  or  port  makes  rapid 
strides  among  these  deluded  victims,  converting  what  they  errone- 
ously conceived  an  indulgence,  into  the  greatest  evil  that  could  have 
befallen  them. 

For  obvious  reasons,  intemperance  in  eating  is  little  less  destruc- 
tive than  the  other  species  ;  since  an  overloaded  stomach,  which  has 
previously  been  weakened,  will  of  itself  excite  a  temporary  fever, 
and  consequently  predispose  to  that  of  the  country. 

That  fatigue,  especially  during  the  heat  of  the  day,  becomes  an 
exciting  cause  of  this  fever,  is  well  known  to  those  who'have  observed 
its  effects  among  the  seamen  employed  in  stowing  the  saltpetre,  or 
loading  and  unloading  the  company's  ships  at  Diamond  Harbour. 
Where  those  laborious  occupations  must  be  carried  on  by  Europeans, 
they  certainly  should  not  take  place  between  eleven  o'clork  and  four 
in  the  afternoon  ;  the  interval  ought  to  be  dedicated  to  dinner,  rest,  and 
light  work  under  the  awning*. 

A  very  common,  and  powerfully  predisposing  cause  of  U  i?  fever, 
has  seldom  been  adverted  to,  though  highly  deserving  of  attention 
—I  mean  those  licentious  indulgences  which  are  but  too  easily  pro- 


ENDEMIC  OF    BENGAL.  69 

cured,  and  too  frequently  practised  on  the  banks  of  the  Ganges,  and 
in  most  other  parts  of  India — I  may  say  of  all  tropical  climates  !  I 
hare  seen  many  melancholy  instances  of  their  pernicious  effects  ; 
and  therefore  it  is  incumbent  on  commanding  officers  of  ships,  to 
keep  as  strict  a  curb  as  possible  on  the  men,  during  the  sickly  season, 
and  on  no  account  whatever  sallow  them  to  straggle  ihrough  the 
villages,  whcie  inebriety,  and  that  too  from  a  v^ry  deleterious  spe- 
cies of  drink,  is  an  inseparable  accompaniment  to  the  illicit  amours 
abovementioned.  In  every  region  virtue  is  its  own  rewi.rd  ;  but 
within  the  torrid  zone,  its  breach  is  more  signally  punished  than  in 
any  olher. 

The  last  predisposing  cause  which  I  shall  mention,  is  the  influence 
of  the  sun  and  moon.  However  sceptical  professional  men  in  Eu- 
rope may  be,  in  regard  to  planetary  influence  in  fevers,  &c.  it  is  too 
plainly  perceptible  between  the  tropics,  to  admit  of  a  doubt.  I  have 
not  only  observed  it  in  others,  but  felt  it  in  my  own  person  in  'ndia 
when  labouring  under  the  effects  of  obstructed  liver. 

It  is  a  certain  fact,  that  if  we  attend  minutely  to  the  state  of  our 
own  frames  and  sensations,  two,  if  not  three  slight  febrile  paroxysms, 
may  be  detected  in  the  course  of  each  diurnal  revolution  of  the  earth, 
independent  of  those  which  succeed  full  meals.  In  high  health  we 
may  not  be  able  to  distinguish  more  than  the  nocturnal  paroxysm, 
which  commences  about  seven  or  eight  o'clock  in  the  evening,  and  is 
not  over  till  two  in  the  morning.  This  is  the  cause  of  that  furred 
tongue,  which  all  may  observe  on  getting  out  of  bed,  more  or  less, 
according  to  the  degree  of  the  paroxysm  ;  and  it  likewise  explains  the 
evening  exacerbation  of  fevers  in  general.  But  valetudinarians  will 
feel,  about  mid-day,  another  slight  febrile  accession,  similar  to  the 
preceding,  except  in  degree  ;  and  in  some  instances  a  third,  but  still 
slighter  one,  is  felt  between  eight  and  ten  o'clock  in  the  morning.  In 
India  I  have  felt  the  two  former  very  distinctly,  and  particularly  at 
full  and  change,  when  I  used  to  be  affected  with  tremor,  a  sense  of 
weakness,  and  sometimes  a  dimness  of  vision  about  mid-day,  succeed- 
ed by  a  certain  quickness  and  irritability  of  pulse,  which  would  con- 
tinue for  an  hour  or  two.  I  was  so  well  aware  of  this,  that  I  made  a 
point  of  keeping  myself  quiet,  and  as  cool  as  possible,  about  the 
abovementioned  period  ;  since  any  exertion  at  that  time,  in  the  heat 
of  the  sun  especially,  increased  the  symptoms  which  I  have  describ- 
ed, in  a  very  considerable  degree.  I  believe  this  is  the  case  with 
most  people,  more  or  less,  and  accounts  for  the  general  complaint  of 
faintness  about  twelve  o'clock  in  the  day,  and  which  is  relieved  by  a 
glass  of  wine  or  other  refreshment.  I  found  the  cold  bath,  where  I 
could  conveniently  apply  it,  almost  entirely  prevent  this  paroxysm, 
and  hence  the  utility  of  bathing  when  the  sun  is  at  his  greatest  alti- 
tude. At  those  times  too,  my  sleep  was  broken  and  disturbed  with 
dreams,  and  a  feverish  heat  towards  midnight,  all  of  which  would  go 
off  about  two  o'clock  in  the  morning.  This  accords  with  the  gene- 
ral remark,  that  the  morning  repose  is  Use  soundest,  and  that  if 
dreams  do  then  occur,  they  are  more  distinct  and  better  remember- 
ed than  those  which  take  place  during  the  nocturnal  paroxysm.  It 


70  EASTERN   HEMISPHERE. 

is  very  natural  to  attribute  such  regular  and  periodical  changes  or 
feelings  in  the  human  frame,  to  the  revolutions  of  the  planet  we  in- 
habit, and  the  influence  of  the  sun  and  moon.  That  this  influence 
predisposes  to,  or  exacerbates  the  paroxysms  of  fever,  in  India  and 
other  tropical  climates,  is  incontestibly  proved  by  daily  observation, 
as  the  publications  of  the  ingenious  and  respectable  Dr.  Baltbur 
evince. 

The  difference  between  this  and  the  yellow  fever  of  the  West  has  been 
always  noticed,  but,  in  my  opinion,  never  adequately  accounted  for  ; 
and  the  investigation  of  this  discordance  is  certainly  interesting,  since 
the  same  general  causes,  both  remote  and  predisposing,  are  allowed 
to  operate  equally  or  nearly  so,  in  both  hemispheres.  Fir.*t,  then, 
let  me  observe,  that  the  average  space  which  a  ship  traverses,  be- 
tween Spithead  and  the  Ganges,  is  U,UOO  miles.  Secondly,  that  in 
this  voyage  we  run  twice  through  the  tropics  ;  tirst  from  Cancer  to 
Capricorn,  and  afterwards  from  Capricorn  back  to  Cancer  again  ; 
besides  a  great  deal  of  oblique  sailing  in  the  vicinity  of  the  southern 
tropic.  During  the  period  of  time  neccessarj  for  this  performance, 
the  human  frame  has  the  best  possible  means  of  accommodating  itself  to 
the  change  of  climate  :  viz.  a  more  steady  range  of  temperature,  and  of 
a  higher  degree  than  that  of  the  ultimate  destination  ;  together  with  an 
atmosphere  untainted  by  any  noxious  exhalation.  In  addition  to  these, 
the  regular  hours  imposed  on  all  classes,  in  ships  proceeding  eastward 7 
the  consequent  habits  of  temperance  acquired,  and  lastly,  the  pauci- 
ty of  luxuries  which  pretty  generally  attends  a  protracted  voyage, 
especially  the  last  weeks,  sometimes  months  of  it,  all  combine  to  low- 
er the  tone  of  the  constitution,  and  impart  to  it  a  considerable  degree 
of  assimilation  before  the  period  of  danger  arrives.  Thus  the  sto- 
mach and  bowels  will  become  somewhat  accustomed  to  the  increased 
secretion  of  bile,  and  even  this  last  will  be  less  profuse,  as  we  are 
more  inured  to  the  high  ranges  of  temperature,  following  the  same 
laws  and  sympathizing  with  the  perspiration. 

Let  us  contrast  this  with  a  transatlantic  voyage.  The  European, 
"  full  of  flesh  and  blood,"  [to  use  a  vulgar,  but  not  inapplicable  ex- 
pression,] embarks  for  the  West  Indies,  in  a  transport  or  other  vessel, 
where  regularity  and  order  are  by  no  means  conspicuous.*  As  he 
is  under  little  control,  and  generally  supplies  a  great  proportion  of 
his  own  fare,  he  endeavours  to  guard  against  any  deficiency  in  that 
important  point ;  in  short,  good  English  viands  smoke  daily  on  the 
festive  board,  while  sufficient  potation — ««  to  keep  the  pores  open," 
is  steadily  applied  ;  till  alter  a  few  w  eks  run,  he  i«  launched  at  once 
into  a  tropical  climate,  and  immediately  Imded,  "  with  all  his  imper- 
fections on  his  head."  It  is  true  that,  when  ashore,  the  facility  of 
procuring  the  "  diffusible  stimuli"  need  not  be  much  insisted  on, 
since  unfortunately,  the  arrack  of  the  east  is  equally  easy  of  access 
to  the  men,  as  the  rurn  of  the  west.  But  unquestionably  the  bad  ef- 
fect will  be  greater  in  the  latter  case,  for  the  reasons  adduced  above. 
With  respect  to  officers,  and  other  genteel  classes  of  society,  on 

*  I  allude  principally  to  troops. 


ENDEMIC    OF    BENGAL.  71 

landing  in  the  western  world,  they  are  destitute  of  many  powerful 
shields  which  are  pretty  general!}'  interposed  between  Europeans  of 
the  east  and  the  burning  climate.  In  the  former  case,  we  may  look 
in  vain  for  the  palankeen,  the  budgerow,  the  punka,  the  tatty,  and 
the  light,  elegant,  and  «.  ool  vestments  of  India,  together  with  the 
numerous  retinue  of  domestics,  anticipating  every  wish,  and  per- 
forming every  office,  that  may  save  the  exertion  of  their  employers. 
The  untravelled  cynic  may  designate  these  luxuries  by  the  contemp- 
tuous epithet  <,f  "  Asiatic  effeminacy  ;"  but  the  medical  philosopher 
will  be  disposed  to  regard  them  as  rational  enjoyments,  or  rather  as 
salutary  precautions,  rendered  necessary  by  the  great  difference  be- 
tween a  temperate  and  torrid  zone.  Nor  are  these  dulcia  mt<z  the 
exclusive  property  of  the  higher  classes  in  India.  The  European 
soldier  is  permitted  to  intermarry  with  the  native  Hindostannee 
nymph  ;  and,  whether  married  or  not,  he  has  generally  a  domiciliated 
chere  amie,  who  cooks,  washes,  and  performs  every  menial  drudgery 
for  massa,  in  health,  besides  becoming  an  invaluable  nurse  when  he 
is  overtaken  by  sickness. 

Under  the  privation  of  these  advantages,  can  we  wonder  at  the  ef- 
fects, which  exposure  to  all  those  causes,  described  as  operating  in 
Bengal,  must  produce  on  the  full,  plethoric  habit  of  an  Englishman, 
only  four  or  five  weeks  from  his  native  skies,  before  he  debarks  on 
the  burning  shores,  or  insalubrious  swamps  and  vallies  of  our  western 
colonies. 

The  more  prominent  distinctive  features  of  the  transatlantic  fever, 
yellow  skin  and  black  vomit,  [though  by  the  bye  they  are  frequently 
absent  in  this,  and  present  in  the  eastern  fever,]  may  I  think  be  at- 
tributed to  the  more  violent  action  in  the  hepatic  system,  and  super- 
abundant secretion  of  vitiated  bile,  which,  by  the  ceaseless  vomiting, 
is  thrown  out  in  deluges  on  the  duodenum  and  stomach,  deranging 
their  structure,  while  regt  rgitation  into  the  blood  suffuses  the  skin. 
"  On  the  first  and  second  days  of  the  disorder,"  says  Dr.  Rush, 
"  many  patients  puked  from  half  a  pint  to  nearly  a  quart,  of  green 
or  yellow  bile.  Four  cases  came  under  my  notice,  in  which  black 
bile  was  discharged  on  the  first  day.  Three  of  these  cases  re- 
covered. I  ascribed  their  recovery  to  the  bile  not  having  yet  ac- 
quired acrimony  enough  to  inflame  or  corrode  the  stomach.  There 
was  frequently,  on  the  fourth  or  fifth  day,  a  discharge  of  matter  from 
the  stomach,  like  the  grounds  of  coffee.  I  believed  it  first  to  be  a 
modification  of  vitiated  bile,  but  I  was  led  afterwards  to  suspect  that 
it  was  produced  by  a  morbid  secretion  in  the  liver,  and  effused  from  it 

into  the  stomach/' >*  That  the  bile  may  become  extremely  acrid 

in  this  stage  of  the  disorder,  is  evident  from  several  observations  and 
experiments.  Dr.  f'hysick's  hand  was  inflamed  in  consequence  of 
its  being  wetted  by  bile  in  this  state,  in  dissecting  a  body.*'  p.  54.  "  I 
am  not  certain  that  the  black  matter  which  was  discharged  in  the  last 
stage  of  the  disorder  was  always  vitiated  or  acrid  bile.  It  was  pro- 
bably, in  some  cases,  the  matter  which  was  formed  in  consequence  of 
the  mortification  of  the  stomach."  p.  56. 

In  respect  to  the  yellow  colour,  Dr.  Rush  is  fully  convinced  that 


72  UASTBRN  HKMI6PHERE. 

it  is  attributable  to  bile.  "  From  these  facts  it  is  evident,'5  says  he, 
"  that  the  yellowness,  in  all  cases,  was  the  effect  of  an  absorption 
and  mixture  of  the  bile  with  the  blood."  p.  70. — Vide  Hunter  and 
Bancroft. 

It  is  not  meant  lo  infer  from  hence,  that  the  febrific  miasms  are 
exaclly  the  same  in  the  east  and  in  the  west  ;  experience  proves  the 
contrary,  as  will  be  shown  in  the  Section  on  Batavian  endemic.  I 
only  mean  to  *ay,  that  the  expression  of  their  effects,  on  the  biliary 
organs  in  particular,  may  be  considerably  modified  by  the  circum- 
stances above  detailed.  Neither  do  I  suppose  that  in  the  last  stages 
of  black  vomit,  the  matter  ejected  is  bilious  ;  but  I  am  confident  that 
the  gastric  derangement  is  in  a  great  measure  occasioned  by  the  de- 
luges of  acrid,  vitiated  bile,  poured  from  the  liver  on  the  stomach, 
during  the  vomiting  in  the  early  stages  of  the  disease.*  Hence,  to 
check  the  gastric  irritability  early,  is  a  most  desirable  object. 

The  stomachs  of  newly  arrived  Europeans  in  the  west  will,  for  the 
reasons  detailed  above,  be  much  more  liable  also  to  take  en  inflam- 
matory action.  This,  and  the  more  violent  orgasm  in  the  hepatic 
system,  appear  to  be  the  principal  distinctive  features  in  which  the 
fevers  of  the  two  hemispheres  differ  ;  and  are,  I  think,  referrible  to 
the  aforesaid  causes.  These  considerations  also  account  for  the 
more  decisive  system  of  depletion  which  is  necessary  in  the  western 
endemic  ;  and  for  the  inutility  of  mercury  till  the  inflammatory  ac- 
tion is  completely  controlled.  In  the  eastern  hemisphere,  on  the 
other  hand,  where  the  biliary  apparatus  is  very  generally  in  a  state 
of  derangement,  anterior  to  febrile  attacks,  the  union  of  mercury 
with  venesection  is  a  rational  measure. 

In  respect  to  the  yellow  colour,  in  the  highly  concentrated  endemic 
fever  of  the  western  world,  there  is  reason  to  doubt  its  cause  being 
a  simply  bilious  suffusion.  It  would  almost  appear  to  be  a  broken 
down  state  of  the  blood — or  a  stagnation  in  the  capillary  system,  such 
as  we  see  after  contusions. 

A  practical  point  of  much  importance  remains  to  be  noticed  ; 
namely,  whether  or  not  the  fevers  in  question  are  contagious.  It  id 
lamentable  to  observe  the  discordance  of  medical  opinions  on  a  ques- 
tion that,  at  first  sight,  might  seem  so  easily  determined.  Thus, 
Clurke,  Liad,  Balfour,  Chisliolm,  Blane,  and  Pym,  are  positive  in 
the  alhrraative  ;  while,  on  the  other  hand.  Hunter,  Jackson,  Mose- 
ley,  Miller,  Bancroft,  and  Burnett,  are  as  decided  in  the  negative  ! 

Yet  here,  as  iu  most  other  instances,  truth  lies  between  the  ex- 
tremes. As  far  as  tny  own  observations  and  judgment  could  guide 
me,  I  have  been  led  to  conclude,  that  the  endemic  fevers  alluded  to. 
are  not  contagious,  till  a  certain  number  of  patients  are  confined  to- 
gether, under  peculiar  circumstances,  when  the  effluvia  may  render 

*  The  above  observations  are  confirmed  by  the  dissections  of  Dr.  Ramsay,  at 
Bellevue  Hospital,  in  1803.  (Vide  Edxub.  Med.  and  Surg.  Jour.  No.  xxxii,  page 
423.)  He  traced,  in  numerous  instances,  the  black  vomit  to  the  gall-bladder  and 
hepatic  ducts  ;  and  to  this  acrid  discharge  he  attributes,  in  a  great  degree,  the 
derangement  in  the  stomach  and  bowels,  which  giv«  rise  to  the  bloody  vomit  sub- 
sequently. 


ENDEMIC  OF  BENGAL.  73 

them  so.  If,  for  instance,  a  man  is  seized  with  fever,  from  greater 
predisposition,  or  from  greater  exposure  to  ihe  causes  enumerated, 
than  his  companions,  he  will  not  communicate  the  disease  to  another, 
who  may  sleep  even  in  the  same  chnmber,  where  common  cleanli- 
ness is  observed.  But  on  the  other  hand,  if  great  numbers  are  at- 
tacked, nearly  at  the  same  time,  and  confined  in  the  sick  birth  of  a 
ship  or  ill  ventilated  apartments,  in  hammocks,  cots,  or  filthy  beds,  it 
is  possible  that  a  contagious  atmosphere  may  be  formed,  [without  an 
attention  to  cleanliness  and  ventilation,  scarcely  compatible,  or  at 
least  hardly  to  be  expected,  in  such  situations,]  which  spreads  a  dis- 
ease wearing  the  livery  of  the  prevailing  endemic,  but  having  a  dan- 
gerous character  superadded,  namely,  the  power  of  reproducing  it- 
self in  other  subjects,  both  independent  of,  and  in  conjunction  with, 
the  original  endemical  causes.*  This  circumstance  reconciles  the 
jarring  evidences  which  have  long  kept  the  public  opinion  in  sus- 
pense. It  has  been  urged,  that  we  ought  to  err  on  the  safe  side,  by 
considering  it  contagious,  and  guarding  accordingly  by  early  separa- 
tion. But  this  plan  is  not  without  its  disadvantages,  and,  if  I  am  not 
greatly  mistaken,  1  have  seen  it  produce  what  it  was  meant  to  pre- 
vent ;  viz.  by  confining  all  who  had  any  symptoms  of  the  fever  in 
one  place  ;  where,  as  on  board  a  ship  in  a  tropical,  or  any  climate,  it 
is  exceedingly  difficult,  if  not  impossible,  to  prevent  the  generation  of 
an  infectious  atmosphere,  and  the  impregnation  of  bed-clothes,  &c. 
with  the  effluvia  from  the  diseased  secretions  and  excretions  of  the 
patients.  On  the  other  hand,  1  have  seen  both  sides  of  the  main  deck 
nearly  filled  with  fevers  of  the  country,  where  screens  and  other 
means  of  separation  could  not  be  obtained,  or  rather,  were  not  insist- 
ed on,  and  yet  no  bad  effects  followed  ;  while  under  similar  circum- 
stances, where  there  were  fewer  sick,  and  all  imaginable  pains  taken 
to  insulate  them,  attendants  have  been  seized,  and  other  symptoms, 
indicative  of  contagion  and  virulence,  have  arisen,  which,  while  they 
seem  fully  to  justify  the  precautions  used,  were  probably  owing  to 
them  alone.  These  hints  may  not  be  entirely  unworthy  of  attention, 
inasmuch  as  they  show  us  how  easily  we  may  be  deceived,  and  how 
positive  we  may  be  in  our  errors.  They  likewise  show  that  free 
ventilation  and  cleanliness  may  in  general  be  confided  in,  between 
the  tropics,  where  seclusion  is  inconvenient  or  impracticable  ;  and 
that  separation  of  the  sick  from  one  another,  as  far  as  possible,  is  a  duty 
not  less  incumbent,  than  that  of  cutting  off  the  communication  be- 
tween them  and  the  healthy.  There  is  this  advantage  attending  the 
former,  that  alarm  is  in  a  great  measure  hushed,  the  depressing  pas- 
sion of  fear  so  far  obviated. 

Before  taking  leave  of  this  fever,  it  will  be  necessary  to  say  a  few 
words  respecting — 

IWTERMITTENTS. 

In  those  parts  of  India  and  China  bordering  on  the  Northern  tropic, 
when  the  sun  is  in  Capricorn,  and  the  cool  season  sets  in,  viz.  from 
the  middle  of  November,  till  the  middle  or  latter  end  of  February,  fe- 

*  Vide  the  Section  on  bilious  fever,  and  also  what  haa  been  said  respecting  th» 
Corunna  fever  in  the  preceding  Section. 

10 


74  EASTERN  HEMISPHERE. 

vers  change  from  the  remittent  to  the  intermittent  form.  Thus  at 
Bombay,  Calcutta,  and  Canton,  particularly  the  last  mentioned  place, 
we  have  ample  specimens  during  the  above  period  of  agues  and  fluxes 
From  the  Bocca  tigris  up  to  Canton,  the  river  is  flanked  with  exten- 
sive paddy  grounds,  intersected  and  watered  in  all  directions  by  the 
minor  branches  of  the  Taa  and  artificial  canals.  The  surrounding 
country,  however,  is  singularly  mountainous  ;  and  at  this  season,  has 
a  dreary,  wild,  and  bleak  appearance.  From  these  mountains  the 
north-east  monsoon  comes  down  with  a  piercing  coldness,  which  the 
Europeans,  relaxed  and  debilitated  by  the  previous  heats,  or  their 
sojourn  on  the  sultry  coasts  of  Hindostan,  are  quite  unable  to  resist. 
As  the  improvident  mariner  has  seldom  any  European  clothing  in  re- 
serve, adapted  to  this  unexpected  exigency,  especially  if  he  has  been 
any  time  in  India,  we  need  not  wonder  that  in  such  circumstances,  a 
great  number  should  be  afflicted  with  intermittents  and  dysente- 
ries at  this  season.  F;-r  many  weeks,  we  had  seldom  fewer  than 
thirty  or  forty,  often  more  at  one  time  laid  up  with  these  com- 
plaints :  they  were  generally  tertians  with  a  few  quartans.  The 
apyrexia  was  tolerably  clear,  and  the  bark  exhibited  in  the  usual 
way  recommended  for  similar  fevers  in  Europe,  was  a  certain  and 
expeditious  cure,  where  no  visceral  obstructions  existed.  In  the  latter 
case,  which  was  but  too  frequent,  mercury  of  course,  was  an  essential 
auxiliary.  It  is  proper  to  remark,  that  in  two  ships  of  war  lying  at 
the  Bocca  tigris,  [the  Grampus  and  Caroline,]  the  bark  was  entirely 
expended  on  the  great  number  of  intermittents.  In  this  dilemma  we 
had  no  other  resource  than  mercury  ;  and  this  medicine  invariably 
stopt  the  paroxysms  as  soon  as  the  system  was  saturated  ;  but  it  must 
not  be  concealed,  that  three-fourths  of  our  patients,  treated  on  this 
plan,  relapsed  as  soon  as  the  effects  of  the  mercury  had  worn  off, 
and  this  after  three,  and  in  a  few  instances,  four  successive  adminis- 
trations, so  as  to  excite  ptyalism.  I  attributed  these  failures  to  the  cold- 
ness and  rawness  of  the  air,  together  with  the  want  of  proper  clothing 
and  defence  against  this  sudden  transition  from  a  hot  to  a  comparative- 
ly cold  climate  ;  very  unfavourable  circumstances  in  the  mercurial 
treatment.  No  ill  effects,  however,  resulted. 

In  the  month  of  October  the  weather  was  so  warm,  and  the  night 
so  cloudless  and  serene,  with  very  little  dew,  that  many  of  us  slept 
in  the  open  air  at  Lintin,  an  island  about  twenty-five  miles  above 
Macao,  where  we  had  tents  ashore  for  the  sick  and  convalescents, 
as  well  as  the  different  working  parties. 

But  in  November  the  nights  became  exceedingly  cold  ;  and  al- 
though there  was  hardly  any  thing  that  could  be  called  a  swamp  or 
marsh  on  the  islapd,  yet  intermittents  and  fluxes  made  their  appear- 
ance, and  continued  to  increase  during  our  stay,  without  any  very 
apparent  cause,  except  this  sudden  vicissitude  in  the  temperature  of 
the  air. 

There  was  indeed  a  very  high  peak  in  the  centre  of  the  island, 
the  sides  of  which  were  covered  with  thick  grass  jungle,  and  over 
this  the  winds  blew  towards  the  ship  and  tents.  There  can  be  no 
doubt  that  hills  and  mountains  arrest  the  course  of  marsh  miasmata 
through  the  air,  and  when  a  sufficient  quantum  of  these  is  collected, 
they  will  produce  their  effects  on  the  human  frame,  in  a  similar 


ENDEMIC  OP  BENGAL.  7Q 

manner,  as  if  issuing  from  their  original  source ;  especially  when, 
the  predisposing  causes  are  in  great  force.  Hence  we  see  how  mi- 
asmal  fevers  may  take  place  on  the  summit  of  Morne  fortune"  e,  or  the 
rock  of  Gibraltar,  without  any  necesssity  for  the  supposition  that  the 
febrific  exhalation  arose  from  those  places  themselves.  We  next 
moved  up  to  Bocca  tigris,  and  got  into  the  vicinity  of  extensive 
marshy  and  paddy  grounds,  which  contributed  greatly  to  the  aug- 
mentation of  the  sick  list. 

It  is  somewhat  curious,  that  a  frigate,  [the  Dedaigneuse,]  belong- 
ing to  the  squadron,  which  lay  in  the  typa,  near  the  city  of  Macao, 
remained  perfectly  healthy,  while  we  were  so  afflicted  with  the  dis- 
eases above-mentioned.  As  the  crew  of  this  ship,  were  exposed  to 
all  the  causes,  predisposing  and  exciting,  which  could  exist  further 
up  the  river,  it  follows  that  marsh  exhalation  must  have  been  here, 
as  elsewhere,  the  fundamental  remote  cause,  that  gave  origin  to  the 
intermittents.  At  Wampoa,  sickness  was  still  more  predominant 
among  the  Indiamen,  than  at  the  Bogue— -not  so  much  owing  to  any 
great  difference  in  the  medical  topography  of  the  two  places,  as  to 
the  vicinity  of  the  former  to  Canton,  to  which  city  parties  of  the 
last-mentioned  ships'  crews  were  in  the  habit  of  repairing  on  leave, 
to  the  no  small  detriment  of  their  health,  from  the  course  of  intem- 
perance pretty  generally  pursued.  The  great  intercourse,  likewise, 
between  Wampoa  and  Canton  afforded  infinite  facility  to  the  intro- 
duction of  inebriating  materials  among  those  who  remained  on  board. 
The  liquor  retailed  to  seamen  in  China  is  certainly  of  a  very  destruc- 
tive nature.  Its  effects  have  attracted  so  much  attention,  that  when 
his  Majesty's  ships  are  leaving  the  coasts  of  India  for  China,  there 
is  generally  an  order  received  from  the  Admiral,  enjoining  the  offi- 
cers to  guard  as  much  as  possible  against  the  introduction  of 
'*  SAMSOO"  among  the  crews,  which  says  the  order,  «« is  found  to  be 
poison  to  the  human  frame." — It  were  a  consummation  devoutly 
to  be  wished,  could  this  injunction  be  extended  to  the  arrack  of  In- 
dia, from  which  the  sarnsoo  only  differs  in  being  more  impregnated 
with  certain  stimulating  materials  prejudicial  to  the  stomach  and 
bowels. 

The  ordinary  mode  of  preparing  Samsoo  is  as  follows  : — "  The 
rice  is  kept  in  hot  water  till  the  grains  are  swollen  ;  it  is  then  mix- 
ed up  with  water,  in  which  has  been  dissolved  a  preparation  called 
'  Pe-kckJ  consisting  of  rice-flour,  liquorice-root,  aniseed,  and  garlic. 
This  hastens  fermentation,  and  imparts  to  the  liquor  a  peculiar  fla- 
vour." It  is  probable,  however,  that  other  more  active  ingredients 
are  added  to  that  in  use  among  the  lower  classes  at  Canton.  Bontius, 
speaking  of  the  dysentery  at  Batavia,  alleges,  as  "  the  principal  cause 
of  this  disease,  the  drinking  an  inflammatory  liquor  called  arrack, 
which  the  Chinese  make  of  rice,  and  the  holoihuria,  or  what  is  called, 
quabbin  in  Holland.  These  hoiothuria  have  so  pungent  a  heat,  that 
the  touch  of  them  ulcerates  the  skin  and  raises  vesicles."  p,  16.  He 
adds  a  pathetic  remark.  "  Happy  were  it  for  our  sailors,  that  they 
drank  more  moderately  of  this  liquor  ;  the  plains  of  India  would  not 
then  be  protuberant  with  the  innumerable  graves  of  the  dead  I"  The 
same  remark  might  be  with  strict  propriety  applied  to  the  arrack  o* 


76  EASTERN    HEMISPHERE. 

India  in  general,  where,  as  at  Bombay  for  instance,  its  pernicious  ef- 
fects are  equally  conspicuous  as  at  Batavia. 

It  may  at  first  sight  appear  singular,  that  mountainous  countries  co- 
yered  with  lofty  woods,  or  thick  jungles,  should  give  rise  to  fevers, 
similar  in  every  respect  to  those  of  flat  and  marshy  districts.  But 
the  reason  is  obvious,  when  we  consider  that  in  the  first-mentioned 
situations  the  surface  of  the  earth  is  constantly  strewed,  particularly 
in  autumn,  with  vegeto-animal  remains,  and  kept  in  a  moist  state  by 
the  rains  or  drippings  of  dews  from  the  superincumbent  foliage.  The 
stratum  of  atmosphere,  therefore,  in  contact  with  the  ground,  be- 
comes highly  impregnated  \rith  effluvia,  which  are  seldom  agitated  by 
breezes,  or  rarefied  by  the  rays  of  the  sun ;  either  of  which  would 
tend  to  dissipate  the  exhalations.  Thus,  among  the  lofty  forests  arid 
impenetrable  jungles  of  Ceylon,  the  most  powerful  miasmata  are  en- 
gendered, producing  fevers  of  great  violence  and  danger.  "  It  is  un- 
der the  branches  of  these  shrubs,"  [in  Ceylon,"]  says  Lord  Valentia, 
"  that  the  fatal  jungle  fever  is  probably  generated.  Not  a  breath  of 
air  can  pass  through  ;  and  the  confined  exhalations  from  the  black 
vegetable  mud,  loaded  with  putrid  effluvia  of  all  kinds,  must  acquire 
a  highly  deleterious  quality,  affecting  both  the  air  and  the  water." 
Travels,  vol.  2. 

Generally  speaking,  however,  these  hill,  or  jungle  fevers,  as  the}' 
are  locally  designated,  appear  in  the  form  of  intermittents,  especially 
among  the  natives,  and  those  Europeans,  whose  constitutions  are  as- 
similated to  the  climate.  Unfortunately,  among  the  latter  class  these 
fevers  either  soon  produce,  or  are  accompanied  by,  visceral  ob- 
structions, too  frequently  terminating  in  confirmed  hepatitis  ;'  hence 
the  necessity  of  checking  them  as  soon  as  possible,  and  of  using  all 
imaginable  precaution  in  guarding  against  the  remote  and  predispos- 
ing causes.  The  treatment,  of  course,  must  vary,  from  a  simple  ad- 
ministration of  bark,  to  its  combination  with  mercury,  or  the  exhibi- 
tion of  the  latter  alone,  so  as  to  keep  up  a  gentle  ptyalism  for  some 
considerable  time.  In  these  elevated  situations,  far  from  seas,  or  even 
rivers,  and  entirely  out  of  the  reach  of  tides,  the  influence  of  the 
moon  is  unequivocally  evinced. 

"  It  is  by  no  means  uncommon,"  says  Captain  Williamson, "  to  see 
persons,  especially  Europeans,  who  have  to  appearance  been  cured 
of  jungle  or  hill  fevers,  as  they  are  called,  and  which  correspond 
exactly  with  our  marsh  fever,  laid  up  at  either  the  full  or  change 
of  the  moon,  or  possibly  at  both,  forbears  after."  This  from  a  non- 
professional  gentleman,  is  another  proof  of  the  sandy  foundation  on 
which  Dr.  Lind's  hypothesis,  before  alluded  to,  rests  ;  and  of  the 
truth  of  Dr.  Balfour's  observations. 


v 

Analytical  Re-view  of  a  Medical  Report  on  the  Epidemic  Fever  o/Coim 
batore,  drawn  up  by  Drs.  Ainsly,  Smith,  and  Christie. 

Sec.  III. — An  epidemic,    spreading  its  ravages  from  Cape  Comor 
ifk  to  the  banks  of  the  Cavery— from  the  Ghauts  to  the  coast  of    Coro 


COIMBATORK  FEVER.  .  77 

mandel,  and  sweeping  to  the  grave  106,789  persons,  presented  a  no- 
ble field  for  investigation — an  unbounded  theatre  for  the  acquisition 
of  medical  knowledge  !  But  as  the  richness  of  the  soil  sometimes 
renders  indolent  the  cultivator  ;  so  a  stunted  harvest  has  been  gather- 
ed from  this  most  luxuriant  field  of  medical  science. 

1.  Causes. — Since  the  time  of  Hippocrates,  atmospheric  vicissi- 
tudes have  been  deemed  insalutary  ;  and  Hoffman  set  them  down  as  the 
general  remote  causes  of  epidemic  fever. — The  committee  believe  that 
JSydenham's  "  Secret  Constitution  of  the  j9«Y,"  is  as  good  an  explanation 
as  can  be  given.  We  shall  not  stop  here  to  discuss  the  point.  They 
justly  remark,  that  an  erroneous  opinion  has  prevailed,  that  marsh 
miasmata  can  only  be  engendered  in  low  swampy  situations,  "  though 
it  is  well  known  that  noxious  vapours  from  woods,  especially  if  thick 
and  ill  ventilated,  are  as  certainly  a  source  of  the  same  mischief.'* 
This  second  source  was  very  abundant  in  several  of  the  ravaged  pro- 
vinces, many  parts  being  so  covered  with  wood,  jungle,  and  rank  ve- 
getation, as  to  be  nearly  impervious.  Another  supposed  origin  of  fe- 
brific  miasmata  was  in  the  salt  marshes  found  in  the  Tinnevelly  and 
Ramnad  districts,  where  the  fever  raged  with  uncommon  severity.  The 
committee  are  of  opinion,  that  marshy  situations  are  not  sufficient  to 
render  fevers  epidemic  ;  there  is  required  the  super-agency  of  a  close, 
moist,  and  sultry  heat,  with  imperfect  ventilation.  Such  an  offensive 
condition  of  the  atmosphere  was  but  too  often  experienced  in  several 
of  the  low  tracts  of  these  districts  during  the  sickly  season,  and  was 
pregnant  with  the  most  baleful  consequences.  Although  great  devi- 
ations from  the  natural  order  of  climate  are,  fortunately,  not  very 
frequent  in  these  regions,  yet,  as  in  the  present  instance,  they  do 
sometimes  take  place  ;  and  are  always  followed  by  disastrous  results. 
Major  Orme  informs  us,  that  in  the  month  of  March  the  S.  W.  mon- 
soon broke  completely  over  the  western  Ghauts,  and  descended  in  vast 
floods  over  the  Coromandel  side  of  the  Peninsula,  destroying  crops 
just  ready  to  be  cut,  sweeping  away  many  of  the  inhabitants,  and  ulti- 
mately, by  creating  a  powerful  evaporation  during  a  sultry  heat,  pro- 
ducing an  epidemic  disease  very  fatal  in  its  consequences. 

The  effects  of  those  miasmata  engendered  amongst  woods  and  jun- 
gles, have  been  too  well  authenticated  to  require  additional  testimo- 
ny. As  electricity  has  been  said  to  promote  putrefaction  in  animal 
bodies,  the  committee  query  how  far  this  fluid,  which  was  very  abund- 
ant in  the  atmosphere  during  the  sickly  seasons,  may  not  have  assist- 
ed in  producing  a  distempered  state  of  the  air.  I  think  this  is  a  very 
questionable  cause  of  epidemia. 

The  predisposing  causes  of  remittent  and  intermittent  fevers  are 
well  known  to  be  those  which  operate  by  producing  debility,  as  bad 
diet,  fatigue,  exposure  to  cold  and  damp,  grief,  mental  anxiety,  &c. 
This  is  illustrated  by  a  remarkable  exemption  from  disease  among  the 
troops  stationed  at  Madura,  while  the  poor  inhabitants  of  the  garrison 
were  swept  off  by  sickness.  The  same  was  observed  at  Dindigul, 
where  two  deaths  only  occurred  among  three  companies  of  troops, 
while  the  needy  inhabitants  of  the  town  were  dying  by  hundreds. 
.  Of  the  exciting  causes",  the  committee  considered  exposure  to  cold 


7ft  EASTERN  HEMISPHERE. 

and  damp,  while  the  body  had  been  relaxed  by  preceding  heat,  and 
the  solar  influence,  as  the  most  powerful. 

"  The  heat  of  the  early  part  of  the  nights,  induced  many  of  the 
natives  to  sleep  in  the  open  air,  by  which  means  they  became  exposed, 
while  yet  perspiring,  to  the  chill  fogs  and  damps  of  the  morning."  p. 
116. 

2.  Mature  and  Types  of  the  Endemic. — /This  fatal  fever  did  not 
differ  essentially  from  the  common  endemic  of  the  country.  Its  epi- 
demic tendency  on  the  present  occasion,  was  altogether  ascribable  to 
the  causes  enumerated  in  the  preceding  section.  It  is  either  remit- 
tent or  intermittent,  according  to  the  constitution,  treatment,  and  sea- 
son of  the  year.  People  by  nature  delicate  and  irritable,  or  rendered 
so  by  irregularities,  or  want  of  care,  are  sometimes  attacked  by  the 
disease  in  the  remittent  form,  proving  bilious  or  nervous,  as  the  con- 
stitution inclines.  The  same  happens  to  the  more  robust,  when  im- 
properly treated,  as  where  bark  is  given  early,  and  before  proper 
evacuations  have  been  premised.  As  the  season  becomes  hotter, 
too,  the  remitting  form  prevails  over  the  intermittent.  Males  suf- 
fered more  than  females,  and  young  people  and  those  of  middle  age, 
more  than  old  people  and  children.  The  remittent  form  sometimes 
makes  its  approaches  very  insidiously.  The  patient  feels  himself 
out  of  sorts  for  a  few  days  ;  his  appetite  fails  him  ;  he  has  squeam- 
ishness,  especially  at  the  sight  of  animal  food  ;  universal  lassitude  ; 
alternate  heats  and  chills ;  stupid  heaviness,  if  not  pain  in  the  head. 
The  eyes  are  clouded  ;  the  ears  ring  ;  the  bowels  are  invariably 
costive.  In  other  cases,  the  enemy  approaches  rapidly  ;  and  rigors, 
great  prostration  of  strength,  vertigo,  nausea,  or  vomiting,  usher  in 
the  disease. 

The  first  paroxysm,  which  is  often  attended  with  delirium  and  epis- 
tgxis,  after  continuing  an  indefinite  period,  with  varying  symptoms, 
terminates  in  a  sweat ;  not  profuse  and  fluent,  as  after  a  regular  hot 
fit  of  ague,  but  clammy  and  partial,  with  the  effect,  however,  of  low- 
ering the  pulse,  and  cooling  the  body,  but  not  to  the  natural  standard. 
The  latter  still  feels  dry  and  uncomfortable  ;  the  pulse  continuing 
smaller  and  quicker  than  it  ought.  This  remission  will  not  be  of 
long  standing,  without  proper  remedial  measures.  A  more  severe 
paroxysm  soon  ensues,  ushered  in  by  vomiting,  (sometimes  of  bile,) 
and  quickly  followed  by  excessive  heat  ;  delirium  ;  great  thirst  ; 
difficult  respiration;  febrile  anxiety  ;  parched  and  brownish  tongue. 
The  next  remission,  (if  it  do  take  place,)  is  less  perfect  than  the  first, 
and  brings  still  less  relief.  In  this  way,  if  medicine,  or  a  spontaneous 
purging  do  not  check  the  disease,  it  will  run  its  fatal  course,  each 
succeeding  attack  proving  worse  than  its  predecessor,  till  exhausted 
nature  begins  to  give  way.  The  pulse  declines  ;  the  countenance 
shrinks,  and  looks  sallow  ;  the  eyes  become  dim  ;  "  the  abdomen 
swells  from  visceral  congestion:'1  the  stomach  loathes  all  food,  when 
hiccup,  stupor,  and  low  delirium  usher  in  death.  Such  severe  cases, 
the  committee  think,  were,  in  general  owing  to  neglect  or  blunders 
at  the  beginning  of  the  disease. 

Intermittent   were  more  intractable,  as  -well  as  more  common. 
The  epidemic  was  void  of  any  contagious  character,  except  in  cases 


C01MBATORE    FEVE$U  79 

that  were  allowed  to  run  into  the  low  continued  form  ;  and  even  here, ' 
the  contagion  was  circumscribed  within  very  narroxv  limits.  The 
types  were,  the  simple  tertian,  the  double  tertian,  the  quotidian,  the 
quartan,  and  the  irregular.  The  following  will  give  some  idea  of 
the  relative  numbers  of  these  forms. — A  native  detachment  at 
Dindigul,  255  strong,  suffered  in  the  following  proportion  :  simp, 
tert.  30;  doub.  tert.  26;  irreg.  24  ;  quotid.  13;  quart.  4.  The 
quotidian  form  was  well  marked,  returning  at  nearly  equal  pe- 
riods, often  attacking  weak  constitutions,  and  leaving  but  little  time 
for  taking  the  bark.  It  was  more  apt  to  occasion  visceral  obstruc- 
tions and  oedematus  swellings  than  any  other  form  of  the  disease. 
The  quartan  was  rare,  but  obstinate,  and  frequently  productive  of 
splenic  obstruction  and  dropsy.  The  irregular  was  very  trouble- 
some, and  seemed  to  correspond  with  Hoffman's  semi-tertian. 

The  Tamool,  or  native  practitioners,  ascribe  the  epidemic  fever 
chiefly  to  two  causes — a  superabundance  of  moisture  in  the  air  and 
earth,  and  the  bad  quality  of  the  water  owing  to  unwholesome  so- 
lutions. We  think  there  is  much  truth  in  their  opinions,  and  have 
had  reason  to  believe  ourselves,  that  the  water,  as  well  as  the  air, 
becomes  impregnated  with  morbific  miasmata. 

Treatment. — On  the  first  appearance  of  the  epidemic,  no  time  was 
lost  in  clearing  out  the  bowels  by  brisk  purgatives  ;  and  soon  after 
the  medicine  had  ceased  to  operate,  the  cinchona  was  prescribed,  ob- 
serving this  rule  respecting  it,  that,  the  nearer  the  time  of  giving  the 
last  dose  of  bark  for  the  day  is  brought  to  the  period  of  attack  ef  the 
cold  stage,  the  more  likely  will  it  be  to  accomplish  the  purpose  in- 
tended.— From  six  to  eight  drachms  of  the  fresh  powdered  bark, 
taken  in  substance,  were  commonly  sufficient  to  keep  off  a  fit,  espe- 
cially if  given  in  the  four  or  five  hours  preceding  the  paroxysm. 
Some  of  the  native  stomachs  could  not  bear  the  powder,  unless  mixed 
with  ginger,  or  given  in  infusion  or  decoction,  with  tinct.  cinchona?, 
and  conf.  aromat.  As  the  bark  sometimes  constipated,  a  few  grains 
of  rhubarb  were  added,  or  laxative  glysters  used.  Thirty  or  forty 
drops  of  laudanum,  with  half  an  ounce  of  the  acetate  of  ammonia, 
given  at  the  commencement  of  the  hot  fit,  often  had  the  effect  of 
shortening  it,  sustaining  the  strength,  and  rendering  the  stomach  re- 
tentive. When  the  perspiration  begins  to  flow,  the  drink  ought  to 
be  tepid  ;  but  when  the  body  is  hot  and  the  skin  dry,  cold  water  is 
both  grateful  and  salutary.  The  bark  must  be  continued  for  some 
time  after  the  fever  disappears,  to  prevent  recurrence.  The  com- 
mittee, as  was  to  be  expected  from  the  schools  of  debility  and  putres- 
cency  in  which  they  were  educated,  declaimed  against  purgatives  in 
this  fever,  "  lest  they  be  productive  of  mischief,  by  occasioning  irri- 
tation, debility,  and  ultimately  an  obstinate  disease — mindful  of  the  les- 
son that  was  taught  them  in  early  life,  by  the  writings  of  the  judicious 
Hoffman,"  &c.  I  quote  this  passage,  not  to  say  that  I  think  drastic 
purgatives  necessary  in  the  simple  form  of  intermittent,  for  I  know 
that  they  are  unnecessary,  and  sometimes  hurtful  ;  but  to  show  that 
the  committee  were  disciples  of  Hoffman  and  of  Spasm. 

When  the  fever,  as  too  often  happened,  ran  its  course  some  days 
unchecked  by  medicine,  then  the  case  was  altered,  for  abdominal 


60  EASTERN  HEMISPHERE. 

congestion  and  visceral  obstruction  soon  took  place,  and  a  dangerous 
state  of  the  disease  was  induced.  In  these  distressing  circumstances,* 
change  of  climate  was  necessary,  and  a  course  of  calomel.  When 
the  mouth  became  affected,  some  of  the  most  unpleasant  symptoms 
disappeared,  and  then  the  bark  was  administered  with  more  safety. 

The  committee  not  unfrequently  met  with  obstinate  intermitterits, 
unaccompanied  apparently  by  visceral  obstruction,  in  which  bark 
was  unavailing.  They  sometimes  tried  with  success  sulphuric 
aether  in  doses  of  one  drachm  and  a  half,  taken  at  the  approach  of 
the  cold  fit  ;  and  also  full  doses  of  laudanum.  The  sulphate  of  zinc 
did  not  answer.  The  Hindoo  practitioners  have  used  arsenic  in  in- 
termittent fevers  time  immemorial,  and  entertain  a  high  opinion  of 
its  virtues  ;  but  the  committee  do  not  approve  of  it  much,  though  it 
sometimes  succeeded  when  all  other  remedies  had  failed.  The  cold 
affusion  was  useful  in  the  hot  fits  ;  nay,  daily  immersion  in  the  sea 
sometimes  proved  the  happy  means  of  checking  agues  which  had 
baffled  every  other  exertion.  A  blister  to  the  nape  of  the  neck  will 
sometimes  check  the  recurrence  of  the  cold  fit.  A  full  doee  of  the 
tinct.  rhei  et  aloes,  at  bed-time,  was  found  by  Mr.  Tait,  of  Trichino- 
poly,  to  stop  agues  that  resisted  every  other  remedy.  Notwithstand- 
ing all  our  endeavours,  the  disease  will  sometimes  run  on  to  coma 
and  death. 

"  In  such  cases  calomel  or  the  blue  pill,  continued  till  the  mouth 
is  a  little  affected,  even  when  no  obstruction  has  taken  place,  is  often 
found  to  be  of  the  greatest  service."  145. 

On  this  I  shall  make  no  comment  ;  the  fact  speaks  for  itself. 
Alarming  bowel  complaints  sometimes  supervene  on  long  protracted 
intermittents  ;  not  attended  with  much  straining,  but  of  an  obstinate 
and  debilitating  nature,  requiring  opiates,  weak  cretaceous  mixtures, 
and  aromatics.  They  too  often  prove  fatal,  especially  among  the 
natives. 

CEdematous  swellings  and  ascites  not  unfrequently  superveneTrom 
pure  debility.  These,  where  no  visceral  obstruction  prevailed,  were 
best  treated  by  tincture  of  squills,  ginger,  and  tinct.  cinchonas,  to- 
gether with  frequent  friction  with  dry  flannel,  and  proper  attention 
to  the  ingesta.  But  when  the  bowels  were  firm,  and  there  was  any 
suspicion  of  organic  derangement  in  the  abdomen,  calomel  in  small 
doses  was  conjoined  with  the  squills  ;  or  what  answered  better,  the 
pilula  hydrargyri. 

This  fever  coming  on  patients  who  had  previously  suffered  from 
liver  affections  or  dysentery,  assumed  an  alarming  and  complex  form, 
requiring  the  nicest  management.  Bark  was  here  to  be  used  with 
great  caution.  Even  the  infusion  and  decoction  were  dangerous, 
where  there  was  any  pain  or  uneasiness  in  the  right  side.  A  blister, 
without  loss  of  time,  was  then  applied,  and  mercury  had  recourse 
to. — R.  Pil.  hydrargyri  gr.  vj  ;  pulv.  ipecac,  gr.  iij.  opii.  gr.  fs  ;  fiant 
pilulae  tres.  Sumatur  una  ter  die  ;  resuming  the  use  of  the  cin- 
chona as  the  hepatic  symptoms  subside.  Sometimes  the  two  reme- 
dies were  combined,  where  the  hepatic  affection  was  chronic  and 
not  very  obtrusive.  An  issue  in  the  right  side,  with  bitters  and 
tonics,  often  proved  serviceable.  Change  of  air  was  superior  to  all 


C01MBATOKE   FEVER.  81 

other  means,  and  diet  of  course  required  constant  attention.  Gentle 
exercise  ;  flannel  next  the  skin,  especially  where  hepatic  affections 
existed  ;  and  the  most  scrupulous  attention  to  the  state  of  the  bowels. 

When,  from  the  appearance  of  the  symptoms,  a  fever  of  the  re- 
mittent kind  is  approaching,  emetics  are  improper  ;  in  this  case,  the 
committee  recommended  six  grains  of  calomel  and  six  of  James's 
powder  to  be  taken  in  the  course  of  12  hours,  which  will  generally 
produce  copious  evacuations,  and  sometimes  diaphoresis. 

t(  On  the  second  day,  when  the  paroxysm  will,  in  many  cases,  be 
found  every  way  more  severe  than  on  the  first,  no  time  is  to  be  lost 
in  having  recourse  to  mercury,  the  remedy  which,  at  such  times,  can 
best  be  relied  on  for  producing  a  proper  intermission.  Seven  or  eight 
grains  of  calomel,  with  three  grains  of  camphor,  are  to  be  well 
rubbed  together,  and  made  into  four  pills,  one  of  which  is  to  be  taken 
every  three  hours  during  the  day.  These  will  often  have  the  de- 
sired effect,  if  continued  for  two  or  three  days,  by  producing  a  de- 
sirable change  in  the  habit,  and  so  favourable  a  remission,  that  the 
bark  may  be  given  with  safety."  154. 

If  this  be  not  a  decisive  evidence  in  favour  of  the  anti-febrile 
powers  of  mercury  on  the  constitution,  I  know  not  what  evidence 
would  carry  conviction  to  the  minds  of  the  declaimers  against  that 
medicine.  It  is  the  more  satisfactory,  as  it  comes  from  the  anti-mer- 
curial party  themselves,  surrounded  with  the  prejudices  of  debility 
and  putrescency. 

The  principal  native  remedies  employed  by  the  Tamool  practi- 
tioners were,  white  arsenic,  about  the  15th  part  of  a  grain,  twice  a 
day  ;  the  barks  of  the  Swietenia  febrifuga  and  melia  Azadirachta  ; 
the  Catcaranja  nut  ;  the  Chukkoo,  (Amom.  Zingib.)  ;  the  Sisori  Am- 
mi ;  bark  of  the  Acacia  Arabica,  and  Tellicherry  bark. 

We  have  lately  heard  it  urged,  that  the  causes  of  intermittent  and 
remittent  fevers  must  necessarily  be  sought  in  low  and  marshy  situa- 
tions ;  whereas  the  testimony  of  unquestionable  writers,  and  this 
document  particularly,  proves,  that  febrific  miasmata  may  rise,  un- 
der certain  conditions,  from  almost  any  soil  ;  and  \vhat  is  still  more 
extraordinary,  that  these  febrific  miasmata  may  be  carried,  by  cur- 
rents of  air,  to  a  distance  far  exceeding  ivhat  has  been  laid  down  by 
some  most  respectable  writers  on  the  subject.  This  epidemic  of 
India  spread  its  poisonous  breath  from  South  to  North,  in  the  direc- 
tion of  the  monsoon,  and  WAS  confidently  believed  by  the  natives  to 
have  its  sources  in  the  Pylney  mountains,  whose  overgrown  woods, 
unventilated  vallies,  and  stagnant  marshes,  could  not  fail  to  engender 
a  more,  rapidly  dangerous  condition  of  the  atmosphere,  than  that 
brought  about  by  the  same  general  causes  on  the  drier  and  less 
woody  plains  of  the  eastern  ranges  of  the  Peninsula. 

The  observations  of  th«  committee  are  corroborated  by  the  testi- 
mony of  others,  particularly  Zimmerman  and  Jackson. 

44  Fevers  of  this  sort,  (says  the  latter,)  arise  in  particular  coun- 
tries, or  districts  of  a  country.  They  travel  in  certain  tracts  :  some- 
times confined  to  narrow  bounds  ;  at  other  times  they  are  more  wide  - 

H 


82  EASTERN    HEMISPHERE. 

]y  diffused." — Medical  Dep.  Brit.  Army,  p.  212.     See  also  Zimmer- 
man's "  Experience,"  vol.  ii.  p.  165. 

It  is  greatly  to  be  lamented,  that  some  of  the  energetic  modes  of 
treatment  lately  introduced  into  the  tnetkodus  medendi  of  fever  had 
not  been  tried  in  the  remittent  forms  of  the  eastern  epidemic.  It 
does  not  appear  that  a  lancet  was  wet  in  any  part  of  the  epidemic 
range  from  Cape  Comoriri  to  the  Cavery  ;  and  therefore  it  is  in  vain 
for  our  Oriental  brethren  to  say  that  it  would  not  have  been  useful, 
when  they  never  gave  it  a  trial.  The  evidence,  however,  in  favour 
of  MERCURY  is  most  unequivocal,  and  will  probably  silence,  if  any 
thing  can,  the  clamour  which  has  been  raised  against  it  in  this  coun- 
try. 


Observations  on  the  Fever  prevalent  in  the  province  of  Guzzerat,  with 
general  remarks  on  the  action  of  Mercury  in  the  diseases  of  India. 
By  A.  GIBSON,  Bombay  Medical  Department. 

SEC.  IV. — It  is  now  pretty  generally  known,  that,  in  the  fevers  of 
India,  mercury  alone  is  to  be  relied  on  in  the  early  treatment,  to 
obviate  immediate  danger. — It  may  be  supposed  to  have  three  modes 
of  action  :  1st,  On  the  hepatic  system  ;  2e%,  On  the  intestinal  canal  ; 
3dly,  On  the  general  constitution. — Probably  all  these  modes  of  ac- 
tion are  essential  to  a  perfect  cure  ;  and  if  either  is  deficient,  the 
certain  consequence  is  death,  or  chronic  obstructions,  which  only 
yield,  if  ever,  to  a  change  of  climate. 

Is?,  If  the  liver  is  not  acted  on,  it  must,  from  the  determination  of 
blood  to  it,  during  the  increased  febrile  action,  be  in  great  danger  of 
being  disorganized,  or  of  its  penicilli  becoming  consolidated,  as  a  ter- 
mination of  the  inflammatory  state. 

%dly,  If  the  bowels  are  torpid  and  constipated,  the  liver  will  still 
be  in  the  same  danger  ;  for  though  it  may  be  pervious  and  active 
enough  to  eliminate  bile-  from  the  blood  sent  to  it  in  the  healthy  state, 
and  in  the  moderate  action  of  the  system,  yet  during  the  continued 
accessions  of  fever,  it  may  be  overpowered  by  the  increased  sangui- 
neous afflux,  which  must  either  augment,  or  continue  stationary,  as 
long  as  the  alimentary  canal  refuses  to  be  moved  by  such  means  as 
would  reduce  or  abate  the  volume  of  circulating  fluid. 

3dly<  I  have  commonly  observed  the  cure  to  be  incomplete,  unless 
the  general  constitution  was  affected  ;  for  such  is  the  type  which  the 
fever  very  frequently  assumes,  that,  unless  counteraction  is  excited 
in  the  system,  by  the  specific  power  of  mercury,  the  healthy  state  both 
of  the  liver  and  bowel*  is  inadequate  to  a  cure  ;  the  paroxysms  become 
continued  ;  the  febrile  state  is  established,  and  in  progress  of  time  ir- 
remediable debility  follows, 

The  species  of  fever,  which  I  have  seen  prevailing  in  the  province 
of  Guzzerat.  partakes  chiefly  of  the  typhoid  character,  though  com- 
monly denominated,  I  presume  incorrectly,  biliou?.  It  differs  from 
the  latter  form  of  fever  in  requiring  less  evacuation  ;  and  from  the 
former,  in  the  remission  being  such  as  to  admit  of  stimuli  being  ad- 
ministered. The  effects  of  stimuli  are  what  one  would  look  for  in 


UUZZEKAT  FEVUli.  83 

ao,  inflammatory  diathesis;  yet  excessive  evacuations  of  any  kind 
seem  only  to  hasten  the  fatal  termination. 

The  affinity  between  the  constitutional  symptoms,  at  the  period 
either  preceding  the  attack  of  fever,  when  the  patient  has  been  long 
languishing  and  unwell,  or  consequent  to  it,  when  the  mercury  has 
acted  imperfectly,  and  hectic  fever  commenced,  cannot  but  strike 
every  observant  practitioner.  Irregular  accessions  of  slight  rigors, 
sometimes  quotidian,  and  sometimes  not  recurring  for  days,  at  uncer- 
tain intervals  ;  burning  heat  of  the  palms  and  feet,  extending  up  the 
legs;  the  feelings  and  actual  heat  of  the  body,  always  above  natural  ; 
a  quick  pulse  readily  increased  by  the  most  gentle  exercises  ;  the  easy 
excitement  of  the  system  to  high  febrile  irritation,  by  the  smallest 
meal  of  animal  food  and  use  of  wine  ;  the  flushed  countenance  :  cold 
claonmy  sweatings  at  one  period,  and  dry,  hot,  parched  skin  at  another, 
with  emaciations,  seems  to  correspond  with  the  phenomena  of  hectic. 
But  as  the  phenomena  in  question  occur  without  suppuration,  we  must 
seek  for  a  cause  in  the  general  debilitated  state  of  the  system,  unless 
an  idiopathic  origin  is  allowed  ;  and  although  I  am  not  prepared  to  de- 
fend an  opinion  on  this  important  point,  the  further  investigation  of 
the  subject  by  others,  may  substantiate  the  hint  at  some  furture  pe- 
riod. A  change  to  a  cold  climate,  if  timely  adopted,  or  even  to  ano- 
ther with  fewer  natural  disadvantages,  and  if  by  sea,  so  much  the  bet- 
ter, fortunately,  in  most  instances,  serves  towards  a  recovery.  In  the 
pining  state  above  described,  are  the  majority  of  those  composing  the 
convalescent-list  of  an  European  regiment  at  sickly  stations.  Among 
the  officers  also  who  embark  for  England  on  sick-leave,  will  be  found 
a  very  large  proportion  in  a  similar  state.  But  the  soldier,  from  his 
humble  situation,  has  not  this  resource  at  command,  but  must  patient- 
ly wait  till  a  relief  of  his  regiment  takes  place,  when  the  only  chance 
of  a  recovery  is  in  his  power  ,  but  in  this  hope  how  many  perish  ! 
medicine  being  now  exhausted  on  him  in  vain. 

Absolute  confinement  during  this  unhealthy  state  of  the  body,  is  not 
often  long  endured,  the  person  going  about  his  usual  occupation,  un- 
willing to  lay  himself  up  in  a  country  where  the  depressing  passions 
are  so  predominant,  and  disease  so  fatal.  But  with  a  multiplicity  of 
uneasy  feelings,  and  a  gradual  decay  of  constitution,  yet  ignorant 
where  to  assign  his  chief  complaint,  in  sleepless  nights  and  restless 
days,  he  lingers  on  a  life  of  extreme  misery,  till  debility,  or  fever, 
or  its  relapse,  compel  him  to  his  sick-chamber. 

In  better  climates,  the  phlogistic  state  of  the  system  is  adverse  to 
the  introduction  of  mercury  ;  but  the  prudent  abstraction  of  blood 
happily  reduces  it  to  that  standard  which  is  most  favourable  for  its 
action.  In  India,  however,  in  fever,  the  disease  in  which  this  is 
most  speedily  to  be  desired,  the  same  mean  would  hut  in  very  few 
cases  be  admissible  ;  for  the  debility  is  so  great  and  instantaneous, 
as  well  as  the  tendency  to  putridity,  that  only  in  the  robust  new- 
comer is  it,  if  ever,  to  be  hazarded!* 

The  spontaneous  haemorrhages  which  are  so  distressing  in  the  worst  cases, 
from  the  nose,  mouth,  and  ears,  have  always  appeared  to  me  to  hasten  death. 
Indeed  I  do  not  remember  an  instance  of  haemorrhage  which  did  not  prove  fatal, 
and  without  exhibiting  the  smallest  remission,  not  even  before  the  period  when 


84          .  EASTERN  HEMISPHERE. 

I  have  only  seen  it  used  beneficially,  where  local  pain  indicated  in- 
flammation to  be  going  on  in  the  contiguous  viscus.  This,  however, 
is  foreign  to  the  fever  which  I  am  describing ;  for,  most  commonly, 
no  uneasiness  is  complained  of,  but  the  general  feelings  of  pyrexia  ; 
and  the  low  delirium  and  stupor  so  soon  follow,  with  the  sinking  pulse, 
that  no  further  information  is  to  be  accurately  obtained  from  the  pa- 
tient ;  and  dissection  generally  demonstrates  nothing  more  than  the 
congestion  in  the  brain,  usually  met  with  in  the  fatal  cases  of  typhus. 
In  this  low  stale  of  the  system,  no  preparatory  steps  are  required 
by  evacuation,  further  than  the  care  and  attention  to  the  unloaded 
and  free  state  of  the  stomach  and  bowels,  so  necessary  in  all  fevers. 
On  the  contrary,  in  many  instances,  so  great  p  the  debility,  that  an 
early  tonic  is  indicated  ;  for  it  would  seem  that  debility,  as  well  as  a 
plethoric  system,  is  equally  inimical  to  the  specific  mercurial  action. 
And  if  the  patient  is  fortunately  invigorated  sufficiently  in  this  way 
to  give  the  mercury  influence,  and  before  any  organ  essential  to  life  is 
injured,  by  the  strictest  nursing  and  attention  afterwards,  the  reco- 
very is  almost  certain,  all  morbid  action  yielding  from  the  moment 
ptyalism  is  brought  on.  But  often  during  the  long  low  period,  when 
every  effort  is  making  to  mercurialize,  the  quantity  introduced,  but 
as  yet  inactive,  is  so  great,  that  when  the  effect  is  accomplished, 
such  is  the  profusion  of  the  ptyalism,  that  the  most  disagreeable  con- 
sequences succeed,  and  a  long  and  precarious  period  of  convales- 
cence. It  is  therefore  a  desideratum,  the  greatest  in  the  treatment 
of  this  fever,  to  know  a  criterion  by  which  to  judge  that  you  have 
pushed  the  mercury  to  the  necessary  extent,  and  no  further.  In  one 
instance,  where  the  patient  was  fast  sinking  and  harassed  with  exces- 
sive diarrhoea,  after  long  mercurial  inunction,  and  the  very  large  ex- 
hibition of  calomel  in  commiseration  of  the  last  moments  of  one  ap- 
parently moribund,  all  further  medicine  was  desisted  from,  but  such 
as  would  give  temporary  vigour  under  causes  so  debilitating,  while 
the  skin  was  yet  hot  and  parched,  tongue  black  and  dry,  thirst  insa- 
tiable, and  pulse  rapid.  The  effects  were  marvellous.  In  twenty- 
four  hours  after,  the  gums  were  inflamed,  and  in  forty  eight  the  sali- 
vation was  begun,  and  with  it  all  symptoms  of  previous  disease  van- 
ished. This,  I  beg  it  to  be  observed,  was  accidental  ;  and,  since  the 
same  cause  did  not  once  occur  again,  during  a  long  period,  among  the 
sick  in  a  large  and  crov\ded  hospital  of  one  of  his  majesty's  regi- 
ments, it  may  be  inferred  that  a  criterion  cannot  be  derived  from  it. 
This  case,  however,  afforded  a  clear  illustration  of  the  inactivity  of 
mercury  in  certain  states  of  the  system,  and  also  a  useful  caution 
against  persevering  beyond  a  certain  extent  in  its  use. 

No  inquiry  can  be  attended  with  a  more  beneficial  result,  if  success- 
ful, than  that  which  is  now  pointed  out  ;  for  so  universal  is  calomel 
iu  use,  and  so  sovereign  is  it  in  efficacy,  above  all  medicines  yet  in- 
troduced into  Indian  practice,  that  unless  administered  by  rule,  and 
watched  strictly  in  its  operation,  there  is  much  dread  of  its  getting  into 
undeserved  disrepute.  Those  of  my  professional  friends  in  India, 
who,  with  myself,  have  lamented,  in  so  many  instances,  the  futility 

it  might  with  certainty  be  considered  an  outward,  and  a  truly  alarming  occur- 


SERINGAPATAM  FEVER.  85 

••'W  •  * 

of  medical  science,  in  climates  so  deleterious,  will,  1  trust,  before  the 
conclusion  of  their  valuable  services,  by  their  researches  into  the  ar- 
cana of  disease,  yet  throw  light  on  a  subject  so  very  obscure  as  the 
diseases  of  India  still  are.  If,  after  the  system  is  already  saturated 
with  mercury,  and  in  a  disease  too  of  the  greatest  debility  and  ten- 
dency to  putrescence,  a  medicine  so  very  powerful  as  calomel  be  per- 
sisted in  longer,  in  the  vain  expectation  of  effects  which  will  never 
become  apparent,  it  is  not  being  too  rash,  perhaps,  to  pronounce  eve- 
ry grain  given  above  a  certain  quantity  to  be  prejudicial,  and  when  in- 
creased to  a  greater  extent,  an  active  poison. 

It  may  seem  empirical  to  European  practitioners,  that  calomel 
should  be  given,  apparently  so  indiscriminately,  in  the  diseases  of 
India  ;  but  in  all,  either  a  counter-action  to  that  existing  in  the  system 
at  the  time,  is  supposed  to  demand  its  use,  or  it  is  rather  to  be  pre- 
sumed, perhaps,  that  the  inflammation  prevailing  in  many  of  them  is  of 
a  peculiar  and  specific  nature,  as  modified  by  climate,  and  will  only 
yield  to  it.  In  fevers  continued  or  remittent,  and  in  dysentery  and 
diseased  liver,  acute  or  chronic,  it  may  be  considered  a  palladium  in 
medicine  ;  but  in  the  unmixed  enteritis,  which  is  too  often  insiduous 
in  its  approach,  and  beyond  the  skill  of  the  physician  when  first  com- 
plained of,  it  is  of  very  doubtful  virtue.  The  preparations  of  mer- 
cury to  be  relied  on  are  only  the  submuriate  and  the  ointment.  The 
blue  pill  is  perfectly  inadequate  to  any  good  purpose,  and  generally 
quite  inert  in  India.  To  such  as  favour  this  essay  with  their  perusal, 
it  may  meet  their  wishes  to  be  informed  of  the  tonic  given  in  that 
stage  of  fever  at  which  mercury  was  left  off.  A  mineral  acid,  but 
above  all,  the  nitric,  is  that  which  can  with  safety  be  ventured  on,  and 
it  will  be  found  to  disappoint  less  than  any  other  medicine.  The  cin- 
chona, and  all  the  class  of  bitters,  only  load  the  stomach,  and  increase 
the  febrile  irritation.  Nitric  acid  is  tonic  without  over  stimulating. 
It  is  a  grateful  and  cooling  beverage  to  the  parched  mouth  and  burn- 
ing body  ;  it  is  therefore  febrifuge  ;  it  is  antiseptic,  and  in  these 
combines  the  good  qualities  chiefly  wanted  at  this  period.  The  best 
test,  perhaps,  of  its  pleasant  virtues,  is  the  incessant  call  made  by  the 
sickly  patient  for  the  acid  drink  he  got  when  last  in  hospital. — Vidt 
Ed.  Journal,  vol.  II. 


Observations  on  the  nature  of  the  climate,  and  the  Fevers  which  prevail 
at  Seringapalam.     By  A.  NICOLL,  M.  D. 

SECT.  V. — Ever  since  the  British  took  possession  of  Serinffapatam, 
their  forces,  both  European  and  native,  have  greatly  suffered  from  the 
insalubrity  of  its  climate.  Any  investigation,  therefore,  into  the  na- 
ture of  the  climate,  and  diseases  which  prevail  there  becomes  pecu- 
liarly interesting  and  important. 

The  following  observations  made  on  the  nature  of  the  climate,  and 
the  fevers  which  appeared  amongst  700  Europeans  and  some  native 
corps  stationed  at  Seringapatam  for  eighteen  months,  will,  I  hope, 
place  this  subject  in  a  more  clear  and  satisfactory  light. 


86  EASTERN  HEM16PHERL. 

D 

Intermittent  fevers  are  prevalent  in  every  part  of  the  Mysoor 
country,  but  are  much  more  common  at  Seringapatam  than  in 
any  other  ;  and  they  vary  according  to  the  changes  of  the  sea- 
son and  conditions  of  the  atmosphere.  In  the  hot  months  of 
the  year,  the  fever  becomes  remittent  or  typhoid  ;  the  latter  usually 
of  that  species  denominated  by  Cullen  Typhus  icterodes.*  As  the  sea- 
son cools,  and  the  weather  becocu^s  more  steady  and  pleasant  the 
remissions  of  the  fever  become  more  distinct  ;  and  as  the  weather 
gets  what  may  be  called  cold,  the  regular  agues  are  formed.  Dy- 
sentery is  frequently  combined,  both  with  remittent  and  intermittent 
fevers  ;  but  is  more  coaannon  in  the  cold  season  than  in  any  other. 
There  is  nothing  peculiar  in  the  approach  of  the  remittent,  much 
less  in  the  ague.  The  yellow  fever  always  presented  itself  in  the 
beginning  like  a  severe  remittent,  generally  with  great  sickness  at 
stomach,  and  vomiting  of  a  greenish  or  bilious  matter.  A  flushing  of 
the  face,  and  a  degree  of  stupor  and  listlessness  ;  a  burning  skin  ;  full 
and  quick  pulse  ;  frequent  respirations,  and  excruciating  pain  in  the 
head  <md  loins,  were  the  great  pathognomonic  symptoms  of  the  dis- 
ease. When  at  this  stage  of  the  disease  a  stop  was  not  made  to  its 
further  progress,  still  greater  excitement  and  irritability  of  the  func- 
tions of  life  came  on,  and  incessant  vomiting  of  a  greenish  or  yellow- 
ish-coloured matter,  delirium  ferox,  and  sometimes  dysentery,  with 
great  violence  succeeded,  and  in  the  course  of  a  few  hours  put  an 
end  to  the  sufferings  of  the  patient.  On  or  about  the  third  day  of 
the  disease,  the  yellowness  of  the  body  generally  appeared  ;  the  ad- 
natas,  the  neck,  breast,  and  belly,  showed  at  first  the  partial  transfu- 
sion which  became  deeper  in  colour,  the  higher  in  violence  the  dis- 
ease arose.  Though  the  disease  runs  its  fatal  course  in  a  few  in- 
stances in  48  hours,  yet  it  was  generally  on  the  sixth  or  seventh  day 
that  the  patient  died.  This  so  often  happened,  that  whenever  I  got 
my  fever  patients  over  these  two  critical  days,  1  contemplated  a 
speedy  solution  of  the  disease  at  hand. 

The  first  four  months  of  the  year  are  excessively  hot,  close,  and, 
sultry,  until  the  Malabar  monsoon  sets  in,  in  May.  At  5  in  the  morn- 
ing the  thermometer  is  generally  about  65°,  and  at  3  in  the  afternoon 
about  94°  Fahrenheit.  In  May'and  June,  by  the  refreshing  showers 
and  breezes  wafted  from  the  mountains,  which  separate  the  Mysoor 
from  the  Malabar  country,  the  climate  is  rendered  tolerably  healthy 
and  pleasant.  Again  it  becomes  hot  and  sultry  in  July  August,  and 
September,  but  nothing  like  to  the  four  first  months  of  the  year,  until 
the  Coromandel  monsoon  begins,  in  October,  which,  by  its  mild  and 
salubrious  influence,  soon  effects  great  and  remarkable  changes 
in  the  air  and  temperature  of  the  place.  At  this  season,  especially 
in  November,  the  thermometer  at  5,  P.  M.  has  been  so  low  as  48°, 
add  in  the  middle  of  the  same  day,  has  risen  to  88°.  I  have  also  fre- 
quently observed  a  difference  of  40  degrees  between  six  o'clock  in  the 
morning  and  twelve  of  the  day.  During  the  hot  months  of  the  year* 
the  wiads  are  generally  southerly  or  easterly  ;  in  the  cold  season, 
they  become  westerly  or  northerly. 

The/orr,  in  which  the  troops  chiefly  reside,  is  in  a  very  low  situa- 
tion, with  lofty  walls  surrounding  it,  which,  io  a  great  measure,  pre- 

*  Synopsis  Nosolog-  Mcth,  cl.  I-  Pyrexiae,  Ord.  I.  Feb.  Gen.  V.  Typhus  Sp,  It 


3ERINGAPATAM  FEVEK.  87 

vent  the  free  circulation  of  air.  Besides  the  barracks,  hospitals, 
&c.  for  the  forces  being  bad,  and  highly  objectionable,  there  is  an  ex- 
tensive bazar  close  to  them,  which,  by  its  filth  and  situation,  becomes 
no  small  nuisance  to  the  Europeans. 

Other  sources  of  noxious  exhalations  are  abundantly  fruitful  at 
Seringapatam.  These,  together  with  a  moist  sultry  atmosphere, 
subject  to  great  changes  of  temperature  from  intense  heat  to  extreme 
cold,  have  in  all  ages,  been  viewed  as  the  origin  of  pestilence  and 
death.*  In  the  ditches  between  the  ramparts  and  in  various  parts  of 
the  fort,  where  all  the  Europeans  and  many  thousand  natives  reside, 
are  constantl,  deposited  all  the  filth  and  corruption  of  the  place.  On 
the  hanks  of  the  Cauvery  river,  and  in  several  places  of  the  island, 
pools,  stagnant  with  offensive  and  putrid  matter,  are  to  be  seen.  All 
the  mass  of  animal  and  vegetable  corruption  from  a  population,  in- 
cluding Europeans  and  natives  no  less  than  90,000,  is  collected  on  a 
'small  space  of  ground,  the  circumference  of  the  island  not  exceeding 
three  miles.  These  materials  of  putrefaction  for  about  eight  months 
of  the  year,  lie  in  those  repositories  which  I  have  mentioned,  until 
the  periodical  rains  of  Malabar  begin,  which,  falling  in  the  ghauts, 
run  down,  and  fill  the  Cauvery  river.  The  filling  of  this  river  is  al- 
ways very  sudden,  and  it  comes  rushing  along  with  great  impetuosity  ; 
sweeps  out  all  the  filth  from  the  ditches  ;  clears  away  all  the  impu- 
rities, so  long  stagnant  in  the  island  ;  and  leaves  the  place,  for  a 
while,  tolerably  healthy,  and  the  air  cool  and  refreshing. 

With  regard  to  the  infectious  nature  of  the  yellow  fever,  some 
doubts  are  entertained,  from  never  observing  a  single  orderly  at- 
tending those  ill  with  the  disease,  or  any  of  the  other  patients  in 
hospital,  who  were  oftentimes  indiscriminately  mixed  together,  for 
the  want  of  room  to  put  our  sirk  and  convalescents  in,  contracting 
the  disease.  However,  the  prevalence  of  this  disease  being  regulat- 
ed in  its  operation  by  a  determined  range  of  atmospheric  heat,  and, 
from  numerous  facts  related,  especially  by  that  enlightened  physi- 
cian, Sir  Gilbert  Blane.t  1  have  no  doubt  but  that,  under  certain 
circumstances  in  regard  to  tie  constitution  of  the  atmosphere,  and 
the  susceptibility  of  individuals,  it  ma}  evince  an  infectious  nature. 

The  persons  who  were  most  subject  to  yellow  fever  at  Seriugapa- 
tam,  where  the  strong  and  robust,  we  had  exposed  themselves  care- 
lessly to  the  vicissitudes  of  the  climate,  and  lived  irregularly. 
Those  who  had  been  much  exhausted  by  almost  habitual  drunken- 
ness, and  long  residence  in  India,  were  the  first  who  suffered,  and 
fell  victims  to  the  disease.  Three  instan  es  came  under  my  notice, 
where,  in  characters  corresponding  to  the  above-mentioned,  the 
powers  of  life  were  destroyed  in  the  first  paroxysm  of  fever.  Irre- 
gularity, drunkenness,  and  exposure  to  the  changes  of  the  climate, 
when  the  body  is  in  a  state  of  perspiration  or  indirect  debility,  are 
powerful  agents  in  rendering  the  functions  of  life  susceptible  of  mor- 
bid associations,  or  liable  to  the  impressions  of  the  morbid  virus; 
yet  certain  situations,  in  respect  to  dryness  and  ventilation,  though 

*  Hippocrat.  Op.  orn.  De  Epid.  Lib.  I.  c.  iii.  p.  238. 
+  Blane,  Disetses  of  Seamen,  p.  605, 


88  EASTERN  HEMISPHERE. 

equally  exposed  to  noxious  blasts  or  exhalations,  make  no  small  change 
in  the  prevalence  and  nature  of  fever. 

APPEARANCES  ON  DISSECTION. 

The  anatomical  examination  of  the  bodies  of  those  who  died  of 
the  yellow  fever,  was  made  with  considerable  attention  and  minute- 
ness ;  but  the  appearances  of  the  morbid  structure  of  the  most  im- 
portant organs,  those  connected  with  the  functions  of  life,  and  seem- 
ingly  with  the  disease,  were  by  no  means  uniform  or  satisfactory, 
nor  could  they  in  any  instance  be  applied  to  the  full  explanation  of 
the  morbid  actions,  which  appeared  in  the  rise,  progress,  and  termi- 
nation of  the  case. 

Brain. — Always  contained  in  its  ventricles  a  large  proportion  of 
serum,  and  its  vessels  were  generally  turgid  with  watery  blood. 

Chest. — Seldom  showed  much  signs  of  morbid  alteration  in  any  of 
its  viscera.  Sometimes  the  heart  appeared  enlarged,  and  the  pericar- 
dium contained  more  water  than  natural.  At  times  larger  portions  of 
lymph,  or  polypi  were  found  in  the  venae  cava,  right  auricle,  and 
left  ventricle.  The  blood  was  always  very  dark,  and  watery,  run- 
ning soon  into  putrefaction. 

Abdomen. — Presented  various  morbid  appearances,  slight  marks  of 
inflammation  on  the  pyloric  portion  of  the  Stomach,  but  apparently 
proceeding  from  the  acrid  matters  found  in  it,  as  the  duodenum,  which 
contained  nearly  similar  matters,  presented  the  same  appearance. 
The  intestines  always  held  large  quantities  of  fetid  matter  of  various 
colours.  The  liver  was  rarely  found  any-wise  diseased,  but  there 
was  always  a  large  secretion  of  bile.  The  gall-bladder  was  always 
turgid  ;  frequently  large  quantities  of  bile  were  seen  floating  on  the 
surface  of  the  intestines.*  When  the  bodies  were  inspected  a  few 
hours  after  death,  the  bile  was  yellow,  but  when  kept  more  than  twelve 
hours,  it  became  black  and  putrid !  The  liquor  found  in  the  pericar- 
dium and  ventricles  of  the  brain,  as  also  in  the  cavity  of  the  abdomen 
at  times,  partook,  but  slightly,  of  some  of  the  properties  of  bile  ; 
they  were,  however,  sufficiently  clear,  as  to  put  it  beyond  doubt,  that 
the  yellowness  of  the  skin,  and  fluids  of  the  body,  in  yellow  fever, 
proceeds  from  the  bile  having  entered  into  the  circulation,  and  com- 
municated to  them  its  colour.! 

From  these  facts  and  observations,  I  am  sorry  to  say,  I  cannot  de- 
rive that  advantage  and  important  results  to  the  practice  of  medicine 
which  might  be  wished.  This  branch  of  medical  science,  which  has 
for  its  object  the  ascertaining  the  seat  and  causes  of  diseases  in  or- 
ganic derangements,  affords  ample  field  for  the  investigation  of  phy- 
sicians and  anatomists,  and  can  only  be  perfected  by  their  unwearied 
exertions. J 

*  How  caine  the  bile  there  ?  Is  it  not  more  likely  to  be  an  effusion  of  yellow 
serum.  J.  J. 

t  Blane,  Observations  on  Fevers,  Part  III.  chap.  I-  p-  411. 

\  Cabanis.  Revolutions  of  Medical  Science,  translation  by  A.  Henderson,  M- 
D.  p.  294. 


SERINGAPATAM  FEVER.  89 

The  plan  which  was  found  most  successful  in  curing  the  yellow  fe- 
ver at  Seringapatam,  was  that  which  formed  its  indications :  on  Isr, 
removing  the  violence  of  reaction,  and,  2nr%,  preventing  exhaus- 
tion of  the  system  by  a  recurrence  of  the  fever.  When  the  violence 
of  reaction  and  inflammatory  diathesis  were  sufficiently  manifest, 
blood-letting  was  employed,  the  quantity  extracted  being  regulated 
by  the  strength,  age,  and  plethoric  state  of  the  patient.  The  appear- 
ance of  the  blood,  when  drawn,  was  no  criterion  »  hatever.  In  no 
instance,  where  generaJ  bleeding  wns  had  timely  recourse  to,  and  the 
quantity  judiciously  taken  away,  did  the  reaction  of  the  system,  the 
morbid  heat,  and  general  irritability  of  the  anitnal  and  natural  func- 
tions, continue  unabated  in  violence.  When  the  disease  has  just 
commenced,  in  any  constitution,  whether  robust  or  plethoric,  or  weak 
and  emaciated,  if  there  are  symptoms  of  any  inflammatory  diathesis, 
bleeding  must  be  employed.*  Small  doses  of  calomel  and  neutral 
salts  must  be  exhibited  every  hour,  until  the  bowels  are  unloaded  of 
their  morbid  contents,  and  the  capillaries  of  the  skin  opened,  and 
the  surface  becomes  moist.  But,  along  with  the  exhibition  of  those 
medicines,  and  after  bleeding,  while  the  skin  is  dry,  the  respirations 
frequent,  and  the  animal  heat  103°  or  108°,  the  cold  effusion  must  be 
resolutely  and  judiciously  applied,  and  repeated,  until  the  reaction 
of  the  system,  and  progress  of  the  disease,  are  arrested.  The  cold 
affusion  is  the  most  powerful  remedy  in  subduing  the  fever :  and  the 
only  preventive  against  the  irritability  of  the  stomach,  was  keeping 
the  bowels  open  by  small  doses  of  calomel  and  jalap,  or  solutions  of 
the  neutral  salts.  As  soon  as  a  distinct  remission  was  obtained,  it 
was  found  absolutely  necessary  to  throw  in  the  bark  and  wine,  and 
prescribe  a  very  nourishing  diet,  in  order  to  prevent  a  recurrence 
of  the  fever,  which,  though  subdued,  is  apt  to  return  again  and  again, 
as  before.  1  found  the  bark  thrown  up  by  injection  into  the  rectum, 
a  valuable  remedy  in  cases  where  the  stomach  was  irritable  and  nau- 
seated it.  In  intermittent  fevers,  1  have  often  exhibited  it  in  the 
quantity  of  an  ounce,  joined  with  a  little  tincture  of  opium,  in  this 
way,  just  before  the  expected  return  of  the  fit,  and  in  no  instance 
did  it  fail  of  moderating  the  violence  of  the  fit,  if  it  did  not  succeed 
in  preventing  its  return  altogether.! 

When  there  was  great  irritability  of  the  stomach,  constant  vomiting 
of  greenish-coloured  matter,  great  morbid  beat  of  the  skin,  delirium, 
and  much  exhaustion  of  the  powers  of  life,  the  cold  affusion,  con* 
stantly  repeated,  while  the  spasmodic  constriction  of  the  vessels  of 
the  skin  continued,  and  the  morbid  associations  remained,  is  the  re- 
medy to  be  depended  on  ;  for,  while  it  subdues  the  principle  of  fever, 
it  invigorates  the  powers  of  life,  and  enables  us  to  clear  the  stomach 
and  intestines  by  gentle  cathartics,  and  laxative  glysters. — These  re- 
medies, when  judiciously  applied  in  the  early  stages  of  fever,  wilt 
seldom  fail  indeed  to  stop  its  progress,  or  bring  it  to  a  speedier  issue  ; 
but  they  are  not  effectual  in  preventing  its  return  where  the  body  is 

;c  Jackson's  Treatise  on  Diseases  of  Jamaica,  p.  31. 

*  Hebcrden,  Comraentarii  de  Morb.  Hist,  et  Curationc,  cap.  zxxviii.  p.  160 

12 


9p  EASTERN    HEMISPHERE, 

again  exposed  to  the  cause  which  first  produced  it.  Bark  is  the  only 
remedy  to  be  depended  on,  and  when  there  is  any  morbid  derange- 
ment in  the  liver  or  spleen,  mercury  must  be  employed.  Blisters  ap- 
plied to  the  head  and  stomach  were  often  of  great  service.  When 
the  paroxysm  was  subsiding,  small  doses  of  opium  and  (Bther  were 
given  with  the  most  salutary  effects.  Under  the  above  system  of 
treatment,  when  the  patient  was  brought  to  us  on  the  first  or  second 
day  of  the  disease,  we  generally  succeeded  in  producing  a  final  solu- 
tion of  the  disease  before  the  fourth  or  sixth  day,  When  the  fever 
continued  beyond  this  period  there  was  always  great  difficulty  in  put- 
ting a  stop  to  its  progress,  if  it  did  not  kill  the  patient  then.  If  the 
bowels  were  not  kept  open,  and  every  slight  exacerbation  of  fever 
checked  by  the  cold  affusion,  the  disease  generally  terminated  fatally, 
sooner  or  later.  But  when  any  slight  accession  or  exacerbation  of 
fever  was  carefully  watched  and  stopped  by  the  cold  affusion,  applied 
in  one  way  or  another,  a  considerable  remission  at  last  took  place, 
which  enabled  us  to  give  the  bark,  and  support  the  powers  of  life  by 
due  stimuli.  Carrying  the  effects  of  calomel  so  far  as  to  produce  sa- 
livation, was  never  found  necessary  or  beneficial  in  the  beginning  of 
the  disease,  but  often  found  valuable,  in  conjunction  with  the  bark,  when 
the  disease  chanced  to  vary  its  type,  or  continued  long,  and  gave  us 
some  reason  to  suspect  the  presence  of  some  organic  derangement,  or 
dropsical  diathesis.  It  thus  appears,  that  the  treatment  of  fever,  of 
whatever  kind  or  form,  unaccompanied  with  organic  derangement,  is, 
now-a-days,  both  as  simple  and  successful  in  India  as  in  Europe. — - 
Vide  Ed.  Med.  Journal,  July  1815. 

BILIOUS  FEVER. 

SECT.  VI. — This  is  the  grand  endemic,  or  rather  epidemic,  (mor 
bus  regionalis,)  of  hot  climates  ;  and  although  greatly  allied  in  many 
of  its  symptoms,  perhaps  generally   combined  with  the  Marsh  Re- 
mittent, already  described,  yet  it  occurs  in  various  places,  both  at  sea 
and  on  shore,  where  paludal  effluvia  cannot  be  suspected. 

Notwithstanding  that  this  fever  is  hardly  ever  mistaken,  by  the 
least  experienced  practitioner,  yet  so  extremely  diversified  are  its 
features,  by  peculiarity  of  constitution,  climate,  season,  nnd  modes  of 
life,  that  it  is  very  difficult  to  give  even  a  general  outline  of  it, 
without  involving  apparent  contradictions.  There  are  always,  how- 
ever, some  prominent  symptoms  which  sufficiently  characterise  bilious 
fever,  fir  every  practical  purpose,  which  is  the  chief  object  in  view. 
These  are,  gastric  irritability  — affection  of  the  prascordia,*  —  and  af- 
fection of  the  head.  Rarely  will  all,  or  any  of  these  be  absent.  The 
other  items  in  the  febrile  train  are  by  no  means  constant  and  regular. 
Thus  the  pulse  is  frequently  regular,  and  sometimes  up  to  120  or  130 
in  the  minute.  It  is  the  same  with  the  temperature  of  the  skin. 
Often,  when  mad  delirium  is  present,  the  pulse  will  be  86,  and  the 
thermometer  in  the  axilla  at  96»  of  Fahrenheit.  The  bowels  are 

*  In  the  term  praecordia  I  always  include  those  viscera  and  parts  immediately 
belaw  the  diaphragm  ;-— the  lirer,  stomach,  and  spleen,  for  instance,  in  the  sense 
of  Fprnelius,  lib,  iv.  De  Febribus, 


BILIOUS  FEVER.  #jl 

almost  always  constipated,  or  in  a  state  of  dysenteric  irritation.  No 
such  thing  as  natural  stools  in  this  fever  are  ever  to  be  seen,  unless 
procured  by  art.  Frequently,  but  not  always,  yellowness  of  the 
eyes,  and  even  of  the  skin,  takes  place  ;  and  the  mental  functions 
are  very  generally  affected,  which  indeed  is  characteristic  of  all 
bilious  diseases.  This  fever  is  not  near  so  dangerous  as  the  more 
concentrated  marsh  endemics,  such  as  those  of  Bengal,  Batavia,  &c. 
Indeed  I  have  long  thought  that  these  last  are  the  bilious  remittents 
of  the  country,  modified  and  greatly  aggravated  by  the  peculiar  na- 
ture of  the  local  miasmata.  However,  that  they  occasionally  exist 
independently  of  each  other,  I  have  likewise  no  doubt  ;  for  we  must 
not  let  the  rage  for  generalising  blind  us  to  facts.  My  meaning  is 
this,  that  the  fever  in  question  frequently  arises  from  atmospheric  heat, 
or  rather  atmospheric  vicissitudes,  deranging  the  functions  or  oven 
structure  of  important  organs  ;  and  that  it  is,  as  Sir  James  M'Grigor 
supposes,  symptomatic  of  local  affection.  Where  marsh  miasma  is  add- 
ed, which  is  generally  thef  case,  then  we  have  the  endemic  of  the  place, 
modified  by  the  peculiar  nature  of  the  effluvia,  and  from  which  we  are 
not  secured  but  by  local  habituation  to  the  oause.  Residence,  there- 
fore, on  the  banks  of  the  Ganges,  is  no  protection  from  the  miasma 
of  St.  Domingo,  or  Batavia,  as  will  be  proved  in  a  su^equent  sec- 
tion. See  also  what  Mr.  Boyle  says  on  the  Sicilian  fever. 

With  respect  to  the  treatment,  I  have  never  found  it  difficult,  when 
the  means  which  I  have  minutely  detailed  under  the  head  of  Bengal 
endemic,  were  early  and  steadily  applied.  Bleeding,  I  know,  is  sel- 
dom employed  ;  but  I  can  state  that  three  other  surgeons  on  the 
station,  besides  myself,  had  recourse  to  venesection  in  the  fevers  of 
India,  with  the  greatest  benefit.  These  were,  Mr.  Dalziel,  late  of 
the  Naval  Hospital  at  Madras  ;  Mr.  Cunningham  of  the  Sceptre  ;  and 
Mr.  Neill.  formerly  of  the  Victor,  latterly  of  the  Sceptre.  I  his  is 
a  small  band  opposed  to  the  ho*t  of  antiphlebotomists  ;  but  it  must 
be  reim  mbered,  that  the  evidence  in  favour  of  bleeding,  is,  from  its 
very  nature,  more  conclusive  than  that  which  is  against  it.  In  the 
first  place,  a  great  proportion  of  practitioners  will  he  deterred  from 
the  use  of  the  lancet  entirely,  by  the  current  of  prejudi-  e.  In  the 
second  place  a  great  many  of  those  who  do  venture  on  it,  will  he  ea- 
sily discouraged  by  any  reverse  at  the  beginning,  which  is  sure  to  be 
attributed  to  the'  heterodox  remedy  ;  a  striking  instance  of  which 
will  be  given  hereafter,  in  the  section  on  "  Endemic  of  Bata- 
via." But  on  the  other  hand,  those  who  persevere  must  be  more 
than  mad,  if  they  continue  a  practice  which  is  not  beneficial  ;  and  if 
it  is,  how  must  their  proofs  accumulate!  and  how  solid  and  experi- 
mental must  be  their  nature,  compared  with  those  on  the  opposite 
side  of  the  question,  where  prejudice  and  timidity  are  so  apt  to  mis- 
lead ?* 

Finally,  my  opinion  is  this  : — that  when  we  wish  to  arrest  the  pro- 
gress of  bilious  fever,  "  cito  et  jucunde"  we  should  in  all  cases, 

*  Since  the  first  edition  of  this  work,  the  proofs  of  benefit  from  renesection  in 
the  bilious  remittent  fevers  of  all  climates  have  so  multiplied,  that  it  is  needles? 
to  insist  further  on  the  propriety  of  the  measure,  in  this  section- 


EASTERN  HEMISPHERE. 

where  the  constitution  is  not  broken  down  by  climate,  and  particular- 
ly where  determinations  to  the  brain  or  liver  are  conspicuous,  as  they 
too  often  are,  take  one  copious  bleeding  at  the  beginning, (the  repeti- 
tion naust  be  guided  by  the  judgment  of  the  practitioner,)  which  will 
effectually  promote  the  operation  of  all  the  succeeding  remedial 
measures,  and  obviate  in  a  great  degree  those  visceral  obstructions 
and  derangements,  which  this  fever  so  frequently  entails  on  the  pati- 
ent. 

The  following  condensed,  but  clear  account  of  this  fever,  as  it  ex- 
hibited itself,  in  all  its  shapes  and  bearings  and  with  no  small  degree 
of  violence,  on  the  great  rn;iss  of  a  ship's  company,  will  convey  a 
better  idea  of  the  disease,  arid  in  a  more  practical  way,  than  any  ge- 
neral description,  however  laboured,  or  however  minute.  I  have 
only  to  premise,  that  the  symptoms  were  carefully  noted,  and  the 
practice  detailed  on  the  spot,  ry  a  gentleman  of  no  mean  talent  for 
observation  ;  and  although  I  differ  from  hirn  on  the  exhibition  of  eme- 
tics, and  the  ornissivn  of  venesection,  it  is  with  regret,  as  I  enter- 
tain the  highest  respect  for  his  abilities  aud  candour.  It  will  be  seen 
that,  in  most  other  points,  his  practice  is  nearly  similar  to  what  I  found 
most  successful  in  the  endemic  of  Bengal. 

"  On  the  l||d  ol  March.  1804,  His  Majesty's  ship  Centurion  dropped 
anchor  in  Bombav  Harbour,  on  her  return  from  Surat :  at  which  time 
the  ship's  company  were  in  good  henlth.  During  the  next  week, 
the  weather  was  variable — hot  and  sultry,  in  general,  through  the 
day,  alternated  with  cold  damp  chills  at  night,  when  the  dews  were 
heavy,  and  the  land  winds  keen  from  the  adjacent  mountainous  coast. 

On  the  9th  of  the  same  month,  several  men  complained  of  slight 
indisposition,  which  we  did  not  consider  of  any  importance,  little 
awareof  th  e  distressing  scene  to  which  this  was  an  immediate  pre- 
lude. 

Csnlurion,  Bombay  Harbour, 

March  \Qth,   1804. 

Eighteen  man  complained  to  me  this  morning,  of  having  been  taken 
suddenly  ill  m  the  night.  Their  general  symptoms  were — severe 
pain  in  the  head,  arms,  loins,  and  lower  extremities  ;  stricture  across  the 
breast  with  great  pain  under  the  scrobiculus  cordis  ;  retching  and 
griping.  In  some,  the  pulse  intermitted,  and  the  temperature  of  the 
skin  was  increased  ;  others  had  cold  chills  with  partial  clammy  sweats  ; 
but  all  complained  of  pain  under  the  frontal  bone  ;  many  of  them 
with  white  furred  tongues  and  thirst.  A  solution  of  salts  and  emetic 
tartar,  designed  to  operate  both  ways,  was  prescribed,  with  plenty  of 
warm  diluent  drinks.  P.  M.  The  solution  operated  well,  both  up- 
vvanis  and  downwards,  in  all  the  patients.  Many  complain  now  of 
pain  in  the  epigastric  region  and  head,  with  burning  hot  skins.  Ga?e 
them  Pulv.  Antim.  gr.  vj.  Tinct.  Opii.  gt.  xx.  Aq  Menth.  un- 
cias  ij.  bora  sornm  sumend.  with  warm  rice  water,  slightly  acidulat- 
ed, for  drink  during  the  night.  The  patients  to  be  secured  from  the 
land-winds,  which  at  this  season  of  the  year  are  considered  very 
pernicious.  Almost  all  these  men  had  been  exposed  to  the  intense 
heat  of  the  sun  by  day,  and  to  the  influence  of  the  night  air,  while  ly- 


BlUOtS  FEVER.  93 

ing  about  the  decks  in  their  watches.  Mr.  Brown,  the  carpenter, 
was  on  shore  in  the  heat  of  the  sun  to-day,  and  attacked  this  afternoon 
with  the  fever. 

'--+f'-<^*<*--  '  i/fe 

Bombay,  March  \\th,  1804. 

Nine  patients  added  to  the  list  this  day.  The  bilious  fever  set  in 
with  nearly  the  *ame  symptoms,  as  yesterday,  and  the  same  mode  of 
treatment  was  pursued. 

Many  of  yesterddy's  patients  are  very  poorly  this  morning  ;  com- 
plaining of  severe  pain  in  the  head,  limbs,  loins,  and  across  the  epi- 
gastric region  ;  with  constant  vomiting  of  viscid  bile.  Prescribed 
from  five  to  ten  grains  of  calomel,  with  small  doses  of  antimonial 
powder,  and  tincture  of  opium,  to  be  taken  three  or  four  times 
a  day. 

There  is  little  intermission  of  pulse  to-day.  In  some  the  skin  is 
cold  ;  in  others  hot  with  insatiable  thirst.  Tongue,  in  most  cases, 
covered  with  a  thick  white  crust.  Great  irritability  of  the  stomach, 
aversion  to  food.  Bowels  rather  constipated — some  have  a  foetid  bi- 
lious purging.  P.  M.  The  calomel  appears  to  allay  the  irritability 
of  the  stomach  ;  while  the  antimonial  powder  and  tincture  of  opium 
keep  up  a  warm  moisture  on  the  skin. 

Bombay,  \ZthMarch. 

Ten  added  to  the  list  this  morning,  with  bilious  fever.  The  symp- 
toms and  treatment  nearly  as  before.  Some  of  the  patients  of  the 
10th  are  better  to  day,  the  irritabifety  of  the  stomach  being  a  good 
deal  allayed  by  the  calomel  and  opium  ;  but  they  still  complain  of 
pain  in  the  head  and  limbs,  with  great  debility.  Eyes  heavy,  and 
tinged  yellow — pulse  full  — bowels  constipated.  Prescribed  a  dose 
of  Natron  Vitriolat.  after  the  operation  of  which,  the  calomel,  &c. 
to  be  continued  as  before. 

The  emetic-cathartic  solution  operated  well  with  the  nine  patients 
of  yesterday,  (1 1th,)  most  of  them  are  very  ill  this  morning.  They 
have  incessant  vomiting  of  green  thick  bile,  with  pain  in  the  epigas- 
tric region  and  head,  thirst  insatiable.  Prescribed  the  calomel, 
opium,  and  antimonial  powder,  as  in  the  other  cases.  No  delirium 
has  yet  appeared  in  any  of  the  patients  ;  nor  much  alteration  from 
health  in  the  pulse.  In  many,  the  temperature  of  the  skin  very 
little,  if  at  all  increased  ;  constipation  of  the  bowels  nearly  a  gene- 
ral symptom. 

The  decks  are  now  crowded  with  sickness. 

Bombay,  \3th  March. 

Eight  added  to  the  list  this  morning,  with  the  prevalent  bilious 
fever.  .  Scarce  any  heat  of  skin,  or  acceleration  of  pulse.  All  ap- 
pear to  labour  under  some  hepatic  (iffection*  which  seems  to  be  imme- 
diately communicate  d  to  1he  brain,  causing  great  p<tin  under  the  frontal 
•bone*  Vomiting,  I  think,  relieves  them  a  good  deal.  The  quanti- 

*  It  was  from  observing  this  symptom,  that  I  was  long  ago  led  to  form  the  ra- 
tio symptomatum  of  fever,  sketched  out  in  the  first  section — namely,  that  inde- 
pendent of  the  sympathy  existing  between  the  brain  and  liver,  the  congestion, 
or  as  it  were,  stagnation  of  blood,  in  the  portal  circle,  causes  a  greater  determi- 


94  EASTERN  HEMISPHERE 

ty  of  bile   they  discharge  is  enormous,  and  of  a  depraved  or  highly 
vitiated  quality. 

Most  patients  of  the  jpth  and  llth  appear  very  ill  ;  complaining 
of  pains  across  the  epigastric  region,  and  in  the  head,  with  frequent 
vomiting  of  bile  ;  tongues  swelled  and  furred — no  great  heat  or  ac- 
celeration of  pulse.  The  constipation  of  bowrls  1  relieve  by  doses  of 
natron  vitriol  or  calomel  and  j  ilap.  The  calomel,  &c.  taken  from 
15  to  30  grains  a  day,  according  to  the  urgency  of  the  symptoms.  No 
appearance  yet  of  ptyalisra  in  any  of  the  patients.  The  thermr-meter 
placed  in  the  axilla  of  several,  did  not  show  more  than  9t>i°  or  97° — 
the  pulse  not  exceeding  88  in  the  minute. 

Many  of  yesterday's  patients  (12th)  are  also  very  ill.  All  appear 
to  labour  under  some  morbid  affection  or  secretion  of  the  liver.  Two 
of  them  much  troubled  with  cough,  and  spasms  in  the  muscles  about 
the  neck,  impending  deglutition  and  respiration.  Blisters,  wiih  vitrio- 
lic aether  and  tinct.  opii.  relieved  this  symptom.  The  warm  bath  had 
no  good  effect.  Pulse  nearly  natural. 

Bombay,   14th  March. 

Nine  added  to  the  list  this  morning,  with  the  prevalent  bilious  fe- 
ver. Two  of  them  were  suddenly  seized  with  violent  mad  delirium, 
and  made  a  dart  to  get  overboard,  but  were  providentially  secured  in 
time.  No  heat  of  skin,  or  acceleration  of  pulse  ;  but  all  complain  of 
pain  in  the  head  and  epigastric  region,  which  emetics  and  blisters  fre- 
quently relieve. 

Those  patient*  who  were  first  attacked  (10th)  are  very  ill,  many  of 
them  highly  tinned  yellow  ;  their  eyes  swelled,  and  the  blood  vessels 
a  good  deal  distended.  Pain  in  the  head  still  continues  severe.  At 
night  many  of  them  are  delirious.  The  mercurial  treatment  conti- 
nued. I  tried  the  bark,  with  nitrous  acid,  in  several  cases  to-day  ; 
but  it  did  much  harm,  greatly  increasing  the  irritability  of  the  sto- 
mach. The  fever  seems  inclined  to  run  through  the  whole  of  the 
ship's  company. 

The  patients  of  yesterday  (13th)  are  very  ill.  The  calomel  in 
general  sits  easy  on  the  stomach,  and  appears  to  check  the  vomiting 
a  good  deal.  I  find  doses  of  the  natron  vitriol,  and  emetic  tartar  cleanse 
the  stomach  and  bowels  belter  than  calomel  and  jalap. 

Bombay,    1 5th  March. 

Five  men  attacked  last  night  ;  one  with  violent  phrensy,  who  was 
in  good  health  a  few  minutes  before.  He  was  all  at  once  seized  \ith 
a  mad  delirium,  and  made  a  dart  to  get  overboard,  but  was  caught. 
Scarce  any  increased  temperature  of  the  skin,  or  acceleration  of  the 
pulse.  The  delirium  was  removed  by  an  emetic.  P.  M.  A  few  have 

nation  to  the  brain,  whereby  that  important  organ  becomes  oppressed,  and  keeps 
up  the  train  of  febrile  symptoms.  If  this  cerebral  congestion  is  relieved  by 
bleeding,  or  any  other  means,  immediate  energy  is  communicated  to  the  heart 
and  arteries — reaction  and  biliary  secretion  follow,  and  the  balance  of  the  circu- 
lation and  excitability  is  once  more  restored.  Vomiting,  as  determining  to  the 
surface,  will  produce  this  effect ;  but  the  gastric  irritability  is  dangerous.  Lastly, 
mercury,  as  keeping  up  a  steady  action  in  the  extreme  vessels  of  the  vena  porta- 
rum,  and  in  all  the  excretories,  prevents  the  balance  of  the  circulation  and  exci- 
tability from  being  again  destroyed. 


BILIOUS    FEVER.  95 

Jt     V 

their  mouths  slightly  affected,  and  are  much  better,  but  still  complain 
of  pain  in  the  head  and  right  hypochondrium.  Our  decks  are  now 
crowded  with  sick,  and  the  effluvia  intolerable.  The  ship  is  daily  fu- 
migated. Sent  twenty  of  the  worst  cases  to  Bombay  Hospital,  many 
of  them  very  ill  and  changing  yellow. 

Bombay,  \ 6th  March. 

Five  men  were  suddenly  seized  during  the  night  with  violent  mad 
delirium — great  oppression  at  the  epigastrium — abdomen  distended — 
perfect  loss  of  memory,  and  all  recollection  of  their  messmates  and 
others  around  them,  mistaking  one  person  for  another. — Great  desire 
to  destroy  their  own  lives,  and  the  lives  of  those  who  held  them  down. 
— The  pupils  of  the  eyes  a  good  deal  dilated,  and  not  inclined  to  con- 
tract when  exposed  to  a  strong  light.*  All  of  these  evidenced  a  great 
desire  for  lime  juice,  which  I  gave  them,  and  which  they  frequently 
mistook  for  porter.  But  at  times  it  was  difficult  to  make  them  swal- 
low any  thing,  as  they  would  crash  the  vessel  in  which  it  was  offered 
between  their  teeth.  When  full  vomiting  was  excited,  it  generally- 
relieved  them,  by  bringing  away  immense  quantities  of  viscid  or  viti- 
ated bile.  They  all  complained,  at  intervals,  of  pain  in  the  head  and 
epigastric  region,  but  particularly  in  the  right  hypochoudrium.  I 
bled  in  one  case,  tried  the  cold  affusion  in  another,  and  the  warm 
bath  with  purgative  enemas  in  a  third,  without  success.! 

Our  decks  now  being  crowded  with  sick,  sent  21  men  to  Bombay 
Hospital,  viz. 

II  of  those  attacked  on   the    10  and    llth  instant;  several  of 
them  changing  yellow,  and  all  of  them  labouring  under  hepa- 
tic affection,  with  great  pain  under  the  frontal  bone. 
5  of  those  attacked  on  the  1 2th  ;  not  quite  so  bad  as  those  who 

were  first  seized. 

5  of  those  taken  ill   13th  and   14th.  — Symptoms  nearly  the 
same. 

Tot.  21  in  number. 

*  The  cerebral  and  abdominal  plethora  is  here  so  strongly  pnmteu,that  I  shouiu 
have  considered  myself  authorised  to  bleed  usque  ad  dtliquium,  or  the  relief  of 
the  symptoms 

t  The  quantity  of  blood  abstracted  is  not  mentioned  :  but  it  is  perfectly  imma- 
terial :  for  unless  venesection  be  carried  usque  ad  deHquium,  or  the  relief  of  the 
Symptoms,  no  possible  good  can  accrue,  but  even  harm.  This  is  a  practical  fact, 
•well  known  to  those  who  have  tried  this  remedy  in  the  east.  It  may  be  account- 
ed for  thus  :  the  portal  congestion,  from  its  peculiar  position,  (in  a  ci.cle  of  ves- 
sels whose  circumference  is  entirely  composedof  capillaries,)  places  a  great  por- 
tion of  the  vital  fluid  nearly  at  rest,  and  determines  the  remainder,  more  particu- 
larly to  the  brain,  by  which  this  organ  becomes  oppressed.  Now,  if  venesection 
be  not  carried  the  length  of  relieving  the  cerebral  congestion,  and  so  letting  loose 
the  energy  of  the  brain  on  the  system  at  large,  it  is  quite  clear  that  we  diminish 
the  strength  without  gaining  our  object,  and  consequently  retrograde  from  the 
proper  path-  This  is  not  meant  to  censure  the  surgeon  whose  practice  is  detail- 
ed. Considering  the  general  prejudice  against  bleeding  in  India  at  that  time,  it 
would  have  required  no  small  degree  of  fortitude  to  employ  so  heterodox  a  reme- 
dy under  the  immediate  eye  of  the  presidency,  where  even  success  would  hardly 
have  supported  the  innovation. 


96  EASTERN  HEMISPHERE. 

The  remaining  patients  on  board  are  very  ill.  All  complain  of 
pain  in  the  head  and  liver,  with  a  diseased  secretion  of  bile,  and  con- 
stipated state  of  the  bowels — -swelled  furred  tongues— restlessness  and 
exacerbation  at  ni-jht,  with  slight  heat  of  skin,  thirst,  and  trifling  ac- 
celeration of  pulse  — frequent  giddiness  and  stupor,  without  the 
least  relish  for  food.  I  continue  to  evacuate  the  bowels  with  natron 
vitriol,  or  calomel  and  jalap,  and  persevere  in  the  mercurial  treat- 
ment till  ptyalism  takes  place. 

Bombay ,  11  th  March. 

Eight  men  attacked  with  fever  during  tlie  last  twenty-four  hours  : 
four  of  them  with  violent  mad  deliriuai  ;  the  others  complained  of 
pain  in  the  head,  loins,  lower  extremities,  and  epigastric  region,  with 
swelled  tremulous  tongues  ;  but  no  great  heat  of  skin,  or  quickness 
of  pulse.  Some  were  slightly  indisposed  for  a  day  or  so  before  ; 
others  had  no  premonitory  sensations  whatever.  They  were  all 
well  evacuated  with  the  emetic-cathartic  solution,  or  calomel  and  ja- 
lap :  I  prefer  the  former,  as  it  acts  both  ways  at  once. 

Several  on  board  are  very  ill,  without  the  least  appearance  of  pty- 
alism  ;  others  have  their  mouths  affected,  and  the  bad  symptoms  dis- 
appearing. In  the  former.  I  can  perceive  little  or  no  alteration  in 
the  temperature  or  pulse  from  a  state  of  health.* 

Sent  17  to  the  hospital  to-day  ;  many  of  them  changing  yellow, 
with  pain  and  fulness  about  the  liver,  and  severe  head-ache. 

Bombay,  Itith  March. 

Six  admitted  this  morning;  three  with  violent  mad  delirium,  which 
lasted  several  hours  ;  in  the  others,  the  symptoms  were  miller.  All 
our  nurses  are  now  dropping  ill,  and  the  fever  seems  to  acquire  a 
contagious  character,  as  it  is  running  through  the  whole  of  the  ship's 
company.f  One  of  the  wardroom  officers  was  attacked  last  night. 
We  now  send  them  on  shore  nearly  as  they  are  taken  ill. — All  labour 
under  some  affection  of  the  liver,  which  is  immediately  communicated  to 
the  brain. 

At  noon  sent  15  of  the  worst  cases  to  the  hospital ;  several  of  them 
changing  yellow.  They  are  generally  attacked  first  in  the  night, 
and  always  experience  an  exacerbation  afterwards,  as  the  evening 
closes  in.  No  remissions  on  alternate  days  ;  the  only  amelioration 
is  in  the  mornings. { 

I  this  day  visited  all  our  patients  at  the  hospital.  Several  of  them 
are  very  ill — many  quite  vellow  ;  and  all  have  great  pain  and  ful- 
ness in  the  region  of  the  liver,  with  constipated  bowels.  They  are 
treated  nearly"  in  the  same  manner  as  on  hoard  ;  the  medical  geatle- 

*  Is  there  not  great  torpor  throughout  the  system  here,  from  the  state  of  the 
brain  ? 

t  Although  it  does  not  follow  that  the  disease  is  contagious,  because  the  nur- 
ses are  taken  ill ;  yet  it  appears  very  probable  that  this  fever  became  contagious 
from  accumulation. 

\  Miasmal  fevers,  when  not  very  concentrated,  often  show  remissions  on  alter- 
nate days  ;  till  at  length,  as  the  season  changes,  they  slide  into  intermitteats. 
When  they  are  so  virulent,  however,  as  to  occaiion  great  and  sudden  derange- 
ment, whether  of  function  or  structure  in  important  organs,  it  is  needless  to  say, 
that  such  remissions  cannot  be  looked  for. 


BILIOUS  FEVER.  97 

aien  there  placing  their  whole  con  fide  nee  in  a  continuance  of  the  mer- 
cury. They  attach  much  importance,  however,  to  friction  with 
ung.  hyd.  fort,  over  the  region  of  the  liver  ;  giving  three  grains  of 
calomel  four  or  five  times  a  day,  in  conjunction  with  small  doses  of 
antimonial  powder  and  opium,  as  occasion  requires.  Two  patients 
at  the  hospital  are  delirious  at  night. 

*•*•:       Bombay,  1 9th  March. 

Twelve  taken  ill  with  fever  since  yesterday  ;  most  of  them  at- 
tacked during  the  night  In  eight  cases  it  set  in  with  violent  mad 
delirium.  Several  of  them  were  in  perfect  health  a  few  minutes  be- 
fore ;  others  had  some  slight  previous  indisposition. 

Six  cases  on  board  have  now  shown  symptoms  of  ptyalism,  and  are 
greatly  relieved  in  all  respects,  with  some  return  of  appetite.  As 
the  spitting  increases,  the  yellowness  of  the  skin  disappears  propor- 
tionally. Prescribed  the  nitrous  acid  both  to  the  convalescents,  and 
those  now  under  the  mercurial  course  :  a  practice  much  recom- 
mended by  Mr.  George  Kier,  surgeon  of  this  presidency. 

Bombay,  C20(h  March. 

Five  people  attacked  since  yesterday  ;  two,  without  a  moment's 
notice,  were  seized  with  violent  mad  delirium.*  The  other  three 
with  symptoms  more  moderate  ;  but  all  with  pain  in  the  head  and 
epigastric  region.  They  were  treated  as  already  detailed.  Sent  18 
of  the  worst  cases  to  the  hospital  ;  all  labouring  under  hepatic  affec- 
tion, and  many  of  them  very  ill.  A  few  more  have  their  mouths  af- 
fected since  yesterday,  and  are  getting  better. 

Bombay,  21  st  March. 

Ten  cases  of  fever  within  the  last  24  hours.  Four  of  these  were 
men  who  came  on  board  from  the  Elphinstone  East-Indiaman  a  few- 
days  ago,  and  were  attacked  with  violent  phrensy  and  convulsive  ex- 
ertions, craving  for  drink  of  various  kinds.  After  the  spasms  were 
allayed,  they  complained  of  pain  in  the  epigastric  region  and  head — 
tongues  swelled — pain  in  the  liver— vomiting  of  acrid  bilef — stricture 
across  the  forehead  and  sinciput — pulse  natural.  After  vomiting, 
they  found  themselves  much  relieved.  Prescribed  calomel,  opium, 
and  antimonial  powder,  as  already  detailed.  At  ten  o'clock  this 
morning  Lieut.  P.  was  attacked  wilh  delirium — pain  in  his  head  and 
epigastric  region— tongue  swelled,  and  white — muttering  between 

*  The  nature  and  violence  of  the  attack  show  that  it  could  not  proceed  from 
latent  miasmata  received  previously  at  Surat.  Neither  could  the  fever  arise  en- 
tirely from  land-wind  effluvia  here,  since  the  other  vessels  lying  in  harbour  were 
not  affected.  Some  people  may  suspect  a  local  cause  in  the  ship's  hold,  or  else- 
where, but  no  such  source  is  traced  by  the  gentlemen  composing  the  survey. 
The  constitutions  of  the  crew,  coming  in  from  the  more  equable  temperature  of 
tiie  sea,  were  strongly  affected  by  the  abrupt  atmospherical  vicissitudes  at  Bom- 
bay ;  and  the  effects  resulting  thence  were  aggravated  by  the  miasmal  impregna- 
tion of  the  land-wind  by  night. 

t  Did  this  violent  mad  delirium  arise  from  the  brain  sympathising  wilh  the  liver 
or  stomach,  where  acrid  bile  might  have  been  accumulated  ?  Or  did  it  arise 
from  exhalations  conveyed  by  the  land-winds,  and  acting  on  the  brain  ?  I  am 
inclined  to  think  that  it  was  owing  to  both. — Contagion  ! 

13 


08  EASTERN  HEMISPHERE. 

his  teeth — no  heat  of  skin.  He  assisted  last  night  in  holding  several 
men  who  had  mad  delirium,  and  probably  inhaled  the  effluvia  from 
their  breath  or  bodies.  Two  patients,  who  were  convalescing  since 
the  nineteenth,  and  taking  nitrous  acid,  seem  inclined  to  relapse  as 
the  soreness  leaves  their  mouths  ;— mercury  again  prescribed. 

*        Bombay,  22d  March. 

Five  added  since  yesterday,  with  the  prevailing  fever.  All  com- 
plain of  pain  in  the  head  and  right  hypochondrium — eyes  and  tongue 
swelled  j*  the  latter  covered  with  a  bilious  crust — small,  hot  bilious 
evacuations  by  stool,  with  great  thirst. — They  cannot  bear  the  slightest 
pressure  on  the  region  of  the  liver. 

I  have  applied  for  a  medical  survey  on  the  state  of  the  ship,  to 
inquire  whether  or  not  the  fever  is  contagious,  and  what  is  the  best 
plan  of  arresting  its  progress. 

Bombay,  23rd  March. 

A  young  man  in  perfect  health,  who  has  been  ten  years  in  India, 
while  assisting  his  sick  messmate  into  the  hospital  boat  to-day,  was 
all  at  once  attacked  with  the  fever.  Severe  pain  in  the  head,  epi- 
gastrium, and  liver,  was  soon  followed  by  the  most  violent  mad  de- 
lirium, and  incoherent  language  ;  he  fancying  the  people  around  him 
were  going  to  murder  him.  No  heat  of  skin,  or  acceleration  of 
pulse.  This  state  lasted  lour  hours,  and  was  relieved  by  a  vomiting 
of  foetid,  green,  acrid  bile. 

The  fever  not  so  prevalent  now,  and  seems  to  have  spent  its  force, 
as  only  one  roan  was  seized  in  the  last  twenty-four  hours.  The 
nights  are  becoming  warmer,  which  I  hope  will  soon  check  its  pro- 
gress. 

Bombay,  24th  March. 

Five  men  attacked  since  yesterday  ;  one  with  the  usual  mad  de- 
lirium. All  labour  under  pain  in  the  head,  epigastrium,  and  liver  : 
•with  white  swelled  tongues  ;  pulse  and  temperature  little  increased. 
Prescribed  gentle  emetics  of  pulv.  ipecacuan.  with  plenty  of  warm 
diluent  drinks,  on  their  first  complaining.!  After  the  operation,  ca- 
lomel, opium,  and  antimonial  powder  four  times  a  day,  with  pedilu- 
vium. 

Pursuant  to  my  request,  a  medical  survey  was  held  on  board 
to-day,  by  the  following  gentlemen,  viz. 

Dr.  Moir,  of  the  medical  Board  ; 

Dr.  Scott,  ditto  ditto ; 

Dr.  Sandwith,  of  the  General  Hospital  ;  and  myself. 

After  an  investigation  and  mature  deliberation,  it  was  agreed  thai 

*  This  symptom  is  noticed  by  Mr.  Tainsh,  on  the  coast  of  Syria,  (Medical  and 
Physical  Journal,)  and  by  the  Gentleman  of  Bussorah,  who  narrates  his  own 
case.  (Transactions  of  a  Society,)  &c.  &c. 

t  Some  change  in  the  administration  of  emetics  is  here  evident,  though  no 
reason  is  assigned.  I  think  the  plan  I  have  recommended,  of  allaying  the  gastric 
irritability  by  calomel,  or  calomel  and  opium,  and  then  procuring  copious  intes- 
tinal evacuations,  will  be  found  the  safest  practice  ;  as  it  effectually  emulges  the 
liver  and  its  ducts,  and  prevents,  or  lessens  the  abdominal  and  cerebral  conges 
tions;  especially  when  uided  by  early  venesection. 


BILIOUS 

the  following  would  be  the  most  effectual .  means   of  checking  this 
fever,  which  appears  to  be  contagious* — 

"  1st.  To  land  all  the  sick  at  the  General  Hospital. 
"  2d.  To  remove  the  ship  to  Butcher's  Island,  and  there  dis- 
embark the  remainder  of  the  ship's  crew,  with  their 
bedding,  &c. 

"  3d.  To  clean,  whitewash,  and  paint  the  ship  throughout;  to 
fumigate  her,  and  likewise  the  people's  bedding,  with 
nitrous  gas  ;  and  to  fire  off  all  the  lower  deck  guns." 

Bombay,  25f/i  March. 

Niae  cases  of  fever  in  the  last  twenty-four  hours.  Three,  who 
were  in  perfect  health  a  few  minutes  before,  were  seized  at  once 
with  mad  delirium.  Several  of  those  patients,  whose  fevers  were 
checked  at  the  commencement  of  the  ptyalism,  and  where  I  trusted 
the  remainder  of  their  cure  to  nitrous  acid,  are  now  relapsing,  their 
mouths  being  quite  well.j 

I  cannot  say  much  in  favour  of  the  acid,  though  so  highly  recom- 
mended by  Dr.  Scott  and  Dr.  Kier  of  the  presidency,  who  give  it  in 
all  cases  during  and  subsequent  to  the  mercurial  course.     Those  at- 
tacked yesterday  were  gently  vomited  with  ipecac,  and  warm  diluent 
drinks  ;  after  which  they  took  small  doses  of  calomel,  opium,  and 
and  pulv.  ant.  four  times  a  day,  with  tepid  bathing  ;  a  practice  much 
recommended  by  Dr.  Moir  of  this  presidency.     Sent  eight  cases  to 
the  hospital — sixteen  on  board. 

Butcher's  Island,  2Sth  March. 

Pursuant  to  the  decision  of  the  Medical  Survey,  we  this  day  land- 
ed on  Butcher's  Island  our  sick,  sixteen  in  number,  in  various  stages 
of  the  fever  :  some  with  their  mouths  getting  sore,  and  the  bad 
symptoms  disappearing— some  in  a  state  of  ptyalism  and  convales- 
cence—and others  with  all  the  usual  symptoms  of  the  fever,  particu- 
larly the  hepatic  affection,  head-ache,  and  yellowness  of  the  eyes 
and  skin. 

B.  Island,  Zlth.  March. 

No  addition  to  the  list  since  landing.  All  those  whose  mouths  are 
affected  have  no  other  complaint  than  debility. — The  sick  are  com- 
fortably situated  in  the  castle,  which  is  well  aired  and  clean. 

B.  Island,  28^  March. 
Several  patients^now  convalescent,  with  sore  mouths.     One  patient 

*  "  It  has  never  been  known,"  says  Dr.  Bancroft,  "  as  I  am  informed,  that  a 
single  case  of  this  fever,  {typhus,)  had  occurred  on  either  side  of  the  Indian  pe- 
ninsula." Essay  on  Yellow  Fever,  page  510.  If  this  be  the  case,  and  if  the  re- 
spectable gentlemen  above-mentioned,  who  had  the  best  means  of  ascertainment 
on  the  spot,  did  not  give  an.  erroneous  judgment,  it  follows,  that  other  fevers  may, 
under  certain  circumstances,  become  contagious. 

I 1  have  expressly  remarked,  in  the  second  section,  that  free  and  copious  ptya- 
lism is  necessary.     Where  this  is  brought  on  in  a  few  days,  and  especially  where 
bleeding  or  other  evacuations  have  been  early  premised,  there  has   seldom  so 
much  derangement  taken  place  in  the  liver,  or  even  its  functions,  as  to  require 
the  continuance  of  mercury.     But  where  no  V.  S.  was  employed,  and  the  disease 
has  gone  on  many  days  before  ptyalism,  as  above,  the  action  of  mercury  must  be 
kept  up  for  some  time  after  tha  fever  ig  checked,  till  the  functions  of  the  liver 
are  completely  restored. 


iOO  EASTERN  HEMISPHERE. 

very  restless  last  night,  with  great  heat  of  skin,  and  pain  in  the  re- 
gion of  the  liver,  which  was  relieved  by  a  blister,  and  calomel  bolus, 
wth  opium  and  antimony.  Most  of  the  others  have  hepatic  affec- 
tions, which  subside  as  the  system  becomes  impregnated  with  mercury. 

B.  Island,  29th  March. 
All  in  progress  to  recovery  ;  their  mouths  getting  sore. 

B.  Island,  30th  March. 

Two  men,  who  were  yesterday  employed  in  cleaning  the  ship, 
have  been  seized  with  fever  ;  but  the  symptoms  are  milder  than  in 
those  formerly  attacked  on  board.  Same  treatment. 

B.  Island,  3\st  March. 

Only  twelve  on  the  list.  Most  of  them  convalescents  with  sore 
mouths. 

B.  Island,  4th  April. 

The  patients  at  Bombay  Hospital  recover  very  slowly. — Almost  all 
of  them  labour  under  affection  of  the  liver,  with  severe  head-ache, 
debility,  and  want  of  appetite  They  have  sent  us  over  thirty  cases 
for  change  of  air.  Two  more  were  attacked  yesterday  with  fever 
and  dysentery  ;  they  had  been  employed  in  cleaning  the  ship.  After 
evacuations,  the  calomel  as  in  the  others. 

B.  Island,  5th  April. 

Of  the  3®  patients  received  from  Bombay  Hospital  none  are  worse. 
They  find  themselves  cooler  and  more  comfortable  here.  Seven! 
have  considerable  affection  of  the  liver,  attended  with  night  fever, 
which  is  sometimes  ushered  in  with  rigors  and  cold  chills,  succeeded 
by  hot  skin,  thirst  and  head-ache.  Prescribed  five  grains  of  calomel, 
one  of  opium,  and  two  of  antimonial  powder,  thrice  a  day  ;  blisters 
to  the  part  affected.  All  my  original  patients  are  better,  with  sore 
mouths  and  debility.  I  tried  the  decoction  of  bark  in  several  cases,  but 
find  they  recover  faster  without  it.  I  also  tried  the  nitrous  acid,  but 
cannot  say  much  in  its  favour.  The  two  patients  wi^h  dysenteric 
symptoms  have  paia  in  the  region  of  the  liver. — The  same  treatment 
as  the  others. 

B.  Island,  6th  April. 

The  patients  from  Bombay  Hospital  recover  surprisingly  fast. 
Three  of  them  were  highly  tinged  yellow,  which  goes  off  as  their 
mouths  become  sore.  Many  have  constipated  bowels  :  decoction  of 
tamarinds,  with  natron  vitr.  an  excellent  laxative.  A  few  of  the 
convalescents,  as  they  get  stronger,  have  a  return  of  pain  in  the  liver, 
for  which  the  calomel  is  again  prescribed. 

The  dysenteric  patients  are  relieved  by  the  calomel  and  opium — 
the  tenesmus  not  near  so  violent.  Mercury  continued. 

B.  Island,  1th  April. 

The  patients  from  the  hospital  daily  gain  strength  and  appetite ; 
more  particularly  those  whose  mouths  are  well  affected  with  mercury. 

All  the  fevers  experience  a  nocturnal  exacerbation  ;  in  some  usher- 
ed in  with  rigors. 


BILIOUS  FEVER.  J01 

In  Bombay  Hospital  this  fever  runs  great  lengths.  Several  patients 
arc  quite  yellow,  with  debility — severe  pain  across  the  epigastrium, 
in  the  head,  and  in  the  loins.  No  great  acceleration  of  pulse  ;  but 
all  are  much  worse  at  night  than  during  the  day.  Calomel,  opium, 
and  aritimonial  powder,  internally,  with  frictions  of  the  uog.  hyd. 
and  frequent  purgatives,  are  the  means  employed  by  the  physicians 
of  the  hospital.  They  also  tried  the  bark  and  nitrous  acid,  with  the 
worst  success,  it  generally  occasioned  great  sickness  at  stomach, 
stricture  on  the  surface,  and  obstructed  perspiration,  with  universal 
inquietude.  Removed  32  cases  more  of  fever  to  Butcher's  Island 
from  the  hospital. 

B.  Island,  Wth  April. 

The  bilious  fever  not  near  so  prevalent  now,  as  when  we  were 
on  board  ;  and  in  all  attacks  the  svmptoms  are  milder. 

The  patients  from  the  hospital  promise  fair  ;  some  have  dysente- 
ric complaints,  which  go  off  as  the  mouth  becomes  sorer.  Two  fresh 
attacks,  with  much  pain  in  the  region  of  the  liver  and  bilious  vomit- 
ing. The  usual  treatment  pursued. 

Many  of  those  last  received  from  the  hospital  complain  of  pain  in 
the  head  and  liver  region.  Their  mouths  had  been  affected  at  the 
hospital,  but  are  not  so  now.  The  mercurial  treatment  to  be  re- 
newed. 

Butcher's  Island,  llth  April     Thermometer  90°. 

In  some  of  the  last  32  patients  from  Bombay  Hospital,  the  fever 
seems  inclined  to  run  great  lengths.  Sometimes  they  appear  tolera- 
bly well ;  at  others,  they  labour  under  severe  pain  in  the  head,  epi- 
gastrium, and  liver,  with  great  debility  and  aversion  to  food.  I  tried 
the  bark  in  several  of  these  cases,  but  think  it  did  harm,  by  increas- 
ing the  pain  in  the  head,  and  general  inquietude  In  other  cases,  I 
gave  small  and  frequently  repeated  doses  of  calomel,  with  the  ni- 
trous acid  which  answered  the  purpose  much  better.  The  constipa- 
tion was  best  obviated  by  decoction  of  tamarinds  with  natron  vitriol. 

The  patients  in  the  general  hospital  recover  very  slowly  ;  and  se- 
veral are  extremely  ill.  The  hospital  is  close,  and  badly  aired  ;  and 
the  men  contrive  to  procure  arrack,  which  they  cannot  so  well  do 
here.  I  therefore  removed  over  sixteen  patients  to-day,  all  very  ill  ; 
two  of  them  quite  yellow,  with  severe  affection  of  the  liver. 

W+ 

B.  Island,  16^  April. 

Most  of  those  last  from  Bombay  Hospital  are  under  the  influence  of 
mercury,  in  which  course  I  persevere.  The  others  convalescing  fast. 

B.  Island,  23d  April. 

Most  of  my  patients  are  now  in  a  fair  way.  We  have  removed  all 
that  are  able  to  bear  removal,  from  the  hospital  to  this  Island.  *  They 
all  labour  under  hepatic  affection,  and  are  under  the  influence  of 
mercury,  which  I  continue. 

Zbth  April. 

We  this  day  embarked  all  our  sick,  84  in  number,  and  dropped 
down  to  the  middle  ground.  All  our  patients  in  rapid  progress  to 
recovery,  and  all  under  the  influence  of  mercury. 


302  EASTERN  HEMISPHERE. 

At  sea,  C21th  April. 

Sailed  yesterday  for  Goa.     Our  patients  in  a  state  of  progressive 
convalescence  ;  thirty-two  remained  behind  at  Bombay  Hospital. 
(Signed)  Wade  Shields,  Surgeon,  Centurion. 

The  perusal  of  this  narrative  cannot  fail  to  excite  our  interest,  and 
strongly  arrest  our  attention.  We  observe  an  unwearied  assiduity 
and  perseverance  in  the  Surgeon,  with  a  coolness  of  observation,  and 
candour  of  recital,  that  greatly  enhance  the  value  of  the  document. 
It  bears  on  its  front  intrinsic  marks  of  fidelity.  There  is  no  finesse 
or  disguise  ;  he  tells  a  plain,  unvarnished  tale.  Few  medical  men 
have  gone  through  more  trying  scenes  in  India,  than  this  gentleman, 
of  which  the  above  is  but  a  trifling  specimen. 

The  following  reflections  on  this  fever  may  here  be  allowed. 

First,  with  respect  to  its  contagious  nature  ;  I  believe  that  few, 
who  have  been  much  in  hot  climates,  will  hesitate  to  pronounce, 
that  at  its  commencement,  it  did  not  exhibit  a  single  trait  of  conta- 
gion. A  ship  comes  in  healthy  from  sea  ;  and  after  being  a  week  in 
port,  where  no  contagious  disease  prevails,  has  all  at  once  eighteen 
of  her  crew  knocked  down  in  one  night  with  fever,  and  every  night 
afterwards  a  similar  repetition,  more  or  less,  till  in  a  few  days — "  the 
decks  are  crowded  with  sick,  and  the  effluvia  intolerable."  From 
this  period  it  certainly  betrays  some  symptoms  of  a  contagious  na- 
ture, particularly  in  the  check  which  it  all  at  once  experienced  on 
their  landing  on  Butcher's  Island,  and  in  the  circumstance  of  the  men 
who  were  cleaning  the  ship  afterwards,  being  the  principal  sufferers. 
Add  to  this,  the  decision  of  the  medical  survey,  judging  it  to  be  con- 
tagious. This  corroborates  my  observation  respecting  the  Endemic 
of  Bengal,  and  which  I  believe  will  apply  to  most  other  endemics,  as 
those  of  Batavia,  Madagascar,  Johanna,  West  Indies,  &c.  namely  ; 
that  they  are  never  originally  contagious  in  their  own  nature,  but 
may  under  peculiar  circumstances,  acquire  that  character  occasional- 
ly, from  accumulation,  confinement,  and  inattention  to  cleanliness 
and  ventilation. 

I  myself  could  never  see  any  just  cause,  why  a  number  of  sick 
men,  crowded  together,  should  not  generate  a  contagious  disease,  as 
well  as  a  crowd  of  people  in  health.  That  the  latter  circumstance 
has  sometimes  happened,  will,  1  believe,  be  very  generally  admitted, 
notwithstanding  the  opinion  of  Dr.  Bancroft.  But  be  this  as  it  may, 
the  fever  in  question  was  a  bilious  fever,  and  one  of  very  considera- 
ble violence  too.  Although  the  season  cf  the  year  was  not  that  of 
autumnal  remittents,  yet  the  land  winds,  in  all  seasons,  and  in  all 
tropical  climates,  are  more  or  less  impregnated  with  miasmata,  and 
that  these  had  a  considerable  share  in  the  fever  above  described,  I 
entertain  no  doubt. 

2dly  ;  the  determination  to  the  liver  and  brain  was  here  so  conspi- 
cuous", that  it  became  the  prominent  feature  of  the  disease  ;  and  al- 
though not  always  so  unequivocally  manifested  as  in  this  instance,  is 
ever  to  be  suspected  in  tropical  fevers. 

Many  of  the  observations  contained  in  the  foregoing  narrative, 
strongly  corroborate  my  ideas  on  the  nature  of  fevers  in  hot  climates. 


BILIOUS  FEVER.  103 

as  detailed  in  a  preceding  section.     The  theory  is  perfectly  applica- 
ble to  the  symptems  of  this  fever. 

In  miasmai  fevers,  the  congestion  in  the  head  and  abdominal  visce- 
ra were  the  consequences  of  impaired  energy  in  the  brain  and  ner- 
vous system,  as  there  explained.  The  same  congestion  takes  place 
here,  partly  from  the  same  cause,  (miasmata  conveyed  by  the  land- 
winds  and  acting  on  the  brain,)  but  principally  in  the  following  man- 
ner : 

The  extreme  vessels  on  the  surface  of  the  body,  and  by  sympathy, 
of  the  vena  portarum  in  the  liver,  having  been  excited  into  inordi- 
nate action  during  the  intense  heat  of  the  day,  are  suddenly  struck 
torpid  by  the  raw,  damp,  chilling  land-winds ;  the  consequence  of 
which  is ,  that  perspiration  and  biliary  secretion  are  checked  ;  the 
blood  determined  inwards,  is  impeded  in  its  passage  through  the  liver, 
and  accumulation  ensues  in  the  portal  circle,  "  which  is  immediately 
communicated  to  the  brain,"  as  observed  in  this  gentleman's  narrative 
more  than  once,  and  as  I  have  already  explained.*  During  this  pe- 
riod, the  bile  stagnating  in  the  biliary  ducts,  becomes  viscid  ;  and  on 
the  recommencement  of  a  hurried  secretion,  from  emetics  or  other 
medicines  determining  the  blood  to  the  surface,  often  so  obstructs  the 
natural  passage  into  the  intestines,  that  regurgitation  into  the  circula- 
tion takes  place  and  tinges  the  skin  yellow.  A  great  deal,  however, 
is  forced  up  through  the  stomach  in  a  viscid  and  vitiated  state  ;  tend- 
ing to  keep  up  the  gastric  irritability,  and  sometimes  to  destroy  the 
stomach  altogether.  This  view  of  the  subject  explains  why  the  men 
were  almost  all  seized  in  the  night,  and  why  a  nocturnal  exacerbation 
was  ever  afterwards  observed.  With  strict  justice,  therefore,  and 
with  more  propriety,  we  might  denominate  the  fever  in  question — 
"  Hepatic,"  rather  than  Bilious  Fever  ;  and  with  some  slight  modifi- 
cation, principally  in  degree  of  violence,  I  shall  show,  in  a  future 
section,  that  in  reality  it  is  alter  et  ufem,  hepatitis  itself. 

3dly,  in  regard  to  the  treatment.  Although,  as  I  have  before  hint- 
ed, 1  differ  from  this  gentleman  respecting  the  exhibition  of  emetics, 
and  the  omission  of  V.  S.  yet,  it  must  be  confessed  that  his  success 
in  the  end  was  great,  and  sufficient  to  confirm  him  in  opinion,  that 
the  practice  was  the  best  that  could  be  devised.  Indeed,  it  was  the 
general  practice  of  the  country.  It  does  not  appear  that  any  deaths 
occurred,  either  on  board  or  at  Butcher's  Island  ;  and  as  eighty- two 
men  were  removed  back  to  the  latter  place  from  the  general  hospi- 
tal, and  thirty-two  left  at  Bombay,  when  the  Centurion  sailed,  the 
whole  number  sent  at  different  times  on  shore  to  the  hospital  is  ac- 
counted for,  viz.  one  hundred  and  fourteen. 

Thus  out  of  full  150  cases  of  this  fever,  (which  it  #11  readily  be 
granted,  was  no  very  mild  or  tractable  disease,)  none  died  unless 
subsequently  at  the  hospital,  out  of  the  32  left  behind.  But  if  we 
look  to  the  sequelae  of  the  disease,  resulting  from  the  great  hepatic 

*  "  Is  is  evident,"  says  Dr.  Blane,  speaking  of  fever,  "  from  a  number  of  facts, 
;  that  the  state  of  the  brain  and  viscera  depends  on  that  of  the  external  surface 
'*  of  the  body  ;  for  a  free  state  of  the  pores  of  the  skin,  provided  it  is  general, 
"  tends  more  than  any  other  circumstance  to  relieve  internal  pain,  and  also  to 
;'  <ake  off  delirium."  3d  edit.  p.  358. 


104  EASTERN  HEMISPHERE. 

derangement  that  accompanied  the  febrile  state,  there  will  be  some 
drawback  on  the  otherwise  uncommon  success  of  the  practice  pur- 
sued. The  utility  of  early  venesection  and  purgatives  is  no  where 
more  conspicuous  than  in  obviating  these  disagreeable  consequences, 
as  will  be  fully  shown  in  the  next  section,  where  they  had  a  fair 
trial. 

One  thing,  however,  is  certain  ;  and  a  very  important  considera- 
tion it  is,  namely,  that  as  the  mercurial  treatment,  unassisted,  was 
here  entirely  followed,  and  implicitly  confided  in,  ooth  on  board  and 
at  the  hospital,  so  it  will  require  some  sophistry  to  explain  away 
these  stubborn  proofs  of  its  extraordinary  power  and  success. 

Had  this  fever,  so  strongly  characterised  by  yellowness  of  the  skin, 
bilious  vomiting,  head-ache,  &c.  happened  in  the  West  Indies,  or  at 
Gibraltar,  or  Cadiz,  and  in  autumn  instead  of  spring  ;  and  had  any 
new  mode  of  practice  ju*t  coming  in  vogue  been  strictly  pursued, 
would  it  not  have  furnished  a  pompons  communication  to  a  medical 
board,  announcing  the  agreeable  intelligence,  that  yellow  fever  might 
now  ••  hide  its  diminished  head  ;"  for  that  150  cases  of  it,  in  a  very 
violent  form,  had  been  successfully  treated,  on  the  new  principle, 
without  the  loss  of  a  man  ! 

Into  how  many  delusions  have  the  medical  world  been  drawn  in 
this  manner?  And  what  jarring  contradictions,  and  virulent  contro- 
versies,  have  resulted  from  them  ! 


ENDEMIC  OF  BATAVIA. 

i 

Drawn  up  by  WADE  SHIELDS,  Esq.  Surgeon  Royal  Navy. 


SEC.  VII. — "  In  the  month  of  June,  1800,  His  Majesty's  ships 
Centurion,  Daedalus,  La  Sybille,  and  Braave,  having  on  board  a  de- 
tachment of  the  12th  regiment,  consisting  of  127  men  and  officers, 
sailed  from  Madras,  on  a  secret  expedition  ;  and  on  the  23rd  of 
August  following,  the  squadron  anchored  in  Batavia  Roads.  The 
Centurion  and  Daedalus  were  placed  about  four  miles  from  the  gar- 
rison, to  blockade  the  port  i  the  Sybille  kept  constantly  shifting 
about  to  interrupt  the  approach  of  small  vessels  to  the  city  ;  and  the 
Braave  lay  at  anchor  under  the  small  island  of  Onrust,  about  three 
miles  from  the  main  land  of  Java. 

"  During  the  first  few  weeks,  the  squadron  continued  tolerably 
healthy,  and  without  any  deaths  ;  although  the  crews  were  much 
harassed  by  night  and  by  day,  in  chasing  the  enemy's  vessels,  row- 
ing guard,  and  loading  or  unl  wading  the  prizes  off  the  island  of  On- 
rust.* The  weather  was  pretty  temperate  at  this  time  ;  the  ther- 
mometer, in  the  shade  generally  ranging  from  82°  to  87°,  with  regu- 
lar sea  and  land  breezes.  When  the  latter,  however,  came  off  from 
the  low,  swampy  grounds  about  Batavia,  early  in  the  mornings,  it 

*  Contrast  this  with  what  happened  to  the  crews  of  the  Russel,  Albion,  and 
Powerful,  at  the  same  place,  in  1806,  when  their  sanguine  hopes  of  surprising: 
the  Dutch  squadron  were  suddenly  dissipated. 


ENDEMIC  OF  BATAV1A.  105 

with  it  a  thick  mist,  accompanied  by  a  very  foetid  smell  ;  all 
of  which  would  gradually  go  off,  as  the  sun  rose,  and  the  sea  breeze 
set  in.  During  the  prevalence  of  this  foetid  mist  i;t  the  morning, 
many  people  would  complain  of  slight  indisposition  in  the  head  and 
stomach,  which  likewise  went  off  as  the  sun  came  out. 

"  About  this  time  the  Braave  disembarked  an  officer  and  some 
men  of  the  12th  regiment  on  duty  at  the  island  of  Onrust,  where  a 
temporary  hospital  was  established  ;  and  here  the  first  appearance  of 
endemic  fever  was  observed.  It  was  not,  however,  in  any  alarming 
degree,  but  chiefly  confined  to  those  who  lived  intemperately  ;  as 
none  of  the  officers  of  that  ship  were  attacked,  though  they  frequent- 
ly slept  on  shore.  Some  of  the  people  having  broken  open  a  spirit- 
store  on  the  island,  were  in  the  habit  of  getting  intoxicated,  in  which 
state  they  often  exposed  themselves  to  the  intense  heat  of  the  sun, 
by  day,  and  the  damp,  cold  dews  of  the  night.  A  few  of  the  12th  re- 
giment fell  victims  to  fever,  much  aggravated,  if  not  occasioned  by  ir- 
regularity ;  in  consequence  of  which,  an  idea  was  very  generally 
propagated,  that  the  island  was  peculiarly  unhealthy. 

"  On  the  14th  September,  the  Centurion  relieved  the  Braave,  and 
took  charge  of  the  hospital,  where  twelve  cases  were  left  behind, 
most  of  them  very  ill,  and  some  of  whom  died.  Prepossessed  against 
the  island,  the  Surgeon  of  the  Centurion  declined  landing  any  of  his 
sick  there,  at  first;  till,  finding  that  some  of  the  Braave'j,  who  were 
exceedingly  ill,  recovered,  an  I  that  none  of  the  nurses  were  attack- 
ed at  the  hospital,  he  ventured  to  laud  six  of  his  worst  patients, 
(bilious  remittents  and  fluxes,)  who  all  did  well.  He  therefore  be- 
came convinced,  that  the  reported  insalubrity  of  the  island  was  un- 
founded, in  a  great  measure,  at  least. 

"  Unfortunately,  however,  the  commanding  officer  of  the  expe- 
dition, conceiving  that  the  vicinity  of  the  island  to  the  main  land  was 
the  cause  of  sickness,  (which  supposition  seemed  corroborated  by 
the  foetid  mists  that  daily  came  off  from  thence  to  the  island,)  ordered 
the  sick  to  be  removed,  on  the  28th  September,  to  the  small  island  of 
Edam,  situated  nine  miles  out  to  sea  ;  a  circumstance  that  he  thought 
must  insure  its  salubrity.  Here  the  tragic  tale  commences  ; — but 
first  let  us  glance  at  the  medical  topography  of  the  two  islands.  On- 
rust is  a  small  island,  three  miles  from  the  main,  well  cleared  of 
trees,  underwood,  and  jungle  ;  nearly  flat,  and  free  from  swamps  or 
marshes,  except  one  very  small  spot,  which,  however,  is  daily 
covered  twice  by  the  tides.  — On  this  island  there  were  many  excel- 
lent buildings,  where  the  convalescents  could  be  separated  from  the 
fever  cases,  and  where  all  could  have  abundance  of  space  and  venti- 
lation. From  the  foetid  exhalations  which  were  conveyed  by  the 
land-winds  from  the  neighbourhood  of  Batavia,  the  sick  were  easily 
secured,  by  closing  Certain  apertures  in  their  apartment,  till  the  sun 
dispersed  the  vapours  in  the  morning ;  alter  which  there  did  not  ap- 
pear to  be  any  danger  from  the  miasmata  disengaged  during  the  day. 
Edam,  on  the  other  hand,  though  further  out  of  the  reach  of  Batavian 
exhalations,  is  covered  with  trees,  long  grass,  and  jungle,  having  a 
part  of  the  island  itself  in  a  stagnant,  marshy  state.  The  buildings 

14 


106  EASTERN    HEMISPHERE. 

here  were  indifferent,  and  only  one  long  ward  could  be  found,  for  the 
sick  and  convalescents  ;  in  consequence  of  which  the  latter  class  of 
patients  experienced  all  those  dire  effects  produced  by  the  depress- 
ing passions,  forever  nurtured  by  the  melancholy  scenes  of  death, 
which  this  fatal  spot  too  constantly  presented  to  their  view  !  Thus,  in 
running  from  a  doubtful  danger,  they  precipitated  themselves  on  cer- 
tain destruction.  In  leaving  Onrust,  (a  cleared  space,)  to  avoid  the 
effluvium  of  Batavia,  weakened  and  diluted  by  a  three  miles  passage 
from  its  source,  they  settled  on  the  jungly  and  marshy  island  of  Edam, 
where  pestilent  miasmata,  in  a  concentrated  form,  issued  from  every 
foot  of  ground  around  them  ! — The  fatal  effects  which  followed,  were 
predicted  by  an  eminent  Surgeon  on  the  spot,  but  his  suggestions 
were  disregarded  or  overruled  ;  distance  from  the  main  being  held 
paramount  to  all  other  considerations. 

Of  sixty  soldiers,  (12th  Regiment,)  landed  at  different  times,  in 
health,  to  do  duty  at  Edam  hospital,  and  other  buildings  on  the  Island, 
between  the  1st  October  and  12th  November,  thirty-one  died,  (be- 
sides five  or  six  at  Onrust,  previously.)  Of  the  remaining  twenty- 
nine,  embarked  on  breaking  up  the  blockade,  (12th  November,) 
twenty-two  died  at  sea  ;  the  other  seven  were  sent  to  Malacca  hospi- 
tal, where  all  or  nearly  all  of  them,  shared  the  same  fate  !  —  In  short, 
only  sixty- two  returned  out  of  the  whole  detachment ;  the  rest 
having  fallen  ingloriously  without  drawing  a  sword  ! 

"  All  the  soldiers  getting  ill  on  Edam,  sixteen  Marines  were  landed 
from  the  Centurion  to  do  night  duty,  as  they  expected  an  attack  from 
the  Dutch  gun-boats.  The  whole  of  these  were  seized  with  the 
fever,  and  thirteen  died  ;  two  recovered,  and  one  was  sent  to  Ma- 
lacca hospital. 

"  The  loss  of  seamen  I  have  not  been  able  exactly  to  ascertain  ; 
but  it  must  have  been  considerable.  Almost  the  whole  of  the  sick, 
[twenty-eight  in  number,]  who  were  removed  from  Onrust  to  Edam, 
[28th  September,]  died.  And  as  nine  Officers,  including  the  Surgeon, 
Mr.  Cornish,  who  were  doing  duty  at  this  dreadful  Island,  perished, 
we  may  form  some  idea  of  the  general  mortality. 

"  It  is  worthy  of  remark,  that  the  Dasdalus,  in  which  26  of  the 
detachment  from  the  12th  Regiment,  were  embarked,  did  not  land  a 
man  on  any  of  the  islands,  nor  did  one  of  her  men  die,  or  suffer  an  at- 
tack of  this  endemic.  Such  is  the  outline  of  its  history  ;  the  fol- 
lowing are  the  features  of  this  fever,  principally  as  it  appeared  at 
Edam,  its  head  quarters  :  — 

"  The  patient,  without  much  previous  notice,  (of  the  first  attack,) 
is  suddenly  seized  with  giddiness  and  cold  chills — sense  of  debility, 
and  vomiting,  with  pain  over  the  orbits,  and  in  the  epigastric  region. 
He  frequently  falls  down,  and  is  insensible  during  the  paroxysm  ;  his 
body  covered  with  cold  clammy  sweats,  Except  at  the  pit  of  the  sto- 
mach,  which  always  feels  hot  to  'the  palm  of  the  hand — the  pulse  is 
small  and  quick.  On  recovering  a  little,  this  train  of  symptoms  is 
succeeded  by  flushings  of  heat— increased  pain  over  the  orbits,  and 
in  the  sinciput— -pain  and  a  sense  of  internal  heat  about  the  stomach 
and  praecordia— oppressed  breathing—the  lower  extremities,  at  this 
lime,  not  un  frequently  covered  with  cold  sweats.  The  eyes  now  be- 


ENDEMIC  OF  BATAVIA.  107 

come,  as  it  were,  protruded,  and  the  countenance  flushed.  Retch- 
ing, and  at  length,  vomiting  of  discoloured,  bilious  matter,  comes  on 
—the  tongue  white  and  furred — the  abdomen  tense  and  full,  with 
pain  in  the  loins  and  lower  extremities.  The  length  of  this  parox- 
ysm varied  from  six  to  eighteen  hours,  and  was  generally  succeeded 
by  cold  rigors — very  often  low  delirium,  preparatory  to  the  next 
stage  or  paroxysm  of  the  fever.  The  intellectual  functions  now  be- 
come much  impaired,  the  patient  not  being  at  all  sensible  of  his 
situation,  or  of  any  particular  ailment. — If  asked  how  he  is?  he 
commonly  answers,  "  Very  well ;"  and  seems  surprised  at  the  ques- 
tion. This  was  a  very  dangerous  symptom,  few  recovering  in  whom 
it  appeared.  In  this  stage  all  the  symptoms  become  gradually,  often 
rapidly  aggravated  ;  particularly,  the  head-ache — pain  and  tension  in 
the  epigastric  region,  and  vomiting;  Some  patients,  on  shore,  were 
carried  off  in  18,  24,  30,  or  40  hours,  and  others  not  till  as  many 
days  after  the  attack,  especially  when  removed  on  board,  from  the 
more  noxious  air  of  the  island.  A  great  proportion  changed,  in  a 
few  days,  to  a  bright  yellow  ;  some  to  a  leaden  colour  :  other  cases 
terminated  fatally,  in  a  very  rapid  manner,  too,  without  the  slightest 
alteration  in  that  respect.  Generally,  however,  the  change  of  co- 
lour, indicated  great  danger.  Vomiting  of  black  bilious  stuff,  re- 
sembling the  grounds  of  coffee,  fiequently  commenced  early,  and 
continued  a  most  distressing  symptom  ;  too  often  baffling  all  our  at- 
tempts to  relieve  it.  In  some,  a  purging  of  vitiated  bile,  or  matter 
resembling  that  which  was  vomited,  occurred  ;  in  a  great  many,  a 
torpor  prevailed  throughout  the  intestinal  canal — rarely  did  any  na- 
tural feces  appear  spontaneously. — The  pupil  of  the  eye  was  often 
dilated,  and  would  not  contract,  on  exposure  to  a  strong  light — in 
others  there  was  great  intolerance  of  light : — both  indicated  dan- 
ger. Low  delirium  was  a  pretty  constant  attendant  on  this  fever, 
from  first  to  last  ;  sometimes,  though  more  rarely,  raging  high  deli- 
rium. Mr.  Carter's  was  an  instance  of  the  latter,  which  he  had  in  a 
very  terrible  degree,  with  red,  inflamed,  and  protruded  eyes — great 
inquietude — hot,  dry  skin — small,  quick  pulse  ;  his  mind  actively 
employed  about  the  stores  and  prizes  on  shore,  of  which  he  had 
charge  previous  to  his  illness.  During  the  violence  of  the  parox- 
ysms, he  was  quite  insensible  to  e?ery  thing  that  was  going  on  around 
him,  constantly  grasping  at,  or  wrenching  those  objects  within  his 
reach.  He  made  frequent  attempts  to  get  overboard.  In  the  low 
delirium,  also,  the  mind  is  much  occupied  on  avocational  subjects  ; 
if  a  seaman,  about  the  ship's  duty  ;  if  a  soldier  about  his  regiment, 
marching,  &c.  Some  patients  were  comatose  from  the  first  attack  ; 
rn  others,  the  fever  was  ushered  in  with  convulsionsy  delirium,  and 
cold  sweats,  without  any  intervening  heat  of  the  surface,  except  at 
the  pit  of  the  stomach,  which,  in  most  cases,  was  burning  hot  to  the 
touch,  and  accompanied  internally  by  a  similar  sensation  according  to 
the  patient's  own  feelings. 

"  Haemorrhage  from  the  mouth  or  nose  seldom  occurred  ;  in  two 
cases,  \\fcich  terminated  fatally,  the  blood  did  not  coagulate,  but  ting- 
ed the  linen  yellow.  Aphtha}  appeared  in  a  few  cases,  and  indicat- 
ed danger.  Subsultus  tendinurn  ofidi  attended  both  on  the  lonr  and 


108  EASTERN  HEMISPHERE. 

high  delirium.  The  pulse  never  could  be  depended  on.  In  the 
very  last  stage  it  has  been  regular  ;  but  in  general  it  is  small,  quick, 
and  either  hard  or  stringy  and  tremulous;  sometimes,  during  the 
reaction  of  the  system,  full  and  hard.  Deafness  was  very  common, 
and  an  unfavourable  symptom.  Two  kinds  of.  eruption  appeared 
about  the  lips — one  such  as  we  often  see  at  the  decline  of  common 
fevers  ;  the  otber,  consisted  of  small  black  or  brown  spots  round  the 
lips,  and  was  likewise  a  dangerous,  indeed  a  fatal  symptom.  With 
this  eruption,  the  teeth,  tongue,  and  fauces  generally  become  cover- 
ed with  a  brown  or  black  crust,  and  the  breath  intolerably  ftetid. 
Locked  jaw  took  place  in  two  cases  at  Onrust  Hospital,  but  the  pa- 
tients were  insensible  of  it  : — both  died.  The  brain  appeared  1he  or- 
gan chiefly  affected  at  first — the  stomach  and  liver  in  succession*.  In 
those  cases  which  occurred  on  hoard,  and  where  the  patient  had  not 
slept  on  shore  at  Edam,  the  symptoms  were  much  milder,  and  the 
fever  resembled  more  the  bilious  remittent  of  other  parts  of  the 
East.  A  great  torpor  prevails  generally  throughout  the  system,  with 
the  low  delirium  ;  blisters,  medicines,  &c.  having  little  effect  on  the 
patient,  who  appears  as  if  intoxicated.  When  roused,  he  recollects 
the  person  who  is  speaking  to  him,  for  a  moment,  and  answers  in  a 
hurried,  incoherent  manner  ;  then  lies  on  his  back,  his  mouth  and 
eyes  half  open  ;  both  feces  and  urine  often  passing  involuntarily.  I 
have  seen  them  remain  in  this  state  for  hours  — nay,  for  days  toge- 
ther, scarcely  moving  a  single  voluntary  muscle  all  that  time.  In 
this  melancholy  situation,  Lieut.  Neville,  of  the  12th  regiment,  lay 
for  some  days  previous  to  his  death.  — Never  was  there  a  disease  so 
deceitful  as  this  fever  :  I  have  frequently  seen  instances  where 
every  symptom  was  so  favourable,  that  I  could  almost  have  pronounc- 
ed my  patient  out  of  danger  :  when  all  at  once  he  would  be  seized 
with  restlesness— black  vomiting -delirium— and  convulsions  - 
which,  in  a  few  hours,  would  hurry  him  out  of  existence  ! 

"  This  was  the  case  with  Mr.  Broughton,  Purser  of  the  Daedalus, 
who  died  of  the  Batavian  endemic  at  Edam  Hospital.  On  the  seventh 
day  of  his  illness  he  took  a  change  for  the  better  ;  and  every  thing  was 
promising.  The  morning  before  he  died,  he  expressed  himself  greatly 
relieved  ;  and  called  for  some  mutton  broth  and  sago,  both  of  which 
he  ate  with  a  good  appetite  ;t  spoke  rationally — and  was  in  good 
spirits.  Towards  evening  the  delusion  vanished — restlessness — black 
vomiting — delirium  and  convulsions  supervened,  and  carried  him  off 
before  morning  !  I  have  seen  many  cases  terminate  in  this  manner. 
Two  patients  at  Edam  complained  of  a  diminished  size  of  the  brain, 
and  that  they  felt  as  if  they  could  shake  it  about  within  the  cranium  : 
— both  died.  Mr.  Cornish,  Surgeon  of  the  Daedalus,  who  had  charge 
fora  while  of  the  hospital,  was  one  ;  he  died  on  the  seventh 'day  of 
his  illness. 

"  The  fatal  terminations  generally  happened  on  the  third—fifth  — 
seventh— ninth,  and  not  unfrequently  the  eleventh  and  thirteenth 
day  ;  if  they  passed  this  period,  they  usually  lingered  out  twenty  or 

*  This  accords  with  my  observations  on  the  Bengal  Endemic,  and  with  the 
mode  in  which  I  supposed  miasmata  to  acl  on  the  human  body. 
t  Hunger  is  a  fatal  symptom  in  the  yellow  fever. 


ENDEMIC  OF  BAT  A  VIA.  109 

vturty  days.  But  very  few  indeed  ever  ultimately  recovered,  who 
had  slept  on  shore,  and  were  attacked  at  that  dreadful  island,  Edam  ! 
No  constitution  was  exempted  from  the  assault  of  this  fever.  It  seized 
with  equal,  or  nearly  equal  violence,  on  those  who  had  been  many 
years  in  India,  and  on  the  most  robust  and  plethoric,  or  newly-ar- 
rived European.  Even  the  Dutch  Officers  and  Malays,  who  had  been 
drawn  from  different  parts  of  Java,  and  whom  we  had  prisoners  at 
Edam,  fell  victims  as  fast,  or  nearly  so,  as  the  English.  Several  of- 
ficers, seamen,  and  soldiers,  were  sent  on  board  from  this  island  in 
hopes  that  the  change  of  air  might  mitigate  the  disease.  Many  of 
even  the  worst  cases  of  these  would  promise  fair  for  a  few  hours  in 
the  forenoon  ;  but  night  always  dispelled  our  hopes,  for  then  the  pa<- 
tient  relapsed  as  bad  as  ever  : — they  almost  all  died.  But  their  fate 
was  considerably  procrastinated  by  the  change  ;  many  of  them  lin- 
gering out  a  great  length  of  time  on  board,  sinking  at  last  from  the  con- 
sequences of  the  fever,  rather  than  from  the  fever  itself.  Several  of 
them  changed  into  obstinate  intermittents  at  sea,  with  great  derange- 
ment of  the  liver,  spleen,  and  bowels.  Indeed  the  liver,  in  most  cases, 
seemed  affected  from  first  to  last  in  this  fever  ;  but  in  all  protracted 
states  of  it,  this  affection  became  the  prominent  symptom.  In  those 
that  were  cut  off  during  the  first  18,  24,  or  30  hours,  the  brain  ap- 
peared to  be  the  organ  oppressed.  With  respect  to  the  question, 
whether  or  not  this  fever  was  contagious,  1  am  decidedly  of  opinion 
that  it  was  not  so.  For  if  all  the  nurses  and  medical  attendants  of 
the  hospital  at  Edam  died,  it  must  be  remembered,  that  they  were 
equally  exposed  to  the  cause  of  fever,  whatever  it  is,  as  the  sol- 
diers and  seamen  who  did  duty  at  the  barracks  and  other  buildings,  or 
who  were  sent  to  the  hospital  for  other  complaints  ;  all,  or  nearly  all 
of  whom  shared  the  same  fate.  Moreover,  what  I  conceive  decides 
the  question  is  this  ;  that  although  on  our  raising  the  blockade  of  Ba- 
tavia,  great  numbers  of  sick,  in  every  stage  of  the  fever,  were  brought 
on  board  from  the  hospital  at  Edam,  yet  not  a  single  nurse,  or  medi- 
cal attendant  of  any  description,  ever  suffered  the  slightest  attack  of 
fever  ;  nor  did  any  circumstances  transpire,  that  could  in  the  least 
favour  the  idea  of  contagion,  notwithstanding  that  the  great  accumula- 
tion of  sick  on  both  decks  rendered  it  a  matter  of  impossibility  to  se- 
parate them  completely  from  those  who  were  well,  nor  at  all  times  to 
prevent  a  considerable  generation  of  effluvia. 

"  From  our  first  arrival  at  Batavia,  in  August,  until  our  return  to 
Malacca,  in  January  following,  we  only  buried  one  man  of  fever,  who 
had  not  slept  on  shore  at  Edam,  Cuypers,  or  Onrust  islands;  whereas 
almost  every  person  who  slept  even  a  single  night  at  Edam,  died.  No 
ill  effects  were  experienced  from  going  on  shore  in  the  day  time,  or 
among  the  sick  at  the  hospital.  1  myself  regularly  visited  the  hos- 
pital of  Edam  every  day,  with  perfect  impunity,  till  one  night  that  1 
staid  rather  late,  attending  the  unfortunate  Surgeon  of  the  Daedalus  ; 
in  consequence  of  which  I  w,as  three  days  afterwards  seized  with  the 
fever,  but  recovered  by  mercury  carried  to  ptyalism.  1  think  it  highly 
probable,  however,  that  had  I  slept  on  shore,  no  medicine  would  have 
saved  my  life. 

"  The  night  before  we  raised  the  blockade,  parties  of  men  and 


HO  EASTERN  HEMISPHERE.  V 

officers  were  sent  on  shore  at  Edam  to  blow  up  and  destroy  the  works 
and  buildings  on  the  island,  which  operations  detained  them  about 
half  the  night  there.  Most  of  these  were  shortly  afterwards  attack- 
ed with  the  fever,  but  all  recovered  except  one,  (Mr.  Parry,  mid- 
shipman ;)  his  fever  too,  was  checked  by  mercury  ;  but  being  of  a 
diseased  habit,  he  relapsed  when  the  soreness  left  his  mouth,  and 
died.  The  gunner,  carpenter,  and  other  officers,  were  all  seized 
with  the  fever  ;  but  the  former,  being  principally  employed  among 
fires,  in  laying  trains,  blowing  up,  &c,  had  the  disease  in  an  infinitely 
milder  degree  than  any  of  the  others. 

"  One  circumstance  more  is  so  singular  in  itself,  and  so  much  at- 
tracted our  notice  at  the  time,  that  I  think  it  deserves  commemora- 
tion. Of  all  the  people  or  patients  who  slept  at  the  fatal  island  of  Edam, 
four  only,  to  the  best  of  my  knowledge,  escaped  the  fever,  entirely,  and 
returned  to  Malacca. — These  were  two  obstinate  venereals,  and  two  chro- 
nic dysenteries  ;  all  under  the  influence  of  mercury,  for  some  time  be- 
fore I  sent  them  to  the  hospital.  Their  complaints  did  not  get  better  in 
the  least  on  shore,  so  that  they  continued  to  take  mercury  there.  They 
slept  in  the  same  ward  with  thejever  patients  All  the  time,  but  never  had 
the  slightest  symptom  of  fever  themselves.  One  other  patient  at  the 
hospital  did  not  catch  the  fever,  but  he  was  sent  there  in  the  last 
stage  of  phthisis,  and  died  a  few  days  after  he  landed. 

"  I  have  omitted  to  mention,  that  despondency,  or  anxious  timidity, 
very  frequently  accompanied  the  access  of  this  fever  ;  while  a  placid 
resignation  to  their  fate,  or  rather,  an  insensibility  to  their  situation, 
marked  its  fatal  close. 

Treatment. 

"  In  this,  as  well  as  in  the  common  fevers  of  India,  where  a  re- 
dundancy of  vitiated  bile  might  be  suspected  lurking  in  the  primae 
via?,  I  have  always  prescribed  a  solution  of  salts  and  emetic  tartar, 
as  the  first  medicine,  which  generally  operated  both  upwards  and 
downwards  ;  and  subsequently,  by  perspiration,  in  a  short  space  of 
time,  to  the  great  relief  of  the  patient.  On  the  same  evening,  an 
anodyne  antimonial  draught,  (vin.  ant.  one  drachm  tinct.  opii,  gut. 
xv.  vel  xx.  aq.  menth.  two  ounces,)  was  exhibited,  to  allay  the  irri- 
tability of  the  stomach — promote  the  cuticular  discharge,  and  dispose 
to  sleep.  Bleeding  I  was  afraid  to  attempt,  as  in  the  only  case,  to 
my  knowledge,  where  it  was  tried  in  this  fever,  the  patient  very  soon 
afterwards  died,  in  a  state  of  putrescence.  From  this  circumstance, 
and  from  some  accounts  which  I  had  rend,  of  its  bad  effects  in  fevers  of 
the  West  Indies,  I  gave  up  all  idea  of  the  lancet.  I  therefore  had  re- 
course to  evacuations  from  the  bowels,  and  from  the  skin.  For  the 
latter  purpose,  I  tried  various  medicines  ;  such  as  the  saline  draughts, 
with  sp.  aether,  nitros.  tepid  bathing,  with  diluents,  &c.  ;  but  I  found 
none  equal  to  small  doses  of  antimonial  wine,  and  tincture  of  opium  ; 
given  frequently,  with  plenty  of  warm,  diluent  drinks,  and  occasional 
pediluvium.  By  perseverance  in  this  plan,  for  a  few  days,  in  the 
less  violent  cases,  the  skin  has  become  relaxed,  with  an  equally  diffus- 
ed perspiration — the  pulse  soft  and  natural ; — the  pains  and  delirium 
fcave  disappeared;  and  nothing  but  debility  remained,  which  was 
soon  removed  by  bitters,  bark,  wine,  and  nourishment. 


ENDEMIC  OF  VTAV1A.  111. 

»«  But  alas  !  in  the  more  concentrated  forms  of  the  disease,  by 
which  we  were  now  surrounded,  this  practice  was  far  from  success- 
ful. For  here  the  patient  hourly  lost  ground  ;  and  seemed  to  be  hurried 
out  of  existence  by  the  local  effects  of  the  fever  ;  chiefly  confined  to  the 
brain  and  liver.  What  the  nature  of  these  local  effects  was,  /  am  un* 
able  to  say.  They  appeared  to  be  either  inflammation — an  accumula- 
tion—or a  greater  determination  of  blood  to  those  organs,  or  perhaps 
something  compounded  of  all  these  ;  and  evinced  by  the  red,  inflamed  state 
of  the  eyes— the  delirium  — the  oppression,  tension,  and  often  pain,  in 
the  epigastric  and  hypochondriac  regions.*  Finding,  then,  that  bleed- 
ing would  be  attended  with  fatal  consequences,  and  that  antiphlogis- 
tics  and  tonics  were  alike  ineffectual,  1  was  forced  to  have  recourse 
to  other  means  ;  and  knowing  that  mercury  was  a  powerful  specific 
against  local  inflammation,  particularly  of  the  liver,  as  well  as- a  most 
valuable  medicine  in  bilious  remittents,  where  visceral  obstructions 
were  forming,  or  formed,  I  placed  my  last  hopes  in  the  employment 
of  this  active  remedy.  I  generally  prescribed  calomel  combined 
with  opium,  and  antimonial  powder,  in  some  few  cases  with  camphor, 
in  the  following  manner  : 

Calomel,  six  or  eight  grains, 

Antimonial  powder,  two  grains, 

Opium,  one  grain. 

"  These  were  made  into  a  bolus,  and  taken  every  three,  four,  or 
six  hours  ;  so  that  from  twenty-four  to  thirty-six  grains  of  calomel 
might  be  taken  in  the  course  of  the  day  and  night. — if  a  salivation 
could  be  excited  in  a  few  days,  the  patient  experienced  an  immediate 
change.  The  fever  entirely  left  him — the  pains  abated — the  intel- 
lectual functions  were  restored— the  stools  became  natural,  and  no- 
thing but  tonics,  nourishing  diet,  and  change  of  air  were  wanting  to 
perfect  the  recovery.  This  last  desideratum,  (change  of  air,)  the 
most  important  of  all  to  convalescents,  was  least  of  all  within  our 
power,  while  we  inhaled  the  noxious  atmosphere  of  Batavia. 

*'  Here,  then,  we  had  the  mortification  to  see  our  patients,  after 
being  rescued  from  the  jaws  of  death — every  symptom  of  fever  gone, 
and  after  being  several  days  convalescent,  with  a  relish  for  food— re- 
lapse one  after  the  other,  as  the  soreness  left  their  mouths,  and  die  al- 
most to  a  man  ! 

"  Many  instances,  however,  occurred  at  Edam  Hospital,  where 
mercury  was  prescribed  in  large  quantities!,  after  other  medicines  had 
failed  in  the  beginning,  without  affecting  their  mouths  ;  in  which  case, 
they  all  proved  fatal.  I  have  sometimes  prescribed  bark  and  wine, 
in  conjunction  with  mercury,  to  support  the  system  during  its  exhibi- 
tion, and  I  think  that  in  several  instances  it  accelerated  the  ptyalism.j 
Blisters  often  gave  temporary  relief  to  local  symptoms,  such  as  pain 
—  hepatic  affection,  and  vomiting.  They  likewise  served  as  stimuli, 
to  rouse  the  patient  from  stupor  and  delirium. 

*  I  need  hardly  remark,  that  these  conclusions,  the  result  «f  observations  made 
at  the  bedside  of  fever,  and  in  an  extensive  field,  form  a  striking  coincidence, 
and  a  corroboration  of  the  theory  of  fever  which  I  framed  in  the  same  school  of 
experience. 

t  This  is  similar  to  Dr.  Balfour's  plat?. 


112  -          EASTERN    HEMISPHERE. 

"  In  the  early  stage  of  this  fever,  the  tepid  bath  was  used  with  ad- 
vantage ;  but  in  advanced  states  of  the  disease,  I  think  it  did  injury, 
by  increasing  debility.  I  have  frequently  experienced  the  greatest 
benefit  from  sponging  the  body  with  cold  vinegar  and  water,  where 
there  was  low  delirium — cold  clammy  sweats— and  stupor.  In  such 
cases  the  pulse,  from  being  120  or  130,  would  fall  to  90,  and  a  re- 
freshing sleep  succeed  ; — but  night  always  brought  on  the  usual  exa- 
cerbation. Gentle  emetics  of  ipecacuanha,  I  have  often  found  to  re- 
lieve the  delirium,  oppressed  breathing,  and  load  at  the  stomach  or 
prascordia,  even  at  an  advanced  period  of  the  disease.  Incases  where 
great  determination  to  (he  brain  appeared,  I  have  of  ten  given  brisk  doses 
of  calomel  and  jalap,  with  surprising  good  effect.  Indeed,  evacuating 
medicines  of  every  kind,  where  they  do  not  tend  to  debilitate  the  system, 
are  extremely  useful  in  the  early  stages  of  this  fever.  Wine,  porter, 
and  nourishment,  did  more  harm  than  good,  except  in  the  advanced 
periods  of  the  disease,  when  porter  was  always  beneficial  in  check- 
ing the  vomiting,  and  allaying  the  irritability  of  the  stomach.  Bark, 
in  many  cases,  did  much  harm,  by  bringing  on  or  increasing  the 
vomiting,  and  other  dangerous  symptoms — besides  checking  the  per- 
spiration, and  rendering  the  patient  hot  and  restless.  In  some  cases, 
however,  I  think  it  produced  good  effects,  especially  when  guarded 
with  opium,  to  make  it  sit  on  the  stomach. 

"  But  could  the  patient  be  removed  from  the  noxious  air  of  Batavia 
into  a  purer  atmosphere  during  the  mercurial  course,  I  should  not  have 
a  doubt  in  the  efficacy  of  mercury  ;  for  it  was  the  only  medicine  that 
ever  bade  fair  to  check  the  ravages  of  this  dreadful  fever.  Without  this 
change  of  air,  I  believe  that  every  human  means  will  have  but  a  tem- 
porary effect  ;  and  excepting  mercury,  Jew  of  them  will  have  even  that. 

"  It  is  necessary  to  say,  that  copious  ptyalism  must  be  brought  on, 
otherwise  it  will  prove  ineffecient.  I  tried  the  nitrous  acid,  as  re- 
commended by  Dr.  Scott  of  Bombay,  but  cannot  say  any  thing  in  its 
favour.  The  Dutch  medical  practice  at  Batavia,  consists  in  giving 
camphor  in  weak  jalap  ;  making  the  patient  drink  quarts  of  it  in  the 
course  of  the  day,  till  the  perspiration  teems  from  every  pore  of  his 
body  ;  keeping  him  all  this  time  in  a  close  room  well  covered  over 
with  warm  bed  clothes,  and  without  paying  the  least  attention  to  any 
urgent  symptoms,  or  other  means  of  arresting  the  fever.  But  this 
plan  was  very  unsuccessful  ;  for  the  mortality  in  the  garrison  of  Ba- 
tavia, while  we  lay  before  it,  was  dreadful,  particularly  among  the 
European  soldiers. 

**  Previous  to  our  appearance,  the  Dutch,  in  general,  resided  a 
few  miles  up  the  country,  on  elevated  ground,  and  out  of  the  reach  of 
those  pestilential  vapours  that  issue  from  the  low  swamps  in  the  vi- 
cinity of  the  city.  There  they  enjoyed  tolerable  good  health  ;  but 
our  arrival  forced  them  into  the  garrison,  where  they  had  hard  duty, 
day  and  night,  in  keeping  a  lookout  upon  us,  and  throwing  up  works 
to  defend  the  place.  The  fever  therefore,  swept  them  off  in  prodi- 
gious numbers,  so  that  their  loss  far  exceeded  ours.  In  an  action 
with  some  of  their  gun-boats,  we  had  a  few  men  wounded,  who  did 
well  on  board.  But  this  §eems  to  be  a  rare  circumstance  ;  for  one 
of  our  officers  being  on  shore  with  a  flag  of  truce,  was  asked  by  the 


ENDEMIC    OF^BATAYIA.  113 

Governor,  how  our  wounds  succeeded  ;  and  being  informed  that 
they  were  all  nearly  well,  he  seemed  quite  astonished,  and  would 
hardly  give  credit  to  the  account  ;  declaring,  upon  his  honour,  tljat 
during  fifty  years  which  he  had  passed  at  Batavia,  he  never  knew  a 
single  instance  of  a  man  surviving  a  wound  received  in  the  noxious 
air  of  the  city  and  its  neighbourhood.*  He  als  >  expressed  great 
surprise  that  our  mortality  in  the  squadron  was  not  greater  ;  as  he 
calculated  on  our  losing  at  leaet  half  our  men  during  our  long  stay 
there.  The  Dutch  ships  generally  lost  from  half  to  three-fourths  of 
their  crews,  between  their  arrival  at  Batavia  and  their  departure  for 
Europe.  *  *,* 

"  CASE  If— JAS.  BARRETT,  Onrust  Hospital. 

"  September  \5th,  1800.  Jrlas  been  ill  about  forty- eight  hours. 
At  5  P.  M.  to  day,  a  mad  delirious  fit  ;  with  difficulty  can  be  kept  in 
bed  ;  tongue  tremulous,  vvhite  and  furred  ;  eyes  red  ;  complains 
frequently  of  his  head,  with  pain  in  the  epigastric  region  ;  skin  hot, 
with  some  perspiration  on  it ;  has  been  taking  bark  three  or  four 
times  to-day;  head  to  be  shaved  and  blistered;  pediluvium  ;  an 
aether  and  anodyne  draught  at  bed-time  — the  bark  infusion  to  be 
given  through  the  night. 

"  16th.  Had  a  very  restless  night  ;  painjn  the  head  excessive*,  and 
not  relieved  by  the  blister  ;  calomel,  gr.  x.  jalap  one  drachm,  statim 
sumend  ;  at  1  P.  M.  it  operated,  and  brought  off  numerous,  copious, 
foetid  green  stools.  At  6  P.  M,  head  not  relieved  ;  a  profuse  per- 
spiration ;  pulse  90»;  tongue  brown  ;  talks  incessantly,  in  the  most 
incoherent  language  ;  all  the  symptoms  very  unfavourable  ;  the  ano- 
dyne antimonial  at  bed-time. 

"  ITth.  He  lay  in  a  "state  of  stupor  all  night  ;  this  morning,  skin 
warm,  and  a  little  moist  ;  decoction  of  bark  every  two  hours,  which 
he  retains  well  on  his  stomach.  At  1  P.  M  lies  in  a  state  of  stupor, 
and  with  difficulty  can  be  roused  ;  mutters  between  his  teeth  inces- 
santly ;  e/es  inflamed  and  prominent ;  abdomen  tense  and  full  ;  pulse 
frequent  and  hard  ;  tongue  dry  ;  bowels  opened  by  an  enema  ;  con- 
tinue the  bark  ;  and  to  take  calomel,  gr.  x.  cpii.  gr.  j.  at  bed-time. 

"  IQth.  First"  part  of  the  night  more  cpmposed  ;  restless  in  the 
latter  ;  this  morning,  stupor  as  before ;  lies  on  his  back,  with  mouth 
and  eyes  half  open  ;  with  difficulty  can  be  roused  ;  body  has  an  of- 
fensive smell ;  coKi»  clammy  sweats,  skin  changing  yellow  fast ; 
pulse  small  and  quick  ;  when  roused,  will  take  whatever  is  offered,; 
the  decoction  of  bark  through  the  day  ;  repeat  the  calomel  and  opi- 
um at  bed-time. 

"  19lh.  Passed  a  tranquil  night ;  repeated  the  calomel  this  morn- 
ing ;  the  decoction  of  bark  to  be  continued  ;  at  1  P.  M.  omitted  the 
bark,  and  exhibited  a  saline  cathartic,  which  brought  off  three  copi- 
ous foetid  stools  ;  at  8  P.  M.  he  appears  better  ;  he  is  perfectly  sen- 
sible ;  skin  a  bright  yellow  ;  but  is  warm,  and* has  an  equally  diffused 
moisture  on  it ;  repeat  the  calomel  and  opium  as  in  the  morning. 

*  This  corroborates  the  circumstance  mentioned  by  Lin  J,  of  the  slightest 
scratches  turning  into  dreadful  ulcers,  on  board  the  Panther  and  Medway,  in 
1764. 

15 


1J4  LASl'ERIf  HEMISPHERE. 


Passed  an  easy  night,  but  had  no  sleep  ;  at  8  this  morning 
he  seems  better  in  every  respect  ;  continues  sensible  ;  repeat  the 
calomel  ;  also  decoction  of  bark  ;  at  1  P.  M.  uneasiness  in  his  sto- 
mach and  bowels  ;  fever  increased  ;  great  incoherence  in  language 
and  ideas  ;  omitted  the  bark  ;  prescribed  a  cathartic,  which  brought 
off  many  copious  foetid  stools  ;  at  eight  in  the  evening  a  remission  of  the 
fever  ;  other  symptoms  more  favourable  ;  the  calomel  continued. 

*'  21  st.  Passed  a  good  night,  and  is  better  this  morning  ;  repeated 
the  calomel  twice  to-day,  with  b-irk  decoction  ;  at  8  P.  M.  an  exa- 
cerbation of  fever  ;  repeat  the  calomel. 

"  22nd  Passed  a  tolerable  night  ;  a  mercurial  odour  on  the  breath  ; 
skin  becomes  less  yellow,  with  equally  diffused  perspiration  ;  the  cal- 
omel and  decoction  as  before. 

"  23rd.  Mouth  sore,  and  all  symptoms  favourable  ;  yellowness  goes 
off  the  skin  ;  perfectly  sensible  ;  no  head-ache  ;  stools  more  natural  ; 
craves  for  food  ;  continue  the  calomel,  with  a  pint  of  wine  and  nourish- 
ing diet. 

"  27Z&.  Ptyalism  did  not  come  on  copious  till  to-day  ;  he  is  now 
free  from  every  complaint,  except  debility  ;  appetite  good  —  spirits 
free  ;  yellow  tinge  almost  gone  ;  ornit  all  medicine  —  convalescent 
list. 

"  28tft.  He  was  this  day  'sent,  with  other  convalescents,  &c.  to  Edam 
Hospital,  where  be  afterwards  caught  the  fever.  He  was  removed 
immediately  on  board  ;  the  same  plan  of  treatment  adopted,  and  as 
soon  as  ptyalism  appeared  he  began  to  mend.  He,  was  one  of  the  very 

few  who  ultimately  recovered  from  the  fever  of  Edam/'* 

• 

«  CASK  H.—WM.  WARD,  Marine,  Onrust  Hospital. 

"  September  \8lh,  1800.  At  I  P.  M.  to-day  complained  of  pain  in 
his  head,  back,  and  loins  ;  skin  burning  hot  ;  tongue  foul  ;  pulse  small 
and  quick  ;  pain  at  the  stomach  ;  nausea  and  retching  ;  an  emetic, 
which  operated  well^j  at  night  the  anodyne  antimonial  draught. 

•*  l$th  Passed  a  restless  night  ;  this  morning  complains  much  of 
his  head  ;  severe  purging  and  griping  ;  skin  intensely  hot  ;  tongue 
foul  and  dry  ;  the  emetic-cathartic  solution,  which  operated  well 
both  ways  ;  at  8  P.  M.  the  anodyne  antimonial  draught. 

"  20i/i.  Passed  a  very  bad  night  ;  high  fever  tins  morning  ;  dysen- 
teric purging  ;  skin  burning  hot  and  dry  ;  tongue  foul  ;  pulse  very 
quick  ;  fixed  pain  about  the  umbilicus  ;  teoesmus  ;  calomel,  gr.  viij  ; 
pulv.  ant.  gr.  ij  ;  opii,  gr.  j  ;  to  be  taken  twice1  a-day. 

"  %lst.  All  the  symptoms  worse  to-day  ;  skin  clammy,  with  par- 
tial sweats  ;  stools  green,  thin,  small,  and  frequent  ;  severe  tenes- 
mus  ;  burning  heat  and  pain  at  the  stomach  ;  ornit  the  calomel  ;  sa- 
line draughts  with  camphor  through  the  day  ;  anodyne  antimonial  at 
night. 

"  22nd*  Passed  a  very  restless  night  ;  severe  purging  of  green, 
fo3tid  stuff;  pain  in  the  head  anil  epigastric  region  excessive  ;  skin  in- 

*  I  leave  it  to  the  candour  and  judgment  of  the  reader,  whether  the  cure  is 
to  be  attributed  here  to  the  bark  decoction,  or  to  the  intestinal  evacuations  and 
mercury.  This  is  a  very  valuable  case—  -for  it  was  a  very  formidable  one  :  o* 
the  18th  it  appeared  nearly  hopeless. 


*  •:'•*•*•• 
•t  I 

ENDEMIC  OF    BATAVJA,  116 

leusely  hot ;  pulse  quick  ;  thirst  insatiable  ;  great  inquietude,  never 
resting  a  minute  in  one  position  ;  had  recourse  again  to  the  calomel, 
opium,  and  antimonial  powder  ;  but  to  be  taken  morning,  noon,  and 
night. —At  eight  P.  M.  a  little  more  composed. 

"  23rd.  Passed  a  better  night ;  this  morning  very  restless  and  un- 
easy ;  all  the  symptoms  as  bad  as  yesterday  morning,  with  the  Addi- 
tion of  frequent  delirium,  and  pain  ifl  the  right  side. — The  same 
treatment  as  yesterday. 

"  24tk.  Slept  some  last  night ;  symptoms  this  morning  rather  more 
favourable  ;  the  internal  burnin^heat  in  the  epigastric  region  not  so 
great ;  the  extremities  covered  with  cold,  clammy  sweats  ;  the  calo- 
mel bolus  repeated  three  times  as  usual,  with  camphor  mixture  every 
four  hours. 

"  25lk.  The  dysenteric  symptoms  not  so  violent  .to-day  ;  heat  and 
pain  in  the  epigastrium  diminished  ;  the  pain  of  the  right  side  sub- 
siding ;  at  noon,  a  violent  paroxysm  of  fever,  ushered  in  with  rigors, 
which  has  left  him  in  a  very  debilitated  state  ;  added  decoction  of  bark 
and  port  wine  to  the  mercurial  treatment. 

"  26th-  Mouth  sore  ;  fever  gone  ;  bowels  easy  ;  asks  for  food  ; 
medicines  continued  as  yesterday; 

'*  21th.  Ptyalism  ;  recovering  fast  ;  omit  the  mercury,  and  to  have 
nourishing  diet. 

"  2Sth.  Ptyalisnf  continues  ;  free  from  all  complaint ;  returned  Oii 
board  of  his  ship.  * 

"  CASE  III.-- Jos.  HUGHES,  Marine,  of  Edam, 

"  October  9th,  IfiOO.  Complained  this  morning  of  the  usual  symp- 
toms of  the  Batavian  fever  ;  his  headache  exceedingly  intense.  He 
had  done  duty  on  mirust  Island,  where  he  slept  and  often  got  intoxi- 
cated with  arrack  ;  an  emetic,  and  after  its  operation,  the  anodyne  an- 
timonial draught. 

"  IQth.  A  very  restless  night ;  great  pain  in  the*  forehead  this  morn- 
ing ;  internal  beat  and  pain  at  the  pit  of  the  stomach  ;  tongue  foul  ; 
bowels  uneasy  ;  pulse  full  and  quick  ;  frequent  small,  green,  foetid 
stools  ;  ordered  the  emetic-cathartic  solution,  which  operated  well 
both  ways  ;  the  anodyne  antimonial  as  last  night. 

*'  llth.  At  one  o'clock  this  morning  he  was  seized  with  convulsive 
twitchings  ;  difficult  breathing  ;  alternate  flushes  and  rigors,  rattling 
in  his  throat  ;  insensibility  ;  pulse  small,  quick,  and  irregular  ;  sp.  c.  c. 
gt.xxx.  aq.  menthse  one  ounce  and  a  half,  aether,  vitriol,  half  a  drachm  ; 
this  paroxysm  lasted  three  hours  with' momentary  intermissions  ;  at 

*  This  is  also  a  very  valuable  case.  It  shows  us  the  fever  accompanied  with 
dysenteric  symptoms — and  where  the  determination  to  the  liver  was  quite  evi- 
dent; 

If  these  honest  and  plain  naratives  do  not  remove  every  shadow  of  doubt,  in 
regard  to  the  power  of  mercury  in  tropical  fevers  of  the  East,  all  human  testi- 
mony is  vain.  |  These  documents  are  more  convincing  than  if  they  came  from 
myself— -for  I  might  either  be  blinded  by  prejudice,  or  have  some  interest  in  dis~ 
troying  the  truth-  Neither  of  these  can  have  operated  here — for  the  practitioner 
evidently  resorted  to  mercury  with  relqctaac*,  an<J  hardly  ever,  till  other  means 
were  first  tried  > 


i 

116  EASTERN    HEMISPHERE. 

eight  this  morning,  more  composed  ;  skin  hot  and  dry  ;  tongue  foul 
and  furred  ;  abdomen  full  and  tense  :  natron,  vitr  one  ounce  ;  two 
copious  foetid  stools  ;  evening,  something  better  ;  perspires  ;  the  night 
draught  as  before. 

"  12th.  Slept  till  midnight  ;  at  one  o'clock,  stole  out  of  bed,  and 
leapt  overboard  ;  but  was  instantly  picked  up  by  a  boat  that  happen- 
ed to  be  alongside.  He  was  now  perfectly  sensible,  and  somewhat 
frightened  ;  could  not  account  for  his  conduct  ;  returned  to  bed  ;  at 
nine  this  morning,  tongue  foul  ;  skin  warm  and  clammy  ;  body  has  a 
disagreeable  smell ;  camphor  julep  every  two  hours  ;  at  1  P.  M.  be- 
came very  restless  ;  made  several  attempts  to  get  overboard,  (to 
walk  in  the  garden,  as  he  expresses  it  ;)  talks  incoherently  ;  at  4 
P.  M.  worse  ;  cold,  profuse,  clammy  sweats  ;  complains  of  no  pain  ; 
when  asked  how  he  does,  repiies,  *'  Very  well  ;"  pulse  small  and 
fluttering  ;  lies  on  his  back,  in  a  state  of  stupor  ;  mouth  and  eyes 
half  open  :  can  hardly  be  roused  ;  the  camphor  julep  continued, 
with  an  opiate  at  night.  He  drank  a  pint  of  Madeira  wine  in  the 
course  of  the  day. 

"  13th.  No  sleep  last  night  ;  cold  clammy  sweats  to-day  ;  made 
several  attempts  to  get  overboard  ;  pulse  small  and  quick  ;  tongue 
covered  with  a  brown  crust  ;  still  answer  that  he  is  «'  very  well," 
(a  dangerous  symptom  ;)  decoction  of  bark  anti  port  wine  ;  his  sto- 
mach retentive  ;  opium  and  camphor  at  bedtime. 

"  14th.  Very  restless  in  the  latter  part  ot  the  night  ;  delirious  ; 
made  several  attempts  to  get  overboard.  This  morning,  violent 
black  vomiting,  which  was  checked  at  1  P.  M.  by  opium,  aether, 
and  a  blister  to  the  epigastrium  ;  great  restlessness  ;  constant  desire 
to  get  overboard ;  skin  cold  and  clammy  ;  brain  and  mental  func- 
tions still  much  disordered  ;  craves  for  wine,  whij^i  is  given  to  him  ; 
at  4  P.  M.  more  collected  ;  begs  to  be  sent  to  tffe  hospital  ;  his  re- 
quest complied  with.  At  6  P  M  ht  got  up,  in  good  spirits  ;  dressed 
himself;  went  into ,  the  boat  unassisted;  when  landed,  he  insisted 
on  carrying  his  own  hammock  and  bed  up  to  the  hospital,  which  he  ac- 
tually did — -he  there  drank  a  glass  of  port  wine,  and  went  to  bed  ;  at 
eight  in  the  Evening  he  was  in  a  sound  sleep,  with  a  fine  warm  mois- 
ture diffused  over  his  skin,  and  every  symptom  favourable;  at  live 
in  the  morning  he  was  found  dead  in  his  bed  ;  lying  on  his  face,  with 
nearly  a  gallon  of  red  and  yellow  stuff,  resembling  blood  and  bile,  un- 
der him;  and  which  was  still  running  from  his  mouth.  On  shifting  him, 
to  have  him  buried,  his  whole  body  emitted  the  most  horrible  effluvia. 
He  must  have  died  suddenly,  and  without  a  groan  ;  as  three  nurses 
sat  up  in  the  ward,  and  thought  him  asleep  all  night.* 

*  This  is  a  singular,  though  I  think,  not  inexplicable  case.  It  furnishes  at  least 
one  important  reflection — namely,  how  easily  we  may  be  deceived  by  the  phan- 
tom debility.  Forty-eight  hours  before  \ti\a  man  carried  his  hammock  to  the  hos- 
pital,— "  he  lay  on  his  back,  his  eyes  and  mouth  half  open — his  pulse  small  and 
fluttering."  Was  not  the  debility  here  apparent,  not  real  ?  Were  not  his  powers 
oppressed — not  exhausted  ?  Else  how  could  two  short  days  of  subsequent  fever  and 
delirium  give  him  the  almost  miraculous  strength — "  to  rise,  take  up  bed,  and 
walk  f"  It  is  quite  inconsistent  with  observation,,  that  this  could  have  been  one 
oitho?e  fatal  calms  preceding  death,  from  mortification  of  an  important  organ. 
In  such  cases,  although  the  patient  fancies  himself  relieved,  or  even  that  he  if 


ENDEMI*  OF  BATAVIA*  117 

"  CASE  IV.  ROBERT  ALDRIDGF,  Marine,  H.  JVf>&'.  Centurion,      Off 

Edam. 

"  13f/i  October,  1800.  Was  seized  last  night  with  fever,  ushered 
in  by  cold  rigors.  At  eight  this  morning,  skin  clammy  ;  head  giddy  ; 
pulse  small  and  quick  ;  tongue  white  and  furred  ;  bowels  uneasy, 
with  pain  about  the  umbilicus  ;  a  saline  cathartic  ;  after  operation  of 
the  cathartic,  camphor  julep  every  two  hours. 

««  14th.  Passed  a  tranquil  night.  At  eight  this  morning,  skin  hot  ; 
severe  pain  in  his  head  ;  stomach  uneasy  ;  an  emetic  of  ipecacuan, 
which  brought  off  much  green  bile  ;  an  anodyne  antimonial  at  bed- 
time. 

"  \5th.  At  ten  o'clock  last  night,  a  great  exacerbation  of  fever, 
with  delirium,  which  remitted  at  four  this  morning.  At  8  A.  M. 
complains  of  debility  and  head-ache  :  skin  soft  and  perspirable  ;  bark 
decoction  every  two  hours  ;  at  noon  became  delirious  ;  skin  hot  and 
dry  ;  at  6  P.  M.  high  fever  ;  bead  much  affected  ;  great  incoherence  ; 
pulse  full  ;  tongue  foul  ;  bowels  costive  ;  omit  the  bark  ;  a  saline 
purgative  procured  three  stools  ;  the  draught  at  bed-time  as  before. 

•'  Ibth.  Passed  a  restless  night  At  eight  this  morning,  high  fe- 
ver ;  severe  pain  in  the  head  and  stomach  ;  internal  burning  heal  in 
the  epigastrium  ;  calomel,  gr.  viij  :  pulv.  am.  gr.  ij  ;  opii.  gr.  j  ;  ft*. 
bolus,  term  die.*  —  AT2  P.  M  skin  moist  and  warm;  pain  in  the 
head  and  stomach  ;  6  P  M.  became  very  hot  and  restless  ;  pain  in 
the  region  of  the  stomach  severe,  with  intense  burning  heat  there, 
both  internal  and  external  ;  calomel,  &c.  continued. 

"  Mlh.  Was  easy  all  night  —  passed  too  copious  stools  ;  skin  was 
warm,  with  equally  diffused  moisture  ;  at  eight  this  morning,  he  is 
better  ;  the  pain  has  left  his  head  and  stomach  ;  at  1  P.  M.  uneasiness 

%•  .      j>r  ' 

strong,  there  is  little  real  force.  The  sound  sleep,  and  warm  moisture  on  the 
skin,  are  very  incompatible  with  actual  mortification.  But  if  we  advert  to  the 
state  of  the  brain  for  several  preceding  days  we  shall  not  hesitate  to  say,  that 
effusion  or  rupture  of  vessels  carried  him  off  instantaneously. 

The  morning  before,  we  see  that  he  was  seized  with  violent  black  vomiting; 
which  was  checked  by  medicine.  The  return  of  this,  when  He  was  in  bed,  af- 
ter the  preceding  exertion,  and  a  great  determination  for  some  time  past  to  the 
brain,  has  caused  sudden  rupture  or  effusion,  which  induced  immediate  death,  or 
apoplexy  ending  in  the  same.  Finally,  was  it  not  this  apparent  debility  which 
prevented  the  exhibition  of  cathartics  and  mercury,  so  successfully  employed  in 
the  preceding  case  ? 

*  Too  late.  An  active  employment  of  mercury  from  the  beginning  without 
any  other  aid  than  venesection  and  copious  intestinal  evacuations,  would  have 
had  the  patient  now  on  the  verge  of  ptyalistn.. 

Let  those  who  are  disposed  to  cavil  at  some  points  of  practice  pursued  here, 
particularly  the  exhibition  of  bark,  and  omission  of  venesection,  point  out  from 
what  sources  the  Surgeon  could  have  then  drawn  a  better  methodus  medendi. 
Certainly  not  from  books  ;  at  least,  not  from  the  works  of  Bentius,  Lind,  Clarke, 
or  Balfour.  Nay,  almost  at  this  day,  venesection  is  condemned  and  bark  ex- 
tolled !  Dr.  Bancroft,  one  of  the  latest  writers  on  Yellow  Fever,  seems  to  rely 
principally  on  bark.  Mr.  Curtis,  the  last  writer  on  the  Diseases  of  India,  boasts 
of  having  seldom  "  wet  a  lancet,  except  in  specific  inflammation." 

If  it  be  said,  why  did  not  observation  point  out  the  necessity  of  breeding,  and 
the  injury  occasioned  by  emetics  and  bark  ?  I  answer,  by  asking,  —  Why  did  not 
observation  point  these  out  long  ago  to  those  writers  enumerated  ?  Why  did  not. 
C  alien  find  out  the  utility  of  purgatives  in  fever  before  Hamilton  ? 


H8  EASTERN  HEMISPHERE, 

in  the  region  of  the  liver  ;  cannot  bear  the  least  pressure  over  it ;  the 
calomel  continued  ter  in  die,  as  usual  ;  at  3  P.  M.  stomach  uneasy  ; 
black  vomit,  (resembling  coffee  grounds,  exactly  ;)  severe  pain  in 
the  forehead  ;  the  effervescing  draughts  every  two  hours  ;  added 
four  grains  of  camphor  to  the  evening  dose  of  calomel. 

"  18ffe.  Restless  night ;  delirium  ;  watery  eyes ;  skin  changing  yel- 
low. This  morning,  complains  of  twitching?  in  the  calves  of  his 
legs  ;  collected  and  sensible  when  spoken  to  ;  calomel  and  camphor 
as  before  ;  blisters  to  his  legs  ;  at  noon,  skin  cold  and  clammy  ;  pro- 
fuse perspirations  ;  tried  the  bark  in  various  forms ;  but  the  very 
sight  of  it  made  him  vomit  ;  the  calomel  and  camphor  continued  ter 
in  die  ;  at  ten  P.  M.  sensible  to  the  pain  of  the  blisters. 

"  19th.  Slept  a  little  last  night  ;  this  morning,  giddiness  ;  skin  of  a 
bright  yellow  colour  ;  took  the  bark  with  much  persuasion  :  at  1 1 
A.  M.  it  made  him  sick,  hot,  and  restless  ;  bowels  uneasy  ;  abdomen 
tense  and  full ;  glysters  brought  away  several  foetid  stools,  and  stuff 
like  grounds  of  coffee  ;  took  xxxiii  grains  of  calomel  to-day,  but  no 
appearance  of  its  entering  the  system  ;  skin  of  a  deep  yellow  colour. 

"  2Qth.  Restless  and  delirious  in  the  night  ;  oozing  "of  blood  from 
nose  and  mouth,  which  tinged  the  linen  yellow.*  This  morning, 
skin  hot  and  dry  ;  tongue  brown  ;  intolerance  of  light-;  head  much 
affected  ;  starts  when  spoken  loudly  to  ;  say*  he  is  "  very  well," 
<and  seems  much  surpiized  at  being  asked  the  question  ;  lies  dto  his 
back,  with  mouth  and  eyes  half  open  ;  pulse  small  and  stringy  ; 
took  xxxii  grains  of  calomel  to-day,  with  camphor  julep. 

"21  st.  Symptoms  as  yesterday.  In  this  state  he  continued  for 
forty  eight  hours,  when  the  black  vomit,  with  convulsions,  carried 
him  off,  on  the  23d  October,  the  10th  day  of  his  illness.  Not  the 
least  symptom  of  ptyalism  could  be  seen,  though  he  took  calomel  to 
the  last  hour. — He  had  done  duty  on  shore,  bofli  at  Cuypers  and 
Onrust,  where  he  lived  very  intemperately.t 

"  CASE  V.     Mr.  THOS.  F.  CARTER,  from  Edam. 

"  October  26lfc,  1800.  Has  been  six  days  ill  with  the  Batavian 
fever  on  Edrrtn  Island,  and  sent  on  board  at  six  o'clock  this  evening; 
in  hopes  that  change  of  air  may  mitigate  the  disease. 

He  now  complains  of  coldness  in  the  lower  extremities  ;  bad  taste 
in  his  mouth  ;  a  troublesome  purging ;  great  dejection  of  spirits  ; 
pain  in  his  head  and  epigastric  region  ;  pulse  small  and  quick  ;  fre- 
quently delirious  before  he  came  on  board  ;  had  taken  bark  in  va- 
rious forms  at  the  hospital,  without  any  benefit  :  on  the  contrary  he 
daily  got  worse.  The  emetic-cathartic  solution  was  given  him  this 
morning  on  shore,  which  is  still  operating;  as  he  was  much  fatigued 
by  coming  on  board,  gave  him  a  glass  of  port  wine  and  the  camphor 
julep. 

"  27*/i.  He  was  delirious  and  sleepless  all  night  ;  skin  hot  and 
dry  ;  the  solution  continued  to  operate  in  the  night  both  ways,  and 
he  passed  several  foetid  stools.  At  nine  this  morning,  all  the  symp- 
toms worse  ;  talks  in  the  most  incoherent  language  ;  tongue  very 

*  If  this  be  not  a  case  of  "  Yellow  Fever ;"  I  know  not  what  is. 

*  Was  there  not  effusion  in  the  brain  here,  as  well  as  derangement  in  the  liver** 


/    •*  * 

EXDEMIC  OF  BATAVU.  219 

foul ;  pulse  full  and  quick ;  complains  of  great  pain  over  the  orbits 
and  sinciput ;  pain  and  burning  internal  heat  at  the  stomach  ;  calomel, 
gr.  viij  ;  camphor,  gr.  iv  ;  opii,  gr.  j.  ter  in  die  j*  a  blister  inter  sca- 
pulas. 

"  2Sth.  First  part  of  the  night  restless  ;  latter  part  quiet,  and 
sleep  a  few  hours.  At  nine  this  morning,  all  the  symptoms  aggra- 
vated ;  delirium  ;  full  quickpui.se  ;  pain  over  the  oroils,  and  in  the 
sinciput  ;  right  eye  much  inflamed  ;  blisters  rose  well  ;  is  sensible 
to  the  pain  ol  it  ;  same  treatment  as  yesterday. 

"  2Ulh.  Delirious  all  last  night  ;  talks  incessantly  this  morning,  in 
very  incoherent  language  ;  says  he  feels  as  if  he  had  two  heads  ;  his 
eyes  cannot  bear  exposure  to  the  light  ;t  has  frequent  convulsive 
twitchings  of  the  tendons ;  repeated  the  calomel  this  morning  ;  he 
drank  a  little  brandy  and  water,  which  he  relished  much  ;  at  8  P.  M. 
very  restless,  skiu  hot  and  dry  ;  tongue  foul  ;  twitchings  of  the  ten- 
dons ;  right  eye  much  inflamed,  and  prominent  ;  had  one  foetid, 
bilious  stool  ;  when  asked  how  he  does,  replies,  "  very  well  j"  and 
that  nothing  is  the  matter  with  him  ;  his  mind  constantly  employed 
about  the  snip's  duty  and  prize  stores  ;  his  countenance  singularly 
wild  and  sallow  :  omit  the  calomel  ;  pediluvium  ;  diaphoretic  pow- 
ders of  camphor  and  nitre  ;  diluents.  4. 

«'  30th.  Very  restless  all  last  night  ;  with  great  difficulty  could  be 
kept  in  bed,  preferring  the  cold  deck  ;  was  highly  delirious  ;  right 
eye  prominent,  and  much  inflamed  ;  complains  of  pain  in  the  calves 
of  the  legs  ;  blisters  to  his  legs  ;  gave  him  a  brisk  dose  of  calomel 
and  jalap,  which  operated,  and  brought  off  two  copious  fcetid  stools  ; 
at  noon,  he  is  much  more  composed  ;|  complains  of  strangury  from 
the  blisters.  Semicupium  and  sp.  aether,  nitros.  gave  relief  to  this 
symptom  ;  great  deafness  ;  clammy,  profuse  sweats  ;  small  weak 
pulse  ;  bark  and  claret  ;  the  calomel  to  be  again  renewed.  At  6 
P.  M.  his  right  eye  still  inflamed,  red  and  prominent  ;  pulse  full ; 
violent  delirium  subsided  ;  half  an  ounce  of  bark t  an&apmt  of  claret, 
since  mo^ningy  which  his  stomach  retains. §  £  ^ 

#  •«  * 

*  This  is  the  seventeenth  day  of  the  disease— greatly  too  late!  •« 

t  There  are  evident  symptoms  of  congestion,  if  not  inflammation  in  the  brain 
here.  This  oppressed  state  of  the  sensorium  renders  the  absorbent  system  so 
torpid,  that  there  is  no  chance  of  the  mercury  being  taken  into  the  constitution. 
Evacuations,  under  these  circumstances,  by  relieving  the  brain,  invariably  acce- 
lerate ptyalisin. 

^  Although  evacuations  always  give  more  or  less  relief  in  this  fever,  yet  tile 
idea  of  debility — that  uulucky  term — seems  ever  to  have  cramped  their  employ- 
ment. ^ 

§"  The  prejudices  that  formerly  existed  against  the  Peruvian  bark,  in  fevers," 
says  Dr.  Hunter,  "  are  no  longer  m  being."  "  They  were  founded  in  idle 
"speculations,  and  originated  with  the  learned,  from  wtypm  they  descended  to  the 
"great  body  of  the  people  ;  but  even  with  the  vulgar  they  are  now  extinct." 
Diseases  of  Jamaica,  page  122.  At.  page  98,  we  have  this  remark,  "  In  almost 
"  every  case  where  the  disease  is  violent,  and  the  patient  much  reduced,  it, 
**  (wine,)  is  highly  grateful  and"  cordial.  It  is  of  the  utmost  consequence,  in  giv- 
"  ing  both  nourishment  und  wine,  that  they  b«  repeated  often.'' 

Dr.  H.  recommends  about  a  pint  a  day,  ia.small  quantities  at  a  time,  and  the 
same  of  food.  Who  cau  blame  the  surgeon  for  pursuing  a  plan  recommended  by 
such  authority  ?  And,  as  I  observed  before,  where  has  he  any  better  instruc- 
tions, in  fevers  of  the  East > 


120  EASTERN  HEMISPHERE. 

"  31s/.  Very  restless  all  night;  with  raging  high  delirium  ;  great 
difficulty  iu  confining  him  to  hi*  bed  ;  tongue  and  lips  brown  and 
crusted  ;  stomach  teose,  with  burning  internal  heat  in  the  epigas- 
trium ;  right  eye  red  and  prominent  ;  at  one  o'clock  lhis>  morning,  a 
blister  renewed  to  th.  back  of  his  head  j  tt  e  calomel  and  jalap  re- 
peated ;  at  six  this  morning  no  butler  ;  right  eye  inflamed,  promi- 
nent, and  seems  starting  out  of  his  head,  nifti  other  symptoms  of  a 
highly  deranged  stale  of  tne  brain;  neither  the  blister  nur  purgative 
has  taken  any  effect*  two  large  yellow  blotches  have  appeared  on  his 
neck  ;  I  am  forced  to  keep  him  lashed  down  in  his  bed,  as  he  made 
several  attempts  to  get  overboard  ;  tore  the^blisters  from  his  head  ; 
constantly  grasping  at  every  object  ;  great*  deafness  ;  no  recollec- 
tion of  any  person  ;  his  mind  still  employed  about  his  accounts  and 
the  ship's  dqty  ;  strong  convulsive  spasm*  of  the  whole  body  ;  so  that 
it  oft  n  requires  two  men,  with  all  their  strength,  to  keep  him  down  ;| 
the  raging  high  delirium  sunk  hourly,  till,  a  few  hours  before  his 
death,  when  we  could  hardly  hear  him  articulate  ;  he  was  carried 
off  with  hiccup  and  convulsions  next  night,  his  body  ^ery  little  re- 
duced, and  without  the  least  disagreeable  smell. 

"  Previously  to  the  attack  of  fever,  he  was  constantly  employed 
on  shore  at  the  island  of  Edam,  where  he  had  charge  of  the  prize- 
stores,  and  where  he  frequently  exposed  himself  to  the  intense  heat 
of  the  sun  b)  day,  and  the  noxious  influence  of  the  air  by  night ;  he 
used  to  sleep  at  the  hospital  ;  he  died  on  the  J  1th  day  of  his  illness^ 
six  days  after  he  came  on  board. 

"  CASE  VI.     Mr.  HAMMOND,  Captain's  Clerk.     Off*  Edam. 

"  October  23rd,  1800.  Was  in  the  habit  of  being  much  on  shore 
at  Edam  Island  during  the  day  ;  but  never  passed^a  whole  night  there  : 
seized  last  evening  with  the  usual  symptoms  of  the  Batavian  fever; 
head  much  affected  ;  great  pain  over  the  orbits  ;  took  the  emetic- 
cathartic  solution,  which  operated  well ;  at  night  the  anodyne  anti- 
mpnial. 

'*  Cz4th.  Passed  a  restless  night  ;  his  bowels  very  uneasy  ;  this 
morning  he  is  very  ill  ;  all  the  symptoms  violent  ;  small,  hot,  bilious 
stools  ;  the  solution  as  yesterday,  which  operated  both  ways';  at 
night  the  draught  repeated. 

"  26f&.  Passed  a  very  bad  night,  with  violent  pain  in  the  head  and 
epigastric  region  ;  hot,  dry  skin :  quick  pulse  ;  great  inquietude  of 
the  system  at  large  ;  could  not  rest  a  moment  in  one  position ;  foul 
tongue.  This  morning  all  the  symptoms  toe  same  as  during  the  night  ; 
calomel,  gr.  viij.  ;  pulr.  ant.  gr.  ij  ;  opii.  gr.  j ;  three  times  a  day.J 
At  8  P.  M.  he  appears  a  little  more  composed. 

<•  26f&.  Had   a  vioje/nt  paroxysm  of  feyer  in  the  night,  ushered  in 

*  The  torpor  alluded  to  i?  here  manifest — and  there  can  be  little  doubt  of  its 
dependence  on  oppressed  sensori urn. 

t  With  the  strength  of  two  men  the  day  before  death— his  body  unreduced— 
and  where  mad  delirium,  and  eyes  starting  from  their  sockets,  declared  the  state 
of  the  brain,  I  should  have  been  tempted  to  bleed  usque  ad  deliquvum,  or  the  re- 
lief of  the  symptoms,  coute  qui  coute. 

|  This  is  the  fourth  day  of  the  disease,  counting  the  evening  of  the  22nd  as  one 


.  • 

ENDEMIC  OP  BATAVIA.  121 

with  cold  rigors.  This  morning,  he  is  very  poorly  indeed  :  distress- 
ing bilious  purging ;  countenance  sallow  and  anxious  ;  all  symptoms 
appear  exceedingly  unfavourable  ;  continue  the  same  treatment. 

"  27f/i.  Passed  a  bad  night ;  no  alteration  for  the  better ;  head- 
ache intense  ;  pain  in  the  epigastric  region  ;  hot,  dry  skin  ;  pulse 
quick;  dysenteric  purging  ;  medicine  continued. 

"  28<A.  No  alteration  :  had  a  violent  exacerbation  of  fever  to-day, 
ushered  in,  as  before,  with  rigors  ;  continued  the  same  treatment  ; 
no  appearance  of  ptyalism. 

"  29th.  Mouth  sore.  All  the  symptoms  alleviated  ;  head-ache, 
and  pain  in  the  epigastric  region,  diminished  ;  bowels  easier  ;  calo- 
mel bolus  twice  a  day  only. 

"  30th.  Mouth  sorer ;  all  the  bad  symptoms  disappearing  ;  com- 
plains only  of  debility  ;  decoction  of  bark  and  wine. 

"  31sf.  Mouth  very  sore  ;  spits  copiously  ;  keen  appetite  ;  omit 
the  calomel  ;  put  him  on  the  convalescent  list,  with  wine,  and  nour- 
ishing diet  ;  from  this  time  he  recovered  rapidly.  This  case  was 
treated  entirely  with  mercury.* 

"  CASE  VII.     Mr.  POWEL,  Master's-Mate.     At  Edam. 

"  November  13th,  1800.  Was  attacked  with  fever  yesterday,  on 
shore,  at  the  island  of  Edam,  where  he  had  resided,  in  charge  of  the 
prize-stores,  since  the  death  of  Mr.  Carter.  This  morning,  com- 
plains of  the  usual  symptoms  ;  pain  and  giddiness  of  the  head  ;  hot 
skin  ;  cold  extremities  ;  quick  pulse  ;  the  emetic-cathartic  solution  ; 
after  the  operation  of  which,  the  anodyne  antimontal. 

"  \4th.  Restless  night ;  was  much  purged  ;  cold  sweats,  burning, 
acrid  heat  at  the  pylorus  ;  pain*over  the  orbits  ;  six  grains  of  calo- 
mel, and  one  of  opium,  thrice  a  day  ;  also  the  camphor  julep  every 
three  hours  ;  port  wine  or  porter,  as  much  as  he  can  take  ;  cold  ab- 
lution ;  at  6  P.  M.  symptoms  nearly  the  same  ;  had  many  foetid, 
bilious  stools,  during  the  day  ;  spirits  greatly  dejected  ;  cold  sweats 
on  the  extremities  ;  pulse  small,  quick,  and  fluttering ;  tongue  brown 
and  crusted  ;  great  apprehension  of  death  ;  bark. 

"  IBth.  No  rest  all  night.  This  morning  all  the  symptoms  worse. 
At  10  A.  M.  the  fatal  black  vomit  has  appeared  ;  cold  sweats  ;  deli- 
rium ;  omit  the  bark,  which  will  not  lie  on  his  stomach  ;  repeat  the 
calomel  ;  asther  and  laudanum  draughts  every  two  hours  ;  evening, 
the  vomiting  checked  a  little  ;  blisters  to  the  head  and  stomach  ; 
skin  begins  to  change  yellow  ;  breath  becomes  foetid  ;  every  symp- 
tom unfavourable. 

"  }6th.  No  sleep  last  night ;  worse  in  every  respect  this  morning  ; 
he  sinks  hourly  ;  low  delirium  ;  muttering  ;  lips  and  teeth  encrusted 
black  ;  breath  foetid  ;  insensible  ;  lies  on  his  back,  mouth  and  eyes 
half  open  ;  skin  intensely  yellow  ;  pulse  small,  and  fluttering  ;  same 
treatment. 


*  It  would  be  difficult  to  conceive  how  a  more  unequivocal  proof  of  the  effi- 
cacy of  any  medicine  could  be  given,  than  is  afforded  in  this  case-  I  had  set  it 
down  as  lost,  till  I  saw  the  words  "  sore  mouth"  oa  the  29th,  which  dispelled  my 
fears  ;  for  well  do  I  know,  from  personal  feeling,  what  ease  this  soreness  brings. 


fXS  EASTERN  HEMISPHERE. 

'"  llth.  Black  vomit  all  night ;  cold  sweats  this  morning  ;  tongue 
black  ;  pulse  fluttering  ;  singultus  ;  eyes  glassy  ;  breath  very  foetid  ; 
stools  involuntary,  and  black,  like  coffee  grounds  ;  lies  on  his  back, 
eyes  and  mouth  half  open  ;  carried  off  in  an  attempt  to  vomit.* 

"  WADE  SHIELDS." 

The  foregoing  cases,  selected  out  of  an  immense  number,  will  be 
sufficient  to  convey  a  very  accurate  idea  of  this  endemic,  and  to  sup- 
port the  remarks  and  general  description  which  preceded  them.  I 
have  exhibited  more  fatal  than  favourable  terminations  ;  as  the  for- 
mer must  include  the  whole  range  of  symptoms,  from  health  to  death, 
and  ascertain  the  inefficacy  of  measures  in  which  we  might  be  apt 
to  place  too  much  confidence-. 

It  certainly  vill  not  be  denied  that  this  is  a  very  interesting  and 
valuable  document,  as  it  gives  us  a  much  clearer  view  of  the  Bata- 
vian  fever  than  any  English  work  in  circulation  ;  accompanied  with 
numerous  collateral  incidents  and  observations,  that  excite  reflection, 
while  they  strongly  rivet  our  attention. 

I  shall  glance  hastily  at  some  prominent  traits  in  the  character  of 
this  fever,  with  a  few  remarks  on  its  cause,  leaving  the  reader  to 
form  his  own  conclusions. 

In  the  first  place,  the  great  similitude  which  it  bears  in  most  of 
its  leading  features,  to  the  endemic  of  the  West,  cannot  have  passed 
unnoticed.  Independently  of  the  yellow  skin  and  black  vomit,  they 
coincide  in  many  minor,  but  characteristic  symptoms  ;  for  instance, 
the  mental  despondency,  amounting  to  timidity  at  the  beginning, 
veering  round  to  nonchalance  or  apathy,  in  the  progress  of  the  dis- 
ease. 

The  fatal  lull,  and  occasional  sensation  of  hunger  too,  which  are 
so  apt  to  deceive  the  inexperienced  in  the  Western  endemic,  fre- 
quently appeared  in  that  of  the  East.  Neither  would  it  seem  very 
difficult  to  account  for  their  discrepancies.  For  whether  we  allow 
that  these  endemics  are  solely  caused  by  the  local  miasmata,  or  are 
the  bilious  remittents  of  hot  climates,  resulting  from  atmospherical 
influence,  but  aggravated  by  these  invisible  agents  ;  still,  in  either 
case,  as  the  cause,  or  combination  of  causes  must  vary,  according 
to  the  nature  of  the  climate  and  soil,  so  we  cannot  expect  to  have 
their  effects  agreeing  in  every  minute  particular.  Nevertheless,  as 
the  operation  of  these  causes  on  the  human  frame  appears  to  be 
nearly  the  same  in  all  climates,  we  can  clearly  discern,  (in  the  broad 
outline  of  their  effects,)  a  strong  family  likeness  through  the  whole 
ghastly  tribe. 

"  facies  non  omnibus  una 

"  Nee  diversa  tamen,  quails  decet  csse  sororum." 

The  opinion  that  these  grand  endemics,  (yellow  fever  for  instance,) 
are  only  the  bilious  remittents  of  all  tropical  climates,  in  a  more  con- 
centrated state  or  degree,  is  founded,  I  fear,  on  too  great  a  rage  for 
generalising.  The  bilious  remittent  may  take  place  an  hundred 
leagues  at  sea,  in  consequence  of  atmospherical  vicissitudes  acting 

*  Will  any  one  assert,  after  reading  this,  and  many  other  cases  here,  that  the 
"•  Yellow  Fever'1  never  appears  in  the  East? 


ENDEMIC  OF    BAT  AVI  A.  123 

on  particular  organs,  whose  functions  were  previously  disturbed  by 
atmospherical  heat.  The  endemic,  on  the  other  hand,  is  produced 
by  a  specific  miasm,  (witness  that  of  the  fatal  island  Edam,)  which, 
independently  of  all  those  peculiar  states  of  the  air,  or  the  body,  re- 
quisite for  the  production  of  bilious  remittent,  will,  when  in  a  con- 
densed form,  kindle  up  at  any  season,  and  in  any  constitution,  a  fever 
of  terrible  malignity. 

These  diseases  then,  may  be  often,  perhaps  generally  combined  ; 
since  their  causes  acquire  force  and  subside,  part  passu,  and  at  the 
same  period  of  the  year.  But  assuredly  they  are  sometimes  totally 
distinct  and  quite  unconnected  with  each  other. 

This  reasoning  is  corroborated  by  the  fact,  that  time,  (for  instance, 
eighteen  months  or  two  years  in  the  West  Indies,)  will  accustom  the 
human  frame  to  the  action  of  the  febrific  miasm,  and  thereby  secure 
it,  generally  speaking,  from  the  endemic,  but  no  number  of  years  is 
a  protection  from  the  bilious  remittent. 

The  circumstance  of  the  Dutch  officers  and  Malays  falling  victims 
at  Edam,  might  seem  to  militate  against  this  doctrine  ;  but  the  objec- 
tion vanishes,  when  we  recollect,  that  by  previously  residing  in  the 
country,  entirely  out  of  the  sphere  of  the  local  effluvium,  they  were 
in  reality  no  more  seasoned  to  it  than  the  English  ;  and  the  mortality 
in  the  garrison  proved  it.  They  were  in  the  same  situation  as  the 
native  or  veteran  West  Indian,  who,  by  spending  a  few  years  in  Eu- 
rope, or  the  interior  of  the  country,  loses  his  protection  against  a  vi- 
sitation of  yellow  fever  on  his  return  to  the  sickly  towns.* 

Neither  will  residence  in  one  tropical  climate,  prove  a  security 
against  the  local  endemic  of  another,  as  the  above  circumstances 
themselves  render  evident.  Thus  the  crew  of  a  ship,  that  has  been, 
two  or  three  years  on  the  Coast  of  Guinea,  and  sails  direct  fromjSi- 
erra  Leone  to  Barbadoes,  which  are  nearly  in  the  same  parallel  of 
latitude,  will  be  as  liable  to  yellow  fever,  as  if  they  had  sailed  from 
England  ;  while  a  two  year's  station  in  the  West  Indies  would  have 
almost  insured  a  subsequent  exemption. 

Indeed,  the  plan  of  seasoning  troops  against  yellow  fever,  by  sta- 
tioning them  for  some  time  previously  at  Gibraltar,  Madeira,  or  in 
the  Mediterranean,  has  completely  failed  ;  and  how  could  it  be  other- 
wise, if  the  Coast  of  Guinea  itself  is  no  protection  ?  a  melancholy 
protf  of  which  was  exhibited  in  H.  M.  S.  Arab,  in  1807  ;  which  ship 
came  from  the  latter  place,  (where  she  had  been  nearly  two  years,) 
to  the  West  Indies,  and  suffered  dreadfully  by  the  yellow  fever,  t 

*  Dr.  Ferguson,  in  mentioning  the  fatal  yellow  fevers  which  ravaged  the  West 
India  Islands  in  1815,  states—"  In  all  it  has  been  confined,  for  the  most  part,  to 
the  towns,  and  except  at  Bridgetown,  to  unseasoned  Europeans.  There  it  ex- 
tended to  unseasoned  sojourners — even  to  Creoles  from  the  interior  of  the  country, 
who,  in  the  time  of  the  insurrection,  were  obliged  to  resort  to  the  town  on  mili- 
tary duty."  Med.  Chtr.  Trans,  vol.  viii.p.  144.  Again,  Mr.  Dickson,  Surgeon 
to  the  Forces,  states,  in  the  48th  Number  of  the  Medical  Repository,  that— 
"  Dreadful  were  the  numbers  the  writer  saw  under  the  mortal  gpasp  of  marsh 
ferer  at  Prince  Rupert's  Dominico.  They  were  subjects  assimilated  to  the  climate, 
although  strangers  to  that  particular  station. 

"  It  is  certain  that  if  having  had  the  West  India  yellow  fever  secures  an  «x« 
*•  emption  from  the  Gibraltar  one,  this  last  gives  no  security  in  kind.  Capt.  John- 


124  EASTERN  HEMISPHERE. 

These  facts,  ("particularly  the  last,)  must  go  far  to  dissolve  the  theo- 
ry of  the  ingenious  Dr.  Bancroft,  who  has  laboured  to  prove,  that 
"  the  security  from  the  disease,  (yellow  fever,)  is  principally  de- 
rived from  the  ability  to  endure  great  heat."  Essay  on  Yellow  Fever, 
page  265.  The  dangerous  consequences  which  might  obviously  re- 
sult from  trusting  to  such  a  protection,  as  well  as  Dr.  B.'s  candour 
and  humanify,  will  induce  him  to  re-consider  the  subject.  The  offi- 
cers and  crew  of  the  Arab,  on  their  arrival  in  Carlisle  Bay,  consider- 
ed themselves  perfectly  seasoned  and  secure  :  but  on  putting  to  sea, 
in  the  course  of  the  month,  the  endemic  broke  out  with  such  violence, 
that  in  one  week  they  lost  thirty-four  men,  and  were  forced  to  put 
into  Antigua,  in  the  greatest  distress. 

Dr.  Bancroft,  indeed,  is  not  singular  in  his  opinion,  which  appears 
to  be  copied  from  Dr,  Trotter,  [Medicina  Nautica,  vol.  1,  page  336,] 
who  has  theorised  widely  on  a  foundation  which  the  foregoing  facts 
completely  overturn.  Dr.  T.  probably  took  the  doctrine  from  Dr. 
Moseley.  who  tells  us,  that  a  seasoning  at  Bermudas  will  secure  us 
from  the  yellew  fever  of  the  West  Indies,  p.  65.  Let  no  such  plan 
be  trusted. 

The  locality  and  range  of  this  febrific  miasma,  are  clearly  decided 
by  the  Daedalus.  Her  ship's  company  breathed  the  same  general 
atmosphere  as  the  other  crews,  for  months  together ;  but  with  the 
exception  of  the  Purser  and  Surgeon,  no  man  belonging  to  her  came 
within  the  fatal  circle,  (in  the  night,  at  least,)  though  seldom  more 
than  two  or  three  miles  from  its  centre.  The  officers  above-mention- 
ed exclusively  felt  its  influence,  and  like  too  many  others,  fell  victims 
to  its  direful  force.  It  is  probable,  however,  that  where  a  trade 
wind  or  monsoon  sets  over  a  large  tract  fraught  with  febrific  miasma- 
ta, these  invisible  agents  may  be  carried  to  a  much  greater  extent 
tham  where  calms  or  gentle  sea  and  land-breezes  prevail.  This  is 
exemplified  in  the  fever  of  Coimbatore,  [Sec.  3.]  and  ought  ever  to, 
be  borne  in  mind  by  navigators  in  anchoring  ships  in  the  vicinity  of 
swamps,  or  generals  in  pitching  tents  or  stationing  troops.  The  di- 
rection and  prevalence  of  winds  are  ever  to  be  coupled  with  the  me- 
dical topography  of  a  place. 

This  document  furnishes  decisive  evidence  on  two  points  of  great 
practical  importance.  One  is,  that  even  within  the  limited  range  of 
this  poison,  its  power  is  nearly  inert,  comparatively  speaking,  during 
the  day  ;  the  other,  that  when  nocturnal  exposure  has  given  rise  to 
the  disease,  it  is  non-contagious.  It  is  obvious  what  an  influence  the 
certain  knowledge  of  these  circumstances  must  have  on  our  conduct, 
and  to  what  useful  purposes  we  may  apply  it. 

In  this,  as  in  all  other  violent  endemics,  the  head  and  epigastric  re- 
gion were,  as  usual,  the  foci  of  the  disease.  The  inutility,  or  rather 
the  injury  of  every  other  medicine,  than  mercury  and  purgatives, 
was  abundantly  manifested.  But  with  all  due  deference  and  respect 
for  the  Surgeon,  and  a  proper  allowance  for  the  embarrassing  situa- 

"  son,  of  the  Queen's  Regiment  now  here,  had  the  Gibraltar  fever  in  1804,  and 
•'he  has  just  now  recovered  with  difficulty  from  a  very  alarming  attack  of  the 
a  prevailiug  Epidemic.'"  Fergi&on  on  vflloiv  fever,  Mtd.  Chir,  Trans,  vol.  viii. 


ENDEMIC  OP  BATAV1A.  126 

uon  in  which  he  was  placed,  I  conceire  that  the  first  remedy  was  not 
applied  early  enough,  or  with  sufficient  boldness  ;  and  that  the  purga- 
tives, through  a  false  fear  of  debility,  were  not  so  frequently  admi- 
nistered as  their  evident  utility  warranted . 

la  the  solitary  instance  where  venesection  had  a  trial,  the  hasty 
conclusion  which  was  thence  formed  of  its  pernicious  effects,  in  con- 
sequence of  the  sudden  death  and  putrescency  of  the  patient,  de- 
serves a  remark.  If  the  reader  will  revert  to  Joseph  Hughes, 
(Case  III.)  who,  after  dressing  himself  in  good  spirits — going  into 
the  boat  without  assistance — carrying  his  hammock  up  to  the  hospital 
— retiring  to  bed,  and  falling  into  a  sound  sleep,  was  nevertheless 
found  dead  in  the  morning,  "  his  body  emitting  the  most  intolerable 
effluvia  ;"  he  will  probably  agree  with  me,  that  had  this  man  been 
bled  on  entering  the  hospital,  his  death  might  have  been  attributed  to 
venesection,  with  as  much  apparent  justice,  as  any  single  incident 
could  support. 

This  may  serve  as  a  lesson  to  us,  how  wary  we  should  be  in  re- 
jecting entirely  a  powerful  remedy,  from  solitary  or  even  several 
failures.  For  how  difficult  is  it,  in  such  ca.ses,  to  say  with  certainty 
— such  is  the  successful,  and  such  the  unsuccessful  medicine  !  The 
prejudice  against  bleeding,  (seemingly  justified  by  this  event,)  was 
engendered  too,  by  "  accounts  which  had  been  read  of  its  bad  ef- 
fects in  fevers  of  the  West  Indies  ;" — fevers  in  which  its  pre- 
eminent service  is  now  ascertained  beyond  the  shadow  of  doubt* 
From  all  these  considerations,  and  from  an  attentive  examination  of 
the  symptoms  themselves,  we  may  conclude,  that  venesection  de- 
serves a  much  further  and  fairer  trial  in  this  fever  ;  and  I  entertain 
little  doubt,  that  it  will  be  found  a  powerful  auxiliary  to  the  other 
means  of  cure. 

Of  the  efficacy  of  mercury,  under  all  its  disadvantages,  I  need  say 
little.  There  is  the  decision  of  the  surgeon  himself,  who  treated 
nearly  ^00  cases  of  the  fever — there  are  specimens  of  these  cases 
detailed — and  there  is  a  strong  proof  of  the  dependence  placed 
on  this  remedy,  where  we  find  the  surgeon  himself  confide  his  own 
life  to  its  power,  when  attacked  by  the  fatal  fever  of  Edam.  I  would, 
however,  recommend  it  to  be  used  in  the  early  and  liberal  manner 
pointed  out  in  the  Bengal  endemic,  with  the  same  attention  to  vene- 
section and  intestinal  evacuations.  The  constitutional  effect  of  the 
mercury  should  be  kept  up  till  strength  be  completely  restored.  The 
cold  affusion  bids  fair,'during  the  reaction  ;  and,  at  all  events,  cold 
applications  to  the  head,  with  warm  pediluvia,  will  invariably  prove 
serviceable. 

The  opinion  of  Dr.  Cullen,  that  the  influence  of  the  remote  cause 
ceases  when  the  fever  is  once  formed,  is  here  proved  to  be  not  only  er- 
roneous, but  dangerous.  Removal  from  the  sphere  of  its  action,  dur- 

What  will  the  reader  think  of  the  following  passage  in  a  modern  publica- 
tion ? — "  In  such  cases  as  seemed  most  to  require  it ;  (blood-letting,)  for  example, 
where  the  patient  was  young,  strong,  of  a  full  habit,  and  lately  arrived  from  Eu- 
rope ;  where  the  pulse  was  quick  and  full,  the  face  flushed,  with  ^reat  heat  and 
headache-;  and  all  these  at  the  beginning  of  the  fever,  bleeding  did  no  good-"- 
H>f  vttr  on  the  Diseases  of  Jamaica,  3rd  edition,  page  1 1«.  * » 


126  EA3TEEN  HEMISPHERE. 

ing  fercr,  invariably  protracted  the  fatal  catastrophe  ;  and  could  the 
patients  have  been  transported  quickly  into  a  pure  air,  while  ptyal- 
ism  went  on,  they  would,  in  all  human  probability,  have  survived, 
as  the  surgeon  himself  believed. 

One  remarkable  incident  remains  to  be  noticed,  and  cannot  have 
eluded  the  observation  of  the  reader.  1  mean  the  circumstance  of 
the  four  mercurial  patients,  who  resisted  the  baleful  influence  of 
Edam.  Such  an  immunity  cannot  be  attributed  to  chance.  The 
proofs  are  both  positive  and  negative.  They,  and  they  only,  escaped 
the  fever.  It  is  rare  that  a  person  fairly  under  the  influence  of  mer- 
cury, for  the  cure  of  any  other  complaint,  is  attacked  either  by  en- 
demic or  contagious  fever.  I  have  seen  several,  who  were  reduced 
by  long  courses  of  mercury  previously,  and  who  had  left  it  off,  fall 
victims  to  fever  and  flux  ;  but  seldom  during  the  exhibition  of  the 
medicine.  We  know  that  a  slight,  or  even  a  free  ptyalism,  may  be 
kept  up  for  weeks  together,  without  any  serious  injury  to  health  ; 
and  if  such  a  state  proved  an  antidote,  (as  it  did  here,)  against  the 
nsost  powerful  cause  of  fever  that  ever,  perhaps,  had  "  a  local  ha- 
bitation, or  a  name,"  the  inconvenience  of  the  prophylactic  is  very 
trifling,  compared  with  the  security  it  may  afford.  The  rationale  of 
the  preservative  is  not  very  unreasonable.  If  it  cure  the  disease,  it 
may  also  have  some  power  in  preventing  it.  Bark  was  formerly 
considered  capable  of  both —(witness  the  Peruvian  drams  that  used 
to  be  served  out  to  wood-cutters  in  hot  climates  ;)  fatal  experience 
has  proved  it  equal  to  neither  !  Mercury,  by  keeping  up  the  action 
of  the  extreme  vessels  on  the  surface,  and  in  the  hepatic  system, 
prevents,  what  I  conceive  to  be  the  paramount  effects  resulting  from 
the  application  of  febrific  miasmata — INE^UILIBRIUM  IN  THE  BALANCE 

OF  THE  CIRCULATION  AND  EXCITABILITY,  AMD  CONGESTION  OR  INFLAM- 
MATION IN  ONE  OR  MORE  OF  THE  INTERNAL  ORGANS. 

It  is  proper  to  observe,  however,  that  many  medical  men  of  ta- 
lents and  observation,  deny  that  mercury  is  possessed  of  any  prophy- 
lactic power.  I  only  state  what  has  come  to  my  own  knowledge  on 
the  subject, 

P.  S. — Since  the  first  and  second  editions  of  this  work,  the  utility  of 
venesection  in  even  the  Congestive  Cholera  of  India,  where  the 
blood  can  scarcely  be  got  to  flow  from  the  veins,  has  been  proved  be- 
yond all  cavil  or  doubt,  and  so  has  the  auxiliary  benefit  of  mercury, 
both  as  an  evacuant  and  sialagogue.  It  is  therefore  gratifying  to  the 
author  that  twenty  years'  experience  of  others  has  confirmed  all  the 
leading  points  of  his  own. 

DISORDERS  OF  THE  HEPATIC  SYSTEM. 


Aspice  quarn  tumeat  magno  Jecur  Ansere  Majus. — MARTIAL. 


SEC.  VIII. — "The  exclusive  efficacy  of  mercury,"  says  Dr.  Saunders, 
"  in  liver  diseases  of  the  continent  of  India,  may  perhaps  be  explain - 
"  ed  by  supposing  they  arise  from  an  indigenous  and  local  poison,  or  mi- 


HEFATIC  DERANGEMENTS. 


127 


«•  «Mia,  peculiar  to  that  country,  unlike  any  thing  known  in  any  other 

'  part  of  the  world,  even  under  similar  latitudes  and  temperatures." 

Had  this  ingenious  and  deservedly  eminent  physician  ever  visited 

the  continent  alluded  to,  his  penetration  would  have  discovered  the 

cause  of  this  phenomenon,  with  out  the  aid  of  an  "  indigenous  poison," 

which,  like  the  introduction  of  an  epic  divinity,  is  a  more  poetical 

than  philosophical  mode  of  extricating  ourselves  from  difficulties,  and 

loosing  the  gordian  knot.* 

In  order  to  clear  the  way  for  this  investigation,  it  is^ecessary  to 
inquire,  whether  this  •'  endemic  of  India"  be  equally  prevalent  in  all 
parts  qf  that  vast  empire.  Here  universal  evidence  gives  the  nega- 
tive, and  every  one,  in  the  least  acquainted  with  the  medical  topo- 
graphy of  the  country,  knows,  that  genuine,  or  idiopathic  hepatitis, 
is  ten  times  more  prevalent  on  the  Coast  of  Coromandel  than  on  the 
plains  of  Bengal ;  while,  on  the  other,  hand,  intermitting  and  remit- 
ting fevers  are  ten  times  more  numerous  in  the  latter  than  in  the  former 
situation.  Let  us  next  see,  if  there  be  any  particular  difference  in 
the  climates  and  temperatures  of  these  two  places.  By  exact  ther- 
mometrical  observations  made  at  Calcutta,  by  Mr.  Trail,  during  a 
whole  year,  the  following  appears  to  be  the  monthly  medium  heat  of 
three  different  diurnal  periods — morning,  noon,  and  evening. 
TABLE — No.  I.* 


February.      .  .  . 

74 
79 
86 

June  

83 
83 
82 

October  

u*.g 

82* 
76 
68 

March              .  .  > 

Tulv 

November 

April  

August  

December  

Annual  Average,  78£  Fahrenheit,  1786.    * 

Let  us  compare  this  with  the  heat  at  the  presidency  on  the  coast. 
— The  following  is  copied  from  the  Madras  Gazette,  showing  the 
state  of  the  thermometer  at  the  Male  Asylum,  during  one  week  in 
July,  1804,  which  was  by  no  means  remarkable  for  any  extraordinary 
range  of  temperature  — 

TABLE— No.  II. 

State  of  the  Thermometer  at  the  Male  Atylum^  Madras. 


1804. 

7A.M. 

Noon. 

3  P.  M. 

8  P.  M. 

Average. 

Remarks. 

July  11   . 

81 
81 
81 
82 
83 
84 
85 

88 
88 
91 
90 
91 
92 
94 

89 
90 
92 
93 
94 
95 
96 

85 
86 
86 
84 
88 
91 
91 

86 
86i 
87i 
87* 
89 
904 
914 

*'  The  thermo- 
meter is  plac'd  in 
a  room  moderate- 
ly exposed  to  the 
weather  and  fac- 
ing the  North- 
West." 

12  • 

13  

14  .... 

1C     . 

Ifi  > 

n.  . 

Total  Average,  88£. 

Now  it  is  well  known,  that  excepting  for  a  few  weeks  at  the  change 
of  the  monsoon,  in  October  and  November,  the  Coromandel  coast  is 

*  See  the  Section  on  Egypt  in  a  subsequent  part  of  this  work,  where  Hepati- 
tis is  proved  to  be  equally  as  prevalent  on  the  Banks  of  the  Nile  as  on  the  Coast  of 
Coromandel.  Hepatitis  is  very  prevalent  also  on  the  Coast  of  Africa,  where  the 
heat  is  excessive. 

t  Vide  2d  vol.  Asiatic  Researches.  ' 


128 


EASTERN  HEMISPHERE. 


remarkable  for  a  cloudless  sky  and  steady  temperature,  all  the  year 
round  ;  the  heat,  however,  being  often  above  the  specimen  exhibit- 
ed, as  the  following  table  from  Dr.  Clarke  will  show  ; — 

TABLE.— No.  III. 

Slate  of  the  Thermometer  on  board  the  TALBOT  Indiaman,  in  Madras  Roads, 
from  the  24/A  July  to  the  23d  August,  1771. 


Month. 

Day 

Hour. 

Ther. 

Month. 

Day 

Hour. 

Ther. 

July  .  .  . 

24 

12 

90 

August  .  . 

8 

7 

96 

6 

96 

9 

12 

89 

25 

12 

88 

4 

87 

26 

12 

90 

10 

12 

93 

3 

93 

4 

88 

27 

12 

90 

(  11 

2 

94 

3 

93 

4 

89 

28 

12 

90 

12 

12 

93 

3 

92 

•: 

4 

90 

29 

12 

93 

13 

12 

90 

4 

96 

4 

87 

30 

13 

90 

14 

12 

89 

. 

4 

94 

15 

12 

89 

31 

12 

91 

3 

90 

4 

93 

16 

12 

90 

August  . 

1 

12 

93 

4 

94 

4 

94 

17 

12 

94 

2 

12 

92 

18 

12 

93 

3 

12 

90 

19 

12 

90 

3 

91 

4 

87 

4 

12 

90 

20 

8 

90 

4 

92 

3 

94 

5 

12 

92 

21 

8 

92 

4 

94 

3 

95 

6 

12 

89 

22 

11 

94 

7 

12 

90 

j 

4 

87 

5 

92 

23 

10 

86 

8 

12 

93   (I 

3 

88 

Total  Average,  91°. 

Dr.  Clarke  remarks  that,  "  on  account  of  the  sandy  soil  of  Madras, 
it  was  found  moderate  enough  to  allow  a  thermometer  to  rise  six  or 
seven  degrees  higher  ashore."  This  would  make  the  average,  for  a 
month  in  succession,  97  or  98°. — Vide  Clarke  on  Long  Voyages, page  56 
et  seq.  Mr.  Curtis,  speaking  of  the  Coromandel  coast,  where  he  re- 
mained on  shore  more  than  a  year,  observes — "  Except  for  two  or 
three  weeks  about  the  shifting  of  the  monsoons,  especially  that  which 
happens  in  the  month  of  October,  a  shower  of  rain  or  a  breeze,  are 
(is)  almost  unknown  ;  scarce  ever  a  haze  or  cloud  appears  upon  the 
horizon,  to  mitigate  the  dazzling  ardour  of  an  almost  vertical  sun  ; 
and  the  thermometer,  through  the  whole  twejity-four  hours,  seldom  or 
never  points  under  80U  of  Fahrenheit,  but  generally  far  above  it" 
Introd.  p.  xvii.  How  far  above  80°  it  generally  points,  the  preced- 
ing tables  will  clearly  evince. 

The  nature  of  the  soil  is  such,  that  while  the  sun  is  above  the  hori- 
zon, it  acquires  a  much  superior  degree  of  temperature  to  that  which 


HEPATIC  DERANGEMENTS.  129 

the  plains  of  Bengal  attain  ;  in  consequence  of  which  the  nights  are 
often  hotter  than  the  days,  when  the  land-winds  prevail  in  May,  June, 
and  July.  I  have  seen  the  thermometer  stand  at  105Q  of  Fahrenheit, 
at  midnight,  and  that  too  on  board  a  ship  riding  at  anchor  in  Masoolipa- 
tam  Roads.  Many  causes  combine  to  produce  so  much  higher  a  range 
of  atmospherical  heat  in  the  Carnatic  than  in  Bengal.  First,  the  coast 
in  question  trends  away  towards  the  equinoctial  line,  while  a  great 
part  of  Bengal  lies  without  the  tropics.  Secondly,  the  soil  of  the  for- 
mer is  gravelly  or  sandy,  and  vegetation  stunted  ;  whereas  that  of 
the  latter  is  clayey,  and  vegetation  luxuriant.  J'hirdly,  the  periodi- 
cal rains  that  fall,  at  the  change  of  the  monsoon,  on  the  coast,  are  in- 
stantly absorbed  by  the  parched  and  sandy  surface,  affording  only  a 
very  temporary  coolness  to  the  air;  while  an  actual  and  extensive 
inundation  covers  Bengal  for  months  together.  If  therefore,  the  noc- 
turnal temperatures  of  the  two  places  were  blended  with  the  diurnal 
— if,  for  instance,  the  thermometer  were  marked  every  hour  at  Ma- 
dras and  Calcutta  throughout  the  year,  and  the  whole  averaged,  there 
would  be  full  ten  degrees  difference  in  the  annual  mean  temperatures 
of  the  two  presidencies.  Bombay  is  nearly  on  a  par  with  Calcutta  ; 
for  although  the  country  surrounding  the  former  is  neither  flat  nor 
inundated,  as  in  Bengal,  yet  its  northern  parallel  of  latitude,  its  insu- 
lar situation,  and  the  montainous  nature  of  the  adjacent  country,  com- 
bine to  render  the  average  annual  temperature  of  Bombay  as  lovv?  if 
not  lower,  than  that  of  Calcutta.* 

An  important,  yet  unnoticed  circumstance,  remains  to  be  consider- 
ed, in  estimating  the  comparative  influence  and  effects  of  the  two  cli- 
mates.— Although  sudden  vicissitudes  of  temperature  are  highly  injuri- 
ous to  the  constitution,  in  general,  and  to  the  hepatic  system  in  parti- 
cular ;  yet  an  annual  change  is  eminently  beneficial.  Thus,  the  first 
table  shows  us,  that  at  Calcutta,  during  four  months  of  the  year,  viz. 
November,  December,  January,  and  February,  the  average  heat  of 
the  day  is  only  71°  Fahrenheit,  five  degrees  below  the  common  sum- 
mer heat  of  England.  As  for  the  nights  I  can  vouch  for  their  being 
cooler  than  summer  nights  at  home  ;  since  a  hoar  frost  is  not  an  un- 
usual sight  on  the  plains  of  Bengal,  in  the  mornings  of  this  period  ;  and 
very  gratifying  have  1  found  the  heat  of  a  blanket  at  Calcutta  in  the 
month  of  December. 

Thus  the  Bengalese,  and  those  in  similar  parallels  of  latitude,  enjoy 
a  kind  of  tropical  winter,  or  exemption  from  hrgh  ranges  of  tempera- 
ture, during  one-third  of  the  year  ;  the  effects  of  which,  in  relieving 
the  hepatic  system  from  excessive  action,-in  bracing  the  whole  frame, 
relaxed  by  the  previous  heats,  and  preparing  it  to  sustain  the  subse- 
quent ones,  may  be  compared  to  a  short  return  to  our  native  skies. 

This  remark  will  be  confirmed  by  the  following  analogical  observa- 
tions of  Dr.  Darwin.  "  Though  all  excesses  of  increase  and  decrease 
of  stimulus  should  be  avoided,  yet  a  certain  variation  of  stimulus 
seems  to  prolong  the  excitability  of  the  system  :  thus,  those  who  are 
uniformly  habituated  to  much  artificial  heat,  as  in  warm  parlours  in 
the  winter  months,  lose  their  irritability,  and  become  feeble,  like  hot- 

*  Vide  Sir  James  M'Grigor's  Mernor,  Edin-  Med.  and  Surg.  Journal. 

17 


130  EASTERN  HEMISPHERE. 

house  plants ;  but  by  frequently  going  for  a  time  into  the  cold  air,  the 
sensorial  power  of  irritability  is  accumulated,  and  they  become  strong- 
er. Whence  it  may  be  deduced,  that  the  variations  of  the  cold 
and  heat  of  this  climate  (England,)  contribute  to  strengthen  its  inha- 
bitants who  are  more  active  and  vigorous  than  those  of  either  much 
warmer  or  much  colder  climates." — Zoonomia. 

Knowing  then,  a?  we  do,  how  uniformly  a  high  temperature  affects 
the  biliary  organs,  and  keeping  the  foregoing  facts  in  view,  can  we 
beat  a  loss  to  account  for  the  greater  frequency  of  genuine  hepatitis 
in  the  Carnatic,  than  in  Bengal  1 — 1  say  genuine,  or  original  hepatitis  ; 
for  most  of  those  cases  which  we  meet  with  at  the  latter  place,  are 
the  consequences,  or  sequelae  of  repeated  intermittents  and  remittents, 
both  marsh  and  jungle. 

The  same  reasoning  applies  to  Bombay,  and  all  other  parts  of  In- 
dia, whose  distance  from  the  equator  produces  a  tropical  winter,  when 
the  sun  is  near  Capricorn;  or  where  peculiarity  of  soil,  elevated 
situation,  or  other  locality,  is  incompatible  with  that  high  and  almost 
unremitting  range  of  temperature,  so  remarkable  on  the  Corornandel 
coast,  so  fully  adequate  to  the  derangement  of  the  hepatic  functions. 

Having  thus  explained,  in  I  trust  a  satisfactory  manner,  the  nature 
of  this  "  local  poison,"  and  how  it  comes  to  operate  more  forcibly  in 
one  part  than  another  of  the  Indian  continent,  it  is  necessary  to  show 
why,  even  in  the  less  sultry  parts  of  the  latter — for  instance,  Bengal, 
the  complaint  is  still  more  prevalent  than  under  similar  latitudes  in 
the  West. 

Dr.  Sauuders  quotes,  in  support  of  his  hypothesis,  the  following 
observation  from  Hunter  on  the  Diseases  of  Jamaica.  "  It  is  a  re- 
"  markable  thing,"  says  the  latter,  "  that  in  the  fc:ast  Indies,  under  the 
"  same  latitude  nearly  as  Jamaica,  that  is,  at  Madras  and  Bombay ,the 
"  disease  known  in  those  countries  by  the  name  of  Liver,  or  Hepa- 
"  titis,  shall  be  the  most  prevailing  disorder  among  Europeans,  and 
"  that  the  same  should  not  be  known  in  the  Island  of  Jamaica."  In 
the  first  place,  there  is  a  geographical  error  in  classing  Madras  and 
Bombay  in  similar  latitudes.  In  the  second  place,  I  assert,  that  there 
is  a  difference  of  ten  degrees  in  the  annual  mean  temperatures  of 
the  two  places,  taking  the  hourly  average  height  of  the  mercury  by  day 
and  by  night,  throughout  the  year.  In  the  third  place,  hepatitis  is  by 
no  means  the  most  prevailing  disease  among  Europeans  at  Bombay  ; 
dysentery  being  infinitely  moie  common.*  But  further,  the  Island 
of  Jamaica,  from  its  situation  in  the  vicinity  of  Cancer,  must  have  its 
"  tropical  winter,"  as  well  as  Bengal,  and  at  the  same  period  ;  while 
its  insular  nature,  and  distance  from  the  American  continent,  insure 
it  the  advantage  of  sea  and  land-breezes,  the  former  coming  iu  cool 
and  refreshing  in  every  direction  from  the  sea  by  day  ;  the  latter  de- 
scending cold  from  the  blue  mountains  by  night. 

On  the  contrary,  in  Bengal,  the  land-winds  are  so  distressing  in 
April  and  May,  as  to  oblige  the  Europeans  to  sit  behind  tattys,  for 
'weeks  together,  to  avoid  being  stifled  with  heat  and  dust.  It  is  far 

*  If  I  afterwards  trace  a  connexion  between  dysentery  and  deranged  hepatic 
function,  it  will  not  invalidate  this  position;  as  the  same  observation  will  apply 
*  Ui»  dysenteries  of  the  West. 


HEPATIC  DERANGEMENTS.  131 

otherwise  in  the  West.  Indeed,  it  is  computed  by  Dr.  Mitchell,  af- 
ter thirty  years  observation,  that  it  is  as  hot  in  the  countries  of  the 
old  continent,  in  latitude  29  or  30,  as  ia  the  countries  of  the  new 
continent  which  lie  in  15  degrees  of  latitude.  M.  de  Paw  makes  the 
difference  between  the  old  and  new  continents,  in  respect  to  tempe- 
rature, amount  to  12°  of  the  thermometer. — Recherches  Philosophi- 
ques. 

"  The  vernal  season  in  these  parts,"  (West  Indies,)  says  Mr. 
Edwards,  "  may  be  said  to  commence  with  May. — The  parched  sa- 
"  vannahs  now  change  their  aspect,  from  a  withered  brown  to  afresh 
"  and  delightful  green.  Gentle  southern  showers  presently  set  in, 
"  which,  falling  about  noon,  occasion  bright  and  rapid  vegetation. 
"  At  this  period,  the  medium  height  of  the  thermometer  is  75°, — 
"  After  these  vernal  showers  have  continued  about  a  fortnight,  the 
"  season  advances  to  maturity,  and  the  tropical  summer  burns  in  its 
"  full  glory.  During  some  hours  in  the  morning,  before  the  sea- 
"  breeze  has  set  in,  the  blaze  of  the  sun  is  fierce  and  intolerable. 
"  But  as  soon  as  this  agreeable  wind  arises,  the  extreme  warmth  is 
"  abated,  and  the  climate  becomes  even  pleasant  in  the  shade.  The 
"  thermometer  now  stands  generally  75°  at  sunrise,  and  85°  at  noon.* 

"  But  whatever  inconvenience  the  inhabitants  of  these  islands  may 
"  sustain  from  diurnal  heat,  is  amply  recompensed  by  the  beauty 
"  and  serenity  of  the  nights  :  the  moon  rises  clear  and  refulgent  in 
"  the  cloudless  horizon — the  landscape  is  fciir  and  beautiful — the  air 
"  cool  and  delicious. 

"  In  November  or  December  the  north  winds  commence  ;  at  first 
"  attended  with  heavy  showers  of  hail,  till  at  last  the  atmosphere 
"  brightens,  and  the  weather,  till  March,  may  be  called  winter.  It 
"  is  a  winter,  however,  remote  from  the  horrors  of  northern  seve- 
"  rity  : — coo/,  wholesome,  and  delicious ." — History  of  the  West  Indies. 

Let  this  description  be  compared  with  that  of  the  coast  of  Coro- 
mandel,  and  we  shall  see  how  easy  it  is  to  make  a  sweeping  classifi- 
cation of  climates  on  paper,  where  little  similarity  exists  in  nature. 

To  return.  The  average  thermometrical  range  of  heat  ought  to 
be,  and  really  is,  lower  at  Jamaica  by  three  degrees  than  either  at 
Bombay  or  Calcutta  ;  anJ  if  so,  how  much  lower  than  at  Madras  ? 
In  Jamaica,  too,  though  the  rainy  season  may  leave  swamps  and 
marshes  at  the  debouchures  of  rivers,  yet  there  is  nothing  like  the 
great  annual  inundation  of  Bengal,  occasioning  such  numerous  inter- 
mittents,  that  too  frequently  terminate  in  hepatitis. 

Here  then  are  the  real  causes  why  the  last-mentioned  complaint 
is  more  observed,  and  indeed  more  prevalent,  in  the  East  than  the 
West;  viz.  the  great  superiority  of  temperature  on  the  Coroman- 
del  coast : — and  the  frequency  of  intermittents  and  remittents  on 
the  marshy  plains  of  Bengal,  or  woody  and  jungly  districts  of  other 
provinces,  as  well  as  of  Bombay  and  Ceylon.  To  these  may  be 
added,  the  more  sudden  and  extensive  transition's  of  temperature, 
which  take  place  on  the  continent  of  India,  than  in  the  islands  of  the 
West,  owing  to  the  greater  degree  of  equilibrium  preserved  in  the 
latter  places  by  the  surrounding  ocean. 

*  Compare  this  with  table  No.  II.— 85°  in  th«  morning,  96°^  at  a»o». 


132  EASTERN    HEMISPHERE. 

"  In  Jamaica,  (says  Dr.  Hunter,)  the  coolest  month  in  the  year  is 
c<  at  least  twelve  degrees  hotter  than  the  hottest  month  in  our  sum- 
"  rners,"  page  174,  3rd  ed.  Now  the  common  summer  heat  of  Eng- 
land is  76° ;  consequently  the  thermometer  must  stand  at  88°  in  the 
"  coolest  month"  at  Jamaica  ;  and  that  too  when  there  are  even 
"  showers  of  hail,"  and  when  the  weather  is  "  cool,  wholesome, 
"  and  delicious  !"  Let  us  compare  this  with  Sir  Gilbert  Blane's 
account  of  the  West  India  temperature  : — "  The  thermometer  stands 
"  very  commonly  at  72°,  at  sunrise  in  ihe  cool  season  ;  rising  to  78° 
"  or  79°  in  the  middle  of  the  day.  In  the  hot  season,  the  common 
"  range  is  from  76°  to  83°.  It  seidom  exceeds  this  in  the  shade  at 
"  sea,  and  the  greatest  height  at  which  I  ever  observed  it  in  the 
"  shade,  at  land,  was  87°." — Diseases  of  Seamen,  page  12. 

In  a  very  interesting  "  Account  of  Jamaica,"  published  in  1808, 
by  a  gentleman  twenty-one  years  resident  at  that  island,  it  is  distinct- 
ly stated  that"  the  medium  temperature  of  the  air  may  be  said  to 
"  be  75°  of  Fahrenheit,"  page  21. 

In  the  very  same  page,  with  some  inconsistency,  Dr.  H.  contra- 
dicts his  own  statement.  "  It  was  hotter ,"  says  he,  c<  than  common  in 
"  the  month  of  June,  by  three  or  four  degrees,  the  thermometer  ris- 
"  ing  many  days  to  90°,  an  unusual  heat  in  that  climate."  If  we  take 
"  three  or  four  degrees"  from  90°,  we  shall  have  86°  or  87°,  what 
Dr.  Blane  states  for  the  month  of  June  in  Jamaica,  whereas,  he  just 
before  made  the  heat  88°  in  the  "  coolest  month  in  the  year,"  which 
is  nine  or  ten  degrees  too  much. 

I  may  here  remark,  that  it  must  have  been  from  data  similar  to  the 
above,  that  Dr.  H.  drew  another  conclusion — namely,  that  atmosphe- 
rical heat  has  no  effect  in  increasing  or  deranging  the  biliary  secre- 
tion. Page  277.  I  shall  merely  place  his  opinion  in  juxta-position 
with  that  of  his  friend  who  quotes  him. 


Dr.  HUNTER. 
"  A  warm  climate,  it  is  alleg- 
ed, increases  the  secretion  of  bile, 
and  renders  it  more  acrid.  There 
does  not  appear  to  be  the  slight- 
est foundation  for  this  assertion." 
—p.  277. 


Dr.  SAUNDERS. 
"  Such  symptoms  as  I  have 
now  enumerated  (viz.  increased 
and  vitiated  secretion  of  bile,)  are 
the  spontaneous  effects  of  a  warm 
climate  on  healthy  constitutions, 
independently  of  any  intemper- 


ance."—On  the  liver,  p.  159. 

Every  author  with  whom  I  ara  acquainted,  excepting  Dr.  Bancroft, 
and  every  one  who  has  observed,  or  felt  the  effects  of  warm  cli- 
mates on  his  own  constitution,  will  agree  with  Dr.  Saunders. 

Lastly,  notwithstanding  Dr.  Hunter's  assertion,  that''  Hepatitis  is  un- 
known in  Jamaica,"  when  \ve  see  so  many  sallow  complexions — ema- 
ciated dysenteries —  nay,  obstructed  livers,  every  day  returning  from 
the  West  Indies  ;  when  we  hear  Dr.  Moseley,  who  practised  twelve 
years  in  Jamaica,  assert,  that  in  hot  climates  a  sound  liver  is  never 
to  be  expected  after  death  ;  and  Dr.  Thomas,  another  West  India 
practitioner,  make  use  of  these  expressions — "  My  own  observation?, 
during  a  practice  of  many  years  in  the  West  Indies,  where  Hepatitis 
is  a  frequent  occurrence,"  &c.  &c.  [Modern  Practice  of  Physic,]  we 
may  safely  conclude,  that  in  the  endemic  fevers,  particularly  the  in- 


fr 

HEPATIC  DERANGEMENTS .  13S 

termittents  and  remittents  of  both  hemispheres,  the  hepatic  system 
suffers  proportionally  in  the  Islands  of  the  Caribean  Sea,  as  well  as 
on  the  Banks  of  the  Ganges,  or  in  the  forests  of  Ceylon.  Indeed, 
Dr.  H.  himself  admits,  that  enlarged  and  obstructed  livers  are  fre- 
quently the  sequela?  of  intermittents  in  Jamaica.*  Such,  it  is  well 
known,  would  obtain  the  appellation  of  Hepatitis  in  Bengal  ;  but 
Dr.  H.  will  not  allow  the  term  because,  forsooth,  these  affections  of 
the  liver  are  not  very  apt  to  run  into  suppuration.  Maay  people, 
indeed,  cannot  be  persuaded  that  the  hepatic  functions  are  at  all  de- 
ranged, unless  Hepatitis,  in  propria  forma,  be  present.— Is  the  sto- 
mach never  disordered  except  in  gastritis  ? 

Having  ascertained  the  91*0,  we  now  proceed  to  the  quo-modo.  I 
have  more  than  once  in  this  essay  alluded  to  a  sympathy,  or  synchro- 
nous action,  subsisting  between  the  extreme  vessels  on  the  surface 
of  the  body,  and  those  of  the  vena  portarum  in  the  liver  ;  a  sympathy 
which,  as  far  as  I  am  acquainted,  has  not  been  noticed  by  any  other  ; 
and  which,  if  proved,  will  account  for  the  increased  secretion  of  bile 
in  hot  climates,  and  lead  to  important  practical  conclusions.  It  is, 
however,  in  those  climates  alluded  to,  where  the  vessels  in  question 
are  more  violently  stimulated  than  in  Europe,  that  we  can  most  ea- 
sily and  distinctly  trace  this  sympathy.  I  have  remarked,  that  when 
we  first  arrive  between  the  tropics,  the  perspiration  and  biliary  se- 
cretion are  both  increased  ;  and  that,  as  we  become  habituated  to  the 
climate,  they  both  decrease,  pari  passu. 

It  is  very  singular  that  the  accurate  Bichat  should  not  only  have 
overlooked  this  circumstance,  which  is  evident  to  the  meanest  capa- 
city, but  advanced  a  doctrine  quite  the  reverse.  u  A  cold  atmosphere," 
says  he,  "  confines  the  functions  of  the  skin,  and  occasions  those  of 
the  mucous  system  to  be  proportionally  extended.  The  internal  se- 
cretions are  more  abundant,  &c."  And  again.  "  In  warm  seasons 
and  weather,  on  the  contrary,  the  skin  acts  more  powerfully,  and  the 
secretions,  particularly  the  urine,  are  diminished."  Anatomic  Gene- 
rale.  This  is  all  right,  had  he  excepted  the  biliary  secretion,  which 
follows  a  law  diametrically  opposite  to  this  ;  viz.  it  is  increased  by  a 
warm,  and  diminished  by  a  cold  atmosphere,  in  the  same  manner  as 
perspiration. 

I  have  likewise  shown  that  in  the  cold,  hot,  and  sweating   stages  of 
fever,  the  two  processes  are  exactly  simultaneous  and  proportionate. 
The  partial  sweats  that  break  out  towards  the  termination  of  the  hot^ 
fit,  are  accompanied,  as    Dr.  Fordyce  remarks,  with  "partial  secre-* 
tion,   and  irradiations  of  heat  arising  from  the  prsscordia."     I  shall 
now  proceed  to  other  examples  illustrative  of  this  sympathy.     The 
Asiatic  and  African,  though  inured  from  their  infancy  to  the  high  tem- 
peratures of  their  respective  climates,  guard,  nevertheless,  against 

*  It  is  remarked  that  the  Creole  children  in  Jamaica  are  subject  to  liver  com- 
plaints. Since  the  1st  Edition  of  this  Work  appeared,  the  documents  showing; 
how  much  the  liver  suffers  in  West  India  climates  and  diseases,  excepting  per- 
haps in  the  Concentrated  or  Yellow  Fever,  where  the  brain  and  stomach  bear 
the  onus  of  disorganization,  have  so  multiplied,  that  nothing  more  may  be  said 
on  that  score.  Hepatitis  is  frequent  in  Egypt,  Coast  of  Guinea,  and  Sicily, 
where  the  heat  is  occasionally  excessive. 


134  EASTERN    HEMISPHERE. 

excessive  perspiration,  and  its  too  frequent  consequence,  suppression, 
by  keeping  the  skin  soft  and  unctuous,  whereby  they  maintain  an 
equable  flow  both  of  perspirable  matter  and  bile.  The  former  is  evi- 
dent to  the  senses  ;  the  latter  is  proved  by  the  regularity  of  their 
bowels,  and  their  general  exemption  from  bilious  or  hepatic  diseases. 
"  The  use  of  oil,"  says  Dr.  dime,  "  instead  of  clogging  the  pores, 
keeps  the  skin  moist  ;  and  while  it  guards  againt  excessive,  promotes 
moderate  and  necessary  perspiration," — 279.  In  our  own  climate, 
the  gentle  diapnoe,  or  insensible  perspiration  of  mild  weather,  coin- 
cides with  the  regular  biliary  secretion  ;  while  it  is  in  August,  when 
the  perspiration  is  most  in  excess,  that  we  see  cholera  morbus,  and 
greatly  increased  secretion  of  bile. 

Bichat  ascertained,  by  direct  experiments,  that  during  the  time  of 
digestion  in  the  stomach,  the  pylorus  is  closed,  and  the  biliary  secre- 
tion diminished.  We  know  that  a  corresponding  heat,  dryness,  and 
constriction  on  the  surface  of  the  body,  are  observable  at  this  pe- 
riod. On  the  other  hand,  he  found  that,  whenever  the  chyme  be- 
gan to  pass  into  the  duodenum,  the  biliary  secretion  was  rapidly  aug- 
mented. We  know  that,  at  this  very  time,  the  surface  relaxes,  and 
the  perspiration  is  increased.  Every  one  knows  the  effects  of  eme- 
tics and  nauseating  medicines  on  the  skin  and  perspiration :  the 
same  effects  are  produced  on  the  biliary  secretion.  "  In  all  cases," 
says  Dr.  Saunders,  "  where  bile  is  secreted  in  too  large  a  quantity, 
the  use  of  emetics  is  improper  ;  indeed,  the  actions  of  nausea  and 
vomiting  increase  its  secretion,"  p.  176.  This  sympathy  is  equally 
visible  where  the  secretion  is  deficient. 

If  we  observe  those  emaciated  objects  returning  from  the  East  and 
West  Indies  with  indurated  livers,  sallow  complexions,  torpid  bowels, 
and  paucity  of  biliary  secretion,  we  invariably  find  the  skin  dry,  con- 
stricted, and  harsh  to  the  feel,  without  any  thing  like  the  softness 
and  moisture  of  health. 

i  In  diabetes,  where  perspiration  is  notoriously  defective,  there  is 
the  most  decisive  evidence  of  diminution  in  the  biliary  se- 
cretion. "  There  are,  perhaps,  few  cases  of  diabetes,"  says  Dr. 
Watt,  *«  without  some  affection  of  the  abdomen,  particularly  in  the 
epigastric  region,"  p.  -17.  "  Some  morbid  change,"  says  the  same 
accurate  observer,  "  in  the  alvine  excretion  always  accompanies  the 
diabetic  habit.  Costiveness  is  perhaps  the  most  common  of  these.  In 
some  instances  the  bowels  have  been  so  remarkably  torpid,  that  even 
the  most  powerful  medicines,  in  uncommonly  large  doses,  produced 
but  trifling  effect."  And,  speaking  of  Stevenson's  case,  he  says, 
"  the  quantity  of  alvine  excretion  was  inconsiderable  ;  it  had  also  an 
"  uncommonly  white  appearance. "-These  facts  speak  for  themselves.* 

In  chloropi?  Dr.  Hamilton  observes,  that — **  the  perspiration  seems 
to  be  checked"— and  '  I  am  persuaded,"  says  Dr.  Saunders,  "  that 
"  in  chlorotie  habits,  the  bile  is  more  insipid — is  secreted  in  less 
"  quantity,  and  of  a  paler  colour  than  in  health,"  p.  232.  "  In  ma- 
"  niacal  habits,"  continues  the  last-mentioned  author,  "  there  is  gene- 

*  Are  not  the  kidnies  irritated  by  the  non-secreted  bile,  (or  rather  the  elements 
of  bile  floating  in  the  circulation,)  into  inordinate  action,  in  diabetes  ?— Are  not 
the  effects  of  bleeding-  and  mercury  thus  explained  ? 


HEPATIC  DERANGEMENTS.  135 

rally  a  defect  in  the  secretion  of  bile."  I  need  not  say  how  marked 
is  the  dry  rigid  skin,  and  deficient  perspiration  in  most  maniacs. 
"  Sea-sickness,"  says  Dr.  Saunders,  "  and  a  sea-voyage,  contribute 
"  very  much  to  restore  the  secretion  of  healthy  bile."  The  well- 
known  effect  of  these  in  determining  to  the  surface,  and  promoting 
perspiration,  especially  that  gentle  diapnoe,  corresponding  with  heal- 
thy secretion  in  the  liver,  need  not  be  insisted  on.  The  torpid  state 
of  the  skin  in  melancholia,  hypochondriasis,  and  most  nervous  disor- 
ders, exactly  coincides  with  that  of  the  liver  and  bowels  in  the  same. 
**  Hypochondriacal  complaints,"  says  Dr.  Saunders,  kt  are  always  at- 
"  tended  with  dyspepsia  and  diminished  secretion,  with  great  torpor 
"  of  the  alimentary  canal," — 192.  And  again,  "  The  symptoms  of 
"  dyspepsia  and  diminished  secretion,  which  are  now  rendered  more 
"  conspicuous  among  females,  from  their  sedentary  life,  are  most  ef- 
"  fectually  removed  by  the  means  suggested," — viz.  sea-sickness  and 
a  sea-voyage,  the  very  surest  means  of  keeping  up  a  regular  and 
healthy  discharge  from  the  pores  of  the  skin. 

The  same  may  be  said  of  exercise,,  which  powerfully  promotes  the 
secretion  of  biles  as  well  as  perspiration* 

There  is  a  curious  case  related  in  the  Edinburgh  Medical  and  Sur- 
gical Journal,  vol.  2,  page  5,  where  an  obstinate  dyspepsia,  [where 
bile  is  known  to  be  deficient,]  could  not  be  cured  till  the  exercises 
[broadsword]  brought  on  a  copious  flow  of  perspiration.  In  cases  of 
deranged  structure  and  deficient  secretion  in  the  liver,  Dr.  Saunders 
recommends,  what  certainly  will  be  found  very  useful—4*  the  tepid 
bath,  and  small  doses  of  mercury." 

Here  the  bath  must  act  first  on  the  skin,  and  probably  on  the  liver, 
from  the  sympathy  in  question — while,  on  the  other  hand,  the  mer- 
cury, which  is  known  to  increase  the  action  in  the  liver,  may  pro- 
duce its  diaphoretic  effect,  from  the  same  consent  of  parts  above  al- 
luded to. 

All  the  passions  corroborate  this  doctrine.  Fear,  grief,  and  the 
other  depressing  passions,  when  moderate,  lessen  the  secretion  of 
bile — render  the  skin  pale  or  sallow,  and  check  the  perspiration. 
On  the  other  hand,  anger  and  rage  are  well  known  to  increase  the 
biliary  secretion  ;  and  their  corresponding  effects  on  the  surface  are 
visible  to  every  eye.  Joy,  hope,  and  what  may  be  termed  the  elat- 
ing passions,  when  in  moderation,  determine  to  the  surface,  and  keep 
up  a  salutary  flow  of  bile  and  insensible  perspiration,  so  congenial  to 
the  healthy  functions  of  the  body.  I  shall  adduce  no  more  examples, 
till  I  come  to  speak  of  dysentery  and  cholera,  which  will,  I  think,  af- 
ford undeniable  proofs  of  the  sympathy  in  question. 

In  the  mean  time,  this  connexion  between  two  important  processes 
in  the  animal  economy,  while  it  fully  accounts  for  the  increase  of  ac- 
tion in  the  hepatic  system,  from  the  influence  of  a  hot  climate  on  the 
surface,  will  be  found  to  elucidate  many  of  the  phenomena  attending 
those  diseases  we  are  considering  ;  and  perhaps  remove  the  stigma 
of  empiricism  so  commonly  attached  to  their  cure. 

It  is  allowed  that  perspiration  and  biliary  secretion  are  increased 
by  tropical  heat,  and  that  the  latter  is  vitiated.  Perhaps,  even  here 
the  parallel  holds  between  the  two.— How  different  is  the  profuse 


13$  EASTERN  HEMISPHERE. 

antf  gross  evacuation  of  sweat,  from  that  insensible  halitus,  or  gazeoua 
fluid,  which  juat  keeps  the  skin  soft  and  smooth  in  health! 

We  know  that  nature  has  recourse  to  the  perspiratory  process  to 
obviate  greater  evils  that  would  accrue  from  accumulated  heat : — we 
have  every  reason  to  believe,  from  analogy,  that  the  increase  of  the 
biliary  secretion  is  also  a  wi*e  mean  employed  by  the  same  invisible 
agent,  to  guard  against  congestion,  and  derangement  in  the  hepatic 
system. 

I  have  shown,  from  Dr.  Currie,  that  even  u  the  necessary  quantity 
' '  of  perspiration  in  a  hot  climate  enfeebles  the  system."  So  the 
increased  and  vitiated  secretion  of  bile  debilitates  and  renders  ir- 
ritable the  whole  tract  of  the  alimentary  canal.  "  The  inhabitants  of 
"  warm  climates,"  says  Dr.  Saunders,  "  are  extremely  subject  to  dis- 
"  eases  arising  from  the  increased  secretion  of  bile,  and  the  excess 
"  of  its  quantity  in  the  primae  viae,  which  either,  by  regurgitation 
"  into  the  stomach,  produces  a  general  languor  of  the  body,  together 
<£  with  nausea,  foul  tongue,  loss  of  appetite  and  indigestion,  or  being 
"  directed  to  the  intestines,  excites  a  painful  diarrhoea,  ultimately 
«•  tending  to  weaken  their  tone,  and  disturb  their  regular  peristaltic 
"motion,"—/).  157. 

As  bile,  especially  when  vitiated,  is  certainly  apt  to  gripe  and 
loosen  the  bowels,  it  might  be  supposed,  that  if  it  be  increased  with 
the  cuticular  discharge,  those  whose  laborious  exertions  keep  them 
every  day  bathed  in  sweat  for  hours,  would  be  continually  subject  to 
diarrhoeas.  But  Nature  has  admirably  guarded  against  such  an  in- 
convenience by  establishing  what  may  be  termed  a  vicarious  sympa- 
thy between  the  skin  and  the  internal  surface  of  the  intestines,  by 
which  the  secretion  of  mucus,  &c.  on  the  latter  is  diminished,  as  the 
perspiration  is  increased.  In  temperate  climates,  therefore,  and 
among  the  laborious  classes  of  society,  this  increase  of  the  biliary 
fluid  is  productive  of  little  or  no  mischief,  being  all  expended  during 
the  digestion  of  their  food,  which  is  generally  composed  of  such  ma- 
terials as  require  strong  organs  and  powerful  fluids  for  that  purpose. 

But  it  is  very  different  with  Europeans  in  hot  climates. — There  the 
vicarious  sympathy  is  not  always  able  to  keep  in  check  the  diarrhoea  ; 
and  when  it  «".s,  the  superabundant  secretion  of  bile  accumulates  in 
the  primaB  vise,  producing  all  the  symptoms  above  enumerated,  till 
its  quantity  or  quality  raises  a  commotion  in  the  bowels,  in  conse- 
quence of  which  it  is  expelled.  Hence  the  impropriety  of  attempt- 
ing athletic  exercises  in  the  heat  of  the  day  between  the  tropics, 
which  must  greatly  increase  the  ill  effects  described. 

These  then  are  the  penalties,  (aggravated,  indeed,  too  often  by 
our  own  misconduct,)  which  are  incurred,  more  or  less,  by  emigra- 
tion from  a  temperate  to  a  torrid  zone !  They  are  the  mild  inflic- 
tions, however,  of  Nature,  wisely  calculated,  and  providentially  de- 
signed, to  ward  off  more  serious  evils. — They  must  be  continued 
long  before  they  induce  actual  and  dangerous  diseases  ;  and  I  am 
convinced  we  might,  in  general,  escape  the  latter,  by  exercising  our 
rational  faculties  in  observing  and  rendering  subservient  to  our  use, 
the  simple,  but  salutary  operations  of  Nature.  After  having  been 
severely  taught  to  feel  the  ills  I  am  going  to  pourtray,  it  is  still  a 


HEPATIC    DERANGEMENTS.  137 

most  pleasing  task  to  trace  the  wisdom  and  benevolence  of  our  Cre- 
ator in  what  might  seem  the  imperfection  of  hi?  works. 

We  now  proceed  to  the  more  serious  injuries  too  frequently  re- 
sulting from  these  spontaneous,  but  salutary  efforts  of  the  constitu- 
tion, when  counteracted  or  goaded  on  by  our  own  injudicious  man- 
agement, or  by  unavoidable  accidents. 

I  have  shown,  on  the  authority  of  Dr.  Currie,  that  excessive  per- 
spiration occasions  a  loss  of  tone  in  the  extreme  vessels  ;  in  conse- 
quence of  which,  the  perspiratory  fluid  continues  to  be  poured  out 
after  the  cause  or  necessity  has  ceased  to  operate.  It  is  precisely 
the  same  with  respect  to  biliary  secretion.  He  has  likewise  observ- 
ed that,  in  the  last-mentioned  state,  the  application  of  even  a  slight 
degree  of  cold  is  pregnant  with  danger,  it  certainly  is  so  ;  and  on 
more  accounts  than  one.  For  not  only  is  the  animal  heat  too  rapid- 
ly abstracted,  but  the  extreme  vessels  on  the  surface,  and  likewise 
those  of  the  vena  portarum,  are  instantly  struck  torpid  ;  the  perspira- 
tion and  biliary  secretion  are  arrested  ;  the  passage  of  the  blood 
through  the  liver  is  obstructed  ;  and  a  temporary  congestion  through- 
out the  portal  circle  is  the  result. 

This  view   illustrates,  and  is  at  the  same  time   con6rmed  by,  the 
observations  of  two  physicians  in  very  different  and  distant  parts  of 
the  world.     Sir  James  M'Grigor  remarks,  that  during  the  march  of 
the  army  over  the  sandy  desert  of  Thebes,  where  the  thermometer 
frequently  stood  at  1 18  in  the  soldiers'  tents,  the  health  of  the  troops 
was  equal  to  what  it  had  been  at  any  former  period  in  India.  "  Heat 
of  itself  then,"  says  he,  k<  does  not  appear  to  be  the  principal  cause 
of  the  prevailing  diseases."     It  certainly  is  not  ;  but  when  excessive 
and  long-continued,  it  induces  that  state  of  the  vessels  on  the  surface, 
and  of  the  liver,  which  is   easily  thrown  into  disease  by  the  sudden 
application  of  slight  degrees  of  cold       This  accounts  for  Dr.  Mose- 
ley's  paradox,  that  "  cold  is  the   cause   of  almost  all  the  diseases  in 
hot  climates,  to   which  climate  alone   is  accessary."     He  refers  the 
mischief  here  entirely  to  checked  perspiration  ;  but  the  connexion 
which  I  have  traced   between   this   and  internal  mischief,  will  more 
amply  elucidate  this  affair.    Thus,  in  the  months  of  April,  May,  and 
beginning  of  June,  at  Calcutta  the  heat  is  considerably  greater  than 
during  the  subsequent   rainy  months  ;   but  perspiration,  though  pro- 
fuse enough,  is  sieady  and  pretty  uniform,  and  the  only  diseases  are 
those  from  increased  secretion  of  bile.     From  the  middle  of  June, 
on  the   other  hand,  the  close,  humid,  and   sultry   atmosphere,  is  at- 
tended with  an  absolute  exudation  from  every  pore  of  a  European's 
body  ;  in  which  state  the  chilling  application  of  rain — the  raw,  noc- 
turnal vapours  — or  the  atmospherical   vicissitudes   of  autumn,  will 
produce,  as   may  easily  be  conceived,  the   effects  I   have  described 
above  ^  the  consequences  of  which  will  be  fever,  dysentery,  or  both.* 
It  is  on  this  account  that  the  Bengalese  are  observed  to  be  more  as- 
siduous in  using  oily  frictions  at  this  period  than  at  any  other.  They 
know,  from  experience,  that  by  such   precautions  they  ar^  enabled 
to  maintain  a  more  uniform  discharge  from  the  pores,  to  c  teck  pro- 
*  Vide  section  on  Bilious  Fever. 
18 


3#  EASTERN  HEMISPHERE. 

fuse  perspiration  by  day,  and  to  obviate  the  effect  of  rain  or  cold  by 
night. 

On  the  Coromandel  coast,  however,  where  the  range  of  tempera- 
ture is  higher  and  more  permanent ;  where  the  duration  of  the*  rain 
is  short;  where  the  nights  are  either  hot,  as  during  the  hot  land- 
winds,  or  temperate,  dry,  and  clear,  as  at  other  times,  the  deteriora- 
tion of  the  hepatic  organs  is  slow  and  gradual,  where  temperance  and 
regularity  are  observed.  But  among  heedless  sailors,  soldiers,  and 
others,  who,  to  the  stimulating  effects  of  the  climate,  add  inebriety, 
too  much  food,  or  ill-timed  exercise,  then  the  biliary  secretion  and 
perspiration  are  so  hurried  and  augmented,  and  the  vessels  so  debi- 
litated, that  the  smallest  atmospherical  vicissitude  becomes  danger- 
rous.* 

The  effects  resulting  from  the  application  of  cold  under  these  cir- 
cumstances, will  be  in  all  degrees  from  a  slight  shiver  to  a  fever,  or 
even  instant  death.  We  will  suppose  them  only  in  a  low  degree. 
During  the  temporary  torpor  of  the  extreme  vessels  on  the  surface, 
and  of  the  vena  portarum,  the  pori  biliarii  and  excretory  ducts  will 
partake  of  the  same  atony,  and  the  bile  will  stagnate,  till  the  reac- 
tion succeeds  and  propels  it  forward  in  its  accustomed  course,  with 
a  degree  of  acceleration  proportioned  to  the  previous  quiescence^ 
It  is  plain,  that  by  frequent  repetitions  of  this,  the  vessels  and  ducts 
in  question  will  lose  tone  ;  and  as  atony  is  the  parent  of  spasm, 
constrictions  of  the  ducts  must  at  these  times  take  place  ;  the  bile 
will  become  viscid,  occasionally,  from  stagnation,  and  be  with  more 
difficulty  brought  forward  into  the  intestines  during  the  subsequent 
increased  action  of  the  vessels.  Thus  obstructions  will  form,  and  an 
inflammatory  congestion  be  constantly  impending,  till  time,  or  some 
accidental  aggravation  of  the  causes  above-mentioned,  kindles  up 
HEPATITIS,  which  will  run  rapidly  into  suppuration,  and  perhaps  in 
a  few  days  destroy  both  the  organ  and  the  life  of  the  patient,  unless 
it  be  skilfully  checked  in  its  career. 

If,  during  this  catastrophe,  we  expect  to  find  the  pathognomonic 
symptoms  of  acute  Hepatitis,  as  it  appears  or  is  described  in  Europe, 
we  will  be  greatly  deceived.  In  cumparatively  few  instances  have  I 
seen  the  violent  rigors,  high  fever,  hard,  quick,  and  full  pulse,  acute 
pain,  &c.  which  we  would  naturally  look  for  as  preceding  the  des- 
truction of  such  a  large  and  important  viscus. 

Such  cases,  however,  pretty  frequently  occur  during  the  first 
twelve  or  eighteen  months  after  arriving  in  the  country.  A  young 
gentleman  of  great  abilities,  and  a  good  constitution,  but  who  des- 
pised all  curbing  rules  of  temperance  or  precaution,  ran  about  in 
the  sun  for  some  days  at  Malacca,  indulging  in  all  sorts  of  licentious- 
ness or  inebriety  ;  and  was  seized  in  a  day  or  two  afterwards,  on  our 
passage  to  China,  with  rigors  and  heat  alternating  ;  succeeded  in  a 
few  hours  by  pain  in  the  right  side,  extending  across  the  pit  of  the 
stomach,  accompanied  with  some  difficulty  in  respiration.  He  did 
not  send  for  me  till  twelve  or  fourteen  hours  after  the  attack.  He 
had  then  high  fever — hard,  quick  pulse — great  dyspnoea — a  short 

Sec  the  Section  on  climate  of  Egypt  in  the  Mediterranean  division  of  this 
where  the  foregoing;  reason  is  still  further  elucidated,  and  confirmed 


HEPATIC    DERANGEMENTS.  13$ 

cough,  and  the  most  excruciating  pain  in  the  region  of  the  liver. 
Although  1  had  then  been  accustomed  to  treat  Hepatitis  as  it  more 
usually  appears  in  India,  and  this  gentleman  had  been  a  voyage  to 
Bengal  in  a  Company's  ship  before  he  joined  us,  yet  the  disease  had 
so  decided  a  European  character,  that  I  determined  on  employing  the 
European  method  of  cure.  Accordingly,  blood  was  drawn  "  pleno 
TTUO,"  from  his  arm,  and  repeated  twice  the  next  day.  His  bowels 
were  kept  open  with  saline  cathartics  ;  and  antimonials,  in  nauseat- 
ing doses,  were  prescribed,  to  relax  the  surface,  which  was  dry  and 
burning.  By  these  means  the  febrile  symptoms  were  greatly  miti- 
gated, and  blisters  to  the  side  seemed  to  relieve  the  local  affection. 
He  still,  however,  hud  great  tenderness  on  pressing  the  right  hypb- 
chondre  ;  and  on  the  fourth  day  he  complained  of  having  a  flux. 

I  knew  but  too  well  how  sure  an  index  this  was  of  mischief  going 
on  in  the  liver  I  therefore  commenced  the  administration  of  mer- 
cury without  delay.  But  while  endeavouring  to  saturate  the  system 
with  this  medicine,  we  were  overtaken  by  a  most  violent  typhoon,  or 
hurricane,  in  the  Chinese  seas,  which  kept  the  ship  in  the  great- 
est agitation,  and  completely  drenched  with  water,  for  many  days  toge- 
ther. I  had  reason  to  believe,  that  he  neglected  at  this  time,  to  take 
his  medicines,  and  I  was  not  able  to  pay  minute  attention  to  him  my- 
self. The  flux  was  now  the  prominent  symptom,  and,  though  I  used 
every  exertion,  I  could  never  afterwards  affect  his  mouth  with  mer- 
cury. 

A  fulness  soon  appeared  in  the  right  side  ;  while  the  shiverings, 
cold  sweats,  and  lastly,  the  colliquative  diarrhoea,  that  terminated  the 
scene,  left  no  doubt  that  abscess  had  not  only  formed,  but  burst  inter- 
nally .  He  dragged  out  a  miserable  existence  of  more  than  three  weeks 
from  the  commencement,  and  died  at  the  island  ofLintin,  where  I  in- 
spected the  body. 

Before  his  dissolution,  the  discharge  per  anum  was  purulent,  and 
dreadfully  foetid.  A  few  hours  before  his  death  he  vomited  a  similar 
matter,  and  then  sunk  rapidly,  retaining  the  possession  of  his  mental 
faculties  till  the  last  moment ;  and  regretting  his  inattention  to  the 
advice  I  had  often  given  him,  previous  to  his  illness,  warning  him 
against  the  effects  of  intemperance  and  exposure  to  the  heat  of  the 
sun. 

On  dissection,  the  liver  was  found  one  entire  mass  of  suppuration 
and  disease.  I  passed  my  hand  from  it  into  the  stomach,  to  which  it  ad- 
hered, and  through  which  an  abscess  had  burst.  Another  adhesion  had 
formed  between  the  liver  and  the  transverse  arch  of  the  colon,  through 
which  was  an  exit  also  for  the  matter.  In  short,  scarce  a  trace  of 
healthy  organization  was  to  be  observed  at  any  distance  from  the  con- 
vex surface  of  this  organ,  which  part  alone  preserved  any  thing  like 
a  natural  appearance. 

I  met  with  few  cases  in  India  so  exquisitely  marked  with  acute  Eu- 
ropean symptoms  as  this.  But  in  all  those  which  exhibited  traits  «t 
all  approximating  to  the  above,  I  delayed  not  a  moment  in  commenc- 
ing the  mercurial  treatment,  in  conjunction  with  the  anti- phlogistic  ; 
the  latter  being  carried  no  further  than  the  inflammatory  symptom* 


140  EASTERN  HEMISPHERE, 

appeared  to  require  ;  the  former  continued  uninterruptedly  till  the 
full  effect  was  produced,  and  till  every  shadow  of  danger  was  gone. 

Such  instances  as  these  cannot  be  mistaken  ;  they  can  too  often  be 
traced  to  evident  and  adequate  causes  ;  such  as  intemperance —  vio- 
ent  exercise  in  the  sun — or  sudden  exposure  to  cold  when  the  body 
has  been  some  time  in  a  state  of  perspiration.  They  will  occur  prin- 
cipally among  those  lately  from  Europe,  or  at  least  within  a  year  or 
two  after  their  arrival  ;  and  such  symptoms  will  be,  in  most  cases, 
confined  to  the  young,  the  robust,  and  plethpric  habits. 

But  in  general,  the  disease  makes  its  approach  in  a  much  more 
questionable  shape,  though  equally  pregnant  with  danger  as  the  fore- 
going, and  not  seldom  more  rapid  in  its  course.  A  man  comes  to  us, 
complaining  of  having  a  flux.  He  says,  he  is  frequently  going  to  stool 
— that  he  is  griped  ;  but  passes  nothing  but  slime — that  his  stools  are 
like  water,  or  some  such  remark.  It  is  ten  to  one  if  he  mentions  any 
other  symptom  at  this  time.  But  if  we  come  to  interrogate  him  more 
closely,  he  will  confess  that  he  has  had  some  soreness  at  the  pit  of  the 
stomach,  or  perhaps  in  the  right  side.  If  we  examine  the  part,  a 
fulness  will  sometimes  appear — if  we  press  upon  it,  he  starts  back. 
or  shrinks  at  least  from  the  pressure. 

If  we  look  into  his  countenance,  besides  a  certain  anxiety,  we  will 
observe  a  dark  kind  of  sallow-ness  in  his  cheeks,  and  a  yellowish  hue 
in  his  eyes.  The  latter  is  seldom  absent  in  hepatic  diseases,  both  in 
India  and  Europe. 

The  temperature  of  the  surface  will  probably  not  be  much  in- 
creased ;  but  the  skin  will  have  a  dry  feel — his  mouth  will  be  clam- 
my, and  his  tongue  have  a  whitish  or  yellow  fur  towards  the  back 
part.  His  pulse,  though  neither  hard  nor  very  quick,  will  have 
an  irritable  throb,  indicative  of  some  internal  affection.  His  urine, 
if  inspected,  which  it  always  should  be,  will  be  found  to  tinge  the  bot- 
tom and  sides  of  the  pot  with  a  piok  sediment,  or  turn  very  turbid 
a  few  hours  after  it  is  voided  ;  and  he  will  generally  complain  of  some 
heat  and  scalding  in  making  water. 

These  are  all  the  external  marks  we  can  perceive  ;  and  the  few 
symptoms  at  the  head  of  the  list  are  all  that  the  heedless  soldier  or 
sailor  has  noticed,  or  at  least  recorded.  Happily  for  the  patient,  as 
well  as  his  physician,  the  degree  of  violence  in  the  bowel  complaint, 
where  other  symptoms  are  not  conspicuous,  will  be  almost  always  a 
sure  index  to  the  rapidity  or  danger  of  that  in  the  liver.  Whereas 
in  those  cases  where  the  symptoms  are  of  the  violent  or  European 
cast— particularly  pain,  fever,  and  dyspnoea,  the  bowels  are  very 
frequently  costive  for  the  first  few  days  of  the  complaint. 

If  it  is  not  early  checked,  it  will  frequently  run  onto  suppuration, 
like  the  case  described,  and  then  the  chance  of  its  pointing,  or  of 
the  matter  finding  its  way  through  ducts  or  adhesions,  with  ultimate 
recovery,  is  faint  indeed.  Other  symptoms  will  occasionally  arise 
in  this  disease,  or  accompany  it  from  the  beginning.  Thus  the  fever 
is  sometimes  smart ;  the  enlargement,  hardness,  or  tenderness  of  the 
part,  more  violent ;  the  inability  of  lying  on  a  particular  side  may  be 
complained  of  a  short  cough  may  attend  :  or  that  particular  sensa- 


HEPATIC  DERANGEMENTS.  141 

tion  in  the  acromion  scapula?  may  be  noticed,  though  it  is  not  very 
often  that  this  last  is  present. 

These  symptoms  and  the  duration  of  the  complaint,  will  vary 
much.  Indeed,  the  latter  is  very  uncertain  ;  as  its  continuance  may 
be  protracted  to  several  weeks,  without  suppuration  or  organic  de- 
rangement of  vital  importance  following. 

This,  then,  is  the  hepatitis  of  India  ;  and  certainly  there  is  no 
small  dissimilarity  in  symptoms,  between  it  and  the  acute  hepatitis  of 
Europe.  The  flux,  which  may  be  termed  the  pathognomonic  of  the 
former,  is  almost  always  wanting  in  the  latter.  The  one,  (Indian,) 
partakes  more  of  inflammatory  congestion  and  obstruction  ;  the  other 
of  active  inflammation,  like  that  of  the  lungs,  kidnies,  &c. 

Such  are  the  marks  that  are  to  guide  the  practitioner  when  the  dis- 
ease is  present.  An  attention  to  the  following  premonitory  symptoms, 
described  for  the  use  of  the  more  intelligent  class  of  patients,  into 
\vhose  hands  this  essay  may  fall,  will  probably  save  them  many  a 
nauseous  dose,  andnmiy  a  tedious  day's  illness. 

In  all  bilious  diseases,  the  mind  is  much  affected.  When  hepatitis 
is  impending,  it  loses  a  portion  of  its  wonted  firmness.  Our  spirits 
are  unequal  ;  we  are  occasionally  gloomy  and  irritable  ;  and  apt  to 
see  things  through  a  distorting  medium.  This  too  frequently  drives 
patients  to  have  recourse  to  those  very  means  which  hasten  on  the 
fatal  catastrophe,  but  which  give  a  temporary  relief  to  disagreeable 
mental  sensations,  that  are  only  symptomatic  of  the  corporeal  affec- 
tion—1  mean,  an  indulgence  in  the  fugitive  pleasures  of  the  bottle. 

The  eye  and  countenance  assume  the  appearance  alluded  to  be- 
fore, termed  Bombycinous  by  Dr,  Darwin  :  and  the  urine  becomes 
high-coloured,  or  tinged  with  bile;  and  almost  invariably  produces 
considerable  scalding  in  its  passage  through  the  urethra.  Dyspeptic 
symptoms  arise,  and  generally  mislead  the  patient  into  a  belief  that 
his  complaint  is  only  indigestion.  After  any  thing  like  a  full  meal, 
we  feel  a  most  uneasy  load  and  sense  of  oppression  about  the  pit  of 
the  stomach,  which  are  relieved  by  yawning,  stretching,  or  standing 
up,  and  aggravated  by  stooping,  or  the  recumbent  posture.  The  di- 
gestion is  never  equal  to  the  appetite,  though  the  latter  is  often  defi- 
cient ;— and  this  leads  to  irregularity  in  the  bowels.  One  day,  there 
are  dark,  clayey  stools,  with  costiveness  ;  another,  they  are  foetid 
and  slimy,  with  flatulence  and  looseness.  The  skin  has  not  the  moist, 
soft  feel  of  health  <  but  often  a  dryness,  with  partial  clammy  per- 
spirations, and  irregular  flushes  and  chills. 

We  may  not  feel,  at  this  time,  any  pain  on  pressing  the  region  of  the 
liver  ;  but  a  short  and  unexpected  step  on  uneven  ground,  will  fre- 
quently cause  a  most  unpleasant  sensation  at  the  pit  of  the  stomach, 
or  in  the  right  side,  as  if  something  dragged  there.  Indeed,  if  the 
patient  be  attentive  to  his  own  feelings,  some  internal  uneasiness  will 
always  be  found  to  precede  the  pain  on  external  pressure  ;  at  least 
I  invariably  found  it  so  in  my  own  person,  and  it  has  more  than  once 
admonished  me  of  my  danger. — The  same  remark  has  been  made  to 
me  by  intelligent  patients.  Disturbed  sleep,  and  frightful  dreams, 
precede  and  accompany  this  disease,  in  almost  every  case.  Nothing 
harassed  me  more  than  this  unpleasant  symptom  ;  and  on  inquiry,  I  al* 


142  EASTERN  HEMISPHERE 

ways  found  my  patients  make  the  same  remark  ;  but  they  will  seldom 
mention  this,  unless  they  are  interrogated. 

When  all,  or  several  of  these  symptoms,  make  their  appearance,  a 
few  doses  of  calomel  and  cathartic  extract,  administered  so  as  to  keep 
us  a  regular  increase  of  the  alvine  evacuations  for  some  days,  toge- 
ther with  the  strictest  abstinence  anJ  caution  in  avoiding  the  ex- 
tremes of  heat,  or  sudden  vicissitudes,  will  often  anticipate  the  attack 
of  this  insidious  disease,  and  entirely  check  it  in  embryo.  If  these 
means,  however,  do  not  remove  the  morbid  train  of  premonitory  sen- 
sations above  described,  mercury  should  be  slowly  introduced,  so  as 
to  produce  a  brassy  taste  in  the  mouth,  and  kept  at  this  point  till  the 
return  of  health  and  strength,  which  would  hardily  ever  fail  to  result. 

It  will  be  readily  understood,  that  the  warning  symptoms  above- 
mentioned,  can  only  be  expected  where  the  disease  is  coming  on  gra- 
dually, from  effects  of  climate,  and  the  more  moderate  application  of 
such  causes  as  hasten  these  effects.  Where  the  excitantia  are  strong 
and  evident,  such  as  great  intemperance  ;  sudden  exposure  to  consi- 
derable atmospherical  vicissitudes,  particularly  to  cold  after  per- 
spiration ;  violent  exercise,  &,c  then  the  interval  between  them  and 
actual  disease,  will  not  always  afford  many  admonitory  sensations. 

Treatment. 

The  medical  practice  of  Inelia  is  more  simple  than  that  of  Europe, 
evidently  from  the  great  connection  which  experience  has  traced  be- 
tween many  apparently  dissimilar  diseases  in  the  former  country  ; 
rendering  it  only  necessary  to  vary,  in  some  degree,  the  same  metho- 
Jus  medendi. 

During  the  first  twelve  months  after  arriving  in  the  country,  when- 
ever the  patient  was  at  all  robust,  the  pyrexia  evident,  or  the  pain 
considerable,  I  bled  at  the  very  commencement,  and  not  with  a  spa- 
ring hand.  I  did  so  with  a  two-fold  view.  One  was  to  relieve  the  febrile 
symptoms,  by  lessening  the  inflhmrnatory  congestion  in  the  liver  and 
portal  circle  ;  the  other  to  lower  the  tone  of  the  constitution,  which 
experience  taught  me,  accelerated  the  effect  of  that  medicine  on 
which  ray  principal  reliance  was  placed.  To  further  both  these  ob- 
ects,  one  or  two  doses  of  calomel,  or  the  pil.  hydrarg.  with  opium, 
and  antimonial  powder,  were  given,  after  copious  venesection,  and  fol- 
lowed by  castor  oil  or  jalap,  which  never  failed  to  bring  down  a  copi- 
ous alvine  discharge,  c<  nsisting  of  any  thing  but  natural  foeces,  or  heal- 
thy bile.  For  in  the  flux  attending  hepatitis,  the  violent  straining  and 
griping  are  succeeded  by  nothing  but  mucus  and  blood,  accompanied 
by  a  distressing  tenesmus,  unless  when  laxatives  are  taken,  and  then 
diseased  secretions  only,  with  occasionally  a  hardened  scybala,  or 
other  fo3cal  accumulation,  are  passed 

It  appears,  by  Mr.  Curtis,  that  the  hospital  practice  at  Madras  in  his 
time,  [40  years  ago,]  was  to  give  three  grains  of  calomel,  with  some  rhu- 
barb and  soap,  night  and  morning,  till  ptyalism  came  on  ;  and  if  it  was 
necessary  to  have  the  mouth  sooner  affected,  a  drachm  of  mercurial 
ointment  was  rubbed  in  on  the  affected  side  every  night.  No  opium 
was  then  thought  of;  but  the  hypothetical  prejudice  against  that  va- 
luable article  is  now,  I  believe,  pretty  well  worn  off ;  and  I  know, 


HEPATIC  DERANGEMENTS.  143 

from  pretty  ample  experience,  that  in  conjunction  with  antimonial 
powder,  it  forms  a  most  admirable  auxiliary  to  the  mercury  ;  not  on- 
ly soothing  many  uneasy  sensations  of  the  patient,  but  determining  to 
the  surface,  and  promoting  a  diaphoresis,  which  is  of  infinite  service 
in  this,  as  in  most  other  diseases. 

In  all  urgent  cases,  I  seldom  ga?e  less  than  twenty-four  grains  of 
calomel  in  the  twenty-four  hours  ;  and  generally  in  the  following 
manner : —  g 

R.  Submur.  Hydrarg.  gr.  vj. 
Pulv.  Antimon.  gr.  iij.  ; 
Opii,  gr.  fs. 
M.  ft.  bolus  —  sexta  quaque  hora  sumendus. 

During  the  exhibition  of  these  medicines,  an  occasional  dose  of 
castor  oil  or  other  laxative,  and  emollient  injections,  contributed  to 
mitigate  the  griping  and  tenesmus  ;  while  blisters  and  leeches  often 
relieved  the  local  pain  of  the  side.  But  these  were  only  secondary 
considerations  :  and  the  grand  object  was  to  get  the  mouth  affected, 
when  the  flux  and  other  symptoms  were  sure  to  give  way. 

The  secretion  of  healthy  bile — the  flow  of  saliva  from  the  mouth 
— and  a  gentle  and  uniform  perspiration  on  the  skin,  were  synchro- 
nous effects  of  the  medicine,  and  certain  indications  of  the  approach- 
ing cure.  But  it  was  necessary  to  keep  up  these  by  smaller  doses  of 
the  medicines  alluded  to,  not  only  till  every  symptom  of  the  disease 
had  vanished,  but  till  the  clear  countenance,  keen  appetite,  and  regu- 
larity of  bowels  had  returned,  and  health  and  strength  were  com- 
pletely restored. 

Indeed,  a  degree  of  obesity  generally  succeeds  the  administration 
of  the  medicine,  and  trie  cure  of  the  disease  ;  nor  need  we  wonder 
at  this,  when  we  consider  the  previously  deranged  state  of  the  di- 
gestive organs,  to  which  a  renewed  energy  is  now  communicated. 

But  in  effecting  these  salutary  objects,  I  have  sometimes  been 
obliged  to  push  the  mercurial  treatment  in  a  much  bolder  manner 
than  above  described.  I  have  myself  taken  calomel  in  twenty  grain, 
doses,  three  times  a  day,  without  experiencing  the  slightest  incon- 
venience from  the  quantity  ;  nay  I  often  found  large  doses  sit  easier 
on  the  stomach,  and  occasion  less  irritation  in  the  bowels  than  small 
ones.  At  this  time,  too,  1  was  using  every  exertion,  by  inunction, 
to  forward  the  ptyalism  ;  yet  it  was  several  days  before  1  could  pro- 
duce any  effect  of  this  kind.  These  doses  may  astonish  those  who 
do  not  know  the  difficulty  of  affecting  the  mouth  with  mercury  in  a 
hot  climate,  when  the  liver  is  verging  to  suppuration.  The  idea  of 
their  purging  and  griping  at  these  times  is  truly  chimerical.  Indeed, 
I  never  saw  any  of  those  terrible  cases  of  hypercatharsis  which 
people  so  much  talk  of,  except  where  cold  was  applied,  and  perspi- 
ration checked  during  salivation,  when  certainly,  as  may  naturally 
be  supposed,  a  severe  bowel  complaint  is  the  consequence.*  But 
in  that  dangerous  state  of  the  liver  which  I  have  mentioned,  when  a 
few  hours  perhaps  must  determine,  whether  healthy  secretion  or  de- 

*  "  Granis  viginti  perfrequenter  usus  sum,  duis  autetn,  quotidiano,  adhibitis 
aliquid  incomodi,  aut  perieuli,  tali  ab  exhibitione  pervenire  nunquam  obser- 
vavi,"— T/ie«*0n  Hepatitis,  by  T.  B.  Wilson,  M.  D.  Surgeon,  R,  N.  1817. 


144  EASTERN    HEMISPHERE. 

structive  suppuration  is  to  result,  a  tardy,  irresolute  practice,  is  preg- 
nant with  mischief.  Unfortunately  at  this  critical  period,  such  is  the 
torpor  throughout  the  lacteal  and  lymphatic  vessels  of  the  abdomen, 
that  the  largest  doses*  internally,  and  the  most  assiduous  inunctions 
externally,  will  sometimes  fail  in  introducing  a  sufficient  quantity  of 
mercury  to  saturate  the  system.  In  the  mild  climate  of  Prince  of 
Wales's  Island,  where  the  temperature  of  the  air  might  be  supposed 
to  favour  absorption^  1  have  had  a  couple  of  Malays  daily  employed, 
for  hours  at  a  time,  in  unsuccessful  frictions,  the  lymphatic  vessels  re- 
fusing to  take  up  the  ointment  in  any  considerable  quantity.  At  the 
commencement  of  this  disease,  and  of  dysentery,  I  have  often  been 
able  to  form  a  tolerably  accurate  prognosis  of  the  difficulty  that  would 
be  experienced  in  raising  ptyalism,  by  observing  the  aptitude  of  the 
absorbents  on  the  surface,  while  a  drachm  or  two  of  mercurial  oint- 
ment were  rubbed  in  on  the  thigh  or  arm,  under  my  own  inspection. 
This  hint  may  be  worth  attending  to.  Here  the  tepid  bath,  by  de- 
termining to  the  surface,  will  sometimes  so  far  restore  the  balance 
of  excitability  and  circulation  as  to  promote  the  absorption  of  the 
mercury,  both  from  the  external  and  internal  surfaces  of  the  body. 
But  great  care  is  to  be  taken  to  avoid  a  subsequent  chill,  and  a  con- 
sequent recoil  of  the  circulation,  which  will  be  sure  to  aggravate  all 
the  symptoms  instead  of  relieving  them. — The  nitro  muriatic  acid 
is  also  to  be  used  in  these  cases.  The  absorption  of  mercury  into 
the  system  is  also  accelerated  by  causing  the  patient  to  swallow  a 
considerable  quantity  of  warm  diluting  drink,  as  thin  water-gruel, 
every  night  at  bed  time. 

It  might  be  expected  that  I  should  here  point  out  the  predisposing 
and  exciting  causes  of  Hepatitis  ,  but  these  have  been  in  a  great  mea- 
sure anticipated  by  the  preceding  remarks.  I  observed,  that  the  ap- 
plication of  cold  to  the  body,  during  and  subsequent  to  perspiration, 
was  by  far  the  most  frequent  rn.mner  in  which  the  disease  was  con- 
tracted ;  but  the  European,  and  the  casual  visiter,  may  well  wonder 
how  cold  can  be  often  applied  on  the  burning  coast  of  Coromandel, 
where  the  temperature  is  high  and  steady  by  day — where  the  nights 
are,  for  months  together,  hot — and  seldom  raw  or  damp,  as  at  Bom- 
bay or  Bengal.  A  nearer  inspection  dispels  the  difficulty,  and  shows 
us  that  nothing  is  more  common  than  such  an  occurrence.  The  Eu- 
ropean soldier  or  sailor,  exhausted  by  exercise  HI  the  heat  of  the 
day  and  by  profuse  perspiration,  strips  himself  the  moment  his  duty 
is  over,  and  throws  himself  clown  opposite  a  window  or  port,  to  inhale 
the  refreshing  sra-breeze  ;  his  shirt,  in  all  probability,  dripping  with 
sweat.  The  effect  of  this  present  gratification  is  well  exemplified 
every  day  before  his  eyes,  by  the  officers  of  his  ship  or  regiment, 
who,  when  hobdaars  and  sah-petre  are  not  at  hand,  refrigerate  their 
wine  or  water,  by  suspending  the  bottles  in  wetted  cloths,  (generally 
worsted  or  woollen,)  and  exposed  to  a  current  of  air,  when  the  eva- 
poration, in  a  few  minutes,  renders  the  contained  fluid  quite  cold. 

It  requires  more  philosophy  or  self-command  than  generally  falls 
to  the  lot  of  the  aforesaid  classes,  to  resist  the  grateful  refreshment 
which  this  dangerous  indulgence  affords.  The  dreadful  sensations 
arising  from  heat  and  thirst  imperiously  demand  fresh  air  and  cold 


UUfATIC    DERANGEMENTS.  145 

tit-ink,  which  few  have  stoicism  enough  to  forego,  even  where  the 
bad  consequences  are  previously  known.  I  shall  have  occasion,  here- 
after, to  relate  some  fatal  instances  of  this  kind,  which  happened  un- 
der my  own  eye.  The  night,  which  nature  designed  as  one  of  the 
grand  restoratives  of  our  energy,  is  the  time  when  many  imprudent 
exposures,  of  the  species  described,  are  made  among  sailors  and  sol- 
diers ;  particularly  the  former,  on  account  of  the  close  and  sultry 
apartments  in  which  the*  sleep,  whereby  they  are  forced  to  make 
frequent  nocturnal  visits,  to  the  open  air,  while  they  are  streaming 
with  perspiration. 

Jt  is  asserted  by  almost  all  writers  on  tropical  climates,  that  atmos- 
pherical vicissitudes  are  comparatively  trifling  in  those  regions,  and 
that  the  thermometrical  range  is  seldom  of  greater  extent,  than  from 
five  to  ten  degrees  daily,  and  fifteen  or  sixteen  degrees  annually.  "  In 
countries  between  the  tropics,"  says  Dr.  Moseley,  "  the  heat  is  nearly 
uniform,  and  seldom  has  been  known  to  vary  through  the  year,  on  any 
given  spot,  either  by  day  or  night,  16  degrees," — p.  2.  This  is  not 
correct  ;  the  thermometer,  at  Bombay  and  Calcutta,  in  the  month  of 
January,  is  frequently  as  low  as  55°  in  the  night  :  and  in  the  month  of 
April  up  to  90°,  or  even  higher,  in  the  day  ;  making  an  annual  vicis- 
situde of  thirty-five  degrees.  And  notwithstanding  Dr.  Moseley's  as- 
sertion to  the  contrary,  a  transition  of  eighty  degrees  in  one  day,  has 
been  witnessed  between  the  tropics.  Sir  James  M'Grigor,  in  his 
Report  to  the  Medical  Beard  at  Bombay,  for  the  month  of  November, 
1800,  observes,  that,  "  the  mercury  had  an  extraordinary  wide  range, 
from  68° — 50°  to  130°  in  the  open  air."— Edin.  Med.  and  Surg. 
Jour.  July,  1805,  p.  271.  And  he  shortly  afterwards  adds- — "  More 
cases  of  Hepatitis  appeared  that  in  either  of  the  two  former  months," 
—  ib.  But  even  on  the  Coromandel  coast,  the  actual  vicissitude  to 
which  the  human  frame  is  often  exposed,  far  exceeds  what  is  gene- 
rally believed.  Let  a  thermometer  be  suspended  in  the  open  air  at 
Madras,  ajid  it  will  point  for  many  hours  in  the  day  to  120°  or  130°, 
but  in  the  night  it  will  fall  to  80°  or  82°.  Here,  then,  is  the  range 
of  40  or  60  degrees  in  the  day,  to  which  hundreds  of  European  sol- 
diers and  sailors  are  unequivocally  exposed  ;  for,  let  it  be  remember- 
ed, that  they  are  kept  neither  in  glass  cases,  nor  the  cuddies  of  India- 
men,  though  the  above  consideration  ought  to  intercede  powerfully 
in  their  behalf,  and  induce  their  officers  never  to  subject  them  to  such 
dangerous  vicissitudes  in  a  climate  of  that  kind,  unless  from  inevitable 
necessity. 

But  this  subject  will  meet  with  a  very  full  consideration  in  the 
prophylactic  part  of  this  essay,  where  1  hope  to  offer  some  important 
remarks  on  certain  means  of  preserving  health  in  hot  climates,  cou- 
uected  with  the  above  topic,  which  have  been  hitherto  passed  over 
unnoticed  or  misunderstood  by  medical  authors. 

I  need  hardly  remark,  that  intemperance  in  spirituous  liquors 
strongly  predisposes  to  and  excites  Hepatitis.  But  it  is  not  general- 
known,  or  suspected,  that  the  depressing  passions,  particularly  grief, 
have  the  same  effect.  I  have  seen  many  instances,  however,  where 
no  doubt  could  be  entertained  on  the  subject.  I  shall  only  i  elate  one. 
la  the  month  of  December,  1803,  while  H.  M.  b.  Centurion  was  lf- 

19 


146  EASTERN  HEMISPHERE , 

ing  at  anchor  in  Mocha  Roads,  two  men,  when,  in  the  act  of  loading  & 
gun,  had  their  arms  blown  away,  and  were  otherwise  dreadfully  shat- 
tered, by  the  gun  going  off,  in  consequence  of  the  neglect  of  a  boat- 
swain's mate,  who  was  captain  of  the  gun.  One  of  the  men  died,  and 
the  circumstance  produced  such  a  degree  of  remorse  and  grief  in 
the  careless  boatswain's  mate  that  he  was  instantly  seized  with  Hepa- 
titis, [though  in  the  prime  of  life  and  health,]  ami  in  a  few  da^s  fol- 
lowed his  unfortunate  shipmate  to  the  grave  ! The  close  sympa- 
thy which  subsists  between  the  brain  and  liver  is  well  known,  and 
strongly  illustrated  in  hot  countries,  where  the  latter  organ,  (like  the 
lungs  in  Europe,)  being  predisposed  to  disease  from  the  general  ef- 
fects of  climate,  suffers  readily  and  obviously,  in  consequence  of  the 
sympathy  in  question. 

I  shall  now  make  a  few  observations  on  those  chronic  derangements 
in  the  liver  and  its  functions,  which,  in  hot  climates,  succeed  violent 
or  repeated  attacks,  such  as  I  have  already  described.  These  de- 
rangements, however,  (especially  of  function,)  are  but  too  often  the 
consequence  of  long  residence  between  the  tropics,  independent  of 
any  serious  or  acute  inflammation  in  this  organ.  Where  induration, 
enlargement,  or  any  particular  structural  alteration  has  taken  place, 
the  external  accompaniments  are  evident  to  the  most  superficial 
glance. 

Sallow  countenance — emaciation — irregular  bowels — high-colour- 
ed urine — scalding  in  its  discharge — low  spirits — often  a  chronic  flux, 
with  pain,  fulness,  or  hardness  in  the  region  of  the  liver — evening 
fever — dry  cough,  and  swellings  of  the  ancles,  are  the  prominent  fea- 
tures of  this  deplorable  malady.  A  degree  of  induration  and  enlarge- 
ment continued  nearly  three  months  after  a  severe  attack  of  Hepatitis 
which  I  experienced  in  my  own  person  ;  and  a  distressing  bowel 
complaint  succeeded,  and  harassed  me  for  more  than  a  year. 

A  return  to  Europe  brought  me  no  relief;  on  the  contrary,  by 
getting  cold  in  my  feet,  while  sitting  in  a  dissecting  room  in  London., 
a  few  weeks  after  my  arrival,  a  violent  Hepatitis  was  induced,  ac- 
companied by  the  usual  dysenteric  symptoms.  The  flux  that  pre- 
ceded, for  so  many  months,  this  last  relapse,  may  serve  as  a  speci- 
men of  those  connected  with  chronic  hepatic  obstruction. 

Once,  perhaps,  in  the  twenty-four  hours,  generally  in  the  morning, 
there  would  be  an  ill-conditioned  frecal  evacuation,  accompanied 
with  mucus,  slime,  and  apparently  vitiated  bile.  After  this,  1  would 
have  two,  three,  and  sometimes  four  hours  respite.  An  uneasy  sen- 
sation would  then  arise  in  my  bowels,  with  rumbling  and  flatulence, 
which  would  proceed  along  the  whole  tract  of  the  intestines,  when 
I  was  forced  suddenly  to  stool,  nothing,  however,  coming  away,  but 
some  slimy  mucus,  streaked  occasionally  with  blood,  or  greenish, 
bilious  sordes.  This  discharge  was  always  attended  with  more  or 
less  griping,  straining,  and  some  slight  degree  of  tenesmus ;  after 
which  another  interval  of  ease,  two  or  three  hours  in  duration, 
would  take  place,  and  then  the  same  symptoms  as  before  described, 
continuing  with  great  punctuality,  for  weeks  and  months  together. 
During  this  period,  my  apppetite  was  tolerably  good,  but  my  spirits 
exceedingly  irregular— generally  depressed.  The  least  excess  in 


HEPATIC  DERANGEMENTS.  147 

or  drinking — the  exposure  to  night  air — or  the  slightest  appli- 
cation of  cold  to  my  feet,  aggravated  my  complaint.  The  cheering 
prospect  of  returning  to  my  native  home,  and  the  hopes  that  climate 
alone  would  effect  a  cure,  together  with  the  want  of  accommodation 
for  undergoing  a  course  of  medicine  on  a  voyage,  where  I  was  only  a 
passenger,  induced  me,  most  unwisely,  to  delay  the  only  effectual 
means  of  curbing  the  disease  ;  till  a  nearly  fatal  relapse  forced  me  to 
have  recourse  to  that  medicine  which  more  than  once  before  pre- 
served mv  life.'  The  flux,  which  all  this  time  was  symptomatic  of 
liver  obstruction  and  irregular  secretion,  was  completely  removed 
with  the  original  cause. 

Two  circumstances  appear  to  be  almost  always  attendant  on  these 
chronic  diseases  of  the  liver— diminished  secretion  of  bile,  and  low 
spirits.  The  former  we  u;ay  account  for  in  two  ways  :  either  as  re- 
sulting from  that  atony  which  takes  place  in  an  organ  that  has  been 
long  stimulated  into  inordinate,  or  at  least  irregula  action,  by  hot 
climates,  &c.  or  from  structural  derangement,  generally  induration, 
which  but  too  often  accompanies  the  preceding  state.  It  is  likewise 
certain,  that  the  bile  is  vitiated  in  quality,  as  well  as  deficient  in 
quantity.  And  the  numerous  complaints  which  we  hear  from  peo- 
ple, with  evidently  torpid  livers,  of  excessive  secretion,  which  they 
conclude  must  be  the  ca.se,  from  the  nausea,  vomiting  of  green  bile, 
sick  head-aches,  yellowness  of  the  eyes,  gripes,  &c.  with  which 
they  are  occasionally  harassed,  arise  from  irregular,  but  on  the 
whole,  diminished  and  disordered  biliary  secretion. 

I  do  not  think  the  ingenious  Dr.  Watt  has  been  very  happy  in  his 
pathological  elucidation  of  bilious  diseases — "  The  liver,"  says  he, 
"  receiving  its  stimulus  from  venous  blood,  has  more  to  do  than  in 
health  ;  hence  the  origin  of  bilious  complaints,  which,  with  low  spi- 
rits, and  prostration  of  strength,  generally  mark  the  first  stage  of 
disease, "—p.  207.  The  liver  may  have  more  to  do  in  bilious  dis- 
eases than  in  health  ;  but  I  am  well  convinced  it  does  less,  i  he  tor- 
por in  that  organ  keeps  a  general  plethora  throughout  the  abdominal 
system  of  black  blood  ;  consequently,  when  it  happens  to  be  occa- 
sionally excited  into  unusual  action,  a  greater  flow  of  vitiated  biliary 
secretion  ensues,  from  this  very  cause  ;  when,  unless  proper  means 
are  employed,  the  viscus  falls  back  again  into  its  previous  state  of 
inactivity.  This  view  of  the  subject  elucidates  the  effects  of  vene- 
section, purgatives,  and  all  the  best  remedial  processes. 

The  torpid  state  of  the  bowels,  dependent  on  that  of  the  liver, 
admits  of  morbid  bilious  accumulations,  (after  those  periods  of  ex- 
citement,) which  lurk  about  the  duodenum,  or  regurgitate  into  the 
stomach,  by  inverted  peristaltic  motion,  producing  all  the  phenome- 
na alluded  to.  But,  in  a  great  proportion  of  patients,  the  torpidity 
of  the  alimentary  canal  is  seldom  roused  by  the  acrimony  of  the 
bile  ;  costiveness  and  low  spirits  going  hand  in  hand,  with  the  most 
obstinate  uniformity. 

The  increase  and  amelioration  of  the  biliary  secretion,  then,  must 
always  be  kept  in  view,  when  treating  this  chronic,  obstructed,  or 
torpid  state  of  the  liver. 

The  connection  which  I  have  traced  between  the  biliary  and  per- 


!48  EASTERN  HEMISPHERE. 

spiratory  processes,  will  elucidate  the  operation  of  those  means  of 
relief,  which  experience  has  determined  ;  it  will  also  suggest  the  use 
of  some  others.  Among  the  remedies  for  this  complaint,  mercury, 
given  in  small  doses,  and  slowly,  so  as  to  keep  up  a  brassy  taste  in 
the  mouth  lor  some  time,  holds  a  distinguished  rank  ;  as  it  effectually 
promotes  the  secretion  of  bile,  and  excites  the  extreme  vessels  on 
the  surface. 

To  increase  (he  latter  effect,  however,  it  has  been  found  useful 
to  combine  with  it  a  small  proportion  of  opium,  and  antimonial  pow- 
der, both  to  guard  the  bowels  from  irritation,  and  determine  to  the 
skin.  It  is  quite  evident,  and  ought  ever  to  be  kept  in  mind,  that  no 
violent  means  should  ever  be  usod  in  stimulating  an  organ  to  action, 
whose  torpor  or  derangement  has  proceeded  from  this  very  stimu- 
lation. The  state  of  the  liver  here  may  be  compared  to  that  of  the 
stomach  in  a  worn-out  drunkard.  It  requires  stimulants  ;  but  they 
must  be  nicely  managed,  else  they  will  be  productive  of  mischief  in- 
stead of  utility. 

The  next  most  salutary  remedial  process,  is  to  keep  up  a  regular 
peristaltic  motion  in  the  bowels,  and  excite  the  mouths  of  the  excre- 
tory ducts  of  the  liver,  which  will  tend  to  eliminate  the  viscid  and 
depraved  secretions  from  that  organ  itself.     I  have  found  no  medi- 
cine better  adapted  to  this  purpose  than  the  following  : 
R.  Ex.  Colocynth.  Comp.  drachmam. 
Subm.  Hydrarg.  gr.  xx. 
Antim.  Tartarisat  gr.  iv. 
Ol.  Carui,  gt.  viii. 
M.  Fiant  pilulae  No.  xxx. 

Vel. 

R.  Ex.  Aloes  spicat.  scrupulum. 
Pulv.  Antimonialis  gr.  x. 
Pil   Hydrargyri  scrupulos  duos. 
Ol.  Carui,  gt.  vj 
M.  Fiant  pilula?  No.  xx. 

One  or  two  of  these  pills,  taken  occasionally  at  bed-time,  will 
move  the  bowels  gently  next  morning  ;  carry  off  disease,  and  pro- 
mote healthy  secretions  of  bile  ;  and  will  be  found  to  obviate,  in  a 
wonderful  manner,  that  mental  despondency,  and  long  train  of  ner- 
vous symptoms,  so  constantly  attendant  on  this  complaint. 

Our  attention  is  n^xt  to  be  directed  to  the  cuticular  discharge. 
This  is  never  to  be  forced  by  heating  or  stimulating,  but  an  insensi- 
ble halitus  promoted,  by  the  most  gentle  means.  Moderate  exercise, 
particularly  gestation,  as  determining  to  the  surface  without  fatigue, 
is  highly  useful.  A  sea- voyage,  combining  these  advantages  with  a 
more  equable  temperature,  and  keeping  up  a  slight  nausea,  as  it  were, 
by  which  the  cutaneo-hepatic  secretions  are  increased,  will  be  found 
beneficial  where  it  can  be  commanded.  The  swing,  an  easy,  and 
perhaps  no  bad  substitute  for  gestation,  or  a  sea-voyage,  1  found  very 
useful  in  my  own  case.  1  was  led  to  try  it  for  amusement  only,  and 
to  dispel  the  ennui  of  protracted  convalescence.  It  certainly  has 
considerable  effect  on  the  skin  — powerfully  determines  to  the  sur- 
face— and  relieves  those  internal  congestions  so  connected  with,  and 


HEPATIC  DERANGEMENTS.  14$ 

dependent  on,  torpor  or  obstruction  in  the  liver.  The  assiduous  and 
daily  application  of  the  flesh-brush  over  the  hypochondriac  region 
will  be  found  to  excite  the  healthy  action  of  the  biliary  organ  in  no 
mean  degree.  Blisters,  or  the  more  permanent  drain  of  a  seton  in 
the  side,  where  there  is  much  local  uneasiness,  will  likewise  be  had 
recourse  to  with  advantage. 

Flannels  are  essentially  necessary,  more  particularly  in  the  varia- 
ble climate  of  this  country,  with  the  minutest  attention  to  the  warmth 
and  dryness  of  the  feet,  especially  where  the  bowels  are  tender.  In 
torpid  livers,  where  cosiiveness  is  a  common  symptom,  flannels,  by 
increasing  the  cuticular  discharge,  appear  at  first  to  constipate.  But 
here,  as  in  the  costiveness  arising  from  a  sea-voyage,  no  ill  effects 
whatever  are  induced  ;  on  the  contrary,  the  digestion  improves, 
evidently  from  the  biliary  secretion  being  augmented  in  both  cases. 

On  the  other  hand,  where  hepatic  obstructions  exist,  with  deter- 
mination to  the  bowels,  keeping  them  in  an  irritable  state,  as  in  my 
own  case,  the  utility  of  flannels  becomes  both  real  and  apparent. 

In  addition  to  the  general  use  of  flannel,  the  local  application  of 
a  bandage  of  the  same  round  the  waist,  in  imitation  of  the  Indian 
cwnmerband,  is  in  these  cases  peculiarly  advantageous.  The  native 
soldiery  in  India  often  contract  bowel  complaints  from  incautiously 
throwing  off  the  cummerbund,  when  heated  on  a  march.  1  could  state 
numerous  instances,  where  the  worst  consequences  resulted  from 
negligence  in  this  respect. 

The  tepid  bath,  using  the  utmost  caution  in  avoiding  a  subsequent 
chill,  will  evidently  be  serviceable,  on  the  same  principle  ;  as  well 
as  the  warm  mineral  waters  taken  internally,  as  recommended  by  Dr. 
Saunders.  The  night  air  and  late  hours,  are  to  be  most  religiously 
avoided  ;  and  a  rigid  temperance,  amounting  to  abstinence  enjoined. 
In  short,  he  who  labours  under  obstructed  liver,  and  hopes  to  protract 
his  existence  with  any  kind  of  comfort  to  himself,  must  abandon  what 
are  called  the*  pleasures  of  the  table  ;"  but  .vhich  are.  in  reality, 
the  bane  of  human  health.  Quantity  is  doubtless  ot  more  consequence 
than  quality;  yet  raw  vegetables  and  pastry,  from  their  increasing 
acidity  and  rancidity  in  the  stomach,  are  very  generally  detrimental. 
Tender  animal  food,  in  small  quantities,  with  well  baked  bread,  or 
ship-biscuit,  forms  perhaps  the  most  easily  digested  aliment  in  such 
cases  In  India,  and  1  believe  in  Europe,  rice  and  curry  will  be 
found  a  salutary  dish.  The  stimulus  ot  the  spice  is  very  different 
from  tint  of  spirits  or  wine  ;  and  the  rice  is,  without  exception,  the 
most  unirritating,  nutritious,  and  easilv  digested  vegetable,  which  the 
bountiful  bosom  of  the  earth  produces. 

With  respect  to  drink,  although  I  certainly  would  recommend  to  my 
patient  the  laconic  Greek  prescription  in  the  pump  room  at  Bath  ; 
yet  1  fear  that  most  of  those  returning  from  the  East  and  West  Indies, 
afflicted  with  hepatic  complaints,  while  they  readily  »llow  that  "  wa- 
ter is  best," — nevertheless,  unanimously  agree,  that  wine  is  most 
palatable.  If  the  latter  cannot  be  dispensed  with,  the  acid  and  as- 
tringent kinds  at  least  are  to  he  rejected.  Malt  liquor  will  seldom 
agree,  and  spirits  ought  to  be  restricted  as  much  as  possible.  I  know 
well,  that  a  dilute  mixture  of  brandy  and  water  has  an  indescribably 


150  EASTERN  HEMISPHERE. 

soothing  effect  on  the  stomach  and  bowels,  in  these  cases,  and  seems 
both  to  agree  best,  and  prove  most  useful  ;  but  I  am  fully  convinced 
it  ultimately  injures  the  tone  of  these  organs,  and  increases  the  mis- 
chief in  the  liver,  unless  it  be  taken  in  the  most  guarded  manner. 
Water  upon  the  whole  is  best. 

All  the  preceding  remarks  presuppose  that  a  change  of  climate  has 
been  effected  ; — for  such  is  the  state  of  the  biliary  organ,  after  re- 
peated attarks  of  Hepatitis,  or  a  long  residence  between  the  tropics, 
that  the  most  active  of  the  above-mentioned  remedial  means  will  give 
but  temporary  relief,  while  the  original  »  ause  continues  to  be  applied. 
I  shall  elucidate  this  more  fully  hereafter,  when  treating  on  dysen- 
tery. And  yet  the  removal  from  a  tropical  to  a  European  climate, 
requires  caution.  Nature  abhors  extremes  and  sudden  vicissitudes. 
It  certainly  is  dangerous  to  return  to  this  country  in  winter,  as  I 
myself  experienced.  I  landed  in  January,  and  before  the  end  of 
February,  I  had  a  complete  relapse  of  Hepatitis,  and  its  accompani- 
ment, flux. 

Those  who  cannot  undertake  the  long  and  expensive  voyage  to 
Europe,  should  endeavour  to  change  a  continental  for  an  insular  si- 
tuation in  India.  Pulo  Penang,  or  Prince  of  Wales'?  Island,  though 
within  six  degrees  of  the  Equator,  enjoys  a  milder  air,  and  a  lower 
range  of  temperature,  than  anv  of  the  presidencies.  Here  are  nei- 
ther the  great  vicissitudes  of  Bombay,  the  marsh  effluvia  of  Bengal, 
nor  the  scorching  heat  of  Madras.  The  climate  is  very  salubrious. 
On  the  mountain  which  occupies  a  great  part  of  the  island,  and  is  of 
considerable  elevation,  bungalows  are  erected  open  to  the  sea  and 
land-breezes,  where  the  thermometer  ranges  between  70  and  KO  de- 
grees, and  where  the  heat  is  never  reflected  or  oppressive.  From 
this  mountain,  t  »o,  the  most  romantic,  extensive,  and  picturesque 
views,  are  presented  to  the  delighted  eye,  contributing  greatly  to 
mental  amusement  and  corporeal  renovation. 

A  temporary  residence  on  that  beautiful  island,  during  a  painful 
illness  and  tedious  convalescence,  has  produced  in  my  mind  a  strong 
local  attachment  towards  it,  and  a  vivid  recollection  of  its  enchanting 
scenery  : — 

Ilia  terrarum  mihi  praeter  omnes 

In?ula  ridet,  ubi  non  Hymetto 

Mella  decedunt,  viridique  certat 
Bacca  vena  fro ; 

Ver  ubi  Ionium,  tepidasque  proebet 

Jupiter  brumas :  et  amicus  Aulon 

"  Gracili  palmae/'*  mini.r.um  falernia 
Invidet  Uvis. 

The  Malayan  peninsula,  from  its  being  a  narrow  slip  of  land, 
washed  on  both  sid^s,  and  nearly  encompassed  by  the  ocean— con- 
stantly covered  with  verdure,  and  open  to  the  sea-breezes,  i«  bless- 
ed with  a  milder  and  cooler  air  than  any  continental  part  of  India  be- 
tween the  tropics,  and  bordering  on  the  coa*t. 

Columbo,  in  the  Island  of  Ceylon,  has  also  many  local  advantages, 

*  The  palma  coccifera,  or  cocoa-nut  tree,  whose  milk  is  equally  delicious  and 
salutary,  flourishes  here  in  the  greatest  perfection,  and  may  vie  with  the  falernian 
juice  in  every  good  quality,  without  any  intoxicating  effect. 


HEPATIC  DERANGEMENTS.  15] 

that  render  it  extremely  salubrious  to  Europeans,  and  consequently 
a  convenient  and  easy  retreat  from  the  opposite  burning  coast.   ' 

The  Cape  oi  Good  Hope,  however  well  adapted  to  the  refresh- 
ment of  a  crew,  after  a  long  voyage,  hy  its  abundant  supplies  of  ani- 
mal and  vegetable  food,  is  by  no  means  calculated,  in  regard  to  cli- 
mate, for  the  recovery  of  hepatic  or  dysenteric  individuals,  return- 
ing from  the  East.  The  daily  atmospherical  vicissitudes,  at  this  ce- 
lebrated promontory,  are  very  great  indeed,  [26  or  30  degrees,]  and 
consequently  injurious  where  the  bowels  were  at  all  effected.  I 
shall  only  mention  one  instance  corroborative  of  this  assertion. 

His  Majesty's  ship  Albion,  on  her  late  return  from  India,  having 
touched  at  the  Cape,  sent  a  number  of  her  people  to  the  hospital, 
afflicted  with  chronic  bowel  and  liver  complaints.  By  the  time  of 
her  departure  for  England,  however,  several  of  these  had  died,  and 
all  the  others  returned  in  a  worse  state  than  when  they  went  on 
shore.  This  fact  is  worth  attending  to  ;  and  deserves  to  be  kept  in 
mind  by  the  valetudinarian. 

The  climate  of  St.  Helena  approximates  more  to  that  of  Europe, 
than  the  climate  of  any  other  inter-tropical  situation.  A  rock  only 
twenty  seven  miles  in  circumference,  surrounded  by  an  immense 
equatorial  ocean,  above  the  level  of  which  it  projects  3000  feet  ; 
whose  summit  is  covered  with  perpetual  verdure,  and  cooled  by  pe- 
rennial breezes,  must  enjoy  y  serenity  of  air,  and  evenness  of  tem- 
perature, far  beyond  any  part  either  of  the  Indies  or  Europe.  The 
medium  height  of  the  thermometer  is  64°,  and  atmospherical  vicissi- 
tudes by  no  means  great  or  sudden.  At  Plantation-House,  the  mer- 
cury does  not  rise  higher  than  72°  in  summer,  nor  fall  lower  than  65° 
in  winter.  A  temporary  stay  at  this  island  would  probably  be  attend- 
ed with  a  salutary  seasoning,  preparatory  to  exposing  the  debilitated 
frame  to  the  rude  inclemencies  and  transitions  of  northern  regions. 
The  scenery,  too,  of  the  interior,  is  as  beautifully  romantic,  as  that 
of  the  exterior  is  stupendously  dreary  and  barren.  The  society, 
however,  is  confined  ;  and  forms  a  striking  contrast  with  the  social 
ease  and  unbounded  hospitality  ot  the  East.  But  alas !  it  is  a  melan- 
choly truth,  that  in  the  complaint  I  have  been  describing,  a  surprising 
mental  despondency,  or  propensity  to  brood  over  misfortunes,  pur- 
sues us  through  every  climate  ! 

Scandit  aeratas  vitiosa  naves 
Cura  !— Quid  terra?  alio  calentes 
Sole  mutamus? — Atrabiliosu* 
Se  raro  fugit  I 

Since  the  Second  edition  of  this  work  was  printed,  it  is  well  known 
that  our  squadron  at  St.  Helena,  suffered  severely  from  dysentery 
and  hepatitis  at  one  tim«. — It  is  impossible  to  account  for  those  visi- 
tations of  sickliness  which  occasionally  afflict  the  healthiest  situations. 
At  St.  Helena,  the  mercurial  treatment  of  dysentery,  with  general 
and  local  bleeding,  was  found  upon  the  whole,  the  most  successful, 
though  many  lives  were  lost  by  relapses,  especially  where  suppu- 
ration took  place  in  the  liver,  which  frequently  happened. 


152  EASTERN 

Sympathetic  connection  between  the  mental  and  hepatic  functions. 

The  manner  in  which  this  mental  depression  becomes  connected 
with  derangement  in  the  hepatic  function,  is  a  suhject  of  curious  in- 
quiry. It  is  not  a  little  singular,  that  two  of  the  most  important  or- 
gans in  the  human  body — the  lungs  and  the  liver,  when  in  a  disordered 
state,  should  exhibit  a  striking  contrast  in  their  effects  on  the  mind. 
Thus,  even  in  the  last  stage  of  ptliisis — "  Hope  springs  eternal  in  the 
hectic  breast ;"  and  the  final  catastrophe  stands  a  long  time  revealed 
to  every  eye  but  that  of  the  patient. 

In  heptic  diseases  on  the  other  hand,  like  Shakspeare's  cowards,  we 
"  die  many  times  before  our  death."  It  is  a  curious  fact,  that  sy- 
philis, a  disease  which  can  only  be  cured  by  that  medicine,  on  which  we 
placed  our  principal  dependence  in  Hepatitis,  is  likewise  attended  with 
a  similar  despondency,  but  in  a  much  less  degree.  There  certainly 
is  a  greater  connexion,  or  reciprocal  influence,  between  the  mental 
and  hepatic  functions  than  is  generally  known  or  suspected.  Experi- 
ence has  shown,  that  both  excess  and  deficiency  in  the  biliary  secre- 
tion affect  the  mental  functions,  though  in  a  somewhat  different  man- 
ner. The  former  seems  to  exert  its  influence  in  two  ways,  viz.  by  its 
irritation  in  the  primae  vise,  and  by  its  absortion  into  the  circulating 
system.  That  vitiated  bile  irritates  the  stomach  and  bowels,  is  admit- 
ted by  all  ;  and  that  part  of  it  is  occasionally  absorbed,  or  regurgi- 
tates into  the  circulation,  is  equally  evident,  from  the  appearance  of 
the  eyes  and  countenance.  The  mental  effects  in  both  these  cases 
are  characterized  by  irritability,  and  what  is  properly  called  a  cho- 
leric disposition  ;  often,  however,  accompanied  by  the  deepest  dejec- 
tion of  spirits,  amounting  almost  to  despair,  where  no  other  adequate 
cause  exists. 

On  the  other  hand,  the  defective  secretion  of  bile  seems  to  ope- 
rate on  body  and  mind  in  three  ways,  viz.  by  the  insipid  quality  of 
the  bile — by  its  absorption — and,  simply,  by  its  paucity  :  the  mental 
effects  characterized  in  such  cases  by  melancholy  or  despondency. 
The  insipidity  of  the  bile  in  those  diseases  where  the  secretion  is 
lessened,  as  in  bypocondriasis,  chlorosis,  &c.  has  been  noticed  by  Dr. 
Saunders  and  others.  The  consequence  of  this  will  be  a  torpor 
throughout  the  system  at  large,  hence  costiveness,  imperfect  diges- 
tion, chylification,  sanguification,  &c.  ensue  ;  the  influence  of  which 
on  the  mind  is  obvious. 

The  bile,  however,  is  not  always  ineipid  in  quality,  where  it  is  de- 
ficient in  quantity.  In  those  cases  where  it  proceeds  from  structural 
alteration  of  the  liver,  or  succeeds  violent  diseases  of  that  organ,  the 
bile  is  occasionally  as  vitiated  and  acrid,  as  where  excessive  secre- 
tion is  going  on.  This  takes  place  especially  when  those  causes  are 
applied  which  formerly  produced  great  excitement  in  the  extreme 
vessels  of  the  vena  portarum  ;  as,  high  temperature — exercise  in 
the  sun— debauches— violent  gusts  of  passion,  &c. 

In  hot  climates,  indeed,  I  have  thought  that  an  inflammatory  state 
of  the  liver  was  sometimes  induced,  or  at  least  increased,  by  the 
acrimony  of  its  own  secretions.  It  has  frequently  been  remarked  by 
others,  and  felt  by  myself,  that  after  brisk  doses  of  calomel  and  ca 


HEPATIC  DERANGEMENTS.  1  03 

fhartic  extract,  the  bilious  evacuations  have  produced  a  sensation,  as 
if  boiling  lead  were  passing  through  the  intestines.  The  freedom  of 
spirits,  or  sensorial  energy,  that  succeeds,  can  only  be  appreciated 
by  those  who  have  experienced  such  disgorgements  of  vitiated  bile  ! 
Every  one  has  observed  how  diseased  secretions,  from  the  internal 
surface  of  the  urethra,  occasionally  inflame  and  ulcerate  the  prepu- 
tium  and  glans  penis,  if  the  greatest  care  be  not  taken  to  defend 
them  by  cleanliness  :  can  we  doubt  that  something  of  the  same  na- 
ture may  take  place  in  the  intestines,  and  even  in  the  ducts  of  the 
liver  itself,  where  the  biliary  secretion  is  extremely  depraved  and 
acrimonious  ?  The  remora  alone  of  viscid  bile  in  the  pori  biliarii 
and  excretory  ducts  of  the  liver,  may  often  occasion  such  obstruc- 
tion in  its  languid  circulation  as  shall  give  rise  to  inflammatory  con- 
gestion in  the  organ.  As  I  have  shown,  therefore,  that  with  irregu- 
lar and  diminished  secretion,  there  is  always  a  degree  of  vitiation,  ab- 
sorption, and  irritation,  I  beg  leave  to  designate  their  united  effect  on 
body  and  mind,  by  the  term  «»  Morbid  biliary  irritation,  or  influence." 
I  conceive  that  this  is  quite  equal  to  the  task  of  originating  those 
mental  maladies,  which  in  their  turn  react  on  the  liver,  stomach,  and 
intestines,  disturbing  their  functions  still  further,  or  increasing  their 
torpor,  as  well  as  that  of  the  whole  system,  by  sympathy  ;  producing, 
at  length,  the  extensive  catalogue  of  dyspeptic,  hypochondriacalj 
and  perhaps  hysterical  complaints  ! 

tls  it  not  this  "  non-secreted  bile"*  which  gives  that  peculiar  sal- 
ow  complexion  to  Europeans  long  resident  in  hot  climates,  so  distin- 
guishable from  a  jaundiced  suffusion  of  absorbed  or  regurgitated  bile  ; 
and  which  is  probably  the  first  shade  that  Nature  effects,  in  bending 
the  colour  to  the  climate  ?  Europeans  do  not  begin  to  assume  this 
sallow  tint  till  the  period  of  superabundant  secretion  is  long  past, 
and  till  atony  and  diminished  action  in  the  hepatic  system  have  com- 
menced. Indeed,  it  is  very  possible,  that  what  at  first  produced  such 
commotion  and  inconvenience  in  the  animal  economy,  would,  in  the 
course  of  a  few  generations,  effect  those  corporeal  changes  in  the 
exterior,  which  ultimately  counteract,  in  a  considerable  degree,  the 
baleful  influence  of  the  climate  itself.  To  be  more  explicit.  The 
derangement  in  the  hepatic  functions,  originating,  indeed,  through 
sympathy  with  the  skin,  affects  in  its  turn  the  tincture  of  that  skin, 
by  means  of  absorbed  and  non-secreted  bile  ;  and  these  yellow  and 
sallow  tints,  acted  on  by  the  rays  of  a  tropical  sun,  gradually  verge, 
in  the  course  of  generations,  to  a  sable  hue.  This  change  of  colour, 
and  in  some  degree,  of  texture  also,  [for  the  rete  mucosum  is  thicker 
in  Indians  than  in  Europeans,]  renders  the  exterior  of  man  less  sen- 
sible to  atmospherical  heat ;  in  consequence  of  which,  a  more  mild  and 
uniform  action  in  the  perspiratory  vessels  succeeds,  and  by  sym- 
pathy, a  correspondent  equilibrium  in  the  secreting  vessels  of 
the  liver.  Thus  the  skin,  which  was  the  first  cause  of  disordered 
secretion  in  the  liver,  becomes  ultimately  the  grand  protection  of  that 
organ,  and  the  derangement  itself,  in  process  of  time,  creates  its  own. 
antidote  ?  This  is  quite  conformable  to  the  known  wisdom  of  Provi- 

.    'By'*  non-secreted  bile,"  I  mean  the  elements  from  whence  bile  is  formed- 

20 


154  EASTERN   HEMISPHERE. 

detice,  and  to  the  unceasing  exertions  of  Nature,  in  remedying  what 
she  cannot  entirely  prevent. 

This  is  a  different  doctrine  from  that  of  Dr.  Smith  :  he  attributes 
the*  black  colour  of  Indians  to  the  superabundant  secretion  of  bile, 
and  its  suffusion  on  the  surface  ;  but  that  will  not  stand  the  test  of 
examination.  He  does  not  take  diminished  secretion,  or  the  elements 
of  bile,  into  the  account ;  nor  does  he  trace  any  connexion  between 
the  hepatic  and  cutaneous  functions.  May  not  the  disposition  to  ul- 
cers in  hot  climates,  and  among  drunken  sailors  in  our  own  climate 
be  accounted  for  by  this  cutaneo-hepatic  sympathy  ?  In  the  first  case, 
the  cutaneous  vessels  are  debilitated  by  the  heat,  and  the  hepatic  by 
sympathy.  In  the  second  case,  the  vessels  of  the  stomach  and  liver 
are  debilitated  by  drink,  and  the  cutaneous  vessels  by  sympathy. 

The  effects  of  intemperance  in  spirituous  liquors  on  the  liver  and 
its  functions,  are  not  only  known  to  every  Tyro  in  the  profession, 
but  are  proverbial  in  the  mouths  of  drunkards  themselves  ;  little, 
therefore,  need  be  said  on  this  subject.  But  that  the  "  depressing 
passions"  should  produce  certain  derangements  in  the  hepatic  func- 
tions, which,  reacting  on  the  mind,  give  rise  to,  or  aggravate  the 
whole  protean  host  of  hypochondriacal,  hysterical,  and  nervous  dis- 
orders, is  by  no  means  generally  admitted  ;  though  the  doctrine  will 
probably  gain  ground. 

The  first  effect  of  these  depressing  passions  in  the  female  sex  is 
felt  in  the  organs  concerned  in  digestion — atony  in  the  stomach — tor- 
por in  the  liver  and  intestines.  The  aliment  passes  into  the  duode- 
num imperfectly  digested — it  there  meets  a  scanty  supply  of  ill-con- 
ditioned or  insipid  bile,  and  pancreatic  juice.  Under  these  circum- 
stances, the  progress  of  the  chyme  through  the  convolutions  of  the 
intestines  must  be  slow,  and  the  chyle  imperfectly  eliminated.  Fecal 
accumulations  take  place  :  and  probably  the  fermentative  process 
goes  on,  for  want  of  bile,  with  an  extrication  of  air,  which  gives  rise 
to  distressing  colic  and  borborygmi.  To  procure  relief  from  these, 
the  spiritous  tincture  and  cordial  have  often  been  the  harbingers  of 
more  dangerous  indulgences,  and  increased  the  malady  which  they 
were  intended  to  alleviate  ! 

By  a  careful  course  of  cathartics,  the  bowels  are  cleared  of  that 
load  of  fecal  and  other  matter,  with  which  they  were  oppressed. 
Healthy  bile  is  thus  solicited  into  the  intestines,  instead  of  having  its 
elements  floating  in  the  circulation. — This  natural  stimulus  promotes 
chylification  ;  which,  strengthening  the  whole  material  fabric,  com- 
municates energy  to  the  mind,  till  at  length,  the  bloom  of  health 
once  more  revisits  the  sallow  cheek  of  despondency. 

But  the  lords  of  the  creation  are  not  exempted  from  the  wide- 
spreading  effects  of  hepatic  derangement.  From  our  large  manu- 
facturing towns,  the  foci  of  sedentary  habits,  intemperance,  and  the 
depressing  passions,  its  influence  may  be  traced  through  every  rami- 
fication of  society.  One  or  two  examples  will  suflice.  The  whole 
of  the  literary  world,  from  the  poet  in  his  garret  to  the  learned  pre- 
sident in  his  hall,  feel  more  or  less  of  its  effects.  This  deficiency 
in  the  secretion  of  bile,  the  consequence  of  mental  exertion  and  cor- 
poreal inactivity,  is  evidently  the  "  morbus  ernditorum,"  which  sick- 


DYSENTERV, 

lies  o^r,  with  the  pale  cast  of  thought,  the  countenances  of  the  stu- 
dious, who  waste  their  hours  and  their  health  by  the  midnight  lamp ! 
To  them  I  need  not  describe  the  malady  ;  they  are  too  familiar  with 
its  various  symptoms;  But  few  of  them  are  aware,  how  far  mate- 
rial causes  can  influence  intellectual  ideas.  If  I  wish  to  exert,  on 
any  particular  occasion,  the  whole  force  of  my  memory,  imagination, 
perception,  and  judgment,  I  know,  from  repeated  experience,  that 
by  previously  emulging  the  liver  and  its  ducts,  and  carrying  off  all 
bilious  colluvies  from  the  alimentary  canal,  by  mercurial  purgatives, 
which  also  excite  a  brisker  secretion  in  the  chylopoetic  viscera,  I 
am  thereby  enabled  to  avail  myself  of  those  faculties  above-mention- 
ed, to  an  infinitely  greater  extent  than  I  otherwise  could.  This  is 
no  theoretical  speculation  ;  it  is  a  practical  fact.  It  may  help  to  ex- 
plain the  great  inequality  which  we  often  observe  in  the  brightest 
effusions  of  fancy  ;  and  show  us,  why  even  the  immortal  Homer 
sometimes  nods.* 

DYSENTERY. 

SEC.  IX. — The  disease  in  question  is  certainly  one  of  great  import- 
ance to  be  acquainted  with  in  the  practice  of  fleets  and  armies.  Ne 
other  complaint — not  even  excepting  fever,  so  much  puzzles  the 
young  beginner  ;  and  for  this  plain  reason,  that  in  the  hour  of  dan- 
ger, both  books  and  men  distract  his  judgment,  and  paralyse  his  arm, 
by  their  diametrically  opposite  directions  !  Let  any  one,  after  read- 
ing Dr.  Harty's  volume  on  Dysentery,  which  gives  a  fair  compendium 
of  the  principal  modern  opinions  and  practices  in  that  disorder,  be  ta- 
ken to  the  bedside  of  a  patient,  and  he  will  be  utterly  unable  to  de- 
cide, in  his  own  mind,  upon  the  mode  of  treatment  most  eligible  to 
adopt ! 

From  this  state  of  anxiety,  is  he  relieved  by  applying  for  advice  to 
men  ?  By  no  means.  One  tells  him,  he  must  consider  dysentery  as 
closely  allied  to  enteritis,  and  depend  principally  on  -venesection. \ 
Another  comes  round,  and  says,  strictures  in  the  colon,  or  small  in- 
testines, are  the  cause  of  dysentery,  occasioning  a  retention  of  the  fe- 
cal and  other  "  peccant  matter  ;"  therefore  he  must  purge.  A  third 
assures  him,  he  will  purge  his  patient  to  death,  and  that  nothing  but 
sudorifics  can  effect  a  cure.  A  fourth  informs  him  that  mercury  is  a 
specific,  and  unless  he  raises  a  ptyalism,  he  will  bury  his  patient. 
In  this  state  of  suspense,  he  vacillates  from  one  direction  to  another, 
and  his  success  is  less  than  if  he  pertinaciously  adhered  to  the  worst 
plan  proposed. 

It  is  true  that  experience  will  in  general,  determine  his  choice  ;  but 
many  an  anxious  hour  will  he  spend,  in  exploring  his  way  through 
this  labyrinth  of  opinions,  and  many  a  blunder  will  he  commit  in  the 
meantime! 

*  For  an  account  of  the  effects  of  the  Nitro-Muriatic  acid  bath  in  affections 
of  the  Lirer,  see  my  work  on  the  Liver,  p.  HI,  3d  edition.  Indeed  I  have  pur- 
posely avoided  enlarging  this  section,  since  I  conclude  that  the  tropical  visiter 
will  place  my  work  on  the  Liver  on  the  same  shelf  with  this . 

t  Vide  Dr.  Wright  on  the  Walcheren  fever,  also  Or-  Somers  on  extreme 
bleeding  io  dysentery  of  the  Peninsula 


156  EASTERN  HEMISPHERE. 

As  there  is  hardly  a  disease  in  the  whole  range  of  nosology,  more 
uniform  in  its  nature  and  symptoms,  than  dysentery,  this  discrepancy 
among  authors  and  practitioners  must  have  originated,  I  conceive,  in 
consequence  of  mistaking  prominent  effects  for  proximate  causes ;  and 
as  the  means  of  cure  directed  against  the  former  have  often  removed 
the  latter,  each  individual  believed  that  he  alone  had  found  out  the 
true  cause  and  cure  of  the  disease.  Thus,  one  physician  examining 
the  body  of  a  patient  who  died  in  a  certain  stage  of  dysentery,  and 
finding  many  traces  of  inflammation,  or  even  sphacelus,  in  different 
parts  of  the  intestines,  without  any  strictures,  frames  his  inflammato- 
ry hypothesis  ;  and  although  he  employs,  as  auxiliaries,  some  of  the 
means  recommended  by  others,  he  makes  venesection  the  principal 
indication — has  tolerable  success,  and  becomes  quite  satisfied  that  he 
has  hit  on  the  proper  plan.  Another  patient  dies  at  a  less  advanced 
period  of  the  disease,  or  where  mortification  had  not  relaxed  and 
effaced  all  signs  of  stricture.  He  is  examined  by  a  different  physician, 
who  finds  the  inner  coat  of  certain  parts  of  the  intestines  corrugated, 
thickened,  and  the  canal  reduced  to  a  very  small  diameter,  withscy- 
bala,  or  rather  fecal  accumulations,  [for  those  who  talk  about  scybala, 
have  not,  I  fear,  examined  the  abdomens  of  many  dysenteries,]  lurking 
in  the  cells  of  the  colon,  or  flexures  of  the  small  intestines,  situated 
above  these  strictures.  Establishing  a  doctrine  on  this,  bleeding  is 
only  had  recourse  to  occasionally  ;  and  certain  medicines,  supposed  to 
have  the  power  of  relaxing  these  spasms  or  strictures,  are  exhibited, 
with  frequent  laxatives,  and  success  is  often  the  result. 

A  third  person,  in  examining  the  bodies  of  dysenteric  patients  af- 
ter death,  in  hot  climates,  finds  abscess,  or  other  organic  derangement 
of  the  liver,  an  appearance  very  common  ;  and  concludes  that  Dysen- 
tery is  Hepatitis  in  disguise.  He  prescribes  mercury,  and  his  suc- 
cess is  still  greater  than  that  of  others  ;  consequently  he  is  positive 
that  he  alone  pursues  the  true  course,  and  entertains  just  ideas  of  the 
disease. 

A  fourth,  observing  that  dysentery  is  always  accompanied  with  cle 
fective  perspiration,  and  taking  up  the  idea  of  Sydenham,  that  it  is  a 
fever  turned  in  on  the  intestines,  has  recourse  to  sudorifics,  to  turn  it 
out  again,  and  not  without  considerable  success  ;  so  that  he  pities 
the  blindness  of  those  who  cannot  see  that  the  disease  is  merely 
*'  the  perspiration  thrown  on  the  bowels."  How  are  we  to  recon- 
cile these  jarring  opinions  and  practices  ?  In  adhering  obstinately  to 
any  one  of  these  plans  we  will  be  often  right :  but  assuredly  we  will 
he  not  seldom  wrong.  On  the  other  hand,  by  giving  a  discretional 
power  to  adopt  one  or  other  of  them,  as  symptoms  may  indicate,  we 
confer  a  license  on  the  young  beginner,  for  which  he  probably  will 
not  thank  us  in  the  hour  of  trial  or  responsibility.  He  who  could 
lay  down  one  fixed  principle,  which  is  uniformly  to  be  kept  in  view, 
through  every  case  and  every  climate, — a  principle  that  would  ex- 
plain the  phenomena  and  the  cure  ;  who  could  give  plain  and  easy 
directions  when  and  where  we  are  to  lean  towards  one  or  other  of 
the  apparently  opposite  modes  of  treatment,  without  ever  losing  sight 
of  the  principle  in  question,  or,  for  a  moment,  relaxing  in  the  pur- 
suit of  that  salutary  object  which  this  principle  points  to,  would  cer 


. 

DVSENTBftV.  157  - 

uinly  deserve  the  thanks  of  the  junior  branches,  at  least,  of  the  pro- 
fession. .  . 

I  have  hinted  what  I  suppose  to  be  the  origin  of  these  clashing 
theories  and  practices  ;  to  wit,  the  mistaking  effects  for  causes. 
Thus,  if  we  do  find  stricture  in  any  part  of  the  intestinal  canal,  what 
produced  it?  This  must  evidently  be  the  effect  of  some  cause.  If 
we  find  inflammation  there,  it  is  proved  to  be  a  consequence,  and  not 
a  cause  of  dysentery,  from  this  plain  fact,  that  in  original  and  une- 
quivocal inflammation  of  the  bowels,  or  enteritis,  constipation  is  al- 
most always  present.  In  hot  climates,  if  we  find  dysentery,  or,  [as 
some  will  not  allow  it  that  name,]  flux,  a  pretty  constant  attendant  on 
Hepatitis,  particularly  the  languid  or  chronic  species  of  it,  it  does 
not  follow  that  Hepatitis  is  a  general  concomitant,  much  less  a  cause 
of  dysentery.  In  many  cases  of  Hepatitis,  especially  when  violent, 
there  is  obstinate  costiveness  ;  and  in  numerous  fatal  cases  of  dysen- 
tery, no  structural  derangement  in  the  liver  can  be  observed. 

Those  who  have  attributed  it  to  suppressed  perspiration,  have 
come  nearer  to,  but  stopped  far,  very  far  short  of,  the  mark.  The 
suppression  of  this  discharge  is,  in  itself,  a  trifling,  though  in  its  con- 
nexion with  others,  it  becomes  an  important  feature  in  the  proximate 
cause  of  dysentery. 

As  causes  can  only  be  traced  by  their  effects,  we  must  endeavour 
to  find  out,  among  the  latter,  such  as  are  always  present  in  dysentery, 
and  have  a  decided  priority  in  occurrence.  These,  I  conceive,  con- 
stitute what  is  meant  by  proximate  cause  in  this,  as  well  as  in  every 
other  disease.  Are  there  any  such,  then,  in  dysentery  ?  I  believe 
there  are  ;  and  this  belief  does  not  rest  on  speculative  grounds.  I 
have  not  learnt  the  knowledge  of  this  disease  from  the  ancients  nor 
the  moderns,  but  studied  it  in  the  book  of  Nature  ;  and  every  one  of 
its  symptoms  has  been  deeply  impressed  on  my  memory,  by  painful 
personal  experience,  both  within  and  without  the  tropics. 

In  every  case  of  dysentery  that  has  ever  come  within  the  range  of 
my  observation,  [and  the  number  has  not  been  inconsiderable,]  two 
functions  were  invariably  disordered  from  the  very  onset,  and  soon 
drew  other  derangements  in  their  train.  These  were,  the  functions 
of  the  skin  and  of  the  liver;  or,  perspiration  and  biliary  secretion. 
I  defy  any  one,  who  has  minutely  regarded  this  disease  at  the  bedside. 
to  produce  a  single  instance  in  which  these  functions  were  carried  en 
in  a  natural  manner,  at  any  period  of  the  disease.  The  partial  clam- 
my sweats  which  are  sometimes  seen  on  the  surface,  with  the  occa- 
sional admixture  of  bilious  sordes  in  the  stools,  so  far  from  being  ob- 
jections, are  proofs  of  this  position  ;  for,  excepting  the  above  appear- 
ances,  which  are  unnatural,  the  regular  perspiration  is  suppressed, 
and  the  healthy  secretion  of  bile  entirely  stopped.  Dr.  Balfour, 
who  had  some  twenty  years'  experience  in  this  complaint,  and  who 
treats  of  it  under  the  name  of  "  putrid  intestinal  remittent  fe-ver" 
states,  at  page  17  of  his  second  Treatise  on  Sol-Lunar  Influence, 
that,—"  At  the  very  beginning  of  putrid  intestinal  fevers,  and  also 
ubout  the  time  of  their  final  crisis,  or  termination,  I  have  often  ob- 
>erved  copious  discharges  of  recent  bile  ;  but  as  the  fever  advanced, 
and  remained  at  its  height,  such  discharges  have  frequently  ceased  to 


158  EASTERN   HEMISPHERE. 

appear;  and  I  have  been  led  to  suspect,  from  these  circumstances, 
that  the  passage  of  the  bile  into  the  duodenum,  during  this  interval,*' 
[viz.  from  the  very  beginning  to  the  crisis  or  termination,]  "  was  at- 
together  stopped."  I  beg  the  reader  will  keep  this  in  mind. 

These,  then,  are  the  tv\o  tirst  links  of  that  morbid  chain  which 
connects  the  remote  cause  with  the  ostensible  form  of  the  disease. 
Whoever  can  break  these,  by  restoring  those  two  functions  to  their 
natural  state — I  care  not  by  what  means  or  medicines — he  will  cure, 
or  rather  prevent,  the  disorder. — But  we  can  seldom  expect  to  be 
called  in  at  this  early  period,  for  Dysentery  is  not  yet  manifested  ; 
although  an  accurate  observer  might,  in  his  own  frame,  often  detect 
these  nascent  movements,  and  by  prompt  measures,  extinguish  the 
disease  in  embryo. 

Some  other  invisible,  at  least,  very  obscure  links,  are  now  to  be 
noticed  : — for  however  confidently  a  proximate  cause  may  be  decided 
on  in  colleges  and  closets,  it  is,  in  nature,  a  series  of  causes.  The 
equilibrium  of  the  circulation  and  excitability  becomes  disturbed. 
In  consequence  of  the  torpor  in  the  extreme  vessels  on  the  surface, 
the  volume  of  blood  is  directed  to  the  interior,  and  the  balance  is 
still  further  broken  by  the  check  which  the  portal  current  meets  in 
the  liver,  from  a  corresponding  torpor  in  the  extreme  or  secreting 
vessels  of  that  organ  ;  the  effect  of  which  is,  that  the  plethora  in 
the  coeliac  and  mesenteric  circles  is  now  greatly  augmented,  and  fe- 
brile symptoms  commence.  The  perspiration  being  stopped,  a  vi- 
carious discharge  of  mucus  and  acrid  serum  is  thrown  from  the  ex- 
tremities of  the  turgid  mesenteric  vessels  upon  the  internal  surface 
of  the  intestines,  which  by  this  time  are  in  a  state  of  irritability.* 
The  disease  now  begins  to  exhibit  itself  unequivocally,  by  the  un- 
easiness in  the  bowels,  the  frequent  desire  tc  stool,  and  the  mucous 
discharges.  We  may  now  plainly  perceive  how  all  those  consequen- 
ces, which  have  so  often  passed  for  causes,  can  arise.  If  the  ple- 
thora be  great,  blood  itself  will  be  poured  out  from  the  mouths  of 
the  distended  mesenteric  and  meseraic  vessels  ;  hence  inflammation 
and  ulceration  may  ensue.  If  any  hardened  feces  lurk  in  the  cells 
of  the  colon,  they  will  be  grasped  by  the  irritable  circular  fibres  of 
the  intestines,  and  rings  or  strictures  will  augment  the  tormina  and 
griping  in  the  bowels. 

In  this  situation,  Nature  evidently  attempts  to  restore,  by  reaction, 
the  balance  of  the  circulation  and  excitability  with  the  cuticular  and 
hepatic  functions,  but  she  rarely  succeeds  *  her  abortive  efforts  too 
often  aggravating,  instead  of  relieving  the  symptoms.  Thus  we 
sometimes  see  a  partial,  ill-conditioned  sweat  on  the  surface,  which 
is  productive  of  no  benefit ;  while  from  the  liver,  an  occasional  gush 
of  vitiated  bile,  like  so  much  boiling  lead,£throws  the  irritable  intes- 

'-  It  may  be  observed  that  the  same  phenomena  take  place  in  most  tropical 
fevers,  and  also  in  severe  cases  of  cholera  morbus,  mort  de  chien,  &c.  This  I 
grant ;  for  the  same  causes  that,  applied  to  one  person,  produce  bilious  fever,  -will 
in  a  second  give  rise  to  hepatitis — in  a  third  to  mort  de  chien — and  in  a  fourth  to 
dysentery,  according  to  the  organ  that  happens  to  be  most  predisposed  to  dis- 
ease. Nay,  a  combination  of  all  these  diseases  will  often  be  found  in  the  same 
case. 


DTSENTERY.  150 

tines  into  painful  contortions,  and  then  the  tormina  and  tenesmus  are 
insufferable  !  Nature,  to  say  the  truth,  is  but  a  sorry  physician  in 
Dysentery.  "  In  hoc  enim  corporis  affectu,"  says  Sir  G.  Baker, 
"  aliquod  certe  in  medicina  opus  est,  baud  multum  in  Naturat  benefi- 
cio."  Where  she  ultimately  gains  her  end,  it  is  where  the  local  ple- 
thora is  reduced  by  the  discharge  from  the  mesenteric  and  meseraic 
vessels,  without  occasioning  much  organic  derangement  in  the  bow- 
els. This  being  effected,  she  more  easily  restores  the  equilibrium 
of  the  circulation  and  excitability  and  the  functions  above  men- 
tioned. But  in  a  great  majority  of  cases,  where  the  disease  is  vio- 
lent, her  exertions  either  hasten  the  fatal  catastrophe,  or  produce 
such  lesion  of  structure  and  function  in  the  chylopoetic  viscera,  as 
induces  a  tedious  chronic  state  of  the  complaint,  very  difficult  to  ma- 
nage. 

The  febrile  symptoms  will,  at  first,  be  in  proportion  to  the  general 
disturbance  in  the  balance  of  the  circulation  and  excitability  ;  they 
will  afterwards  be  kept  up,  or  modified,  by  the  extent  of  the  organic 
derangement  sustained.  The  discharge  of  blood  by  stool,  on  the 
other  hand,  appears  to  be  proportionate  to  the  local  plethora  in  the 
portal  and  mesenteric  circles,  and  to  the  permanence  and  degree  of 
torpor  in  the  liver,  occasioning  that  plethora. 

This  doctrine,  thus  briefly  sketched  out,  if  impartially  considered, 
and  fairly  applied,  will,  1  think,  clearly  account  for  every  phenome- 
non of  the  disease,  from  the  derangement  of  the  liver,  the  largest  of 
all  glands,  to  that  of  the  mesenteric  glands  themselves,  which  have 
in  their  turn  been  considered  as  the  seat,  or  even  the  cause  of  dysen- 
tery. 

But  it  is  not  sufficient  that  it  merely  accounts  for  the  phenomena. 
If  founded  in  nature  and  truth,  it  should,  like  an  arithmetical  rule, 
prove  itself  in  various  ways.  Above  all,  the  practical  application  of 
it  ought  to  involve  no  contradictions  ;  however  various  the  routes  may 
appear,  they  must  all  be  shown  to  tend  ultimately  to  one  point — the 
cure.  It  should  explain  how  different  means  have  attained  the  same 
end  ;  and  finally,  it  should  chalk  out  the  best  and  nearest  path  we  are 
to  pursue.  To  this  task  I  consider  the  doctrine  in  question  perfectly 
equal  ;  though  1  shall  not  apply  it  further  than  to  the  leading  phe- 
nomena of  the  disease,  and  the  principal  methods  of  cure. 

Of  the  former  I  have  spoken  ;  I  now  come  to  the  latter.  The 
practitioner  who  has  set  down  an  inflammatory  state  of  the  intestines 
as  the  cause  of  dysentery,  comes  to  patient,  who  is  very  ill  with  vio- 
lent tormina  and  tenesmus  ;  and  passing  blood,  in  alarming  quantities 
with  his  stools,  which  consist  of  nothing  but  that  and  mucus.  He 
bleeds  copiously,  as  his  principal  indication,  and  prescribes  laxatives 
or  sudorifics  as  minor  means,  and  in  a  trifling  way,  as  auxiliaries. 
He  soon  finds  that  the  flow  of  blood  by  stool,  is  much  reduced — that 
the  tormina  are  mitigated,  and  that  something  more  than  mere  mucus 
comes  away  after  the  laxatives,  with  considerable  relief  to  the  pa- 
tient. Nothing  can  be  more  plain  than  the  way  in  which  these  means 
are  beneficial,  on  the  principle  in  question.  Venesection  lessens  at 
once  the  plethora  in  the  mesenteric  vessels,  and  checks  the  effusion 
from  their  mouths.  A  general  relaxation  throughout  the  whole  sys- 


ItiQ  EASTERN   HEMISPHERE. 

tern  follows — intestinal  strictures  are  relaxed — scybala  and  fecal  ac- 
cumulations pass  off;  and  Nature,  thus,  relieved,  attempts  a  res- 
toration of  equilibrium  in  the  circulation  and  excitability,  evinced  by 
some  degree  of  action  in  the  extreme  vessels  on  the  surface,  and  by 
sympathy,  of  the  secreting  vessels  in  the  liver. 

So  far  the  physician  has  greatly  assisted  the  spontaneous  efforts  of 
the  constitution  ;  and  if  the  latter  be  equal  to  the  task  of  keeping 
things  in  this  prosperous  train,  all  will  be  well— If  not,  the  morbid 
state  returns,  and  with  it  a  fearful  debility,  which  paralyses  his  arm, 
and  embarrasses  his  mind  !  His  patient  may,  or  may  not  recover  ;  but 
1  should  not  like  to  be  in  his  situation,  under  a  man  who  confines  his 
principal  aim  to  the  obviating  of  inflammation.* 

He  who  confides  in  purgatives,  [and  a  great  many  do,  who  know 
little  of  the  complaint.]  from  an  idea,  that  stricture  and  a  retention 
of  the  natural  feces  are  the  essence  of  dysentery,  treads  on  exceed- 
ingly tender  ground.  He  certainly  does  assist  Nature  in  her  most 
ostensible,  but  dangerous  method  of  cure.  If  by  a  course  of  purga- 
tives, he  can  lessen  the  local  plethora,  and  excite  the  healthy  action 
of  the  liver,  [both  which  objects  evacuating  medicines,  particularly 
of  the  mercurial  kind,  are  without  doubt  calculated  to  effect,]  before 
any  material  injury  takes  place  in  the  intestinal  canal,  he  will  suc- 
ceed ;  because  the  general  balance  of  the  circulation  will  soon  be  re- 
stored, when  the  portal  and  mesenteric  plethora  is  removed  ;  and 
the  sympathising  function  of  the  skin  will  participate  in  the  healthy 
action  of  the  liver.  But  in  a  large  proportion  of  cases,  he  will  have 
the  mortification  to  find,  that  such  organic  derangements  occur,  be- 
fore he  can  attain  his  object,  as  will  either  hasten  the  fatal  termina- 
tion, or  prove  a  fruitful  source  of  misery  in  the  chronic  stage  of  the 
disease,  which  too  often  ensues. 

The  rationale  of  the  emetic  and  sudorific  plans,  on  the  principle 
in  view,  is  sufficiently  obvious.  They  not  only  determine  generally 
to  the  surface,  but,  by  exciting  the  healthy  action  of  the  liver,  they 
locally  relieve  the  meseraic  and  mesenteric  plethora,  [a  circumstance 
which  their  employers  did  not  calculate  on,]  and  thus  restore  the 
balance  of  the  circulation  with  the  functions  of  perspiration  and  bi- 
liary secretion. 

But  however  beautiful  this  plan  may  be  in  theory — however  suc- 
cessful it  may  be  in  a  few  sporadic  cases  of  dysentery  in  private  life, 
or  in  a  well-regulated  hospital,  a  more  Utopian  practice  for  fleets  or 
armies,  in  a  tropical  climate,  was  never  seriously  recommended  for 
general  adoption  !  Much  do  I  suspect  that  those  who  praise  or  pro- 
pose it,  have  never  put  it  to  the  test  of  experience,  except  on  a  very 
confined  scale,  and  with  every  convenience  at  hand.  "  There  would 
be  this  inconvenience,"  says  the  judicious  Dr.  Blane,  "  in  constantly 

*  Since  the  first  edition  of  this  work  was  printed,  Dr.  Somers  has  drawn  the 
attention  of  the  medical  world  to  extreme  venesection  in  dysentery  as  it  appeared 
on  the  Peninsula.  But  I  believe  that  experience,  in  tropical  climates  at  least, 
wfll  only  assign  venesection  its  proper  rank  as  a  powerful  auxiliary  in  the  treat- 
ment of  this  formidable  disease.  Dr.  Somers  has  not  the  honour  of  originality 
here.  Dr,  White  used  the  same  venesectio  ad  deliquium,  in  Egypt,  in  1802.  And 
Mr.  White,  a  Navy  Surgeon,  published  a  work  nearly  a  hundred  years  ago,  in 
which  he  lays  down  a  still  more  decisive  system  of  blood-letting  in  dysentery. 


DYSENTERV.  it)  I 

.ncouraging  a  sweat,  that  if  the  tenesmus  should  return,  it  [perspira- 
tion] would  either  be  checked  by  the  patient  getting  frequently  out  of 
bed,  or  there  would  be  danger  of  his  catching  cold." — 3d  ed.  p.  457. 

The  mercurial  plan  is  of  a  very  different  stamp,  in  regard  to  its 
applicability.  Indeed,  the  empirical  exhibition  of  mercury,  as  it  is 
called,  in  hepatic  and  dysenteric  complaints  abroad,  has  quite  shock- 
ed the  feelings  of  some  physicians  at  home.  But  the  army  or  navy 
surgeon,  who  has  a  vast  number  of  dysenteric  patients  coming 
every  day  under  his  care,  smiles  at  these  delicate  scruples.  He 
knows,  by  repeated  observations,  that  if  he  can  bring  on  free  ptyal- 
ism,  the  patient  is  secure  for  that  time  ;  and  this  begets  a  strong  bias 
in  favour,  either  of  the  specific  power  of  mercury,  or  of  the  liver  be- 
ing the  primary  seat  of  the  disease.  With  these  prepossessions,  he 
drives  on  for  the  object  in  view,  regardless  of  particular  symptoms, 
and  disdaining  to  call  in  the  aid  of  those  means  which  1  have  been 
describing,  and  which  are  considered  by  others  as  the  principal  re- 
medies. He  is  generally,  however,  successful  ;  and  if  he  knew  to 
what  extent  he  might  go  with  safety  in  this  empirical  manner,  he 
would  be  still  more  so,  as  shall  be  shown  in  due  time.  But  occasion- 
ally he  is  foiled,  and  cannot  raise  a  ptyalism — then  his  resources  are 
gone  !  The  patient  wastes  away  —  inflammation,  ulceration — even  gan- 
grene may  supervene  ;  or,  some  morning,  he  sees,  with  astonishment, 
several  inches  of  the  rectum,  that  have  passed  off  by  stool  in  the 
night!  Thi<  has  happened  under  my  own  care,  and  /fcnowthat  the 
same  has  occurred  to  several  others. 

Thus  we  see,  that  any  one  of  the  above  methods,  when  set  up  as 
a  principal  to  the  exclusion  of  others  is  attended  with  inconvenience, 
and,  [excepting  perhaps  the  last,]  with  repeated  failures,  if  not  ge- 
neral want  of  sucess,  particularly  in  hot  climates.  A  heterogeneous 
combination  of  them  all,  on  the 'other  hand,  without  order  or  disci- 
pline, and  guided  only  by  the  discretion  or  caprice  of  the  young  prac- 
titioner, would  be  little  better,  if  not  worse  than  a  blind  adherence 
to  one.  Nothing,  in  short,  but  a  controlling  principle,  that  is  ever  to 
be  held  in  view,  under  whose  superintendence  the  above-mentioned 
agents  are  to  be  employed  in  their  proper  spheres,  can  lead  to  a  set- 
tled and  rational  practice  in  dysentery,  or  reconcile  those  jarring  opi- 
nions and  practices  with  whicli  both  books  and  men  continue  to  puz- 
zle the  minds  of  all  those  whom  personal  and  wide  experience  has 
not  emancipated  from  the  trammels  of  authority. 

I  have  declared  the  principle  that  is  to  govern  us,  [the  restoration, 
of  healthy  perspiration  and  biliary  secretion,  with  an  equilibrium  of 
the  circulation  and  excitability.]  and  enumerated,  in  a  general  way, 
the  means  which  we  are  to  use  ;— the  direct  application  of  the  whole 
to  practice,  will  be  illustrated  presently,  by  an  appeal  to  facts. 

I  have  purposely  avoided  as  much  as  possible,  throughout  this  essay, 
to  quote  my  0wn  cases  in  support  of  my  own  doctrines.  The  follow- 
ing short  narrative,  however,  may  be  allowed  a  place  here  ;  and  may 
not  be  uninteresting  or  uninstructive  : — 

A  very  few  weeks  after  my  first  arrival  in  Bengal,  I  made  one  in  a 


1 615  EASTERN  HEMISPHERE. 

party  of  officers  who  landed  a  few  miles  below  Kedgeree,  for  the  pur- 
pose of  shooting  and  of  seeing  the  country. — This  day  was  excessive- 
ly hot — the  ground  was  half  inundated,  and  we  waded  and  rambled 
about,  through  marshes,  jungles,  and  paddyfields — often  with  one-half 
of  our  bodies  under  water,  and  the  other  broiling  in  the  sun,  till  we 
were  fairly  exhausted.  As  we  had  a  sumpter-basket  with  us,  we 
spent  the  whole  day  in  this  manner  ;  and  on  returning  in  the  evening 
to  the  bank*  of  the  Ganges,  at  a  place  appointed,  we  found  that  the 
boat  could  not  approach  the  shore,  the  water  was  so  shoally  ;  we 
therefore  dashed  into  the  river,  and  waded  off  to  where  the  boat  lay 
at  a  grapnel.  By  this  time  it  was  sunset,  and  as  we  had  a  strong  tide 
against  us,  we  sat  in  the  boat  nearly  two  hours,  dripping  wet,  and 
shivering  with  cold,  before  we  got  on  board.  That  night,  my  sleep 
was  disturbed,  and  I  felt  slight  rigors  or  chills,  alternated  with  flush- 
es of  heat  ;  but  in  the  morning  I  got  up  as  usual,  and  concluded  that 
all  was  well.  At  dinner  I  had  no  appetite  ;  and  soon  afterwards  I  felt 
uneasiness  in  my  bowels.  As  the  evening  advanced,  I  had  frequent 
calls  to  stool,  with  griping,  and  some  tenesmus,  nothing  coming  away 
but  mucus.  Fever  now  came  on — my  skin  became  hot,  dry,  aud 
parched — and  by  1 1  o'clock  at  night,  I  could  scarcely  leave  the  com- 
mode. The  misery  of  that  night  will  never  be  erased  from  my  me- 
mory !  I  was  often  delirious,  especially  when  I  lay  down  in  bed  ;  but, 
indeed,  so  dreadful  were  the  tormina  and  tenesmus  —so  incessant 
the  calls  to  stool,  that  little  respite  could  be  procured.  I  had  taken 
a  dose  of  salts  in  the  evening,  but  they  afforded  very  trifling  relief, 
except  by  bringing  off  some  feculencies,  attended  with  a  momentary 
lull.  Garly  in  the  morning,  a  medical  gentleman  belonging  to  an 
East  Indiaman,  visited  me,  and  found  me  in  a  very  bad  way.  I  was 
now  passing  blood  fast,  and  the  fever  ran  high.  I  was  bled,  and  took 
an  ounce  of  castor  oil  immediately  ;  a  few  hours  after  which,  six 
grains  of  calomel,  and  one  of  opium,  were  taken,  and  repeated  every 
five  hours  afterwards,  with  occasional  emollient  injections. 

This  day  passed  rather  easier  than  the  preceding  night— the  tor- 
mina was  somewhat  moderated  by  the  medicine  ;  but  I  had  consider- 
able fever — thirst — restles-nesp,  and  continual  calls  to  stool ;  nothing, 
however,  coming  away,  but  mucus  and  blood.  As  night  closed 
in,  the  exacerbation  was  great.  The  opium  lulled  me  occasionally, 
but  I  was  again  delirious ;  and  the  phantoms  that  haunted  my  ima- 
gination were  worse  than  all  my  corporeal  sufferings,  which  were, 
in  themselves,  indescribably  tormenting.  The  next  day  I  was  very 
weak  ;  and  so  incessant  were  the  griping  and  tenesmus,  that  1  could 
hardly  leave  the  commode.  The  tenesmus  was  what  I  could  not 
bear  with  any  degree  of  fortitude ;  and,  to  procure  a  momentary  re- 
lief from  this  painful  sensation,  1  was  forced  to  sit  frequently  on 
warm  water.  The  calomel  and  opium  bolus  was  now  taken  every 
four  hours,  with  the  addition  of  mercurial  frictions.  An  occasional 
lavement  was  exhibited,  which  gave  much  pain  in  the  exhibition,  and 
I  each  day  took  a  dose  of  castor  oil,  which  brought  off  a  trifling  fe- 
culence, with  inconsiderable  relief.  My  fever  ran  higher  this  day 
than  yesterday,  with  hot,  dry,  constricted  skin.  As  night  approach- 
ed, my  debility,  and  apprehension  of  the  usual  exacerbation  brought 


CV3ENTERV.  163 

on  an  extreme  degree  of  mental  agitation.  The  surgeon  endea- 
voured to  cheer  me  with  the  hope  of  ptyalism,  which,  he  assured 
roe,  would  alleviate  my  sufferings— I  had  then  no  local  experience  in 
the  complaint  myself.  As  the  night  advanced,  all  the  symptoms  be- 
came aggravated,  and  I  was  convinced  that  a  fatal  termination  must 
ensue,  unless  a  speedy  relief  could  be  procured.  I  had  no  other 
hope  but  in  ptyalism  ;  for  my  medical  friend  held  out  no  other  pros- 
pect. I  sent  for  my  assistant,  and  desired  him  to  give  me  a  scruple 
of  calomel,  which  I  instantly  swallowed,  and  found  that  it  produced 
no  additional  uneasiness—on  the  contrary,  I  fancied  it  rather  lulled 
the  tormina.  But  my  sufferings  were  great—  my  debility  was  in- 
creasing rapidly,  and  I  quite  despaired  of  recovery  !  Indeed,  I  look- 
ed forward  with  impatience  to  a  final  release  !  At  four  o'clock  in 
the  morning,  I  repeated  the  dose  of  calomel,  and  at  eight  o'clock, 
[or  between  60  and  70  hours  from  the  attack,]  I  fell,  for  the  first 
time,  into  a  profound  and  refreshing  sleep,  which  lasted  till  near  mid- 
night, when  I  awoke.  It  was  some  minutes  before  I  could  bring  my- 
self to  a  perfect  recollection  of  my  situation  prior  to  this  repose  ; 
but  I  feared  it  was  still  a  dream,  for  I  felt  no  pain  whatever !  My 
skin  was  covered  with  a  warm  moisture,  and  I  lay  for  some  consider- 
able time,  without  moving  a  voluntary  muscle,  doubtful  whether  my 
feelings  and  senses  did  not  deceive  me.  I  now  felt  an  uneasiness  in 
my  bowels,  and  a  call  to  stool.  Alas,  thought  I,  my  miseries  are  not 
yet  over !  I  wrapped  myself  up,  to  prevent  a  chill,  and  was  most 
agreeably  surprised  to  find  that,  with  little  or  no  griping,  I  passed  a 
copious,  feculent,  bilious  stool,  succeeded  by  such  agreeable  sensa- 
tions— acquisition  of  strength,  and  elevation  of  spirits,  that  J  ejacu- 
lated aloud  the  most  sincere  and  heartfelt  tribute  of  gratitude  to  Hea- 
ven for  my  deliverance.  On  getting  into  bed,  I  perceived  that  my 
gums  were  much  swollen,  and  that  the  saliva  was  flowing  from  my 
mouth.  I  took  no  more  medicine,  recovered  rapidly,  and  enjoyed 
the  best  state  of  health  for  some  time  afterwards. 

Mr.  Curtis  may  denominate  this  disease,  "  Pilious  fever  and  flux,'* 
or  "  Hepatic  flux,"  but  as  its  answers  to  every  part  of  Dr.  Cullen's 
definition,  except  the  erroneous  part,  I  must  say,  that  it  is  a  very  fas- 
tidious multiplication  of  distinctions  without  any  real  difference.* 
The  "  nature  of  the  discharge"  has  led  Mr.  Curtis,  and  many  others 
astray.  Often  have  I  been  told  by  gentlemen  that  their  patients  were 
passing  great  quantities  of  bilious  redundancies,  when,  upon  examin- 
ing the  stools,  four-fifths  of  these  were  composed  of  mucus,  tinged 
of  various  hues,  with  vitiated  bile  and  blood.  It  is  astonishing  how 
small  a  quantity  of  the  former  will  communicate  even  a  deep  colour 
to  any  other  fluid.  Mr.  Curtis's  practice,  too,  consisted  almost  en- 
tirely in  purgatives  ;  consequently,  what  with  this  and  the  previous- 
ly disordered  state  of  the  liver  and  its  functions,  we  need  not  won- 
der that  considerable  quantities  of  depraved  bilious  secretions  were 
brought  off  during  the  treatment.  But  these  accidental  varieties  in 
the  appearance  of  the  discharge,  arising  from  local  causes,  and 
greatly  modified  by  the  means  employed  for  cure,  do  not  authorize 
us  to  change  the  name  of  the  disease.  Such  appearances  have  been 
*  Vide  Curtis  OB  the  Diseases  of  India. 


164  EASTERN  HEMISPHERE. 

observed  in  all  countries,  especially  in  autumnal  seasons,  and  where 
purgatives  formed  a  prominent  feature  in  the  methodus  medendi. 
They  have  even  led  to  the  idea,  that  bile  was  the  cause  of  dysen- 
tery. 

Of  the  remote  causes  I  need  say  little.  They  are  the  same  in  all 
parts  of  the  world — atmospherical  vicissitudes.  Perspiration  and 
biliary  secretion  being  in  excess  during  the  intense  heat  of  the  day, 
are  so  much  the  more  easily  checked  by  the  damp  chills  of  the  night ; 
and  the  consequences  which  ensue  are  clearly  deducible  from  the 
principle  I  have  stated.  In  short,  the  same  general  causes  produce 
bilious  fever,  hepatitis,  and  dysentery.  They  are  three  branches 
from  the  same  stem,  the  organs  principally  affected  occasioning  the 
variety  of  aspect. 

Dysentery',  ceteris  paribus,  will  be  the  most  frequent  form  ;  first, 
on  account  of  the  injury  which  the  intestines  are  in  the  habit  of  pre- 
viously sustaining,  from  the  irregular  or  disordered  function  of  the 
liver,  whereby  they  become  weakened  and  irritable  ;  secondly,  be- 
cause they  are  destined,  by  Nature,  to  sustain  the  vicarious  afflux  of 
suppressed  perspiration.  They  are  all  cured  on  the  same  principle, 
and  with  some  slight  variety,  arising  from  local  circumstances,  by 
the  same  remedies — a  strong  proof  of  the  connexion  which  I  have 
traced. 

We  now  see  how  a  few  year's  residence  in  hot  climates  predis- 
poses heedless  soldiers  and  sailors  to  Dysentery,  as  remarked  in  the 
section  on  Yellow  fever,  by  the  experienced  author  of  that  article, 
and  as  is  well  known  to  those  who  have  practised  between  the  tro- 
pics. The  same  principle  explains  the  reason  why  we  so  frequent- 
ly find  dysentery  a  concomitant  on  hepatitis,  especially  that  languid 
species  of  it,  arising  from  obstruction  and  congestion,  with  previous 
derangement  of  function  in  the  liver,  rather  than  acute  European  in- 
flammation. In  the  latter  as  in  enteritis,  the  bowels  are,  for  the  most 
part,  costive.  We  next  proceed  to  the  cure,  and  various  practical 
remarks  connected  with  it. 

There  are  two  safe  and  comparatively  effectual  modes  of  curing 
dysentery.  I  shall  point  out  the  principal  remedy  in  each  method 
first,  and  notice  the  subordinate  auxiliary  ones  afterwards.  One  me- 
thod is,  to  give  mercury,  in  comparatively  small  doses,  either  alone 
or  combined  with  an  anodyne,  or  with  an  anodyne  and  diaphore- 
tic, [which  I  prefer,]  in  such  a  manner,  that  from  24  to  36  or  48 
grains  of  calomel,  according  to  the  urgency  of  the  symptoms,  may 
be  exhibited,  in  divided  portions,  at  three,  four,  or  six-hour  in- 
tervals, during  the  course  of  the  day  and  night.  In  the  same  space 
of  time,  from  two  to  four  grains  of  opium,  and  from  ten  to  fif- 
teen grains  of  antimonial  powder  or  ipecacuan,  may  with  advan- 
tage be  administered,  in  combination  with  the  calomel.  One  or 
two  doses,  at  least,  should  be  given  before  a  laxative  is  prescribed  ; 
and  an  ounce  of  castor  oil  is  the  best  medicine  I  can  recommend  for 
the  latter  purpose.  It  will  often  bring  away  hardened  fecal,  or  viti- 
ated bilious  accumulations,  when  the  irritability  of  the  intestines  is 
previously  allayed  by  the  calomel  and  opium  ;  and  it  will,  in  that 
manner,  soothe  the  tormina  and  tenesmus.  But  although  it  may  be 


DYSENTERY.  16$ 

repeated  every  day,  it  is  never  to  interrupt  the  progress  of  the  main 
remedy. 

When  blood  appears  alarmingly  in  the  stools,  whether  the  fever 
runs  high  or  not,  venesection  may  be  employed  without  the  smallest 
apprehension  of  that  bugbear — DEBILITY. — Emollient  oily  glysters 
may  also  be  occasionally  thrown  up,  to  lull  the  tenesmus  ;  but  as  the 
rectum  is  generally  in  a  very  irritable  state,  glysters  are  often  unma- 
nageable remedies.  A  flannel  shirt  is  to  be  put  on,  and  a  bandage  of 
the  same  with  a  double  or  treble  fold  of  flannel  round  the  abdomen, 
which  is  to  be  rubbed,  once  or  twice  a-day,  with  a  liniment,  composed 
of  mercurial  ointment  and  tincture  of  opium,  well  incorporated.  By 
a  steady  perseverance  in  this  simple  plan,  for  a  few  days,  the  mouth 
will  become  sore,  and  every  bad  symptoms  vanish. 

Thus,  in  less  than  a  page,  is  stated  a  practice,  which  being  founded 
on  principle,  is  generally  applicable  to  almost  every  stage  and  degree 
of  Dysentery,  and  contains  within  itself  resources  against  most  emer- 
gencies. While  we  proceed  directly  forward  to  our  final  object — the 
restoration  of  the  cuticularand  hepatic  secretions,  with  an  equilibri- 
um in  the  circulation  and  excitability,  by  a  combination  of  mercury 
and  diaphoretics,  we  lull  pain,  and  relax  strictures,  at  the  same  time, 
by  the  opium.  To  guard  against  inflammation  of  the  intestines,  we 
have  the  lancet  on  one  side — and  to  carry  off  diseased,  or  irritating 
accumulations,  we  have  laxatives  on  the  other  ;  the  fever  being  prin- 
cipally symptomatic,  will,  of  course,  cease  with  the  cause.  For  the 
successful  issue  of  this  treatment,  in  general,  I  appeal  to  the  rigid  test 
of  future  experience  with  others,  perfectly  conscious  from  my  own,  of 
its  superior  efficacy. 

This  was  the  usual  method  I  pursued,  and  with  results  far  exceed- 
ing my  most  sanguine  expectations.  In  some  cases,  of  more  than 
common  violence,  I  was  occasionally  led  into  a  practice  some\vhat 
different,  which  will  be  noticed  presently. 

It  is  a  little  singular,  that  no  two  medical  gentlemen  on  the  station 
agreed  exactly  in  the  mode  of  administering  mercury — each  was  pro- 
bably attached  by  habit  to  his  own  formula  :  but  in  one  thing  they 
were  all  unanimous — its  astonishing  power  over  the  disease.  This 
speaks  for  itself.  I  shall  here  exhibit  a  few  specimens  of  the  practice 
adopted  by  some  of  the  most  intelligent  surgeons,  and  who  had  the 
longest  and  most  extensive  experience  it  the  Eastern  hemisphere. 

Mr.  Rowlands,  surgeon  of  H.  M.  S.  Tremendous,  [now  surgeon 
of  Halifax  Hospital,]  when  called  to  a  dysenteric  patient,  prescribed, 
first  of  all,  a  dose  of  sulphate  of  magnesia  or  soda  ;  immediately  after 
the  operation  of  which,  one  grain  of  calomel  was  given  every  half 
hour,  with  interruption,  till  ptyalism  took  place,  which  was  generally 
on  the  third  day. — Scarce  any  other  medicine  was  employed,  except 
bladders  of  warm  water  to  the  abdomen,  and  the  anodyne  mercurial 
ointment,  which  I  have  already  noticed. 

Mr.  Henry,  surgeon  of  the  Trident,  a  gentleman  who  passed  a 
great  number  of  years  in  India,  and  had  ample  experience,  proceed- 
ed on  the  following  plan  :  ten  grains  of  colomel  where  given  three 
times  a-day,  till  ptyalism  ensued  ;  interposing  occasional  laxatives 


566  EASTERN  HEMISPHERE. 

—generally  castor  oil,  or  salts  ;  and  in  the  more  advanced  stages  of 
the  disease,  combining  small  doses  of  opium  with  the  calomel. 

Mr.  Shields,  of  the  Centurion,  a  very  experienced  surgeon,  com- 
menced with  a  dose  of  castor  oil  in  mint  water,  and  after  it  had  taken 
effect,  prescribed  an  anodyne  antimonial  draught  in  the  evening.  Mer- 
cury was  then  administered  in  the  following  formula  : — calomel,  a 
drachm,  ipecacuanha,  half  a  drachm,  opium,  gr.  xii.  These  were 
made  into  twenty-four  pills,  two  of  which  were  taken  two  or  three 
times  a-day  according  to  the  urgency  of  the  symptoms,  till  salivation 
came  on,  with  an  occasional  laxative  of  castor  oil. 

Mr.  Scott,  surgeon  of  the  Caroline,  a  judicious  practitioner,  and 
who,  like  myself,  had  been — "  severely  taught  to  feel"  the  violence 
of  this  disease,  as  well  as  of  hepatitis,  pursued  the  following  me- 
thod :— A  saline  cathartic,  [magnes.  sulphat.  an  ounce,]  was  first  or- 
dered, and,  after  its  operation,  an  anodyne  diaphoretic  draught  in  the 
evening.  From  this  time  mercury  was  given  as  follows  :  calomel,  a 
drachm,  opii  gr.  iv.  saponis  q.  s.  ft.  pil.  xx.  One  of  these  to  be  taken 
every  two  hours,  till  ptyalism  ensued,  interposing  a  laxative  when 
griping  was  troublesome,  and  giving  an  anodyne  draught  every  night. 

It  would  be  useless  to  multiply  examples — the  above  are  sufficient 
to  give  an  idea  of  the  general  practice  pursued  in  the  East,  and  form 
so  many  living  testimonies  of  its  efficacy,  of  which  not  a  shadow  of 
doubt  can  be  reasonably  entertained. 

1  have  now  to  notice  a  still  bolder  tract  which  was  followed  by  a 
few  surgeons  in  that  quarter,  without  the  least  communication  of  sen- 
timents on  the  subject— each  conceiving  his  own  plan  to  be  perfectly 
unique.  I  have  mentioned  that,  in  my  own  case,  when  despairing  of 
recovery,  I  took,  in  one  night,  two  scruple  doses  of  calomel,  without 
experiencing  any  increase  of  the  tormina,  or  urgency  to  stool ;  but 
on  the  contrary,  with  an  apparent  alleviation  of  those  distressing 
symptoms.  Although  this  circumstance  did  not  make  much  impres- 
sion on  my  mind  at  the  time,  as  I  considered  it  merely  accidental, 
yet,  when  some  of  my  patients  afterwards  appeared  in  similar  situa- 
tions, and  I  was  in  great  anxiety  about  the  event,  I  ventured  to  have 
recourse  to  the  same  measures,  and  never  in  any  one  instance,  with 
injurious  effects,  but  very  generally  with  an  amelioration  of  symp- 
toms, and  an  aceleration  of  the  object  in  view— ptyalism.  Embolden- 
ed by  this,  I  afterwards  tried  calomel  in  scruple  doses,  two,  three,  or 
even  four  times  a  day,  without  any  other  medicine  whatever ;  and 
found  that  it  almost  invariably  eased  the  tormina,  and  lessened  the 
propensity  to  stool ;  and,  upon  the  whole,  brought  on  ptyalism  sooner 
than  any  other  plan  of  smaller  and  more  frequent  doses.  In  one  or 
two  instances,  however,  it  produced  great  nausea  and  sickness  at  sto- 
mach, with  spasmodic  affections  of  different  parts  of  the  body,  which 
were  soon  removed  by  an  opiate,  combined  with  a  diaphoretic,  to  de- 
termine to  the  surface.  I  did  not,  indeed,  adopt  this  practice  gene- 
rally, being  quite  satisfied,  in  ordinary  circumstances,  with  the  plan 
which  I  have  above  detailed.  But  whenever,  in  doubtful  cases,  I  had 
occasion  to  push  boldly  on  for  ptyalism,  I  gave  the  calomel  in  scruple 
doses  ; which  I  found  by  repeated  experience,  to  sit  easier  than  either 


DYSENTERY. 


•167 


a  smaller  or  a  larger  quantity  of  that  medicine—a  curious,  but  a  cer- 
tain fact. 

I  was  surprised,  long  after  this,  to  find  that  a  German  assistant- 
surgeon,  who  had  charge  of  my  patients  for  some  time,  while  I  was 
at  sick  quarters  on  shore,  made  it  a  very  common  practice  to  cure 
dysenteries  in  this  way.  But  the  following  table  will  show,  that 
experience  had  pointed  out  the  knowledge  of  this  fact  to  others  also. 

Tabular  View  of  Thirty  Cases  of  genuine  idiopathic  Dysentery,  treated 
with  Calomel,  in  scruple  doses,  on  board  H.  M.  S.  Sceptre ,  in  the 
East  Indies,  by  Mr.  JOHN  CUNNINGHAM,  Surgeon  of  that  Ship.  1805. 


j 

Men's  Names. 

No.  of  days 
under  cure 
before  the 
purging 
stopped. 

No.  of  days 
on  the  list 
afterwards, 
before  fit 
for  duty. 

Total  number 
of  days  on  the 
list. 

Scruples  of  ca- 
lomel, taken  in 
scruple  doses 
twice  or  thrice 
a-day. 

Remarks. 

Henry  -  - 

3 

10 

13 

Scr.  VI 

Davis    -  - 

4 

3 

7 

X 

5  S."  s> 

Kenan  -  - 

4 

3 

7 

V 

•£  $  3  «  > 

Jackson    - 

4 

5 

9 

IV 

§  i?2f  »  3 

Humphries 

6 

14 

20 

VIII 

2.2s,i"8  * 

3radock  - 

8 

5 

13 

XII 

g]|  S.r*s 

Paterson  - 

2 

3 

5 

IV 

£-|     B 

finton  -  - 

6 

7 

13 

IX 

5'jL<  n 

Jonnor  -  - 

3 

10 

13 

V 

fp?yn   £* 

Richardson 

4 

9 

13 

V 

W*m 

=  B^ 

Mabley     - 
Smith    -  - 
Dixon  -  - 

9 
4 
,4 

3 
6 
3 

12 
10 

7 

XII 
V 
VI 

II 

Noble    -  - 

6 

12 

18 

XIII 

Smith  (2)  - 

3 

11 

14 

VI 

5'««i<?  g; 

Williams  - 

4 

6 

10 

IV 

^3  =  8 

Murray    - 

3 

6 

9 

V 

8^52 

Stendon    - 

2 

7 

9 

IV 

jjrg  £.g> 

Palmer  -  - 

4 

7 

11 

VII 

lf°-S' 

Lum  -  -  • 

3 

11 

14 

V 

»°5'& 

Salter    -  - 

8 

5 

13 

XVIII 

«Ssj£ 

Stoner  -  - 

5 

3 

8 

IX 

3  —£  ,(», 

M'Cormick 

4 

6 

10 

V 

a|  •""** 

Stoneham  - 

8 

13 

21 

XV 

ffo  >^ 

Kinch    •  - 

2 

5 

7 

IV 

p'&S0^ 

Smith  (  3) 

4 

16 

20 

IX 

p'ljj  g 

Bell    -  - 

2 

3 

5 

III 

g  1  »  1 

Whitehurst 

4 

13 

17 

X 

Kit 

Kenan  (re- 

lapsed) 

3 

7 

10 

VI 

D  So  « 

Wilmot    - 

4 

6 

10 

XII 

If  this  document,  confirming  what  I  have  related  before,  does  not 
remove  every  doubt  or  prejudice  from  the  minds  of  European  prac- 
titioners, they  must  be  proof  against  the  impressions  of  truth.  It  is 
accompanied  by  the  following  remarks  : — 

"  I  am  perfectly  convinced,"  says  Mr.  Cunningham,  **  that  this  is 
the  most  successful  method  of  speedily  impregnating  the  system  with 
mercury,  because  it  does  not  excite  the  alvine  discharge,  so  as  to 
carry  off  the  medicine  by  stool,  as  I  have  too  often  found  smaller 


168  EASTERN  HEMISPHERE. 

doses  do.*  As  far  as  I  could  observe,  larger  doses  than  a  scruple  had 
the  same  effect  as  smaller,  in  aggravating  the  griping  and  purging. 
The  whole  amount  of  my  experience,  then,  in  the  treatment  of  more 
than  200  cases  of  genuine  idiopathic  dysentery,  is  this  : — that  calo- 
mel, administered  in  scruple  doses  twice  or  thrice  a-day,  is  an  almost 
certain  remedy  for  dysentery-— in  hot  climates,  at  least.  There  is 
no  occasion  to  continue  its  use  longer  than  till  the  symptoms  fairly 
give  way.  But  in  obstinate  cases,  the  system  must  be  well  impreg- 
nated before  a  permanent  cure  can  be  expected.  When  the  griping 
or  fixed  pain  in  the  bowels  ceases  after  the  administration  of  a  few 
scruples,  and  especially  if  the  ptyalism  be  appearing,  although  the 
stools  may  continue  frequent,  it  will  be  prudent  to  omit  the  medicine 
for  a  period  or  two,  to  ascertain  the  consequence  ;  for  it  generally 
happens  (hat  under  such  circumstances,  the  purging  also  subsides,  as 
the  ptyahstn  rises,  and  entirely  disappears  with  the  cessation  of  the 
mercurial  action,  which  ought  always  to  be  allowed  to  abate  gradually 
of  itself,  without  purgatives  or  diaphoretics,  otherwise  a  disagreeable 
return  of  the  purging  may  be  the  result. 

"  I  ought  to  notice,  that  although  dysentery  prevailed  in  the  Scep- 
tre to  a  greater  extent  than  in  any  styp  of  her  class  in  India,  during 
the  time  I  belonged  to  her,  yet  not  a  single  instance  of  hepatitis,  su- 
pervening on  the  former  disease,  occurred.  This  was  attributed  by 
others,  as  well  as  by  myself,  to  the  liberal  manner  in  which  I  pre- 
scribed mercury  for  the  cure  of  dysentery,  which  I  am  convinced 
has  some  intimate  connexion  with  hepatitis.  In  the  Albion  and  Rus- 
sel,  where  much  less  calomel  was  used,  liver  complaints  were  very 
prevalent  The  foregoing  table  exhibits  the  quantity  of  calomel  ta- 
ken, and  the  time  required  for  the  cure  of  the  last  thirty  cases  of 
dysentery,  without  any  selection,  that  came  under  my  care."  I  may 
here  add,  that  Mr.  Cunningham,  by  way  of  experiment,  took,  when 
in  perfect  health,  three  scruple  doses  of  calomel  in  one  day  ;  the  only 
effect  of  which  was  an  indescribably  pleasant  sensation  along  the  line 
of  the  alimentary  canal,  with  one  natural  stool  in  the  evening.  Mr. 
Neill,  of  the  Victor,  was  also  in  the  habit  of  giving  calomel  in  scruple 
doses,  for  the  cure  of  dysentery  and  bilious  fever,  with  great  success, 
and  without  ever  experiencing  any  inconvenience  from  the  largeness 
of  the  quantity. 

Since  the  first  edition  of  this  work  appeared,  numerous  testimo- 
nies in  favour  of  scruple  doses  of  calomel  in  dysentery  have  been 
published  by  able  practitioners.  But,  as  I  stated  before,  it  is  only 
in  cases  of  great  urgency,  where  such  large  doses  of  calomel  need 
be  exhibited. 

If  it  be  still  urged,  that  there  is  something  peculiar  in  the  nature 
of  India  fluxes,  which  renders  them  tractable  under  mercury,  and 
that  the  same  treatment  will  not  succeed  in  the  West,  I  happen  to 
have  before  me  a  document,  which  will  go  far  to  settle  that  point. 
In  the  years  1809  and  1810,  fever  and  dysentery  prevailed  to  a 

*  Mr.  Cunningham  had  a  great  prejudice  against  opium  in  this  complaint, 
which  accounts  for  the  remark  on  small  doses  of  calomel.  A  small  proportion  of 
the  former  medicine  will  completely  obviate  this  effect,  without  any  injury,  es- 
pecially if  determined  to  the  skin  by  diaphoretic? 


DYSENTERY.  16$. 

great  extent  on  board  H.  M.  S.  Sceptre,  in  the  West  Indies.  Mr. 
Neill  was  surgeon  of  the  ship  ;  and  adopting  the  Eastern  practice, 
with  which  he  was  well  acquainted,  his  success  was  equal  to  his 
hopes  or  wishes.  I  shall  quote  his  own  words,  and  he  is  now  in 
England  to  vouch  for  their  correctness. 

"  Dysentery  is  certainly  a  disease  of  the  utmost  importance  in. 
this  climate,  (West  Indies,)  and  may  perhaps  be  connected  with  other 
complaints,  which  we  might  not  have  the  most  distant  suspicion  of.* 
Out  of  eighty  well-marked  cases,  three  have  died.  The  first  was  an. 
old  man,  who  had  two  violent  attacks  previous  to  the  last,  or  fatal 
one.  The  second  was  a  very  fine  young  man,  who  had  scarcely  ever 
been  free  from  the  complaint  since  we  left  England.  The  third 
died  of  the  primary  attack,  which  was  accompanied  with  a  much 
greater  degree  of  fever  than  usual.  In  this  last  case,  I  deviated  ia 
some  measure  from  my  usual  plan  of  cure,  in  consequence  of  calo- 
mel not  standing  high  in  the  estimation  of  some  medical  gentlemen  on 
this  station.  Confiding,  therefore,  more  in  the  use  of  occasional 
purgatives  and  opiates,  with  diaphoretics,  my  patient  died.  From 
much  experience  in  this  disease,  I  may  with  confidence  assert,  that 
I  scarcely  remember  to  have  lost  a  patient  in  primary  attacks,  or 
where  the  constitution  was  not  cut  down  by  climate  and  repeated  at- 
tacks, when  mercury  [calomel]  was  given  freely,  so  as  to  open  the 
bowels,  and  bring  on  ptyahsm." 

I  have  only  to  add,  that  since  my  return  to  Europe,  I  have  never 
met  with  a  case  of  dysentery,  where  I  had  the  treatment  from  the 
beginning,  in  my  own  hands,  that  did  not  give  way  to  mercury  and 
its  auxiliaries  as  before  directed,  and  generally  with  more  facility 
than  between  the  tropics. — In  many  cases  of  chronic  dysentery,  too, 
which  I  have  met  with  among  French  prisoners  and  others,  the  prac- 
tice, with  some  slight  modification,  principally  in  the  quantity  of  the 
chief  remedy,  has  succeeded  beyond  my  expectation,  where  the  de- 
gree of  emaciation,  and  the  extent  of  local  derangement,  had  ren- 
dered the  prospect  of  a  cure  almost  hopeless.  A  reference  to  nu- 
merous communications  in  the  periodical  journals  of  late,  ancl  parti- 
cularly to  the  valuable  work  of  Dr.  Armstrong  on  Typhus,  will  show- 
how  much  the  mercurial  practice  is  preferred  to  others  in  dysen'tery. 

Hitherto,  I  hare  only  presented  the  favourable  side  of  the  picture 
to  view  ;  it  now  becomes  a  duty  to  exhibit  its  sad  reverse  !  In  doing 
this,  however,  I  have  the  consolation  of  hoping  that,  sooner  or  later, 
it  may  induce  those  in  whose  hands  alone  the  remedy  is  placed,  to 
apply  it  efficaciously.  I  may  add,  that  the  rationale  which  I  have  at- 
tempted of  the  disease,  is  equally  elucidatory  of  the  failure  as  of  the 
success  in  the  methodus  medendi  recommended. 

Those,  then,  who  hare  had  most  experience  in  hot  climates,  best 
know  the  melancholy  fact,  that  in  every  repetition  of  dysentery,  and 
after  every  successive  year  of  our  residence  between  the  tropics,  we 
find  the  remedy  has  greater  and  greater  difficulty  in  conquering  the 
disease.  In  process  of  time,  as  the  intervals  between  attacks  become 

From  conversations  with  him  on  this  subject  many  yeara  ago  in  TacUfe,  f 
know  he  alludes  to  the  functions  of  the  liver. 

22 


170  EASTEHN  HEMISPHERE. 

curtailed,  we  find  it  a  very  tedious  process  to  bring  the  mouth  affect- 
ed with  mercury  ;  and,  what  is  still  worse,  the  check  thus  given  to 
the  complaint  is  only  temporary  ;  for  soon  after  the  influence  of  the 
medicine  wears  off,  our  patient  returns  upon  our  hands  as  bad  as  ever. 
At  length  the  system  absolutely  refuses  all  impregnation  from  mercu- 
ry :  and  we  have  the  mortification  to  see  our  patient  waste  away,  and 
die,  for  want  of  the  only  remedy  that  possibly  could  arrest  the  hand  of 
death — CHANGE  OF  CLIMATE  ! 

And  how  can  it  be  otherwise,  upon  the  principle  which  I  have  stat- 
ed ?  The  perspiratory  and  biliary  vessels  become  gradually  weak- 
ened, by  their  inordinate  and  irregular  action,  from  the  stimulus  of  at- 
mospherical heat :  they  are  consequently  more  and  more  easily  struck 
torpid  by  the  least  atmospherical  vicissitudes,  and  require  the  addi- 
tional stimulus — or  rather,  the  change  of  stimulus  from  medicine,  to 
excite  their  healtby  action.  Hence,  the  longer  we  ring  those  chan- 
ges, the  nearer  we  approach  that  state  when  the  vessels,  at  last,  cease 
to  obey  all  stimuli — the  functions  alluded  to  cannot  be  restored,  and 
the. unhappy  victim  dies  !  Add  to  this,  that  the  intestines  themselves 
become  more  irritable  by  every  subsequent  attack,  and  even  with- 
out any  attack,  by  the  impaired  stale  of  the  functions  in  question, 
which  annually  increases. 

This  view  of  the  subject  leads  me  to  deplore  the  great  waste  of 
human  life  occasioned,  in  ships  of  war,  by  protracted  stations  in  the 
East  and  West  Indies  !  The  notion  that  time  seasons  us  against  al! 
other  diseases,  as  well  as  yellow  fever,  cannot  now  be  urged,  for  its 
fallacy  is  detected.  From  the  great  endemic  scourge  we  might,  in 
general,  protect  our  seamen,  by  proper  care  ;  but  over  the  disposi- 
tion to  dysentery  and  ulcers,  in  that  class  of  Europeans,  we  have  lit- 
tle control,  since  time  itself  is  our  adversary — omnia  metil  ternpus  ! 

I  shall  now  advert  to  some  more  minute  particulars  in  the  treat- 
ment of  this  complaint,  which,  from  the  documents  1  have  produced 
and  my  own  testimony,  will,  I  trust,  no  longer  be  viewed  in  the  ter- 
rific habiliments  wherewith  it  is  clothed  by  Dr.  Moseley. 

The  use  of  opium  in  dysentery  has  been  loudly  applauded,  and  as 
unconditionally  condemned.  Yet  here,  as  in  many  other  instances, 
it  is  the  abuse  only  which  has  brought  odium  on  a  valuable  medicine. 
Opium  will  do  harm,  if  given  alone  ;  particularly  in  primary  attacks. 
and  in  young  or  plethoric  habits.  If  alternated  with  purgatives,  it 
will  do  little  good — perhaps  even  harm.  But  if  combined  with  ca- 
lomel and  antimonial  powder,  it  will  be  found  a  most  important  auxi- 
liary to  these  medicines,  both  by  preventing  any  intestinal  irritation 
from  the  one,  and  by  increasing  the  diaphoretic  effect  of  the  other. 
All  its  injurious  consequences,  (if  any  such  result  in  this  way,)  may 
be  easily  obviated  by  the  lancet  and  laxatives,  when  symptoms  re- 
quire them. 

The  nitrous  acid  I  have  often  found  a  useful  adjuvant,  particularly 
in  secondary  attacks,  where  the  relaxed  and  weakened  state  of  the 
bowels  seemed  to  keep  up  the  disease.  A  couple  of  drachms  per 
diem,  in  barley  or  cungee  water,  will  diffuse  an  agreeable  sensation 
of  warmth  through  the  alimentary  canal,  and  increase  the  tone  of  the 
intestines. 


DYSENTERV.  171 

J^a  infusion  of  quassia,  or  other  light  bitter,  should  be  immediately 
commenced  on  leaving  off  the  mercury,  and  continued  till  the  sto- 
mach and  bowels  have  recovered  their  vigour.  This  should  never 
be  omitted. 

It  is  hardly  necessary  to  remark,  after  the  principles  I  have  laid 
down,  that  flannel  next  the  skin  is  indispensable,  and  that  the  most 
scrupulous  attention  in  avoiding  dews,  damp  night  air,  or  sudden  at- 
mospherical vicissitudes,  is  necessary  during  convalescence,  to  pre- 
vent a  relapse. 

la  no  disease  is  patience,  on  the  part  of  the  sick,  a  greater  virtue, 
or  more  calculated  to  forward  the  good  effects  of  medicine,  than  in 
dysentery.  If  obedience  be  paid  to  every  call  of  nature,  the  strain- 
ing which  ensues  is  highly  detrimental,  and  I  am  convinced,  augments, 
in  many  cases,  the  discharge  of  blood — -every  motion  of  the  body, 
indeed,  increases  the  desire  to  evacuate.  As  little  or  nothing,  ex- 
cept njucus  and  blood,  comes  away  in  four  efforts  out  of  five,  we 
should  endeavour  to  stifle  the  inclination  to  stool ;  and,  (as  I  know 
by  personal  experience,)  we  shall  often  succeed  ;  for  the  tormina  go 
off  in  a  few  minutes,  and  by  those  means  we  elude  not  only  \the 
straining,  but  the  painful  tenesmus  which  continues  so  long  after  eve- 
ry fruitless  attempt  at  evacuation.  This  circumstance,  though  appa- 
rently of  a  trifling  nature,  is  of  considerable  importance  ;  and  _.  et  it 
has  seldom  been  attended  to,  either  by  authors  or  practitioners.  It 
has  the  sanction  of  antiquity,  however,  as  may  be  seen  in  the  follow- 
ing precept  of  Celsus — "  Et  cum  in  omnijluore  ventris,  turn  in  hoc 
precipue  necessarium  est,  non  quoties  libet  desidere,  sed  quoties 
necesse  est ;  ut  h&cipsa  mora  in  consuetudinem  ferendi  oneris  intes- 
tina  deducat." — lib.  iv.  xm. 

In  the  chronic  dysenteries,  which  so  perplex  us  after  returning  from 
tropical  climates,  all  those  precautions  and  directions  detailed  under 
the  head  of  Chronic  Hepatitis,  (with  which  the  complaint  in  question 
is  generally  associated,)  will  be  found  well  worthy  of  attention — par- 
ticularly flannels  and  occasional  opiates. 

The  diet  in  dysentery  must  of  course  be  of  the  most  unirritating 
and  farinaceous  nature  ;  such  as  sago,  arrow  root,  rice,  &c.  A  very 
excellent  dish  for  chronic  dysenteries,  is  flour  and  milk,  well  boiled 
together,  which  with  a  very  little  sugar  and  spice,  is  highly  relished 
by  the  debilitated  patient. 

But  there  is  one  remark  applicable  to  this,  and  every  febrile  com- 
plaint, whatever  may  be  the  organ  most  affected  ;  namely,  that,  when 
convalescence  takes  place,  the  appetite  too  often  outstrips  the  diges- 
tion, and  so  do  chylification  and  sanguification  exceed  the  various  ex- 
cretions, so  as  to  occasion  a  dangerous  inequilibrium  between  assimi- 
lation and  secretion  ;  the  consequence  of  which  is,  that  the  weakest 
viscus,  or  that  which  has  suffered  most  during  the  previous  illness, 
becomes  overpowered,  and  relapse  ensues  1  This  is  the  great  error 
of  inexperience,  and  it  is  generally  seen  too  late  ! — I  appeal  to 
clinical  observation  for  the  truth  and  the  importance  of  these  re- 
marks. 

In  order  to  render  this  work  as  complete  as  possible  for  the  Tro- 
pical sojourner,  I  shall  add  to  this  section  two  Analytical  reviews, — 


J7-  EASTERN  HEMISPHERE. 

one  of  Mr.  BAMPFIELD'S  work  on  Dysentery  ;  the  other  of  Dr.  Ballin- 
gal's  Treatise. 

Ji  Practical  Treatise  on  Tropical  Dysentery,  more  particularly  as  it 
occurs  in  the  East  Indies  ;  illustrated  by  Cases  and  Appearances  on 
I)issection  :  to  "which  is  added,  a  Practical  Treatise  on  Scorbutic  Dysen- 
tery, with  some  Facts  and  Observations  relative  to  Scurvy.  By  R.  W. 
BAMPFIELD,  Esq.  Surgeon,  Author  of  an  Essay  on  Hemeralopia,  or 
Night  blindness  ;  and  formerly  Surgeon  of  the  Belliqueux  and  War- 
rior, His  Majesty's  Ships  of  the  Line,  serving  in  the  East  and  West 
Indies.  Octavo,  pp.  352.  London,  1819. 

The  work,  though  there  is  no  formal  division  of  chapters  to  that 
effect,  may  be  said  to  consist  of  three  parts.  The  1st  treats  of  acute, 
the  2d  of  ehronic  dysentery  :  and  the  3d  describes  another  species 
which  the  author  chooses,  (whether  rightly  or  not  will  appear  in  the 
sequel,)  to  denominate  scorbutic  dysentery.  1  shall  briefly  review 
each  of  these  in  the  order  here  mentioned. 

I  shall  begin  by  extracting  the  author's  description  of  the  species 
and  varieties  he  has  observed  in  tropical  dysentery,  whether  acute 
or  chronic. 

"  Species  1  ma.  Dysenteria  acuta.  Character ;  while  the  faeces  are 
commonly  retained,  frequent  evacuations  from  the  intestines,  consist- 
ing ef  mucus,  serum,  or  blood,  or  a  mixture  of  these,  take  place  ;  and 
are  preceded  and  attended  by  pain  in  some  part  of  the  abdomen,  and 
accompanied  and  followed  by  tenesmus  ;  pyrexia  is  not  often  evident, 
but  is  sometimes  urgent. 

•*  It  varies  in  degree.  (A.)  Dysenteria  mitis.  In  which  the  stools 
are  not  frequent ;  the  quantity  of  mucus  or  serum  evacuated  is  small, 
and  rarely  tinged  with  blood  ;  there  is  not  any  fever  present ;  and 
the  pain  of  the  abdomen  is  never  constant,  and  is  only  felt  together 
with  tenesmus,  about  the  periods  of  evacuation. 

"  (B.)  Dysenteria  severa.  In  which  the  stools  are  frequent,  and 
recur  from  twelve  to  forty-eight  times,  or  even  oftener,  in  twenty- 
four  hours  ;  the  excretions  of  mucus,  or  serum,  and  the  discharges 
of  blood,  or  a  mixture  of  these  three,  are  copious.  The  tenesmus 
and  tormina  about  the  periods  of  evacuation  are  severely  felt  ;  but 
there  is  no  constant,  fixed,  and  acute  pain  in  any  part  of  the  abdomen. 
or  unequivocal  synocha. 

'*  (C.)  Dysenteria  irtflammatoria.  In  which  there  is  a  constant, 
fixed,  acute  pain  of  some  part  of  the  abdomen  or  intestinal  canal, 
including  the  parts  contained  in  the  pelvis  ;  unequivocal  inflammato- 
ry fever,  (or  synocha  ;)  obstinate  retention  of  faeces,  while  there  are 
very  frequent  and  copious  dejections  of  mucus,  serum,  or  blood,  or 
a  mixture  of  these,  together  with  severe  tormina  and  tenesmus.  The 
blood  drawn  and  concreted  exhibits  the  inflammatory  buff. 

"  Species  2da.  Dytenteria  chronica.  The  acute  is  frequently 
succeeded  by  chronic  dysentery,  as  a  sequela  of  the  varieties  B  and 
C.  In  chronic  dysentery,  the  fasces  are  not  retained  ;  but  frequent, 
loose  faecal  stools,  (a  state  which,  for  brevity,  I  shall  term  diarrhoea,) 
ensue,  mixed  with  dysenteric  excretions,  and  accompanied  with  te- 
nesmus  and  tormina. 


UYSENTERY.  173 

18  Acute  dysentery  is  sometimes  followed  by  diarrhoea,  uncombin- 
•ad  with  dysenteric  excretions,  that  will  be  noticed  when  we  come  to 
the  treatment." 

"  Variety,  (A.)  In  which  diarrhoea  is  accompanied  with  an  uni- 
form continuance  or  a  frequent  recurrence  of  dysenteric  excretions, 
and  of  intestinal  pains  at  the  periods  of  evacuation." 

«*  (B.)  In  which  the  dysenteric  excretions  of  the  intestines  are 
continued  and  often  evacuated,  while  the  bowels  observe  regular  pe- 
riods of  discharging  fasces  of  natural  consistence  and  colour,  the  same 
as  in  health. 

"  (C.)  In  which  the  chronic  stage  of  dysentery  is  protracted  by 
an  ulceration  or  excoriation  of  the  intestines  :  the  diarrhoea  and  mor- 
bid secretions  are  maintained ;  and  pus  is  observed  in  the  evacua- 
tions." 

"  (D.)  In  which  the  chronic  stage  is  protracted  by  a  diseased  en- 
largement of  the  mesenteric  glands,  and,  with  the  following  variety, 
may  be  considered  symptomatic. 

"  (E.)  In  which  it  is  maintained  by  an  abscess  formed  in  one  of 
the  abdominal  viscera  or  their  membranes,  and  is  generally  accom- 
panied by  hectic  fever,"  p.  2,  3. 

This  arrangement  is  certainly  logical  and  luminous,  but  I  scarcely 
see  any  advantage  in  thus  splitting  down  diseases  into  so  many  minute 
varieties.  It  was  the  celebrated  Cullen  who  gave  currency  to  this 
custom  ;  swayed,  perhaps,  more  by  the  example  of  preceding  noso- 
logists,  than  by  his  own  excellent  judgment.  Of  some  diseases  this 
famous  physician  has  enumerated  as  many  varieties  as  there  are  ex- 
citing causes  !  Upon  the  whole,  1  greatly  doubt  whether  such  minute- 
ness of  diagnosis  is  often  possible,  or  if  it  be,  whether  it  is  of  any 
avail  in  actual  practice. 

I  shall  now  follow  the  author  into  his  account  of  the  first  or  acute 
species.  He  has  never  seen  any  thing  that  could  lead  him  to  suspect 
dysentery  to  be  contagious.  This  entirely  coincides  with  my  own 
observations,  and  not  with  mine  merely,  but  with  that  of  every  mo- 
dern practitioner  with  whom  I  am  acquainted.  The  opinion  of  Cul- 
len, Pringle,  Hunter,  Harty,  and  others,  upon  this  point  must  there- 
fore be  set  aside.  Either  the  dysenteries  of  their  day  was  a  differ- 
ent disease  from  what  it  now  is  ;  or  these  eminent  individuals  were 
betrayed  by  their  preconceived  idea-*,  into  a  mistake. — It  is  surely 
of  very  little  present  importance  which  of  these  alternatives  may  be 
the  truth  ;  for  opinions  must  now-a-days  be  decided  not  by  authority, 
but  by  the  touchstone  of  facts  carefully  observed  and  faithfully  re- 
corded. 

Mr.  Bampfield  very  candidly  admits  that  he  has  seldom  or  never 
found  scybalae  in  the  stools  of  dysenteric  patients.  This  is  another 
particular  in  which  his  observation  coincides  with  mine. 

The  author  goes  on  to  describe  the  symptoms  that  affect  the  tongue 
and  fauces,  the  stomach,  intestines  and  liver,  the  urinary  organs,  the 
vascular  and  nervous  systems,  together  with  the  appearances  on  dis- 
section in  dysentery.  What  he  has  advanced  on  these  subjects  is  ex- 
ceedingly accurate'and  methodical,  but  not  particularly  new.  1  shall 


174  EASTERN  HEMISPHERE. 

therefore  pass  this  part  altogether,  as  I  shall  also  the  chapters  on  di- 
agnosis and  prognosis,  and  proceed  at  once  to  his  observations  on  the 
predisposition  to  this  disease.  He  is  of  opinion  that  the  predisposition  to 
an  increased  secretion  from  the  lining  membrane  of  the  organs  of  smell 
and  respiration  in  Europe,  becomes  in  India  a  predisposition  to  an  in- 
creased secretion  from  the  villous  coat  of  the  intestines.  Hence  fluxes 
are  as  common  in  the-latter  climate  as  coughs  and  colds  are  in  the  former. 
This  conversion  or  change,  in  the  locale  of  increased  action,  he  thinks 
.chiefly  attributable  to  the  indulgences  in  heavy  and  stimulating  diet, 
and  the  imprudent  exposures  to  the  night  air,  of  which  the  unwary 
European  newly  arrived  from  his  native  climate,  is  wont  to  be  guilty. 
Atmospheric  vicissitudes,  by  checking  perspiration,  produce  a  similar 
detrimental  effect.  I  do  not  recollect  that  the  following  circum- 
stance has  ever  been  noticed  heretofore  as  a  predisposing  cause  of 
dysentery  : 

"  The  copious  perspiration  of  the  newly  arrived  European  be- 
comes accumulated,  when  he  is  sitting  or  walking,  on  the  lower  part 
of  the  shirt,  more  especially  about  that  part  of  the  abdomen  where 
the  waistband  of  the  small  clothes  or  pantaloons  presses  against  it, 
the  tight  or  close  application  of  which  occasions  an  increase  of  heat 
and  of  perspiration  at  this  particular  part,  during  the  day,  and  inter- 
cepts the  exhalation  as  it  flows  down  the  body  ;  hence  if  he  should  lie 
down  in  this  state,  cold  will  be  induced  on  a  particular  part  of  the 
abdomen,  by  the  evaporation  of  the  exhaled  fluid  from  the  wet  linen 
in  contact  with  it ;  perspiration,  before  profuse,  will  be  now  effec- 
tually suppressed,  and  its  injurious  consequences  be  felt  by  the  chy- 
lopoetic  viscera,"  p.  69. 

According  to  our  author's  observations,  the  stools  in  dysentery  are 
more  frequent  during  the  night,  and  especially  towards  morning  than 
at  any  other  period  of  the  twenty-four  hours.  This  he  seems  in- 
clined to  ascribe  to  "  solar  influence." 

u  The  periods  of  dysenteric  attacks  and  relapses  I  have  observed 
to  be  more  common  at  the  plenilunar  and  novilunar  periods,  than  at 
the  interlunar  intervals.  But  whether  the  increased  attraction  of 
the  moon,  at  the  change  arid  full,  has  any  direct  power  in  producing 
diseases,  I  believe  will  never  be  satisfactorily  determined  ;  and  not- 
withstanding the  ingenious  hypothetical  explanations  of  Dr.  Balfour, 
Dr.  Darwin,  and  others,  I  am  induced  to  conclude  that  it  h&s  only  an 
indirect  influence  or  power  by  the  changes  which  it  occasions  aj: 
those  periods  on  the  atmosphere  and  winds;  for  the  prevalence  of 
fresh  winds,  strong  gales,  and  showers  of  rain,  has  been  observed  to 
be  much  greater  at  these  periods  of  the  moon,  than  at  the  interlunar 
intervals  ;  and  these  by  checking  perspiration,  produce  effects  on 
the  constitution  excitive  of  many  acute  diseases,  which  have  been  in 
part  ascribed  to  the  direct  agency  of  lunar  attraction  on  the  fluids  of 
the  body,  by  supposing  that  it  decreases  the  gravity,  and  diminishes 
the  stimulus,  of  the  particles  of  the  blood,"  p.  8-1. 

With  regard  to  the  proximate  cause,  our  author  seems  to  be  of 
opinion  that  dysentery  is  to  all  intents  and  purposes  inflammation  :  or 
if  these  two  diseases  are  not  exactly  identical,  that,  at  least  the  former 
is  attended  with  analogous  symptoms  and  actions  of  vessels,  and  is 


DYSENTERY.  175 

followed  by  similar  consequences  as  inflammatory  action  of  other  or- 
gans of  the  body.  What  tends  to  confirm  him  in  this  theory  is  the 
disclosure  so  often  made  by  dissection.  On  examining  the  body  after 
death  we  find  visceral  enlargements  and  adhesions,  a  blood-shot  ap- 
pearance of  the  intestines,  ulcers,  abscesses,  and  sometimes  mortifi- 
cation, similar  to  what  are  observed  after  inflammation  of  other  parts 
external  or  internal.  These  appearances  are  very  striking,  yet  we 
hold  them  to  be  equivocal.  Mr.  B.  like  many  others,  has  been  de- 
ceived by  confounding  the  ultimate  changes  with  the  primary  diseas- 
ed movements.  I  am,  in  every  case,  inclined  to  regard  inflammation 
rather  as  a  sequence  than  a  cause  of  dysentery,  as  a  contingent  ef- 
fect, and  not  as  a  uniform  result.  Indeed  the  author  goes  nigh  to  ad- 
mit this  ;  for  in  order  to  make  good  his  theory  he  is  obliged  to  extend 
the  term  inflammation  to  every  increased  action  of  the  capillary  ves- 
sels of  secreting  membranes.  He  says, 

"  Those  who  do  not  choose  to  admit  inflammatory  action  to  be,  in 
all  cases,  the.  proximate  cause  of  dysentery,  in  mild  and  less  severe 
cases,  still  call  it  an  increased  and  morbid  excretion  of  the  capillary 
vessels  of  the  intestines,  although  it  is  assuredly,  equally  philosophi- 
cal to  denominate  this  action  in  dysentery  inflammatory,  as  it  is  the 
action  of  the  minute  secreting  vessels  of  the  urethral  membrane  in 
gonorrhoea,  or  of  the  membranes  of  the  bronchia  and  nose  in  ca- 
tarrh ;  for  in  mild  cases  of  those  diseases,  the  pain  accompanying 
them  is  not  constant  and  acute,  nor  accompanied  with  fever,  or  hard 
pulse  ;  nor  are  recoveries  often  doubtful,1'  p.  90. 

But  although  it  may  be  incorrect  in  speculation  to  view  dysentery 
and  inflammation  as  one,  it  will  generally  be  safe  in  practice  to  apply 
to  the  former  the  same  principles  of  treatment  as  to  the  latter.  We 
should  never  forget  that  a  disease,  though  not  primarily  inflamma- 
tory, may  often  have  a  strong  tendency  to  run  into  that  state.  This 
I  believe  to  be  the  case  in  dysentery  ;  consequently  we  should  use 
the  lancet  as  boldly  in  the  early  stage  of  that  disease,  as  we  do  in  se- 
vere cases  of  spasmodic  colic,  and  with  the  same  views,  namely,  to 
remove  pain  ;  and,  (above  all,)  to  prevent  inflammation.  Whenever 
the  pulse  and  heat  are  high,  and  the  abdomen  painful  on  pressure, 
that  is  to  say  permanently  painful  on  pressure,  and  the  pain  is  con- 
fined to  any  given  point,  there  is  reason  to  fear  that  local  inflamma- 
tion is  begun  there  ;  and  thenceforward  it  behoves  us  to  subdue  it 
by  vigorous  depletion.  The  mere  intensity  of  the  febrile  symptoms, 
considered  per  se,  is  by  no  means  to  be  neglected  ;  for,  as  the  author 
judiciously  observes,  "  fever  rarely  exists  in  the  tropics  without 
being  occasioned  by  local  inflammation  or  determination." 

This  leads  me  to  speak  more  in  detail  of  the  mode  of  cure  laid 
down  by  Mr.  Bampfield.  The  remedies  he  trusts  to  are,  1st.  bleed- 
ing ;  2d.  cathartics  ;  3d.  diaphoretics  ;  and  4th.  mercurials.  He 
discusses  these  under  separate  heads,  and  each  of  them  at  considera- 
ble length.  His  remarks  on  blood-letting  are  singularly  valuable,  and 
have  my  cordial  approbation.  I  think  he  has  deserved  well  of  the 
profession  for  the  pains  he  has  taken  to  introduce  this  remedy  to  m%re 
general  attention.  It  is  gratifying  to  think  that  experience,  on  matters 
of  great  importance,  is  always  uniform  ;  and  that  where  it  finds  men 


176  EASTERN  HEMISPHERE. 

willing  to  obey  its  dictates,  it  always  conducts  them  to  the  same  mode 
of  practice.  For  instance,  it  wa?  not  by  any  preconcerted  opinions 
that  Mr.  Bampfield  was  induced  to  employ  the  lancet  in  dysentery  ; 
but  by  the  careful  observation  of  actual  cases.  I  can  say  the  same 
thing  of  myself  for  experience  led  me  to  the  same  conclusions  with 
those  here  stated  by  the  author.  1  well  recollect  the  reluctance  and 
trepidation  with  which  1  first  "  wetted  a  lancet"  in  a  disease  where  it 
had  been  totally  proscribed  by  the  concurrent  authority  of  all  those 
authors  whose  works  on  the  subject  were  most  esteemed.  "  We 
watched  the  patient,  (says  the  Reviewer  in  the  Medico-Chirurgical 
Journal,*)  in  anxious  dread  of  those  formidable  consequences  which 
has  been  alleged  to  follow  venesection.  But  the  result  was  quite 
contrary  to  what  we  had  been  taught  to  expect  ;  for  all  the  severe 
symptoms  were  greatly  mitigated  by  the  evacuation.  Emboldened  a 
little  by  success,  we  began  cautiously,  but  regularly,  to  employ  blood- 
letting whenever  the  state  of  the  pulse  and  the  heat  of  skin  seemed,  on 
general  principles,  to  warrant  it ;  and  ere  long  we  found  that  dysentery, 
from  being  an  unmanageable  and  baffling  disease,  was  converted  into  a 
form  much  more  responsible  to  the  ordinary  medical  treatment.  Even 
when  the  quantity  of  blood  evacuated  by  stool  was  so  considerable  as 
to  cause  debility  or  prostration  of  strength,  we  did  not  refrain  from  the 
lancet ;  nay,  we  considered  the  use  of  it  to  be  rendered  if  possible, 
more  imperative  on  that  account ;  for  we  viewed  the  haemorrhage 
from  the  intestines  to  be  active  in  its  nature,  and  thought  it  as  incum- 
bent upon  us  to  check  it  by  venesection,  as  it  is  to  check,  (by  bleed- 
ing at  the  arm,)  haemoptysis,  or  any  other  internal  haBtnorrhage.  We 
are  convinced  that  four  ounces  of  blood  lost  by  the  anus  causes  more 
debility  than  four  and  twenty  lost  by  the  arm.  We  look  upon  blood- 
letting to  be  a  very  great  improvement  in  the  modern  treatment  of 
dysentery.  We  give  the  praise  of  it  to  modern  times,  because,  al- 
though it  was  practised  and  recommended  by  Sydenham,  we  greatly 
doubt  whether  the  limited  quantities  he  was  in  the  habit  of  taking 
away,  could  have  exerted  any  very  marke  1  benefit  on  the  disease.  It 
is,  we  believe,  to  Dr.  Whyte  that  the.  profession  are  indebted  for  hav- 
ing shown  the  perfect  safety  of  this  remedy  ;  and  had  this  gentleman 
lived  to  publish  more  extensively  upon  his  experience,  we  have  little 
doubt  that  venesection  would  have  been  earlier  and  more  effectively 
adopted  in  military  and  naval  practice  than  it  has  been.  But  the 
premature  death  of  this  lamented  individual,  from  inoculating  himself 
with  the  matter  of  a  plague  bub  >,  cut  him  short  in  the  middle  of  his 
honourhle  career  ;  and  the  air  of  rashness  which  attended  the  circum- 
stances of  his  decease,  induced  many  to  discountenance  the  practice, 
(stated  in  his  letter  to  H.  R.  H.  the  Duke  of  York  ;  see  Med.  and 
Phys.  Journal,  vol.  ii.)  of  bleeding  to  syncope  in  dysentery,  as  the 
hazardous  experiment  of  a  well-meaning,  but  hot-headed  medical 
enthusiast.  In  consequence  of  this  prejudice,  blood-letting  never 
became  fully  established  as  a  remedy  in  this  disease  until  the  late 
Peninsular  campaigns.  Experience  there  pointed  out  to  military 
medical  gentlemen  a  similar  mode  of  treatment  to  what  had  suggest- 

*  I  may  here  state  the  Reviewer's  name— Dr.  Archibald  Robertson  of  North- 
tmpton. 


177 

a  itself  to  Mr.  Bampfield  and  others  of  his  naval  brethren  employed 
within  the  tropics.  The  whole  of  our  author's  section  on  this  subject 
is  so  excellent,  that  we  are  at  a  loss  what  paragraph  to  extract  in  pre- 
ference to  another.  We  take  the  following  passages  almost  at  ran- 
dom." 

'*  In  dysentery  it  happens  that  a  certain  degree  of  debility  must  be 
induced  either  by  the  antiphlogistic  regimen,  or  by  the  protracted 
disease  gradually  exhausting  the  animal  and  vital  powers  ;  hence 
it  is  thought  preferable  to  induce  a  certain  degree  of  it  at  once,  (by 
bleeding,  to  wit,)  and  thus  put  a  speedy  termination  to  the  disorder, 
and  prevent  the  distressing  and  sometimes  fatal  effects  of  the  chronic 
stage." 

"  In  this  disease,  venesection  is  said  to  be  injurious  by  Dr.  J. 
Clarke,  (p.  324,  325,)  and  probably  his  authority  has  given  rise  to 
the  neglect  and  omission  of  the  practice.  He  admits  that  "  no  eva- 
cuation is  better  calculated  for  the  relief  of  the  patieat,  when  the  dis- 
ease is  accompanied  with  a  fever  of  the  inflammatory  kind.  But,  in 
hot  climates,  fluxes  being  either  of  a  chronic  nature,  or  accompanied 
with  a  low  fever,  the  strength  of  the  patient  sinks  from  the  begin- 
ning." 

It  is  granted  that  there  is  a  peculiar  sensation  of  debility,  the  com- 
panion of  the  very  severe  and  inflammatory  varieties  of  dysenterys 
resembling  what  occurs  in  enteritis,  and  this  sensation  is  maintained 
and  increased  by  the  constant  dysenteric  evacuations,  the  severe 
pains,  the  want  of  sleep,  and  the  exhaustion  of  the  sen.«orial  power 
in  the  sensitive  and  irritative  motions  :  but  as  no  judivious  practi- 
tioner is  deterred  from  bleeding  by  the  peculiar  sensation  of  debility 
attending  gastritis  and  enteritis,  so  let  no  one  be  deterred  from  em- 
ploying it  in  the  inflammatory  forms  of  dysentery.  It  has  been  al- 
ready remarked,  that  the  chronic  stage  is  generally  a  sequela  to  the 
severe  and  inflammatory  varieties,  if  their  acute  stage  be  not  arrested 
and  cured.  If  bleeding  be  not  employed  in  the  inflammatory  varie- 
ty, either  death,  or  a  very  long  chronic  stage,  almost  invariably  en- 
sues. Hence  bleeding  often  does  away  with  the  "•  chronic  nature  of 
fluxes."  I  have  not  observed  that  the  "  fever"  which  accompanies 
dysentery  is  particularly  "  low  :"  however,  Dr.  Cullen,  in  his  JYo- 
sology  has  enumerated  "  typhus  fever"  as  a  characteristic  symptom 
of  enterit^,  but  he  nevertheless  recommends  bleeding  for  its  cure. 
The  author  adds — 

"  Venesection  can  be  dispensed  with  in  the  milder  and  safer  forms 
of  dysentery,  where  the  symptoms  of  inflammation  are  not  present, 
where  the  pain  is  only  occasional,  and  the  evacuations  are  not  copi- 
ous nor  frequent :  these  varieties  will,  in  general,  yield  to  the  other 
remedies  employed  for  the  cure  of  dysentery,"  p.  1 10,  111,113. 

I  cannot  bestow  so  much  commendation  upon  our  author's  chap- 
ter on  cathartics  as  upon  that  on  bleeding.  I  conceive  the  purgatives 
recommended  by  him  to  be  far  too  drastic  and  stimulating  ;  and  1  en- 
tertain very  serious  doubts  whether  jalap,  extract  of  colocynth,  or 
infusion  of  senna,  can  be  with  propriety  employed  in  any  stage  of 
dysentery.  Surely,  on  his  own  notions  as  to  the  strictly  inflammato- 
ry nature  o£  the  disease,  these  medicines  must  be  highly  unsuitable  ; 

23 


178  EASTERN    HEMISPHERE. 

for  would  it  not  follow,  from  his  doctrine,  that  they  should  aggravate 
the  symptoms  ?  What  practitioner  will  venture  to  prescribe  drastic 
purgatives  in  enteritis,  or  to  excite  vehement  action  in  an  intestine 
whose  calibre  is  already  inflamed  ?  If  it  is  necessary  to  give  rest  to 
an  inflamed  muscle,  or  to  withhold  the  stimulus  of  light  from  an  ir- 
ritable eye,  it  i*  no  less  necessary  to  tranquillize  and  soothe  the  bow- 
els by  all  the  means  in  our  power.  In  dysentery,  when  purgatives 
are  necessary,  (and  generally  they  are  indispensable,)  I  never  em- 
ploy any  other  than  those  of  a  mild  and  lubricating  nature.  Castor 
oil  is  almost  the  only  one  that  i*  proper  ;  and  when  it  is  necessary 
to  increase  its  activity,  (hat  can  be  readily  accomplished  by  adding  to 
it  a  few  grains  of  calomel.  Indeed  Mr.  B.  himself  is  fully  aware  of 
the  virtues  of  this  medicine. — The  following  passage  is  an  excellent 
one,  though  rather  at  variance  with  his  recommendation  of  the  dry 
and  more  acrid  purgatives. 

41  The  oleum  ricini  is  perhaps  better  calculated  to  afford  relief 
in  dysentery,  than  any  other  aperient  or  cathartic  ;  for  its  action  is 
not  only  mild  and  generally  effectual,  but  I  have  observed  that  some 
of  it  passes  undecomposed,  in  its  oily  form,  through  the  intestines, 
and  appears  on  the  surface  of  the  excrement,  and  hence  may  serve 
as  a  sort  of  sheather  or  defence  to  the  diseased  intestines,  from  the 
stimulus  of  faeces  and  morbid  secretions,"  p.  124. 

The  observations  on  diaphoretics  contain  nothing  new  ;  we  shall 
therefore  pass  on  to  the  subject  of  mercurials. 

The  author  has  been  in  the  habit  of  prescribing  calomel,  but  he 
seldom  gives  it  alone.  He  thinks  it  greatly  better  to  combine  it  with 
other  purgatives,  or  with  ipecacuanha.  This  remedy  is  generally 
given  with  the  view  of  correcting  the  condition  ot  the  liver  ;  for  all 
practitioners  concur  in  thinking  that  the  function  of  this  mighty  gland 
is  greatly  depraved  in  dysentery,  though  they  may  differ  in  opinion 
as  to  the  relative  importance  of  this  depraved  state — some  regarding 
it  as  the  primary  cause  of  the  symptoms  ;  and  others  viewing  it 
merely  as  one  link  in  the  chain  of  effects  It  would  probably  be 
alike  tiresome  and  unprofitable  to  the  readers  were  I,  in  this  place, 
to  enter  into  minute  discussions  on  the  subject.  I  shall  therefore 
wave  the  matter  altogether,  only  remarking  that  I  suspect  the  liver 
has  not,  till  lately,  been  allowed  its  due  share  of  importance  among 
the  pheRomena  of  this  disease.  I  am  persuaded  that  much  of  the 
exquisite  pain  and  tormina  is  assignable  to  vitiated  bile  passing  over 
the  irritable,  excoriated,  or  ulcerated  surface  of  the  intestines  ;  for 
I  do  not  see  how  otherwise  the  pain,  which  succeeds  the  fullest  ope- 
ration of  a  cathartic,  is  to  be  accounted  for.  The  renal  discharges 
also  afford  an  additional  presumption  that  unhealthy  bile  performs  an 
important  part  in  the  malady.  When  the  urine  is  collected,  it  is  ge- 
nerally of  a  green  or  yellowish  colour,  and  tinges  linen,  evidently 
from  the  admixture  of  bile  ;  and  it  is  generally  passed  with  conside- 
rable heat  and  smarting.  The  latter  uncomfortable  sensation  is  al- 
ways ascribed  to  sympathy  betwixt  the  rectum  and  bladder  ;  but  in- 
stead of  taking  for  granted  that  tenesmus  is  the  cause  of  the  difficult 
micturition,  it  is  more  reasonable  to  believe  that  the  bile,  mixed  with 
urine,  is  the  occasion  of  that  teasing  phenomenon. 


DYSENTERY.  179 

The  mercurial  preparations  prescribed  in  dysentery  are  found  to 
produce  a  solution  of  the  disease  ;  but  whether  they  do  so  by  recti- 
fying the  hepatic  secretion,  or  by  producing  some  more  secret  and 
inexplicable  change  in  the  system  at  large,  is,  at  present,  quite  un- 
known. One  thing,  however,  is  certain  : — as  soon  as  ptyalism  takes 
place,  the  disease  generally  disappears  as  a  matter  of  course. 

In  consequence  of  this  last  fact  being  so  universally  noticed,  some 
practitioners  have  directed  their  views  to  salivation  as  the  sole  indica- 
tion of  cure,  and  have  boldly  prescribed  calomel  alone  in  doses  of 
one  scruple  twice  or  thrice  a  day. 

**  I  myself,"  says  Dr.  Robertson,  "  have  employed  the  scruple 
doses  in  the  dysentery  of  the  western  hemisphere,  and  have  seen  it, 
in  the  great  majority  of  instances,  produce  all  the  benefit  which  Dr. 
Johnson  taught  us  to  expect.  It  deserves  to  be  remarked,  however^ 
that  it  is  a  practice  only  adapted  to  tropical  climates,  for  there  the  hu- 
man frame  is  much  less  susceptible  of  the  action  of  mercury,  and 
consequently  will  bear  much  larger  doses  of  that  metal  than  it  would 
be  prudent  to  prescribe  in  the  climate  of  this  country.*' 

I  frankly  admit,  indeed,  that  the  first  stage  of  dysentery  cannot  be 
treated  on  principles  too  strictly  antiphlogistic  ;  but  I  contend,  that 
when  the  second  stage  has  commenced,  or  in  other  words,  when  the 
previous  increased  action  has  ended  in  congestion,  nothing  can  be 
more  useful  than  to  saturate  the  system  with  mercury.  This  mine- 
ral does  more  to  resolve  irritative  fever,  to  equalize  the  circulation, 
disgorge  the  capillary  vessels,  restore  the  balance  of  the  nervous 
power,  and  open  the  sluices  of  the  various  healthy  secretions  and  ex- 
cretions, than  any  other  remedy  with  which  I  am  acquainted.  Be- 
sides, it  should  be  remembered,  that  calomel  is  a  restringent  as  well 
as  a  cholagogue,  and  that  its  efficacy  consists  as  much  in  restraining 
and  rectifying  the  biliary  and  intestinal  secretions,  when  they  are 
excessive  or  morbid,  as  in  exciting  and  augmenting  them  when  they 
happen  to  be  torpid  or  too  scanty. 

*'  The  propriety  of  impregnating  the  constitution,"  says  Dr.  Ro- 
bertson, "  then  being  admitted,  the  only  question  of  importance  is, 
how  it  is  to  be  done  most  speedily  ?"  1  answer  with  confidence,  says 
he,  "  By  means  of  calomel  in  scruple  doses,  night  and  morning." 
*'  We  should  recollect  that  the  cases  to  which  alone  this  practice  is 
applicable,  are  pregnant  with  great  distress  and  danger,  and  that,  con- 
sequently, delays  are  dangerous.  Nothing  but  the  most  energetic 
practice  will  prove  available  to  save  life,  and  that  evea,  in  too  many 
instances,  fails.  Upon  the  whole,  deferring  to  Mr.  Bampfield's  judg- 
ment and  experience,  but  at  the  same  time  abiding  by  my  own,  I  must 
take  the  liberty  to  declare,  that  I  consider  ail  his  fears  about  exces- 
sive salivation,  hypercatharsis,  and  so  forth,  as  the  results  of  this 
new  practice,  to  be  entirely  illusory.  His  opinion  that,  "  the  induc- 
tion of  salivation  is  incompatible  with  a  high  degree  of  inflammation," 
not  only  takes  for  granted  the  correctness  of  his  own  theory  of  dy- 
senterj,  but  is  in  itselt  perhaps  little  better  than  a  hypothesis.  Be- 
sides, it  carries  no  weight  with  it  as  an  objection  ;  because,  where  is 
the  practitioner  that  would  proceed  to  mercurialize  the  system  until 
he  has  reduced  the  existing  febrile  excitement  ?  Neither  myself,  nor 


180  EASTERN    HEMISPHERE. 

Dr.  Johnson,  have  ever  administered  scruple  doses  or  any  other 
doses  of  calomel,  with  an  attempt  to  salivate,  without  premising  active 
depletion  both  by  blood-letting  and  purgatives." 

His  chapter  on  chronic  dysentery,  is  chiefly  valuable  on  account  of 
the  clearness  and  earnestness  with  which  he  prints  out  the  necessity 
of  dietetic  restrictions  as  auxiliary  to  the  medicines  employed.  He 
details  several  very  illustrative  cases,  where  irregularities,  whether 
in  eating  or  drinking  brought  on  fatal  relapses. 

•'  The  evil  and  aiortal  consequences  resulting  from  intemperance, 
imprudent  indulgences  of  the  appetite,  and  of  the  social  disposition, 
have  been  depicted  in  treating  of  the  variety  A  :  these  errors  are 
more  pernicious  in  this,  and  the  necessity  of  a  most  regular  and 
temperate  life,  and  of  a  strict  dietetic  regimen  is  consequently 
greater.  Obstinate  or  ill  fated  patients  are  sometimes  met  withs 
who  cannot  be  persuaded,  or  induced  by  sufferings,  to  a  proper  diet 
I  have  sometimes  eluded  the  bad  effects  of  their  folly  and  obstinacy, 
by  keeping  up  a  slight  mercurial  soreness  of  mouth,  which  has  com- 
pelled them  to  relinquish  solid  food,  and  to  live  on  broths  and  fari- 
naceous preparations  of  diet,  so  long  as  to  allow  of  a  favourable  state 
of  quiescence  to  the  bowels,  and  to  admit  of  the  establishment  of  a 
healty  action  of  the  ulcer  in  the  intestines.  We  have  no  indirect 
means  of  adroitly  warding  off  the  fate  of  the  determined  inebriate, 
and  can  only  succeed  by  resolute  compulsion,"  p.  242. 

Perhaps  the  most  original  portion  of  the  volume  is  the  part  that 
treats  of  scorbutic  dysentery.  I  read  it  with  very  great  pleasure, 
and  give  Mr.  Bampfield  the  highest  praise  for  the  number  of  curious, 
instructive,  and  interesting  facts  which  he  has  collected  on  the  sub- 
ject of  scurvy.  Yet  I  have  doubts  as  to  the  correctness  of  his  no- 
menclature, when  he  speaks  of  scorbutic  dysentery  :  I  indeed  suspect 
that  it  ought  rather  to  be  considered  an  accidental  co-existence  of  the 
two  diseases  in  the  same  subject,  than  a  distinct  and  specific  variety 
of  dysentery.  This,  however,  is  in  a  great  measure,  matter  of  opi- 
nion. 

He  relates  some  singular  cases,  where  scurvy  appeared  in  the  men 
in  a  week,  or  less,  after  putting  to  sea  ;  and  others,  where  the  sea 
air  was  the  only  obvious  cause.  The  pathology  of  scurvy  is  still 
very  obscure,  notwithstanding  all  the  experience  of  the  late  war; 
that  neither  salt  meat,  sea  air,  nor  atmospheric  heat  is  indispensably 
necessary  to  the  production  of  the  disease,  is  proved  by  what  Dr. 
Gregory  relates  of  a  family  that  came  under  his  observation,  who 
suffered  severely  from  scurvy,  during  a  season  of  dearth,  in  conse- 
quence of  their  chief  diet  having  been  tea.  They  had  used  it  three 
times  a-day. 

Notwithstanding  my  objections  to  some  ef  Mr.  B.'s  doctrines,  1 
entertain  a  high  opinion  of  his  work.  The  talent,  learning,  and  sa- 
gacity it  displays,  will  render  it  a  rich  treat  to  those  who  are  fond  of 
a  well-written  and  well-digested  treatise  on  this  fatal  disease.  To 
th«m  I  conclude  by  recommending  it." — Med.  Cnir.  Journal,  Vol.  1. 


DYSENTERY.  181 

Analytical  Review  of  Dr.  BALLING  AL'S  Observations  on  DYSENTERY, 

Dr.  Ballinga!  objects,  in  limine,  and  well  he  may,  to  Dr.  Gullen'a 
definition  of  dysentery,  at  least  as  it  appears  in  India,  and  we  may 
add,  in  Europe.  In  our  eastern  colonies,  he  observes,  this  disease 
often  makes  considerable  devastation  on  the  intestinal  canal  before 
pyrexia  becomes  evident ;  and  as  to  its  contagious  nature,  it  is  totally 
unnecessary  to  mention  the  absurdity  ot  the  opinion,  once  so  cur-< 
rently  adopted,  and  even  yet  pertinaciously  retained  by  a  few  indi- 
viduals. **  The  appearance  of  «cybalaB,  another  striking  feature  of 
the  disease,  as  characterized  in  Europe,  is  comparatively  a  rare  oc- 
currence in  India."  I  would  ask  Mr.  Ballmgal,  if  his  own  post  mor- 
tem examinations,  or  personal  observations,  confirm  this  story  of  scy- 
balaB  in  European  dysentery  ?  1  can  only  say,  that  during  the  late 
war,  chance  threw  me  in  the  way  of  opening,  and  seeing  opened, 
seme  hundred  bodies  who  died  of  dysentery  in  Europe  ;  and  1  can 
safely  assert,  that  scybalae  are  as  infrequent  here  as  in  India.  We 
thus  see  how  error  may  be  propagated.  The  above  distinction,  which 
exists  only  in  books,  and  in  Mr.  Ballingal's  imagination,  is  brought 
forward  as  a  proof  that  tropical  and  Hyperborean  dysentery  are  dif- 
ferent diseases ! 

Dysentery  then,  in  our  Indian  territories,  is  divided  into  two  varie- 
ties ;  colonitis,  (not  necessarily  implying  the  existence  of  any  dis- 
charge from  the  bowels,)  and  hepatic  flux. 

It  is  colonitis,  which,  according  to  our  author,  makes  the   greatest 
ravages,  at  first,  among  the  European  troops.     The  causes  are  con- 
ceived to  be  "  Heat,  particularly  when  combined  witlj  moisture  ;  the 
immoderate  and  indiscriminate  use  of  fruits  ;  the  abuse  of  spirituous 
liquors  ;  exposure  to  currents  of  wind  an4  noxious  high  dews."     But 
without  attempting  to  account  satisfactorily  for  colonitis,  our*  author 
proceeds  to  a  description  of  the  disease,  taken  from  the  Critical  Re- 
view for   1802,  as  given  in  the  extract  of  a  letter  to  Sir  Walter  Far- 
quhar.     The  writer  of  this  letter  states,  that  the  disease  is  attended 
from  the  beginning  with  a  severe  fixed  pain  above  the  pubes,  attended 
with  extreme  difficulty  of  making  water,  and  frequently  an  entire  sup- 
pression of  urine.     There  is,  at  the  same  time,  a  violent  and  almost 
unceasing  evacuation  from  the  bowels,  of  a  matter  peculiar  to  the 
disease,   and  which  exactly   resembles  the  washings  of  raw  flesh. 
High  fever,  unquenchable  thirst,  and  perpetual  watching,  attend  the 
complaint.     The  pulse  is  hard  and  strong,  resembling  that  in  the 
highest  degree  of  pleurisy,  or  acute   rheumatism.     The  fixed  pain 
above  the  pubes  ;  the  peculiar  evacuation  ;  and  the  suppression  of 
urine,    may,  it  is  thought,  be  considered  pathognomonic  of  this  dis- 
ease.    From  dissection,   the  colon  seems  to  be  primarily  affected  ; 
and  the  bladder  suffers  only  from  communication,  as  the  lower  part 
of  the  large  intestine  is  generally  inflamed.     "  Bleeding  seems  use- 
ful ;  but  opium  given  in  the  commencement  is  the  most  effectual 
remedy."     if  omitted  till  the  fever  supervenes  it  is  injurious,  and 
can  only  be  administered  towards  the  decline  of  the  disease.     The 
remedies  then  are  emollient  glysters  and  drinks,  with  fomentations 
above  the  pubes,  which  are  more  useful  than  blisters. 


182  EASTERN  HEMISPHERE. 

It  has  only  happened  to  Mr.  Ballingal  to  meet  the  disease  with 
these  highly  inflammatory  symptoms,  where  it  occurred  as  a  conse- 
quence of  hard  drinking,  and  where  it  had  made  considerable  pro- 
gress before  medical  assistance  was  called  in. 

"  The  form  of  flux,  now  under  consideration,  commences  in  gene- 
ral with  much  of  the  appearance  of  a  common  diarrhoea  ;  frequent 
and  unseasonable  calls  to  stool,  with  an  irresistible  inclination  to  strain 
over  it.  The  evacuations  are  generally  copious,  of  a  fluid  consis- 
tence, without  any  peculiar  foetor  ;  sometimes  streaked  with  blood, 
and  at  other  times  a  small  quantity  of  blood  is  voided  in  a  separate 
form,  unmixed  with  the  faecal  matter.  The  pulse  in  this  stage  of  the 
disease,  is  seldom  altered  ;  the  heat  of  the  skin  not  perceptibly  in- 
creased, and  the  tongue  is  frequently  but  little  changed  in  its  appear- 
ance. There  is  always  a  great  prostration  of  strength  and  depres- 
sion of  spirits  ;  the  former  symptom  being  always  strongly  dwelt  upon 
by  the  patient  ;  the  appetite  is  indifferent,  and  thirst  urgent.  To 
these  symptoms  succeed  a  fixed  pain  in  the  hypogastrium,  more  or 
less  acute  :  the  pain  sometimes  extending  to,  and  peculiarly  urgent 
in  one  or  both  the  iliac  regions  ;  and  sometimes  to  be  traced  along 
the  whole  course  of  the  colon,  with  a  sense  of  fulness,  tension,  and 
tenderness  upon  pressure  ;  and  on  applying  the  hand  to  the  surface 
of  the  abdomen,  a  preternatural  degree  of  heat  is  frequently  percep- 
tible in  the  integuments  ;  the  evacuations  now  become  more  frequent, 
and  less  copious  ;  they  consist  chiefly  of  blood  and  mucus,  or  are 
composed  of  a  peculiar  bloody  serum,  which  has  very  aptly  been 
compared  to  water  in  which  beef  has  been  washed  or  macerated.  A 
suppression  of  urine  and  distressing  tenesmus  now  become  urgent 
symptoms  ;  the  indifference  to  solid  food  increases,  while  there  is  an 
uncontrollable  desire  for  liquids,  particularly  cold  water,  which  the 
patient  i  prefers  to  any  drink  that  may  be  offered  to  him,  and  from 
which  he  expresses  his  inability  to  refrain,  although  prepossessed 
with  the  idea  of  its  being  injurious.  The  tongue  is  now  generally 
white,  and  furred  ;  sometimes,  however,  exhibiting  a  florid,  smooth, 
and  glassy  appearance,  with  a  tremulous  motion  when  thrust  out  ; 
the  skin  is  either  parching  hot,  so  as  to  render  it  even  painful  to  re- 
tain the  hand  in  contact  with  it,  or  covered  with  profuse  perspiration, 
insomuch  that  it  may  often  be  observed  standing  in  large  drops  on 
the  surface  ;  the  pulse  is  still  frequently  but  little  affected  ;  some- 
times, however,  it  assumes  a  febrile  quickness,  without  any  other 
remarkable  feature  ;  at  other  times  it  will  be  found  without  any  in- 
crease of  velocity,  but  full,  and  bounding  with  a  peculiar  thrilling 
sensation  under  the  fingers.  This  state  of  the  pulse,  whenever  it 
takes  place,  always  denotes  extreme  danger,  and  shows  that  the 
disease  is  rapidly  hurrying  on  to  the  final  stage,  in  which  the  lassi- 
tude and  dejection,  so  conspicuous  throughout  its  course,  are 
now  converted  into  the  utmost  degree  of  anxiety,  depression,  and 
fear  of  death.  The  patient  generally  shows  an  inclination  to  dwell 
upon  symptoms,  which  to  a  spectator  would  appear  of  minor  irn- 
portince.  He  evinces  the  greatest  reluctance  to  part  with  his  me- 
dical attendant,  though  fully  sensible  how  unavailing  the  efforts  of 
medicine  are  likely  to  prove.  The  discharges  by  stool,  which  are 


DYSENTERY,  183 

frequently  involuntary,  are  now  accompanied  with  the  most  intolera- 
ble foetor  ;  they  are  frequently  mixed  with  shreds  of  membrane,  and 
quantities  of  purulent  matter  ;  a  protusion  of  the  gut,  forming  a  com- 
plete procidentia  ani  often  takes  place  ;  and  cases  are  not  wanting, 
where  a  portion  of  the  inner  coat  of  the  intestines,  amounting  to 
some  inches,  has  been  thrown  off  in  a  state  of  mortification,"  p.  49. 

When  things  come  to  this  pass,  death  soon  clones  the  scene.  The 
periods  occupied  in  passing  through  the  different  stages  are  very  va- 
rious, the  disease  often  proving  fatal  within  a  week—  and  at  other  times 
being  protracted  to  two  or  three  weeks,  but  seldom  longer,  whtre 
the  inflammation  is  solely  confined  to  the  colon. 

Our  author  next  proceeds  to  the  symptomatology  of  the  more 
chronic  form  of  disease,  denominated  "  Hepatic  Flux."  This  is 
more  incident  to  men  after  some  residence  in  India,  and  particularly 
those  who  are  prone  to  irregular  and  disordered  secretions  of  bile. 
It  often,  like  the  other,  assumes  the  form  of  diarrho3a  at  first,  and  be- 
comes afterwards  characterized  by  frequent  and  severe  fits  of  griping, 
resembling  cholic  pains,  particularly  urgent  about  the  umbilical  re- 
gion. The  evacuations  at  the  beginning  always  exhibit  something  un- 
natural in  their  colour,  varying  from  the  darkest  inky  hue  to  the  dif- 
ferent degrees  of  green  and  yellow  ;  all  these  colours  often  alternat- 
ing. The  stools  are  accompanied  with  much  flatus,  and  generally 
exhibit  a  frothy  appearance,  attended  with  a  sense  of  scalding  about 
the  anus,  the  patient  enjoying  an  interval  of  ease  after  each  evacua- 
tion. The  intervals,  however,  are  generally  so  short,  that  the  sol- 
dier often  prefers  carrying  a  mat  with  him  to  the  necessary,  in  order 
to  pass  the  night  there,  rather  than  have  to  run  backwards  and  for- 
wards to  the  barrack  room. 

"  From  the  commencement  the  patient  complains  of  nausea,  inap- 
petency ;  preternatural  thirst  ;  bad  taste  in  the  mouth,  the  tongue 
being  furred,  and  loaded  with  a  bilious  crust  ;  the  pulse  quickened 
and  the  skin  parched.  After  a  few  days,  the  stools  become  white, 
passed  with  straining,  and  mixed  with  half-digested  aliment.  The 
complaint,  is  now  denominated  by  the  soldiers  "  the  white  flux."  and 
its  obstinacy  is  well  known  among  them.  The  griping  pains  continue, 
and  sometimes  the  patient  feels  a  permanent  degree  of  oppression 
about  the  epigastric  region.  Nausea,  hiccup,  and  bilious  vomiting 
now  become  highly  distressing  ;  the  thirst  becomes  urgent,  with  las- 
situde, debility,  and  increasing  emaciation.  The  skin  often  commu- 
nicates a  greasy  sensation  to  the  touch.  In  this  way  the  patient  goes 
on  for  weeks,  or  even  months,  the  complaint  terminating  in  recovery, 
or  the  patient  is  carried  off  by  an  abscess  in  the  liver,  or  by  the  ac- 
cession of  ulceration  and  mortification  in  the  course  of  the  colon  ;  the 
accession  of  the  latter  is  to  be  apprehended  from  the  appearance  of 
blood  in  the  stools,  and  the  other  symptoms  of  colonitis  formerly  de- 
tailed," p.  53. 

Post-mortem  Appearances  in  Colonitis.  Inflammation  of  that  part 
of  the  tube  situated  below  the  valve  of  the  colon.  No  disease  of  the 
structure  of  the  liver. 

"  Yet  I  am  by  no  means  disposed  to  infer,  from  the  want  of  morbid 
appearances  in  the  liver,  that  this  viscus  may  not  have  been,  in  many 


184  EASTERN  HEMISPHERE. 

cases,  the  seat  of  diseased  action,  during  the  life  of  the  patient,5'  p, 
53. 

When  the  abdomen  is  laid  open,  an  effusion  of  serum,  sometimes 
mixed  with  coagulable  lymph,  is  found  accumulated  in  this  cavity  ;  the 
omentum  generally  shrunk  firmer  than  usual,  arid  of  a  doughy  feel, 
with  slight  adhesions,  to  the  convolutions  of  the  intestines  ;  at  other 
times  shrivelled  and  destitute  of  fat.  The  stomach  seldom  altered  in 
its  appearance.  The  small  intestines  sound,  sometimes  exhibiting 
slight  inflammatory  patches  adhering  to  the  omentum.  No  peculiar 
appearance  on  the  inner  coat  of  the  small  intestines. 

"  The  great  intestines  again,  the  principal  seats  of  disease,  show 
the  strongest  marks  of  inflammation  in  all  its  stages  ;  some  portions 
exhibiting  externally  a  slight  inflammatory  redness,  while  others  are 
marked  by  the  highest  degree  of  lividity  ;  and  in  some  cases,  parts 
of  the  gut  will  be  found  to  have  given  way,  so  as  to  permit  the  es- 
cape of  air,  and  even  of  fasces,  into  the  cavity  of  the  abdomen  ;  and 
in  these  destructive  effects  of  inflammatory  action,  the  ca3cum,  with 
its  appendix  vermiformis,  and  the  sigmoid  flexure  of  the  colon,  will, 
in  most  cases,  be  found  to  participate  largely."  p.  55. 

The  appearance  of  cells  in  the  colon  is,  in  a  great  measure,  obli- 
terated, and  the  coats  of  the  intestine  often  so  thickened  throughout, 
as  to  suggest  the  idea  of  a  solid  rope  ;  and  so  much  altered  in  tena- 
city— so  brittle  in  texture,  as  not  to  admit  of  being  handled  without 
the  risk  of  rupturing  them.  The  calibre  of  the  gut  is  found  much 
diminished  .by  the  thickening  of  the  coats  ;  the  villous  coat  in  some 
places  abraded  simply,  in  others  ulcerated,  and  besmeared  with 
bloody  mucus,  mixed  with  specks  of  pus.  In  some  places,  this  coat 
of  the  colon  exhibited  a  tuberculous  appearance,  not  inaptly  com- 
pared to  small-pox.  Extravasated  grumous  blood  is  not  unfrequently 
found  in  the  colon.  Scybalae  very  seldom  met  with.  The  liver 
sometimes  free  from  apparent  disease,  at  other  times  preternaturally 
small  and  indurated,  or  enlarged  and  hardened  ;  the  bile  unhealthy 
looking.  The  other  viscera  not  often  or  materially  affected,  except- 
ing the  mesenteric  glands,  which  are  frequently  found  enlarged  and 
obstructed. 

Dr.  Ballingal  having  endeavoured  to  establish  the  existence  of  two 
distinct  modifications  or  varieties  of  India  flux,  proceeds  to  the  treat- 
ment, which  is  very  briefly  detailed.  He  considers  the  colonitis,  or 
acute  form  of  flux,  as  a  local  disease,  unconnected  with  the  liver  or 
the  constitution — an  inflammation,  in  short,  of  the  large  intestine, 
tending  rapidly  to  mortification. 

'*  But  even  allowing  that  a  diseased  action  of  the  liver,  and  a  viti- 
ated state  of  the  biliary  secretion,  have  always  preceded  the  attack 
of  colonitis,  and  have  been,  in  some  measure,  the  cause  of  the  latter 
affection,  still,  in  the  state  we  meet  the  disease,  the  effect  appears  to 
have  greatly  outrun  the  cause  ;  they  bear  no  adequate  proportion  to 
each  other  ;  and  it  is  too  much  to  expect  that,  by  taking  away  the 
one,  the  other  will  cease,"  p.  66. 

I  do  not  conceive  that  this  is  very  good  reasoning.  The  disorder- 
ed function  of  one  organ  will  sometimes  produce  diseased  structure 
in  another,  which  is  infinitely  worse  ;  yet  the  latter  might  have  been 


DYSENTERY.  185 

prevented,  (not  indeed  cured,)  by  removing  the  former.  I  have  no 
objection,  indeed,  to  our  author's  mode  of  obviating  the  local  affection 
of  the  intestine,  whether  it  be  primary  or  secondary  ;  but  if  the 
latter,  the  original  source  of  the  mischief  ought  also  to  be  sought  af- 
ter, and,  if  possible,  removed. 

Dr.  B.  then  recommends  the  vigorous  use  of  topical  remedies,  as 
leeches,  blisters  to  the  surface  of  the  abdomen,  fomentations,  ano- 
dyne, and  astringent  injections.  But  our  author  does  not  reject  the 
use  of  general  remedies,  and  particularly  of  blood-letting.  Of  this 
measure  he  entertains  a  very  favourable  opinion.  He  candidly  owns, 
however,  that  this  opinion  is  grounded  more  on  the  ravages  of  in- 
flammation, so  universally  apparent  in  the  dead,  than  on  any  repeat- 
ed or  extensive  experience  of  its  beneficial  effects  on  the  living." 
In  the  regiment  where  our  author  served,  there  was  a  general  dislike 
to  the  use  of  the  lancet  ;  as  indeed,  there  was,  and  we  fear  still  is, 
among  the  old  practitioners  in  India."  Moreover,  a  long  voyage  of 
full  five  months,  without  having  touched  anywhere  for  refreshments, 
had  lowered  the  tone  of  the  European  constitution,  so  that  by  the 
time  they  got  over  the  first  objection,  from  repeated  experience  of 
the  safety  and  utility  of  bleeding  in  other  diseases,  the  period  for  its 
employment  in  dysentery  was  past,  or  at  least  rendered  extremely 
questionable,  while  the  complicated  nature  of  the  cases  latterly  oc- 
curring lessened  its  necessity. 

"  In  short,  (says  Dr.  B.)  of  the  few  cases  of  dysentery  in  which  I 
have  employed  bleeding;,  the  majority  have,  I  think,  terminated  favour- 
ably ;  and  of  those  in  \\hich  the  result  has  been  fatal,  the  appearances 
on  dissection  have  been  such  as  to  excite  a  sentiment  of  regret  at  not 
having  carried  the  evacuation  further,"  p.  68. 

Purgatives,  Dr.  B.  exhibits  at  the  very  beginning,  in  order  to  clear 
the  alimentary  canal,  and  ascertain  the  state  of  the  faecal  matters.  If 
the  latter  are  not  unhealthy,  while  at  the  same  time  the  purgatives 
produce  an  increase  of  pain  and  tenesmu?,  with  more  copious  dischar- 
ges of  blood  and  mucus,  then  they  become,  to  say  the  least,  unneces- 
sary, perhaps  detrimental,  by  increasing  the  irritability  of  the  intes- 
tines, and  determining  a  greater  flow  of  blood  to  those  parts.  When 
purgatives  are  deemed  necessary,  our  author  has  been  in  the  habit  of 
administering  the  neutral  salts,  with  or  without  the  infusion  of  senna. 

Emetics  our  author  has  no  experience  of  in  dysentery,  and  does  not 
approve  of  them. 

Sudorifics.  "  Of  all  the  general  and  constitutional  remedies  employ- 
ed in  the  form  of  flux,  now  under  consideration,  this  is  the  class  of 
articles  of  which  I  have  the  most  extensive  experience,  and  to  which 
I  am  disposed  to  assign  the  most  powerful  and  salutary  effects." 

In  this  light  he  considers  the  employment  of  opium  and  ipecacuan. 
introduced  into  India  by  Mr.  Abercrombie,  of  the  34th  Regt.  The  prac- 
tice ivas  to  give  several  grains  of  solid  opium,  following  it  by  the  exhi- 
bition of  two  or  more  ounces  of  infusion  of  ipecacuan.  The  other  forms 
of  sudoiifics  which  our  author  chiefly  employed  were  Dover's  powder, 
and  a  :^mbination  of  laudanum  and  antimonial  wine  ;  from  all  of  which 
he  observed  beneficial  effects.  I  would  just  here  ask  our  author,  if  he 

24 


18fc  BASTERft  HEMISPHERE. 

conceives  the  form  of  dysentery  now  under  consideration  to  be  simply 
and  purely  inflammation  of  the  colon,  why  opium  and  ipecacuan,  should 
not  be  equally  beneficial  in  simple  enteritis,  of  every-day  occur- 
rence ?  But  here  is  the  rock  on  which  most  writers  on  dysentery 
split.  They  find,  when  the  disease  proves  mortal,  inflammation  and 
ulceration  in  the  bowels,  and  they  immediately  conclude  that  the  very 
last  link  in  the  chain  of  effects,  was  the  first  in  the  chain  of  causes. 
In  almost  every  case  of  fatal  phrenitis,  we  find  effusion  of  water  at 
the  base  of  the  brain  ;  but  who,  in  his  right  senses,  would  set  down 
hydrocephalus  as  the  cause  of  phrenitis  ?  So  it  is  in  dysentery.  In- 
flammation and  ulceration  are  secondary  or  ternary  links  in  the  mor- 
bid chain  ;  and  many  a  case  of  real  dysentery  is  checked  and  cured, 
before  either  of  these  takes  place — that  is,  when  there  is  merely  an 
increased  afflux  of  blood  to  the  mesenteric  and  portal  vessels,  a 
super-irritation  in  the  mucous  membrane  of  the  bowels,  and  an  in- 
creased discharge  of  acrid  secretions  from  the  intestinal  glands.  But 
to  return. 

Warm  Bath.  This  remedy  was  found  particularly  useful  in  allaying 
pain,  inducing  sleep,  diminishing  the  frequency  of  the  stools,  and 
promoting  the  discharge  of  urine.  Fomentions  to  the  abdomen,  on 
the  same  principle,  are  serviceable. 

Mercury.  When  the  regiment  was  first  disembarked  at  Prince  of 
Wales's  Island,  in  full  European  health  and  vigour,  mercury  alone, 
carried  to  ptyalism,  was  not  very  successful  ;  and  truly  we  wonder, 
how  men  can  be  blind  to  the  obvious  inflammatory  condition  of  the 
system  at  these  times,  and  withhold  the  lancet,  as  auxiliary  to  the 
other  means. 

"  I  can  readily  conceive,  and  indeed  know,  that,  in  cases  of  a  pro- 
tracted disease,  where  the  discharges  from  the  intestines  degenerate 
from  pure  blood  and  mucus,  and  become  of  a  more  diseased  nature  ; 
that  there  is  no  remedy  so  much  to  be  depended  upon  for  the  resto- 
ration of  healthy  secretions  ;  but  in  the  pure  inflammatory  complaint 
I  am  now  speaking  of,  mercury  can  seldom  be  useful,"  p.  74. 

Tropical  Bleeding,  by  leeches  especially,  is  much  recommended 
by  Mr.  B.  on  the  authority  of  a  letter  from  Dr.  Annesley,  surgeon 
of  the  Madras  European  Regiment.  Dr.  Aitkin  also  suggested  to  our 
author  the  application  of  leeches  to  the  anus  in  dysentery. 

Blisters  are  spoken  of  as  useful  auxiliaries,  whenever  there  is  any 
fixed  pain  in  any  part  of  the  colon. 

Injections.  These,  of  all  remedies  employed  in  dysentery,  hare  ap- 
peared to  our  author,  and  to  his  patients,  the  most  instrumental  in  al- 
leviating the  distressing  tenesmus,  diminishing  the  calls  to  stool,  and 
lessening  the  profuse  discharge  of  blood  and  mucus. — We  can  truly 
say  that  we  have  not  found  them  so. 

"  In  the  composition  of  injections,  decoctions  of  bark,  solutions  of 
the  acetate  of  lead,  and  of  the  sulphate  of  zinc,  were  at  first,  pretty 
extensively  employed,  and  with  a  view  of  increasing  their  efficacy, 
were  occasionally  thrown  up  cold." 

Chronic  or  Hepatic  Flux.  This  our  author  looks  upon,  and  jutly  too, 
as  much  more  of  a  constitutional  than  a  local  disease.  The  circum- 
stance of  its  prevailing  among  those  who  have  been  some  time  in 
the  country  ;  the  degree  of  fever  attending  it  j  the  diseased  secre- 


DYSENTERY.  14' 

uons  in  the  stools,  all  evince  functional  derangement  of  the  glandular 
viscera  of  the  abdomen,  as  well  as  of  the  intestinal  tube. 

'*  That  the  functions  of  this  organ,  [the  liver,]  are,  in  most  cases, 
materially,  and  perhaps  primarily  deranged,  and  that  without  a  heal- 
thy action  of  this  viscus,  all  our  curative  efforts  will  prove  nugatory, 
are  facts  very  generally,  and  as  far  as  I  know,  most  justly  believed," 
p.  80. 

Mercury.  "  If,  in  treating  of  the  acute  form  of  flux,  I  have  re- 
frained from  an  indiscriminate,  and,  as  1  conceive,  unmerited  commen- 
dation of  this  powerful  medicine,  it  is  only  in  hopes  of  being  able  to 
urge  its  employment  with  double  force  in  the  form  of  disease  now 
under  consideration  ;  to  recommend  an  implicit  reliance  on  it  in  the 
chronic  form  of  flux  ;  to  ascribe  to  it  an  almost  unlimited  power  in  thjs 
disease  ;  and  to  express  an  opinion,  that  it  will  seldom  disappoint  our 
most  sanguine  hopes.  A  partiality  for  the  use  of  mercury  is  as  con- 
spicuous in  India,  as  the  aversion  to  blood-letting,  formerly  noticed — 
that  partiality  is,  however,  much  better  founded,"  p.  81. 

Almost  every  practitioner  in  India  gives  a  preference  to  some  par- 
ticular preparation  or  form  of  the  remedy  ;  no  weak  proof,  by  the 
bye,  how  much  depends  on  the  medicine  itself,  and  how  little  on  the 
form  of  administration.  If  our  author  has  formed  a  prepossession  on 
this  subject,  it  is  in  favour  of  the  common  blue  pill.  Before  irrita- 
bility of  the  stomach  came  on,  Dr.  B.  thought  that  he  could  affect 
the  system  more  speedily,  and  produce  a  change  in  the  nature  of  the 
evacuations  sooner,  "  by  the  daily  exhibition  of  from  twelve  to  twen- 
ty grains  of  the  blue  pill,"  than  by  any  other  preparation.  Where 
gastric  irritability  prevails,  or  where  mercury  appears  to  affect  the 
bowels,  then  he  thinks  mercurial  frictions  are  preferable,  as  the  sys- 
tem should  be  impregnated  by  rubbing  in  daily  from  one  to  two  or 
three  drachms  of  the  blue  ointment,  according  to  the  urgency  of  the 
symptoms,  the  rapidity  with  which  the  disease  is  proceeding,  and  the 
constitution  of  the  patient. 

"  The  exhibition  of  calomel,  with  opium,  is  a  very  favourite  prac- 
tice with  many,  and  I  have  entered  into  this  to  a  very  considerable 
extent ;  three  or  four  grains  of  calomel,  and  a  grain  of  opium,  made 
into  a  pill,  and  exhibited  every  three  or  four  hours,  I  have  soon 
found  to  produce  ajl  the  beneficial  effects  resulting  from  the  employ- 
ing of  mercury ,"/J3.  82. 
^The  quanti^  will  vary  greatly  in  different  individuals — 

"  But  tHs  always  to  be  carried  the  length  of  producing  considera- 
ble ptyalism  j  and  this,  wherever  the  exhaustion  of  the  patient  does 
not  forbid  it,  is  to  be  kept  up  without  intermission,  until  natural  se- 
cretions return,  and  the  stools  resume  a  healthy  appearance,"  p.  83. 

But  Dr.  B.  wisely  avails  himself  of  other  auxiliaries  in  this  form 
of  dysentery.  Purgatives,  he  thinks,  are  essentially  necessary. 

"  The  castor  oil  is  a  purgative  in  very  extensive  use  amongst  the 
natives  of  India,  and  many  of  the  practitioners  there  give  it  a  prefer- 
ence to  every  other." 

This  is  the  purgative,  indeed,  which  I  have  always  found  to  an- 
swer best  in  India.  The  warm  bath  and  sudorifics  are  often  useful 
to  obviate  the  heat  of  the  skin,  and  relieve  the  febrile  symptoms  in 


188  EASTERN  HEMISPHERE. 

general,  when  they  become  urgent. — Opiates,  blisters,  effervescing 
draughts,  &c.  are  occasionally  necessary  ;  and  tenesmus,  he  thinks, 
is  best  relieved  by  the  anodyne  glysters.  The  cummerband  or  belly 
band  of  flannel,  is  deservedly  praised  by  our  ati'hor. 

"  I  have  thus  far  endeavoured,  both  in  the  history  and  treatment, 
to  show,  that  under  the  general  denomination  of  dysentery  or  flux, 
we  have  two  distinct  forms  of  disease  prevalent  in  India  ;  and  I  now 
proceed  to  observe,  that  although,  during  the  first  years  of  my  ser- 
vice in  that  country,  these  two  diseases  were  often  to  be  met  with 
in  practice  as  distinct  as  I  have  studied  to  keep  them  in  description  ; 
they  became  latterly  more  and  more  blended  together,  and  were  to 
be  found  in  all  possible  varieties  of  combination.  This  is  what  we 
should  naturally  expect  from  reasoning,  and  what  is  amply  confirmed 
by  my  experience,  so  far  as  it  goes.  The  well-known  effects  of 
warm  climates,  independent  of  the  habitual  use  of  spirits,  will  ac- 
count for  the  existence  of  a  liver  affection  in  most  of  the  cases  of 
eolonitis,  which  latterly  occurred  :  while  the  well-known  tendency 
of  the  country  or  pariar  arrack,  (often  rendered  more  deleterious  by 
the  mixture  of  acrid  ingredients,)  to  induce  the  acute  or  inflammatory 
flux,  will  account  for  the  disposition  latterly  evinced  by  the  hepatic 
fluxes,  to  terminate  in  inflammation  of  the  colon.  While  the  two 
forms  of  disease  \vere  thus  frequently  found  co-existent  and  running 
insensibly  into  each  other,  it  was  by  no  mesns  uncommon  to  find 
them  existing  alt  -rnately  for  weeks  or  months,  and  destroying  the 
patient  by  a  form  of  flux,  the  symptoms  of  which  alternately  bore  a 
nearer  relation  to  one  or  other  of  the  diseases  1  have  described. 
These  form  a  description  of  cases  by  far  the  most  perplexing  and 
troublesome  we  meet  with ;  and  with  respect  to  their  treatment,  the 
only  general  rule  that  can  be  laid  down  is,  to  urge  the  one  or  other 
mode  of  core,  in  proportion  as  the  one  or  other  set  of  symptoms  become 
more  pressing.  Arid  where  the  co-existence  of  both  forms  of  flux 
renders  it  necessary  to  adopt  a  means  of  cure  suited  to  this  form  of 
disease,  we  can  only  m^et  it  by  the  simultaneous  adoption  of  both 
modes  of  treatment.  These,  it  will  be  observed,  are  by  no  means 
incompatible  with  each  other ;  the  one  consisting  chiefly  in  the  ex- 
hibition of  local  remedies,  directed  to  the  lower  part  of  the  intesti- 
nal canal,  while  the  other  consists  chiefly  in  the  exhibition  of  mercu- 
ry to  affect  the  system.  Had  the  appearance  of  one  form  of  flux 
uniformly,  or  even  generally,  preceded  the  other,  I  should  have  been 
most  ready  to  take  the  opportunity  of  considering  them  as  different 
stages,  rather  than  different  forms  of  disease  ;  but  the  want  of  uni- 
formity in  this  respect  leaves,  in  my  opinion,  no  room  for  such  a  de- 
scription," p.  89. 

From  the  foregoing  extract,  the  reader  will  be  ready  to  suspect  that 
the  division  of  dysentery  into  eolonitis  and  hepatic  flux  is  rather  fanci- 
ful than  solid  ;  and  that  the  practical  indications  are  full  as  well  founded 
on  the  theory  that  dysentery  is  an  increased  irritation  and  afflux  of 
blood  to  the  mucous  membrane  of  the  intestines,  with  functional  de- 
rangement in  the  liver,  ending  often  in  inflammation  of  the  said  mem- 
brane. On  this  account  I  have  always  considered  the  lancet  as  a 
material  instrument  in  the  treatment  of  dysentery  ;  more,  however 


DYSENTERY.  189 

lo  prevent  the  effects  than  to  remove  the  causes  of  this  disease. 
Whoever  encounters  dysentery  successfully,  will  aim  at  the  restora- 
tion of  the  balance  of  the  circulation  and  excitement,  with  the  heal- 
thy  functions  of  the  skin  and  liver.  He  will  do  this,  and  guard  at  the 
same  time  against  inflammation  of  the  intestines  by  blood-letting, 
whenever  pain  on  pressure  of  the  abdomen,  sanguineous  discharge  in 
the  stools,  and  febrile  movements  in  the  system,  indicate  the  neces- 
sity of  this  measure.  The  functions  of  the  skin  and  liver  will  be 
best  restored  by  calomel,  opium,  and  ipecacuan,  or  antimony,  assisted 
by  the  warm  bath,  quietude,  and  a  regulated  temperature. 


Cholera  Morbus,  Mort  de  Chien,  and  Spasmodic  Cholera  of  India. 

SEC.  X. — In  no  disease  has  a  symptom  passed  for  a  cause,  with 
more  currency  and  less  doubt,  than  in  cholera.  From  Hippocrates 
to  Celsus,  and  from  Celsus  to  baunders,  bile  has  been  condemned, 
without  a  hearing,  as  the  original  perpetrator  of  all  the  mischief. 
**  Bilis  sursum  ac  deorsum  effusiones,"  says  the  first  ;  '•  Bilis  supra, 
infraque  erumpit,"  says  the  second  ;  and,  "  Cholera  Morbus,"  says 
the  last  of  these  authors,  "  may  very  properly  be  considered  under 
the  head  of  those  diseases  which  depend  on  the  increased  tecretion 
of  bile."  On  the  liver,  p.  179.  Yet  I  venture  to  affirm,  that  the  Cho- 
lera does  not  "  depend"  on  an  increase,  but  on  a  diminution,  and,  in 
many  cases,  a  total  suppression  of  the  biliary  secretion. 

A  very  excellent  description  of  the  disease  in  question,    as  it  ap- 
pears in  this  country,  will  be  found  under  its  proper  head,  in  Rees's 
new  Cyclopedia,    written,!  believe,  by   Dr.  Batetnan,   and   taken 
principally  from  Sydenham.     I  shall  extract  the  following  passage 
for  my  text :  "  The  attack  of  this  complaint  is  generally  sudden. 
The  bowels  are  seized  with  griping  pains,  and  the  stools,  which  are 
at  first  thin  and  watery,  as  in  common  diarrhoea,  are  passed  frequent- 
ly.    The  stomach  is  seized  with  sickness,  discharges  its  contents,  and 
rejects  what  is  swallowed.     In  the  course  of  a  Jew  houis,  the  matter 
vomited,  as  well  as  that  which   is  discharged  by  stool,  appears  to  be 
pure  bile,  and  passes  oil'  both  ways,  in  considerable  quantities.     The 
griping  pains  of  the  intestines  now  become  more  severe,  in  conse- 
quence of  the  extraordinary  irritation  of  the  passing  bile,  which  ex- 
cites them  to  partial  and  irregular  spasmodic  contractions.     These 
spasms  are  often  communicated  to  the  abdominal  muscles,  and  to  the 
muscles  of  the  lower  extremities.     The  stomach  is  also  affected  with 
considerable  pain,  and  a  sense  of  great  heat,  in  consequence  of  the 
same  irritation.     There  is  usually  great  thirst,  and  sometimes  a  se- 
vere head-ache,  from  the  sympathy  of  the  head  with  the  stomach. 
The  pulse  becomes  small  and  frequent,  and  the  heat  of  the  skin  is  in- 
creased.    A  great  degree  of  debility,  languor,  and  faintness,  amount- 
ing even  to  syncope,  speedily   comes  on  ;  sometimes  attended  with 
colliquative  sweats,  coldness  of  the  extremities,  (  and  such  like  symp- 
toms,' says  Sydenham,  •  as  frighten  the  bye-standers,  and  kill  the  pa- 
tient in  twenty-four  hours,'  " 


190  EASTERN  HEMISPHERE. 

Now  it  does  appear  somewhat  curious  to  me,  that  if  an  increased 
secretion  of  bile  were  the  cause  of  the  disease,  we  should  see  no- 
thing of  it  till — "  a  few  hours"  after  the  effects  become  obvious ! 
Where  is  the  increased  secretion  all  the  time  ?  Not  in  the  stomach, 
for  it  "  discharges  its  contents,  and  rejects  what  is  swallowed1'  long 
before.  It  is  not  in  the  intestines,  for  the  stools  are  at  first'"  thin  and 
watery."  At  length,  however,  u  pure  bile"  makes  its  appearance  ; 
and  lo!  it  is  accused  of  being  the  cause  of  all ! 

At  what  season  does  this  commonly  take  place  ?  In  August  and 
September.  Certainly  that  is  the  time  for  great  heat  and  increased 
action  in  the  hepatic  system.  But  are  there  no  particular  attendant 
circumstances  ?  Yes,  says  the  author  of  the  foregoing  passage.  «*  It 
has  been  remarked,  that  both  in  hot  climates  and  in  the  hot  seasons  of 
mild  climates,  occasional  falls  of  rain  have  been  particularly  follow- 
ed by  an  epidemic  cholera," — ib.  Indeed  !  a  fall  of  rain  is  wonder- 
fully well  adapted  to  increase  the  secretion  of  bile  !  But  again  : 
"  In  some  places  it  is  probable,  that  the  heat  of  the  season  may  give 
only  a  predisposition,  and  that  certain  ingesta,  sudden  changes  of  tem- 
perature, or  other  causes,  in  this  state  readily  excite  the  disease," 
— ib.  All  these  are  admirably  adapted,  no  doubt,  to  produce  a  great 
flow  of  bile  !  But  let  us  return  to  Dr.  Saunders,  who  has  already  in- 
formed us,  that  Cholera  "  depends  on  the  increased  secretion  of 
bile."  He  says,  "  it  frequently  takes  place  spontaneously,  and  in- 
dependently of  any  sensible  occasional  cause.  At  other  times  it  is 
evidently  connected  with  a  sudden  change  of  temperature  in  the  atmos- 
phere during  those  months,  (August  and  September,)  or  brought  on 
by  drinking  cold  liquors,  or  by  any  thing  else  that  suddenly  chills  the 
body,  especially  when  overheated  by  exercise  or  labour," — p.  181. 
Now,  in  what  manner  we  are  to  connect  these  "evident"  causes 
with  an  "  increased  secretion  of  bile,"  Dr.  Saunders  leaves  us  to  find 
out  as  we  can,  for  he  has  not  even  attempted  an  explanation.  But, 
in  truth,  to  set  about  proving  that  cold  increased  the  hepatic 
action,  would  have  been  inconsistent,  after  what  he  previously  ad- 
vanced respecting  the  operation  of  heat  on  the  biliary  system. 

Having  shown,  1  think  satisfactorily,  the  inadequacy  of  these  doc- 
trines to  an  elucidation  of  the  phenomena,  I  shall  proceed  to  prove, 
that  an  "  increased  secretion  of  bile,"  so  far  from  being  the  cause 
of  Cholera  Morbus,  is,  upon  the  whole,  a  favorable  symptom;  and 
that,  in  the  very  worst  forms  of  the  disease,  it  is  entirely  absent. 

In  no  part  of  the  globe  does  this  terrific  disorder  assume  a  more 
concentrated  state  than  on  the  coasts  of  Ceylon,  especially  its  east- 
ern side.  The  mountains  tower  to  a  great  height,  in  fantastic  shapes, 
or  conical  peaks,  clothed  from  base  to  summit  with  almost  impenetra- 
ble forests  of  lofty  trees,  underwood,  and  jungle.  Deep  vallies  and 
ravines,  still  more  thickly  covered  with  similar  materials,  and  choak- 
ed  up,  as  it  were,  with  all  the  wild  exuberance  of  tropical  vegetation, 
separate  the  mountains  from  each  other,  and  swarm  with  myriads  of 
animals  and  reptiles.  From  these  vallies,  in  the  months  of  May,  June, 
and  July,  when  the  S.  W.  monsoon  is  in  force,  the  gusts  of  land-wind 
come  down,  hot  and  sultry  by  day,  but  chilling  cold  and  damp  by 
night.  Where  mountainous  and  woody,  or  flat,  marshy,  and  jungly 


CHOLERA  OP  INDIA/  101 

tracts,  border  on  the  sea,  atmospherical  vicissitudes  will,  ceterispari- 
i>us,  be  greater,  than  where  the  coast  is  flat  and  gravelly,  or  dry  and 
cultivated.  The  reason  is  obvious.  Thus,  the  vicinity  of  Madras, 
for  instance,  being  a  sandy  or  gravelly  soil,  which,  during  the  in- 
tense heat  of  the  day,  acquires  a  temperature,  perhaps  60  or  70  de- 
grees above  that  of  the  contiguous  ocean,  a  considerable  share  of  the 
night  elapses  before  the  heat  of  the  earth  sinks  to  an  equilibrium 
with  that  of  the  water  ;  and  consequently,  we  seldom  have  the  land- 
wind  cold  there,  except  after  falls  of  rain  ;  and  on  the  contrary, 
in  May  and  June,  it  is  hot  throughout  the  night.  At  Ceylon,  on 
the  other  hand,  the  surface  of  the  ground  being  so  defended  from  the 
sun's  rays  by  woods  and  jungles,  it  never  acquires  any  thing  like  the 
temperature  of  the  opposite  Coromandel  coast ;  and  although  during 
the  months  alluded  to,  when  the  south-west  monsoon  passes  with  great 
strength  over  Ceylon,  the  wind  by  day  be  hot  and  sultry,  as  soon  as 
the  dews  have  fallen  in  the  evening,  and  evaporation  commences 
from  a  very  extended  surface,  the  land-breeze  is  instantly  rendered 
cold  and  raw ;  and  being  then  loaded  with  vapour,  together  with  all 
kinds  of  terrestrial  and  vegetable  exhalations,  communicates  to  our 
feelings  and  frames  a  chill,  far  exceeding  what  the  thermometer  would 
actually  indicate.  The  same  remark  applies  to  Bombay  ;  but  in 
Bengal  there  are  no  regular  sea  and  land-breezes  ;  consequently  the 
changes  of  temperature  are  not  so  abrupt  and  extensive  as  in  the 
fore-mentioned  places. 

Numerous  cases,  exhibiting  the  dire  effects  of  these  atmospherical 
vicissitudes,  aggravated,  no  doubt,  by  the  land-wind  effluvia,  now  lie 
before  me — elects,  indeed,  that  might  well  "  frighten  the  bye-stan- 
ders,"  or  even  Sydenham  himself;  for  the  patient  is  often  cut  off 
in  a  much  shorter  space  of  time  than  twenty-four  hours  !" 

A  seaman  on  board  a  ship,  lying  in  Back-Bay,  Trincomallee,  in 
the  month  of  June,  went  to  bed  rather  intoxicated.  About  midnight 
however,  he  turned  out,  in  a  state  of  perspiration,  and  got  upon 
deck,  as  is  very  usual,  where  he  lay  down  in  the  cold  land-wind,  and 
fell  fast  asleep.  During  the  preceding  day,  the  land-wind  had  been 
hot  and  sultry,  the  thermometer  ranging  from  86  to  88  degrees.  In 
the  night,  the  mercury  fell  to  74°,  with  raw,  damp  gusts  from  the 
shore.  About  four  o'clock  in  the  morning,  he  awoke  with  a  shiver, 
and  left  the  deck  ;  but  was  soon  seized  with  frequent  purging  and 
griping,  his  stools  consisting  of  mucus  and  slime.  Nausea  and  retch- 
ing succeeded  ;  nothing  being  ejected  but  phlegm,  and  the  contents 
of  the  stomach.  His  pulse  was  now  small,  quick,  and  contracted  — 
his  skin  dry,  but  not  hot.  About  eight  o'clock  in  the  morning,  he 
began  to  feel  spasms  in  different  parts  of  his  body,  which  soon  at- 
tacked the  abdominal  muscles,  and  threw  him  into  great  pain.  Dur- 
ing these  paroxysms,  a  cold,  clammy  sweat,  would  be  occasionally 
forced  out,  especially  on  the  face  and  breast.  The  extremities  now 
became  cold,  his  features  shrunk — the  stomach  rejecting  everything 
that  was  offered,  either  as  medicine  or  drink.  The  abdomen  and 
epigastrium,  all  this  time,  was  distended  and  tense,  with  incessant 
watery  purging  and  painful  tenesmus.  By  ten  o'clock,  his  pulse 
could  scarcely  be  felt — his  breathing  was  oppressed  and  laborious — 


192  EASTERN  HEMISPHERE. 

his  eyes  sunk,  and  the  whole  countenance  singularly  expressive  of 
internal  agony  and  distreis  !  The  extremities  were  cold,  shrivelled, 
and  covered  with  clammy  sweats.  The  violence  of  the  spasms  now 
began  to  relax  ;  and  by  eleven  o'clock,  or  seven  hours  from  the  at- 
tack, death  released  him  from  his  sufferings  !  The  warm  bath,  opi- 
um, aether,  and  various  medicines  had  been  tried,  without  affording 
any  relief. 

This  may  serve  as  a  specimen  of  the  worst  form  of  that  dreadful 
disease,  which  has  obtained  the  appellation  of- — "  Mort  de  CVuen,"  or 
Spasmodic  Cholera.  No  bilious  accumulations  are  to  be  seen,  either 
in  the  stools,  or  what  is  ejected  by  vomiting,  from  the  beginning  to 
the  end  of  the  disease.  Neither  is  there  ever  the  slightest  appear- 
ance of  *  natural  and  healthy  perspiration.'  A  watery  fluid  is  occa- 
sionally forced  out  by  the  spasms  and  pain,  while  the  skin  is  shrivelled 
and  tense,  and  the  sub-cutaneous,  or  perspiratory  vessels,  perfectly 
torpid. 

From  such  an  awful  state  of  concentration,  the  disease  assumes  all 
degrees  of  violence,  down  to  a  common  Cholera.  In  exact  propor- 
tion as  bile  appears,  and  the  nearer  it  approaches  to  a  natural  quality, 
so  much  the  less  is  the  danger. 

A  seaman,  from  like  imprudent  exposure  to  the  cold  land-winds, 
after  great  fatigue  during  the  heat  of  the  preceding  day,  was  attacked 
with  symptoms  nearly  similar  to  the  former.  After  the  spasms  came 
on,  however,  he  had  cold  and  hot  fits  alternately,  with  correspond- 
ing sweats,  and  bile  appeared  occasionally,  both  by  vomit  and  stool. 
He  had  swallowed  a  scruple  of  calomel,  and  in  this  case,  blood  was 
taken  from  the  arm,  which  instantly  alleviated  the  spasms.  In  an 
hour  after  the  calomel  was  taken,  a  purgative  enema  brought  off  se- 
veral copious  alvine  evacuations,  followed  by  large  quantities  of  bile, 
some  of  which  was  highly  fetid  and  depraved.  He  now  felt  greatly 
relieved-^-fell  into  a  fine  perspiration  and  sleep,  and  by  the  next  day 
was  perfectly  well. 

I  could  here  adduce  numerous  cases,  both  favourable  and  fatal,  and 
little  differing,  in  essential  symptoms,  from  the  two  related  above. 
But  as  the  point  which  I  have  pledged  myself  to  prove,  must  be  de- 
cided by  unequivocal  and  disinterested  evidence,  I  shall  bring  for- 
ward the  testimony  of  Mr.  Curtis,  a  most  faithful  and  candid  reciter 
of  facts,  as  every  page  in  his  volume  evinces. 

It  is  necessary  to  recollect,  that  the  disease  which  Mr.  Curtis  de- 
scribes, and  the  place  where  it  happened,  [Trincomallee,]  are  those 
alluded  to  in  Dr.  Paisley's  letter,  where  the  latter  affirms,  and  I  think 
with  justice,  that  Mort  de  Chien  is  nothing  more  than  the  highest  de- 
gree of  Cholera  Morbus. 

"  Early  in  the  morning  of  the  21st  June,"  says  Mr.  Curtis,  "  we 
had  two  men  seized  with  the  Mort  de  Chien,  both  of  whom  we  lost 
in  a  few  hours  ;  and  in  the  course  of  the  two  following  days,  three 
more  in  the  same  complaint,  without  meeting  with  one  fortunate  case. 
To  the  26th,  when  we  sailed  for  Negapatam,  we  had  three  new  cases 
of  the  same  kind,  all  of  whom  were  saved,  but  two  of  them  with 
great  difficulty.  Besides  these,  we  had  several  others,  which  were 
of  a  nature  considerably  different ;  being  evidently  combined  with  hi- 


CHOLERA  OF    IN»JA.  IMS 

lious  colluvies  in  the  first  passages,  a  circumstance  not  at  all  discovera- 
ble in  the  five  cases  that  ended  fatally.  Ail  these,  [viz.  where  bile 
appeared,]  were  found  to  be  much  more  tractable — easily  removed, 
and  attended  with  little  danger," — p.  48.  "  In  all  of  them,  [the 
eight  cases  alluded  to,]  the  disease  began  with  a  watery  purging,  at- 
tended with  some  teuesmus,  but  little  or  no  griping.  This  always 
came  on  some  time  in  the  night,  or  early  towards  morning,  and  con- 
tinued some  time  before  any  spasms  were  felt."*****  "  This  purg- 
ing soon  brought  on  great  weakness,  coldness  of  the  extremities,  and 
a  remarkable  paleness,  sinking,  and  lividness  of  the  whole  counte- 
nance. Some  at  this  period  had  nausea,  and  retching  to  vomit,  but 
brought  up  nothing  bilious.  In  a  short  time,  the  spasms  began  to  af- 
fect the  muscles  of  the  thighs,  abdomen  and  thorax  ;  and  lastly ,  they 
passed  to  those  of  the  arms,  hands,  and  fingers," — p.  49.  "  The 

patients  complained  much   of  the  pain  of  these  cramps. As  the 

disease  proceeded,  the  countenance  became  more  pale,  wan,  and  de- 
jected. The  eyes  became  sunk The  pulse  became  more  feeble 

and  sometimes  sank  as  much,  as  not  to  be  felt  at  the  wrist," — p.  50. 
"  The  tongue  was  generally  white,  and  more  or  less  furred  towards 
the  root,  with  thirst,  and  desire  for  cold  drink." "  The  cold- 
ness of  the  extremities,  which  was  perceptible  from  the  first,  conti- 
nued to  increase,  and  spread  over  the  whole  body,  but  with  no  mou- 
ture  on  the  skin,  till  the  severity  of  the  pain  and  spasms  forced  out  a 
clammy  sweat,  which  soon  became  profuse," — p.  51.  *'  All  this 
time,  the  purging  continued  frequent,  and  exhibited  nothing  but  a 
thin  watery  matter,  or  mucus.  In  many,  the  stomach  became  at  last 
so  irritable,  that  nothing  could  be  got  to  rest  upon  it,  every  thing 
that  was  drank  was  spouted  up  immediately.  The  countenance  and 
extremities  became  livid — the  pulsations  of  the  heart  more  quick  an£ 
feeble — the  breathing  laborious.  In  fine,  the  whole  powers  of  life 
fell  under  such  a  great  and  speedy  collapse,  as  to  be  soon  beyond  the 
reach  of  recovery.  In  this  progression,  the  patient  remained  from 
three  to  five  or  six  hours,  from  the  accession  of  the  spasms,  seldom 
longer," — p.  52.  "  In  the  Sea-horse,  it  attacked  some  remarkably 
robust,  powerful,  and  muscular  men,  who  had  been  in  perfect  health 
immediately  before.  Neither,  in  all  our  class  of  bad  and  fatal  cases, 
did  there  appear  any  marks  of  bilious  colluvies,  either  in  the  colour 
of  the  ejected  matter — the  state  of  the  abdomen,  or  the  appearance 
of  the  tongue,  eyes,  and  urine," — p.  56 .  "  We  had,  in- 
deed, another  set  of  cases,  where  the  presence  of  this,  [bile,]  was 
distinguishable  by  all  these  characters,  but  these  were  of  a  far  slighter 
nature,  and  none  of  them  turned  out  any  way  untractable  or  fatal." 
And  again,  at  Madras,  Mr.  Curtis  observes — "  Oul  of  about  twenty 
under  my  care,  a  third  were  evidently  connected  with  bilious  collu- 
vies ;  and  in  these  thjpre  was  no  great  sinking  of  the  pulse,  or  dimi- 
nution of  the  heat, -and  the  spasms  were  confined  to  the  legs  and 
feet," — p.  69.  These  all  recovered.  Lastly,  in  two  cases  of  dis- 
section which  took  place  immediately  after  death  in  this  disease, 
Mr.  Curtis  affirms  that — «*  there  were  no  bilious  accumulations  found 
any  where,  and  the  internal  organs  were  all  in  a  sound  state  \  only 

25 


194  EASTEEN  HEMISPHERE. 

there  was  more  water  than  natural  in  the  pericardium,  and  the  ves- 
sels of  the  lungs,  liver,  and  mesentery,  appeared  to  be  very  turgid, 
and  full  of  blood,"— -p.  72. 

I  appeal  to  every  unbiassed  mind  — nay,  to  prejudice  itself,  whe- 
ther I  have  not  now  proved,  (I  had  almost  said  to  a  demonstration,) 
the  truth  of  that  heterodox  position  with  which  I  set  out  —namely, 
that  li  an  increased  secretion  of  bile,"  so  far  from  being  the  cause  of 
Cholera  Morbus,  is  upon  the  whole,  a  favourable  symptom;  and  that 
in  the  very  worst  cases  of  the  disease.  (Mort  de  Chien  for  instance,) 
it  is  entirely  absent. 

This  point  being  settled,  the  application  of  that  principle,  to  which 
I  have  so  often  adverted — the  connexion  or  sympathy  between  the  func- 
tions of  the  skin  and  liver ,  will  afford  a  more  rational  explanation  of 
the  phenomena,  than  either  "  an  increased  secretion,"  or  a  lurking, 
putrid  accumulation  of  that  fir  famed  mischief  maker — BILE. 

The  sudden  and  powerful  check  to  perspiration — th«  unparalleled 
atony  of  the  extreme  vessels,  debilitated  by  previous  excess  of  ac- 
tion, and  now  struck  utterly  torpid,  by  the  cold,  raw,  damp,  noctur- 
nal land-winds,  loaded  with  vegeto-aqueous  vapour,  and  abounding 
with  terrestrial  and  jungly  exhalations — break  at  once,  and  with  vio- 
lence, the  balance  of  the  circulation.  The  extreme  vessels  of  the 
hepatic  system,  sympathising  with  those  on  the  surface,  completely 
arrest  the  reflux  of  blood  from  the  portal,  coeliac,  and  mesenteric 
circles  ;  hence,  in  the  worst  cases,  a  total  suppression  of  biliary  se- 
cretion, with  distension  of  the  abdomen,  and  shrinking  of  all  exter- 
nal parts.  If  this  continue  any  time,  as  in  M'>n  deChien,  death  must 
be  the  inevitable  consequence,  notwithstanding  the  unavailing  efforts 
which  nature  makes,  by  vomiting  to  determine  to  the  surface — re- 
store the  equilibrium  of  the  blood  and  of  excitability,  and,  with  them, 
the  functions  of  per-piration  and  biliary  secretion.  In  proportion, 
then,  as  the  two  latter  appear,  will  the  danger  be  lessened — our  most 
salutary  objects  attained,  and  the  disease  become  "  less  untractable 
and  fatal." 

The  deluges  of  bile  which  occasionally  burst  forth  on  the  recom- 
mencement of  secretion  in  cholera,  are  the  natural  consequences  of  the 
great  plethora  in  the  portal  and  other  abdominal  circles  of  vessels, 
which  took  place  during  the  previous  check  to  biliary  secretion,  and 
free  passage  of  blood  through  the  liver.  And  thus  we  see,  that  the 
very  last  link  in  the  chain  of  effects,  and  that  too,  a  snlutary  one,  has, 
for  ages,  been  set  down  as  the  cause  of  Cholera — "  increased  secre- 
tion of  bile ! !" 

With  respect  to  the  spasms,  as  they  are  totally  unaccounted  for  by 
my  predecessors,  neither  am  I  bound  to  dive  into  the  mysteries  of 
the  nervous  system,  for  a  solution  of  the  phenomenon.  I  think  I 
have  pretty  clearly  proved,  that  they  are  not  attributable  to  bile  ; 
since,  in  the  most  dangerous  and  fatal  cases,  no  bile  is  to  be  found. 
1  can  easily  conceive  that  the  brain  must  suffer,  from  the  broken  ba- 
lance of  circulation,  as  well  as  from  its  known  sympathies  with  the 
stomach  and  liver,  and  thus,  in  some  measure,  account  for  the  une- 
qual distribution  of  nervous  energy,  which  may  excite  cramps,  and 
throw  various  classes  ef  muscles  into  convulsive  agitations.  I  am 


CHOLERA  OF  INDIA.  195 

the  more  disposed  to  this  opinion,  from  the  circumstance,  that  in 
three  desperate  cases  of  Mort  de  Chien,  the  spasms  were  instanta- 
neously relieved  by  venesection.  In  one  of  them  which  happened 
on  board  the  Centurion,  trismus,  (an  unusual  symptom,)  had  taken 
place — the  eyes  were  fixed,  and  the  pupils  dilated.  Bleeding  was 
attended  with  immediate  good  effects,  and  the  patient  was  well  next 
day. 

Having  mentioned  trismus,  I  may  here  remark,  that  Mort  de  Chien 
must  not  be  confounded  with  that  or  tetanus.  For  although  the 
latter  have  arisen  from  checked  perspiration  in  many  instances,  they 
are  totally  different  from  the  disease  under  consideration.  The  gas- 
tric irritability,  and  dysenteric  purging,  might  be  a  sufficient  diagno- 
sis ;  but  the  spasms  themselves  are  dissimilar.  In  Mort  de  Chien, 
the  affection  is  not  confined  to  a  particnlnr  class  of  muscles  ;  it  passes 
from  one  to  another,  and  those  of  the  neck,  face,  and  back,  are  almost 
always  exempted.  Neither  is  it  a  rigidity,  but  a  fixed  cramp  in  the 
belly  of  the  muscle,  which,  as  Mr.  Curtis  justly  observes,  "  is  ga- 
thered up  into  a  hard  knot  with  excruciating:  pain."  Lastly,  the  vas- 
cular system  is  infinitely  more  affected  in  M'trt  de  Chien  than  in  teta- 
nus, and  the  fatal  termination,  beyond  all  comparison,  more  rapid. 

Nor  is  this  investigation  of  the  proximate  cause  of  Cholera,  a  sub- 
ject of  mere  curiosity  ;  it  is  highly  useful  ;  inasmuch  as  it  strongly 
confirms  and  elucidates  the  principle  which  1  have  kept  in  view 
through  various  diseases  in  this  essay  ;  and  whiit  is  of  more  conse- 
quence, it  point*  directly  to  the  most  indispensable  part  of  the  cure, 
in  the  awful  and  terrific  forms  which  the  disease  assumes  in  these 
parts  of  the  world — riamel, ,  the  early  restoration  of  balance  in  the  cir- 
culation and  excitability;  an  indication  hut  little  dieamt  of  in  the  old 
bilious  theory,  where  every  eye  was  kept  fixed  on  the  lurking  de- 
mon— BILE  ! 

"  In  strong  habits,"  says  Dr.  Paisley,  "  when  the  pulse  keeps  up, 
evacuations  should  he  promoted  both  ways,  by  a  vomit  of  two  or  three 
grains  of  emetic  tartar." — Curtis,  p.  86.  But  soon  after,  he  observes, 
"  In  relaxed  habits,  where  the  pulse  sinks  suddenly,  and  brings  on 
immediate  danger,  the  same  method  must  be  pursued,  but  with  greater 
caution.  The  emetics  and  purges  must  be  gentle,  and  made  cordial 
with  wine,  and  sp.  lavend.  Laudanum  must  be  at  hand,  to  gain  time; 
and  ihough  it  is  a  dangerous  expedient  to  suspend  evacuations  where 
putrid  bile  lurks,  yet,  of  two  evils,  the  least  is  to  be  chosen  ;  for  the 
patient  must  sink  to  death,  if  a  respite  from  evacuations,  pain,  and 
spasm,  is  not  procured."  Nothing  so  true  as  this  last.  Nature  is  here, 
as  it  were,  stunned  with  the  blow  ;  and  the  struggling  efforts  which  she 
makes  to  relieve  herself,  by  vomiting,  &c.  only  exhaust  her  the  soon- 
er, if  not  effectually  assisted  by  art.  We  must  therefore  have  re- 
course to  more  powerful  means  than  wine,  laudanum,  or  lavender. 
The  warm  b*th — cordials  of  the  most  stimulating  kind,  such  as  warm 
punch,  or  toddy,  must  be  added  to  opium  and  calomel,  together  with 
friction,  hot  flannels,  &c.  In  short,  every  means  must  be  tried  to  de- 
termine to  the  surface,  restore  the  equilibrium  of  the  circulation  and 
excitability,  and  with  them  natural  perspiration,  (not  the  clammy 
fluid  forced  out  by  pain  and  spasm,  but  a  mild,  warm  sweat,)  and  bi- 


19$  EASTERN 

liary  secretion.  Calomel  must  never  be  omitted,  because  it  answers 
a  tripple  purpose  : — it  allays  the  inordinate  gastric  irritability— it  ex- 
eites  the  action  of  the  liver — and  it  corrects  the  constipating  effects 
of  the  opium  ;  so  that,  when  the  orgasm  is  over,  some  gentle  laxative 
medicine  may,  with  it,  carry  off  the  diseased  secretions,  which  must 
sooner  or  later  take  place,  if  reaction  can  be  brought  on,  or  recovery 
effected.  When  all  medicines  by  the  mouth  have  been  ineffectual, 
in  allaying  the  orgasm  of  the  stomach  and  bowels,  laudanum,  by  way 
of  injection,  has  succeeded,  and  should  be  had  recourse  to,  though  it 
is  generally  neglected.  1  have  only  slightly  mentioned  venesection, 
though,  from  its  instantaneous  good  effects  in  three  desperate  cases, 
I  am  inclined  to  think  it  might  prove  a  powerful  auxiliary  in  relieving 
the  brain,  and  other  internal  organs,  when  overwhelmed  with  blood, 
even  anterior  to  reaction  ;  and  also  by  moderating  the  violence  of  the 
reaction  itself.  This  idea  is  strengthened  by  the  success  which  has 
lately  attended  depletion  in  various  forms  of  spasmodic  diseases,  and 
by  the  following  communication  from  my  able  friend  Mr.  Sheppard : 
— "  Your  account  of  Dr.  Moulson's  paper  brings  to  my  recollection 
a  practice  somewhat  analogous,  (though  with  a  different  intention,) 
which  I  pursued  during  a  short  service  in  the  Brazil?,  a  few  years 
since,  in  the  violent  form  of  cholera  which  seems  to  be  endemic  there. 
You  have,  I  believe,  described  a  similar  disease,  in  India,  under  the 
name  of  Mart  db  Chien^  in  which  you  recommend  bleeding  with  other 
remedies  ;  but  I  have  now  reference  only  to  the  notes  which  I  made 
of  your  book,  and  therefore  am  not  positive.  In  more  than  forty 
cases  which  came  under  my  care,  during  the  four  months  we  were 
In  the  harbour  of  Rio  Janeiro,  and  on  the  coast,  I  t  found  bleeding 
to  syncope  instantly  and  uniformly  successful  alone.  There  was  no 
critical  biliary  discharge,  but  the  disease  was  removed  before  the 
arm  was  secured,  and  no  subsequent  medicine  was  required.  The 
intestinal  spasm  was  far  more  violent  than  any  I  had  ever  witnessed 
in  the  West  Indies,  (where  the  disease  is  pretty  severe,)  and  bore  a 
strong  resemblance  to  the  convulsive  paroxysm  ;  so  much  so,  that  I 
was  generally  called  to  patients  said  to  be  in  fits  ;  and  the  powers  of 
several  men  were  required  to  restrain  them.  The  first  cases  I  treat- 
ed by  warmth,  frictions,  volatiles,  and  opium,  but  did  no  good  until  I 
adopted  the  plan  I  have  mentioned,  which  in  no  instance  disappointed 
me  ;  the  variations  of  temperature  in  that  climate  are  extraordinari- 
ly great,  frequent,  and  sudden  :  and  to  such  mutations  the  prevalence 
of  intestinal  spasms  may  be  ascribed."* 

"  I  had  heard  much,"  says  Mr.  Curtis,  "  of  latent  and  lurking  bile, 
as  the  general  source  of  India  diseases,  and  resolved  to  seek  (or  and 
hunt  it  out,  by  the  means  employed  by  others — viz.  repeated  small 
doses  of  sal.  glaub  in  aq.  tnenthae  piper,  sharpened  with  a  very 
small  proportion  of  emetic  tartar.  This  plan  was  accordingly  tried 

Mr.  Sheppard  will  see  a  striking  elucidation  of  this  subject  in  a  case  of  hydro- 
phobia, by  Mr.  Webster,  related  in  the  Medico-Chirurgical  Journal.  Dr.  Saun- 
ders  of  Edinburgh  has  long  been  investigating  these  points  of  pathology,  and  will, 
we  hope,  soon  lay  the  results  of  his  labours  before  the  public.  The  next  article 
on  the  great  Epidemic  Cholera  of  India  will  show  how  far  my  suggestion  of  re- 
resection  has  since  been  acted  on. 


CHOLERA  OF  INDIA.  197 

With  our  next  patient.  He  threw  up  a  very  small  quantity  of  greenish- 
coloured  bile,  and  the  solution  operated  much  downwards,  without 
any  reliefer  discharge  of  bilious  matter." — p.  59.  After  the  warm 
bath,  opium,  and  mulled  wine,  had  been  tried  without  success,  Mr. 
Curtis  continues — "  A  warm,  purgative  glyster  was  given  him,  but 
was  followed  by  no  bilious  discharge.  No  vomiting  continued  after 
the  first  exhibition  of  the  purgative,  but  a  repetition  of  it,  to  see  if  any 
bile  lurked  still  in  the  stomach,  and  could  be  solicited  downwards, 
brought  on  continued  retching,  and  he  threw  up  every  thing  after 
this  till  his  death." — ib.  Mr.  Curtis  now  gave  up  the  pursuit  of"  lurk- 
ing bile,"  and  saved  his  next  two  patients  by  the  warm  bath — frictions 
with  hot  arrack — wrapping  them  up  in  blankets,  and  supplying  them 
with  warm  tea  and  arrack,  till  perspiration  broke  out,  when  they  were 
relieved,  and  soon  recovered. 

It  is  only  necessary  to  remark,  in  conclusion,  that  in  the  milder  cases 
of  Mort  de  Chien,  corresponding  to  common  Cholera  Morbus,  when 
the^  bilious  vomiting  and  purging  appear,  Nature  has  then  repelled  the 
original  cause  of  the  disease,  and  is  fast  advancing  with  the  cure. 
"We  have  only  now  to  moderate  and  regulate  her  hurried,  and,  as 
it  were,  frightened  movements  by  opium  and  calomel,  in  pretty  large 
^oses  ;  the  former,  as  I  have  before  hinted,  in  glyster  ;  and  when  all 
is  quiet,  to  carry  downwards,  by  mild  laxatives,  the  effects  of  the  dis- 
order,, and  its  cure — DISEASED  SECRETIONS  OF  BILE. 


Reports  on  the  Epidemic  Cholera  which  has  raged  throughout  Hindo- 
stan  and  the  Peninsula  of  India,  since  August,  1817.  Published  under 
the  Authority  of  the  Bombay  Government.  One  Vol.  4to,  228  Pages. 
Bombay,  1819. 


seu  dira  per  omnes 

Manarent  populos  ssevi  contagia  morbi 

This  important  series  of  documents,  drawn  up  by  the  Medical  Board 
of  Bombay,  was  presented  to  me  through  the  medium  of  Dr.  Scott, 
by  the  desire  of  the  head  of  that  board,  lately  returned  to  Europe.* 
The  work  is  circulating  widely  in  India,  but  cannot  of  course,  be 
known  here,  except  through  such  vehicle  as  the  present.  I  deem  it 
a  duty,  therefore,  to  the  profession  at  large,  to  make  them  more  inti- 
mately acquainted  than  they  have  hitherto  been,  with  one  of  the 
most  awful  and  fatal  epidemics  that  ever  ravaged  our  widely  extend- 
ed Indian  empire.  The  event  itself  is  extremely  interesting  to  the 
profession  in  general,  in  a  pathological  and  therapeutical  point  of  view, 
independently  of  those  numerous  ties  and  associations,  by  which  we 
are  linked  to  the  fate  of  our  Asiatic  possessions.  On  all  these  ac- 
counts I  shall  be  pardoned  for  the  length  to  which  this  analysis  may 
extend,  especially  as  I  shall  strain  every  nerve  to  make  it  as  concen- 
trated as  literary  labour  and  typographical  closeness  can  render  it. 
*Dr-  Steuart,  since  deceased- 


198  EASTERN   HEMISPHERE. 

There  are  some  curious  particulars  attending  the  history  of  this  epi-i 
demic,  which  are  worthy  of  record.  It  first  appeared  in  August  1817, 
in  Zilla  Jessore,  about  100  miles  North  East  of  Calcutta,  but  without 
any  previous  peculiarity  of  weather;  being  considered  by  the  autho- 
rities on  the  spot,  as  of  a  local  nature,  and  attributable  to  the  intempe- 
rate use  or  rank  fish  and  bad  rice  ;  but  it  rapidly  spread  through  the 
adjoining  villages,  running  from  district  to  district,  until  it  had  brought 
the  whole  province  of  Bengal  under  its  influence.  It  next  extended 
to  Behar  ;  and,  having  visited  the  principal  cities  West  and  East  of  the 
Ganges,  reached  the  upper  provinces.  Through  the  large  cities  here 
it  made  a  regular  progress  ;  but  it  was  otherwise  in  the  more  thinly 
peopled  portions  of  country.  "  The  disease  would  sometimes  take  a 
complete  circle  round  a  village,  and  leaving  it  untouched,  pass  on  as 
if  it  were  wholly  to  depart  from  the  district.  Then,  after  a  lapse  of 
weeks,  or  even  months,  it  would  suddenly  return,  and  scarcely  reap- 
pearing in  the  parts  which  had  already  undergone  its  ravages,  would 
nearly  depopulate  the  spot  that  had  so  lately  congratulated  itself  on 
its  escape.  Sometimes,  after  running  a  long  course  on  one  side  of  the 
Ganges,  it  would,  as  if  arrested  by  some  unknown  agent,  at  once  stop  ; 
and  taking  a  rapid  sweep  across  the  river,  lay  all  waste  on  the  oppo- 
site bank."  Report  of  the  Calcutta  Medical  Board. 

In  Calcutta  it  showed  itself  in  the  first  week  of  September,  and  each* 
succeeding  week  added  strength  to  the  malady,  and  more  extended 
influence  to  its  operation.  From  January  till  the  end  of  May  it  was 
at  its  acme,  during  which  peri  >d.  the  mortality  in  the  city  was  seldom 
under  200  a  week  ! 

The  centre  division  of  the  army,  under  the  Commander-in-Chief, 
exhibited  an  awful  specimen  of  the  fatality  of  the  disease.  It  consist- 
ed of  less  than  ten  thousand  fighting  men,  and  the  deaths,  within 
twelve  days,  amounted,  at  the  very  lowest  estimate,  to  three  thousand  ; 
according  to  others,  to  five  and  even  eight  thousand  ! 

On  the  6th  of  August,  1818,  it  reached  Bombay,  taking  about  a 
year  to  cross  the  base  of  the  Great  Indian  Delta.  It  appeared  to  Drs. 
Steuart  and  Phillips,  the  enlightened  members  of  the  medical  board 
at  Bombay,  that  the  disease  was  capable  of  being  **  transported  from 
place  to  place  as  in  cases  of  ordinary  contagion  or  infection,  and  also 
to  pessess  the  power  of  propagating  itself  by  the  same  means  that  ac- 
knowledged contagions  do."  Preface,  xii. 

The  partial  and  irregular  manner  in  which  the  disease  spread  and 
operated  in  the  neighbourhood  of  Bombay,  as  the  cold  season  advanc- 
ed, could  not  be  accounted  for  by  the  medical  board,  "  unless  by  sup- 
posing that  a  diminution  of  temperature,  together  with  exposure,  may 
have  called  into  action  some  latent  remains  of  an  active  poison."  The 
board  next  proceeds  to.  a  description  of  the  disease,  as  drawn  up  by 
the  Medical  Board  of  Bengal,  which  I  shall  here  introduce  verbatim. 

"  Having  thus  given  a  rapid  and  imperfect  sketch  of  the  history  of 
the  epidemic,  the  board  should  now  proceed  to  detail  the  symptoms 
which  attended  its  attack.  This  part  of  their  task  they  will  not  find 
it  difficult  to  accomplish.  The  leading  appearances  of  this  most  fa- 
tal malady  were  but  too  well  marked  on  their  approach  and  subse  - 


CHOLERA  OF  INDIA.  199 

quent  progress  ;  and  amongst  the  myriads  who  were  ittacked,  exhi- 
bited perhaps  less  variety  and  fewfer  discrepancies  than  characterize 
the  operation  of  almost  tny  other  disease  to  which  the  human  body  is 
subject.  The  healthy  and  unhealthy  ;  the  strong  and  feeble  ;  Eu- 
ropeans and  Natives  ;  the  Mussulman  and  Hindoo  ;  the  old  and  young 
of  both  sexes,  and  of  every  temperament  and  condition,  were  alike 
within  its  influence. 

"  The  attack  was  generally  ushered  in  by  a  sense  of  weakness, 
trembling,  giddiness,  nausea,  violent  retching,  vomiting  and  purging, 
of  a  watery,  starchy,  whey-coloured,  or  greenish  fluid.  These 
symptoms  were  accompanied,  or  quickly  followed  by  severe  cramps, 
generally  beginning  in  the  fingers  and  toes,  and  thence  extending  to 
the  wrists  and  fore-arms,  calves  of  the  legs,  thighs,  abdomen,  and 
lower  part  of  the  thorax.  These  were  soon  succeeded  by  pain, 
constriction,  and  oppression  of  stomach  and  pericardium  ;  great  sense 
of  internal  heat  ;  inordinate  thirst,  and  incessant  calls  for  cold  water, 
which  was  no  sooner  swallowed  than  rejected,  together  with  a  quan- 
tity of  phlegm  or  whitish  fluid,  like  seethmgs  of  oatmeal.  The  ac- 
tion of  the  heart  and  arteries  now  nearly  ceased  ;  the  pulse  either 
became  altogether  imperceptible  at  the  wrists  and  temples,  or  so 
weak  as  to  give  to  the  finger  only  an  indistinct  feeling  of  fluttering. 
The  respiration  was  laborious  and  hurried,  sometimes  with  long  and 
frequently  broken  inspirations.  The  skin  grew  cold,  clammy,  cover- 
ed with  large  drop'  of  sweat ;  dank  and  disagreeable  to  the  feel,  and 
discoloured  of  a  bluish,  purple,  or  livid  hue.  There  was  great  and 
sudden  prostration  of  strength  ;  anguish,  and  agitation.  The  coun- 
tenance became  collapsed ;  the  eyes  suffused,  fixed,  and  glassy,  or 
heavy,  and  dull  ;  sunk  in  their  sockets,  and  surrounded  by  dark  cir- 
cles ;  the  cheeks  and  lips  livid  and  bloodless  ;  and  the  whole  surface 
of  the  body  nearly  devoid  of  feeling.  In  feeble  habits,  where  the 
attack  was  exceedingly  violent,  and  unresisted  by  medicine,  the  scene 
was  soon  closed.  The  circulation  and  animal  heat  never  returned; 
the  vomiting  and  purging  continued,  with  thirst  and  restlessness  ;  the 
patient  became  delirious  or  insensible,  with  his  eyes  fixed  in  a  vacant 
stare,  and  sunk  down  in  the  bed  ;  the  spasms  increased,  generally 
within  four  or  five  hours. 

"  The  disease  sometimes  at  once,  and  as  if  it  were  momentarily, 
seized  persons  in  perfect  health ;  at  other  times  those  who  had  been 
debilitated  by  previous  bodily  ailment ;  and  individuals  in  the  latter 
predicament,  generally  sunk  under  the  attack.  Sometimes,  the  sto- 
mach and  bowels  were  disordered  for  §ome  days  before  the  attack, 
which  would  then,  in  a  moment,  come  on  in  full  force,  and  speedily 
reduce  the  patients  to  extremities. 

'•  Such  was  the  general  appearance  of  the  disease  where  it  cut  off 
the  patient  in  its  earlier  stages.  The  primary  symptoms,  however, 
in  many  cases,  admitted  of  considerable  variety.  Sometimes  the 
sickness  and  looseness  were  preceded  by  spasms  ;  sometimes  the 
patient  sunk  at  once,  after  passing  off  a  small  quantity  of  colourless 
fluid,  by  vomiting  and  stool.  The  matter  vomited  in  the  early  stages 
was,  in  most  cases,  colourless  or  milky  ;  sometimes  it  was  green. 
In  like  manner,  the  dejections  were  usually  watery  and  muddy  ; 


200  EASTERN  HEMISPHERE. 

sometimes  red  and  bloody  ;  and  in  a  few  cases,  they  consisted  of  a 
greenish  pulp,  like  half-digested  vegetables.  In  no  instance  was  fe- 
culent matter  passed  in  the  commencement  of  the  disease,  f  he 
cramps  usually  began  in  the  extremities,  and  thence  gradually  crept 
to  the  trunk  ;  sometimes  they  were  simultaneous  in  both  ;  and  some- 
times the  order  of  succession  was  reversed  ;  the  abdomen  being  first 
affected,  and  then  the  hands  and  feet.  These  spasms  hardly  amount- 
ed to  general  convulsion.  They  seemed  rather  affections  of  indi- 
vidual muscles,  and  of  particular  sets  of  fibres  of  those  muscles, 
causing  thrilling  and  quivering  in  the  affected  ptrts,  like  the  flesh  of 
crimped  salmon  ;  and  firmly  stiffening  and  contorting  the  toes  and 
fingers.  The  patient  always  complained  of  pain  across  the  belly, 
which  was  generally  painful  to  the  touch,  and  sometimes  hard  and 
drawn  back  towards  the  spine.  The  burning  sensation  in  the  stomach 
and  bowels  was  always  present ;  and  at  times  extended  along  the 
cardia  and  oesophagus  to  the  throat.  The  powers  of  voluntary  mo- 
tion were,  in  every  instance,  impaired  ;  and  the  mind  obscured. 
The  patient  staggered  like  a  drunken  man,  or  fell  down  like  a  help- 
less child.  Head-ache  over  one  or  both  eyes,  sometimes,  but  rarely 
occurred.  The  pulse,  when  to  be  felt,  was  generally  regular,  and 
extremely  feeble,  sometimes  soft  ;  not  very  quick  ;  usually  ranging 
from  80  to  100.  In  a  few  instances  it  rose  to  140  or  150,  shortly  be- 
fore death.  Then  it  was  indistinct,  small,  feeble,  and  irregular. 
Sometimes  very  rapid,  then  slow  for  one  or  two  beats.  The  mouth 
was  hot  and  dry  ;  the  tongue  parched,  and  deeply  furred,  white, 
yellow,  red,  or  brown.  The  urine  at  first  generally  limpid  and  free- 
ly passed  ;  sometimes  scanty,  with  such  difficulty  as  almost  to  amount 
to  strangury  ;  and  sometimes  hardly  secreted  in  any  quantity,  as  if 
the  kidnies  had  ceased  to  perform  their  office.  In  a  few  cases,  the 
hands  were  tremulous  ;  in  others,  the  patient  declared  himself  free 
from  pain  and  uneasiness,  when  want  of  pulse,  cold  skin,  and  anxiety 
of  features,  portended  speedy  death.  The  cramp  was  invariably  in- 
creased upon  moving. 

"  Where  the  strength  of  the  patient's  constitution,  or  of  the  cura- 
tive means  administered,  were,  although  inadequate  wholly  to  sub- 
due the  disease,  sufficient  to  resist  the  violence  of  its  onset,  nature 
made  various  efforts  to  rally  ;  and  held  out  strong,  but  fallacious  pro- 
mises of  returning  health.  In  such  cases,  the  heat  was  sometimes 
wholly,  at  others  partially  restored  ;  the  chest  and  abdomen  in  the 
latter  case  becoming  warm,  whilst  the  limbs  kept  deadly  cold.  The 
pulse  would  return  ;  grow  moderate  and  full  ;  the  vomiting  and 
cramps  disappear  ;  the  nausea  diminish,  and  the  stools  become  green, 
pitchy,  and  even  feculent ;  and  with  all  these  favourable  appearances 
the  patient  would  suddenly  relapse  ;  chills,  hiccup,  want  of  sleep 
and  anxiety  would  arise  ;  the  vomiting,  oppression,  and  insensibility, 
return  ;  and  in  a  few  hours  terminate  in  death. 

««  When  the  disorder  ran  its  full  course,  the  following  appearances 
presented  themselves.  What  may  be  termed  the  cold  stage,  or  the 
state  of  collapse,  usually  lasted  from  twenty-four  to  forty -eight  hours, 
and  was  seldom  of  more  than  three  complete  days'  duration.  Through- 
out the  first  twenty-four  hours,  nearly  all  the  symptoms  of  deadly 


CHOLERA.  OF  INDIA.  201 

oppression,  the  cold  skin,  feeble  pulse,  vomiting  and  purging,  cramps, 
thirst  and  anguish  continued  undiminished.  When  the  system  show- 
ed symptoms  of  revival,  the  vital  powers  hegan  to  rally,  the  circula- 
tion and  heat  to  be  restored  ;  and  the  spa*ms  and  sickness  to  be  con- 
siderably diminished.  The  warmth  gradually  returned  ;  the  pulse 
rose  in  strength  and  fulness,  and  then  became  sharp  and  sometimes 
hard.  The  tongue  grew  more  deeply  furred  ;  the  thirst  continued, 
with  less  nausea.  The  stools  were  no  longer  like  water  ;  they  be- 
came first  brown  and  watery  ;  then  dark,  t>lack,  and  pitchy  ;  and  the 
bowels,  during  many  days,  continued  to  discharge  immense  loads  of 
vitiated  bile,  until,  with  returning  health,  the  secretions  of  the  liver 
and  other  viscera  gradually  put  on  a  natural  appearance.  The  fever, 
which  invariably  attended  this  second  stage  of  the  disease,  may  be  con- 
sidered to  have  been  rather  the  result  of  Nature's  effort  to  recover 
herself  from  the  rude  shock  which  she  had  sustained,  than  as  form- 
lag  any  integrant  and  necessary  part  of  the  disorder  itself.  It  par- 
took much  of  the  nature  of  the  common  bilious  attacks  prevalent  in 
these  latitudes.  There  was  the  hot  dry  skin  ;  foul,  deeply  furred, 
dry  tongue  ;  parched  mouth  ;  sick  stomach;  depraved  secretions; 
and  quick  variable  pulse  ;  sometimes  with  stupor,  delirium,  and  other 
marked  affections  of  the  brain.  When  the  disorder  proved  fatal  after 
reaching  this  stage,  the  tongue,  from  being  cream-coloured,  grew 
brown,  and  sometimes  dark,  hard,  and  more  deeple  furred  ;  the  teeth 
and  lips  were  covered  with  sordes  ;  the  state  of  the  skio. varied  ; 
chills,  alternating  with  flushes  of  heat  ;  the  pulse  became  weak  and 
tremulous  ;  catching  of  fhe  breath  ;  great  restlessness,  and  deep 
moaning  succeeded  ;  and  the  patient  soon  sunk,  insensible,  under  the 
debilitating  effects  of  frequent  dark,  pitchy,  alvme  discharges. 

"  Of  those  who  died,  it  was  be!ieved,  perhaps  rather  fancifully, 
that  the  bodies  sooner  underwent  putrefaction,  than  those  of  persons 
dying  under  the  ordinary  circumstances  of  mortality.  The  bodies  of 
those  who  had  sunk  in  the  earlier  stages  of  the  malady,  exhibited 
hardly  any  unhealthy  appearance.  Even  in  them,  however,  it  was 
observed,  that  the  intestines  were  paler  and  more  distended  with  air, 
than  usual  ;  and  that  the  abdomen,  upon  being  laid  open,  emitted  a 
a  peculiar  offensive  odour,  wholly  different  from  the  usual  smell  of 
dead  subjects.  In  the  bodies  of  those  who  had  lived  some  time  af- 
ter the  commencement  of  the  attack,  the  stomach  was  generally  of  na- 
tural appearance  externally.  The  colour  of  the  intestines  varied  from 
deep  rose  to  a  dark  hue,  according  as  the  increased  vascular  action 
had  been  arterial  or  venous.  The  stomach,  on  being  cut  into,  was 
found  filled,  sometimes  with  a  transparent,  a  green,  or  d*rk  flaky  fluid. 
On  removing  this,  its  internal  coats,  in  some  cases,  were  perfectly 
healthy  ;  in  others,  and  more  generally,  they  were  crossed  by 
streaks  of  a  deep-red,  interspersed  with  spots  of  inflammation,  made 
up  of  tissues  of  enlarged  vessels.  This  appearance  was  frequently 
continued  to  the  duodenum.  In  a  very  few  cases,  the  whole  internal 
surface  of  the  stomach  was  covered  with  coagulable  lymph  ;  on  re- 
moving which,  a  bloody  gelatine  was  found  laid  on  the  interior  coat, 
in  ridges  or  elevated  streaks.  The  large  intestine  vras  sometimes 

26 


202  EASTERN  HEMISPHERE. 

filled  with  muddy  fluid,  sometimes  lived,  with  dark  bile,  like  tar  ;  just 
as  the  individual  had  died  in  the  earlier  or  later  periods  of  the  attack. 
In  most  cases,  the  liver  was  enlarged,  and  gorged  with  blood.  In  a 
few,  it  was  large,  soft,  light-coloured,  with  greyish  spots,  and  not  ve- 
ry turgid.  In  ethers  again,  it  was  collapsed  and  flaccid.  The  gall- 
bladder, was  without  exception,  full  of  dark  green  or  black  bile. 
The  spleen  and  thoracic  viscera  were,  in  general,  healthy.  The 
great  venous  vessels  were  usually  gorged  ;  and  in  one  case,  the  left 
ventricle  of  the  heart  was  extremely  turgid.  The  brain  was  gene- 
rally of  natural  appearance.  In  one  or  two  instances,  lymph  was  ef- 
fused between  its  membranes,  near  the  coronal  suture,  so  as  to  cause 
extensive  adhesions  ;  in  other  cases,  the  sinuses,  and  the  veins  lead- 
ing to  them,  were  stuffed  with  very  dark  blood. "  xv. — xxi. 

The  following  extracts  will  show  that  the  disease  was  known  to  Sy- 
denham,  and  accurately  described  by  that  observant  physician.  He 
no  where  mentions  bile  as  forming  any  part  of  the  discharges  from 
the  stomach  or  bowels  ;  and  hence  it  may  be  fairly  inferred,  that  such 
discharges  were  not  present.* 

*'  Qui  ab  ingluvie  ac  crapula  nullo  temporis  discrimine  passim  ex- 
citatur  affectus,  ratione  symptomatum  non  absimilis,  neceamdem  cu- 
rationis  methodum  respuens,  tamen  alterius  est  subsellii.  Malum 
ipsum  facile  cognoscitur,  adsunt  enim  vomitus  enormes,  ac  pravorum 
humorum  cum  maxima  difficultate  et  angustia  per  alvum  dejectio  ; 
cardialgia,  sitis.  Pulsus  celer  ac  frequens,  cum  a3stu  et  anxietate, 
-uk^wE-t  non  raro  etiam  parvus  et  inaequalis,  insuper  et  nausea  molestissima, 
feudor  interdum  diaphoreticus,  crurum  et  brachiorum  contractura, 
animi  deliquiuro,  partium  extremarum  frigiditas,  cum  aliis  notae  symp- 
Uft^'f-  tomatibus,  quas  adtantes  magnopere  perterrefaciunt,  atque  etiam  an- 
gusto  viginti  quatuor  horarum  spatio  a3grum  interimant." 

And  again,  in  his  letter  to  Dr.  Brady,  describing  the  epidemics  of 
1674,  5,  and  6,  he  says, 

"  Exeunte  sestate  Cholera  Morbus  epidemice  jam  saeviebat,  et  in- 
sueto  tempestatis  calore  evectus,  atrociora  convulsionum  symptoma- 
ta,  eaque  diuturniora  secum  trahebat,  quam  mihi  prius  unquam  vi- 
dere  contigerat.  Neque  enim  solum  abdomen,  uti  alias  in  hoc  malo, 
sed  uniyersi  jam  corporis  tnusculi,  brachiorum  crurumque  prae  reli- 
quis,  spasmis  tentabantur  dirissimis,  ita  ut  aeger  e  lecto  subinde  exili- 
ret,  si  forte  extenso  quaquaversum  corpore  eorum  vim  posset  elu- 
dere,"  xxiii. 

*  1  have  diligently  searched  the  writings  of  Sydenham,  and  I  assert,  that  in  no 
one  instance,  when  treating  of  Cholera  Morbus,  whether  epidemic  or  sporadic, 
has  he  mentioned  a  discharge  of  bile  as  forming  any  part,  much  less  as  being  the 
cause,  of  cholera.  And  as  Sydenham  is  allowed  to  be  one  of  the  most  accurate 
observers  of  nature,  we  see  on  what  foundation  Dr.  Saunders  and  others  have 
built  their  bilious  theory  of  the  disease.  The  fact  is,  as  I  have  long  ago  stated, 
that  the  discharge  of  bile  in  cholera,  is  a  secondary  or  ternary  link  in  the  chain 
of  cause  and  effect — and  always  a  sanative  effort  of  the  system,  as  well  as  a  fa- 
vourable symptom  of  the  disease. 

I  observe  too,  that  Areteus  describes  the  discharge  of  bile  as  only  an  ulterior 
effect.  "  In  primis,"  says  he,  "  quae  evomuntur,  aqtm  similia  sunt ;  qua?  anus 
«ffundit,  stercorea,  Hquida,  tejrjque  odoris  sentiuntur,  Siquidem  longa  cruditas 
id  maluin  excitavit,  quo  si  per  clysterem  eluanter^rtwto^n'toitosa.  mox  bihoxa 
femntur."--Dc  Chokra,  Chap.  5. 


CHOLERA  OF  INDIA.  203 

The  first  of  the  foregoing  extracts  describes  the  disease  with 
great  accuracy,  as  it  very  generally  affected  the  natives  ;  the  second 
is  well  exemplified  in  Dr.  Barrel's  Report,  as  it  attacked  the  Euro- 
peans of  the  65th  Regiment,  at  Seroor.  The  disease  is  also  accu- 
rately described  by  Girdleston,  and  by  Mr.  Curtis  of  Madras,  in  1782, 
when  it  raged  in  the  Southern  Provinces  of  the  Peninsula.  Dr.  Tay- 
lor also  furnished  the  Medical  Board  with  the  account  of  a  disease 
from  a  Sanscrit  medical  work,  the  MADHOW  NIDAN,  which  clearly 
proves  that  the  complaint  has  been  long  known  to  the  natives. 

"•  It  is  obviously  unnecessary  to  prosecute  this  inquiry  further  ; 
and  we  shall  only  add,  that  Dr.  James  Johnson  is  the  latest  author, 
so  far  as  we  know,  who  has  treated  this  subject,  and  who  has  also 
the  merit  of  having  been  the  first  who  has  generally  pointed  out  the 
best  method  of  cure,  from  a  few  cases  he  met  with  on  fhe  eastern 
coast  of  Ceylon,  where  the  disease  seems  to  be  more  prevalent  than 
in  any  other  part  of  India,"  xxviii. 

The  exciting  and  proximate  causes  of  this  interesting  epidemic 
are, like  those  of  most  others,  concealed  in  utter  darkness—"  atrtt 
caligine  me rsce ;"  great  discrepancy  of  opinion  obtains  in  India  re- 
specting its  contagious  or  non-contagious  influence,  arising  naturally 
out  of  the  difficulty  of  the  subject. 

"  Several  irresistible  facts  already  noticed  or  related  in  the  fol- 
lowing Reports,  and  its  marked  anomaly  from  all  hitherto  known  sim- 
ple epidemics,  would  seem  to  favour  the  doctrine  of  contagion,  while 
the  contrary  supposition  is  only  supported  by  a  species  of  negative 
evidence,"  xxix. 

The  Board,  however,  very  properly  observe,  that  this  is  a  ques- 
tion of  such  importance,  that  it  ought  not  to  be  too  hastily  entertain- 
ed as  proved,  nor  rejected  as  unfounded  ;  but  prosecuted  with  that 
diligent  inquiry  and  cautious  induction,  which  on  every  subject  of 
science,  are  so  necessary  to  the  attainment  of  truth. 

In  respect  to  the  predisposing,  [or  rather  the  exciting  t]  causes, 
practitioners  are  unanimous. 

"  Rapid  atmospherical  vicissitudes,  in  regard  either  to  temperature 
or  moisture  :  exposure  of  the  body  to  currents  of  cold  air,  particu- 
larly the  chill  of  the  evening,  after  being  heated  by  violent  exercise 
of  any  kind,  inducing  debility  or  exhaustion  ;  low  marshy  situations, 
flatulent  or  indigestible  food,  especially  crude  and  watery  vegetables, 
which  compose  a  large  proportion  of  the  diet  of  the  natives  ;  and 
particularly  that  gradual  undermining  of  the  constitution  which  arises 
in  a  condensed,  dirty,  and  ill-fed  mass  of  population,  are  all  unques- 
tionably powerful  predisposing  causes." 

Sad  experience,  however,  has  shown  that  the  absence  of  all  these 
afforded  no  security  against  the  attack.  Whether  the  invisible  cause, 
(whatever  that  may  be,)  acts  more  immediately  on  the  vascular  or 
nervous  system,  the  Board  cannot  take  upon  them  to  determine  ;  but 
from  the  various  modes  of  attack  which  gave  rise  to  the  division  of 
the  disease  into  two  species  and  varieties,  they  are  led  to  the  suppo- 
sition that  sometimes  the  one  system,  sometimes  the  other,  bears  the 
onus  of  the  first  onset  of  the  malady. 

"  The  most  general  attack  seems  to  consist  in  a  spasmodic  affection 


204  EASTERN  HEMISPHERE. 

of  the  stomach,  duodenum,  and  more  especially  the  biliary  ducts? 
(the  total  absence  of  bile  in  the  matter  voided  upwards  and  down- 
wards being,  perhaps,  the  most  uniform  characteristic  of  the  dis- 
ease,) which  quickly  extending  through  the  whole  intestinal  canal, 
discharges  its  contents.  It  is  more  thaa  probable,  however,  that  these 
are  merely  the  first  perceptible  symptoms  ;  for  it  would  appear  that 
a  great  change  has  already  taken  place  in  the  circulating  system,  and 
that  the  action  of  the  heart  itself  has  been  greatly  diminished  before 
they  occur.  This  seems  evident  from  the  numerous  cases  in  which 
neither  vomiting  or  purging  is  present,  and  in  which  the  first  appear- 
ance of  the  disease  is  the  almost  total  suspension  of  the  vital  func- 
tions, immediately  followed  by  severe  spasmodic  affections  of  the 
muscles  and  coldness  of  the  extremities,"  xxxiii. 

Here  the  Board  have  copied  Dr.  Armstrong's  description  of  the 
attack  of  congestive  typhus,  remarking  that 

"  Those  who  are  most  intimate  with  the  disease  in  question,  will 
be  struck  with  the  great  similarity  between  this  and  typhus,  at  their 
first  appearance." 

Dissections,  they  state,  abundantly  prove  that  venous  congestion 
constitutes  the  principal  change  that  takes  place  during  life. 

The  following  passage,  though  long,  cannot  be  abridged  without 
greatly  lessening  its  value. 

*'  On  the  subject  of  the  cure  of  the  disease,  we  need  say  but  lit- 
tle. The  practice  so  judiciously  and  speedily  adopted  by  Dr.  Bur- 
rell  in  the  65th  Regiment,  clearly  proves,  that  at  the  commencement 
of  the  disease  in  Europeans,  blood-letting  is  the  sheet  anchor  of  suc- 
cessful practice  ;  and  perhaps  also  with  natives,  provided  it  be  had 
recourse  to  sufficiently  early  in  the  disease  ;  and  as  long  as  the  vital 
powers  remain,  so  as  to  be  able  to  produce  a  full  stream,  it  ought 
perhaps  never  to  be  neglected,  it  having  been  sufficiently  proved, 
that  the  great  debility  so  much  complained  of  is  merely  apparent. 
Calomel,  as  a  remedy,  certainly  comes  next  in  order,  and  when  em- 
ployed in  proper  doees,  with  the  assistance  of  opium,  and  more  par- 
ticularly in  the  early  stage  of  the  disease,  seems  to  be  equally  effec- 
tual among  natives,  as  venesection  among  Europeans,  in  arresting  its 
progress.  In  all  the  case?  formerly  alluded  to,  when  we  met  the  dis- 
ease on  its  first  attack,  a  single  scruple  dose  of  calomel,  with  sixty 
minims  of  laudanum,  and  an  ounce  of  castor  oil  seven  or  eight  hours 
afterwards,  was  sufficient  to  complete  the  cure.  The  practice  of 
this  place,  as  sufficiently  appears  by  Dr.  Taylor's  report,  bears  ample 
testimony  to  the  control  which  calomel  possesses  over  the  disease,  in 
as  much  as  it  has  often  preserved  life,  when  blood-lelting  could  not 
be  put  in  practice. 

'•  All  other  remedies  must,  in  our  opinion,  be  considered  as  mere 
auxiliaries,  no  doubt  extremely  useful  as  such,  and  ought  never  to  be 
neglected  ;  but  particularly  the  warm  bath  and  stimulating  frictions. 
Even  where  the  disease  appears  to  have  given  way  to  bleeding,  we 
think  it  highly  necessary  constantly  to  administer  calomel.  The 
powerful  effect  of  this  remedy  in  allaying  irritability  of  the  stomach 
and  intestines,  when  given  in  large  doses,  is  generally  acknowledged 
fcy  practitioners,  in  the  severer  attacks  of  dysentery  :  as  a  great  and 


REPORTS  ON  CHOLERA.  203 

permanent  stimulus  to  the  vascular  system,  it  will  be  readily  ac- 
knowledged by  every  one  who  has  suffered  for  any  length  of  time 
under  its  effects  in  ptyalism,  where  the  bounding  pulsations  of  the 
arteries  of  the  temples  and  neck  produce  very  disagreeable  sensa- 
tions, and  even  preclude  sleep.  Its  powers  over  inflammation  of  the 
abdominal  viscera,  the  liver  in  particular,  and  indeed  in  membranous 
and  glandular  inflammation  generally,  are  now  universally  acknow- 
ledged. 

"  In  a  disease,  therefore,  in  which  we  have  every  reason  to  be- 
lieve that  venous  congestion  has  taken  place  to  a  great  extent,  and 
where  we  conclude  that  the  liver,  from  its  peculiar  circulation  and 
structure,  is  more  immediately  liable  to  become  seriously  and  per- 
manently injured,  it  should  not  be  admitted.  We  have  before  men- 
tioned, that  Dr.  James  Johnson  seems  to  have  been  the  first  who 
pointed  out  the  best  method  of  cure.  Since  most  of  the  foregoing 
remarks  were  written,  we  have  seen  the  second  edition  of  that  gen- 
tleman's valuable  work,  in  which  we  find  a  strong  corroborative  tes- 
timony to  the  utility  of  blood-letting  in  this  disease,  or  one  some- 
what similar  to  it,  on  the  coast  of  Brazil,  by  Mr.  Sheppard,  of  \Vit- 
ney,  without  the  assistance  of  any  other  remedy.  The  public  are 
greatly  indebted  to  Mr.  Corbyn,  of  the  Bengal  Establishment,  for  his 
clear  and  comprehensive  letter  on  this  subject,  at  a  time  when  the 
disease  was  producing  the  most  dreadful  ravages  :  the  early  commu- 
nication of  his  practice  has  been  the  means  of  saving  thousands  of 
lives  in  situations  where  Dr.  Johnson's  work  might  not  be  known," 
xlii. 

About  forty  official  reports  from  various  medical  officers,  compose 
the  great  body  of  the  work  before  us,  and  form  the  materials  from 
which  Drs.  Steuart  and  Phillips  have  drawn  up  the  foregoing  lumi- 
nous and  interesting  digest.  It  is  not  necessary  to  go  into  these  re- 
ports individually.  There  never  perhaps  existed  so  unanimous  a 
consent  respecting  the  treatment  of  such  a  wide-spreading  epidemic 
as  these  documents  disclose. 

FURTHER  DOCUMENTS*RESPECTING  CHOLERA. 

1 .  Report  on  the  Epidemic  Cholera  Morbus,  as  it  visited  the  Territo- 
ries subject  to  the  Presidency  of  Bengal,  in  the  Years  1817,  1818, 
and  1819.    Drawn  up  by  order  of  the  Government,  under  the  super- 
intendence of  the  Medical  Board.     By  JAMES  JAMESON,  Assistant 
Surgeon  and  Secretary  to  the  Board.     One  vol.  8vo.     pp.  326. 
Calcutta,  1820. 

2.  Account  of  the  Spasmodic  Cholera,  which  has  lately  prevailed  in  In- 
dia and  other  adjacent  Countries  and  Islands,  4»c.  in  a  Letter  from 
Mr.  Corbyn  to  Sir  Gilbert  Blane.     Medico-Chirurgical  Transac- 
actions.     Vol.  xi.  part  i.     1820. 

"  Noxia  si  penitus  CHOLERAM  saevire  vcnena."    SER. 

Having  given  so  full  an  account  of  this  tremendous  epidemic  ID  my 
Review  of  the  excellent  report  drawn  up  by  the  Bombay  Medical 


20t>  EASTERN    HEMISPHERE. 

Board,  I  dare  not  trespass  on  the  patience  of  my  readers,  by  enter- 
ing into  an  extended  analysis  of  the  present  documents.  Mr.  Jame- 
son appears  to  me  to  have  drawn  up  a  very  impartial  digest  of  the 
various  returns  made  by  full  100  medical  officers.  It  could  hardly 
be  expected  that  no  discrepancy  of  opinion  should  prevail  respecting 
the  cause  and  treatment  of  such  a  wide-spreading  epidemic. — There 
was,  in  fact,  considerable  clash  of  sentiment,  but  as  far  as  thera- 
peutics were  concerned,  a  very  large  and  preponderating  majority  of 
evidence  furnished  ample  grounds  for  the  following  conclusions, 
which  1  shall  give  in  the  words  of  the  author. 

1.  '*  The  disease  sometimes  attacked  with  such  extreme  violence, 
as,  from  the  commencement,  apparently  to  place  the  sufferer  beyond 
the  reach  of  medical  aid,  and  to  render  every  curative  means  em- 
ployed equally  unavailing. 

2.  "  The  difference  in  the  degree  of  mortality  amongst  those  who 
did,  and  those  who  did  not,  take  medicine,  was  such  as  to  leave  no 
doubt,  that,  when  administered  in  time,  and  with  discrimination,  it 
frequently  saved  the  patient  from  death. 

3.  "  The  chances  of  a  patient's  receiving  beneGt  from  medicine, 
diminished  in  proportion  with  the  increased  duration  of  the  attack. 

4.  "  In  Europeans  generally,  and  in  robust  natives,  bleeding  could 
be  uniformly  practised,  where  the  patient  was  seen  within  one,  two, 
or  perhaps  three  hours,  from  the  beginning  of  the  attack  ;  and  in  all 
cases,  in  which  it  is  resorted  to,  under  such  favourable  circumstances, 
it  was  more  successful  than  any  other  remedy  in  cutting  short  the 
disease  ;  usually  resolving  spasms  ;  allaying  the  irritability  of  the 
stomach  and  bowels  ;  and  removing  the  universal  depression  under 
which  the  system  laboured. 

5.  "  Amongst  the  generality  of  natives,  the  depressing  influence 
of  the  disease  was  so  powerful  and  rapid  in  its  operation,  as  almost 
immediately  to  produce  a  complete  collapse,  and  nearly  destroy  arte- 
rial action  ;  and  therefore  to  render  venesection  for  the  moat  part, 
from  the  beginning,  impracticable. 

6.  "  Although  it  cannot  be  affirmed  that  calomel  possessed  any 
specific  power  in  checking  the  disorder,  it  was  undoubtedly  frequent- 
ly useful  in  soothing  irritability  ;  and  was,  perhaps  of  more  certain 
sedative  operation  than  any  other  medicine,"  247. 

Whether  it  was  that  the  epidemic,  in  a  few  places,  totally  changed 
its  nature,  or  that  the  mental  telescopes  of  a  few  individuals  had  one 
lens  more,  or  one  lens  less  than  those  of  the  generality  of  mankind, 
(of  which  we  see  occasional  examples  in  this  country,)  but  so  it  was, 
that  the  above-mentioned  remedial  measures  found  useful  by  nine- 
tenths  of  the  community,  not  only  failed,  but  proved  highly  prejudi- 
cial in  the  hands  of  some. 

In  a  supplement  to  the  work,  it  appears  that  subsequent  to  the 
month  of  June,  1819,  the  disease  re-appeared  in  the  upper  pro- 
vinces, and,  it  would  seem,  with  some  modification,  as  bile  was  fre- 
quently seen  in  the  stools  ;  and  reaction  was  more  violent.  It  is  not 
difficult  to  conceive  that,  under  such  circumstances,  "  large  and  re- 
peated bleedings  proved  the  only  efficacious  means  of  opposing  the 
disorder." 


REPORTS  ON  CHOLERA.  207 

Of  the  remote  causes  of  this  epidemic,  Mr.  Jameson,  and  conse- 
quently the  Calcutta  Board,  can  offer  nothing  satisfactory.  They 
conceive  that  it  could  not  be  owing  solely  to  atmospherical  vicissitudes 
— though  they  were  great — nor  to  contagion — nor  to  any  thing  con- 
nected with  food.  They  conjecture  that  a  morbific  poison  or  miasm, 
however  produced,  was  carried  along  by  the  easterly  winds,  and  gave 
origin  to  the  epidemic.  This  is  all  the  explanation  we  can  expect  in 
the  present  state  of  our  knowledge,  and  on  which  we  shall  make  a 
few  remarks  further  on. 

Mr.  Jameson,  in  labouring  to  subvert  the  hypothesis  of  others,  re- 
specting the  proximate  cause,  or  rather  the  immediate  seat  of  the 
disease,  has  fallen,  as  usual,  into  an  hypothesis  himself.  He  endea- 
vours to  show  that  the  impression  of  the  morbific  cause  is  not  exclu- 
sively made  on  the  skin,  nor  on  the  liver  ;  but  as  far  as  I  can  gather 
from  him,  it  is  on  the  stomach.  Now  this  1  think  is  only  substituting 
one  exclusive  doctrine  for  another.  1  believe  that  all  the  great  or- 
gans of  the  body  are  so  intimately  linked  together,  not  only  by  blood- 
vessels and  nerves,  but  by  sympathetic  association  of  function,  that 
no  one  can  bear  the  onus  of  disease  without  drawing  in  the  others  to 
a  participation.  Moreover,  I  cannot  but  conclude  that  a  cause,  so 
generally  diffused  in  the  atmosphere  as  that  of  an  epidemic  must  al- 
ways be,  will  affect  a  number  of  organs  and  parts  simultaneously — 
particularly  the  whole  of  the  nervous  or  sentient  system  distributed 
over  the  surface  of  the  body,  the  mucous  membrane  of  the  lungs, 
and  the  lining  membrane  of  the  digestive  organs. 

It  is  hypothetical  then  to  limit  the  primary  morbid  impression  to  a 
single  organ  or  tissue,  however  that  part  may  appear  to  suffer  in  the 
course  of  the  disease.  That  the  nervous  system  in  this,  as  indeed 
in  almost  all  other  epidemics,  suffered  the  first  shock,  we  can  prove 
from  Mr.  Jameson's  own  synfitomatology  of  the  disease. 

"  The  irritability  of  stomach,  and  vomiting  formed  a  very  distress- 
ing part  of  the  disorder.  They  were  generally  preceded  by  a  feel- 
ing  of  giddiness,  ind  inclination  to  faint."  And  in  another  place, 
"  In  some  rare  instances,  the  virulence  of  the  disease  was  so  powerful 
as  to  prove  immediately  destructive  of  life  ;  as  if  the  circulation  were 
at  once  arrested,  and  the  vital  powers  wholly  overwhelmed.  In  these 
cases  the  patient  fell  down  as  if  struck  by  lightning,  and  instantly  ex- 
pired," 42. 

Still  less  will  the  post  mortem  researches  bear  out  our  author. 

"  In  many,  especially  those  who  died  early,  the  stomach  and  in- 
testinal canal  were  found  full  of  muddy  fluid,  without  the  slightest 
mark  of  inflammation.  In  others,  the  vessels  of  their  inner  coats 
were  turgid,  sometimes  highly  inflamed,  ulcerated,  and  gangrened. 
The  liver  was  congested,  inflamed,  and  darker  than  usual,  &c."  72. 

The  Bengal  Board  corroborate  the  statement  of  the  Bombay 
Board  respecting  the  non-appearance  of  bile  in  the  stools  or  in  the 
bowels  after  death.  *'  Neither  in  Europeans  nor  in  natives,  was  any 
tinge  of  that  secretion  discovered  in  the  intestinal  canal." 

Mr.  Corbyn's  communication  to  Sir  Gilbert  Blane,  in  the  Medico- 
Chirurgical  transactions,  is  now  more  than  a  thrice  told  tale — having 
been  published  substantially  in  the  Edinburgh  Medical  Journal,  in 


208  EASTERN    HEMISPHERE. 

the  Bombay  reports,  and  in  the  Medico-Chirurgical  Journal  for  April. 
1820.  A  further  experience  of  better  than  a  year,  (being  brought 
up  to  Sept.  1819,  nearly  as  far  as  the  Calcutta  reports,)  has  confirm- 
ed Mr.  Corbyn's  former  statements  relative  to  the  treatment  of  this 
formidable  epidemic. 

"  The  outline  of  the  treatment  alluded  to,  is.  to  administer  twenty 
grains  of  calomel,  (in  powder,  not  in  pills  )  and  to  wash  it  down  with 
sixty  drops  of  laudanum  and  twenty  drops  of  oil  of  peppermint  in 
two  ounces  of  water — to  bleed  freely  in  the  early  stage — and  to  sup- 
port the  warmth  by  external  heat,  the  hot  bath  and  hot  friction,  and 
internally  by  cordials,"  122. 

Sir  Gilbert  Blane,  in  a  commentary  on  the  different  communica- 
tions, has  laboured  to  render  it  at  least  probable  that  this  epidemic 
was  contagious.  It  is  sufficient  to  say  that  the  Calcutta  Medical 
Board,  who  had  better  opportunities  of  ascertaining  this  point  than 
Sir  Gilbert  Blane,  gave  a  decided  negative  to  the  supposition. 

Sir  Gilbert  Blane  has  been  favoured  by  the  Army  Medical  Board, 
with  a  document  from  the  principal  medical  officer  in  the  Isle  of 
France,  showing  that  the  epidemic  appeared  there  on  the  20th  No- 
vember, 1818.  It  has  since  raged  with  great  violence. 

Here,  as  in  India,  the  laborious  classes  of  the  population  suffer- 
ed  most.  «'  With  regard  to  the  practice,  opium  and  calomel  were 
administered  to  the  cases  in  the  army,  but  in  smaller  doses  than  in 
India."  The  principal  medical  officer  denies  contagion,  attributing 
the  epidemic  to  atmospheric  influence.  The  inhabitants,  however, 
believed  the  infection  was  imported  by  the  Topaze  frigate  !  Such 
popular  beliefs,  like  some  popular  disbeliefs  here,  are  little  worthy  of 
notice. 

u  Non  ego  ventosae  plebis  suffragia  venor." 

The  inhabitants  of  Bourbon  acting  on  the  contagious  creed,  institut- 
ed a  strict  quarantine.  But  the  epidemic  laughed  to  scorn  these  lit- 
tle hypothetical  barriers,  and  majched  into  the  place  without  cere- 
mony. 

One  of  the  medical  officers  having  stated  his  opinion  that  the  cause 
of  this  epidemic  was  owing  to  the  issue  of  a  morbific  effluvium  from 
the  earth,  as  was  long  ago  maintained  by  Sydenham,  Sir  Gilbert  Blane 
characterizes  this  opinion  as  "an  assumption  purely  gratuitous,  and 
neither  supported  by  fact  nor  countenanced  by  analogy."  Now  I 
•would  ask  Sir  Gilbert  Blane  if  the  matter  of  contagion,  or  the  febri- 
fic  miasm  from  marshy  soils,  has  ever  been  rendered  cognizable  to 
the  senses  ? — and  what  proof  have  we  of  their  existence  but  by 
their  effects  ?  The  epidemic  in  question,  as  well  as  many  other 
epidemics,  could  not  be  traced  to  contagion,  for  even,  according  to 
Sir  Gilbert's  own  confession — "  it  has  been  found  occasionally,  like 
the  small  pox,  to  break  out  in  spots  a  few  (he  might  have  said  a 
few  hundred,)  miles  distant  from  the  known  seat  of  contagion, 
without  its  being  possible  to  trace  it."  The  idea  of  contagion  then, 
being  almost  universally  given  up,  we  have  but  two  other  proba- 
ble sources — the  earth  and  the  air.  The  longer  I  have  reflected 
on  this  subject,  the  more  I  am  convinced  of  the  truth  of  Sydenham's 


REPORTS  ON  CHOLERA,  209 

conjecture.  We  know  that  certain  states  of  the  earth's  surface  will 
disengage  morbific  agents.  But  it  will  be  triumphantly  asked,  "  have 
these  agents  or  effluvia  been  ever  seen  issuing  from  the  bowels  of  the 
earth  ?"  t  answer,  by  asking  if  they  have  ever  been  seen  descend- 
ing from  the  regions  of  the  air,  or  passing  from  one  person  to  ano- 
ther ? — And  are  there  no  subterraneous  agents  at  work  ?  Do  we  ne- 
ver feel  the  earth  itself  tremble  under  our  feet  from  one  extremity 
of  Europe  to  the  other,  from  the  agency  of  subterraneous  and  un- 
seen causes  ?  Have  we  not  seen  pestilences  quickly  succeed  these 
intestinal  commotions  of  nature  ?  Do  we  not  actually  see  the  elec- 
tric fluid  itself,  at  one  moment  forsake  the  air  and  plunge  into  the 
bowels  of  the  earth  ;  while  the  next  instant,  it  springs  from  thence 
to  the  clouds  over  our  heads  ?  And  is  morbific  effluvium  a  less  subtle 
fluid  than  the  electric  ?  Oh  !  but,  says  Sir  Gilbert  Blane,  "  how  is 
it  conceivable  that  these  effluvia  could  exhale  from  the  earth  in 
the  progressive  manner  in  which  this  disease  extended  itself,  and  how 
will  it  account  for  its  appearing  on  board  of  ships  at  sea  ?"  In  an- 
swer to  this  I  must  first  state,  that  the  great  Eastern  epidemic  spread 
from  one  extremity  of  India  to  the  other,  often  directly  against  mon- 
soon. Now,  how  is  this  reconcileable  with  atmospheric  influence  ? 
It  would  be  very  curious,  too,  if  human  contagion  had  the  power  of 
selecting  a  single  point  out  of  the  thirty-two  in  the  compass,  and  of 
refusing  to  travel  for  a  time  on  any  other  parallel !  It  would  be 
equally  curious  'if  atmospheric  influence  could  propagate  itself  direct- 
ly against  a  trade  wind,  which  blew  in  one  direction  for  six  months 
together ! 

Indeed,  the  capricious  as  well  as  obstinate  courses  which  this  epi- 
demic occasionally  pursued,  are  much  more  explicable  on  the  prin- 
ciple of  a  terrestrial,  than  of  an  atmospheric  or  contagious  influence. 
We  see  the  causes  which  produce  earthquakes  take  the  most  irre- 
gular and  unaccountable  routes  ;  and  as  for  this  morbific  agent  ap- 
pearing at  sea,  we  can  have  no  great  difficulty  in  conceiving  the  pos- 
sibility of  such  an  occurrence,  after  seeing  in  our  own  days,  volcanic 
islands  boiling  up  from  the  bottom  of  the  ocean. 

Upon  the  whole,  I  think  that  we  have  been  much  too  precipitate 
in  rejecting  the  opinion  of  Sydenham,  and  that  no  other  hypothesis* 
if  such  it  be,  is  half  so  plausible  as  the  terrestrial  origin  of  epidemic 
influence,  however  that  influence  may  be  subsequently  transported 
about,  or  modified  by  atmospheric  constitutions. 

And  here  I  cannot  help  stating  it  as  my  decided  conviction,  that  the 
ever-varying  causes  of  epidemic  diseases  will  produce  an  ever-vary- 
ing character  of  them,  and  consequently  an  ever-varying  pathology 
and  treatment.  This  may  be  mortifying  to  the  pride  of  man,  who 
often  builds  an  ingenious  theory  on  the  symptoms  and  treatment  of  a 
single  epidemic,  the  whole  foundation  of  which  is  shaken  to  the  cen- 
tre by  the  next  visitation  of  disease.  It  is  in  vain  to  say  that  epide- 
mics differ  only  in  the  organs  principally  affected.  What  produces 
this  difference  of  seat  ?  Here  we  must  recur  to  an  occult  cause,  how- 
ever we  may  be  inclined  to  account  for  things  without  it.  The  fact 
is,  what  all  unbiassed  observers  have  long  ago  acknowledged,  that  not 

27 


210  EASTERN  HEMISPHERE. 

only  do  the  causes  and  seats  of  epidemic  diseases  materially  differ  at 
different  epochs  ;  but  their  whole  nature  is  modified,  and  requires  an 
ever-varying  modification  of  management.  Nor  do  I  think  that  this 
impassible  bar  to  perfection  is  at  all  injurious  to  medical  science.  If 
pathology  and  therapeutics  could  be  reduced  to  certain  fixed  and 
invariable  rules,  inquiry  would  languish,  and  the  human  mind  would 
soon  lose  its*  most  powerful  stimulus  to  exertion.  Medicine  might 
then  be  administered  by  the  mere  rotitinist  with  as  much  success  as 
by  the  most  intelligent  physician.  But  there  is  no  fear  of  this  con- 
summation in  the  practice  of  physic !  Our  descendants  will  have  to 
go  all  over  the  same  ground  that  we  are  treading,  and  probably  not  a 
single  tenet  of  the  present  time  will  hold  good  fifty  or  even  thirty 
years  hence.  But  if  we  roll  the  stone  of  Sisyphus,  it  is  not  in  vain. 
The  exertion,  though  it  may  be  useless  to  futurity,  is  salutary,  nay 
absolutely  necessary  for  us.  If  our  utmost  efforts  are  incapable  of 
placing  us  one  step  in  advance,  still  a  moment's  cessation  from  labour 
would  inevitably  cause  us  to  retrograde.  But  to  return. 

The  Army  Medical  Board  have  recently  received  intelligence  from 
Ceylon,  and  with  their  accustomed  liberality  have  communicated  the 
same  to  the  profession. 

Dr.  Davy,  who  is  already  known  to  the  profession,  considers  that 
the  epidemic  was  unconnected  with  the  direction  of  the  winds,  the 
topography  of  the  places  visited,  or  any  sensible  changes  in  the  state 
of  the  atmosphere.  In  some  cases,  the  flaccidity  of  the  muscular 
parts  after  death,  resembled  that  produced  in  animals  by  electricity, 
or  when  hunted  to  death.  The  colour  of  the  venous  and  arterial 
blood  was  the  same — both  being  of  the  dark  venous  hue.  The  blood 
drawn  never  presented  a  buffy  coat.  The  air  expired  from  the  lungs 
of  the  sick,  did  not  contain  more  than  one -third  of  the  carbonic  acid 
contained  in  the  breath  of  healthy  people.  Mr.  Finlayson  observed 
in  some  cases,  what  happened  often  in  Bengal,  that  the  operation  of 
the  morbific  cause  was  so  violent  as  to  destroy  life  in  a  few  hours, 
without  any  of  the  characteristic  tokens  of  the  disease,  except  the 
extreme  prostration  of  strength.  The  warm  bath  and  all  other  me- 
dicines seemed  rather  hurtful  than  beneficial. 

"  Non  vota,  non  ars  ulla  correptos  levant !" 

In  these  particular  cases  there  was  such  great  congestion  of  blood 
in  the  brain  "  that  it  had  the  appearance  of  being  enveloped  in  a 
layer  of  dark  coagulated  blood,  or  by  a  diffuse  and  general  ecchy- 
IBOSIS,  and  in  some  cases,  when  it  was  cut  into,  large  quantities  of 
dark  coagulated  blood  gushed  from  it  and  from  the  theca  of  the  spine." 
ID  the  ordinary  form  of  the  disease,  this  appearance  was  wanting,  the 
blood  being  principally  collected  in  the  abdominal  viscera.  The 
blood  was  so  fluid  that  any  opening  of  the  larger  vessels  produced  an 
inconvenient  effusion.  In  several  cases,  the  surface  of  the  heart  and 
pericardium  was  Imed  with  a  green-coloured  gelatinous  fluid.  There 
was  found  a  dark-coloured  fluid  in  the  stomach  and  a  colourless  fluid 
in  the  rest  of  the  intestines,  which  were  blanched  like  tripe.  These 
appearances  were  peculiar  to  cases  of  early  death.  In  the  more  ad- 
vanced stages,  the  morbid  appearances  did  not  differ  materially  from 


BERIBERI.  211 

what  has  already  beea  described  in  another  part  of  this  work.  The 
deaths,  in  several  of  the  stations,  equalled  the  recoveries,  or  even 
exceeded  that  proportion.  In  two  cases,  the  spasmodic  contractions 
continued  for  some  time  after  death  !  "  The  stress  of  the  cure  was 
laid  on  twenty  or  thirty  grains  of  calomel  given  at  first,  and  repeated 
in  doses  of  eight  or  ten  grains  every  second,  third,  or  fourth  hour. 
Blood-letting  was  practised  with  the  same  relief  as  in  other  parts  of 
India."  I  fully  coincide  with  Sir  Gilbert  Blane  in  the  following  pas- 
sage. 

"  We  cannot  conclude  this  article  without  remarking  that  the  me- 
dical officers  of  the  British  empire  in  India  have  done  themselves 
much  honour,  by  the  great  ability,  zeal,  and  humanity  displayed  in 
the  preceding  communications." 

Our  brethren  in  the  Eastern  hemisphere  have  had  most  arduous 
duties  to  fulfil  during  the  last  few  years,  and  I  have  reason  to  believe 
that  the  manner  in  which  they  performed  them  has  reflected  credit 
on  the  profession,  and  on  humanity.  „ 

"  Vir  bonus,  quod  honeste  se  facturum  putaverit,  faciet,  etiamsi 
laboriosum  erit : — faciet,  etiamsi  damnosum  erit  : — faciet,  etiamsi 
pericufcsum  erit." 


BERIBERI. 

SEC.  XI. — The  Beriberi  is  a  disease  of  a  peculiar  nature,  which 
has  been  extremely  frequent,  and  fat-tl  amongst  all  the  troops,  both 
Europeans  and  natives,  in  Ceylon.  In  the  milder  cases  of  this  dis- 
ease, the  patients  are  first  attacked  with  some  stiffness  of  the  legs 
and  thighs,  and  this  is  succeeded  by  numbness  and  oedema,  sometimes 
paralysis  of  the  lower  extremities. 

In  a  course  of  a  few  days,  if  not  prevented  by  medicine,  these 
symptoms  are  succeeded  by  swelling  of  the  whole  body,  attended 
with  a  sense  of  fulness  of  the  belly,  and  more  particularly  with 
weight  and  oppression  at  the  pra=cordia  ;  dyspnoea,  starting  in  the 
sleep,  and  all  the  usual  symptoms  of  hydrothorax.  In  the  latter 
stage,  the  dyspnoea  and  anxiety  become  extreme,  the  uneasiness  at 
the  epigastrium  increases,  attended  with  almost  constant  vomiting, 
and  occasionally  spasms  of  different  muscles  :  the  pulse  becomes 
very  feeble,  the  lips  and  countenance  livid,  and  the  extremities  cold. 

Some  fever,  with  delirium,  often  now  accede,  and  terminate  the 
life  of  the  unfortunate  sufferer.  In  the  more  sudden  and  severe  in- 
stances, the  patients,  from  the  first,  complain  of  universal  debility 
and  extreme  oppression,  anxiety  and  dyspnoea.  In  some  of  these 
instances,  the  progress  of  the  disease  is  so  rapid,  that  it  carries  off 
the  patient  in  six,  twelve,  twenty-four,  or  thirty-six  hours  after  its 
first  attack  :  more  frequently,  however,  its  duration  is  for  several 
weeks. 

In  a  few  cages,  where  the  disease  was  no  less  fatal,  there  was  not 
any  swelling  observable  externally  ;  but  the  patient  with  the  other 
symptoms,  had  evidently  the  bloated  leucophlegmatic  face  of  a  drop; 
sical  person. 


«•:  A  STERN  HEMISPHERE. 

Upon  dissection  of  different  subjects,  w ho  had  died  of  tins  dis- 
ease, more  or  less  water  was  found  in  one  or  all  the  cavities  of  the 
chest ;  most  commonly  in  the  pericardium,  but  in  general,  more  in- 
considerable than  might  have  been  expected  from  the  violence  of  the 
symptoms.  The  cellular  substance  surrounding  the  heart  was,  in 
some  instances,  loaded  with  water  ;  and  the  heart  seemed,  in  two 
or  three  cases  of  an  uncommon  size.  In  one  instance,  in  which  the 
progress  of  the  disease  had  been  very  rapid,  I  found  a  large  coagu- 
lum  of  lymph  in  the  right  auricle.  The  cellular  substance  of  the 
lungs  was,  in  many  cases,  loaded  with  water.  In  a  few  cases,  also, 
there  was  water  effused  in  the  cellular  substance  on  the  surface  of 
the  brain  ;  and,  in  one  instance,  more  than  an  ounce  of  water  was 
collected  in  the  ventricles.  In  most  cnses,  water  was  found  in  the 
abdomen,  and  cellular  membrane  throughout  the  body  ;  and,  in  many 
subjects,  there  was  a  remarkable  obesity,  even  after  a  long  continu- 
ance of  the  disease,  and  of  the  use  of  mercury,  antimony, and  other 
powerful  medicines.  Men  of  every  constitution  are  occasionally  at- 
tacked with  the  Beriberi,  but  the  aged  and  debauched  seem  to  be 
most  liable  to  it ;  and  men  who  have  once  had  the  complaint^ are  the 
most  subject  to  it  in  future.  I  have  remarked  that  a  very  great  pro- 
portion of  the  patients,  seized  with  this  disease,  xvere  men  who  were 
accustomed  to  lead  a  sedentary  and  debauched  life,  such  as  taylors, 
shoemakers,  &c.  who,  when  working  at  their  trade,  are  often  excus- 
ed the  duty  of  the  field,  and,  by  their  double  earnings  are  enabled 
to  procure  a  larger  quantity  of  spirits  than  the  other  men. 

1  have  r.ever  met  with  an  instance  of  this  complaint  in  a  woman, 
an  officer,  or  a  boy,  under  20  ;  although  persons  of  every  descrip- 
tion seem  equally  liable  to  the  other  diseases  of  the  place,  such  as 
fever,  flux,  or  liver  complaint. 

It  would  appear  that  a  stay  for  some  months  on  the  station,  is 
almost  essential  for  the  production  of  the  disease  ;  and  that  the  great- 
est predisposition  to  it  exists,  when  troops  have  been  about  eight  or 
twelve  months  in  the  settlement. 

The  72d  regiment  and  Coast  artillery  landed  here  in  July,  1795. 
The  Beriberi  was  with  them  most  prevalent  in  the  autumn  of  1796  ; 
but  they  had  little  of  it  in  March,  1797,  when  it  was  extremely  fre- 
quent with  the  1st  battalion  European  infantry,  who  had  arrived  here 
in  August,  1796. 

The  80th  regiment  relieved  the  72d  in  March,  1797,  but  suffered 
little  from  the  disease  till  the  November  following.  The  Honoura- 
ble Company's  Malay  corps  arrived  here,  from  Jgffnapatnam,  in 
June,  1797  ;  but  the  complaint  did  not  appear  amongst  them  till  the 
January  following,  when  it  became  very  frequent  and  fatal.  Two 
hundred  drafts  joined  the  80th  at  Trincomalec,  on  the  3d  of  January, 
1798  ;  but  none  of  these  men  had  the  disease  in  January,  February, 
or  March,  although  it  was  then  very  frequent  with  the  other  men  of 
the  regiment :  since  that  time,  however,  these  drafts  have  been  at 
least  as  subject  to  it  as  the  other  men. 

Various  modes  of  cure  have  been  attempted  in  this  disease  :  but  I 
have  of  late  uniformly  pur  sued  the  following  plan  with  uncommon 
success. 


THE   DRACUNCULUS,  OR  GUINEA  WORM. 

In  the  more  mild  cases,  the  patients  are  immediately  put  upon  a 
course  of  calomel  and  squills.  The  perspiration  and  other  evacua- 
tions are  promoted  by  saline  drinks,  or  small  doses  of  antimouial,  or 
James's  powder  ;  and  the  strength  supported  by  cordial  liquors,  most 
generally  gin  punch,  which  assists  much  the  effect  of  the  squills. 

By  these  medicines,  the  symptoms  are  very  often  removed  in  the 
course  of  a  few  days  ;  except  the  numbness  of  the  extremities,  which 
generally  remains  longer  than  the  rest.  Pediluvium  and  stimulant 
liniments  are  then  ordered  to  the  extremities,  and  the  patients  are 
put  upon  a  tonic  flan,  of  bark  and  wine,  or  porter,  which  is  conti- 
nued for  some  time  after  all  the  symptoms  have  disappeared.  In  the 
more  severe  cases,  where  the  dyspnoea,  vomiting,  spasms,  or  other 
symptoms  are  vi<  lent,  it  is  necessary  to  apply  blisters  to  the  breast, 
to  make  use  of  fomentations,  and  the  hot  bath,  and  to  exhibit  the 
strongest  cordials,  and  anti-spasmodics,  as  brandy,  and  particularly 
laudanum  and  vitriolic  aether.  By  these  mean!  I  have,  in  most  in- 
stances, been  enabled  to  relieve  the  dyspnoea,  and  other  urgent  symp- 
toms ;  and  procure  time  for  the  exhibition  of  the  medicines  mention- 
ed above,  which  it  is  sometimes  necessary  to  use  for  several  weeks, 
— Christies  Report,  4*c. 

THE  DRACUNCULUS,  OR  GUINEA  WORM. 

SEC.  XII. — Although  this  worm  attacks  most  parts  of  the  body,  it 
shows  a  preference  to  the  lower  extremities,  particularly  the  feet 
and  ankles,  where  it  is  painful  and  dangerous  in  proportion  as  the 
parts  are  thinly  covered  with  flesh.  It  is  difficult  to  extract  it  from 
the  tarsus  and  metatarsus — sometimes  impossible  from  the  toes.  The 
consequences  are  often,  tedious  suppurations — contraction  of  the  ten- 
dons— diseases  of  the  joints — gangrene.  When  the  worm  is  pulled, 
the  pain  is  sometimes  excruciating,  as  the  animal  would  appear  to  at- 
tach itself  to  the  nerves,  ligaments,  and  tendons.  The  track  of  the 
worm  seems  to  be  in  the  cellular  membrane,  rarely  deeper.  There 
are  seldom  any  premonitory  symptoms.  The  presence  of  the  dis- 
ease is  usually  announced  by  itching,  redness,  and  heat  in  the  skin  of 
the  part,  succeeded  by  a  vehicle,  with  some  swelling  and  inflamma- 
tion. Under  the  vesicle,  which  contains  a  white,  thick  mucus,  the 
head  of  the  worm  may  be  generally  discovered  ;  but  sometimes  not 
till  several  days  after  the  ulceration.  Occasionally  a  small  ulcer  is 
the  first  thing  observed  ;  at  other  times,  tumour  of  the  whole  limb, 
with  much  inflammation.  The  worm  sometimes  appears  like  a  hair, 
several  inches  long,  and  becomes  thicker  as  it  is  extracted  ;  but  it  ge- 
nerally has  a  sharp  point,  and  is  all  of  the  same  thickness.  It  may 
often  be  frit  and  traced  by  the  fingers  like  the  string  of  a  violin,  un- 
der the  skin,  where  it  excites  no  very  sensible  uneasiness,  till  the 
skin  i?  perforated  by  the  animal. 

When  removed  from  the  body  it  exhibits  no  appearance  of  life, 
even  when  extracted  at  one  operation.  In  length,  it  varies  from  18 
inches  to  six  feet.  It  is  elastic,  white,  transparent,  and  contains  a 
gelatinous  substance. 

When  the  disease  is  seated  in  parts  that  are  tender — when  there 


214  EASTERN  HEMISPHERE. 

is  extensive  ulceration — or  where  the  constitution  is  irritable,  there 
is  generally  some  fever,  loss  of  appetite,  debility,  and  evening  exa- 
cerbation, especially  if  the  worm  happen  to  be  drawn  too  tight. 
Swellings  of  the  inguinal  glands  are  sometimes  sympathetically  in- 
duced when  the  complaint  is  situated  in  the  lower  extremities. 

Various  have  been  the  opinions  respecting  the  generation  of  this 
insect.  Both  ancient?  and  moderns  hive  attributed  its  production  to 
the  drinking  of  putrid  stagnant  water?  containing  the  ova  of  the  worm. 
Some  have  regarded  the  worm  as  produced  from  ova  deposited  in  the 
skin  by  insects.  This  last  supposition  is  by  far  the  most  probable, 
notwithstanding  the  ingenious  arguments  brought  forward  by  Dr. 
Chisholm,  in  favour  of  the  aqueous  generation,  and  for  the  following 
reasons: — 1st.  The  disease  most  frequently  attacks  those  parts  of 
the  body  that  are  exposed  to  wet,  as  the  feet  and  legs.  Thus  the 
Bheesties  or  water-carriers  in  India,  who  carry  the  water  in  leather 
bags  on  their  backs,  are  observed  to  be  much  afflicted  with  Guinea 
worm  in  those  parts  that  come  in  contact  with  the  mushuk  or  bag.— 
2d.  It  prevails  in  wet  seasons,  and  damp  situations  more  than  in  dry. 

Many  causes,  however,  may  contribute  to  the  production  of  the 
disease,  as  confinement,  heat,  want  of  cleanliness  in  person  and  habi- 
tation, &c.  and  the  means  of  prevention  are  founded  on  these  premises, 
viz.  cleanliness — avoiding  dampness — keeping  the  feet  and  legs  cover- 
ed, [which  few  European  soldiers  and  sailors  attend  to  in  tropical 
climates,]  bathing  in  the  sea,  in  preference  to  lakes  and  rivers — and 
avoiding  contact  with  those  infected  ;  for  there  is  great  reason  to  be- 
lieve that  the  disease  is  propagated  by  contagion  when  once  produced 
by  other  causes. 

Methodus  Medendi — Mercury,  carried  to  the  length  of  impregna- 
tion of  the  system,*  has  been  considered  by  some  as  a  specific,  and 
so  has  assafoetida  in  Guinea  worm  ;  but  the  local  means  are  those 
most  to  be  depended  on.  Sublala  causa,  tollitur  effectus. 

When  an  inflammatory  tumor  ushers  in  the  disease,  leeches,  cata- 
plasms,fomentations,  and  other  antiphlogistic  measures  are  to  be  pur- 
sued, till  suppuration  occurs,  A.nd  the  head  of  the  worm  becomes  appa- 
rent It  should  then  be  seized  by  the  forceps,  and  pulled  very  gent- 
ly and  gradually  until  there  be  a  little  resistance,  and  the  worm  becomes 
moderately  tight.  The  extraction  is  often  facilitated  by  friction  with 
warm  oil,  and  well  adjusted  pressure  in  the  line  of  the  worm  towards 
the  wound.  When  as  much  of  the  animal  has  been  drawn  out  as  the 
resistance  and  pain  will  admit,  the  end  of  it  should  be  secured  by  a 
ligature  or  thread  passed  round  it  ;  the  thread  should  then  be  tied 
to  a  piece  of  small  bougee,  twisted  lint  or  small  quill,  an  inch  and 
a  half  in  length,  and  with  the  slack  part  of  the  worm,  is  to  be  roll- 
ed up  until  it  be  moderately  tight,  taking  care  that  it  be  not  on  the 
stretch,  as  it  will  occasion  fever,  or  endanger  the  breaking  of  the 
worm.  A  piece  of  adhesive  plaster  is  necessary  to  retain  it  in  its 
place,  and  poultices  may  be  continued,  especially  where  there  is  tu- 
mour, to  promote  a  discharge  and  the  expulsion  of  the  worm. 

In  general,  the  extraction  should  only  be  attempted  once  in 
twenty-four  houri.  Sometimes  a  foot  of  worm  can  be  extracted  at 

*  V''>  Tbisholm  in  Edin.  Journal,  vol.  11 


ELEPHANTIASIS. 

once,  sometimes  not  an  inch.  When  the  whole  is  drawn  out,  the 
sore  may  be  treated  as  a  common  ulcer,  making  moderate  pressure 
on  the  original  track  of  the  worm. 

When  by  injudicious  extraction  the  animal  is  broken,  then  tumour, 
fever,  and  tedious  suppuration  in  that  or  other  parts  are  the  frequent 
consequences.  Here  recourse  must  again  be  had  to  fomentations  and 
cataplasms,  until  the  ruptured  end  of  the  worm  can  be  again  discover- 
ed, and  laid  hold  of. 

When  the  worm  can  be  distinctly  felt  by  the  fingers  under  the  skin, 
before  breaking  through,  it  is  advisable  to  extract  it  by  mean*  of  a 
small  incision  made  over  the  part  where  it  is  most  superficial,  and,  as 
near  as  possible,  over  it§  middle.  A  ligature  should  then  be  appli- 
ed, and  the  worm  extracted  double,  in  the  manner  before  mentioned. 
— Bruce. 


ELEPHANTIASIS.* 

SEC.  XIII. — Mr.  Robinson  conceives  that  two  distinct  varieties,  if 
not  different  diseases,  are  confounded  under  one  name  ;  "  and  what 
is  worse,  are  treated  alike,  though  they  require  very  different  reme- 
dies." As  elephantiasis,  the  lepra  arabum,  is  one  of  the  most  com- 
mon, as  well  as  "  one  of  the  most  gigantic  and  incurable  diseases" 
of  HindosUn,  I  shall  present  a  full  analysis  of  Mr.  Robinson's  paper 
in  this  place,  as  it  will  thereby  have  a  considerable  circulation 
through  our  oriental  and  occidental  dominions. 

Variety  1st.  Exhibits  the  following  symptoms.  One  or  two  cir- 
cumscribed patches  appear  upon  the  skin,  (generally  the  feet  or 
hands,  but  sometimes  the  trunk  or  face,)  of  a  rather  lighter  colour 
than  the  neighbouring  parts,  neither  raised  nor  depressed,  shining  and 
wrinkled,  the  furrows  not  coinciding  with  the  lines  of  the  contiguous 
sound  cuticle.  The  skin  of  these  patches,  is  insensible  even  to  a 
hot  iron.  They  spread  slowly  until  the  skin  of  the  legs,  arms,  and 
whole  body  is  completely  involved,  and  deprived  of  sensibility.  It  is 
in  this  state,  chiefly,  that  the  disease  is  remediable. 

After  a  period,  varying  from  two  months  to  five  or  six  years, 
symptoms  indicative  of  internal  disease,  or  functional  derangement, 
are  developed.     The  pulse  becomes  slow   and  heavy,  the   bowels 
torpid,  the  toes  and  fingers  numbed,  as  with  frost,  appearing  glazed, 
#  somewhat  swelled,  and  nearly  inflexible.     The  mind  exhibits  cor- 
responding traits  of  torpor  and  inactivity  ;  the  soles  of  the  feet  and 
palms  of  the  hands  crack  into  fissures,  dry  and  hard,  as  the  parched 
soil  of  the  country,  the  extremities  of  the  toes  and  fingers,  under 
the  nails,  being  encrusted  with  a  furfuracecus  substance,  and  the 
nails  themselves   raised  up  until   absorption    and  ulceration  occur. 
Still  there  is  no  pain.     The  legs  and  arms  now  swell,  the  skints 
every  where  cracked  and  rough,  cotemporary  with  which  symptom?, 
ulcers  appear  at  the  inside  of  the  joints  of  the  toes  and  fingers,  di- 

• 

*  On  the  Elephantiasis,  as  it  appears  in  Hindostan.  By  JAMES  ROBINSON, 
Esq.  Superintendent  of  the  Insane  Hospital  at  Calcutta,  Meaico-Chirurjicai 
Transactions,  Vol.  x. 


EASTERN  HEMISPHERE. 

rectly  under  the  last  joint  of  the  metatarsal  ormetacarpal  bones  ;  or 
they  corrode  the  thick  sole,  under  the  joint  of  the  os  calcis  or  os  cu- 
boides,  without  any  preceding  tumour,  suppuration,  or  pain,  but  ap- 
parently from  simple  sloughing  off  of  the   integuments,  in  layers  of 
half  an  inch  in  diameter.     A  sanious  discharge  comes  on  ;  the  mus- 
cles, in  ther  turn,  are  destroyed  ;  and  the  joint  being  penetrated  as 
by  an  auger,  **  the  extremity  droops,  and  at  length  falls  a  victim  to 
this  cruel,  tardy,  but  certain  poison."     The  wound  then  heals,  and 
other  joints  are  attacked  in  succession,  every  revolving  year  bring- 
ing with  it  a  trophy  of  this  slow  march  of  death  !  The  patient,  though 
a  spectacle  of  horror  to  others,  and  a  burden  to  himself,  still  clings 
to  life,  and  endeavours  to  cherish  its  remaining  spark,  by  voracious- 
ly devouring  all  he  can  procure.     "  He  will  often  crawl  about  with 
little  but  his  trunk  remaining,  until  old  age  comes  on,  and  at  last  he 
is  carried  of  by  diarrhoea  or  dysentery,  which  the  enfeebled  consti- 
tution has  no  stamina  to  resist."     Although  the  general  health  and 
the  digestive  functions  do  not  suffer  much  throughout  this  loag  and 
tedious  dismemberment,  yet  *'  a  sleepy  inertness  overpowers  every 
faculty,   and  seems  to  benumb,  almost   annihilate,   every  passion,  as 
tvell  of  the  soul  as  of  the  body,  leaving  only  sufficient  sense  and  acti- 
vity to  crawl  through  the  routine  of  existence."  This  our  author  con- 
siders as  a  distinct  variety  of  elephantiasis,  to  uhicb,  on  account  of 
its  most  prominent  trait,  he  would  give  the  name  of  elephantiasis  ana- 
islhetos.     He  has  never  seen  the  larger  joints  attacked,  (a  strange 
assertion  after  telling  us  that  the  patient  creeps  about  with  '•  little  but 
his   trunk  remaining,")  the  nose  destroyed,  or  any  bones  affected, 
save  those  of  the  hands  and  feet.     The  tuberculated  species,  here- 
after to  be  described,  sometimes  supervenes,  "  but  is  by  no  means 
connected  with,  caused  by,  or  necessarily  subsequent  to  this  disease." 
Treatment,   if  we  see  the  patient  in  the  first  stage,  before  described, 
the  prognosis  may  be  favourable.  A  combination  of  mercury  and  anti- 
-  mony,  with  tropical  stimulants,  will  generally  succeed.  A  blister  alone 
kept  open  for  a  few  days  will  often  restore  the  sensibility  of  the  skin, 
and  check  the  disease. 

"  Whenever  the  foot  or  hand  alone  is  affected,  I  usually  apply  a 
strip  of  blistering  plaster  one  inch  and  a  half  wide  all  round  the  limb, 
just  upon  the  line  which  marks  the  sound  from  the  affected  parts. 
Where  this  is  inapplicable,  from  the  extent  of  the  disease,  I  apply  a 
solution  of  muriate  of  mercury,  made  as  follows  : 

R.  Hydr.  muriat.  gr.  viij.  acid,  muriat.  gt.  xx.  Tere  in  vit.  mort. 
deinde  adde  spt.  vini  rectif.  3fJ>aq.  font.  Oij.  M.  This  must  be  rub- 
bed well  on  the  skin,  wherever  affected." 

Mr.  R.  at  the  same  time,  gives  to  an  adult,  half  a  grain  of  calomel, 
three  grains  of  antimonial  powder,  and  from  six  to  ten  of  rad.  ascle- 
pia3  giganteae  every  eight  hours.  This  last  medicine  was  discovered 
several  years  ago  by  Mr.  Playfair,  and  our  author  thinks  the  profes- 
sional world  greatly  indebted  for  the  discovery  of  "  the  most  valua- 
ble medicine  hitherto  derived  from  the  vegetable  kingdom."  Mr. 
Playfair  emphatically  describes  it  as  "  a  vegetable  mercury,  specific 
in  the  cure  of  lues  venerea,  leprosy,  and  cutaneous  eruptions  in  ge- 
neral, the  most  powerful  alternative  hitherto  known,  and  an  excellent 


OBSERVATIONS  ON  DISEASES  OF  INDIA,  &C.  217 

«3eobstraent.  In  all  affections  of  the  skin,  says  he,  I  have  found  it 
very  effectual ;  and  in  the  jugaru  or  leprosy  of  the  joints,  I  have 
never  failed  to  heal  up  all  the  ulcers,  and  often  have  produced  a  per- 
fect cure." 

lo  fl»e  complaint  under  consideration,  Mr.  Robinson  agrees  with 
Mr.  Playfair,  that  the  asclepias,  called  in  Hindostan  "  Mudar"  is 
possessed  of  great  virtues.  He  can  also  bear  witness  to  its  power- 
ful effects  as  a  deobstruent  and  sudorific  in  almost  all  cutaneous  erup- 
tions, arising  from  obstructed  perspiration,  and  an  apathy  of  the  ex- 
treme vessels.  It  causes  a  sense  of  heat  in  ttoe  stomach,  which  ra- 
pidly pervades  every  part  of  the  system,  and  produces  a  titillating 
feel  upon  the  skin  from  the  renewed  circulation  through  the  minute 
vessels.  It  is  inadmissible  where  the  affection  is  inflammatory,  or  the 
eruption  pustular.  Mr.  R.  tried  it  freely  in  lues  venerea,  but  cannot 
venture  to  recommend  it  as  a  substitute  for  mercury.  "  It  will  en- 
able you  to  heal  a  chancre,  but  does  not  eradicate  the  poison."  ID. 
secondary  symptoms,  he  considers  it  an  admirable  ally.  Where  mer- 
cury has  been  used,  but  cannot  be  safely  pushed  further,  the  Mudar 
rapidly  recruits  the  constitution,  heals  the  ulcers,  removes  the 
blotches  from  the  skin,  and  perfects  the  cure.  The  bark  of  the  root 
is  the  only  part  of  the  plant  that  is  useful  in  medicine,  and  should  be 
gathered  in  March,  April,  or  May.  The  bark,  when  well  dried,  is 
easily  beaten  into  a  fine  powder,  of  which  the  dose  is  from  three  to 
ten  grains.  It  grows  in  great  plenty  and  wild  throughout  Hindos- 
tan. 

Variety  2d.  Mr.  Robinson  would  denominate  elephantiasis  tuber- 
culata,  which  has  been  often  described,  and  is  now  occasionally  seen 
in  this  country.  A  very  exquisite  specimen  was  lately  exhibited  at 
Edinburgh,  a  plate  and  case  of  which  is  given  in  the  Monthly  Series 
of  the  Medico-Chirurgical  Journal,  by  Dr.  Lee.  I  shall  not,  there- 
fore, copy  Mr.  Robinson's  description  of  the  disease,  as  he  draws  his 
delineation  principally  from  the  late  Dr.  Adams,  and  Dr.  Bateman. 
In  the  tuberculated  variety,  the  asclepias  does  harm  ;  and  is  there- 
fore inadmissible.  Arsenic,  in  small  doses,  is  the  most  useful  medi- 
cine our  author  has  found,  but  it  is  very  far  from  being  generally  ef- 
fectual. 

Upon  the  whole,  this  is  an  interesting  paper  ;  and  Mr.  Robinson  is 
entitled  to  the  thanks  of  the  profession  for  having  made  known  to 
them  a  vegetable  possessed  of  such  valuable  properties  as  he  as- 
cribes to  the  asclepias  gijantea. 


Miscellaneous  Observations  on  certain  indigenous  Customs,  Diseases,  and 
Remedies,  in  India.  By  Darnel  Johnson,  Esq  formerly  Surgeon  in 
Hon.  Company's  Service,  Bengal  Establishment. 

SEC.  XIV. — The  climate  of  India  not  being  salutary  to  European 
constitutions,  it  is  highly  necessary  for  those  who  are  doomed  to  re- 
side there  great  part  of  their  lives,  to  do  all  in  their  power  to  coun- 

28 


218  EASTERN  HEMISPHERE. 

leract  its  baneful  influence  ;  for  which  purpose,  I  recommend  them 
to  pay  particular  attention  to  the  prevailing  customs  of  the  natives, 
which  have  been  handed  down  to  them  by  their  forefathers,  who 
were  more  enlightened  than  the  present  inhabitants,  or  even,  per- 
haps, than  we  can  have  any  idea  of  from  their  present  state  ;  and 
although  Europeans  in  general  look  down  on  them  with  contempt,  I 
am  persuaded  much  may  be  learnt  from  them,  by  any  one  who  will 
give  himself  the  trouble  to  observe  them  narrowly. 

When  a  European  first  arrives  amongst  them,  he  is  sensibly  struck 
with  their  strange  appearance,  their  dress  being  so  very  different 
from  what  he  has  been  accustomed  to  see  in  Europe,  where  fashion 
and  elegance  of  appearance  are  studied  in  preference  to  ease  and 
usefulness.  In  India  the  same  method  of  dress  has  continued  for 
centuries,  and  is,  in  fact,  a  part  of  their  religion  ;  and  I  imagine  was 
first  adopted  from  physical  principles,  as  being  the  best  suited  to  that 
hot  climate.  The  rich  natives  have  every  thing  on  them  loose,  ex- 
cept their  eumberband,  (that  is,  a  cloth  bound  round  the  lower  part  of 
their  loins,)  which  is  of  great  use  in  supporting  the  belly,  and  thereby 
preventing  ruptures.  The  poorer  classes  go  almost  naked,  and  be- 
smear their  bodies  with  oil,  to  prevent  the  direful  effects  of  a  burning 
sun  on  their  naked  skins.  The  females  dress  very  like  the  men,  all 
loose  except  their  breasts,  which  are  tightly  suspended  in  cloth  or 
silk,  to  prevent  their  falling  down  from  their  weight  and  relaxation. 
They  ornament  their  persons  in  a  variety  of  ways,  which,  though 
considered  by  them  as  adding  to  their  charms  and  beauty,  is  at  first 
fievved  by  Europeans  with  disgust,  and  notwithstanding  that  a  resi- 
dence for  some  time  amongst  them  may  somewhat  reconcile  such  un- 
becoming decorations,  few  ever  give  themselves  the  trouble  to  think 
much  on  the  subject,  or  trace  them  to  their  first  principle,  physical 
utility,  from  which,  1  conceive,  they  for  the  most  part  originated.  I 
will  now  enumerate  a  few,  which  I  think  will  be  sufficient  to  eluci- 
date my  observations  ;  and,  although  I  do  not  approve  of  all  their 
customs,  many  of  them  1  can  account  for  very  differently  from  the 
generally  received  opinion,  and  can  excuse  them  for  adopting  them. 
The  few  I  shall  notice  I  think  will  clearly  show  that  we  ought  not 
to  condemn  them  all  hastily,  for  we  should  recollect  that  length  of 
time  and  experience  have  established  them. 

I  shall  begin  with  observing  the  custom  which  females  have  of  co- 
louring the  palms  of  their  hands,  soles  of  l,Jieir  feet,  and  nails,  red; 
which  they  do  by  pounding  the  leaves  of  mindy  or  hinnah,  (a  species 
of  myrtle,)  mixing  it  with  lime,  and  applying  it  to  those  parts,  where 
it  remains  some  hours.  This  is  considered  an  ornament,  but  I  ima- 
gine it  was  first  used  to  check  the  inordinate  perspiration  in  the  hands 
and  feet,  which  prevails  to  a  great  degree  with  the  natives  of  India, 
giving  their  hands  a  very  disagreeable  cold  clammy  feel,  like  the  sen- 
sation produced  by  handling  a  frog,  and  which  the  application  alluded 
to  entirely  removes. 

The  next  custom  I  shall  remark,  is  their  blacking  the  eye-lids  with 
powdered  antimony.  It  produces  a  strange  contrast  to  the  whites  of 
their  eyes,  which  are  exceedingly  clean.  This,  also,  I  conceive  not 


OBSERVATIONS  ON  DISEASES  OF  INDIA,  &C. 

to  have  been  first  used  for  ornament,  but  to  cure  or  prevent  the  oph- 
thalmia tarsi,  and  it  is  one  of  the  best  remedies  I  know  for  it. 

Again,  females,  after  they  attain  a  certain  age,  or  get  married,  use 
an  application  to  stain  their  teeth  black.  This,  I  also  believe,  was, 
and  is,  used  to  destroy  the  tartar,  and  preserve  the  teeth  and  gums, 
which  it  certainly  does.  The  time  of  life  at  which  they  first  begin 
to  use  it,  is  when  tartar  collects  most,  and  were  it  used  solely  for  or- 
nament, the  young  would  all  have  their  teeth  black,  which  none  of 
them  ever  have.  This  application  is  called  "  Miscee"  and  what  it 
is  composed  of,  I  cannot  say  ; — whatever  it  is,  it  destroys  the  tartar, 
hardens  the  gums,  and  makes  the  teeth  of  a  jet  black,  without  destroy- 
ing the  enamel. 

The  next  custom  I  shall  notice,  is  their  chewing  pawn,  in  the  leaf 
of  which  is  enclosed  a  small  quantity  of  betle  nut,  cardamon  seeds, 
a  clove,  some  gum  :  Rub  :  Astring  :  and  a  small  portion  of  lime. 
The  poorer  people  use  it  without  spices.  This  is  universally  chew- 
ed both  by  men  and  women,  and  is  offered  to  all  strangers,  as  a  com- 
pliment. It  is  a  fine  aromatic,  acts  as  a  stimulus  to  the  fauces  and 
stomach,  and  sweetens  the  breath.  It  causes  the  saliva  to  flow, 
and  reddens  the  mouth,  giving  it  an  appearance  not  pleasing  to  Euro- 
peans. 

Another  custom  is  their  sitting  always  on  the  ground  with  their 
knees  up  to  their  chins,  which  I  know  not  how  to  account  for,  unless 
it  is  that  in  this  position  there  are  very  few  muscles  in  action,  and 
the  pendulous  parts  of  the  body  are  then,  as  it  were,  hung  upon  li- 
gaments, in  the  same  manner  as  a  soldier  "  stands  at  ease,*'  by  sus- 
pending the  weight  of  the  trunk  on  the  ligaments  of  the  thigh  and 
hip.  Europeans  in  India  cannot  sit  long  with  ease,  without  using  a 
morah,  (a  kind  of  stool  to  put  their  legs  on  ;)  if  they  have  not  got 
that,  they  put  their  legs  on  the  table,  and  it  is  not  uncommon  to  see 
a  whole  party  after  dinner  with  their  legs  on  the  table.  A  restless 
uneasiness,  occasioned  by  languid  circulation,  in  the  feet  and  legs, 
causes  this,  which  I  attribute  to  the  heat  of  the  climate  causing  great 
exhaustion,  and  relaxation  ;  for  Europeans  after  having  resided  long 
in  India,  do  not  feel  the  same  inclination  on  their  return  to  their  na- 
tive country. 

Tattooing  and  Shampooing,  (that  is,  using  percussion  and  pres- 
sure,) have  also  the  effect  of  assisting  the  languid  circulation,  and 
the  relief  experienced  from  it  after  fatigue,  can  only  be  judged  of 
by  those  who  have  experienced  it.  Smoking  is  another  custom  in 
general  throughout  India,  and  I  firmly  believe,  is  of  salutary  effect, 
particularly  if  not  indulged  in  to  excess,  or  poisoned  by  the  introduc- 
tion of  intoxicating  ingredients.  Smoking  pure  tobacco  acts  as  a  gen- 
tle stimulus  to  the  intestines,  and  causes  regular  evacuations  ;  with- 
out the  use  of  which,  recourse  to  medicines  would  be  often  found 
necessary.  I  can  vouch  from  experience  that  the  first  pipe  of  a 
morning  always  causes  a  desire  to  go  to  stool,  and  such  as  are  in  the 
habit  of  smoking,  and  are  deprived  of  it  any  morning,  seldom  have 
an  inclination  to  visit  Cloacina's  temple  that  day,  and  are  generally 
troubled  with  head-aches  in  consequence. 

The  last  of  their  salutary  customs  that  I  shall  notice,  is  their  daily 


220  EASTERN  HEMISPHERE. 

habit  of  bathing  in  cold  water,  and  washing  out  their  mouths  after 
every  thing  they  swallow  ;  a  custom  much  to  be  commended  in  eve- 
ry country,  particularly  in  a  hot  one,  where  animal  and  vegetable 
matter  soon  becomes  putrid  under  any  circumstance.  I  shall  here 
digress  a  little,  and  remark  that  Europeans  too  often  accustom  them- 
selves to  wash  their  feet  many  times  a-day,  in  hot  water.  Although 
pleasing  at  the  time,  and  apparently  of  trifling;  consequence,  it  is,  I 
am  convinced,  a  serious  evil,  by  increasing  the  secretions  which  were 
before  too  copious,  and  if  persevered  in  for  a  length  of  time,  will 
add  considerably  to  other  unwholesome  practices,  which  together 
with  the  heat  of  the  climate,  will  soon  wear  out  an  English  constitu- 
tion, and  bring  on  premature  old  age. 

I  shall  now/give  an  account  of  a  few  of  the  diseases  of  India  as  they 
affect  the  natives,  and  their  method  of  curing  them.  Silk  winders, 
who  are  people  employed  to  wind  off  the  silk  from  the  coocoons, 
(chiefly  women,)  from  being  constantly  in  a  sitting  position,  and  from 
their  relaxed  habits,  are  subject  to  a  prolapsus  of  the  anus,  to  obvi- 
ate which,  they  use  a  plug,  (or  pessary,)  every  time  they  have  an 
evacuation  ;  which  they  make  of  the  clayey  sort  of  eurth  that  sur- 
rounds the  tanks.  Hundreds  of  those  plugs  may  be  seen  close  to  the 
edges  of  the  water  near  ^very  silk  factory,  of  a  conical  figure.  A 
new  one  is  made  every  time  those  places  are  visited. 

Elephantiasis. — (The  Black  Leprosy,  or  as  some  call  it,  Falling 
Leprosy,  by  the  natives  called  Judham,)  is  not  general  throughout  In- 
dia, but  rather  local — at  all  events  it  is  much  more  prevalent  in  some 
parts  than  others,  attacking  people  of  particular  habits  ;  and   whe- 
ther it  is  hereditary  as  some  think,  or  not,  is,  in  my  opinion  very  doubt- 
ful, for  although  it  attacks  the  son  whose  father  had  it,  it  should  be 
remembered  that  the  son  always  follows  the  same  business  that  his 
father  did,  and  as  this  disease  attacks  chiefly  such  people  as  have 
their  feet  and  hands  frequently  in  cold  water  or  earth,  (such  as  the 
peasants  in  the  low  marshy  countries  of  Bengal  and  Orissa,)  I  con- 
elude  that  this,  together  with  poorness  of  living,  is  the  first  cause.     I 
am  induced  to  think  so  from  the  circumstance  of  its  attacking  chiefly 
Dobys.  (washermen,)  and  Mollies,  (gardeners,)  in  the  upper  provinces 
of  India,  and  I  conceive  that  cold  and  poorness  of  blood  cause  the  cir- 
culation in  the  extreme  capillary  vessels  to  become  too  languid  ;  the 
consequence  is,  a  gradual  decay  or  depopulation  of  those  parts,  for 
they  have  much  the  appearance   of  persons  who  lose  their  fingers 
and  toes  from  having  been  frost-bitten,  with  this  difference,  that  it 
does  not  proceed  so  rapid,  and  also,  that  after  a  joint  has  fallen  off,  it 
heals  again,  and  remains  well  for  some  months,  when  it  breaks  out 
afresh.     Thus  it  continues  until  all  the  intercarpal  and  sometimes 
earpal  joints  are  destroyed,  when  in  many  instances,  it  heals  altoge- 
ther, and  they  often  live  to  a  tolerable  good  age,  without  ever  experi- 
encing any  return,  which  I  think  indicates  that  it  does  not  proceed 
from  any  humour  in  the  constitution,  but  that  it  is  solely  owing  to  a 
defect  of  the  circulation  in  the  extreme  vessels.     It  should  also  be  ob- 
served, that  having  lost  both  the  use  of  their  hands  and  feet,  they 
cannot  follow  their  occupations,  but  become  mendicants.  I  have  had 
several  natives  with  this  complaint  under  my  care,  and  I  have  tried  a 


OBSERVATIONS  ON  DISEASES  OF  INDIA,  &C.  221 

variety  of  medicines  without  experiencing  much  good  from  them.  A 
native  doctor  told  me  of  a  specific,  and  I  gave  it  to  a  (Doby)  servant 
of  mine  labouring  under  the  complaint  ;  he  took  it  for  some  time,  and 
it  appeared  to  arrest  its  progress,  but  unfortunately  I  was  obliged  to 
quit  India  before  I  could  ascertain  if  it  would  entirely  remove  it.  The. 
specific  consisted  of  pills  made  with  arsenic,  bread,  and  black  pep- 
per, proportions  of  each  I  do  not  recollect,  having  lost  all  memoran- 
da on  the  subject.  1  have  noticed  this,  deeming  it  worthy  of  a  further 
trial  by  any  medical  gentleman  who  may  have  an  opportunity. 

Since  writing  the  above  I  recollect  having  seen  a  paper  on  the  same 
subject  in  one  of  your  Journals,  and  I  have  just  been  looking  at  it,  and 
find  that  in  many  points  my  description  agrees  with  Mr.  Robinson's, 
and  in  others  not.  As  it  is  my  intention  to  give  you  my  own  obser- 
tions  unsophisticated,  without  reference  to,  or  borrowing  a  single  idea 
from  others,  1  shall  make  no  alteration  in  this,  and  only  add  the  fol- 
lowing remarks  on  Mr.  Robinson's  paper. — I  am  clearly  of  opinion 
that  it  is  a  distinct  disease  from  common  leprosy,  and  ought  not  to  be 
classed  with  it,  or  considered  as  Leprous.  The  latter  I  consider  to 
be  a  disease  entirely  of  the  skin. — The  Mudar  Mr.  R  speaks  of  I 
believe  is  called  by  the  natives  of  India  Midaur,  from  Midaun  a  plant, 
it  being  a  shrub  that  is  to  be  found  on  all  the  uncultivated  plains  of 
India, — the  milky  juice  of  which  is  the  only  part  that  I  have  ever 
known  used,  and  that  externally  for  herpetic  complaints  ;  however, 
for  ought  I  know,  it  may  be  a  good  medicine,  internally  — for  I  verily 
believe  there  are  a  variety  of  simples  in  India  possessing  virtues  un- 
known to  the  natives,  and  far  many  more  whose  virtues  they  are  ac- 
quainted with,  the  Europeans  know  nothing  of,  although  the  plants 
may  be  familiar  to  them.  Even  this  Mudar  may  not  be  the  plant  I 
take  it  to  be. 

The  next  disease  that  I  shall  notice  is  called  by  the  natives  Boss, 
which  is  a  chronical  enlargement  of  the  spleen,  and  prevails  through- 
out Indostan,  but  is  most  common  in  the  Jungles  and  hilly  parts  (as 
Ramjhur.)  It  attacks  almost  every  Indian  residing  there  who  is  not  a 
native  of  the  hills,  (but  comes  from  the  low  countries,)  and  sometimes 
it  attacks  the  native  inhabitants.  In  most  instances  it  follows  inter- 
mittent fevers,  and  the  spleen  often  becomes  enormously  large.  In 
such  cases  I  have  never  found  it  to  give  way  to  any  medicines  I  used, 
yet  I  h  ive  seen  them  considerably  reduced  by  the  natives  themselves, 
by  Uiing  the  actual  cautery  with  freedom,  and  taking  half  a  pint  of 
vinegar  every  morning.  They  apply  the  cautery  to  the  swoln  part, 
and  sometimes  all  over  the  abdomen,  giving  them  an  appearance,  like 
a  horse's  leg  that  has  been  fired  for  a  breaking  down,  (as  the  Jockeys 
term  it,)  of  the  large  tendon  of  the  leg. 

As  we  have  improved  in  the  knowledge  of  Anatomy  of  the  hu- 
man body,  in  operations  of  Surgery,  the  knife  has  gained  ground  to  the 
total  disuse  of  the  actual  cautery, 'an  improvement  to  be  highly  valued, 
still  I  am  of  opinion  that  the  actual  cautery  will  again  get  into  use,  I 
do  not  mean  generally,  God  forbid,  but  for  particular  cases  ;  such  as 
require  contraction,  or  union  of  parts,  for  which  I  believe  we  know  of 
nothing  equal  to  it.  An  idea  has  often  struck  me,  that  it  may  be  ap- 
plied with  wonderful  good  effect  to  prevent  the  descent  of  ruptures, 


222  .  EASTERN  HEMISPHERE. 

Would  not  a  deep  impression  of  the  actual  cautery  over  the  ring  of 
the  abdominal  muscles,  (through  which  an  intestine  has  passed,)  so 
contract  them,  as  to  prevent  the  possibility  of  the  guts  falling  down 
again  ?  If  it  would  have  that  effect,  it  would  go  far  to  explode  the  use 
of  trusses,  and  be  of  great  benefit  to  mankind. 

Nyctalops,  is  also  very  common  in  India,  and  when  not  accompanied 
with  a  diseased  liver  or  spleen,  may  be  removed  by  a  few  doses  of 
calomel  united  with  some  other  purgative.  I  am  of  opinion  that  this 
complaint,  as  also  inflammation  of  the  Eyes,  are  often  caused  by  eating 
rice  ;  not  that  it  is  owing  to  any  quality  in  the  nourishment  produc- 
ed from  the  rice,  but  solely  owing  the  rice  not  being  cleaned  from  its 
husks,  which  are  as  sharp  as  needles,  and  very  capable  of  irritating 
the  coats  of  the  stomach.  The  Indian  sailors  are  very  subject  to 
such  complaints,  and  they  often  receive  the  rice  with  the  husks  on, 
it  being  cheaper  to  the  owners  of  the  ships ;  and  also  keeps  better  in 
that  state  ;  the  consequence  is,  that  the  poor  creatures  are  obliged 
to  pound  off  the  husks,  almost  every  time  they  prepare  their  meals, 
and  often  they  are  not  half  cleaned. 

Naukera,  (a  kind  of  Ozoena,)  is  another  very  common  complaint 
in  India.  It  is  an  inflammation  of  the  membrana  pituitaria,  seldom 
attended  with  such  discharge  as  is  common  in  England.  If  neglected, 
it  becomes  a  complete  Ozoena,  or  foul  stinking  ulcer.  The  natives 
prevent  it,  by  introducing  a  sharp-edged  grass,  and  scratching  the 
membrane,  which  being  in  state  of  inflammation,  bleeds  copiously 
and  soon  relieves  them. 

Hydrocele,  is  also  common  in  India. — A  Mr.  Glass.  Surgeon  of 
Bauglepore,  has  given  an  account  of  natives  being  often  cured  of  it, 
by  being  employed  to  beat  indigo  oats.  The  native  doctors  cure  it 
with  a  poultice  made  with  the  pounded  leaves  of  the  indigo  plant, 
and  crude  Sal  Ammoniac.  They  also  apply  tobacco  leaves  to  the 
Scrotum,  (which  they  also  do  for  the  hernia  humoralis,)  and  some- 
times perform  the  operation  for  a  radical  cure  by  incision. 

For  local  swellings  of  the  joints  or  other  parts,  and  also  for  partial 
paralytic  affections,  they  use  a  caustic  application,  which  I  have 
found  very  efficacious.  It  is  made  and  applied  in  the  following  man- 
ner— equal  quantities  of  quick  lime  and  crude  Sal  Ammoniac  are  in- 
corporated together,  and  then  put  into  a  cloth  bag  and  quilted,  and 
then  sprinkled  slightly  with  water,  and  applied  to  the  swollen  part : 
it  causes  considerable  heat  and  pain,  and  when  it  becomes  very  vio- 
lent it  should  be  removed,  and  repeated  as  often  as  thought  necessa- 
ry, taking  care  not  to  keep  it  on  so  long  as  to  cause  blistering  or 
sloughing. — Since  my  return  from  India  1  applied  it  to  a  horse  that 
had  his  knee  swoln  to  twice  its  natural  size  ;  it  remained  on  a  whole 
night,  during  which  time  the  animal  seemed  to  suffer  great  pain  from 
his  incessant  restlessness,  and  to  my  astonishment  in  the  morning,  the 
knee  was  reduced  to  its  natural  size,  and  the  horse  never  after  went 
lame.  In  swellings  of  the  knee  joint  in  men,  from  a  want  of  absorp- 
tion of  the  Synovia,  it  is  a  very  powerful  medicament,  and  I  conceive 
well  worthy  a  trial  by  the  profession  in  this  country. 

The  effect  pressure  has  on  the  human  body  from  wearing  tight 
apparel,  may  in  some  measure  be  judged  of,  from  the  effect  it  has  on 


INFLUENCE  OF  TROPICAL  CLIMATES,  &C.  223 

our  feet  from  tight  shoes,  the  Indians  who  never  wear  tight  shoes, 
use  their  feet  as  second  hands. — Deformity  also  is  of  very  rare  oc- 
currence in  India,  and  may  be  accounted  for  on  the  same  principle 
— that  of  never  checking  nature  by  any  thing  tight  on  their  body. 

I  began  with  observing  that  the  customs  of  the  natives  of  India 
ought  to  be  attended  to  by  Europeans,  and  I  shall  leave  off,  with  this 
observation,  that  they  did  follow  them  in  many  instances  on  their 
first  settling  there,  which  they  have  now  foolishly  left  off.  One  in 
particular  1  shall  mention,  and  that  is — their  dressing  with  cool  and 
light  apparel,  during  the  hot  weather.  When  I  first  arrived  in  India, 
a  broad-cloth  coat  was  scarcely  ever  seen  in  the  hot  months,  except 
on  formal  visits.  At  that  time  the  Governor-General,  Earl  Corn- 
wallis,  always  set  a  good  example  at  his  own  table,  by  taking  off  his 
coat  at  dinner  time,  which  was  generally  followed  by  all  the  company. 
When  I  left  India  in  1809,  broad-cloth  coats  were  worn  at  dinner  in 
the  hot  months  by  almost  all  the  European  inhabitants  ;  which  I  con- 
ceive was  owing  to  the  examples  set  them  by  the  heads  of  the  set- 
tlement. Ako  throughout  the  army,  they  were  worn  at  all  times. 
In  this — etiquette  and  fashion  have  prevailed  over  good  sense  in  not 
adopting  that  which  contributed  both  to  comfort  and  health,  and  I 
hope  if  properly  noticed  as  adding  considerably  to  the  many  other 
causes  in  that  hot  climate  tending  to  impair  European  constitutions, 
that  the  heads  of  Government  will  take  it  into  consideration,  and  be 
induced  to  set  an  example  to  the  contrary  ;  and  also  that  when  dis- 
cipline and  duty  do  not  absolutely  require  it,  commanding  officers 
will  do  the  same,  and  not  oblige  officers  and  men  to  wear  warm 
clothes  at  those  times,  when  they  are  panting  with  heat,  and  perspir- 
ing at  every  pore,  to  the  great  injury  of  their  constitution,  and  event- 
ually of  the  Government  by  whom  they  are  employed. 

D.  JOHNSON. 
TORRINGTON,  DEVON,  Jan.  1821. 


MEDITERRANEAN. 


General  observations  on  the  Climate. 


SEC.  I. — When  we  cast  an  eye  along  the  beautiful  shores  of  this 
great  inland  ocean,  and  survey  the  classic  scenes  which  present  them- 
selves at  every  step — when  we  recollect  that  in  peace  or  in  war,  the 
British  flag,  commercial  or  belligerent,  waves  in  every  port,  and  off 
every  promontory,  from  the  pillars  of  Hercules  to  the  shores  of  the 
Hellespont,  we  cannot  but  acknowledge  that  the  medical  topography 
— the  Endemic — and  the  contagious  diseases  of  this  quarter  of  the 
globe  are  not  less  interesting  to  Britons  than  those  of  either  the 


£24  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

Eastern  or  Western  Hemisphere.  The  more  intimately  we  become 
acquainted  with  the  various  climates  of  the  earth  we  inhabit,  the 
more  we  shall  be  convinced  that  the  "  balance  of  comfort"  is  not  so 
unequally  poised  as  some  querulous  philosophers  imagine.  The 
Eastern  world  has  its  Hepatitis — the  Western  its  causus — the  Northern 
shores  of  the  Mediterranean  have  their  "  pestilential  fevers" — the 
Southern  and  Eastern  are  annually  desolated  by  the  plague!  If 
"  Happy  England"  knows  not  these  but  by  report,  or  in  their  se- 
quelae, she  every  year  sacrifices  nearly  sixty  thousand  of  her  inhabit- 
ants at  the  altar  oi  Phthisis! 

In  exploring  this  interesting  track,  the  labours  of  many  must  be 
united  in  analytical  concentration  ;  and  it  is  upon  this  plan,  hitherto 
unattempted,  that  I  hope  to  condense  into  one  focus,  a  stronger  body 
of  light  on  MEDITERRANEAN  DISEASES  than  has  ever  yet  been  collected 
through  a  single  medium. 

Before  entering  on  localities,  however,  it  may  not  be  improper  to 
make  a  few  general  observations  on  this  extensive  inlet. 

Placed  between  the  burning  sands  of  Africa  on  one  side  and  the 
Alps  and  Pyrenees  on  the  other,  the  Mediterranean  skies  are  alter- 
nately parched  by  the  South-east — chilled  by  the  North-west,  or 
stifled  by  the  sirocco  winds.  Thus  from  Barcelona  to  Genoa,  the 
iron-bound  Coast  presents  a  succession  of  dreary  mountains  and 
craggy  rocks,  the  tops  of  the  former  being  frequently  covered  with 
snow,  from  the  beginning  of  .Vlarch  till  the  end  of  May.  From  these  the 
frigid  Euroclydons  descend  in  whirlwind*  upon  the  contiguous  ocean  ; 
while  at  other  times,  the  sirocco  breathes  fire  from  the  deserts  of 
Sahara  and  Lybia.  During  the  continuance  of  this  wind,  all  nature 
appears  to  languish  ;  vegetation  withers  and  dies — the  beasts  of  the 
field  droop  ;  while  those  who  are  strongly  susceptible  to  electrical 
changes  in  the  air,  such  as  precede  and  attend  a  thunder  storm,  will 
easily  understand  the  effects  of  the  sirocco  on  the  human  frame,  as 
an  increased  degree  of  the  sensations  which  they  then  experience. 
The  animal  spirits  seem  too  much  exhausted  to  admit  of  the  least  bo- 
dily exertion,  and  the  spring  and  elasticity  of  the  air,  appear  to  be 
lost.  The  heat  exceeds  that  of  the  most  fervid  weather  in  Spain  or 
Malta.  This  accession  of  temperature  is  rapid — almost  instantane- 
ous ;  and  the  whole  atmosphere  feels  as  if  inflamed.  The  pores  of 
the  skin  seem  at  once  opened,  and  all  the  fibres  relaxed.  It  some- 
times blows  for  several  days  together,  at  a  medium  heat  of  112°,  de- 
pressing the  spirits,  and  so  suspending  the  powers  of  digestion,  that 
people  who  venture  to  eat  a  hearty  supper  are  generally  found  dead 
next  morning.  Fortunately  for  animated  nature,  it  is  commonly  suc- 
ceeded by  the  Tramontane  or  north  wind,  which,  in  a  short  time,  re- 
stores the  exhausted  powers  of  animal  and  vegetable  life. 

After  this  description,  the  Mediterranean  climate  could  hardly  be 
set  down  as  one  that  was  favourable  to  the  lungs  of  a  Northern  inva- 
lid seeking  refuge  from  the  atmospherical  vicissitudes  of  England. 
Yet  numerous  writers  describe  this  portion  of  the  globe  as  enjoying 
a  happy  medium  between  intertropical  heat  and  hyperborean  cold. 
But  we  must  not  calculate  on  heat,  cold,  or  evenness  of  temperature 
by  the  parallel  of  latitude  ;  on  the  contrary,  as  a  modern  author  has 


MEDITERRANEAN  PHTHISIS. 


225 


justly  observed,  "  storms  most  tremendous  occasionally  burst  from 
the  mountains,  with  the  most  piercing  coldness,  on  many  of  the  boast- 
ed retreats  along  the  Northern  shores  of  the  Mediterranean."  But 
from  words  we  shall  proceed  to  facts.  The  following  table  shows 
the  comparative  receipt  of  pulmonic  and  other  diseases  inio  the  hos- 
pitals of  Minorca,  Malta,  and  Gibraltar,  from  the  Mediterranean 
fleet,  during  the  years  1810 — 1 1 —  12,  from  official  returns  : 


Diseases. 

Malta. 

Gibraltar. 

Minorca. 

Total. 

1810-11-12 

1810-11-12 

1810-11-12 

Phthisis  Pulmonalis 
Pulmonic   Inflamma- 
tion    -     -     -     - 
Fever     -     -     -    - 
Dysentery  -     -    - 

149 

52 

747 
36 

187 

51 
138 

79 

119 

37 
357 
60 

455 

140 

1242 
175 

Total—  Phthisis    and 
Pneumonia  - 
Other  Complaints 

202 
883 

238 
217 

156 

417 

596 
1517 

Ratio  of  Pulmonic  to  the  other  great  complaints,  1  to  2£. 

The  foregoing  table  shows  only  the  comparative  receipts  into  hos- 
pital of  the  grand  divisions  of  disease.  The  rate  of  mortality  is 
quite  another  thing.  Out  of  465  cases  of  Phthisis  alone,  151  died 
before  the  remainder  could  be  shipped  off  for  England,  where,  in  all 
probability,  most  of  them  perished  1  Whereas  out  of  1242  cases  of 
fever,  only  58  died,  and  a  very  small  number  were  invalided.  This 
authentic  document  will  speak  volumes  on  the  climate  of  the  Medi- 
terranean. In  no  other  possible  way  could  so  fair  a  calculation  be 
made,  as  to  the  relative  prevalence  of  complaints,  as  in  a  fleet,  where 
the  crews  of  ships  are  subjected  to  a  similarity  of  regimen,  occupa- 
tion, clothing,  and  discipline  unknown  in  civil  life,  or  even  in  the 
best  regulated  army. 

That  the  abrupt  vicissitudes  of  the  climate  under  consideration 
were  extremely  productive  of  pulmonary  consumption,  the  govern- 
ment, and  the  medical  officers  of  our  fleets  and  hospitals  have  long 
been  aware  ;  but  in  private  practice,  this  is  little  known  ;  and  many 
valuable  lives  are  annually  sacrificed  by  the  very  means  designed  to 
prolong  their  range. 

An  ingenious  little  Thesis  has  lately  been  written  in  Latin  by  Dr. 
Sinclair,  formerly  a  surgeon  in  the  Royal  Navy,  on  the  Mediterra- 
nean Phthisis,  from  which  I  shall  translate  and  condense  a  few  pas* 
sages. 

Sy?nptoms. — Dr.  S.  divides  the  disease  into  two  stages,  the  inflam- 
matory and  suppurative.  The  first  often  advances  on  the  patient 
with  insidious  pace,  and  without  giving  much  alarm  :* — frequently 

*  Dr.  Burnett,  while  speaking  of  pneumonia  in  the  Mediterranean,  observes 
that — »*  He  wishes  to  caution  the  practitioner  against  the  insidious  form  of  the 
'k  milder  attack  of  this  disease,  which  is  but  too  often  considered  of  little  moment 
"  — <M  «  catarrh — and  the  cure  entrusted  to  small  doses  of  antimony  and  a  great 
"  coat — often  to  nature.  With  pain  has  he  witnessed  the  effects  of  this  treatment 
*'  in  the  melancholy  increate  of  consumptive  cases,  which  the  summer's  heat  has 
**  brought  before  him."— Pre/ace  to  1st  Edition. 

29 


226         INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

with  symptoms  of  catarrh,  or  slight  pleurisy,  as  rigors,  heats  and 
chills  alternately — thirst — cough — fever.  By  degrees  these  symp- 
toms become  more  marked,  and  attended  with  lassitude — pains  in  the 
back,  loins,  and  limbs.  To  these  are  occasionally  added,  nausea, 
vomiting,  head  ache,  &c.  The  pulse  is  generally  from  the  begin- 
ning, quick,  hard,  and  full — sometimes  the  contrary.  Acute  pains, 
more  or  le^s  severe,  now  shoot  in  between  the  sixth  and  seventh 
ribs  near  the  sternum.  Sometimes  this  pain  is  complained  of  as  deep 
under  the  breast  bone — quite  through  to  the  spine — or  stretching  to 
the  clavicles,  or  shoulder  bones,  with  difficulty  of  breathing.  These 
symptoms  will  often  become  suddenly  increased,  with  such  oppres- 
sion about  the  praecordia,  and  obstruction  of  the  vital  functions  as 
lead  to  suspicion  of  inflammation  of  the  heart  itself  or  its  coverings. 
The  patient  is  now  harassed  with  a  dry,  irritating  cough— dyspnoea, 
and  inability  to  lie  down.  These  symptoms  are  somewhat  mitigated 
on  the  appearance  of  expectoration,  which  is  rarely  free,  or  tinged 
with  blood.  In  some  people,  who  are  biliously  inclined,  the  pain  in 
the  right  hypochondrium  will  imitate  Hepatitis,  till  purulent  expec- 
toration reveals  the  true  nature  of  the  disease. 

The  termination  is  either  by  resolution — suppuration  with  ulcera- 
tion  of  the  worst  kind — or  effusion. 

Resolution. — In  this  cate,  the  graver  symptoms  subside  before  the 
close  of  the  first  septenary  period — that  is,  about  the  seventh  day, 
the  pain  ceases— the  pulse  becomes  slow — the  expectoration  free, 
whitish,  and  thick — the  skin  relaxes  into  a  gentle  perspiration — the 
thirst  is  assuaged — and  the  appetite  returns.  II  these  salutary  events 
do  not  take  place  before  the  fourteenth  day,  suppuration  is  generally 
the  consequence. 

Suppuration. — In  many  cases,  although  the  violence  of  the  disease 
is  mitigated  by  appropriate  remedies  ;  yet  a  deep-seated,  obtuse  pain 
continues  obstinately  fixed  in  one  side,  with  a  sense  of  weight  there. 
The  difficulty  of  breathing  remains,  and  the  patient  cannot  lie  down. 
Debility  now  increases  fast — emaciation  takes  place — the  pulse  is 
easily  accelerated — the  expectoration  from  being  viscid  and  frothy, 
becomes,  in  a  few  weeks,  opake,  yellow,  or  green.  In  short,  hectic 
fever  is  established,  arid  PHTHISIS  carries  the  victim  to  his  grave  in 
the  course  of  five  or  six  months — generally  towards  the  latter  end  of 
August  or  September.* 

Post  mortem  appearances. — Vomicae  of  various  dimensions  were 
very  often  developed.  The  larger  contained  from  a  few  ounces  to  a 
pint  of  tcetid,  green,  or  yellow  pus.  In  some  cases  empyema — in 
others,  the  lungs  were  ulcerated — beset  with  tubercles  of  different 
sizes,  or  entirely  destroyed,  with  only  a  mass  of  tubercles  remaining 
— and  that  too  within  six  weeks  after  the  stage  of  acute  inflamma- 
tion ! 

Melhodus  Medendi. — During  the  inflammatory  period,  nothing  but 
the  most  decisive  evacuations  from  the  vascular  system  will  save  the 
structure  of  the  lungs  from  that  dreadful  disorganization  described 
above,  and  which  supervenes  on  inflammation  in  the  lungs  in  a  more 
rapid  manner,  here,  than  in  any  other  climate.  Twenty-four  or 
*  Autumnus  tabidis  malus.  Hippoc. 


MEDITERRANEAN    FEVER.  •  -227 

thirty  ounces  of  blood  must  be  immediately  abstracted,  and  this  re- 
iterated according  to  the  violence  of  the  disease.  Saline  cathartics 
— cool  air — cool  drink — rigid  abstinence — antimonials — blisters,  &c. 
are  to  be  used  a?  secondary  means.  In  these  cases,  it  is  not  always 
easy  to  limit  the  extent  of  ulterior  venesection.  If  we  bleed  too  far, 
we  risk  effusion — if  too  little,  suppuration. — This  is  a  most  critical 
and  dangerous  period  6f  the  disease.  About  the  fourth  or  fifth  day 
we  shall  apparently  have  conquered  all  the  more  violent  symptoms, 
and  the  patient  will  be  considered  convalescent — but  all  at  once,  he 
is  seized  with  darting  pains  in  the  chest — the  muscles  of  respiration 
are  spasmed — and  strangulation  is  threatened  by  the  convulsive 
cough!  Blood  must  again  be  drawn,  but  with  caution,  for  the  transi- 
tion from  this  state  to  irremediable  effusion  is  awfully  sudden  and  un- 
certain. Here  local  evacuations  and  other  local  means  may  be  bene- 
ficially put  in  requisition. 

When  PHTHISIS  approaches,  nothing  but  a  retreat  from  the  Mediter- 
ranean before  the  autumn  sets  in,  can  give  a  shadow  of  hope  or  safety 
to  the  patient — 

Frustra  per  autumnos  uocentem 
Corporibus  metuetnus  Austrum.  flor- 
as has  been  proved  by  the  recovery  of  many  invalids,  when  sent  home, 
in  the  autumn,  from  our  fleet.     "  Non  alio  modo  evitari  possunt, 
*'  quam  Coelum  salubriori  mutando  ;  quod  invalidi  plurimi  domum  e 
"  classe   nostra,  in  autumno    quotannis  remissi,  sanescendo,  confir- 
"  mant."     Thesis,  p.  30. 

Dr.  Sinclair  remarks  that  as  in  the  months  of  January  and  Febraa- 
ary,  the  air  is  clear,  temperate,  and  steady  in  the  Mediterranean* 
they  are  the  only  months  in  which  a  physical  invalid  can  safely  so- 
journ on  the  shores,  or  navigate  the  waters  of  this  inland  ocean. 


MEDITERRANEAN  FEVER. 

Analytical  Review  of  Dr.   BURNETT'S   Work  on  the  Bilious  Remittent 
Fever  of  the  Mediterranean. 

SEC.  II. — If  the  destructive  war,  which  ravaged  the  world  for  more 
than  twenty  years,  has  consigned  millions  to  an  early  grave,  it  has, 
like  most  human  events,  been  productive  of  good  as  well  as  evil. 
In  a  medical  point  of  view  it  has  called  forth  original  genius,  in  com- 
bating the  maladies  to  which  we  are  subjected  by  our  emigration  or 
military  enterprizes  ;  and  we  are  much  mistaken,  if  it  has  not  thrown 
great  light  on  a  disease,  the  nature  of  which  has  puzzled  the  physi- 
cians and  philosophers  of  all  ages.  The  awful  forms  whirh  FEVER  as- 
sumes in  fleets  and  armies  beneath  the  burning  skies  of  the  East  and 
West  Indies,  and  around  the  romantic  shores  of  the  Mediterranean, 
gave  rise  to  bold  and  energetic  measures  of  cure,  which  never  could 
have  originated  in  the  retired  paths  of  private  practice.  A  cur?ory 
view  of  our  military  and  naval  medical  writings,  must  clearly  evince 
the  truth  of  this  remark.  But  these  innovations  were  regarded  with 


228  INFLUENCE  OF  TROPICAL  CLIMATES,  &C» 

a  dubious  eye  by  our  medical  brethren  at  home  ;  and  although  the 
Lost  of  prejudices  engendered  in  the  humoral,  spasmodic,  and  Bru- 
uonian  Schools  are  now  fast  dispersing,  it  is  necessary  to  give  every 
new  fact,  illustrative  of  a  more  rational  theory  and  successful|prac- 
tice,  the  widest  publicity,  since  the  phantoms  of  *«  debility  and  putres- 
cency"  continue  still  to  haunt  the  minds  of  a  very  considerable  por- 
tion of  medical  practitioners. 

The  first  part  of  this  volume  proposes  (ogive  "  a  faithful  and  prac- 
tical account  of  the  disease,  as  it  appeared  in  the  ships  and  hospitals 
of  the  Mediterranean  fleet." — Preface. 

Dr.  B.  states  that  excepting  in  one  instance,  the  ships  of  the  fleet 
enjoyed  an  exemption  from  fever  during  the  spring  months,  and 
early  part  of  the  summer,  the  disease  occuring  in  its  epidemic  state, 
either  while  the  ship  was  in  port  refitting,  or  shortly  afterwards. 
The  exception  was  in  H.  M.  S.  Kent,  where  the  disease  broke  out 
while  cruising  off  Toulon,  three  months  after  leaving  harbour.  It  is 
towards  the  end  of  June,  or  beginning  of  July,  that  febrile  affections 
present  themselves  ;  arid  the  usual  symptoms  are  head-ache,  nausea, 
prostration  of  strength,  suffused  eves,  flushed  countenance,  tongue 
•white  and  moist,  thirst,  skin  variable,  both  as  to  temperature  and 
perspiration.  The  same  may  be  said  of  the  pulse  :  but  the  bowels, 
are  generally  costive,  and  the  appetite  impaired.  These  are  the 
milder  symptoms  of  the  disease  in  summer  ;  but  where  the  patient 
has  committed  excesses,  or  been  exposed  to  the  sun  and  night  dews, 
it  frequently  assumes  a  severer  aspect,  resembling  the  autumnal  fever 
of  hot  countries.  At  this  time,  gastric  symptoms  are  seldom  formi- 
dable, the  head  being  the  organ  which  principally  labours  ;  the  relief 
of  which,  and  intestinal  evacuations,  are  the  paramount  objects  of  the 
practitioner's  care. 

As  the  summer  advances,  the  disease  is  more  dangerous.  After 
a  sense  of  lassitude  and  prostration  of  strength,  a  chilliness  extend- 
ing along  the  spine  succeeds  ;  and  this  is  followed  by  considerable 
vascular  action,  accompanied  by  head-ache,  deep-seated  pain  in  the 
orbits,  with  sometimes  a  prominence  of  the  eye-balls,  which  appear 
watery,  inflamed,  and  impatient  of  the  light.  A  flushing,  and  even 
tumefaction  of  the  face,  extending  down  towards  the  breast,  are  not 
unusual,  with  loaded  tongue,  and  bad  taste  in  the  month.  Amongst 
the  usual  symptoms  may  also  be  enumerated,  uneasiness  in  the  epi- 
gastric region,  nausea,  bilious  vomiting,  pains  in  the  joints  and  back, 
and  constipation.  The  pulse  is  generally  full  and  hard,  sometimes 
oppressed,  but  rises  under  the  lancet. — Partial  perspirations  are 
sometimes  observable  ;  but  generally  the  skin  is  dry,  and  the  tem- 
perature increased.  Severe  rigors  sometimes,  but  not  very  com- 
monly, precede  the  hot  stage  of  the  disease.  In  many  cases,  the 
disease  makes  a  sudden  impression,  the  patient  dropping  down  in  a 
state  of  insensibility,  while  at  his  usual  woik.  In  these  cases,  reac- 
tion soon  takes  place,  with  violent  determination  to  the  brain. 

•'  During  the  winter  months,"  says  Dr.  B.  <•  the  morbid  affection 
of  the  brain  is  not,  at  all  times,  so  prominent  a  symptom,"  p.  6. 

1  have  seen  intermittent*  t  and  irregular  remittents,  the  consequence 
of  obstructed  viscera,  occur  at  this  season  ;    but  if  vegeto-auimal 


MEDITERRANEAN  FEVER. 

miasmata  be  the  cause  of  "  the  bilious  remittent,"  when  aided  by 
atmospherical  heat,  the  winter  is  an  unusual  time  for  such  a  disease. 

Dr.  Burnett  very  justly  remarks,  that  if  the  fever  is  not  early 
combated,  or  if  treated  as  a  typhoid  affection,  the  appearances  will 
be  very  different.  The  hoad-ache  will  be  accompanied  by  stupor, 
and  an  indifference  to  surrounding  objects  ;  the  eyes  will  have  a 
duller  look  than  usual,  or  have  a  yellow  tinge  spreading  more  or 
less,  rapidly  to  the  neck  and  body.  The  tongue  will  be  covered 
with  a  thick  yellow  coat,  while  it  is  brown  and  dry  in  the  middle. 
The  prostration  will  be  considerable  ;  the  anxiety  and  pain  in  the 
limbs  great  ;  the  uneasiness  in  the  epigastric  region  will  be  urgent, 
with  bilious  vomiting  and  harassing  singultus. 

44  In  the  severe  attacks,"  says  he  "  about  the  third  day,  there  is 
often  an  appearance  of  complete  remission,  but  the  evening  puts  an 
end  to  the  delusion  ;  an  exacerbation  takes  place,  with  great  increase 
of  all  the  dangerous  symptoms.  Unhappily,  this  deceitful  period 
has  often  been  mistaken  for  a  real  remission  of  the  symptoms,  and 
tonics  and  stimulants  have  been  given,  with  a  view  to  prevent  the  re- 
currence of  the  paroxysm  ;  but  vain,  indeed,  are  all  such  efforts, 
they  serve  but  to  increase  the  malady,"  p.  8.  *'  As  the  disease  ad- 
vances, the  pain  and  uneasiness  about  (.he' epigastric  region  continue 
to  increase  ;  there  is  constant  vomiting  ;  considerable  pain  upon  pres- 
sure, with  restlessness  and  oppression  at  the  praecordia.  The  abdo- 
men is  likewise  painful,  with  frequently  thin,  black,  fetid,  and  some- 
times gelatinous  stools.  The  suffusion,  at  first  of  a  bright  yellow, 
now  assumes  a  darker  hue,"  &c.  p.  9. 

The  symptoms  which  precede  death  in  this  fever,  are  pretty  simi- 
lar to  those  observable  in  the  fevers  of  hotter  countries,  such  as  cof- 
fee-coloured vomiting,  intolerable  uneasiness  in  the  epigastric  regi  on, 
hemorrhages,  subsultus  tendinum,  floccitatio,  black  encrusted  tongue 
and  teeth,  sinking  of  the  pulse,  cold  extremities,  and  finally  death, 
which  terminates  the  scene — "  frequently  on  the  third  or  fourth,  but 
generally  from  the  fifth  to  the  eighth  day  ;  though  sometimes,  death  is 
protracted  beyond  that  period,"  p.  10.  Dr.  Burnett,  contrary  to  the 
observations  of  Cleghorn,  asserts  that  **  in  by  far  the  greater  num- 
ber of  cases,  though  there  are  even  exacerbations,  there  is  but  sel- 
dom atiy  evident  and  clear  remiss-ion  in  the  morning. 

Under  the  head  of"  probable  causes,"  Dr  Burnett  traces  the  in- 
fluence of  marsh  miasmata  in  the  fevers  which  prevail  at  Minorca, 
Malta,  &c  with  many  interesting  and  sensible  remarks  on  the  topogra- 
phy of  those  places.  Dr.  B.  reiterates  the  sentiments  of  former  wri- 
ters on  the  exciting  causes  of  this  fever,  namely,  intemperance,  expo- 
sure to  the  sun  by  day,  and  the  dews  by  night.  The  young  and  pletho- 
ric are  most  subject  to  the  disease,  particularly  the  crews  of  boats, 
and  ships'  companies,  who  have  shared  much  prize-money,  and  are 
permitted  to  spend  it  on  shore,  p.  17.  v 

Our  author  has  not  been  able  to  detect  the  agency  of  contagion  in 
its  production,  but  rationally,  we  are  sure,  allows  that  "  in  the  latter 
stages  of  this  fever,  where  proper  attention  may  not  have  been  paid 
to  personal  cleanliness,  to  the  removal  of  the  excretions,  and  to  VCD- 


230  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

illation,  where  the  sick  are  crowded,  the  surrounding  atmosphere 
may  be  vitiated,"  ibid. 

Method  of  Cure. — Dr.  Burnett  judiciously  enough  divides  the  dis- 
ease into  lour  stages.  1st.  From  the  beginning  till  the  commence- 
ment of  gastric  symptoms  or  yellow  sufiimon,  a  period  of  about  three 
days.  2d.  From  this  period  till  the  appearance  of  nervous  symp- 
toms, the  duration  of  which  is  various.  3d.  From  the  accession  of 
these  last  symptoms,  marked  by  increased  uneasiness  in  the  epigastri- 
um, ischuria,  singultus,  coffee-coloured  vomiting,  &c.  till  death  orcon- 
valescence.  4th.  From  the  commencement  of  convalescence  till 
final  recovery. 

Our  author  but  too  truly  observes,  that  in  the  first  stage  of  the 
disease,  the  prostration  of  strength,  watery  eyes,  axiety,  syncope  on 
the  abstraction  of  blood,  &c.  are  well  calculated  to  deceive  the  inex- 
perienced observer. 

"  Blood-letting,  both  general  and  local,  should  be  had  recourse 
to,  and  repeated,  according  to  the  urgency  of  the  symptoms  :  the  be- 
nefit derived  will  be  greatly  increased  by  the  use  of  purgatives  and 
free  ventilation.  It  will  often  happen,  after  a  few  ounces  of  blood 
have  flowed,  that  syncope  will  be  induced  ;  this  must  not  prevent 
the  repetition  of  the  bleeding,  while  the  symptoms  require  it,"  p.  20. 

Dr.  B.  in  imitation  of  Dr.  Irvine,  prefers  arteiiotomy  at  the  tem- 
ples. 

"  In  the  course  of  an  hour,  the  bleeding  may  generally  be  repeat- 
ed, and  thirty  or  forty  ounces  may  be  taken  away  without  producing 
syncope.  In  bleeding,  the  patient  should  be  laid  in  a  horizontal  po- 
sition," ibid. 

The  purgatives  which  Dr.  Burnett  recommends,  are  those  of  Dr. 
Rush,  namely,  calomel  and  jalap.  He  justly  remarks,  that  the  op- 
pressed pulse  will  rise  under  the  lancet,  and  that  an  accession  of 
strength  is  actually  obtained  by  the  loss  of  blood. 

"  The  great  object,  says  Dr.  Burnett,  is  the  removal  of  the  local 
affection  of  the  brain,  or  other  organ,  and  the  production  of  a  com- 
plete remission  of  the  febrile  symptoms  in  the  least  possible  time.  In 
one  instance,  I  ordered  blood  to  be  taken  from  the  temporal  artery, 
to  the  amount  of  ninety  ounces  in  the  course  of  six  hours  ;  he  was 
convalescent  in  three  days,"  p.  22. 

If,  notwithstanding  all  our  efforts,  the  febrile  symptoms  should  con- 
tinue, Dr.  B,  recommends  in  the  evening,  after  a  repetition,  if  ne- 
cessary, of  the  bleeding,  a  pill  composed  of  calomel  and  antirnonial 
powder,  each  two  grains,  followed  by  a  dose  of  julep,  ammon.  ace- 
tat,  with  cool  drink,  and  the  most  strict  antiphlogistic  regimen. 

In  a  note  at  page  34,  Dr.  B.  states,  that  "  it  is  but  justice  that  I 
should  add,  that  some  surgeons  thought  benefit  was  derived  from  the 
use  of  calomel  in  the  first  stage,  carried  so  far  as  to  excite  ptyalism." 

After  recommending  decisive  evacuations  from  the  vascular  system 
and  the  bowels,  during  the  whole  of  the  first  stage,  but  condemning 
emetics,  Dr.  B.  proceeds  to  the  second  stage,  premising,  that  much 
confidence  must  not  be  placed  in  cold  and  tepid  affusions,  excepting  as 
auxiliaries  to  the  above  measures. 

In  the  second  stage,  he  thinks,  that  where  the  symptoms  indicate 


MEDITERRANEAN    FEVER.  231 

the  necessity  of  venesection,  it  may  still  be  resorted  to,  though  in 
smaller  quantities,  and  the  blood  is  best  drawn  from  the  temporal 
artery.  Blisters  to  the  head,  and  daily  evacuations  from  the  bowels, 
are  here  proper  ;  but  the  cathartics  should  be  of  the  less  powerful 
kind,  such  as  castor  oil,  assisted  by  enemas.  The  irritability  of  the 
stomach  is  to  be  allayed  by  the  application  of  leeches,  and  the  exhibi- 
tion of  saline  draught*,  in  a  state  of  effervescence  to  which  may  be 
added,  small  doses  of  tinct.  opii.  The  application  of  a  large  blister 
to  the  stomach  has  been  also  attended  with  success.  In  this  stage, 
Dr.  B.  speaks  highly  of  the  warm  bath,  and  we  entirely  coincide 
with  him. 

In  the  third  stage,  *'  little  more  can  be  done  than  to  look  on,  and 
endeavour  to  obviate  occasional  symptoms  as  they  occur,"  p.  29.  As 
the  pulse  sinks,  the  stimuli  must  be  increased  ;  and  Dr.  B.  thinks 
that  he  has  seen  much  benefit  from  carbonate  of  ammonia  and  aro- 
matic confection,  in  this  dangerous  stage  of  the  disease.  We  must 
take  care,  however,  while  we  labour  to  restore  the  balance  of  the 
circulation,  not  to  induce  a  state  of  secondary  excitement,  and  thus 
exhaust  the  flame  we  were  endeavouring  to  keep  alive.  Even  here, 
constant  attention  must  be  paid  to  the  bowels,  and  daily  evacuations 
procured.  Dr.  B.  asserts,  that  the  disease  has  seldom  terminated  in 
intermittent,  under  his  own  treatment  ;  but  frequently  under  that  of 
others. 

**  It  appeared  to  be  in  general,  occasioned  by  some  morbid  affection 
°f  the  brain,  liver,  or  other  viscera,"  p.  31. 

In  these  cases,  he  recommends  mercurials  till  the  mouth  becomes 
affected,  (n  the  fourth  or  convalescent  stage,  the  only  interesting  re- 
mark relates  to  the  care  we  should  take,  in  guarding  against  a  relapse 
from  repletion.  While  noticing  the  different  remedies  which  have, 
in  their  day,  been  celebrated  in  this  fever,  Dr.  B.  asserts  of  cinchona, 
that,  *•  under  its  use,  mortality  has  been  great,  relapse  frequent,  and 
as  in  the  cases  of  the  Temeraire  and  Invincible,  dysentery  attacked 
nearly  all  the  patients  who  had  had  fever  in  a  severe  form  ;  nor  was 
there  an  instance,  that  when  given  daring  a  supposed  remission  of 
the  symptoms,  it  prevented  a  return  of  the  paroxysms,"  p.  34. 

On  dissection,  the  vessels  of  the  brain  were  generally  found  dis- 
tended, and  even  gorged  with  blood,  while  the  membranes  were  in- 
flamed, and  the  ventricles  containing  serous  effusions.  In  the  thorax, 
the  lungs  and  other  parts  were  inflamed.  In  the  abdomen,  liver  ge- 
nerally enlarged,  frequently  livid  towards  the  lower  edge  of  its  con- 
cave side.  Gall  bladder  moderately  full  of  inspissated  bile.  Stomach 
generally,  more  or  less  inflamed,  as  also  the  intestines,  p.  37.  et  seq. 

The  cases  and  dissections  occupy  more  than  eighty  pages  of  the 
first  part  of  our  Author's  work.  They  more  than  prove  the  grand 
object  of  Dr.  Burnett,  and  of  many  judicious  writers,  who  have  laid 
the  result  of  their  experience  before  the  public  ;  namely,  that  the 
lancet  must  be  boldly  used  in  those  fevers,  and  in  those  climates, 
where  the  dogmas  of  the  schools,  and  the  timidity  of  practitioners, 
had  nearly  proscribed  it.  In  this  point  of  view,  the  accumulition  of 
facts  will  firmly  support  the  rising  edifice  of  a  more  rational  and  suc- 
cessful mode  of  treatment  than  has  formerly  been  employed,  and  Dr. 


INFLUENCE   OF  TROPICAL  CLIMATES,  &C. 

Burnett's  work  therefore,  entitles  him  to  the  thanks  and  esteem  of  the 
public. 

The  second  part  of  the  work  opens  with  a  sketch  of  the  Author's 
observations  and  practice  in  the  Mediterranean,  while  serving  on 
board  the  Goliath,  Diadem,  Athenienne,  and  finally,  as  physician  to 
the  fleet.  In  the  year  1799,  a  part  of  the  Goliath's  crew,  that  had 
been  employed  in  watering  the  ship  at  Marsa  Scala,  in  the  Island  of 
Malta,  suffered  an  attack  of  bilious  remittent  fever,  the  prominent 
symptoms  of  which  were,  nausea,  vomiting,  head-ache,  flushed  face, 
full  and  frequent  pulse,  thirst,  white  tongue,  and  in  most  cases  deli- 
rium. 

"  The  patients  were  liberally  evacuated  on  their  complaining,  and 
the  bleeding  repeated  according  to  the  urgency  of  the  symptoms  ;  an 
open  state  of  the  bowels  was  preserved,  and  a  mild  diaphoresis  kept 
up.  Blisters  were  applied  to  the  nape  of  the  neck  and  forehead,  and 
a  strict  antiphlogistic  regimen  pursued.  This  soon  produced  a  ces- 
sation of  the  pyrexia,  when  tonics  and  a  well-regulated  diet  complet- 
ed the  cure,"  p.  132. 

In  the  succeeding  year  forty  of  the  Diadem's  crew  were  similarly 
affected  at  Port  Mahon,  **  and  so  speedily  was  a  remission  procured 
by  the  free  use  of  the  lancet,  that  I  had  only  occasion  to  send  two  or 
three  to  the  hospital,"  p.  133.  Dr.  B.  here  acknowledges  that  the 
use  of  emetics  in  a  few  of  the  first  cases  was  highly  prejudicial,  a  fact 
that  will  be  experienced  in  the  fevers  of  most  warm  climates.  In 
this  fever,  small  doses  of  calomel  and  antimonial  powder  were  given 
with  advantage,  after  liberal  evacuations  ;  and  a  simultaneous  appli- 
cation of  cold  water  to  the  head,  and  warm  water  to  the  lower  extre- 
mities, was  productive  of  beneficial  effects,  a  circumstance  that  accords 
with  our  own  experience  in  fevers  of  a  similar  type.  In  one  case, 
which  proved  fatal,  Dr.  Burnett's  assistant  gave  the  patient  an  emetic 
of  tartarized  antimony,  the  consequence  of  which  was,  that  "  the 
vomiting  increased,  and  never  afterwards  for  a  moment  left  him  ;  he 
passed  blood  by  the  nose,  mouth,  and  anus,  and  finally  died  in  the 
hospital,"  p.  134. 

Let  this  prove  a  lesson  against  emetics  in  fevers  of  the  warmer 
regions,  where  gastric  irritability  is  one  of  the  most  formidable  symp- 
toms we  have  to  encounter. 

The  Athenienne's  ship's  company  having  been  much  exposed  to 
the  ardour  of  a  summer  sun  at  Malta,  while  the  vessel  was  docking 
and  refitting  there,  was  attacked  with  fever  attended  by  great  local 
determination,  "  but,"  says  our  Author,  "  by  a  proper  use  of  the 
lancet  in  the  early  stage,  joined  to  purgatives,  they  all  speedily  re- 
covered," p.  135. 

Shortly  after  Dr.  Burnett  was  appointed  physician  to  the  fleet,  in 
1810,  a  fever  broke  out  in  the  Achille,  of  74  guns,  at  Cadiz,  which 
was  reported  to  the  admiral,  "  to  be  the  yellow  fe.ver  of  the  West  Indies, 
and  of  a  very  malignant  and  infectious  nature."  This  caused  great 
alarm  in  the  squadron  ;  but  Dr.  B.  found  that  the  symptoms  were  si- 
milar to  those  he  had  observed  in  the  fevers  at  Mahon,  &c.  and  that 
there  was  great  determination  to  the  thoracic  viscera  in  particular. 
4t  Emetics,  bark,  camphor,  wine,  and  opium  were  employed  in  the 


MEDITERRANEAN 

treatment  of  these  patients,"  which  Dr.  B.  very  properly  ordered  to 
be  laid  aside,  since  two  deaths  had  already  occurred  ;  and  "  the  lan- 
cet was  had  recourse  to  and  used  freely,  and  also  purgatives  ;  this 
soon  produced  a  change  in  the  features  of  this  disease,  and  the  whole, 
except  one  man,  speedily  recovered,"  p.  136. 

Dr.  Burnett  arrived  at  Gibraltar  in  September,  at  which  time  the 
garrison  was  healthy.  The  thermometer  ranged  from  T5  to  80,  and 
about  the  18th  or  19th,  a  deluge  of  rain  fell,  and  continued  three 
days,  the  torrents  from  the  upper  parts  of  the  rock  sweeping  down 
great  quantities  of  putrefying  vegetable  and  animal  substances,  which 
lay  stagnant  with  the  water  in  many  places  where  the  outlets  were 
not  pervious.  After  this  the  weather  became  very  warm  with  east- 
erly winds:  In  the  last  three  days  of  the  month  26  men»  belonging 
to  the  St.  Juan  guard-ship,  were  sent  to  the  hospital  with  the  bilious 
remittent  fever,  four  of  whom  died,  none  of  which  had  been  bled. 
The  general  treatment  was  purgatives,  calomel,  blisiersto  the  region- 
of  the  stomach,  and  gentle  diaphoretics.  The  cold  affusion  was  also 
tried,  and  proved  useful. 

From  Mahon  Dr.  Burnett  proceeded  to  Sicily,  where  he  found 
that  experience  had  already  pointed  out  the  necessity  of  evacuation* 
when  DEBILITY  was  the  most  prominent  symptom,  as  is  evinced  in 
the  communications  from  Dr.  Ross,  of  the  Warrior,  and  others.  The 
army  practitioners  had,  indeed  adopted  the  most  decisive  depletory 
measures  among  the  troops  in  Sicily,  previously  to  this  period,  as  our 
readers  know,  from  the  writings  of  Irvine  and  Boyle  ;  but  in  the 
navy  it  was  only  slowly  introduced,  and  we  believe  Dr.  B.  met  with: 
some  difficulties,  which  however,  his  zeal  surmounted,  in  banishing 
from  the  minds  of  the  medical  gentlemen  under  his  control,  the  phan- 
tom debility,  and  the  delusive  theories  of  the  schools. 

There  is  one  circumstance  which  I  have  not  yet  noticed,  though 
it  has  made  a  deep  impression  on  my  mind,  namely,  that  throughout 
the  descriptions  which  are  given  of  this  "  bilious  remittent  fever," 
by  Dr.  Burnett  and  his  numerous  correspondents,  no  mention  what- 
ever is  made  of  either  diurnal  or  alternate  remissions;  excepting  in 
the  Temeraire  and  Invincible  ;  and  I  cannot  help  expressing  my  sus- 
picion, that  a  great  proportion  of  the  cases  were  fevers  occasioned 
by  atmospherical  transitions  and  irregularities,  rather  than  by  the  ap- 
plication of  vegeto-animal  miasmata  ;  and  that  consequently,  they 
were  attended  with  more  marked  inflammatory  symptoms,  and  as- 
sumed a  less  remittent  type,  than  the  fevers  under  whose  denomina- 
tion they  are  classed.  Perhaps  the  term  *'  bilious  fever,"  (gastric 
irritability  being  no  very  general,)  would  be  more  proper  ;  and 
where  the  cause  can  be  clearly  traced  to  the  operation  of  marsh  mi- 
asmata, the  epithet  "  remittent"  might  be  properly  added,  because 
it  is  rare  indeed  that  remissions  on  alternate  day  in  particular,  can- 
not be  distinctly  perceived.  I  have  offered  these  suggestions  because 
I  am  of  opinion  that  some  modification  of  the  practice  detailed  by 
the  author,  is  necessary  in  the  more  fatal  endemics  of  the  warmer 
climates,  where  that  wonderful  and  powerful  morbific  cause — "  marsh 
miasma,"  attains  a  state  of  concentration  unknown  in  Northern  lati- 

30 


234  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

tudes.  In  the  Temeraire  and  Invincible,  where  the  fever  was  evi- 
dently the  bilious  remittent  of  hot  climates,  the  treatment  was  found- 
ed on  the  directions  of  Lind,  Clarke,  and  Balfoii  ,  whose  works  con- 
tinue still  to  produce  incalculable  mischief  in  the  hands  of  inexperi- 
enced practitioners.  But  the  more  rational  and  successful  doctrines 
and  practices  which  h*ve  lately  been  promulgated  bv  judicious  medi- 
cal men,  both  in  the  army,  and  navy,  will  dissipate,  en-  long,  the  mists 
of  prejudice,  and  annually  save  the  lives  of  thousands  of  our  coun- 
trymen. 'We  have  only  to  read  the  melancholy  ar  count  of  the  fever 
in  the  two  ships  above  mentioned  to  he  convinced  of  these  truths. 

"  On  making  inquiry,  says  Dr.  B  as  to  the  method  of  treatment 
which  had  been  pursued  with  those  men,  I  found  it  to  h;tve  been  by 
the  use  of  emetics,  calomel,  antimony,  bark  and  wine  in  large  quanti- 
ties, with  full  meals  of  animal  food  from  the  beginning,  p.  168. 

I  hardly  know  how  a  surgeon  could  prescribe,  or  a  patient  take, 
"  full  meals  of  animal  food,"  in  a  violent  and  acute  fever,  where  all 
appetite  is  almost  invariably  destroyed.  But  the  medicines  were 
quite  sufficient  to  produce  the  fatal  catastrophe  which  followed, 
Those  who  did  not  fall  immediate  sacrifices,  **  were  constantly  re- 
lapsing ;  several  as  frequently  as  three  times,  most  of  them  once, 
and  some  of  them  were  daily  attacked  with  dysentery,''  p.  159. 
This  was  not  all  ;  for  the  visceral  derangements  induced  by  these 
protracted  and  repeated  attacks  incapaciated  them  in  great  numbers 
for  the  service  of  their  country,  and  left  them  to  drag  out  a  miserable 
existence  in  indigence  and  disease  !  Such  a  e  the  fruits  of  adhering 
to  Brunonian  theories,  and  the  doctrines  of  d«  bility  and  pntrescency, 
taught  with  such  complacency  and  importance  "  in  academic  bowers 
and  learned  halls." 

I  have  hinted  that  certain  modifications  of  the  treatment  pursued 
by  our  author,  would  be  necessary  in  the  bilious  remittent  fevers  of 
warmer  climates,  and  the  reason  is  obvious  ;  altrough  in  the  Medi- 
terranean the  range  of  the  thermometer  equals  at  certain  seasons  the 
scale  of  tropical  temperature,  yet  there  is  not  that  perennial  ardor 
which,  in  equatorial  regions,  keeps  the  functions  of  the  liver  in  so 
deranged  a  state  as  to  render  that  organ  peculiarly  predisposed  to  dis- 
ease, when  the  balance  of  the  circulation  is  violently  disturbed,  as  in 
remittent  and  intermittent  fevers.  On  this  account,  liberal  evacua- 
tions, in  the  early  stages  of  Mediterranean  fevers,  and  slight  tonics 
or  bitters  afterwards,  are  in  general  sufficient  to  conduct  to  a  happy 
termination  :  whereas,  in  other  and  hotter  regions,  particularly  in 
India,  the  use  of  mercury,  in  addition  to  the  means  alluded  to,  is  ab- 
solutely requisite  to  secure  the  biliary  organs  from  obstruction  or  ab- 
ecess. 

"  In  the  Repulse,"  says  Dr.  B.  "  Mr.  Boyd  reports  that  he  had 
been  very  successful  in  combating  it,  [the  fever,]  by  the  early  use  of 
the  lancet  and  purgatives  ;  cold  and  tepid  affusion  he  likewise  found 
serviceable,  as  auxiliaries.  In  some  cases,  copious  and  sudden  affu- 
sion produced  a  diminution  of  febrile  heat,  sweats,  and  a  remission. 
In  several  of  the  patients,  he  mewtions  calomel  as  having  had 
very  excellent  effects.  In  one  case  of  great  danger,  benefit  appeared 


MEDITERRANEAN    FEVER.  235 

to  be  derived  from  the  inunction  of  mercurial  ointment  on  the  epigas- 
tric region,"  p.  149.* 

I  have  already  stated  my  doubts  respecting  the  propriety  of  class- 
ing all  Mediterranean  fevers  under  the  head  of  *'  bilious  remittent," 
as  our  author  has  done,  and  my  belief  that  a  great  many  of  them  oc- 
cured  totally  independent  of  marsh  miasmata.  The  following  ex- 
tracts will  support  this  opinion.  Mr.  Allen,  Surgeon  of  the  hospital 
at  Malta,  after  describing  the  general  symptoms  of  a  fever  which 
broke  out  on  board  the  Pornone,  and  remarking,  that  "  The  head  and 
liver  Deemed  to  be  the  principal  viseera  affected  in  this  fever,"  goes 
on  thus:  "  The  Weazlo  -loop,  refitting  at  the  dock-yard,  has  also 
sent  us  about  thirty,  with  similar  symptoms  to  the  Pomone's.  Our 
method  of  treatment  has  been,  in  the  first  instance,  by  the  abstraction 
of  thirty  ounces  of  blood,  the  exhibition  of  a  cathartic,  and  a  bolus 
composed  of  calomel  and  antimonial  powder,  of  each  two  grains, 
twice  a  day  ;  the  mist,  salin.  In  the  evening,  the  bleeding,  if  neces- 
sary, was  repeated.  Next  day,  if  the  symptoms  required  it,  recourse 
was  again  had  to  abstraction  of  blood,  a  blister  applied  to  the  epigas- 
tric region,  and  the  febrifuge  medicines  continued.  I  consider  this 
fever  to  have  been  brought  on  by  intemperance  and  exposure  to  heat, 
constituting  the  bilious  or  yellow  fever  of  the  island.  It  is  not  con- 
tagious," p.  168. 

In  a  subsequent  fever,  in  the  Weazle,  Mr.  Wardlaw,  whom  our 
author  highly  eulogises  for  his  abilities,  and  whose  statement  conse- 
quently deserves  attention,  reports  thus  :  "  The  state  of  the  wea- 
ther for  these  six  weeks  past  has  been  extrt  mely  warm  ;  the  ther- 
mometer ranging  from  80  to  87  in  the  shade.  The  Weazle  arrived 
at  Malta  in  the  month  of  June,  and  went  up  to  the  dock -yard  to  refit; 
the  ship's  company  were  then  perfectly  healthy.  Liberty  being 
given  to  go  on  shore,  and  they  having  received  a  considerable  share 
of  prize-money,  intemperance  was  the  consequence  ;  and  next  day, 
while  very  much  debilitated,  their  duty  necessarily  exposed  them  to 
the  heat  of  the  sun.  On  the  first  attack,  I  took  away  from  20  to  30 
ounces  of  blood,  with  saline  draughts  and  cathartics,  a  bolus  of  calo- 
mel and  antimonial  powder,  of  each  two  grains  twice  a-day,  till  the 
mouth  was  slightly  affected,  generally  completed  the  cure.  The  liver 
and  brain  seemed  to  be  the  only  visrera  affected  ;  the  liver  from  ob- 
structed ducts,  and  the  brain  from  the  great  determination  of  blood  to 
it,"  p.  170. 

The  remainder  of  the  second  part  of  Dr.  Burnett's  work  is  occu- 
pied in  sketching  the  fevers  of  different  ships,  and  stating  the  reports 
of  their  surgeons  on  the  method  of  treatment,  which  entirely  corres- 
ponded with  what  1  have  detailed  in  the  foregoing  pages.  Bleeding, 
purging,  and  the  exhibition  of  mercury  were  the  prominent  items  in 
the  <k  Methodus  Medendi"  and  will,  1  am  convinced,  triumph  over  the 
boasted  list  of  stimulant,  antiseptic,  and  febrifuge  remedies,  so  long 
imposed  on  the  credulity  of  mankind  by  the  fetters  of  prejudice, 
arid  the  bigotry  of  preconceived  theories. 

*  See  Dr.  Denmark's  Paper  on  the  Mediterranean  Fever  in  the  Medico-Chi- 
r apical  Transactions,  and  Dr.  Boyd's  Paper  on  the  Minorca  Fever  in  a  subse- 
quent section. 


I 

236  l^FLV^S-CR  OF  TROPICAL  CLIMATES,  &C. 

When  the  gates  of  Janus  shall  once  more  be  thrown  open,  and  the 
scourge  of  war,  (which  heaven  avert  !)  be  again  suspended  over  the 
restless  nations  of  the  world,  the  medical  officers  of  our  fleets  and 
armies  will  profit  by  the  labours  of  the  present  race  ;  and  the  bold 
energetic  measures  of  modern  practitioners  in  the  West,  in  the  East, 
and  in  the  North,  will  be  remembered  and  imitated,  when  the  authors 
who  practised  and  promulgated  these  tenets  shall  have  mouldered  in 
the  dust ! 


THE  MINORCA  FEVER  ; 

Translated  and  condensed  from  a  Latin  Thesis, 

WRITTEN  BY  DR.  WILLIAM  BOYD, 
{Formerly  Surgeon  of  Mahon  Hospital,) 

Entitled— DE  FEBRE  MINORCA,  &c.— 1817. 

Sec.  III. — Although  Dr.  Boyd  did  not  meet  with  this  fever  under 
the  remitting  type,  as  described  by  Dr.  Cleghorn,  yet  he  considers  it 
as  only  differing  in  grade,  from  the  marsh  or  bilious  remittent  of  that 
ftnd  other  authors.  It  is  produced  by  the  same  causes — appears  in 
similar  places- — affects  the  same  organs — proves  fatal  to  the  same 
classes  of  people  ;  and  only  differs  in  consequence  of  atmospherical 
influences,  and  a  greater  intensity  of  force  in  the  remote  and  predis- 
posing causes. 

This  fever  could  be  clearly  traced  to  a  local  origin  in  Port  Mahon  ; 
and  was  therefore  not  contagious,  but  a  primary  and  idiopathic  dis- 
ease ;  assuming  the  epidemic  character  only  from  the  state  of  the  air, 
and  the  crowding  of  the  sick.  In  spring,  therefore,  it  appeared  in  its 
simple  form.  But  these  fevers,  in  various  instances,  acquired  a  con- 
tagious quality — that  is,  the  power  of  propagating  themselves  from 
one  individual  to  another.  "  In  casibus  vanis  vim  contagiosam  ftaud 
raro  acquirunt :  id  est,  rim  gignendi  propagandi  quoque  eundem  tnor* 
bum  ab  alio  ad  aliud  corpus,"  p.  3.* 

Symptomatology  — The  first  symptom  was  a  sensation  of  cold, 
which  crept  along  the  spine,  and  over  the  lumbar  region.  To  this 
8'icceeded  head-ache,  generally  confined  to  the  forehead,  temples, 
and  orbits.  The  face  became  flushed  and  tumid  the  eyes  inflamed 
and  suffused  with  tears — the  carotids  and  temporals  pulsated  violent- 
ly. The  countenance  now  became  entirely  changed,  and  in  a  man- 
ner not  to  be  described  in  words  ;  while  the  patient  betrayed  great 
anxiety,  restlessness — dyspnoea,  with  sometimes  pain  and  sense  of 
tightness  in  the  chest,  cough,  inappetent-y— lassitude — thirst,  and 
watching*  The  tongue  is  now  \vhitish  or  yellowish  ;  but  for  the 

*  Dr.  Denmark,  Physician  to  the  Fleet,  who  was  at  Mahou  during  the  preva- 
lence of  this  fever,  and  who  declares  that  he  Was  a  noncontagionist,  observes — 
*'  These  occurences,  however,  served  to  stagger  our  belief;  and  a  combination  of 
subsequent  events  has  conspired  to  make  me  a  convert  to  the  opposite  side  of  the 
question.'' — Med.  Chir.  Trans,  vol.  vK 


MINORCA  FEVER*  237 

most  part  moist,  with  a  bitter  taste  in  the  mouth.  The  heart  beats 
with  great  strength  against  the  ribs — all  the  tangible  arteries  feel  hard 
and  full — and  a  soreness  in  the  flesh  is  complained  of  all  over  the 
body.  The  epigastric  region  is  now  very  tender  ;  and  there  is  nau- 
sea with  bilious  vomiting.  Pains  assail  the  loins — stretch  down  the 
thighs,  and  ultimately  affect  every  joint  and  member.  The  bowels 
are  obstinately  costive.  As  the  disease  advances,  the  pulse  feels 
less  full,  and  is  often  weaker  than  in  health  ;  while  the  thirst  and 
anxiety  are  aggravated.  At  this  period,  the  superior  parts  of  the 
body  will  sometimes  be  covered  wiih  a  profuse  sweat,  while  the  skin 
underneath  shall  feel  burning  and  rigid.  If  the  fever  proceeds,  the 
hot  stages  are  generally,  but  not  always,  preceded  by  rigors. 

When  the  patient  neglects  himself  for  one  or  two  days  after  the 
first  attack  ;  or  if  the  treatment  have  been  inefficient  or  improper, 
then  a  very  different  troin  of  symptoms  takes  place.  Together  with 
stupor,  there  will  also  be  great  pain  in  the  head — a  disinclination  to 
answer  questions — and  an  insensibility >  or  at  least  inattention  to  pass- 
ing occurrences.  The  eyes  will  be  more  turbid — often  inflamed.  A 
yellow  tinge  will  cover  the  adnata.  and  suddenly  spread  to  the  face 
and  neck,  and  thence  over  ihe  whole  surface  of  the  body,  in  less  than 
twenty-four  hours.  The  tongue  now  exhibits  a  thjck  yelluw  crust — 
brownish  arid  dry  towards  the  middle — red  and  inflamed  at  the  sides. 
The  strength  becomes  remarkably  diminished — the  stomach  is  ha- 
rassed with  nausea  and  bilious  vomiting — the  heart  beats  less  strong- 
ly, and  more  quickly — the  countenance  is  collapsed,  and  the  red  tints 
unequally  scattered  over  it. 

After  several  accessions,  and  about  the  third  day,  these  symptoms 
are  suddenly  and  signally  mitigated — the  skin  comes  nearly  to  its 
natural  temperature — the  fever  disappears,  and  nothing  but  debility 
apparently  remains.  But  in  a  short  time,  an  exacerbation  super- 
venes. The  disease  acquires  a  renovated  force,  and  shows  itself  un- 
der quite  a  different  aspect.  A  new  train  of  symptoms  assail,  with 
the  greatest  violence,  the  epigastric  region.  'I  he  sense  of  anxiety 
at  the  precordia  is  now  changed  into  acute  pain,  which  is  greatly  ag- 
gravated by  pressure — the  redness  of  the  eyes  changes  into  yellow- 
ness— the  countenance  is  sunk — the  tongue  is  brown,  and  trembles 
immoderately  when  attempted  to  be  thrust  out — the  pulse  is  rapid  and 
weak — all  desire  for  food  or  drink  vanishes — there  is  perpetual  vo- 
miting of  putrid  bile — the  precordia  are  exceedingly  oppressed — the 
patient  sighs  frequently — the  stools  are  liquid — foetid — slimy,  and  of- 
ten bloody.  The  whole  body  is  now  of  an  intensely  yellow  colour., 
[totum  corpus  alte  flavescit,]  —and  emits  a  foetor  resembling  that  of 
putrid  bile.  The  patient's  mind  is  now  completely  collected,  and  he 
answers  questions  with  promptness  and  clearness — sometimes  there 
is  a  little  aberration  or  negligence  of  surrounding  circumstances. 
From  this  time,  that  is  to  say,  from  the  5ih  till  the  7th  day,  the  pa- 
tient is  harassed  with  a  train  of  nervous  symptoms,  as  subsultus  ten- 
dinum,  tremors  of  the  whole  body,  &c.  which  tend  to  exhaust  the 
strength.  With  pain  in  the  abdomen,  there  is  difficulty  of  swallow- 
ing, and  a  sense  of  ulceration  in  the  fauces,  with  vomiting  of  a  glairy, 
or  black  matter  resembling  the  grounds  of  cnffee.  [Nee  non  vomitus 


238  tNFLUENCB-OF  TROPICAL  CLIMATES,  &C. 

materiae  glutinosae  nigraeque,/ec*7>tts  choavos  similis.]     Pain  about  the 
pubes,  an  inability  to  make  water — a  dangerous  symptom.* 

In  many  cases,  we  observed  swelling  and  suppuration  oftbe  paro- 
tid gland?,  with  petechiae  before  death.  In  others,  there  were  dis- 
charges of  blood  from  the  nostrils,  gums,  fauces.  &c.  In  others  still, 
instead  of  gastric  irritability,  \ve  had  diarrhoaa,  with  discharges  of 
black  fluid,  which  occasioned  great  tormina,  and  rapidly  prostrated 
the  patient's  strength.  The  face,  which  lately  exhibited  a  yellowish 
or  livid  appearance,  now  became  tumefied — the  eyes  lost  all  expres- 
sion, and  became  glassy — the  pupils  dilated — clammy  sweats  broke 
out  unequally  over  the  body — the  tongue  and  gums  turned  quite 
black— the  breathing  became  more  difficult — the  anxiety  more  dis- 
tressing. From  this  time,  coma  or  delirium,  with  coldness  of  the  ex- 
tremities and  intermitting  pulse  took  place  ;  and  convulsions  termi- 
nated the  scene,  from  the  5th  till  the  8th  day,  sometimes  sooner, 
sometimes  later  than  this  period. 

All  the  above  symptoms  were  not  apparent  in  the  same  person, 
nor  ran  an  equally  rapid  course.  In  the  young,  strong  and  plethoric, 
the  march  was  more  violent  and  hurried — in  the  elderly  and  enfee- 
bled the  disease  was  infinitely  milder. — Turbid  urine  letting  fall  a  co- 
pious sediment — discharge  of  bilious  stools,  at  first  black,  afterwards 
yellow  and  copious,  were  favourable  symptoms.  When  the  disease 
continued  beyond  the  usual  time,  and  especially  if  the  skin  kept  its 
yellow  tinge,  the  liver  was  almost  always  affected.  Relapses  were 
not  unfrequent,  particularly  if  great  attention  was  not  paid  to  a  re- 
stricted diet  during  convalescence. 

^Etiology. — Intense  heat,  which  during  the  summer  months  prevail 
without  intermission  in  Mahon  harbour,  where  a  breeze  seldom  ruf- 
fles  the  surface  of  the  water — violent  exercise  in  the  open  sun — in- 
temperance of  every  kind,  in  which  sailors,  on  getting  ashore,  so  un- 
guardedly indulge — exposure  to  the  night,  or  to  dews,  wet,  or  cold, 
after  the  body  had  been  heated  ;  these  were  the  principal  exciting 
causes  that  gave  activity  to  VEGETO-ANIMAL  EXHALATIONS  which  issue 
in  profusion  from  the  harbour  and  vicinity  of  MAHON. 

This  port,  so  destructive  to  the  health  of  belligerent  seamen,  is 
situated  low,  and  the  surrounding  sea  is  so  tranquil,  and  the  tides  so 
imperceptible,  that  whatever  is  thrown  into  the  water  remains  almost 
always  in  the  same  spot.  Now  when  we  consider  the  quantities  of 
putrefying  animal  and  vegetable  substances  that  are  daily  launched 
into  the  harbour,  or  exposed  to  a  tropical  heat  on  its  chores  ;  and 
couple  these  circumstances  with  the  stagnant  state  of  the  water  itself, 
during  the  summer  and  autumn  months  ;  and  moreover,  when  we  ob- 
serve a  pretty  extensive  lake  in  the  vicinity  of  the  port,  which,  in 
winter,  is  filled  by  rains  and  springs,  but  in  summer  exposes  its  half- 
dried,  slimy  bottom  to  the  sun,  whence  pestiferous  effluvia  incessant- 

*  The  above  authentic  document,  drawn  up  by  a  gentleman  of  great  talent 
and  observation,  at  the  bedside  of  sickness,  must  remove  all  doubt  relative  to  the 
existence  of  yellow  fever  in  the  Mediterranean;  while  the  Section  on  Endemic 
of  Batavia  must  have  convinced  the  most  sceptical  that  the  same  disease  appears 
in  the  Eastern  world,  modified  of  course  by  climate,  constitution,  and  cause. 
Compare  this  description  with  Mr.  Amiel's  account  of  the  Gibraltar  lever. 


MINORCA  FEVER.  239 

ly  emanate,  [prope  portura  adest  lacus,  cui  hieme  ex  aquis  pulvis  ac 
fontanis,  constat ;  sed  estate  fere  arescit,  et  limosam  massam  putres- 
centem  relinquit,  ex  qua  pestifera  effluvia  baud  cessant  ^roanare,] 
we  cannot  be  at  a  loss  for  the  generation  of  those  morbific  miaams, 
which,  in  all  hot  climates  and  similar  situations,  give  origin  to  fevers 
analogous  to  the  one  under  consideration. 

Prognosis  :  Favourable. — Little,  or  only  mucous  vomiting  at  the 
beginning  of  the  second  stage — moist  skin — slow  advance  of  the  yel- 
low suffusion — bowels  becoming  loose,  with  bilious  stools — integrity 
of  the  nervous  system  and  its  functions. 

Unfavourable. — Early  accession  of  the  yellow  suffusion — deepness 
of  its  tint — early  disturbance  of  the  sensorial  functions — deep  red- 
ness of  the  face — dullness  of  the  eyes— ^laborious  respiration — feeble, 
creeping,  and  intermitting  pulse — difficulty  of  swallowing — great  tre- 
mour  of  the  tongue — involuntary  discharge  of  fceces,  especially  of  a 
black,  liquid  quality — incessant  vomiting  of  dark-coloured  matters 
and  great  in  proportion  to  the  fluid  swallowed — much  anxiety. 

Post  Mortem  Appearances. — Theressels  of  the  brain  much  distend- 
ed— coverings  not  rarely  inflamed — depositions  of  coagulable  lymph 
between  the  convolutions — adhesions  occasionally  between  the  hemis- 
pheres— ventricles  sometimes  distended  with  lytnpid  or  yellow  lymph 
— lungs  sometimes  inflamed,  with  adhesions  or  effusions — pericardium 
inflamed  with  more  than  usual  water  in  its  cavity.  Diaphragm  often 
inflamed,  with  coats  of  coagulable  lymph.  Lifer,  in  most  instances, 
enlarged — often  inflamed,  with  its  inferior  margin  livid — Gall-Madder 
distended  with  viscid  bile.  Stomach  and  intestines  often  inflamed, 
and  the  villous  cost  of  a  dark  colour. 

These  appearances,  like  the  symptoms,  were  not  all  found  in  the 
same  person,  or  together.  In  some  dissections  we  found  one  set  of 
organs,  in  others  another,  bearing  the  marks  of  disorganizing  action. 
ID  general,  however,  the  brain  and  lungs  seemed  to  bear  the  greatest 
onus  of  disease. 

Consilia  Medendi. — The  disease  naturally  divided  itself  into  two 
stages — the  first  of  reaction  ;  the  second  of  collapse.  In  the  first 
stage  the  object  was  to  moderate  rr  repress  the  violence  of  reaction  ; 
in  the  second,  to  obviate  symptoms,  and  support  the  energies  of  na- 
ture. 

1st  Stage. — Venesection  is  here  our  sheet  anchor.  No  man  can 
lay  down  a  rule  of  quantity .  Blood  must  be  drawn  till  the  symptoms 
are  signally  mitigated,  whether  at  twice,  thrice,  or  four  times  in  the 
day.  I  do  not  think  it  of  much  consequence  from  what  part  of  the 
body  the  blood  be  drawn.  Some  prefer  the  arm,  some  the  jugular 
vein,  others  the  temporal  artery.  To  alleviate  the  head-ache,  I  think 
I  have  found  arteriotomy  at  the  temples  most  powerful  But  the 
vascular  system  must  be  promptly,  and  well  depleted,  through  what- 
ever outlet  the  current  flows,  otherwise  some  texture  or  organiza- 
tion will  give  way,  and  then  the  chances  of  recovery  are  faint  indeed. 

Mean  time  the  head  is  to  be  shaved,  and  kept  constantly  enveloped 
with  cloths  wetted  with  the  coldest  water.  This  is  an  important 
measure,  which  should  never  be  neglected.  In  my  own  person  I  ex- 


$40  INFLUENCE  OF  TROPICAL  CLIMATES,  &.C. 

perienced  its  good  effects,  in  soothing  the  pain — diminishing  the  heat 
— and  tranquillizing  the  irritability  of  the  system.* 

Purgatives. — Our  next  step  is  to  open  the  bowel?,  which  indeed 
must,  be  done  through  the  whole  course  of  the  disease.  For  this 
purpose,  and  also  to  correct  the  vitiated  secretions  of  the  intestinal 
canal  and  liver,  I  have  exhibited  eight  or  ten  grains  of  calomel  every 
four  hours,  without  ever  observing  any  bad  consequences  from  hy- 
percatharsis.  In  every  case  where  ptyalism  came  on,  the  patient 
convalesced — the  stools  became  natural,  and  the  tongue  clean — "  In 
omni  casu  in  quo  (hyd  submur)  salivam  movit,  aeger  plerumque  con- 
valuit,  naturales  tiunt  foeces,  lingua  nitida,  ac  humida."  A  cooling 
regimen  is,  of  course,  to  be  rigidly  observed.  The  cold  affusions  and 
spongings  are  also  valuable  auxiliaries  ;  and  where  the  reaction  is 
not  in  a  salutary  degree,  and  the  interior  organs  appear  oppressed 
—  tepid  affusions  will  be  necesiarj'. 

To  rf lieve  local  symptoms — leeches  to  the  temples,  or  cupping 
may  be  employed  when  general  bleeding  dare  not  be  ventured  on, 
Blisters  also  to  the  head — neck — spine — or  precordial  region  must 
be  had  recourse  to.  In  case?  of  great  collapse  and  deficient v  of  the 
vis  vitce,  the  tepid  bath  will  prove  an  important  measure  in  drawing 
the  circulation  to  the  surface.  The  abdomen  and  extremities  may 
also  be  fomented  often  as  a  substitute,  or  auxiliary  to  the  bath. 

Finally,  when  all  danger  of  inflammation  or  congestion  is  over — 
and  where  great  irritability  of  the  heart  and  nervous  system  pre- 
vails, opiates  may  be  administered,  and  with  great  solace  to  the  feel- 
ings of  the  patient. 

In  the  second  stage,  the  great  difficulty  is  to  restrain  the  vomiting. 
Fomentations  to  the  epigastric  region  are  here  useful,  with  opium, 
aether,  a-  d  camphor  internally — to  which  means  must  be  added  blis- 
ters. Effervescing  draughts  with  small  doses  of  tinct.  opii.  ether, 
infusion  of  columba,  may  be  tried,  and  even  hot  wine  with  spices — 
or  brandy  and  water.  Glysters  with  laudanum  will  sometimes  res- 
train the  gastric  irritability  ;  and  I  have  frequently  given,  where  the 
strength  was  much  exhausted,  30  or  40  drops  of  spirit  of  turpentine 
every  two  hours,  with  great  advantage.  Where  stimulants  are  neces- 
sary at  the  close  of  the  disease,  port  wine  cautiously  administered  is 
the  most  grateful.  Quassia  and  porter  in  small  quantities  during 
convalescence.  But  a  constant  attention  should  be  paid  lest  the  pa- 
tient take  too  much  food,  which  will  readily  induce  a  relapse. 

I  shall  conclude  this  section  with  a  few  short  extracts  from  Dr. 
Denmark's  paper  on  the  same  fever.  "  A  case  of  this  fever  will 
seldom  occur  wherein  the  use  of  the  lancet,  more  or  less,  will  not 
be  applicable.  But  this  powerful  remedy  is  not  in  all  cases  infalli- 
ble. The  danger  consists  in  either  applying  it  too  late,  or  too  often  ; 
and  the  abstraction  of  blood,  under  my  own  direction,  has  accele- 
rated the  patient's  death,  when  circumstances  seemed  to  justify  the 
sure." 
I  shall  now  say  a  few  words  on  Mercury,  our  *'  sheet-anchor" 

*  Dr.  Boyd  nearly  perished  under  this  fever  himself,  but  was  saved  by  profuse 
bleeding.  Dr.  Denmark  states  that  Dr.  B.  caught  the  fever  from  one  of  his  pa- 
tients, Mcd.  Chir,  Trans,  Vol  vi.  p.  301. 


SICILV.  241 

in  affections  where  the  biliary  organs  are  implicated.  Viewed  in  any 
way,  the  utility  of  mercury  is  incontrovertible.  Calomel  is  benefi- 
cial in  whatever  way  it  operates,  w  hether  it  produce  catharsis, 
when  exhibited  with  a  view  to  salivate  ;  or  salivate,  when  intended 
to  act  as  a  cathartic,  the  result,  in  either  case,  will  be  salutary,  though 
perhaps  not  to  the  same  extent.  1  have  prescribed  it  in  various 
forms,  in  order  to  fulfil  both  these  intentions,  and  the  result  has  en- 
abled me  to  speak  most  favourably  of  it.  I  have  frequently  recom- 
mended calomel  in  three  grain  doses,  with  as  much  pulv.  antim. 
every  three  or  four  hours.  The  antimony  seemed  to  assist  the  pur- 
gative operation  of  the  calomel,  and  seldom  failed  to  procure  copious 
bilious  stools,  without  creating  nausea.  In  the  treatment  of  this 
fever,  however,  I  usually  gave  the  calomel  m  fcruple  doses  twice  a- 
day,  in  many  cases  from  the  first  invasion  of  the  cornpl.int,  with  the 
intention  of  speedily  attacking  the  disease,  through  the  system.  But 
in  this  I  commonly  failed  during  the  first  days,  in  plethoric  habits. 
Before  the  system  was  lowered,  it  evinced  no  effect  through  the  me- 
dium of  the  circulation — it  only  kept  the  bowels  clear.  But  after 
the  lapse  of  two  or  three  days,  and  the  use  of  free  venesection  and 
purging  ;  and  at  an  earlier  period  in  debilitated  subjects,  and  in  cases 
of  relapse,  the  mouth  often  became  suddenly  sore  with  profuse 
ptyalism,  and  rapid  convalescence  as  certainly  ensued.  1  do  not 
recollect  any  deaths  after  .the  specific  action  of  the  mercury  showed 
itself ;  nor  did  the  yellow  suffusion  occur  alter  this  symptom  appear- 
ed." Med  Chir.  Trans,  vol.  vi.  p.  307. 

I  trust  thai  this  document  will  prove  a  standard  record  and  faithful 
picture  of  the  MINOKCA  FEVER,  as  long  as  that  Island  offers  a  com- 
mercial port,  or  belligerent  rendezvous  to  the  naval  flag  of  Great  Bri- 
tain. 


SICILY. 

SEC.  IV. — The  climate  of  Sicily  is  always  oppressively  hot  in  sum- 
mer, and  seldom  very  cold  in  winter.  Between  April  and  August 
there  is  little  or  no  rain  ;  towards  the  end  of  the  latter  month,  the 
rains  begin,  but  the  heat  continues  till  the  middle  of  September, 
when  it  rapidly  declines.  From  November  till  May,  the  heat  is 
moderate,  the  mercury  ranging  from  50  up  to  65  or  70°.  In  the  sum- 
mer months,  and  particularly  in  July  and  August,  the  thermometer 
averages  86  in  the  day,  and  is  but  a  very  few  degrees  less  in  the 
night.  Sudden  vicissitudes  of  temperature,  however,  are  consider- 
able—-20  or  30  degrees  in  the  twenty-four  hours.  Of  course,  local 
inflammations  and  congestions  are  common,  and  phthisis  pulmonalis  is 
frequently  fatal.*  Here,  as  in  most  hot  climates,  the  houses  are 
more  calculated  for  counteracting  heat  than  resisting  cold,  or 
preserving  an  equilibrium  of  temperature.  Stone  floors  and  unfinish- 
ed casements  ill  suit  the  delicate  frames  of  the  consumptive  in  winter  ; 
while  in  summer,  the  sensation  of  heat  is  so  great,  that  many  expose 

*  Hepatitis,  according  to  the  testimony  of  Irvine,  frequently  occurs  in  Sicily. 

31 


242  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

themselves  to  dangerous  transitions  rather  than  bear  excessive  warmth 
within  doors.  It  is  in  this  way,  that  many  refer  the  origin  of  their  pul- 
monary complaints  to  the  most  fervid  season  of  the  year.  Light  rains 
in  autumn  are  observed  to  be  unhealthy — evidently  from  their  putting 
the  surface  of  the  earth  in  a  state  capable  of  evolving  febrific  efflu- 
via :  whereas,  nothing  is  so  salutary  as  heavy  rains  about  the  middle 
of  September,  which  at  once  mitigate  the  heat  and  check  the  extrac- 
tion of  miasmata. 

Sicily  is  penetrated  in  several  directions  by  ridges  of  primitive 
hills  of  considerable  height :  between  these  are  numerous  water 
courses,  which  are  dry  in  summer,  and  occasionally  filled  by  torrents 
in  winter.  They  are  designated  by  the  Sicilians,  FIUMARI,  and  are 
used  as  roads  in  the  dry  seasons.  Many  of  them  are  extremely  un- 
healthy in  the  latter  part  of  summer,  and  in  autumn,  and  infested  by 
what  the  natives  term  MALARIA.  The  state  of  this  .Malaria  varies 
much  according  the  state  of  the  season.  A  very  wet  season  will  over- 
whelm, as  it  were,  the  sources  of  this  febrific  ;  while  a  very  dry  one 
will  so  parch  up  the  surface  of  the  earth  as  to  produce  a  similar  effect. 
At  LENTINI,  however,  around  which  the  country  is  marshy,  with  a  con- 
siderable lake  in  the  vicinity,  the  ground  is  partly  freed  from  water 
in  hot  weather,  but  is  never  so  dry  as  to  prevent  the  formation  of 
miasmata.  Here  then  is  a  Malaria  every  year.  In  many  of  the jftti- 
inares  the  stream  disappears  in  the  gravel,  and  percolates  under  the 
surface  of  the  ocean.  Thus  at  the  bottom  of  the  large^wmare  which 
bounds  Messina  on  the  northern  side,  fresh  water  will  be  found  at  a 
foot  depth  close  to  the  sea.  It  is  in  these  kinds  of  fiumares  that  a 
Malaria  prevails,  according  to  the  opinion  of  the  natives,  throughout 
the  year  ;  and  this  probably  accounts  for  the  extrication  of  miasmata 
in  many  parts  of  the  West  Indies  as  well  as  Europe,  where  there  are 
apparently  no  materials  for  their  production.  Thus  some  places  in 
Sicily,  though  on  very  high  ground,  are  sickly  ;  as  Ibesso  or  Gesso, 
about  eight  miles  from  Messina,  situated  upon  some  secondary  moun- 
tains lying  on  the  side  of  the  primitive  ridge  which  runs  northward 
towards  the  Faro,  which  has  always  been  found  an  unhealthy  quar- 
ter for  English  troops.  It  stands  very  high  ;  but  still  there  is  higher 
ground  at  some  miles  distance.  Water  is  scarce  here,  and  there  is 
nothing  like  a  marsh  — At  this  station,  however,  sickness  seldom  oc- 
curs "  unless  after  rains  falling  while  the  ground  is  yet  hot,  which  is 
during  the  heat  of  summer4,  or  early  in  autumn,  when  all  circum- 
stances combine  for  the  production  of  miasmata.5'  Irvine*  p.  6.  This 
may  apply  in  elucidation  of  the  Gibraltar  fever.  **  I  remember,  says 
Dr.  Irvine,  a  muleteer  passing  over  the  hills  near  Obessa,  in  the  mid- 
dle of  August,  during  a  heavy  rain,  who  remarked  that  these  rains 
falling  on  the  heated  ground  would  cause  a  stink,  (puzza,)  and  that 
many  would  be  poisoned."  Ib. 

In  Sicily  the  north  wind  is  cold — the  west  rainy — the  south-east  is 
the  celebrated  Sirocco,  which  seems  to  derive  its  noxious  qualities 
from  heat  combined  with  dampness. — Here,  as  in  most  sultry  lati- 
tudes, the  summer  and  autumn  are  the  unhealthy  seasons. 

The  fevers  of  Sicily  have  been  divided  into  three  classes,  those 
of  sumraer>  autumn,  and  winter.  Those  of  summer  have  appeared 


SICILY .  243 

10  Irvine,  Boyle,  and  others,  to  be  of  an  inflammatory  nature — to  be 
principally  owing  to  excessive  heat — intemperance,  and  inordinate 
exercise.  The  head  seems  to  bear  the  onus  of  disease.  Dr.  Irvine 
bled  from  the  temporal  artery,  repeating  the  operation  pro  re  nata. 
Blisters  were  applied  to  the  head,  and  purgatives  were  administer- 
ed internally.  The  cold  affusion  was  then  applied  on  the  principles 
of  Dr.  Currie.  **  I  never,  says  Dr.  Irvine,  in  any  one  instance,  saw 
the  bleeding  fail  to  remove  the  pain  in  the  head,  and  when  delirium 
was  present,  it  lessened  also  that,"  p.  24.  Encouraged  by  the  alle- 
viations of  the  symptoms,  I  persisted  in  my  plan.  I  bled  a  third  time 
from  the  head,  and  blistered  again  between  the  scapulae,  continuing 
the  cold  affusion.  The  number  of  times  that  this  treatment  was  re- 
peated was  necessarily  regulated  by  the  effect  produced.  I  never 
had  occasion,  however,  to  bleed  more  than  four  times.  But  the 
standard  rule  of  my  practice  was  to  continue  the  bleeding  and  blis- 
tering of  the  head  while  any  degree  of  head-ache  remained,  or  any 
symptom  of  determination  to  the  head  was  visible."  Ib.  Dr.  Irvine 
found  the  bleeding  pave  the  way  for,  and  render  more  efficacious  the 
cold  affusion,  which  when  applied  without  this  preliminary,  afforded 
only  transient  relief. 

"  The  appearances  on  dissection  were  somewhat  various.  In  some 
cases,  nothing  very  remarkable  could  be,  or  was  discovered  in  the 
brain  or  its  membranes.  In  others  the  cerebral  veins  were  turgid 
with  blood.  In  many  there  was  a  red  spot  on  the  dura  mater,  about 
the  middle  of  the  longitudinal  sinus,  of  the  size  of  a  dollar.  Some- 
times a  little  pus,  or  rather  inflammatory  exudation  appeared  upon 
this  spot."  Irvine,  p.  36. — "  1  find  it  diflicult,  says  Dr.  Irvine,  to 
reconcile  the  facts  here  stated,  with  the  ingenious  opinion  of  Dr. 
Clutterbuck.  I  do  not  think  that  phrenitis,  or  any  analogous  disor- 
der of  the  brain,  often,  far  less  always,  exists  in  fevers/1  p  62. 

In  the  autumnal  fevers  of  Sicily,  a  great  many,  when  the  disease 
was  violent  "  became  excessively  yellow"  without  any  alleviation  of 
their  disorder.  The  stomach  is  more  irritable — the  vomiting  is  bi- 
lious, and  of  a  dark-green  colour — the  region  of  the  liver  sometimes 
tender.  These  run  out  to  a  much  greater  length  than  the  summer 
fevers,  but  only  differ  from  them  in  being  accompanied  with  earlier 
prostration  of  strength."  "  I  can  safely  state,  says  Dr.  Irvine,  that 
the  same  sort  of  treatment  which  I  have  used  in  the  summer  fever, 
also  proved  successful  in  these,*'  45.  Purging,  however,  was  more 
necessary,  and  calomel  and  James's  powder  were  found  useful  in 
protracted  cases.  ««  Touching  the  mouth  with  mercury  is  sometimes 
useful  in  cases  where  the  yellowness  is  great,"  47. 

The  winter  fevers,  according  to  Irvine,  had  nothing  remarkable  ia 
their  phenomena  or  progress  ;  but  ran  a  course  analogous  to  the  or- 
dinary cases  of  Synochus  in  England.  "  They  hardly  ever  fail  to 
yield  to  the  four  grand  means  of  topical  bleeding,  [artenotomy,]  blis- 
tering—cold affusion,  and  purging,"  60. 

To  the  above  observations  by  Dr.  Irvine,  which  appear,  on  the 
whole,  judicious  and  correct,  I  shall  add  some  from  the  pen  of  Mr. 
Boyle,  who,  in  my  opinion,  has  given  a  more  rational  explanation  of 


24-4  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

/ 

the  symptoms,  while  his  Methodus  Medendiis  equally  effective  as  Dr. 
Irvine's. 

When  the  epidemic  first  appears,  says  Mr.  Boyle,  in  the  early 
part  of  autumn,  the  fever  preserves  nearly  a  continued  form,  and  on- 
ly remits  after  the  violence  of  the  excitement  has  heen  suhdued.  It 
bears  a  strong  analogy  to  the  bili  >us  remittents  or  all  warm  climates 
— is  closely  allied  to  the  fever  which  visits  other  points  t>f  the  Medi- 
terranean shores,  and  seems  to  differ  only  in  degree  from  those  great 
endemics  which  have  repeatedly  ravaged  the  western  hemisphere. 

"  In  Sicily,  says  Mr.  Boyle,  this  fever  usually  makes  its  appear- 
ance about  the  same  time  that  cholera  morbus  and  other  disorders  of 
the  biliary  organs  are  known  to  prevail,  and  both  diseases  seem  to 
arise  from  causes  of  nearly  a  similar  nature.  It  indeed  appears  to 
be  essential  to  the  production  of  this  fever  that  a  considerable  dimi- 
nution of  temperature,  accompanied  with  much  humidity  of  the  at- 
mosphere, should  suddenly  succeed  to  the  long-continued  heat  of 
summer.  By  those  causes,  an  important  change  is  effected  in  the 
balance  of  the  circulation,  causing  an  unusual  determination  to  the  ab- 
dominal viscera,  and  producing  congestion  or  inflammation  of  the  he- 
patic system,  in  various  degrees,  followed  by  an  increased  and  vitiat- 
ed secretion  of  bile."  Ed.  Jour.  vol.  viii.  184  * 

The  succession  and  order  of  the  symptoms,  marking  the  different 
stages  and  types  of  this  fever,  will  be  readily  explained  by  the  ap- 
pearances on  dissection,  and  seem  to  depend  elm-fly  on  the  degree 
of  inflammation,  and  the  sensibility  of  the  part  concerned.  When 
the  liver  is  very  violently  affected,  the  symptoms  sometimes  even  re- 
semble those  of  hepatitis,  and  which  more  especially  appear  at  the 
commencement  of  the  fever  ;  and  inflammation  of  the  stomach  is  suf- 
ficiently characterized  by  the  anxifty,  restlessness,  vomiting,  and 
prostration  of  strength  which  immediately  follow. 

As  a  common  consequence  of  extensive  peritoneal  inflammation, 
we  sometimes  find  a  quantity  of  serum  effused  into  the  cavity  of  the 
abdomen,  and  various  adhesions  formed  between  its  parietes  and  the 
contained  viscera  ;  and  the  omentum  at  other  times  so  much  wasted, 
as  to  resemble  merely  a  tissue  of  red  vessels.  The  liver  almost  al- 
ways exceeds  its  natural  size,  and  is  aNo  considerably  altered  in  co- 
lour and  texture.  It  is  always  softer  than  natural  :  and  the  system 
of  the  vena  portae  is  always  turgid  with  blood.  The  peritoneal  co- 
vering of  the  liver  is  often  thickened  and  opaque,  and  is  sometimes 
studded  with  white  spots,  or  with  flakes  of  coagulable  lymph.  Some- 
times its  surface  is  irregular,  and  email  indurated  portion «  are  disco- 
vered on  its  convexity,  which,  when  cut  open,  are  found  to  proceed 
from  obstruction  of  some  ramification  of  its  excretory  ducts,  produc- 
ed by  inflammation  of  its  coats,  and  favouring  the  accumulation  of 
viscid  bile. — The  coats  of  the  cyst  generally  partake  of  the  inflamma- 
tion. The  colour  of  the  bile  it  contains  is  various,  and  it  is  some- 
times so  viscid  and  thick,  that  it  can  scarcely  be  forced  out  by  strong 
pressure. 

A  remarkable  alteration  also  takes  place  in  the  appearance  of  the 

*  The  reader  will  not  fail  to  perceive  the  coincidence  of  Mr-  Boyle's  ideas  with 
;ny  own,  though  the  writers  were  separated  many  thousand  miles  at  the  time. 


SICILY.  245 

spleen.  It  does  not  always,  however,  exceed  the  natural  size,  but 
its  softness  is  often  such,  that  it  can  only  be  compared  to  a  mass  of 
coagulated  blood  ;  while,  at  other  times,  it  has  an  unusual  degree  of 
hardness,  with  thickening  and  whiteness  of  its  peritoneal  coat. 

The  stomach  is  frequently  found  contracted  and  empty,  or  inflated 
with  air,  or  distended  with  variously-coloured  fluids,  and  even  pure 
bile.  Sometimes  inflamed  spots  are  covered  on  its  peritoneal  coat  ; 
but  the  internal  surface  is  the  most  frequent  seat  of  disease.  The 
texture  of  the  villous  coat  is  often  completely  destroyed,  and  it  exhi- 
bits an  uniform  red,  of  the  deepest  hue,  in  several  places  approach- 
ing to  a  livid  colour,  and  is  covered  with  coagulable  lymph,  or  a  se- 
cretion of  puriform  matter  tinged  with  blood.  In  other  cases,  the  in- 
flammation is  more  limited,  and  appears  in  rosy  patches  over  its  in- 
ternal surface  or  in  numerous  minute  red  specks. 

This  inflammation  is  never  of  the  phlegmonous  kind,  but  like  true 
erythema,  successively  invades  one  part  after  another,  frequently 
creeping  along  the  whole  course  of  the  alimentary  canal,  attended 
with  thickening  and  pulpiness  of  its  coats. 

The  brain  and  its  membranes  show  no  uncommon  appearances,  or 
marks  of  previous  inflammation. 

The  lungs  are  not  affected,  but  I  have  often  found  a  large  quantity 
of  serum,  of  a  yellowish  colour,  collected  in  the  pericardium,  while 
the  heart  seemed  to  have  suffered  from  inflammation  ;  and  in  two  or 
three  cases,  I  observed  white  patches  of  coagulable  lymph,  appa- 
rently converted  into  firm  glistening  membrane,  easily  separated 
from  its  proper  coats,  on  different  parts  of  its  external  surface. 

Such,  indeed,  is  the  rapid  progress  of  the  disease,  and  the  great 
delicacy  of  the  organ  principally  concerned,  that  our  measures  must 
necessarily  be  prompt  and  vigorous  ;  and  und^r  whatever  varieties  it 
may  appear,  with  respect  to  type,  the  local  symptoms  always  require 
our  first  attention,  and  indicate  the  necessity  of  copious  evacuation  of 
blood.  If  the  fever  be  of  the  continued  form,  under  such  treatment 
it  very  often  becomes  intermittent,  and  when  of  this  latter  form,  we 
thereby  prevent  its  being  changed  into  a  more  dangerous  type,  in  the 
course  of  its  progress. 

From  the  use  of  this  remedy,  we  are  not  always  to  be  deterred  by 
the  smallness  of  the  pulse  ;  and  even  if  deliquium  should  come  on 
after  the  abstraction  of  a  few  ounces  of  blood,  the  operation  may  be 
repeated  soon  afterwards,  without  the  occurrence  of  the  like  acci- 
dent. 

This  indiscriminate  use  of  the  term  debility,  derived  from  some  of 
the  more  general  phenomena  of  disease,  without  regard  to  its  essence 
or  cause,  has  led  into  egregious  error  in  the  treatment  of  this,  as  well 
as  of  some  other  complaints,  which  are  commonly  considered  as  sim- 
ple idiopathic  fevers.  The  anxiety,  languor,  restlessness,  and  pros- 
tration of  strength  which  accompany  this  epidemic,  are  not  symptoms 
of  debility,  but  of  gastritis,  and  depend  on  the  peculiar  structure  of 
the  organ,  aud  its  extensive  sympathy  with  the  whole  system.  A  free 
use  of  the  lancet  is  required  ;  and,  in  order  that  this  remedy  may 
be  productive  of  beneficial  effects,  it  must  be  had  recourse  to  at  an 
early  period  of  the  disease.  Even  when  the  disease  was  too  far  ad. 


246         INFLUBNCE  OF  TROPICAL  CLIMATES,  &C. 

vanced  for  any  permanent  advantage  to  be  expected  from  venesection, 
its  effects  have  been  discovered  by  a  temporary  increase  of  fulness 
of  the  pulse.  What  is  here  said,  applies  equally  to  general  and  lo- 
cal blood-letting  ;  and  this  last  mode  may  be  employed  with  consi- 
derable advantage. 

In  the  inflammation  of  all  delicate  and  highly  sensible  membranes, 
unless  we  succeed  in  the  first  instance,  we  in  vain  attempt  to  subdue 
it  afterwards,  by  acting  on  the  arterial  system  at  large,  and  still  fur- 
ther diminishing  the  visatergo  :  for  the  disease  makes  rapid  progress  ; 
the  texture  of  the  organ  is  speedily  destroyed,  and  its  vitality  is  ir- 
recoverably lost. 

Recourse  must,  therefore,  at  the  same  time,  be  had  to  such  means 
as  possess  some  control  over  the  vessels  of  the  part  suitable  to  its 
peculiar  functions  and-  organization  ;  and  the  effects  of  local  blood- 
letting, by  the  application  of  a  number  of  leeches  to  the  region  of 
the  stomach,  are  to  be  further  assisted  by  large  and  repeated  blisters. 

Nothing  so  much  aggravates  all  the  symptoms,  as  the  presence  of 
acrid  bile,  and  accumulated  feculent  matter.  All  irritation,  there- 
fore, from  such  causes,  is  to  be  carefully  prevented  ;  and,  with  this 
view,  the  contents  of  the  intestines  are  to  be  dislodged  on  the  first 
approach  of  the  disease,  and  their  accumulation  cautiously  guarded 
against  during  its  continuance.  For  this  purpose,  small  doses  of  pur- 
gative medicines  must  be  frequently  administered.  Il  too  often  hap- 
pens, however,  that  the  irritability  of  the  stomach  is  such,  that  me- 
dicines of  this  class  cannot  be  retained,  but  are  instantly  rejected  ; 
and  recourse,  therefore,  must  also  be  had  to  large  emollient  and  lax- 
tive  glysters,  which  must  be  frequently  injected,  and  are  in  all  stages 
of  the  fever,  of  the  most  essential  service.  As  a  purgative,  no  me- 
dicine is  so  well  adapted  to  this  complaint  as  the  sub  muriate  of  mer- 
cury ;  and  its  operation  may  be  sometimes  advantageously  alternated 
with  the  use  of  sulphate  of  magnesia  dissolved  in  water,  and  plenti- 
fully diluted. 

The  effects  of  mercury,  however,  are  not  to  be  estimated  solely 
by  its  purgative  quality ;  but  it  seems  to  be  chiefly  useful  on  ac- 
count of  its  specific  action  on  the  hepatic  system,  and  its  power  of 
affecting,  through  the  medium  of  the  circulation,  secreting  surfaces 
endowed  with  high  irritability,  and  in  a  state  of  inflammation.  This 
remedy  is,  therefore,  to  be  used  externally,  as  well  as  internally  ; 
and  is  to  be  resorted  to  immediately,  as  the  most  powerful  remedy 
we  possess  in  the  treatment  of  this  disease.  Its  effects,  however, 
do  not  always  depend  on  the  quantity  introduced  ;  but  on  certain  con- 
ditions of  the  system,  by  which  the  latter  is  rendered  more  or  less 
susceptible  of  its  action,  and  which  I  do  not  pretend  to  explain. 

This  susceptibility  is  indicated  by  the  effects  produced  on  the  sa- 
livary glands  ;  some  degree  of  ptyalism  follows,  which  affords  the 
surest  prognostic  of  a  favourable  termination  ;  and  the  change  pro- 
duced in  all  the  symptoms  is  generally  quick  and  rapid.  It  some- 
times, however,  happens,  that  the  largest  doses  will  not  produce  sa- 
livation, and  in  such  cases,  the  event  is  invariably  fatal. 

From  the  rapid  manner  in  which  we  are  frequently  induced,  on 
account  of  the  severity  of  the  disease,  to  introduce  this  medicine 


EGVPT. 


into  the  system,  copious  salivation  is  frequently  occasioned,  and  often 
appears  suddenly,  with  bleeding  from  the  gums  ;  but  as  no  advantage 
is  to  be  expected  from  the  mere  secretion  from  the  salivary  glands, 
I  have  succeeded  equally  well,  after  having  ascertained  its  influence 
over  the  disease,  by  continuing  its  use  in  small  doses,  merely  suffi- 
cient to  keep  up  the  mercurial  irritation  in  the  system,  until  the  dis- 
ease was  completely  overcome.  Fr>  m  what  has  been  said,  it  needs 
scarcely  to  be  observed,  that  the  practice  of  besmearing  the  gums 
\vith  mercurial  ointment,  or  rubbing  them  with  calomel,  for  the  pur- 
pose of  encouraging  this  secretion,  is  extremely  ineffectual. 

Sometimes  severe  diarrhoaa  comes  on  during  the  early  stages  of 
recovery,  attended  with  want  of  sleep  ;  in  which  case  1  have  derived 
the  greatest  advantage  from  small  doses  of  opium,  combined  with  ca- 
lomel. / 

We  are  usually  advised,  in  all  fevers  which  show  a  tenddBKJf^ 
intermit,  to  watch  this  period  carefully  ;  and  to  avail  ourselves  of 
the  earliest  opportunity  such  circumstances  afford,  of  exhibiting  bark 
in  large  doses,  with  a  view  to  obvi  ite  the  debility  which,  it  is  said, 
predisposes  to  the  formation  and  return  of  another  paroxysm.  That 
in  some  fevers,  and  in  certain  habits  and  constitutions,  this  may  be 
highly  expedient  and  advisable,  I  do  not  venture  to  deny,  as  such 
practice  stands  supported  by  the  best  authority,  and  is  justified  by 
ample  experience. 

Without  entering,  however,  into  an  examination  of  the  above  prin- 
ciples, which  generally  direct  its  use,  I  feel  myself  warranted  to  af- 
firm, from  the  result  of  several  cases  in  which  this  plan  was  adopted, 
in  the  fever  now  under  consideration,  that  bark  served  only  to  exaspe- 
rate the  local  disease,  and  to  aggravate  every  symptom  of  the  suc- 
ceeding paroxysm. 

In  many  cases  which  occurred  towards  the  final  cessation  of  the 
epidemic,  at  the  close  of  the  autumnal  season,  the  local  symptoms 
were  much  milder,  and  the  fever  became  intermittent,  after  a  mode- 
rate evacuation  of  blood,  and  a  free  use  of  laxative  medicines.  In 
those  cases,  calomel  was  the  medicine  1  chiefly  employed  ;  and  1  al- 
most invariably  observed  that,  when  carried  to  an  extent  sufficient 
to  manifest  its  action  on  the  system  by  the  usual  criterion,  the  pa- 
roxysm soon  after  ceased  to  return."  —  Ed.  Journal. 

The  testimony  of  such  a  man  as  Boyle  in  favour  of  the  union  of 
depletory  measures  with  a  mercurial  treatment,  will  have  some 
weight  ;  and  in  conjunction  with  the  various  documents  brought  for- 
ward in  this  essay,  must  remove  all  doubts  on  the  occasional  necessi- 
ty of  such  a  modification  of  practice. 


EGYPT. 

SEC.  V. — Independent  of  those  sensations  of  pride  Which  every 
Briton  must  feel  at  the  mention  of  Cairo,  Alexandria,  or  the  Nile, 
the  memorable  theatres  of  British  valour,  Egypt  presents  an  inter- 
esting link  in  the  medical  topography  of  tropical  and  tropicoid  cli- 


£48  INFLUENCE  OF  TROPICAL  CLIMATES,  fcc. 

mates.  Stretching,  in  the  shape  of  one  of  its  own  pyramids,  from 
Cancer  to  the  Mediterranean,  and  flanked  on  both  sides  by  burning 
sandy  deserts,  the  tliermometrical  and  barometrical  qualities  of  its 
atmosphere  bear  little  similarity  to  those  of  parallel  latitudes  ;  and 
hence  the  influence  of  this  anomaly  in  climate  on  the  health  of  the 
human  race,  is  a  matter  of  useful  inquiry. 

The  thermometer  at  noon,  in  the  shade  at  Cairo,  averages  97°  in 
the  months  of  May,  June,  July,-  August,  September,  and  October, 
with  a  diurnal  vicissitude  of  30  or  40  degrees.  In  the  winter  months, 
it  averages  70°,  and  is  never  seen  below  40.  Daring  the  hot  season, 
from  March  till  November,  the  air  is  inflamed,  the  sky  sparkling,  and 
the  heat  oppressive  to  all  who  are  unaccustomed  to  it.  The  body 
sweats  profusely,  and  the  slightest  suppression  of  perspiration  is  a 
serious  malady.  The  departure  of  the  sun  tempers,  in  some  degree, 
these  heats.  The  vapours  from  the  earth  soaked  by  the  Nile,  and 
those  brought  from  the  sea  by  northerly  and  westerly  winds  absorb 
the  caloric  dispersed  through  the  atmosphere,  and  produce  an  agree- 
able freshness,  which  causes  the  susceptible  Egyptian  to  shiver  with 
cold  ;  excepting  in  the  winter,  and  near  the  sea,  a  shower  of  rain  is 
rarely  seen.  The  winds  vary  in  their  temperature  and  dry  ness  or 
humidity,  according  to  the  point  from  whence  they  blow,  and  the 
season  of  the  year.  From  the  north  and  west  they  are  moist  and 
cool,  as  passing  over  the  ocean  ;  from  all  the  other  points  they  are 
hot  and  dry,  as  corning  over  vast  tracts  of  burning  sand.  The  south 
wind,  in  particular,  is  called  the  Kamsin,  Simoom,  Samiel,  fyc.  the 
heat  of  which  is  similar  to  that  of  a  large  oven  at  the  moment  of 
drawing  out  the  bread.  The  atmosphere  now  assumes  an  alarming 
aspect — the  sky  becomes  dark  and  lurid — the  sun  loses  his  splendour, 
and  appears  of  a  violet  colour.  The  wind  increasing  gradually  as  it 
continues,  affects  all  animated  nature.  Respiration  becomes  difficult 
— the  skin  parched  and  dry  ;  and  the  body  is  consumed  as  though  by 
an  inward  fire,  for  no  quantity  of  drink  can  restore  the  perspiration. 
In  December  and  January,  however,  these  southerly  winds  are  cooly 
as  they  then  come  over  the  snow-capt  mountains  of  Abyssinia,  the 
sun  being  at  his  furthest  southern  declination. 

Now,  as,  in  summer,  the  most  prevalent  winds  come  from  the 
Mediterrranean  sea,  impregnated  with  aqueous  particles,  so  copious 
dews  are  precipitated  in  the  nights  of  this  period,  all  through  the 
delta  in  particular,  occasioned  by,  and  increasing  the  diurnal  transi- 
tion. Thus  at  Alexandria,  after  sun-set,  in  the  month  of  April,  the 
clothes  exposed  to  the  air,  and  the  terraces  are  soaked  by  the  dews, 
as  though  there  had  been  a  fall  of  rain.  To  this  it  may  be  added 
that  a  portion  of  the  valley  of  Egypt  is  annually  overflowed,  for  two 
or  three  months  in  the  summer,  by  the  waters  of  the  Nile,  either  by 
natural  inundation,  artificial  canals,  or  machinery. 

If  this  slight  medico-topographical  sketch,  be  compared  with  what 
I  have  said  respecting  Bengal  and  the  Coast  of  Coromandel.  it  will, 
at  once,  be  perceived  that  the  climate  of  Egypt  combines,  in  a  con- 
siderable degree,  the  peculiarities  of  both  the  former.  It  has  the 
inundation  from  its  central  river,  as  Bengal  ; — it  has  its  samiels  or  hot 
land-winds,  with  an  excessively  high  range  of  temperature,  as  Ma- 


EuiFi.  249 

* 

dras.  .  JS'ow  -if  these  two  peculiarities  equally  prevail  in  Egypt,  we 
may  expect  to  find  an  equal  ratio  of  the  diseases  peculiar  to  the  two 
Asiatic  localities  above-mentioned  ;  whereas  if  we  find  one  of  the 
climates  predominate  over  the  other,  and  also  one  of  the  classes  of 
disease  obtain  a  proportional  superiority,  it  will  surely  go  far  to  elu- 
cidate and  confirm  the  origin  and  nature  of  those  endemici  peculiar 
to  the  two  oriental  provinces,  described  in  the  early  part  of  this 
work. 

Firstt  the  inundations  of  Bengal  and  Egypt  are  very  different. 
Accompanying  the  former,  there  are  constant  deluges  of  rain  that 
keep  all  parts  of  the  ground  in  a  plash.  la  the  latter,  what  is  not  in- 
undated is  dry.  In  Bengal,  the  bed  of  the  inundation,  when  the  wa- 
ters have  subsided,  remains  long  in  a  miry  state,  in  Egypt,  such  is 
the  power  of  the  sun,  the  aridity  of  the  atmosphere,  and  the  force  of 
perflatioo,  that  the  water  has  no  sooner  deserted  the  plains  than  the 
latter  are  turned  into  a  solid  crust,  which  soon  splits  into  innumerable 
segments.  "  At  that  time,  the  soil,  in  hardness,  resembles  one  con- 
tinued rock,  and  is  fissured  every  where  with  deep  chinks.  When  we 
encamped  in  the  delta,  it  was  impossible  to  drive  a  tent  pin  into  it, 
except  by  fixing  it  in  one  of  the  openings  ;  and  the  detached  clods, 
lying  around,  were  hard  enough  to  be  used  as  mallets."  Dewar  on 
Dysentery  in  Egypt,  p.  3 — 4. 

From  these  circumstances,  we  are  prepared  to  find  that  the  extri- 
cation of  miasmata  in  Eg)  pt  is  on  a  very  confined  scale  indeed,  when 
compared  with  Bengal,  and  consequently  that  remittent  and  intermit- 
tent fevers  are  in  proportion.     "  Egypt,  says  Dr.  Dewar,  is  less  ex- 
posed than  most  other  flat  countries,  in  high  latitudes,  to   bilious 
fevers  of  the  intermittent  and  remittent  kind,  as  it  is  free  from  those 
marshy  miasmata  which  serve  to  generate  and  to  cherish  the  con- 
tagion of  these  diseases.     Intermittent  fevers  only  prevail  during 
the  decrease  of  the  Nile,  in  houses  surrounded  with  stagnant  water. 
At  other  seasons  they  are  confined  to  places  in  the  neighbourhood 
of  extensive  rice  grounds,  such  as  the  town  of  Damietta,"  p.  5. 
It  is  true,  indeed,  that  in  particular  situations,  those  natural  causes 
which  have  happily  secured  Egypt  from  the  deleterious  influence  of 
paludal  effluvia,  are  counteracted  by  the  perverseness  and  filthiness 
of  the  inhabitants.     "  This  advantage,  however,  is  counterbalanced 
by  the  dirty   mode  of  living  that  generally  prevails.     The  people 
seldom  wash  their  clothes,  and  never  shift  them  ongoing  to  bed.   The 
offals  of  butchers'  stalls  are  left  in  the  open  street,  where  they  per- 
petually spread  putrefaction  and  poison  in  the  atmosphere.    The  sun 
would  in  some  degree,  obviate  this   mischief,  by  drying  them  into 
hardness  ;  but  after  they  accumulate  in  the  streets,  they  are  thfOvvn 
into  the  river  or  the  sea, where  they  not  only  pollute  the  water,  but  ly- 
ing just  within  water  mark,  [there  are  no  tides,]  are  soaked  with  that 
quantity  of  moisture  which  is  sufficient  to  k^ep  the  putrefactive  fer- 
mentation in  its  most  active  state,  and  which  allows  them  to  dissemi- 
nate their  effluvia  in  the  air."     On  Dysentery  in  Egypt,  p.  6 

Now,  having  satisfactorily  accounted  for  the  comparative  immunity 
from  miasmal  fevers,  which  the  Egyptians  enjoy,  beyond  the  Benga 

32 


250  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

lese,  let  us  turn  to  the  parallel  between  Egypt  and  the  Coroinandei 
coast.  But  here  the  disparity  of  climate  is  not  so  great  as  in  the  other 
two  instances,  and  the  great  prevailing  diseases  are  proportionally 
analogous.  I  have  traced  the  gradual  deterioration  of  the  biliary  ap- 
paratus On  the  Coromimdel  const  to  a  hijfh  range  of  temperature,  and 
its  sadden  derangements  to  atmospherical  transitions.  The  very  same 
thing  happens  in  Kgvpt — from  similarity  of  cause.  "  Elephantiasis 
and  leprosy,  says  D- .  Dewar,  are  frequent  diseases  in  E^ypt.  O6- 
structions  in  the  liver  and  dropsies  are  still  more  frequent,"  p.  6.  How 
much  our  troops  suffered  from  dysentery,  which  I  have  proved  to  be 
connected  with  liver  disease,  is  \vell  known  to  our  army  surgeons  ; 
and  Baron  Larrey  wa<*  so  struck  with  the  prevalence  of  hepatitis  in 
Egypt,  that  he  has  taken  some  pains  to  frame  a  theory  for  its  expla- 
nation. He  attributes  the  cause  to  a  high  range  of  temperature  dis- 
solving the  fat  of  the  mesentery,  which  becomes  clogged  in  the  liver. 
I  do  not  quote  his  theory  for  its  ingenuity,  but  to  show  the  extent  of 
the  disease.  And  now  I  trust  the  idea  of  Dr.  Saunders  and  many 
others,  that  hepatitis  in  India  is  owing  to  a  local  indigenous  poison 
there,  unlike  any  thing  in  any  other  country,  will  no  longer  be  held. 
— This  section  has  proved  an  identity  of  cause  and  a  similarity  of  ef- 
fect in  India  and  Egypt,  and  consequently  has  solved  a  mystery  that 
obstructed  the  path  of  medical  science  on  an  important  point  in  pa- 
thological investigation.* 

Before  leaving  the  banks  of  the  Nile  let  us  glance  at  a  few  indi- 
genous customs,  from  which  the  medical  philosopher  may  often  glean 
useful  hints.  The  natives,  during  the  hot  season,  subsist  chiefly  en 
vegetables,  pulse,  and  milk.  Thev  make  frequrn*  use  of  the  bath, 
and  avoid  stimulating  beverages.  Those  who  live  in  tents  take  care 
to  have  their  coverings  constructed  double,  in  order  that  the  non- 
eonducting stratum  of  air  may  defend  them  from  the  atmospheric  heat. 
Again,  as  in  the  East,  the  various  folds  of  the  turban  foim  a  power- 
ful non-conductor,  when  they  are  exposed  to  the  direct  rays  of  the 
sun,  and  preserve  them  from  Coups  de  Soleil,  while  the  sash,  like  the 
oriental  cummerbund,  encircling  the  abdomen,  preserves  the  import- 
ant viscera  within  from  the  deleterious  impressions  of  cold,  during 
a  sudden  vicissitude  of  temperature,  or  an  exposure  to  the  df  ws  or 
night  air  ;  thus  forming  an  article  of  utility  as  well  as  ornament. 

*  I  have  already  hinted  that  on  the  Coast  of  Africa  where  the  heat  is  exces- 
sive, liver  complaints  are  very  prevalent.  Of  this  I  lately  saw  a  striking  exam- 
ple in  the  Tigress  brig  after  returning  from  that  station.  No  ship  from  India  ever 
presented  a  more  distressing  picture  of  hepatitis  and  dysentery  than  this  vessel 
did.  Captain  Beaver  in  his  African  memoranda  gives  the  following  thermome- 
trical  ranges  of  the  six  winter  months,  viz.  from  August  to  April.  August  74  to 
82— Sept.  77  to  85— Oct.  81  to  91— Nov.  84  to  96— Dec.  64  to  92— Jan.  63  to  98 
—Feb.  88  to  96— March  86  to  95— April  85  to  94°.  Captain  Beaver's  work 
shows  the  prevalence  of  hepatic  diseases  on  tne  coast. 


THE  ^LAGBE,  ST*1. 


LOIMOLOGIA; 

OR, 

Practical  researches  on  the  Plague. 

SEC.  VI. — Many  philosophers  have  attempted,  and  with  no  meau 
success,  to  trace  a  chain  of  animated  beings  from  man  down  to  the 
polypus  ;  and  thence  through  the  vegetable  creation  to  the  mineral 
in  the  bowels  of  the  earth  ;  so  that — 


Whatever  link  we  strike, 


"  Tenth,  or  ten  thousandth,  breaks  the  chain  alike.'1 

It  would  not,  perhaps,  be  very  difficult  to  show  a  similar  catena 
tion  in  the  circle  of  diseases  by  which  we  are  surrounded.  There  are 
scarcely  two  diseases,  however  opposite  in  their  phenomena  when 
viewed  in  an  insulated  shape,  that  are  not  linked  together  by  others 
partaking  in  the  nature  of  both.  At  a  first  glance  the  yellow  fever 
and  small  pox  would  seem  unmeasurably  separated  and  widely  dis- 
tinct in  every  respect  ;  yet  the  plague  presents  as  fair  a  connecting 
link  between  them  as  the  polypus  does  between  the  animal  and  vege- 
table kingdoms.  Like  Causus,  the  Plague  is  under  the  influence  of 
the  atmosphere,  and  limited  within  certain  thermometrical  ranges  : — 
like  small  pox,  it  is  propagated  by  contact,  inoculation,  or  exhala- 
tion ;  and  productive,  in  general,  of  local  eruptions.  Nevertheless 
it  is  as  distinguishable  from  either,  as  the  polypus  is  from  the  Lord 
of  the  Creation  on  one  side,  or  the  Cedar  of  Lebanon  on  the  other. 

This  destructive  and  misshapen  enemy  of  the  humane  race  has 
ever  been  clothed  in  darkness  and  mystery,  which  add  not  a  little  to 
its  real  and  imaginary  terrors. — It  may  justly  be  characterized  as 
a — 

"  Monstrum  horrendum  informe,  ingens  cui  lumen  ademptum  !" 

Which  unites  all  the  bad  qualities  of  the  two  diseases  alluded  to.  It 
combines  the  rapid  march  and  fatal  issue  of  the  western  causus,  with 
the  dire  contagious  influence  of  the  eastern  Variola  I* 

Such  an  engine  of  destruction  must,  long  ere  this,  have  annihilated 
mankind,  had  not  the  omniscient  Creator  encircled  it  with  various 
atmospherical  barriers  which  are  constantly  arresting  its  progress,  or 
suspending  its  powers.  If  "  the  pen  of  writers  has  done  little  more 
than  record  the  times  and  places  when  and  where  it  proved  most  fatal 
— its  devastations,  and  the  variety  of  modes  of  treatment  which  had  no 
certain  success,"  be  it  remembered  that  this  very  sentence,  so  dis- 
heartening to  the  medical  philosopher,  was,  not  long  since,  applied 
to  dysentery,  over  which  we  have  now  a  very  strong  control.  All 
then  may  not  be  lost  in  respect  to  the  plague.  It  may  yet  come  under 
rule,  and  bow  beneath  the  influence  of  medicine.  At  all  events,  it 

*  One  of  the  latest  writers  on  the  subject  of  plague,  Dr.  Calvert,  asserts  that 
its  poison  radiated  through  the  atmosphere  on  the  inhabitants  of  Valletta,  from  a 
vessel  in  the  centre  of  the  quarantine  harbour,  and  consequently  that  all  pr,ecau- 
tions  against  contact  were  useless  and  delusive. — Med.  Chir.  Trans,  to/  vi. 


252  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

is  our  duty,  as  it  ought  to  be  our  pride,  never  to  succumb  without  a 
struggle.  Let  the  Ottoman  lie  supine  under  the  fetters  of  fatalism, 
while  the  Christian  philosopher  exerts  those  faculties  bestowed  on 
him  by  his  Creator,  in  defending  that  Creator's  noblest  work  from 
premature  decay  ! 

Although  the  venerable  and  laborious  Russel  shall  form  the  text  or 
basis  of  this  section  ;  other  and  more  recent  writings  will  not  be 
overlooked.  But  as  references  and  formal  quotations  would  swell  the 
work  too  much  ;  and  as  I  have  no  particular  theory  or  practice  to 
support  on  the  occasion,  the  reader  will  probably  give  me  credit  for 
fidelity  and  accuracy  in  the  compilation,  and  absolve  me  from  all  sus- 
picion of  misrepresentation. 

Previously,  however,  to  entering  on  the  symptomatology,  &c.  of 
the  disease,  it  is  necessary  to  state  that  I  have  derived  much  assist- 
ance from  my  esteemed  and  able  friend  Dr.  Dickson  of  Clifton,  in 
this  section  of  my  work-  Dr.  Dickson,  while  stationed  in  the  Le- 
vant, in  the  year  1803,  had  frequent  opportunities  of  collecting  inter- 
esting information  relative  to  plague,  and  particularly  from  Padre 
Luigi  de  Trincon  who,  for  a  great  number  of  years,  had  been  super- 
intendant  of  the  plague  hospital  at  Smyrna.  The  history  of  this  ve- 
nerable and  benevolent  man,  as  related  by  himself,  and  authenticated 
by  others,  is  briefly  this.  Having  been  most  severely  attacked  by  the 
plague,  about  thirty-six  years  previously,  and  his  life  being  despaired 
of,  he  made  a  vow,  in  the  event  of  recovery,  to  dedicate  his  services 
to  those  who  should  be  similarly  afflicted.  He  recovered,  and  for 
some  time  adhered  to  his  resolution  ;  but  the  desire  of  revisiting  Pa- 
via,  his  native  country,  induced  him  to  leave  Smyrna.  His  vow, 
however,  continually  recurred  to  him  ;  and  he  soon  returned  again 
to  Smyrna,  where  he  has  ever  since  pursued  his  original  resolution 
of  attending  on  those  afflicted  with  plague.  He  administers  to  his  pa- 
tients with  his  own  hands  ; — consoles  and  cheers  them  ;— sits,  and 
even  sleeps  upon  their  beds  ;  and  in  fine  has  been  .principally  in- 
debted for  his  success  to  such  attentious,  as  he  knows  little  of  medi- 
cine. 

Sub-sect.  I — Symptomatology.  Fever. — This,  according  to  Russel. 
was,  with  very  few  exceptions,  a  constant  attendant  at  one  stage  or 
other,  but  varying  greatly  in  different  subjects.  Usually  preceded 
by  sense  of  weariness,  shivering,  and  confusion  rather  than  pain  in 
the  head.  Cold  stage  shorter  than  in  tertian  ;  but  the  symptoms  in 
hot  stage  more  anomalous  and  alarming.  In  many  cases,  however, 
the  pyrexia  differed  so  little  from  that  in  other  fevers,  as  to  lead  to 
no  diagnosis,  unless  buboos  were  protruded,  which  left  no  doubt. 
Fever  usually  declined  in  the  morning  of  the  second  day  :  but  varied 
much  in  intensity  offeree,  even  in  the  24  hours  ;  the'exacerbations 
being  irregular  as  to  violence  and  duration.  Generally  speaking, 
there  were  morning  remissions  and  evening  exasperations.  Still  the 
march  of  the  disease  was  rapid — the  patient,  on  the  second  or  third 
day,  being  reduced,  in  point  of  muscular  strength  and  sensorial  ener- 
gy, to  the  condition  of  one  in  the  last  stage  of  typhus.  Yet  to  this 
desperate  state  would  succeed  a  remission  in  which  his  senses  and 


THE  PLAGUE.  253 

intellectual  faculties   were  restored — the  vital  functions  went  on 
calmly,  and  all  but  weakness  seemed  to  have  vanished 'like  a  dream. 

Remissions  of  this  kind,  when  early  in  the  disease,  or  unpreceded 
by  a  sweat,  were  often  fallacious;  but  when  on  the  third  day,  or 
later,  and  induced  by  a  sweat,  especially  if  the  pulse  kept  up,  and 
the  head  clear,  they  gave  hopes  of  a  favourable  issue.* 

Delirium. — Not  so  high  as  in  some  other  fevers  t—  seldom  com- 
menced before  the  second  day,  increasing  in  the  exacerbation,  less- 
ening-in  the  remission — sometimes  going  off  for  some  hours  in  the 
day,  but  returning  at  night.  Padre  Luigi  corroborate*  this  statement., 
but  has  seen  delirium  and  insensibility  come  on  early. 

Coma. — Very  often  alternated  with  the  delirium. — It  was  always  a 
dangerous  symptom  ;  but  more  so  as  it  approached  early,  and  failed 
to  abate  in  the  remissions.  The  patient  is  roused  without  difficulty 
— answers  rationally  at  first,  but  soon  becomes  impatient —  denies 
having  slept,  and  as  soon  as  left,  relapses  again  into  slumber. f 

Loss  of  speech,  faultenng,  and  tremor  of  the  tongue,  were  not  un- 
common symptoms.  Impediment  of  speech  sometimes  continued  for 
months  after  recovery.  Dr.  Dickson,  who  had  frequent  opportu- 
nities of  seeing  plague  in  the  Levant,  observes  that  the  tremor  of  the 
lips  is  often  of  a  peculiar  kind,  a  sort  of  biting  motion,  which  is  a 
dangerous  symptom. 

Deafness  was  seldom  observed ;  though  the  sense  of  hearing  was 
occasionally  impaired.  Dr.  Dickson  informs  me  that  the  patients 
sometimes  became  deaf. 

Muddy  Eyes. —  1  his  was  a  remarkable  symptom.  It  sometimes 
was  visible  from  the  fir^t  day,  but  more  commonly  from  the  second 
or  third,  remaining  till  some  favourable  change  took  place.  It  is  a 
strange  compound  of  mudditiess  and  lustre — is  little  affected  by  the 
remissions  ;  but,  in  the  exacerbations,  the  eyes  acquire  a  redness 
that  adds  wildness  to  the  look.  The  disappearance  of  this  symptom 
is  always  favourable.  It  was  almost  invariably  present  in  fatal  cases. 
Sir  B.  Faulkner  considers  it  without  doubt  one  of  the  most  leading 
and  faithful  monitors  of  the  presence  of  plague.  He  was  seldom 
wrong  in  his  diagnosis,  where  any  unusual  whiteness  of  the  tongue 
accompanied  this  appearance  of  the  eye — "  even  though  there  Was 
no  intumescence  or  redness  about  the  glands,  nor  any  confession  of 
complaint."  In  the  first  instance  which  Dr.  Dickson  saw  of  the 
plague,  and  where  he  was  unintentionally  a  visitor,  he  was  particu- 
larly struck  with  the  drunken  appearance  of  the  eye,  and  was  at  a 
loss  what  to  think  of  the  case,  until  the  patient  showed  him  a  bubo 
in  his  groin  ! 

White  Tongue. — The  tongue  was  often  natural  ;  but  when  it  chang- 
ed, it  generally  became  white,  and  remained  moist.  Sometimes  it 

*  The  initialory  symptoms,  according  to  Faulkner,  the  latest  writer,  were  at 
Malta,  besides  the  foregoing,  pain  of  the  back  opposite  to  the  kidneys — drunken 
appearance  of  the  countenance — inability  to  stand  upright — aversion  to  being 
thought  ill.  "  I  have  neither  drunk  wine  nor  spirits,"  said  General  Meuou,  "  and 
yet  1  feel  as  a  drunken  man.*' 

t  Sir  B.  Faulkner  found  it  rise  to  maniacal  fur  >/  in  some  instances,  at  Malta. 

|  The  comatose  symptoms  strongly  resemble  those  of  the  Mariegalante  fever, 
so  well  described  by  Dr.  Dickson  in.  a  subsequent  section. 


£54  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

was  parched,  with  a  yellowish  streak  on  the  sides,  and  a  reddish  in 
the  middle  ;  hut  its  condition  rarely  corresponded  with  the  febrile 
symptoms. 

'Pulse,  is  generally  low,  quick,  and  equal  ;  in  some  bad  cases,  flut- 
tering or  intermittent,  or  low  and  nearly  natural. — In  the  more  ad- 
vanced stages  of  the  disease,  instead  of  rising  in  the  exacerbations, 
the  pulse  was  apt  to  quicken  and  become  so  small  as  scarcely  to  be 
felt.  At  Malta,  in  the  last  plague,  the  pulsations  in  ulterior  periods, 
seemed  to  succeed  each  other  in  a  continued  stream,  and  defied  cal- 
culation. But  this  function  varied  so  much  as  to  be  res  fallacissima. 
Respiration  was  seldom  affected,  except  in  the  exacerbations  of 
advanced  stages,  when  it  became  laborious.  No  pain  felt  on  a  full 
inspiration.  Yet  the  patients  frequently  sigh,  as  if  from  oppression 
on  the  Itfrigs. 

Anxiety,  that  is,  a  sense  of  oppression  about  the  pracordia,  is  a 
constant  attendant  on  the  plague  ;  and  its  early  appearance  was  un- 
favourable. "  The  sick,"  says  Russel,  "  showed  how  severely  they 
suffered,  by  their  perpetually  changing  po*ture,  in  hopes  of  relief; 
but  when  asked  where  their  pain  lay,  they  either  answered  hastily, 
*  they  could  not  tell,'  or  with  a  fixed,  wild  look,  exclaimed  —  '  Kulbi! 
Kulbi  T  (my  heart !  my  heart  !)  This  anxiety  encreasing  as  the  dis- 
ease advanced,  terminated  at  length  in  mortal  inquietude,"  p.  88. 

Pain  at  the  Heart. — Though  this  was  often  conjoined  with,  it  was 
often  distinct  from  the  anxiety  above-mentioned.  The  patients  often 
exclaimed,  as  in  the  other  case,  my  heart !  my  heart !  pointing  to  the 
Scrobic.  Cordis ;  but  then  they  would  add  eujani  Kulbi,  my  heart 
pains  me  !  or  tiaar  fi  Kulbi  ;  my  heart  is  on  fire  !  They  could  not 
bear  the  slightest  pressure  at  the  precordia. 

Debility. — The  sudden  prostration  of  muscular  strength  and  ner- 
vous energy  appertains  in  a  particular  manner  to  the  plague,  beyond 
that  observed  in  any  other  disease.  By  its  higher  degree  the  more 
fatal  forms  of  plague  were  distinguished.  "  Jn  the  most  destructive 
forms  of  the  plague,  the.  vital  principle  seems  to  be  suddenly,  as  it 
were,  extinguished,  or  else  enfeebled  to  a  degree  capable  only  for  a 
short  time  to  resist  the  violence  of  the  disease.  In  the  subordinate 
forms,  the  vital  and  animal  functions,  variously  affected,  are  carried 
on  in  a  defective,  disorderly  manner,  and  denote  more  or  less  danger 
accordingly." — Russel,  p.  89. 

Fainting,  in  different  degrees,  was  a  very  common  symptom,  and 
sometimes,  though  rarely,  terminated  in  syncope.  It  was  not  so  much 
aggravated  by  the  perpendicular,  nor  relieved  by  the  horizontal  pos- 
ture, as  in  other  fevers. 

Convulsions  sometimes  mark  the  access  of  the  fever  ;  and  convul- 
sive motions  of  the  limbs  frequently  attend  the  course  of  the  disease, 
especially  where  there  is  a  numerous  eruption  of  carbuncles.  Sub- 
sultus  tendinum  is  no!  a  very  common  symptom  ;  but  a  continual  trem- 
bling of  the  hands  is  generally  observed.  Luigi  informed  Dr.  Dick- 
son  that  singultus  was  not  an  uncommon  symptom,  and  that  sneezing 
was  a  very  favourable  phenomenon. 

Urine. — Nothing  decisive  can  be  learnt  from  this  excretion.     Lui- 


THE  PRAGUE.  25o 

gi,  however,  frequently  observed  it  of  a  very  high  colour,  and  depo- 
siting a  lateritious  sediment. — Dickson. 

Perspiration. — Where  the  skin  remains  torpid  and  dry  continually; 
or  where  short  and  precipitate  sweats  are  attended  with  no  favourable 
symptoms,  danger  is  to  be  apprehended,  On  the  other  hand,  the 
spontaneous  supervention  of  an  earl)  perspiration  is  a  flattering  orneii. 

Polluting. — This  symptom,  according  to  Russel,  is  *'  absent  in  a 
large  proportion  of  the  sick."  Where  it  began  early,  and  continued 
obstinate,  it  was  a  fatal  symptom. — Bile  was  sometimes  thrown  up, 
accompanied  with  bitter  taste  in  the  mouth  — "  a  yellowness  in  eyes," 
and  "  a  blackish  liquor  sometimes  came  off  the  stomach  in  the  last 
stage  of  the  disease,  in  the  production  of  which,  blood  may,  perhaps, 
have  had  some  share." — Russel.  Faulkner  makes  no  mention  of 
vomiting  in  the  late  plague  at  Malta  ;  but  says,  that  in  the  worst  spe- 
cies the  "  stomach  was  extremely  irritable."  Russel  admits  that 
nausea  was  more  common.  Is  not  "stomach  extremely  irritable" 
equivalent  to  the  mention  of  vomiting  ? 

Diarrhea, — sometimes  comes  on  the  first  day,  but  more  usually 
supervenes  in  the  advanced  stages  of  the  diseases,  and  in  either  case, 
unless  other  things  were  favourable,  may  be  set  do*vn  as  a  signuinfu- 
nestissimwn.  Russel,  and  Faulkner.  The  latter  observes  that,  in  the 
plague  at  Malta,  the  alvine  evacuations  were  commonly  of  a  darker 
appearance  than  natural — sometimes  of  a  greenish  tinge  mixed  with 
scybala,  particularly  where  voracity  of  appetite  attended.  Dr.  Rus- 
sel sometimes  saw  dark-coloured  blood  discharged  by  stool,  unmixed 
with  feces,  and  without  griping.  "  Costlveness  was  attended  with  no 
harm,  and  often  with  little  inconvenience."  Russel.  Luigi  confirms 
this  remark. 

Hcemorrhnges  were,  in  general,  unfavourable  symptoms. 

Thirst,  the  never-failing  attendant  on  febrile  diseases,  is  by  no 
means  invariably  present,  even  in  the  worst  forms  of  the  plague, 
"  The  like  remark  holds  of  want  of  appetite.  Throughout  the  dis- 
ease, this  function  is  not  only  not  impaired  but  augmented  to  a  degree 
bordering  on  voracity."  Faulkner. 

We  shall  not  follow  Dr.  Russel  through  his  six  classes  of  the  dis- 
ease, but  rather  adopt  the  concise  and  less  complicated  divisions  of 
Sir  Brooke  Faulkner,  in  his  recent  description  of  the  plague  at  Mal- 
ta. 

Species  I. — That  in  which,  at  the  first  attack,  the  energy  of  the 
brain  and  nervous  system  is  greatly  impaired,  indicated  by  coma,  slow 
drawling  or  interrupted  utterance.  In  this  description  of  the  dis- 
ease, the  tongue  is  white,  but  little  loaded  with  sordes,  and  usually 
clean,  more  or  less,  towards  the  centre  and  extremity  ;  the  anxiety 
is  great ;  cast  of  countenance  pale  ;  stomach  extremely  irritable,  and 
the  strength  much  impaired.  Rigors  and  pain  in  the  lower  part  of 
the  back  are  among  the  early  precursors  of  the  other  symptoms. 
This  was  observed  to  be  the  most  fatal  species  of  plague,  and  pre- 
vailed chiefly  at  the  commencement  of  the  late  disasters.  Those 
who  were  thus  affected  died  sometimes  in  the  course  of  a  few  hours, 
and  with  petechiae. 

Species  //.—The  next  species  I  would  describe  is,  that  in  which 


256  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

the  state  of  the  brain  is  the  very  reverse  of  what  takes  place  in  the 
former,  the  symptoms  generally  denoting  a  high  degree  of  excite- 
ment :  the  pain  of  the  head  is  intense  ;  thirst  frequently  considerable, 
though  sometimes  wanting ;  countenance  flushed ;  and  utterance 
hurriod.  The  attack  is  ushered  in  by  the  same  rigors  and  pain  of 
back  as  the  foregoing.  Epi*taxis  not  unfrequently  occurs  in  this 
class  of  the  disorder.  The  glandular  swellings  come  out  very  tar- 
dily, and  after  appearing,  recede  again,  without  any  remission  of  the 
general  symptoms.  Carbuncles  arise  over  different  parts  of  the  body 
or  extremities,  which  are  rapidly  disposed  to  gangrenous  inflamma- 
tion. The  delirium  continues  extremely  high  and  uninterrupted,  and 
the  patient  perishes  in  the  course  of  two  or  three  days.  Sometimes 
he  lingers  so  far  as  the  seventh,  yp t  rarely  beyond  this  period,  with- 
out some  signs  of  amendment.  Of  this  second  description,  the  ex- 
amples have  been  very  numerous,  and  were  nearly  as  fatal  as  the 
preceding.  In  the  countenances  of  some,  just  previous  to  the  ac- 
cession of  the  more  violent  symptoms,  there  is  an  appearance  of  dis- 
pair  and  horror  which  baffles  all  description,  and  can  never  be  well 
mistaken  by  those  who  have  seen  it  once. 

Specie*  III. — The  third  species  which  I  would  enumerate,  is  nearh 
a  kin  to  the  last,  onlv  the  symptoms  are  much  milder,  and  the  brain 
comparatively  little  affected.  The  buboes  and  other  tumours  go  on 
more  readily  and  kindly  to  suppuration,  and  by  a  prompt  and, early 
employment  of  remedies,  to  assist  the  salutary  operations  of  nature, 
the  patient  has  a  tolerable  chance  of  surviving.  Cases  of  this  kind 
are  often  so  mild,  that  persons  have  been  known  to  walk  about  in 
seeming  good  health,  and  without  any  evident  inconvenience  from 
the  buboes.  Of  this  last  species,  the  instances  have,  thank  God,  not 
been  unfrequent,  chiefly  occurring  towards  the  declension  of  the  ma- 
lady." 

Buboes  and  Carbuncles. — The  presence  of  these,  separately  or  in 
conjunction,  is  diagnostic  of  true  plague;  and  removes  all  doubt  as 
to  its  nature  ;  "  but  fatal  has  been  the  error  of  rashly  ,/rom  their  ab- 
sence, pronouncing  a  distemper  not  to  be  the  plague,  which,  in  the  se- 
quel, has  desolated  regions,  and  which  early  precaution  might  pro- 
bably have  prevented  from  spreading." — Russel. 

Although  in  some  of  the  worst  forms  of  the  disease,  [for  instance 
in  Russel's  and  Faulkner's  first  classes,  where  the  patients  frequent- 
ly perished  in  twenty-four  or  thirty -six  hours,] — buboes  and  carbun- 
cles are  rare,  yet,  generally  speaking,  they  may  be  considered  as 
constantly  concomitant  phenomena  : — not  so  carbuncles,  which  were 
observed  in  about  one-third  of  the  infected  only.  The  inguinal,  ax- 
illary, parotid,  maxillary  and  cervical  glands  were  the  seats  of  buboes 
in  the  order  they  are  set  down  ;  but  the  first  was  by  far  the  most  fre- 
quent. The  inguinal  pestilential  bubo  was,  for  the  most  part,  situat- 
ed lower  in  the  thigh  than  that  of  the  venereal.  A  burning,  shoot- 
ing pain,  is  often  felt  in  the  -part,  anterior  to  the  appearance  of  swel- 
ling ;  and,  when  the  tumour  is  once  formed,  there  is  always  pain  on 
pressure.  In  the  incipient  state  of  the  buba,  a  small,  hard,  round 
tumour  is  felt  by  the  finger,  more  or  less  deeply  seated,  but  gene- 
rally moveable  under  the  skin,  which  is  yet  colourless  and  non-protu 


THE  PLAGUE.  ,25} 

berant.  As  the  gland  enlarges,  it  commonly  takes  an  oblong  form — 
becomes  more  moveable, — and  the  integuments  thickening,  protrude 
into  a  visible,  circumscribed  tumour,  without  external  inflammation. 
The  progress  to  maturity  is  more  or  less  rapid  ;  but  not  apparently 
influenced  by  strength  of  constitution  or  the  contrary — hence  the 
prognosis  from  the  bubo  is  very  uncertain. 

In  Dr.  Kussel's  experience,  the  bubo  seldom  began  to  inflame  ex- 
ternally, or  show  symptoms  of  maturation  till  the  fever  had  abated, 
and  was  manifestly  on  the  decline.  This  happened  at  various  pe- 
riods, but  rarely  sooner  than  the  8th  or  9th  day,  the  inflammation 
then  advancing,  the  tumour,  by  degrees  softened,  and  opened  of  itself 
between  the  loth  and  22nd  day.  The  buboes  that  did  not  suppurate, 
dispersed  gradually  in  one  or  two  months. 

In  a  very  large  proportion  of  Dr.  Ku*se1's  patients  the  buboes 
made  their  appearance  in  the  course  of  the  first  day.  la  the  slight- 
est cases,  they  were  often  the  first  sympio  n  of  infection. 

Carbuncles  were  seldom  observed  by  Dr.  Russel  before  the  month 
of  May — they  grew  rife  in  the  summer,  and  became  gradually  less 
common  in  autumn.  The  carbuncles  that  fell  under  the  observation 
of  Sir  Brooke  Faulkner  in  the  late  plague  in  Malta  were  of  that  kind 
described  by  authors  as  the  wet  carbuncle,  sloughing  into  very  deep 
sores,  and  attended  during  the  progress  of  inflammation,  with  an  ex- 
tremely painful  burning  sensation.  At  first,  they  arose  like  a  phleg- 
mon, gradually  acquiring  a  diffused  and  highly  inflamed  base,  and  hav- 
ing, not  far  from  the  apex,  a  concentric  areola  of  a  deep  livid,  and 
more  internally  of  a  cineritious  colour,  and  a  glossy  appearance. 
These  carbuncles  were  not  confined  to  any  particular  part  of  the  body 
or  limbs,  though  most  commonly  they  are  situated  upon  some  part  of 
the  extremities.  Of  the  dry  carbuncles,  as  they  occurred  in  a  few 
cases,  the  description  corresponds  with  that  of  authors — being  of  a 
dark,  gangrenous  colour,  without  much  pain,  with  little  or  no  inflam- 
tion,  or  elevation  above  the  surface.  These  were  always  unfavoura- 
ble symptoms. 

Petechiaz  in  the  plague  at  Malta  were  various  in  point  of  size  and 
colour — in  some,  of  a  dark,  or  dusky  brown — in  others  livid — in  some, 
so  small  as  to  be  almost  imperceptible — in  others,  as  large  as  flea 
bites.  Situation,  over  the  breast,  arms,  wrist — sometimes  over  the 
back,  or  lower  extremities. 

Pathology. — As  scarce  a  ray  of  light  beams  upon  this  subject  from 
Post  Mortem  researches,*  and  probably  never  will,  we  are  left  to 
ground  our  pathological  opinions  on  the  phenomena  of  the  disease, 
in  its  course  to  recovery  or  death.  Upon  a  careful  review  of  these, 
it  is  but  too  plain  that  remedial  measures  have  had,  as  yet,  scarcely 
any  control  over  plague.  In  the  graver  forms,  medicine  has  been 

*  Baron  Larrey  opened  a  few  bodies  dead  of  the  plague  iu  Egypt,  and  found 
the  lirer  engorged  and  disorganized — the  stomach  and  intestines  gangrened — the 
heart  soft  and  flabby.  The  brain  was  not  examined.  One  of  the  assistants  who 
helped  to  open  the  bodies  caught  the  plague  and  died.  The  above  phenomena 
are  little  different  from  those  presented  as  the  effects  of  other  fatal  congestive 
ferers. 

33 


25$  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

confessedly  useless — in  the  milder,  it  was  probably  unnecessary — in 
the  intermediate  shades  it  may  have  had  some  influence.  From  this, 
and  various  other  considerations,  we  may  most  safely  conclude  that 
plague,  though  influenced  by  the  atmosphere,  is  propagated  by  a  poi- 
son or  contagion,  strictly  SMI  generis, — equally  as  much  so  indeed,  as 
that  of  variola.  Now,  over  any  one  of  these  eruptive  contagions, 
excepting  the  syphilitic  by  mercury,  and  the  variolousby  inoculation, 
we  have  not  one  particle  of  power,  after  it  is  received  into  the  sys- 
tem.* In  what  way  they  produce  their  baneful  influence  on  the  liv- 
ing machine  we  are  nearly,  if  not  totally  ignorant ;  but  their  effects 
are  expressed  by  three  great  features  or  phenomena — depression  and 
reaction,  with  a  local  determination.  In  the  first,  when  excessive, 
and  consequently  dangerous,  the  powers  of  the  system  seem  paralyz- 
ed or  stifled,  and  are  not  unfrequently  annihilated  ; — In  the  second? 
when  excessive,  and  consequently  dangerous,  Nature  appears  in  her 
frantic  efforts,  to  commit  suicide  on  herself,  by  destroying  some  or- 
gan essential  to  life,  or  exhausting,  beyond  recruit,  the  whole  fabric  ; 
— In  the  third,  or  local  eruption,  some  sanative  process  is  effected, 
of  which  we  only  know  that  it  is  sanative — 


•Sive  illis  omne  per  ignem 


Excoquitur  vitium,  atque  exudat  inutilis  humor  : — 

Seu  plures  calor  ille  vias,  et  cseca  relaxat 

Spiramenta.  Georgicorum,  lib.  I — p.  87. 

Now  till  we  find  out  specifics  for  the  other  contagious  poisons,  as 
mercury  proves  in  syphilis,  the  sum  total  of  our  knowledge  leads  but 
to  this  ;  that  in  the  first  instance,  we  are  to  endeavour  to  rouse  or 
animate — in  the  second,  to  curb  or  restrain,  and  in  the  third,  to  leave 
alone,  the  EFFORTS  OF  NATURE. 

This  reasoning,  indeed,  will  very  nearly  apply  to  the  whole  range 
of  fevers  ;  but  unfortunately  there  is  something  more  mysterious 
and  intractible  in  those  accompanied  by  eruptions,  than  in  any  of  the 
others.  This  is  particularly  the  case,  in  those  forms  of  plague  where 
nature  appears  to  lie  jprostrate  under  the  influence  of  the  poison, 
without  the  power  of 'resistance,  much  less  of  reaction  !  Here  we 
may  apply  the  warm  bath  to  the  external  surface  of  the  body,  and 
cordials  or  stimulants  to  the  internal  ;  but  alas  !  the  nervous  and  vas- 
cular systems  are  so  entirely  deranged,  that  nature,  unable  to  avail 
herself  of  our  assistance,  sinks  in  the  struggle,  without  the  means  of 
extricating  herself  from  the  mortal  grasp  of  the  enemy,  or  the  pow- 
er of  accelerating  her  own  destruction  ! 

Plague,  as  an  eruptive  fever,  differs  so  essentially  from  endemic  or 
uiiasmal  fevers,  not  only  in  respect  to  its  contagious  origin,  but  its 
critical  determinations,  and  also  the  mode  of  treatment,  that  one 
would  hardly  expect  to  find  an  amalgamation  attempted  in  the  pre- 
sent day.  Yet  such  a  doctrine  has  been  recently  maintained  by  two 
medical  gentlemen,  Dr.  Kobertson,  and  Mr.  Torrie.t  The  latter 
asserted  that  the  plague  was  not  contagious,  and  fell,  of  course,  a  vic- 
tim to  his  own  infatuation  ;  the  former  endeavours  to  show  that  the 

"  I  mean  we  have  no  power  in  arresting  the  progress  of  the  poison;  though  we 
have  much  in  mitigating  the  violence  of  reaction  in  the  si/stem  itself, 
t  London  Medical  Repository,  Dec.  1817. 


THE  PLAGUE. 

causes  of  plague  and  remittent  fever  are  the  same,  that  the  symp- 
toms, and  post  mortem  appearances  differ  only  in  degree.  He  ac- 
knowledges, however,  that  he  never  saw  the  Blague,  and  independ- 
ently of  this,  his  arguments  are  not  of  that  weight  that  require  a  se- 
rious refutation. 

Therapeutics. — The  following  is  an  abstract  of  Dr.  Russel's  Me- 
thodus  Medendi.  One  early  bleeding ;  which  was  very  seldom  re- 
peated, excepting  where  circumstances  unequivocally  demanded  it. 
Where  vomiting  was  a  concomitant  symptom,  it  was  encouraged  by 
draughts  of  warm  chamomile  tea,  till  the  stomach  was  well  cleared  of 
bile  or  other  colluvies.  Where  this  was  not  sufficient,  an  emetic  of 
ipecacuan,  was  exhibited,  after  which  an  opiate.  Purgatives  were 
rarely  given. 

As  soon  as  the  stomach  was  settled,  mild  sudorifics  were  adminis- 
tered in  small  doses,  as  the  acetate  of  ammonia  and  citrate  of  potash. 
If  a  diarrhoea  prevailed,  as  it  was  never  observed  to  prove  critical, 
it  was  restrained  by  diascordium  and  opiates.  Dilution — cool  air  in 
the  beginning ;  but  towards  the  height  of  the  exacerbations,  upon  the 
first  appearance  of  moisture  on  the  skin,  the  sick  were  kept  mode- 
rately covered  up  from  the  chin  downwards.  The  diet  was  the 
lightest  possible.  For  the  coma  and  delirium,  sinapisms  and  pedilu- 
via  were  employed.  For  the  oppression  at  the  pracordia,  mild  cor- 
dials, accidulated  drinks,  and  cool  air  were  serviceable.  After  the 
height,  and  through  the  decline  of  the  disease,  bark  in  powder  or 
tincture  was  exhibited.  In  the  decline  of  the  disease  purging  was 
employed  by  the  European,  but  seldom  by  the  native  practitioners. 
Relapses,  though  exceedingly  rare,  do  sometimes  take  place. 

Treatment  of  the  Plague  at  Malta. — Sir  Brooke  Faulkner's  indica- 
tions are,  1st.  when  inflammatory  symptoms  are  violent  at  the  begin- 
ning, to  moderate  them  cautiously.  2nd.  to  restrain  all  inordinate  ef- 
forts of  nature  ;  or  support  her  when  exhausted.  3d.  to  counteract 
putrescency.  4th.  to  evacuate  the  morbific  matter.  These  indica- 
tions are  proposed  to  be  fulfilled  by  evacuants,  tonics,  antiseptics, 
blisters,  sudorifics. 

Evacuants. — Purgatives  are  rarely  ventured  on  by  the  Maltese, 
except  in  very  strong,  plethoric  habits,  when  sulphate  of  magnesia 
is  given.  At  other  times,  supertartrite  of  potash,  manna,  almond 
oil,  &c.  are  most  esteemed.  Bleeding,  even  locally,  was  a  preca- 
rious remedy,  and  no  decisive  benefit  was  obtained  from  its  use. 
Blisters  to  the  temples,  nape  of  the  neck,  head,  and  shoulder*  were 
applied,  in  high  delirium,  or  very  low  coma.  Sinapisms  to  the  soles 
of  the  feet.  Mild  emetics  of  ipecacuan,  at  the  very  beginning. 

The  Maltese  prescribe  bark,  Colombo,  gentian,  and  serpentaria,  as 
soon  as  the  state  of  the  head  allows.  As  a  sudorific,  the  acetate  of 
ammonia  was  preferred.  Opium  in  some  cases  was  useful ;  but  re- 
quired caution  in  the  administration.  Wine  was  given  in  the  advanc- 
ed stages,  and  often  with  benefit  ;  but  required  great  limitation.  The 
same  of  cordials.  The  surgeon  of  the  3d  Garrison  Battalion,  Mr. 
Stafford,  has  published  several  cases  in  the  12th  vol.  Ed.  Journal, 
where  mercurial  frictions,  externally,  and  calomel  internally,  proved 
very  successful.  The  warm  bath  also  proved  useful.  The  cold  af° 


260  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

fusion  was  tried  in  a  few  cases,  and  Sir  B.  Faulkner  is  inclined  to 
augur  favourably  of  it,  when  guided  by  the  principles  laid  down  by 
Currie. 

Such  i*  nearly  the  sum  of  the  information  Dr.  F.  has  been  enabled 
to  collect  upon  this  disheartening  subject.  It  only  verifies  the  words 
of  the  Poet — 

Dum  visum  mortale  raalum  tantoque  latebat 
Causa  nocens  cladis,  pugnatum  cst  arte  medendi, 
Exitiurn  superabat  opem,  quse  victa  jactbat 

Prophylaxis. — Since  we  have  made  so  few  advances  in  the  cure, 
we  must  be  the  more  vigilant  in  regard  to  prevention.  Of  all  the 
means  which  have  been  recommended  by  ancients  or  moderns,  none 
are  equ*l  to  personal  cleanliness — temperance — avoiding  contact,  or 
using  immediate  ablutions  afterwards — shunning  the  breath,  or  va- 
pour exhaling  from  the  bodies  of  the  sick — ventilation — moderate 
exercise — attention  to  the  great  functions  of  digestion,  perspiration, 
biliary  secretion,  &c. — Confidence.  But  a  most  important  measure 
is  the  use  of  oiled  dresses,  the  texture  of  which  is  so  completely  close 
as  to  prevent  the  passage  of  the  most  minute  particles  of  any  matter 
from  without.  By  these  means  every  attendant  on  the  military  pest 
hospitals  in  Malta  escaped  the  contagion.  As  to  oil  frictions,  they 
are  precarious  preventives,  though  highly  recommended  by  some, 
particularly  Baldwin  and  Luigi. 

The  oil  dress  over  every  part  of  the  body,  while  a  sponge  mois- 
tened with  vinegar  is  held  to  the  face,  seems  the  most  certain  pro- 
phylactic. Miuht  not  a  mask  be  annexed  to  the  oil  dress,  with  a  tube 
of  leather  fitted  to  the  mouth,  and  leading  out  of  a  door  or  window, 
through  whir  h  the  medical  attendant  might  breathe  while  visiting  the 
infected  in  Pest  Hospitals  and  Lazarettos  ? 

Sinre  writing  the  above,  a  m-.  !;  '"i«  Actually  been  constructed  by  a 
foreigner,  composed  of  pieces  of  light  line  sponge,  which  are  to  be 
soaked  in  different  kinds  of  fluids,  according  to  the  nature  of  the  de- 
leterous  gas  or  febrific  miasm  against  which  we  are  to  guard.  This, 
upon  the  whole,  seems  belter  than  the  mask  and  tube. 

Since  the  second  Edition  of  this  work  was  printed,  one  or  two  Mem- 
bers of  the  House  of  Commons  were  deluded  by  Dr.  M'Lean's  wri- 
tings into  a  persuasion  that  Plague  was  not  contagious.  Accordingly 
a  committee  was  appointed,  and  the  Author  of  this  work,  among 
others,  was  examined.  But  nearly  the  whole  of  the  evidence  went 
so  completely  against  the  wild  speculations  of  the  learned  Doctor, 
that  the  Plague  question  has  dropped  to  the  ground  ! 


WEST  COAST  OF  AFRICA.  261 


COAST  OF  AFRICA. 

Some  Account  of  the  Climate  an<f  Medical  Topography  of  the  West  Coast 
of  Africa.  From  the  Quarterly  Journal  of  Foreign  Medicine  and 
Surgery  for  January,  1821.* 

In  the  view  we  shall  endeavour  to  present  of  the  topography  of 
the  coast  of  Africa  as  influencing  the  human  system,  our  observations, 
although  confined  to  that  part,  commonly  known  under  the  appella- 
tion of  the  coast  of  Guinea,  will,  nevertheless,  from  the  general  aspect 
and  nature  of  the  soil  and  seasons,  he  applicable  to  a  considerable 
portion  of  country  extending  in  both  a  northerly  and  southerly  direc- 
tion from  that  embraced  in  the  following  Memoir.  That  part  of  the 
African  coast  to  which  we  shall  limit  our  description,  (and  which  was 
presented  to  our  personal  observation,)  commences  at  Cape  de  Verde 
in  lat.  15°  north,  and  16£°  west  longitude,  and  extends  first  in  a  south- 
east direction,  and  afterwards  direct  east  to  Cape  Formosa,  in  4°  north 
lat.  and  6°  east  longitude,  comprehending  upwards  of  two  thousand 
miles  of  the  African  shore  within  its  range. 

This  part  of  the  coast  becomes  interesting  in  many  points  of  view. 
Towards  each  of  its  extremities  are  situated  all  the  African  settlements 
possessed  not  ouly  by  this  country,  but  also  those  belonging  to  the 
Dutch  and  Danes.  Its  centre  is  the  least  known  to  the  Europeans. 
To  the  medical  philosopher,  the  nature  of  its  soil  and  climate  ren- 
ders it  a  fertile  field  for  speculation,  and  its  diseases  a  subject  deserv- 
ing of  closer  inquiry.  To  every  one  interested  in  the  mental  and 
moral  elevation  ot  our  species  it  affords  prospects  the  most  humiliat- 
ing and  degrading.  Tribes  of  negroes,  different  in  the  degree  of 
savage  existence,  inhabit  the  coast,  and  extend  towards  the  interior  ; 
and  although  the  difference  of  their  customs  and  superstitions  modify, 
in  some  respects,  the  extent  of  their  social  and  moral  perceptions, 
still  they  are  not  many  degrees  removed  above  the  ferae  naturae. 
Tribes  of  Anthropophagi  inhabit  various  places  on  the  sea  coast,  and 
in  the  interior ;  one  was  seen  by  ourselves  on  the  western  boundary 
of  the  Ivory  coast,  all  of  themjjffet  likely  descendants  of  the  Ethi- 
opes  Anthropophagi  of  PtolemjMB  the  savage  Ethiopians  described 
by  Herodotus.  A  race  of  almosTwamphibious  Ichthyophagi  exist  on 
the  Grain  coast  in  a  state  of  migration,  plundering  the  inhabitants, 
who  are  not  more  than  a  degree  removed  above  themselves  in  the 
scale  of  civilization  ;  and  human  sacrifice  is  performed  by  all,  with 
the  most  wanton  indulgence  and  exultation,  even  in  those  districts 
that  have  enjoyed  an  intercourse  with  Europeans  for  nearly  three 
hundred  years.  • 

No  account  of  the  discoveries  made  by  the  expedition  sent  out  by 
Necho  king  of  Egypt,  nor  in  the  subsequent  one  undertaken  by  Han- 
no,  has  reached  our  times,  sufficient  for  us  to  form  an  opinion  of  the 
aspect  of  the  country,  during  the  remote  periods  of  antiquity.  The 

*  The  reader  will  readily  perceive  that  there  are  some  doctrines  in  this  article 
a  little  at  variance  with  what  I  have  maintained  in  other  parts  of  the  work 
They  do  not,  however,  require  discussion  here.— -J,  J. 


262  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

very  limited  and  superficial  description  given  of  the  west  coast  of 
Africa  by  the  less  ancient  philosophers,  Ptolemy  and  Pliny,  merely 
shows  that  the  north-west  extremity  of  this  part  was  not  unknown  to 
them.  If  we  may  be  allowed  to  speculate  on  the  subject,  the  nature 
of  the  soil  and  climate,  and  general  aspect  of  the  country,  are  per- 
haps nearly  the  same  at  the  present  day,  as  they  were  at  that  period. 
If,  however,  they  have  undergone  any  material  change,  it  cannot  be 
supposed  to  have  been  towards  a  state  of  amelioration.  The  decom- 
position of  the  superior  and  more  exposed  strata  of  rocks,  and  the 
continued  production  and  decay  in  the  vegetable  kingdom,  that  must 
have  been  going  on  during  the  intervening  ages,  render  it  more  pro- 
bable that  an  opposite  change  has  been  the  result.  We  are  induced 
to  conclude  that  an  accumulation  of  soil  has  thus  taken  place,  which 
every  successive  age  would  render  more  rich  and  absorbent,  and  con- 
sequently more  exuberant  in  its  productions.  With  this  increase  of 
luxuriance  upon  its  surface,  this  country  would  necessarily  become 
more  fertile  in  disease. 


-Macies,  et  nova  febriam 


Terris  incubuit  cohors.  Hon.  Book  I.  Ode  3. 

The  Portuguese  navigators  were  the  first  of  the  nations  of  modern 
civilization  to  visit  this  coast,  and  to  erect  settlements.  They  began 
towards  the  middle  of  the  fifteenth  century  to  extend  their  voyages 
beyond  Cape  de  Verde,  and  every  successive  adventurer  proceeded 
further  than  his  predecessor,  until,  before  the  end  of  that  century, 
the  whole  of  this  coast  was  visited. 

We  shall  commence  our  description  of  this  coast,  with  the  part 
first  visited,  and  proceed  along  its  shores  to  the  southern  limit,  which 
we  assigned  ourselves  in  the  proemium. 

The  first  novelty  that  strikes  the  visitor  of  the  African  coast  is  its 
extreme  lowness.  The  earliest  indication  of  its  approach  will  be  af- 
forded him  by  the  temperature  of  the  sea  diminishing  considerably, 
even  before  the  seaman's  plummet  has  declared  the  depth  of  water. 
Its  depth  begins  gradually  to  lessen,  and  at  length  the  soundings  are 
reduced  to  ten  or  twelve  fathoms  ;  the  land  at  last  appears  ;  the  tops 
of  trees  appear  to  emerge  out  of  the  water,  towards  the  eastern  ho- 
rizon ;  and  in  a  few  hours  the  appJBpnce  of  a  dense  and  nearly  level 
forest  indicates  its  near  approH|r  While  advancing  towards  the 
coast,  or  sailing  in  its  parallel,  the  nights  are  enlivened  by  the  con- 
stant flashes  of  lightning  upon  the  land,  or  when  at  too  great  a  dis- 
tance to  descry  it,  they  are  seen  gleaming  in  constant  succession  to- 
wards that  quarter  of  the  horizon  in  which  it  lies. 

The  River  Gambia  flows  into  the  Atlantic  Ocean  in  lat.  !3iQ  north, 
and  16°  west  long,  about  halfway  between  Cape  de  Verde  and  Cape 
Roxo. 

The  general  appearance  of  this  river,  from  the  account  given  by 
Ptolemy,  seems  to  have  been  nearly  the  same  in  his  time  as  at  pre- 
sent. The  country  adjoining  is  low,  and  in  most  places  thickly 
wooded.  The  soil  is  generally  sandy  ;  in  low  situations  it  approaches 
to  a  black  mould,  while,  in  the  lagoons,  and  near  the  banks  of  the  ri- 
ver, the  constant  inundations  during  the  rainy  season,  and  the  accu- 
mulation of  mud  and  ooze  which  takes  place,  render  it  extremely 


\VEST  COAST  OF  AFRICA.  .263 

rich  and  absorbent.  The  banks  of  the  Gambia  swarm  with  musqui- 
tos,  the  different  species  of  termites,  formicae,  and  with  all  the  other 
insects  and  reptiles  that  are  generally  natives  of  similar  climates. 
They  are  particularly  numerous  after  the  termination  of  the  rains. 
At  that  season  the  earth  may  indeed  be  said  to  teem  with  them,  mark- 
ing a  soil  extremely  fertile  in  the  elements  requisite  to  the  produc- 
tion and  growth  of  that  class  of  the  animal  creation  ;  as  well  as  in 
those  principles  which  are  productive  of  disease. 

The  settlement  of  St.  Mary  is  placed  near  the  entrance  of  this  ri- 
ver, and  although  not  so  thickly  wooded  as  most  of  our  African  set- 
tlements, yet,  from  the  sources  of  disease  supplied  from  its  banks 
and  adjoining  swamps,  it  has  been  found  as  fatal  to  European  con- 
stitutions. The  nature  of  the  soil  and  its  less  dense  vegetation,  ren- 
der at  some  seasons  the  degree  of  heat  frequently  greater  than  in 
most  of  the  other  settlements  on  this  part  of  the  coast ;  and  when 
the  sun  has  considerably  passed  the  equator,  towards  his  greatest 
northern  declination,  the  thermometer  in  the  shade  has  frequently 
indicated  upwards  of  100°.  The  rainy  season  commences  in  July, 
and  continues  about  four  months.  During  this  season,  but  more  es- 
pecially about  its  commencement  and  termination,  fevers  of  the  inter- 
mittent and  remittent  types  are  very  general,  and  frequently  prove 
malignant.  The  diseases  that  are  most  prevalent  are  continued,  re- 
mittent, and  intermittent  fevers,  dysentery,  and  cholera  morbus. — 
These  are  endemic  at  all  seasons  among  recent  visitors,  if  they  re- 
main sufficiently  long  ;  and  also  very  frequently  attack  seasoned  re- 
sidenters.  The  fever  alters  its  type  here,  as  in  all  other  places  on 
the  coast,  according  to  the  period  of  residence  in  the  country,  and 
individual  circumstances  of  the  patients. 

The  quantity  of  rain  which  falls  throughout  the  year  may  be  con- 
sidered from  ninety  to  a  hundred  and  fifteen  inches.  The  prevail- 
ing winds  during  the  dry  season,  are  the  usual  sea  and  land-breezes. 
Tornadoes  are  frequent  about  the  setting  in  of  the  rains,  and  at  their 
conclusion.  During  their  continuance  the  winds  prevail  from  the 
W.  S.  W.  fraught  with  the  accumulated  moisture  exhaled  from  the 
equatorial  Atlantic.  The  harmattan  wind  is  more  feeble  in  its  effects 
towards  this  part  of  the  country.  That  part  of  the  coast  which  ex- 
tends from  i2i°  to  10°  north  lat.  is  particularly  shelving,  and  in  many 
places  is  elevated  into  dangerous  shoals  and  sand  banks.  These 
shoals,  in  consequence  of  greater  elevation  in  some  places,  assume 
the  appearance  of  small  islands,  and  lie  detached  at  a  considerable 
distance  from  the  continent. 

The  Rio  Grande  falls  into  the  sea  in  12^  degrees — in  the  place 
where  the  coast  is  prominently  marked  by  a  shelving  character.  Its 
mouth  is  almost  concealed  in  the  approach  from  the  sea,  by  several 
considerable  islands.  They  appear  from  the  assimilation  of  their 
surface  and  degree  of  elevation,  as  if  separated  from  the  continent  by 
the  course  of  the  rirer  ;  while  the  aspect  of  their  shores,  and  the 
character  of  the  soil,  render  it  as  probable  that  they  have  been  form- 
ed from  the  accumulating  debris,  washed  down  by  the  rivers  during 
the  rainy  seasons  from  the  adjoining  country,  as  well  as  from  the  ex- 
tremity of  the  Kong  mountains,  which,  crossing  Africa,  terminate  at 


264  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

no  great  distance  from  this  part  of  the  coast.  From  among  this  ina- 
mense  range  of  mountains,  the  more  considerable  streams,  which  af- 
terwards by  their  increase  form  the  majestic  rivers  of  the  Gambia,  Rio 
Grande,  Sierra  Leone,  and  others  that  present  themselves  along  this 
part  of  the  coast,  derive  their  origin.  Of  the  islands  scattered  be- 
fore the  mouth  of  this  river,  the  most  considerable  and  most  adjacent 
to  the  continent  is  the  island  of  Bulama — a  name  become  notorious  in 
medical  controversy,  from  its  having  been  the  source  from  which  ma- 
ny of  those  who  espouse  the  doctrine  of  the  contagious  nature  of  the 
yellow  fever  suppose  the  epidemic  to  have  bt  en  derived,  which  ra- 
vaged the  West  Indies  during  1793  and  following  years.  We  shall 
endeavour  to  present  our  readers  with  a  view  of  its  topography. 

its  situation,  in  the  very  entrance  of  the  Rio  Grande,  gives  the  ap- 
pearance of  two  distinct  mouths  to  that  river.  Jn  length  it  is  about 
fifteen  miles,  and  about  ten  in  breadth. —  it  presents  in  every  direction 
an  almost  level  superficies  thickly  wooded,  and  the  stems  of  the  more 
considerable  trees  surrounded  by  a  dense  underwood. 

Places  more  devoid  of  the  bulky  vegetable  productions  are  cover- 
ed by  a  thick  and  deep  grass.  The  soil  varies  from  a  loamy  earth  to 
a  heavy  clay  ;  and  the  shores  assume  either  a  sandy  or  muddy  ap- 
pearance, according  as  they  are  washed  on  one  side,  by  the  currents 
of  the  sea,  and  on  the  other,  by  the  stream  of  the  river.  On  the 
sides  which  in  fact  form  part  of  the  banks  of  the  river,  every  retiring 
tide  leaves  it  in  some  degree  covered  by  the  ooze  and  mud  borne  on 
its  current,  and  there  left  to  rapid  decay  in  a  moist  and  hot  atmos- 
phere. No  situation  could  be  chosen  more  fertile  in  the  causes  of 
endemic  fever  :  both  from  its  peculiar  position,  and  also  from  the  na- 
ture of  the  soil  and  exuberant  vegetation. 

The  situation,  in  the  mouth  of  the  river,  renders  it  obnoxious  to 
the  effects  of  the  land-wind,  which  may  naturally  be  expected  to  be 
fraught  with  the  noxious  exhalations  produced  from  its  banks,  the 
adjoining  lagoons,  and  rice  grounds  ;  while  towards  the  sea  it  is  in  a 
considerable  degree  sheltered  from  the  salutary  effects  of  the  sea- 
breeze,  by  the  numerous  and  even  large  islands  that  lay  without  it. 
No  one  acquainted  with  a  tropical  climate,  but  would  conclude  a  pri- 
ori, from  such  a  position,  and  from  such  a  soil  and  climate  as  we  have 
described,  that  the  most  severe  cases  of  endemic  fever  must  be  the 
result.  We  cannot  be  surprised  that  the  wretched  individuals  who 
attempted  to  settle  upon  this  island  were  so  deeply  afflicted  ;  we 
would  have  been  much  more  astonished  had  any  escaped.  That  the 
disease  did  not  make  its  appearance  among  them  until  a  considerable 
time  after  they  had  deserted  this  miusmal  hot-bed,  was  to  be  expect- 
ed by  every  one  experienced  in  its  causes.  Even  when  most  con- 
centrated, they  never,  we  believe,  affect  the  system  before  the  se- 
venth day  ;  and  in  many  cases  a  considerable  number  of  weeks  elapse 
before  the  febrile  action  commences. 

The  time  which  was  subsequently  spent  by  them  at  Sierra  Leone, 
where  many  of  them  died,  and  others  sickened,  afforded  those  who 
escaped  at  Bulama,  and  whose  minds  were  under  the  sedative  effects 
arising  from  disappointment,  a  fresh  exposure  to  causes  not  a  whit 
less  potent  in  producing  malignant  effects.  Many  of  our  enlighten- 


WEST  COAST  OF  AtRlCA.  266 

ed  brethren,  who  are  conversant  with  the  great  length  of  time  the 
miasmal  poison  will  la}'  dormant  in  the  system,  operating  changes  in 
it,  preparatory  to  bursting  into  actual  disease,  will  join  us  in  the  be- 
lief, that  those  who  sickened  during  their  passage  across  the  Atlantic, 
and  by  that  means  gave  rise  to  the  fallacious  appearance  of  conta- 
gion, derived  their  disease  on  the  African  shores,  by  the  direct  ope- 
ration of  the  endemic  causes  of  yellow  fever  upon  their  individual 
systems.  If  there  were  any  who  had  no  decided  symptoms  of  dis- 
ease until  they  reached  the  West  Indies,  and  then  were  seized,  we 
consider  it  very  likely  that  the  state  of  the  atmosphere,  so  faithfully 
described  by  Dr.  Clarke,  as  most  prevalent  throughout  these  islands 
at  that  time,  might  have  brought  into  full  action,  as  soon  as  they  came 
within  its  influence,  those  seeds  of  disease  which  were  sown  in  the 
system  in  Africa,  and  which  otherwise  might  have  never  appeared, 
but  by  this  super-addition  of  epidemic  causes.  If,  however,  this 
should  be  rejected  as  not  being  sufficiently  probable,  we  can  assign 
another  cause,  one  by  no  means  unlikely  to  have  had  effect  after  the 
mental  and  physical  privations  of  such  an  attempt,  followed  by  such 
a  voyage.  It  is  highly  probable  that  states  of  the  system  might  have 
been  possessed  by  those  individuals,  which  resisted  the  even  highly 
concentrated  causes  of  endemic  fever  to  which  they  were  presented 
in  Africa  ;  yet  subsequently,  when  both  the  mind  and  body  must  have 
undergone  some  change,  from  the  scenes  in  which  both  suffered,  they 
surely  could  not  be  supposed  proof  against  the  more  energetic 
causes,  which  are  necessary  to  the  generation  of  an  epidemic  form  of 
the  disease,  and  which  was  then  commencing  in  the  West  Indies.  It 
is  by  no  means  a  fair  conclusion,  because  several  of  the  inhabitants 
of  Grenada,  who  visited  the  vessel  that  conveyed  the  settlers  from 
Bulama,  were  afterwards  seized  with  this  epidemic  at  the  time  of  its 
making  its  appearance  in  the  island,  that  therefore  they  were  infect- 
ed from  that  vessel.  It  is  well  known  that  the  epidemic  was  then 
commencing,  not  only  in  the  West  Indies,  but  also  throughout  the 
United  States  of  America  ;  therefore  it  becomes  infinitely  more  like- 
ly, that  the  disease  in  those  individuals  was  produced  by  causes  quite 
unconnected  with  the  Bulama  settlers  ;  and  would  have  appeared 
under  exactly  the  same  circumstances  iif  they  had  never  visited  the 
island.  The  epidemic  state  of  the  atmosphere  so  sensibly  felt,  so 
far  as  this  fever  extended,  giving  rise  to  a  malignant  modification  of 
the  disease,  was  materially  different  in  character  from  the  usual  en- 
demic of  the  African  coast. 

The  fever,  which  proved  so  fatal  to  the  Bulama  settlers  was  the 
seasoning,  or  endemic  produced  by  causes  strictly  confined  to  the 
place  from  which  it  was  derived,  acting  upon  the  susceptibility  of  new 
comers,  and  assuming  either  the  continued,  or  remittent  type,  accord- 
ing to  the  peculiar  circumstances  of  the  patient,  but  >vith  no  pecu- 
liar malignity  in  the  disease;  whereas,  the  West  Indian,  epidemic  put 
on  a  much  more  violent  aspect,  affecting  not  only  those  lately  arriv- 
ed in  that  island,  but  also  seasoned  individuals  and  long  reeidenter?, 
evidently  the  result  of  causes  more  multiplied  and  intense  than  those. 
by  which  thev  had  been  previously  affected. 

34 


266  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

If  the  origin  of  both  diseases  be  closely  looked  into,  the  former 
will  be  found  derived  from  the  products  of  vegetable  decay,  floating 
in  a  warm  and  moist  atmosphere  ;  the  latter  combined  those  causes, 
with  the  extrication  from  an  exposed  surface  of  the  more  subtile  ele- 
ments, necessary  to  the  constitution  of  a  rich  soil,  and  both  were 
joined  to  a  peculiar  condition  of  the  air,  particularly  favouring  their 
production,  as  well  as  disposing  the  human  system  to  their  direct  ope- 
ration. 

To  the  state  of  the  electric  fluid  contained  in  the  atmosphere,  this 
peculiar  alteration  may  have  been  owing  in  no  inconsiderable  degree  ; 
and  that  such  was  actually  the  case,  not  only  in  this,  but  also  in  other 
epidemics,  we  could  adduce  the  most  convincing  proofs,  did  we  not 
consider  ourselves  as  having  strayed  sufficiently  long  from  the  subject 
under  consideration.  From  our  knowledge  of  the  African  endemic 
we  must  conclude,  that  no  proof  has  been  ever  adduced  of  its  being 
capable  of  propagation  by  means  of  contagion,  and  we  believe  it  im- 
possible.* We  therefore  consider  the  ingenious  attempt  of  Dr.  Chis- 
hohn  and  his  followers  to  convey  a  contagious  yellow  fever  from  Afri- 
ca, and  propagate  it  at  once  not  only  throughout  the  West  Indies,  but 
also  through  America,  like  the  fabled  flight  of  Daedalus — one  to 
which  the  solar  beams  are  inimical. 


•Daedaleis 


Nititur  pennis. HORACE. 

After  leaving  the  entrance  of  this  river  and  passing  along  the  coast, 
which  takes  a  south-east  direction,  a  low  and  swampy  country  every 
where  presents  itself,  exhibiting  the  same  unvaried  aspect  of  luxuri- 
ant vegetation.  The  whole  distance,  (upwards  of  200  miles,)  until 
we  approach  the  colony  of  Sierra  Leone,  does  not  exhibit  a  single 
hill,  or  even  prominence,  that  can  serve  as  a  land-mark  to  the  mari- 
ner. 

Within  this  extent  many  large  rivers,  deriving  their  origin  from 
the  high  land  forming  the  base  of  the  Kong  mountains,  flow  into  the 
sea.  The  most  considerable  are  the  Rio  Nunez,  the  Rio  Pongas, 
and  the  Dembia.  These  rivers,  during  the  rainy  season,  inundate  a 
great  part  of  the  surrounding  country. 

Sierra  Leone. — As  we  approach  this  river  the  country  assumes 
rather  a  more  varied  aspect.  The  mountains  of  Sierra  Leone,  the 
first  that  have  presented  themselves  along  this  extensive  range  of 
coast,  overlook  the  river  from  its  southern  banks,  while  their  western 
base  is  washed  by  the  waters  of  the  Atlantic.  When  viewed  from 
the  sea,  the  uniformly  low  and  marshy  country,  seen  extending  in 
every  direction,  give  them  a  more  majestic  appearance  than  their 
actual  elevation  would  otherwise  entitle  them  to.  These  mountains 
run  in  an  easterly  direction,  and  nearly  parallel  with  the  course  of 
the  river,  for  about  twelve  miles,  without  diminishing  in  altitude  ; 
they  then  terminate  abruptly  in  low  swamps,  through  which  the  Bunch 
river  flows  in  a  slow  and  muddy  stream.  On  the  side  toward  the  sea 
a  chain  of  hills  extends  along  the  coast  for  several  miles.  These 
mountains  are  covered  on  every  side  to  their  summits  by  immense 
forests  and  luxuriant  vegetation. 

*  I  consider  this  expression  of  the  writer  as  far  too  strong. — J.  J. 


WEST  COAST  OF   AFRICA.  267 

Free  Town,  the  British  colony  upon  this  river,  is  situated  about 
six  miles  from  its  entrance,  upon  its  south  side,  and  is  elevated  from 
forty  to  seventy  feet  above  the  general  rise  of  the  river,  which  at 
this  place  is  about  ten  miles  across.  The  soil  is  an  argillaceous  earth 
of  a  red  colour,  covering  iron  clay  stone,  which  apparently  rests  on 
syentic  rock.  Unless  where  built  upon,  it  is  covered  by  majes- 
tic trees,  and  a  vast  profusion  of  shrubs  and  grass.  Among  these, 
the  wild  cotton  tree,  (bomax  ceiba,)  the  palm  tree,  (carica  papaya,) 
the  cocoa  tree,  (cocos  nucifera,)  &.c.  hold  a  conspicuous  place.  The 
swamps,  so  abundant  at  the  foot  of  the  mountains,  and  along  the 
banks  of  the  Bunch,  which  falls  into  it  about  seven  miles  from  the 
colony,  are  covered  by  an  impenetrable  vegetation,  chiefly  consisting 
of  mangrove  bushes,  (rhizophera  mangle  ;)  which,  by  the  very  ex- 
tensive manner  they  propagate  themselves  in  all  wet  situations,  (by 
shoots  thrown  off  from  their  upper  branches,)  form  impervious 
tracts  ;  and  are  so  intricately  wove  together  as  to  defy  eradication  by 
the  most  powerful  means.  They  cover  the  banks  of  these,  and  in- 
deed all  the  African  rivers  ;  and  by  furnishing  a  natural  barrier,  pre- 
serve them  in  the  same  channels.  They  also  contribute  most  power- 
fully in  rendering  such  situations  the  certain  source  of  disease,  by 
retaining  the  mud  and  ooze,  and  other  matters  conveyed  by  the  river, 
among  their  entangled  branches.  The  country  to  the  north  and  east 
of  Sierra  Leone  is  inhabited  by  the  extensive  native  States  of  Tim- 
mances  and  Benna  Soosoos,  and  on  the  north  by  the  Bulams. 

No  situation  on  the  African  coast  could  have  been  more  unfavoura- 
bly chosen  for  European  constitutions  than  the  one  now  under  con- 
sideration :  an  abundant  supply  of  «?ood  water  is  the  only  circumstance 
we  can  adduce  in  its  favour.  On  the  south  and  sonth-west,  the  colo- 
ny is  overhung  by  the  mountains  already  mentioned,  the  only  range 
that  arrests  the  eye  of  the  voyager  for  upwards  of  1,000  miles  in 
either  direction  along  the  coast.  These  with  undivided  attraction, 
arrest  and  condense  at  all  seasons  of  the  year  the  moisture  exhaled, 
not  only  from  the  Atlantic  Ocean,  but  at  the  same  time  from  the  very 
absorbent  soil,  and  the  numerous  marshes  and  rivers  that  surround 
them  in  every  direction.  Hence  in  opposition  to  a  well  known  law 
in  the  science  of  climate,  "  that  the  number  of  days  of  rain  diminish 
as  we  approach  the  equator,  while  the  quantity  of  rain  that  annually 
falls  increases."  The  actual  number  of  d  >ys  in  which  rain  falls  is 
greater  than  in  most  northern  climates.  By  a  register  kept  at  this 
colony,  the  number  of  rainy  days  amounted  to  2o4  ;  and  •  f  the  re- 
maining dry  days,  although  the  moisture  in  the  atmosphere  was  not 
actually  condensed  into  rain,  yet  the  greater  proportion  of  them  ex- 
hibited its  progress  towards  that  state  ;  not  only  the  adjoining  moun- 
tains, but  the  river  and  its  banks  being  covered  by  fogs  and  haze.  In- 
deed few  days  occur  throughout  the  year,  which  afforded  a  dear  view 
of  the  mountain  tops  :  clouds  are  seen  generally  either  covering  their 
heads,  or  resting  upon  their  sides,  at  different  degrees  of  altitude. 

The  rainy  season  commences  in  June,  and  terminates  with  October, 
and  is  both  introduced  and  closed  by  tornadoes.  Their  number,  by 
an  account  kept,  during  one  whole  year  amounted  to  fifty-four  ;  no 
part  being  more  obnoxious  to  them  than  this  and  the  grain  -coasts. 


INFLUENCE  Ol-    TROPICAL  CLIMATES,  &C. 

The  quantity  of  rain  during  the  year  may  vary  from  one  hundred  to 
one  hundred  and  twenty  inches.  We  cannot  suppose  it  often  to  fall 
short  of  the  former.  Thunder  and  lightning  are  of  frequent  occur- 
rence here,  as  they  also  are  along  the  whole  coast ;  the  former  by 
the  loud  reverberation  from  the  sides  of  the  mountains,  becomes  dou- 
bly tremendous.  The  winds  during  the  rains  generally  blow  from 
the  S.  W.  or  VV.  S.  W.  About  their  commencement,  and  after  their 
conclusion,  the  atmosphere  is  generally  tranquil.  At  other  seasons 
the  sea  and  land-winds  occur,  but  not  in  regular  succession.  The  sea- 
breeze  seldom  appears,  and  when  it  does,  it  generally  dies  away  in  a 
few  hours,  leaving  the  air  sultry  and  stagnant.  The  land-winds  come 
on  about  sun-set,  and  only  amount  to  very  light  breezes  ;  and  from 
blowing  over  the  adjoining  rivers  and  swamps,  are  generally  a  source 
of  disease,  especially  to  such  vessels  as  may  lie  in  the  river  within 
their  noxious  influence.  The  harmattan  is  less  frequently  and  more 
feebly  felt  here  than  on  the  Gold  coast. 

The  temperature  of  the  air  at  Sierra  Leone  is  generally  not  great- 
er than  95°,  but  its  tranquil  state,  in  regard  to  its  horizontal  motion, 
favours  the  concentration  and  multiplication  of  the  foreign  ingredients, 
derived  from  the  soil  and  decaying  vegetation  ;  consequently,  the 
atmosphere  in  this  state  feels  very  sultry  and  oppressive.  The  mean 
temperature  obtained  from  the  degree  of  heat  observed  at  different 
periods  of  the  day  throughout  the  year,  was  from  83°  to  83i°.  The 
hypothetical  scale  laid  down  by  Professor  Lesslie,*  from  the  empiri- 
cal law  discovered  by  Professor  Mayer  of  Gottingen,  gives  for  the 
same  latitude  83-2°.  The  harmony  here  observable  in  conclusions 
from  data  so  different,  is  not  a  little  surprizing. 

The  diseases  which  the  medical  philosopher  would  be  led  to  ex- 
pect, resulting  from  the  operation  of  this  climate  upon  European 
constitutions,  are  exactly  those  which  are  constantly  presenting  them- 
selves. They  are,  however,  considerably  modified  in  many  of  their 
phenomena  by  the  period  of  residence,  and  circumstances  peculiar 
to  the  patient.  Accordingly,  continued  and  remittent  fevers,  (com- 
monly called  yellow  fever,)  intermittents,  dysentery,  cholera  mor- 
bus,  enlargements  of  the  spleen,  and  chronic  inflammation  of  the 
liver, — are  the  diseases  of  most  frequent  occurrence,  and  generally 
prove  annually  fdtal  to  about  one-third  of  the  white  population.  Of 
those  who  die,  about  eight-tenths  are  carried  off  by  fever,  the  type 
of  which  varies  according  to  the  period  of  residence  and  the  consti- 
tution of  the  individual  ;  but  whatever  aspect  it  may  assume,  it  de- 
rives its  origin  from  the  same  causes.  An  occurrence  took  place, 
here,  which  affords  the  most  convincing  proof  of  the  correctness  of 
our  position  : — Nine  sailors  direct  from  England,  and  belonging  to 
the  vessel  in  which  we  were,  all  of  them  having  previously  been 
either  on  this  coast  or  in  the  West  Indies,  were  put  into  a  boat  to 
convey  our  party  to  the  colony,  the  vessel  being  becalmed  at  a  con- 
siderable distance  from  the  entrance  of  the  river.  Of  those  nine  in- 
dividuals, five  had  had  yellow  fever  on  either  the  African  or  Ameri- 
can coast.  The  season  of  our  arrival  was  in  the  end  of  June  :  the 
periodical  raiua  had  just  commenced.  The  day  was  far  advanced 
*  Article,  climate.— Supplement  to  Encyclo.  Britan. 


WEST  COAST  OF  AFRICA.  269 

before  we  landed  at  Free  Town,  and  the  overcast  sky  that  had  suc- 
ceeded a  cloudless  morning,  was  pouring  down  its  rain  in  torrents. 
The  men  were  detained  under  shelter  till  the  evening,  when  the 
weather  appearing  more  favourable,  they  were  allowed  to  return  to 
the  vessel.  On  their  way  they  were  overtaken  by  a  tornado,  which 
drove  them  upon  the  north  and  more  swampy  bank  of  the  river. 
There  they  remained  in  their  drenched  clothes,  inhaling  the  mias- 
mata disengaged  from  this  productive  source  until  next  morning, 
when  they  reached  the  vessel.  These  were  the  oi.ly  individuals 
composing  the  ship's  crew  that  had  any  intercourse  with  the  land, 
and  in  them  the  effects  of  this  exposure  were  soon  expected  to  fol- 
low. About  ten  days  after  this  occurrence  the  first  man  sickened, 
and  within  three  weeks  eight  out  of  the  nine  had  fever,  under  va- 
rious forms.  The  vessel  only  remained  nine  days  at  Sierra  Leone, 
and  consequently  was  beyond  the  influence  of  the  common  causes  of 
disease  in  that  climate,  before  any  one  was  taken  ill.  Of  the  four 
who  had  never  before  been  in  a  warm  climate,  three  had  the  disease 
in  the  continued  and  most  concentrated  type,  the  other  in  the  remit- 
tent form.  Of  the  five  who,  at  a  former  period  of  their  lives,  had 
suffered  from  the  same  disease,  three  had  it  now  in  the  remittent 
form,  one  a  regular  tertian,  ana1  the  fifth,  had  no  disease  at  the  end 
of  two  months.*  These  eight  men  were  treated  according  to  the 
type  of  fever,  and  prominent  symptoms  which  were  developed  in>the 
course  of  the  disease.  They  all  recovered  ;  but  they  were,  during 
the  treatment,  completely  removed  from  the  causes  from  which  the 
disease  originated; 

After  passing  Sierra  Leone,  the  country  appears  studded  by  hills, 
covered  with  wood  to  their  summits.  As  we  approach  the  bay  of 
Sherbro',  they  gradually  diminish  in  elevation,  and  soon  entirely  dis- 
appear. From  Sierra  Leone  to  Sherbro',  the  distance  is  about 
eighty  miles  ;  within  this  extent  four  considerable  rivers  fall  into  the 
sea.  This  bay  is  formed  by  a  range  of  low  islands,  whose  south- 
east extremity  touches  the  continent,  and  leaves  it  in  an  oblique  di- 
rection, thus  presenting  a  capacious  opening  towards  the  north-west. 
The  country,  so  far  as  it  can  be  viewed  in  either  direction,  is  low 
and  swampy  ;  and  although  a  fine  sandy  beach  is  seen  edging  the 
land,  yet  the  soil  is  of  a  deep  and  heavy  clay.  Upon  passing  the 
large,  but  low  island  of  Sherbro',  (one  of  the  range  just  mentioned,) 
and  for  upwards  of  seventy  miles,  the  country  is  uniformly  1  >w  and 
swampy,  and  much  intersected  with  rivers,  until  we  arrive  at  Cape 
Mount.  This  nearly  conical  mountain  is  situated  on  the  south  side 
of  a  spacious  river,  bearing  the  same  name.  As  we  advance  along 
the  coast,  the  elevation  so  abruptly  assumed  on  the  south  bank  of 
this  river  gradually  diminishes  ;  and  within  the  space  of  a  few  miles 
the  characteristic  feature  of  lowness  is  again  presented  to  our  view. 
The  country  is  every  where  thickly  wooded.  Proceeding  from  Cape 
Mount,  along  nearly  a  straight  shore,  Cape  Mezurado,  an  elevated 
head-land,  appears.  The  latter  is  ahout  fifty  miles  distant  from  the 

*  We  afterwards  understood  from  the  captain  of  4he  vessel — that,  at  a  period  of 
between  three  and  four  weeks  subsequently,  this  man  died  after  five  days  illness  ; 
but  they  were  then  lying  within  the  influence  of  the  usual  causes  of  the  disease. 


"70  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

former,  and  like  it  forms  the  southern  barrier  to  a  large  river,  which 
bears  the  same  name  usually  given  to  the  Cape.  These  rivers  inun- 
date most  of  the  country  during  the  rainy  season. 

The  Grain  Coast  commences  at  this  river,  (.Vlezurado,)  which  is 
situated  in  6.  30°  north  lat.  and  10°  west  long,  and  terminates  at  Cape 
Palmas,  in  4°  north  lat.  and  7.  20°  west.  This  coast  runs  between 
these  limits  in  an  even  direction,  without  affording  the  least  variety  of 
appearance.  Not  a  prominence  is  seen  throughout.  A  dense  forest 
covers  an  uniformly  low  land,  through  which  a  great  number  of  small 
stremes  flow  with  a  sluggish  course.  None  of  them  are  large  enough 
to  be  dignified  by  the  name  of  a  river  ;  nor  can  they  admit  of  navigation, 
but  hy  the  small  canoes  of  the  natives.  The  coast  is  every  where 
shelving,  and  the  immense  swell,  especially  during  the  rainy  season, 
that  rolls  in  from  the  Atlantic,  renders  this  unsheltered  shore  gene- 
rally impracticable  to  all,  but  the  almost  amphibious  negroes. 

Their  villages  are  built  upon  the  sea  side,  near  the  swampy  mouths 
of  those  rivulets  ;  affording  them  a  greater  facility  of  obtaining  sub 
sistence  from  both  elements.  The  soil  is  a  deep,  rich,  and  heavy 
earth,  no  where  leaving  a  stone  or  rock  exposed.  This  immense 
plain,  during  the  rainy  season,  is  almost  one  entire  morass  ;  hence 
rice  is  generally  cultivated,  and  forms  the  chief  food  of  the  inhabit- 
ants. While  viewing  the  land  at  a  distance  of  two  or  three  miles, 
the  slow  and  successive  billows  are  heard  breaking,  with  a  continued 
roar,  upon  the  extended  and  narrow  beach  ;  and  the  continued  line  of 
foaming  surf  separates  like  a  zone  that  tumultuous  element  from  the 
compact  and  variously-shaded  productions  of  the  soil,  which  form  one 
immense  forest  as  far  as  the  view  can  extend.  Occasionally,  one  or 
more  trees  are  seen  greatly  elevated  above  the  rest,  forming  the  most 
striking  land-mark,  by  which  seamen  may  recognize  the  different 
parts  of  this  coast.  Places  designed  for  the  growth  of  any  of  the  fa- 
rinaceous grasses  or  roots,  usually  cultivated  in  this  country,  have, 
towards  the  end  of  the  dry  season,  their  exuberant,  but  now  withered 
productions,  set  on  fire  ;  and  with  little  further  preparation  the  seeds 
are  put  into  the  ground.  The  quantity  of  rain  during  the  year  is 
nearly  the  same  as  on  that  part  of  the  coast  already  described.  This 
season  commences  with  June,  and  continues  about  four  months,  at- 
tended with  almost  continued  thunder  and  lightning.  The  wind  dur- 
ing this  time  generally  blows  from  the  south-west.  To  this  season 
succeeds  about  a  month  of  continued  fogs,  with  an  almost  tranquil 
state  of  the  atmosphere,  arising  from  the  exhalation  of  the  moisture 
from  the  absorbent  soil.  Although  during  these  fogs  the  actual  rise 
of  temperature  is  inconsiderable,  yet  this  is  constantly  the  most  nox- 
ious season  of  the  year  ;  and  were  it  not,  that  the  almost  daily  occur- 
rence of  tornadoes  carry  before  them  the  rapidly  disengaged  malaria 
in  their  tumultuous  sweep,  this  part  of  the  coast  would  be  uninhabita- 
ble to  the  nobler  class  of  animals.  As  it  is — they  exhibit  in  all  their 
species,  the  lowest  varieties  of  formation. 

Ivory  Coast. — At  Cape  Palmas  we  enter  upon  the  Ivory  coa?t,  which 
runs  E.  N.  E.  to  Cape  Lahou,  in  5°  north  lat.  and  4°  west  long., 
where  it  terminates.  This  part,  like  the  Grain  coast,  is  throughout 
its  greater  extent  low  and  swampy  ;  where  it  approaches  the  Gold 


WEST  COAST  OF  AFRICA.  271 

coast,  the  country  in  many  places  assumes  the  appearance  of  a  low 
table  land.  The  quantity  of  rain  and  prevailing  winds,  and  degrees  of 
temperature,  are  nearly  the  same  in  this  district  of  the  country  as  in 
the  last  described.  Indeed  the  whole  extent  of  coast  from  the  Bay 
of  Sherbro'  to  Cape  Lahoii,  embracing  about  700  miles,  possesses  an 
uniform  character  in  the  soil  and  seasons,  and  in  the  luxuriance  of  the 
vegetable  kingdom  An  everlasting  sameness  in  the  face  of  the  coun- 
try reigns  throughout ;  and  with  a  single  exception,  not  a  mountain, 
or  hill,  presents  itself  as  far  as  the  sight  can  reach  towards  the  inte- 
rior. The  unif  rrnly  low  surface  is  frequently  intersected  by  small 
rivulets,  but  it  no  where  presents  any  considerable  or  navigable  ri- 
vers. Places  devoid  of  the  more  majestic  vegetable  production  are 
completely  covered  by  mangroves  and  brambles,  through  which,  paths 
between  the  native  towns,  and  from  them  to  their  cultivated  fields, 
are  with  difficulty  formed  ;  or  even  kept  open.  Those  luxuriant  na- 
tives of  the  soil  extend  to  the  very  edge  of  the  sandy  beach,  scarce- 
ly a  rock  being  exposed.  Where,  however,  the  violence  of  the  surf 
has  succeeded  in  removing  the  deep  clay  soil,  rocks  of  the  primary 
formation  are  met  with.  Granite,  micaceous  schistus,  and  clay-slate, 
have  been  thus  in  various  places  exposed. 

The  Gold  Coast. — After  passing  Cape  Lahou,  we  enter  upon  the 
Gold  Coast.  It  derives  this  appellation  from  the  gold  obtained  by 
washing  the  alluvial  soil.  It  extends  in  almost  the  same  direction 
with  the  former,  running  nearly  east,  in  the  lat.  of  5°  north,  until  it 
reaches  the  Rio  Volta  in  2°  east  longitude,  where  it  terminates  ;  thus 
embracing  an  extent  of  300  miles. 

This  district  of  country  assumes  a  more  favourable  aspect,  than 
any  other  upon  the  western  side  of  Africa.  The  natural  wealth  of 
the  country,  the  more  varied  soil,  and  the  situation  it  enjoys  in  re- 
spect of  proximity  to  the  interior  kingdoms  of  this  extensive  quarter 
of  the  globe,  render  it  better  calculated,  than  any  other  we  have  vi- 
sited, for  European  trade  and  colonization.  To  the  voyager  accus- 
tomed to  view  the  dull  uniformity  displayed  by  the  Grain  and  Ivory 
coasts,  this  exhibits  more  attractions.  The  great  variety  of  scenery 
and  the  regular  succession  of  low  hills,  that  present  themselves  as 
we  advance,  with  occasional  rocky  prominences,  running  into  the 
sea,  afford  more  striking  prospects  than  before  presented.  This  is 
also  enlivened  by  the  appearance  at  distant  intervals,  of  the  seats  of 
small  but  civilized  societies,  forming  the  different  European  settle- 
ments, that  are  met  with  on  the  African  coast.  There  are,  however, 
many  striking  disadvantages  under  which  it  labours,  and  indeed  in 
common,  with  the  greater  part  previously  described. 

The  want  of  navigable  rivers,  and  the  unprotecteJfcature  of  the 
shore,  from  the  deficiency  of  creeks  and  harbours,  are  alone  great 
detriments  to  mercantile  intercourse.  In  many  situations  in  this  par- 
ticular district,  the  scarcity  of  good  water  during  the  dry  season,  is  a 
matter  of  serious  inconvenience,  and  even  a  source  of  disease. 

The  native  inhabitants  are  more  numerous,  and  their  circumstan- 
ces considerably  superior  to  the  other  Negro  tribes,  who  had  hither- 
to fallen  under  our  observation. 

Apollonia  is  the  first  European  settlement  we  meet  with  upon  this 


272  INFLUENCE  0*    TROPICAL  CLIMATES,  &C. 

coast.  It  belongs  to  the  British  African  Company,  and  is  situated  iti 
an  extensive  plain,  in  2£°  west  lat.  In  most  places  it  is  thickly  wood- 
ed, but  in  others  subjected  to  the  cultivation  of  rice.  It  is  intersect- 
ed by  small  rivers,  that  inundate  the  greater  part  of  the  country  dur- 
ing the  rainy  season.  The  soil  is  a  deep  loamy  clay.  The  plain  ter- 
minates in  low  hills  as  we  advance  towards  the  interior  of  the  coun- 
try. Between  these  and  the  settlement  is  situated  a  tine  lake  of  about 
seven  or  eight  miles  circumference,  its  banks  are  marshy,  and  even 
during  the  dry  season  cannot  fail  of  loading  the  land  winds  with  mi- 
asms  ;  with  which,  indeed,  the  surrounding  country,  from  its  low  and 
wet  soil,  and  exuberant  vegetation,  must  abound,  through  the  great- 
er part  of  the  year.  As  we  proceed  up  the  country,  large  open  pra- 
iries, or  meadows  of  long  rank  grass,  are  frequently  met  with,  in  which 
elephants  are  found  browsing  even  within  a  very  few  miles  of  the  sea 
shore.  This  place  is  fruitful  in  the  usual  endemic  diseases  of  tropi- 
cal climates. 

After  leaving  Apollonia,  the  coast  is  more  hilly  and  varied  in  its  ap- 
pearance, and  generally  densely  wooded,  excepting  the  small  patches 
of  cultivated  ground  required  to  raise  sustenance  for  the  inhabitants. 
Jlxim,  a  small  fort  belonging  to  the  Dutch,  standing  upon  one  of  the 
promontories,  forming  Cape  Three  Points,  next  presents  itself.  The 
soil  here  is  a  deep  and  fine  red  earth,  in  the  lower  strata  ;  towards 
the  surface  it  is  more  loose  and  sandy.  The  surrounding  country  is 
every  where  covered  by  a  thick  vegetatioa.  Alter  quitting  this  place 
we  arrive  at  Hollandia,  once  a  considerable  fort  belonging  to  the 
Dutch,  but  now  deserted.  It  is  situated  upon  the  sea  side,  as  are  all 
the  European  settlements  on  this  coast.  The  appearance  of  the  coun- 
try is  nearly  the  same  with  the  part  already  mentioned. 

Dixcove,  a  British  fort,  is  built  upon  an  elevated  prominence,  form- 
ing the  boundary  of  a  large  creek,  in  1.  30°  west  long.  The  country 
adjoining  is  hilly,  and  nearly  impenetrably  covered  by  large  trees  and 
bushes.  The  soil  is  generally  a  deep  tenaceous  fine  clay,  leaving  no 
where  a  rock  in  sight,  unless  upon  the  sea  side.  The  limited  view 
afforded,  led  us  to  suppose  them  entirely  of  the  primitive  formation  ; 
quartoze  and  syenitic  blocks  being  thrown  upon  the  beach  by  the 
immense  surf.  The  mouth  of  this  creek  is  greatly  obstructed  by  coral 
reefs. 

This  small  fort  is  picturesquely  situated,  overlooking  the  small  bay 
and  Negro  Town  on  the  one  side,  and  on  the  other  the  extended 
ocean,  while  the  adjoining  country  exhibits  a  mass  of  verdure  in  va- 
rious tints  ;  and  from  the  abrupt  elevatfcn  of  immense  trees,  amidst 
the  other  comparatively  dwarfish  productions  of  the  soil,  a  diversi- 
fied light  arfRshade  are  produced,  new  to  those  recently  arrived  in  a 
tropical  country. 

Succondee  is  the  next  place  deserving  of  observation.  Here  the 
British  and  Dutch  have  settlements.  The  Dutch  fort  is  erected  up- 
on a  prominence  of  micaceous  rock  of  considerable  elevation,  form- 
ing the  eastern  boundary  of  a  spacious  bay. — The  British  settlement 
stands  at  a  short  distance  from  the  head  of  this  bay  in  a  low  and 
marshy  situation.  The  soil  in  most  parts  is  a  deep  and  fine  absorb- 
ent clay  ;  iu  others,  a  dark  and  rich  earth  ;  and  with  the  exception 


WEST  COAST  OX  AFRICA.  i>7£ 

oi  cultivated  patches,  that  are  uncommonly  fertile,  the  country  is 
quite  uncleared  of  its  luxuriant  productions.  Insects  and  reptiles, 
usually  found  in  hot  climates  in  all  very  moist  soils,  are  very  abun- 
dant. The  very  absorbent  nature  of  the  soil  along  the  whole  of  this 
part  of  the  country,  and  its  moist  state  during  a  great  portion  of  the 
year,  render  this  place  productive  of  fevers  and  diseases  of  the  se- 
creting organs.  In  our  progress  towards  the  eastern  part  of  this 
coast,  we  arrive  at  Commenda,  an  English  fort.  It  is  placed  in  a  low 
marshy  situation,  but  the  country  towards  the  interior  is  more  ele- 
vated. The  soil  is  either  wet  and  swampy,  or  of  a  deep  and  loamy 
clay. 

St.  George  del  Mina  is  the  chief  settlement  belonging  to  Holland, 
and  the  seat  of  their  African  Government.  It  is  the  best  fortress 
upon  the  coast,  and  is  situated  on  a  sm;tll  peninsula,  formed  by  an  in- 
considerable river  running  obliquely  into  the.^ea.  The  immediate  vici- 
nity of  this  fortification  and  adjoining  town  is  better  cultivated  than  any 
part  upon  the  coast  ;  even  here  the  Dutch  have  in  some  degree  pur- 
sued their  favourite  recreation  of  horticulture.  The  surrounding 
country  is  level,  and  profusely  covered  by  the  usual  vegetable  pro- 
ductions. The  soil  is  in  some  places  of  a  light  earth,  covering  a 
deep,  heavy,  and  tenacious  clay  ;  in  other  places  it  is  a  deep  clay 
throughout,  of  nearly  the  same  kind  as  is  usually  met  with  on  this 
coast.  The  adjoining  native  town  is  populous,  and  its  inhabitants 
even  wealthy. 

Cape  Coast  Castle,  the  principal  settlement  belonging  to  this  coun- 
try, stands  upon  a  very  low  and  insignificant  prominence  of  granite 
and  quartz  rocks.  The  native  town  is  placed  near  the  walls  of  the 
castle,  between  it  and  the  adjoining  country.  This  town  is  built  of 
the  tenacious  and  heavy  clay  which  forms  the  soil  on  which  it  stands, 
and  the  houses  are  so  closely  placed  to  each  other,  as  scarcely  to  al- 
low a  passage  between  them  ;  during  the  rainy  season  every  house 
appears  placed  in  a  mire  of  clay  and  mud. 

In  every  considerable  vacancy,  and  on  the  grounds  immediately 
surrounding  the  town,  accumulations  of  every  species  of  filth  would 
soon  take  place,  did  not  the  moist  and  warm  atmosphere  promote  its 
decomposition  and  carry  off  the  volatilized  products,  while  insects, 
reptiles,  and  birds,  assist  in  furthering  the  same  effect.  The  soil  is 
rather  various,  in  some  places  it  is  a  rich  black  earth,  in  others  a 
brown  heavy  clay,  interspersed  by  small  fragments  of  mica  and 
quartz  ;  but  in  all  places  it  is  uncommonly  deep,  and  exuberant  in  its 
wild  productions  ;  from  which,  with  exception  of  the  patches  of  corn 
or  rice  fields  under  cultivation,  it  is  completely  uncleared.  There 
is  no  river  in  the  vicinity,  and  consequently  the  supply  of  good  water 
is  very  deficient  during  the  dry  season.  It  then  abounds  with  ani- 
malcula4.  and  the  noxious  gases,  disengaged  in  the  low  and  marshy 
ravines,  from  which  it  is  generally  obtained. 

In  our  eastern  progress  along  the  coast,  the  next  place  of  import- 
ance to  which  we  will  turn  our  attention,  is  Anamaboo>  a  fort  belong- 
ing to  this  country.  It  stands  upon  the  sea  side,  in  a  very  low  situa- 
tion, with  a  large  native  town  between  it  and  the  neighbouring  coun- 

35 


£74  jiN'£r,toENC&  OK  TROPICAL  CLIMATES,  &c. 

try,  which  is  hilly  and  covered  with  clumps  of  majestic  trees,  every 
where  surrounded  by  a  dense  underwood.  The  soil  does  not  differ 
from  that  we  hnve  already  mentioned.  In  travelling  along  this  part 
of  the  coast  several  other  forts  and  settlements,  belonging  both  to  this 
country,  to  the  Danes,  and  the  Dutch,  present  themselves  ;  some 
have  been  relinquished  since  the  abolition  of  the  slave  trade,  but  all 
of  them  are  similarly  situated  with  those  we  have  already  mentioned, 
and  the  soil  and  aspect  of  the  country  continue  the  same  until  we  ar- 
rive at  Accrah,  in  1°  east  longitude. 

The  Accrah  Country,  in  which'  the  English,  Dutch,  and  Danes  have 
settlements,  is  one  most  extensive  and  beautiful  plain.  As  far  as  the 
sight  can  reach,  not  a  hill  can  be  seen,  unless  in  days  of  unusual  clear- 
ness, very  distant  mountains  may  be  descried  in  the  interior  of  the 
country.  This  very  extensive  plain  may  be  considered  as  one  im- 
mense meadow  oflorig  grass,  with  occasional  picturesque  clumps  of 
trees.  The  unincumbered  state  of  the  soil,  as  well  as  its  peculiar 
nature,  are  favourable  to  cultivation,  and  the  health  of  both  natives 
and  Europeans.  The  alluvial  earth,  through  the  whole  of  this  coun- 
try, and  for  nearly  100  miles  eastward,  varies  from  almost  a  pure 
sand,  to  a  sandy  mould,  resting  upon  horizontal  strata  of  primary 
sandstone,  and  allowing  the  rains  to  percolate  and  flow  along  the  in- 
ferior layers.  Owing  to  this,  and  the  open  state  of  the  country,  agri- 
culture is  more  attended  to  ;  and  endemic  diseases,  that  abound  in 
all  the  countries  we  have  hitherto  described,  more  seldom  occur 
here.  This  comparative  salubrity  of  climate  induces  convalescents 
from  the  neighbouring  settlements  to  resort  to  this  place  ;  and  the 
advantages  they  obtain  are  most  striking.  Nor  is  the  different  effects 
of  these  climates  confined  to  the  human  species  ;  many  of  the  more 
perfect  animals,  such  as  horses,  dogs,  &c.  which  either  cannot  live 
for  a  short  time,  or  enjny  a  sickly  existence  on  most  parts  of  this  coast, 
are  abundant  in  this  district  of  country.  From  the  nature  of  the 
soil  permitting  the  moisture  to  find  a  ready  passage  through  its  strata, 
the  sun'*  rays  produce  a  higher  degree  of  temperature  on  its  surface? 
and  consequently  the  sea  and  land-breezes  blow  in  more  regular  suc- 
cession* The  former  is  more  refreshing,  while  the  latter  is  infinite- 
ly less  fraught  with  the  noxious  gases. 

The  greater  extent  of  the  Gold  coast,  with  the  exception  of  the 
beautiful  county  of  Accrah,  is  of  a  deep  and  rich  clay  soil,  covered 
by  an  exuberant  vegetation  and  lofty  forests.  The  different  Euro- 
pean settlements  scattered  along  its  margin,  are  generally  erected 
abd  retained  \vithout  regard  to  salubrity.  This  is  particularly  the 
case  with  those  belonging  to  this  country  ;  most  of  them  being  plac- 
ed in  lo\v  situations,  and  either  surrounded  by,  or  in  the  immediate 
vicinity  of,  the  most  fertile  sources  of  malaria.  Every  breeze  must 
waft  it  into  the  apartments  of  the  susceptible  tenant.  The  great 
depth  of  the  absorbent  soil,  and  its  dense  verdure  and  impenetrable 
Underwood,  absorb  the  greater  part  of  the  periodical  rains  ;  little 
of  it  finds  its  way  to  the  sea,  hence  the  paucity  of  rivers  along  this 
part  of  the  coast.  The  rains  commence  in  May,  and  terminate  about 
the  beginning  of  August.  They  are  afterwards  quickly  evaporated 
by  a  vertical  sun  from  the  retentive  soil,  conveying  the  gases 


WEST  COAST  0£'  AFRICA. 

rated  from  it  and  the  decaying  vegetables.  This  is  very  sensibly 
evinced  by  a  month's  continuance  of  fogs  and  haze,  which  always 
follows  this  season.  The  moisture  and  gases  thus  produced  from 
the  soil,  in  conjunction  with  that  obtained  from  the  neighbouring 
ocean,  are  again  precipitated,  and  constitute  what  is  called  the  after 
rains,  which  fall  about  the  end  of  September  and  in  October.  The 
quantity  of  rain  during  the  year  is  from  80  to  100  inches.  The  wind 
during  the  first  rains  always  blows  from  the  sea.  During  the  foggy 
season  the  air  is  generaly  tranquil,  owing  to  the  copious  evaporation 
from  the  earth's  surface,  after  its  almost  deluged  state.  This  condi- 
tion of  the  atmosphere  favours  the  concentration  of  the  noxious  ele- 
ments given  off  by  the  soil,  &c.  and  renders  it  more  sultry  and  op- 
pressive, than  is  indicated  by  the  actual  rise  of  temperature.  Its 
mean  through  the  whole  year  does  not  exceed  831°,  generally  rang- 
ing from  72  to  96°.  The  barometer  does  not  vary  above  one-eighth 
of  an  inch  on  either  side  of  30°. 

During  the  dry  season  the  sea  and  land-breezes  are  regular  ;  and 
on  this  part  of  the  coast  the  harmattan,  or  dry  east  wind  is  of  fre- 
quent occurrence  in  this  season.  Its  beneficial  influence  in  promot- 
ing recovery  from  all  the  diseases  experienced  in  this  country  is  always 
remarkable  ;  nor  are  its  effects  confined  to  promoting  recovery,  or 
invigorating  the  debilitated  ;  epidemics  are  arrested  in  the  midst  of 
their  progress,  and  even  the  virus  of  small-pox  will  not  begin  to  act 
upon  the  system,  during  its  continuance,  and  if  already  commenced, 
the  progress  will  always  be  favourable. 

Throughout  the  greater  part  of  this  district  of  the  .African  coast, 
vegetable  productions  form  the  chief  source  of  subsistence.   But  ani- 
mal food,  although  not  abundantly  supplied  them,  is  still  within   the 
reach  of  the  more  wealthy,  especially  in  the  northern  countries  em- 
braced by  this  sketch,  and  in  the  richer  kingdoms   of  Akim,  Dahor 
iney,  and  Ayo,  that  are  situated  inland,  from  the  eastern  exir^mity  of 
the  Gold  coast. — The  surface  of  the  soil  may  be  considered,  gene- 
rally speaking,  as  entirely  uncultivated.  The  preparation  it  receives 
can  scarcely  deserve  the  name  of  cultivation,  nevertheless  it  seldom 
fails  in   producing  abundantly  from  the  seeds   committed   to  it ;  as, 
however,  they  only  subject  to   culture   what  they  consider  sufficient 
for  their  sustenance  until  the  return  of  the  season,  a  scarcity  occa- 
sionally happens.     This  is  always  the  effect  of  a  shorter  or  longer 
duration  of  the  rains,  and  consequently  gives  rise  only  to  a  partial 
failure  in  their  crops  : — According  to  the  soil  and  situation,  they  cul- 
tivate  rice,  millet,  maize,  (zea   mays,)  yams,  (dioscorea  bulbifera,) 
plantains,  (rnusa  sapientum,)  sweet  potatoes,  (convolvulus  batatas,) 
sweet  or  innocuous  cassada,  (jatropha  janipha  ;)  the  poisonous  spe- 
cies, (I.  manihot,)  is  also  cultivated,  and  is  employed  in  sauces  with 
the  capsicum   annuum,  or  C.  frutescens,  or  also   with   the   amomum 
grana  paradisii  ;  during  the  boiling  it  undergoes  in   the   process,  it 
loses  its  noxious  qualities.  Ground-nuts,  (arachis  hynogea,)  form  ano- 
ther considerable  article  of  food  ;  these  grow  near  the  extremity  of  the 
root  of  the  plant.  In  addition  to  those,  we  may  enumerate  the  follow- 
ing fruits  that  are  abundant : — Ananas,   (bromelia  bananas,)  bana- 
nas, (rausa  paradisaica,)  cocoa-nuts,  (cocoa  nucifera.)  guayavos,  (gua- 


276  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

yava  psidium,)  papaws.  (carica  papaya,)  water-melons,  (anguria  tri- 
lobata,)  limes,  (citrus  medica,)  and  several  species  of  the  tamarind. 

After  passing  along  the  champaign  and  open  country  of  Accrah,  we 
arrive  at  the  similarly  situated  settlements  of  Prampram  and  Ningo. 
The  soil  on  this  part  of  the  coast  is  light  and  sandy,  and  generally 
open  and  well  cultivated. — Game  may  be  had  in  tolerable  abundance  ; 
deer,  hares,  patridges,  guinea-fowls  being  seen  in  great  numbers, 
Domestic  animals  are  also  much  more  abundant  in  this  part  of  the 
coast.  From  Ningo  a  few  miles  brings  us  to  the  Rio  Volta,  a  large 
river,  at  the  entrance  of  which  the  Danes  have  a  fort.  Although  ca- 
pacious at  the  entrance,  and  so  far  as  it  has  been  navigated,  apparent- 
ly of  considerable  magnitude,  yet  the  numerous  sand  banks  and  rocks 
at  its  mouth  render  it  of  dangerous  navigation.  This,  as  the  rest  of 
the  large  rivers  on  this  part  of  the  coast,  abounds  with  crocodiles 
and  hippopotami.  The  coast  to  the  eastward  of  this  river  (frequent- 
ly received  the  appellation  of  the  Slave  coast,)  for  many  miles  retains 
nearly  the  same  species  of  soil  with  that  just  mentioned.  This  coun- 
try formerly  possessed  two  settlements  on  this  part  of  the  coast,  in 
the  dominions  of  the  King  of  Dahomey  ;  they  were  relinquished  af- 
ter the  abolition  of  the  slave  trade. 

The  Slave  Coast  commences  at  Rio  Volta,  and  extends  to  the  Bay 
of  Biafra,  in  lat.  3°  north  and  ?i°  east  longitude. — The  whole  of  this 
coast  is  remarkably  lew  and  swampy,  and  deeply  indented  by  creeks, 
and  the  capacious  but  often  shoaly  mouths  of  the  large  rivers  that 
flow  into  this  part  of  the  Gulf  of  Guinea.  The  most  remarkable  of 
these  are  the  Formosa,  old  and  new  Calabar,  and  the  Cross  and  del 
Rey  rivers.  According  to  Reichard,  these  are  different  mouths  of 
the  Niger,  by  which  it  disembogues  itself  into  the  Atlantic.  These 
rivers  flow  through  the  extensive  kingdoms  of  Benin,  Warree,  and 
Biafra,  and  are  navigable  to  a  considerable  distance  from  their  en- 
trance. Owing  to  the  extensive  traffic  carried  on  with  the  different 
States  in  their  vicinity,  in  palm  oil,  ivory,  and  ebony,  &c.  given  in 
exchange  for  British  manufactures  ;  and  to  the  facilities  which  they 
afford  to  the  native  traders  from  the  more  inland  States,  for  the 
transport  of  their  commodities,  these  rivers  are  more  frequented  than 
any  on  this  coast.  Their  banks,  however,  are  so  swampy,  and  the 
soil  in  general  so  richly  wooded,  as  to  render  commercial  specula- 
tion an  undertaking  of  surprising  enterprise  on  the  part  of  Eu- 
ropeans, constituting  the  crews  of  vessels  proceeding  to  this 
country.  We  believe  half  of  those  who  proceed  on  such  a  voyage 
never  return  ;  and  we  have  known  instances  of  one-forth  only  surviv- 
ing their  short  stay  in  this  climate.  The  necessity  for  vessels  pro- 
ceeding some  distance  up  these  rivers,  in  order  to  enter  upon  the 
field  of  traffic,  necessarily  brings  them  within  the  sphere  of  action  of 
the  malaria  generated  from  the  mud,  ooze,  and  decaying  vegetables, 
which  continually  cover  their  banks.  These  sources  of  disease  are 
greatly  multiplied,  both  during  and  after  the  rainy  season,  from  the 
nearly  inundated  state  of  the  country,  and  by  the  sultry  and  stagnant 
state  of  the  atmosphere.  The  diseases  which  prove  so  fatal  to  the 
crews  of  vessels,  (who  are  the  only  visitors  of  this  country,)  are  con- 
tinued ?nd  remittent  fevers,  dysentery,  and  cholera  morbus.  The- 


""•  WEST  COAST  OF  AFRICA.  277 

unhappy  victim  of  disease  may  consider  himself  so  far  fortunate,  if 
he  escape  with  an  attack  of  one  of  these  only  ;  not  unfrequently  dy- 
sentery carries  off  the  individual  whom  fever  had  spared.  The  soil 
in  this  part  of  the  coast  is  generally  a  muddy  clay.  The  district  that 
adjoins  the  Gold  Coast,  and  forms  a  part  of  the  kingdom  of  Dahomey, 
is  more  open  ;  and  the  soil  is  generally  sandy,  or  varying  from  that 
to  a  gravelly  clay.  The  quantity  of  rain,  and  the  rise  of  tempera- 
ture, may  be  considered  the  same  here  as  in  the  countries  previous- 
ly described.  The  sea-breezes  are  neither  so  strong  nor  so  regular 
in  succession  on  this  part  of  the  coast  as  in  most  of  its  divisions  al- 
ready mentioned. 

From  the  account  we  have  attempted  to  give  of  this  part  of  the 
African  coast,  oar  readers  must  be  struck  by  the  sameness  of  aspect, 
which  the  whole  of  it  affords.  This,  as  may  naturally  be  supposed, 
gives  rise  to  a  similar  uniformity  in  the  character  of  the  diseases  to 
which  Europeans,  either  lately  arrived,  or  for  a  considerable  time 
resident  in  it,  are  subject.  These,  as  may  be  expected,  vary  accord- 
ing to  the  time  of  residence,  the  intensity  of  the  causes,  and  indi- 
vidual circumstances  of  the  patient. 

We  shall  conclude  this  article  with  a  few  brief  observations  on  the 
more  fatal  diseases  of  the  country — fevers  and  dysentery.  Those 
who  arrive  in  this  country  are  subject,  within  the  first  nine  months, 
and  more  frequently  within  as  many  weeks,  to  the  endemic  yellow 
fever,  to  bilious  diarrhoea,  to  cholera  morbus,  and  dysentery.  If  a 
bilious  diarrhrea  or  cholera  precede  an  attack  of  fever  in  the  new 
comer,  (or  what  is  usually  called  the  seasoning,)  of  a  tolerably  sound 
constitution,  both  diseases  may  be  comparatively  mild. 

Fever  is  the  disease  which  produces  the  greatest  degree  of  mortali- 
ty, and  may  attack  new  comers  at  all  periods  of  the  year.  Nor  do 
residenters  remain  long  without  suffering  from  its  visits,  although 
under  a  different  type.  When  unacclimates,  of  a  phlegmatic  or  me- 
lancholic temperament,  are  subjected  to  the  causes  of  the  disease  in 
considerable  concentration,  the  vital  energy  may  be  so  completely 
overwhelmed  as  to  be  incapable  of  reaction,  and  none  of  the  symp- 
toms of  that  stage  of  the  disease  can  be  discernible.  In  such  cases 
the  frame  of  the  subject,  in  the  space  of  from  one  to  five  days,  sinks 
into  dissolution,  exhibiting  a  liquescent  form  of  fever  ;  the  body 
being  semiputrescent,  even  before  vitality  has  entirely  relinquished 
her  seat.  In  those  of  a  full  habit,  of  a  strong  muscular  formation,  or 
of  the  sanguine  or  irritable  temperaments,  violent  symptoms  of  reac- 
tion rapidly  supervene  to  those  which  indicated  the  stage  of  inva- 
sion ;  these,  if  not  arrested  by  judicious  treatment,  exhaust  the  vital 
energy  in  a  period  proportionately  to  their  degree  of  intensity,  and 
the  resistance  made  by  the  constitution.  This  consequent  exhaus- 
tion may  be  so  great  as  to  be  incompatible  with  the  continuance  of 
life  ;  or  some  important  organ  may,  during  the  height  of  the  excite- 
ment, suffer  in  such  a  manner  as  to  put  a  speedy  stop  to  the  vital  re- 
lations of  the  system.  Either  of  these  effects  may  individually  ope- 
rate in  producing  death,  or  they  may  combine  in  being  its  more  im- 
mediate cause.  In  long  residenters  the  fevers  that  terminate  fatally 
are  generally  of  a  remittent  type  ;  in  them,  the  changes  wrought 


278  1NFLUBNCE  OF  TROPICAL  CLIMATES,  &C. 

upon  the  system,  previous  to  the  last  and  grand  change,  are  seldom 
so  simple  ;  along  with  considerable  exhaustion  of  the  vital  energy, 
there  is  always  present  considerable  visceral  disease.  Intermittents 
are  common  among  the  acclimates,  and  often  induce  visceral  disease. 

Dysentery  is  more  frequent  upon  the  Gold  coast  than  on  any  other 
part.  This  may  be  owing  to  the  scarcity  of  good  water.  The  mode 
of  living  has  also  a  considerable  share  in  giving  rise  to  this  disease. 
In  now  comers  it  is  chiefly  confined  to  the  mucous  membrane  of  the 
colon  and  rectum,  with  increased  action  of  the  muscular  fibres,  espe- 
cially the  longitudinal  fasciculi  ;  these  contract  the  colon  into  cells, 
and  from  being  considerably  shorter  than  the  intestines,  even  in 
the  healthy  state,  this  viscus  is  drawn  into  folds  that  meet  those  of  the 
opposite  side  ;  thus  forming  complete  valves  against  the  further  pro- 
gress of  the  contents,  or  of  the  matters  thrown  into  this  by  the  small 
intestines.* 

In  unacclimates  this  disease  is  more  acute,  and  generally  requires 
depletion,  with  medicines  calculated  to  allay  the  irritation  and  spasms, 
constituting  some  of  the  leading  symptoms  of  the  disease.  Irritating 
purgatives,  &c.  only  tend  to  prolong  the  disease.  In  long  residenters 
it  is  generally  combined  with  considerable  disease  in  the  liver  and 
spleen,  and  then  not  unfrequently  assumes  the  chronic  form  ;  such  a 
complication  will  consequently  point  out  the  treatment.  Our  limits 
prevent  us  from  taking  a  view  of  the  other  but  less  prevalent  dis- 
eases. 

Among  the  natives  fever  seldom  appears  ;  they  are  not  however, 
exempt  from  its  attack.  It  generally  assumes  an  ephemeral  form, 
and  is  frequently  complained  of  according  to  the  organ  chiefly  affect- 
ed, as  when  the  head,  stomach,  or  bowels  become  considerably  de- 
ranged through  the  course  of  the  febrile  action.  Fever,  however, 
sometimes  commences,  and  runs  through  the  regular  stages,  without 
any  particular  organ  suffering  the  onus  of  disease  ;  but  the  different 
stages  are  always  of  shorter  duration  in  them  than  in  Europeans  ; 
and  the  action  of  the  heart  becomes  more  rapidly  increased.  During 
the  course  of  the  excitement,  it  more  frequently  is  the  case  that  some 
particular  organ  or  tissue  suffers  in  such  a  manner  as  to  arrest  the  at- 
tention of  both  patient  and  physician  to  that  alone.  Dysentery  is  of 
frequent  occurrence  among  them,  and  often  assumes  an  epidemic 
character. 

*  We  have  met  with  the  pure  idiopathic  cases  of  this  disease,  in  which  no  de- 
rangement was  visible  in  the  liver.  We  consider  the  exclusive  manner  of  treat- 
ing dysentery  with  mercury,  recommended  by  many,  as  evincing  narrow  views  ot 
pathology,  inasmuch  as  it  attributes  its  origin  to  diseased  secretion  of  the  liver, 
We  do  not  doubt,  that  both  diseases  may  take  place  simultaneously,  or  the  one 
supervene  on  the  other ;  and  thus  both  may  be  prolonged  or  exalted,  either  in- 
dividually or  conjunctly.  Of  this  we  have  seen  proofs,  established  by  post  mor- 
tem inspection.  We  also  disagree  with  those,  especially  our  continental  bre- 
thren, who  consider  dysentery  as  a  colonitis.  That  there  is  inflammation  of  the 
mucus  membrane  of  this  intestine,  frequently  extending  along  the  rectum  on  one 
side,  and  to  the  small  intestines  on  the  other,  we  grant ;  but  there  are  also  an  ir- 
ritable state  and  spasmodic  action  existing  in  the  muscular  fibres,  and  were  in- 
flammation also  existing  in  them,  these  in  our  opinion,  could  not  take  place.  The 
inflammation  no  doubt  extends  to  the  cellular  tissue  connecting  both  coats,  and  in 
its  progress  in  this  connecting  membrane  detaches  the  mucous  tissue. — Reviewer. 


YELLOW  FEVER.  279 

During  the  course  of  this  hasty  sketch,  our  readers  cannot  fail  of 
perceiving  from  the  nature  of  the  soil  and  its  productions,  from  the  to- 
pography and  climate  of  the  country,  that  it  must  be  productive  of  the 
sources  of  these  endemic  diseases. 

To  trace  the  effects  of  those  causes  upon  the  frame — to  inquire 
by  experiment  and  observation  into  the  series  of  causes  and  effects, 
as  they  are  sensibly  developed  in  the  system,  as  well  as  into  their 
primary  mode  of  action — vrere  the  objects  that  chiefly  led  us  to  en- 
counter a  climate,  in  which  no  one  could  be  placed  a  night  without 
danger.  These  inquiries  will  be  soon  laid  before  our  brethren  :  we 
have  only  to  regret  that  no  facilities  were  afforded  us  for  extending 
them  as  we  could  have  wished  ;  but,  notwithstanding,  we  have  some 
reason  to  be  satisfied  with  the  result." — Foreign  Journal. 

I  have  introduced  the  foregoing. 


WESTERN  HEMISPHERE. 


ON  YELLOW  FEVER. 

The  disease  which  I  am  now  to  consider  has  no  common  claims  to 
the  attention  of  the  Medical  Philosopher.— The  extent  and  frequency 
of  its  epidemical  visitations  ; — -its  fatal  tendency  and  rapid  career  ;-— 
and  the  merciless  selection  of  the  more  robust  and  healthy  as  its  legi- 
timate prey,— are  circumstances  in  the  history  of  Yellow  Fever, 
which  cannot  fail  to  command  a  deep  feeling  of  interest  in  the  inves- 
tigation of  its  origin  and  nature. 

Much  light  has,  of  late  years,  been  thrown  on  this  subject  by  the 
contributions  of  various  practitioners  in  the  public  service,  who  have 
meritoriously  employed  a  portion  of  their  retirement  subsequent  to 
the  war,  in  giving  to  the  world  the  sum  of  their  observation  and  ex- 
perience, It  is  to  be  regretted,  however,  that  an  increased  familiarity 
with  the  scenes  of  woe,  has  not  produced  a  corresponding  unison  of 
sentiment  in  regard  to  the  aetiology  of  the  disease  from  which  those 
events  have  sprung  ; — It  may  even  be  said,  that  no  question  in  medi- 
cal science  has  been  more  keenly  agitated  than  that  of  the  contagious 
or  non-contagious  origin  of  Yellow  Fever.  The  discussion  of  this 
point  will  be  brought  forward  hereafter.  Omitting  the  names  of  the 
older  writers,  I  shall  here  confine  myself  to  a  brief  enumeration  of 
the  principal  of  those  who  have  subsequently  published  their  opi- 
nions in  favour  of,  or  in  opposition  to  the  doctrine  of  contagion,  with- 
out, however,  aiming  at  giving  a  complete  list,  or  of  being  scrupu- 
lously exact  as  to  the  priority  of  their  respective  publications.  In 
favour  of  the  contagious  nature  of  Yellow  Fever,  we  have  the  au- 
thority of  Lind,  Blane,  William  Wright,  Chi^holm,  W.  Currie,  Tho- 
mas, Pugnet,  Bally,  Gonzales,  Pym,  and  Fellowes.  On  th«  other 


INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

hand,  in  the  list  of  authorities  who  consider  it  as  not  contagious,  are 
included  the  names  of  Hunter,  Jackson,  Moseley,  Hush,  Miller, 
Bancroft,  Lempriere,  Deveze,  Saveresy,  Valentin,  Dickson,  Me  Ar- 
thur, Burnett,  Doughty,  Veitch,  Ferguson,  Dickinson,  Mortimer, 
Sheppard,  Robertson,  &c.  It  will  be  seen  that,  numerically,  the  ad- 
vantage is  greatly  on  the  side  of  the  latter  ;  and  it  is  but  candid  to 
admit  that,  in  opportunities,  also,  the  preponderance  is  still  more  in 
favour  of  the  non-contagionists,  many  of  whom,  for  a  series  of  years, 
held  official  situations  in  the  West  Indies  which  afforded  them  ample 
means  of  observing  this  fatal  disease,  in  various  places,  and  in  all  its 
forms . 

I  shall  first  lay  before  my  readers  copious  reviews  of  the  essay 
and  sequel  of  Dr.  Bancroft  on  Yellow  Fever,  which  will  be  found  to 
include  a  full  discussion  of  the  controverted  points  ;  to  these  will 
succeed  two  philosophical  papers  by  Drs.  Dickson  and  Ferguson  ; 
and  the  subject  will  be  concluded  by  the.  correct  and  valuable  histo- 
ries and  methods  of  treatment  of  this  formidable  endemic  by  Dr.  Me 
Arthur  and  Mr.  Dickinson.  The  department  will  thus,  I  trust,  be 
found  to  present  a  comprehensive  expose  of  the  opinions  of  the  most 
recent  writers  on  Yellow  Fever  ;  of  whom  it  is  but  justice  to  add, 
that  their  acknowledged  abilities  and  ample  experience  in  this  dis- 
ease, are  sure  pledges  of  the  importance  and  accuracy  of  whatever 
proceeds  from  their  pens. 


Jin  Essay  on  the  Disease  called  YELLOW  FEVER,  with  observations  con- 
cerning Febrile  Contagion,  Typhus  Fever,  Dysentery,  and  the  Plague  • 
partly  delivered  as  the  Gulstonian  Lectures,  before  the  College  of  Phy- 
sicians, in  the  Years  1806  and  1807.  By  EDWARD  NATHANIEL  BAN- 
CROFT, M.  D.  Fellow  of  the  Royal  College  of  Physicians,  Physician 
to  the  Army,  and  late  Physician  to  St.  George's  Hospital.  London. 
1811,  pp.  811. 

SEC.  I. — Dr.  Bancroft  having,  in  the  year  1806,  been  appointed  to 
deliver  the  Gulstonian  Lectures  before  the  College  of  Physicians, 
made  choice  of  the  Yellow  Fever  as  the  subject  for  that  occasion  ; 
and  certainly  no  subject  can  be  more  interesting  than  fever,  the  na- 
ture and  causes  of  which  are  still  involved  in  so  much  obscurity,  and 
in  the  medical  treatment  of  which  disease  we  are  still  so  far  from  be- 
ing universally  successful,  that  every  attempt  to  add  to  our  knowledge, 
and  improve  our  treatment  of  so  dreadful  a  scourge  to  mankind,  de- 
serves to  be  received  with  thankfulness  and  examined  with  candour. 

The  Essay  on  Yellow  Fever  is  divided  into  four  parts  ;  the  first  of 
which  contains  observations  on  the  Symptoms  and  Mode  of  Treat- 
ment. Previous,  however,  to  giving  a  detail  of  the  history  and  pro- 
gress of  the  disease,  the  author  enters  into  a  discussion  respecting 
the  propriety  of  its  present  name.  This  is  derived  from  one  parti- 
cular symptom,  the  colour  of  the  skin  ;  pretty  general,  indeed,  but 
not  universal,  nor  even  essential  to  the  existence  of  the  disease,  nor 
proportioned  to  the  magnitude  of  its  violence  and  danger.  Were  the 


YELLOW  FEVER.  28 1 

name  of  the  disease  to  be  derived  from  a  single  symptom  only,  the 
author  thinks  Causus  would  be  a  more  appropriate  title  ;  not  only  as 
a  burning  heat  of  the  skin  occurs  more  generally  than  yellowness  of 
it,  but  because  also  the  degree  of  heat  existing,  affords  some  indica- 
tion for  the  successful  treatment  of  the  disease.     A  great  objection 
that  may  be  urged  against  both  there  names  is,  that  these  symptoms 
occur  in  various  degrees  in  most  other  fevers,  and  are  not  characte- 
ristic of  the  nature  and  properties  of  any  one.     The  fever  in  ques- 
tion has  been  called  by  Sauvages  Typhus  icierodes,  but  it  is  not  gene- 
rally connected    with  any  morbid  state  of  the   liver  or  the  bile  ;   by 
Cullen,  Typhus  cumjlavedine  cults  ;  by  the  French,  Muladie  de  Siam, 
and  Fievre  Matelntle ;    by    the   Spaniards,   Chapeton'ida,   and  Vomito 
prieto  ;  the  latter  of  which  names  the  author  thinks  equally  objec- 
tionable with  Yellow  Fever,  since  neither  the  black  vomit  nor  yel- 
lowness is>  universally  present,  nor  peculiar  to  this  disease.   Sporadic 
fevers,  occurring  in  very  warm  climates  from  any  accidental  cause,  are, 
the  author  observes,  liable  to  be  accompanied  with  the  same  severe 
and   fatal  symptoms  which  occur  in  the  epidemic  yellow  fever,  and 
have  accordingly  been  confounded  with  this  latter.     They  are  to  be 
distinguished,  first,  by  the  causes  of  the  former  being  generally  some 
excess,  over-fatigue,  taking  cold,  or  affections  of  the  mind,  operating 
therefore  on  a  few  individuals  only  ;  while  the  causes  of  the  latter 
are  of  a  more  general  nature,  and  operate  on  a  considerable  number 
of  persons  at  the  same  time  :  Secondly,  by  their  progress  ;  the  first 
being  always  of  a  continued  type,  the  latter  almost  always  manifest- 
ing a  disposition  to  remit.     It  is  of  the  epidemic  disease  the  author 
principally  treats,  although  his  observations  are  equally  applicable  to 
both  diseases. 

There  is  reason,  however,  to  apprehend,  as  frequently  happens  in. 
nosological  arrangements,  that  the  above  distinction  of  type  is  ra- 
ther artificial  than  iounded  in  nature.  In  the  plethoric  stranger,  and 
in  arid  situations,  the  Fever  is  usually  ardent  and  continued  ;  while 
in  those  who  have  resided  some  time  in  the  climate,  whose  systems 
are  reduced  from  a  state  of  high  health  and  European  vigour,  and  in 
uncleared  woody  places,  it  frequently  assumes  the  remittent  form  : 
in  other  words,  the  type  will  much  depend  on  the  habit  of  the  patient, 
season,  locality,  and  the  nature  and  intensity  of  the  peculiarly  excit- 
ing cause. 

Symptoms.  As  the  attack  and  progress  of  these  are  well  described 
by  the  author,  I  shall  give  them  in  his  own  words. 

'*  The  progress  and  violence  of  the  yellow  fever  differ  greatly,  ac- 
cording to  the  force  of  its  cause,  the  vigour  and  excitability  of  the  pa- 
tient, and  season  of  the  year.  When  it  prevails  epidemically  in  hot 
climates,  and  attacks  young  and  robust  men,  lately  arrived  from  tempe- 
rate regions,  the  disorder  commonly  appears  in  its  most  aggravated 
form.  In  this,  the  patient  first  complains  of  lassitude,  restlessness,  slight 
sensations  of  cold  and  nausea,  which  symptoms  are  soon  succeeded  by 
strong  arterial  action,  intense  heat,  flushing  of  the  face,  redness  of  the 
eyes,  great  pain  and  throbbing  in  ihe  head  and  in  the  eye-balls,  un- 
easiness and  pain  in  the  stomach,  oppression  of  the  praecordia,  a 

36 


S82  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

white  fur  on  the  tongue,  and  a  dry  parched  skin,  withfr  quick,  full, 
tense,  and  generally  strong  pulse,  though  it  is  sometimes  oppress- 
ed and  irregular.  These  symptoms  are  speedily  accompanied  by 
frequent  efforts  to  vomit,  especially  after  swallowing  food  or  drink, 
with  discharges,  first  of  such  matters  as  the  stomach  happens  to  con- 
tain, and  afterwards  of  considerable  quantities  of  bile,  appearing  first 
yellow  and  then  green,  sometimes  tinged  with  blood,  but  in  the  pro- 
gress of  the  disorder  with  matters  of  darker  colours  ;  an  increase  of 
pain,  heat,  and  soreness  at  the  prrecordia,  also  occurs,  with  constant 
wakefulness,  and  frequently  with  delirium,  more  or  less  violent. 
This  paroxysm,  or  exacerbation,  which  has  been  called  the  inflam- 
matory, or  the  febrile  stage,  generally  lasts  thirty  six  hours,  but  is 
sometime«  protracted  for  seventy-two  hours,  and  even  longer,  proba- 
bly in  consequence  of  either  general  or  local  inflammation,  (particu- 
larly in  the  brain  or  stomach,)  or  of  irregularity  in  the  circulation, 
which  are  known  to  prolong  the  paroxysms  in  fevers  of  type. 

**  A  remission  then  occurs,  in  which  many  of  the  symptoms  sub- 
side, so  often  as  to  induce  a  belief  that  the  fever  is  at  an  end,  and 
recovery  about  to  take  place.  Frequently,  however,  the  foundations 
of  irreparable  injury  to  the  brain  or  stomach  have  already  been  laid 
in  the  former  paroxysm  ;  and  in  such  cases  the  remission  is  short  and 
imperfect.  During  these  remissions,  the  pulse  often  returns  appa- 
rently to  the  condition  of  health,  the  skin  feels  cool  and  moist,  and 
the  intellect,  if  previously  disturbed,  sometimes  becomes  clear  ; 
sometimes,  however,  the  patient  remains  in  a  quiet  and  stupid  state, 
a  symptom  generally  denoting  great  danger. — Another  sign  of  danger, 
as  denoting  a  very  morbid  condition  of  the  stomach,  is  the  renewal 
of  the  efforts  to  vomit,  when  pressure  is  made  on  that  organ,  or  food 
is  swallowed.  After  a  certain  interval,  this  remitting  stage  is  suc- 
ceeded by  another,  which  may  be  called  a  second  paroxysm,  and 
which,  probably,  would  appear  as  a  renewed  exacerbation,  if  the 
violent  effects  of  the  first  had  not  almost  exhausted  the  patient's  ex- 
citability, and  in  conjunction  with  the  extreme  depression  of  strength 
which  usually  attends  inflammation  of  the  brain  or  stomach,  rendered 
him  nearly  unsusceptible  of  those  morbid  actions  which  are  neces- 
sary for  that  purpose. — In  this  latt'er  stage,  then,  instead  of  great  fe- 
brile heat,  and  strong  arterial  action,  the  wamth  of  the  body,  and  the 
frequency  and  strength  of  the  pulse,  are  often  less  than  when  the 
patient  was  in  health  ;  but  frequently  the  pain  and  heat  in  the  sto- 
mach become  excruciating,  with  incessant  strainings  to  vomit,  which 
in  most  of  the  fatal  cases,  are  followed  by  hiccough,  and  repeated 
discharges  of  matters  resembling  turbid  coffee,  more  or  less  diluted, 
or  the  grounds  of  coffee,  and  also  by  evacuations  of  similar  dark 
matters  from  the  bowels.  Here  it  is  to  be  observed,  that  when  these 
symptoms  occur,  (indicating  a  violent  affection  of  the  stomach  and 
bowels,)  the  patient  is,  in  general,  sufficiently  in  possession  of  his 
intellects  to  know  those  about  him,  and  to  give  distinct  answers  to 
questions  made  to  him,  although  his  excessive  weakness  often  renders 
him  incapable  of  mental  exertion,  and  his  inability  even  to  raise  his 
head,  miy  induce  the  appearance  of  coma.  In  those  cases,  how- 


YELLOW  !FEV€IU 

ever,  in  which  the  brain  has  suffered  greater  injury  than  the  sto- 
mach, the  retching  and  black  vomit,  just  described,  do  not  so  com- 
monly occur,  but,  instead  of  them,  low  muttering,  or  coma,  with  con- 
vulsions of  the  muscles  of  the  face,  and  other  parts  of  the  body, 
supervene.  About  this  time,  also  the  tongue  and  teeth  are  covered 
with  a  dark  brown  fur  ;  yellowness  of  the  skin  and  petechiae  make 
their  appearance;  the  urine,  when  passed,  has  a  putrid  smell  and 
dark  colour  ;  the  faeces  likewise  become  most  offensively  putrid  ; 
haemorrhages  sometimes  take  place  from  the  nostrils,  gums,  and  va- 
rious other  internal  surfaces  ;  there  is  in  some  patients,  a  suppression 
of  urine  ;  in  others  an  involuntary  discharge  of  it,  and  of  the  faeces  ; 
the  pulse  becomes  feeble  and  intermits  ;  the  breathing  is  laborious  ; 
portions  of  the  skin  assume  a  livid  colour  ;  the  extremities  grow- 
cold  ;  and  life  is  gradually  extinguished." 

The  above  description  of  the  disease  accords  with  the  distinction 
which  the  author  has  attempted  t>  establish  ;  but  as  he  is  here  de- 
lineating the  most  severe  and  fatal  form  of  yellow  fever,  the  propri- 
ety of  characterizing  the  subsidence  of  great  heat  and  vascular  action 
at  the  close  of  the  6rst  stage  as  "  a  remission,"  is  very  questionable. 
It  is,  in  fact,  the  transition  from  inordinate  action  to  exhaustion — to 
that  almost  hopeless  state  which,  (the  foundation  of  almost  irrepara- 
ble mischief  having  been  already  laid  in  the  most  important  viscera,) 
is  speedily  to  terminate  in  disorganization  and  death,  and  has  nothing 
in  it  of  the  salutary  tendency  of  a  remission.  As  Dr.  Gillespie  ob- 
serves, **  it  is  proper  to  caution  young  practitioners  against  a  mis- 
take very  common  with  regard  to  the  yellow,  or  ardent  fever  ;  that 
is,  of  taking  the  fatal  stage  which  follows  the  cessation  of  ardent  heat 
and  great  excitement,  and  which  accompanies  a  sphacelus  of  the  vis- 
cera, for  a  salutary  crisis  of  the  disease.'* — Diseases  of  Seamen* 
"  Cette  diminution  des  symptomes  en  impose  quelquefois  au  malade, 
et  meme  aux  me"decins  in  experimented . " — Diet,  des  Sciences  Medi- 
cules — tome  xv.  p.  336. 

This  declension  of  fever  at*  the  close  of  the  first  stage  excited  ear- 
ly attention,  and  is  often  so  marked  as  to  have  been  frequently  mis- 
taken for  a  proof  of  returning  health.  It  is  noticed  by  Dr.  Hume, 
who  had  the  charge  of  the  naval  hospital  at  Jamaica  between  the 
years  1739  and  1749,  and  was  afterwards  a  Commissioner  of  the  Sick 
and  Hurt  Board,  in  the  following  terms  :  "  The  pulse  is  at  first  full, 
quick,  and  strong,  but  in  forty  eight  hours  after  seizure,  or  there- 
abouts, it  sometimes  becomes  calm  and  regular,  scarce  to  be  distin- 
guished from  the  pul*e  of  a  person  in  health." — See  Dr.  Hume's 
Account  of  the  Yellow  Fever,  published  by  Dr.  Donald  Munro. 

The  preceding,  (says  Dr.  Bancroft,)  is  a  description  of  the  disease 
in  its  most  violent  form,  and  it  sometimes  proceeds  with  such  rapidi- 
ty as  to  destroy  the  patient  on  the  third  or  fourth  day,  or  even  soon- 
er. It  seldom  happens  that  in  the  most  severe  cases  the  head  and 
the  stomach  are  both  equally  affected  ;  one  of  those  organs  however 
generally  suffers  such  derangement  as  to  destroy  the  patient.  Those 
who  die  early  in  the  disease  appear  to  perish  from  an  affection  of  the 
head,  with  less  vomiting,  whereas  those  who  have  the  stomach  more 
violently  affected,  are  usually  found  to  have  their  mental  faculties 


284  INFLUENCE  OF  TROPICAL  CLIMATES,  &.C. 

clear  though  much  weakened  ;  and  they  seldom  expire  before  the 
end  of  the  fourth,  or  the  beginning  of  the  fifth  day,  p    17. 

The  dissections  of  patients  dying  of  this  fever  have  discovered  ap- 
pearances correspondent  to  the  affection  of  the  part  most  violently 
attacked  by  the  disease. — Where  the  affection  of  the  head  has  form- 
ed the  principal  feature  of  the  disorder,  the  integument*  of  the  brain 
have  generally  been  found  more  or  le**  inflamed,  especially  near  the 
temporal  bones  ;  the  vessels  of  the  dura  mater  and  of  the  pia  maler 
were  not  unfrequently  observed  to  be  very  turgid  with  bl'iod.  which 
was  also  sometimes  extravasated.  Effusions  of  watery  fluid  have 
likewise  been  seen  over  the  surface  of  the  brain,  or  in  vesicles  be- 
tween the  pia  mater  and  the  tunica  ararhnoidea.  In  some  cases  the 
integuments  have  been  so  firmly  attached  to  each  other,  and  to  the 
brain,  that  in  attempting  to  raise,  or  separate  them,  a  part  of  the 
substance  of  the  brain  has  been  torn  up  The  volume  of  the  brain 
is  often  increased,  and  the  substance  of  it  is,  in  some  instances,  more 
firm  than  usual  ;  when  cut,  the  vessels  distributed  through  it  have 
been  so  distended  with  blood,  that  the  medullary  part  has  immediately 
become  thickly  spotted  with  red  points,  owing;  to  the  oozing  of  blood 
from  the  divided  vessels  ;  and  it  was  not  rare  to  find  that  some  of 
those  vessels  had  been  ruptured,  and  that  blood  had  escaped  into  the 
substance  of  the  brain.  The  ventricles  usually  contained  water,  of 
a  yellow  colour,  and  were  in  some  cases  quite  filled  with  it.  The 
plexus  choroides  has  often  been  loaded  with  blood. 

In  those  cases  of  the  disease  where  the  symptoms  indicating  a  se- 
vere affection  of  the  stomaoh  have  been  predominant,  inflammation 
of  that  viscus  has  been  disrovered  upon  dissection.  In  some  cases, 
almost  the  whole  inner  surface  was  inflamed  ;  very  often  portions  of 
the  villous  coat  were  ahraded,  nor  unfrequently  observed  floating 
among  the  contents  of  that  viscus.  Mark-  of  inflammation,  but  less 
violent  than  these,  have  also  been  often  seen  in  the  smaller  intestines, 
especially  near  the  pylorus,  The  inflammation  seems  to  be  of  the 
kind  denominated  erythernatic  ;  this  kind  of  inflammation  is  apt  to 
spread,  the  author  observes,  wherever  there  is  a  continuity  of  mem- 
brane or  of  structure  ;  and  as  such  continuity  exi  ts  through  the  whole 
alimentary  canal,  the  viscera  nearest  to  the  stomach  must  be  liable  to 
participate  in  the  inflammatory  affection  of  the  latter. 

The  Black  Vomit  is  so  universal  a  symptom  in  severe  cases  of  yel- 
low fever,  that  it  becomes  an  important  object  to  ascertain  its  source 
and  origin.  Many  writers  have  attributed  it  to  a  superabundant  and 
altered  secretion  of  bile,  but  certainly  without  foundation,  as  is  evi- 
dent from  the  facts  stated  by  our  author,  both  from  his  own  observa- 
tion and  that  of  several  other  physicians,  'n  the  greater  number  of 
dissections  the  liver  has  been  found  in  a  healthy  state,  and  where  it 
has  differed  from  its  natural  appearance,  it  has  frequently  been  of  a 
paler  colour  ;  the  gall-bladder  has  also  at  the  sume  time  been  found 
in  a  healthy  state,  containing  its  usual  quantity  of  bile,  not  at  all  al- 
tered in  its  appearance  or  properties. 

At  a  time  when  the  stomach  has  been  distended  with  black  vomit, 
the  passage  from  the  duodenum  into  the  stomach  has  been  complete- 
ly obstructed  by  the  pylorus  valve,  so  that  no  portion  of  the  matter 


YELLOW  FETER. 

could  have  deen  derived  from  the  hepatic  system,  in  every  part  of 
which  system  the  bile  was  quite  natural  in  colour,  taste,  and  consis- 
tence. The  matter  of  black  vomit,  compared  with  bile,  differs  ma- 
terially from  it  in  all  its  physical  qualities  ;  '*  it  differs  from  it  in  co- 
lour ;  for  however  dark  the  bile  may  appear  in  its  most  concentrated 
state,  it  always  displays  a  yellowish,  or  greenish  yellow  tinge,  when 
spread  on  a  white  surface,  or  when  diluted  ;  and  this  i«»  never  ob- 
served with  the  matter  of  black  vomit.  It  has  also  been  found  that 
an  addition  of  bile  to  the  latter,  altered  its  nature  so  much  as  to  give 
it  an  appearance  different  from  what  it  had  before  ;  nor  could  the 
black  vomit  be  imitated  by  any  mixture  of  various  proportions  of 
dark-coloured  bile  with  the  fluids  found  in  the  stomach,  it  differs 
most  decidedly  in  taste  ;  the  black  vomit  being  always  insipid,  when 
freed  from  other  foreign  matters,  whereas  the  bile  can  never,  by  any 
means,  be  deprived  of  intense  bitterness." 

If  then  the  black  vomit  is  not  bile  in  a  morbid  state,  nor  contains 
any  portion  of  that  fluid,  whence  is  it  derived  1  It  must  proceed  from 
the  stomach  itself,  and  appears  to  be  in  most  cases,  a  consequence  of 
inflammation  of  that  viscus.  Some  physicians  have  entertained  an 
opinion  that  the  black  vomit  is  a  particular  morbid  secretion  by  the 
inflamed  vessels  or  glands  of  the  stomach  ;  Dr.  Bancroft  thinks,  that 
"  it  is  merely  blood  which  has  been  effused  from  some  of  the  small 
arteries,  ruptured  in  consequence  of  the  separation  of  certain  por- 
tions of  the  villous  coat,  and  has  coagulated  within  the  general  cavi- 
ty of  the  stomach,  or  on  the  surface  over  which  it  was  effused  ;  and 
having  been  afterwards  detached  and  triturated  by  the  violent  and 
frequent  contractions  of  that  organ  in  the  efforts  to  vomit, "has  had  its 
appearance  as  a  coagulum  of  blood  altered,  and  its  colour  darkened 
by  the  gastric  juice,  or  by  some  chemical  decomposition,  either  spon- 
taneous, or  produced  by  the  action  of  the  air,  or  other  matters  con- 
tained in  the  stomach."  In  confirmation  of  this  opinion  it  is  stated 
that  in  many  cases,  portions  of  the  inner  surface  of  the  stomach  have 
been  covered  with  a  coat  of  thick  blackish  Matter,  and  upon  remov- 
ing this  coat,  the  parts  beneath  it,  and  no  other,  were  found  inflamed. 
The  substance  thus  obtained  was  exactly  similar  to  black  vomit,  and 
there  is  reason  to  believe  that  it  must  have  been  derived  from  the 
vessels  of  the  inflamed  part.  At  those  spots  moreover,  where  the 
villous  coat  had  been  abraded,  the  extremities  of  arteries  have  been 
frequently  seen  filled  with  this  dark  coloured  matter  ;  and  collec- 
tions of  the  same  matter  have  even  been  discovered  immediately  un- 
der the  villous  coat.  A  relaxation  of  the  vessels  of  the  stomach  may 
give  rise  to  haemorrhage  from  that  viscu«,  as  we  find  happens  in  some 
cases  of  extreme  debility,  and.  probably,  this  may  take  place  in  some 
very  few  instances  of  yellow  fever,  where  the  coats  of  the  stomach 
remain  entire  ;  but  the  author  concludes,  with  great  reason,  •*  that 
the  black  vomit  is  much  less  frequently  the  consequence  of  a  relaxa- 
tion of  vessels,  than  of  a  separation  of  some  portions  of  the  internal 
coats  of  the  stomach." 

The  Affections  of  the  Skin  in  this  disease  are  in  some  respects  simi- 
lar to  those  which  take  places  in  other  fevers  ;  during  the  strong  ar- 
terial action  which  succeeds  the  first  attack,  the  skin  becomes  exces- 


286  INFLUENCE  OF  TROFICAL  CLIMATES,  &C. 

sively  dry  and  parched,  with  an  intensely  burning  or  pungent  heat. 
Sweats  are  in  this  stage  a  very  rare  occurrence  ;  and  when  they  do 
appear,  no  relief  is  afforded  by  them.  A  feeling  of  general  soreness 
of  the  skin  also  takes  place  in  many  patients.  Of  the  yellow  suffu- 
sion, which  has  given  name  to  the  disease,  we  hare  the  following  des- 
cription : 

*'  The  yellowness  beings  in  a  few  cases,  within  the  first  forty -eight 
hours  ;  sometimes  on  the  third  day,  and  frequently  not  until  the  fourth 
or  fifth.  It  is,  indeed,  sometimes  observed  but  a  few  minutes  before, 
or  a  little  after  death.  I  believe,  that  in  many  instances  it  might,  with 
attention,  be  discovered  on  the  eyes  ;  but  it  is  commonly  first  observ- 
ed on  the  cheeks,  extending  towards  the  temples,  and  about  the  angles 
of  the  nose  and  mouth  ;  about  the  lower  jaw  and  on  the  neck,  along 
the  course  of  the  jugular  veins,  whence  it  afterwards  spreads  in  stripes 
and  patches  along  the  breast  and  back,  downwards,  so  as  at  last  to  be- 
come universal  in  some  patients,  though  in  others  it  remains  partial. 
The  yellowness  is  sometimes  of  a  dingy  or  brownish  hue,  sometimes 
of  a  pale  lemon,  and  at  others,  of  a  full  orange  colour.  When  the 
yellowness  appears  only  in  patches  or  spots,  and  of  a  dingy  or  brown- 
ish hue,  these  are  frequently  intermixed  with  other  spots  of  a  florid 
red,  or  a  purple,  or  livid  colour." 

This  yellowness  of  the  skin  is,  with  one  partial  exception,  deriv- 
ed from  the  bile  ;  and  the  manner  of  its  entrance  into  the  blood-ves- 
sels is  thus  accounted  for  by  the  author.  "  When  there  has  been 
very  frequent  and  violent  vomiting  for  some  length  of  time,  the  sto- 
mach, diaphragm,  and  abdominal  muscles,  are  apt  to  become  irritable 
to  an  extreme  degree,  s  » that  at  e  ich  effort  of  the  former  to  discharge 
its  contents,  the  latter  will  frequently  be  thrown  instantaneously  into 
sfrong  spasmodic  contractions,  and  the  liver,  together  with  the  gall- 
bladder, will  be  as  it  were,  suddenly  caught,  and  tightly  squeezed  in 
a  powerful  press  ;  the  necessary  consequence  of  which  pressure 
seems  to  be,  that  all  the  fluids  contained  in  that  viscus  will  be  driven 
towards  both  extremities,*backwards  as  well  as  forwards,  in  those 
vessels  which  are  not  provided  with  valves  to  prevent  their  retro- 
grade motion.  Under  such  circumstances  it  can  scarcely  be  doubted, 
that  the  bile  will  be  forced  to  regurgitate  in  this  manner,  and  pass 
from  those  ducts  into  the  vena  cava  at  each  violent  compression  of 
the  liver  ;  and  that  by  continued  and  strong  spasmodic  contractions 
of  the  before-mentioned  muscles  in  vomiting,  a  considerable  quan- 
tity of  bile  may  be  carried  into  the  circulation,  and  a  yellow  suffusion 
resembling  jaundice  be  very  speedily  produced." 

In  this  manner  also  is  the  yellowness  of  the  skin  accounted  for 
which  succeeds  from  the  bite  of  venomous  reptiles,  and  the  poisoning 
by  some  specie?  of  mushrooms,  and  certain  poisonous  fishes  ;  in  all 
which  cases,  violent  convulsive  vomiting  is  a  usual  symptom.  The 
exception  to  the  yellow  suffusion  being  derived  from  the  bile,  refers 
to  those  cases  in  which  the  yellowness  of  the  skin  occurs  partially, 
or  in  patches  or  spots  ;  in  these  instances  it  is  thought  to  be  produced 
by  a  cause  similar  to  that  which  produces  the  yellowness  that  follows 
ecchymosis,  and  to  be  connected  with  that  particular  state  of  the  blood 
and  of  the  vessels  which  gives  rise  to  haemorrhages  from  various  parts 


YELLOW  FETER.  287 

ot'  the  body,  external  and  internal.  It  is  accordingly  in  these  last 
cases  that  extreme  danger  is  more  certainly  indicated,  than  in  the  ge- 
neral suffusion  arising  from  compression  of  the  liver. 

Having  given  Dr.  Bancroft's  account  of  the  Black  Vomit  and  the 
Yellow  Suffusion,  I  may  remark  that  his  explanation  of  the  nature  and 
origin  of  the- former,  (though  somewhat  different  from  the  view  of  Dr. 
Jackson  i»  his  sketch  of  the  history  and  cure  of  fehrile  diseases,  p  63 
-4,)  nearly  coincivles  with  that  of  other  accurate  observers  of  the  phe- 
nomena of  the  disease  and  the  appearance*  on  dissection.* 

With  respect  to  the  yellowness  of  the  skin,  Dr.  Bancroft's  expla- 
nation is  not  quite  so  satisfactory.  Drs.  Dick^on  and  Mr.  Arthur  hoth 
inform  me,  that  they  have  occasionally  seen  this  symptom,  previous 
to  the  occurrence  of  vomiting  ;  as  well  as  in  cases,  where  fiom  great 
attention  to  allay  the  gastric  irritability,  or  other  causes,  as  when  the 
head  is  greatly  or  chiefly  affected,  but  little  vomiting  comparatively, 
had  occurred  in  the  course  of  the  disease  ;  and  Mr.  Dickinson,  in  his 
work,  also  remarks,  "  that  vomiting  does  not  always  precede,  nor 
does  it  always  occur  when  the  bilious  suffusion  takes  place,"  p.  171. 

That  of  Broussai*  appears  the  more  correct  exposition.  He  is  of 
opinion  that  the  yellow  colour  depends  solely  on  the  violent  irritation 
of  the  duodenum,  which  is  propagated  to  the  secretory  organ  of  the 
bile  ;  that  all  the  other  symptoms  of  this  fever  are  those  of  inflamma- 
tion of  the  stomach  and  small  intestines;  and  that  the  researches  of 
Pugnet,  Tommasini,  Dubrieul,  and  many  others,  have  no  doubt  of 
the  correctness  of  this  determination  respecting  the  seat  of  the  dis- 
ease. 

The  yellow  dingy  patches  in  the  advanced  stage,  which  our  author 
considers  an  exception,  produced  by  a  cau-*e  similar  to  the  yellowness 
following  ecchymosis,  and  probably  connected  with  that  peculiar 
state  of  the  blood  and  loss  of  power  in  the  smaller  vessels  which 
gives  rise  to  passive  haemorrhage,  is  indicative  of  the  worst  stage  of 
the  disorder  ;  and  is  probably  dependent  on  the  peculiarly  unfavoura- 
ble habit,  or  deleterious  nature  of  the  exciting  cause,  and  sometimes 
on  the  previous  treatment  of  the  patient. 

The  yellow  fever  has,  by  several  authors  and  practitioners,  been 
confounded  with  the  Plague  as  well  as  with  Typhus,  from  both  of 
which  it  essentially  differs.  Reserving  for  discussion  in  another  part 
of  the  volume  the  question,  whether  yellow  fever,  like  the  others, 
can  be  propagated  by  contagion  ;  the  author  next  lays  down  several 
diagnostic  signs  by  which  these  diseases  are  to  be  distinguished  from 
each  other  :  the  yellow  fever  differs  from  the  plague,  in  that  it  pre- 
vails only  in  those  countries,  and  in  those  seasons,  in  which  the  heat 
is,  or  has  recently  been,  so  great  as  would  destroy  or  stop  the  pro- 
gress of  the  plague;  in  the  intertropical  climates,  therefore,  so  favoura- 
ble to  the  existence  of  the  yellow  fever,  the  plague  is  not  at  all  known. 
The  glandular  and  cutaneous  affections,  called  buboes  and  carbun- 
cles, so  constantly  accompanying  the  plague,  are  not  found  to  exist  in 

*  See  Dr.  Bancroft's  appeqdix,  No.  I,  containing  "  Observations  on  the  Black 
Vomit,"  by  Dr.  Physic,  and  Dr.  Ffirth,  extracted  from  the  New-York  Medical 
Repository,  vol.  5th,  p.  129,  and  Dr.  Cox's  Medial  Museum,  vol.  1st-  p.  116- 
118,  also  Dr.  Mc.Arthur'a  account  in  the  subsequent  pages. 


USo     '  INFLUENCE  OF  TROPICAL  CLIMATES,  &LC. 

the  yellow  fever.  A  violent  febrile  paroxysm  is  essential  to  the  cha- 
racter of  yellow  fever,  whilst,  according  to  the  best  authority,  per- 
sons have  been  attacked  with  the  plague  without  having  the  least  fe- 
brile affection,  as  sometimes  happens  in  small  pox,  scarlet  fever,  and 
measles.  Black*  are  very  rarely  seized  with  the  yellow  fever  ;  and 
when  seized  are  much  les*  violently  affected  by  it  than  Whites,  living 
under  the  same  circumstances  ;  whereas  they  are  not  less  susceptible 
than  Whites  of  the  pLigue,  and  die  of  it  in  a  far  greater  proportion. 

"  Yellow  fever  differs  from  typhus  in  the  following  circumstances, 
viz.  it  prevails,  as  I  have  already  mentioned,  only  during,  or  imme- 
diately after,  very  hot  seasons,  in  which  typhus  is  soon  extinguished  ; 
and  it  is,  in  its  turn,  completely  extinguished  upon  the  accession  of 
cold  weather,  in  which  typhus  is  commonly  most  prevalent  ;  it 
attacks  most  readily  and  most  violently  the  young  and  robust,  over 
whom  typhus  is  allowed  to  have  the  least  power  ;  it  begins  with 
much  greater  exertions  of  the  living  power  than  typhus  ;  is  attended 
with  many  different  symptoms,  and  terminates  much  sooner  ;  it  is, 
besides,  disposed  to  remit,  and  it  frequently  changes  into  a  regular 
remittent,  and  sometimes  even  into  an  intermittent  fever,  which  true 
typhus  is  never  observed  to  do." 

Having  thus  given  a  general  outline  of  the  symptoms  and  progress 
of  the  disease,  the  author  proceeds  to  a  consideration  of  the  various 
remedies  proposed  for  its  cure,  and  offers  some  observations  on  the 
propriety  and  utility  of  each. 

Blteding. — A  great  contrariety  of  opinion,  the  author  observes, 
has  subsisted  on  the  subject  of  bleeding  in  yellow  fever  ;  some  con- 
sidering it  as  an  indispensable  remedy,  and  others  alleging,  that  near- 
ly all  who  were  bled  had  died.  Independently  of  actual  experience, 
several  circumstances  attending  this  disease  appear  to  render  it  pro- 
bable, that  the  evacuation  of  blood  would  be  serviceable  to  the  pa- 
tients labouring  under  it.  This  fever,  especially  the  violent  forms  of 
it,  seldom  occur  among  any  other  persons  than  strangers  recently  ar- 
rived from  temperate  climates  ;  the  greater  part  of  whom  will  com- 
monly be  found  to  be  young,  robust  and  vigorous.  In  its  first  stage 
it  is  frequently  accompanied  with  a  very  considerable  degree  of  ge- 
neral inflammation,  (which  is,  the  author  thinks,  perhaps  greater 
than  in  any  other  kind  of  fever,)  indicated  by  a  hard,  full  and  strong 
pulse  ;  the  distressing  sense  of  universal  distension,  the  red,  starting, 
watery  eye,  and  the  parched  skin.  Those  who  have  falfen  victims 
to  the  disease  have  generally  exhibited,  on  dissection,  signs  of  con- 
siderable inflammation  in  various  organs,  and  especially  in  the  head 
and  stomach.  That  the  duration  of  a  paroxysm  of  fever  is  length- 
ened, and  its  distressing  consequences  augmented  by  general  inflam- 
mation, is  well  ascertained  by  experience,  and  no  method  is  so  likely 
to  obviate  these  as  bleeding.  To  render  it  beneficial  it  should  be 
resorted  to  very  early,  (as  within  24  hours,  or  even  twelve,  if  possi- 
ble, from  the  attack  ;)  and  to  prove  effectual,  it  should  be  performed 
copiously,  from  a  large  orifice,  soon  after  general  inflammatory  ac- 
tion is  perceived  ;  more  benefit  arising  from  taking  away  a  large 
quantity  of  blood  at  once,  than  by  a  larger  evacuation  at  two  or  more 
bleedings.  The  propriety  of  the  evacuation  being  made  at  all,  how- 


YELLOW  FEVER.  28& 

ever,  and  the  quantity  of  blood  to  be  taken,  must  be  determined  by 
the  circumstances  of  each  patient. 

The  above  recommendation  of  blood-letting,  is  feeble  when  com- 
pared with  that  of  several  other  modern  authors,  but  I  am  not  dis- 
posed to  cavil  with  the  writer  on  this  account,  or  to  place  my  faith 
too  exclusively  in  any  remedy  ;  for  in  different  epidemics  and  states 
of  the  constitution,  the  same  measure  will  be  followed  with  very  dif- 
ferent results. — There  can  be  no  doubt,  however,  that  in  so  power- 
ful a  disease,  our  hopes  mu.«t  chiefly  rest  on  powerful  means  ;  and 
that  in  the  class  of  subjects  generally  selected  by  thi*  fever,  the 
young  and  robust,  the  lancet  should  be  used  with  a  bold  hand.  But 
it  should  be  ever  kept  in  mind,  that  the,  chance  of  success  will  almost 
entirely  depend  upon  its  being  used  within  a  fetv  hours  after  the 
commencement  of  the  attack.  When  employed  too  late,  it  will  cer- 
tainly hasten,  though  it  may  smooth,  the  passage  to  the  grave,- — for  it 
has  often  been  observed  that  patients  who  had  been  blooded  died 
with  much  less  suffering  than  those  who  had  not  undergone  this  ope^ 
ration. 

Cold  Water  is,  our  author  thinks,  a  very  efficacious  remedy  in  the' 
yellow  fever  ;  and  when  applied  externally,  affords  very  gre'at  relief 
to  the  feelings  of  the  patient,  who  is  frequently  distressed  with  a  sen- 
sation of  burning  heat  ;  the  temperature  of  the  skin,  at  the  same 
time,  being  actually  raised  so  much  as  four  degrees  of  Fahrenheit's 
thermometer  above  the  natural  standard.  It  is  only  when  the  heat 
of  the  body  is  above  the  natural  standard  that  cold  water  should  be 
applied  externally  ;  and  the  period  of  its  application,  and  the  fre- 
quency of  its  repetition,  must  generally  be  determined  by  the  feel- 
ings of  the  patient ;  for,  should  he  become  chilled  by  it,  much  mis- 
chief might  ensue.  To  avoid  the  fatigue  to  the  patient,  which  the 
usual  mode  of  applying  this  remedy  is  apt  to  induce,  the  author 
recommends,  as  a  useful  substitute,  that  he  should  be  covered,  as  he 
lies  in  bed,  with  a  single  sheet  wetted  with  cold  water,  which,  by 
evaporation,  will  gradually  reduce  the  temperature  of  his  body  to  a 
proper  standard. 

Notwithstanding  this  caution,  the  affusion  of  cold  water  in  the  first 
stage  is  by  much  the  best  and  most  efficacious  mode  of  proceeding  ; 
but  as  the  disease  advances,  aspersion,  or  ablution,  may  be  substitut- 
ed with  advantage,  for  then  the  shock  might  be  injurious,  and  the  ob- 
ject is  to  allay  morbid  heat  and  febrile  irritation. 

The  author  is  of  opinion  that  much  benefit  also  arises  from  cold 
water  taken  internally  as  drink  ;  small  quantities  of  which,  frequent- 
ly repeated,  he  has  observed  to  moderate  the  excessive  heat  of  body, 
as  well  as  the  violence  of  general  febrile  action  ;  it  is  efficacious  like- 
wise in  disposing  the  skin  to  perspire  gently,  and  in  preventing  in- 
flammation of  the  stomach,  or  diminishing  and  removing  it  after  it  had 
been  excited.  The  author's  experience  i«  confirmed  by  that  of  se- 
veral other  practitioners  ;  and  the  general  utility  of  cold  drinks 'ia 
fevers  has  been  acknowledged  by  all  physicians,  ancient  as  well  as 
modern,  while  the  author  thinks  it  has  been  too  seldom  employed  by 
British  and  American  physicians  in  their  treatment  of  yellow  fever* 

37 


290  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

Purgatives  are  proper  to  obviate  that  stale  of  costiveness  which 
frequently  precedes,  and  generally  accompanies,  yellow  fever  ;  they 
should  be  such  as  will  not  offend  or  irritate  the  stomach  hy  their 
bulk  or  quality  ;  the  author  appears  rather  to  employ  them  for  the 
purpose  of  preventing  an  accumulation  of  f<ecal  matters,  which  might 
produce  morbid  irritability  in  the  whole  intestinal  canal,  and  aggra- 
vate other  symptoms,  than  as  means  of  carrying  off  the  fever,  as  has 
been  proposed  by  Dr.  Hamilton  in  the  fevers  of  this  country. 

Here,  also,  the  author  is  too  sparing  in  his  approbation  of  so  va- 
luable an  auxiliary  as  purgativr-s  ;  though  he  very  properly  recom- 
mends such  as  will  not  offend  the  stomach  by  their  bulk  or  quality. 
Full  doses  of  calomel  combined  with  jalap,  compound  extract  of  Co- 
locynth,  &c.  assisted  hy  enemas,  if  necessary }  should  be  given  so  as 
to  insure  early  free  evacuations — nor  should  we  rest  until  this  object 
be  obtained  ;  and  such  quantities  of  medicines  of  this  class  should 
be  repeated  during  the  course  of  the  disease  as  will  obtain  two  or 
more  motions  daily. 

Emetics  are  very  properly  reprobrated  by  Dr.  Bancroft  in  the  yel- 
low fever,  on  the  grounds  that  gastric  irritability  is  usually  a  very 
early  symptom — one  of  the  most  difficult  to  allay — and  of  the  most 
dangerous  tendency.  So  far  from  being  removed  it  is  too  invariably 
aggravated  by  the  use  of  emetics  ;  as  indeed  must  be  expected  when 
the  irritability  of  this  organ,  instead  of  being  caused  by  bile,  undi- 
gested aliment,  or  other  offending  matter,  originates  from  sympathy 
with  the  morbid  condition  of  the  brain  or  of  the  surface,  or,  as  is  too 
often  the  case,  from  rising  inflammation  in  the  coats  of  the  stomach 
itself.  Neither,  observes  our  author,  are  their  pernicious  effects 
confined  to  this  viscus,  for  the  violent  efforts  to  vomit  exhaust  the 
strength  and  propel  a  larger  quantity  of  blood  to  the  brain,  already- 
suffering  from  undue  excitation.  Instead  of  increasing,  therefore, 
the  object  is  to  calm  and  allay  the  irritation  of  the  stomach  as  much 
as  possible  ;  and  the  most  likely  method  of  effecting  this  indication  is 
by  an  active  and  judicious  employment  of  such  means  as  lessen  the 
general  fever  and  local  inflammatory  action — by  keeping  the  bowels 
freely  open,  by  abstracting  morbid  heat  from  the  surface,  by  avoiding 
the  irritation  of  distension  from  drink  or  medicine,  and  by  the  counter 
irritation  of  a  large  blister  over  the  epigastrium.  With  the  same 
view  Dr.  B.  has  tried  small  doses  of  opium,  as  half  a  grain,  at  inter- 
vals, but  though  it  might  succeed  in  allaying  a  slight  degree  of  gastric 
irritability,  the  utility  of  opium  is  not  only  very  questionable,  but  in 
the  early  stage,  or  in  a  high  state  of  vascular  or  cerebral  excitement 
it  must  prove  decidedly  injurious. 

Sudorifics  are  also  justly  disapproved  of  by  Dr.  Bancroft,  as  tend- 
ing to  increase  that  disposition  to  vomit,  from  which  the  greatest  dan- 
ger is  to  be  apprehended.  The  preparations  of  antimony,  especially, 
too  often  leave  behind  them  a  degree  of  gastric  irritability  which  re- 
sists all  our  endeavours  to  appease  it,  and  there  can  be  no  doubt 
that  by  aiding  this  formidable  symptom,  they  have  been  too  frequent- 
ly employed  to  the  irreparable  injury  of  the  patient,  while  the  in- 
tention with  which  they  are  exhibited  cannot  be  effected  by  such 
means.  For  this  purpose  saline  draughts  in  a  state  of  effervescence- 


YELLOW  FEVER.  291 

and  other  mild  febrifuges /may  be  used  ;  but  the  most  effectual  mode 
of  restoring  the  natural  functions  of  the*surface,  is  by  cold  or  tepid 
affusion,  or  ablution,  and  such  other  measures  as  lessen  morbid  heat, 
and  febrile  action. 

The  Peruvian  Bark,  Dr.  B.  thinks,  may  be  exhibited  as  soon  as  the 
febrile  commotion  subsides  ;  but,  like  opium,  the  early  use  of  cin- 
chona is  of  very  questionable  propriety  :  there  will  he  a  risk  of  its 
reproducing  vomiting  if  it  has  subsided,  and  if  it  continues,  any  at- 
tempt to  muke  bark  remain  upon  the  stomach  is  equally  hopeless  and 
objectionable.  Indeed,  Dr.  B.'s  caution  not  to  give  it  "  when  there 
is  a  parched  skin,  a  hard  pulse,  a  dry  tongue,  great  heat  and  pain  at 
the  stomach,  or  delirium,'*  is  tantamount  to  a  prohibition  in  a  vast 
majority  of  instances  ;  for  too  often  are  some  of  those  or  other  dan- 
gerous symptom*,  where  it  is  equally  inadmissible,  the  very  difficul- 
ties with  which  we  have  to  contend. 

These  observations,  however,  chiefly  apply  to  the  ardent  con- 
tinued form  of  yellow  fever.  For  in  cases  where  decided  remissions 
are  observed,  in  marshy  situations,  arid  in  habits  reduced  by  long  re-,, 
sidence  or  otherwise;  in  fine,  where  the  febrile  movements  are  nei- 
ther of  the  same  rapidity,  nor  inflammatory  tendency,  the  bark  is 
often  of  the  greatest  service,  and  is  chiefly  depended  upon  in  the 
French,  and  some  of  the  other  Islands,  most  fruitful  in  vegetable  life 
and  decay.  When  the  violence  of  the  first  stage  is  passed,  and  the 
patient  is  rapidly  merging  in  a  state  of  great  exhaustion  and  depres- 
sion of  the  nervous  energy  and  vital  power,  cordials  and  stimulants, 
as  wine,  or  even  spirit  diluted,  ammonia,  capsicum,  &c.  are  to  be  re- 
sorted to  ;  and  small  quantities  of  some  bland  nutritious  matter  should 
be  cautiously  but  arduously  administered.  But  instead  of  attempt- 
ing to  do  too  much  in  the  advanced  period,  we  should  carefully  re- 
member, that  it  is  only  in  the  first  and  inflammatory  s'agf>,  and  soon 
after  its  onset,  that  we  can  hope  by  active  measures  either  to  subdue 
the  disease,  or  to  disarm  it  of  its  dangerous  tendency  to  rapid  disor- 
ganization and  death. 

It  is  not  to  be  wondered  at,  that  in  a  disease  so  frequently  fatal  in 
its  event,  and  so  unmanageable  by  mild  and  ordinary  methods,  re- 
course should  have  been  had  to  Mercury,  whose  effects  upon  the  ani- 
mal ceconomy,  whether  salutary  or  deleterious,  are  generally  very 
powerful.  It  certainly  has  been  employed  to  a  considerable  extent 
in  yellow  fever,  but  whether  advantageously  or  not,  is  a  matter  of 
some  doubt.  No  inconsiderable  authorities  may  be  adduced  on  each 
side  of  the  question,  and  their  decision  of  the  point  in  dispute,  is  said 
equally  to  rest  on  the  basis  of  expe-ience.  The  most  common  ope- 
ration of  this  metal,  when  exhibited  internally,  is  either  to  produce 
copious  evacuations  by  stool,  or  to  act  upon  the  salivary  glands,  so  as 
to  excite  considerable  salivation  ;  and  in  both  cases,  benefit  has  been 
said  to  be  derived  from  its  exhibition.  In  thoee  cases  of  recovery 
which  have  followed  the  employment  of  mercury,  some  evident  effects 
of  its  operation  have  been  commonly  manifested,  while  in  cases  which 
have  terminated  fatally  under  its  use,  no  perceptible  action  has  arisen 
from  it  ;  whence  the  recovery  in  the  former  case  has  been  attribut- 
ed to  the  action  thus  produced,  while  the  fatal  event  has  been  sup- 


INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

posed  to  be  owing  to  the  want  of  such  action.  Such  reasoning,  how- 
ever, there  is  ground  to  think  is  too  often  fallacious.  Supposing  that 
the  patients  labouring  under  yellow  fever,  in  whom  a  salivation  can 
be  excited,  generally  recover,  it  is  not  necessarily  to  be  inferred,  that 
their  recovery  was  effected  by  the  salivation  ;  or  that  when  patients 
died,  to  whom  mercury  had  been  given,  and  no  salivation  had  been 
produced,  such  patients  died,  becau-e  mercury  had  not  been  taken 
In  sufficient  quantity  to  produce  that  excretion.  It  is  far  more  reason- 
able to  conclude.  Dr.  B.  thinks,  that  where  persons  had  recovered 
from  the  yellow  fever,  after  having  been  silivated.  their  recovery 
was  not  occasioned  by  the  salivation,  but  was  the  consequence  ot  such 
a  condition  of  the  powers  of  life,  and  of  the  functions  connected 
therewith,  as  induced  a  mitigation  of  the.  disorder  ;  for  the  same  rea- 
son, and,  perhaps,  in  the  same  degree  as  it  favoured  the  operation  of 
the  mercury  upon  such  persons  ;  and,  therefore,  that  although  reco- 
very has  not  unfrequenlly  followed  or  accompanied  salivation,  the 
latter  was  not  the  cause  of  the  former.  In  like  manner,  there  is 
reason  to  conclude,  he  thinks,  that  when  patients  die  of  yellow  fever, 
after  all  attempts  to  excite  salivation  in  them  have  failed,  their  deaths 
have  resulted,  not  from  the  want  of  any  good  effect  which  salivation 
may  be  thought  capable  of  producing,  but  because  the  condition  of 
their  living  or  sensorial  power,  and  of  the  functions  depending  there- 
on, had  already  become  so  morbid,  as  to  render  their  recovery  im- 
possible. We  shall  here  give  the  summary  of  our  author's  reason- 
ing upon  this  important  subject,  the  exhibition  of  mercury. 

*'  In  order,  however,  to  attain  the  truth  upon  this  important  sub- 
ject, it  is  not  sufficient  for  us  to  discover,  that  recovery  generally 
follows  salivation  in  yellow  fever  though  even  this  is  contradicted  by 
many  very  rrgpoctal.le  authorities  ;  but  we  must  ascertain  whether 
those  practitioners  who  excite  salivation  in  as  many  of  their  patients 
as  may  he  suiceptible  of  it,  under  that  disorder,  do  in  fact  I«>se  a 
smaller  proportion  of  them  than  those  who  purposely  abstain  from 
all  endeavours  to  produce  that  discharge  ;  and  on  this  point,  I  must 
declare,  that  after  some  experience,  assisted  by  no  ordinary  portion 
of  inquiry  and  information,  1  have  not  been  able  to  discover  that  the 
salivators  were  more  successful  than  the  others.  And  if  not  more 
successful,  their  practice  has  certainly  been  hurtful  ;  because  in 
most  of  the  persons  who  have  recovered,  the  (perhaps  useless)  sali- 
vation had  retarded  the  convalescence,  and  produced  very  trouble- 
some affections  of  the  tongue,  mouth,  and  throat,  with  other  ill  con- 
sequences, as  is  well  known  and  acknowledged,  even  by  its  advo- 
cates. Dr.  Chisholm,  (at  page  367,  of  vol.  i.  of  his  Essay,)  warmly 
acknowledges  his  '*  obligation*  to  Dr.  Rush,  for  supporting  in  a  mas- 
terly manner,"  and  «*  pursuing  the  mercurial  mode  of  treatment," 
and  expresses  both  "  admiration  and  respect"  for  his  '«  fortitude"  in 
doing  so. 

But  Dr.  Rush,  notwithstanding  this  support  and  this  fortitude,  has 
candidly  stated,  that  '  in  the  City  Hospital,  (of  Philadelphia,)  where 
bleeding  was  sparingly  used,  and  where  the  Physician  depended  chiefly 
upon  salvation  more  than  one-half  died  of  all  the  patients  who  were 


YELLOW  FEVER.  293 

"  To  one  who  is  sincerely  desirous  of  discovering  and  adhering 
to  the  truth,  it  is  extremely  difficult  to  reconcile,  or  account  for,  the 
very  opposite  testimonies  given  on  this  subject  ;  and  the  doing  it 
would  moreover  be  too  invidious  for  me  to  attempt  it  This,  how- 
ever, appears  certain,  that  the  good  effects  of  the  mercurial  treatment 
have  been  greatly  exaggerated  by  persons,  who  either  were  deceived, 
or  were  willing  to  deceive  others  ;  that  many  persons  have  died  of  the 
fever  in  question,  although  mercury  administered  externally  or  inter- 
nally, had  produced  a  copious  salivary  discharge  ;  and  that  in  very 
many  others  who  have  recovered,  this  discharge  did  not  begin  until 
after  a  solution,  or  a  great  mitigation  of  the  disease  had  evidently 
taken  place  ;  which  solution  or  mitigation,  therefore,  could  not  have 
been  the  effect  of  salivation."* 

After  having  thus  gone  through  the  account  of  the  symptoms  and 
treatment  of  the  Yellow  Fever,  we  come  to  a  consideration  of  its 
causes.  A  belief  has  prevailed  of  the  contagious  nature  of  this  dis- 
ease ;  and  the  origin  of  it,  in  different  places,  has  been  ascribed  to 
the  action  of  contagion.  Our  author  strongly  controverts  this  opi- 
nion ;  and  while  he  denies  that  any  instances  of  the  fever  have  ever 
been  clearly  shown  to  arise  from  contagion,  he  enters  into  an  elabo- 
rate discussion,  to  show  the  impossibility  of  its  doing  so.  It  has  been 
asserted  by  some  authors  of  eminence,  that  all  fevers  are  naturally 
contagious,  and  capable  of  exciting  fever  in  other  persons.!  Among 
those  who  have  so  asserted,  Dr.  George  Fordyce  is  to  be  found,  and 
he  has  expressed  himself  very  strongly  on  this  subject  ;  his  opinion 
is,  that  a  peculiar  matter  is  generated  in  the  body  of  a  man  in  fever, 
which  being  carried  by  the  atmosphere,  and  applied  to  some  part  of 
the  body  of  a  person  in  health,  causes  a  fever  to  take  place  in  him  ; 
and  he  adds,  that  thi?  infectious  matter  is  produced  by  all  fevers  what' 
ever.  In  confirmation  of  this  opinion,  he  adds,  that  "by  lepeated  expe- 
rience it  is  now  known  that,  although  it  very  frequently  happens  that  a 
man  coming  near  another  afflicted  with  fever,  is  not  afterwards  affected 
with  the  disease,  yet.  of  any  number  of  men,  one-half  of  whom  go 
near  a  person  ill  of  this  disease,  and  the  other  half  do  not  go  near  a 
person  so  diseased,  a  greater  number  of  the  former  will  be  affected 
with  fever  than  of  the  latter,  in  a  short  period  afterwards."  Again, 
he  says,  **  the  author  has  known  seven  out  of  nine,  who  went  near  a 
person  afflicted  with  fever,  seized  with  the  disease  in  the  space  of 
three  weeks  afterwards  ;  there  is,  therefore,  a  perfect  ground  from 
experience,  for  believing,  that  coming  near  a  person  afflicted  with 
fever  is  a  cause  of  the  disease." 

Dr.  Bancroft's  objections  to  this  opinion  of  Dr.  Fordyce  are  thus 
stated.  "  This  general  indiscriminating  assertion,  if  it  were  true, 
could  only  prove  that  some  fevers  are  contagious  ;  not  that  all  are  so. 
But  the  assertion  is  manifestly  founded  upon  a  supposed  probability, 
or  presumption,  that  such  effects  would  result  from  the  causes  here 
described  ;  for  no  one  can  believe,  that  an  actual  experiment  was 

*  Mr,  Sheppard  in  a  very  able  Paper  in  the  13th  Volume  of  the  Edinburgh 
Medical  and  Surgical  Journal  has  adduced  the  opinions  of  various  modern  Prac- 
titioners in  corroboration  of  the  inutility  of  attempting  to  affect  the  system  with 
Mercury,  during  the  active  stage  of  Yellow  Fever. 

*  Drs-  Cleghorn,  Robert  Hamilton,  John  Clark,  Fordyce,  &c. 


294  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

ever  made  by  selecting  a  certain  number  of  persons,  and  sending  one- 
half  of  them  into  close  communication  with  a  febrile  patient,  and  after- 
wards contrasting  what  happened  to  those  who  were  not  allowed  to 
approach  any  person  labouring  under  fever.  Nor  would  a  single  ex- 
periment afford  any  conviction  on  tins  subject,  for  reasons  too  obvi- 
ous to  require  explanation.  Much  also  would  depend  on  the  species 
of  fever  to  whirh  the  individuals  in  question  are  supposed  to  have 
been  exposed,  which  is  not  mentioned  by  Dr.  Fordyce.  Few  per- 
sons, if  any,  doubt  of  the  contagious  quality  of  what  is  called  Jail  Fe- 
ver, and  few  believe  that  intermittent  fevers  possess  th'at  quality." 

Before  we  go  further,  I  must  reply,  in  answer  to  these  objec- 
tions, that  we  can  scarcely  allow  Dr  Fordyce's  assertion  to  be 
founded  upon  a  supposed  probability  or  presumption,  when  he  affirms 
that  by  repealed  experience  it  is  now  known,  &c.  ;  and  although  we 
cannot  prove  that  Dr.  Fordyce  actually  made  the  experiment  of  se- 
lecting a  certain  nnmber  of  persons,  and  sending  one- half  of  them 
into  close  communication  with  a  febrile  patient,  and  afterwards 
contrasting  what  happened  to  these  with  the  condition  of  those  who 
were  not  allowed  to  approach  any  person  labouring  under  fever  ; 
we  may  be  convinced  from  the  well  known  character  of  the  Doctor, 
that  he  would  not  neglect  any  practicable  method  of  ascertaining  the 
truth  of  an  opinion  he  was  about  to  publish  to  the  world.  Would  he 
not  have  been  warranted  in  his  conclusion,  if  he  had  ascertained,  that 
out  of  a  given  number  (sufficiently  large)  of  patients  coming  under  his 
care  with  fever,  more  than  one  half  had.  within  a  short  period,  been 
near  persons  affected  with  fever  ?  I  do  not  think  the  validity  of  the 
argument  at  all  depends  on  the  species  of  fever,  since  it  is  evident 
that  Dr.  Fordyce  was  not  now  speaking  of  fevers  propagating  them- 
selves by  specific  contagions,  but  of  the  generation  of  infectious  mat- 
ter in  fevers,  which  might  produce  in  other  persons  fever,  either  si- 
milar to  themselves  or  different  from  them,  depending  on  circum- 
stances peculiar  to  the  persons  exposed  to  its  action  ;  and  that  he 
did  not  deny  to  intertmttents  the  power  of  thus  generating  infectious 
matter  we  are  assured,  by  his  saying  that  intermittent  fevers  produce 
this  matter,  or,  in  other  words,  are  infectious  ;  and  that,  "  he  knows 
this  from  his  own  observation,  as  well  as  that  of  others."  So  far  as 
argument  goes,  grounded  on  facts,  I  think  we  have  another  in  favour 
of  Dr.  Fordyce's  opinion.  Do  we  not  sometimes  see  an  individual  in 
a  family  seized  with  fever,  when  no  intercourse  with  other  febrile 
persons  could  be  traced,  where  indeed  it  was  almost  impossible  any 
should  have  taken  place  ?  and  do  we  not  see  afterwards  several 
members  of  the  same  family  affected  with  fever,  communicated  as 
far  as  we  can  judge  by  the  person  first  affected  ?  In  this  case,  one  of 
two  things  must  be  true  ;  either  the  action  of  contagion  cannot  be  so 
limited  in  extent,  as  has  been  contended,  if  the  first  person  took  the 
fever  from  infection  ;  or  a  matter  must  have  been  generated  in  the 
person  first  affected  capable  of  producing  fever  in  others.  We  must 
choose  between  the  unlimited  diffusion  of  febrile  infection,  or  the  ge- 
neration of  it  in  fevers  arising  from  other  causes. 

Of  Ntgative  proofs,  1  confess,  Dr.  Bancroft  has  produced  sufficient 
to  show  that  fever  may  sometimes  exist  to  a  considerable  extent,  with- 


YELLO'.V  FEVER. 


out  producing  fever  in  other  persons  communicating  with  those  origi- 
nally attacked  ;  some  of  these  proofs  I  shall  lay  before  my  readers, 
only  remarking  first,  that  they  are  all  instances  of  marsh  remittent  fe- 
yer,  and  that  Dr.  Fordyce  says  intermitting  fevers  are  not  nearly  so 
apt  to  produce  contagious  matter,  at  least  to  propagate  it,  as  continued 
fevers  ;  and  secondly,  that  most  of  these  instances  occurred  in  cli- 
mates very  different  from  that  of  this  country,  and  it  is  to  th»s  coun- 
try Dr.  Fordyce's  observations  are  perhaps  chiefly  intended  to  apply. 

The  first  instance  mentioned  by  Dr.  Bancroft,  i*  that  recorded  by 
Dr.  Trotter,  in  his  Medicina  Nautica,  occurring  at  the  Island  of  St. 
Thomas's,  1762,  where  all  the  people  who  were  lodged  ashore  dur- 
ing night,  died  afterwards  on  the  passage,  while  the  rest  of  the  ship's 
company  remained  remarkably  healthy.  A  similar  instance  also  oc- 
curred in  the  crews  of  the  Fonsborne  and  Nottingham  East  India- 
men,  at  the  Comora  Islands,  in  the  years  1765  and  1766.  Of  this 
fever,  Dr.  Badenock,  then  surgeon  of  the  Nottingham,  observes,  it 
infected  only  those  who  slept  on  shore,  and  having  gone  through  them 
the  fever  ceased  ;  this  he  says,  was  also  the  case  with  those  on  board 
the  Ponsborne,  of  whom,  it  appears,  no  less  than  seventy  died.  A 
similar  occurrence  is  related  by  Dr.  John  Clark,  in  the  first  volume 
of  his  Observations  on  the  Diseases  which  prevail  in  Long  Voyages 
to  Hot  Countries,  page  124  ;  after  describing  the  low  place,  "  cover- 
ed with  impenetrable  mangroves,  at  North  Island,  near  the  Streights 
of  Sunda,  where  most  of  the  East  India  ships  take  in  wood  and  water 
for  their  homeward  voyage  ;"  he  adds,  that  "  a  Danish  ship,  in  1768, 
anchored  at  this  island,  and  sent  twelve  of  her  people  on  shore  to  fill 
water,  where  they  only  remained  two  nights.  Every  one  of  them 
were  seized  with  a  fever,  of  which  none  recovered;  but,  although 
the  ship  went  out  to  sea,  none,  except  the  twelve  who  slept  on  shore, 
were  attacked  with  the  complaint.  Here  again  was  a  fever  so  violent 
as  to  kill  every  one  in  whom  it  was  excited,  and  from  a  cause  so  pow- 
erful as  to  effect  every  one  who  was  exposed  to  it  ;  which,  notwith- 
standing, did  not  reproduce  itself  in  a  single  instance." 

One  of  the  most  decisive  instances  of  the  non-contagious  quality  of 
the  marsh  remittent  fever  is,  the  author  thinks,  to  be  found  in  the 
late  unfortunate  Walcheren  expedition,  wherein  nearly  thirty  thou- 
sand men  and  officers  were  attacked  by  fever,  which  proved  fatal  to 
nearly  one-sixth  of  the  whole  number  of  sick  ;  and  yet  not  a  single 
case  could  be  discovered  in  which  there  vvals  reason  to  suppose  that 
any  one  person  caught  the  fever  from  another,  either  upon  the  island 
of  Walcheren,  or  among  the  sick  removed  to  this  country  ;  so  that  we 
may  fairly  conclude,  if  fevers  of  this  description  are  ever  conta- 
gious, and  communicated  to  those  not  previously  exposed  to  marsh 
miasmata,  the  instances  are  rare  and  solitary,  and  that,  in  general, 
they  must  be  ranked  as  non-contagious  ;  we  shall  see,  hereafter,  the 
author's  reasons  for  classing  the  yellow  fever  among  the  species  of 
marsh  remittents,  and  his  proofs  of  its  non-contagious  quality.* 

*  In  enumerating  the  chief  writers  for,  and  against  contagion,  at  the  com- 
mencement of  this  section,  I  have  omitted  Drs.  Palloni,  Arejula,  Hossack,  and  se- 
veral others,  because  they  consider  this  disease  as  contagious,  or  infectious,  in  some 
situations,  and  in  others  not  contagious  ;  and  therefore  cannot,  with  propriety,  bo 
classed  with  either  party- 


296          INFLUENCE  OB'  TROPICAL  CLIMATKS,  &C. 

Another  question,  amply  discussed  by  our  author  previous  to  his 
enumeration  of  the  causes  of  yelldw  fever,  is,  whether  a  fever,  strict- 
ly contagious,  can  be  generated  by  an  accumulation  of  filth,  or  of  pu- 
trefungor  putrid  matters,  or  by  the  crowding  of  healthy  persons  into 
co  .fined,  or  ill-ventilated,  and  unclean  places  ?  With  respect  to  the 
first  part  <>f  the  proposition  the  generation  of  contagious  fever  by  the 
accumulation  of  pu  refying  or  putrid  dead  animal  matter,  I  believe 
the  general  opinion  of  the  medical  world  is  against  putrefaction  be- 
ing a  source  of  febrile  contagion,  and  therefore  it  is  unnecessa- 
ry to  repeat  the  various  instances  related  by  the  author,  of  large 
masses  of  these  matters  existing  in  different  places,  and  no  fever 
having  been  traced  to  arise  from  them  ;  but  physicians  are  not 
so  unanimous  in  their  belief  concerning  the  power  of  emanations 
from  the  healthy  living  body,  to  generate,  when  accumulated  and  con- 
centrated, fever  of  a  contagious  nature,  and  therefore  it  may  be 
vvorth  while  to  state  some  of  the  arguments  and  farts  adduced  by 
Dr.  Bancroft,  in  favour  of  the  innoxious  qualities  of  human  effluvia, 
so  far  as  regards  the  production  of  fever.  That  crowding,  filth, 
and  deficient  ventilation,  ma^  i^Ve  place  in  a  variety  of  situations 
without  producing  contagious  fever,  the  author  has  shown  in  instanc- 
ing the  mode  of  life  led  by  the  inhabitants  of  the  more  northern  cli- 
mates, who  are  shut  up  for  a  long  severe  winter  in  jourts,  or  subter- 
raneous dwellings,  each  common  to  many  families,  in  which  they  live 
in  horrible  filihiness,  among  whom  fever  is  not  known  to  arise  ;  the 
wretched  confined  situation  of  the  slaves  on  the  middle  passage  of 
the  slave  ships,  in  a  sultry  climate,  without  any  production  of  conta- 
gious fever  among  them  ;  and  the  memorable  occurrence  of  the  con- 
finement of  British  subjects  in  the  Black  hole,  at  Calcutta,  in  June, 
1736,  where,  out  of  146  persons  shut  up  a  whole  night  in  a  dungeon, 
about  a  cube  of  18  feet,  only  23  remained  alive  in  the  morning  ;  none 
of  whom  were  afterwards  affected  with  fever.  All  these  instances, 
however,  having  occurred  in  climates  where  the  extremes  of  tem- 
perature might  be  supposed  to  counteract  and  destroy  the  tendency 
to  contagion  arising  from  these  circumstances,  it  becomes  of  great 
importance  to  examine  Dr.  Bancroft's  explanation  of  the  supposed 
production  of  contagious  fevers  from  similar  circumstances  in  this 
country. 

The  first  memorable  instance  of  mortality  from  the  apparent  ef- 
fects of  morbid  contagion  noticed  by  our  author,  is  that  occurring  at 
the  Black  Assize,  at  Oxford,  in  the  month  of  July,  1577.  The  cir- 
cumstances of  this  event  are  well  known,  and  the  opinion  has  been 
generally  prevalent,  that  the  disease  was  communicated  by  infection. 
The  author,  at  great  length,  and  with  much  ingenuity,  endeavours 
to  controvert  this  opinion  ;  I  must  refer  our  readers  to  the  work 
itself  for  the  arguments  he  makes  use  of  for  this  purpose,  and  con- 
tent myself  with  giving  the  conclusion  he  draws  as  the  result  of  his 
investigation. 

"  The  most  probable  meaning  of  all  these  accounts  would  seem 
to  be,  that,  about  the  time  when  sentence  was  passed  on  the  prison- 
ers, a  noxious  vapour,  in  some  degree  perceptible  to  the  senses,  and 


VELLOW  FEVER.  297 

proceeding  either  from  the  prisoners  or  the  earth,*  had  been  sud- 
denly diffused  through  (he  hall,  and  that,  in  consequence  thereof,  a 
great  part  of  those  who  were  present  had  been  almost  immediately 
attacked,  and  that  many  died  within  a  few  hours. 

**  There  is,  however,  no  cause  of  disease  with  \\hich  I  am  acquaint- 
ed, whose  effects  would  have  been  such  as  are  here  described.  Pes- 
tilential contagion  cannot  be  suspected,  because  that  would  have  re- 
quired contact,  and  because  the  symptoms  of  the  disease  were  not  like 
those  of  the  plague,  nor  was  it  contagious.  And  there  is  as  little  rea- 
son to  suspect  the  contagion  of  typhus,  or  jail  fever,  (especially  at 
that  season  of  the  year  )  there  being  no  instance  recorded,  or  known, 
of  its  producing  disease  so  suddenly,  nor  of  that  disease,  when  pro- 
duced, terminating  so  speedily  in  death.  Nor  were  the  symptoms 
such  as  occur  in  jail  fevers  :  nor  does  the  contagion  of  that  fever 
spare  women,  children,  and  poor  people,  as  the  cause  of  this  disease 
is  stated  to  have  done,  (but  on  the  contrary  :)  nord  >  the  stoutest  and 
most  robust  sooner  perish  by  it,  as  the  Register  of  Merton  College 
declares  to  have  happened  in  this  disease.  ('  Et  ut  quisque  fortissi- 
mus,  ita  citissime  moritur.')  "  Whether  the  facts  connected  with 
the  production,  and  nature  of  this  disease  have  been  misrepresented, 
or,  whether  it  proceeded  from  a  cause  which  has  ceased  to  operate 
in  later  times,  1  leave  for  the  decision  of  others." 

Passing  over  the  accounts  of  sickness  and  mortality  occurring  at 
Exeter,  in  1586;  at  Taunton,  in  1730;  and  at  Launceston,  in  1742, 
since  Dr.  Bancroft  does  not  seem  to  deny  there  being  instances  of 
jail  infection,  we  come  to  the  remarkable  occurrence  which  took 
place  at  London  in  May,  1750,  at  the  Sessions  of  the  Old  Bailey, 
which  proved  fatal  to  the  Lord  Mayor  and  two  of  the  Judges,  with 

*  Camden  makes  use  of  the  words  venenoso  etpestilcnti  hal it  usivef  adore  incur  - 
ceratorum,  site  ex  solo  ita  correpti  sunt  plerique  omnes  qui  aderam,  &c.  and  Sir 
Richard  Baker  says,  "  suddenly  they  were  surprised  with  a  pestilential  savour; 
whether  arising  from  the  noisome  smell  of  the  prisoners,  or  from  the  damp  ground, 
is  uncertain."  Dr.  Bancroft  in  a  note,  observes,  "  the  expressions  seem  to  point 
at  marsh  effluvia,  which,  at  that  season  of  the  year,  would  be  more  likely  to  oc- 
casion disease  than  typhus  contagion,  and  in  a  shorter  space  of  time,  and  chiefly 
upon  vigorous  men  ;  probably,  also,  the  situation  of  the  place  was  suitable  for 
their  production.  The  old  Shire  Hall,  in  which  sentence  was  passed  on  Rowland 
Jencks,  was  placed  in  the  yard  of  Oxford  Castle,  (once  deemed  impregnable,) 
which  stood  on  the  west  side  of  the  town,  at  a  small  distance  from  the  river  /»w, 
whose  banks,  especially  at  that  time,  were  low.  The  prison  was  also  within  the 
Castle,  at  about  200  yards  distance  from  the  Hall,  and  consisted  of  a  multangular 
tower,  called  St.  George's,  (on  the  west  side  of  the  Castle,)  together  with  an  ad- 
joing  church,  which  also  bore  the  name  of  St.  George,  and  two  square  rooms,  all 
connected  oue  with  the  other,  and  made  the  common  jail  for  the  county,  by  a  sta- 
tute in  the  reign  of  Henry  the  Third.  See  Grose's  Antiquities  of  England,  vol. 
iv.  p.  182-3;  also,  King's  Vestiges  of  Oxford  Castle,  p.  28.  In  the  Appendix  to 
Thomas  Hearne's  Preface  to  Gulielmi  Neubrigensis  Historia,  &c.  p.  88,  is  a  print 
representing  the  Castle  of  Oxford,  and  on  the  other  side  of  the  river  is  a  mount, 
at  the  foot  of  which  are  the  ruins  of  an  old  building,  which  are  thus  described  in 
a  note  to  the  plate,  viz.  Reliquiae  doruus  in  qua  assizw  olim  tenebantur,  donee 
obpestem  subitaneam  ad  alium  civitatis  locum  regnante  Elisabethd  transferre  pla- 
cuit."  But  though  I  think  marsh  miasmata  a  more  probable  cause  of  the  disease 
in  question  than  typhus  contagion,  1  am  far  from  believing  that  they  would  have 
produced  effects,  such  as  are  said  to  have  occurred  at  this  Black  Assize." 

38 


OF  TROPIfAF,  CLIMATES,  &C. 

ieveral  eminent  and  other  persons.  These  were  supposed  to  have 
been  infected  by  the  contagion  of  jail  fever,  brought  into  the  court 
from  Newgate.  Such  was  the  opinion  of  Sir  John  Pringle,  Dr. 
Hales,  and  other  eminent  men.  Our  author,  however,  is  of  a  far  dif- 
ferent opinion  ;  and  having  given  in  the  Appendix  a  copious  state- 
ment of  the  whole  transaction,  and  pointed  out  an  important  fact,  ac- 
knowledged by  those  who  have  recorded  the  occurrence,  viz.  the 
opening  of  a  large  windozv  in  front,  and  on  the  left  hand  of  the  court, 
proves  that  the  mischief  done,  or  sickness  produced,  was  confined 
to*  those  who  were  placed  in  the  direction  of  this  stream  of  cold  air, 
which,  therefore,  contained  and  conveyed  the  morbid  influence,  what- 
ever il  was,  that  occasioned  the  fever  ;  and  endeavours  to  show  that 
this  stream  of  air  did  not  direct  the  putrid  streams  to  that  part  of  the 
fcourt  where  the  Judges  were  seated,  as  asserted  by  Sir  John  Prin- 
gle :  but  that  the  disease  which  took  placf  in  the  different  individuals, 
was  in  consequence  of  the  morbid  affection  from  the  application  of  cold. 
Whatever  objection  may  be  urged  against  the  opinion  of  this  fever 
being  produced  by  cold,  on  account  of  the  great  mortality  which 
took  place,  will  apply,  the  author  thinks,  with  equal  force,  against 
its  having  been  produced  by  contagion,  since  the  most  concentrated 
and  virulent  jail  infection  ever  known  in  this  country,  has  never  pro- 
duced a  fourth  part  so  many  deaths  among  an  equal  number  of  sick  ; 
and  he  adds,  "  though  the  mortality  in  question  was  greater  than  I 
should  have  expected  from  a  fever  produced  by  the  sudden  applica- 
tion of  cold,  yet,  so  many  things  are  capable  of  increasing  and  ag- 
gravating the  morbid  effects  of  that  cause,  particularly  by  inducing 
local  and  mortal  inflammation  in  some  important  organ,  or  viscus,  that 
it  is  much  less  surprising  that  a  fever  so  produced  should  occasion  an 
unprecedented  mortality,  than  it  would  have  been,  if  so  many  deaths 
had  resulted  from  a  jail  or  typhus  fever."  See  Appendix  No.  iv.  p. 
653. 

I  have  been  thus  full  in  stating  our  author's  view  of  the  question 
respecting  the  generation  of  contagion,  because  it  is  one  of  serious 
importance,  and  one  on  which  much  uncertainty  still  prevails.  Little 
doubt  has  been  entertained  by  many  men  of  respectable  talents  and 
extensive  observation,  of  the  generation  of  contagion  in  close  and  ill- 
ventilated  apartments  ;  1  shall  instance  two  only,  the  late  Dr.  Mur- 
ray, of  London,  who  took  so  active  a  part  in  the  establishment  of  a 
fever  house  of  recovery  in  the  metropolis,  and  Dr.  Ferriar,  who  di- 
rected his  attention  to  a  similar  establishment  in  Manchester,  because 
they  may  be  supposed  to  have  inquired  into  the  subject  with  the 
greatest  care.  The  latter  says,  **  It  is  a  fact,  equally  alarming  and 
true,  that  many  persons  in  indigent  circumstances  are  exposed  in  our 
great  towns,  to  such  evils  as  I  have  shown  to  be  productive  of  febrile 
contagion." 

"  One  of  the  most  satisfactory  instances  of  this  sort  was  observed 
by  Dr.  Heysham,  at  Carlisle,  in  1778  or  1779.  A  fever  of  the  ner- 
vous kind  raged  in  that  city,  which  did  not  seem  to  have  been  intro- 
duced from  any  neighbouring  place.  Dr.  Heysham,  with  great  in- 

*  Dr.  Bancroft  has  given  an  engraved  plan  of  the  Old  Bailey,  describing  the 
precise  situation  of  the  Judges,  Jurors,  &e. 


BELLOW  FEVER.  29$ 

dustry,  traced  its  origin  to  a  house  near  one  of  the  gates,  which  was 
tenanted  by  five  or  six  very  poor  families  ;  these  unhappy  creatures 
had  blocked  up  every  avenue  of  li^ht  with  which  even  wretchedness 
could  dispense,  and  thus  contaminated  the  air  of  their  cells  to  such  a 
degree,  as  to  produce  the  poison  of  fever  among  them  "  "  The 
plague  itself  appears  to  originate  with  the  crowded  inhabitants  of  ihe 
miserable  villages  in  the  East."* 

No  doubt,  however,  can  exist  of  the  propagation  of  the  febrile  in- 
fection being  facilitated  by  want  of  cleanliness  and  ventilation  ;  and 
this  knowledge  will  be  a  sufficient  inducement  to  obviate  this  source 
of  its  diffusion  when  practicable. 

The  most  frequent,  or  rather,  according  to  our  author,  the  only 
exciting  cause  of  yellow  fever,  is  the  application  of  marsh  miasmata 
to  the  human  body,  and  the  disease,  therefore,  is  really  a  marsh  re- 
mittent fever.  The  opinion  held  by  some  eminent  men,  that  fevers 
of  this  description  might  be  produced  by  simple  moisture  alone,  is,  I 
think,  successfully  controverted  by  Dr.  Bancroft ;  and  he  accordingly 
looks  for  the  specific  cause  of  the  fever  arising  into  the  air  in  some- 
thing from  the  decomposition  of  animal  or  vegetable  matters.  Suffi- 
cient has  been  stated  in  the  former  part  of  the  volume  to  show  that 
the  most  extensive  decomposition  of  animal  matters  may  be  going  on, 
without  any  disease  taking  place  in  those  exposed  to  the  exhalation* 
therefrom  ;  it  follows  then,  that  the  noxious  particles,  whatever  they 
be,  in  marsh  exhalations,  arise  from  the  decomposition  of  vegetable 
substances  ;  and  this  opinion  is  strengthened  by  the  fact,  that  fevers 
are  sometimes  produced  in  persons  employed  in  the  preparation  of 
flax  and  hemp,  and  in  those  who  continue  near  the  heaps  of  indigo- 
plant,  laid  together  after  the  colouring  matter  is  extracted.  Whether 
any  one  particular  gas,  known  to  be  produced  by  vegetable  decompo- 
sition, or  a  combination  of  several  of  these  gasses,  or  some  matter 
not  yet  detected,  is  the  efficient  cause  of  the  disease,  can,  in  the  pre- 
sent state  of  science,  be  no  more  than  matter  of  conjecture.  We 
know,  however,  that  the  action  of  this  cause  is  facilitated  and  in- 
creased by  the  concurrence  of  certain  circumstances,  and  that  its 
operation  is  more  powerful  in  hot  climates  and  hot  seasons,  than  in 
the  contrary  ;  but  our  author  points  out  a  difference  of  susceptibility 
in  persons  exposed  to  marsh  miasmata,  which  renders  their  influence 
on  the  system  more  or  less  powerful  ;  his  observations  on  this  sub- 
ject are  so  important,  that  I  cannot  refrain  from  laying  them  before 
my  readers. 

"  There  is,  however,  another  condition  of  the  body,  which  is  of 
great  importance,  in  regard  to  the  production  of  yellow  fever,  and 
which,  therefore,  requires  a  particular  investigation  ;  I  mean,  the 
cause  of  that  remarkable  susceptibility  to  this  disease,  which  is  com- 
monly found  in  persons  who  have  just  arrived  at  places  where  it  oc- 
curs, from  cold  or  temperate  climates  ;  and  of  the  equally  remark- 
able exemption  from  it,  which  is  commonly  experienced  by  the  old 
inhabitants  of  hot  countries  ;  and  which  in  the  latter,  is  universally 
ascribed  to  their  having  become  seasoned,  as  it  is  called  ;  but,  how- 
ever familiar  this  term  may  be,  and  of  whatever  importance  its  pro- 

*  Ferriar,  Vol.  1.  pp.  240  and  245- 


300  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

per  signification  really  is,  (since  it  involves  the  means  of  preserva- 
tion from  one  of  the  most  dreadful  maladies  which  afflict  the  human 
race,)  it  has  been  long  employed  either  without  any  precise  mean- 
ing, or  with  meanings  which  are  inadmissible.  Thus  it  is  often  said, 
that  a  person  is  seasoned  who  has  once  had  the  yellow  fever  ;  but 
very  improperly,  because  the  same  individual  may  have  the  disorder 
several  times  ;  besides  ivhich,  many  persons  become  exempt  from  the 
fever,  and  ought,  therefore,  to  he  considered  as  being  truly  seasoned, 
without  having  ever  suffered  an  attack  of  the  disease.  It  is  also  fre- 
quently believed,  that  one  may  become  seasoned  by  residing  long  in 
those  towns  in  which  the  yellow  fever  is  apt  to  recur  ;  but  the  very 
great  numbers  of  the  inhabitants  of  Philadelphia,  New-York,  Malaga, 
Cadiz,  Seville,  &c.  who  have  been  swept  off  by  the  distemper,  within 
a  few  years,  are  melancholy  proofs  that  an  efficacious  seasoning  is 
not  to  be  acquired  merely  by  such  residence.  Nor  can  it  be  said, 
that  those  who  live  near  marshes  are  peculiarly  seasoned,  because. 
in  hot  countries,  numbers  of  persons,  who  live  at  a  distance  from 
marshes,  are  proof  against  the  yellow  fever,  although  they  are  some- 
times attacked  with  slight  remittents  or  intermittents. 

"  After  some  reflection  on  this  interesting  subject,  the  various  de- 
grees of  susceptibility  which  are  observed  in  different  individuals  or 
in  different  places,  seem  to  me  capable  of  explanation  on  a  very  sim- 
ple principle  ;  1  mean  the  effects  of  temperature  on  the  human  frame, 
which  does  not  appear  to  have  been  sufficiently  noticed. 

"  The  body,  whilst  in  health,  is  found  always  to  be,  with  very 
slight  variation,  at  the  temperature  of  98  degrees  of  Fahrenheit's 
thermometer,  and  there  is  good  reason  to  think  that  any  considerable 
variation  from  this  point,  would  necessarily  produce  morbid  effects. 
It  seems,  therefore,  to  be  of  high  importance,  that  the  body  should 
be  preserved  from  sut  h  deviations  ;  and  the  Author  of  Nature  has, 
accordingly,  provided  efficacious  means  for  that  end.  Different  opi- 
nions are  indeed  entertained  concerning  these  means  ;  and  since  the 
later  chemical  discoveries  have  been  made,  it  has  been  generally  be- 
lieved, that,  in  an  atmosphere,  the  temperature  of  which  is  less  than 
98  degrees,  the  heat  of  the  human  body  is  maintained  at  that  point, 
by  a  process  similar  to  that  of  combustion,  and  depending  upon  a 
combination  of  oxygen  gas,  (taken  imo  the  lungs  by  respiration,) 
with  carbon  and  hydrogen  ;  and  that,  in  an  atmosphere  heated  above 
98  degrees,  the  temperature  of  the  body  is  kept  do.vn  at  that  point 
by  the  effect  of  an  evaporation  of  matters  perspired  from  the  skin. 
There  are,  however,  insurmountable  diffcultie*  opposed  to  this  doc- 
trine, but  a  full  statement  of  them  would,  in  some  degree,  be  foreign 
to  the  subject  under  our  consideration  ;  I  will,  therefore,  at  present, 
only  remark,  that  it  is  utterly  incredible  that  these  opposite  processes 
should  ever  be  carried  on  so  accurately  in  reference  to  each  other ,  and 
be  so  exactly  balanced,  as  invariably  to  keep  the  body  at  the  heat  of 
98  degrees,  in  all  the  diversities  of  temperature  that  occur  in  differ- 
ent climates  and  situations,  and  therefore,  that  this  important  conser- 
vatory function  must  depend  on  a  power  more  exalted  in  its  nature, 
and  more  certain  in  its  operations,  which  can  be  no  other  than  the 


YELLOW  FEVER.  30l 

power  of  life ;  a  power  which,  in  proportion  as  it  is  more  vigorous 
in  robust  individuals  at  the  prime  of  life,  notoriously  enables  them  to 
resist  the  opposite  extremes  of  heat  and  cold,  and  preserve  their  bo- 
dies at  the  proper  standard  more  perfectly,  and  for  a  greater  length 
of  time,  than  at  a  more  advanced  age.  I  will  not  venture  to  assert 
that  no  addition  to  the  heat  of  the  body  can  be  made,  either  directly 
or  indirectly,  by  the  combination  of  oxygen  with  the  blood,  and  1  rea- 
dily admit  that  its  temperature  may  be  diminished  by  a  copious  eva- 
poration from  its  surface  ;  but  if  either  of  these  causes  should  co- 
operate with  the  living  power  to  a  small  extent,  the  one  in  raising 
and  the  other  in  lowering  what  is  called  animal  heat,  it  must  al- 
ways be  in  complete  subordination  to  the  higher  principle  of  which  I 
have  been  speaking,  and  to  which  nature  has  committed  the  important 
charge  of  preserving  the  temperature  of  the  body  at  the  standard  of 
health,  amidst  all  the  varieties  of  climate,  and  of  external  circum- 
stances. This  is  a  charge  which  cannot  be  fulfilled  in  an  atmosphere 
like  that  of  England,  the  mean  temperature  of  which  may  be  esti- 
mated at  50°,  without  a  considerable  expenditure  of  the  living  pow- 
er, in  order  to  generate  constantly  at  the  mean  rate  of  48°  of  animal 
heat ;  and  after  the  body  has  been,  for  a  length  of  time,  accustomed 
to  make  this  exertion,  it  is  easy  to  perceive  that,  upon  removing  into 
a  warm  climate,  such  as  that  of  the  West  Indies,  the  general  mean 
temperature  of  which  may  be  taken  at  79°  or  bO°,  very  material 
changes  in  the  functions  of  the  system  become  absolutely  necessary 
for  the  preservation  of  health. — But  these  changes  are  not  to  be  sud- 
denly effected  ;  and,  until  the  body  becomes  perfectly  accommodat- 
ed to  the  heat  of  this  new  climate,  the  whole  animal  economy  must 
be  considered  as  almost  in  a  state  of  morbid  excitement,  it  is  not 
this  state,  (of  excitement,)  however,  which  alone  is  productive  of  le- 
ver ;  since  we  know  that  innumerable  persons  have  gone  from  Eu-. 
rope  to  the  hottest  regions  of  the  globe,  and  have  continued  there 
for  years,  will  out  being  attacked  by  fever,  when  other  causes  did  not 
assist  in  producing  that  disease.  The  inhabitants  of  South  Carolina, 
as  I  have  lately  mentioned,  were  exposed  to  this  kind  of  excitement, 
in  an  extreme  degree,  during  a  great  part  of  the  summer  of  1762, 
and  yet  had  never  been  more  healthy  ;  and  other  instances  of  the 
same  import  might,  if  necessary,  be  adduced." 

k<  But,  although  the  simple  operation  of  the  warmth  of  hot  climates 
upon  the  human  body  be  not  the  cause  of  this  d'^ease,  yet  it  is  chiefly, 
if  not  entirely,  to  the  various  degrees  of  that  derangement  which  it 
occasions  in  persons  not  accustomed  to  warm  climates,  that  I  attribute 
all  those  varieties  of  liability  to  the  epidemic  yellow  fever,  which  are 
observable  in  different  individuals,  from  the  extreme  susceptibility  of 
northern  strangers  to  the  almost  complete  immunity  of  Creoles,  and 
more  especially  of  African  negroes.  It  may  be  very  difficult  to  point 
out  the  particular  means  by  which  heat  occasions  this  extreme  suscep- 
tibility ;  and  yet  it  is  not  difficult  to  understand,  that  a  morbid  cause 
may  be  able  to  produce  a  much  more  violent  disease,  when  it  is  assist- 
ed by  the  co-operation  of  so  powerful  an  agent  as  heat,  than  it  could 
produce  when  acting  by  its  own  single  influence  ;  and  it  is  upon  this 


302  INFLUENCE  OF  TROPJCAL  CLIMATES,  &C. 

principle  that  I  shall  endeavour  to  explain  the  general  law,  by  which 
the  susceptibility  to  the  yellow  fever  is  cceleris  paribus,  regulated," 
p.  254. 

The  author  then  takes  a  concise  view  of  the  climates  in  which  the 
yellow  fever  has  principally  raged,  and  applies  the  principle  just  men- 
tioned, to  the  results  which  the  experience  of  several  years  in  each 
of  them  has  afforded.  It  appears,  that  negroes  are  far  less  liable  to 
be  affected  with  yellow  fever  than  white  persons  ;  and  it  was  observ- 
ed at  Cadiz  in  1800,  that  persons  lately  arrived  in  that  city  from  the 
West  Indies,  did  not  suffer  an  attack  of  the  epidemic,  while  those  per- 
sons who  had  come  from  Canada  and  other  northern  countries,  were 
yery  liable  to  the  disease.  The  security  from  the  attacks  of  this  fever 
derived  from  the  "  ability  to  endure  great  heat,"  continues  only  so  long 
as  this  ability  continues  ;  for  if  the  inhabitants  of  warm  climates  re- 
move fora  few  years  into  cold  countries,  and  afterwards  return,  they 
are  then  found  liable  to  the  fever.  From  all  the  facts  stated,  and 
from  the  repeated  observations  made  by  the  author,  he  thinks  him- 
self justified  in  his  opinion,  that  the  joint  influence  of  marsh  mias- 
mata, and  of  an  atmosphere  unusually  and  sufficiently  heated,  upon 
persons  habituated  to  a  cold  or  temperate  climate,  is  of  itself,  fully 
capable  of  causing  an  epidemic  yellow  fever,  exactly  resembling  that 
which  has  committed  such  ravages  in  the  West  Indies,  the  United 
States  of  America,  and  the  South  of  Europe. 

Upon  the  preceding  theory,  that  those  varieties  of  liability  to  the 
epidemic  yellow  fever  which  are  observable  in  different  individuals 
are  to  be  attributed  "  chiefly,  if  not  entirely,  to  the  various  degrees 
of  that  derangement  which  heat  occasions  in  persons  not  accustomed 
to  warm  climates,"  it  may  be  necessary  to  offer  some  observations  ; 
for  there  is  reason  to  fear  that  this  view  of  the  subject  is  much  too 
limited.  The  ability  to  endure  great  heat  is  undoubtedly  a  consi- 
derable, but  it  is  not  the  only,  or  perhaps  even  the  chief  source  of 
immunity  ;  otherwise  those  who  have  been  inured  to  other  tropical 
regions,  where  the  temperature  is  as  high,  or  higher  than  it  is  in  the 
West  Indies,  would  be  protected  from  the  yellow  fever,  which  is  far 
from  being  the  case.  The  leading  features  of  Dr.  Bancroft's  writ- 
ings are,  great  industry  in  research,  and  acuteness  in  argument.  Ad- 
miring these  talents,  it  is  not  from  a  disposition  to  criticise,  but  from 
the  momentous  importance  of  this  part  of  the  subject,  that  I  am  in- 
duced to  reconsider  his  discussion  of  the  question — in  what  does  this 
seasoning  consist  ?  He  contends,  that  it  is  not  from  having  previously 
undergone  the  fever,  because  the  same  individual  may  have  it  seve- 
ral times  ;  and  because  many  persons  become  exempt  without  ever 
having  suffered  an  attack  of  it.  To  this  it  may  be  answered — it  is 
true  that  a  person  is  not  secured  by  having  had  the  fever  once,  as 
some  writers  of  limited  experience  have  discovered,  but  it  is  also  true 
that  he  will  be  less  liable  after  having  sustained  an  attack  of  this,  or 
any  disease  which  reduces  the  tone  and  vigour  of  the  system  ;  and 
that  those  who  escape  altogether  do  not  acquire  their  security  by 
mere  length  of  residence,  and  consequent  habituation  to  the  predis- 
ponent,  tropical  heat,  but  also  because  they  have  been  gradually 


YELLOW  FEVER.  303 

exposed,  and  inured  to  the  other  remote  causes  of  the  disease.* 
Again,  Dr.  B.  observes,  it  is  not  from  residing  long  in  any  place  in 
which  the  yellow  fever  is  apt  to  occur,  as  the  multitudes  who  were 
swept  off  at  Philadelphia,  New-York,  Malaga,  Cadiz,  &c.  abundantly 
demonstrate  ;  but  these  are  places  in  the  temperate  zone,  whose  va- 
riations of  climate  must  ever  prevent  the  inhabitants  from  acquiring 
^insusceptibility,  as  will  appear  more  clearly  hereafter  ;  and  if  sea- 
soning cannot  be  induced  by  intertropica!  residence  alone,  with  how 
much  less  reason,  a  fortiori  can  such  effect  be  expected  from  the 
ultra-tropical  situations  above  specified.  The  last  argument  of  Dr. 
Bancroft  is — that  it  is  not  from  residing  habitually  near  marshes,  be- 
cause numbers  of  persons  who  live  at  a  distance  from  marshes  in  hot 
climates  are  proof  against  the  yellow  fever,  although  they  are  some- 
times attacked  with  slight  remittents  or  intermittents,  (p  246.)  Now, 
in  the  first  place,  the  living  at  a  distance  from  marshes  proves  little 
or  nothing,  because  the  whole  bearing  of  Dr.  B.'s  researches  is  to 
show  that  febrific  exhalations  "  are  often  emitted  from  soils  and  si- 
tuations which  have  no  resemblance  to  a  marsh,"  (Sequel,  p.  254  ;) 
and  secondly,  as  these  people  do  suffer  attacks  of  the  milder  recur- 
rent type,  they  certainly  would  be  liable,  at  particular  seasons,  to  the 
more  aggravated  form  of  fever,  if  they  had  recently  arrived,  instead 
of  having  been  gradually  inured  to  these  miasms  ;  or  if,  though  fa- 
voured by  longer  residence,  they  were  exposed  to  more  concentrated 
miasmata.  Upon  the  whole,  then,  it  is  not  upon  any  simple  princi- 
ple— as  the  being  accustomed  to  great  heat,  that  we  can  explain  the 
grounds  of  exemption  from  yellow  fever. 

If  this  disease  were  simply  a  calenture  as  Moseley  and  some-later 
writers  seem  to  consider  it,  then  indeed  we  need  look  for  no  further 
source  of  exemption  than  the  power  of  resisting  the  effects  of  high 
temperature  ;  but  as  the  novelty  and  consequently  the  force  of  the 
impression  of  insolation  must  be  greatly  diminished  by  habit,  and  as 
notwithstanding  individuals  have  too  frequently  fallen  victims  to  yel- 
low fever  who  have  been  exposed  for  years  together  to  a  tropical 
heat,  when  brought  fully  under  the  operation  of  noxious  causes,  the 
conclusion  is  inevitable,  that  habituation  to  the  local  febrific  effluvia, 
be  they  from  the  soil  or  other  source, — and  to  other  agency,  beyond 
that  of  solar  heat,  is  indispensable  to  security.  In  proof  of  this,  me- 
dical men  who  have  resided  for  a  length  of  time  in  the  Antilles,  have 
repeatedly  observed  individuals  fall  victims  to  the  yellow  fever,  after 
having  been  two,  three,  four,  or  more  years  in  that  country  ;  evinc- 
ing that  the  being  inured  to  a  high  temperature  is  but  one  disqualify- 
ing property,  and  of  itself  unable  to  confer  immunity,  (though  I  am 
far  from  questioning  its  relative  importance  in  greatly  contributing  to 
this  result,)  when  other  powerful  exciting  causes  are  applied. 

The  Fourth  Part  of  this  Essay  contains  a  history  of  the  yellow 
fever  in  the  various  places  in  which  it  has  often  prevailed  as  an  epi- 
demic ;  the  intervals  of  its  appearing  epidemically  are  sometimes 
considerable,  while  at  other  times  the  fever  rages  more  frequently. 

*  Mr.  Sheppard  has  further  illustrated  this  subject  in  a  paper  inserted  in  the 
47th  No.  of  the  Edinburgh  Medical  and  Surgical  Journal. 


§04  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

In  no  instance,  however,  can  its  origin  be  traced  to  contagion,  but  it 
seems  always  to  have  been  produced  by  local  causes,  aided  by  the  in- 
creased temperature  of  the  season.  Our  author  therefore  next  en- 
deavours to  establish  the  identity  or  near  affinity -and  connexion  of  the 
yellew  fever  with  the  fevers  which  are  indisputably  and  notoriously 
produced  by  marsh  miasmata.  These  latter  have  certain  characte- 
ristic peculiarities ,  which  are  pointed  out  by  the  author,  and  after- 
wards compared  with  those  phenomena  which  accompany  the  yellow 
fever,  to  show  the  very  great  similarity  and  near  resemblance  be- 
between  the  two  diseases. — These  characteristic  peculiarities  of 
marsh  fever.s,  as  stated  by  Dr.  Bancroft,  are,  1st.  That  of  occurring 
in  their  simple  and  mild  form  of  intermittents  during  the  spring.  2nd. 
That  of  being  exasperated,  converted  to  remittent,  and  apparently 
to  continued  fevers,  by  excessive  summer  heat ;  and  this,  generally, 
with  a  great  increase  of  malignity,  (especially  in  low  and  moist  situa- 
tions.) when  this  excessive  heat  is  long  continued,  and  accompanied 
with  a  total,  or  very  unusual,  deprivation,  oj  rain.  3d.  That  of  their 
being  re-converted  and  brought  back  to  their  mild  intermittent  form, 
at  the  approach  or  commencement  of  winter,  and  afterwards  extin- 
guished, or  suspended,  by  a  continued  frost.  4th.  That  of  most  fre- 
quently and  violently  attacking  strangers  from  colder  climates  and 
more  salubrious  situations.  And,  5th.  That  of  never  being  commu- 
nicated from  person  to  person  by  a  contagious  property. 

In  addition  to  the  facts  and  authorities  already  mentioned  in  the 
former  part  of  the  volume,  as  tending  to  prove  these  peculiarities  in 
marsh  remittent  fevers,  the  author  brings  a  great  number  of  addi- 
tional proofs  to  the  same  point,  and  afterwards  shows  the  existence 
of  similar  phenomena  in  the  yellow  fever,  in  his  account  of  the  histo- 
ry of  its  origin  and  progress  in  almost  all  the  West  India  Islands,  and 
at  several  places  in  North  America.  To  follow  Dr.  Bancroft  through 
the  whole  of  this  diffuse  statement  is  impracticable,  but  I  shall  sub- 
join his  inferences  on  the  subject  of  the  identity  of  the  two  diseases, 
which  naturally  arise  from  the  history  and  statement  he  had  previ- 
ously given. 

*'  Those  of  my  readers  who,  by  a  love  of  truth,  may  have  been  in- 
duced to  follow  me  attentively  in  the  view  which  I  have  now  taken 
of  the  yellow  fever  in  different  parts  of  America,  and  whose  minds 
are  unbiassed,  will,  I  am  confident,  clearly  recognize,  in  that  disease, 
all  the  peculiar  features  and  characteristic  marks  by  which  marsh  fe- 
vers are  distinguished  in  all  parts  of  the  world.  And  they  will  na- 
turally conclude,  that  though  it  be  the  most  aggravated  and  virulent 
of  the  fevers  arising  from  miasmata,  this  aggravatioa  and  violence 
are  produced  only  by  a  greater  concentration  or  virulence  in  the  lat- 
ter, joined  to  a  greater  intensity  of  atmospherical  heat,  acting  on  per- 
sons but  little  accustomed  to  bear  it,  whilst  they  retain  the  excitabi- 
lity of  cold  or  temperate  climates,  together  with  an  habitual  disposi- 
tion to  generate  that  portion  of  animal  heat  which  such  climates  re- 
quire. They  will  have  seen  that  the  yellow,  like  other  marsh  fevers, 
is  always  exasperated  by  great  heat,  and  extinguished  or  mitigated 
by  cold  ;  that  between  the  tropics  it  prevails  simultaneously  with  the 
milder  forms  of  marsh  fevers,  violently  attacking  st rangers  from  cold 


YELLOW  FEVER.  305 

climates,  whilst  the  natives  or  long  residents  are  at  most  only  subject 
to  intermittents  or  mild  remittents.  They  will  have  also  seen,  that 
in  temperate  situations  this  disease,  in  the  early  part  of  summer,  be- 
fore the  atmosphere  has  become  intensely  hot,  is  commonly  preced- 
ed by,  or  rather  shows  itself  in,  the  forms  of  intermitting  or  remittent 
fever  ;  and  that  when  being  exasperated  by  excess  of  heat,  it  has  as- 
sumed, and  for  some  time  prevailed  under,  the  appearance  of  an  epi- 
demic yellow  fever,  the  accession  of  cool  weather  speedily  reduces 
it  again  to  its  milder  forms,  and  that  a  freezing  temperature  soon  puts 
an  end  to  its  appearance,  even  in  those  forms,  as  it  commonly  does 
to  other  fevers  occasioned  by  exhalations  from  marshes,  and  to  no 
others.  And  they  will  also  have  seen,  that  the  common  bilious  remit- 
tent of  hot  climates,  which  is  universally  admitted  to  be  the  effect  of 
miasmata,  differs  from  the  yellow  fever  only  by  being  a  little  le^s  vio- 
lent ;  that,  at  the  utmost,  their  symptoms  vary  only  in  degree  ;  and 
that,  in  truth,  even  this  difference  is  often  so  imperceptible,  that  the 
College  of  Physicians  in  Philadelphia,  when  anxious  to  assign  a  dis- 
tinction between  the  yellou  and  the  bilious  remittent  fevers,  thought 
it  necessary  to  allege  one,  which  is  not  only  invisible,  but  without  ea> 
istence,  i.  e.  contagion.  In  fact,  there  is  no  difference  between  these 
fevers,  excepting  the  greater  violence,  and  consequently,  greater 
danger  attending  the  former  than  the  latter  ;  for  the  yellow  colour 
appears  in  both  :  and  supposing  the  fatal  black  vomit,  with  profuse 
hemorrhages  and  petechias,  to  occur  only  in  what  is  called  yellow  fe- 
ver, (though  they  are  sometimes  seen  in  fevers  known  and  admitted 
to  arise  solely  from  marsh  effluvia,)  they  cannot  be  included  among 
its  essential  or  distinguishing  symptoms,  unless  death  be  also  consider- 
ed as  essential  to  the  disease.  Nor  can  any  exasperation  of  symp- 
toms, which  has  been  preceded  by  a  great  degree  of  heat>  give  any 
reason  to  suspect  that  a  fever,  whose  symptoms  are  thus  exasperated, 
did  not  originate  from  miasmata,  because  such  an  exasperation  is  in- 
variably produced  by  th.it  cause  in  marsh  fevers  ;  and  by  it  they  are 
susceptible  of  the  most  dangerous  and  malignant  appearances. 

"  With  so  many  proofs  of  identity  in  their  cause,  and  of  the  near- 
est affinity  in  their  symptoms  and  reciprocal  conversions  into  each 
other,  as  well  as  in  their  effects  on  the  human  body,  and  their  changes 
by  heat  and  cold,  &c.  it  would  be  highly  unreasonable  not  to  consider 
them  as  being  only  varieties  of  one  disease.  And  I  think  with  Dr. 
Rush,  that  we  might  as  well  '  distinguish  the  rain  which  falls  in  gentle 
showers  in  Great  Britain,  from  that  which  is  poured  in  torrents  from 
the  clouds  in  the  West  Indies,  by  different  names  and  qualities,  as  impose 
specific  names  and  characters  upon  the  different  slates  of  bilious,  (or 
marsh,)  fever."* 

*  That  the  fatal  Endemic  of  the  West  Indies  is  the  highest  grade,  or  most  ag- 
gravated form  of  Tropical  Fever,  is  now,  with  some  exceptions,  the  general  con- 
clusion of  the  best  informed  practitioners.  Besides  many  authorities,  inciden- 
tally cited  on  this  point,  in  the  course  of  this  discussion,  it  is  also  the  opinion  ot 
the  following  able  Physicians,  whose  opportunities  of  witnessing  Fever  in  vari- 
ous Climates,  have,  from  their  official  situations,  been  very  extensive,  viz. — Drs. 
Pinckard,  Cole,  Gray,  Muttlebury,  Denmark,  Veitch,  Mortimer,  Macmullin, 

39 


306          INFLUENCE  ©F  TROPICAL  CLIMATES,  &C. 

The  Fifth  Part  commences  with  a  Chapter  on  Typhus  or  Conta- 
gious Fever  ;  a  term  vaguely  applied  at  present  to  designate  gene- 
rally all  low  or  slow  fevers  arising  from  threat  fatigue,  cold  and  damp 
habitations,  unwholesome  or  insufficient  food,  anxiety,  grief,  fear,  and 
other  depressing  passions  and  debilitating  causes,  having  no  connec- 
tion with  contagion,  nor  any  power  of  producing  a  contagious  disease, 
but  which  should,  the  author  thinks,  be  restri  ted  to  a  fever  sui  ge- 
neris, strictly  contagious,  and  derived  exclusively  from  its  own  speci- 
fic cause,  or  contagion.  1  have  before  stated  Dr.  Bancroft's  opinions 
on  the  origin  and  propagation  of  febrile  contagion,  and  pointed  out 
wherein  he  differs  from  the  generally  received  notions  on  this  sub- 
ject. The  difficulty  of  determining  whether  any  individual  case  of 
typhus  has  originated  from  some  of  the  causes  which  have  usually 
been  considered  adequate  to  its  production,  or  whether  common  low 
fever  may  have  degenerated  into  typhus,  as  has  been  sometimes  sup- 
posed, must  be  very  great,  if,  as  the  author  is  inclined  to  believe,  an 
interval  of  five  or  six  months  may  sometimes  elapse  before  the  actual 
production  of  fever  by  typhus  contagion  received  into  the  system, 
especially  if  the  summer  should  intervene  previous  to  an  attack  ;  in 
which  case  the  occurrence  of  fever  would,  the  author  thinks,  almost 
always  be  postponed  until  the  following  winter.  Under  such  circum- 
stances, I  do  not  see  how  the  question  is  to  be  determined  satisfacto- 
rily, since  it  is  nearly  impossible  to  demonstrate  that  any  person  has 
not  been  unconsciously  exposed  to  typhus  contagion  many  months 
before,  whilst  his  fever  has  apparently  been  produced  by  fatigue, 
cold,  &c. 

The  history  of  contagious  fever  is  involved  in  great  obscurity  ; 
nor  is  it  until  lately  that  it  has  been  observed  and  distinguished  with 
any  tolerable  accuracy.  Typhus  differs  in  almost  every  particular 
from  yellow  fever;  it  is  pioperly  a  disease  of  cold  climates:  the 
heat  which  is  favourable  to  yellow  fever,  soon  puts  an  end  to  the  ty- 

Vance,  Forbes,  &c.     See  Bancroft's  Sequel,  and  also  a  very  good  Paper  by  Dr. 
Musgrave,  Medical  and  Chirurgical  Transactions,  Vol.  ix. 

Some  highly  respectable  observers  are  also  of  opinion,  that  the  modiflcations 
impressed  on  the  endemic  febrile  cause  by  the  influence  of  locality  and  of  season, 
are  manifested  not  only  by  variety  of  type,  but  also  by  the  production  of  the  dy- 
senteric and  ulcerative  forms  of  fever.  Dr.  Jackson  remarks,  "  In  the  interior 
of  most  of  the  Islands,  at  an  elevation  of  five  or  six  hundred  feet  above  the  level 
of  the  sea,  among  a  series  of  mountainous  ridges,  not  exposed  directly  to  currents 
of  exhalation  from  swampy  and  low  grounds,  the  form  of  disease  is  sometimes  in- 
termittent, sometimes  r'-mittent,  or  continued,  but  more  generally  dysenteric,  for 
the  most  part  slight  and  manageable,  sometimes  violent  and  dangerous.  The 
eruptive  and  ulcerative,  or  sore  leg  belongs  also  to  the  elevated  situation,  especi- 
ally in  the  dry  season.1'  Sketch  of  Febrile  Diseases,  p.  8.— On  the  conversions 
of  the  febrile  cause,  Dr.  Lempriere  thus  expresses  himself — "  In  low  flat  situa- 
tions, where  during  the  rainy  season  the  water  did  not  readily  pass  off,  I  found 
active  continued  and  remittent  fevers,  and  obstinate  and  fatal  intermittents  to 
prevail  In  the  vicinity  of  Lagoons,  where  water  was  always  present,  dysentery 
and  common  intermittents  were  observable.  In  the  first  elevation  of  mountains, 
mild  intermittents,  in  the  second  elevation  obstinate  ulcers,  and  in  the  third  and 
still  higher  elevation  neither  fevers,  dysenteries,  nor  ulcers  were  common."—  On. 
the  difference  of  situation  and  elevation,  as  favouring  a  tendency  to  fevers,  dysen- 
tery, or  ulcer.  Dr.  Porter,  who  served  in  the  West  Indies  at  the  same  period, 
holds  an  opinion  very  similar  to  that  ef  Dr.  Lempriere 


YKLLOVV  FEVE8.  307 

fihus  contagion  ;  whilst  the  cold  seasons  and  climates,  which  stop  the 
ravages  of  yellow  fever,  are  the  most  prolific  in  fevers  of  contagion. 
The  susceptibility  to  typhus  is  also  in  direct  opposition  to  that  for  the 
yellow  fever.     We   have  seen  that  persons  going  from  cooler  into 
hot  climates,  are  more  obnoxious  to  the  yellow  fever  than  the  natives 
or  Ions  residents  in  those  donates  •.  whereas,  *«  those  who  hy  birth 
and  residence  have  been  long  habituated  to  intertropical  climates, 
are,  when  they  remove  into  the  cold,  particularly  susceptible  of  the 
action  of  typhus  contagion,  if  exposed  to  it.     The  accession  and  pro- 
gress of  the  symptoms  also  are  very  different  in  the  two  diseases  ; 
typhus  is  generally  accompanied  with  less  mortality,  and  the  derange- 
ment which  it  occasions  in  the  system  is  much  less  permanent  and 
mischievous,  than  that  which  accompanies  or  results  from  even  the 
remittent  fever  of  Europe."     As  a  proof  of  this,  the  author  com- 
pares the  events  produced  by  typhus  in  the  British  army,  subse- 
quently to  the  return  of  the  troops  from  Corunna  in  1809,  with  those 
which  attended  or  followed  the  expedition  to  Zealand  in  the  same 
year,  when  our  soldiers  had  been  exposed  to  the  causes  producing 
the  remittent  fever.     It  appears,  that  in  the  former  instance  the 
deaths  did  not  exceed  one  in  ten  of  the  sick,  notwithstanding  some 
disadvantages  of  accommodation  and  treatment  under  which  they  la- 
boured ;  whereas,  on  the  Zealand  expedition,  the  deaths  were  but  a 
small  fraction  less  than  one  in  eight,  although  no  such  disadvantages 
existed  ;  and  "  the  recoveries  much  more  tedious,  relapses  perhaps 
one  hundred  times  more  frequent,  and  very  often  followed  hy  perma- 
nent obstructions  or  morbid  alterations  of  the  viscera,  ending  in  drop- 
sy, or  other  chronical  affections." 

Dr  Bancroft  having  been  employed  with  the  troops  from  Spain, 
labouring  under  typhus,  availed  himself  of  the  opportunity  of  ascer- 
taining the  time  which  the  contagion  may  remain  latent  after  its  ap- 
plication to  the  human  body.  For  this  purpose  he  procured  returns 
of  the  orderlies  and  nurses  who  had  attended  the  sick  in  question, 
and  had  been  afterwards  attacked  with  the  same  fever ;  and  also  an 
account  of  the  time  when  the  attendance  of  each  began,  and  of  the 
interval  which  succeeded  previous  to  the  attack.  The  sum  of  his 
observations  is  thus  stated. 

"  It  results,  therefore,  from  this  statement,  that  among  the  ninety- 
nine  orderlies  and  nurses,  who  had  probably  not  been  exposed  to  the 
contagion  before  their  attendance  on  the  sick  commenced,  the  earliest 
attack  was  on  the  13th  day,  and  the  lattst  on  the  68th  ;  but  these  re- 
turns were  made  up  about  the  20th  of  April,  and  it  appears  that  some 
who  had  escaped  till  that  time,  were  afterwards  attacked." 

The  second  Chapter  contains  observations  on  Dysentery,  wherein 
the  author  contends  against  this  being  a  disease  of  contagion,  except 
when  it  exists  together  with  typhus  fever,  (a  connection,  however, 
he  seems  much  inclined  to  doubt  ever  taking  place  ;)  but  he  asserts, 
that  for  the  most  part  it  is  produced  by  the  same  causes  which  give 
rise  to  remittent  fever,  viz.  heat  and  marsh  miasmata.  The  circum- 
stances which  determine  the  morbid  influence  of  mar^h  effluvia  to- 
wards the  intestines,  so  as  to  excite  the  disease  in  question,  rather  than 
-  intermitting  or  remitting  fevers,  do  not,  he  thinks,  seem  to  be  yet  well 


308  INFLUENCE  OF  TROHCAL  CLIMATES,  &(J. 

understood.  Various  facts  are  stated  by  Dr.  Bancroft,  proving  the 
non-contagious  property  of  dysentery,  and  showing  that  it  is  frequently 
epidemic  at  the  same  periods  and  in  the  same  places  with  marsh  re- 
mittent fever,and  the  probability  of  their  acknowledging  the  same  cause 
is  increased  by  the  alternate  succession  of  one  disease  to  another,  which 
so  often  takes  place.  The  author's  treatment  of  the  disease  is  accor- 
dingly founded  upon  this  view  of  its  nature  and  cause  ;  and  as  hia 
directions  on  this  head  are  comprised  in  few  words,  I  shall  here  give 
them. 

'*  As  in  this  disease  there  is  manifestly  a  morbid  determination  of 
febrile  or  inflammatory  action  upon  the  intestines,  1  think,  and  have 
always  found  it  beneficial,  speedily  to  counteract  this  disposition,  and 
produce  an  opposite  determination,  so  far  at  least  as  to  create  a  sa- 
lutary distribution  of  the  blood,  and  of  the  living  power,  through- 
out the  body,  and  especially  upon  its  surface,  by  suitable  diaphore- 
tics, combined  with  opium,  in  small  doses  ;  by  the  application  of  flan- 
nels immediately  to  the  skin,  and  more  especially  round  the  abdo- 
men ;  and  in  urgent  cases  by  the  warm  bath,  (continued  for  the  space 
of  an  hour,  if  the  patient  can  bear  it  so  long,)  warm  fomentations, 
and  especially  blisters  upon  the  belly,  taking  care  at  the  same  time  to 
promote  sufficient  evacuations  by  stool,  to  relieve  the  intestines  as 
much  as  possible  from  all  irritation  and  uneasiness,  which  they  might 
suffer  by  a  retention  of  hardened  faeces  or  scybala,  and  other  matters. 
For  this  last  purpose  the  neutral  purging  salts  with  manna  are  proper, 
or  a  mixture  of  the  oleum  Ricini,  with  the  juice  of  a  ripe  orange,  and 
a  little  mucilage  of  gum  arabic,  which  will  agree  better  with  most 
stomachs,  nnd  prove  equally  efficacious  ;  emollient  purgative  clysters 
may  also  be  employed.  Should  the  disease  be  attended  with  consi- 
derable fever,  care  must  be  taken  not  lo  increase  it  by  too  frequent  use 
of  diaphoretics  and  opium.  When  the  disease,  by  long  protraction, 
has  occasioned  ulcerations  of  the  intestines,  and  more  especially  when 
it  is  complicated  with  an  affection  of  the  liver,  calomel  should  be  pre- 
ferred as  a  purgative,  and  it  should  also  be  employed  with  opium,  so 
as  to  excite  a  soreness  of  the  mouth."  In  addition  to  this,  the  food 
should  be  light  and  easy  of  digestion  ;  when  the  patient  has  any  par- 
ticular craving,  it  may  almost  always,  the  author  says,  be  safely  in- 
dulged. The  last  Chapter  is  on  the  Plague. 

Here  1  shall  conclude  the  present  section,  and  introduce  an  able 
analysis  of  Dr.  Bancroft's  subsequent  Work,  entitled  "  A  Sequel  to 
an  E«say  on  Yellow  Fever,"  drawn  up  for  the  Medico-Chirurgical 
Jowrn-i/forFeb.  1818,  by  my  esteemed  friend  Mr.  Sheppard,  of  Wit- 
ney,  a  gentleman  of  much  experience  and  of  sound  judgment.  It 
stands  in  the  plural  number  as  originally  written. 


Sequel  to  an  Essay  on  the  Yellow  Fever,  principally  intended  to  prove, 
by  inconteslible  facts,  and  important  documents,  that  the  Fever,  call- 
ed Bui  am  >  or  Pestilential,  has  no  Existence  as  a  distinct,  or  a  conta- 
gious Disease.  By  EDWARD  NATHANIEL  BANCROFT,  M.  D.  Fellow 
of  the  Royal  College  of  Physicians,  Physician  to  the  Army,  and 


VELLOW  FEVER.  309 

late  Physician  to  St.  George's  Hospital.     London,  1817.  8vo.  pp. 
487.   [Medico-Chirurgical  Journal.] 

Sec.  II. — The  Medical  History  of  our  West  India  possessions  pre- 
sents a  melancholy  detail  of  a  vast  destruction  of  human  life  from  the 
ravages  of  the  disease  which  forms  the  subject  of  the  volume  before 
us  ;  and  the  painful  feelings  which  the  retrospect  is  calculated  to 
produce,  are  certainly  not  lessened  by  the  reflection,  that  the  state 
of  active  and  protracted  warfare  in  which  we  have  been  involved, 
has,  in  addition  to  the  other  miseries  which  have  flowed  from  that 
source,  principally  contributed  to  swell  the  catalogue  of  victims  to 
this  scourge  ;  —that  many  thousands  of  our  brave  countrymen  have 
escaped  the  fury  of  battle,  and  all  the  varied  dangers  "per  mare, per 
saxa,  per  ignes,"  incidental  to  the  life  of  the  soldier  and  sailor,  only 
to  fall  an  inglorious  sacrifice  to  this  insatiate  foe !  Nor  have  its  visi- 
tation? been  limite'd  to  the  transatlantic  shores  alone  ;  the  inhabitants 
of  many  of  the  southern  p^rts  of  Europe  have,  on  various  occasions, 
felt  severely  the  pressure  of  affliction  and  mortality  from  this  widely 
extended  cause.  While  in  common  with  every  feeling  mind,  we  re- 
gret the  discrepancy  of  opinion  respecting  its  origin  and  nature, 
which  has  prevailed'among  the  only  legitimate  judges  of  the  question, 
and  condemn  the  asperity  and  intemperateness  in  which  the  contend- 
ing parties  have  too  frequently  indulged,  we  cannot  but  rejoice  in  the 
prospect  which  now  opens  on  us,  of  the  discussion  being  at  length 
brought  to  a  speedy  termination.  The  overwhelming  mass  of  evi- 
dence which  Dr.  Bancroft  has  now  brought  forward,  in  disproof  of 
the  existence  of  contagion  in  yellow  fever,  will,  we  confidently  anti- 
cipate, put  to  flight  a  chimera,  which  has  in  too  many  instances  se- 
duced the  attention  from  the  true  sources  of  the  disease.  The  pe- 
riodical publications,  it  is  true,  have  lately  teemed  with  refutations  of 
the  doctrine  of  contagion  ;  but  in  the  fleeting  and  insulated  form  of 
those  communications,  much  of  their  weight  and  authority  is  neces- 
sarily lost.  We  therefore  hail  with  real  satisfaction  the  appearance 
of  a  work  containing  an  invaluable  store  of  original  and  highly  re- 
spectable documents,  collected  and  arranged  with  no  ordinary  re- 
search and  ability,  and  supported  by  argumentative  talents  of  the 
first  order.  Since  the  appearance  of  the  Author's  former  volume, 
two  publications  have  issued  from  the  press  in  support  of  the  distinct 
nature  and  contagious  quality  of  the  "  Bulam,"  or  yellow  fever  ;  and 
by  one  of  the  writers  a  claim  has  been  preferred  to  the  discovery  of 
the  alleged  peculiarity  of  its  attacking  the  human  frame  only  once. 
With  the  view  of  effecting  the  subversion  of  these  doctrines,  Dr. 
Bancroft  has  again  entered  the  Arena  ;  and  on  all  the  principal  bear- 
ings of  the  question,  we  conceive  that  his  triumph  is  complete.  The 
quantity  of  matter  accumulated  in  the  present  volume,  almost  defies 
an  adequate  analysis  ;  but  as  from  the  analogy  of  our  opinions  on  the 
subject  with  those  of  the  author,  we  find  very  little  to  oppugn,  or  to 
criticize,  we  shall  endeavour  to  lay  before  our  readers  a  condensed 
view  of  the  most  important  topics  under  discussion. 

We  are  informed  in  the  Introduction,  that  the  Lords  of  the  Privy 
Council  deemed  the  opinions  of  Dr.  Pym  of  sufficient  importance  to 


310  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

induce  them  to  make  application  to  the  College  of  Physicians  for  in- 
formation on  the  two  chief  points  which  he  has  endeavoured  to  esta- 
blish ; — the  contagious  nature  of  yellow  fever,  and  the  peculiarity  of 
its  attacking  only  once.  The  reply  of  the  College,  although  on  the 
whole  favourable  to  Dr.  Pym's  pretensions,  was  undecided,  as  they 
properly  alleged,  for  want  of  experience  in  the  disease.  Applica- 
tion was  then  made  by  the  Council  to  the  Army  and  Naval  Medical 
Boards.  Concerning  the  communication  from  the  former  Board,  Dr. 
Bancroft  has  not  been  authorized  to  give  any  information.  The  lat- 
ter, having  collected  the  opinions  of  those  naval  medical  officers 
whose  experience  enabled  them  to  adduce  facts  and  observations  in 
support,  or  in  refutation  of  Dr.  Pym's  propositions,  transmitted  a 
concise  analysis  thereof  to  the  Lords  of  the  Council,  together  with 
the  original  Reports.  To  these  their  Lordships  have  been  pleased 
to  allow  Dr.  Bancroft  free  access,  and  from  thatsource  a  large  portion 
of  the  evidence  contained  in  this  volume  is  derive'd. 

The  author  begins  his  Inquiry  by  controverting  the  diagnostics  by 
which  Dr.  Pym  distinguishes  his  Bulam  from  the  bilious  continued, 
and  bilious  remittent  Fevers  ;  and  we  are  of  opinion,  that  he  has  un- 
deniably proved  that  no  specific  difference  exists  between  these  forms 
of  fever  ;  that  the  points  on  which  Dr.  Pym  has  attempted  to  found 
a  diagnosis,  are  merely  differences  of  degree,  and,  that,  (excepting 
the  last,  the  black  vomiL)  they  are  not  peculiar,  uniform,  nor  essen- 
tial to  the  fever  in  question.  Indeed,  it  appears  to  us,  that  they  ob- 
tain more  or  less  in  most  dangerous  fevers,  as,  we  conceive,  must  be 
evident  not  only  to  all  personally  and  extensively  conversant  with 
yellow  fever,  but  even  with  fever  in  general  :  and,  further,  that  Dr. 
Pym  has  himself  proved  the  futility,  and  destroyed  the  foundation  of 
such  diagnosis,  (if  we  were  to  grant  his  assumption,  of  which,  how- 
ever, an  ipse  dixit  is  the  substitute  for  proof.)  by  asserting,  that  even 
Dr.  Rush  himself  mistook  the  bilious  remittent  for  the  Bulam  Fever. 
— Pym's  Obs.  p.  209. 

Of  these  alleged  diagnostics,  the  two  first,  the  appearance  of  the 
eyes,  and  the  nature  and  seat  of  the  head-ache,  the  author  satisfac- 
torily shows  from  various  authorities,  to  be  vague  and  indeterminate, 
and,  therefore,  perfectly  useless  in  diagnosis.  With  regard  to  the 
absence  of  remissions,  constituting  the  third  diagnostic  of  the  Bulam, 
Dr.  Bancroft  adduces  a  mass  of  evidence  to  prove  "  the  simultaneous 
appearance  of  both  forms  of  the  fever,  and  their  reciprocal  conver- 
sions into  each  other  at  particular  places  and  seasons  ;  together  with 
the  invariable  appearance  of  remittents  at  the  same  places,  both  before 
the  high  atmospheric  temperature  has  operated  sufficiently  to  give 
them  the  continued  form,  and  also  after  the  effects  of  this  high  tem- 
perature have  ceased  to  exist."  Further,  Dr.  Pym  has  derived  the 
epidemics  of  Gibraltar  by  importation  from  those  of  Cadiz,  Malaga, 
and  Carthagena,  and  has  thereby  identified  them  with  the  fevers  of 
those  places  ;  and  Sir  James  Fellowes  states,  that  Arejula,  Gonzales, 
and  Flores  are  •'  the  three  most  eminent  physicians  in  Cadiz,  and  he 
believes  in  Spain."  Now,  unfortunately  for  this  principal  diagnostic, 
all  those  writers  distinctly  mention  remissions  in  their  descriptions  of 
the  Spanish  epidemics  ;  and  as  regards  the  fever  in  Gibraltar,  remis- 


YELLOW  FEVER.  311 

sions  are  proved  by  evidence  of  seven  medical  officers  of  that  gar- 
rison in  the  epidemic  of  1814.  The  fourth,  or  the  infrequency  and 
paleness  of  the  yellow  colour  of  the  skin,  cannot  be  viewed  other- 
wise than  a  relative  expression  ;  and  it  will  be  sufficient  to  state,  that, 
from  the  accounts  of  Sir  James  Fellowes,  Sir  Joseph  Gilpin,  Mr. 
Donnet,  and  others,  the  suffusion  of  the  skin  is  observed  in  every  in- 
termediate shade  between  a  lively  yellowness,  and  a  dingy,  or  dark 
hue.  The  author  also  rejects  the  fifth  diagnostic,  the  duration  of  the 
disease,  on  the  principle  of  the  want  of  uniformity.  Dr.  Pym  says, 
it  runs  its  course  in  from  one  to  five  days  ;  it  is  admitted,  that  it  com- 
monly does  so  in  its  most  aggravated  form  ;  but  it  is  proved  from 
Arejula,  Sir  James  Fellowes,  Dr.  Burnett,  Labat,  and  Dr.  Chisholm, 
that  it  often  continues  much  longer  :  further,  Dr.  Pym  states,  that 
"  the  remittent  sometimes  proves  fatal  on  the  second  or  third  day  ;" 
and  according  to  Dr.  Hunter  it  even  runs  its  course  in  twenty-four 
hours.  We  have  ourselves  witnessed  dealh  on  the  third  day,  in  a 
violent  remittent  imbibed  in  the  month  of  September,  in  one  of  the 
most  northern  rivers  of  the  United  States.  Lastly,  respecting  the 
sixth  alleged  diagnostic,  the  gangrenous  state  of  the  stomach,  and  the 
appearance  of  black  vomit,  Dr.  Bancroft  exposes  the  futility  of  such 
criteria,  the  first  of  which  can  only  be  known  after  death  ;  and  the 
latter  "  is  the  almost  unerring  harbinger  of  death."  The  chief 
value  of  a  diagnostic  is  to  enable  us  to  ascertain  the  true  nature  of  a 
disease  ;  but  this  refers  to  its  consequences  only.  Neither  is  the 
black  vomit  peculiar  to  the  continued  form  ;  for  the  authorities  of 
Pringle,  Cleghorn,  Hunter,  Rush,  and  Burnett,  prove  its  occurrence 
in  the  remittent. 

"  I  shall  only  add,  concerning  this  black  vomiting,  that  as  it  is  a 
mortal  symptom,  never  occurring,  it  may  be  said,  in  those  who  reco- 
ver, and  one  which  is  often  wanting  among  those  who  die,  its  appear- 
ance in  this  disease  must  be  much  rarer  even  than  death  ;  and  this 
circumstance,  joined  to  that  of  its  not  being  '  peculiar'  to  the  fever 
in  question,  render  it  very  unfit  to  be  produced  as  a  diagnostic  there- 
of," p.  30. 

Adverting  to  the  inconsistencies  contained  in  Dr.  Pym's  account 
of  the  condition  of  the  pulse  and  skin,  "  for  which,"  he  says,  "  the 
Bulam  Fever  is  remarkable,"  the  Author  thus  expresses  himself: — 

**  Descriptions  of  symptoms  being  simply  records  of  natural  events 
in  disease,  which  stand  unalterable,  however  opinions  about  them  may 
change,  will  the  confusion,  the  inconsistencies,  and  errors,  every 
where  apparent  in  Dr.  Pym's  attempt  to  frame  a  diagnosis  for  the 
Bulam  Fever,  be  deemed  very  excusable  in  one  who  claims  merit 
for  discovering  peculiarities  therein,  which  had  escaped  the  sagacity 
and  penetration  of  all  Other  observers." 

We  apprehend  that  sufficient  has  been  said  to  show,  that  the  ques- 
tion of  the  continued  form  of  fever,  or  the  Bulam,  is  merely  one  of 
degree  ;  that  the  peculiarities  which  are  said  to  distinguish  the  Bu- 
lam from  all  other  fevers,  do  not  exist  ;  and  that,  therefore,  the  sup- 
posed distinct  fever  must  be  as  imaginary  as  the  peculiarities  them- 
selves.* 

*  Dr.  Musgrave,  of  Antigua,  who  also  has  successfully  controverted  all  Dr. 


312  INFLUENCE  OF  TROflCAL  CLIMATES,  &C. 

The  second  chapter  is  devoted  to  the  consideration  of  other  alleg- 
ed peculiarities,  more  especially  the  non-liability  to  a  second  attack  ; 
which  it  is  stated  was  brought  under  the  notice  of  the  Privy  Coun- 
cil, in  consequence  of  an  application  from  Dr.  Pym. 

The  merit  of  originality  in  this  supposed  discovery  is  disputed  ; 
Sir  James  Fellowes  awards  it  to  the  Spanish  practitioners  generally  ; 
Dr.  Pym  claims  it  as  exclusively  his  own,  and  fixes  on  the  20th  day 
of  October,  1804,  as  the  period  when  that  event  took  place  in  the 
garrison  of  Gibraltar. — The  security,  he  represents,  to  be  similar  to 
that  which  an  individual  acquires  by  having  undergone  the  sma!l-pox. 
Now,  Professor  Berthe,  in  his  "  Precis  Historique,"  &c.  published 
in  1802,  gives  an  extract  of  a  printed  letter,  dated  at  Cadiz,  May  6th, 
1802,  in  which  the  writer  plainly  states,  that,  like  small-pox,  after 
one  attack,  a  future  seizure  rarely  occurs.  This  opinion,  however, 
the  Professor  designates  as  fallacious  and  dangerous.  In  the  epide- 
mic of  Cadiz  also  in  1800,  towards  the  decline  of  the  fever,  the  civil 
authorities  of  that  place  grounded  their  police  measures  on  this  opi- 
nion : 

"  Guards  where  stationed  at  the  gates,  to  exclude  all  persons  from 
entering  the  city,  who  did  not  produce  certificates  of  having  already 
had  the  fever." 

Arejula  had  likewise  pointed  out  the  security  afforded  by  an  at- 
tack of  the  fever,  in  the  epidemics  of  Medina,  Sidonia,  Malaga,  and 
other  places  in  Spain  ;  and  states  in  page  3l9,  that 

"  At  these  places,  and  almost  every  other,  he  selected  as  assistants 
to  the  sick,  those  who  had  previously  undergone  the  epidemics." 

So  much  for  the  originality  of  the  alledged  discovery,  to  the  credit 
of  which,  even  had  it  been  confirmed  by  experience,  we  apprehend, 
on  the  principle  of  "  suum  cuique."  Dr.  Pym  had  no  claim.  As  to 
the  reality  of  this  supposed  "  peculiarity,"  we  consider  the  evidence 
adduced  by  Dr.  Bancroft  from  the  Reports  of  the  naval  medical  offi- 
cers, before  adverted  to,  as  well  as  the  result  of  the  examination  of 
the  different  Journals  of  naval  surgeons  employed  in  the  West  Indies, 
to  be  perfectly  conclusive  in  the  negative.  This  opinion  is  corrobo- 
rated by  the  answers  of  five  army  surgeons,  and  three  assistant  sur- 
geons of  the  garrison  of  Gibraltar  during  the  epidemic  of  1814,  to  the 
questions  proposed  to  them  by  Deputy  Inspector  Eraser  ;  they  all  bear 
distinct  testimony  to  second  attacks. 

We  can  only  briefly  notice,  the  author's  exposition  of  the  frailty  of 
Dr.  Pym's  alleged  proofs  of  absolute  immunity  after  one  attack.  In 
the  instance  of  the  epidemic  of  Gibraltar  in  1804,  (on  which  the  sup- 

Pym's  principal  positions,  remarks  :— "  Had  Drs.  Pym  or  Gilpin,  or  any  one 
holding  their  opinions,  practised  in  Antigua  during  the  late  Epidemic,  still  pre- 
possessed with  the  idea  of  Black  Vomit  being  distinctive  of  Yellow  Fever,  I  ven- 
ture to  assert,  without  fear  of  contradiction,  that  he  or  they,  (spite  of  every  pre- 
conceived notion,)  must  in  candour  have  admitted,  that  a  disease  at  least  answer- 
ing in  every  respect  the  description  given  by  themselves,  could  ostensibly  be  pro- 
duced by  miasmata  alone  ;  and  that  in  comparing  a  mass  of  cases  occurring  in 
town  and  country,  with  Creoles  and  Europeans,  a  continued  chain  could  be  trac- 
ed, link  by  link,  from  the  most  concentrated  form  as  it  invades  new  comers,  to 
the  simple  intermittent,  which  we  so  frequently  meet  with  among  the  slaves,"  p 
•jf3 — Medical  and  Chirurgical  Transactions,  vol  ix. 


YELLOW  FEVER.  313 

posed  discovery  seems  to  have  been  founded,)  it  is  stated,  that  one 
hundred  and!*twenty-two  men  who  had  escaped  the  fever,  were  found 
on  inquiry  to  have  been  in  the  West  Indies  at  some  former  period, 
which  is  inferred  to  have  been  the  cause  of  their  exemption  ;  and 
that  the  57th  regiment,  which  had  recently  served  in  Trinidad,  was 
introduced  into  the  garrison  during-  the  prevalence  of  the  epidemic, 
with  impunity.  These  are  alleged  to  be  proofs  of  the  Bulam  Fever 
not  attacking  a  second  time  ;  but  both  instances  obviously  involve 
the  assumption,  that  all  who  have  visited  the  West  Indies,  have  ne- 
cessarily undergone  an  attack  of  Yellow  Fever  ;— a  fallacy  we  need 
not  stop  to  refute.  The  instance  of  the  men  of  the  10th  regiment, 
which  acquired  their  security  by  service  in  the  East  Indies,  is  still 
more  palpably  defective  ;  because,  Dr.  Pym  having  laboured  to  prove 
that  the  Bulam  has  never  appeared  in  the  East  Indies,  the  men  of  the 
10th  regiment  could  not,  on  his  own  principles,  have  obtained  their 
immunity  by  previous  attacks. 

Indeed,  it  appears  to  us,  that  Dr.  Pym  has  not  steadily  contemplated 
the  security,  constituting  his  alleged  discovery ,  in  a  determinate  point 
of  view.  In  general,  he  compares  it  to  the  almost  absolute  immunity 
which  an  attack  of  the  small-pox  confers  ;  but  at  other  times  he  plain- 
ly speaks  of  it  as,  (what  in  truth  it  amounts  to,)  merely  a  relative  se- 
curity ;  for  instance,  in  his  account  of  the  epidemic  Yellow  Fever  of 
the  70th  regiment  in  Martinique,  in  179t,  he  says,  every  individual 
in  the  regiment  was  attacked  ;  and,  that  three  officers  who  had  beea 
several  years  in  the  West  Indies,  some  time  before,  had  it  in  so  mild 
a  form,  as  to  make  it  unnecessary  for  them  to  be  c<  nfined  to  bed  :-— 
again,  the  regiments  in  Martinique  that  had  been  some  years  ia  the 
West  Indies,  he  says,  were  attacked,  (in  1794,)  equally  with  the 
corps  lately  arrived  from  England  ;  but  with  this  difference,  that  the 
former  **  siiffered  a  comparatively  small  mortality  :"  And  further,  in 
the  above-mentioned  case  of  the  10th  regiment  at  Gibraltar,  he  states, 
that  "  eight  officers  who  had  been  in  India,  were  attacked  with  the 
fever,  and  all  recovered. — Seven  officers  who  had  not  been  in  India, 
had  the  disease  in  so  different  a  form,  that  five  of  them  died."  These 
we  take  to  be  fair  illustrations  of  relative  security,  acquired  by  habi- 
tuution  to,  or  seasoning  in,  a  tropical  climate  ;  and  prove,  that  in  or- 
der to  obtain  such  comparative  security,  it  is  not  necessary  that  the 
individuals  should  have  passed  through  an  attack  of  Yellow  Fever  ; 
while  on  the  other  hand,  we  may  safely  trust  to  the  evidence  adduced 
by  Dr.  Bancroft,  to  establish  that  one,  or  even  a  repetition  of  attacks, 
does  not  confer  absolute  non-liability. 

We  have  been  somewhat  diffuse  on  this  point,  from  a  sense  of  its 
importance  ;  and  because  we  are  anxious  to  exhibit  the  merits  of  the 
case  in  as  distinct  a  form  as  our  observation  of  the  subject  permits  ; 
and  we  refer  to  the  evidence  itself  in  support  of  our  opinion,  that  the 
supposed  non-liability  to  a  second  attack,  so  far  from  resembling  the 
immunity  after  small  pox,  is  strictly  a  relative  security,  totbe  acquir- 
ed as  certainly,  though  more  gradually,  by  tropical  residence,  (which 
involves  habituation  to  the  remote  cause,)  as  by  having  passed  through 
an  attack  of  the  disease  ;— a  condition  of  the  habit  which  confers  se- 

40 


314  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

curity  only  when  the  concentration  and  force  of  the  endemic  causes 
do  not  exceed  the  degree  to  which  the  individual  may  have  heen  pre- 
viously habituated  ; — and,  lastly,  a  mean  of  exemption  which  is  liable 
to  he  destroyed  by  (e  converse,)  the  regenerated  susceptibility  which 
a  return  to,  and  residence  in  a  northern  climate  effectuate.  That  the 
exemption  is  absolute  after  one  or  more  attacks,  we  consider  to  be 
perfectly,  and  most  satisfactorily  disproved  ;  and  we  cannot  well  ab- 
stain from  expressing  our  astonishment  how  Dr  Pym  could  ever  have 
entertained  such  an  idea,  much  less  have  vaunted  it  as  a  discovery  ; 
for  very  little  reflection  might  have  shown  him,  that  it  could  not  have 
escaped  the  observation,  but  must  have  been  evident  to,  and  eagerly 
caught  at  by  those  who  had  passed  a  series  of  years  amidst  Yellow 
Fever,  had  such  absolute  immunity  any  existence.  The  facts  includ- 
ed in  the  documents  now  brought  forward  by  Dr.  Bancroft,  will,  we 
cannot  doubt,  be  deemed  decisive;  and  consign  to  oblivion  the  pre- 
mature notion  of  a  discovery  in  a  supposed  "  peculiarity,"  which  he 
has  proved,  does  not  exist  ;  and  which,  even  fora  moment  supposing 
its  existence  to  be  any  thing  more  than  relative,  had  been  pointed  out, 
and  acted  on  by  the  Spaniaids  many  years  previous  to  the  20th  of 
October,  1804. 

Dr.  Kergusson,  Inspector  of  Military  Hospitals  in  the  Windward  Is- 
lands, in  his  Communication  to  the  Army  Medical  Board,  observes  on 
this  point, 

"  Another  piece  of  doctrine  has  been  promulgated  from  the  writings 
of  the  authors  above  alluded  to,  (Drs.  Pym  and  Fellowes  ;)  that  the 
Yellow  Fever  cannot  be  received  by  the  same  subject  more  than  once. 
Of  this  we  again,  who  live  amongst  Yellow  Fever,  not  only  know  no- 
thing, but  we  see  it  contradicted  by  the  daily  experience  of  our  lives." 
Page  87. 

We  have  always  protested  with  Dr.  Bancroft  against  the  subtilty 
of  making  the  black  vomit  a  criterion  of  the  Bulam  Fever,  and  regu- 
lating the  admissibility  of  the  proofs  of  future  attacks  by  that  assum- 
ed standard.  By  acknowledging  the  legitimacy  of  such  a  criterion, 
as  few  or  none  recover  after  that  symptom  has  appeared,  a  difficulty, 
nearly  tantamount  to  impossibility,  is  incurred,  of  ever  adducing  in  the 
course  of  even  a  long  life,  an  unobjectionable  instance  of  a  second 
attack.  When  black  vomit,  and  its  usual  immediate  sequel,  death, 
take  place,  the  patient  is  relieved  from  future  attacks  of  any  kind  ; 
but  in  less  aggravated  forms  of  Yellow  Fever,  where  there  has  been 
no  black  vomit,  and  the  patient  has  recovered,  then  in  the  event  of  a 
second  attack,  say  the  advocates  for  the  Nova  Festis,  the  original  one 
was  not  a  case  of  Bulam,  for  one  of  our  diagnostics  was  wanting  ; 
there  was  no  black  vomit ! — and  vice  versa.  Accordingly,  we  find 
this  subterfuge  incessantly  resorted  to.  Against  such  sophistry,  ar- 
guments are  vain  ;  and  facts,  for  the  reasons  we  have  assigned,  diffi- 
cult to  be  applied.  The  Report  of  Inspector  Fergusson  from  Barba- 
does,  amongst  other  cases  of  second  attacks,  contains,  however,  one 
decisive  instance  of  even  black  vomit  occurring  twice  in  the  same  in- 
dividual.— A  patient  of  Dr.  Caddel,  a  physician  of  the  greatest  expe- 
rience in  Barbadoes,  miraculously  recovered  from  yellow  fever  with 
distinct  black  vomit,  "  and  died  some  Years  afterwards  of  the  same 


VEI.LOW  FEVER.  316 

disease,  and  with  the  same  symptom." — Against  a  tact  ef  such  decisive 
import,  we  know  not  what  reply  can  be  opposed,  unless  it  be,  *'  JVo» 
persuadebis,  etiamsi  persuaseris." 

In  a  rejoinder  of  considerable  extent,  Dr  Bancroft  adverts  to  Dr. 
Pym's  examination  of  the  authorities  h«  has  adduced  in  his  Essay 
against  the  doctrine  of  contagion.  He  complains  of  a  disingenuous 
and  partial  selection  of  those  authorities  for  that  purpose  ;  und  ex- 
presses his  conviction,  that  they  have  passed  the  ordeal  without  in- 
jury- 

"  Here  Dr.  Pyra  closes  the  account  of  what  he  term?  my  autho- 
rities ;  and  he  manifestly  intends  to  have  it  believed,  that  he  has  no- 
ticed and  refuted  all  those  which  I  had  adduced  ;  when  in  fart,  he 
has  completely  shunned  even  the  mentioning  of  nine  tenths  of  them. 
The  few  whom  he  notices  were  O'-viously  s-  lected  only  hecause 
they  had  said  or  admitted  something  capable  of  being  distorted  con- 
trary to  the  real  and  sincere  meaning  of  each  ;  and  in  effecting  this 
distortion  he  exults,  as  *  having  by  cross-questioning  my  witnesses, 
brought  out  the  truth,1  and  tcon\icted  me  upon  my  own  evidence  :' 
although  in  regard  to  the  great  body  of  those  who  are  more  proper- 
ly my  witnesses,  he  is  so  far  from  having  cross-examined  them,  that 
he  has  not  even  looked  them  in  the  face  ;  and  my  readers,  I  firmlj 
believe,  will  be  convinced  that  he  has  not  been  able  to  invalidate  or 
weaken  any  one  testimony  or  opinion  which  I  had  alleged  to  prove 
the  fever  in  question  to  be  void  of  contagion."  page  1 10 — 1 1 1. 

A  similar  complaint  is  preferred  of  an  equally  uncandid  and  par- 
tial selection  of  some  of  his  evidences  against  contagion,  for  the  pur- 
pose of  examination  ;  and  the  irrefragable  character  of  the  remain- 
der is  thence  very  justly  inferred.  We  think  it  but  an  act  of  com- 
mon justice  to  Dr.  Bancroft,  to  insert  in  his  own  words,  the  recapi- 
tulation of  the  evidences  against  contagion,  contained  in  his  former 
volume,  which  Dr.  Pym  has  not  thought  proper  to  oppugn,  or  even 
to  notice  ;  leaving  our  readers  to  draw  their  own  inferences  as  to 
the  probable  motives  for  such  cautious  proceeding. 

"  I  have  now  examined  all  that  in  any  way  merited  notice  of  what 
Dr.  Pym  has  advanced  against  my  authorities  and  arguments,  with 
the  exception  of  some  circumstances  relative  to  Cadiz  and  Gibraltar, 
which  are  reserved  for  future  consideration  ;  and  1  cannot  but  be- 
lieve that  my  readers  will  have  been  convinced  of  the  fallacy  of  those 
principles  upon  which  he  has  endeavoured  to  explain,  or  rather  to 
evade,  my  inferences,  and  of  the  ahortiveness  of  his  endeavours  to 
invalidate,  in  a  single  instance,  either  my  testimonies  or  my  reason- 
ings. There  remains  besides  a  great  mass  of  evidence  of  which  he 
has  studiously  avoided  even  the  smallest  notice  ;  and  this  must  of 
course  be  considered  not  only  as  subsiding  in  lull  strength,  but  as 
having  been  deemed  by  him  unquestionable  and  invulnerable  :  for 
otherwise,  with  his  dispositions,  and  the  latitude  of  every  kind  in 
which  he  has  indulged,  it  ra*y  be  presumed,  that  it  would  not  have 
been  left  without  some  hostile  attempt.  To  this  evidence,  therefore, 
I  refer  my  readers  with  confidence,  and  more  especially  to  the  very 
accurate  and  respectable  one  of  Dr.  James  Clarke,  at  pages  332, 
333,  334,  and  760,  761  of  my  Essay  ;  and  that  of  Mr.  Young,  In- 


INtLtENCE  OF  TROPIC  At  CLIMATES,  &C. 

spector-General  of  Hospitals,  and  of  all  the  superior  medical  officers 
of  the  army  under  Sir  Ralph  Abercromby  in  the  Windward  Islands, 
j>.  334,  335  ;  those  of  M.  M.  Desportes  and  Valentin  at  St.  Domin- 
go, p.  338—341  ;  that  of  Doctor  Hector  M'Lean,  with  the  opinions 
of  Drs.  Jackson,  S  ott,  Wright,  and  G  >rdon,  and  nearly,  if  not  all, 
the  other  medical  officers  of  the  British  army  at  St,  Domingo,  p.  341, 
342  ;  and  that  of  Dr.  Hume,  p.  346,  347  ;  those  of  Dr.  Walker  and 
of  Dr.  Grant  of  Jamaica;  p.  350,  351  ;  that  of  Dr.  Ramsay,  and  of 
all  the  medical  practitioners  of  the  State  of  South  Carolina,  declared 
unanimously  at  a  General  Meeting  in  Charleston,  p.  355,  359  ;  that 
of  Dr.  de  Rosset  of  Wilmington,  in  North  Carolina,  p.  359  ;  the  opi- 
nions of  Drs.  Valentin,  Taylor,  Hansford,  Selden,  and  Whitehead,in 
Virginia,  p.  360,  362  ;  that  of  Dr.  Davidge  at  Baltimore,  p.  363,  366  ; 
that  of  Dr.  Vaughan,  in  the  State  of  Delaware,  p.  367,  369  ;  the 
opinions  of  many  Physicians  at  Philadelphia,  between  pages  372  and 
386  ;  and  at  New-York,  p.  387,  389  ;  and  those  of  Dr.  Coit  of  New 
London,  Dr.  Wheaton,  of  Providence,  and  Drs.  Warren  and  Brown 
of  Boston,  p.  401,  406.  I  request  also  the  attention  of  my  readers 
to  the  facts  partly  stated,  and  partly  recapitulated  between  pages  406 
and  430  ;  and,  finally,  to  the  very  important  Official  Message  from 
the  President  of  the  United  States  on  this  subject  to  the  two  houses 
of  Congress,  p.  430,  containing  such  an  uncontradicted  and  incon- 
trovertible statement  of  facts,  as  ought,  in  every  unprejudiced  mind, 
to  remove  &Very  suspicion  of  the  existence  of  contagion  in  the  Yel- 
low Fever,  at  least,  in  that  part  of  the  world,"  pages  li'O — 122.* 

Although  Dr  Bancroft  considers  this  quantity  of  uncontracted  evi- 
dence to  be  "  more  than  sufficient  to  overthrow  Dr.  Pym's  superstruc- 
ture, more  especially  as  the  foundation  of  it  has  been  removed  in  the 
first  chapter  of  tbe  present  publication,"  he  adduces  a  multiplicity  of 
additional  facts  and  authorities  in  proof  of  the  local  origin  of  Yellow 
Fever,  and  of  its  being  destitute  of  the  quality  of  contagion.  Among 
Other  documents,  one  from  New-York  is  not  the  least  curious,  which 
proves  from  the  Contagioni?ts  themselves,  that  a  Fever  in  every  respect 
resembling  ihe  Bulam,  prevailed  in  that  city,  nearly  two  years  before  the 
arrival  of  the  hankey  at  Grenada!  page  124 — 126. 

In  illustration  of  the  identity  of  cause  of  the  continued  Yellow  Fe- 
rer,  and  of  the  recurrent  forms,  the  following  Extract  from  the  Offici- 
al Report  of  Dr.  Dickson,  the  late  able  physican  to  the  Leeward  Is- 
land Fleet,  will  be  duly  appreciated. 

•"  At  Barbadoes  and  Antigua,  I  had  generally  seen  the  disease  of  an 

*  The  above  references  include  the  opinions  of  Drs.  Caldwell,  Miller,  and 
other  eminent  Physicians  Several  other  very  recent  authorities  might  be  ad- 
duced who  consider  the  Yellow  Fever  of  Endemic  origin,  and  concur  in  ascrib- 
ing it  to  local  causes  and  atmospherical  influence — but  to  these  a  brief  allusion 
enly  can  here  be  made :  see  the  Treatises  of  Doctors  Girardin,  Irvine,  Reese, 
Le  Fort,  &,c.  and  the  accounts  of  Dortors  Watts,  Revere,  and  other  Writers,  in 
the  different  Periodical  Works  lately  published  in  the  United  States.  Dr.  Watts, 
speaking  of  America,  observes,  **  from  one  end  of  the  Continent  to  the  other,  it 
has  been  officially  announced  during  the  last  season,  that  the  Yellow  Fever  was 
not  communicated  from  one  person  to  another,  and  not  even  in  Hospitals  where 
the  sick  have  been  admitted  in  great  numbers.'' — New-York  Med  and  Sur.  Rc~ 
gister,  Part,  ii — Vol.  1,  1820.  See  also,  lately  republished,  the  work  of  the  ex- 
perienced M.  Dereze — Paris,  1820, 


YfeLLOW  FEVER.  317 

ardent  continued  form,  and  did  not  fully  understand  why  authors  talk- 
ed of  a  Bilious  Remittent  Yellow  Fever,  u^til  after  the  capture  of  the 
French  and  Danish  Islands.  But  the  anomalies  of  fever,  the  shades 
and  changes  which  it  assumes  according  to  the  intensity  of  the  excit- 
ing causes,  (which  there  were  purely  and  wholly  /oca/,)  the  state  of 
predisposition,  or  the  spot  of  residence,  could  no  where  be  more 
strongly  pourtra\ed  than  in  the  destructive  epidemic  of  Mariegalante 
in  the  autumn  of  1808,  from  the  most  concentrated  marsh  miasmata; 
when  the  different  types  of  fever  were  converted  into  each  other,  of 
the  worst  and  most  aggravated  species  I  have  ever  witnessed.  Some 
were  affected  with  the  highly  concentrated  Yellow  Fever  in  the  con- 
tinued form  ;  others  with  comatose  remittents  or  intermittent*,  the  ex- 
acerbations of  which  were  so  violent  as  to  carry  off  a  patient  in  two 
or  three  paroxysms  ;  while  others  sunk  into  a  low  protracted  cha- 
racter of  fever  resembling  typhus,"  p.  143—144. 

After  stating  the  opinions  of  the  Naval  Medical  Officers  who  re- 
ported on  the  question  of  contagion,  Dr.  Bancroft  gives  the  following 
summary  of  them ;  from  which  it  will  be  seen  that  the  evidence 
against  contagion  is  as  great  and  uniform,  as  perhaps  can  ever  be  ex- 
pected on  any  disputed  point. 

"  Having  stated  the  opinions  delivered  in  the  Reports  transmitted 
to  the  Privy  Council,  it  may  be  proper  to  give  a  summary  of  them  j 
and,  I  will  therefore  mention  that,  of  the  twenty-four  Gentlemen  from 
whom  these  Reports  were  obtained,  three,  (Mr.  Gregory,  No.  12, 
Dr.  Keiti,  No.  15,  and  Dr.  Magrath,  No.  17,)  haveomi  led  the  state- 
ment of  any  opinion  on  the  subject  of  contagion,  as  connected  with 
the  fever  in  question  :  three  others,  (Dr.  Weir,  No.  I.  Dr.  Blair, 
No.  2,  and  Mr.  Tobin,  No.  21,)  have  expressed  their  opinions  that 
it  is  contagious  :  one  of  them,  (Mr.  Brien,  No.  20,)  declares  his  be- 
lief that,  in  individual  or  solitary  cases,  it  is  *  incapable  of  communi- 
cating itself  to  those  who  are  contiguous,'  but '  that,  when  several 
were  labouring  under  the  disease  at  the  same  time,  he  believes  it  to 
be  highly  contagious.'  And,  another  Gentleman,  (Dr.  Gardiner,  No. 
9,)  appears  to  think,  that  local  causes  contributed  at  least  as  much  to 
the  production  of  the  fever  in  Gibraltar  in  1813,  as  contagion.  Of 
the  remaining  sixteen,  the  majority  have  absolutely  and  positively  de- 
nied the  existence  of  any  contagious  property  in  this  fever ;  and  the 
rest  have  declared  their  belief,  that  it  is  not  naturally  or  property  a 
contagious  disease,  although  several  of  them  are  inclined  to  believe 
that  it  may,  (as  they  suppose  to  happen  with  most  other  diseases,)  ac- 
quire a  contagious  property  by  crowding,  filth,  &c.  Most  of  the  six- 
teen gentlemen,  who  declare  that  the  fever  under  consideration  is 
not  contagious,  have  alleged  decisive  facts  to  support  their  declara- 
tions, some  of  which  1  have  already  quoted  ;  ann,  I  shall  hereafter 
have  occasion  to  notice  some  of  the  others,"  p.  178 — 179. 

When  we  reflect  that  this  evidence  in  great  part  proceeds  from 
physicians  to  fleets,  and  surgeons  of  hospitals  who  have  lived  among 
yellow  fever  for  a  series  of  years  ;  and,  that  the  reports  here  adduced 
are  few  indeed,  when  compared  to  the  great  body  of  medical  officers, 
who,  with  very  few  exceptions,  we  have  had  occasion  to  know,  are 
uniformly  opposed  to  contagion  ;  when  to  these  are  added  the  opi- 


318          INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

nions  of  Drs.  Fergusson,  Muttlebury,  and  Adolpbus,  who  have  long 
held  official  situations  of  the  highest  responsibility  in  the  West  Indies  ; 
when  the  number  and  length  of  service  of  those  who  have  given 
their  opinion  so  decidedly  against  contagion  are  considered, — the 
preponderance  is  immense  ;  especially  as  far  as  the  yellow  fever  of 
the  Weft  Indies  i-  concerned. 

It  would  appear  from  the  Report  of  the  College  of  Physicians  to 
the  Lord.*  of  the  Privy  Council,  that  they  entertain  the  opinion  that 
Yellow  Fever  may  prevail  in  the  British  Island?!.  They  express 
their  belief  that  **  the  cold  of  our  climate  would  not  prove  a  prevser- 
vative  against  the  rout  <gion,"  (of  Yellow  Fever  )  because  *'  it  ap- 
pears that  during  the  months  of  October  and  November,  when  the 
fever  raged  at  Gibraltar,  Malaga,  and  Leghorn,  the  temperature  was 
greatly  below  the  average  heat  of  our  summer."  This  inference 
we  beg  leave  to  dissent  from  ;  and  in  extenuation  observe,  that  the 
College  in  deducing  such  conclusion  does  not  appear  to  have*  been 
aware  of  the  necessity  of  a  certain  preceding  duration  of  high  tempe- 
rature, which  experience  proves  to  be  indispensable  to  the  develope- 
ment  of  epidemic  Yellow  Fever.  Within  the  tropics  the  requisite 
degree  of  heat  is  never  absent :  and  in  those  places  without  the  tro- 
pics which  have  been  occasionally  visited  by  the  disease,  as  North 
America,  and  the  Spanish  Peninsula,  the  meteorological  observations 
of  the  various  years  in  which  it  has  prevailed  concur  in  the  pre-ex- 
istence  of  high  atmospheric  temperature,  for  many  weeks  before  the 
appearance  of  the  epidemics.  Temperature  to  this  requisite  extent 
seldom  obtains  in  this  climate  ;  and  when  it  does  occur,  is  very  tran- 
sitory. Such  evanescent  influence  is  totally  inadequate  to  the  pro- 
duction of  the  disease  ;  and  while  from  insularity,  or  other  causes, 
our  climate  retains  its  mutable  character,  we  may,  without  temerity, 
discard  all  apprehensions  of  the  existence  of  Yellow  Fever  among 
us.  In  corroboration  of  the  steady  pre-duration  of  high  atmosphe- 
ric temperature,  as  the  '*  sine  qua  non1'  of  the  developement  of  epi- 
demic Yellovv  Fever,  the  following  extract  from  a  provincial  news- 
paper is  not  inapplicable. 

"  It  has  been  ascertained  from  tables  and  records  for  the  last  twen- 
ty-four years,  that  in  Philadelphia,  the  Yellow  Fever  does  not  pre- 
vail when  the  months  of  June  and  July  do  not  exceed  70  degrees  ;  but 
that  in  every  summer  since  1795,  when  the  average  heat  of  these 
months  has  exceeded  79  degrees,  then  the  fever  has  raged  ;  and  that  it 
has  been  must  fatal  in  those  years,  in  which  the  thermometer  has  in- 
dicated the  greatest  altitude. — Hampshire  Telegraph^  Nov.  1,  1817. 

In  several  of  the  Reports  transmitted  to  the  Privy  Council,  a  be- 
lief is  expressed  that  the  Yellow  Fever,  although  it  does  not  origi- 
nate in  contagion,  or  legitimately  possess  such  quality,  might  acquire 
it  under  accumulation  of  the  sick,  and  deficient  ventilation.  The  au- 
thor admits,  that  the  disease  may  be  aggravated  by  such  circum- 
stances ;  but  unconditionally  denies  the  possibility  of  its  acquiring 
such  fortuitous  contagious  power.  On  this  point,  (as  far  as  the  tropi- 
cal endemic  is  concerned,)  we  concur  with  Dr.  Bancroft ;  because  on 
reference  to  our  experience  of  many  years  in  the  West  Indies,  we 
cannot  charge  our  recollection  with  any  instance  of  Yellow  Fever 


YELLOW  FEVER.  319 

having  manifested  such  contingent  property  of  contagion,  under  any 
circumstances.  One  source  of  fallacious  deduction  on  this  point, 
seems  to  have  been  the  too  narrow  limitation  of  the  range  of  predis- 
position ;  for  example,  a  ship  enters  an  unhealthy  port ;  her  men 
imbibe  the  local  noxious  exhalations,  and  are  exposed  to  the  other 
remote  causes  of  fever  ;  she  sails  with  a  long  li*t  of  fevers  ;  the  at- 
tacks continue  at  sea,  in  the  order  of  predisposition,  while  the  local 
source  of  the  fever  has  been  left  behind  some  hundreds  of  miles,  and 
is  perhaps  forgotten  ;  the  sick  are  unavoidably  crowded,  and  at 
length,  in  the  absence  of  the  original  cause,  the  seizures  are  ascrib- 
ed to  a  contagious  property  acquired  by  accumulation  ;  when  in  (act, 
the  various  periods  of  attack  should  have  been  referred  to  the  varied 
degrees  of  predisposition.  In  offering  this  explanation  in  favour  of 
the  ultra  opinion,  we  merely  state  the  result  of  our  observation. 
Neither  can  we  admit  the  justice  of  the  inference,  that  such  alleged 
contingent  property  is  favourable  to  the  doctrine  of  a  peculiar  and 
distinct  disease,  the  Bulam  ;  which  its  advocates  contend  is  conta- 
gious ab  origine.  independent  of  those  fortuitous  circumstances,  under 
which  only,  some  have  supposed,  (not  proved.)  the  Yellow  Fever  to 
become  contagious.  Moreover,  we  imagine,  that  those  most  inclined 
to  this  opinion,  will  not  agree  with  Dr.  Pym,  that  it  can  be  conveyed 
and  re-conveyed  across  the  Atlantic,  and  from  one  place  to  another  ; 
because  we  conceive  that  such  a  property,  if  ever  possessed,  is  not  of 
that  permanent  and  imperishable  nature  to  admit  of  transportation 
whenever  the  Contagionists  wave  their  wand  ;  but  is  dependent  upon 
a  casual,  local,  and  transient  coincidence  of  agency  ;  we  therefore 
agree  with  Dr.  Bancroft,  that  it  proves  nothing  in  favour  of  Dr.  PynVs 
view  of  the  subject,  its  nature  or  origin. 

We  are  glad  to  find,  that  the  author  has  now  bestowed  due  atten- 
tion on  a  prolific  source  of  fever  under  high  temperature,  the  nox- 
ious exhalations  from  the  foul  hold  of  a  ship.  By  disregarding  this 
common  cause  of  fever,  a  contagious  origin  has  been  erroneously  as- 
signed to  fevers,  which,  making  their  appearance  without  exposure 
to  land  influence,  could  not  he  supposed  to  have  sprung  from  an  en- 
demic source.  Of  the  frequency  of  such  a  cause  of  even  the  most 
aggravated  Yellow  Fevers,  no  one  ran  doubt  after  perusing  the  facts 
contained  in  the  fourth  chapter ;  to  which  we  are  the  more  desirous 
of  directing  the  attention  of  our  readers,  because  we  are  of  opinion 
that  they  will  satisfactorily  reconcile  several  seeming  instances  of 
contagious  fever,  with  th*ir  true  origin,  an  impure  atmosphere  from 
the  exhalations  from  a  foul  hold.  It  is  needless  to  dwell  on  the  im- 
portance of  the  distinction  ;  the  history  of  the  transports  from  Car- 
thagena,  in  which  the  epidemic  of  Gibraltar  in  1810,  was  reported  to 
have  been  imported,  will  hereafter  be  shown  to  be  a  strong  case  in 
point.  The  accounts  of  the  Regalia  transport,  by  Drs.  Fergusson 
and  Mortimer,  and  of  the  Antelope  and  Childers  ships  of  war,  in 
which  Yellow  Fevers  of  a  destructive  order  recently  prevailed  from 
this  cause,  as  attested  by  Dr.  Crichton  and  Mr.  Niell,  will  he  read 
with  the  greatest  interest.  The  observations  of  Dr.  Fergusson  will 
show,  that  had  the  Regalia  arrived  a  year  later  in  Barbadoes,  she 
would  probably  have  enjoyed  equal  notoriety  with  the  much  calum- 


320  INFLUENCE  OF  TROPICAL  CLIMATES,  &.C. 

/ 

mated  Hankey  ;  the  late  sickness  in  that  island  would  have  been  re- 
ferred to  a  second  African  importation  in  the  Regalia,  and  error  thus 
confirmed.  Dr.  Fergusson  concludes  his  observations  on  this  subject 
with  the  following  important  Remarks. 

"  I  am  aware  how  much  1  have  been  favoured  by  circumstances, 
and  what  a  different  interpretation  the  facts  I  have  collected  would 
have  borne,  had  the  present  epidemic  that  now  afflicts  the  islands, 
(1816,)  broken  out  in  the  ordinary  course  of  seasons,  a  year  earlier, 
at  the  time  the  Regalia  was  here  ;  my  task  would  then  have  been  a 
much  more  difficult  one,  for  these,  (facts,)  instead  of  assisting  me  to 
elicit  the  truth  in  the  manner  I  have  done,  would  in  that  case  have 
been  turned  to  the  confirmation  of  error,  and  the  perpetuation  of 
the  delusions,  in  regard  to  imported  contagions,"  p.  239. 

From  abundant  experience  of  the  danger,  we  fully  coincide  with 
the  author  in  deprecating  the  practice  of  heaving  down  vessels  of 
war,  in  the  West  Indies,  in  the  ordinary  routine  of  service  at  least  ; 
as  well  as  from  the  excessive  fatigue  and  exertion  it  demands,  as  be- 
cause it  is  a  process  which  requires  for  its  execution,  local  security  ; 
or,  in  other  words,  a  landlocked,  and  therefore,  generally  an  unheal- 
thy harbour.  The  instances  of  sickness  and  mortality  from  the  ef- 
fecls  of  clearing  a  foul  hold,  in  an  unhealthy  harbour,  are  number- 
less ;  Dr.  Bancroft  relates  a  remarkable  one,  amongst  several  others, 
in  the  "  highly  interesting"  Report  of  Doctor  Dickson. 

**  Of  the  production  of  Yellow  Fever,  accompanied,  in  twenty-two 
cases  with  black  vomit,  and  consequent  death,  on  board  the  Circe  fri- 
gate, principally  from  the  duties  of  clearing  the  hold  and  heaving 
down ;  by  which  so  many  of  the  ship's  company  were  soon  after  at- 
tacked with  this  fever,  that  a  hundred  and  forty-six  men  were  sent  to 
the  hospital  at  Antigua,"  p.  210. 

The  fifth  chapter  refers  to  the  origin  of  the  Spanish  epidemics. 
In  speaking  of  the  Peninsula  Fnver,  we  wish  distinctly  to  state,  that 
our  conclusions  are  drawn  from  the  analogy  of  the  laws  of  the  Yel- 
low Fever  of  the  West  Indies,  with  which  our  acquaintance  has 
been  sufficiently  extensive  ;  and  as  the  Contagionists  have  themselves 
identified  those  diseases,  we  presume  the  propriety  of  reasoning  by 
such  analogy  will  not  be  disputed.  By  employing  the  term  "  marsh 
miasmata"  to  designate  the  exhalations  from  the  soil,  to  which  Dr. 
Bancroft  in  his  former  work,  ascribed  the  origin  of  Yellow  Fever, 
he  has  given  his  opponents  an  opportunity  of  apparently  convicting 
him  on  his  own  evidence,  by  adducing  the  obvious  inference,  that 
where  there  is  no  marsh,  the  Yellow  Fever  could  not  have  been 
caused  by  such  miasmata.  The  topography  of  some  places,  where 
the  epidemii  has  prevailed,  as  Cadiz  and  Gibraltar,  but  where  there 
are  no  ostensible  marshes,  has  been  accordingly  exhibited  with  ex- 
ultation, as  a  positive  refutation  of  his  doctrine.  The  error  arises 
wholly  from  the  inadequacy  of  the  term  employed  to  express  the 
origin  of  such  miasmata  ;  and  to  show  that  it  is  incorrect  to  ascribe 
to  the  author  the  opinion,  that  Yellow  Fever  is  always  the  product 
of  a  distinct  and  ostensible  marsh  ;  we  subjoin  an  explanatory  quo- 
tation. 

"  In  treating  of  the  Ardent  or  Yellow  Fever,  as  it  has  occurred 


VELLOW   FEVER.  321 

at  Gibraltar,  Cadiz,  and  other  southern  parts  of  Spain,  I  ascribed  its 
production  to  the  action  of  those  vapours,  or  exhalations  which  re- 
sult from  the  decomposition  of  vegetable,  or  vegetable  and  animal 
matters,  in  a  temperature  of  not  less  than  8U°  of  Fahrenheit's  ther- 
mometer, and  which  are  commonly  called  marsh  or  paludal  miasma- 
ta ;  an  appellation  which,  in  compliance  with  custom,  1  h^d  occasion- 
ally adopted,  though  I  well  knew,  and  had  repeatedly  declared,  that 
such  exhalations  or  vapours  are  often  emitted  from  soils  and  situations 
which  had  no  resemblance  to  a  raars/i,"  p.  253 — -6-1. 

Again,  in  a  Note,  at  page  91  <>f  his  Essay,  he  sa^s, 

"•  I  beg  to  state  in  this  place,  that,  in  joining  the  epithet  marsh  or 
marshy,  to  the  terms  miasmata,  exhalations,  effluvia,  &.c.  and  in  con- 
sidering these  as  a  cause  of  fever,  /  do  not  mean  to  intimate  that  such 
miasmata,  fyc.  are  emitted  solely  from  marshes;  (it  being  certain  that 
they  frequently  arise  from  soils  in  a  different  state  ;)  but  only  to  desig- 
nate the  quality  of  (hose  vapours,  which  are  eminently  the  product  of 
marshy  grounds." 

This  ought  to  have  been  a  sufficient  security  against  the  miscon- 
structions which  his  opinions  on  this  point  have  suffered.  With  re- 
spect to  the  existence  of  paludal  effluvia  at  Cadiz  and  Gibraltar,  he 
adduces  the  prevalence  during  the  summer  and  autumn  of  remittent 
fevers  at  those  places,  the  acknowledged  offspring  of  such  exhala- 
tions, as  indisputably  demonstrating  their  presence  and  influence, 
however  they  may  be  produced,  or  from  whatever  source  derived  ; 
and  a*  further  proof  of  the  unirersality  of  this  cause  of  fever  through- 
out the  Peninsula,  the  statement  of  Sir  James  M'Grigor  is  not  irre- 
levant, which  shows,  that  22,914  cases  of  ague  were  altogether  ad- 
mitted into  the  British  military  hospitals  in  that  country. 

In  the  investigation  of  the  alleged  proofs  of  the  importation  of 
the  various  epidemics  into  Spain,  the  author  has  displayed  his  usual 
ability  and  research  ;  and  we  must  observe,  that  his  exposures  of 
the  frailties,  inconsistencies,  and  anachronisms,  wi'h  which  those 
statements  abound,  refer  equally  to  the  proofs  of  Sir  James  Fel- 
lovves,  and  of  Dr.  Pym.  Of  the  first  epidemic  of  Cadiz  in  1800,  he 
naturally  asks,  if  the  disease  is  sui  generis,  and  has  not  appeared  for 
thirty-six  years  previous  to  1800  ;  from  whence  was  it  imported  on 
that  occasion  ? 

"  There  must  have  been  somewhere  on  our  globe,  a  spot  on  which 
this  disease  had  existed  not  long  before  the  time  of  its  supposed  im- 
portation, and  where  it  was  found  to  possess  a  contagious  power. 
That  they  have  either  proved  this,  or  that  there  is  in  fact  any  such 
place  on  earth,  I  must  confidently  deny." 

We  cannot  accompany  him  through  his  scrutiny  of  the  pretended 
importation  into  Cadiz,  in  1800.  and  into  Malaga  in  1803  and  1804  ;  for 
these  we  must  refer  to  the  volume  iiself.  The  meteorological  state- 
ments of  Sir  James  Fellowes  afford  to  our  minds,  an  adequate  expla- 
nation of  the  aggravation  and  epidemical  extension  of  the  usual  en- 
demic at  Cadiz  in  1800  ;  while  the  gradual  progress  of  the  disease, 
and  the  imperceptible  conversion  of  the  ordinary  and  milder,  into  the 
more  rare  and  exalted  form,  constituting  yellow  fever,  as  manifested 

41 


322  jtfjri.vsNeg  OF  TROPICAL  CJM&ATES,  &c. 

by  the  difficulties  and  dissentions  which  the  Spanish  physicians  elpe" 
rienced  in  their  attempts  to  fix  the  date,  when  the  usual  autumnal  fe- 
ver could  be  said  to  have  ceased,  and  the  epidemic  yellow  fever  to 
have  begun,  confirm  us  in  our  opinion,  that  the  question  of  Bulam,  or 
Continued  Yellow  Fever,  is  truly  one  of  degree,  and  not  of  specific 
difference. 

The  author's  former  remarks  on  the  defective  signification  of  the 
term  "  marsh  miasmata,"  to  express  the  miasm  of  decomposition,  are 
more  especially  applicable  to  the  medical  topography  of  Gibraltar,  not 
unfrequently  styled  "  par  excellence"  the  Rock.  The  idea  of  the  de- 
velopement  of  paludal  effluvia  from  a  surface  ostensibly  so  dissimilar 
to  a  marsh,  has  not  merely  been  denied  ;  it  has  been  assailed  by  ridi- 
cule. The  rarity  of  agues  in  Gibraltar  has  also  been  adduced  in 
proof  of  the  non-generation  of  those  exhalations  at  that  place.  This, 
however,  as  the  author  shows,  betrays  a  very  limited  acquaintance 
tvith  the  modifications  which  are  impressed  on  endemic  fever  by  the 
influence  of  locality  ;  and  while  remittents  are  acknowledged  to  be 
the  usual  form  of  the  autumnal  fever  in  Gibraltar,  (as  well  as  in  Ca- 
diz,) we  need  take  very  little  pains  to  prove  the  existence  and  influ- 
ence of  febrile  exhalations  from  the  soil,  however  ingeniously  the 
speculators  on  the  locality  of  an  elevated  rock,  and  on  the  absence  of 
agues,  may  argue  to  the  contrary.  The  examination  of  the  impor- 
tation account  of  the  epidemic  into  Gibraltar  in  1804,  is  prefaced  by 
this  observation. 

44  At  present,  therefore,  it  will  be  sufficient  for  me  to  suggest  as 
fllvioiis  and  prominent  causes  of  the  epidemic  in  question,  the  accu- 
mulation of  decomposable  matters  within  the  town  and  the  long  pre- 
valence of  a  dry  and  scorching  east  wind,  which  produced  a  very  high 
atmospheric  temperature,  without  any  salutary  ventilation  of  the 
place,  as  it  was  completely  obstructed  in  its  course  by  the  high  moun- 
tain behind  the  town,  in  and  over  which  the  air  was  for  many  weeks 
nearly  stagnant.  A  similar  dry  and  scorching  east  wind,  blowing 
with  too  little  force  to  change  and  purify  the  atmosphere,  has  invari- 
ably preceded,  and  accompanied  every  recurrence  of  the  yellow  fe- 
ver at  Cadiz,  and  other  cities  of  Spain.  And  its  effects,  in  the  year 
1804,  were  very  extensive  and  remarkable,  p.  342 — 343. 

We  learn  from  the  result  of  the  inquiry  into  the  alleged  importa- 
tion of  that  year,  that  Santos,  the  person  who  is  accused  of  having 
imported  the  contagion  into  Gibraltar,  from  Cadiz,  according  to  one 
account  on  the  28th  of  August,  but  according  to  another,  on  the  25th, 
left  Cadiz  several  dajs  before  the  time  which  Dr.  Arejula,  the  chief 
official  superintendant  of  all  things  belonging  to  the  Andalusian  epi- 
demic, has  declared  to  be  the  day  on  which  the  existence  of  the  yel- 
low fever  was  first  discovered  at  Cadiz.  He  could  not  therefore 
have  imported  a  disease  from  Cadiz  which  had  no  existence  there. 
The  importation  by  Santos,  has  been  attempted  to  be  corroborated 
by  the  evidence  of  a  Mr.  Pratt,  who  was  also  in  Cadiz,  and  from 
whom  Santos  is  alleged  to  have  derived  his  contagion,  while  they  re- 
sided in  the  same  tavern.  But  the  author  says,  that  a  very  cursory 
view  of  his  examination  is  sufficient  to  make  any  one  "  sensible  oi  the 
Obvious  and  ipreconcileable  contradictions  which  it  contains,  and  of 


.YELLOW 

the  absolute  impossibility  of  its  being  true.w  The  affidavit  of  this 
person  states,  that  he  was  taken  ill  while  living  in  a  tavern  in  Cadiz, 
about  the  18th  or  20th  of  August ;  that  eight  days  afterwards,  he  had 
symptoms  of  black  or  bloody  vomiting  ;  that  then,  fearful  of  being 
sent  to  an  hospital,  he  removed  to  another  part  of  the  town,  and  ulti- 
mately recovered  ;  and  that  after  his  recovery  he  applied  for  a  pas- 
sage to  Gibraltar  in  the  same  vessel  in  which  Santos  returned  to  that 
place,  but  was  refused  on  account  of  his  very  yellow  look.  The  pri- 
ma  facie  improbability  of  a  person  who  laboured  under  black  vomit, 
being  able  to  shift  his  quarters  from  the  apprehension  of  any  contin- 
gency, needs  not  to  be  insisted  on  ;  but  the  conclusion  of  the  story  is 
fatal  to  its  credibility,  and  destroys  all  relation  between  the  deponent's 
and  Santos's  illness  ;  for  the  vessel  in  which  Santos  returned  to  Gi- 
braltar, and  in  which  Mr.  Pratt  says,  he  was  refused  a  passage  after 
his  recovery,  left  Cadiz,  at  the  latest,  on  the  24th  of  August,  (as  San- 
tos and  Sir  James  Fellowes  assert,  and  public  records  prove,)  several 
days  before  the  occurrence  of  the  alleged  black  vomit  ia  the  course  of 
Mr.  Pratt's  illness. 

From  such  a  tissue  of  contradictions,  we  know  not  what  points  can 
be  selected  as  entitled  to  belief.  The  statements  intended  to  esta- 
blish the  fact  of  importation,  reciprocally  destroy  their  respective 
foundations.  We,  therefore,  recur  with  unshaken  confidence  to  the 
domestic  origin  of  the  epidemics  ;  and  proceed  to  show,  Ait  the 
bases  of  the  subsequent  attempts  to  fix  the  mode  of  importation  are 
equally  deficient  in  solidity. 

A  coincidence  of  local  and  atmospherical  causes,  similar  to  those 
which  produced  the  epidemic  of  1804,  again  aggravated  the  usual  re- 
mittent of  Gibraltar,  (which  had  regularly  prevailed  there  in  every 
intermediate  year,)  towards  the  close  of  the  autumn  of  1810,  to  the 
degree  of  concentrated  yellow  fever.  The  epidemic  of  that  year 
has  also  been  alleged  to  have  been  imported  by  some  transports  from 
Carthagena,  crowded  with  French  deserters.  The  substantiabilityr 
of  this  allegation  may  be  in  some  degree  appreciated  by  stating,  that 
it  rests  wholly  on  the  gratuitous  assumption  of  a  breach  of  quaran- 
tine. Some  cases  of  fever  had  appeared  among  the  soldiers  in  the 
transports,  previous  to  their  arrival  at  Gibraltar,  of  which  one  man 
had  died.  Sickness  ceased  shortly  after  their  removal  into  hulks 
provided  for  their  reception,  and  it  does  not  appear  that  the  fever  was 
there  communicated  to  any  person  ;  but  the  contagious  nature  of  the 
disease  was  inferred  from  the  subsequent  attacks  of  the  seamen,  who 
remained  in  the  transports,  and  of  Mr.  Arthur,  who  was  sent  on 
board  them  from  the  garrison  to  treat  the  sick.  The  cause  of  fe vet- 
in  those  vessels,  the  author  justly  ascribes  to  the  noxious  emanations 
from  their  holds,  which,  in  a  former  chapter,  he  hns  shown  to  be  ca- 
pable  of  producing  the  worst  yellow  fevers.  The  attacks  of  Mr. 
Arthur  arid  the  seamen,  are  not  proofs  that  the  disease  was  conta- 
gious :  the  cause  being  local,  every  person  exposed  to  its  influence, 
might  be  expected  to  suffer,  without  the  assumption  of  contagious 
agency.  Dr.  Bancroft  refers  to  Dr.  Burnett's  previous  statement  in 
support  of  his  rejection  of  the  opinion  of  an  imported  contagion  by 
these  transports  ;  bnt,  it  is  necessary  to  repeat,  that  these  vessel* 


324  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

having  been  placed  in  strict  quarantine  immediately  on  their  arrival 
at  Gibraltar,  the  contagionists,  in  order  to  explain  the  origin  of  the 
epidemic  hy  importation,  are  driven  to  the  extremity  of  assuming  a 
breach  of  quarantine.  We  would  ask,  if  assumptions  so  perfectly 
gratuitous,  be  expected  to  be  received  as  bona  tide  proofs  of  an  affir- 
mation, what  fable,  however  preposterous,  could  be  rejected  on  the 
score  of  want  of  evidence  ? 

In  the  next  epidemic  in  18 S3,  Sir  Joseph  Gilpin  was  at  the  head 
of  the  medical  department  in  Gibraltar.  In  a  letter  to  Dr.  Chisholm, 
published  in  the  Edinburgh  Medical  and  Surgical  Journal,  in  speak- 
ing of  the  contagious  nature  of  yellow  fever,  and  of  its  importation 
in  1793  from  Africa  in  Grenada,  he  states,  "  of  the  infected  state  of 
the  Hankey,  1  never  did,  nor  ever  shall,  entertain  the  least  doubt.'* 
This  is  certainly  sufficiently  declaratory  of  the  tendency  of  his  an- 
tecedent opinions.  He  says,  that  the  first  cases  of  the  epidemic  of 
1813,  occurred  in  two  strangers,  who  imported  it  into  Gibraltar  on 
the  1  Hh  of  August,  in  a  vessel  called  the  Fortune,  from  Cadiz,  where 
he  states,  (very  erroneously,  as  will  be  shown,)  the  epidemic  in 
question  prevailed  at  the  period  of  their  departure.  Now,  Lieute- 
nant General  Campbell,  the  Lieutenant  Governor  of  Gibraltar,  writes 
to  Sir  James  Duff,  the  British  Consul  at  Cadiz,  on  the  13th  of  Sep- 
tember, 1813,  stating,  that  some  cases  of  fever  had  lately  occurred 
in  the%arrison,  **  but  that  there  was  not  one  of  a  contagious  nature, 
as  they  were  peculiar  to  the  season  only."  Here  we  have  the  high- 
est authc  rily  that  no  contagious  disease  prevailed  in  Gibraltar  for 
more  than  a  month  after  the  arrival  of  the  strangers  from  Cadiz  : 
and  the  non-existence  of  the  epidemic  at  Cadiz,  not  merely  at  the 
time  of  their  departure  from  thence,  but  for  a  considerable  time  af- 
terwards, is  proved  by  the  testimony  of  Sir  James  Fellowes,  who  in 
speaking  of  Cadiz,  states,  at  page  256,  4*  in  fact,  until  the  end  of  Au- 
gust, the  people  collectively  were,  according  to  all  the  reports  at 
the  time,  in  a  healthy  state,  and  at  page  261,  he  remarks,  that  it  was 
only  on  the  14th  of  September  that  he  observed  any  case  in  the  Bri- 
tish hospitals  that  excitfd  his  suspicions."  These  statements  prove, 
(as  in  the  instance  of  1804,)  that  no  disease  prevailed  at  Cadiz,  at 
the  time  of  the  departure  of  the  Fortune  from  that  port  ;  she  could 
not  therefore,  have  imported  a  nonentity.  Further,  it  has  been  seen, 
that  more  than  a  month  elapsed  after  the  arrival  of  the  Fortune  at 
Gibraltar,  before  the  epidemic  was  observed  in  that  garrison  ;  on 
which  point  Dr.  Bancroft  observes, 

*•  As  Dr.  Pym  confidently  asserts  that  the  contagion  of  the  Bulatn 
produces  disease  in  four  days,  at  least  in  Gibraltar,  its  existence  must 
have  been  made  manifest  by  the  occurrence  of  very  many  attacks 
within  that  interval  ;  while,  if  it  had  been  known  to  have  produced 
even  one,  Sir  Joseph  Gilpin  must  have  been  highly  culpable,  had  he 
not  informed  the  Lieutenant  Governor  thereof,"  p.  375 — 376. 

It  is  not  a  little  curious,  that  *'  the  garrison  of  Gibraltar  was  in 
strict  quarantine  for  several  months  before  the  malady  made  its  appear- 
ance, and  a  Board  of  Health  was  sitting  almost  daily  on  account  of 
the  plague  which  had  broken  out  at  Malta/' 

This  circumstance,  added  to  the  assumed  breach  of  quarantine  in 


YELLOW  FEVER.  325 

1810,  inevitably  involves  the  dilemma,  of  either  acknowledging  the 
futility  of  quarantine  regulations  for  the  prevention  of  the  Bulam  ; 
or  otherwise,  that  the  disease  was  not  in  either  case  imported.  The 
advocates  for  quarantines  are  at  liberty  to  choose  their  difficulty — 
the  impossibility  of  supporting  both  positions  is  palpable. 

The  origin  of  the  epidemic  of  1814,  the  last  which  has  occurred 
in  Gibraltar,  has  not  been  attempted  to  be  referred  to  importation, 
except  by  one  individual,  who  advances  no  facts  in  support  of  his 
opinion.  By  the  replies  to  the  questions  proposed  by  Deputy  In- 
spector Fraser  to  the  medical  offireis  of  the  garrison,  seventeen  in 
number,  we  learn,  that  twelve  declared  it  to  be  their  belief,  that  the 
disease  originated  in  domestic  or  local  causes,  unconnected  with  im- 
portation. Three  were  neutral  ;  one  declined  offering  an  opinion  ; 
and  one  only  derived  it  from  importation.  The  original  documents 
adduced  in  proof  of  the  domestic  origin  of  the  epidemic  of  that  year, 
are  too  numerous  for  us  even  to  glance  at,  We,  therefore,  take  our 
leave  of  the  subject  of  yellow  fever  at  Gibraltar,  by  repealing  our 
perfect  concurrence  with  the  author,  after  a  deliberate  consideration 
of  the  question,  that  the  fever  which  has  prevailed  there  epidemi- 
cally several  times  within  the  present  century,  originated  from  local 
or  domestic  causes,  and  was  destitute  of  any  contagious  property. 

The  seventh  and  last  chapter  contains  an  inquiry  into  the  causes  of 
the  epidemics  of  Cadiz,  and  other  places  in  Spain  in  1810,  and  in 
some  subsequent  years  ;  but,  as  the  disease  was  avowedly  the  same 
with  that  of  former  periods,  it  will  not  be  incumbent  on  us  to  notice 
all  the  particular  subjects,  which,  in  order  to  leave  nothing  relating 
to  these  epidemics  without  investigation,  Dr.  Bancroft  has  deemed  it 
his  duty  to  examine.  With  respect  to  the  fever  of  Carthagena  in 
1810,  which  caused  the  deaths  of  3000  persons  in  six  or  eight  weeks, 
he  observes, 

"  We  are  told  by  Dr.  Burnett,  (p.  274.)  that  Dr.  Ri?euno,  Phy- 
sician to  the  Spanish  Royal  Hospital  there,  '  positively  asserts,  that 
the  fever  was  brought  from  Cadiz  and  Gibraltar,  in  1810  ;'  while  Dr. 
Pym  as  positively  asserted  it  to  have  been  carried  from  Carthagena 
to  Gibraltar.  This  last  assertion  has  already  been  proved  to  be  er- 
roneous, (see  page  359,  &,c.)  and  the  former  must  be  so,  because  the 
ardent  yellow  fever,  or  Bulam,  did  not  appear  at  Gibraltar,  (except 
in  the  transports,)  until  near  the  middle  of  October,  a  month  after 
the  disease  had  been  prevalent  in  Carthagena  ;  and  this  observation 
is  also  applicable  to  Cadiz,  which  continued  healthy  till  the  middle 
of  September,  '  before  which  time  many  deaths  had  occurred  at  Car- 
thagena ;'  and  these  contradictory  assertions  serve  only  to  manifest 
the  readiness  with  which  the  contagionists,  who  believe  that  an  epi- 
demic yellow  fever  must  always  proceed  from  imported  contagion, 
hazard  tales  to  account  for  it,"  p.  415. 

The  history  of  an  epidemic  yellow  fever,  which  prevailed  in  the 
64th  regiment  at  Stony  Hill  in  Jamaica,  has  been  brought  forward  by 
Dr.  Pym,  as  a  proof  of  the  contagious  origin  of  that  disease.  This  opi- 
nion rests  on  the  circumstance,  that  a  detachment  of  tiie  54th  regiment, 
which  was  sent  from  Stony  Hill  to  Fort  Augusta,  and  there  quarter- 
ed with  a  negro  regiment  and  some  European  troops,  became  sickly  ; 


326  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

and  that  after  their  returu  to  Stony  Hill,  fever  passed  through  the 
whole  regiment.  It  is  not  said  from  whence  the  contagion  was  deriv- 
ed ;  certainly  not  from  the  Negroes  at  Fort  Augusta,  who  know  no- 
thing of  yellow  fever  ;  nor  yet  from  the  European  troops  in  those 
quarters  ;  nor  is  it  stated,  that  the  other  regiments  in  the  same  quar- 
ters with  the  detachment  of  the  54th,  were  not  aifected  by  the  fever. 
"  If  therefore  no  contagion  existed  in  Fort  Augusta,  none  could  have 
been  carried  to  Stony  Hill." 

This  statement  had  already  been  controverted  by  Mr.  Doughty  in 
his  valuable  publication  on  Yellow  Fever. 

"  That  the  54th  Regiment  was  attacked  with  the  aggravated  form 
of  yellow  fever,  as  described  in  these  letters,  (published  by  Dr. 
Pym,)  I  readily  admit  ;  and,  that  the  other  corps  in  the  same  quar- 
ters did  not  suffer,  as  stated  by  Mr.  Rocket,  I  also  most  firmly  be- 
lieve. Now,  as  Mr.  Redmond  and  Mr.  Pym  agree  that  the  fever 
which  prevailed  in  the  54th  regiment  was  highly  contagious,  and  Mr. 
Rocket  asserts  the  other  corps  remained  unaffected  with  it,  I  ask 
from  what  source  did  the  64th  imbibe  its  contagion  ?  The  fever  de- 
veloped itself  at  the  season  when  the  endemic  cause  prevailed,  and 
which  might  that  year  be  more,  powerful,  and  exert  its  influence  to  a 
wider  extent,  than*  it  had  clone  the  preceding  years.  The  soldiers  of 
the  54th  were  susceptible  of  its  influence,  whilst  those  of  the  other 
corps  were  not  in  the  same  degree  ;  because  one  of  those  latter  re- 
giments had  been  in  the  island,  to  my  knowledge,  not  less  than  three, 
and  the  other  six  years,  and  a  great  part  of  the  time  in  quarters,  an- 
nually visited  with  yellow  fever."  Observations  on  Yellow  Fever,  p. 
54. 

There  remains  the  history  of  another  epidemic  yellow  fever,  re- 
corded by  Dr.  Pym  as  owing  its  origin  to  contagion,  which  we  are 
somewhat  surprised  to  find  that  Dr.  Bancroft  has  omitted  to  notice  ; 
more  especially  as  his  local  knowledge  of  the  scene  of  the  transac- 
tion, (with  which  we  also  have  some  acquaintance,)  would,  we  ap- 
prehend, have  rendered  the  task  of  its  refutation  void  of  difficulty. 
We  allude  to  the  fever  of  the  70th  regiment  in  Fort  Edward,  Marti- 
nique, in  1794  ;  and  refer  to  Dr.  Fergusson's  excellent  topographi- 
cal remarks  on  Fort  Royal  ;  (Med.  Chir.  Trans.  Vol.  viii.  p.  1 19  to 
122,)  and  also  to  Mr.  Mortimer's  introductory  letter  to  his  valuable 
report  on  Yellow  Fever,  published  in  the  Medico-Chirurgical  Jour- 
nal, in  proof,  that  the  sickness  of  that  regiment,  attributed  by  Dr.  Pym 
to  contagion,  (Obs.  on  the  Bulam  Fever,  p.  10 — 14,)  depended 
wholly  upon  local  and  indigenous  cause?. 

We  conclude  this  subject  with  the  author's  exhortation  respecting 
the  preconceived  opinions  of  contagion,  which  strangers  usually  car- 
ry with  them  into  tropical  climates  ;  but  which,  in  by  far  the  majo- 
rity of  instances,  ultimately  yield  to  a  more  intimate  acquaintance 
with  the  habitudes  of  the  disease  in  question. 

"  I  earnestly  request  my  readers  attentively  to  reflect  upon  the 
facts  stated  in  this  chapter  ;  and  especially  upon  the  readiness  with 
which  numerous  medical  men,  respectable  by  their  characters,  their 
conduct,  and  their  professional  ranks,  have  come  forward  to  make 
confessions  which  are  generally  felt  as  in  some  degree  humiliating, 


VELX-OiV  FEVER.  327 

by  acknowledging  that  they  had,  when  they  first  arrived  in  the  re- 
gions of  yellow  fever,  entertained  opinions,  deeply  fixed  in  their 
minds  by  the  ordinary  course  of  medical  education,  which  however, 
after  more  extensive  observation  and  better  means  of  information, 
they  had  found  reason  to  abandon  as  erroneous,  and  been  forced  to 
adopt  conclusions  directly  the  reverse,  in  regard  to  the  alleged  con- 
tagious nature  of  the  yellow  fever.  This  is  stated  to  have  been  done 
by  Dr.  M'Lean,  Dr.  Fergusson,  and  all  their  colleagues  on  the  hos- 
pital staff  at  St.  Domingo  ;  it  was  done  also  by  myself,  and  almost  all 
on  the  hospital  staff  in  the  Windward  Islands,  (see  the  letter  of  Mr. 
Voung,  Inspector  General,  on  this  subject,  at  page  335  of  my  Essay  ;) 
it  was  done  by  Dr.  Dickson,  and  as  he  declares?,  generally  by  others 
in  the  circle  of  his  acquaintance  ;  and,  beside  many  others,  it  will 
soon  appear  to  have  been  done  by  Dr.  Erly  at  Sierra  Leone,  on  the 
very  coast  where  Dr.  Pym  and  Dr.  Chisholrn  pretend  to  derive  their 
Bulam  fever.  In  all  these  cases,  the  change  of  opinion  has  been  made 
spontaneously  and  disinterestedly,  by  the  silent  and  gradual,  but  cer- 
tain operation  of  truth  ;  and  without  any  desire  to  gain  credit  by  a 
supposed  preservation  of  many  lives  from  a  danger  which  had  no  ex- 
istence, and  without  any  of  those  views  to  promotion  and  reward, 
which  may  have  produced  some  of  the  exertions  and  erroneous 
statements  lately  made,  in  regard  to  the  fever  under  consideration," 
p.  189—191. 

On  the  subject  of  typhus  within  the  tropics,  we  think  Dr.  Ban- 
croft has  somewhat,  and  with  advantage, modified  his  former  opinions  ; 
for  his  admission,  page  174,  seems  to  sanction  a  greater  latitude  of 
inference,  than  could  be  deduced  from  his  former  volume,  respecting 
its  being  carried  as  far  as  Barbadoes.  We  also  are  of  opinion,  that 
typhus  may,  and  does  exist  occasionally  within  the  tropics  ;  and  we 
have  seen  what  we  consider  to  be  the  unequivocal  cases  of  that  dis- 
ease on  the  Atlantic  Equator  ;  but  we  coincide  with  the  author,  that 
the  climate  is  extremely  unfavourable  to  the  existence  and  perpetua- 
tion of  typhus  contagion,  and  that  it  ultimately  exhausts  itself. 

Upon  the  occasional  occurrence  of  a  hybrid  disease,  which  Dr. 
Bancroft  simply  alludes  to  as  having  noticed  in  his  Essay  "  without 
either  approbation  or  disapprobation,"  we  do  not  profess  to  offer  any 
decided  opinion.  It  is  known,  that  Sir  John  Pringle,  Sir  Gilbert 
Blane,  Dr.  Lempriere,  and  others,  have  spoken  of  a  mixed  or  hybrid 
fever  ;  and  we  have  understood,  that  Dr.  Dickson  is  of  opinion,  that 
he  has  seen  some  instances  which  favour  the  existence  of  such  cha- 
racter of  disease  ;  where  the  appearance  and  duration  of  the  symp- 
toms were  so  indeterminate  between  typhus  and  yellow  fever,  that  it 
was  difficult  to  say,  to  which  order  of  fever  they  most  belonged. 
But  we  believe,  at  the  same  time,  that  he  considers  such  occurrences 
as  extremely  rare  ;  that  he  has  not  detected  any  satisfactory  evidence 
of  their  possessing  an  infectious  quality  ;  and  that  under  the  influ- 
ence of  climate,  they  soon  disappear,  and  are  succeeded  by  the  le- 
gitimate endemic  of  the  West  Indies.  Such  questions  can  only,  we 
conceive,  be  ultimately  decided- by  those  who  may  enjoy  similarly  ex- 
tensive opportunities  of  witnessing  the  disease  under  all  varieties  of 
circumstances  and  character. 


328  INFLUENCE  OF  TROPICAL  CLIMATES,   &C. 

We  conclude  by  expressing  our  sense  of  the  ingenuity,  acuteness, 
and  research,  which  the  author  has  exerted  with  equal  facility  and 
effect  in  the  present  elaborate  production  ;  and  we  are  satisfied,  that 
the  voluminous  mass  of  irrefragable  evidence  which  he  has  been  en- 
abled to  adduce,  will  impress  conviction  on  every  unprejudiced  mind, 
of  the  perfect  triumph  he  has  achieved  by  the  complete  refutation  of 
the  opposite  opinion,  of  the  existence  of  th.e  Bulam  as  a  distinct  con- 
tagious fever,  attacking  but  once.  In  the  preceding  analysis,  we 
have  aimed  at  the  inclusion  of  the  most  prominent  parts  of  the  dis- 
cussion ;  for  its  length  we  plead  the  importance  of  the  inquiry,  and 
the  desire  to  diffuse  a  portion,  at  least,  of  the  information  with  which 
the  pages  of  this  "  Sequel"  are  enriched,  as  well  as  to  contribute  our 
mite  to  the  advancement  of  what  we  consider  to  be  the  cause  of  truth , 
and  to  the  correction  of  a  popular  error  ;  for  as  the  author  justly  ob- 
serves in  his  conclusions,  the  supposition  of  the  existence  of  conta- 
gion "  accords  with  the  prejudices  and  apprehensions  of  the  greater 
part  of  mankind,  who  are  prone  to  believe  that  all  diseases  are  con- 
tagious when  they  become  generally  prevalent."  To  those  whose 
lot  and  duty  it  has  been  to  alleviate  the  sufferings  inflicted  by  yellow 
fever,  and  who,  therefore,  with  us,  naturally  feel  a  peculiar  interest 
in  the  discussion,  we  need  not  say  more  to  induce  them  to  avail  them- 
selves of  the  information  and  experience  accumulated  in  this  volume. 


Topographical  Remarks,  illustrating  the  causes  and  prevention  of  the 
Tropical  Endemic  or  Yellow  Ff.ver,  by  Dr.  DICKSON,  F.  R.  S.  Ed. 
F.  L  S.  Fe:low  of  the  Roy  tl  College  of  Physicians  of  Edinburgh,  and 
late.  Physician  to  the  Fleet,  and  Inspector  of  Hospitals  in  the  West 
Indies. 

Quod  sol  atque  imbresdederant,quod  terra  crearat 

Sponte  sua.  LUCRET.  Lib.  v. 

Sec.  III. — As  the  knowledge  of  a  disease  is  of  interest  in  propor- 
tion to  its  danger  or  frequency,  and  as  the  means  of  prevention  de- 
pend upon  a  correct  appreciation  of  its  causes,  the  investigation  of 
the  laws  which  govern  the  Tropical  Endemic  is  confessedly  of  the 
highest  importance. — With  this  view  I  offered  some  topographical  re- 
marks on  the  Eiioloiry,  and  Prevention  of  the  Yellow  Fever,  in  the 
13th  Vol.  of  the  Edinburgh  Medical  and  Surgical  Journal  ;"and,  on 
the  present  occasion,  I  have  endeavoured,  by  the  addition  of  several 
observations  and  illustrations,  still  further  to  elucidate  the  subject. 

Marsh  Miasma  has  been  very  generally,  and  justly  considered  as  a 
grand  source  of  the  fevers  of  warm  climates ;  and  it  is  a  very  fre- 
quent though  not  the  only  source  of  the  destructive  form  of  the  Tro- 
pical Endemic.  While  its  operation  has  been  too  exclusively  insisted 
upon  by  some  authors,  it  has  been  admitted  under  great  limitations 
only  by  others.  The  term,  indeed,  is  not  free  from  objection,  since 
it  has  caused  the  latter  to  receive  it  in  a  sense  far  too  strict  and  lite- 
ral, and  to  question  the  existence  of  such  exhalations,  except  in  the 
vicinity  of  a  complete  swamp  or  marsh. 


Ifcl.LOW  FEVEK. 

I  am  at  present  to  consider  the  miasmata  of  decomposition,  with 
reference  to  their  effect,  and  not  to  their  intimate  nature,  in  whatever 
situation  they  may  occur  ;  and,  in  this  general  sense,  it  appears  to 
me,  that,  in  a  temperature  so  uniformly  high  as  that  of  the  West 
Indies,  and  where  de-composition  is  so  rapidly  promoted  by  the  agency 
of  heat  and  moisture,  there  can  he  very  few  places  where  the  occa- 
sional production  of  noxious  effluvia  may  not  be  calculated  upon  on 
shore  ;  and  sometimes,  also,  on  ship-board.  Of  fever  arising  in 
particular  ships,  from  impure  exhalations  emanating  from  a  foul  state 
of  the  hold,  continuing  notwithstanding  every  attention  to  preventive 
measures,  and  ceasing  only  upon  the  hold  being  cleared,  I  have  seen 
many  well  marked  instances.  As  the  most  unseasoned  part  of  a 
ship's  company,  and  especially  strangers,  will  he  most  liable  to  suffer  ; 
in  this  case,  it  is  easy  to  perceive  that  such  attacks  might  sometimes 
be  construed  in  favour  of  infectious  fever  ;  but  that  they  proceeded 
solely  from  the  source  above  mentioned,  appears  to  me  clearly  de- 
monstrated by  the  previous  inefficacy  of  ventilation  and  cleanliness, 
— by  the  impunity  with  which  promiscuous  intercourse,  elsewhere, 
is  maintained  with  other  ships^ — by  the  extinction  of  the  disease 
upon  the  hold  being  cleared,  and*  not  till  then, — and  by  its  not  being 
propagated  or  communicated  by  the  sick,  when  removed  from  its  ori- 
ginal source.  I  shall  adduce  one  example,  where,  from  the  peculiar 
construction  of  the  vessel,  the  source  of  the  febrific  exhalations 
could  be  more  clearly  ascertained  than  when  they  arise  from  a  foul 
state  of  the  ballast  in  general.  In  April,  1807,  a  fever  prevailed  in 
the  Dart,  lying  guard-ship  at  Barbadoes,  which,  at  first,  was  attri- 
buted to  land  influence,  and  irregularities  committed  by  the  men  em- 
ployed on  shore  ;  but  as  it  continued  from  time  to  time,  to  attack  new 
comers,  especially  after  sleeping  two  or  three  nights  on  board,  an  in- 
ternal cause  became  suspected.  The  ship  was  divided  into  com- 
partments below,  so  as  to  allow  of  the  water  being  carried  into  large 
tanks  or  cisterns,  instead  of  the  usual  manner  ;  and  these,  having 
been  disused  in  harbour,  their  bottoms  wore  found  to  be  covered 
with  an  offensive  deposition  of  slimy  mud.  On  the  17th  of  May,  cases 
of  fever  still  supervening,  I  find  by  my  notes  that  this  evil  had  been 
detected,  and  remedied  ;  and  communications  between  the  divisions 
had  been  opened,  so  as  to  allow  a  free  circulation  of  air  below  ;  and 
on  the  24th  I  find  it  stated,  "  for  the  last  week  no  fresh  attacks  of 
fever  had  occurred  on  board  the  Dart."  The  fatal  cases  terminated 
at  the  hospital  with  the  usual  symptoms  of  yellow  fever.  As  such 
fevers  may  occur  at  various  periods  after  exposure,  consequently, 
after  the  cause  has  been  removed,  the  early  cessation  of  the  disease, 
in  the  present  instance,  is  more  material,  where  the  ship  was  con- 
stantly receiving  new  men  ;  because  their  not  being  affected  subse- 
quently, showed  that  the  cause  which  had  existed  previously,  existed 
no  longer.  * 

Impure  effluvia  will  be  most  apt  to  be  generated  in  a  new  ship, 
particularly  if  built  of  green  wood  ;  or  where  the  shingle  ballast  has 
not  been  restowed  for  a  length  of  time,  or  had  not  been,  originally, 
carefully  selected.  If  such  exhalations,  (between  which  and  animal 

42 


330  INFLUENCE  OF  TKOPirAL  CLIMATES,  &C- 

effluvia,  confined  or  produced  by  the  human  body  under  disease,  a 
wide  distinction  obtain?,  though  their  effects  have  been  often  con- 
founded,) be  admitted  to  occur,  occasionally  in  a  man  of  war,  where 
cleanliness  is  proverbial,  it  is  easy  to  perceive,  that,  by  the  agency 
of  heat  and  moisture,  they  may,  under  particular  circumstances,  in  a 
transport  or  merchantship,  become  so  abundant  and  concentrated, 
that  the  hold,  without  the  expression  being  very  figurative,  might  be 
denominated  a  ship  marsh.* 

But  a  grand  source  of  obscurity  and  of  contradictory  opinions  ap- 
pears to  me  to  originate  from  a  want  of  attention  to  those  different 
stales  of  the  system,  involving  a  great  diversity  of  liability  to  the 
Vellow  Fever,  from  the  lowest  grade  of  European  susceptibility  to 
the  highest  degree  of  disposition  to  the  disease,  short  of  actual  Fe- 
ver. Consistently  with  this  diversity,  it  follows  that  a  quantum  of 
cause  altogether  innoxious  and  insignificant  in  the  former,  would  be 
fully  competent  to  induce  the  disease  in  the  latter  state  of  the  sys- 
tem ;  hence  it  is  easy  to  understand,  that  according  to  the  gradations 
in  the  scale  of  susceptibility  will  be  the  power  of  the  noxious  impres- 
sion ;  and  moreover  that,  what  in  one  suhject  would  constitute  a  pre- 
disponent,  in  another,  possessing  a  higher  degree  of  disposition, 
would  prove  an  exciting  cause  of  the  Yellow  Fever.  I  have  here 
used  the  word  Disposition  instead  of  Predisposition,  (though  I  should 
have  preferred  the  more  familiar  term,)  because  it  might  be  con- 
tended that  the  latter  ought  to  imply  an  original,  or.  at  least,  a  pre- 
vious, rather  than  an  acquired  tendency. 

The  degree  of  such  disposition  may  fluctuate  considerably  during 
the  earlier  period  of  an  European's  residence  in  the  West  Indies, 
according  to  his  age,  habits,  locality,  the  season  of  the  year,  and  as 
various  stimuli  have  a  greater  or  less  influence  upon  the  system  ;  or, 
in  other  words,  in  proportion  as  it  has  been  freely  and  suddenly,  or 
cautiously  and  gradually  exposed  to  their  operation.  In  such  a  cli- 
mate, where  the  youthful,  sanguine  temperament  is,  at  any  rate, 
goaded  by  the  stimulus  of  unnatural  heat,  into  a  degree  of  iebricu- 
lar  excitement,  it  is  not  extraordinary  that,  from  free  living,  intem- 
perance, or  undue  exposure  or  exertion,  there  should  be  much  dan- 
ger of  this  artificial  excitation  terminating  in  real  fever,  until  the 
system  becomes  gradually  inured,  and  less  sensible  of  such  influence 
by  the  effect  of  habit,  or  assimilated  by  the  supervention  of,  what 
have  been  called  ,  seasoning,  or  milder  attacks  of  sickness. 

The  dangerous  increase  of  susceptibility  may  be  often  observed  in 
Ships  recently  arrived  from  Europe,  continuing  healthy,  \vhile  refit- 
ting in  harbour,  for  ten  days,  a  fortnight,  or  longer,  according  to  the 
season,  and  becoming  very  sickly  afterwards.  Its  variation,  and  de- 
cline, are  sufficiently  exemplified  in  the  disparity  of  health  enjoyed  by 
the  crews  of  ships  under  repair,  at  the  same  time,  and  in  the  same  har- 

*  A  very  apposite  and  striking  illustration  of  this  remark  has  subsequently  ap- 
peared in  the  account  of  the  sickness  in  the  Regalia  transport,  by  Drs.  Fergus- 
son  and  Mortimer. — Vide  Medico-Chirurgical  Transactions,  vol.  viii.  p.  108;  and 
Bancroft's  "  Sequel,"  p.  217,  et  sig.  In  the  latter  able  Work,  several  other  in- 
stances of  Fever,  arising  from  an  impure  state  of  the  hold,  are  extracted  from  my 
official  Report  to  the  Naval  Medical  Board,  and  other  source?. 


4TULLOW 


331 


bour,  and  exposed  to  precisely  similar  exciting  causes,  but  differing  ia 
the  length  of  their  residence  in  a  tropical  climate,  or  the  degree  of  ex- 
posure or  sickness  to  which  they  had  been  previously  subjected.  The 
variation  in  these  respects  will  cause  such  dissimilar  results,  that  a  fa- 
tal fever  will  become  general,  in  a  short  time  in  one  ship  ;  in  another 
the  sickness  will  be  partial,  and  less  dangerous  ;  while  a  third  will  be 
altogether  exempt,  or  experience  only  mild  and  occasional  attacks. 
This  gradation  will  be  sufficiently  obvious,  although  its  uniformity  may 
be  somewhat  affected  by  peculiarities  in  season,  modes  of  discipline, 
and  various  minuter  causes,  while  the  chief  circumstances  are  appa- 
rently the  same. 

The  danger  of  a  West  India  climate,  or,  in  other  words,  the  tenden- 
cy to  yellow  fever,  I  conceive,  then,  to  be  in  the  compound  ratio  of 
the  disposition,  and  the  force  of  the  exciting  cause  ;  a  weaker  excit- 
ing cause  being  sufficient  when  the  system  is  strongly  disposed,  and 
vice  versa  ;  for,  fortunately  these  often  obtain  in  an  inverse  propor- 
tion ;  and  the  constitution  has  been  more  or  less  habituated,  previ- 
ously to  any  considerable  exposure.  How  greatly  the  preservation 
of  health  must  depend  upon  the  inurement  being  gradual,  is  too  ob- 
vious to  require  any  comment.  The  degree  of  security,  however,  that 
may  be  acquired,  will  be  relative  ;  for  the  susceptibility  will  be  less 
after  an  attack  of  this  fever, — or  from  being  habituated  to  miasmata, 
or  other  remote  causes,  than  from  mere  length  of  residence. 

Marshy  effluvia,  or  similar  impure  emanations  in  other  situations,  I 
have  already  stated  to  be,  in  my  opinion,  a  great  source  of  yellow  fe- 
ver, either  as  a  predisposing  or  exciting  cause  ;  but,  if  the  above  pre- 
mises be  correct,  it  further  follows,  that  the  causes  of  yellow  fever 
may  be  the  same  as  the  remote  causes  of  fever  in  general ;  that  they 
may  act  in  various  degrees  of  intensity,  or  combination  ;  that  the  weak- 
er require  the  aid  of  disposition,  to  become  efficient ;  but  when  the 
system  is  highly  excited,  or  prepared  to  fall  into  fever,  that  any  ad- 
ditional agency,  though  of  itself  inoperative  and  insignificant,  may  be- 
come the  occasional  cause  ;  and  consequently,  that  this  disease  may 
be  called  into  action,  in  some  cases,  by  such  as  are  feeble,  dissimilar, 
and  so  obscure  as  to  elude  investigation. 

In  speaking  of  causation,  then,  1  do  not  mean  to  express  individual 
agency,  but  any  concurrence  of  circumstances  which  constitutes  a 
cause  ;  for  I  imagine  we  can  seldom,  in  pathological  physics  at  least, 
calculate  upon  either  singleness  of  cause,  or  simplicity  of  effect.  If 
the  preceding  principles  are  well-founded,  it  will  not  be  necessary 
here  to  enter  into  any  length  of  illustration  to  show,  that  sporadic 
cases  may  arise,  in  this  way,  at  all  seasons  of  the  year,  from  insolation 
or  undue  exposure,  intemperance,  fatigue,  or  other  irregularities,  as 
well  as  from  circumstances  so  minute,  as  often  to  escape  detection  ; 
that  a  number  of  men,  such  as  a  regiment,  or  a  ship's  company,  or 
any  part  of  them,  from  similarity  of  temperament,  employment,  or 
situation,  will  often  suffer  simultaneously,  particularly  during  the  hur- 
ricane season,  and  all  the  latter  half  of  the  year  ;  and  that  in  parti- 
cular years,  from  previous  unseasonable  weather,  or  an  epidemic 
constitution  of  the  atmosphere,  and  in  all  years,  during  the  sickly 
months,  when  a  considerable  number  of  unassimilated  men  have  been 


332          INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

recently  introduced  into  the  West  Indies,  the  yellow  fever  may  be 
expected  to  become  general  among  them,  and  to  be  attended  with 
great  mortality,  particularly  after  much  exposure  and  exertion,  often 
inseparable  from  active  warfare.  As  the  constitution  will  suffer  less 
excitement  from  the  heat,  the  coming  from  another  part  of  the  torrid 
zone,  or  a  southern  climate,  will  confer  a  certain  degree  of  protec- 
tion, but  this  will  he  only  sufficient  to  gnard  against  the  weaker,  or 
ordinary  causes  of  yellow  f<-ver.  The  gradation  which  1  have  above 
attempted  to  explain,  is  well  illustrated  by  the  f>l!owing  unstudied, 
but  impressive  extract  of  a  letter  from  Mr.  Sheppard,  now  lying  be- 
fore me  : — "  While  we  were  all  ill,  and  dying  in  the  Alligator,  in 
English  Harbour,  shortly  after  our  arrival  in  the  West  Indies,  the 
Emerald  which  had  been  two  or  three  years  in  the  climate,  remained 
near  us  health}',  though  under  precisely  the  same  circumstances  of 
duty  and  exposure.  The  Emerald  was  succeeded  in  her  situation  by 
the  Carysfort,  fresh  from  Europe,  which  ship,  in  a  few  weeks,  buried 
almost  all  hands." 

From  regarding  the  habits,  as  well  a*  the  aetiology  of  tropical  en- 
demic, the  laws  which  govern  its  appearance  seem  to  me  to  be  en- 
tirely different  from  those  of  the  plague  and  (vphus fever,  with  which  it 
has  been  sometimes  compared.  To  those  disorders,  strangers,  and  the 
natives  of  the  countries  in  which  they  prevail,  are  cceteris  paribus,  ob- 
noxious in  the  same  degree  ;  and  all  such  as  are  equally  exposed,  may 
be  said  to  be  equally  endangered.  But  it  is  totally  different  in  the 
legitimate  yellow  fever  in  the  West  Indies.  It  i*  the  disease  of  man- 
hood, of  the  excited,  unassimilated,  full  habit.  It  more  rarely  attacks 
an  earlier  or  later  period  of  life  ;  and  seldom  females,  or  only  in 
proportion,  as  from  intemperance  or  other  causes,  they  approach  to 
the  habit  of  the  male  sex  ;  while  old  residents,  whether  native  or  as- 
similated, and  people  of  colour,  though  subject  to  remittent  and  other 
milder  forms,  may  be  said  to  be  almost  entirely  exempted  from  this 
severe  form  of  disease, — for  they  are  so,  with  as  rare  exceptions  as 
we  witness  in  the  application  of  any  other  general  rule. 

But  whatever  may  be  the  peculiar  coincidence  of  circumstances,  or 
modification  of  cause,  most  fertile  in  the  generation  of  yellow  fever, 
an  uniformly  high  temperature  is  the  causa  sine  qua  non.  This  is  li- 
terally and  eminently  entitled  to  be  so  denominated,  because  it  indis- 
pensably precedes  the  effect.  In  the  Carribean  Archipelago,  the 
temperature  is  not  only  high,  but  equably  and  durably  so  ;  and  from 
its  little  variation  in  this  respect,  I  consider  the  yellow  fever  as  the 
legitimate  product  of  the  climate  ;  for  in  the  more  southern  colonies 
on  the  Continent,  where,  from  the  vicinity  of  woods,  mountains,  &c. 
the  temperature,  though  often  as  high,  is  not  uniformly  so,  and  where 
the  winds  are  more  variable,  and  the  nights  cooler,  the  disease  is 
much  less  prevalent,  and  oftener  assumes  a  remittent  type. 

To  the  importance  which  I  attach  to  an  equably  high  atmospheric 
temperature,  it  may  be  objected  by  some  persons-,  that,  in  countries 
which  should  be  still  more  favourable  to  this  disease,  because  the 
heat  is  mere  intense,  and  also  in  places  lying  in  the  same  latitude, 
the  yellow  fever  is  not  known.  But,  in  the  first  place,  it  becomes  in- 
cumbent on  such  persons  to  show,  why  a  temperature  above  a  cer- 


YELLOW  FEVER.  #33 

tain  height  ought  to  be  more  favourable  ;  for,  on  the  contrary,  I 
should  expect  that  great  heat  would  dissipate  and  destroy,  if  not  pre- 
vent, the  formation  of  the  miasmata  of  decomposition  ;  and,  second- 
ly, it  by  no  means  follows  that  the  climate  of  two  places  is  alike,  be- 
cause they  lie  at  the  same  distance  from  'he  equator. 

Mr.  Humboldt  remarks,  that  the  salubrity  of  tropical  climates  de- 
pends more  on  the  dryness  of  the  air,  than  on  any  of  its  other  sensi- 
ble qualities  :  *«  The  burning  province  of  Cumana,  the  coast  of  Co- 
ra, and  the  plains  of  Caraccas,  prove  that  excessive  heat,  alone,  is 
not  unfavourable  to  human  life." 

All  historians  concur  in  admitting  the  different  laws  to  which  the 
corresponding  degrees  of  the  two  hemispheres  are  subject,  with  re- 
spect to  the  distribution  of  heat  and  cold  ;  for  the  exceptions,  from 
local  causes,  stated  by  Calvigero,  cannot  affect  the  general  princi- 
ples. The  difference  in  the  same  latitude  has  been  estimated  at  12 
or  more  degrees  ;  but  according  to  relative  situation,  it  must  be  often 
much  greater. 

The  dissimilarity  of  climate,  between  the  eastern  and  western 
sides  of  the  New  Continent,  from  this  cause,  and  from  the  greater  va- 
riableness of  the  wind,  is  also  noticed  by  various  writers,  and  parti- 
cularly in  the  voyages  of  Ulloa,  Anson,  and  others. 

At  Lima,  which  is  but  a  little  further  on  one  side  of  the  equator 
than  Carthagen  i  is  on  the  other,  the  heat  is  far  more  moderate  ;  and 
the  observations  made  by  the  academicians  at  Quito  show,  that,  from 
its  elevated  situation,  although  close  to  the  line,  the  thermometer 
does  not  rise  there  so  high  in  summer  as  it  does  in  Paris  ;  nor  does 
it  fall  so  low  as  in  the  temperate  climates  of  Europe  in  winter,  so 
uniform  are  the  seasons.  See  Rees,  Pinkerton,  Walton,  &c. 

This  disparity  of  Old  and  New  Continent,  and  of  places  lying  in 
the  same  parallel,  is  sufficiently  accounted  for  upon  philosophical 
principles,  and  depends  on  the  elevation,  depression,  extent,  or  con- 
figuration of  country,  direction  of  the  winds,  nature  and  cultivation 
of  the  soil,  proximity  and  height  of  mountains,  vicinity  of  the  sea,  and 
many  circumstances  which  modify  the  temperature  of  a  climate,  be- 
sides its  distance  from  the  equator,  and  the  consequent  more  verti- 
cal, or  more  oblique  incidence  of  the  solar  rays. 

Dr.  Robertson  observes,  "  while  the  negro  on  the  coast  of  Africa 
is  scorched  with  unremitting  heat,  the  inhabitant  of  Peru  breathes  an 
air  equally  mild  and  temperate,  and  is  perpetually  shaded  under  a 
canopy  of  grey  clouds,  which  intercepts  the  fierce  beam?  of  the  sun 
without  obstructing  his  friendly  influence.  Along  the  eastern  coast  of 
America,  the  climate,  though  more  similar  to  that  of  the  torrid  zone, 
in  other  parts  of  the  earth,  is  nevertheless  considerably  milder,  than 
in  these  countries  of  Asia  and  Africa,  which  lie  in  the  slfce  lati- 
tude." 

He  afterwards  shows,  that  the.  trade  wind  is  still  further  cooled  in 
its  passage  from  the  Atlantic  to  the  Pacific  shore  of  the  New  Continent. 
**  As  this  wind  advances  across  America,  it  meets  with  immense  plarog 
covered  with  impenetrabfe  forests,  or  occupied  by  large  rivers, 
marshes,  and  stagnating  waters,  where  it  can  recover  no  considerable 
degree  of  heat  ;  at  length  it  arrives  at  the  Andes,  which  run  from 


334  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

north  to  south  through  the  whole  Continent.  ID  passing  over  their 
elevated  and  frozen  summits,  it  is  so  thoroughly  cooled,  that  the 
greater  part  of  the  countries  beyond  them  hardly  feel  the  ardour  to 
which  they  seem  exposed  by  their  situation.  In  the  other  provinces 
of  America,  from  Tierra  Firme,  westward  to  the  Mexican  empire, 
the  heat  of  the  climate  is  tempered  in  some  places  by  the  elevation  of 
the  land  above  the  sea,  in  others  by  the  extraordinary  humidity,  and  al- 
so by  the  enormous  mountains  scattered  over  this  tract." — History  of 
America,  vol.  11.  p.  9,  et  seg.  9th  edit.  Hence  the  great  salubrity 
of  the  table-land,  in  the  centre  of  New  Spain,  compared  with  the 
low  marshy  lands  upon  the  coast. 

On  the  opposite  side  of  Mexico,  where  the  distance  is  so  much  less 
than  across  the  other  parts  of  the  Continent,  the  influence  upon  dis- 
ease is  yet  considerable.  Thus  we  learn  that  although  bilious  fevers 
and  cholera  morbus  prevail,  the  black  vomit  has  never  yet  been  ob- 
served on  the  west  coast  of  New  Spain,  while  Vera  Cruz  is  consi- 
dered as  the  chief  seat  of  that  terrible  distemper. 

The  disastrous  results  of  the  expeditions  to  Carthagena,  Porto 
Bello,  Vera  Cruz,  &c.  which  have  been  the  theme  of  the  historian, 
and  of  the  poet,  have,  indeed,  fatally  proved  the  peculiar  noxious- 
ness of  the  extremely  hot,  alluvial,  and  marshy  soil  of  the  eastern 
shore. 

Even  in  the  short  distance  of  60  miles,  between  Panama  and  Por- 
to Bello,  the  difference  is  sufficiently  perceptible,  although,  from  im- 
provements, it  may  be  less  so  of  late  years.  Ulloa  remarks,  that  the 
garrison  detachments  sent  from  thelformer  to  the  latter,  "  though 
coming  from  a  place  so  near,  are  affected  to  such  a  degree,  that,  in 
less  than  a  month,  they  are  so  attenuated,  as  to  be  unable  to  do  any 
duty,  till  custom  again  restores  them  to  their  strength  ;"  and  that 
"  the  inhabitants  of  Panama  are  not  so  meagre  and  pale  as  those  who 
live  at  Carlhagena,  and  Porto  Bello." — Translation  by  Adams,  vol. 
i.  p.  98,  and  123,  4th  edit. 

I  am  the  more  anxious  to  advert  to  these  points,  because  they  as- 
sist in  explaining  the  influence  of  locality  and  susceptibility  in  the 
production  of  yellow  fever. 

For,  beside?  the  lower  and  more  variable  temperature  and  winds 
on  the  extensive  coast  washed  by  the  Pacific  Ocean,  the  introduction 
of  Europeans  is  more  gradual  and  limited,  and  their  constitutions  may 
be  supposed  to  have  lost  that  freshness,  (if  I  may  use  the  expression,) 
so  favourable  to  this  disease,  by  the  length  of  the  voyage  and  cli- 
mates through  which  they  must  pass  ;  or  by  the  seasoning  attacks, 
to  which  they  are  liable  before  they  reach  their  destination,  if  they 
land  at  an  eastern  port. 

Thalte  are  two  powerful  reasons,  then,  why  Europeans,  on  the 
other  side,  are  so  much  less  subject  to  yellow  fever  :  They  have  not 
only  lost  a  considerable  share  of  their  original  susceptibility  by  pre- 
assimiiation,  but  their  equatorial  parallelism  is  so  far  counteracted  by 
the  difference  of  climate,  that  they  may  be  considered,  though  ac- 
tually living  in  the  same,  as  virtually  living  in  a  more  northern  lati- 
tude. 

The  converse  of  this  proposition  appears  to  me  well  adapted  to 


YELLOW  FEVER.  335 

explain  the  occasional  appearance  of  the  fever  which  has  excited  so 
much  controversy  in  America  and  in  the  south  of  Europe.  During 
the  unusual  and  long  continued  height  of  the  thermometer,  by  which 
these  epidemics  have  been  preceded,  the  inhabitants  are  virtually  placed 
in  a  new  or  tropical  climate;  and  the  same  general  effect  follows  which 
would  result  from  the  sudden  transition  of  a  body  of  men  to  the  West 
Indies ,  with  a  considerable  share  of  northern  susceptibility.  In  both 
cases  the  constitution,  being  urt assimilated  to  the  change,  will  be  liable 
to  be  affected  by  the  unusually  heated  and  peculiar  state  of  the  atmos- 
phere, whether  its  influence  may  be  admitted  to  consist  in  producing  the 
dispositional  tendency  of  which  I  have  spoken,  or  the  developement  of 
those  miasmal  products  most  favourable  to  this  form  of  fever ,  or  in  both. 

Hence  the  natives  of  the  torrid,  and  of  the  temperate  zone,  are 
upon  a  very  different  footing  in  respect  to  susceptibility.  For  while 
the  former  may  be  considered  as  exempt  from  yellow  fever,  the  in- 
habitants of  the  United  States,  and  of  Spain,  (though  probably  some- 
what less  liable  than  more  northern  strangers,)  cannot  be  seasoned 
against  it  by  any  length  of  residence  in  their  native  country.  For, 
from  the  variations  ot  temperature  to  which  they  are  exposed,  they 
may  be  expected  to  lose  during  the  winter  any  degree  of  assimilation 
they  may  have  acquired  during  the  almost  tropical  heat  of«the  pre- 
ceding summer  ;  and,  (like  the  natives  of  the  Antilles,  after  residing 
a  certain  time  in  Europe,)  they  become  liable  to  be  attacked  by  the 
yellow  fever,  when  the  thermometer  has  maintained,  for  a  certain 
period,  the  degree  of  heat  necessary  to  produce  the  requisite  dispo- 
sition, or  the  evolution  of  sufficiently  concentrated  miasmata. 

As  illustrating  the  grounds  upon  which  the  occasional  appearance 
of  the  yellow  fever  may  be  anticipated  in  ultra-tropical  situations, 
and  at  the  same  time  pointing  out  some  of  the  sources  by  the  reme- 
dying of  which  the  chance  of  its  occurrence  may  be  diminished,  I 
shall  here  introduce  the  remarks  of  M.  Deveze,  on  the  locality  of 
Philadelphia,  quoted  from  the  second  volume  of  the  Quarterly  Jour- 
nal of  Foreign  Medicine  and  Surgery,  p.  434 — 5. — "  M.  Deveze  en- 
ters upon  the  first  chapter  with  a  topographical  description  of  Phila- 
delphia ;  and  from  its  situation  upon  a  plain  on  the  banks  of  the  De- 
laware, intersected  by  large  ditches,  from  which  the  winter's  rain  can 
only  escape  by  evaporation,  carrying  along  with  it  the  detritus  of  the 
clay  soil,  and  the  vapours  and  gasses  arising  from  the  decomposition 
of  the  vegetable  and  animal  substances  which  cover  their  banks  ; 
from  the  sudden  transitions  of  temperature  and  humidity  of  the  at- 
mosphere, not  only  in  regard  to  its  annual  or  monthly  variations,  but 
in  respect  to  what  usually  takes  place  within  the  twenty-four  hours  ; 
concludes  that  Philadelphia  from  these  combined  causes,  must  fre- 
quently not  only  be  the  seat  of  sporadic  cases  of  fever,  but  also  of 
the  more  destructive  epidemic  forms  of  this  disease.  That  the  cha- 
racter of  the  fever  which  appears  in  the  southern  parts  of  the  Unit- 
ed States,  should  put  on  the  same  form  with  the  fevers  of  tropical 
climates  is  indeed  almost  to  be  expected,  from  the  excessively  rich, 
deep,  and  absorbent  nature  of  the  soil  ;  combined  with  the  other  ad- 
ventitious circumstances  of  stagnant  pools  and  ditches,  filth  of  various 
descriptions,  gasses  arising  from  decomposed  organized  remains, 


33l»  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

floating  in  an  atmosphere,  whose  temperature,  during  the  summer 
months,  almost  exceeds  that  within  the  tropics,  and  which,  according 
to  M.  Deveze,  was  found  by  the  French  emigrants  at  Philadelphia 
more  debilitating  than  they  experienced  at  St.  Domingo." — Traite 
de  \-d  Fievre,  Jaune  ;  Par  Jean  Deveze,  1820.  See  also  the  grafical 
remarks  of  Dr.  Robertson  ;  and  those  of  Dr.  Girardin  on  the  topo- 
graphy of  Louisiana. 

M  Deveze,  moreover,  found  that  the  quantity  of  electric  fluid  ex- 
isting in  the  atmosphere  was  there  extremely  variable  ;  and  that  the 
number  of  insects  was  unusually  great,  during  the  hot  months,  when 
the  epidemic  raged  in  that  city, — a  strong  indication  of  insalubrity. 
It  may  be  proper  in  this  place  to  remark  that,  in  such  climates,  re- 
sults drawn  from  the  greatest  and  smaljest  elevations  of  the  thermo- 
meter at  certain  periods,  give  no  information  respecting  the  mean 
temperature  ;  for,  from  inattention  to  this  point,  in  discussing  the 
question  whether  the  heats  might  be  considered  as  extraordinary  in 
epidemical  seasons,  it  has  been  affirmed  that  the  heat  was  greater  in 
some  healthy,  than  in  unhealthy  years,  because  the  thermometer 
rose  a  few  degrees  higher  in  the  former  than  in  the  latter. 

Upon  ultra- tropical  yellow  fever  I  do  not  propose  to  offer  any 
observations  at  present  ;  but  I  am  inclined  to  believe,  that  the  dis- 
crepancy of  opinion  is  much  to  be  attributed  to  partial  and  incom- 
plete views  of  disease  in  limited  and  detached  situations  ;  and  that 
the  more  we  see  of  fevers  in  the  various  quarters  of  the  world,  the 
more  we  shaft  be  induced  to  refer  to  general  but  determinate  princi- 
ples their  phenomena,  as  well  as  their  mode  of  action  or  effects  upon 
the  body,  though  tho  latter,  of  course,  will  be  susceptible  of  great 
diversity,  according  to  the  nature  or  concentration  of  cause,  indivi- 
duality of  constitution  and  structure,  and  relative  importance  of  the 
organs  particularly  affected. 

In  his  celebrated  work  on  the  political  state  of  New  Spain,  to 
which  1  have  already  alluded,  M.  de  Humboldt  seems  to  have  justly 
appreciated  the  influence  of  uniformity  of  temperature,  situation  and, 
individual  susceptibility,  in  the  production  of  yellow  fever.  I  shall 
quote  from  my  notes,  as  I  have  not  the  book  before  me.  He  is  of 
opinion  that  the  yellow  fever  has  occurred  sporadically  whenever 
persons  born  in  a  cold  climate  have  been  expose^!  in  the  torrid  zone 
to  air  loaded  with  miasmata  ;  and  he  very  properly  cautions  us  against 
confounding  the  period  when  a  disease  was  first  described,  with  the 
date  of  its  first  appearance. 

The  yellow  fever,  he  informs  us,  is  still  unknown  at  Acapulco, 
though,  from  the  uniformity  of  the  heat,  he  is  apprehensive  that,  if 
ever  developed,  it  will  continue  the  whole  year,  as  in  other  situations 
where  the  temperature  varies  only  two  or  three  degrees  during  the 
year  ;  and  he  most  judiciously  remarks,  that,  if  this  port,  instead  of 
being  frequented  by  ships  from  Manilla,  Guayaquil,  and  other  places 
of  the  torrid  zone,  received  ships  from  Chili,  or  the  north  west  coast 
of  America,  if  it  were  visited  at  the  same  time  by  a  great  number  of 
Europeans,  or  of  Highland  Mexicans,  the  bilious  would  probably 
soon  degenerate  into  the  yellow  ferer,  and  the  germ  of  this  last  dis- 
ease would  develope  itself  in  a  still  more  fatal  manner  than  at  Vera 


k  EL  LOW  FEV£a.  337 

Cruz.  M.  Humboldt  afterwards  gives  a  still  more  satisfactory  reason 
why  it  is  not  brought  from  Chili,  viz.  that  it  does  not  exist  there  ;— 
which  I  imagine  to  be  not  a  little  applicable  to  the  Bulama,  and  some 
other  instances  of  imputed  importation,  like  that  from  Siam,  charac- 
terised by  Dr.  Lind  as  "  truly  chimerical."  For,  after  stating  that 
the  yellow  fever  has  not  appeared  upon  the  coast  of  the  Pacific 
Ocean  during  the  last  fifty  years,  except  at  Panama,  and  that  there, 
as  at  Callao,  the  commencement  of  a  great  epidemic  is  often  marked 
by  the  arrival  of  some  ships  from  Chili,  he  adds,  not  that  they  im- 
ported the  disease  from  a  country  where  it  never  existed,  but  because 
the  inhabitants  coming  from  the  healthiest  country  in  the  world,  ex- 
perienced the  same  fatal  effects  of  a  sultry  air  vitiated  with  putrid 
emanations,  as  the  inhabitants  of  the  north.  See  the  4th  Volume, 
by  Black,  and  the  29th  Number  of  the  Edinburgh  Medical  and  Surgi- 
cal Journal. 

The  same  reasoning,  I  may  observe,  particularly  applies  to  the 
error  which  has  been  so  often  committed,  of  mistaking  epidemic  for 
contagious  diseases,  and  supposing  them  to  be  imported  by  new 
comers,  because,  from  unassimilation  to  the  new  atmosphere,  they 
are  generally  the  first  and  greatest  sufferers  from  local  causes.  Thus, 
Uiloa  states,  though  he  does  not  seem  to  believe  it,  that,  when  the 
black  vomit  first  appeared  at  Guayaquil  in  1740,  the  galleons  of  the 
South  Sea  having  touched  there,  it  was  the  general  opinion  that  they 
had  brought  that  distemper,  and  that  great  numbers  died  on  board  the 
ships,  together  with  many  foreigners,  but  very  few  of  the  natives. — 
Adams,  vol.  i.  p.  161.  I  need  hardly  remark  how  infinitely  more 
probable  it  is,  that  the  sailors,  coming  from  a  pure  air,  suffered  from 
the  unhealthy  marsh  in  the  vicinity,  which  Eslalla  describes  as  infect- 
ing the  city,  at  particular  seasons,  with  pestilential  vapours  ;  but 
which  to  the  natives,  from  habituation,  were  comparatively  inoxious. 
Even  in  ordinary  seasons,  ia  the  West  Indies,  it  is  not  infrequently 
observed,  that  men,  though  partially  seasoned  in  one  place,  are,  never- 
theless, liable  to  be  again  attacked  by  fever  u,>ou  their  removal  to 
another,  or  even  to  a  different  part  of  the  same  island  ;  and  this 
sometimes  happens,  although  the  latter  may  be  esteemed  as  healthy, 
or  even  a  healthier  situation  ;  proving  the  influence  of  a  new,  or  in 
some  respect  differently  modified  atmosphere,  or  of  other  circum- 
stances which  the  apparent  locality,  though  it  may  in  some  degree* 
is  insufficient  wholly  to  explain. 

It  is  therefore  probable,  that  in  different  places  and  seasons  there 
is  not  only  a  difference  in  the  power  or  intensity,  but  in  the  nature 
and  combination  of  febrific  miasmata,  upon  which  the  increased  lia- 
bility to  sickness,  on  a  change  of  residence,  may,  in  a  great  measure 
depend. 

Indeed,  we  not  only  observe  striking  peculiarities  in  the  features 
of  disease,  in  different  climates,  but  often  a  considerable  change  in 
the  state  of  health  from  a  seemingly  inconsiderable  change  of  situa- 
tion ;  and  if  such  effects  happen  from  modifications  ef  climate,  soil, 
or  other  circumstances,  for  which  we  are  so  often  unable  to  account, 
it  is  necessarily  much  more  to  be  expected  that  strangers  arriving  at 

43 


33$  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

the  commencement  of  a  sickly  or  epidemic  season,  should  be  the  ear- 
liest victims  ;  and  thus,  erroneously,  they  have  been  sometimes 
thought  to  have  brought  a  disease,  merely  because  they  were  the 
first  affected  by  new  miasmata,  or  other  local  causes,  increasing;  the 
susceptibility  of  a  habit  probably  already  prone  to  febrile  or  inflam- 
matory action. 

As  for  the  reasons  already  given,  and  from  personal  observation  of 
the  tropical  endemic  in  almost  every  variety  of  situation — ^proving  it 
to  arise  in  hot,  low,  moist,  close  places,  when  new  men  are  exposed 
to  miasmata,  intemperance,  insolation,  or  fatigue — I  must  consider 
the  yellow  fever,  not  as  an  imported  or  contagious  disease,  but  as  a 
strictly  local"  and  indigenous  evil,  "  quod  sol  atque  irnbres  dederant, 
quod  terra  crearat  sponte  sua,"  to  use  the  words  of  Lucretius  in  a 
different  application.  I  shall  only  remark  here,  that  if  it  possessed 
any  contagious  property,  it  is  to  me  altogether  unaccountable,  that 
conviction  thereof  should  not  have  been  coerced,  almost  with  the 
force  of  mathematical  demonstration,  long  before  the  present  day, 
considering  the  continual  and  unrestricted  intercourse  generally  car- 
ried on  between  the  ships,  as  well  as  between  the  opposite  sides  of  the 
Isthmus  of  Darien.  But,  on  the  contrary,  examples  of  individual  dis- 
ease, or  of  a  limited  number  only,  are  constantly  occurring  in  the  same 
ship,  again  and  again,  without  extending  further  ;  and  it  becomes  epide- 
mic as  I  have  endeavoured  to  explain,  only  when  a  generally  operating 
cause  product  a  ageneral  effect.  Hence  it  is  legitimately  endemic  in  the 
West  Indies,  and  i>ecomes  often  epidemi :  there  at  particular  seasons, 
and  occasionally,  in  other  countries,  alter  exposure  to  the  influence  of 
tropical  heat.  If  the  fever  of  Gibraltar  and  other  parts  of  Spain  be 
the  same  disease,  and  if  it  possess  any  such  property,  which  1  consi- 
der as  still  remaining  to  be  proved.  1  must  therefore  contend  that  it 
is  not  a  native,  but  an  adventitious  character,  and  that,  like  other  dis- 
eases attended  with  febrile  action  in  temperate  climates  especially, 
it  is  susceptible  of  being  modified  by  the  occasional  coincidence  of  pe- 
culiar circumstances,  such  modification  placing  it  in  a  class  which,  in 
my  official  report  on  the  subject  to  the  Naval  Medical  Board,  (per- 
haps inaccurately,  but  for  the  sake  of  distinction  merely,)  i  called 
Diffusible  Disorders,  the  power  of  dissemination  in  such  not  being, 
as  in  other  communicable  diseases,  native  and  inherent,  but  contin- 
gent and  acquired,*  Although  1  do  not  mean  here  to  enter  further 

*  Although  decidedly  of  opinion  that  the  yellow  fever  of  the  West  Indies  is 
Rot  a  contagious  disorder,  and  that  the  climate  is  highly  inimical  to  the  very  ex- 
istence of  contagion,  Dr.  DM  kson  does  not  mean  to  deny  the  abstract  possibility 
of  any  fever  becoming  so,  under  particular  circumstances,  at  least  in  temperate 
climates;  but  he  contends,  that  a  distinction  ought  to  be  made  between  an  inhe- 
rent, and  an  adventitious  property  In  a  former  communication  to  the  author  he 
observes,  that  he  uses  the  term  Diffusible  Disorders  to  express  not  a  native  and 
permanent,  but  an  acquired  and  temporary  power  of  dissemination  ;  and  he  pro- 
poses indicating  the  degree  of  such  power  by  a  change  of  termination.  Thus  us- 
ing the  same  epithet,  [for  the  propriety  of  which  he  does  not  contend,  but  only 
for  the  sake  of  illustration,]  a  diffusive  disease  might  signify  that  which  can  or 
may  diffuse  itself;  and  a  diffusible  one,  that  which  can  or  may  be  diffused  j  the 
latter  requiring  for  this  purpose  the  co-operation  of  a  peculiar,  but  transitive 
coincidence  of  circumstances.  For  such  purposes,  he  remarks,  we  have  the  po- 
tential ttclive..  and  potential  passive  adjectives  as  they  are  called  by  Home  Tooke 


YELLOW  FEYER. 

upon  the  question  of  the  Peninsula  fever,  yet,  as  its  progress  has  beea 
considered  by  some  to  be  satisfactorily  traced,  and  its  prevalence  to 
be  unaccounted  for  by  any  supposition  of  an  epidemic  change  of  the 
air,  or  endemic  origin,  without  a  reference  to  contagion,  I  may  be 
permitted  to  remark,  in  passing,  without  dwelling  upon  the  inference, 
that,  in  the  latest  work  upon  the  subject,  and  in  whi^h  this  opinion  is 
temperately  supported,  the  concurrence  of  a  certain  height  of  tempe- 
rature, and  of  a  combination  of  circumstances  difficult  to  define,  but 
connected  with  the  climate  and  individual  predisposition, — is  never- 
theless admitted  to  be  necessary  to  the  existence  of  the  disorder. 

Indeed,  stronger  evidence  of  a  highly  deleterious  state  of  the  at- 
mosphere, as  exemplified  by  its  pernicious  influence  upon  animal  life, 
in  these  instances  at  least,  cannot  well  be  adduced,  than  that  furnished 
by  the  author  of  the  report*  himself  ;  for,  in  the  fever  at  Cadiz  in 
1300,  Sir  James  Fellowes,  1  believe  in  page  45,  speaking  of  the  air, 
says,  "  its  noxious  qualities  affected  even  animals  ;  canary  birds  died 
with  blood  issuing  from  their  hills  ;"  and  he  quotes  the  authority  of 
Arejula  in  further  proof  of  similar  fatal  effects  upon  domestic  animals, 
particularly  dogs,  cats,  horses,  poultry,  and  birds. 

In  equinoctial  regions  the  effect  of  elevation,  (as  indeed  was  con- 
jectured by  some  of  the  ancients,)  is  equivalent  to  that  of  latitude.  We 
are  informed,  that  the  farm  of  L'£ncero,  beyond  Vera  Cruz,  which  is 
3043  feet  above  the  level  of  the  Ocean,  is  the  superior  limit  of  the 
Vomito  ;  and  that  the  Mexican  Oaks  descend  no  further  than  this  place, 
being  unable  to  vegetate  in  a  heat  sufficient  to  develope  the  germ  of 
the  yellow  fever.  The  situation  of  Vera  Cruz,  indeed,  is  peculiarly 
adapted  to  establish  the  nature  and  indigenous  origin  of  this  disease. 
The  traveller  by  the  ascent  of  a  few  hours  is  carried  beyond  its 
reach,  from  the  rapidity  with  which  the  ground  rises  to  the  westward, 
for  it  is  not  felt  beyond  ten  leagues  from  the  coast  ;  while,  converse- 
ly, the  Creoles  who  inhabit  the  elevated  table-land  of  New  Spain, 
where  the  mean  temperature  is  about  60°,  and  where  the  thermome- 
ter sometimes  falls  below  the  freezing  point,  when  they  descend  the 
eastern  declivity  of  the  Cordillera,  are  plunged  as  it  were  at  once 
"  unanointed,  unannealed"  into  the  extremely  hot  and  deleterious 
atmosphere  of  Vera  Cruz,  and  suffer  even  in  a  greater  proportion 
than  European  strangers  who  approach  it  gradually  by  vea.  In  fact, 
these  Mexican  Mountaineers  in  descending  from  Perote  to  the  coast, 
in  sixteen  hours  are  transported  from  the  temperate  to  the  torrid 
zone,  and  by  this  sudden  change  are  exposed  to  all  the  dangers  of  a 
new  and  fatal  endemical  disease.  This  concentrated  variety  of  cli- 
mate, and  its  influence  on  the  vegetable,  as  well  as  the  animal  crea- 

Belonging  to  the  former  \ve  have  the  termination  ive,  borrowed  from  the  La- 
tin, and  ic  from  the  Greek  : — belonging  to  the  latter  we  have,  (from  the  Latin  bt- 
lis,")  the  terminations  ablr  and  ible  ;  and  also  the  contraction  He  having  one  com- 
mon signification. — Scaliger  distinctly  points  out  the  force  of  the  two  terminations 
His  and  ivus, '  duas  habuere  apud  latinos,  totidem  apud  graecos,  terminationes— 
in  ivus  activam  in  His  passivam,  &c.'  Dr.  Dickson  further  suggests  whether,  in 
speaking  of  absolutely  contagious  or  infectious  diseases  we  might  not,  by  the  noua 
substantive  or  adjective,  indicate  a  greater  or  less  degree  of  such  power  :  as  in 
the  latter  by  the  terminations  osus  and  ivus,  &LC.  ex  infections  and  infectfvwf. 
**  Haec  omnia  infectiva  appellantur." — Vitr.  \, 


340  INFLUENCE  OP  TROPICAL  CLIMATES,  &C. 

tion,  is  depicted  with  such  force  and  beauty  by  Baron  Humboldt,  that 
I  cannot  resist  laying  before  the  reader  a  description  which,  in  a  few 
lines,  carries  him  from  the  burning  plains  in  the  vicinity  of  the  sea, 
to  the  regions  of  perpetual  snow  :  "  The  admirable  order  with  which 
different  tribes  of  vegetables  rise  above  one  another  by  strata,  as  it 
were,  is  no  where  more  perceptible  than  in  ascending  from  the  port 
of  Vera  Cruz  to  the  table -land  of  Perote.  We  see  there  the  physi- 
ognomy of  the  country,  the  aspect  of  the  sky,  the  form  of  plants,  the 
figures  of  animals,  the  manners  of  the  inhabitants,  and  the  kind  of 
cultivation  followed  by  them,  assume  a  different  appearance  at  every 
step  of  our  progress. 

As  we  ascend,  nature  appears  gradually  less  animated,  the  beauty 
of  the  vegetable  forms  diminishes,  the  shoots  become  less  succulent, 
and  the  flowers  less  coloured.  The  sight  of  the  Mexican  oak  quiets 
the  alarms  of  travellers  newly  landed  at  Vera  Cruz.  Its  presence 
demonstrates  to  him  that  he  has  left  behind  him  the  zone  so  justly 
dreaded  by  the  people  of  the  North,  under  which  the  yellow  fever 
exercises  its  ravages  in  New  Spain. 

This  inferior  limit  of  oaks  warns  the  colonist  who  inhabits  the 
central  table-land  how  far  he  may  descend  towards  the  coast  with- 
out dread  of  the  mortal  disease  of  the  vomito.  Forests  of  liquiu- 
amber  near  Xalapa,  announce,  by  the  freshness  of  their  verdure, 
that  this  is  the  elevation  at  which  the  clouds  suspended  over  the 
ocean,  come  in  contact  with  the  basaltic  summits  of  the  Cordillera. 
A  little  higher,  near  La  Banderilia,  the  nutritive  fruit  of  the  banana 
tree  comes  no  longer  to  maturity.  In  this  foggy  and  cold  region, 
therefore,  want  spurs  on  the  Indian  to  labour,  and  excites  his  indus- 
try. At  the  height  of  San  Miguel  pines  begin  to  mingle  with  the 
oaks,  which  are  found  by  the  traveller  as  high  as  the  elevated 
plains  of  Perote,  where  he  beholds  the  delightful  aspect  of  fields 
sown  with  wheat.  Eight  hundred  metres  higher,  the  coldness  of  the 
climate  will  no  longer  admit  of  the  vegetation  of  the  oaks  ;  and  pines 
alone  there  cover  the  rocks,  whose  summits  enter  the  zone  of  eter- 
nal snow.  Thus  in  a  few  hours,  the  naturalist,  in  this  miraculous 
country,  ascends  the  whole  scale  of  vegetation,  from  the  heliconia, 
and  the  banana  plant,  whose  glossy  leaves  swell  out  into  extraordi- 
nary dimensions,  to  the  stunted  parenchyma  of  the  resinous  trees.'" 
— Political  Essay  on  the  kingdom  of  New  Spain,  translated  by  Black, 
vol.  ii.  p.  261 — 2. 

In  accounting  for  the  tropical  endemic  becoming  epidemic  at  par- 
ticular seasons,  the  eminent  traveller  just  referred  to,  further  shows 
the  intimate  connection  on  the  coast  of  Mexico,  between  the  pro- 
gress of  the  disease,  and  the  temperature  and  state  of  the  seasons  ; 
and,  accordingly,  that,  at  Vera  Cruz,  the  vomito  prieto  does  not  com- 
mence generally,  till  the  tin  dium  heat  is  76°  Fahr.  It  is,  therefore, 
seldom  seen  in  December,  January,  and  February,  unless  it  has  been 
very  violent  in  the  summer,  when  it  continues  more  or  less  through 
the  winter ;  but,  as  he  observes,  although  it  is  hotter  in  May,  its 
ravages  are  more  dreadful  in  September  and  October,  because  a  cer- 
tain duration  seems  necessary  to  develope  its  full  force  ;  which  must, 
moreover,  be  augmented  after  the  rains  have  ceased,  which  last 


YELLOW  FEVER.  341 

from  June  to  September,  as  well  as  be  influenced  by  the  direction  of 
the  winds.  The  same  increase  of  disease,  I  may  remark,  is  observ- 
ed in  the  islands,  daring  the  hurricane  months  ;  and  this  is  also  in 
proportion  as  the  previous  weather  has  been  unseasonable  ;  but  the 
medical  heat  at  which  the  disease  begins  to  be  prevalent,  may  be 
calculated  at,  at  least,  from  6°  to  10°  higher  ;  from  which  it  may 
be  deduced,  that,  in  proportion  as  the  air  is  more  loaded  with 
miasmata,  as  on  the  Atlantic  shores  of  NTew  Spun,  the  disease  may 
become  active  at  a  lower  temperature,  than  when  these  effluvia  are 
less  abundant  and  concentrated  ;  and  it  may  further  account  for  its 
appearance  beyond  the  tropics,  during  the  summer  heat. 

In  proof  of  the  effect  of  seasons,  1  have  now  before  me  a  letter 
from  Doctor  Macarthur,  who  ably  conducted  the  Naval  Hospital  at 
Barbadoes  for  several  years,  corresponding  with  his  report  to  the 
Medical  Board  in  September,  1809,  in  which  he  says  : — "  I  remark- 
ed, while  at  Barbadoes,  that  the  fever  was  more  frequent,  and  more 
violent  when  the  rains  were  partial,  than  when  continued  and  gene- 
ral. The  heat  of  the  sun  produced  the  decomposition  of  animal  and 
vegetable  substances  more  rapidly  when  the  earth  was  slightly  mois- 
tened by  rain,  than  when  perfectly  drenched.  In  these  years,  when 
the  rain  fell  abundantly  during  the  months  of  June,  July,  and  August, 
the  fever  did  not  appear  until  September,  October,  and  November. 
On  the  contrary,  when  June.  July,  and  August,  were  comparatively 
dry  months,  the  fever  invaded  us  earlier. —  We  know  in  Europe  that 
the  effluvia  from  marshes  are  more  deleterious  a  week  or  two  after  the 
beginning  of  dry  hot  weather,  than  immediately  after  the  rains  are 
over  ;  the  first  evaporation  from  the  surface  of  the  marsh  being  in- 
oxious,  compared  with  that  which  afterwards  follows."  Upon  the 
same  principle,  as  has  been  well  explained  by  Dr.  Bancroft  and 
others,  it  is  not  during  excessively  wet  or  dry  seasons,  but  sometime 
after  the  rains,  or  after  partial  showers,  that  marshy  effluvia  are  most 
abundant  and  concentrated,  as  I  saw  dreadfully  exemplified  in  the 
garrison  epidemic  at  Mariegalante,  in  the  autumn  of  1 808.  At  cer- 
tain seasons,  therefore,  in  hot  countries,  wherever  there  are  vege- 
table and  animal  life  and  decay,  even  though  no  water  be  stagnating 
on  the  earth,  the  whole  flat  surface  may  be  considered  as  a  marsh  ; 
and,  consequently,  there  can  be  very  few  situations,  as  1  mentioned 
at  the  commencement,  exempt  from  the  occasional  influence  of  such 
miasmata. 

It  is  only  by  tracing  its  connection  with  the  seasons,  then,  that  we 
can  rationally  expect  to  unfold  the  laws  of  the  tropical  endemic,  and 
such  topographical  hints  as  I  have  here  offered,  if  followed  up,  I 
should  hope  would  materially  contribute  to  this  end,  although  the 
peculiar  and  intimate  combination  of  circumstances,  as  well  as  its 
sporadical  occurrence,  must  often  depend  upon  causes  so  minute  as 
to  elude  all  investigation. 

The  degree  of  exemption  from  the  disease  will  be,  generally,  con- 
ditional, and  contingent  upon  various  circumstances  ;  for  though  in- 
demnity to  a  considerable  extent  may  be  purchased  by  a  previous 
attack,  or  by  mere  length  of  residence,  yet  such  protection  is  but 


342  INFLUENCE  OF  TROflCAL  CLIMATES,  &C. 

relative,  and,  though  a  sufficient  security  against  ordinary  causes,  is 
not  proof  against  such  as  are  of  great  intensity. 

The  Circe  frigate,  after  having  been  several  times  at  Antigua,  and 
escaping  with  a  limited  number  or  only  individual  instances  of  yel- 
low fever,  by  putting  to  sea  before  it  became  general,  entered  En- 
glish harbour,  vthi<  h  was  then  healthy,  on  the  4th  of  January,  1808, 
no  man  requiring  medicine.  In  five  days  afterwards  the  fever  ap- 
peared, and,  from  being  engaged  in  the  unwholesome  duty  of  clear- 
ing the  hold,  and  heaving  down,  between  that  period  and  the  2nd  of 
February,  146  men  were  sent  to  the  hospital,  of  which  number  22 
died  with  black  vomit,  although  it  was  then  the  healthiest  season  of 
the  year,  and  the  ship  had  been  nearly  two  years  and  ten  months  in 
the  West  Indies. 

Still,  though  the  immunity  was  far  from  amounting  to  insusceptibili- 
ty, the  danger  here  was  much  lessened  by  partial  assimilation  ;  for 
it  may  be  fairly  inferred,  that  the  mortality  would  have  been  much 
greater  if  the  ship  had  been  recently  from  England. 

A  great  proportion  of  these  men  had  suffered  previous  attacks  of 
fever  ;  and  I  think  there  can  be  as  little  doubt,  that  some  of  them,  at 
least,  would  have  terminated  in  the  same  way,  if  they  had  not  been 
controlled. 

As  the  degree  of  immunity  will  he  modified  by  various  circum- 
stances, so  will  the  success  in  the  treatment  of  the  yellow  fever  be 
modified  by  season,  situation,  severity  »f  the  attack,  habit  of  the  pa- 
tient, &c.  But,  without  entering  into  any  detail  upon  the  mode  of 
cure,  which  I  have  treated  of  elsewhere,*  and  which  is  ably  laid 
down  in  the  following  pages  by  others,  I  shall  content  myself  with 
observing  shortly,  that  though  success  will  be  greatly  influenced  by 
locality  and  constitution,  and  though  the  symptoms  of  this  malady  do 
not  always  permit,  nor  can  they,  where  they  do  authorize,  be  always 
arrested  by  the  copious  abstraction  of  blood  ;  yet  I  feel  justified  in 
saying,  that  it  is  only  from  this  remedy,  employed  while  the  fever  is 
forming,  or  within  a  short  time  after  it  is  formed,  aided,  of  course,  by 
purgatives,  and  by  the  cold  affusion,  if  indicated,  that  we  can  entertain 
any  plausible  expectation  of  arresting  a  disease  where  the  morbid  mo- 
tions are  of  such  inordinate  power  and  rapidity.  In  making  this  remark, 
I  more  particularly  allude  to  that  which  I  have  most  frequently  wit- 
nessed, the  ardent  continued  form  of  this  disease,  where  the  deceitful 
pause,  during  the  transition  from  one  stage  to  the  other,  has  been  so 
often  mistaken  for  a  remission.  To  admit  the  effects  of  the  morbid  ac- 
tion upon  the  stomach,  contiguous  intestine,  and  brain,  often  in  the 
course  of  a  few  hours,  would  appear  to  me  equivalent  to  admitting  that 
we  could  only  rationally  hope  to  counteract  them  by  such  powerful 
means,  provided  we  put  aside  preconceived  opinions  and  theory. 

The  ability  with  which  men  bear  the  lo.^s  of  blood,  I  have  already 
allowed  very  much  to  depend  upon  habit  and  locality  ;  and  its  effica- 
cy entirely  on  the  early  stage  of  the  disease. 

In  situations  peculiarly  pestilential,  or  where,  from  concentration 
of  cause,  the  animal  energy  is  so  far  depressed,  as  early  to  incapaci- 
tate the  functions  for  the  performance  of  those  duties  by  which  life 
*  Edinburgh  Medical  and  Surgical  Journal,  vol.  9th. 


YELLOW  FEf ER.  343 

i$  supported,— -or  after  sufficient  time  has  elapsed  to  have  allowed  the 
establishment  of  fatal  congestions,— -I  do  not  pretend  that  there  is  any 
hope  of  these  being  removed,  but,  on  the  contrary,  death  will  be  ac- 
celerated by  the  use  of  the  lancet.  All  I  mean  to  say  is,  that,  during 
the  first  stage,  at  least  in  the  sh^pe  in  which  1  have  most  frequently 
seen  the  disease,  and  while  the  progress  of  inflammation  in  the  most 
vital  parts  is  rapidly  proceeding,  yet  still  remediahle,  I  am  acquainted 
with  no  other  remedy  which  has  either  time  or  power  to  save  them 
from  disorganization. 

Having  had  hut  too  many  opportunities  of  being  convinced  of  the 
want  of  commensurate  efficacy  in  those  inerter  means  by  which  the 
fevers  of  temperate  climates  arc  often  conducted  to  a  safe  termina- 
tion. I  feel  perfectly  satisfied  when  I  bear  of  great  success  in  the 
treatment  of  this  disease,  either  that  results  so  fortunate  have  been 
the  reward  of  a  prompt  and  decisive  plan  of  treatment  at  the  very 
commencement,  or  that  the  disorder  was  of  a  far  milder,  and  more 
remediable  nature  than  that  which'  1  have  been  accustomed  to,  un- 
der the  name  of  yellow  fever.  Would  to  God  I  could  say,  that  the 
most  prompt  and  decisive  measures  will  be  generally  attended  with 
success  ;  but  I  may  say,  that  this  will  almost  entirely  depend  upon 
the  earliness  of  their  application  ;  or  upon  the  judgment  to  deter- 
mine when  the  di-ease  ha*  so  far  advanced,  that  they  are  no  longer 
applicable,  and  must  be  succeeded  by  an  immediate,  and  entirely  op- 
posite mode  of  treatment. 

The  mediocrity  of  remedies  often  causes  them  to  retain  that  re- 
putation which  they  have  previously,  and  sometimes  unjustly  acquir- 
ed ;  but  the  power  of  a  remedy  so  active  as  venesection,  yet  whose 
utility  is  so  entirely  dependant,  not  only  on  time  and  quantity,  but  on 
the  varying  state  of  the  system,  is  in  continual  danger  of  being  rated 
too  high  or  too  low.  I  am  sorry,  therefore,  to  observe,  that  it  is 
spoken  of  with  too  much  confidence  by  some  writers  ;  because  this 
tends  on  failure  to  bring  its  character  into  disrepute  with  others, 
though  it  oftener  suffers  from  the  opposite  extreme  of  unfounded  ap- 
prehension. 

Upon  the  now  undisputed  and  general  utility  of  purgatives,  it  is 
quite  unnecessary  to  say  any  thing  here  :  they  have  not  only  the 
great  advantage  of  being  eminently  serviceable  where  blood-letting  is 
proper,  but  where  it  cannot  be  resorted  to,  and  in  a  vast  variety  of 
milder  cases  of  fever,  where  it  is  not  required. 

The  general  healthiness  of  the  West  Indies,  as  well  as  of  particular 
Islands,  varies  considerably  in  different  years,  and  at  different  pe- 
riods. It  is  liable  to  be  affected  by  certain  states  of  the  air,  as  unsual- 
ly  wet,  or  dry  and  close,  or  otherwise  unseasonable  weather  for  the 
time  of  the  year,  by  calms,  by  variations,  (especially  to  the  south- 
ward,) from  the  usual  trade  winds,  and  in  the  quantity  of  the  Electric 
Fluid,  and  in  certain  years,  by  what  has  been  termed  "  an  Epidemic 
Constitution  of  the  Atmosphere." 

Individual  safety  in  the  Western  Hemisphere  will  be  best  consulted 
by  attending  to  the  comprehensive  maxim  of  Celsus — viz.  by  avoid- 
ing various  predisposing  and  exciting  causes,  until  the  physical  sensi- 
bility of  the  system  is  reduced  by  habit ;  and  in  proportion  as  this  ad- 


344  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

vice  is  adhered  to,  the  Naval  Practitioner  may  be  assured  that  not 
only  the  chance  of  sickness  will  be  greatly  diminished  in  his  own 
person,  but  that  in  a  well  regulated  ship,  aided  by  the  earnest  and 
judicious  co-operation  of  the  officers,  the  lives  of  the  men  under  his 
charge  may  be  preserved  to  an  extent  beyond  his  expectations,  in  or- 
dinary seasons  and  circumstances. 

During  war,  indeed,  when  the  influx  of  unassimilated  Constitutions 
is  considerable,  and  especially  after  much  exertion  and  active  ser- 
vice, great  sickness  and  mortality  are,  I  fear,  unavoidable  ;  but,  ge- 
nerally speaking,  the  result  will  depend  upon  the  number  of  Europe- 
ans introduced,  the  time  and  situation  chosen,  and  the  exposure  being 
limited  at  first,  and  gradually  increased,  or  otherwise.  It  is,  there- 
fore, of  the  utmost  consequence  that  bodies  of  men,  whether  sol- 
diers or  sailors,  should  arrive  in  that  country  at  the  coolest  season  of 
the  year,  (and  if  such  can  be  selected  as  have  previously  served  in  a 
warm  climate,  they  should  invariably  be  preferred  ;)  that  the  former 
should  be  sent  to  the  healthiest  Islands,  or  positions  at  first ;  gradu- 
ally exposed  to  duty  under  a  vertical  sun,  and,  instead  of  being  quar- 
tered in  the  low,  hot,  alluvial  ground,  in  the  vicinity  of  the  towns 
skirting  the  leeward  bays,  that  their  barracks  should  be  built  on  hills 
of  moderate  elevation,  sufficiently  distant  from  marshy,  damp  ground, 
infested  with  insects,  and  from  thickly  wooded  ravines,  where  the 
rank  and  luxuriant  vegetation  bespeaks  the  existence  of  exhalations 
unfriendly  to  health. 

The  importance  of  such  selection  was  eminently  exemplified  by 
the  saving  of  health  and  of  life  that  accrued  from  the  erection  of  new 
barracks  for  the  troops,  in  a  more  interior  and  elevated  situation,  after 
the  capture  of  Guadaloupe,in  1 8 10,  by  Admiral  the  Hon.  Sir  Alexander 
Cochrane,  ihen  Governor  oftiie  Island.  The  humanity  of  this  mea- 
sure, and  the  judgment  previously  displayed  by  the  Commander  in 
Chief  in  the  scite  and  construction  of  the  Naval  Hospital  at  Barba- 
does,  &c.  have  been  warmly  and  deservedly  eulogized  by  the  most 
experienced  men  in  both  services  ;  suffice  it  to  mention  the  names  of 
Drs.  Jackson*  and  Me.  Arthur  : — to  me  it  may  be  permitted  to  pay  a 
not  less  just  and  earnest  tribute  of  respect  to  that  unwearied  benevo- 
lence which  prompted  his  immediate  attention  to  every  proposal  for 
the  welfare  of  the  seamen,  and  insured  not  only  his  concurrence,  but 
active  co-operation  in  whatever  could  add  to  th,eir  comfort  in  health, 
or  alleviate  their  misery  in  sickness. 

I-  The  healthiness  of  the  ships  stationed  in  the  Caribbean  Sea,  will 
very  much  depend  upon  the  state  of  discipline,  and  degree  of  at- 
tention paid  to  the  crews  It  will  be  especially  preserved  by  staying 
in  harbour  as  little  as  possible  ;  and  by  cruizing  to  the  northward,  or 
resorting  to  Halifax,  or  elsewhere,  during  the  hurricane  season,  or 
when  repairs  which  will  require  detention  for  any  length  of  time  in 
port  are  necessary.  In  tine,  it  will  chiefly  depend  upon  avoiding  all 
undue  exposure  to  the  sun,  rain,  night  air,  fatigue,  intemperance,  and 
unwholesome  shore  duties  ;  and  upon  attention  to  diflerent  regula- 
tions, and  preventive  measures,  of  which  1  have  had  ample  oppor- 

*  Vide  Jackson's  Sketch  of  the  History  and  Cure  of  Febrile  Diseases.  1817 — 
pp.  386— and  392-3. 


BELLOW  FBVER,  345 

tunities  of  appreciating  and  stating  the  value,  from  the  inspection, 
and  the  medical  reports,  of  generally  between  sixty  and  seventy  ves- 
sels of  war. 

Many  of  these  being  of  a  local  and  temporary  nature,  it  would  be 
needless  to  specify  here  ;  but  I  may  shortly  notice  that  the  intermis- 
sion of  labour  during  the  hottest  hours  of  the  day,  working  as  much 
as  possible  under  cover,  giving  a  portion  of  cocoa  before  going  to 
duty  after  sunrise,  wearing  flannel,  injoining  a  soluble  state  of  the 
bowels,  serving  spruce  beer  or  sound  wine  instead  of  rum,  and  when 
this  could  not  be  done,  issuing  the  latter  of  a  certain  age  and  quality, 
and  finally,  (for  of  the  victualling,  in  the  improved  state  of  the  na- 
vy, it  is  unnecessary  to  speak,)  the  adoption  of  every  means  to  di- 
minish the  frequency  of  intoxication,  were  the  chief  of  those  mea- 
sures from  which  thevmost  beneficial  effects  were  observed. 

But  of  all  occupations  the  most  desirable  to  avoid  is  that  of  clear- 
ing a  foul  hold  in  the  West  Indies  ;  and,  therefore,  whenever  it  is 
possible,  ships  requiring  this  to  be  done  should  be  sent  out  of  the 
country  :  for  not  only  is  it  highly  dangerous  in  itself,  on  account  of 
the  noxious  gasses  disengaged,  but  because  it  is  generally  necessary 
to  perform  it  in  a  secure,  or  land-locked,  and  consequently  unheal- 
thy harbour,  such  as  that  of  Antigua. 

Where  the  subject  is  of  such  importance,  though  at  the  risk  of 
tautology,  I  request  leave,  in  conclusion,  to  repeat,  that  the  bad  ef- 
fects of  staying  in  port  too  long  at  one  time,  and  of  harbour  duties, 
particularly  early  in  the  morning  and  after  the  setting  of  the  sun,  as 
well  as  during  his  meridian  power,  cannot  be  too  strongly  adverted 
to  ;  and,  therefore,  a  measure  of  paramount  importance  is  the  em- 
ployment of  negroes,  natives  of  the  country,  or  at  least  of  men  ac- 
customed to  the  torrid  zone,  in  wooding,  watering,  transporting  stores, 
rjgg'ng  clearing,  careening  ships,  &c.  and  in  fine,  in  all  such  occu- 
pations as  must  subject  men  to  excessive  heat,  or  deleterious  exha- 
lations, which  cannot  fail  of  being  highly  dangerous  to  the  health  of 
the  unassimilated  European. 

But  the  great  object,  I  conceive,  is  to  relieve  the  ships  on  that 
station,  (the  prospect  of  which,  alone,  has  a  wonderful  effect  on  the 
health  and  spirits  of  the  men,)  so  often  that  a  foul  state  of  the  hold, 
and  the  necessity  of  cleaning  it  in  that  country,  shall  as  seldom  as 
possible  arise.  During  the  most  active  period  of  nearly  eight  years 
of  the  war,  considerable  sickness  and  mortality  rnnst  necessarily  have 
occurred  ;  but  in  that  time,  I  have  likewise  had  the  great  satisfaction 
of  witnessing,  in  various  ships,  and  on  various  -occasions,  that  a  de- 
gree of  health  was  maintained  in  that  climate  beyond  my  most  san- 
guine expectations, — particularly  latterly,  when  the  season  of  active 
warfare  being  past,  the  necessity  was  precluded,  and  consequently 
the  unwholesome  duties  of  clearing  the  hold,  heaving  down,  or  un- 
dergoing lengthened  repairs  in  the  close  harbours  of  the  West  Indies, 
were  interdicted  ;  and  1  am 'therefore  led  to  conclude,  that  to  avoid 
the  stronger  exciting  causes  of  yellow  fever,  is,  to  a  great  extent,  to 
escape  the  disease. 

44 


t34b  INFLUENCE  OF  TROPICAL  CLIMATES,  &C, 


Observations  on  the  locale  of  Yellow  Fever,  by  Dr.  FERGUSSON,  F.  R.  S. 
Ed.     Inspector  of  Military  Hospitals. 

Sec.  IV.— The  principal  West  India  towns  and  garrisons  for  the 
troops  are  situated  on  the  leeward  shores  of  the  country,  at  the  bot- 
tom of  the  deepest  bays  that  can  be  found,  as  a  protection  to  their 
trade  against  the  winds  from  the  sea.  The  soil  must  consequently  be 
alluvial,  and  is  often  marshy.  Nine-tenths  of  the  towns  are  inclosed 
by  high  hills  rising  immediately  behind  them,  which  exclude  the  sea- 
breeze  that,  in  its  natural  course,  ought  to  reach  them  from  the  wind- 
ward side  of  the  country.  As  their  elevation  is  generally  little  above 
the  level  of  the  sea,  we  have  abundant  reason  to  conclude,  that  if 
the  highest  degrees  of  reflected  tropical  heat,  defective  perflation, 
and  the  miasmata  that  reside  in  marshy  soils,  or  may  be  formed  in, 
the  drier  alluvial  ones  by  heavy  rains,  can  produce  aggravated  re- 
mittent fever,  it  must  happen  under  such  circumstances,  especially 
where  police  and  cleanliness  are  entirely  disregarded. 

The  settlements  of  the  planter,  in  like  manner  are  formed,  not  on 
the  elevated  mountain  ridge  from  which  the  periodical  rains  have 
washed  away  the  soil,  but  in  the  alluvial  ground  beneath,  where  his 
labour  can  with  more  certainty  be  turned  to  profit.  Nor  is  it  to  be 
wondered  at,  under  such  circumstances,  that  a  body  of  raw  troops  or 
young  civilians,  come  to  settle  in  town  or  country,  should  be  swept 
away  by  tropical  fevers.  The  wonder  is  why  it  does  not  happen 
with  more  unerring  certainty  ;  for  there  are  seasons,  and  even 
courses  of  seasons  under  apparently  similar  circumstances  of  heat 
and  moisture,  when  even  tiie  declared  swamp  is  comparatively  innox- 
ious to  the  newly  arrived  European,  and  still  more  so  to  the  season- 
ed inhabitant.  This  begets  in  the  young  adventurer  or  hardened  vo- 
tary of  wealth,  a  fatal  delusion  of  confidence  which,  though  so  often 
exposed  by  the  melancholy  recurrence  of  fatal  fevers  is  never  cured. 

The  pestiferous  quality  of  miasmata  does  not  appear  to  depend  ne- 
cessarily either  upon  aqueous  or  vegetable  putrefaction,  however 
frequently  it  may  be  found  combined  with  both.  Every  one  knows 
that  the  miasmata  are  not  generated  from  the  body  of  the  lake  or 
pool,  but  from  its  drying,  or  half-dried  margins.  The  swamp  is  no 
more  than  this  margin  rolled  up  under  another  shape.  Water,  with- 
out being  absorbed  by  the  subjacent  soil,  gives  out  no  febrific  effluvia. 
One  of  the  healthiest  quarters  in  the  West  Indies,  is  that  of  the  field 
officers  on  Berkshire  hill,  the  bed-room  of  which  is  placed  over  a 
deep  stone  reservoir  of  water.  But  this  said  febrific  miasma  is  very 
certainly  generated  from  the  paucity  of  water  where  it  has  previously 
abounded,  provided  that  paucity  be  short  of  actual  dryness.  To  the 
production  of  this  a  high  atmospherical  temperature  is  indispensa- 
ble ; — and  in  proportion  to  the  intensity  of  temperature  is  the  inten- 
sity of  power  in  the  miasma  produced,  varying  its  effects  on  the  hu- 
man frame,  from  the  ordinary  ague  of  Europe^  and  the  West  India 
Mountain  fever,  to  the  highest  degree  of  remittent,  and  yellow  fe- 
ver, which  is  never  found  remote  from  the  level  of  the  sea.  It  is 
comparatively  innoxious  to  those  who  have  had  the  good  fortune  to 


YELLOW  FEVER.  34$ 

become  habituated  to  its  influence  ;  and  attacks  with  singular  pecu- 
liarity of  selection  the  robust,  the  young,  and  the  healthy,  in  their 
fi  st  approach  to  its  abode.  If  these  be  granted,  1  think  we  may  be 
able  to  explain  from  the  various  compositions  of  soil,  its  elevation, 
aspect,  and  texture,  as  affording  capacity  to  retain  moisture,  why 
every  dry  one  can  be  brought,  during  an  uncommonly  wet  season, 
through  the  influence  of  tropical  heat,  into  the  state  of  a  marsh  that 
gives  out  noxious  vapours  ;  while  a  marshy  one  approaching  to  dry- 
ness  through  previous  drought  may  be  made  perfectly  healthy  from 
the  same  abundant  rains.  Thus  Barbadoes,  which  from  its  cleared 
calcareous  soil,  is  far  more  salubrious,  in  general,  than  Trinidad,  has 
been  lately  afflicted  severely  with  the  worst  forms  of  yellow  fever ; 
while  the  latter  island  remained  perfectly  healthy.  In  both  places  it 
has  rained  abundantly — particularly  in  Trinidad,  whose  extensive 
marshes  have  been  overflown  ;  while  the  alluvial  soil  on  the  shelves 
of  table-land  at  Barbadoes  has  been  converted  into  a  temporary 
swamp.  So  at  St.  Lucia,  when  the  garrison  on  the  lofty  position  of 
Morne.  Fortune  is  healthy  during  the  fine  dry  weather,  the  inhabitants 
of  the  town  of  Castrus,  at  the  base  of  the  same  hill  immediately  be- 
low, and  within  half  cannon  shot,  are  visited  by  the  worst  fevers,  and 
vice  versa  : — The  dry  weather  gives  activity  to  the  miasmata  which 
the  rains  dilute,  refresh,  or  condense,  at  the  same  time  that  they  are 
forming  pools,  and  temporary  swamps  on  the  shoulders  of  the  hill, 
immediately  beneath  the  barracks,  on  the  summit  of  Morne  Fortune. 

So  a  deep  ravine,  impervious  to  the  rays  of  the  sun,  and  free  cur- 
rent of  air,  that  has  been  a  water  course,  may  still,  after  its  surface 
appears  dried  by  the  summer  heat,  retain  sufficient  underground 
moisture  to  give  out  the  most  dangerous  miasmata — the  more  dange- 
rous because  the  more  concentrated  for  want  of  perflation  ;  — and  so, 
in  fine,  salubrious  and  insalubrious  soils  may,  under  such  circum- 
stances, change  places,  in  regard  to  health  ;  and  localities  in  the 
neighbourhood  of  each,  under  the  same  modifications  of  climate,  be 
very  differently  affected.* 

It  has  been  inferred  that  yellow  fever  belongs  to  a  different  family 
from  that  of  intermittent,  because  it  seldom  occurs  at  the  same  time 
with,  or  breaks  off,  in  convalescence,  into  ague.  Ague  indeed  is  not 
a  common  production  in  the  hot  low-land  on  or  near  the  level  of  the 
sea — where  alone  the  yellow  fever  is  found.  It  is  very  rare,  for  in- 
stance, to  hear  of  an  ague  originating  in  the  leeward  sea-port  town 
of  Basseterre,  Guadaloupe,  either  amongst  the  troops  or  inhabitants  ; 
but  in  the  barracks  on  the  cool  marshy  hills  above  the  town,  at  an 
elevation  of  less  than  a  thousand  feet,  it  is  a  very  common  disease, 
among  officers  and  soldiers,  while  their  comrades  in  the  town  are  de- 
voured by  concentrated  remittents.  The  same  may  be  said  of  near- 
ly the  whole  of  the  West  India  towns.  They  are  all  so  marshy  that, 

*  The  reader  is  probably  aware  that  some  Authors,  as  Dr.  Jackson  and  Mr. 
Doughty,  consider  an  excess  of  the  principle  of  Vegetation  as  the  cause  of  Fever  : 
"  It  would  appear  that  the  materials  of  vegetation  abounding  in  excess,  acted 
upon  by  a  powerful  cause,  give  out  a  principle,  which  not  being  expended  in  the 
growth  and  nourishment  of  Plants,  is  diffused  to  a  certain  extent  in  the  atmos- 
phere, occasioning  a  derangement  of  such  bodies  aa  come  within  the  sphere  of  its 
action."— Jackson's  Outline  of  the  History  and  Cure  of  Fever, 


348  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

in  colder  latitudes,  they  could  not  possibly  escape  agues,  which  how- 
ever, very  seldom  originate,  and  are  nearly  unknown  amongst  them. 
The  inhabitants  of  Barbadoes  boast  that  they  are  exempt  from  agues, 
though  the  island  has  several  marshes.  Thus  the  reason  is  plain  : — 
There  are  very  few  ridges  there  of  sufficient  elevation  to  belong  to 
the  region  of  intermiltents,  even  supposing  their  sides  to  be  marshy, 
which  they  never  are.  The  swamps  are  all  in  the  lowest  levels  of 
the  land ;  and  when  their  morbific  miasmata  act  upon  the  human  bo- 
dy, they  produce  the  greater  or  lew  concentrated  forms  of  remittent 
fever,  according  as  their  powers  are  regulated  by  the  temperature 
and  climate  of  the  season,  or  as  the  subject  is  presented  under  more 
or  less  favourable  circumstances  of  seasoning,  excitement,  &c. 

I  am  far  from  presuming  to  deny,  says  Dr.  Fergusson,  that  there 
are  fevers  from  pure  excitement ;  "/or  soldiers  and  others  have  been 
attacked  and  died  of  yell  jw  fever  before  they  landed  in  the  West  Indies, 
or  could  be  exposed  to  the  influence  of  land  miasmata  in  any  shape.'' 
From  this  it  would  appear  that  a  calenture,  [the  synocha  of  Cullen,] 
the  pure  offspring  of  heat,  as  pneumonia  is  of  cold,  runs  a  course 
similar  to  the  yellow  fever. 

"  To  the  argument  that  the  highest  degree  of  concentrated  remit- 
"  tent  or  yellow  fever,  should  neither  remit  nor  break  oft'  into  ague, 
"  it  seems  sufficient  to  reply,  that  /or  any  disease  to  observe  regular 
"  laws,  it  is  necessary  that  the  vital  organs  principally  affected  should 
u  continue  in  a  certain  degree  of  integrity  ;  that  their  functions 
"  should  only  be  disturbed  and  preverted  to  a  given  point  ;  that  they 
**  should  still  be  discernible  as  functions,  and  not  be  utterly  over- 
"  whelmed  and  extinguished  by  the  violent  cerebral  action  and 
"  speedy  gangrene  of  the  stomach  that  take  place  in  aggravated  yel- 
"  low  fever.  As  the  ulcer  of  a  specific  poison  that  would  run  a  regu- 
"  lated  course  according  to  acknowledged  laws,  if  it  be  driven  to  a 
"  high  inflammation  or  sphacelus,  no  longer  belongs  to  the  original 
"  stock,  and  is  emancipated  from  those  laws  ;  so  the  violent  actions 
"  of  the  above  fever  impair  and  destroy  the  animal  functions  by  which 
"  its  crisis  and  remissions  are  regulated,  or  speedily  engender  a  neuf 
*'  disease  ;  as  new  as  the  conversion  of  an  ordinary  venereal  chancre 
"  into  a  phagedenic  slough,  through  the  application  of  a  potential 
"  cautery." 

I  may  refer  to  the  section  on  Bilious  Fever,  in  the  first  edition  of 
my  work,  for  a  similarity  of  doctrine. 

By  Malaria,  Dr.  F.  means  to  express  something  that  is  more  de- 
cidedly than  mia«mata  the  product  of  underground  moisture,  which 
can  only  be  sublimated,  so  as  to  produce  its  specific  effects,  by  long- 
continued  solar  heat  —  a  more  subtle  miasm,  in  fact,  of  which  the  sur- 
face gives  no  warning,  but  of  which  the  existence  is  proved  from  its 
effects  on  habitations  that  are  placed  in  the  draught  of  the  dry  ditches 
of  fort«,  no  matter  how  rocky  or  dry,  if  they  are  deep,  and  also  of 
deep  ravines.  At  Fort  Matilda,  in  Basseterre,  Guadaloupe,  a  well- 
raised  artillery  store-house  and  guard  room,  placed  in  Bouchure,  at 
the  confluence  of  two  of  the  ditches,  was  found  to  be  utterly  uninha- 
bitable. The  same  malign  influence  affected  the  houses  that  were 
placed  opposite  the  deep  ravines  of  rivers,  no  matter  how  pure  and 


YELLOW  FEVER.  349 

pebbly  the  channel,  as  also  all  the  dwellings  situated  on  the  leeward 
base  of  the  mountains.* 

It  would  also  appear  that  these  effluvia,  during  certain  states  of 
stagnation  of  atmosphere,  as  during  the  sultry  calms  of  the  hurricane 
months  in  the  West  Indies,  accumulate  in  the  dirty  ill-ventilated 
streets  of  West  India  towns,  to  the  danger  of  all^who  are  unseasoned 
to  their  influence.  Here  strangtrs  will  have  the  highest  degree  of 
ardent  fever. 

It  is  probable,  too,  that  the  healthiness  of  seasons  in  unhealthy  cli- 
mates, depends  less  on  the  amount  of  heat  and  moisture,  than  on  the 
•ventilation  of  the  climates  by  powerful,  regular  trade  winds,  like  the 
trade  winds  between  the  tropics  ;  for  whenever  these  have  been 
withheld  for  a  time,  the  accumulated  morbific  emanations  from  under- 
ground moisture  will  act  upon  the  human  body,  like  the  accumulated 
typhoid  principles  in  crowded  hospitals,  when  undiluted  with  a  due 
proportion  of  atmospheric  air.t 

I  shall  conclude  this  section  with  some  observations  on  the  Fever 
of  Mariegalante,  in  the  West  Indies,  communicated  to  the  Author 
by  Dr.  Dickson. 

The  history  of  the  fevers  at  Mariegalante,  from  July  to  Decem- 
ber, 1808,  is  not  only  well  calculated  to  show  the   destructive  pow- 
ers of  concentrated  marsh  miasmata,  in  tropical  climates,  at  certain 
seasons  ;  but  also  the  modifications   of  fever  which  arise  according 
to  intensity  of  cause,  locality,   atmospherical  vicissitudes,  epidemic 
influence,   or  degree    of  constitutional   predisposition.     The  diffe- 
rence of  effect,  however,  as  marked  by  difference  of  type,  or  ano- 
malous  appearances,  is   here  particularly  worthy  of  attention,  be- 
cause the  men  were  limited  to  a  small  space,  insulated  and  exposed 
to  the  same  causes  which  were  strictly  local  and  indigenous,  but  affect- 
ed by  differences  of  temperament  or  habits,  degree  of  habituation  or  ex- 
posure, and  other  relative  circumstances.  I  can,  however,  only  pro- 
pose here  to  give  a  hasty  and  imperfect  sketch  of  the  sickly  period 
in  question,  owing  to  deficiencies  in  the  reports  during  the  illness  of 
the  successive  medical  officers,  and  the  space  and  time  it  would  oc- 
cupy, minutely  to  analyse  those  in  my  possession.     For  some  months 
after  the  capture  of  the  Island,  the  marines  composing  the  garrisons 
enjoyed  a  very   fair  degree  of  health  ;  but    from   the   beginning  of 
July,  (the  usual   commencement  of  the   sickly  season  there,)  after 
heavy  rams  succeeded    by  intense   heat,   fever   became  daily  more 
frequent  in  occurrence,  and  aggravated  in  character.     Upon  my  ar- 
rival on  the  29th  of  the  same  month,  I  found  the  disease  had  made 
such  progress  as  caused  me  to  entertain  the   most  painful  apprehen- 
sions for  the    fate  of  the   garrison.     It  originally  consisted  of  only 
350  men,  and  there  were  then  150  on  the  medical  list,  40  of  whom 
were   affected  with  fever,    15  with  dysentery,  and    75  with  ulcers, 
many  of  which  owing  to  the  sir kess  of  the  surgeon,  and  the  accumu- 
lation of  cases,  had  attained  a   considerable   degree  of  malignancy. 
Of  the  first  disease,  many  had   the  yellow  or  endemic  fever  of  the 

*  See  the  section  on  Scily. 

t  See  Dr  Ferguson's  paper  in  the  8tfi  vol.  Med.  Chir.  Transactions,  from 
which  the  above  has  been  abstracted  and  condensed. 


INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

West  Indies,  in  its  most  aggravated  form,  with  black  vomit  ;  in 
others,  it  was  of  a  more  protracted  character,  and  with  symptoms 
more  resembling  those  of  typhus  ;  while  the  remainder  had  remit- 
tent or  intermittent  levers.  On  my  first  view  of  the  sick,  and  of 
the  low  swampy  situation  of  the  town  of  GRAND  BOURG,  together 
with  the  season  of  the  year,  I  was  impressed  with  the  most  unfa- 
vourable anticipations,  and  represented  to  the  Commander  in  Chief, 
that  although  I  had  expected  to  find  much  sickness  at  Mariegalante, 
I  had  not  been  prepared  for  the  conclusion  I  was  then  obliged  to 
form  — viz.  the  total  reduction  of  the  strength  of  the  garrison  in  the 
course  of  the  hurricane  months,  unless  the  sickness  could  be  arrest- 
ed. That  my  prognostic  was  but  too  accurate,  will  appear  in  the 
sequel.  The  closest  inspection,  on  the  following  day,  tended  but  to 
confirm  and  extend  this  conclusion  :  my  report  expressed  the  grief 
with  which  I  offered  my  opinion  that  the  garrison  would  be  shortly 
incapacitated  for  any  duty  ;  and  that  the  only  chance  of  averting  this 
depended  on  the  adoption  of  measures  of  the  greatest  promptitude 
and  energy. 

The  first  object  was  to  remove,  as  far  as  it  was  possible  both  the 
sick  and  well  from  their  unhealthy  habitations ;  rendered  still  more 
Doxious  by  the  accumulation  of  disease  ;  and  where  this  could  not 
be  effected,  to  cleanse  and  pur.-fy  the  apartments,  and  to  arrange,  and 
to  separate  the  sick.  &c.  The  next  considerations  were  the  clear- 
ing away  of  whatever  was  filthy  and  offensive  around  them  ;  the  em- 
ployment of  negroes  for  this,  and  various  other  fatiguing  and  dange- 
rous duties  ;  the  avoiding  of  exposure  to  the  sun  and  rain  ;  a  more 
regular  supply  of  fresh  diet,  and  of  wine  and  spruce  beer  to  the 
troops,  instead  of  rum  ;  and  lastly,  the  adoption  of  every  measure 
which  could  prevent  the  facility  of  intemperance,  and  excess  with 
noxious  new  spirit.  A  more  elevated  situation  was  procured  for  the 
convalescents,  on  the  hill  ;  and  a  large  house  on  the  sea-shore  to  the 
eastward,  and  consequently  generally  to  the  windward  of  the  swampy 
grounds,  was  selected  for  an  hospital  ;  but  the  latter,  owing  to  re- 
ports of  its  insalubrity  and  other  difficulties,  was  never  occupied  ; 
though  I  was  decidedly  of  opinion  that  the  removal  of  the  men,  any- 
where, was  preferable  to  their  remaining  in  their  former  situation, 
which  had  been  replete  with  disease  and  death.  After  making  those 
arrangements,  Dr.  Mortimer,  then  surgeon  of  the  flag-ship,  who  had 
handsomely  volunteered  his  services,  was  left  in  charge  of  the  sick  ; 
and  according  to  his  official  report,  published  in  the  Nineteenth 
Number  of  the  Medico-Chirurgical  Journal,  for  the  first  two  or  three 
days,  such  was  the  amendment  produced  by  the  measures  concerted, 
that  a  considerable  diminution  of  disease  was  calculated  upon.  But 
alas  !  the  remission  was  but  temporary  :  the  men  could  not  be  re- 
moved beyond  the  reach  of  noxious  exhalations,  emanating  in  all  di- 
rections from  the  low  swampy  ground  covered  with  rank  vegeta- 
tion ;  the  concentration  of  the  marsh  miasma  ;  and  the  predisposi- 
tion favoured  by  apprehension  and  irregularities,  increased  daily, 
and  the  fever  proceeded  with  augmented  power  and  rapidity,  until 
it  had  swept  off  half  the  garrison.  The  aspect  of  the  country,  Dr. 
Mortimer  observes,  "  seems  particularly  favourable  to  such  exhala- 


YELLOW  FEVER,  ,351 

*  *'•*«# 

Uons.  On  viewing  it,  you  almost  constantly  find  bills  of  easy  ascent, 
intersected  by  lesser  declivities,  and  these  on  both  sides  encompassed 
by  swamps  ;*so  that  whether  in  the  interior,  or  the  town,  sickness 
nearly  equally  obtains."  The  enemy  taking  advantage  of  the  dis-, 
abled  state  of  the  garrison,  attacked  the  island  on  the  23rd  August, 
and  although  iu  a  short  time  it  was  re-captured,  and  reinforced  by 
fresh  detachments,  the  sickness  was  necessarily  much  increased  by 
the  fatigue,  exposure,  and  irregularities  incidental  to  warfare.  Many 
of  the  old  as  well  as  the  new  troops  were  seized  with  the  fatal  fever  : 
indeed  the  worst  cases  were  second  attacks,  brought  on  by  exposure 
and  excesses,  and  by  the  end  of  September,  this  ill-fated  little  garri- 
son had  lost  by  disease  234  men.  As  a  most  faithful  description  of 
the  yellow  fever  by  Dr.  Me.  Arthur  appears  elsewhere,  and  as  Dr. 
Mortimer's  report  on  the  endemic  in  question  has  been  inserted  in 
the  Medico-Chirurgical  Journal,  as  above  noticed,  I  do  not  propose 
giving  any  further  account  of  it  here. 

The  only  treatment  which  appears  to  have  had  any  effect  was 
that  of  blood-letting  and  purgatives,  if  resorted  to  sufficiently  early  ; 
but  even  these  measures  were  inefficacious  unless  employed  at  the 
very  commencement ;  and  after  what  has  been  said,  it  is  hardly  ne- 
cessary to  add  that  the  power  and  rapidity  of  the  disease  were  too 
often  such  as  to  set  medical  control  at  defiance  ;  indeed,  in  its  highest 
grade,  there  is  so  little  chance  and  time  for  the  interposition  of  our 
art,  that  it  may  almost  be  considered  irremediable  ;  and,  in  some  in- 
stances, men  who  complained  of  head-ache  and  giddiness  in  the  after- 
noon, were  dead  by  the  next  morning. 

Dr.  Mortimer  was  taken  ill  before  he  had  finished  his  report,  and 
was  received  on  board  the  flag-ship  in  a  state  of  extreme  danger,  from 
which  he  with  difficulty  recovered. — He  was  succeeded  by  Mr.  Wal- 
ler, (who  like  his  predecessors  suffered  much  from  the  unhealthiness 
of  the  situation,)  and  from  whose  communications  chiefly  I  have  ex- 
tracted the  remaining  account  of  disease  at  Mariegalante.  The  yel- 
low fever  declined  towards,  and  indeed  altogether  ceased  by  the  end 
of  September,  when  the  season  become  rainy  ;  and  it  was  succeeded 
by  cases  of  a  protracted  description,  extending  to  the  period  of  twenty 
days  or  longer  ;  and  though  characterized  by  some  peculiar  and 
anomalous  appearances,  with  symptoms  much  resembling  those  of 
typhus.  During  the  months  of  October  and  November,  the  weather 
was  wet  and  squally  ;  and  there  was  comparatively  but  little  fever, 
with  the  exception  of  quotidian  intermittents,  which  were  by  no 
means  severe,  and  yielded  readily  to  the  moderate  use  of  bark.  In 
December,  the  tertian  became  the  prevalent  type,  but  early  in  this 
mouth  intermittent  paroxysms  occurred  of  an  alarming  character, 
and  of  such  an  intensity,  that  in  some  cases,  after  one  or  more  attacks 
the  patient  was  carried  off  by  coma  and  convulsions.  In  this  way 
seven  men  died  within  twenty-four  hours  ;  and  some  even  in  a  much 
shorter  period,  so  as  at  first  to  induce  a  suspicion  of  poison.  The 
symptoms  may  in  some  have  been  partly  attributable  to  their  having 
taken  a  large  quantity  of  rum,  with  the  view  of  preventing  the  ague  ; 
but  they  also  occurred  in  others  who  had  not  tried  this  pernicious 
experiment.  In  one  man  who  died  in  about  two  hours,  a  green  se- 


352  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

tlitnent,  supposed  at  first  to  be  some  poisonous  vegetable,  was  found 
in  the  stomach.  In  others  who  were  opened,  however,  no  such  mat- 
ter was  discovered  ;  but  only  a  bilious  looking  fluid,  similar  to  what 
was  ejected  by  many,  hut  not  by  all,  before  death.  In  almost  every 
dissection  a  large  quantity  of  this  flui  I  was  found  in  the  stomach,  dy- 
ing every  thing  it  touched  of  a  very  deep  yellow  colour — very  turbid, 
saponaceous,  adhering  to  the  side.*  ol  the  vessel,  with  an  odour  of 
ammonia  so  strong  and  pungent,  as  to  excite  the  olfactory  nerves, 
and  appearing  to  be  particularly  acrid  ;  but  not  at  all  resembling  the 
matter  with  the.  green  sediment  abovementioned,  nor  the  black  vomit 
of  yellow  fever,  nor  even  the  yellow  fluid  which  is  first  thrown  up 
in  that  disease.  The  action  of  this  fluid  on  the  nerves  of  the  stomach 
seemed  to  be  the  cause  of  the  comatose  symptoms  which  came  on, 
soon  after  the  invasion  of  the  paroxysm,  or  at  the  commencement  of 
the  hot  stage  ;  as,  whenever  au  emetic  was  previously  given,  a  con- 
siderable quantity  of  it  was  brought  up  ;  but  the  remedy  seemed  al- 
so to  increase  the  secretion  of  it  ;  for  as  much  would  be  ejected  in 
the  course  of  the  succeeding  day  as  had  been  discharged  by  the  eme- 
tic.— In  the  greater  number,  the  comatose  symptoms  did  not  appear 
till  after  the  patient  had  sustained  two  or  three  paroxysms  :  many, 
however,  died  in  the  first  paroxysm,  when  the  coma  did  appear,  but 
more  in  the  second  paroxysm.  To  this  account  of  the  seventy  of 
the  disease,  I  c:;n  well  give  credit,  from  the  cases  which  fell  under 
my  own  observation,  while  at  Manegalante.  In  one  instance  1  re- 
collect to  have  seen  a  man  in  whom,  hot  only,  as  mentioned  by  Senac, 
the  hot  and  sweating  stages  occurred  together,  but  all  the  three  stages 
seemed  to  be  concentrated  ..t  once  ;  for  wl.ilc  his  teeth  were  chat- 
tering and  his  body  shivering  from  the  sensation  of  extreme  cold,  his 
skin  felt  excessively  hot  to  the  touch,  and  large  drops  of  perspiration 
were  standing  on  his  face  and  breast.*  When  the  disease  was  of  the 
tertian  type,  Mr.  Waller  observes  that  the  symptoms  lasted  about 
thirty-six  hours,  or  until  about  two  o'clock  in  the  morning  of  the  day 
after  the  attack  ;  when  of  the  quotidian  type  the  duration  was  about 
eighteen  hours,  and  somewhat  milder,  but  the  intermissions  being 
only  six  hours  were  lens  complete  than  in  the  tertian  paroxysms. 
In  the  latter  part  of  the  paroxysm  the  pulse  and  skin  sunk  remarka- 
bly low,  as  in  the  fever  about  to  be  described  ;  but  they  rose  again 
dui^ng  the  apyrexia,  nearly  to  the  natural  standard,  and  the  patient 
then  complained  chiefly  of  debility.  In  every  instance  where  the 
patient  survived  the  second  shock,  he  recovered  ultimately,  but  sel- 
dom without  having  had  six  or  seven  paroxysms.  In  this  disease, 
denominated  by  Mr.  Waller,  "  the  comatose  intermittent,"  his  prac- 
tice was  to  give  an  emetic,  an  hour  before  the  accession  of  the  at- 
tack, which  appeared  of  considerable,  service  in  mitigating  it  :  a  blis- 
ter was  applied  to  the  head,  and  sometimes  between  the  shoulders, 
and  the  bowels  were  kept  very  open  with  calomel.  His  principal 
reliance,  however,  was  on  mercurial  frictions  repeated  every  hour  ; 

*  Besides  Senac,  Cleghorn,  Stork,  Pringle,  Frank,  Burserius,  and  various  other 
authors  adduce  instances  where  the  order  of  the  paroxysm  was  deranged,  or 
some  of  the  stages  wanting,  and  of  various  anomalous  appearances  in  intermit- 
tents. 


YELLOW  FEYER.  363 

and  by  this  remedy  he  thinks  many  lives  were  saved,  though  in  one 
instance  only  was  ptyalism  the  consequence  of  it.  When  the  pa- 
roxysms ceased,  it  was  discontinued;  and  the  hark  was  substituted. 
The  patients  continued  long  in  a  state  of  convalescence  ;  and  fre- 
quently showed  symptoms  of  diseased  spleen.  Towards  the  end  of 
November  the  northerly  winds  set  in  ;  vast  quantities  of  rain  fell 
during  the  night  ;  and  soon  afterward*,  that  is,  early  in  December, 
fever  became  prevalent.  This  fever  occurred  at  the  same  period, 
and  in  some  respects  bore  a  strong  similitude  to  the  aggravated  inter- 
mittent above  described  ;  but  it  was  of  a  different  type,  and  appeared 
in  duration  and  symptoms  to  be  intermediate  between  yellow  fever 
and  typhus.  As  this  fever  was  characterized  by  the  supervention  of 
extraordinary  symptoms,  viz.  coma,  reduction  of  temperature,  and 
periodical  vomiting,  I  shall  give  a  more  particular  account  of  it,  as  it  is 
described,  though  more  summarily  than  in  the  minute,  and  I  have 
every  reason  to  suppose,  faithful  report  of  Mr.  Waller. 

Description  of  the  Fever. — The  patient  complains  of  being  taken 
ill  in  the  evening  ;  but,  upon  more  minute  inquiry,  it  is  generally 
found  that  a  slight  head-ache  was  felt  in  the  morning,  with  a  sense  of 
lassitude  and  pain  in  the  limbs  ;  which  symptoms  were  relieved  at 
dinner,  but  returned,  in  an  increased  degree,  about  sun-set.  Slight 
rigours  then  occur,  and  are  often  felt  for  some  time  after  the  heat 
has  accumulated  on  the  surface  of  he  body  ;  they  generally  continue 
about  an  hour,  when  the  temperature  becomes  steady  ;  though  at  a 
lower  point  than  is  usu  tl  in  the  commencement  of  yellow  fever,  and 
considerable  thirst  and  anxiety  suceed,  while  the  face  and  general  sur- 
face become  flushed  ;  and  the  blood  vessels  of  the  eye  turgid.  The 
pulse  is  now  full,  firm,  and  frequent ;  but  tiie  skin,  though  hot,  is  seldom 
without  some  degree  of  moisture  and  softness.  Perspiration  usually 
comes  on  early,  and  continues  free  and  general,  during  the  remainder 
of  the  paroxysm, which  ceases  about  two  or  three  hours  before  daylight. 
The  patient  then  falls  asleep  for  some  hours,  and  awakes  refreshed,  and 
with  a  considerable  remission  of  all  the  febrile  symptoms  ;  the  pulse  is 
now  less  full  ;  butstill  frequent,  and  often  irregular  ;  and  the  tongue, 
which  was  nearly  white  before,  is  found  thickly  coated  with  mucus, 
whitish  round  the  edges,  but  very  foul  and  brown  in  the  middle.  The 
patient  complains  now  only  of  debility,  and  a  dull  heavy  sensation 
of  the  head  increased  on  motion,  and  shows  a  propensity  to  sleep. 
The  apyrexia  continues  till  about  noon,  when  the  same  febrile  symp- 
toms recur,  but  increased  in  violence  and  duration.  The  remission 
next  morning  is  less  complete,  and  the  exacerbation  comes  on  ear- 
lier. In  general  there  is  no  third  remission  ;  the  fever  becomes 
continued,  arid  is  early  accompanied  by  great  irritability  of  stomach 
beginning  with  vomiting  of  bilious  matter,  and  afterwards  of  every 
thing  that  is  taken,  with  very  distressing  retching,  uneasiness  and  pain 
when  it  is  empty.  The  dull  heavy  pain  in  the  forehead,  with  verti- 
go on  motion,  is  always  complained  of,  which,  with  the  pains  of  the 
limbs,  generally  continues  through  the  disease.  The  bowels  are  for 
the  most  part  relaxed,  sometimes  very  loose,  and  the  stools  watery. 
The  patient  most  frequently  continues  in  this  state  four  or  five  days, 

45 


354  1NFMJENTE  OF  TROPICAL  CEIMATES,  &€. 

tvhen  a  new  train  of  symptoms  appears,  which  give  the  distinguish  • 
ing  character  to  this  fever  ;  sometimes,  however,  they  appear  ear- 
lier, at  others  not  until  signs  of  convalescence  have  occurred.  The 
first  symptom  is  a  remarkable  degree  of  stupor  ;  the  patient  displays 
the  greatest  indifference  to  every  thing  around  him  ;  is  with  difficulty 
aroused  to  answer  questions,  or  to  take  any  thing  ;  and  seems  much 
disconcerted  at  having  been  disturbed.  The  pulse,  which  was  before 
tolerably  full  and  firm,  sinks  rapidly,  and  throbs  with  a  quick  unequal 
motion  under  the  finger  ;  sometimes  it  is  scarcely  perceptible,  and 
not  unfrequently  it  cannot  be  felt  at  the  wrist  at  all.  The  heat  of  the 
surface  too,  generally  subsides,  but  in  this  stage  it  is  very  variable, 
though  there  is  reason  to  believe  that  if  the  patient  were  left  to  him- 
self he  would  become  quite  cold  ;  indeed  this  coldness  of  the  skin  is 
very  remarkable  ia  a  great  number  of  cases  ;  and  in  some  appears 
to  be  beyond  what  is  felt  in  the  living  body  under  any  circumstances  : 
yet  the  patient  does  not  appear  to  feel  any  uneasiness  from  it.  With 
this  extraordinary  reduction  of  temperature,  the  skin  is  not  anserat- 
ed,  but  cold  and  clammy  ;  and  it  sometimes  continues  for  several 
days.  The  tongue  is  now  found  to  be  dry  and  hard,  and  the  teeth 
and  lips  become  covered  with  a  dark-coloured  fur.  The  patient  ap- 
pears to  sleep  much  during  the  day,  or  rather  he  lies  in  a  kind  of  stu- 
por without  sleeping,  but  at  night  is,  for  the  most  part,  delirious. 
He  now  seldom  complains  of  pain,  or  only  in  the  region  of  the 
stomach,  where  it  is  sometimes  very  severe.  The  vomiting,  at  this 
period,  often  subsides  ;  but  frequently  also  it  comes  on  every  day 
about  the  same  time,  and  is  attended  with  very  painful  spasmodic 
contractions  of  the  stomach.  This  periodical  vomiting  observes  its 
periods  with  great  regularity  :  is  a  very  untractable  symptom,  and 
little  susceptible,  of  alleviation,  by  any  remedy  that  has  been  tried. 
The  vertigo  is  also  exceedingly  distressing,  and  increases  so  much,  in 
an  erect  posture,  that  the  patient  immediately  falls  down  ;  and  even 
when  recumbent  he  complains  of  the  giddiness  or  a  very  unpleasant 
sensation  in  the  head.  It  sometimes  continues  after  the  other  symp- 
toms have  disappeared,  and  is  always  extremely  tenacious.  The 
symptoms  just  enumerated  continue  three,  four,  or  five  days  ;  and 
then  gradually  subside.  But  this,  though  the  most  favourable,  is  not 
the  most  frequent  termination  ;  it  oftener  happens  that  the  stupor 
increases  to  a  state  of  complete  coma,  or  accompanied  by  muttering 
delirium,  sub^ultus  tendinum,  and  involuntary  discharges.  The  pulse 
sinks  until  it  can  be  no  longer  felt  any  where  ;  the  whole  body  be- 
comes cold  and  cadaverous  ;  and,  in  some  cases,  of  a  deep  yellow 
colour,  with  no  other  signs  of  life  than  a  feeble  respiration.  Some- 
times, at  uncertain  intervals,  the  pulse  and  heat  rise,  and  the  patient 
becomes  anxious  and  restless  for  two  or  three  hours  ;  then  falls  again 
into  the  former  state.  But  these  changes  may  be  effected  by  the  re- 
medies employed,  as  it  is  more  than  probable  that  they  would  not  so 
often  appear  if  the  patient  were  left  to  himself.  In  this  stage,  death 
very  frequently  happens  ;  but  however  bad  the  patient  may  be,  when 
the  formidable  symptoms  continue  above  forty-eight  hours,  it  affords 
a  strong  presumption  that  he  will  recover  ;  and  this  sometimes  has 
taken  place  after  he  has  lain  in  this  state  for  four  days.  In  such  in- 


355 

stances,  when  the  system  emerges  from  torpidity,  the  coma  lirst  dis- 
appears by  degrees,  and  the  pulse  gradually  rises ;  but  the  patients 
continue  for  a  long  time  in  a  state  of  excessive  debility,  and  not  un- 
frequently  fall  victims  to  second  attacks  or  to  dysentery.  This  dis- 
ease first  attacked  many  of  those  who  had  suffered  from  concentrated 
fever  in  July  and  August ;  its  average  duration  is  twelve. days,  when 
it  terminates  in  a  quotidian  intermittent,  convalescence,  or  death. 

It  may  appear  but  little  in  favour  of  the  plan  of  treatment,  to  state 
that  out  of  sixty-one  seized  with  this  fever,  in  December,  half  of 
them  died  ;  yet  when  those  very  formidable  symptoms  are  taken  into 
consideration,  it  is  but  fair  to  infer  that  remedial  measures  were  not 
only  employed  with  much  advantage  in  the  early,  but  also  in  the  ul- 
terior stages  of  the  disease,  from  there  being  time  to  put  them  in 
practice,  according  to  the  existing  indications.  In  the  early  period 
of  the  disease,  Mr.  Waller  observes,  it  wafrahvays  considered  neces- 
sary to  lessen  the  excitement  by  bleeding,  purgatives,  and  the  other 
parts  of  the  antiphlogistic  regimen.  But  as  this  stage  of  excessive 
excitement  was  in  some  cases  of  much  shorter  duration  than  in  others^ 
it  frequently  happened  that  the  patient  did  not  complain  sufficiently 
early  to  receive  much  benefit  from  depletion,  or  even  to  bear  any 
abduction  of  blood.  Indeed  symptoms  of  exhaustion  sometimes  ap- 
peared even  in  the  first  paroxysm,  and  in  a  number  of  cases,  no  re- 
mission supervened  ;  but  whenever  it  was  authorized,  the  lancet  was 
invariably  and  freely  used  in  the  first  stage,  and  always  with  advan- 
tage ;  in  every  instance,  the  bowels  were  well  evacuated  by  purga- 
tives, and  by  large  and  frequent  doses  of  calomel.  Emetics,  he  says, 
were  frequently  tried,  at  first,  but  not  with  so  good  an  effect  as  was 
expected  from  them  ;  and  but  a  very  short  relief  from  the  nausea 
was  experienced  after  their  use,  when  this  symptom  existed,  in  a  con- 
siderable degree,  in  the  first  stage.  Upon  this  point  I  shall  wave  any 
remarks,  as  occasionally  they  may  have  been  useful  in  the  modified 
disease  under  consideration  \  but  in  the  inflammatory  and  rapid  yel- 
low fever,  I  am  of  opinion  that  the  exhibition  of  emetics,  or  of  an- 
timonial  or  other  nauseating  medicines,  cannot  be  too  strongly  depre- 
cated. In  the  present  case,  it  was  only  in  the  first  attack,  or  dur- 
ing the  exacerbation,  that  the  patient  could  bear  any  evacuation, 
except  by  the  bowels,  which  were  always  kept  very  open,,  so  long  as 
the  pulse  was  at  all  full,  or  retained  any  firmness  ;  but,  when  the 
stupor  supervened,  he  could  no  longer  bear  any  debilitating  process. 
To  allay  the  gastric  irritability,  blisters,  mercurial  frictions,  effer- 
vescing draughts,  small  pods  of  capsicum,  &c.  were  employed,  but 
generally  with  very  little  effect.  The  best  remedy  seemed  to  be  a 
grain  of  opium  in  a  pill,  repeated  according  to  the  vomiting  ;  but 
even  this  was  often  rejected.  So  soon  as  stupor  or  coma  appeared, 
stimulants  were  resorted  to  ;  blisters  to  the  head,  wine,  camphor, 
ammonia,  and  mercurial  frictions  ;  and,  in  the  low  state  above  des- 
cribed, there  is  no  doubt  that  the  friction  itself,  as  well  as  the  reme- 
dy, was  of  service.  The  delirium  was  generally  immediately  rp- 
lieved  by  blistering  the  head.  The  formidable  degree  of  coma,  Mr. 
Waller  observes,  mostly  came  on  in  the  morning  early  ;  but  he  was 
unable  to  ascertain  whether  it  was  preceded  by  any  peculiar  sensa- 


356  INFLUENCE  OF  TROPICAL  CLIMATES,  &C« 

tion,  by  which  its  approach  could  be  certainly  known.  The  prog- 
nosis was  unfavourable  in  proportion  to  the  intensity  of  coma,  reduc- 
tion of  heat,  and  gastric  irritability  ;  little  dependence  could  be 
placed  on  the  circulation.  The  danger  was  great  when  the  patient 
lay  in  a  state  of  reverie  :  much  greater  when  there  was  delirium  in 
the  day  time,  than  when  in  the  night  In  the  comatose  affection,  he 
speaks  in  the  most  favourable  term*  of  mercurial  friction?,  and  ad- 
duces their  success  in  some  rases  considered  desperate,  when  the  pa- 
tient had  been  lying  in  this  lethargic  state  for  four,  five,  or  more 
days,  with  the  pulse,  for  many  hours,  imperceptible,  and  the  re- 
markable coldness  of  skin  above  described.  These  frictions  re- 
quired to  be  frequently  and  persevering!}'  repeated  ;  and  latterly  he 
was  in  the  habit  of  rubbing  in  a  drachm  or  two  drachms  of  the  strong 
ointment  every  hour  ;  which  method  seemed  preferable  to  any 
other.  To  his  opinion  of  the  value  of  mercury  in  protracted  or 
congestive  cases,  after  the  active  stages  of  fever  are  past,  and  parti- 
cularly to  its  efficacy  in  visceral  obstructions  and  derangements  which 
are  the  sequel  of  certain  fevers,  1  perfectly  subscribe.  In  many 
such  cases,  it  is  not  only  a  most  valuable  resource,  at  a  period  when 
we  have  no  other  indication  to  pursue,  but  also,  perhaps,  where  no 
Other  remedy  would  be  successful;  hut  of  its  inutility,  except  as  a 
purgative,  where  there  is  high  febrile  and  inflammatory  action,  as  in 
the  early  stage  of  concentrated  yellow  fever,  I  am  fully  convinced  ; 
and  trust  I  need  not  here  deprecate  the  wasting  of  those  precious 
moments,  when  only  the  disease  can  be  controlled,  in  fruitless  at- 
tempts to  institute  the  mercurial  action.  With  respect  to  the  combi- 
nation of  this  with  the  depletory  pi  »n  of  treatment,  I  am  inclined  to 
think  that  the  mercury  has  often  enjoyed  a  larger  share  of  the  cre- 
dit than  it  has  been  entitled  to  ;  because  in  many  such  cases,  it  has 
been  indebted  for  the  power  of  exerting  its  specific  action,  to  the  de- 
pletion, which,  at  the  same  time,  has  been  employed.  When  we 
can  command  a  warm  bath,  in  cases  like  those  above,  1  need  not  say 
how  much  it  would  contribute  to  the  object  in  view  :  it  i?  to  be  re- 
gretted that  there  does  not  appear  to  have  been  an  opportunity  of 
ascertaining  the  actual  temperature  of  the  skin  by  the  thermometer. 
With  respect  to  the  causes  of  this  (ever,  Mr.  Waller  does  not  offer 
any  decided  opinion.  It  was,  at  first,  attributed  to  the  northerly 
wind  wafting  a  very  offensive  odour  from  the  bury  ing-ground  ;  owing 
to  the  hasty  and  imperfect  inhumation  of  the  bodies,  which  was  ac- 
cordingly remedied.  The  disease  certainly  began  to  prevail  after 
the  northerly  winds  set  in  ;  but  it  is  unnecessary  to  add  any  aetiolo- 
gical  observations  after  what  has  been  said  of  the  abundant  sources 
of  deleterious  exhalations  at  Mariegalante. 


Account  of  the  Causus ;  or,  Yellow  Fever  of  the  West  Indies.  By  Dr. 
Me.  ARTHUR,  F.  L.  S.  Licentiate  of  the  Royal  College  of  Physicians 
of  London,  and  late  Physician  to  the  Naval  Hospital  at  Deal. 

SEC.  V. — The  following  concise,  bat  animated   description  of  the 
fatal  Western  Endemic  was  written  in  1809,  by  Dr.  Me.  Arthur,  late 


YELLOW  FBTER.  367 

physician  to  the  Royal  Hospital,  Deal  ;  and  as  he  had  the  superin- 
tendence of  a  public  hospital  nearly  six  years,  at  Barbadoes.  in  the 
West  Indies,  wilh  the  most  extensive  field  for  observation,  this  docu- 
ment will  be  found  highly  interesting  and  valuable. 

The  endemic  fever,  commonly  called  the  yellow  fever,  certainly 
excites  the  first  interest,  both  «-n  account  of  the  mortality  which  at- 
tends it,  and  the  discrepancy  among  prof  ssional  men  respecting  its 
nature  and  treatment.  The  inhabitants  of  the  West  India  Ulands 
are  subject  to  various  fevers  of  the  simple  continued,  catarrh.il,  and 
remittent  kind.  These  attack  indiscriminately  the  native,  or  the  sea- 
soned European,  and  are  as  mild  as  fevers  of  a  similar  type  in  Eu- 
rope. But  the  fatal  fever,  of  which  1  am  about  to  give  some  account, 
for  the  most  part  attacks  persons  from  Europe,  within  the  first  year 
and  a  half  after  their  arrival  in  the  country,  and  more  particularly 
seamen  and  soldiers. 

It  generally  appears  at  a  certain  period  of  the  year,  earlier  or 
later,  milder  or  more  aggravated,  according  to  the  state  of  the  wea- 
ther during  that  season.  Solitary  instances,  however,  occur  at  all 
seasons  of  the  year,  when  favoured  by  predisposition,  assisted  by 
strong  exciting  causes.  The  natives  are  not  entirely  exempt,  but.  to 
them  it  rarely  proves  fatal. 

It  is  certain  that  all  the  West  India  islands  have  their  healthy  and 
unhealthy  seasons,  varied  by  the  condition  of  the  surface,  by  being 
mountainous  or  flat,  woody  or  cleared,  dry  or  intersected  with  swamps, 
&c.  Barbadoes  is  clear  of  wood,  the  land  is  moderately  raised  abo^e 
the  level  of  the  sea,  and  every  spot  is  ciiltivaied  ;  there  are  but  few 
swamps  and  those  are  inconsiderable — and  some  rivulets  only  occa- 
sionally swelled  by  the  rains. 

From  the  middle  of  January  to  the  beginning  of  May,  the  air  is 
temperate  and  dry.  In  May  the  rainy  season  begins  and  continues 
till  the  end  of  September.  October  and  November  are  generally 
dry,  if  much  rain  has  fallen  in  the  preceding  months.  Rain  again 
falls  towards  the  latter  end  of  December,  and  till  the  middle  of  Ja- 
nuary. Bridgetown  and  its  vicinity  are  extremely  hot  from  June  to 
November,  the  thermometer  at  noon  varying  from  84  to  90°  in  the 
shade. 

The  parallel  of  health  between  the  Army  and  Navy  is  worthy  of 
notice.  The  fever  for  some  preceding  years  has  appeared  in  both 
about  the  same  time,  and  attacked  men  of  similar  habits  ;  but  has  in 
general  been  more  aggravated  on  shore  than  at  sea,  or  even  on  board 
the  ships  lying  in  Carlisle  Bay. 

This  fever  is  usually  ushered  in  by  the  sensations  which  precedes 
other  fevers  ;  such  as  lassitude,  stiffness,  and  pain  of  the  back,  loins, 
and  extremities  ;  generally  accompanied  by  some  degree  of  coldness. 
These  are  soon  succeeded  by  a  severe  pain  of  the  head  ;  a  sense  of 
fullness  of  the  eye- balls  ;  intolerance  of  light ;  skin  dry,  and  impart- 
ing a  burning  heat  to  the  hand  ;  pulse  full  and  quick  ;  tongue  cover- 
ed with  a  whitish  mucus,  but  often  not  materially  altered  from  the 
state  of  health  ;  bowels  bound.  I  may  here  remark,  that  the  actual 
degree  of  heat,  as  indicated  by  the  thermometer,  is  not  proportion- 
ate to  the  intensity  communicated  to  the  touch.  It  gerreralty  varied 


358  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

between  99  and  102°,  very  seldom  exceeding  103° ;  yet  the  skin  im- 
parted a  burning  caustic  sensation  to  the  hand  at  these  times. 

If  the  patient  has  been  attacked  in  the  night,  he  awakes  with  op- 
pressive heat,  head  ache,  and  the  other  symptoms  of  fever,  the  sen- 
sation of  cold  having  passed  unnoticed.  At  other  times,  after  fatigue- 
ing  exercise  in  the  sun,  and  sometimes  after  a  hearty  meal,  the  vio- 
lent head-ache,  and  other  symptoms  of  the  fever,  are  ushered  in  by 
an  instant  loss  of  muscular  power,  and  immediate  depression  of  ner- 
vous energy.  The  patient,  as  if  he  were  stunned  by  a  blow,  falls 
down,  his  eyes  swimming  in  tears.  In  those  cases,  delirium  is  an 
early  symptom.  In  a  few  hours,  (he  pain  of  the  loins  increases,  and, 
in  aggravated  cases,  stretches  forward  towards  the  umbilicus  ;  the 
countenance  is  flushed  ;  the  white  of  the  eye  as  if  finely  injected  by 
blood-vessels,  the  albuginea  appearing  through  the  interstices  of  the 
net-work  of  vessels,  of  a  peculiar  blue,  shining,  cartilaginous  white- 
ness. 

During  the  first  twelve  hours,  the  patient  is  not  particularly  rest- 
less, enjoys  some  sleep,  and,  when  covered  with  the  bed-clothes, 
has  partial  perspirations  on  his  face,  neck,  and  breast. 

About  the  end  of  this  period,  there  is  a  great  exacerbation  of  the 
fever ;  he  becomes  restless  ;  the  heat  and  dryness  of  the  skin  in- 
crease ;  there  is  much  pain  of  the  eyes  and  frontal  sinuses  ;  the  pain 
of  the  thighs  and  legs  is  augmented  ;  thirst  is  increased,  with  a  sen- 
sation of  pressure  about  the  region  of  the  stomach.  Nausea  and  vo- 
miting occur  towards  the  end  of  the  first  twenty-four  hours.  If  the 
fever  has  not  been  arrested  within  thirty-six  hours  from  its  commence- 
ment, the  patient  is  in  imminent  danger,  arid  all  the  symptoms  are 
aggravated  ;  the  pulse  is  strong  and  full,  and  pulsation  of  the  caro- 
tids appear  distinct  on  each  side  of  the  neck.  The  skin  continues 
hot  and  dry  ;  the  thirst  is  increased  ;  there  is  much  anxiety,  the  pa- 
tient continually  shifting  his  posture  ;  the  urine  becomes  high-colour- 
ed ;  all  his  uneasiness  is  referred  to  his  head  and  loins.  A  sensation 
of  pain  is  felt  about  the  umbilicus,  when  pressed  upon  ;  the  white 
of  the  eye  now  appears  of  a  dirty  concentrated  yellow  colour,  and 
apparently  thickened,  so  as  to  form  a  ring  round  the  margin  of  the 
cornea.  The  blood-vessels  of  the  eye  appear  more  enlarged  and 
tortuous  ;  knees  drawn  upwards  to  the  abdomen  ;  frequent  vomiting, 
with  much  strainings  ;  mucus,  and  his  common  drink  only,  being  eject- 
ed. Delirium  comes  on  about  the  end  of  the  second  day.  There  is 
now  a  dryness,  or  slight  sensation  of  soreness  of  the  throat  when 
swallowing  ;  j^pd  about  this  time,  an  urgent  sensation  of  hunger  fre- 
quently comes  on,  and  a  remarkable  want  of  power  in  the  lower  ex- 
tremities, resembling  partial  paralysis  of  the  limbs.  About  this  time, 
also,  the  pain  of  the  loins  is  so  severe,  that  the  patient  expresses  him- 
self as  if  his  "  back  was  broken." 

The  third  day,  or  stage,  begins  by  apparent  amelioration  of  all 
the  bad  symptoms,  the  vomiting  and  thirst  excepted.  The  matter 
ejected  has  small,  membranaceous  looking  floccuji  floating  in  it,  re- 
sembling the  crust  washed  from  a  port-wine  bottle.  The  thirst  is 
now  urgent,  and  there  is  an  incessant  demand  for  cold  water*  which 
is  almost  immediately  rejected  by  the  stomach.  The  heat  of  the 


YELLOW 

is  reduced  ;  the  pulse  sinks  to,  or  below  its  natural  standard  • 
the  patient,  for  an  hour  or  two,  expresses  himself  to  be  greatly  re- 
lieved, and  at  this  time,  a  person  unacquainted  with  the  nature  of  the 
disease  would  have  hopes  oHbis  recovery.  This  state,  however,  is 
of  short  duration,  amd  the  delusion  soon  vanishes. — The  delirium 
increases  ;  the  matter  ejected  from  the  stomach  becomes  black  as 
coffee-grounds,  and  is  somewhat  viscid.  Diarrhoea  comes  on  ;  first 
green,  then  black,  like  the  matter  vomited.  The  patient  often  com- 
plains of  being  unable  to  pass  his  stools,  from  a  want  of  power  in 
the  abdominal  muscles.  There  is  an  acrid,  burning  sensation  of  the 
stomach,  and  soreness  of  the  throat^extendiug  along  the  whole 
course  of  the  oesophagus,  in  attempting  to  swallow  ;  eyes,  as  if  suf- 
fused with  blood  y  skin  a  dirty  yellow  ;  parts  round  the  neck,  and 
places  pressed  upon  in  bed,  of  a  livid  colour.  More  hemorrhage 
or  less  takes  place  from  the  nose,  mouth,  and  anus,  and  a  deposition 
of  blood  from  the  urine.  The  delirium  becomes  violent  ;  the  body 
as  if  it  were  writhed  with  pain,  the  knees  incessantly  drawn  up  to 
the  belly.  The  patient  seizes,  with  c«  nvulsive  grasp,  his  cradle,  or 
any  thing  within  his  reach,  and  prefers  the  hard  floor  to  his  bed. 
The  pulse  now  sinks  ;  respiration  becomes  laborious  ;  the  countenance 
collapsed — the  lustre  of  the  eye  gone. — For  some  hours  he,  lies  in 
a  state  of  insensibility  before  death  ;  at  other  times,  expires  after 
some  convulsive  exertion,  or  ineffectual  effort  to  vomit.  The  tongue 
is  sometimes  but  little  altered  during  the  course  of  the  fever  ;  and 
if  loaded  in  the  early  stages,  it  often  becomes  clean,  and  of  a  vivid 
red  before  death. 

Such  is  the  regular  succession  of  symptoms  which  characterize 
this  fever,  but  of  longer  or  shorter  duration,  according  to  the  vio- 
lence of  the  disease,  or  strength  of  the  powers  of  lite  to  resist  it. 

In  weakly  habits,  the  vascular  aotion  at  the  beginning  is  less 
marked  ;  and  in  these  cases,  the  fever  is  generally  more  protracted, 
and  the  patient  expires  unaffected  by  the  laborious  respiration,  and 
convulsive  motions,  which  attend  the  last  struggles  of  life,  in  the 
more  violent  degrees  of  this  endemic.  Very  often  the  patient  re- 
tains his  senses  till  within  a  few  minutes  of  his  death  ;  and  some- 
times will  predict,  with  considerable  precision,  the  hour  of  his  dis- 
solution. 

In  the  early  stages  of  the  worst  cases  of  this  fever,  there  is  much 
anxiety  in  the  countenance  of  the  patient,  who  expresses  a  despair  of 
recovery.  This  fear  does  not  appear  to  proceed  from  any  natural 
timidity,  but  seems  rather  a  symptom  of  the  disease.  In  the  last  stage, 
there  is  as  much  resignation -to  his  fate,  as  there  was  apprehension  at 
the  beginning.  The  fever  of  the  Amelia  in  1804,  and  of  the  Nor- 
thumberland and  Atlas  in  1805,  terminated  fatally  from  the  second  day 
to  the  fourth  day.  The  fevers  of  1807  and  1808,  extended  from  the 
third  day  to  the  fifth.  I  have  never  noticed  a. remission  during  the 
whole  course  of  the  fever.  Several  cases  of  remittent  fever  under 
my  care  terminated  in  the  endemic  fever. 

A  certain  number  of  those  attacked  by  this  fever,  if  prompt  mea- 
sures to  subdue  it  had  been  employed,  recovered  from  its  first  stage. 


3GO  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

They  exhibited  evident  signs  of  amendment  within  the  first  twenty- 
four,  or  at  furthest  thirty-six  hours,  from  its  first  attack.  Also  a  con- 
siderable proportion  recovered  from  the  second  stage  ;  that  is  to 
say,  prpviously  to  black  vomiting  unequivocally  appearing.  But  I 
have  only  known  thirteen  ca<es,  in  above  five  years,  to  have  reco- 
vered from  the  last  stage  Some  of  these  were  afterwards  invalided, 
in  consequence  of  dyspeptic  complaints,  and  generally  disordered 
state  of  the  stomach,  and  other  abdominal  viscera. 

In  these  cases,  the  stomach  gradually  became  retentive  ;  the  eyes 
and  skin  became  of  a  more  vivid  yellow  :  they  had  refreshing  sleep, 
but  continued  extremely  weak  and  languid  for  a  long  time.  The 
oozing  of  blood  from  the  fauces  and  gums  also  continued  for  some 
days-  and  the  deposition  of  blood  in  the  urine  remained^  longest ; 
this  excretion  being  always  the  last  to  return  to  its  natural  healthy 
condition. 

Pain  of  the  back,  early  stretching  round  to  the  navel — soreness  in 
the  throat  and  oesophagus — heat  and  acrid  sensation  in  the  stomach — 
urgent  thirst — hunger — want  of  power,  resembling  paralysis  of  the 
limbs — violent  delirium — despondency — enlargement  of  the  blood- 
vessels, and  a  red-yellow  colour  of  the  white  of  the  eye,  either  sing- 
ly or  collectively,  indicate  extreme  danger  ;  and  when  the  black  vo- 
mit has  appeared,  scarcely  a  hope  remains  ! 

The  following  were  the  appearances  after  death,  [four  cases  ex- 
cepted,]  in  above  an  hundred  bodies  which  1  have  inspected. 

Omentum  little  altered.  — Peritoneal  coat  of  the  stomach  occasion- 
ally marked,  in  a  slight  degree,  by  inflammation. — The  stomach  con- 
tained more  or  less  of  a  viscid,  black  fluid,  such  as  was  ejected  by 
vomiting. — Irregular  spots,  patches,  and  streaks  of  the  internal  sur- 
face of  the  stomach,  in  a  state  of  inflammation,  gangrene,  or  sphace- 
lus. — Sometimes  large  portions  of  the  villous  coat  destroyed,  as  if 
corroded  by  some  acrid  matter. —The  small  intestines  and  coccum 
inflated  ivith  air,  and  often  containing  lumbrici,  and  a  small  quantity 
of  dark-coloured  faeces,  were  inflamed,  and  in  many  places  approach- 
ing to  the  state  of  gangrene.  No  marks  of  inflammation  in  the  colon, 
but  it  was  singularly  contracted. — Lower  part  of  the  rectum  fre- 
quently excoriated — Concave  surface  of  the  liver  occasionally  inflam- 
ed.— Gall-bladder  turgid  with  ropy  bile  ;  and,  in  some  instances,  its 
coats  were  one-fourth  of  an  inch  in  thickness. — Other  viscera  of  the 
abdomen  little  changed.  —  In  the  thorax,  the  posterior  part  of  the  su- 
perior lobules  of  the  lungs,  generally  were  very  turgid  with  blood. 
Internal  surface  of  the  oesophagus,  throughout  its  whole  extent  in- 
flamed. 

In  ten  cases  of  a  peculiarly  aggravated  degree  of  fever,  where 
much  delirium  had  been  present,  I  opened  the  head.  The  blood- 
vessels, in  some  instances,  seemed  more  turgid  with  blood  than  usu- 
al. In  two  cases,  there  were  about  two  ounces  of  serum  effused  into 
the  lateral  ventricles  ;  but  in  five  cases  the  brain  did  not  exhibit  any 
marked  appearance  of  disease. 

The  black  matter  found  in  the  stomach  did  not  resemble  bile  ; 
hut  evidently  was  blood  poured  into  the  stomach  from  the  relaxed 


Y£LI*OW  FEV£ft,  361 

vessels,  or  excoriated  and  gangrenous  surfaces,  altered  by  the  vitiat- 
ed secretion  of  the  gastric  fluids.* 

Europeans,  within  the  first  eighteen  months  after  their  arrival  in 
the  country,  being  almost  exclusively  obnoxious  to  the  yellow  fever, 
it  is  natural  to  suppose,  that  there  is  something  in  the  European  con- 
stitution, favourable  to  the  morbid  motions  which  constitute  this  fe- 
ver ;  and  lhat  this  peculiar  habit  consists  in  a  disposition  to  take  oa 
inflammatory  action.  Persons  seasoned  to  the  climate,  and  even  na- 
tives, by  sudden  alterations'  in  their  mode  of  life,  sometimes  acquire 
this  predisposition.  Young  people  born  in  the  West  Indies,  and  edu- 
cated in  England,  and  persons  having  resided  some  years  in  England, 
after  they  had  passed  the  greatest  part  of  their  lives  between  the 
tropics,  are  liable  to  this  fever  on  their  return  to  the  We»t  Indies. 

This  disposition  is  excited  into  action  by  a  variety  of  causes  ;  the 
chief  of  which  are — intemperance  ;  excessive  fatigue  in  the  sun  ; 
perspiration  checked,  by  being  exposed  to  a  current  of  air,  or  sleep- 
ing exposed  to  the  dews  ;  costiveness,  &c. — (n  tact,  whatever  be- 
comes an  exciting  cause  of  fever  in  any  country,  is  equally  so  in  this  , 
but  unfortunately  it  is  not  the  snuie  fever  that  is  induced.  % 

It  has  been  observed,  and  very  frequently  urged  by  the  ban  vivanta 
as  an  excuse  for  his  mode  of  life,  that  men  who  live  in  the  most  tem- 
perate manner,  are  as  liable  to  fever,  if  not  more  so,  than  those  who 
follow  the  opposite  extreme. — There  is  an  appearance  of  truth  in 
this  remark.  Often  the  temperate  and  sober  are  seized  with  this  fe- 
ver, under  circumstances  where  the  drunkard  escapes. 

A  stranger,  on  his  arrival  in  this  country,  unless  possessed  of  more 
than  ordinary  resolution,  is  assailed  by  so  many  temptations,  that  he 
has  not  the  power  to  follow  the  plan  he  may  have  laid  down  for  his 
own  regulations.  He  commits  an  occasional  excess,  and  next  morn- 
ing awakes  in  a  high  fever  ;  while  the  man  accustomed  to  his  "  mos- 
quito dose,"  probably  feels  no  uneasiness,  or  if  he  has  a  slight  head- 
ache from  his  last  night's  debauch,  flies  for  relief  to  his  hot  punch 
or  sangaree.  The  more  temperate  and  n  gular  a  man  ha»  lived,  any 
deviation  will  become,  in  a  proportionate  degree,  a  stronger  exciting 
cause  of  fever.  But  if  the  drunkard  and  the  sober  man  should  be 
attacked  with  fever,  the  former  has  by  no  means  an  equal  chance  of 
recovery  with  the  latter. 

Contagion  as  a  source  of  this  fever  is  entirely  rejected  by  those 
professional  men  who  have  the  greatest  opportunity  of  information, 
now  resident  in  the  West  Indies.  No  case  occurred  where  the  fever 
could  be  traced  to  a  contagious  source.  No  place  could  be  better 
adapted  to  spread  contagion  than  the  building  appropriated  to  the 
sick  in  Bridgetown,  before  the  occupation  of  the  excellent  new  hos- 
pital, in  May,  1807.  The  patients  and  their  bedding  were  carried 
to  it  through  the  town  by  any  hired  labourers :  they  were  often 
obliged  to  take  shelter  in  houses  by  the  way  ;  and  this  to  the  credit 
of  the  poor  inhabitants,  waf  never  refused  them.  From  want  of 

*  This  was  written  two  years  previous  to  Dr.  Bancroft's  publication.  It  very 
nearly  agrees  with  his  opinion,  and  those  of  the  American  practitioners,  noticed 
in" the  first  section. 

46 


362  INFLUENCE  OP  TROPICAL  CLIMATES,  &C. 

means  of  separation,  fevers  and  other  complaints  were  huddled  to- 
gether in  the  same  ward.  The  officers  and  nurses  lodged  and  visited 
in  every  part  of  the  town  ;  and  lodgings  were  procured  for  sick  offi- 
cers wherever  there  wa*  room  in  the  town,  when  they  were  requir- 
ed, without  hesitation.  Yet,  notwithstanding  all  this  unrestricted 
communication,  no  instance  occurred  where  fever  couli  be  traced  to 
a  contagious  source  :  and  surely,  if  it  were  contagious,  it  would  not 
be  so  generally  confined  to  men  recently  arrived  in  the  country. 

In  the  very  first  stage  of  this  fever,  it  would  probably  be  difficult 
to  distinguish  it  from  the  other  continued  fevers  of  the  country.  Its 
violence  is  one  criterion  by  which  we  might  form  a  judgment.  We 
must  also  look  to  the  particular  circumstances  of  the  person  attack- 
ed.— If  he  has  been  but  a  short  time  from  Europe  ; — if  he  has  been 
taken  ill  after  a  debauch — fatigue — or  unusual  exposure  to  the  sun, 
or  to  a  partial  current  of  air,  or  after  sleeping  in  the  night  air,  there 
is  much  reason  to  apprehend  yellow  fever  ;  more  particularly  if  the 
eyes  be  inflamed,  and  the  pain  of  the  loins  stretched  forward  to  the 
navel,  with  soreness  of  the  throat — heat  and  acrid  sensation  in  the 
stomach  >;  a  feeling  of  pressure  there,  and  urgent  desire  for  cold 
drink.  These,  and  the  other  symptoms  already  described,  will  indi- 
cate the  nature  and  the  danger  of  the  disease. 

In  the  early  part  of  my  superintendance,  1  gave  the  fairest  trial  to 
every  mode  of  practice  recommended  by  eminent  practitioners,  in- 
cluding the  mercurial  plan  of  treatment. — But  in  no  instance  in  the 
worst  cases  that  terminated  in  death,  however  protracted  the  fever 
might  have  been,  could  the  mouth  be  affected  ;  while  in  the  milder 
cases,  where  the  fever  subsided  in  36  or  48  hours,  the  mercurial  ac- 
tion became  manifest  within  that  period.  In  some  protracted  cases, 
ptyalism  did  not  appear  for  several  days  after  the  mercury  had  been 
discontinued — and  in  others,  after  the  gums  were  affected,  where  the 
patients  had  a  relapse,  the  mercurial  immediately  ceased,  or  was  sus- 
pended. But  the  submuriate  of  mercury  I  continued  to  employ  with 
much  advantage,  as  a  purgative  but  in  smaller  doses  of  course,  than 
when  I  attempted  to  excite  salivation. 

Bleeding  largely,  in  the  early  stage  of  the  fever  has  been  found 
of  the  most  eminent  service.  When  employed  after  the  first  stage  of 
the  fever  had  passed  by,  it  did  injury,  and  certainly  hurried  on  dis- 
solution. The  following  plan  is  that  which  has  been  pursued  at  this 
hospital,  for  several  years  ;  it  is  that  which  has  been  practiced  on  this 
station,  and  has  been  attended,  (would  I  could  say  with  uniformly  the 
happiest  effect !)  with  at  least  superior  success  to  any  other. 

From  twelve  to  twenty-four  ounces  of  blood  and  upwards  are 
drawn  from  the  arm,  as  soon  after  the  accession  of  the  fever  as  pos- 
sible. The  blood  should  be  drawn  until  derangement  of  the  vascu- 
lar action  has  taken  place,  by  the  quantity  of  blood  extracted  ;  indi- 
cated by  approaching  syncope,  nausea,  and  vomiting.  Should  faintiag 
come  on,  from  mental  emotion,  such  at  the  dread  of  the  lancet,  sight 
of  the  blood,  &c.  the  bleeding  is  to  be  continued  after  the  patient  has 
revived,  until  a  quantity  proportioned  to  the  strength  is  drawn  off. 
Six  grains  of  calomel,  and  double  that  quantity  of  cathartic  extract, 
are  to  be  immediately  given  ;  and  if  this  medicine  does  not  operate 


VELLOW  FEVER. 

in  three  hours,  it  is  to  be  repeated.  At  the  end  of  six  hours,  if  the 
purgative  has  not  yet  had  effect,  it  is  to  be  assisted  by  an  enema  ;  and 
either  an  ounce  and  a  half  of  sulphate  of  magnesia  or  soda,  or  half 
a  drachm  of  jalap,  with  an  equal  quantity  of  supertartrate  of  potass, 
is  to  be  given. 

In  eight  hoars  after  the  patient  has  been  blooded,  six  or  eight  fall 
copious  evacuations  should  be  procured. 

During  this  time,  if  the  skin  be  hot  and  dry,  the  cold  affusion  is  to 
be  employed  every  two  hours.  Partial  perspiration,  in  the  early 
stage  of  the  fever,  should  deter  from  its  use.  The  greater  the 
force  with  which  the  water  is  applied,  the  more  benefit  is  to  be  de- 
rived from  it.  When  there  is  much  pain  of  the  head,  the  hair  is  to 
be  shaved  off.  Thus  the  treatment,  during  the  first  twenty-four  or 
thirty-six  hours,  consists  in  one  full,  large  bleeding — purgatives,  so  as 
to  procure  several  copious  alvine  evacuations — the  cold  affusion* — 
shaving  the  head  ;  and  the  liberal  use  of  barley  water,  or  any  other 
weak  drink. 

Under  this  plan,  fifty  patients  out  of  one  hundred,  attacked  by  the 
genuine  endemic  fever,  will  show  evident  signs  of  amendment  within 
the  above-mentioned  period.  A  general  perspiration,  not  profuse, 
will  break  out  ;  the  heat  of  the  skin  will  be  reduced  ;  head-ache  and 
pain  of  the  thighs  and  legs  will  he  abated  ;  the  red  vessels  in  the 
white  of  the  eye  will  disappear  ;  the  thirst  will  be  lessened  ;  and  in 
short,  all  the  feelings  of  the  patient  will  become  more  agreeable. 
From  this  state  they  recover  with  extraordinary  rapidity.  In  one 
week  they  are  restored  to  perfect  health. 

If  this  favourable  change  does  not  take  place  within  the  period 
alluded  to,  there  is  much  danger.  The  patient  becomes  restless  ; 
the  sensation  of  pain  is  more  acute  ;  delirium,  vomiting,  and  other 
bad  symptoms  succeed.  In  this  stage,  the  bowels  are  to  be  kept 
loose — two  or  three  stools  are  to  be  procured  every  twenty-four 
hours,  by  calomel,  given  in  four  grain  doses,  three  or  four  times 
a-day,  as  the  state  of  the  bowels  may  indicate.  The  cold  affusion  is 
to  be  continued,  lessening  the  force  with  which  the  water  is  applied, 
as  the  vascular  action  and  heat  diminish.  The  warm  bath  will  also 
be  advisable  in  certain  cases,  and  removing  the  irritation  of  heat  by 
frequently  sponging  the  palms  of  the  hands,  arms,  and  other  parts 
with  lime  juice,  spirit,  &c.  where  a  cold  affusion  cannot  be  employ- 
ed. If  delirium  and  vomiting  are  present,  blisters  are  to  be  applied 
to  the  head  and  nape  of  the  neck.  Before  the  heat  is  reduced,  and 
the  vascular  action  brought  down  to  its  natural  standard,  stimulants 
are  employed  ;  such  as  wine,  at  first  in  small  quantities,  gradually 
increasing;  it ;  capsicum,  in  the  form  of  pills.  If  the  patient  has  been, 
much  addicted  to  spirits,  toddy  in  lieu  of  wine  is  to  be  allowed  ;  but 
the  stimulant  from  which  I  have  observed  the  greatest  benefit,  is  the 
carbonate  of  ammonia,  in  doses  of  six  or  eight  grains  every  two  hours, 
with  doses  of  nitrous  aether,  diluted  with  water.  When  vomiting  is 
urgent,  the  patients  are  to  be  restrained  from  drinking  much  ;  and 

*  The  vapour  bath,  now  coining  into  use  at  the  naval  hospitals  abroad,  bids  fair 
to  prove  a  powerful  auxiliary  iu  soliciting  the  blood  to  the  surface,  and  thus  re- 
lieving ihe  internal  organs  from  the  effects  of  CONGESTION. 


364  IN&lVEKCE  Ol»  TROPICAL  CLIMATES,  &C. 

wheti  the  stomach  is  empty,  more  benefit  is  derived  from  two  table- 
spoonsful  of  arrow-root  every  half  hour,  than  from  any  medicine  I 
kave  known.  Sulphuric  aether,  and  even  ardent  spirits,  to  restrain 
Vomiting,  as  the  heat  and  vascular  motion  subside,  have  been  taken 
with  partial  relief 

This  state  may  continue  for  two  days,  or  even  longer,  before  there 
is  any  relief.  The  tirst  favourable  symptom  is  usually  a  refreshing 
sleep,  and  the  absence  of  delirium.  A  warm  and  moderate  perspi- 
ration covers  the  surface  ;  and  if  the  skin  and  eyes  have  been  yel- 
low, the  colour  becomes  more  bright. 

Convalescence  from  thi«  stage  of  fever  is  much  more  slow  than 
from  the  first.  Much  attention  to  the  state  of  the  bowels,  and  the 
liberal  use  of  the  decoction  of  bark,  with  vitriolic  acid,  if  there  be 
tnuch  oozing  of  blood  from  the  gums  and  fauces,  are  necessary.  From 
that  stage  in  which  the  black  vomit  is  the  prominent  symptom,  few — 
tery  few  recover.— Dark-coloured  fluids,  however,  have  been  often 
taken  for  black  romit,  where  the  litter  did  not  exist,  and  thus  nurses, 
and  even  medical  men,  have  been  deceived.  All  the  cases  that  re- 
covered at  this  hospital  were  certainly  unexpected.— This  dreadful 
symptom  had  continued  in  all  of  ihem  about  twelve  hours  ;  oozings 
of  blood  from  various  parts,  stools  as  black  as  ink,  &c.  were  present. 
The  first  sign  of  amendment  was  the  stomach  becoming  retentive, 
and  the  enjoyment  of  a  few  hours  sleep.  The  yellow  colour  of  the 
eyes  and  skin  became  daily  brighter,  till  at  last  the  patient  had  the 
ftiost  perfect  jaundiced  look  ;  the  colour  of  the  stools  keeping  pace 
with  that  of  the  eyes  and  skin.  Th°  stimulating  plan  of  treatment, 
after  full  and  copious  evacuations  in  the  earliest  stage  of  the  disease, 
was  gradually  be^un  with  these  patients  long  before  the  vascular  ac- 
tion had  been  reduced  to  its  natural  standard.  Wine  frequently,  and 
in  small  quantities — the  carbonate  of  ammonia — capsicum,  with  ar- 
row-root, Were  assiduously  administered  ;  and  whenever  the  appe- 
tite of  the  patient  craved  for  brisk  porter,  spruce  beer,  &c.  they 
were  never  denied  ;  but  these  and  other  drinks  were  given  in  small 
quantities  at  a  time,  as  larger  caused  instant  vomiting. 

Relapses  from  this  fever  frequently  terminate  fatally. — Want  of 
appetite,  and  sensation  of  fulness  at  the  stomach,  usually  precede 
the  common  train  of  symptoms.  In  these  cases,  I  found  an  emetic 
give  instantaneous  relief.  The  patient  generally  vomits  a  large  quan- 
tity of  aeruginous-colou-  ed  matter,  and  the  evacuation  is  attended  by 
immediate  ease  :  two  or  three  drachms  of  the  tartarised  antimonial 
tvine,  (Edin.  Phar.)  are  generally  sufficient  for  the  purpose.  In  the 
usual  practice  of  the  hospital,  emetics  are  omitted  :  they  delay  the 
exhibition  of  brisk  purgatives,  which  are  required  to  move  the  bow- 
els in  this  fever.  But  there  is  one  form  of  the  endemic  commencing 
with  diarrhoea,  and  sometimes  dysenteric  symptoms,  in  which  eme- 
tics are  employed  with  advantage.  When  the  fever,  however,  com- 
mences in  this  way,  it  is  less  dangerous,  though  more  protracted,  than 
\vhere  costiveness  and  torpidity  of  the  bowels  attend.* 

*  "  Thfe  most  favourable  cases  of  the  yellow  fever,  are  those  in  which  a  bilious 
**  diarrhoea  comes  ou;  while  the  most  fatal  are  those  in  which  the  bowels  are  so 
"  torpid  as  to  be  insensible  to  any  stimulus,  either  from  their  own  contents  or 
*  from  medicine,"— JW<me,  3d  erf.  p,  450. 


VELLOW  FEVEH.  363 

It  has  been  said,  that  persons  who  have  once  had  the  yellow  fever 
are  not  again  liable  to  be  attacked.  This  is  not  the  fact:  I  have 
more  than  once  had  a  man  under  my  care  with  yellow  fever,  who  af- 
terwards died  of  another  attack  of  the  same  disease, 

In  this,  as  in  other  diseases,  anomalous  symptoms  will  occasionally 
occur,  requiring  slight  modifications  of  treatment  ;  but  these  can  be 
only  learnt  at  the  bedside.  On  this  account,  I  forbear  to  enumerate 
laudanum,  aether,  ginger  tea,  effervescing  draughts,  champaigne,  &c. 
which  in  high  practice  are  sometimes  prescribed. 


On  the  Inflammatory  Endemic  of  New  Comers  to  the  West  Indies  from 
temperate  Climates.  By  NODES  DICKINSON,  Esq.  Member  of  the 
Royal  College  of  Surgeons,  4«c.* 

SEC.  VI. — Introduction. — This  disease  is  the  effect  of  sudden 
change  of  climate  upon  new  comers  of  a  sanguine  temperament ; 
and  is  commonly  designated  the  yellow  Fever,  from  the  occurrence 
of  an  incidental  symptom. 

In  a  few  weeks  the  stranger  is  brought  from  a  climate  in  which 
the  atmospheric  temperature,  at  the  time  of  his  departure  is,  per- 
haps, under  30°  to  90°  of  Fahrenheit  in  the  shade  ;  and  130°  when 
exposed  to  the  direct  action  of  the  solar  rays. 

The  inflammatory  endemic  being,  exclusively,  incidental  to  stran- 
gers from  the  temperate  regions,  will  be  found  to  occur  with  a  pre- 
valency  proportioned  to  their  numbers  :  sporadically  when  these  are 
few,  and,  in  appearance,  epidemically  when  many  are  introduced  at 
the  same  time. 

When  it  happens  in  a  mild  degree  it  is  appropriately  called  a  "  sea- 
zoning."  The  reduction  of  the  system  by  the  evacuations  employed 
for  its  removal  is  very  frequently  preventive  of  a  future  seizure. 

The  probability  of  an  attack  of  the  inflammatory  endemic  very 
much  depends  upon  the  degree  of  inflammatory  diathesis.  The  causes 
which  produce  a  severe  affection  in  young  and  plethoric  strangers, 
seldom  affect  the  older  residents.  Natives  of  the  country  and  Africans 
escape  its  seizure.  "^  omen  and  children,  the  aged  and  weakly,  are 
less  liable  than  the  robust  and  strong. 

The  inflammatory  endemic,  which,  in  its  mildest  fornfj,  has  been 
regarded  a  "  sporadic  febricula"  is  under  a  severer  aspect,  when  at- 
tended by  a  yellowness  of  the  skin  and  black  vomiting,  often  erro- 
neously considered  an  infectious  epidemic  of  malignant  character. 

It  is  a  disease  in  which  there  is  from  the  beginning  a  state  of  univer- 
sally increased  excitement,  with  a  direct  tendency  to  general  inflam- 
mation, soon  accompanied  by  the  actual  inflammation  of  certain  or- 
gans. Very  mnch  of  the  mischief  ensues  from  a  want  of  moderat- 

*  The  following  valuable  observations  have  been  kindly  drawn  up  by  my  able 
and  esteemed  friend,  Mr.  Dickinson  of  this  Metropolis,  whose  ample  experience, 
as  a  Staff  Surgeon  in  the  West  Indies,  enabled  him  to  present  to  the  public  an 
important  work  on  the  inflammatory  Endemic  in  question,  of  which  the  present 
paper  may  be  considered  a  very  concentrated  Analysis.  It  will  be  observed  that 
Mr.  D.  confines  himself  to  that  form  of  the  fever  which  attacks  new  comers,  and 
is  produced  by  Insolation. 


INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

ing  the  first  excitement.  If  this  be  subdued  there  is  little  to  appre- 
hend from  consequent  debility.  The  patient  will  recover,  and  with 
the  advantage  of  a  system  prepared  for  the  climate  in  future,  in  so 
far  as  the  inflammatory  endemic  is  concerned. 

Producing  Causes  and  Prevention. — The  causes  of  the  inflammato- 
ry endemic  are  predisponent  and  exciting.  The  predisposition  con- 
sist;? in  an  inflammatory  diathesis — an  aptitude  to  diseases  of  general 
increased  excitement :  this  appears^sufficiently  manifest  by  a  consider- 
ation of  the  subjects  already  stated  as  exclusively  liable  to  its  attacks. 
The  exciting  cause  is  an  exposure  to  solar  radiation  while  unaccus- 
tomed to  its  influence,  and  unprepared  to  resist  the  force  of  its  im- 
pression by  the  adoption  of  preventive  measures.  The  effect  of  heat 
is  liable  to  augmentation  if  accompanied  by  violent  exercise,  by  full 
living,  and  intoxication. 

Whatever  tends  to  diminish  the  predisposition  forms  the  ground- 
work of  prevention  :  it  is  founded  in  reason  and  proved  by  experi- 
ence. The  detail  consists  in  bleeding,  purging,  cold  bathing,  absti- 
nence from  fermented  liquors,  and  a  spare  diet  of  animal  food.  These 
should  be  employed,  agreeable  to  the  state  of  individual  predisposi- 
tion, until  the  inflammatory  diathesis  is  reduced.  If  the  immediate 
exciting  cause  be  diminished  in  its  power,  by  the  new  comer  repairing 
at  his  arrival  in  the  West  Indies  to  an  elevated  situation,  where  the 
temperature  is  low,  compared  with  the  heat  of  the  maritime  towns, 
his  safety  will  be  greatly  inured.  To  avoid,  as  much  as  possible,  ex- 
posure to  thft  direct  and  powerful  radiation  of  the  sun  :  to  use  ex- 
ercise, in  moderation  only,  and  to  observe  an  undeviatingrule  of  tem- 
perance and  sobriety,  are  to  obviate  the  action  of  the  exciting  causes 
and  prevent  the  disease.  Diurnal  vicissitudes  of  temperature  should 
be  carefully  guarded  against  by  the  unseasoned  stranger.  A  danger- 
ous state  of  excitement  is  liable  to  result  from  the  increased  suscep- 
tibility induced  by  the  sudden  application  of  cold  to  the  surface,  when 
this,  although  trifling  in  degree,  is  immediately  succeeded  by  the  sti- 
mulation of  inordinate  heat. 

Symptoms  and  Treatment. — The  history  of  the  inflammatory  en- 
demic and  its  general  character  are  such  as  the  nature  of  its  causes 
must  obviously  suggest.  ^ 

It  occurs  with  different  degrees  of  severity  in  the  ratio  of  the  im- 
pkession  of  its  exciting  causes  and  individual  predisposition.  Two 
cases  are  seldom  precisely  alike  in  this  particular.  It  varies  from  a 
"  seasoning"  or  mild  synocha  to  the  most  formidable  seizure. 

A  slight  attack  has  seldom  been  recognised  to  bear  strict  affinity 
with  the  much  dreaded  "  yellow  fever."  Considered  merely  a 
"  seasoning,"  it  has  rarely  been  regarded  of  the  sarife  kind,  produced 
by  the  same  causes,  and  prevented,  or  removed  by  the  same  general 
means,  which  are  applicable  to  the  more  violent  disease. 

The  inflammatory  endemic  in  its  severe  aspect,  and  when  neglected 
at  the  attack,  consists  of  two  stages.  In  the  first,  there  is  increased 
excitement,  resulting  from  an  unusual  stimulus  applied  in  an  exces- 
sive degree  to  a  system  peculiarly  sensible  to  its  impression  :  it  pro- 
duces a  derangement  in  the  functions  of  some  or  many  viscera.  If 
this  goes  on,  the  second  stage  appears,  in  which  the  structure  of 


YELLOW  FEVER.  367 

these  viscera  is  altered  to  a  degree  incompatible  with  the  living 
state. — Thus  the  disease  proceeds  from  high  excitement  to  irrepara- 
ble exhaustion,  as  we  shall  perceive  by  attending  to  the  history  of  its 
symptoms.  In  the  less  severe  example  there  is  chilliness  at  the  on- 
set, soon  followed  by  a  permanent  and  universal  sense  of  heat — 
flushed  face — inflamed  eyes — head-ache — increased  susceptibility  to 
the  impressions  of  light  and  sound — vertigo — drowsiness — sighing — 
— white  tongue — arid  fauces — thirst — wandering  pains— loss  of  ap- 
petite— costiveness — high-coloured  urine — dry  skin — nausea — full 
and  frequent  pulse  ; — should  these  symptoms  in  a  severe  degree  re- 
main without  control,  the  disease  is  soon  increased  to  its  most  aggra- 
vated form.  The  patient  is  extremely  restless,  with  a  continual  de- 
sire to  alter  his  position,  but  without  relief.  The  heat  and  head-ache 
are  intense — the  carotids  throb  with  unusual  violence.  There  is 
sometimes  a  furious  delirium — tinnitus  aurium  and  even  loss  of  sight. 
There  is,  occasionally,  a  dry  cough  with  pain  in  the  side,  and  almost 
invariably  a  sense  of  heat,  oppression,  and  pain  on  pressure  at  the 
praecordia,  accompanied  by  constant  sighing.  Vomiting  sometimes 
comes  on  very  early  in  the  attack.  There  is  often  great  drowsiness 
but  no  refreshing  sleep.  In  some  cases  an  acute  pain  is  felt  in  the 
right  side  :  and  a  yellow  colour  of  the  skin  often  supervenes.  This 
yellowness  is  occasioned  by  the  presence  of  bile,  which  is  also  de- 
tected in  the  urine  and  serum  discharged  from  blisters.  Should  the 
passage  of  the  bile  into  the  intestines  spontaneously  take  place  or  be 
procured  by  the  action  of  purgatives,  this  jaundiced  appearance,  will, 
generally,  be  prevented  :  nevertheless,  in  some  cases  it  may  possibly 
arise  from  a  redundant  secretion,  even  when  the  bilious  canals  are 
free  :  and  a  bilious  vomiting  and  purging  may  occur  with  the  yellow- 
ness of  the  skin  and  carry  off  the  attack.  These  symptoms  proceed 
with  various  degrees  of  violence,  and  they  occupy  an  uncertain  pe- 
riod. Within  12 — 24 — or  36  hours  ;  or,  perhaps,  after  a  longer, 
but  indefinite  time,  an  important  change  takes  place.  It  marks  the 
commencement  of  the  second  stage.  Many  of  the  most  urgent 
symptoms  decline.  The  pain  and  heat  of  surface  subside.  There 
is  a  sense  of  cold  with  dampness  of  the  skin.  This  change  at  first  so 
much  assumes  the  appearance  of  febrile  remission  as  to  give  great 
hope  to  the  inexperienced  practitioner  ;  but  it  speaks  a  state  of  the 
utmost  danger.  In  some  cases  the  patient  sinks,  at  once,  after  the 
subsidence  of  excitement^  apparently  destroyed  by  the  general  affec- 
tion, without  any  previously  severe  determination  of  blood  to  parti- 
cular organs ;  and  he  dies  at  the  moment  of  hope  in  his  amendment. 
But  more  commonly  the  catastrophe  is  not  so  sudden.  With  the  di- 
minution of  heat  and  pain,  the  pulse  falls — the  countenance  exhibits 
great  distress — the  eye  is  sunk — the  pupil  dilated,  sometimes  delirium 
continues — at  others,  there  is  great  insensibility  with  tendency  to 
coma.  Vomiting,  occasionally,  continues  without  intermission  : — at 
times,  however,  the  stomach  remains  tranquil  :  and  this,  when  there 
is  much  cerebral  disturbance. 

As  the  disease  advances  a  discolouration  of  the  skin  often  takes 
place.  It  appears  in  yellow,  brown,  and  livid  patches.  This  dis- 
colouration never  comes  on  until  the  subsidence  of  the  symptoms  of 


368  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

excitement,  however  early  in  point  of  time.  It  qccurs  with  the  pas- 
sive haemorrhagy  from  various  parts  :  from  the  nose,  corners  of  the 
eyes,  ears,  &c.  ;  and  at  the  same  time  with  the  black  vomiting. 
This  change  of  colour  appears  to  arise  from  e  :chymosis  proceeding 
from  exhaustion  of  the  vis  vita?  in  the  capillary  vessels  of  the  sur- 
face in  consequence  of  previous  inordinate  excitement.  It  is  very 
dissimilar  from  the  bilious  yellowness  already  noticed  as  an  inciden- 
tal symptom  of  the  first  stage  of  the  disease. 

The  first  discharges  from  the  stomach  are  merely  the  ingesta  ;  af- 
terwards a  large  quantity  of  serous  fluid  is  ejected  when  little  has 
been  drunk.  In  a  more  advanced  stage  of  the  complaint  the  mate- 
rial thrown  up  is  ropy  and  mixed  with  numerous  small  shreds,  floc- 
culi,  or  membranaceous  films  which  float  in  the  ejected  liquid. 
These  soon  acquire  a  dark  brown,  purple,  or  black  colour,  but  do 
not,  at  first,  communicate  much  general  tint  to  the  fluid  in  which 
they  are  suspended.  Afterwards,  the  matters  vomited  are  more  in- 
timately mixed  together  ;  and  with  the  addition  of  dark  coloured 
blood  which  is  effused  into  the  stomach,  vitiated  bile,  and  other  mor- 
bid secretions,  give  an  appearance  in  the  aggregate  of  coffee-grounds. 
There  is  at  thi*  period,  usually,  a  purging  of  dark-coloured  matter 
resembling  tar  mixed  with  black  blood. 

Sometimes  within  the  first  forty  hours,  at  others  after  a  more  pro- 
tracted period,  the  scene  draws  toward  a  close  with  the  ordinary 
phenomena  of  approaching  dissolution,  which  accompany  the  last 
stages  of  acute  disease  in  general.  There  are  dilated  pupil — stra- 
bismus— singultus  —  subsultus  tendinum — coma  -  deliquium — haemor- 
rhage from  various  channels — suppression  of  urine— low  muttering 
delirium-  total  insensibility — occasionally  violent  raving,  and  an  in- 
cessant disposition  to  rise  in  bed.  These  are  among  the  last  symp- 
toms of  an  unsubdued  attack,  and  they  mark  the  near  approach  of 
death. 

An  examination  post  mortem  exhibits  unequivocal  vestiges  of  pre- 
vious inflammation.  In  the  brain,  increased  vascularity  and  a  deep 
redness  of  the  membranes — rupture  of  the  vessels — adhesion  of  the 
hemispheres  and  membranes — caagulable  lymph — extravasated  blood 
—  serous  effusion.  In  the  stomach,  a  lymphatic  film  adheres  to  the 
surface  of  the  villous  coat  in  different  parts  ;  but  is  easily  detached. 
During  the  last  remains  of  life  it  is  ejected  with  the  fluid  contents  of 
this  organ.  Numerous  dark-coloured  spots  are  interspersed  upon 
the  villous  coat  which  present  the  mouths  of  vessels  from  whence 
there  oozes  black  blood.  The  same  appearances  are  seen  through- 
out the  track  of  the  intestines — the  liver  is  occasionally  much  dis- 
eased :  it  is  livid  and  overspread  with  dark-coloured  patches — fre- 
quently of  a  deep  purple  colour  throughout  its  structure — greatly 
enlarged,  and  filled  with  blood. 

These  are  the  usual  symptoms  of  the  inflammatory  endemic,  and 
of  its  destructive  inroads,  upon  the  healthy  fabric  of  the  body,  sup- 
posing it  to  pursue  an  uninterrupted  course  in  an  example  of  great 
severity.  These  symptoms  are,  nevertheless,  very  irregular  both 
in  their  general  appearance,  their  degrees  of  violence,  their  precise 
order  of  succession  and  duration.  Thus  we  find  that  after  a  period  of 


TETANUS.  o£'J 

violent  and  uncontrolled  excitement,  exhaustion  succeeds.  The  in- 
creased action  of  the  heart  and  augmented  heat  of  the  surface  sub- 
side, healthy  secretion  is  not  performed — the  blood  passes  into  the 
capillaries,  without  undergoing  the  necessary  change  in  the  secret- 
ing organs,  giving  rise  to  congestions  and  effusion,  and  passive  hae- 
morrhage from  every  outlet. 

The  consideration  of  these  stages  of  increased  excitement  and  ex- 
haustion determines  the  rationale  of  the  treatment  ;  as  an  attention  to 
the  nature  of  the  producing  causes  afforded  the  ground  of  preven- 
tion. The  curative  indication  is  established  upon  the  inflammatory 
character  of  the  disease  at  the  attack  ;  and,  therefore,  comprehends 
the  means  of  subduing  general  excitement,  and  of  preventing  thereby 
the  determination  of  blood  upon  particular  organs.  The  treatment 
is  simple  at  the  commencement  of  the  disease,  and  is  fully  anaounced 
by  the  symptoms  of  that  stage.  In  the  first  place,  every  cause  of  ir- 
ritation should  be  removed.  These  will  be  obvious  to  the  practi- 
tioner as  they  may  present  themselves  on  particular  occasions- 
Their  removal  is  to  be  effected  by  the  "  antiphlogistic  regimen," 
which  should  be  strictly  enjoined. 

If,  at  the  moment  of  attack,  the  stomach  is  loaded  with  fo  od,  or 
over  stimulated  by  strong  drink,  an  emetic  should  obviate  the  im- 
pression of  this  exciting  cause.  After  which,  we  must  resort  to 
general  bleeding — the  warm  bath — cold  lotions  to  the  head — cool 
air — cold  drink — active  purging — blisters — cold  ablution  when  the 
heat  returns — injections  of  cold  sea-water.  These  measures  must  be 
used  to  reduce  excitement  and  prevent  the  debility  liable  to  result 
from  over-exertion  generally,  and  from  over-distention  of  particular 
vessels,  causing  congestion  ;  while,  in  the  occurrence  of  determina- 
tion of  blood  to  the  head,  stomach,  lungs,  or  to  the  hepatic  region, 
topical  bleeding  and  blisters  must  be  employed  to  remove  congestions 
already  formed  and  allow  the  weakened  vessels  to  recover  their  tone. 
If,  however,  the  exhaustion  of  the  second  stage  has  supervened,  the 
practitioner  can  administer  but  feeble  aid.  Quietude,  a  cool  atmos- 
phere, gentle  laxatives,  nourishment,  and  sleep,  present  the  only 
means  of  restoration. 

In  this  disease  the  restorative  powers  of  nature  must  not  be  waited 
for.  It  does  not  possess  any  salutary  reaction — any  adequate  means 
of  curing  itself.  The  chance  of  recovery  is  always  diminished  in  a 
ratio  proportioned  to  the  length  of  time  which  is  suffered  to  elapse 
without  the  employment  of  decided  antiphlogistic  measures. 


TETANUS. 

SEC.  VII. — This  opprobrium  medicorum,  though  an  occasional  so- 
journerin  all  climates,  has  its  principal  seat  and  throne  between  the 
tropics.  The  disease,  however,  is  equally  fatal,  though  not  near  so 
frequent  in  a  cold,  as  in  a  warm  cWtnate.  According  to  my  own  ex- 
perience, and  that  of  most  of  mv  naval  and  military  friends,  the 

47 


INFLUENCE  OF  TKOF1CAL  CMMATES,  &C. 

traumatic  is  greatly  more  dangerous  than  the  idiopatbic  species , 
though  this  sentiment  does  not  accord  with  that  of  Dr.  Morrison,  the 
latest  writer  on  the  subject. 

The  Symptomatology  of  Tetanus  is  by  no  means  necessary  in  this 
place,  since  it  is  impossible  for  the  variest  tyro  to  mistake  the  disease. 
Some  pathological  aud  therapeutical  observations  only  will  here  be 
introduced. 

Pathology. — Dr.  Morrison,  in  his  recent  treatise  on  Tetanus,  as- 
serts that  dissection  has  thrown  little  if  any  light  on  the  seat  or  na- 
ture of  the  disease.  But  some  late  papers  arid  investigations  would 
seem  to  diffuse  a  ray  of  light  on  the  obscurity  of  this  pathological 
track,  and  induce  us  to  believe  th  it  we  have  too  long  neglected  the 
morbid  anatomy  of  the  spinal  cord,  and  of  the  medulla  oblongata,  in 
diseases  attended  with  violent  spasmodic  affections.  Dr.  Sanders,  of 
Edinburgh,  has  long  laboured  in  the  developement  of  this  dark  sub- 
ject, and  not  without  some  success.  The  harmonious  balance,  not 
only  of  the  circulation  in  itself,  but  in  its  relation  with  the  nervous 
system,  has  too  long  been  overlooked  ;  but  new  light  is  now  break- 
ing in  upon  our  minds  from  the  tomb.  The  inequilibrium  in  the  ba- 
lance of  the  excitement,  which  exists  in  almost  all  diseases,  is  here 
evinced,  in  characters  that  can  hardly  fail  to  be  understood.  While 
the  class  of  voluntary  muscles  is  in  complete  spasm,  various  organs 
— more  especially  the  chylo  poetic  viscera,  are  utterly  torpid. — • 
This  inequilibrium  in  the  balance  of  the  excitement  shows  itself, 
even  before  the  developement  of  spasm,  in  the  torpor  and  costive- 
ness  of  the  alimentary  canal  precursory  of,  and  contemporaneous 
with  Tetanus,  as  was  sagaciously  remarked  by  that  accurate  observer 
of  nature,  Dr.  Dickson,  in  the  7th  volume  of  the  Medico-Chirurgical 
Transactions. 

We  must  therefore  look  to  the  origins  of  those  nerves  which  sup- 
ply spasmed  muscles,  for  the  immediate  seat  of  the  mischief;  and 
there  it  will  be  found,  without  a  doubt.  Dissections  of  the  base  of 
the  brain,  medulla  oblongata,  and  medulla  spinalis,  have  not,  till  late- 
ly, been  prosecuted  with  any  thing  like  accuracy. 

Dr.  Reid  has  now  forcibly  drawn  the  attention  of  the  medical  world 
to  this  subject,  and  it  will,  no  doubt,  be  well  investigated.  It  has 
1  >ng  been  remarked,  indeed,  that  in  Tetanus  the  natural  functions  are 
little  affected,  and  the  same  may  be  said  of  the  intellectual  functions, 
and  those  muscles  and  organs  supplied  by  the  nerves  of  sense.  These 
considerations  naturally  lead  to  the  conclusion  that  the  thoracic  and 
abdominal  viscera  are  not  primarily  affected,  and  that  the  origin  of 
the  disease  is  not  in  the  nervoas  substance  supplying  those  organs — 
in  short,  that  the  cerebral  and  ganghonic  systems  are  only  drawn  in 
subsequen  ly,  and  that  the  spiaal  cord  is  the  original  and  principal  seat 
of  Tetanus 

Case  in  elucidation,  [from  Dr.  Reid.]  -  A  boy  14  years  of  age,  af- 
ter receiving  a  severe  bruise  in  the  toes  of  the  right  foot,  was  ex- 
posed to  the  vicissitudes  of  the  weather  in  the  month  of  February: 
He  was  seized  four  or  iive  days  afterwards,  with  tetanus,  and  died  in 
thirty-six  hours.  Dissection.' — Viscera  of  the  abdomen  and  thorax 
perfectly  sound,  as  were  all  the  muscular  parts.  On  opening  the 


TETANUS.  '371 

spine,  from  the  back  part,  and  on  raising  the  nervous  mass,  (with  its 
dura  mater  entire,)  from  the  spine,  "  there  appeared  a  considerable 
effusion  of  blood  in  the  cellular  tissue,  connecting  it  to  the  upper 
lumbar,  and  lower  do!Sil  vertebras.  A  similar  effusion  occurred  also 
along  the  bodies  of  the  upper  dorsal  and  two  lower  cervical  verte- 
brae. On  slitting  up  the  dura  mater  on  the  anterior  surface,  the 
nervous  mass  appeared  highly  vascular,  and  the  vessels  of  every 
description  remarkably  tortuous.  The  only  appearance  in  the  ner- 
vous substance  itself,  was  a  deeper  tinge  than  natural  in  its  cortical 
and  medullary  parts." 

From  these  appearances,  corresponding  with  the  investigations  of 
Dr.  Sanders,  it  follows  that  tetanus  is  radically  an  inflammatory  dis- 
ease. But  general  blood-letting  here  will  not  be  near  so  efficacious 
as  local  abstractions  of  blood  from  the  spine — blisters  — purgatives— 
and  finally,  mercury  and  opium  to  equalize  the  balance  of  the  cir- 
culation and  excitement.  The  following  observations  from  Dr.  Mor- 
rison, the  latest  writer  on  tropical  tetanus,  may  be  appropriately  in- 
troduced here. 

Dr.  Morrison  was  led  to  compose  his  present  Treatise  on  Tetanus, 
from  having  had  considerable  experience  in  that  disease,  during  an 
eight  years  practice  in  the  Colony  of  Demerara,  where  it  is  of  fre- 
quent occurrence.  The  land  of  this  part  of  the  South  American 
Continent  is  low,  flat,  and  marshy,  abounding  with  swamps,  and, 
with  the  exception  of  a  strip  along  the  banks  of  the  Demerari,  is  co- 
vered with  trees  of  vari  ms  dimensions,  whose  roots,  for  a  great  part 
of  the  year,  lie  bedded  in  water  The  prevalent  diseases  are  inter- 
mittents,  fevers,  hepatitis,  enteritis,  rheumatism,  dysentery,  and, 
among  children,  hydrocephalus. 

Dr.  M.  does  not  look  upon  Tetanus,  even  the  traumatic  form,  as 
so  very  dangerous  a  disease,  in  tropical  climates,  as  authors  have  re- 
presented it.  He  has  witnessed  many  instances  of  recovery  both 
from  traumatic  and  idiopathic  tetanus,  and,  strange  as  it  may  appear, 
the  instances  of  cure  in  the  former  have  been  nearly  as  numerous  as 
in  the  latter.  In  upwards  of  twenty  cases  of  this  disease  which  he 
witnessed  among  negroes,  the  pulse  was,  in  no  instance,  accelerated 
in  the  manner  related  by  Dr.  Parry.  He  has  never  known  it  above 
98,  whether  the  termination  was  favourable  or  fatal. — The  following 
prognostic  passage  we  shall  transcribe. 

"  When  the  disease  comes  on  gradually  ;  when  for  the  first  three 
or  four  days  the  mu  cles  of  the  jaws  are  solely  affected,  and  that  per- 
haps not  in  any  alarming  degree  ;  when  the  abdomen  is  not  ii-eter- 
naturally  hard,  or  the  bowels  obstinately  costive  ;  when  the  skin 
is  moist  and  moderately  warm,  and  above  all,  when  the  patient  en- 
joys sleep,  we  may,  (by  the  means  hereafter  to  be  spoken  of,)  en- 
tertain strong  hopes  of  an  eventual  recovery.  An  increased  flow  of 
saliva  where  mercury  has,  or  has  not  been  used,  is  always  to  be  re- 
garded as  favourable  ;  the  less  the  general  air  of  the  countenance  is 
changed,  the  better.  On  the  other  hand,  when  the  attack  is  violent 
and  sudden  :  when  the  muscles  of  the  neck,  back,  and  abdomen  are 
rigidly  contracted  ;  when  the  patient  complains  of  a  shooting  pain 
from  the  sternum  towards  the  spine  ;  when  the  belly  feels  hard  like 


"372  JNFJLUEHteE  OF  TROFJCAfc  LLIMATE3,  &C. 

a  board,  and  the  least  pressure  thereon  produces  spasmodic  twitch- 
ing or  contractions  of  the  muscles  of  the  neck,  jaws,  &c.  ;  or  when 
the  same  effect  is  brought  about  by  the  presentation  of  any  sub- 
stance, (solid  or  fluid,)  near  the  mouth,  we  have  much  reason  to  fear 
a  fatal  termination.  Spasmodic  starlings  of  the  muscles  set  in  some- 
times early  in  the  disease,  and  recurring  every  eight  or  ten  minutes 
are  to  be  regarded  as  very  unfavourable,"  p.  29. 

The  only  disease  which  tetanus  can  he  confounded  with,  is  rabies 
contagiosa.  In  the  latter,  however,  there  is  generally  fever  ;  fre- 
quently increased  heat  of  the  body.  In  rabies  contagiosa,  vomiting 
is  common  at  the  commencement  ;  not  so  in  tetanus.  The  delirium 
too,  of  hydrophobia  is  absent  in  tetanus.  The  shooting  pain  from  the 
sternum  to  the  spine  is  seldom  wanting  in  tetanus,  or  present  in  the 
other. 

Treatment  of  Tetanus. — Dr.  M.  believes,  that  spontaneous  cures  do 
occasionally  take  place  in  tropical  climates.  One  decided  instance 
of  traumatic  tetanus  giving  way  to  the  efforts  of  nature  fell  under  his 
own  observation.  The  treatment  of  idiopathic  and  symptomatic  te- 
tanus is  considered  the  same.  For  although  it  is  common  and  pro- 
per in  the  West  Indies  to  apply  some  stimulating  substances,  as  ol. 
terebinth,  or  the  like,  to  recent  wounds,  together  with  emollient  ca- 
taplasms, so  as  to  induce  free  suppuration,  yet  when  constitutional 
tetanic  symptoms  have  once  commenced,  there  is  little  or  no  depend- 
ence on  local  treatment.  By  way  of  prevention,  Dr.  Clarke  advises 
a  slight  mercurial  ptyalism  to  be  brought  on  after  wounds  in  hot  cli- 
mates, or  under  suspicious  circumstances.  For  the  same  purpose, 
the  complete  division  of  half  divided  nerves,  tendons,  &c.  might  be 
proper.  The  Spanish  physicians  bathe  the  wound,  for  an  hour  or 
more,  in  warm  oil,  while  some  subsequently  apply  lunar  caustic,  su- 
peracetate  of  lead,  &c.  The  principal  general  remedies  that  have 
fceen  recommended  are,  the  cold  affusion,  mercurj7,  opiates,  wine 
and  bark,  the  warm  bath,  cathartics,  blisters,  antispasmodics.  We 
shall  not  stop  to  notice  the  history  of  each  of  these  remedies,  but 
give  the  substance  of  Dr.  M.'s  own  remarks  and  experience.  During 
the  doctor's  first  three  years  residence  in  Demerara,  and  in  the  first 
eight  or  ten  cases,  the  cold  affusion  was  invariably  used,  but  with  so 
little  success  that  it  was  ultimately  left  entirely  off,  and  the  warm 
bath  substituted. 

Mercury. — Spontaneous  salivation  has  often  been  observed  in  teta- 
nic patients  whose  cases  terminated  favourably,  hence  probably  the 
first  idea  of  using  mercury.  In  hot  countries  tetanus  is  seldom  go 
rapid  as  to  prevent  the  introduction  of  mercury  in  quantity  sufficient 
to  salivate,  before  the  disease  runs  its  course,  whether  favourably  or 
fatally  ;  and,  as  in  all  climates  mercury  interferes  not  with  other  re- 
medies, Dr.  M.  thinks  its  administration  ought  never  to  be  omitted. 

*'  I  undoubtedly  have  had  many  examples  of  the  good  effects  from 
mercury  in  the  cure  of  this  disease.  Four  grains  of  calomel  given 
two  or  three  times  a-day,  with  three  or  four  drachms  of  the  ointment 
well  rubbed  on  the  neck  and  spine  night  and  morning,  I  believe  to 
be  excellent  practice.  A  much  larger  quantity  of  the  ointment  may 
l&e  used  on  different  parts  of  the  body  :  indeed,  the  more  continued 


TETANUS.  37S 

the  friction,  the  better.  The  constitution  labouring  under  this  dis- 
ease, will  mostly  appear  as  proof  agaioit  the  usual  effects  of  this  me- 
dicine ;  but  when  salivation  can  be  brought  about,  it  will,  in  a  great 
majority  of  cases  be  found  to  be  attended  with  the  happiest  conse- 
quences. Allowing  the  spontaneous  salivation,  which  sometimes  oc- 
curs, to  be  more  the  effect  than  the  cause  of  the  cure,  still  we  should 
be  inclined  to  throw  in  large  quantities  of  mercury,  merely  with  a 
view  of  bringing  on  any  different  action  in  the  system.*' 

The  submuriate  of  mercury  with  scammony  or  jalap  as  a  purge  is 
also  recommended  by  our  author. 

Opium. — This  appears  the  sheet-anchor  of  our  author  in  this  dis- 
ease.    He  has  met  with  more  than  a  dozen  cases  where  the  cure  of 
tetanus  could  be  fairly  attributed  to  this  medicine ;  and  he  has  met 
with  no  instance  of  recovery  in  which  he  did  not  conceive  that  it 
bore  a  principal  part.     It  must  be  given,  however,   in  very  large 
doses,  the  system  under  tetanus  being  little  affected  by  doses  of  opi- 
um that  in  other  circumstances  would  produce  striking  effects. 

"  A  practitioner,"  says  Dr.  M.  "  for  whose  acuteness  and  discern- 
ment I  have  great  respect,  gave  to  an  old  man,  in  my  presence,  who 
was  in  an  incipient  stage  of  this  disease,  about  half  an  ounce  of  tinc- 
ture of  opium  in  four  ounces  of  rum,  as  ajirst  dose,  directing,  at  the 
same  time,  the  spirit  to  be  frequently  repeated,  and  the  man  got  per- 
fectly over  the  complaint  in  a  few  days,"  57. 

Dr.  M.  directs  that  an  adult  should  commence  with  one  hundred 
drops  of  the  tincture,  (bowels  being  opened,)  increasing  each  suc- 
ceeding dose  one-third  every  two  hours,  unless  sleep  or  stertor  in  the 
breathing  ensue  ;  ordering  at  the  same  time,  wine  or  ardent  spirits, 
in  as  large  quantities  as  the  patient  can  be  induced  to  swallow.  A 
pint  of  spirits,  or  double  that  quantity  of  wine  in  the  twenty-four 
hours  will  not  be  too  much.  Tincture  of  opium  is  also  to  be  rubbed 
on  the  spine. 

The  Warm  Bath  is  regarded  by  our  author  in  a  favourable  point  of 
view.  It  has  afforded  much  present  relief  on  several  occasions 
under  his  own  eye,  where  the  spasmodic  twitchings  were  frequent 
and  troublesome.  He  depends  very  little  on  it,  however,  and  justly 
observes,  that  the  exertion  or  movement  which  the  patients  must  un- 
dergo, in  order  to  get  into  the  bath,  will  often  more  than  counterba- 
lance any  good  effects  that  can  be  expected  from  it.  Patients  are  so 
alive  to  all  external  impressions,  that  the  least  exertion  is  often  suffi- 
cient to  excite  violent  spasms.  On  this  account  the  patient  should  be 
kept  as  quiet  as  possible,  and  very  few  questions  asked  him.  The 
chamber  should  be  kept  darkened,  and  every  thing  tending  to  excite 
mental  exertion  avoided. 

Blisters,  though  recommended  in  high  terms  by  a  few  medical  prac- 
titioners, can  only  be  looked  upon  in  the  light  of  adjuvants.  The 
course  of  the  spine  appears  the  best  site  of  their  application. 

Bark  and  Wine. — Dr.  M.  recommends,  that  during  the  exhibition 
of  opium,  large  quantities  of  wine  or  diluted  alkohol  be  administer- 
ed, in  order  to  second  its  effects. 

Recapitulation. — "  The  bowels  should  be  kept  as  free  as  possible, 
We  must  endeavour  to  bring  about  an  operation  every  twelve  hours, 


374  INFLUENCE  OF  TROPICAL  CLIMATES,  tc. 

This,  even  by  the  aid  of  strong  cathartics,  or  purgative  injections, 
will  be  found  very  difficult  to  be  obtained  ;  the  sphincter  ani  some- 
times scarcely  admitting  the  introduction  of  a  clyster-pipe,  and  the 
exhibition  of  the  strongest  purgatives  may  often  be  attended  with 
little  or  no  effect.  Sulphate  of  soda,  jalap  and  calomel,  scammony, 
pil.  aloes  cum  colocynthide,  &c.  are  as  proper  for  this  purpose  as 
any  other,  aided  by  stimulating  clysters,  such  as  solution  of  muriate 
or  sulphate  of  soda,  with  olive  oil  ;  the  resin  of  turpentine,  suspend- 
ed by  the  yolk  of  an  egg ;  solutions  of  soap,  &c.  1  have  found  it,  on 
two  or  three  occasions,  impossible  to  open  the  bowels  freely,  till  af- 
ter large  quantities  of  opium  had  been  taken,  which  seemed  to  bring 
about  a  general  relaxation  ;  or  until  the  system  had  been  evidently 
under  the  influence  of  mercury  ;  and,  indeed,  these  are  the  two  me- 
dicines on  which  we  are  to  place  the  greatest  confidence,  in  the  treat- 
ment of  this  disease  :  they  must  be  given,  however,  as  before  re- 
marked, in  large  doses,  and  frequently  repeated.  I  once  gave  a  pa- 
tient, who  is,  1  believe,  still  living,  ten  grains  of  opium  and  twenty 
of  calomel,  in  pills,  and  five  ounces  of  tincture  of  opium,  in  wine, 
all  in  the  space  of  twelve  hours. 

"  Next  to  opium,  I  certainly  look  on  the  preparations  of  quicksil- 
ver as  the  most  valuable.  Large  quantities  of  the  ointment  may  be 
rubbed  in  on  the  spine,  neck,  legs,  &c.  with  repeated  doses  of  sub- 
muriate  internally.  Wine  and  ardent  spirits  should  be  given  freely  ; 
indeed,  the  constitution  here  appears  as  insensible  to  their  usual  ef- 
fect?, as  to  those  of  opium  :  and  quantities,  which  in  a  state  of  health, 
would  produce  stupid  intoxication,  now  neither  exhilarate  the  spirits, 
nor  disturb  that  serenity  of  mind  so  conspicuous  throughout  the  dis- 
ease. 

"  The  warm  bath  will  often  be  found  a  useful  auxiliary  ;  when  we 
expect  to  derive  advantages  from  it,  the  vessel  used  should  be  so 
capacious,  as  to  allow  the  patient  to  be  as  little  confined  as  possible, 
and  the  water  should  be  sufficient  to  cover  the  shoulders  completely. 
I  have  found  a  common  rum  puncheon  sawed  across  at  the  centre, 
very  convenient  for  the  purpose. 

"  I  have  generally  used  blistering  plasters,  but  confess  I  have  ne- 
ver experienced  much  benefit  from  their  application 

<c  When  the  disease  is  conquered,  the  patient  should  take  wine  and 
bark  for  many  weeks,"  p.  70. 

On  the  above  passage  1  would  remark  that  the  local  abstractions  of 
blood  by  leeches  and  cupping  from  the  neighbourhood  of  the  spine, 
with  subsequent  blisters  there,  are  not  inconsistent  with  the  plan  of 
treatment  recommended  by  Dr.  Morrison.  For  it  inust  be  remem- 
bered that  such  is  the  unequal  distribution  of  the  blood  and  excitabi- 
lity in  the  system,  under  this  disease,  that  one  part  is  completely  tor- 
pid while  another  is  on  the  point  of  extravasation  from  turgescence 
or  inflammation.  It  is  evident  from  this  view  c»f  the  affair,  that  we 
must  stimulate  the  torpid  organs  at  the  very  moment  we  are  employ- 
ing sedatives,  and  counter-irritants,  or  abstracting  blood  from  the  con- 
gested parts. — Hence  too  the  great  value  of  purgatives  and  mercu- 
ry. The  former  bring  back  the  excitement  to  the  abdominal  visce- 
ra, aod  powerfully  determinate  from  the  spine  ;  the  latter  sets  all  the 


DYSKNTERY  OF  NEW  ORLEANS.  375 

Decretory  and  excretory  apparatus  to  work,  while  it  equalizes  the 
circulation  in  every  part  of  the  system. 

ii- 

Observations  on  the  Dysentery  of  Ne-&  Orttans.     By  ARCHIBALD  RO- 
BERTSON, M.  D.  Resident  Physician  at  Northampton.* 

SEC.  VIII. — About  the  middle  of  November,  1814,  the  expedition- 
ary force  destined  to  act  against  New  Orleans  arrived  at  Jamaica,  under 
the  command  of  Vice-Admiral  the  Hon.  Sir  Alexander  Cochrane  ;  and 
the  whole  fleet  of  ships~of  war  and  transports,  having  rendezvoused 
there,  took  their  departure  from  Negril  Bay,  at  the  west  end  of  that 
island,  about  the  end  of  November,  full  of  health  and  hope. 

Before  the  middle  of  December,  the  fleet  arrived  on  the  coast  of 
Louisiana,  and  took  steps  for  disembarking  the  troops  without  delay 
— a  measure  against  which  nature  seemed  to  have  opposed  ample  and 
almost  insurmountable  obstacles.  Moreover,  the  passage  of  those 
lakes  which  formed  the  only  practicable  approach,  was  obstructed 
by  five  large  American  smacks  or  gun  vessels,  mounting  several  hea- 
vy guns  each,  and  admirably  adapted,  from  their  build,  for  operating 
in  those  shallow  waters. 

The  latter  vexatious  impediment,  however,  was  soon  conquered  by 
our  sailors,  who  showed,  on  this  occasion,  all  that**  aes  triplex,"  — 
that  hardy,  careless,  characteristic  valour  for  which  they  are  so  illus- 
trious. The  boats  of  the  fleet,  manned  and  armed,  were  sent  away, 
and,  after  a  tiresome  row  of  thirty -six  hours,  succeeded  in  penning 
the  enemy  up  in  a  creek,  where  they  attacked  them  against  the  su- 
perior odds  of  their  position  and  their  force,  and  after  a  furious  en- 
gagement, captured  every  one  of  them.  This  achievement  was  de- 
cidedly  gallant,  and  would  have  stood  amidst  the  most  brilliant  feats 
of  naval  warfare,  had  not  the  subsequent  failure  of  the  main  object 
of  the  expedition  thrown  a  bleak  shade  over  its  lustre. 

About  the  beginning  of  January,  (1815,)  bowel  complaints,  which 
had  previously  appeared  amongst  the  b- ats*  crews  and  the  fatigue 
parties  of  the  army,  began  to  be  very  rife.  —  They  varied  in  degree 
of  severity,  from  the  milder  symptoms  of  dysentery  to  its  most  ag- 
gravated forms.  I  may  enumerate  in  a  few  words  the  symptoms  of 
the  disease.  The  patients,  for  the  most  part,  complained  of  severe 
tormina,  tenesmus,  scanty  blood  dejections,  want  of  appetite  and 
strength,  general  pains  and  soreness,  and  strong  disposition  to  vomit 
on  taking  either  food  or  drink.  The  tongue  was  white  or  yellow  ; 
the  eye  languid  ;  the  pulse  above  100,  small  and  easily  compressed  ; 
the  skin  often  dry,  or  covered  with  clammy  sweat,  but  always  consi- 
derably increased  in  temperature. 

The  causes  were,  generally  speaking,  obvious  enough.  — The  men 
had  been  rowing  all  day,  and  sleeping  all  night  in  the  open  boats. 
They  had  incautiously  drank  the  brackish  water  of  the  lakes,  and 

*  1  have  been  obliged >  for  want  of  space,  to  greatly  curtail  Dr.  Robertson*' s  va- 
luable paper,  by  omitting  the  part  of  it  which  treats  on  fever — a  subject  which 
has  occupied  a  great  portion  of  this  work, — J.  JOHNSON. 


370  INFLUENCE  OF  TROF1CAL  CLIMATES,  &C< 

had  sometimes  been  obliged  to  eat  their  beef  or  pork  raw,  when,  on 
an  emergency,  they  were  deprived  of  an  opportunity  of  cooking  it. 
They  were  often  drenched  with  rain,  or  dripping  with  spray,  with- 
out being  able  to  put  on  dry  clothes.  Added  to  all  this  the  weather 
was  extremely  cold,  particularly  in  the  night,  the  thermometer  be- 
fore sun-rise  being  often  as  low  as  25  or  26  degrees,  rising  no  higher 
during  the  day  than  30  or  38  degrees,  and  seldom  above  50.* 

The  locality  of  the  general  rendezvous  for  the  boats  was  very  bad, 
(though  the  best  that  could  be  found,)  being  a  miry  place,  covered 
with  reeds,  and  abounding  in  miasrnal  exhalations. 

The  encampment  of  the  army,  too,  was  on  a  swampy  spot  on  the 
left  bank  of  the  Mississippi,  about  six  miles  from  New  Orleans.  In- 
deed, the  whole  vicinity  is  a  swamp,  which,  after  the  raias  so  fre- 
quent at  that  season  of  the  year,  became  a  perfect  puddle.  Having 
the  Mississippi  on  their  left,  they  drank  its  discoloured  and  polluted 
water,  and  were  exposed  to  the  effluvium  of  its  slimy  mud,  as  well  as 
to  the  paludal  exhalations  of  an  impracticable  wooded  morass  on 
their  right.  The  huts,  also,  in  which  the  troops  were  sheltered, 
were  far  from  being  impervious  either  to  rain  or  cold  :  so  that,  upon 
the  whole,  the  army  and  navy,  in  point  of  privations,  were  much  upon 
a  par.  > 

On  the  first  appearance  of  Dysentery,  its  treatment  was  commenc- 
ed by  a  flannel  reller  bound  tight  round  the  abdomen,  and  ordering 
flannel  clothing  next  the  skin,  if  the  patients  had  it  not  already. 
Saline  cathartics,  and  particularly  oleum  ricini,  with  now  and  then 
a  few  grains  of  calomel  were  repeatedly  given,  until  the  stools  were 
increased  in  quantity  and  more  freely  rendered.  At  the  same  time, 
plentiful  dilution  with  tepid  gruel,  warm  tea,  rice,  or  barley-water, 
(with  a  tinge  of  port-wine  andli  little  sugar,  so  as  to  remove  its  nau- 
seous insipidity,  and  allure  the  patient  to  drink  it  in  such  quantities  as 
would  prove  useful,)  as  also  decoctions  of  linseed  or  of  gum  arabic? 
I  always  considered  of  primary  importance  as  well  in  promoting  the 
cure,  as  in  alleviating  symptoms.  Demulcent  drinks  I  hold  to  be  of 
much  moment  in  this  complaint,  as  they,  no  doubt,  in  some  measure, 
defend  the  irritable  or  semi-inflamed  coats  of  the  bowels  from  the 
stimulus  of  the  ingesta,  besides  sheathing  the  acrimonious  secretions 
which,  during  this  disease,  are  unquestionably  poured  out  from  the 
intestinal  glands,  and  supplying  the  want  of  excretion  from  the  mu- 

*  The  Physiologist  might  hare  contemplated  with  interest,  on  this  occasion, 
the  marked  difference  in  the  eft'ect  of  cold  on  the  European  and  the  African  con- 
stitutions. While  the  former  were,  comparatively,  only  incommoded,  the  latter 
were  severely  injured  by  it.  Many  soldiers  of  the  Negro  regiments  had  their 
feet  frost-bitten,  and  lost  their  toes  by  the  consequent  gangrene  and  sphacelus. 
Some  of  them  even -died  in  the  camp  or  in  the  boats,  from  excessive  cold.  Of 
our  own  people,  many  of  the  boat's  crews,  and  even  of  the  officers,  on  their  re- 
turn from  boat  service,  were  incapacitated  for  six  or  ten  days,  by  pain,  numbness, 
shooting,  and  tingli  ug  of  the  lower  extremities.  They  expressed  their  distress 
to  be  as  great  as  if  their  feet  and  legs,  from  the  knees  downwards,  had  been  one 
immense  chilblain !  Various  remedies  were  tried  for  this  teasing  affection  ;  but 
nothing  I  could  devise  gave  any  relief.  Temporary  ease  was  derived  from  fre- 
quently bathing  the  feet  in  cold  salt  water.  This  peculiar  affection  I  no  where 
find  mentioned  6y  writers  on  the  effects  of  cold. 


•DYSENTERY  OP  NEW  ORLEANS.  377 

-ous  follicles. — I  have  had  occasion  to  see  even  olive  oil  given  with 
this  view,  in  doses  of  an  ounce  or  two,  and  the  relief  that  always  fol- 
lowed it,  even  though  it  had  no  laxative  effect,  was  very  conspicuous. 

When  the  primae  via?  had  been  fully  evacuated,  an  attempt  was 
made  to  restore  the  natural  secretions,  and  the  balance  of  the  circu- 
lation, by  opening  the  pores  of  the  skin.  Antimonial  powder,  with 
opium  was  employed  for  this  purpose  ;  but  more  generally  the  pulvis 
ipecacuanhas  compositus,  which  certainly  seemed  to  succeed  best. 

Whenever  tormina  and  straining  returned  in  a  worse  degree  than 
ordinary,  a  cathartic  was  given  in  the  morning,  followed  by  a  large 
dose  of  opium,  or  an  anodyne  diaphoretic  at  night. 

Believing,  as  I  firmly  do,  that  wherever  there  is  morbid  activity  of 
tho  vascular,  and  increased  mobility  or  excitability  of  the  nervous 
system,  (the  former  evinced  by  undue  velocity  and  force  of  motion  of 
the  heart  and  great  vessels,  and  the  latter  by  morbid  evolvement  of 
animal  heat,  general  pains,  lassitude,  &c.)  ther*  blood-letting  is  very 
seldom  inadmissible,  whatever  be  the  name  or  nature  of  the  disease, 
— it  is  almost  unnecessary  to  say  that,  in  the  complaint  I  am  now  des- 
cribing, the  lancet  formed  a  leading  agent  in  the  methodus  medendi. 
Whenever  the  stools  resembled  the  "  lotura  carnium,"  I  practised 
depletion  with  as  much  freedom  as  if  there  had  been  active  hasmor- 
rhage  from  the  intestines  from  any  other  cause  ; — the  amended  ap- 
pearance of  the  alvine  discharges,  and  the  diminution  of  the  pyrex- 
ial  symptoms  not  only  justified  but  sanctioned  the  apparent  boldness 
of  a  measure,  which,  i  have  reason  to  know,  has  succeeded  equally 
well  in  other  hands  besides  my  own.  Many  of  our  primary  cases, 
however,  were  not  so  severe  as  to  require  venesection. 

By  these  means,  aided  by  perfect  quietude,  repose,  and  low  diet, 
the  febrile  state  soon  disappeared,  and  nothing  remained  but  debility 
and  irregularity  of  the  bowels,  which  were  to  be  removed  by  the 
mistura  cretae  cum  opio,  the  infusum  quassias  excelsae,  or  the  mistura 
ciachonae,  given  thrice  or  four  times  a-day,  and  a  gentle  laxative  once 
in  three  or  four  days. 

Many  of  our  earlier  and  milder  cases  yielded  to  this  treatment ; 
but  those  of  a  severer  sort  required  measures  less  inert.  In  these 
malignant  forms  of  the  disease,  1  began  by  giving  a  strong  saline  or  lu- 
bricating cathartic.  Here,  too,  blood-letting  was  very  freely  prac- 
tised, when  the  patients  were  young  and  robust,  or  indeed,  whenever 
the  force  of  the  pulse  and  pyrexia  seemed  on  general  principles,. to 
justify  it.  I  never  once  saw  cause  to  repent  of  this  evacuation, 
though  I  have  more  than  once  carried  it  to  a  great  extent.  It  often 
moderated  local  pain  of  the  abdomen,  diminished  the  severity  of  the 
griping,  and,  when  practised  with  prudence,  did  not  perceptibly  in- 
crease the  subsequent  debility.  —  These  preliminary  steps  being  ta- 
ken, I  immediately  commenced  the  use  of  calomel,  and  pushed  on 
undeviatingly  to  salivation,  from  the  belief,  which  seems  to  be  well- 
founded,  of  an  occult  connection  betwixt  dysentery  and  a  morbid  con- 
dition of  the  liver. 

The  doses  I  gave  were  regulated  by  the  constitution  of  the  pa- 
tients, and  the  actual  state  of  the  symptoms  ;  but  one  scruple  night  and 

48 


378  INFLUENCE  Qf  TROBICAL  CLIMATES,  &C« 

morning,  was  the  most  usual  prescription, — seldom  less  than  ten 
grains  thrice  a-day  !  I  gave  a  scruple  night  and  morning  so  often,  and 
in  such  great  variety  of  habits,  that  I  *oon  ceased  to  be  at  all  fearful 
•f  hypercatharsis,  or,  indeed,  of  aoy  other  unpleasant  effect.  It  cer- 
tainly seldom,  in  any  case  increased  tormina  nd  tenesmus,  but  ge- 
nerally lessened  both  very  materially,  and  produced  five  or  six  large 
motions,  voided  \vith  less  straining,  and  less  tinged  with  blood.  I  have 
in  this  way  given  16,  24,  or  32  scruple*  of  calomel  in  the  course  of 
half  as  many  days,  before  the  tn  >uth  became  affected.  When  the 
gums  were  fairly  sore,  with  some  ptyalism,  the  calomel  was  omitted, 
the  tormina,  tenesmus,  and  general  fever  disappeared  as  a  matter  of 
course,  and  the  bowels  gradually  returned  to  their  natural  state,  the 
stools  often  changing,  in  one  night's  time,  from  a  dark  brown  or  spin- 
age  colour,  to  a  bright  healthy  yellow,  with  the  odour  of  natural  fae- 
ces. Some  tonic  or  stomachic  was  prescribed  during  the  days  of  con- 
Talescence  ;  and  generally,  as  soon  as  the  mouth  was  well,  the  pa- 
tients were  fit  for  duty. 

Calomel  was  often  thus  given  alone  and  uncombined  ;  but  often  I 
thought  it  preferable,  on  account  of  occasional  symptoms,  to  conjoin 
with  it  two  grains  of  opium,  or  to  give  at  noon,  (in  the  interval  be- 
tween the  doses  of  calomel,)  twelve  or  fifteen  grains  of  the  pulvis 
ipecacuanha?  compositus. — This  was  done  in  order  to  lessen  the  irri- 
tability of  the  bowels,  and  to  support  the  cuticular  discharge.  Under 
such  management,  every  case  recovered  where  no  visceral  obstruc- 
tions existed,  or  where  the  co  existent  disease  of  the  liver  was  not 
irretrievable  from  having  passed  into  disorganization. 

As  to  the  fact  of  visceral  obstructions,  1  believe  they  are  a  more 
frequent  occurrence,  even  in  our  own  climate,  than  is  generally  sup- 
posed ;  but  I  am  persuaded  that,  of  those  who  have  lived  for  any 
length  of  time  within  the  tropics,  scarcely  fewer  than  four-fifths 
have  one  viscus  or  other  in  the  abdomen,  more  or  less  altered  by 
morbid  action.  This  opinion  is  deduced  from  a  very  considerable 
Dumber  of  dissections  of  such  subjects. 

Opium  is  one  of  those  remedies  of  doubtful  utility  in  dysentery, 
which  has  been  by  some  violently  decried,  and  by  most  rather  spa- 
ringly used,  from  its  alleged  tendency  to  suspend  the  natural  secre- 
tions, lock  up  the  excretory  ducts,  and  check  the  transpiration  by  the 
skin.  Candour  obliges  me  to  say  that  I  have  used  it  largely,  parti- 
cularly in  the  chronic  forms  of  the  disease,  and  that  I  have  never  no- 
ticed any  of  the  unfavourable  effects  urged  against  it  ;  but  on  the 
contrary,  can  bear  witness  with  the  illussrious  Sydenham,  Dr. 
John  Hunter,  and  several  living  authors,  to  its  beneficial  power. 
Given  after  purgatives,  it  can  seldom  be  unsafe, — and,  if  it  does  no 
more,  it  procures  a  temporary  truce  from  the  disease.  How  import- 
ant a  cessation  from  suffering  is,  in  every  illness,  but  more  especially 
in  so  endless  and  harassing  a  complaint  as  dysentery,  1  need  not  say — 
prejudices,  probably  illusory  and  theoretical,  ought  to  give  way  to  an 
advantage  so  substantial. 

Nevertheless  it  must  be  admitted,  that  in  the  early  or  acute  stage 
©f  dysentery,  this  remedy  must  be  administered  with  a  very  cautious 
and  discriminating  hand,— inasmuch  as,  at  that  period  of  the  disease, 


&YSENTERV  OF  NEW  ORLEAKa.  37$ 

inflammation  either  exists  overtly,  or  disguised  under  some  of  its  pe- 
culiar modifications.  Under  such  circumstances,  therefore,  it  be- 
comes necessary  not  only  to  premise  the  opium  with  blood- letting  and 
purgatives,  but  also  to  combine  it  with  same  untrritating  diaphoretic, 
such  as  pulvis  ipecac,  aquajacetetis  ammonias,  &c.  in  order  to  pre- 
vent it  from  increasing  vascular  action,  and  suppressing  cutaneous 
excretion. 

Almost  the  whole  body  of  the  profession  have  concurred  in  prais- 
ing injections  in  this  disease.  I,  of  course,  defer  to  the  experience 
of  others,  while  1  detail  my  own.  Having  found  them  almost  uni- 
formly hurtful,  I  entirely  laid  them  aside.  The  irritation  produce! 
by  the  introduction  of  the  pipe,  more  than  counterbalances  the  sooth- 
ing effects  of  the  injection.  Besides  the  disagreeableness  of  this 
species  of  remedy,  when  often  repeated,  to  the  good  old  English  ha- 
bits of  delicacy,  I  have  always  seen  that,  were  the  enema  ever  so 
bland,  or  ever  so  small  in  volume,  it  could  not  be  retained  beyond  a 
very  few  minutes,  and  always  occasioned  more  straining  and  tenesmus 
in  the  sequel.  As  a  commodious  substitute  for  injections,  I  have  di- 
rected patients  to  insinuate  into  the  anus  a  small  crumb  or  two  of 
opium,  softened  betwixt  their  fingers  for  the  purpose  ;  —or  have 
caused  warm  fomentations  to  be  used  to  the  parts,  and  bladders  of 
hot  water  to  be  applied  to  the  hypogastric  region.  These  are  wont 
to  succeed  so  well,  tl.at  the  patients  themselves  speak  in  the  strong- 
est terms  of  the  relief  afforded  by  them. 

The  diet  of  the  sick  is  of  the  utmost  consequence  in  this  com- 
plaint. It  should  be  so  regulated  that  nothing  cold  either  in  the 
shape  of  food  or  drink,  be  taken  into  the  stomach^  Sago,  arrow  root, 
weak  soups,  &c.  may  be  used  during  the  pressure  of  the  disease  ; 
and  animal  jellies,  and  other  articles,  easy  of  digestion,  during  con- 
valescence. When  the  disease  has  yielded,  it  is  of  the  first  con- 
sequence that  we  do  not  prematurely  indulge  the  patient  with  animal 
food,  even  though  his  appetite  strongly  crave  it ;  for  it  must  be  ob- 
vious that  such  food  will  be  received  into  an  alimentary  canal,  as  yet 
by  far  too  weak  to  digest  or  assimilate  any  but  a  very  small  portion 
of  it.  Hence  springs  a  dreadful  source  of  irritation  to  the  weak 
and  irregular  bowels  ;  and  1  am  satisfied  that  I  have  seen  some  fatal 
relapses  of  dysentery  brought  on  by  the  injudicious  kindness  of  the 
patient's  friends,  who  have  clandestinely  indulged  him  with  animal 
diet,  under  the  erroneous  impression  of  thereby  strengthening  him. 
In  many  other  instances,  1  have  seen  apparently  very  venial  excesses 
either  in  the  quantity  or  quality  of  the  food  during  convalescence, 
induce  true  lienteria :  in  truth,  the  latter  complaint  is  too  apt  to  be 
the  consequence  of  long  protracted  attacks  of  dysentery,  do  what  we 
will,  and  be  our  dietetic  restrictions  what  they  may.  I  need  scarce- 
ly add  that  vegetables  and  fruit,  unless  well  boiled,  and  used  in  very 
sparing  quantity,  are  quite  inadmissible,  —  owing  to  their  pronenesg 
to  run  into  the  acetous  fermentation,  in  all  instances  where  the  chylo- 
poetic  organs  are  debilitated. 

Blisters  to  the  abdomen  I  have  occasionally  used,  and  that  with 
some  apparent  advantage,  in  this  disease.  But  I  believe,  most  prac- 
tical men  will  agree  with  me  when  1  say,  that  if  due  use  has  been 


380  INFLUENCE  OF  TROF1GAL  CLIMATES,  &.C. 

made  of  the  lancet  at  the  outset  of  the  complaint,  the  subsequent  and 
subordinate  aid  of  vesicatories  will  very  rarely  be  any  way  essential, 
or  necessary.  Besides,  they  labour  under  the  objection  of  causing 
often  difficult  micturition  from  the  absorption  of  the  cantharides  ; 
and  it  must  be  recollected  that,  in  most  cases  of  dysentery,  strangu- 
ry is  already  existing,  from  sympathy  betwixt  the  bladder  and  the 
rectum,  while  the  latter  is  in  a  state  of  constant  and  almost  incon- 
ceivable irritation  from  tenesmus.  It  might  be  well  to  try  whether 
the  interposition  of  a  bit  of  muslin  betwixt  the  blister  and  the  skin, 
would  have  the  effect,  as  it  is  said  to  have,  of  preventing  the  absorp- 
tion of  cantharides. 

The  advanced-guard  of  the  army  was  disembarked  on  the  24th  of 
December,  and  took  up  a  position  on  the  only  road  to  New  Orleans, 
and  there  awaited  the  landing  of  the  remainder.  After  several  mi- 
nor skirmishes,  the  troops,  (with  whom  the  marines  of  the  fleet  and 
sailors  trained  to  small  arms,  had  previously  been  incorporated,) 
were  formed  into  columns,  and  on  the  morning  of  the  8th  of  Janua- 
ry, before  day-light,  advanced  to  storm  the  American  lines. 

'J  hese  works  were  defended  by  a  broad  ditch  filled  with  water, 
as  also  by  a  palisade,  and  a  wall  mounted  with  numerous  pieces  of 
cannon.  The  enemy,  apprised  of  our  intended  invasion,  had  drawn 
these  lines  quite  across  the  only  route  to  New  Orleans.  They  were 
absolutely  inaccessible  at  their  flanks,  as  their  right  touched  the  Mis- 
sissippi, and  their  left  rested  on  an  impassable  wooded  morass.  This 
was  the  spot  which  the  laws  of  nature  as  well  as  the  rules  of  art  had 
concurred  to  strengthen  ;  this  was  the  strait  which  the  Americans 
would  fain  compare  to  the  immortal  pass  of  Thermopylae  ;  but  en- 
trenched, as  they  were,  to  the  teeth,  and  fighting,  in  effect,  com- 
pletely under  cover,  there  was  no  call  for  the  self-denying  devoted- 
ness  of  a  Leonidas,  and  no  exercise  for  either  the  active  or  passive 
valour  of  Sparta. 

The  attempt  to  storm  failed  :  our  columns  were  beat  back  at  eve- 
ry point,  with  a  loss,  I  believe,  of  more  than  five  hundred  kHIed,  and 
upwards  of  twelve  hundred  wounded. 

The  expedition  being  thus  foiled  in  its  object,  the  troops  were  once 
more  collected  on  board  the  fleet,  and  proceeded  off  Mobile  river, 
to  attack  the  town  of  that  name.  Fort  Bowyer,  which  defends  the 
harbour's  mouth,  being  quickly  and  regularly  invested,  was  captur- 
ed on  the  llth  of  February  :  but  the  ulterior  operations  were  sus- 
pended by  the  arrival,  from  England,  of  the  news  of  the  peace  of 
Ghent.  The  troops  were  disembarked  on  a  sandy  uninhabited  spot, 
called  Dauphin  Island,  there  to  await  the  ratification  of  the  treaty, 
and  the  arrival  of  such  supplies  of  provisions  as  would  enable  them 
to  prosecute  the  voyage  homeward. 

It  is  worthy  of  remark,  that,  notwithstanding  the  almost  unex- 
ampled fatigues  and  privations  of  all  sorts  to  which  the  army  and 
navy  had  been  exposed  while  before  New  Orleans,  sickness  of  any 
kind,  up  to  the  8th  of  January,  had  made  comparatively  little  pro- 
gress amongst  them.  The  bowel  complaints,  though  numerous, 
-were  for  the  most  part,  easily  removed  ;  and  no  other  disease  of  any 


DYSENTERY  OF  NEW  ORLEANS.  381 

consequence  prevailed.  It  is  not  a  little  remarkable  in  the  medical 
history  of  fleets  and  armies,  that,  during  the  fatigues  and  sufferings  of 
a  hot  campaign,  or  the  active  progress  of  warlike  operations,  the 
men  are  very  little  subject  to  illness  of  any  sort ;  as  if  the  elation  of 
hope,  and  the  other  great  passions  with  which  they  are  agitated,  had 
the  virtue  to  steel  the  constitution  against  the  most  powerful  causes 
of  disease.  This  circumstance  no  less  curious  than  true— proudly 
proves  the  aetherial  origin  of  our  nature,  and  goes  far  to  assert  the 
almost  omnipotency  of  mind  over  matter ! — No  sooner,  however, 
does  a  great  failure,  and  the  dejection  it  draws  after  it, — a  cessation 
of  operations  and  a  return  to  the  *'  vita  mollis"  allow  the  spirit  of 
enterprize  to  flag,  than  the  previous  fatigues,  and  exposures  begin  to 
tell  upon  the  constitution  by  their  usual  results — disease.  Like  a 
machine  wound  up  beyond  its  pitch — the  excitement  of  accumulated 
motives  once  withdrawn, — the  human  frame  rapidly  runs  down,  and 
yields  with  a  facility  almost  as  unexpected  as  its  former  resistance. 
Hence,  after  a  campaign,  diseases  of  every  kind  are  prone  to  a  type 
of  debility  and  aggravation,  and  the  proportion  of  deaths  is  unusually 
numerous. 

Accordingly,  in  the  instance  before  us,  the  pressure  of  ill  success 
began  to  be  severely  felt  after  the  failure  of  the  8th,  and  the  conse- 
quent re-embarkation  of  the  army.  By  this  time  unremitted  fatigue, 
poor  living — and  that  at  short  allowance,  with  the  total  want  of  fresh 
beef  and  succulent  vegetables,  not  only  altered  for  the  worse  the 
character  of  the  bowel  complaints,  and  produced  a  fatal  relapse  in 
some  recently  cured,  but  also  introduced  scurvy,  with  its  multiplied 
series  of  perplexing  symptoms.  Exposure  to  marsh  miasmata,  also, 
produced  many  cases  of  fever,  which  were  at  first  intermittent,  but 
as  the  weather  grew  hot,  put  on  the  violent  remittent,  or,  more  gene- 
rally, the  ardent  continued  form.  The  great  increase  of  atmosphe- 
ric heat  which  now  took  place  evidently  exasperated  the  type  of  the 
prevailing  dysentery,  as  well  as  that  of  the  fever  :  this,  along  with 
some  other  facts,  which  I  shall  state  hereafter,  induced  me  to  believe 
that  one  common  miasm  gives  rise  to  these  two  forms  of  disease,  and 
that  the  former  is  essentially  different  from  the  dysentery  of  cold  cli- 
mates, which,  being  merely  a  vicarious  discharge  from  the  intestines, 
owing  generally  to  suppressed  perspiration,  is,  for  the  most  part, 
rendered  milder,  if  not  altogether  extinguished  by  the  genial  warmth 
of  the  season. 

Dysentery  now  put  on  that  aggravated  form  in  which  it  has  so  often 
scourged  our  camps  and  fleets ;  and  never  shall  I  forget  the  terrible 
force  of  this  invisible  enemy.  In  all  cases  it  was  a  very  baffling  un- 
tractable  disease,  but  in  those  who  had  previously  served  long  in 
warm  climates,  and  whose  livers  were  thereby  affected,  it  was  almost 
uniformly  mortal. — When  the  disease  attacked  such  persons,  it  was  a 
subject  of  melancholy  but  curious  speculation  to  witness  the  head- 
long course  of  the  malady,  and  how  unavailing  any  species  of  treat- 
ment invariably  proved.  It  knew  neither  pause  nor  hindrance,  but 
like  the  fabled  vulture  of  ancient  mythology,  pursued  its  cruel  task 
from  day  to  day.  Dissection  always  brought  to  light  extensive  vis- 


382  INFLUENCE  OP  TROPICAL  CLIMATES,  &C. 

ceral  obstructions,  particularly  chronic  inflammation  or  abscess  o£ 
the  liver,  with  or  without  enlargement  of  thai  viscus. 

Nothing  but  experience  can  convey  adequate  ideas  of  the  ungo- 
vernable nature  of  this  disease,  or  of  the  insidious  masked  approaches 
of  its  attack.  Days  of  an  indisposition,  apparently  trivial,  sometimes 
occur,  ere  the  peculiar  symptoms  of  dysentery  show  themselves,  and 
would  induce  a  practitioner  unacquainted  with  tropical  diseases,  and 
unaware  of  the  peculiar  character  of  the  prevailing  epidemic,  to  pro- 
nounce the  complaint  trifling,  or  as  being  nothing  more  than  slight 
fever,  symptomatic  of  gastric  disorder  ; — at  other  times,  smarter  py- 
rexia,  and  occasionally  a  pain  in  the  right  side,  obtuse  or  acute,  fol- 
lowed by  frequent  copious  dark-green  stools,  (like  boiled  spinage,} 
slightly  tinged  with  blood,  are  the  form  of  the  disease. 

In  most  of  the  cases,  griping  was  little  complained  of.  There  was 
merely  a  sense  of  weight  in  the  hypogastric  region,  and  a  copious 
Jlux  of  green  or  dark  brown  cnlluvies,  voided  without  straining.  The 
tongue  was  covered  with  a  yellow  fur,  which,  in  the  advanced  stage 
of  the  disease,  became  thick,  dark,  and  immoveable  as  a  slab  of  black 
marble  The  pulse  was  sharp,  frequent  and  weak  :  frequent  retch- 
ing and  hiccup  attended,  and  a  sensation  a?  if  all  the  drink  swallowed 
hot  or  cool,  ran  speedily  through  the  intestines.  OHener  the  com- 
plaint would  make  its  attack  with  the  common  introductory  symptoms, 
and  no  pain  in  the  right  hypochondrium  was  felt  throughout  the  dis- 
ease, either  on  inspiration,  or  strong  pressure  under  the  false  ribs. 
In  whatever  garb  of  disguise  it  made  its  appearance,  disease  of  the 
liver,  (as  1  have  before  stated,)  and  consequently  a  vitiated  state  of 
its  secretions,  were  undoubtedly  the  primary  cause  of  the  mischief. 
Dissection  of  the  fatal  cases  showed  structural  derangement, — a  soft 
friable  condition,  and  general  suppuration  of  that  gland.  I  have  of- 
ten found  two  separate  abscesses  in  the  parenchyma  of  its  large  lobe, 
the  one  generally  less  deep-seated  than  the  other,  and  containing,  in 
some  instances,  a  quart  of  pus,  similar  in  colour  and  consistence  to 
what  is  usually  found  in  psoas  abscesses.  How  such  extensive  disor- 
ganization, and  formation  of  matter  could  take  place  without  any  pre- 
ceding palpable  indication  of  local  mischief,  is  to  me  still  a  mystery. 
But  such  was  the  fact.* 

*  Since  these  observations  were  first  published  in  the  Edinburgh  Journal,  al- 
most every  one  has  expressed  his  surprise  at  the  co-existence  of  such  extensive 
hepatic  disease  with  tropical  dysentery  :  nay,  the  thing  is  so  striking-  in  itself,  and 
Js  so  contrary  to  established  opinion,  that  not  a  few  have  gone  so  far  as  to  deny  it 
altogether,  or  to  assert  that  it  must  be  a  very  rare  occurence  indeed  ,  and  that  the 
affection  of  the  liver  is  merely  contingent,  and  not  necessarily  connected  with  dy- 
sentery. I  think  I  am  warranted  by  facts  in  maintaining  the  contrary, — viz. 
That  the  co-existence  is  very  frequent,  if  not  uniform ;  and  that  the  connexion 
is  no  less  strict  than  that  of  cause  and  effect 

I  can,  however,  well  excuse  a  degree  of  scepticism  on  this  point,  knowing  that 
what  happened  to  myself  may  equally  happen  to  others, — namely,  that  many 
cases  of  dysentery  may  be  examined  after  death,  without  the  concomitant  disease 
of  the  liver  being  discovered  : — for  who  would  dream  of  cutting  minutely  into 
that  viscus,  in  a  disease  generally  supposed  to  bear  no  relation  to  it  ? 

It  was  by  accident  I  first  discovered  the  fact,  and  J  shall  relate  it  concisely,  just 
as  it  happened :  a  Naval  Officer,  for  whose  talents  and  virtues  I  shall  ever  enter- 
tain the  highest  respect,  whose  memory  I  shall  ever  affectionately  cherish,  and 


.  DYSENTERY  OF  NEW  ORLEANS,  383 

On  the  villous  coat  of  the  colon  and  rectum,  there  were  numerous 
excoriated  points,  with  small  superficial  ulcers  here  and  there  ;  but 
BO  morbid  alterations  were  found  there  sufficient  to  account  for  death  : 
— no  gangrene — no  ravages  in  short,  like  those  related  by  Sir  John 
Pringle,  Harty,  and  others,  in  their  accounts  of  thU  malady. 

In  fact,  (to  give  a  condensed  view  of  the  whole  matter,)  the  phe- 
nomena of  the  cases  that  recovered,  as  well  as  the  morbid  appear- 
ances of  those  that  died,  impressed  upon  my  mind  a  conviction  that, 
the  diseased  condition  of  the  liver  was  the  soil  irom  which  dysentery 
drew  its  malignant  growth,  strength,  and  nurture.  This  was  the 

whose  death  I  shall  ever  regret  as  the  loss  of  a  valued  friend,  was  the  first  on 
board  H.  M.  S.  Cydnus  that  fell  a  martyr  to  dysentery  off  New  Orleans.— He 
happened  to  die  at  sea,  and  it  became  desirable  to  preserve  his  body  until  w© 
should  reach  some  port,  where  the  funeral  honours  due  to  his  rank  might  be  de- 
corously paid.  In  order  to  effect  this,  it  became  necessary  to  remove  the  iutes- 
tin  os.  While  doing  so,  I  ascertained  that  the  liver  was  much  enlarged,  and  there- 
fore thought  that  it  also  had  belter  be  removed.  Having  separated  it  from  its  la- 
teral connections,  1  passed  my  hand  up  under  the  ribs  in  order  to  detach  it  from 
the  diaphragm.  While  making  a  slight  pressure  for  the  latter  purpose,  1  was  as- 
tonished to  find  the  points  of  my  fingers  pass  through  the  thin  parites  of  a  large 
abscess  in  the  upper  and  central  part  of  the  right  lobe,  from  which  upwards  of  a 
quart  of  pus  forthwith  flowed.  After  the  liver  had  been  removed  and  laid  out 
for  minute  inspection,  I  found  the  abscess  of  such  extent,  and  so  lined  in  its  inner 
surface  with  a  thick,  fretted,  and  irregular  exudation  of  coagulable  lymph,  that 
it  resembled  a  familiar  and  homely  object,— namely,  a  large  winter  glove  lined 
with  worsted! — On  accurate  examination,  a  second  abscess  was  found,  lower 
down  in  the  large  lobe,  containing  a  pint  of  pus. 

This  officer  had  never  at  any  period  of  the  disease  felt  any  pain  in  his  side  :— 
from  his  general  intelligence,  and  from  the  accurate  descriptions  he  gave  me  daily 
of  his  minutest  sensations,  I  am  convinced  he  would  have  mentioned  that  pain, 
had  it  existed  even  to  the  extent  of  a  "  sensus  molestiae."  Besides,  he  was  one 
of  the  last  men  in  the  world  that  one  would  have  suspected  of  hepatic  affection, 
being  florid  in  complexion,  and  having  previously  enjoyed  the  best  health  all  his 
life. 

Instructed  by  this  insidious  case,  I  had  my  eye  to  the  liver  ever  afterwards ; 
but  pain  of  side,  or  pain  on  pressure  under  the  ribs,  was  by  no  means  often  felt, 
though  dissection  after  death  brought  to  light  hepatic  disorganization  equally  ex- 
tensive as  in  the  above  case.  In  many,  the  liver  to  appearance,  had  the  colour 
and  size  of. health,  and  it  was  not  till  on  cutting  into  its  parenchymatous  sub- 
stance that  the  extensive  abscesses  were  discovered. 

These  facts  are  of  such  high  importance  in  the  pathology  of  dysentery,  and  so 
much  depends  upon  the  degree  of  credit  that  may  be  attached  to  them,  that  I  am 
sincerely  glad  in  being  now  able  to  say,  that  they  do  not  rest  upon  my  solitary  or 
isolated  observation.  Within  these  few  days  I  have  been  favoured  with  an  excel- 
lent and  most  interesting  communication  from  James  Simpson,  Esq.  Surgeon,  R. 
N.  in  which  he  details  to  me  the  cases  and  appearances  on  dissection  of  several 
dysenteries  that  were  treated  by  him  in  the  East  Indies  At  the  time  he  made  the 
observation,  he  was  not  aware  that  similar  ones  had  been  made  by  myself  in  the 
Western  Hemisphere  ;  therefore  his  remarks  must  carry  with  them  the  force  of 
unbiassed  and  independent  observation.  The  symptoms  before,  and  the  morbid 
changes,  after,  death,  were  substantially — nay,  exactly — the  same  as  I  have  de- 
tailed in  this  paper,  and  in  my  Inaugural  Dissertation  :  and  Mr.  Simpson,  speak- 
ing from  the  facts  he  has  so  often  witnessed,  expresses  his  conviction  that  "future 
experience  will  unfold  to  us  that  liver  disease  is  an  inseparable  attendant  of  dy- 
sentery in  warm  climates." — I  am  sorry  that  want  of  space  prevents  me  from  co- 
pying more  amply  his  able  and  satisfactory  details.  I  have  reason  to  know  that 
the  observations  of  some  other  practitioners  exactly  concur  with  those  of  Mr. 
Simpson  and  myself 


$84  INFLUENCE  OP  TROPICAL  CLIMATES,  &C. 

s<  fons  et  origo  mail ;"  by  it  the  dysentery  was  excited,  and,  only  by 
its  removal  could  it  be  removed  !  This  view  of  the  disease  I  conceive 
to  be  of  great  consequence,  and  trust  it  will  meet  with  due  conside- 
ration from  the  profession,  inasmuch  as  it  is  a  view  not  taken  up  has- 
tily, or  out  of  complaisance  to  a  favourite  hypothesis,  but  deduced 
from  nearly  two  hundred  cases,  and  built  upon  the  corner-stone  of 
morbid  dissections.  I  hope  the  time  is  not  far  distant  when  more 
accurate  observation  will  teach  medical  men  at  large,  to  regard  this 
disease  merely  as  secondary  to,  and  symptomatic  of  hepatic  affection, 
and  to  seek  its  more  immediate  cause  in  a  morbid  condition  of  that 
important  organ,  the  liver.  Whatever  may  be  the  mode  of  connec- 
tion* between  hepatic  derangement  and  dysentery,  I  am  convinced 
from  analyzing  my  own  sensations,  as  well  as  from  having  counted  in 
others  the  links  of  the  pathological  chain,  that,  at  least  in  tropical  cli- 
mates these  two  diseases  are  connected  like  cause  and  effect.  The 
practice  which  most  readily  removes  the  disease,  too,  tends  much  to 
confirm  me  in  this  conviction  ;  for  the  "  mercurial  method"  I  have 
pushed  to  a  great  extent,  and  its  results  have  been  such  as  to  give  it 
a  very  decided  preference  in  my  estimation.  Calomel,  (that  great 
specific  in  obstructions  of  the  liver,  and  justly  styled  by  Dr.  Curry, 
of  London,  a  cholagogue,)  given  in  large  doses — say  one  scruple  twice 
a-day — combined  with  opium,  to  cause  it  to  be  retained  in  the  system, 
corrects  the  condition  of  the  liver  by  emulging  its  ducts,  unloading 
its  congested  or  over-gorged  vessels,  removing  undue  determinations 
of  blood  to  its  yielding  texture,  prompting  the  healthy  secretion  of 
its  peculiar  fluid,  and  thereby  resolves  Pyrexia. — As  soon  as  ptyalism 
takes  place,  the  dysenteric  symptoms  disappear,  and  the  appetite 
gradually  returns.  Upon  the  whole,  my  own  experience,  as  well  as 
that  of  some  others  who  served  on  this  expedition,  warrants  a  far 

*  About  the  mode  of  that  connection  I  have  indeed  speculated  pretty  freely  and 
pretty  largely  elsewhere,  having  employed  a  good  many  pages  of  my  Thesis  in 
the  discussion  of  the  ratio  symptomatum  as  well  as  of  the  ratio  causarum — yet  I 
must  confess,  that  the  opinions  are  purely,  or  at  least  in  a  great  measure  specula- 
tive ;  and  that  they  are  not  satisfactory,  even  to  my  own  mind. 

I  shall  not  further  detain  the  reader  in  this  place,  but  pass  the  matter  over  en- 
tirely, resigning  to  writers  of  greater  native  talent,  and  better  inured  to  habits  of 
difficult  investigation,  the  task  of  establishing  a  theory  of  the  disease  which  shall 
at  oace  be  rational,  and  shall  satisfactorily  explain  all  the  phenomena. 

I  may,  however,  be  permitted  to  hint  that  no  hypothesis  which  has  simplicity 
for  its  basis  will  ever  explain  this  disease :  unquestionably  Dr  Johnson's  leading 
idea  is  a  most  valuable  one,  viz.  that  in  our  investigations  of  this  malady  we  must 
seek  its  source  not  in  one  morbid  cause,  but  in  a  series  of  morbid  causes. 

I  wish  it  to  be  distinctly  understood  that  it  is  my  inability  alone  that  induces  me 
not  to  attempt  the  theory  of  this  disease  ;  for  I  shall  never  fall  in  with  that  tone 
of  affected  contempt  for  all  theories,  in  which  presumptuous  dulnessso  often  shel- 
ters its  imbecility,  and  vapid  indolence  so  often  masks  its  habitual  and  insuperable 
torpor.  Such  ill-bestowed  contempt  may  be  sufficiently  reproved  by  simply  stat- 
ing the  undeniable  fact,  that  not  only  in  medical,  but  in  every  other  branch  of  na- 
tural and  experimental  science,  few  brilliant  discoveries  have  been  made  except 
by  those  acute  and  industrious  men  who  were  labouring  to  establish  some  darling 
hypothesis.  Though  they  were  often  disappointed  of  the  results  they  had  in  view, 
still  they  were  generally  compensated  by  the  discovery  of  something  equally  or 
more  valuable; — just  as  the  peasant  who  was  told  to  dig  for  hidden  treasure, 
though  disappointed  of  the  prize  he  expected,  derived  a  more  rich  and  perma- 
nent treasure,  from  the  digging  and  fertilizing  of  the  land  during  his  vain  search. 


DYSENTERY  OF  NEW  ORLEANS.  38ft 

more  certain  expectation  from  this  mode  of  treatment  than  from  thfe 
alternation  of  purgatives  with  astringents,  or  any  other  heretofore  ia 
use. — I  must  here  observe,  however,  that  I  by  no  means  go  the 
length  of  saying  that  dysentery  in  our  own  climate  always  requires 
the  excitement  of  ptyalism  by  mercury  for  its  cure  ;  because  with 
us  it  is  almost  always  a  slight  disease,  and  compared  with  the  fell 
and  fatal  form  of  tropical  flux,  might  be  termed  the  "  spurious  dy- 
sentery." In  ordinary  cases,  therefore,  to  push  mercury  the  whole 
length  of  salivation,  would  be  merely  substituting  one  ailment,  and 
that  perhaps  a  more  troublesome  one,  for  another  less  so  :  (for  let 
it  ever  be  remembered  that  ptyalism  is  not  without  its  inconveni- 
encies,  and  sometimes  not  without  its  dangers,  as  I  myself  have  seen  :) 
consequently  in  such  instances,  if  we  equalize  the  circulation  by  the 
warm  bath,  a  purgative,  and  a  sudorific  or  two,  we  shall  generally 
find  the  disease  yield.  Frequent  discharges  of  slimy  mucus,  attend- 
ed with  tormina,  tenesmus,  and  feverishness,  though  designated  by 
the  general  name  of  dysentery,  are,  in  this  country,  often  dependent 
merely  on  aerial  vicissitudes  and  consequent  suppression  of  the  cuti- 
cular  discharge,  and  differ  widely  both  in  their  cause  and  character 
from  the  true  dysentery  of  warmer,  but  less  salubrious  regions.  But 
even  in  this  climate,  I  contend,  the  principles  of  cure  here  laid 
down  will  apply  with  utility,  and  that  in  cases  which  resist  the  more 
ordinary  treatment,  calomel  given  in  larger  or  smaller  doses,  (accord- 
ing to  circumstances,)  will  be  equally  beneficial  as  within  the  tro- 
pics, provided  the  patient  be  always  kept  in  a  room  whose  tempera- 
ture is  between  60  and  70. 

I  have  no  hesitation  in  affirming  that  at  New  Orleans  the  success 
of  the  treatment  by  calomel  was  far  greater  than  that  by  the  usual 
mode,  and  1  shall  here  relate  a  fact  which  may  be  regarded  as  deci- 
sive of  the  rival  merits  of  the  two  methods  of  cure.  The  Cydnus 
frigate,  in  which  I  served,  remained  in  the  Gulf  of  Mexico,  after  all 
the  rest  of  our  force  had  retired.  From  the  large  expenditure  of 
calomel,  1  at  last  had  none  left,  and  there  was  not  a  grain  to  be  pro* 
cured. — At  this  time  I  had  several  cases  of  dysentery,  which,  from 
necessity,  I  was  obliged  to  treat,  for  several  days,  on  the  old  plan, 
by  neutral  salts  or  oleum  ricini  alternated  with  anodyne  sudorifics, 
rhubarb,  diluents,  mistura  cretacea,  &c.  One  case  was,  indeed,  of 
so  bad  a  type  that  I  had  made  up  my  mind  for  its  ending  fatally. 
Luckily,  however,  our  arrival  at  the  Havanna  enabled  me  to  procure 
a  supply  of  good  calomel  ;  and  I  immediately  commenced  with  ten- 
grain  doses  thrice  a-day.  Xext  morning  the  patient  was  better  ;  had 
passed  a  more  tolerable  night  ;  had  less  tormina  and  tenesmus,  and 
a  cleaner  tongue.  I  increased  the  dose  to  one  scruple  night  and  morn- 
ing, and  thenceforth  his  improvement  was  perceptible  from  day  to 
day.  The  pyrexia  soon  abated,  and,  in  ten  days,  his  dejections  from 
being  green  and  foetid,  had  recovered  the  natural  yellow  colour  or 
nearly  so.  No  complaint  remained  but  a  sore  mouth.  This  patient, 
like  most  of  the  others,  had  been  very  liberally  bled  at  the  onset  of 
the  disorder.  He  is  now  living,  (so  far  as  I  know,)  and  is  an  exam- 
ple of  the  superior  efficacy  of  this  mode  of  treatment. — The  above 

49 


316  ISKLVSNeE  OF  TROPICAL  CE1MATE9,  &C, 

is  merely  one  of  many  instances  where  f  have  seen  caiomel  work 
rapidly,  and  like  a  charm. 

To'prove  with  how  little  apprehension  calomel  may  be  given  to 
persons  of  all  ages,  1  may  state  that  to  a  boy  of  14,  one  hundred  and 
jtfty-two  grains  were  given  during  the  acute  stage  of  a  most  dange- 
rous attack  of  dysentery,  before  his  month  became  fairly  sore  ! !  He 
fully  recovered. 

Though  mercury  had,  in  this  manner,  such  commanding  influence 
over  the  disease,  still  experience  here  was  not  always  uniform,  for 
there  were  several  vexatious  instances  where  it  failed.  I  do  not 
speak  of  the  fatal  cases,  of  which,  unhappily  we  had  fifteen,  (for  in 
them  neither  laxatives,  astringents,  fomentations,  blisters,  opiates, 
mercurial  frictions  on  the  abdomen,  nor  calomel  pushed  to  salivation, 
ever  were  able  to  keep  off  the  unhappy  event,)  but  expressly  of 
those  few  instances  where  the  patients,  after  being'apparently  cured, 
relapsed  without  any  assignable  cause,  or  where  ptyalism  mitigated 
the  symptoms  somewhat — perhaps  even  suspended  the  disease  en- 
tirely until  the  mouth  was  well,  and  then  it  returned  with  much  of 
its  original  violence.  The  disease  thus  ran  into  the  chronic  form, 
and  harassed  the  patient  for  weeks,  or  even  months — with  the  va- 
rious symptoms  arising  from  a  weak,  irritable  condition  of  the  primae 
via3,  irregular  hepatic  secretion,  and  imperfect  formation  of  the 
chyme. — The  chief  of  these  symptoms  were  vomiting  after  meals, 
night  sweats,  febriculae,  watching,  arid  skin,  pains  in  the  lower  belly, 
occasional  tenesmus,  frequent  costiveness,  followed  by  spontaneous 
diarrhoea  and  discharges  of  blood,  attended  also  with  frequent  pro- 
lapsus ani  and  difficult  micturition. 

In  conducting  the  cure,  very  delicate  management  was  requisite  ;, 
— in  fact  the  disease  required  rather  to  be  led  than  driven.  A  strict- 
ly regulated  diet,  and  the  use  of  flannel  next  the  skin,  were  of  the 
highest  consequence.  At  the  same  time  the  patient  was  put  under 
a  gentle  and  gradual  course  of  calomel,  taking  three  or  four  grains 
morning  and  evening,  and  rubbing  in  a  portion  of  mercurial  ointment 
on  the  belly  and  right  side.  Laxatives  and  astringents  were  employ- 
ee! occasionally,  but,  above  all,  the  greatest  use  was  made  of  opium 
both  internally,  and  locally  per  anum,  and  it  really  effected  most 
conspicuous  benefit.  Sulphate  of  zinc  I  now  and  then  tried  ;  but 
from  the  nausea  which  it  excited,  even  in  three  grain  pills  morning 
and  evening,  and  from  its  apparent  inefficacy  in  the  disease,  I  should 
scarcely,  in  future,  be  tempted  to  give  it  further  trials.  The  tonic 
power  of  Peruvian  lark  was  very  useful  both  as  an  astringent  to  the 
bowels,  and  as  a  restorative  to  the  whole  system.  When  the  mouth 
was  recovered  from  the  first  gentle  course  of  mercury,  if  the  com- 
plaint had  not  yielded,  I  did  not  hesitate  to  use  calomel  again  and 
again  in  the  same  gradual  manner,  till  the  gums  were  repeatedly 
somewhat  affected,  and  then  gave  tonics  as  before.  This  assiduous 
perseverance,  and  the  patient  attention  which  it  implied,  I  am  happy 
to  say,  were  well  rewarded — many  patients  were  thus  recovered 
from  a  state  — not  hopeless  indeed — but  very  precarious,  and  were 
re-established  in  firm  health. 

It  is  worthy  of  remark  that  relapses  in  this  disease  are,  more 


OF  NEW  ORLEANS.  387 

than  in  any  other  I  know,  peculiarly  frequent  and  fatal.  Moat  of 
the  deaths  occurred  in  relapsed  cases.  In  one  instance  a  patient  re- 
lapsed thrice,  and  the  third  was  more  untractable  than  the  preced- 
ing ;  in  him  a  large  abscess  sprang  up  in  the  epigastric  region  towards 
the  close  of  the  disease,  and  burst— discharging  profusely  bloody 
and  bilious  sordes,  evincing  that  the  abscess  had  its  radicle  in  the 
liver,  as  dissection  afterwards  more  clearly  proved.  In  two  or  three 
instances,  the  belly,  during  convalescence,  became  tumid  and  tense 
— and  remained  thus  for  a  considerable  time  after  their  recovery 
from  dysentery.  This  tumefaction  the  patients  attributed  to  the  state 
of  their  liver,  and  believed  themselves  to  be  **  Liver-grown,"  as  they 
expressed  it ;  but  from  the  spontaneous  and  ofter  sudden  disappear- 
ance of  this  peculiar  symptom,  I  am  rather  induced  to  ascribe  thft 
distension  to  the  secretion  and  extrication  of  flatus,  from  the  weak- 
ened villous  coat  of  the  intestines,  and  from  its  accumulation  in  their 
convolutions  and  in  the  cells  of  the  colon. 

•I  never  had  any  reason  to  suspect  this  disease,  or  the  pyrexia 
which  ushered  it  in,  and  attended  it,  to  be  in  any  measure  contagious  ^ 
inasmuch  as  it  did  not  appear  indiscriminately,  or  spread  from  man. 
to  man  by  communication;  but  was  entirely  confined,  both  primarily 
and  ultimately,  to  that  portion  of  the  crew,  whom  duty  led  on  shore, 
or  who  were  employed  in  the  boats  on  the  river  Apalachicola.  Every 
boat's  crew  that  returned  from  such  service  was  sure  to  bring  a  re- 
inforcement to  the  sick  list ;  and  out  of  six  new  patients  thus  added, 
three  would  be  found  labouring  under  ardent  fever — (for  the  weather 
was  by  this  time  hot,)  and  the  remaining  three  under  dysentery  of 
the  above-described  type.  From  this  fact,  repeatedly  and  constantly 
observed,  I  am  induced  to  draw  the  conclusion  that  both  these  com- 
plaints are  excited  by  one  and  the  same  special  miasma  ;  for,  of  a 
given  number  of  men  taken  ill  in  'consequence  of  exposure  to  the 
predisposing  and  exciting  causes,  it  seemed  as  uncertain  as  the  toss-up 
of  a  half-penny  whether  the  one  or  the  other  of  these  diseases  would 
develope  itself  in  an  individual  or  individuals  so  exposed.  This, 
however,  I  advance  rather  as  an  opinion  countenanced  by  facts,  than 
as  being  in  itself  a  fact ;  for  I  am  well  aware  of  the  weight  of  au- 
thority that  is  against  me  on  this  point,  and  must  confess  that  my 
means  of  observation  have  not  been  sufficiently  extensive  to  warrant 
a  positive  induction. 


PART  III. 

TROPICAL  HYGIENE ; 

OR, 

HINTS  FOR  THE  ^RESERVATION  OF  HEALTH  IN  ALL  HOT 
CLIMATES. 


. 

Prestat  argento,  superatque  f  ulvum 
Sanitas  aurum,  superatque  censum 
Quamyis  ingentem,validaeque  vires 
Omnia  prestant. 

-  * 

As  prevention  is  better  than  cure,  it  might  seem  more  natural  to 
have  detailed  the  means  of  preserving  health,  before  entering  on  the 
treatment  of  diseases  themselves.  This  plan  has  accordingly  been 
adopted  by  Dr.  Moseley  ;  but  I  think  it  an  injudicious  one.  In  des- 
cribing effects,  I  have  traced  pretty  minutely  their  causes ;  and  in  that 
way  must  have  obviated  a  vast  tautology  in  this  part  of  the  work. 
Besides,  by  exhibiting  both  causes  and  effects  in  one  view,  I  am  con- 
Yinced  that  the  salutary  impression  is  always  stronger.  For  example  ; 
could  the  gravest  anathema,  denounced  with  all  due  solemnity,  against 
sleeping  ashore  on  insalubrious  coasts,  excite  half  so  much  interest 
in  the  mind  of  an  European,  as  the  fatal  catastrophe  at  Edam  Island  ? 
—But  another  great  point  is  gained  by  this  plan.  The  various  reason- 
ings and  remarks  which  accompanied  the  treatment  and  description  of 
diseases,  will  enable  even  the  general  reader  to  comprehend,  with  in- 
finitely more  ease,  the  rationale  of  those  prophylactic  measures,  which 
1  am  now  to  delineate  ;  and  which,  at  every  step,  will  recall  to  his 
memory  the  deplorable  effects  resulting  from  a  contempt  of  them. 
This  is  no  inconsiderable  object  ;  for  we  all  know  the  gratification 
•which  springs  from  understanding  what  we  read.  And,  in  truth,  it  is  a 
pleasure — nay,  it  is  a  positive  advantage,  to  be  able  to  explain,  even, 
on  a  false  theory,  the  principles  of  a  useful  practice.  But  as  theory, 
in  this  instance  at  least,  is  the  legitimate  offspring  of  experience,  so, 
I  trust,  the  superstructure  is  as  firm  as  the  foundation. 

It  has  been  remarked,  by  a  very  competent  judge, ««  that  by  taking 
the  general  outline  of  indigenous  customs  for  our  guide,  if  we  err,  it 
will  be  on  the  safe  side."  This  is  a  good  rule  ;  but  unfortunately  it 
is  impracticable — by  those,  at  least,  who  stand  most  in  need  of  one. 
For,  before  we  can  become  acquainted  with  these  indigenous  customs, 
it  will  be  too  late  for  many  of  us  to  adopt  them  ;  and  could  we  see 
them  at  one  coup  <Ten7,  when  we  first  "enter  a  tropical  climate,  how 
are  we  to  avail  ourselves  of  them,  unless  they  happen  to  be  in  uni- 
aon  with  the  habits  of  our  countrymen  already  resident  there,  who 
would  not  fail  to  sneer  at  the  adoption  of  any  plan  which  had  not  the 


TROPICAL  HYGIENE. 

sanction  of  their  superior  experience.  But  independently  of  this, 
it  would  be  strange  if  the  progress  which  has  been  made  in  the 
knowledge  of  the  animal  economy,  as  well  as  in  other  sciences,  did 
not  enable  us  to  correct  many  "  indigenous  customs,"  which,  in  re- 
ality, have  ignorance,  superstition,  or  even  vice  for  their  foundation. 
This  applies  particularly  to  the  Eastern  World,  where  the  natives 
are  neither  in  a  state  of  nature,  nor  yet  refinement ;  but  where  we 
see  a  strange  medley  of  ludicrous  and  ridiculous  customs— of  Hindoo 
and  Mahommedan  manners,  from  which  the  European  philosopher 
may  glean  much  useful  local  knowledge,  while  he  exercises  his  rea- 
son and  discrimination,  in  separating  the  grain  from  the  chaff. 

Another  advice  has  been  given  us  ;  namely,  to  observe  and  imitate 
the  conduct  of  our  own  countrymen  long  resident  in  the  climate* 
This  is  certainly  the  most  practicable  ;  but,  in  my  opinion,  it  is  not 
the  safest  plan.  And  for  this  plain  reason,  that  residence  alone  con- 
fers on  them  immunities  and  privileges,  of  which  it  would  be  death 
for  us,  in  many  instances,  to  claim  a  participation,  before  the  period 
of  our  probation  has  expired.  I  think  I  shall  be  able  to  show,  here- 
after, that  the  unseasoned  European  may  apply,  with  safety,  certain 
preventive  checks  to  the  influence  of  climate,  which  would  be  in- 
convenient, if  not  hazardous,  to  those  on  whom  the  said  influence 
had  long  operated.  The  stranger,  then,  must  go  with  the  general 
stream  of  society,  especially  at  the  beginning  ;  but  there  is  no  situa- 
tion even  here,  where  he  may  not  obviate,  in  a  great  measure,  the 
first  and  most  dangerous  effects  of  the  new  climate,  by  a  strict  obser- 
vance of  two  fundamental  rules  — TEMPERANCE  and  COOLNESS.  The 
latter,  indeed,  includes  the  former  ;  and,  simple  as  it  may  appear,  it 
is,  in  reality,  the  grand  principle  of  Inter-tropical  Hygiene,  which 
must  ever  be  kept  in  view,  and  regulate  all  our  measures  for  the 
preservation  of  health.  nvit  " 

Common  sense,  independently  of  all  observation  or  reasoning  on 
the  subject,  might,  a  priori,  come  to  this  conclusion.  From  heat 
spring  all  those  effects  which  originally  predispose  to  the  reception  or 
operation  of  other  moribific  causes.  And  how  can  we  obviate  these 
effects  of  heat  but  by  calling  in  the  aid  of  its  antagonist,  cold*.  To 
the  sudden  application, of  the  latter,  after  the  former  has  effected  its 
feaneful  influence  on  the  human  framed  1  have  traced  mos't  of  thpse 
diseases  attributable  to  climate  ;  nothing,  therefore,  can  be  more  rea- 
sonable, than  that  our  great  object  is  to  moderate,  by  all  possible 
means,  the  heat,  and  habituate  ourselves  from  the  beginning  to  the 
impressions  of  cold.  The,  result  will  be,  that  we  shall  thereby  bid 
defiance  to  the  alternations  or  vicissitudes  of  both  these  powerful 
agents.  This  is,  in  truth,  the  guand  secret  of  counteracting  the  influ- 
ence of  tropical  climates  on  European  constitutions  ;  and  its  practical 
application  to  the  common  purposes  of  life.,  as  well  as  to  particular 
exigencies,  it  shall  now  be  my  task  to  render  as  easy  and  intelligible 
as  I  can.  For  the  sake  of  perspicuity,  1  shall  h^re,  as  hitherto,  class 
my  observations  under  separate  heads;  though,  from  the  nature  of 
the  subject,  1  shall  consider  myself  much  less  tied  down  to  forrasy 
titan  in  the  two  preceding  parts  of  the  essay  ;  and  consequently  shall 

*  I  overlook  the  useless  litigation  respecting  cold  being  the  absence  of  heat. 


3§0  INFLUENCE  OF  TR0F1CAL  CLIMATES,  &(C. 

not  be  over  nice  in  confining  myself  to  a  dry,  didactic  rehearsal  of 
medical  rules  and  precautions.  The  scope  and  purport  of  any  di- 
gression, however,  shall  always  point  to  my  principal  design — the 
preservation  of  health. 


,  DRESS. 

SE«.  I. — I  shall  not  stop  here,  to  inquire  whether  this  be  an  unne- 
cessary luxury  of  our  own  invention,  or  originally  designed  for  us  by 
our  Creator.  The  force  of  habit  is  no  doubt,  great ;  and  the  Cana- 
dian who,  in  reply  to  the  European's  inquiry,  respecting  his  ability 
to  bear  cold  applied  to  his  naked  body,  observed,  that  "  he  was  all 
face"  gave  no  bad  elucidation  of  the  affair.  Passing  over  the  great 
African  peninsula,  where  man  enjoys  that  happy  state  of  nudity  and 
nature,  mental  as  well  as  corporeal,  on  which  our  learned  philoso- 
phers have  lavished  such  merited  encomiums,  we  come  to  the  ancient 
and  civilized  race  of  Hindoos  ;  and  here,  too,  we  shall  be  constrained 
to  admire  the  almost  omnipotent  power  of  custom,  as  exemplified  in 
the  persons  of  some  of  the  first  objects  that  arrest  our  attention. 

The  habiliment  of  the  Bengal  dandy  or  waterman,  who  rows  or 
drags  our  budjrow  up  the  Ganges,  consists  in  a  small,  narrow  piece  of 
cloth  [doty]  passed  between  the  thighs,  and  fastened  before  and  be- 
hind to  a  piece  of  stout  packthread,  that  encircles  the  waist.  In  this 
dress,  or  undress,  corresponding  pretty  nearly  to  the  fig-leaf  of  our 
great  progenitor,  he  exposes  hi*  skin  to  the  action  of  a  tropical  sun — 
a  deluge  of  rain,  or  a  piercing  north- wester,  with  equal  indifference  ! 
After  "  tugging  at  the  oar,"  for  hours  together,  in  the  scorching 
noontide  heat,  till  perspiration  issues  from  every  pore,  he  darts  over- 
board, when  necessary,  with  the  track-rope  on  his  shoulder,  and 
wades  through  puddles  and  marshes — this  moment  up  to  the  middle, 
or  the  shoulders  in  water — the  next,  in  the  open  air,  with  a  rapid 
evaporation  from  the  whole  surface  of  his  body  !  All  this,  too,  on  a 
scanty  meal  of  rice,  being  seldom  paid  more  than — three  pence  per 
day  board  wages  ! 

Here  is  one  of  those  indigenous  customs,  which  we  shall  not  find  it 
very  safe  to  imitate ;  though  many  of  our  keen  European  sportsmen 
have  undergone  for  pleasure,  or  in  search  of  a  snipe,  what  the  poor 
dandy  is  forced  to  perform  for  a  livelihood.  It  is  hardly  necessary 
to  remark,  that  such  pursuits  are  at  the  risk  of  life,  and  are  highly 
destructive  of  health.  ^  - 

But,  independent  of  habit,  Nature  has  previously  done  a  great 
deal  towards  the  security  of  the  dandy,  by  forming  the  colour,  and  in 
some  respects  the  texture,  of  his  skin,  in  such  a  manner,  that  the  ex- 
treme veisels  on  the  surface  are  neither  so  violently  stimulated  b> 
the  heat,  nor  so  easily  struck  torpid  by  sudden  transitions  to  cold. 
Certain  it  is,  that  the,  action  of  the  perspiratory  vessels,  too,  is  dif- 
ferent from  that  of  the  same  vessels  in  Europeans — at  least,  they  se- 
crete a  very  different  kind  of  fluid  ;  being  more  of  an  oily  and  tena- 
cious nature  than  the  sweat  of  the  latter.  This,  in  conjunction  with 
the  oil  so  assiduously  and  regularly  rubbed  over  the  surface  every 


+  f   .          TROF1CAL  ttYOIENE.  39} 

*!ay  by  all  ranks  and  casts  of  both  sexes,  must  greatly  tend  to  preserve 
a  softness  and  pliability  of  the  skin,  and  a  moderate,  equable  flow  of 
perspiration.* 

But  if  we  look  beyond  the  hardy  and  labouring  casts  of  natives,  we 
observe  both  Hindoo  and  Mahommedan  guarding  most  cautiously 
against  solar  heat,  as  well  as  cold.  The  turban  and  cummerband 
meet  our  eye  at  every  step  : — the  former,  to  defend  the  head  from 
the  direct  rays  of  a  powerful  sun  ;  the  latter,  apparently,  for  the  pur- 
pose of  preserving  the  important  viscera  of  the  abdomen  from  the 
deleterious  impressions  of  cold.  This  [cummerband]  is  certainly  a 
most  valuable  part  of  their  dress  ;  and  one  that  is  highly  deserving 
of  imitation. 

Such  are  the  essential^  articles  of  native  dress  ;  the  light,  flowing 
robes  of  cotton,  silk,  calico,  &c.  varying  according  to  the  taste  or  cir- 
cumstances of  the  wearer,  and  being  more  for  ornament  than  use.  A 
very  good  substitute  for  the  turban  is  a  large  cotton  handkerchief, 
folded  up  in  the  hat ;  and  were  we  are  exposed  to  the  direct  influence 
of  solar  heat,  it  may,  with  much  advantage,  be  kept  moistened  with 
water.  In  situations  where  atmospherical  vicissitudes  are  sudden,  a 
fine  shawl  round  the  waist  forms  an  excellent  cummerband,  and 
should  never  be  neglected,  especially  by  those  who  have  been  some 
time  in  the  country,  or  whose  bowels  are  in  any  degree  tender. 

When  we  enter  the  tropics,  we  must  bid  adieu  to  the  luxury  of  li- 
nen— if  what  is  both  uncomfortable  and  unsafe,  in  those  climates,  can 
be  styled  a  luxury.  There  are  many  substantial  reasons  for  so  do- 
ing. Cotton,  from  it  slowness  as  a  conductor  of  heat  is  admirably 
adapted  for  the  tropics.  It  must  be  recollected,  that  the  temperature 
of  the  atmosphere,  sub  dio,  in  the  hot  seasons,  exceeds  that  of  the 
blood  by  many  degrees  ;  and  even  in  the  shade,  it  too  often  equals, 
or  rises  above,  the  heat  of  the  body's  surface,  which  is  always,  dur- 
ing health,  some  degrees  below  97°.  Here,  then,  we  have  a  cover- 
ing which  is  cooler  than  linen  ;  inasmuch  as  it  conducts  more  slowly 
the  excess  of  external  heat  to  our  bodies.  But  this  is  not  the  only 
advantage,  though  a  great  one.  When  a  vicissitude  takes  place,  and 
the  atmospherical  temperature  sinks  suddenly  far  below  that  of  the 
body,  the  cotton,  still  faithful  to  its  trust,  abstracts  more  slowly  the 
heat/rom  our  bodies,  and  thus  preserves  a  more  steady  equilibrium 
there.  To  all  these  must  be  added  the  facility  with  which  it  absorbs 
the  perspiration  ;  while  linen  would  feel  quite  wet,  and  during  the 
exposure  to  a  breeze  under  such  circumstances,  would  often  occa- 
sion a  shiver,  and  be  followed  by  dangerous  consequences. 

That  woollen  and  cotton  should  be  warmer  than  linen  in  low  tem- 
peratures, will  be  readily  granted  ;  but  that  it  should  be  cooler  in 
high  temperatures,  will  probably  be  much  doubted.  If  the  following 
easy  experiment  be  tried,  the  result  will  decide  the  point  in  question. 
Let  two  beds  be  placed  in  the  same  room,  at  Madras,  we  will  say, 

*  It  is  curious,  that  the  upper  classes  of  native  ladies,  especially  Mahommedan, 
as  if  determined  that  nothing  of  European  complexion  should  appertain  to  them, 
are  in  the  habit  of  staining  red,  -with  the  mindy  or  hinna  plant,  the  palms  of 
their  hands  and  soles  of  their  feet,  the  only  parts  of  the  external  surface  where 
the  rele  mucosum,  or  seat  of  colour  among  them,  cannot  maintain  its  deep  tint,  on 
account  Of  the  friction. 


392  INFLUENCE  OF  TROPICAL  CLIMATES,  &C. 

when  the  thermometer  stands  at  90° ;  and  let  one  be  covered  with  a 
pair  of  blankets,  the  other  with  a  pair  of  linen  sheets,  during  the 
day.  On  removing  both  coverings  in  the  evening,  the  bed  on  which 
were  placed  the  blankets,  will  be  found  cool  and  pleasant ;  the  other 
uncomfortably  warm.  The  reason  is  obvious.  The  linen  readilj 
transmitted  the  heat  of  the  atmosphere  to  all  parts  of  the  subjacent 
bed  ;  the  woollen,  on  the  contrary,  as  a  non-conductor,  prevented 
the  bed  from  acquiring  the  atmospherical  range  of  temperature, 
simply  by  obstructing  the  transmission  of  heat  from  without.  This 
experiment  not  only  proves  the  position,  but  furnishes  us  with  a 
grateful  and  salutary  luxury,  free  of  trouble  or  expense. — The  mu- 
sical ladies  of  India  are  not  unacquainted  with  this  secret,  since  they 
take  care  to  keep  their  pianos  well  covered  with  blankets  in  the  hot 
season,  to  defend  them  from  the  heat,  and  prevent  their  warping. 

From  this  view  of  the  subject,  flannel  might  be  supposed  superior 
to  cotton;  and  indeed,  at  certain  seasons,  in  particular  places — for 
instance,  Ceylon,  Bombay,  and  Canton,  where  the  mercury  often 
takes  a  wide  range,  in  a  very  short  space  of  time,  the  former  is  a 
safer  covering  than  the  latter,  and  is  adopted  by  many  experienced 
and  seasoned  Europeans.  But,  in  general,  flannel  is  inconvenient,  for 
three  reasons.  First,  it  is  too  heavy  ;  an  insuperable  objection. 
Secondly,  where  the  temperature  of  the  atmosphere  ranges  pretty 
steadily  a  little  below  that  of  the  skin,  the  flannel  is  much  too  slow  a 
conductor  of  heat  from  the  body.  Thirdly,  the  spicul  of  flannel 
prove  too  irritating,  and  increase  the  action  of  the  perspiratory  ves- 
sels on  the  surface,  where  our  great  object  is  to  moderate  that  pro- 
cess. From  the  second  and  third  objections,  indeed,  even  cotton  or 
calico  is  not  quite  free,  unless  of  a  fine  fabric,  when  its  good  quali- 
ties far  counterbalance  any  inconvenience  in  the  above  respects. 

In1  some  of  the  upper  provinces  of  Bengal,  where  the  summer  is 
intensely  hot,  and  the  winter  sharp,  the  dress  of  native  shepherds, 
who  are  exposed  to  all  weather,  consists  in  a  blanket  gathered  in  at 
one  end,  which  goes  over  the  head,  the  rest  hanging  down  on  all 
sides  like  a  cloak.  This  answers  the  triple  purpose  of  a  chattah  in 
the  summer,  to  keep  out  the  heat — of  a  tent  in  the  rainy  season  to 
throw  off  the  wet — and  of  a  coat  in  the  winter,  to  defend  the  body 
from  the  piercing  cold.  Hence  our  ridicule  of  the  Portuguese  and 
Spaniards,  in  various  parts  of  the  world,  for  wearing  their  long  black 
cloaks  in  summer,  **  to  keep  them  coo/,"  is  founded  on  prejudice  ra- 
ther than  considerate  observation. 

The  necessity  which  tyrant  custom — perhaps  policy,  has  imposed 
on  us,  of  continuing  to  appear  in  European  dress — particularly  in 
uniforms,  on  almost  all  public  occasions,  and  in  all  formal  parties, 
under  a  burning  sky,  is  not  one  of  the  least  miseries  of  a  tropical 
life  !  It  is  true,  that  this  ceremony  is  often  waved,  in  the  more  so- 
cial circles  th?t  gainer  round  the  supper-table,  where  the  light,  cool, 
and  elegant  vestures  of  the  East,  supersede  the  cumbrous  garb  of 
Northern  climates.  It  is  certainly  laughable,  or  rather  pitiable 
enough,  to  behold,  for  some  time  after  each  fresh  importation  from 
Europe,  a  number  of  griffinish  sticklers  for  decorum,  whom  no  per- 
suasions can  induce  to  cast  their  exuviv,  even  in  the  most  affable 


TROPICAL  HYGIENE.  393 

company,  pinioned,  as  it  were,  in  their  stiff  habiliments,  while  the 
streams  of  perspiration  that  issue  from  every  pore,  and  ooze  through 
various  angles  of  their  dress,  might  almostrinduce  us  to  fear  that  they 
were  on  the  point  of  realizing  Hamlet's  wish  ;  and  that,  in  good  ear- 
nest, their 

«  Solid  flesh  would'inelt— 
"  Thaw,  and  resolve  itself  in  a  dew  !" 

It  too  often  happens,  however,  that  a^  pice  of  ceremony  attaches 
to  the  kind  host — or  perhaps  hostess,  in  which  case,  as  no  encourage- 
ment will  he  given  to  derobe,  the  poor  griffin  must  fret  and  fume,  with 
prickly  heat  and  perspiration,  till  the  regalement  is  concluded.  .  By 
this  time  he  is,  doubtless,  in  an  excellent  condition  for  encountering 
the  raw,  chilling  vapours  of  the  night,  on  his  way  home  ! 

It  were  "  a  consummation  devoutljlto  be  wished,'1- — though,  I  fear, 
little  to  be  expected,  that  the  European  badges  of  distinction,  in  ex- 
terior decoration,  could  be  dispensed  with,  at  all  festivals,  public 
and  private — formal,  social,  or  domestic,  within  the  torrid  zone. 
Tt  requires  but  the  m#st  superficial  glance  to  perceive,  that  cool- 
ness during  our  repasts  is  salutary,  as  well  as  comfprtable  ;  and 
that,  from  the  extensive  sympathies  existing  between  the  skin  and 
several  important  organs,  particularly  the  stomach  and  liver,  the 
converse  of  the  position  is  equally  true  ;  especially  as,  in  the  latter 
case,  we  are  led  a  little  too  much  to  the  use  of  **  gently  stimulating 
liquids,"  to  support  thet  discharge  ;  the  bad  consequences  of  which 
are  pointed  out  at  page  16  of  this  essay,  and  will  be  again  consider- 
ed in  the  section  on  Drink.* 

There  is  an  injurious  practice,  into  which  xalmost  every  European 
is  led,  on  first  visiting  a  tropical  climate,  but  particularly  the  Eastern 
world,  which  has  never  been  noticed,  I  believe,  by  medical  writers, 
though  well  entitled  to  consideration.  In  the  country  last  mentioned, 
body  linen,  or  rather  cotton  is  remarkably  cheap,  and  washing  is  per- 
formed on  such  moderate  terms,  that  one  hundred  shirts  may  be  even 
bleached  for  about  10s.  sterling,  on  an  average.  A  large  stock  of 
these  useful  articles  is,  then,  the  first  object  of  northern  strangers, 
which  "  Blackey^  indeed,  knows  full  well,  and  takes  especial  care  to 
turn  to  his  own  advantage.  But  this  is  a  trifling  consideration. — The 
European,  contemplating,  with  great  satisfaction  the  multitude  of 
changes  he  has  thus  cheaply  amassed,  and  calculating  the  very  rea- 
sonable terms  of  ablution,  determines  to  enjoy  in  its  fullest  extent  a 
luxury,  which  he  deems  both  salutary  and  grateful,  independently  of 
all  considerations  respecting  appearance.  It  is  therefore  very  com- 
mon to  see  him  shift  his  linen  three  or  four  times  a-day,  during  the 
period  of  his  novitiate,  when  perspiration  is  indeed  superabundant. 
But,  let  me  assure  him,  that  he  is  pursuing  an  injudicious,—  nay,  an 
injurious  system  ;  that  the  fluid  alluded  to,  already  in  excess,  is  thus 
powerfully  solicited  ;  and  the  action  of  the  perspiratory  vessels,  with 

*  I  am  sorry  to  learn  that  European  Habiliments  and  Regimentals  are  still 
more  in  use  on  all  occasions  of  festivity  now,  than  in  my  time,  in  India.  Nothing 
can  be  worse  policy,  with  all  due  submission  to  their  High  Mightinesses  the  Na- 
bobs of  the  East- 

50 


3$4  TROPICAL  ȴ6IENE. 

all  their  associations,  morbidly  increased,  instead  of  being  restrained. 
But  what  is  to  be  done  ?  The  newly  arrived  European  justly  ob- 
serves, that  he  finds  himself  drenched  with  sweat  three  or  four  times 
a-day,  in  which  state  he  cannot  remain  with  either  safety  or  comfort 
Certainly  it  would  be  useless  to  point  out  the  evil,  without  suggesting 
the  remedy  ;  and  happily  it  may  be  obviated  to  a  considerable  extent, 
in  a  very  simple  and  easy  manner.  In  those  climates,  when  linen 
becomes  wet  in  a  few  hours  with  perspiration,  it  by  no  means  follows 
that  it  is  soiled  thereby,  in  any  material  degree.  It  should  not,  there- 
fore, be  consigned  to  the  wash,  but  carefully  dried,  and  worn  again, 
once,  or  even  twice  ;  and  that,  too,  without  the  smallest  infringe- 
ment on  the  laws  of  personal  cleanliness,  but  with  the  most  salutary 
effect  on  the  health.  It  is  astonishing  how  much  less  exhausting  is 
the  linen,  which  has  been  once  or  twice  impregnated  with  the  fluid 
of  perspiration,  than  that  which  is  fresh  from  the  mangle.  By  this 
plan,  no  more  than  one  shirt  is  rendered  unfit  for  use  every  day  ;  and 
in  cool  weather,  or  at  sea,  not  more,  perhaps,  than  four  shirts  a  week. 
Necessity,  the  mother  of  invention,  first  taught  me  this  piece  of 
knowledge,  in  consequence  of  having  lost  my  stock  once,  by  sailing 
suddenly  from  Trincomalee  ;  but  1  know  that,  however  trivial  the 
circumstance  may  appear,  an  attention  to  what  1  have  related,  will, 
in  reality,  prove  more  beneficial  than  precautions  of  seemingly 
greater  magnitude.  Its  rationale  is  in  direct  unison  with  the  grand 
and  fundamental  object  in  tropical  prophylactics  — TO  MODERATE, 

WITHOUT  CHECKING  THE  CUTICULAR  DISCHARGE. 

The  property  which  frequent  change  of  linen  has,  in  exciting  cuti- 
eular  secretion,  and  the  effects  resulting  from  the  sympathy  of  the  skin 
with  the  stomach,  liver,  and  lungs,  may  account,  in  a  great  measure, 
for  the  superior  health  .which  accompanies  cleanliness,  in  our  own 
climate  ;  and,  on  the  contrary,  for  the  diseases  of  the  indigent  and 
slovenly,  which  are  almost  invariably  connected  with,  or  dependent 
on,  irregularity  or  suppression  of  the  cuticular  discharge.  Intelli- 
gent females  well  know  the  peculiar  effect  of  clean  linen  on  them- 
selves, at  particular  periods. 

To  the  above  observations  on  dress,  I  may  add,  that  no  European 
should,  where  he  can  avoid  it,  expose  himself  to  the  sun  between  the 
hours  of  ten  and  four  in  the  day.  If  forced,  during  that  period,  to  be 
out  of  doors,  the  ehattah  should  never  be  neglected,  if  he  wish  to  guard 
against  coup  de  soleil,  or  some  other  dangerous  consequence  of  im- 
prudent exposure. 

FOOD. 

SEC.  II. — Although  I  entirely  agree  with  Celsus,  that — «•  sanis  om- 
nia  ?cma;"  and  with  a  late  eminent  physician,  that  an  attention  to 
quantity  is  of  infinitely  more  consequence  than  quality  in  our  repasts  ; 
and  although  I  also  believe,  that  an  over  fastidious  regard  to  either 
will  render  us  unfit  for  society,  and  not  more  health?  after  all  ;  yet, 
when  we  change  our  native  and  temperate  skies  of  Europe  for  the 
torrid  zone,  many  of  us  may  find,  when  it  is  too  late,  that  we  can 
hardly  attend  too  strictly  t«  the  quantity  and  quality  of  OUF  food,  dur- 


tng  the  period  of  assimilation,  at  least,  to  the  new  climate  ;  and  that 
a  due  regulation  of  this  important  non-natural  will  turn  out  a  power- 
ful engine  in  the  preservation  of  health. 

It  is  notv  pretty  generally  known,  from  dire  experience,  indeed, 
that  instead  of  a  disposition  to  debility  and  putrescency,  an  inflamma- 
tory diathesis,  or  tendency  to  plethora,  characterises  the  European 
and  his  diseases,  for  a  year  or  two,  at  least,  after  his  arrival  between 
the  tropics  ;  and  hence  provident  Nature  endeavours  to  guard  against 
the  evil,  by  diminishing  our  relish  for  food.  But  alas  !  how  prone 
are  we  to  spur  the  jaded  appetite,  not  only  "  by  dishes  tortured  from 
their  native  taste,"  but  by  the  more  dangerous  stimulants  of  wine  or 
other  liquors,  as  well  as  condiments  and  spices,  which  should  be  re- 
served for  that  general  relaxation  and  debility  which  unavoidably  sti- 
pervene  during  a  protracted  residence  in  sultry  climates.  Here  is  an 
instance  where  we  cannot  safely  imitate  the  seasoned  European,  trt- 
deed,  there  are  no  points  of  Hygiene,  to  which  the  attention  of  a 
new  comer  should  be  more  particularly  directed*  than  to  the  quantity 
and  simplicity  of  his  viands  ;  especially  as  they  are  practical  points 
entirely  within  his  own  superintendence,  and  a  due  regulation  of 
which,  is  not  at  all  calculated  to  draw  on  him  the  observation  of 
others — a  very  great  advantage. 

Every  valetudinarian,  particularly  the  hectic,  knows  full  well  the 
febrile  paroxysm  which  follows  a  full  meal :  the  same  takes  place  ia 
every  individual,  more  or  less,  whatever  may  be  the  state  of  health 
at  the  time.  How  cautious,  then,  should  we  J>e,  of  exacerbating 
these  natural  paroxysms,  when  placed  in  situations  where  various 
other  febrific  causes  are  constantly  impending  over,  or  even  assailing 
us  !  The  febrile  stricture  which  obtains  on  the  surface  of  our  bodies, 
and  in  the  secreting  vessels  of  the  liver,  during  the  gastric  digestion 
of  our  food,  as  evinced  by  a  diminution  of  the  cutaneous  and  he- 
patic secretions,  (vide  page  134,)  will,  of  course,  be  proportioned 
to  the  duration  and  difficulty  of  that  process  in  the  stomach,  and 
to  the  quantity  of  ingesta  ;  and  as  a  corresponding  increase  of  the 
two  secretions  succeeds,  when  the  chyme  passes  into  the  intestines, 
we  see  clearly  the  propriety  of  moderating  them  by  abstemiousness, 
since  they  are  already  in  excess  from  the  heat  of  the  climate  aloaft, 
and  this  excess  is  one  of  the  first  links,  in  the  chain  of  causes  and  ef- 
fects, that  leads  ultimately  to  various  derangements  of  function  and 
structure  in  important  organs,  as  exemplified  in  hepatitis,  dysentery, 
and  in  many  parts  of  this  essay. 

That  vegetable  food,  generally  speaking,  is  better  adapted  to  a 
tropical  climate  than  animal,  I  think  we  may  admit,  and  particularly 
among  unseasoned  Europeans  : — not  that  it  is  quicker  or  easier  of 
digestion,  (it  certainly  is  slower  in  this  respect,)  but  it  excites  less 
commotion  in  the  system  during  that  process,  and  is  not  so  apt  to  in- 
duce plethora  afterwards.  It  is  very  questionable  whether  the  an- 
cient Hindoo  legislators  had  not  an  eye  rather  to  policy  than  health, 
when  they  introduced  th£  prohibition  of  animal  food  as  a  divine  man- 
date.— They  probably  thought,  and  in  my  opinion  with  good  reagon, 
that  the  injunction  woold  tend  to  diffuse  a  more  humane  disposition 
among  the  people,  by  strongly  reprobating  the  efiusion  of  blood,  01 


39ti  TitepieiL  HYGIENE. 

depriving  any  being  of  existence  ;  and  these  prejudices  were  ad- 
mirably sustained  by  the  doctrine  of  transmigration. 

But,  whatever  might  have  been  the  medical  objections  of  BRAMHA 
to  carnivorous  banquets,  certain  it  is,  that  a  race  of  what  now  may 
come  under  the  denomination  of  **  natives,"  (the  Mahommedans,) 
amounting  to,  perhaps,  a  seventh  or  eighth  of  the  whole  population, 
make  no  scruple  of  indulging  freely  in  most  kinds  of  animal  food  : 
who,  in  the  face  of  the  shuddering  Hindoo,  will  sacrilegiously  slay 
and  eat  that  great  Indian  deity,  the  cotfc  ;  and  who,  in  their  turn,  look 
with  perfect  abhorrence  on  the  polluted  Englishman,  who  regales 
himself— not,  indeed,  on  four-footed  deity,  but  in  the  Mussulman's 
opinion,  with  worse  than  cannibalism,  on  devil  incarnate — PORK  ! 
Yet  Hindoo,  Mahommedan,  and  European — at  least,  the  two  first, 
while  moderation  is  observed  in  their  respective  meals,  enjoy  equal 
health,  and  attain  equal  longevity. 

If,  however,  we  critically  examine  the  different  casts,  or  rather 
classes  of  society,  in  India,  we  shall  find  that  their  physical  powers 
and  appearances  are  considerably  modified  by  their  manner  of  living. 
Nothing  strikes  the  stranger  with  greater  astonishment,  than  the  per- 
sonal contrast  between  the  rich  and  the  poor  !  Almost  the  whole  of 
the  upper  classes  are  absolutely  FALSTAFFS  ;  and  often  have  I  been 
puzzled  to  know  how  some  of  them  cold  stow  themselves  away  in  a 
palankeen,  and  still  more  so,  how  their  bearers  could  trot  along  under 
the  pressure  of  such  human  porpoises !  The  truth  is.  that  the  Hin« 
dostanee  fops,  (and  most  of  the  superior  orders  are  such,)  pride 
themselves  above  all  things,  on  rotundity  of  corporation,  and  parti- 
cularly on  the  magnitude  of  their  heads. 

To  acquire  such  elegant  distinctions,  one  would  be  tempted  to  sus- 
pect, that  they  occasionally  broke  the  vegetable  regime,  and  indulged 
in  better  fare  than  BRAMHA  thought  proper  to  prescribe.  But  no  ; 
all  is  accomplished  by  ghee  and  indolence !  Of  the  former,  which  is 
a  kind  of  semi-liquid  butter,  made  by  evaporating  the  aqueous  part 
from  the  rich  milk  of  the  buffalo,  they  swill  immense  quantities  ;  and 
whatever  we  may  hear,  from  the  fireside  travellers,  of  Hindoo  tem- 
perance and  abstemiousness,  these  gentry  contrive  to  become  as  bi- 
lious, occasionally,  as  their  European  neighbours,  and  manage  to  cur- 
tail the  natural  period  of  their  existence  full  as  efficaciously  as  their 
brother  "  gourmands"  on  this  side  of  the  water — making  their  exits, 
too,  by  the  same  short  routes  of  apoplexy,  and  other  fashionable  near 
cuts  to  heaven. 

The  lower  or  industrious  classes,  on  the  other  hand,  who  live  al- 
most exclusively  on  vegetables,  certainly  bear  a  striking  resemblance 
to  "  Pharaoh's  lean-fleshed  kine."  But  although  they  have  not  the 
physical  strength  of  a  European,  they  make  up  for  this,  in  what  may 
be  termed  "  bottom;"  for  it  is  well" known,  that  a  native  will  go 
through  three  times  as  much  fatigue,  under  a  burning  sky,  as  would 
kill  an  Englishman  outright — witness  the  palankeen  bearers,  coolies, 
dandies,  hircarrahs,  &c.  Nor  is  temperance  always  a  prominent  fea- 
ture in  the  character  of  these  gentry  ;  for  what  with  bang,  toddy, 
urmck,  opium,  and  oth^Jpebriating  materials,  which  all  countries 
;ce  in  sojue  shape  or  other,  and  which  all  nations  have  shown 


TROPICAL  HYGIENE.  397 

their  ingenuity  in  manufacturing,  they  not  seldom  "  muddle  their 
brains,"  with  as  much  glee  as  the  same  description  of  people  in  our 
own  latitudes.  Those,  on  the  other  hand,  who,  from  local  situation, 
poverty,  or  principle,  adhere  to  the  dictates  of  their  religion  and  cast 
with  great  pertinacity,  and  seldom  admit  animal  food  within  the  cir- 
cle of  their  repast,  (milk  excepted,)  are  certainly  exempted  from 
numerous  ills  that  await  our  and  their  countrymen,  who  transgress 
the  rules  of  temperance.  Yet,  when  they  are  overtaken  by  disease, 
they  have  not  stamina,  and  debility  characterises  the  symptoms. 
Upon  the  whole,  I  am  inclined  to  think  that,  taking  the  average  lon- 
gevity of  all  ranks  and  classes  throughout  the  vast  oriental  peninsula, 
the  period  of  human  life  falls  a  full  eighth  short  of  its  European  range. 
— But  as  this  does  not  quadrate  with  the  opinions  of  speculative  phi- 
losophers at  home,  who  will  equalize  the  age  of  man  all  over  the 
world,  I  shall  cite  the  authority  of  a  very  intelligent  Officer,  whom  I 
have  so  often  quoted  before,  and  who  had  some  twenty  year's  ac- 
quaintance with  the  country  in  question.  "  Longevity,"  says  he, 
•'  certainly  is  not  characteristic  of  India.  Whether  this  is  owing  to 
the  excessive  heat,  or  the  indolence  of  the  upper,  and  drudgery  of 
the  lower  classes,  it  may  be  difficult  to  decide  -r  but  certain  it  is,  that 
we  rarely  see  an  instance  of  any  one  arriving  at  sixty  years  of  age."* 

From  indigenous  customs,  then,  in  respect  to  animal  and  vegetable 
food,  we  ran  draw  no  inference  that  absolutely  prohibits  the/ormer, 
but  enough  to  convince  us,  that  during  the  first  years  of  our  sojourn 
between  the  tropics,  we  should  lean  towards  the  Hindoo  model  ;  and 
as  the  tone  of  the  constitution  becomes  lowered,  or  assimilated,  we 
may  safely  adopt  the  Mahommedan  manners. 

The  period  of  our  meals,  in  hot  climates,  indeed  in  all  climates,  is 
worthy  of  notice.  Both  Hindoo  and  Mahommedan  breakfast  early — 
generally  about  sunrise.  Their  early  hours  cannot  be  too  closely 
imitated  by  Europeans.  This  is  a  very  substantial  meal,  particular- 
ly with  the  Hindoo  ;  for  rarely  does  he  take  any  thing  else  till  the 
evening  :  a  custom,  in  my  opinion,  that  would  be  very  prejudicial  to 
Europeans. — Breakfasts,  among  the  latter,  are  often  productive  of 
more  injury  than  dinners,  especially  where  fish,  eggs,  ham,  &c.  are  de- 
voured without  mercy,  as  not  unfrequently  happens.  Many  a  nau- 
seous dose  of  medicine  have  I  been  obliged  to  swallow,  from  indulg- 
ing too  freely  in  these  articles  ;  but  I  saw  my  error  before  it  was 
too  late.  Most  people  suppose,  that  as  a  good  appetite  in  the  morn- 
ing is  a  sign  of  health,  so  they  cannot  do  sufficient  honour  to  the 
breakfast  table  ;  but  the  stomach,  though  it  may  relish,  is  seldom 
equal  to  the  digestion  of  such  alimentary  substances  as  those  alluded 
to,  where  a  sound  night's  rest  has  hardly  ever  been  procured.  I 
have  seen  the  most  unequivocal  bad  effects  from  heavy  breakfasts, 
in  others,  as  well  as  in  my  own  person ;  and  1  shall  relate  one  in- 
stance that  may  well  serve  as  a  drawback  upon  the  pleasures  of  a 

luxurious  dtjeunte  in  the  East.     Mr.  B Purser  of  a  frigate,  a 

gentleman  well  known  on  the  station,  was  as  determined  a  bonvivant 
as  ever  I  had  the  honour  of  being  acquainted  with. — "  De  mortuis 
nil  nisi  uerum." — He  certainly  had  possessed  a  most  excellent  con- 
*  Oriental  Field  Sports,  vol.  1,  p.  236. 

..i,  ,;L;  ,M 


398  TROPICAL 

stitution  ;  for  I  have  seen  it  perform  prodigies,  and  falsify  the  must 
confident  medical  prognostications  !  He  had  served  many  years  in 
the  West  Indies,  where  he  passed  through  the  usual  ordeals  of  yel- 
low fever,  dysentery,  &c.  with  eclat ;  and  he  came  to  the  East  with 
the  most  sovereign  contempt  for  every  maxim  of  the  Hygeian  god- 
dess !  Although  he  never  neglected,  even  by  accident,  his  daily  and 
nightly  libations  to  the  rosy  god,  yet  no  sportsman  on  the  Caledonian 
mouutains  could  do  more  justice  to  a  Highland  breakfast  than  he. 
Indeed,  he  rarely  went  to  sea  without  an  ample  private  stock  of  epi- 
curian  provender  ;  and  1  have  seen  him  thrown  into  a  violent  parox- 
ysm of  rage,  on  finding  that  two  nice-looking  hams,  which  he  had 
purchased  in  China,  resisted  all  attacks  of  the  knife,  in  consequence 
of  a  certain  ligneous  principle,  which  *•  FUKKI"  had  contrived  to  sub- 
stitute, with  admirable  dexterity,  for  the  more  savoury  fibres  of  the 
porker !  The  items  of  the  last  breakfast  which  he  made,  minuted  on 
the  spot  by  a  Ge.rman  surgeon  who  attended  him,  are  now  before  me. 
The  prominent  articles  were,  four  hard-boiled  eggs,  two  dried  fishes, 
two  plates  of  rice,  with  chillies,  condiments,  and  a  proportionate  al- 
lowance of  bread,  butter,  coffee,  &c.  Many  a  time  had  I  seen  him 
indulge  in  this  kind  of  fare  with  perfect  impunity  ;  but  all  things  have 
an  end,  and  this  proved  his  final  breakfast !  He  was  almost  immedi- 
ately taken  ill,  and  continued  several  days  in  the  greatest  agony  im- 
aginable !  Notwithstanding  all  the  efforts  of  the  surgeon,  no  passage 
downwards  could  ever  be  procured  till  a  few  hours  before  his  death, 
when  mortification  relaxed  all  strictures.  Let  the  fate  of  the  dead 
prove  a  warning  to  the  living! 

The  newly  arrived  European  should  content  himself  with  plain 
breakfasts  of  bread  and  butter,  with  tea  or  coffee  ;  and  avoid  indulg- 
ing in  meat,  fish,  eggs,  or  buttered  toast.  The  latter  often  occasions 
rancidity,  with  nausea  at  the  stomach,  and  increases  the  secretion  of 
bile,  already  in  excess.  Indeed,  a  glance  at  master  Babachee,  but- 
tering our  toast  with  the  greasy  wing  of  a  fowl,  or  an  old,  dirty  piece 
of  rag,  will  have  more  effect  in  restraining  the  consumption  of  this 
article,  than  any  didactic  precept  which  I  can  lay  down  ;  and  a  pic- 
turesque sight  of  this  kind  may  be  procured  any  morning,  by  taking  a 
stroll  in  the  purlieus  of  the  kitchen. 

In  regard  to  dinner,  Europeans  appear  of  late  to  study  conveni- 
ence rather  than  health,  by  deferring  that  meal  till  sunset.  This  was 
not  the  case  some  forty  or  fifty  years  ago  ;  and  many  families,  even 
now,  dine  at  a  much  earlier  hour,  except  when  tyrant  custom  and 
ceremony  prevent  them.  In  truth,  the  modern  dinner  in  India  is 
perfectly  superfluous,  and  too  generally  hurtful.  The  tiffin,  at  one 
o'clock,  consisting  of  light  curries,  or  the  like,  with  a  glass  or  two  of 
wine,  and  some  fruit,  is  a  natural,  a  necessary,  and  a  salutary  repast. 
—  But  the  gorgeous  table — the  savoury  viands  — the  stimulating  wines 
of  the  evening  feast,  prolonged  by  the  fascination  of  social  converse, 
greatly  exacerbate  the  nocturnal  paroxysm  of  fever  imposed  on  us  by 
the  hand  of  nature,  and  break  with  feverish  dreams,  the  hours  which 
should  be  dedicated  to  repose  !  The  consequences  resulting  from 
this  are  quite  obvious.  It  may  be  observed,  that  the  natives  them- 
selves  make  their  principal  meal  at  sunset,  when  the  heat  is  less  dis- 


TROPICAL  HYOIESK. 

tressing,  and  insects  neither  so  numerous  nor  teaziog  ;  but  it  must  be 
recollected,  that  they,  in  general,  eat  nothing  between  breakfast  and 
dinner  ;  and  that  among  the  Hindoos  and  lower  classes  of  Mahomme 
dans,  &c.  the  evening  meal  is  by  no  means  of  a  stimulating  quality, 
while  no  provocative  variety,  or  other  adrentitious  circumstances, 
can  have  much  effect  in  goading  the  appetite  beyond  its  natural  lerel. 
Add  to  this,  that  in  the  upper  provinces,  among  Mahommedans  of  dig- 
tinction,  who  can  afford  more  substantial,  and  animal  food,  the  dinner 
hour  is  one  or  two  o'clock,  and  after  that,  little  or  nothing,  except 
coffee,  sweetmeats,  or  fruit,  is  taken  during  the  evening. 

He,  then,  who  consults  his  health  in  the  Eastern  world,  or  in  any 
tropical  climate,  will  beware  of  indulging  in  this  second  and  unneces- 
sary dinner,  particularly  during  the  period  of  his  probation  ;  but  will 
rather  be  satisfied  with  the  meridian  repast,  aa  the  principal  meal, 
when  tea  or  coffee,  at  six  or  seven  o'clock  in  the  evening,  will  be 
found  a  grateful  refreshment.  After  this,  bis  rest  will  be  as  natural 
and  refreshing,  as  can  be  expected  in  such  a  climate  ;  an'd  he  will 
rise  next  morning  with  infinitely  more  vigour,  than  if  he  had  crowned 
a  sumptuous  dinner  with  a  bottle  of  wine  the  preceding  evening. 
Let  but  a  trial  of  one  week  put  these  directions  to  the  test*  and  they 
will  be  found  to  have  a  more  substantial  foundation  than  theory. 
r  Of  supper  it  is  not  necessary  to  speak,  as  it  is  a  mere  matter  of 
ceremony  in  hot  climates,  excepting  after  assemblies,  or  on  some 
public  occasions,  which  indeed  are  badly  suited  to  the  torrid  zone. 

A  limited  indulgence  in  fruits,  during  the  first  year,  is  prudent. 
Although  I  myself  never  had  any  reason  to  believe  that  they  actually 
occasioned  dysentery,  yet,  where  the  intestines  are  already  in  an  ir- 
ritable state,  from  irregular  or  vitiated  secretions  of  bile,  they  cer- 
tainly tend  to  increase  that  irritability,  and  consequently  predispose 
to  the  complaint  in  question.  Particular  kinds  of  fruit,  too,  have  pe- 
culiar effects  on  certain  constitutions.  Thus,  mangoes  have  some- 
thing stimulating  and  heating  in  them,  of  a  terebinthinate  nature, 
which  not  seldom  brings  out  a  plentiful  crop  of  pustules,  or  even 
boils,  on  the  unseasoned  European.  A  patient  of  mine,  who  died 
from  the  irritation  of  an  eruption  of  this  kind,  had  been  much  addict- 
ed to  an  unrestrained  indulgence  in  fruit,  particularly  mangoes  ; — 
indeed  their  effect  in  this  way  is  familiarly  known  in  India.  M  either 
is  pine  apple,  (though  very  delicious,)  the  safest  fruit  to  make  too 
free  with  at  first.  Good  ripe  shaddocks  are  very  grateful  in  hot 
weather,  from  their  subacid  and  cooling  juice,  so  well  adapted  to  al- 
lay the  unpleasant  sensation  of  thirst.  Plantains  and  bananas  are 
wholesome  and  nutritious,  especially  when  frittered.  The  spices  and 
condiments  of  the  country,  as  I  before  hinted,  should  be  reserved 
for  those  ulterior  periods  of  our  residence  in  hot  climates,  when  the 
tone  of  the  constitution  is  lowered,  and  the  stomach  participates  ia 
the  general  relaxation.  They  are  then  safe  and  salutary. 


TROPICAL  Hi  GIEPifc, 


DRINK. 

SEC.  III. — I  shall  not  here  attempt  to  prove,  that  WATER  is  the 
simple  and  salutary  beverage  designed  by  Nature  for  Man,  as  well  as 
other  Animals.  In  every  nation,  even  the  most  refined  and  modern, 
a  great  majority  appear,  by  their  practice  at  least,  to  entertain  no 
such  belief.  They  have,  with  no  small  ingenuity,  contrived  so  to 
medicate  the  native  fountain,  that  they  are  always  either  outstripping, 
or  lagging  behind,  the  placid  stream  of  life  I  The  same  magic  bowl 
which,  this  moment,  can  raise  its  votaries  into  heroes  and  demi-gods, 
will,  in  a  few  hours,  sink  them  beneath  the  level  of  the  brute  cre- 
ation ! 

The  moralist  and  philosopher  have  long  descanted  on  this  theme, 
with  little  success  ;  for,  until  people  begin  to  feel  the  corporeal  ef- 
fects of  intemperance,  a  deaf  ear  is  turned  to  the  most  impressive  ha- 
rangues against  that  deplorable  propensity  ;  and  even  then,  but  very 
few  have  resolution  and  fortitude  to  stem  the  evil  habit !  Let  us  do 
our  duty,  however,  in  conscientiously  pourtraying  the  effects  of  drink 
in  a  tropical  climate. 

I  have  already  observed,  that  the  grand  secret,  or  fundamental  rule, 
for  preserving  health  in  hot  countries,  is,  "  TO  KEEP  THE  BODY  COOL." 
I  have  also  alluded  to  the  strong  sympathy  that  subsists  between  the 
skin  and  several  internal  organs,  as  the  stomach,  liver,  and  intestinal 
canal.  On  this  principle,  common  sense  alone  would  point  out  the 
propriety  of  avoiding  heating  and  stimulating  drink,  for  the  same  rea- 
sons that  we  endeavour  to  guard  against  the  high  temper  of  the  cli- 
mate. But  no  ;  a  wretched,  sensual  theory  has  spread  from  the  vul- 
gar to  many  in  the  profession,  (who  ought  to  kaow  better,)  that 
since  the  heat  of  the  climate  occasions  a  profuse  perspiration,  and 
consequently  renders  that  discharge  the  more  liable  to  a  sudden 
check,  we  are  to  aid  and  assist  these  natural  causes  by  the  use  of 
"  gently  stimulating  liquids,"  and,  of  course,  increase  those  very  ef- 
fects which  we  pretend  to  obviate  !  "  A  little  shrub  and  water," 
says  Mr.  Curtis,  (Diseases  of  India,)  "  or  Madeira  and  water,  between 
meals,  is  useful,  and  in  some  measure  necessary^  to  keep  up  the  tone 
of  the  digestive  organs,  and  to  supply,  [i.  e.  augment,]  the  waste 
occasioned  by  an  excessive  perspiration,"  p.  281.  I  can  assure  Mr. 
Curtis  that,  however  netessary  this  practice  might  have  been  thought 
in  his  time,  (forty  years  ago,)  it  is  now  considered  not  only  unnecessa- 
ry, but  disgraceful  ;  and  that  in  no  respectable  circle  in  the  Eastern 
world,  beyond  the  confines  of  the  "  Punch-house,"  where  no  Euro- 
pean of  character  will  ever  be  seen,  [especially  in  Bengal,]  is  any 
sangaree,  porter-cup,  or  other  "  gently  stimulating  liquid,"  made  use 
of  "  between  meals."  And  I  take  this  opportunity  of  informing  and 
warning  every  new-comer,  that  the  very  call  of  "  brandy -shrub -pan- 
ny  /"  will  endanger  his  being  marked  as  a  "  vilandus  est"  and  that  a 
perseverance  in  such  habit  will  inevitably,  and  very  quickly  too,  ex- 
clude him  from  every  estimable  circle  of  his  own  countrymen,  who 
will  not  fail  to  note  him  as  in  the  road  to  ruin ! 

Nor  did  these  most  excellent  habits  of  temperance  originate  in  any 


TRONCAL  HYGIENE.  401 

medical  precepts  or  admonitions — far  from  it  !  The  professional  ad- 
viser was  by  no  means  solicitous  to  inculcate  a  doctrine,  which  it 
might  not  suit  his  taste  to  practise.  But  in  a  vast  empire,  held  by 
the  frail  tenure  of  opinion,  and  especially  where  the  current  of  reli- 
gious prejudices,  Brahmin  as  well  as  Moslem,  ran  strong  against  in- 
toxication, it  was  soon  found  necessary,  from  imperious  motives  of  po- 
licy, rather  than  of  health,  to  discourage  every  tendency  towards  the 
acquisition  of  such  dangerous  habits.  Hence  the  inebriate  was  just- 
ly considered  as  not  merely  culpable  in  destroying  his  own  health* 
individually,  but  as  deteriorating  the  European  character  in  the  eyes 
of  those  natives,  whom  it  was  desirable  at  all  times  to  impress  with  al 
deep  sense  of  our  superiority.  Happily,  what  was1  promotive  of  our 
interest,  was  preservative  of  our  health,  as  well  as  conducive  to  out* 
happiness  ;  and  the  general  temperance  in  this  respect,  which  now 
characterises  the  Anglo-Asiatic  circles  of  society,  as  contrasted  with 
Anglo-West-Indian  manners,  must  utterly  confound  those  fine-spun 
theories,  which  the  votaries  of  porter-cup,  sangaree,  and  oth^r 
*'  gently  itimulating  liquids,"  have  invented  about — "  supporting 
perspiration,"  "  keeping  up  the  tone  of  the  digestive  organs,"  &c; 
all  which  experience  has  proved  to  be  not  only  ideal  but  pernicioui  ! 
"  On  the  meeting  together  of  a  company  of  this  class,"  [planters,] 
says  a  modern  writer  on  the  West  Indies,  "  they  were  accustomed 
invariably,  to  sit  and  continue  swilling  strong  punch,  (sometimes 
half  rum,)  and  saaoking  segars,  till  they  could  neither  see  nor  stand  ; 
and  he  who  could  swallow  the  greatest  quantity  of  this  liquid  fire,  or 
infuse  in  it  the  greatest  quantity  of  ardent  spirits,  was  considered  the 
cleverest  fellow."  Account  of  Jamaica  and  its  Inhabitants,  1808. — 
p.  189.  And  again  ;  "  The  inferior  orders,  in  the  towns,  are  by 
no  means  exempt  from  the  reproach  of  intemperance  ;  nor  are  the 
more  opulent  classes,  generally  speaking,  behind  hand  in  this  respect. 
Sangaree,  arrack-punch,  and  other  potations,  are  pretty  freely  drank, 
early  in  the  day,  in  the  taverns,"  p.  199 

I  can  conceive  only  one  plausible  argument  which  the  trans-atlantic 
Brunonian  can  adduce,  in  support  of  his  doctrine  after  the  unwel- 
come denouement  which  I  have  brought  forward  respecting  oriental 
customs  ;  namely,  that  as  the  range  of  atmospheric  heat,  in  the  West 
Indies,  is  several  degrees  below  that  of  the  East,  it  may  be  necessary 
to  counterbalance  this  deficit  of  external  heat,  by  the  more  assiduous 
application  of  internal  stimulus  !  For  this  hint  he  will  no  doubt,  be 
much  obliged  to  me,  as  he  must  consider  the  argument  irresistible. 

I  may  here  remark,  that  too  much  praise  cannot  be  given  to  the 
Captains  of  East  Indiamen,  for  the  lessons  of  temperance  and  deco- 
rum that  are  generally  taught  on  board  their  ships,  (whatever  may 
be  the  motives,)  during  the  outward  bound  passage.  The  very  best 
effects  result  from  this  early  initiatory  discipline,  in  a  thousand  dif- 
ferent ways.  Rarely,  indeed,  in  the  vessels  alluded  to,  does  the  de- 
canter make  more  than  half  a  dozen  tours,  (often  not  so  many,)  after 
the  cloth  is  removed  at  dinner,  before  the  company  disperse,  by  a 
delicate,  but  well-known  signal,  either  to  take  the  air  upon  deck,  or 
amuse  themselves  with  books — chess—music,  or  the  like,  till  the 


402  TROPICAL  HYGIENE. 

evening.  After  a  very  frugal  supper,  the  bottle  makes  a  tour  or  two, 
when  the  significant  toast  of — **  good  night,  ladies  and  gentlemen  /" 
sends  every  one  at  an  early  hoar  to  repose. 

It  may  readily  he  conceived,  of  what  incalculable  utility  five  or  six 
months'  regimen  of  this  kind  must  prove  to  Europeans,  approaching 
a  tropical  climate  ;  especially  when  policy  and  imperious  custom  will 
enforce  its  continuance  there  !  It  is  true,  that  at  each  of  the  presi- 
dencies, there  may  he  found  several  individuals  of  the  old  bacchana- 
lian school,  whose  wit,  humour,  or  vocal  powers,  are  sometimes 
courted,  on  particular  occasions,  to  —  "  set  the  table  in  a  roar."  But 
let  not  such  expect  to  mingle  in  the  domestic  circles  of  respectable 
society,  (where  alone  true  enjoyment  is  to  be  found,)  either  in  the 
civil  or  military  departments.  No  such  thing  as  a  regimental  mess 
exists  in  India  ;  and  as  convivial  association  thus  becomes  perfectly 
optional,  the  least  tendency  to  inebriety  will  assuredly  insulate  the 
individual  who,  from  solitary  indulgence  and  reflection,  soon  falls  a 
martyr  to  the  baneful  effects  of  INTEMPERANCE  ! 

The  navy  presents  a  different  aspect.  Fewer  of  these  have  an 
opportunity  of  becoming  acquainted  with  the  domestic  manners  either 
of  the  natives  or  Europeans  on  shore  ;  and  therefore,  they  more  fre- 
quently pursue  their  usual  course  of  living,  both  in  food  and  drink, 
for  a  considerable  time  after  arriving  on  the  station  ;  verifying  the 
observation,  that — 

"  Ccelum  non  animum  mutant  qui  transmare  currunt." 

And  although  they  are  fortunately  less  exposed,  in  general,  to  many 
of  those  causes  which  aggravate  the  effects  of  inebriety  ashore,  yet 
much  injury  is  produced  before  they  see  their  error. 

A  very  common  opinion  prevails,  even  in  the  profession, — and  I 
am  not  prepared  to  deny  its  validity,  that  during  the  operation  of 
wine  or  spirits  on  the  human  frame,  we  are  better  able  to  resist  the 
agency  of  certain  morbid  causes,  as  contagion,  marsh  effluvium,  cold, 
&c.  But  let  it  be  remembered,  that  it  is  only  while  the  excitement 
lasts,  that  we  can  hope  for  any  superior  degree  of  immunity  from  the 
said  noxious  agents  ;  after  which,  we  become  doubly  disposed  to- 
wards their  reception  and  operation  !  Nor  am  1  fully  convinced,  by 
all  the  stories  I  have  heard  or  read,  that  inebriety  has,  in  any  case  or 
emergency,  even  a  momentary  superiority  over  habitual  temperance. 

The  delusion  in  respect  to  vinous  and  spirituous  potations,  in  hot 
climates,  is  kept  up  chiefly  by  this  circumstance,  that  their  bad  effects 
are,  in  reality,  not  so  conspicuous  as  one  would  expect  ;  and  they 
rather  predispose  to,  and  aggravate  the  various  causes  of  disease  re- 
sulting from  climate,  than  produce  direct  indisposition  themselves  ; 
consequently,  superficial  observation  places  their  effects  to  the  ac- 
count of  other  agents.  But  the  truth  is,  that  as  drunkenness,  in  a 
moral  point  of  view,  leads  to  every  vice  ;  so,  in  a  medical  point  of 
view,  it  accelerates  the  attack,  and  renders  more  difficult  the  cure  of 
every  disease,  more  particularly  the  diseases  of  hot  climates  ;  be- 
eause  it  has  a  specific  effect,  I  may  say,  on  those  organs  to  which  the 
deleterious  influence  of  climate  is  peculiarly  directed.  If  the  Nor- 
thern inebriate  is  proverbially  subject  to  hepatic  derangement,  where 


TROPICAL    HYGIENE.  4QS 

the  coldness  of  the  atmosphere  powerfully  counterpoises,  by  its  ac- 
tion on  the  surface,' the  internal  injury  induced  by  strong  drink,  how 
can  the  Anglo-East  or  West  Indian  expect  to  escape,  when  the  exter- 
nal and  internal  causes  run  in  perfect  unison,  and  promote  each 
other's  effects  by  a  wonderful  sympathy. 

It  has  been  considered  wise,  as  I  before  hinted,  to  take  the  season- 
ed European  for  our  model,  in  every  thing  that  respects  our  regime 
of  the  non-naturals.  "  Strangers,"  says  Mr.  Curtis,  "  arriving  in 
India,  if  they  regard  the  preservation  of  health,  cannot  too  soon  adopt 
the  modes  of  living  followed  by  the  experienced  European  residents 
there."  I  do  not  conceive  this  to  be  a  good  medical  maxim,  even  in 
India,  where  temperance  is  scarcely  a  virtue  ;  and  certain  I  am,  that 
it  is  a  most  dangerous  precept  in  the  West,  for  reasons  which  I  have 
lately  rendered  sufficiently  obvious.  It  confounds  all  discrimination 
between  the  very  different  habits  of  body,  which  the  seasoned  and  un- 
seasoned possess.  It  is  consonant  with  experience,  as  well  as  theory, 
that  the  former  class  may  indulge  in  the  luxuries  of  the  table  with  in- 
finitely less  risk  than  the  latter ;  and  this  should  ever  be  held  in 
view.  In  short,  the  nearer  we  approach  to  a  perfectly  aqueous  re- 
gimen in  drink,  during  the  first  year  at  least,  so  much  the  better 
chance  have  we  of  avoiding  sickness  ;  ami  the  more  slowly  and  gra- 
dually we  deviate  from  this  afterwards,  so  much  the  more  retentive 
will  we  be  of  that  invaluable  blessing — HEALTH  ! 

It  might  appear  very  reasonable,  that  in  a  climate  where  ennui 
reigns  triumphant,  and  an  unaccountable  languor  pervades  both  mind 
and  body,  we  should  cheer  our  drooping  spirits  with  the  mirth-in- 
spiring bowl  ; — a  precept  which  Hafiz  has  repeatedly  enjoined.  But 
Hafiz,  though  an  excellent  poet,  and  like  his  predecessor,  Homer,  a 
votary  of  Bacchus,  was  not  much  of  a  physician  ;  and  without  doubt, 
his  "  liquid  r«6?/,"  as  calls  it,  is  one  of  the  worst  of  all  prescriptions 
for  a  "  pensive  heart."  I  remember  a  gentleman  at  Prince  of 
Wales's  Island,  [Mr.  S.]  some  years  ago,  who  was  remarkable  for  his 
convivial  talents  and  flow  of  spirits.  The  first  time  I  happened  to  be 
in  a  large  company  with  him,  I  attributed  his  animation  and  hilarity 
to  the  wine,  and  expected  to  see  them  flag,  as  is  usual,  when  the  first 
effects  of  the  bottle  were  past  off ;  but  I  was  surprised  to  find  them 
maintain  a  uniform  level,  after  many  younger  heroes  had  bowed  to 
the  rosy  god.  1  now  contrived  to  get  near  him,  and  enter  into  con- 
versation, when  he  disclosed  the  secret,  by  assuring  me  he  had  drunk 
nothing  but  water  for  many  years  in  India  ;  that  in  consequence  his 
health  was  excellent — his  spirits  free — his  mental  faculties  uncloud- 
ed, although  far  advanced  on  time's  list :  in  short,  that  he  could  con- 
scientiously recommend  the  «'  antediluvian"  beverage,  as  he  termed 
it,  to  every  one  that  sojourned  in  a  tropical  climate. 

But  I  am  not  so  Utopian,  as  to  expect  that  this  salutary  example  will 
be  generally  followed  ;  though  it  may  lead  a  few  to  imitate  it,  till  the 
constitution  is  naturalized,  when  the  pleasures  of  temperance  may  pro- 
bably induce  them  to  persevere.  At  all  events,  the  new  comer  should 
never  exceed  three  or  four  glasses  of  wine  after  dinner,  or  on  any 
account,  admit  it  to  his  lips  between  meals,  unless  excessive  fatigue 


404  TROPICAL  HYGIENE. 

and  thirst  render  drink  indispensable,  when  cold  water  might  be  in- 
jurious.    Spirits,  of  course,  should  be  utterly  prescribed. 

One  circumstance,  however,  should  always  be  kept  in  mind,  to  wit, 
that  when  a  course  of  temperance  is  fully  entered  on,  no  considera- 
tion should  induce  us  to  commit  an  occasional  debauch,  especially 
during  our  seasoning  ;  for  we  are  at  those  times  in  infinitely  greater 
danger  of  endemic  attacks,  than  the  habitual  bacchanal. 

It  has  been  remarked,  by  many  sensible  observers,  that  acids  are 
injurious  to  the  stomach  ami  bowels  between  the  tropics.  I  will  not 
contradict,  though  1  cannot  confirm  this  observation.  1  never  saw 
any  bad  effects  myself  from  their  use  ;  and  I  know  some  medical  gen- 
tlemen, long  resident  in  India,  who  drank  very  freely  of  sherbet,  at 
all  times  when  thirst  was  troublesome.  Nature  seems  to  point  out 
the  vegetable  acids,  in  hot  climates,  as  grateful  in  allaying  drought, 
and  diffusing  a  coolness  from  the  stomach  all  over  the  body.  It  is 
very  probable,  however,  that  where  the  alimentary  canal  is  in  an  ir- 
ritable state,  they  may  excite  diarrhoea  ;  and  this  last  frequently 
leads  to  more  serious  disturbance  in  the  functions  of  the  digestive  or- 
gans. Where  the  tone  of  the  stomach,  too,  is  weak,  (as  is  often  the 
case,)  and  that  organ  is  disposed  to  generate  acidity,  the  acids  in  ques- 
tion may  readily  prove  injurious. 

It  has  also  been  said,  that  a  too  free  use  of  cocoa-nut  water,  or 
milk,  as  it  is  sometimes  called,  has  produced  bowel  complaints.  My 
own  observations  are  not  in  unison  with  this  remark.  It  was  my  fa- 
vourite beverage,  and  never  did  1  feel  in  my  own  person  or  perceive 
in  others,  the  slightest  inconvenience  from  indulging  in  this  most  de- 
licious liquid.  It  ought,  however,  to  be  fresh-drawn,  limpid,  sweet, 
and  never  drunk  after  the  deposit  on  the  inside  of  the  shell  begins  to 
assume  the  form  of  a  consistent  crust. 

I  have  alluded  to  the  danger  of  drinking  cold  fluids  when  the  body 
is  heated,  and  particularly  where  perspiration  has  continued  profuse 
for  any  time.  I  could  furnish  many  instances,  illustrative  of  this  po- 
sition, but  shall  only  adduce  the  following  : — 

Lieutenant  Britton,  of  the  Royal  Marines,  (at  that  time  belonging 
to  his  Majesty's  shv  Grampus.)  a  very  fine  young  gentleman,  had 
heated  and  fatigued  himself,  by  driving  about  the  streets  and  bazars 
of  Calcutta,  in  the  autumn  of  1803,  in  which  state,  he  had  the  im- 
prudence to  swallow  an  ice-cream,  for  the  purpose  of  allaying  his 
thirst.  Of  the  effects  of  this  he  died,  a  few  weeks  afterwards,  on 
his  passage  to  Madras,  under  my  own  care.  It  brought  on  inflam.- 
mation  about  the  fauces,  which  subsequently  spread  down  along  the 
membrane  lining  the  trachea,  to  the  lungs,  producing  symptoms  ex- 
actly resembling  croup,  He  died  in  dreadful  agonies,  flying  from  one 
part  of  the  ship  to  another,  for  relief  from  the  dyspnoea  and  oppres- 
sion on  his  chest.  Various  remedies  were  tried,  but  all  in  vain.  Let 
this  prove  a  caution  to  the  living  !  «'  The  danger,  says  Dr.  Dewar, 
of  drinking  cold  water  in  that  state  of  the  system,  was  most  strik- 
ing when  a  copious  draught  was  quickly  taken  after  extraordinary 
heat  and  fatigue.  An  acute  pain  was  instantly  produced  in  the 
stomach,  and  rapidly  extended  through  the  rest  of  the  body  which 
threatened  to  overpower  the  whole  vigour  of  the  frame."  On  Dy- 


TROPICAL  HYGIENE.  405 

sentery,  p.  50.  A  navy  surgeon  died  at  Mannorice  in  Asia  Minor, 
after  a  very  short  illness  contracted  by  taking  a  draught  of  cold  wa- 
ter in  a  hot  state  of  body.  For  numerous  examples  of  a  similar  na- 
ture, see  Currie's  Medical  Reports. 


EXERCISE,  &c. 

SEC.  IV. — This  is  one  of  the  luxuries  of  a  northern  climate,  to 
which  we  must,  in  a  great  measure,  bid  adieu,  between  the  tropics. 
The  principal  object  and  effect  of  exercise  in  the  former  situation, 
appear  to  consist  in  keeping  up  a  proper  balance  in  the  circulation 
— in  supporting  the  functions  of  the  skin,  and  promoting  the  various 
secretions.  But  perspiration  and  certain  secretions,  (the  biliary,  for 
instance,)  being  already  in  excess,  in  equatorial  regions,  a  persever- 
ance in  our  customary  European  exercises,  would  prove  highly  inju- 
rious, and  often  does  so,  by  greatly  aggravating  the  natural  effects  of 
climate.  Nevertheless,  as  this  excess  very  soon  leads  to  debility  and 
diminished  action,  in  the  functions  alluded  to,  with  a  corresponding 
inequiiibrium  of  the  blood,  so  it  is  necessary  to  counteract  these,  by 
such  active  or  passive  exercise  as  the  climate  will  admit,  at  particular 
periods  of  the  day  or  year ;  a  discrimination  imperiously  demanded, 
if  we  mean  to  preserve  our  health.  Thus,  when  the  sun  is  near  the 
meridian,  for  several  hours  in  the  day,  on  the  plains  of  India,  not  a 
leaf  is  seen  to  move — every  animated  being  retreats  under  cover — 
and  even  the  "  adjutant"  [gigantic  crane,]  of  Bengal,  whose  stomach 
will  bear  an  ounce  of  emetic  tartar  without  complaining,  soars  out  of 
the  reach  of  the  earth's  reflected  heat,  and  either  perches  on  the 
highest  pinnacles  of  lofty  buildings,  or  hovers  in  the  upper  regions 
of  the  air  a  scarcely  discernible  speck.  At  this  time  the  Hindoo  re- 
tires, as  it  were  instinctively,  to  the  innermost  apartment  of  his  bum- 
ble shed,  where  both  light  and  heat  are  excluded.  There  he  sits 
quietly,  in  the  midst  of  his  family,  regaling  himself  with  cold  water 
or  sherbet,  while  a  mild  but  pretty  copious  perspiration,  flows  from 
every  pore,  and  contributes  powerfully  to  his  refrigeration.* 

As  soon  as  the  cool  of  the  evening,  however,  commences,  all  na- 
ture becomes  suddenly  renovated,  and  both  men  and  animals  swarm 
in  myriads  frocn  their  respective  haunts  !  Then  it  is,  that  the  espla- 
nade at  Calcutta,  and  the  Mount  road  near  Madras,  pour  on  the  as- 
tonished eye  of  the  stranger  a  vast  assemblage  of  all  nations,  casts, 
and  complexions,  comprehending  an  endless  and  unequalled  variety 
of  costume  and  character,  hurrying  to  and  fro,  in  all  kinds  of  vehi- 
cles as  well  as  on  foot,  enjoying  the  refreshing  air  of  the  evening  ! 
The  same  scene  is  witnessed  early  in  the  morning,  particularly  du- 
ring the  cool  season,  in  Bengal  ;  but  in  the  rainy  season  there,  and 
while  the  hot  lands-winds  prevail  on  the  Coromandel  coast,  the  life 
of  a  European  is  irksome  to  the  last  degree  !  Perspiration  being  then 
profuse,  the  most  trifling  exertion  is  followed  by  languor  and  lassi- 

*  What  with  the  smoke  of  the  house,  [for  there  is  no  chimney,]  and  the  oil  ou 
his  skin,  a  native  is  hardly  ever  annoyed  by  mosquitoes,  as  foreigners  are. 


406  TROPICAL  HYGIENE. 

tude.  Cooped  up  behind  a  tatty,  or  lolling  about  under  a  punka,  he 
can  neither  amuse  his  mind,  nor  exercise  his  body,  and  taedium  vitas 
reigns  uncontrolled  during  these  gloomy  periods  !  It  need  hardly 
be  urged,  how  injurious  active  exercises"  would  be  to  Europeans,  at 
such  times  ;  or  indeed,  durmg  the  heat  of  the  day,  at  any  time  Yet 
hundreds  annually  perish  from  this  very  cause  ;  particularly  in  the 
West  Indies,  after  each  influx  of  Europeans  during  war  ! 

Who  would  expect  to  find  dancing  a  prominent  amusement  in  a 
tropical  climate  ?  The  natives  of  the  West  Indies  are  excessively 
fond  of  this  exercise  ;  but  in  the  east  there  are  wise  wen  still,  for  in- 
stead of  dancing  themselves,  they  employ  the  nautch-girls  to  dance 
for  them. 

It  might  seem  ill-natured  if  I  animadverted  on  the  custom  of  my 
fair  countrywomen,  who  show  off  with  such  eclat,  at  the  Pantheon  in 
Madras,  regardless  of  all  thermometrical  indications.  The  prac- 
tice is  not  salutary,  however  politic  it  may  be  found — and  it  certain- 
ly does  not  appear  to  agree  so  well  with  married  ladies  as  with  vir- 
gins, whatever  may  be  the  reason. 

I  have  shown  that  the  range  of  atmospherical  heat  is  considerably 
higher  in  the  East  than  in  the  West,  and  that  in  the  latter  part  of  the 
world  they  are  exempted  from  hot  land-winds,  and  more  favoured 
with  cool  sea  breezes,  than  the  inhabitants  of  the  former.  Still, 
Europeans,  although  they  may  not  enjoy  better  health,  experience 
infinitely  less  mortality  in  the  peninsula  of  India,  than  in  the  West 
Indian  Archipelago.  If  a  thousand  European  troops,  for  instance, 
are  debarked  at  Kingston,  Jamaica,  and  an  equal  number  at  Madras, 
at  the  same  time,  we  shall  find  the  former  lose,  in  all  probability, 
one-third— perhaps  one  half  their  number,  during  the  first  eighteen 
months  :  while  the  other  corps  will  not  lose  more  than  a  thirtieth  or 
a  fortieth  part  of  their  total,  in  the  same  period.  But  if  we  examine 
the  two  bodies  of  men  at  the  end  of  five  or  six  years,  we  shall  not 
find  the  same  disproportion.  Hepaticand  dysenteric  complaints,  by  that 
time,  will  have  brought  the  Eastern  corps  somewhat  nearer  a  par 
with  their  Western  countrymen.  'I  he  great  onus  of  disease  bears 
on  theirs*  year  of  a  European's  residence  in  the  West  Indies,  because 
that  is  the  period  within  which  the  endemic  or  yellow  fever  makes  its 
attack ;  after  which,  he  feels  the  effects  of  climate  in  a  more  mode- 
rate degree.  — In  the  East,  fever,  (excepting  in  Bengal,)  is  by  no 
means  general ;  and  the  first  year  is  not  distinguished  by  mortality. 
But  the  climate  being  much  hotter,  and  the  atmospherical  vicissitudes 
more  sudden  and  extensive,  each  subsequent  year  produces  great 
mischief  in  important  organs  ;  and  the  wonder  is,  why  he  does 
not  suffer  infinitely  more  than  the  Anglo-West  .Indian  ! 

I  have  already  adduced  several  causes  for  this  disparity  ;  (vide 
pages  70  and  71,)  one,  the  greater  length  of  an  East  India  voy- 
age, with  its  concomitant  abstemious  regimen,  the  reverse  of 
which  so  much  predisposes  to  the  violent  assaults  of  the  Western 
endemic.  Another,  is  the  laudable  temperance  and  decorum,  pre- 
scribed by  general  custom  in  the  Eastern  world,  obviating,  in  no 
slight  degree,  the  deleterious  influence  of  climate.  I  shall  now  pro- 
ceed to  make  some  observations  on  other  differences  in  the  modes  of 


TROPICAL  HVG1ENE.  407 

Hie,  and  means  of  preserving  health  in  the  two  countries,  as  elucida- 
tory of  this  subject,  hoping  that  the  interest  and  utility  of  the  discus- 
sion will  sufficiently  excuse  its  informal  position  in  this  section. 

First,  then,  the  HOUSES  of  the  East,  whether  permanent  mansions 
or  temporary  bungalows,  are  better  calculated  for  counteracting  the 
heat  of  the  atmosphere  than  those  of  the  West.     As  there  is  no 
dread  of  earthquakes  or  hurricanes,  in  the  former  place,  the  dwel- 
lings are  solid — the    apartments  lofty — the  windows  large,  and  the 
floors,  in  general,  composed  of  terras,  which  being  often   sprinkled 
with  water,  is  cool  to  the  feet,  and  diffuses  an  agreeable  refrigera- 
tion through  the  room.     Add   to  this,  that  the   spacious  verendahs 
ward  off  the  glare  of  the  sun,  and  reflected  heat,  (an  important  con- 
sideration,) by  day,  and  afford  a  most   pleasant  retreat  in  the  eve- 
ning, for  enjoying  the  cool  air.     The  tatties,  which  are  affixed  to  the 
doors   and  other  apertures,  in  the  hot  season,  and  kept  constantly 
wet  by  bheesties,  or  water-carriers,  whereby  the  breeze  is  cooled  by 
evaporation,  in  its  passage  through  the  humid  grass,  of  which  the 
tatty  is  constructed,   prove   a  very  salutary  and   grateful   defence 
against  the  hot  land-winds  ;  since  this  simple  expedient  makes  a  dif- 
ference of  twenty  or  thirty  degrees,  between  the  bheesty's  and   the 
European's  side  of  the  tatty!     It  appears,  however,  lhat  in  the  East 
we  have  not  been  sufficiently  attentive  to  the  prevention  of  reflected 
heat  and  glare  ;  a  circumstance  of  infinitely  greater  consequence 
than  the  freest  ventilation.     Let  us  learn  from  the  native.     His  ha- 
bitation has  very  few  apertures,  and  those   high  up.     His  floor,  and 
the  inside  of  the  walls,  are  moistened  two  or  three  times  a-day,  with 
a  solution  of  cow-dung  in  water,  which,  however  disagreeable  to 
the  olfactories  of  a  European,  keeps  the  interior  of  the  dwelling  as 
cool  as  it  is  dark.     Here  he   sits  on  his  mat,  enjoying  bis    aqueous, 
but  salutary  beverage  ;  and  with  such  simple  means  and  materials, 
counteracts  the  heat  of  the  climate  more  effectually  than  the  Euro- 
pean, in  his  superb  anci  costly  edifice.     "  Those  who  live  in  houses," 
says    Dr.  Winterbottoin,    "  the  walls  of  which  are  plastered  with 
mud,  frequently,  during   the  continuance  of  hot  weather,  wet   the 
walls  and  floor,  to  cool  the  air  ;  this  is  a  very  hurtful  practice,  as  it 
renders  the  air  moist,  and  brings  it  nearly  into  the  state  it  is  in  du- 
ring the  rainy  seasons." — On  Hot  climates,  p.  16.     This,  like  many 
other  observations  founded  on  contracted  views,  and  favourite  theo- 
ries, is  completely  contradicted  by  the  broad  basis  of  facts.     It  re- 
minds us  of  a  passage  in  Dr.  Robertson's  third  volume  on  the  Dis- 
eases of  Seamen,  where  he  undertakes  to  prove,  that  it  is  the  moisture 
of  the  air  over  marshes  that  causes  disease  ;  and,  in  short,  questions 

whether  miasmata  ever   produced  fever except  on   board  the 

WEAZLE  sloop  of  war,  when  he   was  surgeon  of    her  on   the  coast  of 
Africa ! ! 

The  upper  classes  of  natives,  also,  have  not  been  inattentive  to 
the  prevention  of  reflected  heat.  The  houses  of  Benares,  for  in- 
stance, are  of  solid  stone,  and  generally  six  stories  high,  with  small 
windows.  The  streets  are  so  extremely  narrow,  that  the  sun  has 
very  little  access  to  them  ;  obviating  thereby  the  disagreeable  effects 
of  glare.  The  windows  are  small,  because,  from  the  height  of  the 


ot  tne 


408  TROPICAL  HYGItiNK. 

houses  it  would  be  impracticable  to  apply  tatties  during  the  hot  winds ; 
whereas,  in  low  country-houses,  or  bungalows,  they  are  large,  in  or- 
der to  extend  the  refrigerating  influence  of  the  tatties. 

The  dazzling  whiteness  of  European  houses  in  India  is  not  only  in- 
convenient, but  in  some  degree  injurious,  to  the  eyes,  at  least  ;  and 
a  verendab,  entirely  encompassing  the  mansion,  would  contribute 
greatly  to  the  refrigeration  of  the  interior  apartments  ;  the  most  com- 
fortable of  which,  by  the  by,  on  the  ground  floor,  used  to  be  appro- 
priated to  the  use  of  palankeens,  and  lumber,  but  are  now  wisely 
converted  into  offices,  &c. 

The  punka,  suspended  from  the  lofty  ceilings  of  the  Eastern  rooms, 
and  kept  waving  overhead,  especially  during  our  repasts,  is  a  very 
necessary  piece  of  what  may  be  fastidiously  styled  "  Asiatic  luxury." 
Indeed,  were  it  not  for  this  and  the  tatty,  some  parts  of  India  would 
be  scarcely  habitable  by  Europeans,  at  certain  seasons. 

It  is  observed,  in  a  recent  "  Account  of  Jamaica,"  by  a  gentleman 
long  resident  there,  that  the  "  Asiatic  effeminacy  of  being  carried 
about  in  a  palankeen,  has  not  yet  reached  the  West  Indies."  It 
would  be  well  if  several  other  Asiatic  effeminacies,  [temperance  for 
example,]  were  more  generally  adopted  in  the  transatlantic  islands. 
But  tjhat  the  Anglo-West-Indian  rejects  this  luxurious  vehicle,  merely 
through  any  scruple  respecting  its  effeminacy,  is  rather  too  much  for 
credence.  If  a  dozen  of  sturdy  balasore-bearers  could  be  hired  in 
Jamaica  for  the  trifling  sum  of  four  or  five  shillings  a  day,  including 
all  expenses,  the  Western  Nabob  and  Nabobees  Would  soon  conde- 
scend to  recline  in  the  palankeens,  with  as  much  state  as  their  "  effe- 
minate" brethren  of  the  East.  But  the  plain  reason  is,  that  neither 
the  country  itself  nor  its  imported  population  will  admit  of  a  convey- 
ance, which  is  cheap,  elegant,  and  convenient,  on  the  sultry  plains  of 
India.* 

Gestation  in  a  palankeen,  however,  is  a  species  of  passive  exercise 
exceedingly  well  adapted  to  a  tropical  climate.  The  languid  circula- 
tion of  the  blood  in  those  who  have  been  long  resident  there,  is  point- 
edly evinced  by  the  inclination  which  every  one  feels  for  raising  the 
lower  extremities  on  a  parallel  with  the  body,  when  at  rest ;  and 
this  object  is  completely  attained  in  the  palankeen,  which  indeed 
renders  it  a  peculiarly  agreeable  vehicle.  On  the  same  principle 
we  may  explain  the  pleasure  and  the  utility  of  sham-pooing,  where 
the  gentle  pressure  and  friction  of  a  soft  hand,  over  the  surface  of 
the  body,  but  particularly  the  limbs,  invigorate  the  circulation  after 
fatigue,  and  excite  the  insensible  cuticular  secretion.  I  much  won- 
der that  the  swing  is  not  more  used  between  the  tropics.  In  chronic 
derangements  of  the  viscera  it  must  be  salutary,  by  its  tendency  to 
determine  to  the  surface,  and  relax  the  sub-cutaneous  vessels,  which 
are  generally  torpid  in  those  diseases.  It  might  be  practised  in  the 
evenings  and  morning- — and  within  doors,  when  the  state  of  the  wea- 

*  Cheeks  of  kuss-kuss,  a  sort  of  grass,  of  which  the  fatties  are  made,  being: 
affixed  to  the  doors  of  palankeens,  and  k»pt  moist,  enable  Europeans  to  travel 
during  the  hottest  weather.  A  wet  palampore^  or  covering  of  calico,  is  a  tolerable 

-, 


I  ROPICAL  HYGIENE.  409 

ther,  or  other  circumstances,  did  not  permit  gestation,  or  active  efc- 
ercise  in  the  open  air. 

A  propensity  towards  smoaking  would  not  be  expected,  a  priori,  in 
a  tropical  climate.  Yet  the  practice  is  very  general  among  Europe- 
ans and  Natives,  and  seems  to  spring  from  that  listlessness  and  want 
of  mental  energy,  so  predominant  in  the  character  both  of  sojourn- 
ers  and  permanent  inhabitants  of  sultry  latitudes.  As  the  custom 
may  not  be  insalutary  at  certain  seasons  of  the  year,  in  particular 
places,  where  marshy  or  other  deleterious  exhalations  abound  ;  and 
as  it  is  often  a  succedaneum  for  more  dangerous  indulgences,  it  is  best, 
perhaps,  to  pass  it  over  with  little  comment.  Yet  it  has  ever  appear- 
ed to  me  a  degrading  habjt,  for  a  gentleman  to  become  a  slave  to  his 
hookah  ;  and  it  is  beyond  endurance,  to  see  a  great,  lusty  hookah- 
burdaaf,  insinuate  the  pipe  of  his  long  snake  into  the  delicate  hand  of 
a  European  lady,  after  dinner,  who  plies  the  machine  with  as  much 
glee,  as  the  sable  and  subordinate  nymph  of  the  country  does  her 
nereaul!  For  the  honour  and  delicacy  of  the  sex,  this  practice  is  by 
no  means  common  ;  and  the  wonder  is,  that  it  ever  should  have  ex- 
isted. 

In  the  article  of  dress,  the  Anglo-East  Indians  have  a  manifest  ad- 
vantage over  those  of  the  West.  The  delicious  and  salutary  bever- 
age of  cool  drink,  too,  is  more  in  use  among  the  former  than  the  lat- 
ter ;  partly  owing  to  custom,  and  partly  to  opulence,  which  enables 
all  ranks  of  Europeans  to  have  their  wine,  water,  &c.  refrigerated 
with  saltpetre,  by  a  particular  servant,  set  apart  for  that  sole  purpose, 
and  called  in  Bengal — Aub-daar.  The  effect  of  these  gelid  potations 
on  the  stomach  is  diffused  from  thence,  by  sympathy,  over  the  whole 
frame,  but  especially  over  the  external  surface  of  the  body,  coun- 
teracting in  no  mean  degree,  the  natural  influence  of  the  climate.  It 
is  true,  the  bottles  are  brought  on  table  in  the  West  Indies,  envelop- 
ed in  wetted  napkins ;  but  the  effect  is  far  inferior  to  that  produced 
by  the  nitrous  solution  ;  and  as  the  aub-daar's  art  is  extended  to  all 
kinds  of  drink,  this  grateful  luxury  is  ever  at  hand. 


BATHING. 

SEC.  V. — "  I  dare  not,"  says  Dr.  Moseley,  "  recommend  cold  ba- 
thing, [in  the  West  Indies  ;]  if  is  death  with  intemperance,  and  dan- 
gerous where  there  is  any  fault  in  the  viscera.  It  is  a  luxury  denied 
to  almost  all,  except  the  sober  and  abstemious  females,  who  well  know 
the  delight  and  advantage  of  it," — 3d  ed.  p.  90.  In  respect  to  its 
being  "  death  with  intemperance,"  I  believe  that  numerous  inebri- 
ates could  tell  the  doctor  a  different  story  ;  but,  as  it  is  presumed  he 
never  deigns  to  look  into  a  modern  author,  he  is  unacquainted  with 
various  facts  that  militate  against  his  dogma.  The  well-known  instance 
of  Mr.  Weeks,  of  Jamaica,  who  always  went  to  sleep  in  cold  water, 
when  intoxicated,  is  sufficiently  in  point.  Many  a  time  have  I  seea 
it  bring  the  drunken  sailor  to  bis  senses  at  once  ;  and  invariably  have 

52 


4/0  feftGFlCAL  HY<;iENT,. 


I  observed  it  to  moderate  the  excitement  of  spirituous  potations.  I 
knew  a  getleman  who  always  went  to  sleep  with  his  head  on  a  wet 
swab,  whenever  he  had  taken  a  good  "  mosquito  done  ;"  and  the  con- 
sequence was,  that  he  very  seldom  complained  of  head-ache  next 
day.  It  is  true,  that  if  the  cold  bath  be  injudiciously  used,  during 
the  indirect  debility  succeeding  &  debauch,  there  may  not  be  suffi- 
cient energy  in  the  constitution  to  bring  on  re-action  ;  and  then,  of 
course,  it  would  be  injurious.  But  this  is  a  discrimination  to  which 
the  genius  of  a  Moseley  could  not  stoop.  Granting,  ho\vever,  v?hat 
is  certainly  true,  that  the  cold  bath  is  dangerous,  where  visceral  ob- 
structions obtained,  I  cannot  concf  ive  why  it  should  be  denied  to  al- 
most all,  except  females,  in  hot  climates  ;  unless  we  take  those  vis- 
ceral derangments  with  us  from  Europe.  Surely  we  might  be  allow- 
ed "  the  delight  and  advantage"  of  it  till  these  disordered  states  oc- 
cur! 

But  whatever  theory  may  have  discouraged  bathing,  and  recommend- 
«d  the  use  of  **  gently  stimulating  liquids,"  in  the  West  ;  wide  ex- 
perience has  completely  settled  these  points,  long  ago,  in  the  East. 
There,  the  Native  arid  European  —  the  old  and  the  young  —  the  male 
and  the  female,  resort  to  the  BATH,  as  the  greatest  luxury  ^  and  the 
best  preservative  of  health.  In  truth,  it  is  one  of  the  most  powerful  en- 
gines we  possess,  for  counteracting  the  destructive  influence  of  a 
hot  climate,  because  it  connects  the  most  grateful  sensations  with 
the  most  salutary  effects  —  it  is  indeed  both  utile  et  dulce. 

Nature,  or  instinct  itself,  points  out  the  external  application  of 
cold  water  to  the  body,  to  moderate  the  action  of  atmospheric  heat. 
The  buffalo  is  a  familiar  example.  In  the  middle  or  hot  period  of  the 
day,  these  animals  repair  to  pools  or  marshes,  and  wading  in,  either 
stand  or  lie  down  there,  with  every  part  except  the  nose  immersed 
in  water  ;  or,  where  there  is  not  water,  in  the  mud.  At  these  times, 
by  the  by,  it  is  very  dangerous  for  Europeans  to  approach  their 
haunts.  They  generally  start  up  all  at  once,  'on  being  disturbed  ; 
and  if  one  or  two  begin  to  snort  and  advance,  the  European  is  in  im- 
minent peril  :  nothing  but  the  most  rapid  retreat  to  a  place  of  safety, 
can  secure  his  life.  A  red  coat  is  a  very  unfortunate  dress  at  such 
critical  rencontres,  as  the  animals  in  question  have  a  decided  antipa- 
thy to  that  colour. 

It  requires  but  little  penetration  to  see,  that  the  Brahminical  in- 
junctions, relating  to  ablutions,  were  founded  on  the  preservation  of 
present  health  to  the  body  ;  though  the  future  happiness  of  the  soul 
was  artfully  held  out  as  a  superior  inducement  to  the  performance 
of  these  ceremonies,  so  necessary  beneath  a  burning  sky.  The  su- 
perstitious Hindoo  rarely  omits  bathing,  once  or  oftener,  every  day, 
in  the  sacred  stream  of  the  Ganges,  [or  other  consecrated  river,] 
from  which  he  is  not  deterred  even  by  the  voracious  alligator,  who 
frequently  carries  him  off  in  the  religious  act  !  He  generally  wades 
eut  to  a  moderate  depth  —  then,  shutting  his  eyes,  and  putting  his  fin- 
gers in  his  ears,  he  squats  himself  under  water  two  or  three  times 
—  washes  his  doty  —  and  returns,  cool  and  contented,  to  his  humble 
cot. 

The  Europeans  and  upper  classes  of  Mahommedans,  however,  feel- 


TROPICAL  HYOIENE.  414 

ing  no  great  desire  for  risking  teie-a-tetes  with  sharks  or  alligators, 
are,  in  general,  satisfied  with  a  few  pots  of  cold  water  thrown  over 
their  heads,  at  home,  once,  twice,  or  oftener  every  day,  according  to 
the  season  of  the  year,  and  the  person's  own  inclinations.  This, 
being  unattended  either  with  fatigue  or  expense,  is  well  adapted  to 
all  circumstances  and  situations,  and  answers  the  end  in  view  effec- 
tually enough. 

I  have  shown,  in  various  parts  of  this  essay,  that  most  of  the  dis- 
eases of  tropical  climates  are  attributable  to  atmospherical  vicissitudes. 
Now,  there  is  nothing  that  steels  the  human  frame,  with  more  cer- 
tainty, against  the  effects  of  these,  than  the  cold  bath.  We  are  the 
very  creatures  of  habit ;  and,  consequently,  habituationis  the  surest 
prophylactic.  The  cold  bath  not  only  counteracts  the  influence  of 
heat,  by  suspending  its  operation  for  the  time,  but  it  safely  inures  us 
to  the  sudden  application  of  cold,  the  fruitful  source  of  so  many  dis- 
orders. By  keeping  the  skin  clean,  cool,  and  soft,  it  moderates  ex- 
cessive, and  supports  a  natural  and  equable  cuticular  discharge  ;  and 
from  the  "  cutatieo-hepatic  sympathy,"  so  often  noticed,  the  functions 
of  the  liver  partake  of  this  salutary  equilibrium — a  circumstance 
hitherto  overlooked. — The  use  of  the  cold  bath,  then,  should  be  re- 
gularly and  daily  persevered  in,  from  the  moment  we  enter  the  tro- 
pics ;  and  when,  from  long  residence  there,  the  functions  above  al- 
luded to  begin  to  be  irregular  and  defective,  instead  of  in  excess,  we 
may  prudently  veer  round,  by  degrees,  to  the  tepid  bath,  which  will 
be  found  a  most  valuable  part  of  Tropical  Hygiene  among  the  sea- 
soned Europeans. 

As  the  cold  bath  is  passive,  (for  it  is  seldom  that  the  exhausting 
exertion  of  swimming  accompanies  it,)  so  it  may  be  used  at  any  ptS- 
riod  of  the  day  ;  though  the  mornings  and  evenings  are  generally 
selected  by  Europeans  in  the  East ;  immediately  after  leaving  their 
couch  and  before  dinner.  The  bath  is  very  refreshing,  when  we 
rise  unrecruited  from  a  bad  night's  rest ;  and  powerfully  obviates 
that  train  of  nervous  symptoms,  so  universally  complained  of  by  our 
countrymen  between  the  tropics.  Before  dinner  it  is  salutary,  ap- 
parently from  that  connexion  which  subsists  between  the  external 
surface  and  the  stomach,  in  consequence  of  which  the  tone  of  the 
latter  is  increased,  and  the  disagreeable  sensation  of  thirst  removed, 
that  might  otherwise  induce  to  too  much  potation  during  the  repast. 
— It  is,  however,  imprudent  to  bathe  while  the  process  of  digestion 
is  going  on  in  the  stomach,  as  it  disturbs  that  important  operation. 
Where  visceral  derangements  of  any  extent,  particularly  in  the 
liver,  have  taken  place,  the  cold  bath  must  be  hazardous,  from  the 
sudden  afflux  of  blood  directed  from  the  surface  to  the  interior,  and 
also  on  account  of  the  subsequent  vascular  reaction.  The  tepid 
bath,  taking  care  to  avoid  a  chill  afterwardSj  will  in  these  cases,  be 
substituted  with  great  advantage. 


* 


412  TROPI6AL 


SLEEP. 

SEC.  VI. — When  we  bid  adieu  to  the  temperate  skies  of  Europe 
with  all  its  '*  long  nights  of  revelry,"  and  enter  the  tropics,  particu- 
larly in  the  Eastern  hemisphere,  we  may  calculate  in  a  great  falling 
off  in  this  "  solace  of  our  woes."  The  disturbed  repose,  which  we 
almost  always  experience  there,  has  a  greater  influence  on  our  con- 
stitutions than  is  generally  imagined,  notwithstanding  the  silence  of 
authors  on  this  subject.  Nature  will  not  be  cozened  with  impunity. 
Whatever  we  detract  from  the  period  of  our  natural  sleep,  will  as- 
suredly be  deducted  in  the  end,  from  the  natural  range  of  our  exist- 
ence, independently  of  the  predisposition  to  disease,  which  is  thus 
perpetually  generated.  This  is  a  melancholy  reflection  ;  but  it  is 
truth,  and  it  should  induce  us  to  exert  our  rational  faculties  in  obvi- 
ating the  evil. 

When  the  sun  withdraws  his  beams,  and  the  intense  heat  of  the 
atmosphere  is  mitigated,  we  might  expect  a  comfortable  interval  of 
repose — but  this  would  be  a  vain  hope.  A  new  host  of  foes  instantly 
appear  in  arms  to  annoy  us  !  mosquitoes,  ants,  and  cock-roaches,  lead 
-on  the  insect  tribes — the  bat  wheels  in  aerial  circuits  over  our  headss 
on  which  he  sometimes  condescends  to  alight,  without  ceremony — 
while  the  snake  patroles  about,  in  the  purlieus  of  our  apartment  : 
coils  himself  up  under  our  beds,  or  even  deigns  to  become  our  bed- 
fellow without  waiting  the  formality  of  an  invitation  !* 

The  great  object  of  a  European  is  to  sleep  cool.  This  enables  him 
io  procure  more  rest  than  he  otherwise  could  do  ;  and  by  giving  his 
frame  a  respite,  as  it  were,  from  the  great  stimulus  of  heat,  imparts 
to  it  a  tone  and  vigour — or  as  Dr.  Darwin  would  say,  "  an  accumula- 
tion of  excitability,"  so  necessary  to  meet  the  exhaustion  of  the  en- 
suing day,  as  well  as  to  repair  that  of  the  preceding. 

A  great  waste  of  strength — indeed,  of  life,  arises  from  our  inabi- 
lity, on  many  accounts,  to  obtain  this  cool  repose  at  night.  Thus 
rains,  heavy  dews,  or  exhalations  from  contiguous  marshes,  woods,  or 
jungles,  often  render  it  unsafe  or  impossible  to  sleep  in  the  open  air  ; 
a  practice  fraught  with  the  most  beneficial  consequences,  where  the 
above-mentioned  obstacles  do  not  prevent  its  execution.  But,  pend- 
ing the  hot  and  dry  season  in  Bengal,  and  almost  always  on  the  Coro- 
mandel  coast,  except  during  the  hot  laud-winds,  or  at  the  change  of 
the  monsoons,  we  may  indulge,  not  only  with  safety,  but  with  infinite 
advantage,  in  the  seemingly  dangerous  luxury  of  sleeping  abroad  in 
the  oper  air. 

I  am  well  aware  of  the  prejudices  entertained  against  this  custom, 
"by  great  numbers,  both  in  and  out  of  the  profession  ;  but  I  am  con- 

*  Many  instances  have  occurred  of  snakes  being  found  coiled  away  between 
children  in  bed.  It  is  said,  that  if  a  chaffing-dish,  filled  with  clear,  live  embers, 
be  quietly  placed  on  the  floor  of  a  room,  i*  such  emergency,  the  reptiles  will  re- 
pair to  it ;  especially  if  some  new  milk  be  also  left  near  the  chaffing-dish — Great 
presence  of  mind  is  here  necessary,  in  order  not  lo  disturb  those  dangerous  crea- 
tures suddenly  in  their  retreat. 


TROPICAL  HYGIENE. 

viuced,  from  personal  experience  and  observation,  that  the  practice, 
under  the  specified  restrictions,  is  highly  salutary,  and  I  know  it  is 
sanctioned  by  some  of  the  best-informed  veterans,  who  have  spent 
most  part  of  their  lives  between  the  tropics.  Speaking  on  this  sub- 
ject, the  judicious  Captain  Wiliamson  remarks  that — "  few,  very 
few  instances  could  be  adduced,  of  any  serious  indisposition  having 
attended  it  ;  while,  on  the  other  hand,  it  is  confessed  by  all  who  have 
adopted  it,  that  the  greatest  refreshment  has  ever  resulted  ;  enabling 
them  to  rise  early,  divested  of  that  most  distressing  lassitude,  attend- 
ant upon  sleeping  in  an  apartment  absolutely  communicating  a  febrile 
sensation,  and  peculiarly  oppressive  to  the  lungs." — East  India  Va- 
de-Mecum. 

If  it  be  observed,  that  I  have  all  along  held  up  to  view  the  danger 
of  atmospherical  vicissitudes,  to  which  this  practice  would  apparent- 
ly expose  us  ;  I  answer,  that  I  have  also  maintained,  that  early  habi- 
tuation  to  these  was  the  surest  preservative  against  their  injurious  ef- 
fects, as  exemplified  in  the  use  of  the  bath.  The  truth  is,  however, 
that  while  the  custom  of  sleeping  in  the  open  air  steels  the  human 
frame  against  these  same  effects,  it  is,  in  reality,  attended  with  less 
exposure  to  sudden  atmospherical  transitions  than  the  opposite  plan* 
Nature  is  ever  indulgent  when  we  observe  her  ways,  and  obey  her 
dictates.  Excepting  the  periods  and  places  alluded  to,  the  transition 
in  the  open  air,  from  the  scorching  heat  of  the  day  to  the  cool  sere- 
nity of  night,  is  gradual  and  easy.  To  this  the  human  frame  bends 
with  safety,  and  we  sink  into  a  grateful  and  sound  sleep,  that  reno- 
vates every  corporeal  and  mental  faculty.  Whereas,  those  who  ex- 
clude themselves  from  the  breath  of  heaven,  whether  from  necessity 
or  inclination,  become  languid,  from  the  continued  operation  of  heat, 
and  the  want  of  repose  ;  in  consequence  of  which,  the  slightest 
aerial  vicissitude,  (either  from  leaving  their  couch,  or  admitting  a 
partial  current  of  cool  air,  which  they  are  often  compelled  to  do,) 
unhinges  the  tenor  of  their  health,  and  deranges  the  functions  of  im- 
portant organs !  These  are  they,  who  require  the  afternoon  siesta, 
and  to  whom,  indeed,  it  is  necessary,  on  account  of  the  abridged  re- 
freshment and  sleep  of  the  night ;  while  the  others  are  able  to  go 
through  the  avocations  of  the  day,  without  any  such  substitute — a 
great  and  manifest  advantage. 

Indigenous  custom  is,  generally  speaking,  in  favour  of  sleeping  in 
the  open  air,  during  the  hot  seasons,  in  most  Eastern  countries.  The 
practice,  indeed,  is  less  adopted  in  Bengal,  for  very  obvious  reasons, 
than  on  the  Coromandel  coast ;  but  the  Native  sleeps  much  cooler, 
at  all  times,  than  the  European,  from  this  circumstance — that  his  bed 
seldom  consists  of  more  than  a  mat,  while  a  piece  of  calico  wrapped 
round  him,  supplies  the  place  of  bed  clothes.  The  more  closely  we 
imitate  these  the  better  will  it  be  for  us.  Indeed,  a  thin  hair  ma- 
tress,  with  a  sheet  and  palampore,  are  the  only  requisites,  indepen- 
dently of  the  thin  gauze  or  mosquito  curtains,  which  defend  us  from 
insects,  and,  when  we  sleep  out  on  the  chabootuh,  arrest  any  particles 
of  moisture  that  may  be  floating  in  the  atmosphere.  Early  hours  are 
here  indispensable.  The  fashionable  nocturnal  dissipation  of  Europe 


414  TROPICAL  HYtilERK. 

would  soon  cut  the  thread  of  our  existence  between  the  tropics. 
The  order  of  nature  is  never  inverted  with  impunity,  in  the  most 
temperate  climates  ;  beneath  the  torrid  zone,  it  is  certain  destruction. 
The  hour  of  retirement  to  repose  should  never  be  protracted  beyond 
ten  o'clock  ;  and  at  day-light  we  should  start  from  our  couch,  to  en- 
joy the  cool,  the  fragrant,  and  salubrious  breath  of  rnorn. 

We  shall  conclude  this  section  with  a  few  remarks  on  Incubus,  or 
Night-rnare — a  very  troublesome  visitor  to  a  tropical  couch. 

The  proximate  came  of  Incubus  has  given  rise  to  various  specula- 
tions. A  very  general  opinion  prevails  that  this  affection  is  produc- 
ed by  mechanical  obstruction  to  the  blo<  d's  circulation,  from  parti- 
cular position  of  the  body.  It  is  a  certain  fact,  however,  that  no  pos- 
ture is  a  security  from *oight-mare  among  the  predisposed  ;  neither 
is  a  full  stomach  to  be  accused  as  the  cause,  nor  an  empty  one  to  be 
expected  as  the  antidote  of  this  disorder.  There  is,  however,  an  al- 
most universal  opinion,  that  incubus  attacks  persons  only  while  on 
their  backs  !  and  this  opinion  seems  to  have  some  foundation  in  fact, 
from  the  following  circumstances.  One  of  the  symptoms  almost  in- 
separable from  the  disease  is  this,  that  the  patient  appears  to  himself 
to  be  kept  down  upon  the  back  by  some  external  force  ;  and  as,  at 
the  moment  of  recovering  the  power  of  volition,  a  great  confusion  of 
ideas  prevails,  a  person  may  easily  imagine  that  he  has  recovered 
himself  by  some  effort  of  his  own,  by  turning  from  his  back  to  his 
side.  But  these  things  are  extremely  fallacious,  as  there  is  no  trust- 
ing to  the  senses  during  a  paroxysm  of  incubu*. 

It  appears,  however,  from  the  mode  of  treatment  to  which  this 
disease  gives  way,  that  the  primary  cause,  in  whatever  manner  it 
may  act,  has  its  seat  in  the  digestive  organs,  and  that  night-mare  ori- 
ginates in  defective  digestion,  whereby  the  food  which  should  be  con- 
verted into  good  chyle,  is  transformed  into  a  half-digested  mass  of 
acid  matter,  which  is  productive  of  heart-burn,  eructations,  flatu- 
lence, gripes,  with  the  whole  train  of  dyspeptic  and  hypocondriacal 
complaints. 

There  are  many  stomachs  which  convert  every  thing  they  receive 
instantly  into  an  acid  ;  and  such  will  be  generally  found  to  be  the  case 
with  persons  subject  to  habitual  night-mare,  or  frightful  dreams  and 
disturbed  sleep.  Such  stomachs  are  too  frequently  distended  with 
some  acid  gag,  which  alone  gives  rise,  in  many  cases,  to  paroxysms 
of  incubus  ;  and  may  often  be  instantly  removed  by  any  warm  cor- 
dial, as  peppermint,  gin,  brandy,  carbonate  of  ammonia,  &c.  Whytt 
used  generally  to  take  a  small  wine-glassful  of  brandy  going  to  bed, 
in  order  to  keep  off  night-mare  and  terrific  dreams  to  which  he  was 
very  subject. 

Of  all  medicines,  however,  the  carbonate  of  soda,  taken  in  a  little 
ale  or  porter,  as  recommended  by  Mr.  Waller,  will  be  found  the 
most  efficacious.  About  a  scruple,  going  to  bed,  is  a  sufficient  dose  : 
and  where  acidities  prevail  in  the  stomach,  the  same  quantity,  twice 
in  the  day  will  be  useful.  This  medicine  not  only  neutralizes  any 
acid  in  the  first  passages,  but  likewise  brings  away  by  stool,  vast 
quantities  of  viscid  slimy  matter,  so  acrid  as  to  burn  and  excoriate  the 


HYGIENE-, 

parts  it  touches.  The  appetite  now  generally  improves  ;  but  the 
propensity  to  acidify  remains  for  a  long  time  in  the  stomach,  and  re- 
quires great  attention  to  diet  and  regimen.  There  are  few  people 
with  whom  particular  kinds  of  food  do  not  disagree,  and  these  being 
known  should  be  avoided.  Thus  chesnuts  or  sour  wine  will  almost 
always  produce  incubus  among  those  predisposed  to  it,  as  was  ob- 
served by  Hildanus.  "  Qwt  scire  cupit  quid  sit  Incubus  ?  Is  ante  *om- 
nutn  comedat  castaneas,  tt  svperbibat  vinumfcecvlentutn."  In  this 
country,  cucumbers,  nuts,  apples,  and  flatulent  kinds  of  food,  are  the 
articles  most  likely  to  bring  on  night  mare. 

The  following  draught  1  have  found  very  efficacious  in  preventing 
attacks  of  incubus,  viz.  carbonate  of  ammonia,  ten  grains,  compound 
tincture  of  cardamoms,  three  drachms,  cinnamon  water,  two  ounces, 
to  be  taken  going  to  bed. 

Intemperance  of  any  kind  is  hurtful.  Most  vegetables  disagree  ; 
and  pastry,  fat,  greasy,  and  salted  meat,  are  to  be  avoided.  Moderate 
exercise  is  as  beneficial ,  as  sedentary  employments,  intense  study, 
and  late  hours  are  prejudicial. 


THE  PASSIONS. 

SEC.  VII.  — I  have  not  yet  alluded  to  the  conduct  of  the  Passions, 
because  most  of  the  precepts  that  apply  to  the  regulation  of  them  ia 
cold  climates,  will  be  equally  applicable  here.  But  I  may  be  per- 
mitted to  correct  an  erroneous,  (I  think,)  though  very  general  opi- 
nion, that  there  is  something  peculiar  in  a  tropical  climate,  which  ex- 
cites certain  passions  in  a  higher  degree  than  in  temperate  regions. 
"  There  is,"  says  Dr.  Moseley,  "  in  the  inhabitants  of  hot  climates, 
unless  present  sickness  has  an  absolute  control  over  the  body,  a 
promptitude  and  bias  to  pleasure,  and  an  alienation  from  serious 
thought  and  deep  reflection.  The  brilliancy  of  the  skies,  and  the 
beauty  of  the  atmosphere,  conspire  to  influence  the  nerves  against 
philosophy  and  her  frigid  tenets,  and  forbid  their  practice  among  the 
children  of  the  sun,"— p.  87.  This  is  a  very  superficial,  and  a  very 
false  view  of  the  affair.  It  is  likewise  a  very  immoral  one  ;  for  it  fur- 
nishes the  dissolute  libertine  with  a  physical  excuse  for  his  debauche- 
ries, when  the  real  source  may  be  traced  to  relaxation  of  religious  and 
moral  principles  !  I  would  ask  Dr.  Moseley  to  explain  the  reason  why, 
if  the  "  promptitude  to  pleasure"  be  increased  in  a  hot  climate,  the 
ability  to  pursue  or  practice  it  should  be  lessened  ? — a  truth  well 
known  to  every  debauchee. 

If  the  prevalence  of  polygamy  in  warm  climates  be  adduced,  I  an- 
swer, that  in  countries  where  plurality  of  women  is  allowed,  a  minute 
and  accurate  investigation  will  show,  that  among  the  lower  orders  of 
people  the  licence  of  the  prophet  is  an  empty  compliment,  for  they 
find  one  wife  quite  enough.  And  as  for  the  higher  ranks  of  society, 
there  is  not  one  in  twenty  who  has  more  than  one  wife,  nor  one  in  five 
hundred  who  has  more  than  two.  If  we  compare  this  last  part  of 
the  statement  with  the  picture  of  life  in  the  beau  monde  at  home> 


4h'  TROPICAL  HYGIENE. 

we  shall  not  have  much  reason  to  congratulate  ourselves  on  the  great 
physical  continence  resulting  from  our  gloomy  skies,  as  contrasted  with 
the  *'  bias  to  pleasure"  which  springs  from  levity  of  atmosphere  be- 
tween the  tropics. 

May  we  not  attribute  the  premature  decay  of  Native  women  in  hot 
climates,  to  the  long-established  custom  of  early  marriages  in  that 
sex,  originally  introduced  by  the  despotism  of  man,  but  which  has 
now  effected  an  actual  degeneracy  in  the  female  part  of  the  creation. 
"  It  is  a  disgrace  to  a  woman  not  to  be  married  before  twenty  years 
of  age  ;  and  we  often  see  wives,  with  children  at  their  breasts  as 
soon  as  they  enter  their  teens."  I  have  no  doubt  that,  to  the  con- 
tinued operation  of  this  cause,  through  a  long  series  of  centuries,  is 
owing  the  deterioration  in  question  ;  for  it  is  not  conformable  to  the 
known  wisdom  of  the  Creator,  that  such  an  inequality  should  natu- 
rally exist  between  the  sexes. 

But  to  return.  The  removal  of  religious  and  moral  restraint — 
the  temptations  to  vice — the  facility  of  the  means,  and  the  force  of 
example,  are  the  real  causes  of  this  «•  bias  to  pleasure  ;"  and  in 
respect  to  the  effects  of  licentious  indulgencies  between  the  tropics, 
I  can  assure  my  reader,  that  he  will  find,  probably  when  it  is  too  late, 
how  much  more  dangerous  and  destructive  they  are  than  in  Europe. 

He  now  has  explained  to  him  the  nature  of  this  "  propensity  ;" 
and  as  the  principal  cause  resides  neither  in  the  air,  nor  the  **  brilli- 
ancy of  the  skies,"  but  in  his  own  breast,  he  has  no  excuse  for  per- 
mitting it  to  sprout  into  the  wild  luxuriance  of  unbridled  excess. 

The  monotony  of  life,  and  the  apathy  of  mind,  so  conspicuous 
among  Europeans  in  hot  climates,  together  wiih  the  obstacles  to  ma- 
trimony, too  often  lead  to  vicious  and  immoral  connexions  with  Na- 
tive f;  males,  which  speedily  sap  the  foundation  of  principles  imbibed 
in  early  youth,  and  involve  a  train  of  consequences,  not  seldom  em- 
barrassing, if  not  embittering  every  subsequent  period  of  life !  It  is 
here  that  a  taste  for  some  of  the  more  refined  and  elegant  species  of 
literature,  will  prove  an  invaluable  acquisition  for  dispelling  enni»V 
the  moth  of  mind  and  body. 


THE  END.