tudes. In the Temeraire and Invincible, where the fever was evidently the bilious remittent of hot climates, the treatment was founded on the directions of Lind, Clarke, and Balfour, whose works continue still to produce incalculable mischief in the hands of inexperienced practitioners. But the more rational and successful doctrines and practices which have lately been promulgated by judicious medical men, both in the army, and navy, will dissipate, ere long, the mists of prejudice, and annually save the lives of thousands of our countrymen. We have only to read the melancholy account of the fever in the two ships above-mentioned, to be 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 have been by the use of emetics, calomel, antimony, bark and wine in large quantithes, with full meals of animal food from the beginning, n. 158.

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 relapsing; 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 are the fruits of adhering to Brunonian theories, and the doctrines of debility and putrescency, 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; although in the Mediterranean 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 disease, when the balance of the circulation is violently disturbed, as in remittent and intermittent fevers. On this account, liberal evacuations, 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 absolutely requisite to secure the biliary organs from obstruction or ab

scess.

"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 affusion produced a diminution of febrile heat, sweats, and a remission. In several of the patients, he mentions calomel as having had very excellent effects. In one case of great danger, benefit appeared

My Falalily uns produced ritters pre

or

ting too little or too much from the Lite uses the Mark Wives of

to be derived from the inunction of mercurial ointment on the epigastric region," p. 149.*

I have already stated my doubts respecting the propriety of classing all Mediterranean fevers under the head of "bilious remittent," as our author has done, and my belief that a great many of them occured totally independent of marsh miasmata. The following extracts 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 Pomone, and remarking, that “The head and liver seemed to be the principal viscera affected in this fever," goes on thus: "The Weazle sloop, 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 necessary, was repeated. Next day, if the symptoms required it, recourse was again had to abstraction of blood, a blister applied to the epigastric 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 contagious," 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 weather for these six weeks past has been extremely warm; the thermometer 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 calomel 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 viscera affected; the liver from obstructed 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 occupied in sketching the fevers of different ships, and stating the reports of their surgeons on the method of treatment, which entirely corresponded with what I have detailed in the foregoing pages. Bleeding, purging, and the exhibition of mercury were the prominent items in the Methodus Medendi," and will, I 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, and the bigotry of preconceived theories.

64

* See Dr. Denmark's Paper on the Mediterranean Fever in the Medico-Chirurgical Transactions, and Dr. Boyd's Paper on the Minorca Fever in a subsequent section.

the full amals,
Cavadas-road Priny leon

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!

Entitled-DE FEBRE MINORCÆ, &c.—1817.

SEC. II. 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 and 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 predisposing causes.

This fever could be clearly traced to a local origin in Port Mahon; and was therefore not contagious, but a primary and idiopathic disease; 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 contagious quality--that is, the power of propagating themselves from one individual to another. "In casibus variis vim contagiosam haud raro acquirunt: id est, vim gignendi propagandi quoque eundem morbum 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 succeeded 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 violently. The countenance now became entirely changed, and in a manner 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, inappetency-lassitude-thirst, and watching. The tongue is now whitish or yellowish; but for the

Dr. Denmark, Physician to the Fleet, who was at Mahon during the prevalence 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. vi.

Good

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 nausea 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 with 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 train 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 passing 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 the whole surface of the body, in less than twenty-four hours. The tongue now exhibits a thick yellow crustbrownish and dry towards the middle-red and inflamed at the sides. The strength becomes remarkably diminished-the stomach is harassed with nausea and bilious vomiting-the heart beats less strongly, 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 supervenes. The disease acquires a renovated force, and shows itself under quite a different aspect. A new train of symptoms assail, with the greatest violence, the epigastric region. The sense of anxiety at the precordia is now changed into acute pain, which is greatly aggravated by pressure-the redness of the eyes changes into yellowness 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 vomiting of putrid bile-the precordia are exceedingly oppressed-the patient sighs frequently-the stools are liquid-foetid-slimy, and often 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 5th till the 7th day, the patient is harassed with a train of nervous symptoms, as subsultus tendinum, tremors of the whole body, &c. which tend to exhaust the strength. With pain in the abdomen, there is difficulty of swallowing, and a sense of ulceration in the fauces, with vomiting of a glairy, or black matter resembling the grounds of coffee. [Nec non vomitus

materiæ glutinosæ nigræque, fecibus choava similis.] Pain about the pubes, an inability to make water--a dangerous symptom.*

In many cases, we observed swelling and suppuration of the parotid glands, with petechia before death. In others, there were discharges of blood from the nostrils, gums, fauces, &c. In others still, instead of gastric irritability, we had diarrhoea, 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 expression, 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 distressing. From this time, coma or delirium, with coldness of the extremities and intermitting pulse took place; and convulsions terminated 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 enfeebled the disease was infinitely milder.--Turbid urine letting fall a copious 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 restricted diet during convalescence.

Eriology.-Intense heat, which during the summer months prevail without intermission in Mahon harbour, where a breeze selɔm ruffles the surface of the water--violent exercise in the open sun-intemperance of every kind, in which sailors, on getting ashore, so unguardedly 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 shores; and couple these circumstances with the stagnant state of the water itself, during the summer and autumn months; and moreover, when we observe a pretty extensive lake in the vicinity of the port, which, in winter, is filled by rains and springs, but in summer exposes its halfdried, 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 fever.