VG 227 A5i UC-NRLf 3 23a ifts III jM ! U>'le patronage at home, only to deal misery and death among the unfortunate and too credulous, who suppose that, because they come from Britain, where the medical profession are known to possess so much ability, they must necessarily be useful for all the diseases for which they are recommended. Upon the mercenary authors of this wholesale murder rests a fearful and a er ofiicer to desist. of the Island ()f Minorca. 27 Trial by jury is here unknown, but fortunately the judge, before whom the case was brought, was our friend in return for some small service rendered to a member of his family. These proceedings at court were conducted with an ingenuity which would have been creditable to a Philadelphia lawyer, or some of the gentlemen of the long robe at Westminster Hall. We will, therefore, mention one or two of the most important points. The first case mentioned in the indictment was for having extracted a cataract from the eye of Mr. Escudera, in the presence of some ten or twelve of the citizens of Mahon ; and although all tliese gentlemen were present, yet the fact of the operation was not proved to the satisfaction of the court. One did not look on while operating, another did not see the lens extracted, a third did not know the day of the month on which it was done, and a fourth stated that it was in the afternoon and not in the morning, as set forth in the indictment ; all of which was deemed sufficient to acquit us of the charge. During the investigation, the judge received several abusive and threatening anonymous letters, the authorship of which was attributed to one of the native physicians, who, upon being charged with it, plead "not guilty." The writing was disguised, but, unluckily for the author, the very fact that he did not find an education necessary to the art of physic, served for his conviction ; for, as the letter contained many errors of orthography, the judge directed him to write a copy of the letter as it was dictated to him in court ; and, when compared with the anonymous letter, unfortunately for him, every error was found to correspond precisely, notwithstanding the handwriting was entirely diflerent. The decision of the court was in our favor, and the cost, amounting to forty dollars, was ordered to be paid by the Medical Association of the place ; but this event was followed by an open declaration of war on the part of the united faculty, who drove us from the field by the following formidable document, through the hands of O. Rich, Esq., U. S. Consul, and Commodore Isaac Hull : — " Suhdclcgation of the Medical Junto at Mahon. " Sir, — It has been repeatedly complained of to the Medical Subdelegate of Mahon, that you gave and still give advice, and practice as a Physician and Surgeon among the citizens of Her Catholic Majesty's dominions, without the Royal licence. You are, therefore, hereby notified, positively and peremptorily, to discontinue all such practices for the future; and you are not permitted to perform the functions of a Physician or Surgeon to any other individuals than the Anglo-American citizens of your own country. "I kiss your hand. " F. HERNANDEZ, Medkal Subdclegate.. " J. M. FoLTz, Surgeon U. S. Navy. After the reception of this missile, we declined giving our advice to such as applied for it; but a few days after, a child was brought to us from Barcelona, in Spain, with club feet, which was of a proper age and in an excellent condition for an operation. At the same time, a lieutenant of the Spanish army applied for aid, with a permission from the governor for us to prescribe in his case, which we offered cheerfully to do, on condition that permission would be also given to operate oa 28 FoUz on the French Military Hospital the child ; but this his excellency refused to gi-ant. Still desirous to relieve the child, which had undergone the dangers of a voyage at sea for the purpose of having this operation done, we proposed to operate on board one of tlie ships of war in the harbor ; but the father, a British subject and a man of some property, prudently declined, as he was convinced, should we operate after the positive refusal of the governor, that the opportunity would be gladly seized upon to impose on him a heavy fine. The child was, therefore, taken to Marseilles, at the hazard of another voyage at sea, to have an operation done, which could have been performed here in two or three minutes. We have been particular in detailing these cases, as they will not only give a correct idea of the condition of the medical profession in Spain, but will also apprise the reader of the oppression of the government. The only hospital or charitable institution at Mahon is an hospital for foundlings, which is liberally endowed, having at this time about one hundred names upon its register entitled to its charities, among whom are twenty-seven children. Every child deposited here can ever after claim the shelter of the institution ; and, although usually placed out to masters as soon as they reach a proper age, yet they ever look to this establishment as their home in after life. There is throughout the Island no dispensary for the distribution of medicines to the poor; and, so far as we could judge, there is but little charity to them from the medical men. They are, indeed, compelled by their own wants to ask some remuneration for their services, insisting usually upon some fee, and being willing to take the most trifling amount rather than to go away empty-handed. As we were ordered, shortly after these doctors' quarrels, for service afloat, the little ill-will occasioned for the moment was soon " in the deep bosom of the ocean buried." AVe shall, indeed, ever rejoice to hear of their individual and united prosperity, for there are among them many of whom we shall ever have the most agreeable and pleasing recollections, and we shall pray that the causes which have occasioned their present humble position may speedily be removed. III. — FRENCH MILITARY HOSPITAL ON THE ISLE DE LOS REYOS. Near the centre of the harbor of Mahon is the Isle de los Reyos, — a small island on which a large naval hospital was erected, in 1796, by Sir William Burnett, the present distinguished physician in chief of the British navy. This harbor, at that time, when the supremacy of the seas was contested with England by the combined navies of France and Spain, was the great naval depot of Great Britain in this sea ; and it was from this port that Toulon was kept in blockade under Lords Nelson and Collingvvood. Fort St. Philip, at the entrance of the port, was then one of the most formidable fortifications in the world, which, however, was blown up and destroyed before the Island was surrendered. The hospital erected for the use of the British fleet is still in a good state of preservation, consisting of two parallel ranges of wards, which would comfortably accommodate six hundred patients. These two wings are connected at either end by ranges of buildings, intended for the officers of the establishment, with the necessary offices of such an institution ; and throughout, the buildings are well adapted for the purposes for which they were intended. During the summer of 1S35, on the Isle de los Reyos. 29* the cholera made its appearance in our squadron, and a portion of the building was appropriated for the use of the sick ; but since then they have not been occupied. The protracted wars in Algeria, Avhere that indomitable chief, Abd- cl-kader, has year after year subverted all the grand projects of the army of France, had Hlled the hospitals at Algiers to overflowing ; and the French government appHed for the use of the hospital at Mahon, for such of the sick as were able to be transported to this island, — an application which was promptly granted. W'c visited AJfjiers in the summer of 1839, the first year of the war ^ . . . . rt against the Bedouin chief, at which time the total number of troo])s in the colony was forty-five thousand. Since then, the number of troops has at various times exceeded seventy thousand, and disastrous as these campaigns have been, the number destroyed by their formidable enemies is but a fraction of those who fell victims to the climate. As nearly as we could ascertain from credible sources of information, there has beea an average of three thousand deaths among the troops from dysentery and fever every summer, since the commencement of the war. When it is remembered that these troojis all leave France in perfect health, and that they remain but a short time in Afiica, it will be seen that this army has suffered dreadfully. Dysentery and fevers annually sweep their ranks, and not only arc the hospitals crowded to overflowing with the sick and dying, but even the highways are strewed with them ; and such are yearly their privations and suflerings, that none but a nation with the highest enthusiasm for military glory and renown, could endure them. Tlie total number sick in the hospital at Algiers at the period of our visit, was near three thousand. These were accommodated in three hospitals; one was within the town, containing about five hundred, the other two were without the walls of the city, being large, spacious, and well supplied with every necessary. One stands on the east, the other on the west side of the town, constituting series of extensive stone buildings, one story high, erected for the cavalry of the Dey ; but they have been converted into military hospitals, for which, in this vvarin, climate, they are peculiarly adapted. In the winter of 18-39 and '40, a commission, consisting af a physician, a surgeon, and an officer of engineers, arrived at IMahon, and placed the hospital and apartments at the quarantine in a condition to receive the sick. The buildings throughout were placed in perfect order, and: between four and five hundred beds were arranged for the reception of such invalids as could endure the fatigues of transportation from Algiers, a distance of two hundred and fifty miles ; and early in the summer, every bed was occupied. As soon as sufficiently recovered, they were sent on to Toulon, and their places filled by weekly arrivals from the seat of war. Nine-tenths of tliese patients suffered from dysentery and enteritis, and very many died on their passage or immediately after their arrival. Such was the desire of all once more to see " la belle France,^' that many, in their dying moments, pileously implored to be sent on board the steamers, which were especially arranged for their comfort, convinced that only to leave the shores of Africa would ensure their recovery ; and we were informed by the medical officers, that recoveries did in very many cases take place, which had been hopeless, and in which all attempts at a cure by any other means would have beeo unavailing. Such were the operations of hope, and of the love of home, 3* 30 Foltz on the French Militari/ Hosjntal, ^v. upon the minds of these enthusiastic and gallant soldiers ; and there can exist no doubt but that the establishment of this hospital was the means of saving many a valuable life. The medical part of the hospital was under the charge of M. Hutin, and the surgical under that of M. Jourdan, both gentlemen of the highest professional attainments ; and these principals were assisted by a corps of about thirty assistants, than whom no men could have been more devoted to their duties; and it is with much pleasure that we are able to record our testimony in favor of the humanity and kindness with which the sufferings and wants of these soldiers of France Avere administered to by their medical attendants. As further proof of the military character and honor of this chivalrous nation, we will mention that every medical officer, in addition to his oath of office, makes a solemn and public pledge of his honor, that in every case in which aid is required, he will render it with kindness and humanity ; and faithfully did those at the military hospital at Mahon redeem their pledge. We regret our inability to give the correct number of admissions, discharges, and deaths. The first and last were, however, very great, the mortality being evidently due to the malignancy of the diseases acquired in one of the most insalubrious parts of the globe, in which the most efficient medical treatment would be of little avail. In the treatment, the influence of Broussais' school was very manifest ; leeches and enemata, with mucilaginous and demulcent drinks, formed the basis of all remediate measures ; and this treatment in recent cases, or in a less aggravated form of disease than was here presented, would doubtless have been very efficient. Having ourselves encountered this form of malignant febrile disease in its very hot-bed, at Batavia, in the East Indies, where the progress was so rapid that it often proved fatal within forty-eight and seventy-two hours from the time of the accession, we found that the only safety for the patient consisted in an energetic and vigorous treatment; and this disease of Africa presented many of the peculiar symptoms which were met with in the disease as presented in India, particularly in the derangement of the functions of the skin and liver, in whicli the prompt but judicious use of the lancet and mercury were loudly demanded. For the successful treatment of this disease in the East, we were indebted to the invaluable work of Dr. James Johnson on tropical climates ; and much esteemed as that excellent work is in Europe and the United States, it is to the practitioner in intertropical climates only that its great merits can be known. From what we witnessed in the hospitals of Algiers, as well as that at Mahon, we were convinced of a similarity as regards the etiology, and Ave would have consequently rejoiced to have seen the same energetic treatment which we had found so effectual elsewhere pursued in these cases. In the violent diseases of warm countries, where the system is exposed to malaria and miasm, their progress is always rapid ; and even in those milder cases, where the patient himself suffers but little, he usually survives a mere wreck, with premature old age and debility ; all of which might have been prevented by a bold and active treatment in the early stages of the disease. Various proceedings on the part of the French excited the suspicions of the Spanish government, and it did not escape the observation of that vigilant officer, Colonel Fitzgerald, her Britannic majesty's consul at Mahon, that France was looking toward an occupation of this group of Stafisdcs oflhe United States' Naval Hosjntal at Mahon. ?> 1 islands, as her first step upon tlie explosion of the Eastern question, which at that time engaged the attention of all Europe. Careful surveys were made of the harbor, and the elevation and distance of the surrounding hills were accurately made by the French engineers; but, notwithstanding the care evidently taken not to excite observation, these measures were speedily followed by an order from Madrid, for the French to evacuate the hospital on La isle de los Reyos. This was effected in the spring of 1841 ; and it subsequently appeared, from the declaration of M. Jaubert, in the French Chambers, who held a situation in the ministry under the Thiers administration, that the cabinet had. actually determined to occupy the Balearic Islands, as her first movement in the war. To this England would, doubtless, have interposed her protest, — a measure which would have been hailed with delight by the oppressed and helpless inhabitants of this valuable Island, with whom a change of government, — the only panacea for their evils, political and social, moral and physical, — forms the subject of their daily piayers. IV. — STATISTICS OF THE UNITED STATEs' NAVAL HOSPITAL AT MAUON. At the period of entering upon the duties of hospital surgeon to the Mediterranean squadron, tlie force consisted of one hundred and sixty guns, with eighteen hundred men. under the command of Commodore Isaac Hull, with the Ohio (eighty guns) flag-ship. Subsequently a forty-four gun frigate joined the fijrce, which increased the number of men to twenty-two hundred. The crowded state of ships of war, at all times, renders the situation of the sick on board extremely uncom- fortable ; and when the number of invalids is great, they materially interfere with the duties of the ship. At the same time that they impair her efficiency, the wet decks and exposure to atmospheric vicissitudes, materially retard their recovery. An hospital was therefore established at this port, — the depot for the squadron, — for the treatment of such cases of disease and accidents (to which sailors are peculiarly subject), as cannot receive the necessary comforts and attendance on board ship. The building appropriated for the purpose was a large dwelling, situated on the borders of the town, and sufficiently extensive com- fortably to accommodate about forty patients ; but we have had more than sixty within its walls at the same time, embracing, however, many cases which could be crowded together without inconvenience to one another. Three weeks before our arrival, twenty-two invalids from the hospital, including one officer, sailed for the United States, Of these, seven had affections of the chest, five chronic enteritis, two stricture, two epilepsy, three rheumatism, one syphilitic iritis, and two were superannuated. Two died on the passage home. On the 17th of August, nine patients entered the hospital, who had just been admitted to pratique after twenty days' quarantine. They had last been upon the coast of Syria and Egypt, where at this season, the plague is always found ; but which has never made its appearance on board our ships of war, notwithstanding they cruise in the Levant annually. Five of these cases had affections of the alimentary canal, one had a fracture, one phthisis, one syphilis, and one rheumatism. The case of phthisis was a native of New Grenada, having apparently been a long time in 32 Foltz on the Statistics of the United States' bad health, anJ having suffered, when young, from the epidemic fevers of the Magdalena river. When admitted he was much emaciated ; he had copious expectoration of pus, hectic, and night sweats. Our treatment could only be palliative, and in the third week of his admission, he exj^ired. Upon a post-mortem examination, tubercles were not only found in the lungs, but also in the meninges of the brain. September 6th. Fourteen were admitted after having passed the summer cruising in the Archipelago. Nine of these cases were chi'onic diarrhoea, the consequence of dysentery, which had prevailed to some extent, but in a mild form, during the season. Two had ulcers, one secondary syphilis, one epilepsy, and one coxalgia. These cases presented nothing remarkable in their character, nor were they more difficult in treatment than such cases usually are in seamen ; for they, be it understood, rejoice in availing themselves of every opportunity to "weather the doctor," and resort to every expedient to procure liquor and indulge in the worst of dissipation, notwithstanding it is always at the expense of much suffering? and not unfrequently even at the risk of life. As the poor sailor has but little to live for, often an outcast from friends and home, a wanderer upon the wide world, he is best satisfied, when disease and death approach, if his suffering can be abbreviated. We have ourselves witnessed many cases, considered incurable by the patient himself, in which, with the recklessness peculiar to a seaman, he has indulged in dissipation with a view of accelerating death ; and from this indulgence he can be protected only by the unceasing vigilance of the officers. A majority of the admissions were from diseases of the intestinal canal, which naval practitioners find among the most frequent, as well as amoncr the most unmanasfeable of the diseases of seamen ; and this tendency to gastric disease, especially in hot climates, is doubtless pro- duced by the indigestible diet to which they are confined at sea. This follows from the fact, that the salt provisions are frequently kept years before they are served out, which, with the beans, ships' duff, and large quantity of spirits formerly issued, produce those severe forms of gastric affections, as well as dyspepsia, to which sailors are peculiarly subject. In the last named disease, the most judicious and careful treatment will be of little avail, so long as the patient is confined on board ship ; but if a change to a residence on shore is made, with a mild farinaceous diet, more will be effected in a few weeks, than any treatment on board. AVhen ulceration had taken place in the mucous membrane, which will be found to be the casein a majority of instances, the mineral astringents are found most effectual ; and at the head of these remedies stands, agreeably to our experience, the acetate of lead, in doses of from one to two grains, twice a day, in combination with one-eighth of a grain of opium. This we have repeatedly known to cure the most inveterate cases supervening upon the severe forms of the dysentery of the tropics. The sulphate of copper, in doses of one- sixteenth to one-eighth of a grain, combined with opium or lactucarium, we have also used with benefit; but a careful attention to diet will be found the most important matter in such cases, to which, the use of enemata of cold water or a simple infusion of sem. lini will be useful adjuvants. No article of the materia medica, have we seen do as much good, in those chronic affections of the intestines, as the acetate of Naval Hosjiital at Mahon. 33 lead properly administered. Care should be taken that the pieparatlon contain no carbonate oflcad, from which alone unpleasant consequences are to be apprehended. Case of Hemiplegia. — One of the most important cases under treatment at this time, was that of assistant-surgeon Van Wyck, who was affected with hemiplegia. As we had but a short time previously met with several of the cases of Mr. Turnbull, in London, in which the use of the strychnine was attended with benefit, we eagerly embraced this opportunity of prescribing this article ; and from the youth and general good health of the patient, we entered upon the treatment, sanguine of success. The patient was twenty-one years of age, and had just enteret] the navy after a collegiate course, in which he had carried away the highest honors ; and from his devotion to his profes- sion, he promised much future usefulness. A\'ithin twenty-four hours of sailing from New York, he was seized with paralysis of the left side, which also deprived him of the powers of articulation. Three months elapsed from the time of being paralyzed, until he came under our care. From the time of the attack he had been subject to violent epileptic convulsions, which returned periodically, at intervals of about a fortnight. For this he had been copiously bled, which for the future was avoided as much as possible ; and it was found that arresting the circulation iu the extremities by means of a tourniquet, would seldom fail to put a stop to the convulsions, which is a method of treatment that we have practised with much success in the epilepsy of seamen, — a class of men who are very obnoxious to this disease. We have recently seen it mentioned in the European journals, that pressure upon the carotids will seldom fail to arrest epileptic convulsions ; and from the benefit which we have so frequently witnessed, from pressure upon the arteries of the extremities, we could confidently anticipate the best results fi-om interrupting the cii'culation in the carotids, in those cases in which there is so great a determination to the brain, as frequently to cause the production of lesions and effusions. The strychnine was ordered in solution, commencing with one-sixteenth of a grain, ter in die, and the paralyzed side was bathed once a day with a solution of nux vomica. The dose was gradually increased until one-third of a grain was taken, when spasms and involuntary muscular contractions took place in the paralyzed limbs. This manifestation of the influence of the medicine was hailed as a favorable symptom, and its use was now diligently persevered in, with the effect of increasing the spasmodic action to a great extent; but no additional voluntary motion was acquired. At the termination of eight weeks' use of the strychnine, as the convulsions became very violent, and the symptoms presented indications that the system was suffering from the medicine, its use was discontinued ; and hereupon, these unpleasant symptoms gradually disappeared. At intervals, for several months, the strychnine was ordered in various forms, and in smaller quantities, but without any favorable result. A seton in the nape of the neck was of service ; and after restoring his general health, he ultimately embarked for the United States in charge of his relatives, who encountered all the difficulties of a voyage to the Mediterranean, to restore him again to the family circle. In this case, as well as in the numerous instances in which the strychnine was administered among the natives, the favorable consequences did not follow whicli weie met with in the hands of Mr. Turnbull. 34 Foltzc»;» the Statistics of the United States^ Upon the termination of tlie quarter ending the 30th of September, twenty-two patients were under treatment in the hospital, including three officers. Of these, five had affections of the chest, nine of the intestinal canal, two syphilis, one fracture, one epilepsy, two rheuma- tism, one coxalgia, and one ulcer. One patient had died during the quarter from tubercular phthisis. For the quarter ending the 31st of December, 1839, sixty-two had been admitted. Of these, thirty-one were cases of itch, in boys, who were immediately transferred to the hospital, to guard against a propagation of the disease in crowded ships. This affection is one which is very prevalent among seamen, — a liability attributable in a great degree to their diet ; and, as may be anticipated, difficulties are presented in its cure, which are seldom or never encountered in private practice. Five of the cases resisted the administration of sulphur externally and internally ; but the eruption speedily disappeared under the use of an ointment of the iodide of iron, with small alterative doses of the proto-iodide of mercury, prohibiting at the same time the use of stimulating animal food. There is in this disease unquestionably- much less liability to its attack in those who have previously suffered from it; and in not a few, it observes the law which obtains among many of the exanthemata, of securing an immunity from a second attack in the same individual ; and we have met with many cases of serious organic affections, the development of which could be distinctly traced to a severe attack of psora. Of the remaining cases, eleven were affections of the chest, of which two proved fatal within the quarter ; three were fractures, one dislocation, one paralysis, one aneurism^ one syphilis, and one rheumatism. Case of Aneurism. — The case of aneurism was in the person of an aged quarter-gunner, who, from his long and useful services, had strong claims upon our careful attentions, but who proved a most ungovernable and unmanageable patient. He was fifty-five years of age, and for twelve months previous to his admission, had suffered much from violent palpitations of the heart, and recently, a tumor had made its appearance beneath the left clavicle, which pulsated strongly. In the umbilical region, there was also a very perceptible enlargement, which not only pulsated strongly when pressed upon in a line with the artery, but communicated the same throbbing sensation when elevated from the spine by lateral pressure, which, as the patient was much emaciated, could be easily effected ; and it was from this abdominal tumor that he suffered most inconvenience. His only complaint was from the " thumping amicLshipf as he expressed it. Having witnessed the most happy results from the strict enforcement of the treatment of Valsalva among the native Minorcans, we were desirous of pursuing the same course in this case ; and for many days, and even weeks, when closely watched, he confined himself to his bed, taking no other food than the most mild and unirritating diet, while Withering's infusion of digitalis was administered to the fullest extent that his system would allow. Under this course he was much improved, which promised at least to prolong his life, and pass it comparatively without pain ; but, in the midst of this nursing, he would at midnight leave his bed, scale the walls, and without his clothing rush to the first grogshop. Here he would drink, quarrel and fight, as long as he was able to stand ; and when overcome by his exertions, he would be brought back to the Naval Hospital at Mahon. 35 hospital, to undergo another course of arrow-root and digitalis When intoxicated, h.s exertions were powerful, and it was frequently necessary L?r;i '° /■' "'r! '';" ^'^-^'^'-y--^-^^ during hls^..^; and at these times, the action of the heart and throbbing in the aneurismal tumors were so violent, as to occasion great apprehension of an immediate rupture. In this situation, it was necessary to bleed him freely • and such was the condition of his fluids, that the blood contained but 'little coloring matter, and from the scarification, after the use of cups serum would continue to flow until arrested by a compress. This 'course continued for many months, until his final return to the United States \Ve were equally astonished at the great strength manifested by him' when under the mfluence of liquor, and that the case did not prove fatal during some one of his excesses. After each debauch, when perhaps scarcely able to raise his head, he would say that he felt much better • and if we vvould only give him a little more rum, he would be sure to get well. Had our patient joined the " tee-totallers," it would have been ot more service to him than all our medicine and advice. A'^ery many cases are brought to the hospital occurrinmorrliage from the lungs was relieved by copious venesection on the spot where he fell. He continued to improve slowly; and after the foreign substances mentioned above vveie discharged l)y means of an abscess in the right side, he recovered with a collapse of tlie lung. Nearly all the wounds were severe, and several were dangerous ; but from the comfortable quarters on the gun-deck of the frigate, and the uniform tem])erature of the atmosphere, they all recovered with unusual rapidity. We remained twelve days, during which time tlie thermometer stood at 85°, at meridian of each day, with alternate land and sea breezes. Tlie severe exertions of the crew at the time of the attack on shore, and the necessary subsequent labor and exposure in watering the ship, after a long period of light duty, produced a material change in the health of the crew; and this was promoted by the absence of excitement which had for a time pre- vailed among all, and perhaps also by causes of a climatic nature. The sick list of three, in one month, increased to fifty-seven. Fifty-two cases of disease of the bowels and twelve of bilious fever, were treated within the month, notwithstanding fresh meat and vegetables were daily served to all hands, and every precaution was used to protect the men from the sun. We have here a confirmation of an extraordinary fact, recorded in the " Statistical Report on the Sickness and Mortality of the Army of the United States," embracing the period from 1819 to 1839 : — '"It is, indeed, a remarkable fact in the medical history of fleets and armies, that, during the active projiress of warlike operations, troops are little subject to the influence of disease. It seems as though the excitement of the passions has the power of steeling the system against the agency of morbific causes. On the contrary, as soon as tlie excite- ment is withdrawn, by a cessation of operations and a return to the monotony of a garrison, the constitution manifests the consequences of recent fatigue and exposure.'' The Malays in this vicinity, which is in 4° north latitude, are healthy and robust, compared with their Asiatic and .Javanese neighbors. They are very temperate in their habits, use but little animal food, and, like all Mahomedans, bathe frequently. Our numerous merchant vessels which have for years visited this coast, engaged in the pepper trade, enjoy comparative health, and apprehend but little danger when on the coast of Sumatra ; while the shores of Java and Borneo, on the contrary, are shunned as we do a pest-house. The topographical configuration of the west coast of Sumatra will readily account for its salubrity. Bold hills and spurs of mountains extend down to the sea ; and although nature here revels in perpetual verduie, and there is a constant decay of vegetable matter, yet there are no fens and marshes, the mountain streams being precipitated with rapidity to the sea. Mount Ophir of Solomon is directly inland from this port, being distinctly visible whenever the atmosphere is free from clouds. We met with many of the natives who had suffered recently from small pox; and goitre was very common among them, — a disease which here at least cannot be attributed to snow-water as the exciting cause, for snow never falls even upon the mountains. On the 16th of February, we sailed from the west coast of Sumatra, and crossed the 52 Foltz's Medical Statistics of a equator on the 20th, with the thermometer at 85°. On the 25th, the sick list was again reduced to thirty, no new cases of diarrhaea having been admitted since leaving port ; and the wounded were all doing well. On the 28th, we anchored in Bantam Bay, on the northwestern extremity of Java, just within the Straits of Sunda. A change was here made in the ration by order of Commodore Downes, which contributed materially to the preservation of the health of the ship's company. Portions of the beef, pork, and beans, which constitute the navy ration, were discontinued, and rice and curry served out in lieu of them. The spirit ration was divided into three portions, one of which was given in the morning, one at noon, and the other in the evening. All hands were ordered to wear flannel ; and they were daily inspected at quarters by the ofiicers, to see that the order was complied with. At Bantam Bay, \ve remained twelve days, wooding and watering ship; and during this period, the mean temperature at nonn was 82*^, with the regular land and sea-breezes, and several showers every day. Fifteen cases of dysentery and four cases of fever, were admitted upon the report, with a daily average of twenty-nine sick during our .stay. On the 19th of March, we arrived at Batavia; and with a hope to preserve the crew in good health, we anchored four miles from the shore. This port has been more fatal to navigators than any other on the o-lobe. The largest and most valuable Indiamen have often here been laid up for want of hands to navigate them, and here entire ships' crews have found their graves. It was in this port that Dr. James Johnson encountered the malignant fever which committed such dreadful ravages in the English squadron in 1S06. and which forms the basis of his invaluable work upon the diseases of tropical climates. As we were consecjuently not without the most dieadfiil forebodings, we adopted every precautionary means of prevention that had heretofore been found useful. Awnings were spread over the ship day and night, — native Javanese boats' crews were employed to do the necessary boat-duties of the ship, — the men were carefully sheltered from the sun ; in a word, all unnecessary duty was avoided. Those officers who visited the shores, spent as little time as possible in the city. They went directly into the country, where a purer atmosphere prevails, and they strictly observed the most rigid temperance. To Dr. Johnson we were much indebted for many valuable hints on prevention ; and after the occurrence of disease, we were enabled at once to pursue a course of treatment, with the result of which we had much occasion to be highly gratified. Indeed, to him we acknowledge professional obligations, which it will ever be out of our power to There was but little variation in the temperature during our stay at Batavia, and the regular return of the land and sea breeze prevented the heat from becoming 0]ipressive ; the mean at noon was 82°. AVhen the land breeze first reached us in the evening, it was charged with the most oftensive eflluvia from the fens and marshes, which stretch along the shores ; and although anchored four miles fiom the land, this noxious atmosphere was so oppressive, that all on board complained much of it. This malaria doubtless brings with it the seeds of the diseases from which strangers suffer so much. The city is situated in G'' of south latitude, and is intersected by dykes Voyage of Circumnavigatio^i of the Globe. 53 4 and canals, to which the Dutch settlers are so partial, and which mate- rially contributed to its insalubrity. The walls which formerly surrounded the town were removed, when in possession of Great Britain, by Sir Stamford Jvallles ; and the city, at the same time, was extended to the higher and more healthy grounds beyond, where at present the foreign merchants and residents are congregated. The governor and Dutcli troops are stationed in the interior, where the climate is less noxious to strangers; but a few years' residence in Java is sure to be followed by physical and mental enervation. Notwithstanding our precautions, the number of sick daily increased, those reporting themselves sick suHering from a severe form of dys- entery accomj)anied with much inflammation, tormina, and tenesmus. In several cases, the disease assumed a most malignant character from the commencement ; and in one case, a robust, vigorous, young man, it terminated fatally within twenty-four hours from the time of its accession. Copious blood-letting, local and general, was ordered in the commencement, and emetics administered to counteract the great tendency to visceral congestion, and to restore a healthy action to the deranged functions of the skin and liver. Mercurials in combination with opium and ipecacuanha were regularly administered, and fre- quently with the most favorable results ; and in conjunction with this, mercurial inunctions were used, to accelerate the action of the mercury ; and when ptyalism occurred, the patient in almost every instance was relieved, notwithstanding it did not in every case prevent a fatal ter- mination. When this course of treatment did not arrest the progress of the disease within a few days, bloody ftutid evacuations followed, with gangrene, collapse, and death. On the 10th of April, in consequence of the increase of sickness, we sailed from Batavia with forty-two cases of dy.sentery on board. On the 20th, we crossed the equator, the thermometer being at 90®, and the sick report increasing. On the 21st, at meridian, at anchor one mile Dorth of the equator, the weather calm, and the thermometer at 85°, fifty cases of dysentery were on the report, and new cases occuriing daily. Chloride of lime was used freely about the cots and hammocks of the sick, and every possible attention was paid to cleanliness. On the 1st of May, three deaths occurred within the preceding twenty-four hours ; but the numlier of cases was reduced to thirty-four, and no new ones had appeared within several days. Since leaving port the ther- mometer averaged 84°, with calm and light airs. After being at sea twenty days, we had sailed but six hundred miles, with a vertical sun, being, indeed, almtjst directly under the equator. On the ])revious night, we experienced the most tremendousthunder, lightning, and rain, without wind ; and on the following morning, we had a light breeze which continued until our arrival at Canton, after a passage of thirty- nine days. From this time, the health of the crew continued to improve. One hundred and til'ty cases of dysentery were registered within a few weeks, among which there occurred but thirteen deaths, — a proportion truly small, when compared with the number of fatal cases on board other ships in the China seas. The Potomac remained at the Island of Lintin for nineteen days; the mean temjierature at noon was 80'^, with a fresh sea breeze which thoroughly ventilated the ship. 'I'lie average number on the sick report was twenty-six, three-fourths of whom had chronic dysentery, and six 54 Follz's Medical Statistics of a suffered from bilious fever. The Linlin fleet, which remains at anchor here for many months at a time, usually enjoys good health ; but dysentery and fever, during some seasons, ^arove very fatal. Although the native Chinese appear to suffer but little from the epidemic diseases, yet they are but a feeble and enervated race. We were informed by a resident American surgeon, that he had frequently met with cases among the natives, in which fractures would not unite ; and ulcerations are also extremely difficult to heal, in consequence of this debilitated state of the vital powers. Ships going to the East Indies cannot be too cai'eful in enforcing the regulations adopted on board the Potomac ; for, we were thereby enabled to carry a larger number of men in safety through those seas, than had probably ever before been accomplished. The less animal food consumed, the better; and the entire abolition of the spirituous portion of the ration, would, we are satisfied, be also attended with much benefit in these excessively hot climes. We sailed for the Sandwich Islands on the 5th of June, with thick heavy weather, and a fresh breeze. On the ninth, during a typhon, with the thermometer at 80'^, there 'were two deaths from chronic dysentery. The easting was made between the 34th and 36th degrees of north latitude, with strong westerly winds and cool wet weather, which comjiletely changed the character of the diseases on board. Pleuritis, intermittents, and inflammatory affections, took the place of dysentery ; but they were not of an aggravated character. Twenty-five was the average on the sick report for the passage. We arrived at Oahu, Sandwich Islands, on the 23d July, after a passage of forty-eight days ; and here we remained for twenty-three days. Dur- ing this period, the mean of the thermometer at noon was at 78°, and that of the barometer 29.90 in. Thecrew were here granted liberty — " a run on shore," — which was much enjoyed ; and it was followed by a much smaller increase in the number of sick, than generally ensues from liberty in a port which has greater facilities for dissipation and intem- perance. On the day of entering the port, seventeen were imder medical treatment, and at the time of sailing, twenty-two, which is a very small number in view of the largeness of the crew. The Sandwich Islands are situated in 20*^ north latitude. The climate appears peculiarly favorable to the human constitution ; fi>r the natives are extremely large and corpulent, and such as are accustomed to labor, are possessed of great strength. This tendency to corpulency is much encouraged, particularly in females, in whom it is considered the greatest evidence of beauty ; and to this result, their native food, the aurwn matulaium, or wake robin, is said to contribute in an especial manner. This plant, which is cultivated with care, contains a large portion of fecula, from which they manufacture starch, made into j^''^) which, eaten with rawji'^li^ is considered one of their greatest luxuries. The natives suffer much from a species of leprosy, which they call the craw-craws ; and to cure which, they undergo a course of treatment with the kavaroot, — a powerful alterative and narcotic. Upon the arrival of the missionaries, infanticide was of very frequent occuri-once. To effect this purpose, they used a drastic, purgative, indigenous bean, which not unfrequently destroyed tlie mother, and seldom failed to produce abortion ; but this horrid practice, through the salutary influence of the missionaries, has been in a great measure discontinued. Voyage of Circumnavigation of the Globe. 55 We sailed for the Society Islands on the 15th of August, and crossed the equator on the 5th of Septcmher. in 5° west longitude, with the thermometer at 80*^, and the south-oast trades. At this time there were twenty-four on the sick rej)ort. Twelve cases of intermittent fever Avere admitted during the passage ; and many of those laboring under dysentery continued to suHbr upon our approach to the equator, from chronic diarrha'a. A few degrees north of the equator we met with calms and heavy rains, with the thermometer langing above 80'', when these cases of relapse occurred. On the twenty-eighth day we anchored at the Island of Otaheite, having an average of twenty-seven under treatment for the time at sea. At this island the crew were much on shore, wooding and watering ship, the tropical fruits were procured in the greatest abundance, and no unpleasant consequences resulted from their use. We lost one of the crew while in this port, from concealed strangulated hernia. This island, which is in latitude 16'' south, consists in its interior of high volcanic mountain land, surrounded by a fertile belt of rich alluvial de])osit near the shores. The climate is truly delightful, and all the wants of the natives are supplied by the spontaneous productions of nature. The natives have not so great a Btature as those of the Sandwich Islands; but they are more gay and cheerful in their character, and many of the females are delicate and graceful. A light complexion is much esteemed amoncr them, to improve which they avoid the sun, and bathe themselves with the juice of the papa, which is an indigenous plant. Their diet consists of fresh vegetables, fruit, and fish, uf which the bread-fruit constitutes the principai ; and as all the trojncal fruits are here produced spontaneously, labor is unnecessary, and their lives are consequently inactive and indolent. The Missionaries who remain some time in the Society Islands, seldom escape an attack of elephantiasis. We met with two who suffered from this disease in a most aggravated form. The natives also suffer much from this affliction. The passage between Otaheite and Valparaiso in Chili was made in the vicinity of the thirty-fifth degree of south latitude ; and as it was in the winter of the southern hemisphere, much colder weather w-as encountered than we had previously met with, accompanied with rain, wind, and a rough sea. The ship was exceedingly uncomfortable, and the change of weather once more completely revolutionized the type of disease. Fifteen cases of pneumonia and pleuritis, with twenty-two cases of rheumatism, were admitted upon the sick report. INIilder forms of catarrh and inflamed tonsils were numerous, and the general liability of the crew to indisposition, upon exposure and bad weather, indicated that all began to suffer from the long period passed at sea. After a passage of thirty-four days, we arrived at Valparaiso, having had an average of thirty-six patients, who required careful treatment during the voyage. Besides, many had been excused from duty, from time to time, in consequence of slight indisposition, but who were not ])laced on the sick report. Among the number sick on this passage were two cases of scurvy, which did not manifest themselves until we came under the influence of the land air. The first few days in port aggravated the disease, but as the symptoms were mild, the patients speedily recovered ; and these were the only cases of scurvy which presented themselves during the cruise. The Potomac arrived at Valparaiso, which is in the same longitude with New York, on the 56 Foltz's Medical Statistics of a twenty-fourth of October, 1832, having been fourteen months from the United States, nearly twelve of which had been passed at sea. Soon after arriving, liberty was given to the crew, which, as usual, for a few days, more than doubled the number on the sick report. Eleven were treated for mania a potu, and many contracted syphiHs. We remained forty days in port, during which time the crew were freely supplied with fresh provisions, and were allowed relaxation after a long period of active service at sea. The mean of the tliermometer at noon was 66^ and that of the barometer 29.75 in. This is here the season of spring ; high winds prevail from the south, without rain. The number sick averaged nearly forty for each day in port, a majority of them suffeiing from the effects of the cruise on shore, and the consequent dissipation. Valparaiso, which is in 33^ south latitude, is surrounded by spurs of the Andes, which run down in bold blufts to the sea. The climate is one of the most salubrious in the world ; and to the early Spanish conquerors, who reached it after their invasion of Mexico and Peru, where they suffered much from the intense heat and arid soil, this port was so enchanting that it received the name of the *' vale of Paradise." Santiago, the capital of Chili, is ninety miles inland, at the foot of the Cordillera, with a population of nearly fifty thousand. The capital is remarkable for sudden vicissitudes of temperature, the days being very hot, while the nights are cold. This is occasioned by the snow-clad mountains near the city, the cold atmosphere from their summits descending into the highly rarefied atmosphere of the plains below. Kemittent and intermittent fevers are very common, as well as rheu- matism, and the whole class of phlegmasia?, which invariably result from extremes of heat and cold. Goitre is frequently met with, every indivi- dual in some families being affected with it, — a disease which the natives, as in Switzerland, attribute to the use of the snow-water from the mountains, which supplies the town ; but this explanation would surely be laughed at by the patients affected similarly, that we saw in the island of Sumatra. The various preparations of iodine have been found very efficacious in its treatment. While at Santiago we heard of a case of extirpation of the thyroid gland, which resulted in the death of the patient. On the second of December we sailed for Lima, with the usual south wind, and arrived at Callao on the fifteenth, the sick report having been reduced to eighteen. We remained in this port for seventy-five days, during which peiiod the ship's hold was broken out, and every part thoroughly cleaned and painted. The weather was uniformly clear, with a most delightful south wind ; here it never rains, and at this season, mists and fogs aie equally unknown ; the mean of the thermo- meter at noon was 70^", and that of the barometer 29.85 in., with a daily proportion of twenty-four upon the sick report. Four cases of remitting fever were treated ; there was but little arterial excitement, with much disturbance of the nervous system, and it was found that they would not bear the use of the lancet. The city of Lima, which is in 12*^ south latitude, is eight miles from the bay. The inhabitants, although much enervated by the continued high temperature, and their di.ssipated and indolent lives, leading to premature old age, yet enjoy good, if not robust, health. Although ^foreigners suffer less from acute diseases than in India, yet they aie 'nsidiously worn down by the climate, notwiths.tanding the most extreme Voyage of Circumnavigation of the Globe, 57 temperance and regularity in living. The streets of Lima are kept very clean, many having streams of water running through them; and to this must bo adclecl, as an additional cause of tlieir exemption from malignant disease, the remarkable property of the atmos{>here in orodiicing dry jiutrefaction, whiqh thus prevents all noxious eilhivia. Dead animals are suffered to remain in the roads; and the Pantheon, in which all the dead of the city are interred, notwithstanding open to the air, never emits the least disagreeable efHuvia. This j)roperty of the atmosphere arises from the large quantity of nitrate of soda difi'useJ through it, from the soil, and which in situations that have not been disturbed for a long period, may be found deposited in small crystals. The long chain of the Andes, which forms the immense barrier along the entire western coast of South America, with an elevation of from twelve to eighteen thousand feet, completely interrupts the progress of the winds from the east, the only direction from whicli they blow along the coast of Peru, being from the south ; and as these south winds are much colder than the air they encounter in their progress towards the equator, and as their capacity for humidity consequently continues to increase, it follows that rain cannot form. Rain is consequently unknown in these countries ; but as the winds reach the Isthmus of Darien, the air becomes surcharged with moisture, which is there precipitated in torrents. Our ships of war pass much time in this port, with generally a large sick report. Dysentery sometimes prevails to a great extent, and during the months of July and August, when fogs prevail, those predisposed to tubercular phthisis are liable to have the disease developed. We here lost one of the crew from consumption; and an officer from the U. S. Ship Falmouth, who was seized with htemoptysis, was transferred to the Potomac, in the hope that a change to Valparaiso would be of service; but the case terminated fatally soon after our return to Chili. On the twenty-eighth of February, 1833, we sailed for Valparaiso, which we reached in sixteen days, after a cold, wet, and boisterous passage ; the mean of the thermometer was 64°, and the average number on the sick list was twenty-three. We remained in port sixty- seven days, during the months of March, April, and Way, (these bein"- the autumn months in Chili), with much colder weather than at the time of our previous visit. In May we had two severe northers, which, as the harbor is open to the north, are dangerous; and both were accom- panied with rain. These northers, which are always indicated by the barometer, only occur at this season. The average on the sick report during our stay, was twenty-one ; and this number was kept up in consequence of the liberty given to the crew on shore. Several cases of pleuritis, rheumatism, and inguinal adenitis, occurred in consequence of the exposure and the wet ship. At Lima, cases of chronic diarrhtea presented themselves, which were relieved soon after a change to a cooler climate. On the twenty-fifth of April, a case of small-pox occurred in one of the sei'vants, who contracted the disease on shore. As soon as the character of the aftection was ascertained, the patient was transferred to an hospital on shore, to prevent its extension. Within a few days, another case made its appearance, and this was followed by a third, all of whom were sent on shore. On the first of INIay, during a norther, he thermometer fell to 40°, there being now a large sick list, composed 58 Foltz's Medical Stai/stics of a chiefly of inflammatory affections. During our stay, fourteen were upon the report witli scrofulous affections, twenty-two with pulmonary and hepatic inflammation, and si;s:teen with rheumatism. Four weeks having elapsed since the appearance of the last case of variola, it was thou"-ht that the disease had disappeared, and we consequently, on the twenty- second of May, sailed for Coquimbo, which we reached in three days; hut on the eleventh of June other cases of variola presented themselves, which placed beyond a doubt the fact that the contagion was on board ship, and that it would inevitably extend throughout the entire ship's company. It was now determined to inoculate the whole ship's company, as we would thereby materially diminish the severity of the disease, and accelerate its progress throughout the ship ; for, as lono- as it continued on board, we were subject to a most irksome quarantine. On the twentieth, all hands were called to muster; and beginning with the officers, every individual who was not marked with the small-pox was inoculated with lymph taken from a well-developed case on board. The number inoculated was two hundred and eighty-seven, all of whom had their grog stopped, and wei'e daily furnished with fresh provisions. At this time the general health of the crew was very good, havin_ V fc* II r RPRK^l-EV n LD 21-100m-2,'55 „ .General Library (B139S22 ) 476" ^"'^"'^^^tle^'**'"''^ m ■ iliiillll;:':;"!!:, {•111 I ll^'Jl i' ill!! Ii 111 UiitiitiiiiliuiiiiitMiiuiiiiiiitiinHilniiiiiiiuiiil !iHlliimi!ll!llllll!llll!l'lllIil!imi!!l!ll»!i i,i ;