NATIONAL LIBRARY OF MEDICINE
             Washington
Founded 1836
U. S. Department of Health, Education, and Welfare
             Public Health Service 
 
 
-?*^.
*LJL     ^
           OBSERVATIONS        / /«?  Z-.
            ON THE DISEASE CALLED
      THE  PLAGUE,
         ON THE  DTSENTERT,
   THE  OPHTHALMY OF EGYPT,
                    AND ON
       THE MEANS  OF PREVENTION.
           WITH SOME REMARKS ON THE
    YELLOW  FEVER OF CADIZ,
                   AND THE
DESCRIPTION AND PLAN OF AN. HOSPITAL
  TOR THE RECEPTION  OF PATIENTS AFFECTED WITH
       EPIDEMIC AND CONTAGIOUS DISEASES.
     BY  P. ASSALINI, M. D.
One of the Chief Surgeons of the Consular Guards, &c. &c.
      TRANSLATED FROM THE FRENCH
          BY ADAM NEALE,
Of the University of Edinburgh, Member of the Royal College
    of Surgeons of that City, and late Suigeon of the
          Shropshire Regiment of Militia.
            TO WHICH IS ADDED,
        A  LETTER CONCERNING                 /^
THE SEASONING, OR YELLOW FEVER
           OF THE WEST-INDIES.
    BY GEORGE PINCKAKD, M. D. &c.
NEW-YORK:
Piinted and sold by T. & J. SWORDS, Pointers to the Fafnltj»
          of Physic of Columbia College.
1806V Ct,>

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TRANSLATOR'S PREFACE,
AMIDST the variety of acute diseases
which have at different times depopu-
lated the earth, and imperiously called
forth the energies of governments, and
the solicitude  and exertions  of  indivi-
duals, the plague has long maintained a
fatal pre-eminence.  After ravaging, for
several centuries, the finest countries of
Europe,  Asia, and  Africa, it seems at
length to have usurped a lasting domi-
nion over the  imperial  city of Constan-
tinople,  the coast of the Levant, and
the whole country  of the  Ptolomies,
where,  conjoined with the sloth, filth,
and misery of the inhabitants,  it bids
defiance to the power of medicine. 
               (  iv   )
   Happily  for this country,  we  have
long been  strangers to its attacks.   A
period,  indeed, of more than a century
has elapsed since it has  been observed
in this metropolis.   But although thus
fortunately estranged from its destructive
influence, we must still continue to feel
a lively interest  in the progress of this
disease, and more particularly since the
occurrence  of  the  late  campaign  in
Egypt.   That country may again be-
come the theatre of war,  and it is there-
fore doubly incumbent on us to procure
every possible information on the sub-
ject of its diseases, in order that we may
the better  be enabled to  preserve the
valuable lives of our brave troops.
   It is  to  be sincerely regretted,  that
none  of our own countrymen who be-
longed to the army of Egypt have,  as
yet, come forward with the information
which they must have collected on this
disease; and we are therefore constrained, 
               (  v  )
for the present, to have recourse to the
writings  of the medical officers of the
French army, who, it may here be re-
marked, possessed more extensive means
of acquiring an accurate knowledge of
the subject than our medical staff,  ow-
ing to their longer  residence in Egypt,
and  to their having had a larger  field
for practice  and  observation, from the
superior magnitude  of the French army.
   But independently of the utility of
the knowledge of the plague and  epi-
demics of Egypt, in a military and po-
litical point  of view, the  subject  pos-
sesses the most general  and extensive
claims to our attention.   A just idea of
the nature  of diseases is only to be ac-
quired by a knowledge and investigation
of various  facts;  and  that  physician
who,  to a sound judgment, unites  the
most  extensive acquaintance with  the
maladies of different countries, will cer-
                 A2 
               (   vi   )
tainly be, ceteris paribus, the best prac-
titioner.
  Such then being my views in under-
taking the  translation of this  work, I
trust that it will  fulfil the  object pro-
posed ;  and I  sincerely hope, • that a
knowledge  of  the facts  therein con-
tained may conduce to  throw  further
light on the contagious and epidemic dis-
eases both of this and  other countries. 
     INTRODUCTION
            BY THE

AMERICAN PUBLISHERS.
VyNE  of  the objects of the work of
Assalini is to combat a prejudice among
the European nations, that the disease
which they call the Plague is contagious.
He derives his  facts  and  arguments
from the Mahometan regions which he
has visited; and  they come  with great
force  from  an eye-witness of so much
intelligence and  candour.   But there is
another source whence  the  like consi-
derations may be deduced.  We mean
the narratives of  the people themselves,
into whose cities the contagion of plague
has been pretended to  have been  im-
ported from the Turkish countries.  The 
               (   viii  )
 greater part of these relations will be
 found defective in their proofs;  and no-
 thing more is necessary to evince their
 inconclusiveness  than to peruse  those
 publications with this object in  view.  If
it turns out,  upon investigation,  that this
 disorder is really not contagious, and that
 a great noise  has been  made  about it
 without sufficient cause, and for no good
 purpose, then a  great error in society
will be corrected, and many of the evils
consequent  upon  it will be removed.
This inquiry is the more important, be-
cause the importers of plague from the
 Levant argue  in  about  the  same man*
ner with the importers  of yellow  fever
from the West-Indies.
  The misrepresentations and  mistakes
which have prevailed in America on
the subject of yellow fever, have  been
pretty fully detected  and exposed.   It
has, however,  been a work of time and
labour;  but in a country, and among 
               (   ix   )
a people where the utmost freedom of
inquiry is allowed, and where the whole
•body of citizens have a deep interest, as
well as curiosity, to examine thoroughly
the alleged contagiousness of their au-
tumnal fevers,  there has been collected
a  great  mass of evidence against that
opinion within the last ten years.  And
the result of this minute and patient dis-
cussion, that there  is  no morbid venom
or poison  sui generis produced by any
secretory action of the vessels during a
yellow fever, whereby that disease xan
be communicated  from one  person to
another, has  led  many  gentlemen to
doubt the contagiousness of the distem-
per, which, in a small region of Europe,
bordering on the Mediterranean sea, be-
tween  the Adriatic  and  Atlantic, has
been denominated the Plague. The con-
nection  between the  United States and
the North African  powers has  strength-
ened these doubts, by affording us strong 
               i  x  )
evidence against the opinions prevailing
among  the Christian nations,  through
Dr. Cowdrey, an American prisoner at*
Tripoli, and Dr. Davis, Consul at Tunis,
in Barbary.  And  the  expeditions to
Egypt have had  this good  effect,  that
they  have  enabled  several cautious ob-
servers to see for themselves  that  ma-
lady,  the very name of which, like that
of an apparition among weak and cre-
dulous people, fills the  inhabitants of
Christian Europe  with terror;  and have
induced them to bear witness against its
contagious  nature.
  Contemplating the alarming stories
about the importation of the plague into
Christendom, and  the expensive  esta-
blishments  that have been made for the
purpose of keeping it out;  it appears ex-
tremely probable all this dread of  con-
tagion,  and the  rigour of quarantines
and lazarettoes to guard against it, have,
in reality,, no better foundation than the 
               (  xi  )
equally positive, though delusive  tales
propagated about our domestic  yellow
«fever.   With this view, Bertrand's Rela-
tion Historique de la Peste de Marseille,
en  1720,  is worthy of being read.   As
this is the great authority whence the
contagionists derive their  arguments, a
copy was sought, and fortunately pro-
cured from  the very  place whose cala-
mities are therein related.   This book is
the more worthy of perusal, because, by
establishing  the  belief of contagion in
plague, it gave rise to the famous code
of regulations which were published in
17 80,  under the title of  Reglemens du
Bureau de Sante.   And these rules and
orders of  Marseilles, predicated upon
the existence of a most  subtil and  viru-
lent pestilential  .contagion, have had a
credit given to them almost as exten-
sive and obligatory as the maritime laws
of Rhodes and Oleron.
  The narrative of Bertrand is the ground- 
               (  xii  )
work of a mighty superstructure.   His
historical relation serves the same purpose
to prove the contagiousness of the plague,
and  its introduction from  Syria   into
France, as Chisholm's Essay answers to
show that  the Malignant  Pestilential
Fever was carried from  Guinea to the
West-Indies and the United States.  The
improbable and unfounded  nature of
the latter account is  now generally un-
derstood,  and candid  members of the
profession excuse, while  they  lament
such a capital mistake in so sensible and
respectable a writer.  This discovery na-
turally prompted an inquiry into the
weight and pertinency of the evidence
which Bertrand's volume contains.  For,
if it should be found to be weak or irre-
levant, then  the vision about contagion
vanishes, and all the  apparatus to keep it
away becomes vain or useless.
   " The facts,  (says Dr. Mitchill, in
his letter to the Board of Health in New- 
              ( xiii  )
York, September 10, 1806),  on the oc-
currence of the memorable mortality at
Marseilles in 1720, as I collect them
from Bertrand's book, warrant no such
conclusion as he has drawn from them,
and  may be  summarily stated thus:
That city had suffered, at different times,
nineteen visitations of plague that were
important enough  to  be remembered;
this was the twentieth.  This year, corn
and other necessaries were dearer than
common, not so much,  says the author,
from actual scarcity, as from the remark-
able want of money; but which, to all
poor people, amounted to the same thing.
   " The season is described as not being
remarkably different from common years.
In the course of June, the inhabitants be-
came sickly. The disease began among
sailors and indigent people near the har-
bour,  and gradually extended the circle
of its action.  The  people and their ma-
gistrates grew  uneasy,   and  expressed
                   a 
               (  xlv  )
different opinions about it, and,  on re-
ferring it to the members of the medical
profession, they,  as usual, also differed
in opinion.  One class of them expressed
their solemn conviction,  that it neither
proceeded from  a  vitiated  atmosphere
nor a scantiness of food, but was derived
from contagion imported from Sidon, in
Syria, on board a ship which sailed thence
January 31,  and  arrived on  the 25th of
May, with a clean bill of health, and a
sickly crew, at Marseilles.  Mr.Bertrand,
who is the chief of this sect, says,  the
vessel also touched at Tripoli and Cyprus,
and brought  certificates of health from
both those places.  The Captain, during
the voyage,  had  put  into Leghorn, on
account of the wretched and dying con-
dition of his crew,  and had  received a
certificate from a  physician and surgeon
there, purporting that they died of a ma-
lignant pestilential fever.  Several other
vessels arrived from the same ports about 
               (  xv   }
the last of May and in the  beginning
of June, bringing foul  bills, there being
suspicions and  appearances of plague;
but  none of their  crews are stated to
have  been unhealthy.  On  the other
hand, there was a numerous and intelli-
gent body that contended in favour of its
local  origin at home.  These ascribed
the endemic to atmospheric distempera-
ture, vile and scanty food, and to fear and
the depressing passions. This side of the
question was maintained strenuously in
numerous publications, by Mr. Deidier,
Professor  Maille  of Capors,  Dr. Boyer
of Toulon, and Professors Chicoyneau
and  Verny of Montpellier.   All those
were  men  of high  character, and, ex-
cept one, were  eye  witnesses  of the dis-
temper; beheld it  in  its worst  forms,
and deliberately spoke  and printed their
conviction, that it was an ordinary ma-
lignant disease, and by no means conta-
gious. 
               {   xvi  )
 '" The points of importation and domes-
tic origin were as fiercely disputed at that
time, as they have ever been since. Mr.
Bertrand, Mr. Pons, Mr. Peysonnel, bro-
ther Victorin, and the other persons who
were  contagionists, ascribed all the mis-
chief to the arrival of the vessels from
the Levant, and satisfied  themselves  of
the landing of the contagion  at the la-
zaretto; whence, after having multiplied
and  recruited itself, it slipped insensi-
bly into the neighbouring  part of the
town,  crept  insidiously from house  to
house, and  from street to street,  until
it gained possession of  the whole; and,
finally, glided by the same secret and
silent advances into the adjoining coun-
try. Their  opponents considered all this
to be  prejudice, mistake,  and delusion.
There was no proof, they said, that con-
tagion existed  in the Syrian and Cyprian
ports  when the accused ship left them.
If contagion had existed, there was no 
               (  xvii  )
evidence of its having been taken  on
board.  In  a  voyage  of nearly three
months'  duration,  nothing was more
common than  the existence of  sickness
among a crew. There was no necessity
of charging such a sickness to the ports
whence they  sailed;  for  it was much
more probable that  it arose on   ship-
board, and  was of strictly local origin
there.   The occurrence of fevers, and
of death during  the passage,  had no-
thing to do with the places whence they
took  their  last departure.  Persons  at
sea had no more security against sickness
and  mortality  than when on shore, and
therefore might, in the nature of things,
become infirm, and even end their days,
from, causes arising within the  vessel it-
self.  So, if a ship  had arrived in a sickly
and unclean condition at any city,  it did
not follow  that her unhealthiness and
filth  must be spread far and wide among
the inhabitants. Independent of all these
                 a 2 
               (  xviii  )
considerations,  on examining  the  facts
it  was found,  that this dangerous dis-
ease had  been  progressing,  by regular
steps, among the  lower class of people;
that it resembled the home-bred malig-
nant distemper  of 1709 and 1710;  that
it was connected with the wretchedness
and famished condition of the poorer in-
habitants,  who  compose the great body
of society; and, in short,  that the popu-
lace, starving upon meagre and damaged
food, became sickly of course from the
common necessity of the case. The most
decisive proof was adduced,  that before
the arrival of the  suspected ship, to wit,
early in May,  and in April, and  even
during part of the preceding year, 1719,
diseases, accompanied with buboes, pa-
rotids,  and  carbuncles,  had appeared.
The sudden deaths of the porters were
not owing to a  blast of pestilential  con-
tagion, inhaled  from the  bales  of goods
they were landing, but  to debility and 
               (  xix  )
impoverishment consequent upon bad
living, and to the sudden and total failure
of their strength when applied to carry
a load.  The attacks were in  situations
so remote from each other, and the pa-
tients so utterly free from  all communi-
cation, cither with one another or with
the ship and her contents, that the dis-
temper was truly endemic in its origin,
uncontagious in its nature, and as much
a  domestic  malady as any other that
ever afflicted the inhabitants.
   " If Mr.  Malthus, said Dr.  Mitchill,
had thought of this case,  he could not
have given a better example than it af-
fords, of the increase of human beings
beyond the amount of subsistence ;  and
of the occurrence of a  pestilence, to rid
society of its superfluous members, and
reduce the number of mouths tothequanr
tity of aliment provided to feed them.
   " While this severe, though  necessary
work was going on, of trimming off the 
              (  xx  )
luxuriance and overgrowth of their po-
pulation, the Marseillians bore it  with
the patience with which mankind gene-
rally endure misfortunes.  Matters  went
on from bad to worse, until near the end
of July, when  an  opinion  was propa-
gated that the disorder among them was
the true Asiatic plague.  This was at first
violently opposed by the multitude. The
authors of it were reviled and insulted.
A more wilful and pernicious falsehood,
they declared,  had never been propa-
gated to the injury of the Burghers.   But
although these were incredulous,  there
were, at length,  persons enough to give
full credit to the story. The rumour that
the plague had  been brought from .the
Turkish dominions, was propagated far
and wide.  It gained believers almost in
every place to which it extended; and in
a very short time this unhappy city was
put under an interdict, and cut off from
the intercourse of society, lest the plague. 
              (  xxi }
by which it was desolated, should over-
whelm the adjacent settlements, villages
and towns by its contagion.
  " As soon as the disease was declared
to be the plague, a series of new proceed-
ings and sorrows began, infinitely more
tragical than all that had happened be-
fore.   The surrounding  places refused
to bring supplies  to  market.   The par-
liament indeed forbade the intercourse
under severe penalties.  Barricades were
ordered for the purpose of keeping them
in.   They were  prohibited going into
the country for safety, or  even to buy
provisions.  The immediate consequence
was an  extreme and general failure of
food.  The bakers were destitute of corn
and  meal.  As  early  as the  third  of
August the bread  fell  short,  and  the
multitude marched  from one  street to
another, insulting  the bakers  at their
houses.   They were agitated  by rage
and tumult.  At  length,  to prevent im- 
               (  xxii  )
mediate famine, two markets were esta-
blished  on the great avenues,  six miles
from  the  city, and another on the sea-
side.  These were  fortified by  double
barriers, officers and  guards,  to allow
sales,  but  to prevent communications.
Thus  were  these ill-fated  people sur-
rounded, and, in great numbers, literally
starved to  death.
  " For, though these supplies relieved
the scarcity in some measure,  there
were multitudes who received no benefit
from them. They were two leagues from
the city.  The poor,  the sick, and the
helpless could not travel so far.  Many
of them indeed were unable to buy,
had the market been held at its accus-
tomed place,  or at their  own doors.
The price of every thing immediately
rose.  Labour became dearer than ever
was known.   The stores of wine, so ne-
cessary an article of diet to the French,
were nearly exhausted.  Butcher's meat 
               ( xxiii  )
was very difficult to procure upon any
terms.   In short, famine became more
formidable than the plague itself.  The
original scarcity, bad as it was,  did not
bear a comparison with the hunger, suf-
ferings,  and mortality that resulted  from
these ill-judged regulations.  The  cala-
mity of  1720 ought to be denominated
the famine,  rather than the plague of
Marseilles: for clearly more appear to
have been starved  than to have died in
any  other way.
  " The labouring classes, and those who
do the work of society for hire,  perished
first; and the greater part of them having
died, and  there being none to  replace
them, it was impossible  to get  work
done, even for money.   A large pro-
portion   of  male and female  servants,
waiters,  and laqueys also  famished at
an early period; and it was oftentimes
quite out  of the   power of the  most
wealthy persons to  procure domestics to 
               ( xxiv  )
perform the ordinary services of life, by
the highest wages.  The survivors were
obliged to perform their own labour and
attendance.   In the progress of the sea-
son, many of the butchers, bakers, and
fishermen yielded their lives to the pres-
sure of the common calamity.  The dis-
tress of this was sorely felt by all the in-
dividuals yet alive.  Of these, the re-
maining poor were starving for want of
their accustomed employment; and the
rich, because they could not exchange
their money for  common necessaries.
The houses, throughout all their  apart-
ments  and recesses, were strewed with
the dying and the  dead.  All the  streets
were covered with carcases. The  grave-
diggers had  disappeared.  LTndertakers
and sextons were not to be found.  About
a thousand corpses were daily thrown in-
to the streets to putrify, until, at length,
a passenger could scarcely walk without
treading on them.  In some places he 
              (  XXV )
was obliged to tread  on  them.   In the
public walks, and  before the Church
doors, they were piled up in large heaps,
men, women,  and  children.   Persons
of all ages and conditions were under-
going the process of corruption, as they
overspread  the  pavements, and filling
the atmosphere  with their noxious ex-
halations.   And this  domestic source
of pestilential effluvia was itself enough,
without other agents, to  have depopu-
lated the city.   To augment their dis-
tresses, an opinion was  started,  that the
contagion  was carried from one person
and  place to another by dogs.  Instantly
a  war of  extermination  was declared
against these poor animals, and the land
and the  water  stank  with  the septic
fluids proceeding  from  thousands  of
them that were killed.    This shocking
condition of things  continued until  to-
ward the end of September.  And, con-
sidering these concurring causes of mis-
                  b 
               (  xxv'i  )
,-dhief,  one is apt to wonder that the
mortality was limited to fifty thousand.
It might be  reasonably expected,  that
under such circumstances, in a popula-
tion of eighty thousand,  a much larger
proportion would have been destroyed.
   " Finally,  the  surviving confessors,
physicians and surgeons, exhausted and
discouraged by all they had suffered, and
by all that they feared,  ceased at once,
to administer their  services,  and aban-
doned the wretches to their fate.  When
these men  withdrew their attendance,
and sought their own safety by flight,
the misfortunes of the miserable inhabit-
ants were wrought  up  to  the  highest
pitch.   They  had  long endured the
depressing  operation of fear.   In many
the  apprehension of danger had been
changed into ghastly terror.  But now
the  small remains  of fortitude  forsook
them, and they sunk under the pres-
sure of  dejection and  despair.   Their 
               (  xxvii f
minds and bodies became the prey of a
debility  which  ended in languor  and
death,  or which  predisposed  them to
receive  morbid impressions that they
might  otherwise have  repelled.   The
dread of the plague, when augmented
by  the  horror  of desertion by all  who
could administer help or comfort, was
a fatal aggravation of their woes.
  " These woes, however, had some  alle-
viation  toward  the  termination of the
calamity.  For,  during  the  season of
Lent, the good Bishop,  the celebrated
Castelmoron, who,  by an ordinance of
24th February,  dispensed with the rule
of rigid abstinence, and permitted the use
of  meat four times a week, substituted,
instead of fasting, the recital of certain
particular prayers. On the 4th of March,
solemn   application  was made in the
Jesuits'  Chapel,  to  St. Francis Xavier,
for his  intercession  with Heaven to ar-
rest the mischief;  and  on  the   21st 
              ( xxviii )
a similar service was performed to  the
sacred heart of Jesus, in the Capuchin's
Church, for the same purpose, and con-
tinued  in both  for nine  or  ten  days.
Altars were erected  in various public
places, and mass celebrated there.  Even
the ancient custom of  carrying the via-
ticum to the sick  in  every parish was
permitted during the fortnight of Easter.
In like manner a procession  had been
formed on the 31st of December, by the
Bishop  carrying  the  holy sacraments,
attended by the surviving clergy, around
the ramparts.  He pronounced the  be-
nediction at the gates of the town, and
in the ditches where the dead had been
deposited, to implore  the  mercy of  the
Lord  upon  those  unhappy  defuncts
whom the calamity had deprived of ec-
clesiastical sepulture.   And, on the 15th
of the  preceding November,  the same
pious  prelate  had walked bare-footed,
with a torch in his hand, to an altar 
               (  xxix J
which had  been erected in the park,
and  after having celebrated mass,  and
given the consolation of his advice and
exhortation to the people, he ascended
to the top of the steeple in the parish
Church of Accoules, and pronounced a
blessing  upon the whole city  at once,
while the ringing of bells, and the firing
of cannon notified the inhabitants to join
their prayers to those of their Bishop.
It was seriously agitated between two of
the great churches, whether  the relics
of the saints ought not  to  be brought
forth to view; but,  owing to a difficulty
in settling certain points of ceremony and
etiquette, these sacred  treasures were
not exhibited.
   " This accident,  therefore,  partook
much-more of a famine than a pestilence,
since the true causes were; 1. Scantiness
and  badness of food; 2. An unhealthy
season among the  poor  and  labouring
orders;  3. The consternation  on their
                 b2 
              (  XXX )
distemper being  proclaimed  the true
Turkish plague;  4. The starving condi-
tion to which  the inhabitants were fur-
ther  reduced by  the regulations of the
police; 5. The envenomed quality of the
atmosphere, from the rotten bodies of
unburied men  and dogs; 6. The prostra-
tion and annihilation of  animal power
by  grief, despondency,  and the most
depressing passions.  And still, notwith-
standing all  these circumstances and
occurrences, enough in all sober  consi-
deration  to desolate a city, it  has been
the fashion, ever  since Bertrand's book
was published, to  quote it as the highest
authority in favour of an imported  conta-
gion that stirred up such complicated and
unspeakable mischief; mischief which
derived infinitely more of its fatality from
bad management, than its own inherent
malignity.   This  author  has written an
elaborate  and sensible  account of the
sickness  and its accompaniments.  He 
               (  xxxi )
is  as impartial  as can be expected in a
person who is a strong and zealous advo-
cate for contagion and importation.  On
the occurrence of a more than common
sickness  at Marseilles,  it became a sub-
ject of rational inquiry to  discover its
cause.   Mr. Bertrand adopted the belief
of  its  introduction from a foreign port,
and patched up a story about contagion
brought  from Sidon and Tripoli.  I say,
patched  up  a story, because  the exist-
ence of  such contagion has never been
proved by the evidence  of one  of  the
senses. The contagion is a mere conceit
of  the mind;  and all  reasoning  upon
such a visionary and fancied agent can
be  but hypothesis, and have  no better
claim  to our  assent  than the fluid of
magnetism and the ether of gravitation.
Upon such a conjecture, all  the  public
proceedings  were founded;  an assump-
tion not  near so worthy of our assent, as
if it had been said that the invisible angel 
               ( xxxii )
©f destruction had literally and bodily
descended, sword in  hand, to execute a
heavy judgment of his Lord,
   " On reading this  famous book,  and
comparing and weighing the evidence
it contains, I am entirely convinced that
the importing party  have failed to  sup-
port their assertions  by,  I will not say
logical or legal proof,, but even by that
evidence which is fit to convince a plain
understanding  here^  in North-America,
after a  lapse  of more  than  fourscore
years.
   " Are we then to  give credit to the
phantom, which deceived the people of
France to the destruction of the Marseil-
lians,  and misled their intelligent  his-
torian himself?  By  no means.  Let us
rather sift the whole testimony,  and, dis-
regarding the  erroneous conclusions of
our predecessors, decide upon the  facts
for ourselves.  If we  do so, we '•hall  find
the plague of Marseilles, which has been 
              ( xxxiri )
quoted and  dwelt upon as the clearest
case of imported contagion that ever ex-
isted, to be unsupported by the necessary
evidence, even on the allegations of its
warmest  advocates."
   Having stated  thus far a  summary
of the contents of one of the  most cele-
brated works on the importation of plague
into France, we shall next insert the ac-
count of its pretended importation into
Sicily, in 1743.  This  is taken  from
Dr. Mitchill's letter to Dr. Rodgers, the
Health   Officer of the  port  of  New-
York.

*' Analysis of Turriano's  Treatise
   onthe Plague a/Messina, in Sicily,
   1743;  and an Account of the  Use  of
   the Rack and Torture to prove the Dis-
   temper contagious.
   " The city of Messina, in  Sicily, suf-
 fered a dreadful  visitation of sickness in
 1743.   An account of it was written by 
               ( xxxiv  )
 Horace  Turriano, and published at
 Naples, in 1745, under the title of■ Me*-
 moria Istorica del Contagio dclla Citta di
 Messina   del  Anno  1743.   Turriano's
 book contains several  particulars well
 worthy of  notice.  He  says  that the
 spring of the year which  preceded the
 pestilence was rough and cold.   South-
 erly winds prevailed, which were stormy
 and cloudy.   The cold at the time of
 the  equinox was scarcely less than that
 of the preceding winter. But the winds
 continued to blow  from  the same quar-
 ter,  and an epidemical catarrh began to
 prevail among the people.   Soon after
 an alteration was perceived in the type
 of the ordinary diseases of  the place.
 This new form of the usual distempers
manifested itself in coughing,  hoarse-
ness, pain in the breast, swellings of the
 throat and glands of the neck,  with other
symptoms of the true and spurious an-
 gina.  In some there were swellings of 
              X XXXV )
the glands in the groins  and near the
ears, and fevers wore a malignant aspect.
   " Some of their prophets had foretold
a sickly season, and now they began to
apprehend a mortal epidemic, similar to
those which, at different times,  had af-
flicted Genoa, Alexandria, Milan, Naples,
Rome, and other places.
   " In this state of things they made a
discovery, which satisfied all their minds
what the true cause of this sickness was.
It was established to their  satisfaction,
that a Genoese tartan, under Neapolitan
colours, had arrived at  Messina, after a
passage of thirty days, from Missolongo,
in the mouth of the gulf of Lepanto,
opposite  to Cephalonia.  She  brought
wool, wheat, and  some fine  manufac-
tures  of the Levant.  She had  a clean
bill of health,  but  had lost one of her
crew  on the voyage. The survivors were
well.   She had had no communication
with any other vessel or port since she 
              { xxxvi )
"sailed.  And the Captain  declared  that
the man had died of an  ordinary  dis-
ease,  caused  by fatigue on a disastrous
and tempestuous voyage.   She was ad-
mitted to  quarantine;  and while  the
wool  was  unloading,  ihe Captain, ex-
posed to the sickly atmosphere on shore,
fell sick  with an erysipelas of his face,
and died on the third day. Two days af-
ter, another man, who had been ashore,
also became  sick  on  his  return  to the
tartan, and died  with a  swelling in
the arm-pit,  and petechias all over his
body.
   " A consultation was  held  by the
magistrates and physicians on the alarm
occasioned by these accidents,  and the
tartan, and all her contents, except the
men, ordered to be carried to a remote
place and burned.  Ail the other people
continued  well.
   " The full quarantine of forty  days
being performed,  and Te Deum sung, 
              (  xxxvii )
an alarm was given that, in another part
of the city,  a disease prevailed,  accom-
panied with  buboes  and other pestilen-
tial symptoms.  The physicians sent to
examine  the sick  reported,  that the
distemper was nothing more  than the
epidemic which  had  prevailed  since
February.  They grounded their opinion
upon the  fact,  that it was not  conta-
gious, and did not spread from person to
person.   Therefore  it could not be the
plague,  whose essential character, they
said, it was to be  in the highest degree
contagious.   Physicians, surgeons, con-
fessors  and barbers  escaped it,  though
they attended the sick in hospitals. And
the like immunity had happened in the
malignant sickness at Bronte and  Modica
some time before.  The distemper, how-
ever, went on to increase with so much
violence and  mortality, that on  the 4th
of June it was allowed by all parties tq
be the true plague.
                  c 
              (  xxxviii )
   " The story of its introduction by the
before-mentioned  tartan,  was not now
deemed  sufficient,  in  the judgment of
the magistrates of Messina,  to prove the
introduction of the plague.  They there-
fore apprehended two  sailors, belonging
to another vessel, a suspected pink. By
threats of torture,  and the  sight of the
rack,  a  confession was extorted  from
them  of  the  arrival of the pink  at the
port of Messina,  after a coasting voyage
to Modon, Patras, Missolongo, and other
places.   The contagion was brought on
board in  some rolls of tobacco, or bags
of biscuit;  and  after  having destroyed
several persons belonging to the  pink,
was landed among the  unfortunate Mes-
sinians. Being completely satisfied with
this forced story,  which was modified by
the engine of  terror  so  as  to answer
every  purpose  they  wished,  they  re-
nounced  the first one as erroneous and
unnecessary. 
               ( xxxix )
   " The plague continued with but little
abatement  of its  fury, notwithstanding
the relics  of St. Lucia and St. Bernard
were  sent to Messina from Syracuse to
stop it,  until the  2d of July,  when  the
people took down  from the great altar
the ancient image of their tutelary saint,
the Holy Mary, the mother of God,
and carried it in procession through  the
streets.   From that day  the  plague  be-
gan  to  decline,  after numerous other
processions  had failed,  and other saints
been applied to in vain.
   " As  soon as the sickness was declared
to be the plague, the inhabitants were
panic-struck.   There were no bakers to
prepare bread. There were no labourers
to dig graves.  There were no nurses to
attend the sick.  And as the distemper
was  deemed  contagious, every  person
was afraid to touch another, and even to
approach him.   The people of the sur-
rounding country refused  to bring  fuel 
               (   xl   )
or provisions to market, and guarded the
roads leading out of town with so much
strictness as to prevent the flight of the
unhappy citizens into the country. The
putrefying carcases of the dead lay scat-
tered through the houses,  heaped up in
the streets, and piled in larger  collec-
tions at the church doors.  These were
so dangerous and  shocking, that, at
length, the furniture and wooden work
of houses were carried into the streets for
making fires to burn them.  From these
funeral piles  fire was several times com-
municated to the neighbouring  build-
ings.  And by those direful consequences
of the opinion entertained by the Franks,
of the  contagiousness and importation of
the plague, the Messinians,   instead of
losing  a few  hundred  persons, as they
might have done by proper regulations,
managed  matters so badly as  to  destroy
above  forty thousand lives that  season.
The Turks judge  more  like  rational 
               (   xli  )
creatures about this disease, and do not
frighten, starve  and poison themselves
to death on account of it.
   " After the abatement of this calamity,
so great a  part of  which was brought
upon themselves by their own impru-
dence, they  concluded that a general
purification was necessary to restore to
health their city, contaminated by con-
tagion.   To superintend this grand ope-
ration, the famous Dr. Polacco was sent
for from Venice.   And  under his eye
they went from house to house,  and,
after various washings, ventilations,  and
other processes,  concluded by fumigat-
ing with mixtures of pitch, brimstone, sal
ammoniac, frankincense,  storax,  harts-
horn shavings, raspings of pine, juniper-
berries, dried rosemary, old leather, long
pepper, camphor, gun-powder, orpiment,
and  antimony.   And  this  ceremony be-
ing  over, the surviving inhabitants re-
turned to their homes, as fully convinced
                 c 2 
               (  xlii )
that the perfumery had destroyed the la-
tent contagion, as that the image of the
Virgin had stayed its ^active malignity.
  " Professor Thomas Fasano judged
better on this subject.  He published a
book at Naples on the epidemic fever
which desolated that city in 1764. It is
entitled,  Delia Febbre Epidemic a soffcrta
in Napoli VAnno  1764. Libra iii.  Di
Tomasso Fasano.  He is so wholly con-
vinced of local and domestic origin, that
he does  not  even mention  any  thing
about a ship.  And this, in a sea-port, is a
very remarkable circumstance.  Fasano,
with great good sense, lays it down as a
principle, that  an epidemic is a slight
plague, and that the plague is a powerful and
furious epidemic, (che I'epidemia  fosse
un leggiera peste, e la peste  un' epide-
mia gagliarda e furiosa.)   And,  in like
manner, MichaelSarcone, who wrote
an history, in two volumes,  of the dis-
tempers  which prevailed  at  Naples in 
               (  xliii  )
1764, under the title of Istoria Raggio-
nata de  Mali osservati in Napoli nelV in-
tero corso dell' Anno 1764, does not pre-
tend that this  epidemic was any thing
else than a  pestilence  consequent upon
the extreme scarcity and famine of the.
preceding year. 
 
CONTENTS,
                                             Page;.
 Introduction                                   1
Meteorological observations,  temperature,  weight
  of the  atmosphere,  direction of the winds,  and
  state of the sky during the year 7 (1798-9) at
  Cairo.....-     11
Observations on the diseases which attacked the army
  of the East in Egypt and in Syria, during the years
  6 and 7 (4798-9) of the French Republic, contain-
  ing an  investigation of its identity with the plague  13
Whether this disease be really contagious       -    16
Of the symptoms accompanying this disease    -    26
Of the causes which could have produced this disease
  in Egypt and Syria     -                  -     35
Indications of cure      _      ...     42
 Treatment      -      -                        ib.
Of buboes and gangrenes, known under the  name of
  carbuncles or anthraxes      -              -    51
Of the means to be used for preventing the attacks
  of this disease                                 56
Of the means which might be employed in Egypt to
  destroy th« epidemic fevers                     68 
                     C  xlvi  )
                                              Page.
 Of the seclusion of the Franks during the time of
   the plague      -                               73
 Of lazarettoes and quarantines      -              7d
 Reflections on the  epidemic fever observed in the
   Ligurian Republic, and  in the hospitals of the
   army of Italy, in the year 8 (1799  1800)   -      89
 Reflections on the  yellow fever which appeared at
   Cadiz in the year  1800       -                  93
 Symptoms            -                          94
 Causes               ...       -      95
 Method of cure    -  -      .      -      -      97
 Means of prevention         -                   100
Queries respecting the yellow fever which appeared
   at Cadiz in the year 1800        -       -      101
 On the dysentery          ...      104
Treatment, and means of preventing this disorder  108
On the ophthalmy of  Egypt         -       -      116
Description of the ball of the eye      -       -     117
Description of the ophthalmy        -      -      123
Causes      -                     -             125
Indications          -      -       -      _      132
General treatment of the ophthalmy        -      133
Treatment of the simple ophthalmy    -    -      136
Ti-eatment of the complicated ophthalmy   -       139
The treatment used by the Egyptians for the cure of
  the ophthalmy      -                          145
Powders, ointments,  and collyriums  used in Egypt
  in the treatment of the ophthalmy     -           148
On the means of preventing the ophthahTiy    -    150
Description  and plan of an hospital  for  soldiers
  attacked in Egypt with  the disease called the
  plague, &c.                          -        15a 
                     (  xlvii  )
                                               Page,
Report made to the Society of the School of Medi-
  cine at Paris      ....       176
Report made to the Consuls of the French Republic,
  by the Minister of War, the 15 Germinal,  year
  9  (4th April,  1801)                             196
Additional Notes             .-        -           199
Appendix.  Concerning the Seasoning, or  Yellow
  Fever of the West-indies       -       •.       2lt 
 
INTRODUCTION.
 HAVING been appointed to attend the
 grand  park,  of artillery during the expedi-
 tion to Syria, in the rank of medical officer,
 I arrived at Jaffa on the 15th Ventose, in
 the year 7 (the 6th March, 1799), and on
 the  18th (9th), I took the charge of the
hospitals in that city.
  Forty days afterwards I received order?
to follow into Egypt General Damas, and
several other soldiers,  who  had been  se-
verely  wounded ;  the unhealthiness of the
country and other circumstances requiring
that measure.   On our return to Damietta
the  citizens who composed the board of
health  there considering us to he affected
with the plague, put us under  strict qua-
rantine. To beguile the ennui of my prison,
I resolved to commit to writing (although
                   B 
                  (   2  )
in a  foreign  language)  the  observations
which I had made on the disease which was
the cause of otir seclusion.. I employed my-
self successively in this<way during the dif-
ferent quarantines which I afterwards un-
derwent at Cairo,  at Malta,  and  in the
lazaretto of Marseilles.  These opportuni-
ties  of  observation   led  me  to entertain
doubts respecting the cause of the plague,
and to form conclusions that have not been
generally adopted; which scepticism, con-
joined with the  peculiar circumstances in
which I found myself placed during my re-
sidence in  the Levant, have furnished  me
with  evidences and facts which will contri-
bute, in my opinion, to discover the real
causes of the  disease of Egypt, called  the
plague.  This object  will be the more easily
attained in proportion to the attention paid
by the respectable general officers,  the well
educated medical staff,  the  natural philoso-
phers, geologists, and  other philosophical
men  attached  to  the colony of  Egypt.
   I  have also added some particulars re-
specting lazarettoes,  the seclusion  of  the 
                 i   3  )
Franks  in their own  houses during the
plague, the dysentery, and the ophthalmy.
  Before we treat of these diseases,  it will
not be improper to  give some idea  of the
circumstances which contributed to  impair
the health of our soldiers  on their  arrival
in Egypt.
  On the 16th Messidor of the year 6 (5th
of July, 1798), after a voyage of forty-five
days, the army of the East landed at Alex-
andria, in the best possible state of health,
notwithstanding  the  inevitable inconveni-
ences  resulting  to land troops from a sea
voyage.  On our arrival at  Alexandria, we
were  encamped  upon a dry, barren, and
scorched soil:  the thermometer stood at
mid-day at 26° (82° Fahrenheit), the  nights
were  cool;  but  the  immense quantity of
gnats or musquitoes prevented sleep by their
punctures, which threw  the skin  into  a
state  of inflammation resembling the mea-
sles.   It would be difficult to express the
painful sensation which these  insects pro-
duced at the moment when they thrust their
stings into the substance of the skin. 
                 (   4  )
  The army, not finding a sufficient quan-
tity of fresh provisions in Alexandria, was
obliged to  continue to draw its  supply
from the fleet.  This food was far from be-
ing of the best quality;  the water likewise
in the cisterns of Alexandria was  scanty,
muddy, and of a taste by no means plea-
sant to  people just arrived  from Europe.
At this time also the nights  were not only
cool but damp;  the ground was moist at
day-break, as if  there had  been  a  fall of
rain;  winds from the south-west quarter
prevailed: the vapours of the sea, and the
exhalations of the lake Mareotis,  which
was not yet dried up, contributed to  render
a residence at Alexandria very unhealthy,
particularly at this season.  In short, Alex-
andria had just been visited with the  plague,
and the Franks lived still shut up  in their
houses.
  By the  18 Messidor (7th July), the whole
army was on its  march for  Cairo.   As we
had not  been accustomed  in Europe to
trouble  ourselves with live  stock,  nor to
carry a  supply of water with us, we neg- 
                 (  5  )
lected these precautions; but what  suffer-
ings did we not endure during our march
from Alexandria to Rhamanieh, across a
country  become a  perfect desert,  since,
through the negligence of the ancient go-
vernment, it is not now reached  by the
waters of the inundation? Having at length
arrived at the  Nile, we had the means of
quenching the  burning thirst which great
fatigue had rendered the more insupport-
able.  Continuing  our  march  along  the
banks of this river, we frequsntly met with
fields of pastequcs,  or  water melons;- and
daring the remainder of our march to Cairo,
these delicious fruits continued to furnish
the most delightful and agreeable  repasts,
and  produced  a  surprising  effect on  the
health of our soldiers.
  The army, after having  gained the fa-
mous battle  of the Pyramids,  arrived on
the  2d Thermidor (21st July), at Giseh,
and  on the 4th (23d), at Cairo; where we
found plenty of bread, meat of every kind,
milk,  eggs,  fish,  greens,  and excellent
grapes, at a moderate price:  wine was
                  B  2 
                (   6  )
scarce, but brandy and coffee supplied it^
place.  The heat at Cairo was  greater by
three degrees than at Alexandria,  the ther-
mometer standing at 29° (86°);  and to-
wards  the  end of Thermidor  (middle of
August),  it got up to 31° (89° Fahrenheit).
  The Nile continued sensibly to overflow;
and on the 1st Fructidor (19th of August),
the dikes of the Calich were cut to allow
the waters  to enter into the squares and
gardens of Cairo: on the whole, the inun-
dation was considerable.
   At the beginning of Vendemiaire, in the
year 7 (the latter end of September, 1798),
the thermometer was at 23*° (75°) at mid-
day, and during the night at 17° (64° Fah-
renheit), although but a  few days before it
had been at 31° (89° Fahrenheit) at noon,
and during the night at 22° (74° Fahrenh.)
This change of temperature of course sub-
jected our soldiers to diseases, because they
were not yet  accustomed to the  climate,
and unacquainted with  the necessary pre-
 cautions.  The soldiers of the  divisions on
 actual service always  passed the night in 
                (  7  )
the open air, or, if on the Nile, slept in
open  barks, whilst those in  garrison, in
order  to profit by the coolness of the night,
slept  constantly out of their quarters, or
close  to large windows thrown open, where
they  were exposed  to  the north  wind:
the perspiration was thereby checked, and
gave  rise not only to  rheumatic affections,
which are very common in Egypt, but like-
wise  to the dysentery and ophthalmy.  If
to  these positive causes  be added the mi-
asmata exhaled by the  numerous  marshes
in Lower Egypt, we  shall possibly  disco-
ver the  real source of the epidemic fevers
which are  known by the  name of  the
plague, those of Jaffa having been of the
same nature.   Before we treat  of these, it
may not be amiss  to describe  the  medical
topography of  that city,  and  to point out
the particular circumstances which contri-
 buted to  develope  a disease that proved
more destructive  there than in any other
 place.
.  Jaffa, or Joppa, the small sea-port town
 of the ancient Palestine,  upon the Mediter- 
                (  8-   )
ranean, is situated  on  an eminence,  and
built in the form of  an  amphitheatre, in
northern latitude 32° 20', and in 52° 55' of
longitude from the meridian of Paris.  The
sea washes its  walls on the north and the
west: several very extensive  woods, com-
posed of an innumerable quantity of bushes,
orange, citron, and other  fruit trees, cover
this  city on the south and the east sides*
The chain of mountains which stretch from
north  to south, oppose a barrier to the
clouds  brought by the winds from the west
and north, and give rise to the formation
of thick  mists and heavy rains, which take
place in this part of Syria during the winter
and  spring.   The nature of the  soil,  and
the want of ditches  and canals to drain the
ground, occasion several ponds or marshes,
which  can only be  carried off by evapora-
tion.   The French  army,, on its arrival at
Jaffa,  encamped close to three of these
ponds, the waters of which supplied their
wants  till their departure for Acre.
   On  the taking of Jaffa by assault, the
number  of Turks killed  and  half buried;} 
                I   9   i
the bodies of those whom the sea threw
back, and left on the shores;  the miasmata
arising from  the putrefaction of the car-
cases of the  horses and camels left dead
upon the  ground,  or dragged scarcely be-
yond the  walls ; the want of fresh provi-
sions ; the filthiness of the inhabitants ; the
hordes of  Bedouin Arabs who blockaded
the city ;  these circumstances conjoined, in
a few days overwhelmed us with all  the
miseries of war, famine, and pestilence.
  The resemblance between several of the
diseases observed  in Europe, and  the epi-
demic fevers  of  Egypt,  has induced  me to
say a few words on that which showed it-
self in the Ligurian Republic in the year 8
(1799—1800), and upon the yellow fever
which broke out  at Cadiz in the year 9
j(l800, 1801).
  Some  epidemic  diseases   are  rendered
contagious, by merely  bringing together a
certain number of  individuals into the same
place, and particularly in badly ventilated
hospitals.   In order to avoid  this inconve-
nience, I  have  conceived  the design  of an 
                (   io  )
hospital for the garrisons of each principal
city on the coast of Egypt.  It appeared to
me to unite several advantages, and I have
had the plan engraved.  I have also added
some details relative to service, and the oily
frictions,  as  practised in different cities in
the Levant, but particularly at Smyrna, in
the treatment of the plague.  I submit the
whole to the judgment of my fellow prac-
titioners, that they  may extract from it in-
formation towards attaining a  knowledge of
the mode of treating the disease, preserving
the health of the medical officers and those
employed in  the hospitals; and  to  prove
that the epidemic  disease of the coast of
Egypt is not always the plague.
Sat mihi, si prosim, scribendi magna voluntas. 
	METEOROLOGICAL OBSERVAl							iONS.	•
Temperature	according to the scale of Fahrenheit's Thermometer.					Mean weight. of he air.			
								Mean direc-tion of the	Mean state of the sky.
		Greatest deg		Least degree		Ban.me er.			
At Cairo in th 1798-17	e year 7,	of heat.		of heat				winds.	
	99.______^___					Jta(2X177?,H7T1/	Minimum. inch. line.		
	1 Morn. | Noon,			Morn.	Noon.	inch. line.			
From 23 cept	to 23 Oct. j 65°		76°	65°	76°	28 2	28	S. S. E.	Cloudy.
23 Oct	22 Nov ! 57 6		72	50 5	64	28 2	28 1	S. E.	Foggy.
22 Nov.	22 Dec. 50		68	49	63	28 4	28 2	S. S. W.	Foggy-
22 Dec.	21 Jan.; 42 6		72	37	55	28 6	27	S.varia. W.	Cloudy. Rainy.
21 Jan.	20 Feb.j 55		66		53	28 3	28 2	S. S. E.	Some clouds.
20 Feb.	22 Mar. 62				41	28 2	28	E.	Cloudy.
22 Mar.	21 Apr.i 62		53 5			28 4	28 1	S E.	Clear.
21 Apr.	21 Mav! 68		85	50	73	28 1	28	N E.	Clear.
21 May	20 June	71 5	90	61 5	79 5	28 4	28 1	N. E.	Clear.
20 June	20 July	75 5	88 5	62	85	28 4	28	N E.	Clear.
20 July	- 19 Aug.	'73 5	89	53	83	28 4	28	N.	Clear.
19 Aug.	23 Sep.	84 5'			68	28 2	28	N. E.	Clear j
 
 
(  13  )
       OBSERVATIONS
                  ON

            THE DISEASES

Which attacked the Army of the East in
  Egypt and in Syria, during the Years
  6  and 7  (1798,  1799)  of the  French
  Republic.
 I AM at a loss what name  to give to a
disease which attacks several individuals at
the same time, and the chief symptoms of
which are fever, buboes, partial gangrenes,
or carbuncles, prostration of strength, head-
ach  and  delirium, and  which generally
carries off the  patient on the  third or fifth
day.
  This disease, which every year shows
itself more or less along the  coast of the
Mediterranean and Archipelago, from Alex-
                  C 
                (   14  )
andrla to Constantinople, has been named
the Plague.   The  Europeans, who have
been long settled in the Levant, as well as
those who practise medicine in Egypt and
Syria, have called it the plague; and, rela-
tively to the number of its victims, they
style it, the mild plague, or the malignant
plague.  Prosper Alpinus informs us, that
the plague  is brought into  this country
along with the merchandise coming out of
Greece, Syria,  or Barbary.   He asserts,
that the plague which comes from Greece
or from Syria to Cairo, is mild4 and of short
duration;  whilst that which  comes from
Barbary is  fatal, and  lasts a  longer time;
that this disease shows itself at  the  com-
mencement  of September,  and constantly
ceases in June,  whatever may be its vio-
lence.  The Europeans and the inhabitants
of  the Levant,  settled in  Egypt and in
Syria,  look upon the eve  of St. John as
the last day of the plague for that season.
Those who are persuaded that this malady
can only be contracted by  contagion,  not
-being able, to impute the cause of the pesti- 
                (   15  )
lential  disease which appeared amongst our
troops  to the arrival of  any  vessel from
abroad, on account of the blockade by the
English squadron,  have pretended to attri-
bute it to goods which, since the year before,
had been left infected in the magazines of
Alexandria and  Damietta.  As it is an opi-
nion commonly received, that the pestilen-
tial virus adhering to some stuffs remains in-
active during the heats of summer,  but that
in winter it recovers its former activity, and
causes  the plague  to burst  forth  anew;
others  have thought  that this malady had
existed during  the whole year at Alexan-
dria,  although   it  did not show itself  in
several individuals  at the  same time till the
winter season.  Those who have employed
themselves in investigating the nature  of
this disease, agree in saying, that  the poi-
son of the plague is an unknown, invisible
vapour, which comes from distant countries,
and  is  communicated by actual  contact
from one body  to another, exerting its de-
structive powers on persons of every age
and temperament.   As to myself,  I avow, 
                 (   16  )
that I cannot form  any idea of this vapour.
The medical officers of the  army of the
east, not meeting with all the characteristic
symptoms  of the  plague  in this disease,
called it the fever  zvith buboes.   Savaresi,
the physician in ordinary to the army,  dis-
tinguished  it into  the synochus,  simplex,
h/mphaticus,  lymphaticus pestilentialis, and
typhus gravior.   A great number called it
the prevailing disease; but I preferred call-
ing it the epidemic  fever, that  I  might not
make use of the denomination of the plague,
a name full of terror, and often more mor^
tal than the disease itself.

 Whether this disease be really contagious <

  Contagion has been distinguished by au-
thors into volatile contagion and  fixed con-
tagion.   The plague, which is certainly of
all diseases the most severe and most fatal,
has been supposed  to arise from fixed con-
tagion;  and, according to the established
principles of lazarettos, it  has been judged
sufficient to avoid immediate contact to  es- 
                (   n  )
cape  the  plague,  and that hindering all
communication  will  arrest its  progress:
without this precaution,  they pretend that
the disease is communicated, and propa-
gates itself from one country to another.
   I have seen a great number  of persons
who have been attacked by the  epidemic,
after having had communication with others
who were already sick.; and I would have
adopted the  conclusion,  that it was to the
eontagion they ought to attribute their dis-
ease,  if I had not also seen a much greater
number who continued to enjoy good health,
in spite of the most decided communica-
tion.   I have  even  seen several individuals
contract  the  disease,  and  die, although
they had been living shut up, according to
the manner of the Franks.  I should have
thought it right to conclude, that the dis-
ease of which  we are now speaking was
contagious, had I seen the Egyptians and
Syrians fall under its  influence  as  well  as
our soldiers, with whom  they had constant
intercourse.  As soon as any one of our men
was attacked,  two Turks led  or carried
                  G"2 
                (   18  )
him to  the  hospital.   There is no doubt
that several  of them shared the clothes of
infected persons, without contracting  the
disease.  If it had been  contagious, as is
pretended, it would not  have been possi-
ble to have  arrested its progress in Lower
Egypt, nor to have hindered its spreading
to Cairo.   The lazaretto  established near
Boulac was  at that time  of very little  use
towards effecting so important an object,
It is well known, that the fear of quaran-
tine only caused the inhabitants to  devise
schemes to elude the vigilance of the guards
of health,  and custom-house officers.  Seve-
ral Frenchmen and superior officers coming
from Alexandria and Damietta  by the Nile
to Cairo,  to avoid being  detained for  five
daysin quarantine, landed, with their horses,
about a league from  Boulac, and entered
Cairo without performing it.  How  many
pacquets and letters coming from Alexan-
dria and Damietta, where the disease was
raging,  entered Cairo without  producing
any bad effect!  What I have just said of
the soldiers coming from Lower Egypt will 
                    (   19   )

apply to those  who came from Syria, where

the same disease had  broken out.*

   In the  month of Floreal (April, May)

three  soldiers  coming  from  Bekaire-Tel-

Agy,  a fort situated  three leagues from

Cairo,  where this disease had shown itself,

were conducted  to the hospital  of Ibrahim

Bey: they died two days afterwards.  These

men had intercourse with  more  than sixty

persons.    The committee of health gave



  * On his return from Acre,  I attended the  General of divi-
sion Lasnes, whilst he was still under quarantine in the isle of
Roda.  I extracted a musket ball, which had struck him in the
temple, below the left eye, and  which, passing along the tem-
poral bone, had buried itself behind the ear.   A little instru-
ment which 1 had in-vented for making counter openings, was
of great use to me in this operation, as it helped me to discover
the  ball, which was supposed  to have  come out at the ear,
where there was an opening which poured out a good deal of
blood at the time of the wound.  This instrument directed me
to the ball, without making useless probings or incisions. Soon
after the arrival of this General at Roda, on being called in
consultation, I extracted this ball, which had  been so difficult
to discover, that it had remained in that position during thirty-
^even days.
  It was in the breach at Acre that rh'i6 brave officer received
this dangerous wound: he immediately fell senseless; and his
soldiers, believing him dead, brought  him off from the battle,
by dragging him by the feet for upwards of two hundred paces,
that his  body might not be left in the hands of the Turks.
Twenty days after my operation, he  chose,  in opposition to
my  advice, to follow General  Bonaparte to  Aboukir, where
he contributed greatly to the memorable defeat  of the whole
army of Mustapha Pacha.  At  this time he is commander ia
chief of the consular guards at Paris. 
                (  20  )
it as their opinion that they died of the
plague, and ordered this hospital to be put
under a strict quarantine; during the course
of which not  a symptom of the plague oc-
curred,  nor even a single  death;  although
just before there had died more than two
every fortnight.
  After the death of several medical offi-
cers at Jaffa,  General Grezieu, command*
ing this province, recommended to the com*
missary of war,  a native,, who had the re-
putation of being an excellent physician for
the plague: it was agreed that he should
prescribe under the inspection of a French
surgeon.  This man opened the buboes in-
discriminately, his knowledge in medicine
not being extensive.   For several years he
had  attended such inhabitants  of Jaffa as
were attacked by the plague, and  he  used
no precaution whatever to preserve himself
from this  complaint, nor to avoid  contact.
Thave seen him get  up with his bare feet
on  the  bed of General Grezieu,  covered
with sweat, and take him by the  arms to
change his posture, although he was  then 
                (  21   )
attacked with  a carbuncle,  of  which  he
died an hour afterwards.   When he  had
opened the buboes with his bistoury, he
took a bit of lint, or a little charpee, to
wipe it, after which he placed it betweeiv
his forehead and his turban: he went in this
way from one patient to another, not only
in the  hospital, but  even throughout the
city, and  did not put it back into his case
until his visits were  over.   Citizens Des-
genette and Larray, the one physician, the
other surgeon  in chief to the army  of the
east, as well as several others of my col-
leagues,  exposed  themselves as  much to
the contagion without suffering any  incon-
venience.   It would be tedious to mention
here all the particulars.  Citizen Larray,
besides the operations practised in this dis-
ease, opened  several  of the dead  bodies,
and examined  with great attention  all the
parts, but particularly the buboes, and the
state of the lymphatic glands, all of which
were in general found more or less enlarged.
Citizen Desgenette pointed  out to me two
punctures, which he had made on himself, 
                (   22  )
while in Syria, with a lancet dipt in the pus
of a bubo: he made this inoculation, per-
suaded that the disease was not contagious,
and both of these learned and  zealous staff
officers have continued to enjoy good health.
The Commander in Chief, Bonaparte, great
in every emergency, braved, on several oc-
casions, the dangers of the contagion.   I
have  seen him in  the hospitals at Jaffa,
inspecting the wards, and talking familiarly
with the soldiers attacked by the epidemic
fever and buboes:  a  conduct which  pro-
duced the best effect,.not only on the spirits
of the sick, but of the whole army.  This
heroic example encouraged  at the same
time  the hospital  attendants,  whom  the
progress of the disease, and the fear of con-
tagion had alarmed considerably.   I know
that the advocates for contagion cite exam-
ples of persons and very  large families who
have  died, because they had  touched  the
sick, or the effects belonging to them, which,
in their opinion, contained  the germ of the
disease:  but  they  do not  foresee,  that  it
would result from this reasoning, that what 
                (  23   )
they say of this disease may be said of the
opthalmy of Egypt, the fevers of Mantua,
and, in fine, of  all epidemics.
   During the  2d year  of the  Republic
(179.4), ten  thousand men perished in the
space  of four  months in the army of the
Pyrenees, comprising almost  all  the medi-
cal officers, and hospital attendants.   In
the year 3 (1795), and in  7  and 8 (1799,
 1800,) the same calamity befel the  army
of Italy in the bay of Genoa,  and in the
environs of Nice.   Luckily,  not discover-
ing buboes, they did not pronounce it the
plague, nor contagious, although the mor-
tality was such,  that a great many soldiers,
and some entire families, fell  victims to the
same disease.   (See the Journal de Medi-
cine, an.  9, page 373).   The  campagnia
of Rome, the  environs of Perpignan, the
departments of  l'Ain in France, Hungary,
Guinea,  Bengal, and other countries, both
in Europe and elsewhere,  present  spots
where fevers show themselves, which make
considerable  ravages,  and which  are ac-
 knowledged to be epidemic, without being 
                t  24  )
contagious, and mortal without being consi-
 dered the plague.  Lind, in speaking of Ben-
gal, says, that in the rainy seasons malignant
 fevers are contracted, which prove immedi-
 ately fatal;  the body becomes covered with
 livid spots, and the corpse  black in a few
 hours.   If  these diseases be neither conta-
 gious, nor the plague, why give this terrible
 name to the epidemic observed in^Egypt and
^yria, and assert it to be  contagious?   One
 may contract, in my opinion, this disease,
 when the causes  which produce it shall by
 degrees have impaired the health, and pre-
 disposed the body to take on diseased ac-
 tion : I will then admit,  that if a person be
exposed to  breathe the  infected air in the
 chamber of a patient, or should he stay too
long  in the same atmosphere, he will run
 a  great  risk of contracting the prevailing
 malady.  I have been careful never to stay
longer by the sick than  the  time requisite
 to perform  the necessary operations; after
 which I always went out to respire a better
air.   In this way I have been  preserved
 from a disease which, in forty days, carried 
               (  25   )
off one third of the  garrison of Jaffa, in-
cluding the commandant of the province,
the governor of the pla'ce, and nine medical
officers.  I experienced a real  satisfaction,
when I approached the  sick and felt their
pulse,  whether to learn their situation, or
to encferage them by assuring  them that
they had**not the plague.   How often have
I seen them resume  their courage and re-
cover, after this  assurance,  and some  ad-
vice, which acted more on the mind than
on the body!  Among our operations in
these cases, bleeding required, more than
all others, our close approach to the patient
and his bed, because  it is impossible to per-
form it at a distance.  For my own part,  I
followed the common method, Without tak-
ing any precaution, except that of avoiding
the patient's breath.   In opening the bubo
of an officer, the pus and corrupted  blood
spouted out on the back of my hand.   I
have slept in  sheets which,  without  my
knowledge, had been washed  by a female
patient who died the day after:  She was
the daughter of the  consul of Ramie.  A
                    D 
                (  26  )
 young German, the wife of one of our sol-
 diers, came to  consult me at the hospital,
 during my absence: she laid herself on my
 bed a quarter  of an hour: I went to visit
 her on the following day at her own house,
 and found her expiring.  I  confess,  that
 these and  other similar accidents did  not
 contribute to render me more tranquil;  but
 I had made up my mind:  besides, I was
 at my post.
   I  will leave  to  those who  believe  this
 disease contagious,  the trouble of explain-
 ing  all these facts, and many more, well
 known to the army of Syria.   The conser-
 vators  of health, and those  employed in
 lazarettoes, will be pleased to observe, that
 I speak of the  disease which  showed itself
 during the years 6 and 7 (1798,  1799), in
 Egypt and Syria,  and  not of the plague.

 Of the symptoms accompanying this disease.

   An universal debility, accompanied by a
 great weight in the head, is a constant pre-
cursory symptom.  The countenance has a 
                (   27   )
particularly  stupid look, difficult to be de-
scribed.   If the patient be of a sanguine
temperament, and  of a fine skin, his ap-
pearance becomes bloated, and his colour
of a redish  purple; the minute vessels of
the tunica conjunctiva become turgid  with
blood, as at the commencement of a slight
ophthalmy:  the patient in this state does
not leave his usual occupations,  but endea-
vours  to  keep on  his  trembling  legs,  al-
though obliged often  to have  recourse to
some  object  for support:  he yawns fre-
quently,  rubs his face, and at last retires to
lay himself  in some solitary place, where
he covers his head,  and gives himself up to
sleep.  If in  this state he be left without
assistance, his pulse becomes more quick
and frequent, the heat of his skin  more in-
tense,  and  the  universal debility greater.
If interrogated, he stammers out a  reply;
his ideas become confused, and on the third
or fifth day he dies delirious.  Amongst the
symptoms which were observed  to precede
this disease,  there  was  a general  affection
of the nervous system, loss  of appetite, 
                (  28   )
slight inclinations  ta vomit;  the  tongue
rarely showed any marks  of derangement
in the stomach; the  stools became altered
and  liquid;  the urine  resembled distilled
water; the glands of the groins and arm-
pits, rarely those of the neck, became pain-
ful and  swelled, and gave rise to buboes.
In general, the whole lymphatic system ap-
peared affected.  Often small black spots
showed  themselves on the skin, which be-
came perfect gangrenes.  The dead bodies
did  not  in  general  present  any external
change worthy of remark; sometimes there
were found ecchimoses,  or livid spots, on
the parts of generation,  and on those parts
on which the  body rested.  Nothing very
extraordinary showed itself in the internal
parts;  the lymphatic  glands alone were
particularly  affected.   This malady was
very mortal in  Egypt,  and especially in
Syria: one third of those attacked died in
the early stage of the disease, the majority
with buboes.  Sweats were favourable, and
carried  off the fever; speedily after which
the  buboes disappeared:  sometimes they 
                (   29  )
came to suppuration, which rendered the
disease and the convalescence very linger-
ing.  Carbuncles and gangrenes were bad
symptoms.
  Of the inhabitants of Jaffa who perished
by the plague, a great number were infants,
Very few women,  some  men, almost all
strangers.  In general,  the temperament
and constitution of body, state of the fluids,
age and sex  of  the patient, the  season,
the  air,  the  winds, situation, the  fear of
death, and all the affections of the mind,
modified this disease more Or less.  Persons
of a full habit, infants with  a fine skin and
flaxen  hair,  young  people  of a  sanguine
temperament and irritable fibre, were more
liable to the disease than those advanced in
age, or of a dry and bilious temperament.
Such is  my own habit of body; and I  have
no  doubt that it was the cause of my en-
joying health in the midst of so many dan-
gers.  After  seeing a certian number of
sick, I could not only distinguish at a glance
their disease, but I was very rarely mista-
ken in my  prognosis.  I advised  individu-
                  D2 
                (   30  )
als, in other  respects well and robust, to
leave Jaffa, on  account of their tempera-
ment.    I  encouraged, on the contrary,
many others, because  they were,  in my
opinion, of a constitution and temperament
which rendered them fit to resist the influ-
ence of the disease.  The following parti-
culars will perhaps appear minute;  but on
the subject of so remarkable a  disease, I
think that  trifling remarks, supported by
facts, may be of some utility.
   Immediately after the plague had mani-
fested itself in Jaffa, Citizen Engelfret, and
his partner, two French merchants, esta-
blished  and  known for  several  years in
Egypt and Syria, shut themselves up alone
in their own  house; the one was of a full
moist temperament, the other meagre, and
of a dry fibre:  they were  persuaded that
seclusion and perfumes would preserve them
from this malady, which they believed to
be  the plague.   After some days  I per-
ceived that the latter began to contract the
colour and appearance of a person  about
to fall sick. I communicated my suspicions 
                (  31   )
to Engelfret, and advised him to quit their
damp abode.  Two days after, that very man
was attacked with a violent head-ach, ac-
companied with fever and buboes, and died
on the third day in the arms of his friend.
I encouraged the affrighted Engelfret, who,
in consequence of the  contagion, thought
himself gone: he confided  very much  on
the knowledge I had of his temperament,
which  appeared to me a complete protec-
tion  from the disease.   The  same thing
happened a  little time after  to Citizens
Malus  and Bringuer;  the  one chief of a
battalion, and the other captain of engi-
neers:  both were attacked  with the  same
disease.  The first, who was  of a bilious
temperament and delicate constitution, re-
covered; but the  second,  who was san-
guine, robust, and of a strong constitution,
could not survive it.
  Being sent for to the tent of General
Boyer,  and of Citizen  Amelin, encamped
without  the  walls of Jaffa, to avoid all
communication with the city, I saw Citi-
zen St. Simon, knight of Malta, and mem- 
                (   32  )
 ber of the institute of Egypt, severely at-
 tacked  with  the  disease: I  immediately
 despaired of his life:  he died  two days af-
 terwards.   I  assured, at the same time,
 Citizen Amelin, that his interpreter would
 recover, although he had, besides the head-
 ach, pain and swelling of the glands of his
 groins.    Having  had  an attack  of  the
 plague  the  preceding year, he  was very
 much alarmed at having it again.  I caused
 him to be put into my servant's room, and
 Lhad some excellent warm punch prepared
 for him: I recommended him to cover him-
 self well to bring on sweating.  Two days
 after he was able to  return,  in company
 with his master, to Cairo.
   The keeper of the  store-house  at  Jaffa,
 a man of full habit  and moist temperament,
 was one of those  who was the longest in
 falling ill.   He assumed an  air  of plea-
 santry  when one spoke to him about pre-
cautions.  One day, seeing him jawning,
rubbing his face, and  looking  sorrowful, I
did not hesitate to foretel to Citizen fillers;
commissary of war, with whom I was then 
                (   33  )
walking, that it was all over with the store-
keeper.   I was called the same day to go
to see him: I found him so completely re-
duced, that I announced  to his comrades
his approaching death, which very soon
happened.
   I  should tire out  the  patience of  my
readers,  if I were to  mention all the facts
which prove the facility with which a prog-
nosis may be formed in this disease.
   I have observed that those attacked  be-
came almost  immediately indifferent and
insensible  to their  situation; so much so,
as to refuse making use of means to obtain
a  cure.    I in  vain recommended  to  my
friend Auriol,  physician  to the  army, to
employ  remedies, of which he himself had
proved  the efficacy  on several  occasions:
he preferred  covering  his head and going
to sleep:  he died in a few days.   How of-
ten have I not entreated  individuals to get
up and  show me their buboes! but  they
were in  so complete an apathy, that  they
preferred lying abed  and sleeping, which
was a certain symptom of their approach- 
                (   34  )
 mg  death,  at  least unless  profuse sweats
 put an  end to the  disease.   An infirmary-
 major, of a delicate constitution and bilious
 temperament, attacked with a bubo in his
 right groin, with  fever  and  drowsiness,
 heard, on the second  night of his disease,
 several  persons  knocking at his door; he
 made no answer: the people believed  that
 he was  dead, or just dying: in this belief
 they forced  the lock, entered his chamber,
 and seized on his effects, - which were  in a
 trunk,, and even his sash, which was under
 his pillow.  The disease had reduced  him
 to such  a state of apathy, that, although he
 perceived they  were plun^ring  him, he
 preferred  lying  in  his bed  and  sleeping,
 rather than opposing their taking away his
property.   He  continued  to sleep;   but,
fortunately for him, profuse sweats came
on,  which carried off, the  disease,  and put
him in a state, on the following day, of re*
claiming his effects, by detailing  the  cir-
cumstances of the preceding night. 
(  35  )
Of the  causes  which  could have produced
      this disease in Egypt and Syria.

   This disease  showed  itself  in the year 7
(1799),  at  Alexandria  and  Damietta, in
the  months  of Vendemiaire  (September,
October)  and Brumaire (October, Novem-
ber), afterwards at Rosetta, and two months
thereafter in  the  army of Syria.   On the
19 Ventose (11th  March), I saw, for the
first time, under  the walls of Jaffa,  about
twenty  soldiers attacked  with  the disease,
who,  not being able to keep on their feet,
had lain down around my tent.   I had them
carried to the field hospital,*  (ambulance)
v/here the  majority  of  them ended  their
days.
  * Being entrusted with the charge of the field hospital, as
well as the head quarters, I recollect to have amputated the
thigh of a soldier, whose leg had been carried off close to the
knee by a ball, with fractures of the condyles of the femur:
on the day after the operation he was in a pretty  tolerable
state, although he was placed between two unfortunate men
who had died the same night with buboes.  This patient, after
the storming of Jaffa, was removed to the hospital, where he
recovered perfectly.   Citizen Zink, surgeon  of the second
class, and Citizen Miot,  commissary of war, who had charge
of the head quarters, and assisted at this operation, were wit-
cesses to this fact. 
                (  36   )
   In the supposition of contagion it is still
a question to be answered,  whether the
disease was brought  into Syria  by the sol-
diers coming from Damietta, or whether
the Turks taken prisoners  at El-Arich and
Jaffa communicated  the infection to the
French army?
  It has never been clearly proved that the
soldiers of Diezzar at El-Arich and at Jaffa
were attacked  with  the disease.  I saw,
close to our camp, about four thousand of
these prisoners driven together like flocks of
sheep, and closely guarded for three days
and three  nights, without a single one fall-
ing sick.   If the disease had been amongst
these people, it would  certainly have dis-
covered itself in some of them, which did
not happen.  This fact, known to the whole
army, sufficiently proves, that neither the
plague nor any other disease existed among
the troops of the  Pacha  of  Acre.  The
case was  the same  with  regard to the
Turkish troops who were in El-Arich; since
the Mograbins, who fought in this fort, and
who were retained in the rear of our army, 
                {   37  )
forming a corps of auxiliaries, enjoyed, to
a man, perfect health.
   Let us next inquire, whether the troops
of the division  Kleber, coming from  Da-
mietta, could have brought the disease to
the  army which came direct from Cairo.
It is a certian fact, that,  after its departure
from Damietta, the division Kleber had no
more  sick,  and, upon  the arrival of the
army of Egypt in Syria, it marched to Jaffa,
and  afterwards towards the Jordan, with-
out having any intercourse with the troops
which came from Cairo.
  If  the army coming from Egypt,  on its
arrival in Syria, was  attacked  by an  epi*
demic disease, which, from the havock it
caused, was called the plague, it ought not
to be attributed to contagion,  but to  the
fatigues we  underwent in crossing the de-
serts which separate Egypt from Syria.  In
order to have a just idea of this, it will be
useful here to  trace back the  march of the
troops.
  The army appointed to march into Syria,
left Cairo about the middle of the month
                   E 
                (   38  )
Pluviose,  of the year 7 (the beginning of
February, 1799); and although then winter,
the days were very hot, and the nights clear
and temperate.  The  army, which enjoyed
perfect health, crossed the desert with he-
roic courage.   Having, in a few days,  con-
sumed the water which we carried  in  our
rear, we were often  forced,  by want, to
make use of brackish water, or mud mixed
with water, which, instead of diminishing,
only increased our thirst.  To this privation
was  added the  want  of live  stock;  and
having no other resources, we killed the
horses and camels, now become useless to
us, and fed on their flesh, which we were
obliged to eat without  bread.   After a
march of one-and-twenty days,  we arrived
in Syria, and halted the 5th Ventose (24th
February), close to Gaza;  the 11th  (2d
March), near Ramla;  and on the 13th (4th
March),  under the walls of Jaffa.
  The soil of Syria presented neither the
barren plains, nor the  burning sands of the
desert which we  had just crossed.  At this
period the westerly winds, loaded with va- 
                (  39  )
pours from the sea, prevailed: these vapours,
condensing  in  a colder temperature, pro-
duced very heavy rains, accompanied with
dreadful storms, which rendered  the roads
more fatiguing.  The flats became filled
with water, so that the waters of the rivu-
lets, which we were often obliged to ford,
came up to our sashes at the first step.
  How often were not our soldiers drenched
with  the  rains, not only during the day,
but also during the night!   They had  all
slept on the  damp  soil of Ramla, had  all
breathed the thick fogs of its environs, co-
vered with  an immense number of olive-
trees;  all had not  equal opportunities of
drying their wet clothes, of covering them-
selves during the night in order to perspire,
nor of procuring a little brandy to  warm
themselves.   Having arrived at Jaffa, the
division Bon was encamped on the right, the
division Lannes on the left: the head quar-
ters of the General  and  the  park of artil-
lery were  on an eminence to the south of
the city: the division Bon was placed close
to the sea, immediately on the  banks of a 
                (   40  )
lake full of stagnant water, and the direc-
tion of the winds was such that the exha-
lations of these marshes were carried into
the camp of this division.  The disease first
began to show  itself amongst these troops,
although they had come direct from Cairo,
Citizen St. Ourse, surgeon of the first class,
made a circumstantial report to the medical
officers in chief of the army, apprising them,.
that the  division Bon, and the 32d  demi-
brigade  especially,  were  affected with  a
suspicious disease, accompanied with bu-
boes, from which the other divisions  were
not exempt.  It is well known that the air
of Jaffa, and of the whole coast  of  Syria,
is damp, heavy, and infected by the exha-
lations of marshes,  and that the  action of
the sun's rays through this thick atmosphere
is  very  pernicious.   Our  soldiers, after  a
residence  of  eight months in Egypt,  were
neither  accustomed  to cold  nor rain, and
could not become habituated to  the  great
varieties  of the temperature  of Syria  with
impunity.  The fine climate of Cairo, and.
the air which they there breathed, gave to 
                (   41   )
the body a  state of remarkable  health,
which of course became impaired in a damp
and unhealthy situation. It is well known
that an  atmosphere loaded with  exhala-
tions, whether vegetable or animal, con-
tains less of oxygen than a pure air;  and
since oxygen is the principle which furnishes
caloric, it follows, that in a vitiated atmos-
phere, the health must become weakened
for want of caloric.  Hence, spirituous li-
quors, and a  strengthening and aromatic
diet, would have been very  useful, because
they excite  the  principle which gives life
to the circulation of the blood and fluids
in general.  We had  nothing at Jaffa but
rice and bad bread ; animal  food, wine and
brandy were wholly wanting.
   I constantly observed that whenever the
winds from the  south and south-west pre-
vailed,  the number of sick and of deaths
was always increased.  The contrary  hap-
pened in fine  weather,  and  when the wind
came from the north.
   Damietta, Rosetta, and Alexandria, dur-
ing the autumn and winter,  became in the
                  E2 
                (   42  )
same state, as we  shall observe hereafter.
Alpinus has remarked, that every year very
malignant  epidemics break  out in these
cities.  Autumno grassantur febres pestilen-
tiales mult<e qua subdole invadunt, et scepe
medicum et cegrum  decipiunt.   (Alpinus de
Medicina Egyptiorum.)

           Indications of cure.

  The indications in the treatment of this
disease were,
  1. To  diminish the superabundant quan-
tity of fluids,  when such a state existed.
  2. To empty the primae viae, when they
were loaded.
  3. To excite perspiration and sweating.

               Treatment.

  When  at the commencement of  the dis-
ease I met with  persons of a good  consti-
tution, who had decided symptoms of true
inflammation, I saw the necessity of mak-
ing use of bleeding,  in proportion to their 
                (  43  )
strength;  and I found this happen  oftener
than I should have imagined.   I never had
occasion to repeat it; but when it was indi-
cated,  this first operation succeeded very
well: the head-ach,  as well as drowsiness,
diminished; the pulse became soft, and the
skin relaxed, which facilitated perspiration
and  sweating.   This artificial  state of re^-
laxation at the same  time  disposed the so^-
lids the better to support  the action of se-
datives and sudorifics.  When I met with
symptoms which convinced me that the
primae viae were loaded, and when the pa-
tient had been  already  sick,  I preferred
making him drink a glass of tepid water,
with two  ounces of olive  oil,  in order to
evacuate the stomach, without irritating or
enfeebling it by an emetic.  I administered
with advantage tartar emetic in the dose of
two or three grains dissolved in four or six
pints of water, as a sudorific, but never as
an emetic or purgative, since these reme-
dies always proved  hurtful.   I gave a de-
coction of  tamarinds, or of herbs,  as a
drink, to carry off the bilious stools, in those 
                (  44   )
cases where this evacuation appeared use-
ful.   Having thus prepared the patient, I
proceeded to  calm the nervous irritation,
and to excite perspiration and sweating;
for which purpose I prescribed, three or
four times a day,  a little almond emulsion,
with, fifteen or twenty drops of the liquid
laudanum of Sydenham.  At the same time
I advised the patient to keep himself tran-
quil, and well covered, in order to hasten
the perspiration necessary for his cure.
   While  we were still  under the  walls of
Jaffa,  not having any  other medicines, I
made  several  of the soldiers take a cup of
coffee, with the juice of a citron, instead
of sugar,  and this repeated five or six times
a day.  On our  entering  Jaffa, I  found,a
little Peruvian bark.   I then  had the  fol-
lowing mixture prepared for the sick:
  Peruvian bark in powder, coffee  in pow-
der, each  one drachm, boiled in eight oun-
ces of water for a quarter of an hour, so
as to form a strong decoction, towards the
end adding the yellow rind of a citron.
  I gave  this  mixture  to several patients 
                (   45  )
dreadfully ill, every six hours, for three days
together, and with great  success.   I like-
wise found it very useful as a preservative;
and I had a cupful given every  morning to
the wounded,  to support their strength;
and these men often complained that they
had not  received a full cup of the bitter
coffee,  for  so  they  called  the  decoction.
From the use of this draught, and of warm
lemonade made spirituous when we could
find a little brandy to add  to it,  I have seen
a great number of individuals attacked with
the disease,  recover; and more than two
hundred wounded  preserved,  in spite of
their  constant  communication  with those
who were infected.
   To diminish  the  head-ach of our sick,
many of our physxians have recommended
the application of blisters to the  nape of
the neck,  the  arms, and  legs.   If we had
had any cantharides, or blistering plaster, at
Jaffa, I should have preferred applying one
over the scalp,  as is recommended in apo-
plexies,  affections of the brain, &c. having
often seen this practice adopted by the cele* 
                (  46   j
brated Desault, when I attended his course
at the Hospital of Charity, and the Hotel
Dieu at Paris.
   It has been observed, that those people
who  manufacture or carry oil, are never
attacked with  the plague.  Hence, it has
been  maintained, that frictions of tepid oil
prevent or cure this disease.  The result of
the observations  made  by  Father Louis of
Padua, director of the hospital for the plague
at Smyrna, is the  most favourable.  He as-
serts,  that during the  twenty-seven years
which he has been in this situation, he has
seen no  means employed against  this dis-
ease more useful than frictions of oil; and
to this day, in Smyrna,, and several other la-
zarettoes in the Levant, frictions of tepid oil
are generally adopted as the best remedy.
As soon as a  patient,  attacked  with  the
plague, is received into the  hospital  at
Smyrna,  he is taken into a close  chamber,
where they light a large pan of  coals,  in
which they throw sugar and  juniper  ber-
ries, or other perfumes; they then strip off
all his clothes, and rub his whole body with 
                (   47  )
warm oil, until  profuse sweats break out.
The patient is then put into bed; and when-
ever the  sweating ceases, they repeat  the
frictions  in the  same manner, and  so on
successively during several days,  until the
disease has spent its violence in consequence
of the sweating.  One  pint  of oil is suffi-
cient for each friction, taking care not to
commence the  second before the  sweating
occasioned by the first has ceased.  Those
who rub the  patient take no  other precau-
tion than that of avoiding his breath; and
in this way none of them have ever caught
the disease.
   In the space of five years,  two hundred
and fifty  persons infected with plague have
been received into the hospital at Smyrna,
and I am assured that all those who were
thus treated  have recovered,  and that  the
number  of persons  preserved  from  the
plague by frictions of oil is immense.
   In whatever way oily frictions act on the
human body, one  thing is certain, that in
the mode practised at  Smyrna,  they  are
useful.  In my  opinion., the  tepid oil sof- 
                (   48   )
tens and relaxes the skin, opens and sets
free all the pores or extremities of the ex-
haling vessels,  whilst  it produces  quite a
contrary  effect  on the terminations of the
lymphatic  absorbents, which it  closes up
and obstructs.
  During the fever, the  skin  is commonly
dry and  shrivelled, the extremities  of the
exhaling vessels, or pores of the  skin, are
closed, and present too  great a  resistance
to the more liquid part of the blood, which
is retained  in the mass of fluids.  This does
not happen when the texture of the skin is
relaxed, and  the pores open.  Besides, the
oil  contributes  to  cleanse the skin  more
than  any other  fluid,  and absorbs, at the
same  time, a part of the caloric accumu-
lated  on the surface of the body;  hence,
perspiration  and  profuse  sweats  follow,
which alone cure these diseases.
  To prolong the  sweating,  or to excite it
when slow in breaking out,  it is necessary
to have recourse to other  means at the same
time.   Opium in substance, and  all its dif-
ferent preparations and  combinations, the 
(   49   )
theriaca, dioscordium, and James's powder,
are the sudorifics most employed.  Cam-
phor, valerian, sal ammoniac, and pure am-
 monia,  spirit of hartshorn, the decoction
of the sudorific woods, of elder flowers, of
the leaves  of sage, and  especially  punch,
are of great use  in this disease.   These not
only  excite sweating, but also give tone to
the fibre, re-establish and  strengthen all the
bodily and mental functions, and bring back
i healthy state of action.*
   To whatever  it may have been owing, it
is at  least certain, that our medical officers
in chief,  Citizens Desgenette aind Larray*
in Syria ; Citizen Dieche, near Acre ; Citi-
zen Savaresi,  at Damietta; Sotttra, at Ro-
setta; Ghislemi,  Balbes, at Alexandria;
and several other physicians and surgeons,
  * The directing commissary, TVIichaud, being at Alexandria,
 shut up in his own house, which he dreaded  quitting on ac-
count of the mortality from the plague, which had broken out
there, perceiving one evening that he was about to-be attacked
with the disease, whicn had just carried off eleven persons in
the same house, resolved to prepare a large bowl full of warm
punch, the whole of which he drank off before he went to
bed.  During the night he had such violent sweatSj that of*
the morning he found himself quite drenched, as if several
buckets full of water had been poured over his body and bed.
The symptoms of the malady disappeared, and he recovered
(perfectly.  He is now in France.
                      F 
                t   50  )
constantly  cured two thirds  of  the sick
under their care, the major part with  bu-
boes.  The activity, zeal and constancy
which these medical officers displayed under
such circumstances,  merit  the highest  eu-
Jogium; and  what trophies have they  not
earned in the numerous victims whom they
rescued from the grave!   The cure of so
great a number of patients of  this  descrip-
tion proves how inhuman  and  barbarous it
is to abandon to their fate the  unfortunate,
under the pretext that, having the plague,
they may communicate their  disease in a
thousand fanciful ways.   It follows, from
this desertion, that  they are shut  up,  fled
from, proscribed, and crowded together,
the most part of the time in infected places
so ill suited to their cure,  that they would,
on  the contrary, have contracted  the  dis-
ease, if they had not had it  already.   There
they no longer find the beneficient hand to
afford them succour, or diminish their  suf-
ferings.  The  overseers of the hospitals,
whom fear and terror have rendered deaf
to  their wants, fly  from  them, or  refuse 
                (   51   )
themthdfse things of which they stand most
in need;  so that they are forced  to  end
their days in a manner the most melancholy
and  afflicting  in the eyes  of  him  who;
through choice,  prefers  and exercises the
practice of physic.

Of bidwes and gangrenes, known under the'
     name of carbuncles, or ahthraxes.

   In my  medical essay  on  the lymphatic
system, I have shown the situation and im-
mense number of glands belonging to these
vessels.    Wherever there  are superficial
lymphatic glands, there buboes may arise:
in fact,  it is not uncommon to see this dis-
ease in  different parts of the  body at the
same time.   When these  glands become
inflamed, they  either remain, scirrhous for
some time,  or  go  off by resolution; but
most frequently they suppurate.
   When the buboes are accompanied with
a low fever, drowsiness, and loss of strength,
the patient dies  before any signs of  suppu-
ration appear in the parts. 
                (   52  y
  To facilitate  the  suppuration  of these
glands, or buboes, some applied cataplasms
of different kinds, but without any advant-
age, and they always attributed the loss o£
their patient to the buboes which did not
suppurate.  Afterwards, contrary to all the
principles of the art,  they opened these
glands with the bistoury, before they showed
any  symptom of suppuration.  They soon
perceived that this  practice was not more
successful than the first; and it was then
determined to make use of actual cautery,
from a persuasion that the fire would hasten
the suppuration of the buboes, and put an
end to  the disease.   I myself was  of this
way of thinking, and I made two  cauteries
with a hot iron,  by  means  of which I pe-
netrated down to the very glands:  the in-
flammation  which  followed  produced no
advantage.  Citizens Auriol and St. Ourse,
who employed this practice after me, not
being more successful, gave it up.  I at
last recommended the repeated use of fric-
tions of  tepid olive oil  upon the  diseased
glands,  to soften  the skin, and  facilitate 
                i  53   )
suppuration; and whenever there were cer-
tain symptoms of a collection of matter in
the bubo,. I opened it with a bistoury, and
healed the sore.
   I was sent  for,  within a few days after
my arrival at Jaffa, by Don Joacina Cenda-,
grandee of Spain, father procureur, or agent,
of the fathers of the holy land, a man very
robust, of a full habit and sanguine tem-
perament, aged about fifty-five.   He  had
been  attacked the evening before  with fe-
ver, preceded by slight  shivering,  accom-
panied by such violent symptoms of inflam*
mation,  that  I  thought  it proper  to take
away some blood.   As he complained very
much  of a  fixed pain in  his  loins, I  re-
quested  to  examine  the part:  what  was
my surprise  on seeing between the last dor-
sal and first lumbar vertebrae, a little round
black spot,  surrounded with a purple erisi-
pelas,  very extensive,  and  covered with
small vesicles, or  phlyctenae,  filled with a
transparent  fluid.  I  then  understood that
the real nature of his  case was a carbuncle,
©r rather a gangrenous affection, wThich, in.
                   F2 
                (  54   )
 three days, became seventeen inches in cir-
 cumference, and three lines in thickness at
 its  edges;  at its  centre it had the consist-
 ence  and colour of black leather.   This
 patient took, in three days, five ounces of
 Peruvian bark, made use of weak lemon-
 ade for drink, and  for nourishment  took
 some rice boiled in a very little water, with-.
 out salt, and  seasoned with canella,  and
 orange flour water.   He also  took every
 day a large cup of Spanish chocolate,  and
 sometimes some Mokacoffee, and recovered
 completely.   I heard of him  afterwards
 when in  Egypt, and particularly a year af-
 ter, when at Alexandria.   He had resided
 for twenty  years in ancient Palestine, dur-
 ing which  lapse  of time he  had seen the
 plague fifteen  times epidemic.   He  had
 never contracted the disease, notwithstand-
 ing his duties  as a clergyman were expos-
ing him constantly to the contagion.
  I have seen  these  black spots like pete-
 chias, degenerate into true gangrenous es-
 chars, although at first they appeared, of
 very little moment. 
                (   55  J
  This disease, although  local,  had for its
cause the bad state of health of the patient;
hence it was necessary  to attack the cause
first, in order to hasten the separation of
the diseased from the sound  parts.  The
use of bark  and of opium, recommended
by the most celebrated physicians in gan-
grenes,  antiseptics,  corroborants,  and sti-
mulants, were of the  greatest  use,  after
having subdued the first symptoms of inflam-
mation.  The oily frictions, and the cerate
of Galen,  as simple emollients, may con-
tribute to the spontaneous separation of the
gangrenous part: an operation more of na-
ture than of art.
  I have seen in Jaffa  some soldiers with
pimples or ulcers on their face,  of a parti-
cular description :  although it was at Jaffa,
I believe  that this  might have been the
same as the disease called the pimple of
Aleppo.   The description  which travellers
give of this disease  in  their works autho-
rises  me to  think so.   (See Volney  and
others.)
  I may be permitted  to call in  question 
                 (  56   )
 the opinion that this disease arises from' the
 quality of the waters which  are  drank in
 this country.   We observe several diseases
 indigenous in many places;, without being
 able to determine their  causes; and there
 appears to me as little foundation  for attri-
 buting the pimple of Aleppo  to the waters
 of its  environs,  the lepra  arabum  to  the
 bread  of Cairo, the elephantiasis to the salt
 fish of Damietta,  the  hydrocele  to  the
 brandy of dates,  the ophthalmy to rice;  as
 for attributing the plague to  an unknown
 vapour,  brought almost  every year from
distant countries  into Egypt.

 Of the means  to be used for preventing this
                 disease.

   During my  stay at Jaffa, I  made use  of
no extraordinary means to avoid it.   I was
convinced  that the disease was epidemic,
and  that, if my  health  became  impaired
by a concurrence of any  causes whatever,
I could not escape  it, even by the most
strict seclusion, no> not even if I had been 
                (   57  )
surrounded by the  whole guard of health
fgarde sanitaire).   As  I was  persuaded
that obstructed perspiration, damp and in-
fected air, the exhalations of marshes, and
bad food, were the principal causes of this
disease, I endeavoured to avoid unhealthy
places, damp and cold air, and made use
of the best food I could  procure; and as I
knew the influence of the affections of the
mind in predisposing to  disease, I avoided
all  melancholy ideas, by being always em-
ployed.
  When I went  to the  hospital, I always-
endeavoured to arrive there without being
in a perspiration;  and before  entering the
wards, I took, in the apothecary's shop, a
large cup of the bitter coffee.   During my
visit, I held  in my hand a citron stuck full
of  cloves, without  attributing to it any
great importance.   After paying my visit,
I took a walk,  or got on horseback; and
although  not of a constitution to perspire
easily, I never returned  without  being in
a sweat.   Before going  to bed, I took  a
glass of  punch,  or spirituous lemonade^ 
                (  58   j
 made  very hot; after which  I lay down^.
 covering myself well up.  During the night
 I  never failed to  perspire  considerably*
 These were the only precautions which I
 took to preserve myself from the disease of
 Jaffa.
   During all the epidemic fevers, and even
 the most dreadfuf-pfagues, there have been
 in those cities  and provinces,  where these
 diseases were raging, some healthy spots.
 The citadel of Cairo  presents one example*
 It has  been observed, that  the inhabitants
 of this fort and  its environs  have always es-
 caped  from the plague, even from  that of
 the year 1791.  If the inhabitants  of  this
fort, in spite of their  daily intercourse with
 those of the city,  were preserved from this
 disease, it must be because the damp and
infected air which had destroyed the health
of the  inhabitants of Lower Cairo, had not
 sufficient elevation to reach to the  highest
part of the citadel  and  its environs,  and
 consequently  could  not impair the health
of those who lived there.
   At  the time  when I was doing,  duty ia 
               1   59  1
the military  hospital of this fort, I have
often seen, at the rising and setting of the
sun, the whole city enveloped in a mist so
thick,  that it was impossible to distinguish
even one of the  innumerable minarets of
this immense metropolis, although the fort
was then enlightened by the rays of the
sun, and the air which we  there breathed
was elastic, pure,  and light.
   In 1764, an epidemic fever showed itself
in the  kingdom of Naples, and, conjoined
with famine, made such immense havock,
that two hundred thousand  persons  pe-
rished.  Negligence and terror had with-
drawn  from  the  sick, scattered here  and
there over the city,  all kind of assistance;
a circumstance which became the principal
cause of the progress of  this disease.   Ex-
perience having shown that  the sick remov-
ed to  the  sea shore  recovered, a number
of hospitals  and lazarettoes  were  esta-
blished there.   It was  observed that the
nurses, and those employed in the hospitals,
didmot contract the disease, in spite of the
contagion.   The principal remedies  which 
                (  60  1
were  employed  at  this epoch were  iced
water, the bark,  musk, and the vegetable
and mineral acids in large doses.
  I can  recommend nothing  more useful
and efficacious in such cases, than to re*
move from those places where these epi-
demics prevail, and  to choose a place where
the air is more healthy.  With respect  to
soldiers,  every time  that a disease threatens
to spread itself amongst them, a circum-
stance very common in Lower Egypt dur-
ing the unhealthy season, it is very import-
ant to remove the camp to a healthier situ-
ation, and to have the garrisons relieved by
troops coming from healthy quarters, and
then send  the former to places  where the
disease has not been.   There they lose the
predisposition which they had to contract
the disease, while  the troops which  shall
have relieved the garrisons will not contract
it so easily, because  they will not have that
predisposition; and every time  that the
health of these  new  troops shall  become
impaired, they ought, without delaying on
any pretext, to  be  relieved in their turn, 
                (  61   )
even if it should be by those  who  were
there before.  In order to prevent all sus-
picion,  and avoid all  danger of carrying
the disease where it has not been before,
they should take nothing with them but
their necessaries; they should avoid as much
as possible halting in  villages;  and each
time when they happen to  encamp, they
should expose their  baggage and cldthes
to the air, which would not fail of dispers-
ing every  principle of  contagion, and set-
ting at  ease the minds of  those who are
timorous.   By thus changing successively
the garrisons, we should preserve in  good
health  a whole army,  even  in  places the
most infected.  When  the rains shall have
ceased,  the heats of summer returned, and
the marshes  have dried up; in  a word,
when the season shall  have  changed, and
every place become equally healthy, we
may then leave off these useful yet trouble-
some marches and countermarches.
  During the expedition to Syria,  the °-e-
neral of division  Dugas, commandant of
Cairo and Lower Egypt, being informed
                   G 
                 (   62  )
 that the plague existed amongst the garrison
 of Fort Birketalagi,  immediately stopt  its
 progress,  by sending the garrison to Cuba;
 there  the soldiers,  respiring a  pure and
 wholesome air, recovered their health in a
 few  days, and the  troops just arrived  at
 Birketalagi,  preserved themselves in good
 health, the more  easily, by paying a  proper
 attention  to cleanliness.  This prudent Ge-
 neral had before  observed, at Damietta, the
 advantages resulting  from this  measure,  as
the following letters, which he wrrote  to
 General Bonaparte,  the 17th and 24th Ni-
 vose, 8th year (8th and 15th March,  1800),.
bear testimony,

     " Damietta, 17 Nivose (%th March).

  " The  second  demi-brigade  of light in-
 fantry is affected with the prevailing ma-
 lady, more particularly than the others: this
 same regiment was  also severely attacked
 at Menzaleh with  another fever,  which
 obliged more  than  two  hundred men  to
 .enter the hospital. A battal.on of the 65th 
                (   63  )
Went to relieve them; they have inhabited
the same barracks,  and occupied the same
posts, during  twenty-five days, and have
not had a single sick man.  Only one officer
has  had the prevailing fever, and  he  has
recovered.  I  am convinced  that this  dis-
ease takes its  origin from the bitter cold-
ness of the nights, and that it is the conse-
quence  of checked perspiration, a cause
which,  acting on several individuals at the
same time, gives to the disease a contagious
appearance, which  vanishes on a closer
examination."
   In his letter of the  24th (15th March),
he proposes to  send to Mansoura the com-
panies of  the  second   demi-brigade  for
change of air,  the quarters which they oc-
cupied  at  Damietta  being  unwholesome,
and their spirits dejected by a prepossession
which it was necessary to do away.
   As soon as the second demi-brigade was
on its march for Syria, forming  part of the
division Kleber, it became perfectly healthy;
whereas at Damietta, it had furnished  five
sixths of the sick in the hospital. 
                (   64  )
  I have also remarked, that it is even use-
ful for the troops to march from one place
to another, although both quarters happen
to be equally infected.  How often have I
not seen soldiers who, on seeing their com-
rades dying, fled from Gaza, although they
themselves had  the   fever  and buboes!
These patients, at the time of their leaving
the hospital,  were scarcely able to hold
themselves upright;  but,  after having got
some leagues into the desert, their strength
returned, and they arrived at Jaffa in better
health.
  After having rested themselves some days,
I advised them to continue their route to-
wards Acre, in order to give rise to a greater
change in their physical and moral constiu>
tion.  It  was thus that  Citizen  Marillac,
officer of artillery,  recovered, who was not
able to get well in Jaffa:  he was become so
feeble, so meagre, and so much  disfigured,
that his friends could hardly recognise him,
In this state of debility he endeavoured to
travel to  the camp at Acre.  Having ar-
rived there, he received orders to return to 
                C  65   )
jfaffa,  with some troops appointed to take
charge  of  a convoy  of  ammunition,  and
pieces  of  artillery.   In a little time he re-
gained  his good plight and former colour.
Change of place and air, in diseases of de-
bility,  and  particularly in epidemics, has
been found useful at all times; and, I will
even add,  however severe the symptoms,
however advanced the disease, or weak the
patient may have been.   This is  so true,
that I  have actually seen  men recover, who
had not, to all appearance, two hours to
live.   Of this fact, those who assisted at
the evacuation of  the   hospitals  in Syria
were  witnesses.  It  would be impossible
to conceive the  importance, or appreciate
the advantages resulting from this measure,
if one had not had the means of judging of
it by experience.   Whilst the disease was
making the greatest progress at Alexandria
and Rosetta, the soldiers of the naval legion
escorted, for a long  while,  the  caravans
which  went by land.  They all  enjoyed
the best health during this  active service;,
but scarcely had they  become stationary at
                  G2 
                 (   66   )
Rosetta,  when more than two thirds  fell
sick.   This fact is well known, and parti-
cularly by General  Martinet,  who then
commanded that legion.   I am persuaded,
that if those  men  had, instead of remain-
ing at Rosetta, crossed the  desert to go to
Cairo, or  elsewhere, they  would  all have
been preserved from the disease.   The  Be-
douin  Arabs, wandering in the deserts, are
never  attacked, notwithstanding their com-
munication with the infected cities,  during
the time of their most dreadful plagues.
   How many individuals, on the return of
the army of Syria to Egypt, recovered their
health  in  the desert, even at the  distance
of a few  leagues  from  Acre,  from  Kaiffa,
from Jaffa, and from  Gaza!  If they  had
remained a few days longer in these cities,
they would, in all probability, have fallen
victims to the disease.*

  * General  Damas, severely wounded in the mountains of
Mont Tabor, by a ball which had broken the humerus near its
articulation with the fore arm,  was removed to Jaffa, and
lodged in the house of the fathers of the Holy Land.  The
accidents following upon this wound were very severe, and se-
veral times endangered the loss not only of the arm, but the
life of the patient.   This General, during the times of dresa- 
(  67   )
            It is a fact, that some of our sick soldiers

          in  Syria,  on seeing  the departure of the

          army for  Egypt,  endeavoured  to follow it

          on foot; and although  from their debility*

          they fell several times on the ground,  they

          got  up  again, and  contrived to  follow the

          columns until their  arrival  in Egypt, where

          they recovered their health.

            Citizen Mechaud, chief of a battalion of

          engineers, communicated to me the follow-

          ing fact,  which happened whilst  he  cora-

>          manded at  Katie.   Some soldiers, on  their

          return from Gaza with a convoy, discovered

          at a distance a French  soldier wandering


          ing his wound,  was supported by his valet de chambre, who,
          without any bad design, kept concealed a pestilential bubo-,
          which he then had, and continued in that state for two  days to
          wait upon his master.  There was at the same time in  the
          house four persons attacked with the plague, two of .whom
          died, which made General Damas determine to dismiss  his ser-
          vant, and change his lodging.   I had him removed to the most
          elevated part of the castle of Jaffa, in order to avoid the damp
          air as much as  possible.  In spite of this, his wounds, which
          had before showed every appearance  of healing, shortly took
          on a bad aspect, and I observed him from day to day contract-
          ing the predisposition to the disease.  The fear of seeing him
          die of the plague determined me to  advise him to quit Jaffa.
          From the second day of his being at sea, all the symptoms of
          the plague disappeared, and his arm healed: he can now make
          use of it as well as formerly.  He has since been nominated
          general of division, and chief of the etat major general, and
          performed the  glorious campaigns of the year 8 against the
          army of the Grand Vizier. 
                 (   68  }
 amongst the sands, about two leagues from
 the fort; they went up to him,  and found
 him with a bundle of sorrel under his arm:
 .this man had been  attacked with the epi-
 demic disease, and during his delirium, had
 run off  from the hospital.  During the fif-
 teen days which followed, he had taken no
 other nourishment but sorrel,  and he reco-
 vered  perfectly.   I  have seen  this  plant
 in  several  places in  the desert,  its  leaves
 scarcely raised above the  sand:  on pulling
 it up by the roots, it presents a weak means
 of  diminishing  the burning  thirst of the
 traveller..

 Of the  means ivhich might be employed w
    Egypt to destroy the epidemic fevers.

  Before speaking  of  the  means which
might contribute to render Lower Egypt as
healthy as the finest countries of Europe,
it will  not be useless to premise some to-
pographic medical notions of Alexandria;
Rosetta, and Damietta;  in which cities
every year epidemic fevers break out, 
                f  63   )
  Alexandria is a city celebrated in ancient
history, situated at 31° 13' 5" northern la-
titude, and at  27° 35' of longitude from
the meridian of Paris.  It is washed by the
sea on the west and the  north, and on the
east and south  are situated the lakes  Ma>-
reotis and  Madiez.  Rosetta is situated at
28°  8' 30" of longitude from  the meridian
of Paris,  and  at  31°  25'  20"  of northern
latitude.   It lies  about  two leagues  from
the sea, upon the  left bank of the Nile: to
the eastward, on the other side of the Nile,
there are a great number of flat grounds,
which, after the  inundation of  the river,
form very numerous and extensive marshes.
   Damietta, the  third celebrated city  on
the coast  of Egypt,  on the eastern bank of
the phatnitic branch of the Nile, lying in
29° 29' 15" of  longitude from the meridian
of Paris,  and 31° 25' 43" of northern lati-
tude, has the sea and the lake  Menzaleh
to the north, and is divided  by the Nile.
The  fields of rice which surround this city
contribute to infect the  air; besides, there
are several lakes,  pools, and marshes in its 
                 (   TO  )
 environs, which render it very unhealthy;
 Senanieh, among others, is a village remark-
 able for its insalubrity.
   The  heavy rains which fall  during the
 winter at Damietta, at Rosetta, and Alex-
 andria, contribute  greatly to produce  dis-
 eases, which the sonth winds, the fogs, and
 exhalations of the marshes render more dan-
 gerous.  It is asserted, that  these diseases
 are more frequent when the  inundations of
 the Nile are high,  and of long duration.
 The inundation of the year  6 (1798)  was
 ©ne of the most considerable;  notwithstand-
 ing which  the  disease did not show itself
 but in those cities on the coast of the Me-
 diterranean.
  The other cities  of the Delta, Boulac,
 Cairo,  Gizeh,  and  the whole  of  Upper
Egypt, were preserved from it. In the fort
of Birket-El-Agi alone, a few deaths hap-
pened from a suspicious disease, which, in
my opinion,  without  having recourse to
contagion,  were  occasioned  by the evapo-
ration of the  stagnant  waters of the Lake
af the Pilgrims, so called on account of the 
                (   71  )
meeting together, at this spot, of the grand
caravan, which every year sets off from Cairo
for Mecca.   The putrefaction of the aqua-
tic plants, and of the immense quantities of
fish in this, lake, contribute to its develope-
ment.
  In  the ancient histories of Egypt, there
is no  mention made of the  plague.  The
former inhabitants of this celebrated coun-
try either did not  distinguish this disease
from  others,  or were unacquainted with it.
  It  is certain  that Alexandria, Rosetta,
and Damietta, as, well as the whole surface
of Lower Egypt, are so much changed, that
formerly these places might have been the
most healthy parts of Africa.  The ruins
of entire cities, destroyed and overwhelmed;
the majestic remains of ancient monuments,
preserved in  spite of the  overthrowing ac-
tion of time, which at this  day  are in part
submerged and  surrounded by  water, are
sufficient to  prove  the revolutions  which
this part of the globe has  undergone.  The
profound and interesting researches made
by General Andreossi, and  by the respect- 
                (  W   )
 able body of philosophical men and mem-
 bers of the French Institute in Egypt, are
 worthy of examination:  they are preserved
 in the Egyptian decade.
   At this day the lakes, the marshes, and
 the filthiness which one finds in the cities
 of Lower Egypt, are the principal causes
 of the frequent  diseases  to which they are
 subject, and which can never be eradicated
 until we  have found means to  purify the
 atmosphere of their environs.  This import-
 ant advantage may be obtained by draining
 off the waters of the lakes, and filling them
 up;  by keeping the cities  clean, paving
 them, and  giving a free exit to  the  rain
 water,  which,  stagnating in  different parts
 of the cities, becomes corrupted, and,  con-
joined with filths, infects the atmosphere.
 By similar  operations,  several  cities  and
 provinces in Europe, Amerca, and the In-
 dies,  have been rendered healthy.  I have
 no doubt that the salubrity which we at this
•day enjoy in France and  Italy, is the result
 of the amelioration of agriculture, and the
 perfection of the arts. 
(  73   )
Of the Seclusion of the Franks during the
           time of the Plague.

   When the Franks residing in Egypt are
assured that the plague has  broken out in
the place where  they live, they retire into
their houses, shutting all their doors, and
having  no intercourse with  any one until
the 23d of June, the eve of St. John.  Not
only are their doors closely  shut,  but they
block up with care even the smallest holes,
in order  to prevent any animal  entering
their dwelling; and if by chance a cat should
creep in,  they immediately pursue and kill
it.  For this purpose they have loaded mus-
kets always in  readiness, and springs set
in the suspected parts of the  house.   The
cats of the family are shut up in cages, like
fowls; and if, unfortunately for them, they
chance to leave their prison, and make their
escape,  on their return they are killed with-
out mercy, according to the  sanitary lazvsi
in case  they should, during  their absence,
have contracted the poison of the plague,
                    H 
                (   74   )
and brought it home attached to their tail,
or hair of their skin.   In the lower court,
or near to the gate of the house, they place
three large earthen vases filled with water,
a bason with vinegar, a furnace with coal,
some  odoriferous  herbs,   antipestilential
powder and pastes,iron pincers, a large knife
or stiletto,  and some other utensils used for
destroying  the poison of the plague.  Each
family has  a Turkish domestic,  who is not
comprised  in  the  shutting up, and  who is
employed to transact all  commissions: this
man  comes every morning to his master's
house with the necessary provisions, which
he hasbought at market.  The porter, who is
generally the steadiest person in the family,
and the most strict observer of the sanitary
laws, after having reconnoitred the domes-
tic, descends with the key in his hand, opens
the door, and retires to the top of the stair-
case, in order to avoid all risk of contagion
from  the servant, who,  entering into the
court, puts the  provisions,  such as meat,
fish, herbs, and fruit, into the vases full of
water.  If he  has  money, he puts that into 
               (  75  )
the vinegar; if papers of importance, such,
as bills of exchange, invoices, &c.  he puts
these near the  furnace;  and after he has
heard from a distance the porter give him
his orders for the  following day, he with-
draws.  The porter follows, and shuts the
gate of the house:  then, after having taken
in his hand a kind of magic ring,  he stirs
about in the water the meat, the fish, and the
herbs, in order  to drown  and destroy the
pestilential poison.   He then takes the mo-
ney out of the bason of vinegar, and, hav-
ing  lighted the  coals, he  throws  on them
some powders  and perfumes:  afterwards,
with the pincers,  he takes the papers, and
places  them  over the furnace,  where they
remain at least for two hours in the smoke;
by this method, in their opinion,  they are
freed from all  poison, and may  then be
touched without communicating the plague.
They likewise purify sealed letters, and other
papers, by piercing them with the stiletto
in two or three places, and dipping them
in the vinegar.  The linen and other clothes
washed out of the house may be admitted 
                (   76  )
 without any risk, provided they be still wet.
 The bread prepared in the house,  and sent
 to the oven to  be  baked, may be received
 without any precaution, provided  it has
 never  been touched as long as it was hot.
 Tobacco, pulse,  sugar,  coffee, and  every
 thing which, in the lazarettoes, is called a
 substance not contaminating  (substance non
 contumace), may be admitted without pre-
 caution into the insulated houses.  The con-
 taminated  substances  are  absolutely ba-
 nished the house till the 23d of June, the
 day when all danger of the plague ceases,
 whatever may have been its  violence.  The
 inhabitants of  the  Levant have a general
 belief that the eve of St. John puts a limit
 to the  plague; and at this epoch they leave
 their cloisters,embracing andcongratulating
 each other on having escaped the scourge.

     Of Lazarettoes and Quarantines.

  Lazarettoes are  large buildings situated
 commonly on the sea beach, at a little dis-
tance from the harbours, consisting of lodg- 
                (  77   )
ings, hospitals, magazines, and very exten-
sive enclosures, and including a portion of
the roadstead, or harbour, capable of con-
taining a certain number of vessels.
  These lazarettoes are destined to receive
and retain,  for a limited time,  passengers
and ships' crews, merchandise and vessels
coming from places where the plague is rag-
ing,  so that they may have  no intercourse
with any one whatever,  till the termination
of the quarantine.
   Quarantines are divided into quarantines
of rigour, and those of observation.  Qua-
rantines of observation never exceed fifteen
days, and are neyer less than five:  quaran-
tines of rigour consist of thirty-nine  days,
or forty,  computing from the day of com-
mencing.
   Such vessels as come either from the coast
of Africa,  in the Mediterranean,  or from
any sea-port town in the Levant,  are put
under  quarantine;  that is to say,  they sail
into that part of the roadstead, or harbour,
which is appropriated to the lazaretto; after
which the captain of  the vessel  presents
                  H2 
                C  78   )
to the board of health (bureau sanitairej
his certificate of health, in which are spe-
cified his destination, the day of his depar-
ture,  the names of himself and his  vessel,
the cargo,  the number of  his crew and
passengers,  and whether, in the place from
whence he came,  there were any instances
of  the  plague.   This certificate  is  taken
through a  grating by means of a pair of
long pincers, and is not read until it has been
thoroughly perfumed and dipped in vinegar.
If the certificate gives notice of the plague,
the vessel is considered foul (brute) ; if on
the contrary, it states that,  for some time
past,  there has not been an instance of the
plague in the place from whence she sailed,
she is considered  clean (nette)s if  it was
only  a  short time since  the plague had
ceased, she  is considered suspected (sus-
pecte).  In the first case, the passengers and
ship's crew  are  strictly reviewed at a dis-
tance;  and  although every one of  them
should enjoy  perfect health, they are all
placed under a quarantine of rigour.  When
the certificate is clean, the quarantine lasts 
                (   79   )
a shorter time; and in the third  and last
case, it is a quarantine of observation, which
lasts a longer or shorter time,  according to
the decision of the conservators of health.
  If any vessel, before entering the harbour,
has been visited by a vessel from the coast
of Africa, or from a sea-port in the Levant,
or belonging to an enemy,  she  is  placed
under strict quarantine, even if she had come
from  the nearest port; as,  according to the
sanitary laws, her certificate  is considered
foul (brute).
  When merchandise is put under quaran-
tine,  it is deposited within  the enclosure,
or in the magazines appopriated for that
purpose.  The establishment for this  end,
at Marseilles, is very beautiful, of prodi-
gious extent,  and shows the  importance of
the commerce which France carries on with
the Levant.  The  passengers are put on
shore, and sent into the enclosure with one
or more guards of the committee of health
fcomite sanitaire), while the ship's crew re-»
main on board, with some others.  The por-
ters,  and those persons employed  to purify 
                 (   80  )
 the merchandise, in order to ascertain whe-
 ther or not the bales of wool and cotton con-
 tain the vapour of the plague, open them in
 the middle, and thrust in  their bare arms,
 believing that, if they contained the plague,
 the disease  would  without fail show itself
 on them.  They break open the chests and
 trunks,  and expose to the air the bales of
 flax and of silk, the cloths, sails, stuffs, and,
 in short, every article on board.  They pre-
 tend  in  this way to facilitate the  evapora-
 tion of  the  pestilential fomes, which per-
 chance might have been brought  in along
 with  the merchandise.  At length, after
 having exposed every thing day and night
 to the air for the space of thirty-nine days
 (serene) ; after having,  in  the course of the
 quarantine,  perfumed the  passengers, the
 ship's crew,  and the vessel,  three times,
they permit them to enter the harbour.
  If, during the time of the quarantine, any
one falls  sick and dies, should the  cause of
his  death be suspected, the quarantine  is
prolonged, and sometimes it recommences,
and this every time such an accident happens. 
                (   81  )
  When the death of several persons on
board puts out of doubt the existence of the
plague, and that it is making progress in-
stead of diminishing,  the laws of health
condemn the vessel, without  any reserve,
to the  flames.  Those who  compose  the
crew, after being stripped of all their clothes,
and having their whole bodies shaved and
washed in sea-water, are admitted into the
lazaretto, in order to undergo there a rigor-
ous quarantine.   The vessel,  with its mer-
chandise,  is towed out  to sea, where it is
either sunk or committed to the flames.   If
the porters employed to purify the merchan-
dise  are attacked with the plague during
the quarantine, or some days after that ope-
ration,  the committee of health pronounce
the  goods  infected,  and, without  delay,
cause them  to be burnt or sunk.
   It has often been said,  that in breaking
open a letter,  or in opening a bale of cotton
containing  the  germ of the plague, men
have been struck down  and  killed by the
pestilential vapour.  I have never been able
 to meet with a single eye-witness of this 
                 (   82  )
 fact, notwithstanding the inquiries which I
 have made in the lazarettoes of Marseilles,
 of Toulon,  of Genoa, Spezia, Leghorn,
 Malta, and in the Levant.   All agree  in
 repeating, that they have heard of such  an
 occurrence, but that they have never seen
 it happen.  Among those whom I have
 interrogated  about this fact, I may name
 Citizen Martin, captain of the lazaretto of
 Marseilles, who, for thirty years past, has
 held that situation: this brave and respect-
 able man told me, that during that time he
had seen opened and emptied some millions
 of bales of cotton,  silk, furs, feathers, and
 other goods, coming  from several  places
where the plague  raged,  without having
ever seen a single accident of the kind.
  Observation, necessity,  and  experience
have  taught that all substances which are
necessary to life, are not equally susceptible
of imbibing  the  pestilential  poison; that
there  are even some which are not suscep-
tible of contracting it, and  which conse-
quently cannot  communicate  the plague.
  The substances liable to  communicate 
                (  83   )
the plague are called contaminating, while
those which cannot imbibe  this poison, are
called non-contaminating.
  I think we  may distinguish three classes
of contaminating substances.   For example,
wool, cotton, silk, hemp, stuffs, hides, all
kinds of hairy skins and furs,  are contami-
nating substances of the first class.   These
substances do not lose their infectious qua-
lities until after forty days exposure to the
air (serhie).
  There are goods which,  in order to pu-
rify from the poison of the plague, it is suf-
ficient to put in vinegar,  or in perfumes;
such are papers, as well as samples of stuffs,
&c. which I rank in  the second class.
   Gold, silver,  and  all the other metals,
porcelain, delft-ware, and  glass, although
they are non-contaminating substances, may
contain some  foreign body, charged  with
pestilential poison, if they have  been hand-
led by infected persons; and they ought to
be put in water, as well as fresh fish,  meat,
herbs, fruits,  and all kinds  of animals hav-
ing hairy skins.  I consider these substances 
                (   84  )
as contaminating of the third class;  fresh,
or sea-water being perfectly sufficient  to de-
stroy any of their contagious properties.
   Wax-cloth and stuffs, when they are wet,
do not communicate  the plague.  Every
kind of wood, straw,  hay, flowers, osiers,
mats,  provided no hempen  nor cotton
threads enter into their texture, wax  lights
and candles, provided the wick  be  burnt
to the level  of the wax or tallow,  ivory,
mother  of pearl, wheat, seeds,  tobacco,
coffee, sugar, pepper, and aromatics, salt,
oil, and liquors, are  not liable to imbide
nor to communicate the plague.
   These  principles  being established, the
officers of health prolong, abridge, or mo-
dify the quarantine, delivering or  detaining
for a longer or shorter time the persons and
goods in the lazarettoes.
   It follows from these principles, acknow-
ledged by the  officers of health,  that you
may inhabit the same  house, the same ves-
sel, the same chamber, walk together, sleep
upon the  same  beds,  or the  same  mats,
and keep company with persons under qua- 
                (   85  )
rantine, even whilst they are attacked with
the plague,  provided you  do not  touch
them neither directly nor  indirectly.   You
may take snuff offered by a person having
the plague, provided the box be of  wood
or of shell.  There  is no danger even in
breaking  bread with them,  provided the
bread be cold; for if it were warm, it  might
communicate the plague.  How then is the
reason of all this to be explained?   Those
who wish to have the fullest  details upon
lazarettoes, quarantines, the manner  of pu-
rifying  contaminating  substances, and to
acquire  the  fullest ideas  on the  subject of
the  plague,  should consult  the  codes of
health at Marseilles, at Toulon, and at Ve-
nice.  They will also find,  in a work of
J. P.  Papon,  ci-devant historiographer of
Provence,  printed  at Paris  in  1800, the
memorable epochs  of  the  plague,  from
1491 before the birth of Christ, till that of
Marseilles in 1721  of  the  Christian sera.
They will there learn the  means which are
proposed for preventing this disease, upon
the frontiers of a country which it is  ravage
                   I 
                (  86   )
ing, as well as the precautions to be adopted
in cities having  the plague.  There is also
a good deal said ofthe purification of goods,
of houses, of preservatives, of lazarettoes,
of the police of sea-ports, &c.  Had I not
predetermined to state nothing but the ob-
servations made by myself in Egypt and
Syria, I should have added a few reflections
on the  work of this author.  I,  however,
reserve them till a future occasion, when I
mean to analyse  this disease more at length.
   On an unprejudiced examination of the
works of writers on  the plague,' we find
nothing but  frightful recitals of what hap-
pened in the epidemics which they  have
described.   They alHnsist on the necessity
of quarantines,  and  forbid the inhabitants,
under pain of death, to quit their houses,
whenever there  has  happened  any death
by the plague; believing that this means will
suffice in stopping its progress.   It is not
difficult to conceive  that  the shutting  up
together of several people in good health,
.and some sick, and obliging them to breathe
the same air, which every day becomes more 
                C  87  )
and  more infected, must augment the dis-
ease of those who are already sick, and ex-
pose the others to contract it.  Experience
has proved that these seclusions, or shuttings
up  (renfermemens), have never  succeeded
in arresting  the progress of the plague.
This disease always commences by attack-
ing the poor in the  most  unwholesome
quarters of the city; after which the health
of the inhabitants in good circumstances be-
comes impaired,  and  at length death levels
indiscriminately the poor and the rich. Then,
all becomes confusion in the city: the magis-
trates are no  longer able to  maintain their
authority, the shuttings up cease by little and
little, the season changes, the atmosphere
becomes purified,  those who have escaped
recover strength  and  courage,  and  all at
once  the  epidemic ceases.   This is what
has been  observed in all plagues,  but par-
ticularly in  that of  Marseilles,  in  1721,
The history of these  epidemics strikes one
with  horror;  and, after  comparing them
with the most malignant plagues of the Le-
vant, where the shuttings up are  only in use
amongst a very small number of individuals, 
                (  88   )
I have no hesitation  in declaring, that in
Europe the mortality has been the greatest.
It is generally thought that the  principles
of fatalism of the Turks contribute greatly
to increase the propagation of this disease
amongst them, because they will not make
use of any precautions.  This much  how-
ever is certain, that the  Mussulmen, during
the plague, attend on their sick with  parti-
cular care even to the last moment of their
lives; whilst,  on the contrary, our sick are
separated from the  rest  of the family, and
abandoned to  their unfortunate  lot,  the
mother even refusing  to carry assistance to
her own son during the agonies  of death,
and  the  husband not daring to  approach
the dearest object of his affections, who re-
quests  from him a drop  of water in a  voice
the most tender and supplicating.  A like
inhumanity has place neither in  Asia  nor
in Africa; and if I were doomed to  be at-
tacked by the plague, I should by far pre-
fer being in the hands of the Turks, than
in those of the Europeans.
           Si quid novisti rectius istis,
     Candidus imperti; si non his utere mecunv 
(  89  )
REFLECTIONS
        THE EPIDEMIC FEVER
Observed in the Ligurian Republic, and in
  the Hospitals of the Army of Italy, in the
  Year 8 (1799-1800).
 1 HE analogy and  affinity which  all epi-
 demic fevers bear to each other; the facility
 with which an alarm is propagated as soon
 as one of these dreadful diseases discovers
 itself in any city or  province, has induced
 me to state here my opinions upon a pecu-
 liar epidemic fever,  which alarmed the in-
 habitants of the environs  of Montpellier,
 during the first months of the year 8 (1799-
 1800).   See the Journal de Medecin, page
 373.
   An epidemic  disease spread  its ravages
 m the hospitals of the army of Italy3  and
carried off daily its numerous victims.  Fly-
ing report, which  always magnifies every
                   12 
                (  90   )
danger, and attenuates every good, spoke
of nothing but the number of deaths:  al-
ready even the name of the pestilential dis-
ease spread dismay far and  wide.  In this
alarming  situation, the  public  authority
thought proper to consult the school of me-
dicine  of Montpellier, which hastened to
calm their inquietude, and reanimate their
spirits, by proving that  this fever, falsely
regarded as pestilential,  was not at all dif-
ferent from the fever of hospitals, the typhus
carcerum of Pringle, or the fever of camps and
armies, febris castrensis :  and, as a mode of
preservation, they recommended a generous
strengthening  regimen,  great  cleanliness,
pure and frequently renovated  air, and a
state of mind exempt from fear  and inquie-
tude.
  On my return from Egypt to France, I
arrived in the  gulf of Jouan the 25th  Prai-
rial of the year 8 (14th June, 1800), and I
collected  the  particulars of the  epidemic
which  had just carried off a great number
of the inhabitants, and of the soldiers in the
environs.   It was the same  as that which 
                { .91   }
we have just been describing;  and it was
observed during this epidemic, that the in-
habitants residing near  the sea  were more
exposed than those who were at some dis-
tance ;  and that there were several villages
situated on the heights,  which had not even
a single sick person.
   With regard to this disease, the majority
attributed it to the rains and the fogs.  A
citizen  of the environs  of Antibes assured
me, that if  this  disease had taken   place
some months before, it would, without fail,
have been attributed to the vessels just ar-
rived from Egypt, and which had  put ashore
at Frejus without performing quarantine.
A similar epidemic,  probably  the  same,
showed itself in the hospitals of Genoa some
months after; and it was stated in the pub-
lic papers,  that a physician of that city had
refused  to go and take  charge of the sick
of the hospital, for fear of the contagion.  I
am led to think that this citizen was read-
ing at the time the work of M.  Papon, in
which  are  related  the  particulars of the
plague  of Marseilles.   If I were to give 
                (   92  )
advice to medical officers employed in treat?-
ing epidemic diseases, it would be to banish
melancholy and fear, to live well, and avoid
all excess; and if they are fond of readings
to choose amusing books  in  preference to-
those which treat of the plague. 
{  93  )
     ,  REFLECTIONS
                   on
   THE YELLOW FEVER OF CADIZ

           In the Year 1800.


AN treating of the disease of Egypt, known
by the name of the plague, and of the epi-
demic fever,  observed  during  the year 8
(1800), in the bay of Genoa, at Nice, and
at Montpellier,  we have  seen with  what
facility we are deceived  with regard  to the
nature and causes of these  diseases. When
a dreadful epidemic breaks out in any city
or province, we, without fail, have recourse
to some peculiar poison, imported from dis-
tant  countries.   Hence, some  have  made
the yellow fever come from Palestine, and
others from the West-Indies.
  Amongst the authors who have written
on this disease,  some say that it spreads it-
self by contagion ; others, that this happens 
                (   94  )
but  rarely.   (See Hillary's Description of
the Yellow Fever which prevailed at Bar-
badoes.)  There are even some physicians
who maintain that it is no wise contagious.
In the Journal de Medecin, of Paris,in the
year 9 (1801), Citizen Halle, professor of
the school of medicine,  has  given  us the
history of the yellow fever of Cadiz.  As we
have been treating  of an epidemic which
may have some affinity with other diseases
of this nature, I may just be  permitted to
mention here its principal features,  and to
add  some reflections  and  queries,  which
may perhaps tend to procure us some more
distinct ideas  of this disease.

               Symptoms.

  From the 10th to the 15th of August, in
the year 1800, there broke out in the quar-
ter of St. Mary, at Cadiz, a fever, which, in
the end,  ravaged this city, in a short time:
it had the character of a slow nervous fe-
ver.   In the supplement of the Gazette of
Madrid,  we  read, that some  corsairs and 
                (   95   )
sailors, consisting both of strangers and na-
tives, brought this disease  into a single fa-
mily in this populous part of the town, and
that from  thence it  communicated  itself
to all those who had any intercourse with
them, and afterwards spread itself to all the
other quarters,  attacking  indiscriminately
all classes of the inhabitants of this city.

                 •Causes.

  With regard to the cause of this disease,
the author of the Journal de Medecin thinks
that it certainly was not caused  by  the im-
portation of any  contagion.   He  thinks^
with reason, that fear and terror, and the
long-continued heats of a burning summer,
preceded by heavy rains, and followed by
a very  warm easterly wind, which lasted
forty days, and which made the  thermome-
ter of  Fahrenheit  mount  to 85 degrees,
might,  in the end, have facilitated and ren-
dered more rapid the course of this disease,
called the yellow fever on account of the
yellowness  which supervened.   It began 
                (   96  )
by shiverings, accompanied by general un-
easiness, and a bilious vomiting of a yellow
or green colour, stools of the same nature,
loss of strength,  quick pulse, burning skin,
heavy pains in the head, temples and or-
bits,  pains in the loins, the bones, and su-
perior orifice  of the stomach.   If these
symptoms  continued  increasing until  the
fourth or fifth day, the patient was  in jeo-
pardy : the yellowness supervened, accom-
panied by subsultus  tendinum,  petechias,
and hiccough; the vomitings and stools be-
came bloody,  blackish, and foetid;  the ex-
tremities cold;  and all the symptoms of
putridity appeared. If, on the contrary, the
sick felt some relief on the first days of the
disease,  there was then reason to look for
their recovery: the yellowness, haemorrha-
ges from the nose or the fundament, were
not  bad symptoms, provided  vomiting or
hiccough did not  supervene.  Some  pati-
ents were observed to have phlyctense,  and
swellings of  the parotids;  and others  had
phlegmonous tumours, which  were termi-
nated by gangrene. 
                 t   97  )
  'The dissections  of several dead  bodies
showed bilious collections in the liver, the
gall bladder distended, the gall ducts ob-
structed, and in general  an erysipelatous
inflammation of the abdominal viscera,  and
very  frequently gangrene  of the intestines
and stomach.

              Method of cure.

  Several patients, who were slightly at-
tacked, were cured by a little  of the ack
dulous tartrite of pot-ash, some  decoction
of  bark, slight sudorifics,  lemonade,  and
nitrous  drinks, not omitting glysters,  and
some gentle laxatives.   In the more severe
attacks, vomits on the first  day of the dis-
ease were employed ;* the second day bark
was administered,  in order  to prevent the
exacerbation on  the third;  whey,  with a
little syrup of borax, or  nitrous aether,  was

  * Citizen Halle has with reason remarked, that almost all
those who have seen the  yellow fever in the West-Indies, have
dreaded emetics, as augmenting the irritation in the stomach,
exciting vomitings which could not be stopt, and hastening the
gangrene  of this viscus.  (See Roupp, Bruce, Lind,  Hi)
fary, &c.)
                     K 
                (  9* ')
added to the tisans, and advantage was de-
rived from  glysters of decoction of tama-
rinds, or  decoction of bark.  In order to
moderate the vomiting, and calm the hic-
cough, they gave camphor emulsion in large
doses: emulsion, with lemon juice  in par-
ticular, was most successful in stopping the
hiccough.  In the haemorrhages they made
use of the sulphuric acid, sufficiently diluted,
but in repeated doses.   Blisters produced
the best effects during the comatose state.*
  In those  cases where,  with the yellow-
ness, a bilious diarrhoea came  on, they ad-
ministered a laxative tisan made from ta-
marinds.   If the evacuations were  accom-
panied with fainting fits,  they  gave  the pa-
tient a few spoonfuls of  a cordial mixture,
with some vitriolic aether mixed with water
of linden tree flowers; the burning heat in
the intestines was moderated by emollient,
oily, and anodyne glysters.   In the  worst
cases they employed  the  decoction of bark

  *  Hillary says, that blisters, so far from being useful, aug-
mented the comatose affection, the  trembling, subsultus tendt-
num, colduecs of the extremitie-s, and haemorrhage. 
                C   9'9\   )
with vitriolic aether, opium,  the liquor ano^
dynus, &c.   Sometimes  a  violent fever
showed itself,  followed  by fits of intermis-
sion ; and although the bark prevented the
attack on  the following day, the patient
was destroyed in a very short  time.  This
circumstance recals to my mind a case nearly
of the same kind,  which occurred to me
whilst I was physician and surgeon in chief
of  the Duke. of Modena's body guards.
M. Volpi, a young man belonging to the
corps, of a very robust habit,  not being
able to void his water,  endeavoured to in-
troduce into the urethra some thick violin
string, which irritated the prostate and pas-
sage to such a degree, that  a  considerable
swelling  of the yard followed,   accompa-
nied with inflammation.  The case was so
severe, that I  called in consultation one of
the physicians of the city, who  considered
the patient to  be attacked with an intermit-
tent fever, and persuaded him to take bark
in large  doses, in order to stop  the double
tertian, which  was  merely symptomatic,
arising from the inflammation of the  uri- 
               (  100   )
nary passages,  and  followed exactly  the
course of a true fever of suppuration.  The
physician gave himself credit on seeing the
patient free from fever,  but the gangrene
made such a rapid progress that death fol-
lowed when we believed him out of dan-
ger.   It is clearly to be perceived, that bark
was  not  the most appropriate  remedy in
such a case, and that its  tonic action only
augmented the disorder, particularly as it
was administered at a period of the disease
when the irritation and state of the patient
required emollients and refrigerants.
  It appears evident to me, that the yellow
fever of Cadiz, in spite of its resemblance
to the slow nervous fever, had at times the
inflammatory character;  and it is not  sur-
prising that the bark then hastened the gan-
grene, by augmenting the inflammation.

           Means of prevention.

  At the breaking out of the disease  at Ca-
diz,  the common sewers were ordered to be
cleansed, and the dead bodies buried with- 
                (   101  )
out the city.  An hospital also was provided
for the soldiers and sailors, at some distance.
These means could not fail of being very
proper, and much more useful than water-
ing the doors of the houses, than the smoke
of the branches of green  pine burnt in the
public squares and streets, the fumigating
and  sprinkling the  houses  with aromatic
vinegar, and the firing off of gun-powder in
different quarters; means truly of small avail
in purifying the atmosphere  of a city such
as Cadiz.

Queries respecting the Yellow Fever which
   appeared at Cadiz in  the year 1800.

   1.  Is it quite certain that this disease was
the yellow fever?
   2.  Is it  sufficiently proved  that it was
contagious?
   3. Is it a certain fact that the corsairs and
sailors brought  this disease into Cadiz?
  4.  What are  the circumstantial details
which prove these assertions?
  5,  The heavy rains of the spring, the ex-
                   K2 
               (  102   )
eessive heats of the  summer,  the hot and
constant easterly winds, the hardships which
the inhabitants had experienced, and were
still suffering—were these not sufficient cau-
ses to give rise to a disease  dreadfully epi-
demic, contagious, and mortal?
   6. What  were the means employed for
arresting its progress?
   7. How were  the means of curing and
destroying it discovered?
   8. If it  was contagious,  how came  its
progress  to be stopt  amongst  that class of
people who possessed neither the means nor
the possibility of avoiding the contagion?
   9. If it  was evidently contagious, how
came it not to be communicated  at other
times, when there were received into Cadiz
without  precaution,  persons recently con-
valescent,  and perhaps attacked with the
yeUow fever, coming from Carolina  and
Philadelphia?  If a predisposition be requi-
site to produce it, the disease  then cannot
be eminently  contagious.
   10.  The influences of seasons, times and
situations, are equally fatal to all,  and not 
               (  103   )
more so to the poor than to the rich.  The
effects of contagion, on the contrary, may
be  prevented by  persons  possessing  the •
means  of preserving themselves from  it.
As to the poor,  it is impossible for them to
avoid it, particularly, if they have any sick
amongst them.
  11. Was the number of deaths known ?
  12. Was it  as  considerable as  is  re-
ported I.
Ssepe fama crescit eun.do. 
(   104  )
ON  THE DYSENTERY.
 1 HE  dysenteric flux  attacked a great
 number of our soldiers in Egypt, at the be-
 ginning of autumn, in the year 6 (1798), that
 is to say, when  the coolness of this season
 began to moderate the excessive heats< of
 summer.
   Obstructed perspiration was the chief
 eause of this disease. It is well known that
 when the pores  of the skin  are closed up,
 the fluids are carried to the intestines, and:
 give rise to diarrhcea.  Cutis stricta, alvus-
 lax a est.
   Sanctorius has proved to us, that of the
 eight pounds of nourishment which a man
 takes during the twenty-four hours, he loses
 five by  perspiration.   If  this perspiration
happens to be stopped  by any cause what-
 ever,  derangements in  the animal functions
 must  necessarily follow.  Experience  has
shown us that it is to the intestines the fluids
 are carried, and  produce diarrhoea. 
               (  105   )
  This disease showed itself on the majority
of our soldiers a very short time after their
arrival in Egypt.  We have said, in the In-
troduction, that the  nights were cold and
damp, and that the men took no precaution
to guard against their bad effects.   Hence,.
amongst other inconveniences which neces-
sarily followed, our troops  were  first  at-
tacked with diarrhoea.  The pasteques,  or
water-melons,  the milk,, and the water of
the Nile, which our  soldiers drank in too
great a  quantity,  contributed to keep  up
this excessive evacuation.   In several indi-
viduals,  the diarrhoea degenerated into the
white dysentery; and it was not unusual to
hear  the patient say, " My  stomach does
not now digest my food, for it passes in the
same state as  when I take it."  They did
not suffer any cholic pains,  and very few
made use of any remedies for  its cure. The
frequency of the stools did not fail to irritate
and heat the extremity of the rectum.  This
excoriation was nothing but the effect of the
quantity, and not the quality of the stools,
as the slight inflammation which attacks the 
                (  106   )
nostrils in coryza is owing to the quantity
of lymph which flows over the parts, and
not  to its  acrimonious   quality,  as  some
suppose.
   Besides the fluids of perspiration, which
are carried to the intestines,  the bile flows
in a  greater quantity into this canal,  the
stomach loses its strength, and the gastric
juice becomes less powerful, or when scarce^
ly secreted, flows into the intestinal tube;
on account  of the  over-increase of the pe-
ristaltic motion.   This derangement of the
stomach must of course produce bad diges-
tion; and the half-digested food must give
rise to the disengagement of  a quantity of
air.   It is to this particular gas that I attri-
bute  the  first cholic  pains which the sick
experience.  In this period of the disorder
there supervenes,  in my opinion, on  the
irritated parts, some slight  inflammations
upon different spots in-the intestines, and
segments of the  internal coat are in some
points detached,  whence there follows the
mucous or  glary dejections,  which  many
persons call the grease of the intestines, 
                {   107  )
  When the diarrhoea has arrived at this
second stage, it is then become dangerous,
and requires to be treated in the manner
we shall now point out.
  If we neglect to use the means proper for
checking the progress of this disease, it very
soon becomes a true bilious fever, accom-
panied with very frequent stools, requiring
very considerable efforts to void a quantity
of glary and often bloody matter.   Several
of the sick in this state, weary of following
the advice of physicians, tried to arrest the
course of their disorder by eating hard boil-
ed eggs, sprouting beans, and other reme-
dies, considered as specific. A great weight
at the stomach,  burning thirst, bilious vomit-
ings, stools of a blackish colour, putrid, and
of an insufferable stench, were soon the
consequence of this bad practice. But still,
hoping  to be cured in twenty-four hours,
they preferred  going on taking a  load  of
medicines, directly contrary to each other,
which were given them by quacks;  and  in
this manner completely dissipated  the little
strength they had  left. 
                (   108  1
  After this statement, it is easy to be per-
ceived that I distinguish three stages in the
dysentery of Egypt.  The first stage is the
simple flux, or diarrhoea; the second is
when it is accompanied by cholic pains, and
mucous evacuations;  and the third,  when
fever shows itself,  and the evacuations be-
come bilious, putrid, and bloody.

Treatment,  and means of preventing this
                Disorder.

  The indications which present themselves
in the treatment of the dysentery, vary ac-
cording to the different  stages  of the dis-
ease.   In general,  in  the  simple  flux it is
necessary to facilitate the evacuation of the
putrid or vitiated  matter contained in the
stomach   and intestines; to  diminish  the
great sensibility of these parts, and  to re-
establish  the obstructed perspiration.  In
order to  facilitate the evacuation of the pu-
trid and  vitiated matter in  the stomach and
intestines, I constantly prescribed an emetic
in the morning.  I preferred ipecacuanha to 
               (   109  )
the tartarised  antimony; and  in the even*
ing I gave  the  sick an anodyne draught,
with twenty drops  of the liquid laudanum
of Sydenham: I  recommended to them at
the same  time to keep themselves well co-
vered,  and  I afterwards made them take
some boluses of diascordium, the white de-
coction for  ordinary drink,  some rice and
sheep's trotters for food. The oranges and
pomegranates, fruits in great abundance in
this country during the season when this dis-
order prevails, were very useful in quench-
ing the thirst and refreshing the mouth,
without relaxing the stomach and intestines,
as watery drinks are apt to do.  Afterwards,
the conserve of orange peel, preserved with
sugar and not honey, coffee, and a little Cy-
prus wine, contributed greatly to strengthen
the functions of  the stomach.
   When  the evacuations   had  recovered
their proper consistence, the  patient was
considered as cured : but if a too great con-
stipation followed,  glysters were preferable
to purgatives, since the  slightest  laxatives
exposed the patient to a relapse.  When the
                   I, 
               {   no  )
fitix was accompanied  with colic  pains,
and the patient's stools  were mucous and
glary,  I  had recourse to injections  of de-
coction of lintseed,  poppy heads, of milk,
of broth made from tripe and sheep's trot-
ters, &c. &c.   For a long time, and under
different  circumstances,  I made use of a
number  of remedies,  cried  up  in that
country as specifics in the cure  of the dy-
senteric flux;  but  I have never been able
to collect a sufficient number of facts to
convince myself of their good effects.
  I am persuaded, that  in  order to treat
this disease in the  second and third stages,
we must pay attention to the constitution
and strength of the  patients, in order not
to irritate  too much with  tonics and as-
tringents on the one hand, nor to relax
them by laxatives  and refrigerants on the
other.  I have seen individuals,  to  whom
bleeding  was of great utility: I have also
seen others, to whom it proved quite the
contrary.   Opiates have, in the  course of
twenty-four hours, cured some  who had
$?een  long ill,  without any inconvenience 
                (   111  )
accruing afterwards; but  I have  seen the
same class  of remedies augment  consider-
ably the fever and colic  pains in persons
of a meagre, delicate, and  bilious habit.
In this case  lemonade, with the  acidulous
tartrite of pot-ash,  or the tisan made  from
tamarinds for drink, rice for food, and glys-
ters of milk, produced the best effects.  I
am,  however, persuaded, that the food of
which the  sick  made choice,, and the ex-
cesses  which they committed,  were fre-
quently the chief causes which  prevented
their recovery.
  When the  dysentery, accompanied  with
fever,  has  arrived  at its  third stage, the
fever  ought to- be  treated as putrid,  and
the, bilious  evacuations  accompanying it
should not be stopt; but as soon as we can
flatter ourselves with having evacuated all
the bile  and other corrupted matter,  by a
moderate use of gentle laxatives, sometimes
giving a weak  decoction of rhubarb, at
another  small  doses of ipecacuanha, we
ought  then to  have recourse to  anodynes
and opiates. 
               (  112   )
  Citizens  Desgenettes and  Larray,  chief
officers on the medical staff of the army of
the East, and all my colleagues, have ac-
knowledged, in the  treatment of this dis-
ease, the sovereign powers of opium, which,
administered at  a proper period, produces
constantly the best effects.
  I have not had occasion to make use of
blisters, as I do not  believe them to be of
much utility.  In order to quiet the pains
in the abdomen, I have  always preferred,
in every kind  of colic,  to have  recourse
to anodyne fomentations and tepid baths,
when the strength of the patient admitted
of it, according to the practice of Pringle,
Lind, and other celebrated  authors. These
great practitioners,  in order to  dispel the
pains,  likewise  made use of a  blistering
plaster  applied  over the  abdomen;  and
Citizen Barbes, physician in ordinary to the
army of Egypt, used to apply large blisters
over the abdomen of several patients at-
tacked with dysentery, of  whose safety he
despaired, and in a few days they recovered,
(See the Egyptian Decade.) 
               (  IIS   )
  Several persons stopt  the dysenteric flux
by giving small draughts of decoction of
the peel of pomegranate, three times a day,
or still oftener. InUpper Egypt they make
use of quinces seasoned with  pepper,  to
stop the diarrhoea-and dysentery.  In Italy
they boil this same fruit  in a small quantity
of water till it becomes reduced to  a jelly,
which they give with advantage by spoon-
fuls to the. sick.  In France  it is given in
the form of a conserve.
  Amongst the remedies which the physi-
cians  of Cairo recommend for curing the
dysentery, is a fruit, from Sennaar, called
hao-bab, or the monkey's bread.   The rind
of this fruit powdered  and taken in small
doses, frequently repeated, as well as the
substance adhering to the seeds, which has
a sourish-sweet agreeable taste,  is extolled
as a specific in the dysentery  of  Egypt.   I
mvself made use of it at Cairo in  several
cases  with advantage;  and I found in the
sweet powder of the hao-bab, an antiseptic
as well as an astringent, quality.
  The means to be  employed for preserv-
                   L2 
                (   114  )
ing oneself from the  dysenteric flux, con-
sists in avoiding the suppression of perspi-
ration, by  sleeping in a well-closed  apart-
ment,  and  by covering oneself thoroughly
when forced to pass the  night in the open
air.  It is very useful in Egypt, in order to
prevent too great a relaxation of the fibres
of the  stomach,  to mix with the Nile wa-
ter, which  serves for ordinary drink, a little
brandy, in  preference to vinegar.  This pre-
caution becomes  the more necessary,  if
much use be made of lemonade.  The want
of wine is of great consequence to those who
are habituated to that liquor.   In Egypt
they who  substituted brandy and  coffee in
place of wine, enjoyed good health :  those,
on the  contrary, who drank nothing but the
Nile water in great quantities, and took a
good deal of milk, greens, and watery fruits;
who, in the evening and night, to enjoy the
cool air, undressed themselves, or slept upon
the damp ground, were attacked with dy-
sentery ; and when these  individuals perse-
vered in following this regimen,  they were
soon under the  necessity of applying for 
                (   us  )
medical assistance.  Doctors Bruant,  Bar-
bes, Savaresi, and  Renati, physicians in or-
dinary to the arfny of the East, paid par-
ticular attention to this disease.  (See their
Memoirs in the Egyptian Decade.| 
(  116  )
            ON THE

OPHTHALMY OF  EGYPT.
 1  HE ophthalmy of Egypt is a true de-
fluxion  of humours  which deposits itself
either upon one eye only, or upon both at
the same time.  This disease  is endemial,
sporadic, and  epidemic;  and takes place
principally on  the  approach of autumn.
Autumno lippitudines 8C oculorum fluxiones
Jhint.  (Hippocrates.)
  The ophthalmy  of Egypt showed itself
among the soldiers of the army of the East
at the commencement of the year 6  (1798),
and continued  till the month of Frimaire
(middle of November) in the year 7  (1799).
More than two-thirds of the army were
attacked almost at  the same time, which
made the duty of the garrisons very severe.
This disease harassed not only our soldiers,
but also the inhabitants of Lower and Up- 
                (   "7  J
per Egypt.  The common duration of the
ophthalmy was from  seven to eight  days.
I have seen a great  many recover in less
time, and  I have seen others continue to
suffer under it for several months.
   Many  individuals,  after  having,  been
cured  of ophthalmy  once, were  attacked
again.  I had a little  Maltese  servant, who
had this disease euery time that he slept in
the open  air.
   Those who took care to manage  them-
selves as they were ordered, recovered per-
fectly  in a short  time; others had a great
deal of difficulty in getting rid of this dis-
order; and some who unfortunately were
at a distance from all medical assistance,
contracted very complicated organic affec-
tions,  which often terminated in  the total
loss of the organ of sight.

     Description of the Ball of the Eye.

   The wish which several very respectable
 persons have expressed of having first some
 ideas  of the organization of the ball of the 
               (   118   )
 eye, has induced me to give the following
 short description :
   The eye is composed of three coats, which
 are, the cornea, the choroid, and the retina;
 and of three humours, namely, the vitreous,
 crystalline, and aqueous.
   The cornea is divided into the transparent
 and opaque cornea.
   The opaque cornea is the most external
 coat, or what is commonly called the white
 of the  eye; its texture  is very compact,
 and like that of the cornea:  it extends from
 the bottom  of the eye forwards to the  an-
 terior part, where  it meets  the  transparent
 cornea:
   The transparent cornea  is the most ele-
 vated part, commonly called the black of the
 eye, and may be compared to the glass of
 a watch set  in its case.
   The transparent  cornea  is composed of
a great many very  minute  diaphanous la-
minae, placed the one over  the  other,  and
has a serosity which  exudes through  the
 pores of these laminae.
   The choroid is a coat like the skin of a 
                (   H9  )
black grape; it is spread all over the opaque
cornea, from the bottom of the eye to its
junction with  the transparent cornea.
  The retina  is  a coat  formed by the ex-
pansion of the optic nerve : it is very mi-
nute, soft,  of  a whitish colour, and spread
over the bottom of the  eye.
  The optic nerve is  a round white  cord,
which extends from the brain into the ca-
vity of the eye,  where it is expanded, and
forms the retina.
  The cavity of the eye is divided into two
chambers,  the one called the anterior, and
the other the  posterior  chamber: the first
is very small;  the  second  forms almost the
whole cavity of the eye.
  The diaphragm, or membranous circle,
which divides the  cavity of the eye,  is cal-
led the iris. This  very delicate and  minute
membrane is contiguous to the termination
of  the  transparent cornea,  at the place
where it is united  with  the opaque cornea,
and has in its middle a small hole called the
pupil, which contracts itself in a strong light,
and dilates itself  in a  weak light.   The 
               (  120   )
colour of the iris varies, and according to
its varieties,  the eyes are  black in some
persons,  and blue in others.
  The posterior chamber of the eye is filled
by the vitreous and crystalline humours, and
the anterior by the aqueous humour.
  The vitreous humour is so named from
its resemblance to melted glass : it is formed
by an  extremely fine coat,  which includes
in its cells a kind of gummy water.
  The crystalline is a  little  transparent
body, like a diamond, of a  lenticular form,
convex on its two sides:  it is placed  on the
anterior part of the vitreous humour,  imme-
diately behind the pupil, where it is retained
by a very minute coat,  called the crystal-
line.
  The anterior chamber comprehends the
space which remains between the crystal-
line lens and transparent cornea, where we
find the aqueous humour, so called from its
resemblance to water.
  The rays of light which convey to the  eyes
the images of bodies, undergo a refraction
in passing through the transparent  cornea 
               (  121   )
and aqueous humour: after having passed
through the pupil, the crystalline lens causes
them to undergo one still greater, which is
lessened by the vitreous humour, and the
image is  stopt by  the retina, the seat of
sight.
   The ball of the eye  is covered by two
eyelids, the one the superior, the other the
inferior; and we distinguish here two angles,
the one the large, or internal, the other the
small,  or external.   The eyelids, or palpe-
bral, are  formed by strong minute  liga-
ments, which support two small curved car-
tilages, running lengthwise  on their edges,
which are called tarsi:  these tarsi, towards
the great angles, have  two holes, called la-
chrymal points; they are fringed with hairs,
known under the  name of  cilia.   The
palpebral are  covered  by the  common in-
teguments, and are lined internally  by  a
soft flaccid membrane, known by the name
of conjunctiva, which is stretched over the
surface of the eye as far as the transparent
cornea.  The  inner surface of the palpebral
is furnished   with  a number  of follicles,
                   M 
                (   122   )
called the glands of Meibomius, which se-
crete from the blood a peculiar fluid for the
purpose of keeping the eye moist, and les-
sening the effects of friction, which results
from the continual winking of the palpe-
bral.
   A small gland, situated under the smaller
angle of the orbit, furnishes the tears, and
,is called the lachrymal gland.
   At the great angle  of  each eye we ob-
serve  a little reddish  tubercle, which se-
cretes a mucilaginous fluid, that contributes
-to retain  in the  great angle, the dust and
other foreign  matter  which are  casually
blown into  this part.  I saw, in  Egypt,
-several individuals who  had hairs  in this
tubercle.
   The fluids  secreted by  the  lachrymal
glands, the serosity which exudes through
the  pores of the transparent  cornea, the
fluids of the glands of Meibomius, and of
the tubercles, after having moistened theball
of the eye, are absorbed  by the lachrymal
points, and carried into the lachrymal sac,
and from that  by the  nasal canal into the 
                (   123  )
nostrils.   All  these  parts have,  in  their
organization,  arteries, veins,  nerves,  and
lymphatic vessels, which  it would be too
tedious to detail.

       Description of  the Ophthalmy.

  The ophthalmy  of Egypt first showed it-
self by a slight head-ach:  sometimes it was
preceded by a few shooting pains in the ball
of the eye, followed by  a flow of tears,
which, for the moment, assuaged  the pain :
often the patient fancied that he had a par-
ticle  of  sand in his eye, which  distressed
him.   We generally  remarked, that those
in the best health were attacked all at once
with ophthalmy, accompanied  with an un-
easiness  and  considerable weight  in the
eyes, followed by an excessive flow of scald-
ing tears, to make use of the expression of
the  sick.  On examining  the  eyes in this
state,  the vessels  of the  conjunctiva ap-
peared red and distended; often the con-
junctiva was elevated to such a  degree, that
Jhe transparent cornea appeared  quite bu- 
f   124   )
ried in it, and of very small diameter. Then
the  palpebral became cedematose,  the pa-
tient could no longer endure the light,  the
flow of tears increased, and generally be-
came changed into a thick,  and sometimes
yellow matter.*
   I think we may call the  ophthalmy, ar-
rived  at  this  stage,  although  very  severe,
the simple ophthalmy;  and the  ophthalmy
complicated^ when the gorging of the con-
junctiva, the  swelling of the palpebral, and
the pain  of the eyes became  so consider-
able, that fever showed itself, and some in-
jury or organic lesion was perceived in the
ball of the eye, as specks,  staphylomas, hy-
popius, and other diseases peculiar to this
organ.

  * This matter was nothing more than the fluid of the glands,
or follicles of Meibomius, which the inflammation had ren-
dered thick.  We see this change happen to the skin in slight
burns, and after the action of cantharides ; for the first day
there is nothing poured out from the affected parts but lymph,
the day after, thicker matter, which  finally becomes changed
into true pus.  The inflammation  of the conjunctiva, in the
ophthalmy of Egypt, and that of the membrane of the urethra*
afford discharges, of which the appearance is exactly similar. 
(  125   )
                 Causes.

  With regard to the cause of the ophthal-
my of Egypt, some say that it is the sands of
the desert which bring it on; others,  that
it is ammoniac mixed with the dust;  and
others that it is nitre.  Savaresi says,  that
the nitrate of pot-ash, which has been im-
properly called nitrous dust, does not at all
injure the eyes, but that it is the clay which
has alumine for its  base, and  the  chalk,
which is a combination of the carbonic acid
with lime, earthy  substances widely scat-
tered  over the whole soil  of Egypt,  which
cause the ophthalmy.  (See  the Egyptian
Decade, vol. ii. page 161.)
  Amongst the causes, I consider the  in-
tense  light of the sun as the principal,  and
that what contributed most to cause a de-
termination to the delicate parts of the  ball
of the eye, was a considerable degree of ir-
ritation,  followed by an indirect debility,
to make use of the Brovvnonian expression.
It  is  not in Egypt  only  that we find com-
                  M2 
                (   126  )■
plicated diseases of the eyes, but in many
other places.  At Bologna in Italy, for ex-
ample,  when a stranger arrives there, he is
not long in remarking a considerable num-
ber of blind people, who,  during the  day,
sing and play on different instruments in the
squares of this great city: one also observes.
there a  great many individuals, who have
the eye-ball projecting, and more bulky than
in its natural state, and staphylomas, specks,
and other defects  of that kind.  It is well
known  that these  affections are the conse-
quence  of different inflammations caused by
the light of the sun reflected from the walls
of the houses, which are white-washed with
lime.  This light,  during the summer, be-
comes  so intense, that it  fatigues and in-
jures the organ of sight, particularly in those
persons who, from their sphere in life, or
property, cannot avoid it. (See the Memoires
de la Institut de Sciences de  Bologne.)
  At Malta, in the year 7 (1799),  one half
of the garrison was  attacked  with the me-
ralopie.   This disease was attributed to the
too great irritation caused by the rays of the 
                 (   127   )
sun reflected by the surface of the walls,
and from the  ground, which  is composed
of very white calcareous earth.*
  In  Egypt the view of immense barren
plains,  the reverberation of the rays of the
sun, reflected from the ground,, intersected
with streets and squares, and from the water
and sandy banks of the  Nile,  the heat and
blaze of which are so great  at mid-day, that
the eye can scarcely see  the spot where one^
wishes to place one's foot,  must necessarily
enfeeble, fatigue, and dispose the organ of,
sight to particular affections.  The masons
of  Egypt  being more exposed to this glare
of  light than  others, have almost all dis-
eased eyes.  Savaresi asserts that this arises
from the  lime  which they are  constantly
handling, and from the atmosphere in which
they live, being loaded  with  chalky, argil-
laceous,  and calcareous particles.^ The fol-

  * Citizen Rober, physician to the army of the East, at the
head of the hospital staff of the island of Malta,  has made
 some very interesting remarks upon this disorder, on the topo-
graphy of the island, and the physical and medical constitu-
 tions of the years 6, 7, and 8 (1798, 1799, and 1800).  It is
 to be  wished, for the benefit of  the  profession, that he may
 commit this w<wk to the press. 
                (   128  )
lowing fact appears to me to prove com-
pletely, that the calcareous  particles  dif-
fused in the atmosphere do not produce the
mischief which is  apprehended.   In the
hospital at Giseh, at the time of its first es-
tablishment, the wards were white-washed,
or rather laid over with a  very  thick stra-
tum of lime, applied to the walls by means
of a miserable broom of osiers, according
to the manner of the country.   The walls
exhaled, for several days, a  very  strong
smell peculiar to lime, which certainly arose
from  minute  calcareous particles, which,
having become very dry, diffused themselves
in the atmosphere of the wards.  This hos-
pital was appointed to receive the  soldiers
attacked with the ophthalmy,  who were to
come to it from the hospitals  at Cairo, and
who actually arrived to the number of about
one hundred, towards the end of Frimaire, in
the year 7 (middle of December,  1799), the
walls being  scarcely dry.   Having the care
of these men, who had been for a long time
suffering under the  disease of the  eyes, I
was very uneasy lest I should  see them lose 
                (   129  )
their  sight entirely; but I was agreeably
surprised on finding them  all a great deal
better on the following day.  Citizens Cha-
teau-Neuf, Dumay, Cerresoli, medical offr-
eers, and all the  persons attached to this
hospital, can attest the truth of this amelio-
ration, which was attributed to the situation
being less damp than the wards from which
they had come, and tor the leaving off the
emollient and  aqueous collyria, of which
they had  before been  making abuse; and
perhaps to the  stimulant action of the cal-
careous exhalations.
  But this much, however, is certain, that if
the dust or the sand of the soil of Egypt
were the cause  of the ophthalmy,  this ma-
lady would not cease attacking the inhabit-
ants during the whole course of the year,
with the same violence, since there is hardly
a day passes without one's being obliged to
walk in a kind of thick mist,  or in whirl-
winds  of dust,  elevated by  the winds, by
men on foot and on horseback, and by the
camels and asses. To prove this fact, I ap-
peal to those persons who have frequented 
               (   130  )
the highways of Bulac and Old Cairo.  If
this dust, blown into the eyes, were the sole
cause of the ophthalmy, when there was no
dust  we  ought td have  been exempt from
it.  We, notwithstanding, experienced the
contrary  in the Delta, and particularly on
the cultivated banks of the Nile, during the
time of its inundation. Whenever we were
there exposed to currents  of air during the
night,  we were immediately attacked with
this disorder, without being able to attri-
bute it either to the sand or dust, which
were then under water.   It  was more par-
ticularly, I repeat, during the  inundation
of the Nile, that a great number of our sol-
diers were attacked with the ophthalmy.
(See the Egyptian Decade.) How  came
the French of the  division Dessaix, to re-
turn from Upper Egypt  to Cairo attacked
with ophthalmy, although they had been
constantly embarked upon the Nile ? I ob-
served that the sappers appointed to manage
the flying bridge established on the Nile,
between Giseh  and the isle of Raoudah,
were all  attacked with this disorder; and I 
               (  131   )
have  seen  a number of persons who had
contracted this disease, although they had
never stirred out of their houses, which were
perfectly secured from any dust.
   Having the charge at Cairo of the surgi-
cal duty of the military  hospital  No. 1,  I
remarked that several wounded men  con-
tracted the ophthalmy, from merely having
been placed near to a window not properly
closed, or in a wretched ward, which had
been roofed  over with mats laid at such a
distance from each  other, that  in  several
places one  might have observed the course
of the stars in the meridian. The ophthalmy
supervening upon these unfortunates in the
hospital, has been often more difficult to cure
than the wounds which brought them there.
It cannot be said that it was the dust blown
•through the windows which was the cause
of the malady, since at that time the squares
of Cairo were still  inundated, and particu-
larly  that pi  Beker-Tell-Fild, which  that
very hospital overlooked. This was in Bru-
maire  of the year 7  (October, November,
1799:) 
                (  132  -)
   Nevertheless, I do not pretend to say that
the dust of the soil  of Egypt may not be
hurtful to the eyes,  but I think that  alone
it is not sufficient to excite ophthalmy; and
it appears to me more probable, as I have
already said, that this disease arose from the
suppression of  perspiration,  which  takes
place  very often in  Egypt, particularly  at
night, and which throws itself on the weakest
part, choosing sometimes the intestines, and
oftener the eyes, fatigued by too vivid light
of the sun. Such  is, in  my opinion, the real
cause of the ophthalmy of Egypt.

               Indications.

   In the general treatment of ophthalmy,
it is proper, first, to  draw off into  other
channels the blood  and fluids,  which are
carried to the  eyes  in too  great quantity.
Secondly, to restore  their tone to the coats
and the other parts  of the  eye, which are
too much relaxed. 
(  133  )
  General Treatment of the Ophthalmy.

  Atony,  relaxation,  and asthenia, were
constantly combmed in the ophthalmy of
Egypt,  denominated with  propriety  the
lymphatic inflammation (iippitudo) of the
ancients.  I had many opportunities of see-
ing and treating this disease in several hos-
pitals, and  particularly at Giseh, a place
situated  about half a league  distant from
Cairo, on the left bank of the Nile,  sur-
rounded  by walls on  the  south  and the
west, and washed by the river on the east
and north sides.  During the  time of the
overflowing of the Nile,  several fields and
gardens situated  within  the  precincts of
the walls of Giseh, were  inundated.  The
great workshops of the  park of artillery lay
quite close to these waters; the northerly
winds prevailed constantly ; the quarters of
our workmen and soldiers were not at all
secured from  the  cold  air and  the damp,
which penetrated  into their chambers with
as much facility during the night as the heat
                    N 
               {   134   )
and excessive light entered them during the
dav. These inconveniences were the princi-
pal causes which occasioned the ophthalmy
to show itself more at Giseh than elsewhere.
To these common  causes  may  be added
those which  are peculiar to blacksmiths,
founders,  tinmen,  locksmiths, armourers,
farriers, bakers, &c.  who, from their em-
ployments, are exposed  to the  heat and
light of burning coals: in spite of which,
during the six months that I had the chief
charge of this service, I had the satisfaction
of seeing all those affected recover, and  in
a  very  short  time.   Of two thousand at-
tacked  with  the pphthalmy, whom  I at-
tended in  Egypt, not one  lost his  sight, ex-
cepting the Abbe Elias, interpreter, a man
sixty  years of  age, and  who at last con-
tracted a speck, which prevented him from
seeing with the left  eye.
   In  the  treatment of this disorder,  I re-
commended them not to  make use  of any
cataplasm, to  banish  milk, washes, and
emollient  eollyria.   I followed the custom
pf the people of the country, who  look upon 
               (  135   )
Water as  most injurious to the  eyes.  Irt
truth, the abuse which was made of it could
not fail to weaken and obstruct still more the
parts  already too  much  relaxed.  We all
know  the inconveniences  resulting  front
wetting the eyes day and night, or keeping
wet linen  rags on the palpebral. Water too
frequently applied to the external surface of
the palpebrae and forehead, the neglect of the
means acknowledged to be useful, and the
abuse of remedies administered by quacks,
wrere  the  sole causes which  produced the
bad cases  of this disease.  At Belbes, a sol-
dier attacked with the ophthalmy  experi-
enced such  violent pains in his eyes,  that,
being almost frantic, he rushed out of his
lodging, and without seeing where he went,
began to run backward and forward.  This
unfortunate man fell over  a heap of pines
and  palm-trees, and by his fall wounded
himself in different places, particularly on
the palpebrae, from which there followed a
good deal of blood : the pains were relieved,
and he recovered in a few days.
   It was  after  this accident that bleeding 
               (  136   )
came into vogue, and there was not a single
patient who did not desire to be bled either
in the arm, foot, jugulars, or temples; but
we very soon discovered that it was blood
very unprofitably lost.  We then substituted
successively the use of  leeches,  scarifica-
tions, blisters, and  finally setons.   These
means were found, in general,  more ap-
propriate, and we should have derived from
them much greater advantage, if the sick
would have desisted from wetting their eyes
so often.

    Treatment of the simple Ophthalmy.

   Citizen  Bonaud,  commissary  of  war,
charged with the service of  the  park  of
artillery, a  man  very well known by his
talents  and zeal,  had seconded me  in esta-
blishing a little pharmacy, and consulting
room, where such sick as were able to walk
came to me every morning.
   I immediately administered to them the
remedies which  I thought necessary.   I
gave, at the same time, to those with the 
                 (   137  )
ophthalmy,  a weak solution of  verdigrise,
prepared according to the method of Janin,*
oculist at Lyons, more or less strong accord-
ing to the degree of turgidity of the vessels
of the  conjunctiva.  When  there existed
too great a degree of sensibility in the parts,
I added to the collyrium  a small  quantity
of the acetite of lead, and I showed them
the manner  of using it, which consisted in
opening the eyelids widely, and letting fall
directly  on the ball of the eye one or two
drops,  or more,  which diffused  themselves
all over the surface of the conjunctiva.
   This  fluid  produced at the  moment  a
slight  pricking, followed   by some  tears,
which served to wash the edges of the eye-
lids.  I desired this  operation to be repeated
at least four times a day, recommending to

  * Mr. Janin's formula is as follows:
      R. Aq. Rosse.
         ----Plantaginis. an 5.vj.
         Zinc. Vitrioiat gr. xxiv.
         Pulv. Rad. Iridis. Florent.  gr. xxxvi.
         Pulv. JTruginis. gr. xij.  M. bene in mortario tit
ft. collyrium.----He observes, that it is an excellent remedy in
the early stage of ophthalmy, as it prevents the constant flow
of tears;  and that it also improves the sight of aged and short-
sighted persons.  See Janin Mem. et  Obseryat. &c. sur UOiil^
Paris, 1772.  T.
                     N2- 
               (  138  )
the patients to wipe their  eyes frequently
with a bit of rag kept for the purpose, but
not to wash them.  I at the same time made
them sensible  of the necessity of keeping
themselves well covered during the night,
and  protecting their eyes during  the day
from the excessive  light, by making a kind
of shade with  their handkerchief,  without
bandaging their eyes as they had before
done.
  The facility  with which the simple ophh
thalmy got well, according to this  method,
confirmed me in my opinion, that it was a
true defluxion of humours, which might be
compared to a coryza.
  I was obliged sometimes to make use  of
small blisters applied to the temples, or be-
hind the ears:  I preferred, for this purpose,
a blistering piaster, which I allowed  to
remain applied during  the  whole of the
attendance, without changing it, or making
use of any  bandage.  I have employed,
with advantage, small plasters of this paste,
immediately over the teguments of the pal*.
pebrse, in order to remove their  swelling 
               (  139   )
and atony. In proportion as the symptoms
of ophthalmy diminished, I made my colly«
rium more tonic, not only to assure  myself
of the cure, but also  to prevent a relapse;
without which precaution this accident hap-
pened very frequently, and then the disorder
became more obstinate, and frequently com^
plicated.
  When  those  attacked with ophthalmy
were of a plethoric and sanguine tempera-r
ment, I had recourse to blood-letting; when
their bowels were constipated, I prescribed
purgatives; and I followed exactly  the ad-
vice of Hippocrates, who has told us, Ocu-r
lorum fluxiones,  alvi fuxic curantur. This
practice became still, more necessary, when
the ophthalmy had succeeded to diarrhoea*
which happened very  frequently in Egypt.

  Treatment of the complicated Ophthalmy.

  The complex ophthalmy varied  accord-
ing  to the nature of  the organic lesion of
the affected parts, the  degree of the disease,
and  other accidental circumstances, 
               (  i^o   )
  It constantly happens that, in all obsti-
nate ophthalmies, all the functions become
deranged, and  particularly that of the sto-
mach :  hence, affections of this viscus were
very frequently complicated with the oph-
thalmy, which then yielded to the repeated
use of emetics and purgatives.
  Often the most severe symptoms accom-
panying ophthalmy  arise from  a state of
extreme sensibility in the patient, and we
then find symptoms decidedly nervous.  One
of my colleagues (Citizen Cerresoli), during
his attack, was in a such state of agitation,
that he  often found himself forced involun-
tarily to shed scalding tears.
  In  the complicated ophthalmies, along
with a great sensibility of the nervous sys-
tem, there came on the most violent pains
in  the  head, the pulse became high, the
patients could obtain neither ease nor sleep,
and as they were deprived of sight, the fear
of remaining in that  situation augmented
the uneasiness  of the sufferer, to whom it
became necessary to give soporifics and ano-
dynes,  to which was added  blood-let ting>. 
               (   141  )
when  the  strength  and  constitution per-
mitted.
  When the ophthalmy approached its ter-
mination, the  patient began to distinguish
objects, which appeared to him surrounded
with a  thick mist;  this mist disappeared
by  little and  little:  the  conjunctiva  re-
covered  its natural  colour instead of the
purple hue which it had before;, the exces-
sive sensibility of the  retina  diminished;;
and, at  length,  after a good deal of time,
trouble, and suffering, the patient found
himself quite recovered. But when the oph-
thalmy became  complicated with organic
lesion,  the consequences were  much  more
troublesome;  the  treatment varied accord-
ing to the  seat and nature of the affection;;
sometimes  the  conjunctiva  was  so very
turgid, that it projected quite  beyond  the
palpebral,  which  then could not  entirely
cover  it.  In this case, besides the common
remedies,  we recommended and  practised
scarifications, and  even horizontal incisions,
thereby removing whole portions of  the
conjunctiva; but I observed that this prac- 
                (   142  )
 lice was seldom productive of any good ef-
 fects:  therefore I prefer the application of
 leeches, which bring away a greater quan-
 tity of blood.   The use of the citron oint-
 ment, No. 14, was  of some use, and gradu-
 ally removed the turgidity of the vessels of
 the conjunctiva.
   At other times the portion of the conjunc-
 tiva lining the  palpebral,, became  so volu-
 minous, that these were reverted, producing
 the most hideous effect: we then made use
 of the same remedies as in the  turgidity of
 the  conjunctiva.  A bandage  indeed was
 suggested, to compress and retain in its po-
 sition the superior eyelid, after having care-
 fully replaced  it; but it very soon became
 reverted anew.
   The majority of  those individuals who
were attacked with  this particular affection,
had,, at the same time, some other defect
in the  ball of the eye:  in some the whole
of the  transparent  cornea was  become  ei-
ther opaque, or projecting,, or ulcerated.  In
this last case, the transparent cornea being -
no longer able to resist the pressure of the 
                (   143  )
humours contained within the eye, gave
way, and the patient at this moment expe-
rienced a shock which he compared to the
shot of a pistol, the aqueous humour escaped
as at the moment of the incision of the cor-
nea in  the operation for extracting the ca-
taract,  and  the  iris coming  into  contact
with the cornea, adhesion of these parts
took place,  and  cut off every hope of re-
storing  sight to these unfortunate sufferers.
When  specks arose  from pus  collected be-
tween the laminae of the transparent cornea,
they disappeared on giving the matter vent;
and when produced by the inflammation of
the cornea,  they vanished and re-appeared,
in proportion  as the  inflammation dimi-
nished  or increased.
  In several soldiers whom I  accompanied
from Egypt  to France, I observed that the
specks  which  they  had at  their  departure
from Alexandria,   were  diminished after
some days sail; and on their arrival in France
they clearly distinguished objects, not  only
sideways, as before, but  when  placed di-
rectly before them.  I  know some of these 
                 (   144   )
Individuals, who had been reported  as in-
valids in Egypt, and  who  are  at this time
in  the  Consular Guards.   Whenever the
specks  on  the transparent cornea do not
arise from the disorganization of its laminae,
there  is always  reason  to hope  that the
lymphatic vessels will absorb  the  extrava-
sated  and thickened  fluids  forming  these
specks ; but  whenever  the organization is
so  much changed, that the transparent cor-
nea is become opaque  in its  centre, then
there  remains no other method of restoring
vision, but performing the operation  for the
artificial pupil.*
   The  staphylomas,  hypopions,  cataracts,
and  other  similar  consecutive diseases re-
quire particular  treatment,  and the  most
delicate operations, which it was not always

  * 1 had made at Reggio, in 1788, a small pair of forceps for
separating a portioa-of. the iris from the opaque cornea, and
making in this manner an artificial lateral pupil, in the form of
a. crescent. In the year 5 (1797), Citizen Demours, a celebrated
oculist in Paris,  succeeded in making an artificial pupil, by cut-
ting off a small shred quite close to  the opaque cornea, where
there did not remain above a fifth of the transparent cornea in
a natural state, and separated from the iris. This operation has
been followed with the greatest success, and proves the daily
progress of surgery in France. 
               I   145  j
prudent  to undertake in Egypt.  Citizen
Larray performed at Cairo some operations
of this kind with various success.  This in-
genious and zealous practitioner was one of
the foremost in applying himself to inquiries
into the nature of the ophthalmy, and pre-
sented to the Institute of Cairo a very full
account of this disease. Citizens Bruant and
Savaresi have  also inserted some reflections
on this subject in the Egyptian  Decade.

The Treatment used by the Egyptians for the
          Cure of tlie Ophthalmy.

  When the natives of Egypt are attacked
with the ophthalmy, they cover their eyes
with several muslin handkerchiefs, and are
very careful not to touch  or apply any thing
•to them during the first seven days. At night
they cover, with great care, their head and
body, by  which means the perspiration is
restored,  which greatly contributes to their
recovery in a short time. Often severe symp-
toms show themselves; and then they make
use of various  powders, and astringent and
                   O 
                 (  146  )
tonic collyriums.   (See the table,  p. 148.)
Several have their heads shaved, and  scarifi-
cations  made  on  their temples and fore?-
heads;  they apply  leeches  to the angles of
their eyes,  and cupping-glasses to the nape
of the neck,* blisters behind the ears, where
they also sometimes apply cautery; they, at
the same time,  make use of different oint-
ments,  and coloured and  thick collyriums;
for if the Collyriums were liquid and trans-
parent,  they  would,  in their opinion, be
hurtful and injurious to the eyes.
   At Giseh, and other places, I have seen
them paint their eyebrows and all  the edge
of the orbit, with  a pencil dipt in a mix-
ture, either white  or yellow, or sometimes
black.  It was difficult  to keep oneself from
laughing  at seeing these poor sick  people
almost  blind,  with  the  contour  of their
eyes besmeared with these different colours.
  * The Egyptians, for performing this operation, make use of
a small cow's horn, open at it? base, the other extremity also
open, and provided with  a kind of parchment  valve: they
place the  base of this horn upon the skin, at the spot where
they wish to perform their  cupping; they then exhaust the air
by means of suction, and after having in this way formed the
necessary vacuum, they close the valve, which prevents the en-
trance of the external air into the cavity of the horn. 
                 (   147  )
They were expressly forbid to touch, wash,
or cover their eyes, and were not to use anf
other remedy for three days, if they wished
to get well.
   The  astonishing number of  persons of
both sexes, blind in one or both eyes, whom
one meets with in Egypt, proves that theiu
treatment is not  at all efficacious.   Indeed,
in the complicated ophthalmies/ what can
we expect from such  remedies, but loss of
eyesight,  as some of our  soldiers experi-
enced wTho were thus treated.
   I agree with  the inhabitants of Egypt,
that emollients,  cataplasms, and water, are
hurtful in the  cure of this disorder;  but I
assert likewise, that to neglect every kind of
remedy  is  to  confide too much to nature,
and too little to  the resources of art.  Their
principle of fatalism,  God decrees, God has
decreed,  makes them  neglect many things
which might be of utility to their health.*
  * Amongst the great number of blind people whom I ex-
amined at Cairo, I saw very few individuals who had true ca-
taracts capable of being operated upon with success. The ma-
jority had either staphylomas, or the cornea totally opaque, or
the eyes almost entirely evacuated.  When I proposed to cure
those having cataracts by means of a small incision,  they r£- 
(   148   )
Powders,  Ointments, and Collyriums, used

   in  Egypt  in the  Treatment of the Oph-

   thalmy.



   No. 1.  Nut galls  and  pulverized  anti-

mony, each equal parts; mix and make into

a powder.

   No. 2. This powder,  mixed  with vine-

gar,  forming a kind of ink.


plied to me  with the greatest coolness, J shall be cured without
any incision if God decrees it: and it was not possible for me to
persuade any of these fatalists to allow the operation to be per-
formed.
  Citizen Berti, of Venice, surgeon oculist,  only performed
at Cairo, during eighteen months, two operations  for the ca-
taract,  on two beys, with whom lie was very much displeased,
because, after having completely cured them,  they  said  that
they could not see so well as formerly, and that the  operation
had been badly performed,  because he had not  evacuated the
humours of their eyes with his lancet.  This instance of the folly
of the Turks made me determine to abandon the operation for
the cataract, to which I  had paid a good deal of attention when
in France and Italy,  where I had practised it with success, both
according to the method of  Demours, and with an instrument
of my own invention, which bears some resemblance  to that of
Guerin. I had this instrument made at Paris in 1786: it was
presented to the Academy of Sciences by Citizen Sebatier, who
wished much to read to them my sentiments upon that instru-
ment,  and likewise upon that of Citizen Guerin, of Bcurdeaux,
which had then appeared at Paris.
  Citizen Malacarne, professor of surgery at Padua, had these
same reflections, and the case in  which I had made use of my1
instrument with success, inserted some time afterwards in the
Journal of  Citizen  Bragnatelli,  entitled,  Bibliotbeca Physko
jtfedica. 
(   149   )
   No. 3. Sugar-candy, sulphate of alumine,

nitrate  of  pot-ash,  equal  parts;  mix and

make into  a powder, for destroying specks

on the cornea.

   No. 4. Chichm* in powder, sugar-candy,

alum or  sulphate  of alumine, equal parts;

mix the whole with vinegar.

   No. 5. Infusion of saffron, and some drops

of the  tincture of  opium as a  resolutive

anodyne collyrium.

   No. 6. The soap  collyrium, a solution  of

soap in alcohol.

   No. 7. The tonic collyrium, a solution of

the sulphate of  zinc in  water,  mixed with


  * The-chichm is a black seed very common at Cairo:  it is
brought by the  caravans from Darfour and Senaar.  Citizen
Delille, member of the Institute of Cairo, sowed this seed in
Egypt:  it gave  the cassia, absus;  Linnaeus, ccssia hispida ; of
which he communicated to the Institute of Egypt, and that of
France, the following description:—The cassia, absus, is a
small hairy plant, whose stalk is slender and herbaceous,  its
leaves alternate,  pinnate, composed of  two pairs of leaflets,
occupying only the upper part of the plant.  The flowers are of
a-deep yellow, and disposed in  little loose clusters; they pro-
duced hairy, narrow,  compressed pods, about five centimetres
in  length (one inch), enclosing black roundish-oval shining
seeds.
  Citizen Fontaine, professor at the Jardin des Plantes, told
me, that about three years ago Citizen Olivier, member of the
Institute, had brought this seed from Persia, under the name of'
cassia, absus; that these seeds had  been sown in the Jardin des
Plantes; and that they also had produced the cassia hispida.

                       02 
               (   150  )
vinegar and brandy; useful in affections of
the palpebrae  and tarsi.
  No. 8.  Muriate of soda,  dissolved in
water, mixed with vinegar;  useful in the
simple ophthalmy.
  No. 9. Solution  of verdigrise.
  No. 10.  Solution of acetite of lead.
  No. 11.  Cerusse mixed with water, used
to paint the contour of the eyes white.
  No. 12.  Saffron  bruised and mixed  with
cerusse, and a little vinegar, for painting in
yellow.
  No. 13.  Ink of  antimony, for painting
in black.  (See No. 1.)
  No. 14.  The desiccative ointment, made
by adding some oxyde  of mercury, formed
by the nitric acid to any ointment.
  No. 15.  The vegeto-mineral water.

On the Means of preventing the Ophthalmy.

  We have already said  that it was not at
all  difficult to preserve  oneself  from the
ophthalmy, provided we keep ourselves pro-
tected from the currents of cold and damp 
                (   151   )
air, it being well known that this precaution
alone is sufficient.  At Cairo,  the Monks
and Franks, and also those inhabitants who
adopt proper precautions, are not at all sub-
ject to this disease.
   The  soldiers  on guard,  or  upon night
piquet, should, during the night, cover up
well both their head and feet, and particu-
larly if they are obliged to make a voyage
on the Nile; and in cold and damp places,
they should avoid, as much  as possible, the
smallest currents  of  air.  Several persons
have  been attacked  with  the ophthalmy
after having slept near a window which had
not been properly closed, it was in this way
that Citizen Fevre, engineer of bridges and
causeways, and member of the commission
of arts, was attacked with the ophthalmy
in one eye, the first  night after his arrival
at Cairo from Syria,  although he had slept
the preceding  nights in the open air, in a
bark on the Nile, without experiencing the
smallest inconvenience,  because he  had
taken care to keep himself well covered.  He
had a great deal of difficulty in getting rid 
               (  152   )
of his ophthalmy; and if he  neglected for
a single day to make  use of  the collyrium
(No. 9),  he was attacked  without fail on
the day  following.  We have remarked,
that this collyrium prevented or  stopt the
progress  of the ophthalmy; and I have no
doubt that  it might also be  useful as a pre-
servative..  This slight styptic must neces-
sarily act uponthe vessels of the conjunctiva,
the lachrymal  ducts,  the glands of Meibo-
mius, the lachrymal caruncle, the pores of
the cornea, and- preserve these parts from
that state of relaxation which is the princi-
pal cause of the ophthalmy of Egypt, andr
of a great many of those of Europe.
  The- general of  division, Beillard, was
severely  attacked with  the-  ophthalmy at
Giseh, while he commanded that province.
He attributed  his cure to that same collyri-
um ; and sometime afterwards, having gone
into Upper Egypt, I sent to him, as a pre-
servative, a mixture of verdigrise and ace-
tite of lead in  powder, which he dissolved
in rose-water.  When he happened to be
short of the collyrium, I recommended to 
                (   153  )
him the use of a mixture of brandy and pure
water.  The ointments, besides  other in-
conveniences, were very apt to turn rancid.
  In order to diminish the impression of the
light,  green  spectacles have been  recom-
mended.  This  method is very good, but
one must use spectacles a little better made
than  those  which the Turks sold  to us.
They consisted of a half-mask of Morocco
leather, furnished with two miserable pieces
of coloured glass,  pasted between two bits
of leather: they lay too close upon the eyes;
and  heated them very much.  Indeed, all
those who used  them, laid them aside in a
short time, after having experienced not only
their inutility, but also their inconvenience.
As to myself, I never made use either of
spectacles, of collyriums, nor of any pre-
servative  to protect me from the burning
sand,  the nitric, ammoniacal, or calcarious
dust, nor even  to protect myself from the
excessive light:  but  at no  time either the
refreshing coolness of the evenings, or the
beauty of the nights, could  induce  me  to
kave my windows open,  or to sleep in the 
                  (   154  I

open air; and when I was  obliged on duty
to  do  so,  my boat-cloak served  me for  a
tent, and became my aegis.
  Note. I have no doubt that the catarrhal ophthalmy which
prevailed at Vienna, in Germany, in 1799, was of the  nature
of the Egyptian ophthalmy.  (See the Bibliotheq. Germanig.
torn. iv. page 132.) 
j(  155   )
                THE

    DESCRIPTION AND PLAN

                 OF

AN HOSPITAL  FOR  SOLDIERS,

    Attacked in Egypt with the Disease
           called the Plague.
J.N  speaking of the disease epidemic  in
Egypt and Syria, called  the  Plague, we
pointed out the  means to be used for self-
preservation ; but it must be confessed that
it  is not  always  in our power to avoid the
causes which produce it; and the soldiers
composing  the  garrisons of  Alexandria,
Rosetta, and Damietta,  may be  attacked
with  it,  particularly during the  rainy and
unhealthy seasons.  It is well known, that
in order to cure any epidemic disease what-
soever, there is  nothing  more useful  than
to place the sick in healthy, dry,  and well
aired places. 
                (   156  )
   During the twenty years that I have stu-
died and practised physic,  I  have seen a
great many hospitals in Italy, Switzerland,
France, England, and Egypt, and met with
many very beautiful; but very few indeed
which united  the advantages  necessary for
the object proposed: that of Heggio is, in
my opinion, the most healthy, and best con-
ducted of all  those which I have examined
in detail.   As surgeon in chief of this hos-
pital for nine  years together, I had every op-
portunity of convincing myself of this truth.
The large hospitals are seldom kept clean,
and are always unhealthy on account of the
number of sick brought  together into the
same place.   The hospitals which  I  have
seen in Lower Egypt, and particularly that
at Alexandria, called the Hospital for Plague
Patients, was more adapted for producing
than for curing the fever.   I  am also well
convinced, that it is by  no means  easy to
convert churches  and  mosques  into good
hospitals,notwithstanding the good will and
talents of the  engineers; and if we consider
the enormous expense which the repairs of 
               (   157  )
such a place require, before it is converted
into an  hospital, I am certain  that  one
might  have constructed  the whole quite
new.
  It is for the purpose of procuring, if pos-
sible, for these establishments  all  the ad-
vantages of which they are susceptible,  that
I have conceived  the plan of an hospital for
the garrisons of the principal cities on the
coast of Egypt.   I take for granted,  that
we follow the advice which I gave  for pre-
venting the epidemic fevers of this  country
at the  same time; and then an hospital ca-
pable of holding  about one hundred  fever
patients will be  sufficient for any garrison
whatever, either  at Alexandria, Rosetta, or
Damietta; and if experience should prove
that such an hospital as the  one proposed
will not be sufficient for the number of sick,
we  may construct, at  a certain distance,
another like the first; but we  ought  to avoid
bringing together into  the same place too
great  a  number   of fever patients.   The
crowding together a number of sick in the
same  hospital, has been,  and  always will
                   P 
                (   158  )
be, contrary to  the true  principles of the
practice of physic, whatsoever may be the
disease;  a fortiori, in the  treating an epi-
demic, whose symptoms are such as to have
procured it the title of the plague.  The
hospital  of which  I submit the plan, will
not contain  more than one hundred beds :
it  will consist of three wards; a large one
for the sick  soldiers, a smaller for officers,
and a third for convalescents.  It will also
have a sudatory, or dry bagnio, for oily fric-
tions, the  whole  on the first floor.  The
ground floor  will contain  the  necessary
offices.   This building  will be very simple,
and easily erected, particularly in Egypt.

              Particulars.

   There ought to be in each room for the
reception of patients, a fire-place, a large
bason, a cistern with  a bath, some stone
Seats and presses.
   There should be in  the room for warm
oily frictions, a stove chimney, or a fire-place
d la Desarnold,  and some  presses. 
               (  159   )
  In the great ward there  should be two
tiers of windows, one over the other;  the
latter should be open down to  the floor of
the wards, the better to renew the air,  the
carbonic acid of which always occupies the
lower parts of the wards.  They should have
gratings formed of perpendicular bars for at
least half their height, in order to prevent
all accidents which might  happen to pati-
ents in a state  of delirium.
  Each of these  windows,  or  balconies,
should  be closed  by two  shutters, which
should open into  the wards ; their  upper
halves should  be glazed, and have ventila-
tors to  facilitate  the passage of light  and
air  into  the wards.   The  shutters of the
windows should be made to fit well to each
other, so that  they may close accurately.
  The pavement of the wards should have
some degree of slope inwards, so as to pre-
vent, in case of any accident,  or after wash-
ing the  floor, any moisture remaining  under
the beds, which is a circumstance very es-
sential to the healthiness of an hospital, and
generally too much neglected. 
               (   160  )
  The necessaries in that part of the galle-
ries which we have pointed out, would unite
the advantages of being without the wards,
and, at  the same time, within the reach of
the convalescents and those patients able to
walk.   They  should be  placed in excava-
tions in the  pillars, in  the form of nitches,
and should be paved and lined with marble.
The water from the roofs should flow off by
leaden pipes into the necessaries, as well as
that from the  cisterns; and the troughs for
the tisans,  that from  the pharmacy, the
kitchen, the baths,  and wash-house, should
be carried off into the  sea, or the Nile, by
the same common  sewer.
  Such sick as are unable to go as far as the
necessaries, should  be placed, by the assist-
ance of the attendants, on a  copper vessel,
tinned over on both sides, and the edges
rounded off, to prevent its hurting the thighs
of the sick :  it should also be pretty strong
and wide at its base, so  as  to  sustain the
whole weight of a body  without any  dan-
ger of upsetting: it should likewise have a
cover to fit its opening exactly.   Hence, 
                (   161  )
when thus closed, it will not spread any dis-
agreeable smell, which is an inestimable ad-
vantage, particularly to the attendants. The
earthen utensils  commonly used should be
banished from this  hospital, since,  if they
are not quite new,  they become infectious.
If,  during some of  the days in winter, the
cold be considerable, which is not uncom-
mon, particularly at  Damietta, it will be
useful to light pans of coals in the wards,
which will also help to change the air.
  Among other advantages attending this
hospital would be  that of having its own
wash-house  and burying-ground distinct,
and, at the same time, quite near. Wehav-e
all  observed with  what  facility an alarm
spreads itself in any city which is suspected
of having the plague, while the sight of the
dead bodies justifies the dread,  and spreads
dismay.  I  confess that I never saw  any
thing so hideous and  shocking as the.ferry-
boat into which  the dead bodies proceeding
from  the hospitals  at Jaffa were thrown,
for the  purpose of  being taken out of the
city to be buried.   In the hospital which I
                   P2 
               (  162   )
propose,  whenever  a death happens,  the
body would be immediately removed into
the dead-room, and  afterwards consigned,
along with some quick-lime and sand, to a
deep grave in the burying-ground.
  The rose de vents (wind dial), in the in-
terior of the tower, would point out to the
officer on guard,  whether or not it would
be preferable to have the windows of the
south or  north sides  opened,  and whether
or not the sick should be advised to remain
in their  wards,  or to walk  on the great
terrace.
  By the aid of  the  necessary instruments
with which  modern  philosophy  has  made
us acquainted, it would be easy to learn not
only the  degree  of heat, but all the other
qualities  or  properties of the atmosphere.
These meteorological observations, the me-
dical topography of the environs of the hos-
pital, as well as remarks respecting the suc-
cession of diseases, and their causes, should
be preserved in a journal kept for this pur-
pose, which would become valuable towards
improving the practice of physic. 
               {   163  )
  Citizen Desgenettes, in Thermidor of the
year 6 (July 1798), addressed a very inter-
esting circular letter to the physicians of the
army of the East, recommending a plan for
collecting the  physical and medical topo-
graphy of Egpyt.  The majority of his fellow
practitioners complied with the wishes of
the  physician general;  but among their
reports, I do  not find  the topographical,
meteorological, and medical  observations
brought together into one journal, or table,
as in thatwhich I-propose, and which would
be very easily kept, whenever the medical
officers were furnished with the necessary
instruments.   Subjoined  is  the  form of a
table, which would pretty nearly fulfil and
present atone view the object proposed. 
(   164  )  '
METEOROLOGICAL
Made in the Military



   Commencing —— day
At sun-rise. Two hours after mid-day. At sun-set.	State of the sky.	Direc-tion of the winds.	Thermometer placed.	
			In the ward.	In the open air-
C Sun-rise Monday. -\ 2 o'clock. £ Sun-set.				
C Sun-rise. Tuesday. <2 o'clock. (_ Sun-set.				
C Sun-rise. Wednesday < 2 o'clock. (_ Sun-set.				
C Sun-rise. Thursday. < 2 o'clock. £ Sun-set.				
C Sun-rise. Friday. -s 2 o'clock. £ Sun-set.				
C Sun-rise. Saturday. < 2 o'clock. £ Sun-set.				
C Sun-rise. Sunday. ■s 2 o'clock. C Sun-set.				
 
(   165   )
OBSERVATIONS
Hospital at



of the Month ——, of — year.
Barome-ter.	Hygro-meter.	Electro-meter.	Nilome-ter.	Observations.
 
             {  166  )








MILITARY HOSPITAL AT







        MEDICAL TOPOGRAPHY.
   PROGRESS OF THE SICK.
















  THE SPECIES OF DISEASES.
















OBSERVATIONS AND REMARKS. 
(   167  )
  Practice  to be followed on the Beception  of
         the Sick into the Hospital.

   Whenever a patient arrives at the  hos-
  pital, the porter  should show him into the
  Small room adjoining the admitting board.
  There he  must be examined by the surgeon
  on  guard,  who, after having made himself
  acquainted with the nature of his  disease,
  should  give  him a  billet, with which  he
  should  immediately pass to the room for
  receiving patients,  where the store-keeper
  must make him  undo  his knapsack,  and,
  after taking  an accurate account of  all
  his property,  ought to throw his foul linen
  into a bason full of  water, burn his useless
  effects, and  then  place  the rest   in the
  magazine for the knapsacks,  and his mus-
  ket and sabre in the  room for depositing
  arms:  every  article should have  a ticket
' affixed.   The patient, after  being stript,
  should  be washed  with tepid water, and
  rubbed well with  soap from head  to foot,
  after the manner of the Turks.  After this 
                (   138  )
operation,  they  should  throw over him a
shirt, a great coat  and cap, and give him
a pair of wooden sandals:  he should then
be conducted to the room for frictions. On
being brought into  this sudatory, he ought
to be placed on a bed, and one or two hos-
pital-attendants  should begin  rubbing him
rather briskly from head to  foot with  a
spunge dipt in warm olive oii.  These fric-
tions must be performed quickly, and .should
not last longer than  three or four minutes at
farthest: the freshest and purest oil should
be made use of.  If he has buboes, it will
be sufficient merely to anoint them.   The
patient  should  be  well covered, and will
then soon begin to  sweat j to  encourage
which  he should take some tea, or  other
diaphoretic drink.  When the sweating be-
gins to subside, the patient should be  again
dressed in his shirt and great coat,  and re-
moved, well covered, to a bed in the large
ward, or into the officers' ward. These fric-
tions should  be  repeated  every day till the
patient  is out of  danger;  and  when  the
physician thinks fit, he should be removed 
               (   169  )
into the convalescents' ward.   It is useless
to add, that the necessary medicines should
be administered at the same time,  to facili-
tate the patient's recovery.
  As to regimen, that should be regulated
by  the attending physician.  To those at-
tacked with  the plague at Smyrna, they
give, during the first five or six days, some
vermicelli, well boiled in water without salt;
afterwards a  little rice,  some spoonfuls of
sweetmeats, a cup of strong  Moka coffee,
and one or two biscuits. When the patient
begins to  get better, they give him some
soup  made with herbs, a little fine white
bread, a few raisins, and a very ripe orange
or  pear.   It is not till after the thirtieth day
that  they give him soup made from meat;
 and about the end of forty days they permit
him to take a little boiled or roasted veal,
with a moderate quantity of wTine.
   With  respect  to the duty and employ-
ment of those attached to this hospital, the
regulations should be nearly  the  same as
those of the other military hospitals of the
^Republic.
                    a 
                (   170  )
   As it is of importance, in  order to pre-
 serve oneself from this disease,  not  to re-
 main too long in the same place, the medi-
 cal  officers,  and all the attendants, should
 be  relieved  every two months,  or sooner,
 if their health requires  it.
   All the persons attached to the hospital
 ought to be  lodged out of doors.  The sur-
 geon and the apothecary on  guard should
 be  changed every  twenty-four hours, and
 they ought to be at least three days off duty.
 The  hospital  orderlies, the  servants, and
 others attached to  the ward for receiving
 pa'ients, to  the room  for frictions,  to the
 wash-house, stores, &c. should do duty  al-
 ternately; and when they are not employed,
 they should  be prohibited from entering the
 hospital.  This measure is of more import-
 ance than may be imagined, since often the
 allurement of a few indirect gains,  causes
 them to forget the dangers which they run by
 remaining too long close to the sick.  I have
 seen these fellows lavish their attentions  on
 some poor wretch, because he happened to
jpossess  a  little money, and  they foresaw 
that his death was at hand ; but no soonee
had his purse or his girdle disappeared, than-
their  assiduities  diminished, and the more
rapidly if some  fresh object for plundering
happened to be  presented to these demons
of avarice.
   It was  in  this way  that  several indivi-
duals contracted the disease,  and finished
their days without enjoying either the spoils
or compensation* which they had scraped
together.
   The  salaries of the orderly men,  as well
as their rations of wine, brandy, and coffee,
ought to be augmented, which would con-
tribute to preserve them from the epidemic,
and would induce them to pay attention to
their duty.
   Before  concluding,  it  will be of some
utility to  mention here some  facts which
have  been published by Father Louis, of
Padua, director of the hospital for plague-
patients at Smyrna.  In  1793  twenty-two
Venetian  sailors inhabited,  during twenty-
five days, a damp chamber  on the ground
floor, along with three persons affected with 
               (  172   )
the plague, who died: the inunction with
oil saved all the others.   In the same year
three families of Armenians, one thirteen,
the second eleven, the third nine in num-
ber, preserved  themselves by the  same
means, and attended on their relations who
had  the plague,  without contracting  the
contagion, although they slept on  the same
beds, and supported almost constantly these
poor creatures in their arms.   In  1794  one
poor woman remained shut up in the same
apartment, along with thirteen persons hav-
ing the plague: she nursed them all, and pre-
served herself from the contagion, by using
frictions with oil.  One Ragusan family had
that year two of its number attacked with
the plague: they dipt themselves (if I may
be  allowed the expression) in oil, and, in
consequence, entirely escaped.  At this day
the  use  of oily frictions is very  generally
adopted in the Levant.
   Citizen Peron, of Toulon, surgeon of the
first class in  the  navy,  who has resided at
Smyrna  for several years as  a  physician,
communicated  to me  several particulars 
                (  173   )
respecting the plague and oily frictions, all
which have confirmed me in the opinions
which I  have delivered in  the course of
this work.  It is to be wished, that Father
Louis, of Padua, and all those who adopt
this practice, would  publish their observa-
tions; since, in  my opinion, the frictions
with oil are not only useful in curing, but in
preventing the  plague.   I  therefore  felt
anxious  to propose the  adoption,  and to
detail the particulars  to  be observed in the
use  of this remedy;  and I will add also,
that I think the use of oily frictions in a su-
datory  (frictions oVhuile (I etuve), may be
made  of much more extensive application.
A great  deal might  be said on the modus
agendi of this remedy; but  I disclaim all
system, and we  have not  as yet a sufficient
number of observations on which to ground
a theory:  let us be contented, for the pre-
sent, with consulting experience, and  foL
lowing its indications.
   If it should so happen, that, from  the
draining of the  marshes, the plague, and
other diseases of that nature, should dis-
                   Q2 
               (   174  )
appear, and the coast of Egypt, along the
Mediterranean, should become as healthy
as the rest  of that fine country, this hospi-
tal may then be appropriated to the recep^
tion and cure of patients having  the itch
and  venereal disease,  as the chamber of
reception would  serve for a bath, and in
that set apart for warm oily frictions might-
be performed the frictions proper in these
diseases.
   After what I have set  forth in this work*
there could be nothing  to be dreaded  on
the score of the contagion, which might be
communicated  to these  fresh tenants; be-r
sides an exposure to the  air (une serene) of
all effects for forty days, if judged requisite,
would remove every danger and objection.
   Patients  with dysentery, ophthalmy,  and
even those  with  wounds, might  be also
cured there> as they would be in no danger
of hospital  fever,,  or gangrene: the  surgeons
might perform their operations in the room
set aside for frictions.  A fter an engage-
ment,  either by sea or land, or in case of a
debarkation of troops, if more space should 
               (  175  )
be  requisite, the  great terrace which  is
above might be very soon converted into a
ward, which would double the number of
beds, and by  placing  those  in  the  other
wards a little closer, room might be made
for three hundred provisional beds:  and the
same number of offices would be sufficient.
for this service.
   During the  time of an  epidemic, the
bringing together so great a number of sick
would be perfectly inadmissible, and the
hospital should then be put into its former
state.. 
C  !76  >
               REPORT

                  MADE TO

          THE SOCIE TY

                  or THE

    SCHOOL OF MEDICINE AT PARIS,

Opon a Work written by M. Assalini, entitled, Observations
  upon the Disease called the Plague, &c. Extracted from the
  Registers of the Society of the School of Medicine of Paris:
  the Sitting of the 14th Ventose, Year 9 (6th March, 1801).
 1  HE  work which M. Assalini presents
to the Society, under the title of Observa-
tionson  the Disease  called'the Plague, &c.
contains some remarks made  by the author
on the diseases which prevailed epidemically
in the army  of the East, both  in Egypt
and in  Syria; upon  some  other  diseases
reputed  contagious; the  dysentery and the
ophthalmy  of Egypt; and the  plan  of an
hospital  proper for  the  treatment  of the
diseases  which are epidemic in this colony. 
               (  177  )
  The intention  of the author is to make
known the facts to which he was witness.
He has drawn a conclusion differing widely
in many respects from the common opinion,
particularly on  the  fact  of contagion, as
well as on the supposed cause of the disease
known under the name of the plague.
  We shall just give a summary idea of the
observations  contained in  this work.
  In the  Introduction, M. Assalini men-
tions the circumstances which  might pos-
sibly affect the health of the soldiers, after
the epoch  of their landing at Alexandria,
The heat of the days, the cold damps of
the nights, the exhalations  of  the  marshy
lakes, the quality of the food, the scarcity
and want of water during their march across
the desert plains, from  Alexandria to Cairo,
in the year 6, the imprudence of sleeping
out  of quarters,  or in the currents of air
from open windows,  comprise the whole
of the causes to which the author  attributes
the greater  part of  the  ophthalmies  and
dysenteries.   He gives afterwards  a short
description of Jaffa  (the ancient Joppa), 
                (   178  )
of the lakes which surround it, and  the
miseries which the war brought together in
that city, in the course of the year 7 (1799).
  In the meteorological table of the year 7
(1799), at  Cairo, we perceive the climate
of Egypt characterized by a remarkable se-
renity of sky, interrupted only in the month
of Nivose  (December, January) by  some
rains;  and  the whole year divided  into six
uninterrupted months of a clear serene sky,
and  into six other months of a sky covered
with some clouds,  among which are two
months of mists;  namely, the  months  of
Brumaire and  Frimaire (October, Novem-
ber, December).
  After these preliminary remarks, the au-
thor treats  of the  diseases which afflicted
the army of Egypt during the years 6 and
7 (1798 and 1799),
  The principal is a disease which attacks
several individuals at the same time; the
chief symptoms of which are, fever, buboes,
carbuncles, loss of strength, head-ach, and
delirium ; which most frequently carries off
the  patient  about the third or fifth, day, and 
               (   179  )
which every year showsr itself more or less,
along the coasts of the Mediterranean and
the Archipelago, from Alexandria to Con-
stantinople. It has been called the Plagues
a  dreadful name,  because it conveys  to
the mind the combined ideas of an inevit-
able contagion, and almost certain death.
Hence,  to avoid  the  fatal influence of a
word to which so  dreadful an appendage
has been linked, the author calk the fevers
which desolated the  French army by the
name of epidemic fevers.   By others it has
been  called the fever with buboes.
   Among the characteristic symptoms of
these fevers, the author especially remarked
an uncommon apathy, in consequence of
which the patient  seeks out some solitary
spot,  where,  covering  his head, and giving
himself up to  sleep, he becomes totally  in-
different  to the most  powerful calls of in-,
terest; in which state he remains till  seized
with  delirium: he dies on the third or fifth
day after the.attack.
   Here M. Assalini puts  the query, whe-
ther or not this disease be really contagious? 
                (   180  )
The following are the facts on which he
grounds his reply.
  Although a great many persons were at-
tacked with the fever  with buboes,  after
having had communication  with the  sick,
there was a still greater number on whom
this  intercourse produced no such effect;
and,  on  the other hand,  many, in spite of
the most complete  shutting up, fell  under
its influence.
  The Egyptians, Syrians, and Turks, who
communicated without any precaution with
the sick, and shared the effects of those who
died, did not contract the disease.
  The neglect with which the regulations of
lazarettoes and the laws of quarantines, on
the roads from Alexandria and Damietta to
Cairo, were observed, did not occasion the
disease to spread itself to the latter city.
  Into the hospital of Ibrahim Bey three
patients were received,  who died two days
after  of the disease; yet, of sixty persons
who were then in that hospital, not  one
caught the contagion.
  The physicians of the country, and Citi- 
                (   181   )
zens Desgenettes  and Larray, braved the
contagion throughout: the first inoculated
himself in the arms and  groins, yet none of
them were attacked with the disease.
  The author received on his hands the pus
of buboes which he was laying open: he
slept in  sheets washed  by  a woman who
died the next day of the disease ; a sick wo-
man reposed herself on his bed, and died in
like manner on  the day after: yet he  had
no  attack of the malady.
  In his inquiry into the causes which gave
rise to the developing of this disease in the
army of Syria, M. Assalini makes the foli
lowing reflections.
  The Turks made  prisoners  at El-Arish,)
and at Jaffa, could not have communicated
the contagion, because they themselves were
not affected with  the disease.
  The division Kleber, at its departure from
Damietta, was in very good health, in which  -
state it continued  while crossing the desert:
the army then arrived free from contagion j
it could not, according  to the author, meet
with the germs of the disease, but in  the fa-
                     ll 
                (   182  )
 tigue, want  of water, and  scarcity of live
 stock in the desert, in the winds, the rains,
 and the inconstant weather, and difference
 of the climate of Syria from that of Egypt,
 in the topographical  disposition of the en-
 campments around  Jaffa,  in  the  marshy
 waters of a lake in  the  neighbourhood of
 which  was encamped that  division of the
 army which was the  first  attacked, although
 it came direct from Cairo.
   Rosetta^ Damietta, and Alexandria, sur-
 rounded by marshes, and of course exposed
 to the  like influences, are  subject to the
 same diseases.
   In Egypt the places elevated above the
 damp and infected vapours which fall down
 upon the plains, were constantly exempt
 from contagion.   These vapours envelope
 the  habitations of the lower  country in a
 mist, which  is very  visible either  at the
 rising or setting of the sun.  Of the places
 which,  on account  of situation, are pro-
tected from  this  scourge, the  ciradel  of
Cairo is quoted as one instance. Its inha-
bitants, during  the plague of 1791,  were 
                (   183   )
exempt from the disease, which laid waste
the lower town, with which, nevertheless,
they continued to hold constant intercourse.
The author  mentions other examples, pre-
senting similar results.
   It is a known fact, that in the unhealthy
latitudes of Africa and America, one method
not only of preserving from, but likewise of
curing those affected with the diseases ende-
mic in those places, even when threatened
with approaching death, is the  removing
them to another situation. Often the wished-
for effect is produced by the mere change of
place, although perhaps the spot to which
the journey is made does not afford superior
advantages in point of healthiness.*
   M. Assalini observed  the  same  fact in
the Egyptian fevers with buboes.   He cites
a great many instances, from which he con-
cludes, that  no distinction ought to be
drawn between the  causes and phenomena
of the production of  fevers with  buboes,

  * In America, however, it is in the removing from the coast
to the interior of the country, that these fortunate changes are*
most remarked. 
               (   184  )
and of those which desolate other countries,
and which have never been suspected to be
of a contagious type.   Lastly, the author
mentions  an observation which he thinks
important.
  During all the time that the English pre-
vented the arrival of any vessel in Egypt,
the disease raged in  the army of the East,
On the contrary, when the blockade was
abandoned, and Tripolitan, Algerine, and
other vessels were permitted to come in, the
disease did not take place during that period.
  From all these observations, as might be
expected, M. Assalini concludes,  that the
disease which attacked the army of the East
in Egypt and Syria, and which, considered
in its  individual  symptoms, bore a good
deal the character of the disease known by
the name  of the plague, considered collec-
tively, was evidently epidemic, and not truly
contagious; and that it was occasioned  by
local causes, and not by a germ  brought
from abroad.
  After these reflections, M. Assalini pro-
ceeds to  the  consideration  of  the  treat- 
                (   185  )
ment.   He reduces it to three indications:
to diminish  plethora  when it  exists, to
empty the primae viae when they are loaded,
and  to  excite  perspiration and sweating.
As the two first indications are only condi-
tional, it  is evident that the third is  that
which he  considers as  essential and  funda-
mental.
   We shall not follow  him through the de-
tails, but  will only remark, that one of the
means of which he speaks most favourably,
either as a preservative,  or as useful in the
treatment, is the use of corlee without sugar,
mixed with citron juice, and given by cup-
fuls five or six times a day.  He treats pretty
fully on oily frictions,  which have been for
some time celebrated,  and appears to place
a  good deal  of confidence  in  them.  In
general, the  tonic  and sudorific treatment
followed by Citizens Desgenettes and Lar-
ray in Syria, Dieche near Acre, Savaresi at
Damietta, Sotira at Rosetta,  Ghisleni and
Balbes at  Alexandria,  constantly saved, he
says, two  thirds of the sick, the greater part
affected with buboes.
                   R2 
               (  186   )
  As to the particular treatment of the car-
buncles and buboes, M. Assalini condemns
the practice  of opening  or burning them
with the actual cautery,  before they come
to maturity.   He  recommends the use of
cinchona internally, externally anointing the
tumours with oil; and he thinks that they
should be opened  whenever  symptoms of
suppuration have appeared.
  The  particular  precautions which  M.
Assalini made use of for  his own preserva-
tion, consisted merely in avoiding as much as
possible remaining in  the unhealthy places,
making use  of the best food he could pro-
cure, and keeping himself constantly em-
ployed, in order to avoid low spirits.  He
took care to arrive at the hospital  without
being in a sweat;  before going his round,
he drank a large cupful of bitter coffee; on
leaving the hospital,  he rode out on horse-
back, till he  brought on  sweating; and,
before  going to bed,  he  took a  cupful of
punch quite  hot, which made him  perspire
profusely during the night.  As to the rest,
he took no precautions against the contact 
                (   187  )
of the infected, except avoiding the direct
impression of their breath.
  With regard to general precautions, one
of the principal which he recommends, to
support which he quotes a number of facts,
and on which he  relies with  most  confi-
dence,  is. the moving the troops, and suc-
cessively changing the garrisons from one
quarter  to  another.   Lastly, measures of
police for keeping the streets clean, and in
good order, the necessity of paving them,
and of draining the morasses by canals, and
filling them up to prevent the stagnation of
the waters, are precautions,  the importance
of which appears to him evident, on consi-
dering the present state of  the environs of
Damietta, Rosetta, Alexandria, and the
fort of Birket-El-Hadji, and which, con-
jointly with the restoring and  bringing to
perfection the art of agriculture, appear to
him necessary, in order  to  place Egypt in
that state of salubrity which it undoubtedly
enjoyed in the time of its ancient prosperity.
May his wishes  be  accomplished:  may
the beginning of this century  witness the 
               (  188   )
complete extermination of two of the most
dreadful scourges of humanity, the  small-
pox and the plague !
  After  these  different  observations,  the
author  gives an account of  the  customs
followed by the Franks or the Europeans
in the  Levant,  the  precautions used in la-
zarettoes, and the laws of quarantines. The
particulars of this department of the  public
police  are sufficiently known.  But possibly
some concern may be felt on seeing in what
an  unfavourable light  the author  views
these  establishments, from  his comparing
together the deplorable  effects  resulting
from  terror and shuttings  up during  the
European plagues, and the less fatal effects,
as he says,  of the unconcern  of the Mus-
sulmen ; an  indifference which  at least
prevents them from being deaf to the calls
of their friends and relations, who, on their
death-bed, implore their assistance.   How-
ever true the  author's reflections  mav be,
his intention can never be to authorize the
national gratitude to be withheld from the
patriotism of those citizens who have esta* 
                (   189  )
blished and supported, to the present time,
the lazaretto of  Marseilles, and who, dur-
ing twenty-four years,  have been the senti-
nels of France,  for the purpose of preserv-
ing the public health.
   M. Assalini next says a  few words on
the  disease  which,  in the  year 8 (1799-
1800), attacked the army of Italy in the
Ligurian Republic.   It  was of the nature
of the jail fever, and was not at all conta-
gious.   He adds  some  reflections on the
yellow fever of  Cadiz.  The several ques-
tions which  he puts  on this  point, the
doubts  which he  starts on the- degree of
mortality caused by that  disease, and on its
spreading by  contagion,  can  only be re-
solved and removed by an exact knowledge
of the facts.
   The dysentery, to which he was witness
in Egypt, appears  to him uniformly to arise
from the suppression of perspiration, owing
to the imprudence with which  the soldiers
exposed themselves, by sleeping in the cold
and damp night air.  He distinguishes  it
into three, degrees:  the  first consisting of 
                (   190  )
simple dysentery, without colic; the second
accompanied by colic and  mucous evacua-
tions;  and the third accompanied by fever,
bilious,  putrid, and  bloody  evacuations.
In the treatment,  varied according to the
indications and circumstances,  the author
mentions the advantages obtained by means
of opium,  the  utility, in certain cases, of
blisters  applied to the abdomen,  and of
the fruit called bao-bab, or monkey's bread
(Adansonia bao-bab), much recommended
by the native physicians.  He recommends
the practice  of adding a  little coffee, or
brandy,  to the Nile water, as a preserva-
tive against this disease.
  Lastly, the ophthalmy,  divided  by the
author into the simple and the complicated,
that is  to  say, with  swelling of the con-
junctiva and palpebrae, violent pains and
fever,  and various organic lesions of the
ball  of the eye—the ophthalmy appeared
to M. Assalini constantly produced by the
influence of the cold night air, joined to
the fatiguing  effect of the  burning heat
and excessive light of the sun  on the organ 
                (  191   )
 of sight.   The sands driven by the winds,
 and the saline  substances with which they
 are  impregnated, appeared to  him  to be
 only accessory influences, which may pos-
 sibly aggravate the  effects, but which are
 subordinate to  the principal cause: in  short,
 that this disease, and the dysentery,  in his
 opinion, only differ from each other in the
-part affected, and are especially determined
 in proportion as  the one or the other be-
comes most irritated or enfeebled.
   The treatment of the ophthalmy presents
nothing  new.  He  reduces it to the em-
 ploying of means to produce revulsion, and
 of tonic and astringent collyriums,  not for-
 getting to follow the indications presented
 by the several  consecutive organic lesions.
 The  remedies  of the  country are  of little
 value, and  the precautions for preventing
 the attack consist in being careful not to
 sleep in the open air, but particularly in
 the current of air from open windows ; and
 when on duty in  the field, to keep the head
 covered, and protected with a cloak.
   ,M. Assalini  concludes his work with the 
                (   192  )
plan of an hospital adapted to the country.
It consists  of  a large building, the  fronts
look to the east and west, and the windows
extend from the ceiling to the floor.   The
ends looking  to the south and north are
easily shut against these winds,  so danger-
ous in that  country.   There are likewise
rooms adapted for stoves,  oily frictions, for
the  reception of convalescents,  and for
other purposes. A wind-dial (rose de vents),
communicating with  a weather-cock,  is
plaeed in the  ward,  in order that the phy-
sician may regulate  the opening and shut-
ting the windows, and ventilating the wards
according  to  the weather.   The  building
is terminated  at top by  an  open terrace,
adapted  for a promenade during the time
of the epidemic. There are  likewise seve-
ral other arrangements,  well  adapted  to
the necessary  purposes of such a building.
   Such is the concise idea which  we have
thought  fit  to give here of M. Assalini's
work.  It remains for experience to  decide
the queries therein discussed  on the subject
of contagion; queries on which immediately 
               (  193   )
depends  the theory  of the preservative
means, and of those proposed for the destroy-
ing the source of the pestilence.   However
strong his reasoning may appear, before pro-
nouncing judgment it behoves us to wait
until  the united observations of all  those
physicians who have observed the same phe-
nomena as himself upon the same theatre,
and at the same time, shall begin to dissipate
our doubts, and to teach us whether or not
the ancient opinions,  consecrated by time,
and the  authority  of  the  greatest  names,
ought to be ranked amongst those  preju-
dices  which time  destroys  so  slowly, but
which the lights of philosophy and science
ought at length to  overturn.
  In supposing the decision perfectly con-
formable to the  observations of M. Assa-
lini, and to the conclusions which he  draws
from them, there  will still remain on the
phenomenon  of  contagion,  a  great  num-
ber of other questions to be resolved: and
when we not only  consider the diversity of
qpinion amongst the observers, but when
we compare the facts with each other, and,
                   S 
               (   194  )
at the same time, consider the  phenomena
of contagion in those diseases in which this
property exists beyond a doubt, it may be
asked, whether it may not be possible to
imagine  that the  same disease  mav not be
more or less contagious, or even not at all
so, according to circumstances,such as the
violence of the epidemic,  the  state of the
intervals of the contagion,  and  the particu-
lar predispositions of those individuals who
are attacked with it; predispositions which
may have  something both of an epidemic
and  also endemic tendency; so that a dis-
ease exactly the  same in its characteristic
symptoms,  shall perhaps  have  been  re-
marked at  different times,  and in different
places, to be contagious or non-contagious,
by observers of equal accuracy and inftnv
mation?   This is not  a question of simple
theory,  or  of pure curiosity.
   In pursuing this inquiry, the  physician
ought, without doubt, to be cool, and un-
biassed by  prejudice, or any foreign consi-
deration; but he  should  also be persuaded
of this very important truth, that if it be 
                (   195  )
useful  in  such cases  to inspire individuals
with confidence, it is no less important not
to lull into a false security the solicitude of
governments.
  Nevertheless, the work of M. Assalini
appears to us to be important in its object;
valuable from the collection of facts which
it presents us, useful and judicious from the
manner in which they are  compared and
discussed; and, without prejudging its ul-
timate consequences, we think that it may
contribute to diffuse  information on a sub-
ject become more interesting than ever, and
which is thus submitted to the meditations
of  observers, and the attention of govern-
ments.
       (Signed)      Thouret and Halle,
                        Commissioners.

A true Copy, in the name of the Committee
   of Administration of the School of Medi-
   cine, the 24 th Ventose,  in  the year 9.
(Signed)        Thouret, Director. 
(   !96  )
            REPORT

Made to the Consuls of the French Republic,
  by the Minister of War, the 15 Germinal,
  Year 9 (Uh April,  1801J
       Minister of War has received such
important details on  the state of the hos-
pitals of the army of the East, that he thinks
it proper to submit the result to the inspec-
tion of the Consuls.
  In Europe, during  the war,  the number
of sick was to that of effective men as one to
twelve; and before the  revolution, during
peace,  the proportion was  the same.   In
Egypt  it has been, during the month of
Brumaire (October and November), as one
to twenty-eight; and during Frimaire (No-
vember, December), as one to thirty
  In Europe, in the military hospitals, the
number of deaths is to that of sick admitted
The 
                (   197   )
during the  month, as one to twenty-three.
In Egypt, during the month of Brumaire,
the proportion has commonly been as one
to forty-three;  and in Frimaire, as one to
thirty-seven.
  The increase  of deaths  during  this last
month was owing  to the contagious dis-
                cs             o
ease which, though little spread,  was  be-
ginning to  show itself.
  It is known that in Europe the  number
of sick is to the population as one to twenty,
and that in a month the mortality is to the
number of sick as one  to nineteen ;  so
that the best established facts  prove, that
the climate of Egypt is already become to
Frenchmen more healthy than their native
country, or than any other country in Eu-
rope :  what then will it be when the sci-
ences and arts shall have diffused  all their
advantages, and shall have  banished from
it its contagious diseases, and instructed us
in the  means of preventing the ophthalmy ?
  By  making  for  those two months the
number of daily reports of  the sick in the
hospitals of the army of the East equal to
                    S2 
               (   198  )
unity, we find that the daily reports  have
been,
  For febrile diseases   -     -     0.393
      Wounded       -     -     0.187
      Venereal        -     -     0.369
      Contagious disease    -     0.007
      The ophthalmy       -     0.044
                                1.000

  You perceive, Citizen  Consuls, the re-
markable salubrity of this fine country, for*
merly the cradle of the arts and sciences,
which  was  the granary of Rome, which
ought to be the emporium  of commerce
between  India and Europe, and which is
one of the theatres on which have  been
most signally displayed the spirit and bra-
very of Frenchmen.
       (SignedJ        Alex. Berthier, 
i  199  X
ADDITIONAL  NOTES,
                Page 71, line 11.

ClTIZEN CERRESOLI, physician of the army of
the East, in his journey from Cairo to Siout, speak*
ing of the plague,  says, that he never has been able
to collect the information be wished for respecting
this disease; but,  after a great many  accounts,  he
concludes, that the word plague, or koube'h in Arabic,
is a generic denomination applied to acute  and ma-
lignant diseases..

              Page 72, line the last.

  It is commonly  asserted that the, heat in • Egypt
puts a stop to the  progress of the plague,  whilst it
makes it burst out at Constantinople..  How is this
fact to be accounted for?  The explanation  is,  in
my opinion,  very simple.   At Constantinople  the
exhalations from various bodies in a state of putre-
faction are very copious during summer:  the cold
«f winter prevents their, formation,  and the disease 
(  200  >
ceases.   In Egypt, on  the  contrary, the action  of
the sun is very powerful, even  during winter, and
gives rise to noxious exhalations, as we have proved
elsewhere.  When the, low grounds  have become
dry, which happens about  the  month of Messidor
(in June,  at the festival of St. John), then the coast
of Lower Egypt becomes as healthy as  the rest of
that fine country.
  The environs of Modena were formerly  subject
to a class of diseases, which Torti has with justice
denominated malignant fevers^ because they frequently
carried  off the patient  during the third paroxysm,
and even when considered out of danger. Debility,
drowsiness, and excruciating head-ach, were  the
principal symptoms of these  fevers ; between which
and those of Egypt there exists a strong resemblance.
At this  day the malignant fevers of Torti have either
disappeared altogether, or  are  become very rare.
This change has been attributed to the filling up of
the  ditches and morasses which surround the city
and citadel of  Modena,  the  corrupting waters of
which occasioned exhalations which infected the  air.
The celebrated Torti has taught us the mode of
curing this disease as if by  enchantment, by means
of Peruvian bark, given in large doses, frequently
repeated.
   I had an opportunity of seeing and treating this
disease  near Mantua: its course  is so rapid, and its
symptoms so  violent, that in order  to stop its pro-
gress I was always obliged to give  three ounces of 
(  201   )
bark, mixed with wine or water,  in the course of
twenty-four hours, between one paroxysm and ano-
ther; and when the  patient was  weak, I  did not
omit adding more or less of liquid laudanum,  ac-
cording to their state of constitution.
  Those  physicians  who, from a dread that this
practice will overheat, or cause obstruction, prefer
the  use of refrigerants, or purgatives,  in order to
evacuate the bile, have constantly  the mortification
of seeing their patients carried off as if apoplectic,
and  in a  very  short time;  and if they escape, after
suffering  from fever  for  several  months,  they  at
length become dcopsical, which they never fail to
attribute  to the bark, which they were too late in
prescribing.  Practitioners of experience, who treat
this disease successfully,  according to  Torti's me-
thod, agree, that these diseases may be cured with
bark of a good quality, but not with powdered oak-
bark, such a was furnished at one time  to the mili-
tary hospitals of the  army of Italy; which  was  the
real cause of the loss of many brave men, and of the
disease frequently terminating in obstinate  obstruc-
tions.  The physicians  and apothecaries  who  did
duty in the different hospitals for febrile diseases at
Milan can attest the truth of this fact.

              Page 109,  line the last.

   Change of place and air was often useful  in the
,most obstinate cases  of dysentery. 
(  202  )
  Citizens Livron, Pagliano, and Corance, attacked
with a diarrhoea which would not give way to all the
remedies which Citizen Desgenettes and myself had
prescribed them,  very soon recovered by  removing
from Cairo  to  Alexandria.   A great many persons
who had the dysentery very severely at Alexandria,
got well by removing to Cairo.  I remember Gene-
ral Bessiere, who now commands the cavalry of the
Consular Guards at Paris, so ill and pulled  down at
Cairo, that  his life was  thought in danger: he re*
covered in a very short time at Giseh.

                Page 113, line 24.

  The hab-hab is the fruit of the bao-bab, or baho-bab,
a tree of a monstrous size, which grows in Ethiopia
and Senegal: by the natives of this island it is called
goui,  and its fruit boui; by the French callebassier, or
gourd-tree, and its fruit pain de singe,  or the monkey-
bread. Adanson, after returning from Senegal, com-
municated, in the year 1761, some very curious and
interesting particulars respecting this tree, and  its
medical properties, to the Royal Academy of Sci-
ences at Paris.   As these are a good deal  connected
with the subject I have been just treating,  it may not
be amiss to  give here the following particulars.
  The bao-bab, on a near view, looks more like a
forest than a single tree.  Its trunk is seldom more
than  ten or twelve feet high, but  its circumference
is generally from seventy-five to seventy-six feet and 
                    (  203  )

a half.  This immense trunk Is crowned by a great
number of branches,  remarkable on account of their
size, but still more on account of their length, which
varies from fifty to  sixty feet.   That branch which
springs from its centre  rises  vertically, but those
from its sides have  generally a horizontal direction*
These trees commonly have  a great  many roots,
almost as  large and numerous as their branches, but
of a still  greater length.   Adanson saw one which
measured one hundred and sixty feet  long: it be-
longed to a tree of the middling size.
   The leaves of the bao-bab are elliptical,  pointed
at the extremities, about five inches long,  and one
or two inches broad, of a moderate thickness, glossy,
entire, having no serrated edges, the upper surface
of a bright  green, the under surface  of a pale green
colour, crossed obliquely by alternate nerves, rounded
off,  little  elevated, and attached from three to seven
together,  upon a common foot  stalk  like a fan, pre-
cisely like the horse-chesnut.
   The flowers  of this tree, when in  bud, form a
globe of  almost  three inches  in diameter;  and on
blowing become four inches in length,  and one in
breadth:  two or three spring out from every  branch,
each suspended  by a cylindrical peduncle,  a  foot
long,  and five lines thick.  The xalix  of  each of
these flowers is of a single piece, in  the  shape of a
saucer, the edges  of which are divided into  five
equal triangular portions: it is entirely covered with
bairs  of a whitish colour, and shining on the upper 
(  204  )
surface, and green on  the under surface; it falls off
as soon as  the fruit is set.   The  petals are  five
in number,  within which arises a  hollow cylinder,
crowned with about seven hundred  stamens,  in the
form of a ring, the filaments of which have on their
summit small  anthers, which,  on  bursting,  throw
out a whitish pollen.   From the centre of the calix
arises the pistil, the length of which a little exceeds
that of the  petals;  it is composed of three  parts,
namely, an oyary, a style, and several stigmas.  The
ovary is egg-shaped, ending in a point, and entirely
covered by thick  shining hairs;  its  summit supports
a very long  cylindrical style, a little bent, hollow in-
ternally, and crowned by ten or fourteen  prismatic
triangular bodies, pretty  large  and shaggy,  called
stigmas.  The ovary of the flower of the bao-bab,
on ripening, becomes a considerable fruit, of an egg-
like shape,  pointed  at both  ends, about a foot or a
foot and a  half long,  and from four  to  six inches
thick,  suspended by  a cylindrical  peduncle,  about
two feet long, and more than one inch in diameter;
its rind is woody, very hard, two or three lines thick,
.and covered externally with  a  down  composed of
green hairs, which give it that colour.  On rubbing
off this  down, it  appears  blackish,  and strongly
marked by ten or fourteen furrows, which run along
its whole length  like so many  rays-:  when we cut
this fruit through, we  discover in it ten or fourteen
membranous  partitions, of  a reddish colour,  and
stringy texture, which divide it longitudinally from 
                    (  .263   )
top to bottom into as many cells, which  are  com-
pletely filled with seeds : these partitions are attached
to the inner walls of the woody  rind, and are.joined
together at the centre of the fruit, as round a com-
mon axis, as long as it preserves its first  moisture;
but,  on becoming dry, they separate widely apart,
leaving a  hollow at the centre.  In  this dry state
they resemble  a good deal,  both in substance and
shape,  that part of the dura mater called the falx.
The  seeds, on opening the fruit, do not appear dis-
tinct ; nothing is at first seen but a spongy substance,
which is whitish in the sound fruits, and reddish in
those which are ill formed, or very old.  When the
fruit is first ripe, this substance forms but one massi
on account of the moisture which it still possesses;
but on drying it becomes friable, and separates either
of itself, or on the smallest shake, into a great many
irregular polygons, each of which contains a blackish
brown  seed, glossy,  kidney-shaped, about five lines
long, and three lines  thick, from the  sinuosity of
which  arises  a cord, or reddish filament,  very long,
 which  is  attached horizontally, as  to a  placenta,
into  the inner edge of the partitions at the centre of
 the fruit.
   This tree sheds its leaves in the month of Novem-
ber, and puts them forth anew in  June,  flowers in
 July, and in the months of October and November
 its fruits are quite ripe.
   With  regard to the medical  virtues of this tree,
 Adanson  says, that  the natives of  Senegal dry the
                         T 
(  206  )
 leaves in the shade, and then reduce  them  to pow-
 der, which powder  they  call lalo: they put two or
 three  pinches of this  into their food,  in order to
 moderate the excessive heat of their blood, and keep
 up a plentiful perspiration, which preserves  them in
 good health.
   Adanson asserts, that  he himself was preserved
 from the fevers which he calls ardent, and  which
 spread epidemically, attacking the natives of Senegal,
 and especially the Europeans, whom  they carry off
 in great numbers, during the months of September
 and October; that is to say, on the sudden  ceasing
 of the rains, when the sun begins to dry up the pools
 of water which are left on the ground.  At this dan-
 gerous  season Adanson made a weak tisan from the
 leaves of the bao-bab: this tisan is tasteless: when
 it is made very strong, it discovers  a faint taste,
 which  is easily  corrected by adding a litttle sugar,
 or a little liquorice root. .  Every year, during these
 two months only, he took half a pint of this decoc-
 tion in  the  morning, and the same quantity in the
 evening after the great heat.   He  likewise took it
 towards the middle of the  day;  but  that  was only
 when he felt some degree of head-ach, indicating the
 attack of fever. By this means he  prevented, during
 a residence  of five years  in Senegal, the diarrhoeas
 and ardent fevers, which are almost the only diseases
to be dreaded in  that country.   To  display more
 strikingly the good effects of this tisan, taken during
the critical season, he relates the following fact: 
                    C  207  )

  " In the month of September, 1751, when the ardent
fevers were raging  more than had been remembered
for several years past in Senegal,  I continued," says
Adanson, " my fatiguing excursions a hunting and
botanising, with as much eagerness as I  could have
done at home; and one of my friends who followed
my example, in using the  tisan,  was the only one
besides myself who pursued his  usual occupations,
whilst all the other French officers were confined to
bed, a circumstance  which surprised them much,
particularly  as to  my friend, whose very delicate
constitution  appeared  more susceptible  of the im-
pressions of bad air,  which was  believed to be the
chief cause of the epidemic diseases of this season.
A remedy so innocent, so simple, and from which I
experienced such good effects, ought to be employed
during this season, to prevent not only these burning
fevers, but also the ardor urince, which is very com-
mon  during the sickly season; that is to say,  from
the month of July till  the month of November.  Ex-
perience  has  convinced me, that this tisan alone is
sufficient, provided  wine is abstained from."
  The fruit of the bao-bab is of no less use than the
leaves we have just mentioned ;  they eat the fungous
pulp surrounding the seeds; it has a sourish taste,
rather pleasant, particularly  in the  fruits of that year,
which are still in some degree fresh.  In time this
fruit loses considerably in its good qualities; never-
theless,  it is  exported from Senegal to the neigh- 
                    (  208   )

bouring nations in the kingdom of  Morocco, and in
Egypt.
  Prosper Alpinus says,  that this fruit is brought to
Cairo in so dry a state, that its pulp can be reduced
into a powder, which  is there called earth of Lemnos.
It is generally used in pestilential fevers, in spittings
of blood, the lientery, dysentery, and hepatirrhcea:
it is likewise used  to moderate the menstrual dis-
charge.  The dose of this powder  passed  through
a fine sieve, is one drachm: the physicians prescribe
it for the sick above-mentioned, and make them take
it either  in  solution in  the plantain water, or  in in-
fusion or decoction in common water.  Prosper Al-
pinus is the first botanist who has mentioned this
tree, and he  has given the following description of
its fruit:                                o
  " Bao-bab est  fructus magnitudine mali citri,  cu-
curbits similis, intus semina nigra, dura, extremis
in unum seminarium  quasi inclinantibus, et substan-
tiam cucurbitarum similcm  habent, quse in recenti-
bus  est humida, rubra,  sapore  acido non  ingrato
fructus  recenter ab arbore exscissus, gustui admo«
dum gratus est: valentes extinguit multumque  re-
frigerat, febresque omnes putridas,  prsecipueque pes-
tilentes sanat.   Cairi habitatores fructum in  pulve-
rem reddunt, quse terra Lemnos appellatur; estque
apud multos familiarissimus  illius  ce  terrae usus ad
pestiferas febres, turn ad sputum sanguinis, ad lien-
terias, dysenteriam, cruentumque hepaticumfluorem, 
(  209   )
 necnon  ad uteri menses firmandos.  Alii hujusce
 terra; in subtilissimum pulverem redacts drachmam
 cum  aqua plantaginis dissolutam exhibent,  alii de-
 cocto, alii infuso iitentis."  See Alpinus Des Plantis
 Egypt i.
   In  the Jardin des Plantes at Paris  there are seve-
 ral specimens of the  fruit of the bao-bab, in  very
 good  preservation.  The celebrated Jussieu pointed
 out to me a covering on the outside  of the green
<lown, which  I had never observed in Egypt: the
 taste  of the pulp of this fruit  was not at all different
 from  that of the  powder of  Lemnos, which I had
 tasted at Cairo,  and used in the cure of the  dysen-
 tery.
   Citizen Frank, physician of the army  of the  East, a
 person well known in the republic of letters, was bu-
 sily engaged while I was at Cairo, in a work on the
 Materia Medica of the Egyptians, in which he pro-
 poses giving some  interesting particulars on the use
 of the fruit of the bao-bab, and of several other plants
 brought into Egypt from the interior of  Africa.  It is
 to be  wished  that travellers  in  foreign countries
 would imitate  the  inhabitants of Africa, who are in
 the habit of carrying constantly with them the seeds
 of fruits, of pulse, and of those trees of which they
make constant use ; and it is from this  circumstance
that  several  plants from Africa  have  been  trans-
 ported to America, where, at this time, they have
become  so multiplied, that they  appear  natural to
 these  different colonies.
                        T2 
(  210  )
             Page  131, line the last.

  Citizen Lazowski,  chief of a brigade of engineers,
who has  lately returned to France, assured me, that
he had been attacked with ophthalmy in Egypt four
different times, and always  during the height of the
inundations of the Nile, and in  those places where
there was neither sand nor dust.  He went one even-
ing to sail in a boat on the place Lisbekir, in order to
assist at an artificial  fire-work on the water; he was
immediately  attacked with the most violent and ob-
stinate ophthalmy.  This distinguished  officer also
told me, that he had travelled across the desert four
times, and  had remained during a month at El-Arish,
encamped  amongst  the sands, which were  often
blown by  whirlwinds into  the  camp,  without his
having ever experienced an  attack of ophthalmy.
   The troops in garrison at Kene,  and those on the
ports on the Nile, in Upper Egypt, had almost all the
disorder in their eyes during the time of the inun-
dation,  and got well  on going to relieve the garrison
of Cocyra,  a port on the Red Sea, although they had
to travel across twenty-four  leagues of desert.  They
attributed their cure to the waters oiBiranba, a foun-
tain which  they met with on  their route.  This water
is whitish,  and of a strong cathartic quality. 
(  211  )
APPENDIX.
The following Article is taken from " Notes on the
  West-Indies; -written during the Expedition under
  the Command of the late General Sir Ralph Aber-
  cromby, &c.  By George Pinckard,  M. D. of the
  Royal College of Physicians" Ssfc.   In three Vo-
  lumes, published in London in 1806.


  CONCERNING  THE SEASONING, OR
             YELLOW FEVER.

1\S you express a strong interest regarding the
malady which has committed such afflicting ravages
in our  army, and desire  to have a letter devoted
exclusively to the subject,  I now proceed to lay be-
fore you a summary, which, although it may not
afford you any additional information, may serve
as a recapitulation of what has been already trans-
mitted to you, from  time to time, in my frequent
communications.  I shall  confine  myself principally
to what concerns the nature of the disease, feeling
that a minute detail of the symptoms, and mode of
treatment, would not only be less interesting, but
perhaps very tedious to you. 
(  212  )
   After all that I have been able to observe, with
 respect to this dread complaint,  I  think that,  re-
 garding it as a malady of the  West-India colonies,
 it may, correctly,  be said to be the effect of climate
 operating upon exotic bodies.   It  is the  fever of
 the  country—an endemial malady,  which attacks
 those  most  severely whose  general vigour,  and
 whose firmness, or density of fibre, offer the strong-
 est resistance. To look for it in ships and vessels,
 or to strain the eye across the ocean, in order to fix
 its birth-place upon the opposite coast of the Atlan-
 tic,  or to trace its descent from the shores of  the
 Indian seas, were to overlook the reality in search
 of a phantom.—It  needs no foreign  parent:  the
 prolific earth is  its mother—its  father the bright
 God who governs the day.
   When Europeans first  take up their  residence in
 the  West-Indies, it is usual for them, sooner or
 later after  their arrival, to undergo an attack of
 fever, which, in times of peace and  tranquillity,
 when, as they are called, the " new comers" are  but
 few, is termed a " seasoning-fever"—but, in times
 of war, when, from  great multitudes arriving at the
 same period, its  destructive effects are more strik-
 ing, is baptized with the terrific name of—" yelloxv
fever:-—but, whether denominated seasoning, yellow,
 Bulam, or Siam, or marked by any other appella-
 tion, it is only the common bilious fever of hot cli-
 mates : and it appears under  an intermittent, a re-
 mittent, or a continued form, according to the soil 
(  213  )
and situation of the place ; or the habit of the body,
and  other  circumstances of the person attacked.
In negros and Creoles it is frequently an ague—in
those who are in a degree acclimates a remittent—
and in new-comers a continued, or, as it is commonly
termed,  a yellow fever—preserving, in each case,'
a distinct type throughout its  course; while, in
other instances  of its attack upon  Europeans, it
shifts its form, and runs its progress with the most
uncertain irregularity: in proof of which I may re-
mark that it has  happened  to  myself to receive
newly-arrived soldiers into the hospital, at one and
the same time, with this seasoning  malady, under
all the varieties of its intermittent,  remittent,  and
continued form; and, although each  has been differ-
ently attacked, all of them have died, in the course
of only a few days, with every symptom of the most
malignant yellow fever.
   Nature, in her all-preserving care, hath endowed
the human frame with the power of accommodating
itself to all the various climates  upon the habitable
regions of our globe; yet hath  she  more expressly
adapted our  organs  to the particular climate in
which she hath stationed us:  so constituting the
nice and delicate movements of the animal machine,
that we  cannot, without peril, expose ourselves to
sudden or violent transitions.
   To the inhabitants of different regions is given a
something of constitutional difference, which it were
difficult  precisely to define: but it belongs to a  cer* 
(  214  )
 tain original conformation, creating a difference of
 fibre or stamina,  which more particularly befits the
 body for the specific region in which it is designed
 to move.   Yet, while much is attributed  to our pa-
 rent nature, it ought not to be forgotten that habit
 is our foster-mother, and that she follows nature
 very closely in her influence upon the human frame;
 and hence it is that by long residence, and similarity
 of pursuit, so near  an approach to this specific and
 original structure may be acquired, as to promote
 healthy action in  a being removed to a foreign, and
 even to an ungenial climate : still,  this is only the
 yielding of a body originally different; for the as-
 similation is never  so complete as  to be in all re-
 spects the same.  The constitution of a negro from
 Africa, or the West-Indies, never becomes entirely
 British, although he reside in England the greater
 part of hia days :  and however much an European,
 by long residence in the  West-Indies, be  brought
 to resemble  a creole,  he can never acquire, pre-
 cisely, the constitution of a native : some marks of
 original conformation will still remain, and  a some-
thing even in his general appearance, to distinguish
 him.
  Nor is this difference of organization confined to
 the human subject: other animal bodies, and also
 vegetables, differ in their structure and external ap-
 pearance, in different climates. The wool of sheep,
 removed from a northern region to the West-Indies,
 becomes hair: and  the almost tasteless potatoe of 
                   (  215  )
Europe assumes a strong saccharine flavour from
tropical culture.
  The influence of the atmosphere, not only in dif-
ferent  climates, but under  its  various changes in
the same climate, is, at all moments, and in all coun-
tries, far greater than common opinion supposes:
nor has the attention of medical men been suffi-
ciently directed to this circumstance, although it is
of great magnitude.  Hypochondriacs,  persons sub-
ject to rheumatism, or asthma, and those afflicted
with painful thickenings of the cuticle  (usually
termed corns), become exquisitely sensible of the
slightest variations in the state of the  atmosphere;
and from hence it may be concluded, that it cannot
but operate, at all moments, with a powerful effect
upon the tender fibres of our delicately organized
vessels; and if in our native region the influence
be so  considerable, how infinitely important must
it be when the body is exposed to the  stronger im-
pressions of an unnatural climate

   <«......, where the sun, with downward torrid ray,
   Rills with the barb'rous glories of the day."

   Without entering more minutely into the subject,
which  might swell my letter into a volume, suffice
it to remark, that there appears to be a certain gra-
dation in the tone, or firmness of the  animal fibre,
as we  proceed from  the hotter through the more
temperate  regions; not following in exact mathe- 
                    (  216  )

matical proportion, but sufficiently manifest to fbnfl
some standard for general observation; and, per-
haps, sufficient to sanction the assumption  that the
density or laxity of  the human fibre bears an inti-
mate alliance with  the temperature of the climate,
with respect to  heat or cold, although it  may be
influenced,  likewise, in no inconsiderable  degree,
by  other circumstances;  such as the dryness or
moisture of the atmosphere, the state of the soil,
the  manner of clothing,  and the habits pursued.
In the colder regions towards the poles, the fibre is
firmer, the  circulation of  the fluids slower, and the
secretions more languid;  while in the warmer re-
gions, near the equator, the fibre is lax, respiration
quicker,  the circulation more rapid, and the  secre-
tions more copious, and more speedily performed.
In order, therefore, to fit the constitution of a polar
inhabitant for a tropical climate, or to accommodate
the system of a tropical inhabitant to a polar atmos-
phere, it is needful that the change should be  gra-
dual,  that the necessary density or laxity be induc-
ed, with as little risk as possible of disorganiza-
tion,  and  consequent dissolution.*   It not  only


   * It is probable that our troops might be rendered nearly a*
effective for service in the West-Indies as in Europe, were it
possible, in all cases, to prepare them for the  climate by slow
 and gradual approaches; as for  instance, by first letting rhem
 serve, for a time, at Gibraltar,  and afterwards employing them,
 for a year or two, in the more windward islands, such as Bar-
 badoes or Antigua, before they were sent upon duty to the
 other colonies. 
                   (  217  )
happens that the inhabitants of cold climates suffer,
on being  transferred to  the tropical regions—the
negroes can as ill support the change to a northern
atmosphere,  and accordingly they  are frequendy
the victims of being brought to Europe; for, amidst
the cold of our winter,  all their energies seem to
be destroyed,  and their faculties benumbed.  They
seldom live  to old  age, but, commonly, sink into
marasmus, or are cut off by early consumption.
  Fever,  excessive heat,  violent passion, or any
other cause which greatly, and  suddenly hurries
the circulation of the fluids,  diminishes the  tone
and energy of the living  animal fibre, and deprives
it of that degree of firmness which is necessary to
health; but, by gradually habituating the body to
the change,  a  high degree of increased circulation,
or a considerable diminution of the original density
of fibre may be supported, without any consequent
derangement of structure—the increased action of
the vessels, the augmented velocity of ;he fluids,
and the subsequent laxity of fibre, induced by great
heat, or high  fever, may be borne,  provided they
are not so sudden,  nor long continued,  as to cause
disorganization.
  We  have  many familiar examples which testify
the effect  of original conformation, and the power-
ful influence of habit upon the animal body,  with
respect to its state of health or disease.  If a per-
son accustomed to live  in the gloom of London
should expose his  face,  for only a short time, to
                       U 
                    C  218  }
«fhe full rays of a Brighton sun,  the skin would be
separated as if by the application of a blister ; but
if a hardy shepherd of the downs were to lie upon
the hills,  with his  face  open to the  broad sun
throughout the whole day, not the smallest part of
the cuticle would be disturbed.
   A negro, to whom the  climate is congenial, can
run over the hills in the  West-Indies,  for many
hours  together, without suffering the  slightest in-
convenience;  but if an European of more unyield-
ing fibre, and but lately  arrived within the tropics,
were to follow him  in such a course, it would be
more  than  probable—it would be almost certain,
that, within a few succeeding hours, a fever would
complete the disorganization, and send him to the
grave.
   So, the fluids of a racer  may be hurried violently
through his vessels, without any injury to the natu-
ral organization : but if an unpractised horse, of a
different original conformation,  were  to be taken
from the cart, and made to gallop, with all possible
speed, over a course  of four or -six miles,  it is pro-
bable that from the increased impulse, and the re-
sistance of his unaccommodating fibre, fever,  dis-
organization, and death would speedily ensue.
   In cold or temperate  climates, bulls are baited,
and hares hunted, in order that the sound texture
©f their  fibres may be broken down, and the mus-
cles made tender, by  their  dving in the  fever of in-
creased and violent circulation.—This  is a fact so 
                   C  219  )
svell known to all sportsmen, that a hunted hare is:
always preferred to one that has been shot, or taken
by other means.
  Epicures  let their  meat  hang after it is killed;
until the atmosphere has effected the same purpose,
by a different process, and it be made tender by a
decomposition, or partial  putrefaction.  But in the
West-Indies it is common  to see the animal  alive
in the  market,  and to have its joints smoking  upon
table  the same day at dinner: it is slaughtered,
dressed, and eaten, without the flesh growing cold ;
and yet there  is no complaint of  the meat being
hard or tough.
  These remarks will serve to lead your attention
more particularly to the subject of climate, and to
the effects of habit and original conformation; there-
fore,  without attempting to enter more particularly
into all the various changes which the febrile action
produces in destroying life, or the specific mode in
which these changes are effected,  I may proceed
to state a few  other general circumstances, which
will show the application of what has been already
said to the subject in question, viz. the  continued
or yellow fever.
   Creoles and  negroes are not subject to the  fever
in its continued or most malignant form; but when
it does invade  them, it more commonly assumes a
remittent or intermittent type.—In these classes,
the original conformation, aided by a constant ex-
posure to the heat and atmosphere of these regions, 
(  220  )
has established a due state of fibre, and given to the
body a certain congeniality which empowers it  to
continue its healthy action, amidst all the circum-
stances of climate and situation.
  Europeans who have resided during a period of
several years  in the West-Indies, are seldom at-
tacked with the fever in  its continued form; but
when it seizes them, it commonly assumes the type
of a remittent.—In persons of this class,  the body,
from long exposure  to the  climate, has become
creolise  or acclimate, approaching to the conform
mation of the natives, by having the original firm-
ness of fibre reduced to the appropriate standard for
continuing the healthy  action, under exposure  to
preternatural heat.
  The strongest men—those of the most dense  or
rigid fibre, are most subject to the high degrees of
the continued, or yellow fever; and are  most fre-
quently, and most rapidly destroyed by it.
  Women, children,  convalescents  from former
malady, and those who have been reduced by the
use  of mercurial remedies, are less frequently the
objects of its attack ; and when it does sieze them,
it is commonly milder, and less rapid in its pro-
gress.  In these classes, the state of the animal fibre,
either from original conformation, or from eventual
circumstances, more nearly  approaches to that  of
the Creoles and natives.
  In North-America, the  inhabitants, who con-
stantly reside in the most southern states, are seldom 
                    (   221  }

attacked with the fever in its more violent, or con-
tinued form; while those of the north-east states are
destroyed by it in great numbers: but, even in these
states, it is remarked  that the fever more readily
seizes strangers from Europe, or peasants from the
interior  provinces,  than the natives  of the towns
in which the disease prevails.—These facts are pe-
culiarly striking, and they seem to admit of ready
explanation. The inhabitants of the southern states,
from residing in constant heat, are acclimates, and,
in constitution, approach nearly to the Creoles or
natives of  the West-Indies: but those residing in
the  more  northern  states, although  exposed  to a
very high  degree of heat- during  the summer, can
never become creolises, on account of the interven-
ing winter, which annually renews  the predisposi-
tion, and  creates  a  susceptibility of the  disease—■
still, from residing,  during part of the year, in ex-
cessive heat, and remaining,  at  all  times, in the
atmosphere of their towns,  even the inhabitants of
the place where the disease  prevails, are, in some
degree,  less susceptible of the most malignant form
of the fever than strangers  from Europe, or pea-
sants from the provinces, whose more dense  and
rigid  fibre renders them in  a peculiar manner pre-
disposed.
   From these  remarks,  it would seem that the
presence of contagion  is in no  : gree  necessary
to the production of this fever.  Indeed, its invasion
is governed by circumstances very  opposite to sll
                       U2 
                   (  222  )
the- known laws of contagion: for, in proportion asp
the body approaches the Creole structure, so is  it
able to support the change of temperature, and to
resist the fatal effects of the seasoning malady.  If
the constitution, either from  natural organization,
or from  long residence, be assimilated to the cli-
mate, i. e. if it be reduced to the common standard
of the Creoles, it  has nothing to apprehend from
the disease ; but if it be not,  the fever will,  assur-
edly, make  its attack, without waiting for any such
cause as contagion.
   Moreover, if it can be ascertained that certain
classes of people are most liable to be attacked, and
if it can be proved that there is a certain gradation,
according as they have been more  or less exposed
to the influence of climate, it were equally unne-
cessary and  unphilosophical to call in the aid of a
power,  the  application of whose laws it were im-
possible to reconcile with the appearances observed-
No  disease  of known contagion is influenced by
the circumstances  which are  daily  seen to govern
the progress of the yellow fever; if, therefore, we
are to regard contagion as the parent of this disease,
it must be  a contagion  of a  very  uncommon and
peculiar appetite;  for it is a circumstance both sin-
gular and unprecedented, that an active and wide-
spreading contagion, prevailing in any particular
country,  should,  expressly,  avoid  the inhabitants
of that  country, and only lie  in wait for strangers ;
and, further, that should these not chance to arrive, 
                   (  223_  )

even for many years, this insatiate devourer, not
relishing the food of her own country, should not
once require sustenance, nor stir abroad for support,
but content herself to fast, throughout the whole
period,  and  again rush forth, with undiminished
vigour,  the very moment that strangers appear!  I
think I might say, with the  greatest correctness,
that if no stranger, from a colder  climate,  should
visit the West-India colonies for the space of five,
ten, or any given number of years, that no instance
of the yellow fever, distinct from the bilious remit-
tent fever of the country,  would be known  during
that period -r yet,  if a body of men, unaccustomed
to the  climate, should arrive from Europe  in the
month of July or August immediately succeeding, a
considerable  proportion of them  would be seized,
and probably destroyed by this disease, before they
had commemorated the first  return of a new year:
but can it be supposed that a most subtile and active
contagion  would thus remain latent, for any speci-
fied term, amidst whole hosts of natives, suddenly,
and as it were, impulsively,  resume all its destruc-
tive powers, as soon  as a body of more robust fo-
reigners should come within its reach ?
   In England, the harvest men and strangers who
go into the  fens  of  Kent or Lincolnshire in the
autumn, are more readily attacked with the ende-
mial fever of these provinces than the inhabitants
who constantly  reside in the atmosphere which
 causes it; yet we do not learn that, during the pre- 
(  224  J
valence of any contagious malady in these districts,-
the contagion cautiously  avoids the men of Kent:
or Lincolnshire,  to lie in wait for strangers;  nor
perhaps, will any physician venture to assert  that
the Kentish fever is produced by contagion.
  It would seem more probable that the contagion
of any particular country should regard the subjects
of that country,  in some degree, as her appropriate
prey.  The plica Polonica shuns not the peoleof
Poland, nor the sibbins those of Scotland—neither
have the yaws any disrelish for the Creoles or the
Africans.  But what  seems most surprising is that
this lady of choice  appetite,, who despises  such
common food as the languid blacks of the West-
Indies, when she takes a sail down to America, as
if her appetite were sharpened by the voyage,  will^.
occasionally, condescend  to feast upon, a fine stout
negro of the United States.
  This is a fact, which is totally irreconcilable upon
the principle of  the disease proceeding from  conta-
gion.—-The negro of the West-Indies, from always
living in a high degree of heat, has no susceptibility:
but the negro of America acquires a predisposition
from the recurrent cold of the winter.  The fibre cf
the one is relaxed and-yielding—of the other dense
and resisting.—In the same Avay it is explained why
the  inhabitants   of Louisiana,  Georgia,  and the
Carolinas are less- subject to the disease than those
of  Virginia, Pennsylvania, and New-York.   Did
the fever spread  itself by contagion,  we  know  of 
C  225  )
no cause why it should extend its ravages to the
north instead of the south—why it should seize
whites in preference to blacks—why prefer a robust
European to a languid creole;—aor  why it should
have a distaste for the sable race of the West-Indies
—yet relish the  negroes of North-America.
  It is  not a law of contagion to make its attack
upon the most robust and vigorous people:—more
commonly it assails those of tender fibre.  Were
any given number of strong healthy men,  and the
same  number of children to  be exposed, at the
same  time,  to  the  mfluence  of the contagion  of
small-pox, measles, or scarlatina, common obser-
vation informs us that the children would be found
to be most susceptible of the  impression,  and at-
tacked in the greatest number: but the very reverse
of this would be the case were they  to be exposed,
in a similar  manner,  to the cause  producing the
yellow fever—the men would  be found to be most
susceptible, and  a greater proportion  of them would
fall victims to the disease.
  Not only does this fever attack Europeans, newly
arrived  in the West-Indies, in preference to Creoles,
negroes, and those who, by a long continued resi-
dence, have  become  acclimates; but even  among
these unhappy Europeans who chance to  suit her
appetite, she still has her partialities; for the most
healthy and robust, and in general  those who are
the earliest subjected  to  great exertions, and the
high  degrees of temperature, are  sooner  seized, 
(  226  )
and more rapidly destroyed,  than those  of laxer
fibre,  or those who have the opportunity of becom-
ing more gradually acclimates.
  But the " New-comers," if exposed to the vaws,.
the cra-cra, or any other disease of decided conta-
gion,  are not found to be more susceptible than the
Creoles or the negroes:  although, with  regard to
the bites of musquitoes and other insects,  the  dif-
ference of effect upon the Europeans and the peo-
ple of the climate is as peculiarly marked as  it is
with respect  to the yellow fever.   The small punc-
ture made in the skin of a robust European by a mus-
quito, or a sand-fly, frequently becomes inflamed,.
tumefies, breaks into a sore, spreads into a malig-
nant ulcer,  and ultimately robs the  hardy son of
the North of his life—while the languid Creole, or
the negro, quietly lets  the insect bite,  without ap-
prehending any of this sad train of consequences.
  Seeing that the fever can, unquestionably, be pro-
duced without contagion, some contend that, in its
passage through the body, it generates a matter
which is capable of producing the  disease by being
diffused in the  atmosphere^ and  that it thus be-
comes infectious.  But even in thi3 widest  sense of
the term,  I cannot consider  it  to be either a conta-
gious or infectious malady;  for it  does not appear
that,  by  an  inherent  process, the  living human
body  has the power  of generating the appropriate
pabulum necessary for the  production or  support
©f this fever: or that the  disease, in. its progress> 
                   (  227  )
through the human frame, begets a poison sui ge-
neris, which may be conveyed from one person to
produce the disorder in another.
  The contagious or infectious fever which  pro-
ceeds from distempered  human exhalations  is  a
distinct maladv.   The yellow fever has a different
origin—is  different in its svmptoms—and requires
a different mode  of treatment.  They both have
their different  degrees, and  the mild typhus, and
typhus gravior of  England are  not  more alike than
the continued and the remittent fever of the West-
Indies.  Perhaps  the mild and the  confluent small-
pox are more unlike: yet no one denies that either
is small-pox—nor doubts that both  are  derived
from the same cause—the same specific virus.
   If the medical attendants,  and the (white) order-
lies, who have been employed in the hospitals, have
suffered from the fever; still they have only suffered
in common with the officers and soldiers, who have
not been quartered near the hospitals ; and, as their
proportion  of  duty and fatigue has been uncom-
monlv great, it were  not to be expected  that they
could escape better than their comrades.
   But I have said that this fever  does not attack
the  blacks of the West-Indies:  I  may, therefore,
mention a  remarkable fact,  which, more than  all
others, would  seem to militate against the doctrine
of the yellow fever being, originally, a contagious,
or becoming, in the  course of its  progress, an in-
fectious  malady,  viz.  that, of the multitudes of 
(  228  )
 black men and women whom I have had occasion
 to  see employed constantly  in  the hospitals,  and
 who have executed all the menial duties about the
 sick,  the  dying, and the dead,  I never yet knew
 even  a single instance of any one  of them,  either
 male or female, taking the disease.   Perhaps no one
 will  contend that this would have happened  had
 the hospitals been equally crowded with patients in
 small-pox, measles, scarlet fever, the  common jail
 fever, or any complaint decidedly infectious.*
  The yellow fever  prevails  most  commonly,  and
 most extensively, at the decline of the wet season
 of the year,  when the rains and  the sun irregularly
 alternate,  and cause  unsettled weather; and  this is
 also the period when the bilious remittent, and the
 ague  appear among the Creoles  and  negroes.   In
the midst, or at the very height of the wet season,
 and during the finer dry season,  the fever,  in all its

  * In the year 1793, a body of emigrants from St. Domingo,
 amounting to upwards of SCO in number, who had made their
 escape from that colony,  under all the circumstances of the
 most  afflicting depression, arrived at Philadelphia, at the time
 when the yellow fever  raged with its utmost  malignity: yet,
 not one of  them was attacked with  the afflicting  malady
 which was then desolating the town.  And, as if expressly to
 make this fact  the more striking, it likewise happened that the
 emigrants who arrived at the same distressing period from
 Ireland, the States of Germany, and other parts of Europe,
 were  attacked  by the fever, even in greater proportion  than
 the Americans themselves.—It is not the property of any con-
 tagion to exhibit  such marked partialities   The autumn tem-
 perature of  Philadelphia  was .congenial to  the emigrants from
 St. Domingo: they were acclimates, and therefore not suscep-
 tible of the  disease ; while those from  Europe, being  the in-
 habitants of colder regions, were in a peculiar degree predis-
posed. 
                   (  229  )
shapes, is far less common: likewise in the dry and
elevated parts of the country,  which  are open  to
the breeze, it is out of all proportion less frequent
than in low damp situations, in the  vallies, and
about the openings of the rivers.  In North-Ame-
rica it is principally, nay almost exclusively a dis-
ease of the  low and crowded towns, situated upon
the borders of the rivers, and the bays of the sea;
and is scarcely known in the higher, or more inte-
rior parts of the country.
   The great favouring circumstances, therefore,
appear to be a high degree  of temperature, and a
moist state of the atmosphere ; to which may, per-
 haps, be added the ill chosen situation of the towns:
 but, from the particular season in which it spreads
 its ravages, and from all the host of concomitances,
 it would seem that we are to regard some miasma,
 or unwholesome exhalation, as the true pabulum of
 the disease.
   At the high period of the wet season the ditches
 and canals are full, and  the  brooks  and  rivulets
 fluent, so that  the noxious exhalations are neither
 so readily  formed, nor so easily taken up into  the
 atmosphere : and, in the dry season,  these deadly
 vapours are either chased away by the breeze, or
 rendered effete  by the intense rays of  the sun—but
 during  the intermediate period, at the decline of
 the wet season, every circumstance tends to favour
 their  production, and to  promote their diffusioa
 and suspension in the surrounding air.
                        X 
                   (  230 ')

  The fever is most readily generated in new cols-
nies, where the land is only partially cleared of its
wood, badly cultivated, and  the  half-drained soil
left to exhale its noxious vapours into the surround-
ing atmosphere.   In  the  older  colonies, where
the forests have been long  cut  down,  the land
brought under general cultivation, and its surface
more opened  to the breeze, it is  found to be  less
prevalent.  Examples  of this  are  seen in the old
islands of Barbadoes and Antigua, contrasted with
those of Grenada and Trinidad.  The former are
well cleared, and universally tilled,  and from situ-
ation,  as well as culture, freely exposed to the in-
fluence of the trade wind;—in these,  the disease
but very seldom appears.   The latter are not yet
brought under general cultivation, but are partially
covered with wood, and the atmosphere is damper,
and less purified by the breeze:-—here, the fever
frequently and fatally rages.
   In new  settlements where the land is recently
brought into  cultivation,  and not well cleared of
drained, and particularly  in the vicinity of the
towns or habitations, which are commonly  placed
at the lowest  and most insalubrious spots, for the
tonvenience  of commerce, the  drainings of the
higher  lands, and  often the  filth of rivers, or of
ha} s and inlets of the ocean, together with decayed
leaves,  plants, and  roots, and, in  short, the  whole
exuvice of the vegetable world collect, remain, and
grow  putrid, and,  in such  situations,  the very 
                   (  231  )
weeds and coarser plants become rank and exu?
berant,  and,  growing up only to decay, add to the
 fermenting mass,  which, by holding  the  impure
waters stagnant, accumulates and creates a noxious
swamp ; and thus is generated the hideous Python
who, though  often conquered by the darting rays of
Apollo, again uplifts his deadly front, and can only
be subdued by  the more steady and persevering in.,
dustry of man*
  Wnen the effect of climate and situation shall be
fully  understood,  and duly estimated, the  yellow
fever may be no longer the scourge of our mer-
chants,  or planters,  and our  armies: yet,  after the
long  and  fatal  experience the world has  had, it is
equally lamentable and surprising that men should
still blindly continue in  error, with respect  to the
situations chosen for  their  towns and dwellings.
Contrary to  their  better  knowledge,  they prefer
the convenience of commerce to the more import-
 ant advantages of health, and fix their habitations,
 as it were expressly, upon the most unhealthy points
 of  the  globe.   In every nation, and almost every
 colony, striking examples might be selected of the
 strange folly and  neglect with which we regard a
 circumstance of such serious magnitude.  Armies,
 perishing with  fever,  or dysentery,  have  been
 snatched from threatened destruction, by change
 of  situation;  and  countries, almost m.-riting the
 reproachful  term pestilential,  have  been rendered
 salubrious by  attentions to  the soil; still,  on the 
(  232  )
score of health, much remains to be done, by manr
kind  fixing their residence  where the atmosphere
is least exposed to noxious exhalations.  But, alas !
commerce,  and her prostitute  suite, riches,  dissi-
pation,  and luxury, deafen the loud calls of the
fair  Hygeia, with  her more virtuous train,  ease,
tranquillity and happiness ; and while man remains
ambitious, and wealth be made the public road to
honours and distinctions in society, health will con-
tinue to be only a secondary object of his consider-
ation. It is in the province  of the  physician to ex-
pose  this fatal error—to philosophy it belongs to
.remove it.
  I woidd remark  that the  fever of these regions
seems,  in many respects, to be governed by the
same circumstances as the endemic fever of Kent
and Lincolnshire, in England, and, indeed, when it
attacks the natives  of the country, it even assumes
the same type and symptoms :  and I much suspect
that if it could happen that the temperature of these
provinces should continue as high as from 80° to
90°  during the  summer, and  heavy rains should
fall in July, you would have yellow fever  in the
months of August  and September: but, while die
general heat of the summer shall continue  below
70°,  there can be  no fear  of  yellow fever being
generated in England—<and still less of it being
imported; for this is just as improbable as that the
Kentish fever should be carried off in a Scots trad-
ing vessel, a»d spread  among the inhabitants of 
                    (  233  )   N

 Edinburgh, whose rocks, and streams, and healthy
 mountains preclude its visitation.
   In order to exhibit, in a more striking point of
 view,  the similarity, or I might say the identity of
 the intermittent, the remittent, and the yellow fever
 of the West-Indies, and to show that they are only
 different degrees of the same disease, I may briefly
 enumerate the more prominent points in which the
 resemblance is observed.
   1. They run  indiscriminately into  each other—a
 quotidian, or a remittent, sometimes becoming a
 malignant yellow fever;  and a yellow fever some-
 times  degenerating into a remittent, or an inter-
 mittent.
   2. They are  all  seen to be connected with a de-
 rangement of the biliary system; and a common se-
 quel of each, is a chronic affection of the liver.
   3. They all prevail, most extensively, at the same
 period of the year;  viz. the decline  of the wet
 season.
   4. A bilious vomiting is common to them all.
   5. They are all,  occasional!}-, attended with a yel-
 lowness of the skin and the eyes.
   6. In their relapses, and frequently in their first
 attack, they all bear a .close alliance wTith the lunar
 periods.
   7. The intermittent, the remittent, or the conti-
nued type, or in other words, the milder, the inter-
mediate, or the more malignant form is assumed,
according to the state of vigour, the  period of resi-
                      X2 
                   (  234  )

tfeence  in  the  climate, and other circumstances o£
the subject attacked.
  8. They all, occasionally, affect the same person
various times.
  With respect to the alleged novelty,—the recent
production or importation of the yellow fever, it
appears to be an  error, which  may be explained
away,  by the circumstance mentioned above; viz.
that during a period of peace and tranquillity it is
less frequent, and passes  under the milder name
of seasoning fever; but from recurring in a time of
war, it creates new alarm, and consequently issues
forth with a new appellation.  Its existence is,  no
doubt, coeval with the  discovery of the colonies j
for it  is mentioned by  some of the oldest authors
who have written upon the subject of the West-
Indies, and is pointedly noticed by Pere Labat,  an
author who himself experienced an  attack of it in
the year  1694.  Were  it fit to  offer a conjecture
with regard to its duration,  I might suggest that,
in all probability,  it will continue to prevail so long
as greedy lucre shall  impel the  inhabitants of cold
climates to pay their devotions to Plutus, by a pil-
grimage to tropical fields; unless these fields shall
be so  improved by tillage  as to  destroy the ser-
pent, and deprive  the fever of the aliment neces*
sary for its support.
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