p!*»li*#ifc^kl;^f••>^':yyrt i^mMM^yy^y y- "''r^y: •> NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service Aj*U _ Jks-VeU^fLJjg* A TREATISE ON The Diseases of Negroes, Sfc. fyc* ' • -■■.....iii ■ ————»»■>——^—J——. mi —ir> '. *'&-.•.'-"-££&£? V oy 1 4 •«- •• - ^^> -*->-*;**•' *-**: TREATISE ON THE DISEASES OF NEGROES, AS THEY OCCUR IN THE ISLAND OF JAMAICA: WITH OBSERVATIONS ON THE COUNTRY REMEDIES. BY ^ JAMES THOMSON, M. D. •Mr Aliis, non sibi nsibi" vx%'i'iy JAMAICA: PRINTED BY ALEX. AIKMAN, J UN. Printer to the King's Most Excellent Majesty and to the Hon. House of Assembly, 1820. TO JOHN quiER, Esq. ALLOW the Son of your old Friend and Partner to prefix your name to a few pages, that contain an attempt to describe the Diseases of Negroes. To your examination, above that of all others, I feel the greatest dim*dence in submitting them, sanctioned as your experience is now by a residence and constant practice of upwards of half a century in this island. You will find, however, in every part of them the results of many of your valuable communications and observations, which you have so kindly transmitted. That you may long continue to enjoy the blessings of health, and be just y styled the Vene- rable Father of our Profession in this island, is the sincerest wish of YOUR AFFECTIONATE FRIEND, JAMES THOMSON. Jamaica, September, 1820, In 5 CONTENTS. Page. Introductory Remarks ... ... ... I Fevers ... ... ... ... 13 Pleurisy, &c. ... ... ... ... 19 Peripneumonia Notha, or Bastard Pleurisy 24 Influenza ... ... ... ... 28 Dysentery ... ... ... 34? Diarrhoea, &c. ... ... ... ... 40 Cholera Morbus ... ... ... 41 Cholic ... ... ... ... 42 Pain in the Stomach—Indigestion ... *& Dirt-Eating ... ... ... ... 44 Gonorrhoea, Strictures, &c. ... ... 47 Diseases of the Eye ... ... ... 53 Locked Jaw ... ... ... 55 Worms ... ... ... ... qi Small-Pox, Chicken-Pox, and Cow-Pox ... 69 Itch, Ring-Worm, &c. ... ... ... 73 Catarrh, Sore-Throat, Rheumatism, &c. ... 74 Ruptures ... ... ... ... 75 Burns ... ... ... ... 77 Yaws ... 01 Leprosy ... ... #<# o/-r Elephantiasis ... ... ... ... 100 Ulcers ... ... ... ... 203 Management of Pregnant Women, and Diseases of Children ... ... ... >## jjq viii Pace. Trismus Nascentium, or Locked Jaw of Infants 119 Hydrocephalus, or Water in the Head ... 123 Remarks on the Constitutional and Hereditary Com- plaints of Negroes ... ... ... 129 Some Observations and Experiments on the Medici- nal Plants of Jamaica . ... ... 144 Weights, Measures, &c. .... ... ... 157 Doses of Medicines for Adults ... ... 158 Forms of Medicines, ... ... ... 160 List of Medicines necessary to be imported 166 Ditto ditto, &c. which are produced in the Country, . and ought to be kept on every estate ... ... 167 rNTRODUCTORY REMARKS W HILE prosecuting my medical studies et the Uni- versity of Edinburgh, I was strongly advised by my friend the late Dr. W. Wright, formerly hjgh in the medical department of ^his island, if my situation in life ever led me to the West-Indies, 40 institute inquiries into the nature of the disorders to which the ne- groes are liable, as affording a subject rich with materials. Though he had himself published an edition of Grainger's Treatise on the Disorders df the West-Indies, he was the first to acknowledge its imperfections, and the necessity there was for having a more ex- tended and complete system of medical practice. When I parted from that wortiiy character to come to this island, he put into my bands several of his manuscripts, which at nne time he had intend- ed to make public, -but, from the infirmities of age and bad health, he was induced to relinquish this idea. A considerable addition has lately been made to them from the same quarter; and, though in a very imperfect state, they are valuable as containing the ob- servations of one, who, through life, possessed the most discrimi- nating judgment J b*VG lost no opportunity, since my residence in this klanrf, that could augment the value of these; and, if health and farther experience are afforded me, I wjEat a future period give to the profession the result of various inquiries, which may benefit those, ^hosc fortune* may lead them to this part of the world, A In the meantime I have been advised by many, thoroughly sC' quainted with the interests of this island, to write a treatise on the more important diseases of negroes, divested of all technical and theoretical language, .so asto enable jthe planter to affo*d,reJief with more confidence and success when medical assistance is not at hand, and where it often, I am sorry to say, is not worth having. With these views the following work has been composed. It will remain with a numerous and intelligent «lnss of men, who have the ma- nagement of negroes entrusted to their cnre, to decide how far I have succeeded in the undertaking. My best thanks are due to many who have assisted me with their remarks and advice, but particularly so to Alex. Aikman,' senior, Esq. of this island, for the friendly manner'in which he favoured me with the perusal of some valuable MSS. in hiis possession, and other papers, containing much original information on the diseases of the West-Indies* If the contents of these pages should meet with public approba- tion, they may chance to fall into the hands of one who is just commencing his career as a planter, or of some medical gentle- man, whose practice has yet to be adapted to the constitutions of those resident in a tropical climate : A Yew observations, therefore, oi> the habits of the negro race may not he improper, as tending to,corject many errors that are prevalent on this subject.' We hear persons, who have never resided among the natives of Africa, exclaim that they are astonished how one can distinguish the individuals, seeing they all have woolly hair, and are of a uni- form complexion. The remark, it is needless to say, is the result of the most superficial examination ; They are brought from the most diversified, regions, and present modifications in stature, comi plcxion, and moral qualities, that equal in every respect those ac- knowledged to exist amongst the inhabitants of the European con- tinent. In.d;sposition they are represented; as base, treacherous, 9 and revengeful: Alas ! what confidence can we place in those who report the characters of others with so much decision, while in reality they are incapable of discriminating their own. It would be foreign in this place to enter into a minute descrijH tion of the moral disposition of this race of people. No one had more opportunities than a medical man of witnessing those scene* that call forth the tenderest feelings of our nature. Professional dtt* ties lead us to a knowledge of the most minute domestic arrange- ments, that are only known to those in habits of the closest intima- cy. The endearing appellation of shipmate, and the general ones of brother and cousin, so common with them, arc the genuine ex- pressions of a being capable of the most acute moral sensibility. Some time ago I instituted a series of experiments regarding the differences of anatomical structure, observable in the European and negro, but particularly those of the skin. The result has since been published in England. After various and minute re- searches, I satisfied myself that, contrary to the common opinion,; there does not exist any distinct membrane, that occasions the black colour in the African; that we cannot shew it by any means. that are not artificial, but that in the coa^-black negro there is a plexus of vessels, which ramify on the exterior surface of the1 true skin: these secrete a peculiar matter, on which depends the difference of colour; that, as the shade of complexion becomes lighter, the intensity of this peculiar substance is diminished, until it vanishes entirely in the quadroon. By blistering the surface, by the application of boiling water, and by putrefaction taking place*' we can detach the plexus of vessels with the colouring matter, and exhibit it in a distinct form ; but a rupture of the connecting parts* must have preceded this. And it is from not attending to this circumstance that many anatomists have been led into the erFor of considering it a peculiarity in the structure of the ne££tff>aee. If I might be allowed to hazard >\ conjecture on the-utility of A 2 fhis substance, I would observe that the increased activity- of .th« cutaneous system deposites a large quantity of secreted fluid on tha surface of the skin. Black, from its known powers,,not only ab- sorbs, but radiates, more heat than any other colour. The pigment pgevents its penetrating deeply,, and as the perspirable matter,, when ab$ut to be elevated in a gaseous form, acquires an increased ca- paeity for caloric, a large quantity of heat is taken up, and the surface kept constantly in a much cooler state than it would other1* wise be. I by nO means wish to be understood to say, that climate is the cause of this operation. That question remains undecided. It could easily be solved, but it might give offence to many, whoso interest forbids them to adopt the results of philosophical investi- gation. rj. When we remove the cuticle, after a bliatef has been used,, we occasionally see patches of a much lighter colour than the surround-* h*$ parts. From the strength of the vesication, or frorh the rough-* ne$s »with which the'raw surface has been dressed, the colouring principle has been detached from these .spots; in the jet black ne- gro it is capable of being regenerated, though very slowly : We have examples of this in those negroes^ who have in their own country undergone the operation of having the greater portion of the skin on the brow and forehead removed; they are called here Brc* ehit negrors. The cicatrix is quite black ; so is also the surface, that covers the part where the mamma yaw has been. The scars of ©Id wound* in siich people are also black. This peculiar secretion is liable to disease, particularly on the hands and feet, giving rise to r sirigular mottled appearance, which i.s called leopard skin* In the Albino this-substance is probably also in a similar state, though dissections are awantihg to confirm this conjecture. As the completion change?, we find a greater tardiness in part* wounded or blistered in recovering their former state. This may be every day observed in the sambo and mulatto patient. . A weeik solution of exymuriatic acid, a^phed. td the skin iWi some time, has the effect of diminishing greatly the intensity of the colour, which is only restored after a considerable time elaptea s If we detach the membrane, and put it into* * mixture of this acid* we destroy the colouring principle entirely, and there remain* qnly a pulpy mass. It would be attended with little advantage to state all the enaf©* mical differences between the European and negros which nume- rous dissections of the latter have enabled me to ascertain. I may only mention that I have universally found the head thicker! and heavier in proportion ; the facial angle exhibiting the greatest va- riety ; the fore-arm in the generality of cases is by no means longer than that of the European ; the print of the foot shew* that th* arch is much smaller,, and the subject corisequently less adapted for walking, I have repeatedly analysed the blood, as well in * healthy stata as otherwise, and could not detect the ledst variation. As to the cause of the black colour in the negr©> there is rt© sa- tisfactory explanation. It does not follow the gradations of tern* perature* We have light coloured and red negroes^ as they are called, from adjoining countries: There are facts to shew that three hundred years have made little alteration in the Complexion! where intercourse with the natives has been avoided 5 why, intense heat should produce black has never yet been explained; some ilk* genious men have affirmed that our JbU. parents- were black* and that the European complexion is? a degenerated state, I should be sorry to think this was true, if it was for no other reason than that the enthusiasm excited by Milton's--diviae description of OUr^wr mother Eve should be shaded by such a ludicrous assertion. u;. The cutaneous system of the African is in health very active, and from its being suddenly deranged we may date the origin of the greater number of hi* disorders; in all of them, more or }<$s, theur perspiration is attended with a iwik, unpleasant smell, which 8 insane rises to that degree as to become quite insufferable* Re- peated bathings have no effect in diminishing the odour. The matter secreted is of an acrid nature, and changes quickly to red a piece of litmus paper.; It is of very great consequence to attend to tin* secretion in diseased states of the body, o I remember once to^ have prognosticated a fatal termination in the case of a negro woman,' from.its suddenly ceasing, though there were not present at the time any very urgent symptoms; in pregnancy it is diminished, and after menstruation ceases entirely, as also in old age. '°- ;"»'-><»•- -—■ • vr. ; .lurMm a o" »r.i duto•'.? . ')i:l io c :■.'.:: > SOOl I The importance of maintaining a proper equilibrium in the ac j Uon of the cutaneous system .ought: never to be dost sight of by- tV.ose who are engaged in treating the disorders of negrOcs. It is of-importance foot merely in itself but rrsorei so^from the immense-' Variety ofcsympathies} ithat are called into action when its functions: become disordered.' oThc lungs and bowels, from, their intimate connection, become the,seat of acute disease, attended with fatal - consequences; indeed, we can uniformly resolve all the alarming dfeertiefs of these people into some sudden disturbance of the equi- Htotf&m, ivhich naturally prevails between these great centres of sensibility: Nota moment should be lost in endeavouring to re- duce this irregular state by every means in our power. Conges- tions of the lungs and bowels are most speedily obviated by attack- ing the diseased organ, and rotising by the most powerful stimuli th% sympathetic energy of the external parts. When any morbiH- activity of the skin is suddenly repelled, it universally falls on some internal viseus, and is manifested by the irritability of the whole etiustittttion. •«■ Those, therefore, in any degree aware of the exist-' enee of the connection now pointed out/- will be enabled, by the ad- ministration of judicious remedies, to afford relief equal in every respect to what could have been given, if the patient had been un- der ^he care of the most experienced physician. rt •«'■ 'v', 's.-. u- 'J.':. >-'. ;j->-- ..£. ■■ * v.. ,-.f .. -n& •• sAc?6ther: the t**» in every examination that has come under my consider- ation : No overflow of bile is to be found, and the fact is well wor- thy the attention of those who practise amongst them. On the contrary, I have been assured by those, who have had ample means of judging, that abcesses and other deranged states of the liver are' frequent amongst them after a residence in a cold climate. This* was found to be the case in many instances with those, who were brought from Nova-Scotia, and allowed to settle in jSierra-Lebnc, and a general increase of complaints follows a removal to a tem- perate, and still more so to a cold, climate. How will the stic- klers for cutaneous, hepatic sympathy be enabled to shape these facts to their theoretical speculations ? Every region on this earth ha* its own climate, men, morals, and religion. In vain would the ambitious self-love of some persuade us that one system should be common to all. The history of our species might read them a melancholy lesson regarding the millions that have been sacri- ficed in, %hc prosecution of this fatal delusion ; and the feeble pro- gress made in subduing the innumerable barriers against it might teach them how little is to be expected from similar efforts in future : Who could restrain their ridicule if we attempted the develope- ment of the infantile mind by means of abstract reasoning and theoretical sentences? Yet we force on the prejudiced mind of the savage the relation of mysterious trhths which he never can understand, and preach to'him a code of motels that is not con- nected by a single early association. The intimate union of medioino and magic in the mind of the African is worthy the consideration :ii , ■ * .-*- * St. Thomas hi tho Vale. ..' " f Maladies des nitres. Paris, 1776. 15 irregular, cold shivermg?,' debility, and lassitude, which Excite no alarm. . More generally the attack commences suddenly j with the most acute pains along the back^ and prostration of, strength : In one night's rime the patient,cannot move himself int.bed. ,The countenance is completely altered, the features sharp, eyes glisten- ing, the painof the head is intolerable* great aversion to light, the ar- teries of the head throb in the most visible manner, the heart beats violently, the breathing is hurried, and not complete: The fever excites, on the surface a burning*, biting heat', as it has been calk'dj from its leaving a tingling, sensation.;at. the.-extremities .of the fingers after they have, .bccn; witiulrawuv The Urine is high -co- loured, and passed in small quantities. The symptoms; most cha- racteristic at. this period of the disease, are the-singular deprivation of strength :; He is thrown down in .a few hours,..and cannot move. Also the dreadful anxiety and despondency : Ke gives,himself up for. lost j and utters his fe'elifigs.in ,a;low, languid voice. * Towards evening a low kjad of .delirium, comes',oil: . He appears confused, and requires to .have the question several'times repeated before he can makean answer. There is constant watchfulness, except towards morning, when he doses for. a. short-time.. Every symptom now mitigates. After continuing from twelve to reighteen hours-,, and a crisis seems to have taken place by a copious- per*^>iratio* 1, or' free evacuation of the. bowels,-.and »!ic urine befcoming. muddy, as .the patient is now extremely lo\r,; we have no hesitation, in giving bark, wine, and Other stimulating substances;*, with the view of preventing the return of Ycvcr. It is not till, the afternoon of the second day th.nt. we are. convinced of the fatal -error committed: Restlessness;, shivering, and febrile anxiety, ;nvith aggravation, of 'every feeling* denote the accession of a second attacks The de- lirium is much severer j the thirst is irresistible* the heat very irre- gular over the surface, and moving from one part to another! The tongue and jips arc parched, and acquire a thick brown fur, which also covers the teeth.: Articulation becomes, extremely dif- ficult and inaudible:. The .patiotit is constantly muttering to him- fcelft .■• These dommotions, after a certain time, sftbrf'ide. A cnld; clammy swee.l succeeds, affording no maimer of relief. The sub^ ject is suhk to the lowest' degree, has irregular starting?, with fre- quent syncope* on the Jca,st. exertion, j After i the seeuikl or-third accession of fever, it i$ seldom that we can. observe any regularity in tli0 progress of the. diseasc.yr The remedies used havcibeeu of iha? 1« active kind, that we can n» longer distinguish the salutary move* ments of nature from such as are excited by artificial stimuli: The returns of fever are irregular: As the patient gets weaker, they are- repeated every three or four hours with diminished violence, and when we least expect the*). £ An interval of considerable du- ration may intervene from the application of a well-timed re- medy, ami, when we flatter ourselves with hopes of recovery, de- bility beyond the power of medicine suddenly supervenes, and the most powerful stimuli fail to excite the smallest return of sensibility : The parts rested on or blistered mortify, and the ex* haustion is such that the transition from life to death is imper- ceptible. jJ< '*'■ Such is the progress of this fatal fever. Let us now attend to those appearances that may influence our opinion in prognosti- cating the. termination. )-.v.'j!> This is the only fever in which critical days and critical evacu* ations are distinctly marked. Compared with the European, the pulse is much more-moderate-during it's course, and the salutary operations of the system are much less easily effected, and for the most they terminate in a considerable deposition of matter on thi aponeurotic expansion of the 'body; The fever usually terminates qn the eleventh, fourteenth, seven- teenth,-or twenty-first day : Tf it passes thislast, the treatment has been ill-directed, the forces of the system have'beea unable to produce-a favourable crisis, or a deposition" has taken place on some important viscus. J\ ' '■;. Jj. >i ^ ■ <( The.fourth day tof the fever announces what will pass on the seventh? that is to say, we arc enabled to judge of' the tendency of nature to any particular evacuation,''''J Thus, if the accession of fever on the fourth day is not very severe, and the pulse pretty equal, we may hope for a resolution of the disease on the seventh by means of perspiration: If the bowels- are1 more than usually distendedj and'there-be -intermission o£ the'pulse, nature indicates that it will be: by the bowel*? and, if the Urine be disturbed en that day, and the pulse unequal, it will be through that channel tliat a salutary operation will proceed. !.•• >i- All evacuations by sweat or stool that happen before the fourth dayi and bring with,them no relief; are pernicious, and indicate a severe disease, ami a terminationum an unfavourable day. The seventh day does not afford «ny.means of jud^m** 0f ^\}Rt 17 fstri happen oh the eleventh ; The operations of nature have by that time been too much interrupted by active medicines. If, on critical days the urine becomes thick, and deposites a sediment, wh'ch remains for two days, we may pronounce |he sub- j -ft out of danger ; but if it is thick at the onset of the disease, and afterwards becomes limpid* or turns so after a critical evacu- ation, the prognosis is fatal. Delirium early in the fever, and invading suddenly with in-, flamed eyes aud beating at the tempk's, is unfavourable : Not so, if it comes on gradually, unless attemled with profuse swtats and frequent pulse. Gradual deafness., without delirium or fierceness, in the progress of the fever, U favourable; a glazed1, fixed appear- ance of the eyes in the intervals of fever is bad. If there is con- stant watchfulness, moderate pulse, and turbid mine during the first days, we may predict a tedious case, and very, often sudden* unexpected death. The stronger the fever is at the Commence- ment, without endangering life, the speedier and more marked will be the crisis. If the tongue is of a high red colour, or suddenly loses that fur characteristic of this fever, there will be a fatal termination. Early diarrhoea, which gives no relitf, should be checked, and if the matter passed is black, accompanied with delirium, there are no Lopes. It is a maxim in most fevers that, when early delirium comes on, we must suspect the cause to be in the bowels: It would be highly dangerous to act on this principle in the present form. Every oue of a weak, relaxed habit of body is liable to this fe- ver. V\ omen who have produced many children, and, those la« bouring under great mental agitation, the age of puberty, when the physical powers of the body are suddenly excited, and the important process of menstruation not thoroughly established, are particularly obnoxious to the attacks of this insidious dis- order; and, according to their previous habits and constitution, the type will assume more of a malignant or nervous character. Before proceeding to the treatment requisite in this fever, every, one should be convinced of the truth of the following observations before he administers the. simplest remedy : That, cjontr#r-y to tl^. genor^l opinion entertained of tropical f vers, the powers of the system will operate the most effectual and Isdutary changes in; removing tjie fever, wbkji no efforts of art can C 18 imitate. Negroes, in particular, having no confidence in nature or her operations, in defiance of our utmost exertions, give the strongest stimulating substances in the very first stages, in order to remove that apparent debility, which creates so much alarm. When this fever has once established itself in the constitution, no mode of practice can cut it short, and all our endeavours to re- move it by an artifioal crisis are highly pernicious. To watch attentively (after removing tha more urgent symptoms) the ten- dency nature has to produce a critical termination ought to be our sole operation : She must be assisted by the mildest and gentlest means, and the rerief afforded by her efforts on critical days most carefully noted. If the symptoms, during the febrile accession, are too violent, they must be moderated, especially on the fourth and seventh d ;ys, which are the most critical ones. If, in the in- tervals, the powers of life arc endangered by too great a debility, mild stimulant applications are warranted in gradual succession. If we are called in an early state, although the symptoms be urgent, we should seldom or ever have recourse, to the lancet, without first weighing every circumstance in the constitution of the patient: Very seldom is it necessary. A gentle emetic of 15 grains of ipecacuanha, or one of tartar emetic, provided the tongue is loaded, along with 10 of antimonial powders, may be requisite, drinking freely of vervain tea, or other country remedies, to promote a perspiration. If there is irritation at the stomach-, the effervescing mixture, saline draught, toast and water, mint tea, with peppermint, may be tried. After the operation of the puke, a purge may be given. A mixture of Epsom or Glauber salts, with nut-oil, is excellent, and operates easily. 8trong purge* are to be avoided. After having fulfilled these indications, we should not be too anxious to urge the use of further medicines. Many push the sweating system to an extreme degree, but after the fourth day it only debilitates the patient, without for ward in» the operations of nature. In fact, every thing that is given to ex- cite a discharge in the early state, unless it agrees with efforts of the system, aggravates the febrile disorder. In the first intermission of fever, we should avoid the fatal error of exhibtmg bark and stimulants; it is better to wait for a short t me, and observe the course nature means to pursue, than inter- rupt h'r operations by injudicious practices : Draughts, composed M' nitrous ether, wi:h sweet spirits of nitre, or hartshorn/ mild 19 drinks, with weak brandy and water, and towards night paregoric, are amply sufficient at this period \ if a second attack-of lever eu- suesj with delirium, we must exert every measure to subdue any Untoward severity; sponging with vinegar and water, binding the head with fresh cooling leaves, plenty of acid drinks, and ripe fruits. It is during the second intermission that medical assistance be- comes of importance. I could enter minutely into the subject* but the application of that assistance requires so much knowledge and experience as to exert the judgment of the ablest practitioners. llcpeated blisters and cataplasms, mulled wine, brandy, or old rum, with ether, camphor, opium, and hartshorn, are now parti- cularly valuable; every hour that we can sustain life increases the chances the patient has of recovery; this should never be forgotten : Pills of carbonate of ammonia and wild cinnamon or pepper are re- quisite ;* the bowels must be moved by clyster or oily purges j the thick fur, already mentioned as adhering to the teeth and tongue, in this fever, is no indication of the necessity for active cathartics j we may sink our patient by such a proceeding beyond recovery. It is astonishing, even in an advanced stage of this fever, how the strength is recruited by the patient's being carried into the open air, and allowed to enjoy the refreshing breeze. Bark, in every form, is absolutely necessary when the symptoms after a few days become remittent. °' PLEURISY, &c. I have generally found a most erroneous idea to prevail amongst Jrhose who have the charge of negroes with regard to this disease. They look on every sudden attack, attended with cough and diffi- culty of breathing, as denoting inflammation of the lungs, and re- * Take carbonate of ammonia or-smelling salts, one drachm; camphor, half a drachm : Make into twelve pills, one or two when there is great dt'j.'lity. Take strong bird pepper, one drachm y camphor, one scruple: powdered wild •infiwnon, one drachm; oil of peppermint, ten drops: Form into convenient sized piHsj three or four occasionally when low. Aqua ammonia, nitrous ether, of each a tea-spoonful, to be taken in a glass of Strong mulled brandy. Tnfiiiion of bird peppers, a wine-glassful, aqua ammonia, a t«*a-spoonful. 0a*i|>h«r aai opium mny be combined in a variety of liquid forms. 12 20 quiring immediate and copious bleeding, without respect to other symptoms. If this error merely regarded the name of the disease, it would be Qf little consequer.ee, but unfortunately the life of the patient is most materially involved. I shall therefore point cut the proper distinctions that should be kept in view, so as to enable every one to call in the timely assistance of those who, by their ex- perience, are rnore enabled to afford relief. .--. Plemis"y8 strictly speaking, means an inflammation only of the pjemaor serpus-meiubrane that cover* the ribs internally and the. surhjce pf the lungs Pneumonia means an inflammation of the suUmncc of the lungs themselves, with or without the pleura. It will tufiivicntly answer all practical purposes, if we consider botli -of these modifications., as. one disease, and under the name of pleurisy. - It commences with rigors, succeeded by strong burning fc\irt affecting chiefly the vfuee and palms of the hands, difficulty of breathing, which is so great as to threaten suffocation; at other tunes the patient says he could breathe, but that an acute pain sucU denly catches him in the chest, which makes him desist; the anxiety is greptt as is expressed by the countenance and restless state .of the bedyj there is a short dry cough ; occasionally expec- torptiop of blood, prbloody mucus; there is a thumping pulse, which to the feeling much lescnUes the vibration of a tight musical string under the finger; the pain may be fixed, so that the finger can be placed on the spot, or general, so as to be referred to no particular ptiit; tongue white and slimy, urine high-coloured, and passed in small quantity. If the disease.is not tiikeu in time, the symptoms increase, till a fatal htmorrhagy follows, e>r water is collected. More generally the lever abates, and rigors, with a sense of fulness, denote the formation of an abscess in the lungs, that bursts, and terminates the life of the patient. ? rl hi5 acute disease attacks those of a robust, plethorip habit of body, and of the sanguine temperament. I leuce it is more fre- quently met with in men than women, in those seasems when suel- den alternations of the weather prevail, and their duties lead them tip be exposed to the night air. * Such negroes in the prime of life do not know what, sickness means, They are ashamed to complain, and, when we add-to this the natural insensible state of the lungs, the disease ha* oi^n 4;ot «uch a footing, that they only refer to the seat of their^cSmpIaint after the symptomatic fever has increased the sensibility of th$ lungs to a morbid degree: In this situation they present them - solves to those who, arguing from their former uniform state of heulih, ore not aware of the increasing danger. A. negro of such a disposition ought never to ]jc refused admission into the hospital: They will not always at first avow their disease, and, from their uninterrupted state of g*)od health, they are more apt to ascribe their symptoms to witchcraft. They have no notion of their own sir tuatiou. and make vague answers to the moat important questions, I have mentioned that the pulse feels hard and throbbing; it is so in most cases; but, when the disease has come on gradually, it is not universally so; the system *s oppressed, and the pulses only risen after vuy copious bleeding; the debility is apparent. These circumstances render pleurisy a much, more latal disease to negroes than it would otherwise be. Our first inquiry should be to discover die nature of our patient's constitution, hit previous habits, if he has recently been exposed to the vicissitudes of cold and heat, the exciting causes of the disease. If we are satined of the existence of these and other circumstances, we should lose no time in detracting blood, and that with no spar- ing hand. If the veins arc small or deep seated, it is preferable to open one or both of the jugular veins, and allow the stieam to flow from a large orifice. On this much of our success depends. The finger should be kept constantly on the artery at the wrist during the operation. This I would particularly insist on, if the pulse hah been previously oppressed. To a person, not of the me- dical pfofjssioji, the favourable change will convince him that he is acting with propriety, and allow him to proceed more boldly in his mode of treatment, and no medical man ought to despise the assistance it may render him. The appearance of the blood and the change of symptom- mu t guide us in our future operations. Immediately alter the first copious bleeding a strong purgv of neutral salts, with James's or antimonial powders, should be given, and plenty of mild rnucik.ginoUo drinks, but by no means have re- course to blisters. If we are called in the early stage of the disease, this is too common an error. If we cannot subdue the disease by other means, we shall have too much occasion to trust to them at a future period. If, after leaving the patient to the efforts of nature for seven or eight hours', we find the pulse to augment, the pain and other symptoms not relieved, the vein must again be 23 opened, and the same, or a larger quantity, withdrawn. The.blood previously taken should be inspected, and if the surface Ts Concave, white, and contracted, we may proceed with more freedom in the second operation, though the direction majr appear of little conse- quence, 'we ought to receive the blood in" separate vessels, each not holding more than an ordinary tea-cupful. It is astonishing what a difference is'found in the contents of the various cups; which would not be observed if it had been in one mass. The ex- tent of depletion is quite uncertain, and, when pushed to any length, should always be under the direction of a proper person. I have in several instances within sixty hours taken away eighty ou'nces of blood from a robust negro, and saved his life. After the second or third day bleeding becomes very dangerous, and by many is al- together interdicted, yet where the febrile anxiety remains distress* ing, it may be resorted to in a modified form. If, after repeated bleedings, we have reduced the pulse to a quiet moderate vibration, and the other symptoms are relieved, wc should trust a good deal to nature: We have done every thing in our power, and the various preparations of emollients and pectorals will be but of secondary assistance. Nature, or the powers of the constitution to restore health, is what very few trust to, especially in warm climates. The negroes have an idea that they never cari recover, without an immense variety of remedies being adminis- tered. In this they are, as in many other things, mistaken. The West-Indies is a climate similar to their own in most respects, and it would certainly be an anomaly in the all-merciful goodness of Providence, if this extensive race of beings had been left to the unopposed malignancy of disease. The case, however, is far other- wise, and, if we are not too proud to learn, we may, from atten- tively watching the slow though certain operations of the system, have a mode"of practice pointed out to us, which theory would ne ver have taught us. From the intimate sympathy that subsists be- twixt the lungs and lower extremities, we should endeavour by every means to excite the action of the latter, so as to remove the violent congestion that has taken place in the thorax. It is cha- racteristic of this disorder, that the limbs become cold and be- numbed, which generally proves fatal. We should lose no tim« in applying blister to the calves of the legs, cataplasms of pepper and mustard, and the constant repetition of the warm'bath, and flanr-Vi clothing, to excite free perspiration. ' * • ' 23 After having subdued the inflammatory, symptoms, the-only hopes we have are that nature will resolve the.disease by a crisis : This she generally effects by means of a copious expectoration of mucus, which we too often interrupt, by the premature and hurt- ful administration of our numerous boasted pectoral compositions. During the second and third days we may venture on the follow- ing mixture,* and, as the symptoms of fever, &c. are general by aggravated towards night, at bed-time, if they be repeated, with any mild mucilaginous drink, to allay the cough, which interrupts a refreshing sleep, and induces a return of the irritation, repeated warm fomentations to the chest are of great service before we use blisters, though in general they are but little attended to: They may be composed of a bath made from anj> bush the negro may have a fancy for: They should be continued for one or two hour*; at a time, and changed the moment they become cold. If, towards the close of the second or beginning of the third day, we find the more urgent affections mitigatec), yet there re- main difficulty of. breathing, local pain, and irregular returns of fever, the.pulse and appearance of die last drawn blooel in such a state that we can urge that .evacuation no further, then a large anel powerful blister, may. be .applied to the. side of the chest most complained of, .previously sprinkling ..some tartar emetic on the surface of it, so as to ensure a more certain vesication. The inha- lation of the steams of warm water, with sweet spirits of nitre, .should be diligently persisted in, adding imy simple bush that may be supposed to act on the lungs. If the disease is to terminate by expectoration, it generally ap- pears on the fourth or fifth day : We may then assist nature with aty pur preparations. Nurses and learned old men are at liberty to) produce their boasted chrouicle of cures and certain salvation, descended through a long train of ancestry; they resemble the greetings of women anel children bestowed on the warrior who re- turns with victory ; they are pleasing as marks of affection, and Snore so from the recolle.ct.ion of what hu,s passed. Those men* iioncdf below may prove useful at this period. # Spirit of Mindererus, half an ounce; laudanum, 20 drops; niucillage, so as to form a draught. ■f- (jov/foot leaf, boiled up-with honey; the young calabash, roasted,'and mixed 'Mth syrup; lignumvitfe, with a few drops of laudanum ; the syrup of toiu balsam. T*uth gum ammonia, sqailii, &c. may all be used, according to the inclination of lSq patient. e* I again repeat the caution regarding the use of strong put*^ in this disorder. After the first, which ought to bo powerful, i* there is occasion w^i'm to move the bowels, let it be elone by oily medicines or enemas: When expectoration is about to commence, a drastic purge may not only defeat the intention of nature, but sink the patient beyond the hojjcs of restoration. When this disease terminates uafavoumbly, as by the formations of tubercles or vomica, the symptoms and treatment become so complicated as to require the best medical advice : I have therefore omitted the description, as foreign to the nature of this work. PERIPNEUMONIA NOTHA, on BASTARD PLEURISY. I have endeavoured in the preceding pages to give the descrip- tion of a disease, whose symptoms are so acute as to enable cv. ry one to act with promptitude anel vigour. That I am about to mention is of a very different nature. It has not been accurately described by any author on the diseases, of negroes, so far as I know of, and at this time is quite misunderstood by the majority of planters, and only known to those medical men who have wit- nessed its rapiel and fatal progress. Unfortunately for the pa- tient, it is generally confounded with pleurisy, to which, at the very commencement, it bears some resemblance, but, in other re- spects, is of the most opposite nature. It is this disease which is alluded to, when we hear those exclaim, who ought to have known better, that they were astonished, considering the urgency of the symptoms, the patient could not stand bleeding, but sank after the first operation. The patient may have laboured for some time under cough and difficult respiration : Without claiming any particular attention suddenly in the night, or after any unusual exertion, the breath- ing becomes so laborious as to threaten instant suffocation. No position gives relief: The shoulders are drawn up towards the ears, and the knees to the chest: The anxiety is /indescribable : The face is swelled as well as the neck, anel the countenance of the negro becomes of a dark copper red. The respiration i$ at- »5 derided with n ra'tling noise, but there is no expectoration, anel lit- tle cough : l\.ver is much less than in the former disease. The patient eagerly grasps the hand, anel piteously prays for relief in an almost inarticulate whisper: The pulse id soft, and unequal in strength : The'to?!gtie shortly ge\s a thick, dark, mucous.covering: No particular part is complained of. The cheeks are often colel, and otlu-r parts of a burning heat. The most marked symptoms are die sudtlen prostration of strength in the negro, anxiety, anel despondency. These symptoms include the more usual mode of attack : They vary, however, from, the nature of the subject and s.vjrity of the disease in elderly women. About'the cessation of the menstrual period they come on gradually, and uniformly ter- minate in water in the client. In many instances, from its prevalence at a particular period, it has been said to be epidemical, accompanied with a remarkable tend nicy to putrescence: This is doubtful. Those who are deceived by the apparent symptoms of inflam- mation, anel proceed at once to let blootl freely, and give strong purges, have too often to witness a fatal termination. The lungs b.come every hour more and more oppressed with fluid, till suf- f< cationput&an end to the patient's sufferings: This has leel many to call the disease iri the West-Indies Humoral Asthma. The subjects that suffer most arc those of a wenkiy, bad habit of body. Women who have borne many children, and particularly those with whom menstruation is ceasing, dirt-caters, young chil- dren, and all at an advanced period of life, and who have at any time been subject to pulmonary complaints.* The dissections of bodies I have made of those negroes who have Sunk under the disease have been numerous. I have uniformly found effusion of a viscid matter into the cells and substance of the lungs and bronchia?, attended with partial inflammation of the mu- cous membrane; in some place-, abscesses with bloody matter.—. D * In the Mi?, writings of Dr. Wright, formerly an cminemt Physician in this Jslan.l, I find the following remarkable observation, which I have oftui seen veri- fied, though not to the extent he mentions:— " I have* very often seen in the West-Indies among negroes difficult, quick breathing, with bad expectoration ; fever, and other frightful symptoms of inflam- mation of the brjii^t, take their principal rise from quantities of putrid bile and other sorJes lod ,el in the primae vire, and often also from wonrs. An immense discharge or* one or the other will take place suddenly and give insta.t relief, leav- tej tiiO Du.-to.- <»aJ h'i '>»i^e:\i quite in tae back-ground." 26 When the patient lingered any time, water was found in the cavity of the chest and abdomen, and in some instances in the brain ; *eT that, whatever may have caused the disease, the mode of termina- tion was nearly alike in all. When we are called to prescribe for a patient under such symp- toms, we are often much puzzled in what manner to act. The fever and difficulty of breathing suggest the idea of inflam- mation, but the state of the pulse, fluttering and unequal, does not agree. If, after considering the present and previous habit of the patient, the mode of attack, &c. We may be warranted in drawing away a few ounces of bfood, then tic up the vein, and form our prognosis* from it when coagulated ; should it be watery and loose, we have not a moment's time to spare. A large blister may be applied to the chest on one or both sides; a strong oily cathartic, mixed with Epsom salts, given; warm fo- mentations to the chest' and feet. The numerous class of expecto- rants will showthemselves of little advantage in such a case, if we place too much confidence in them ; our chief hope rests upon the effect of local stimulant applications to the lungs themselves by inhalation; warm water, vinegar, sweet spirits of nitre, ether, tur- pentine, fumes of strong spirits, smoke of the benzoin and myrrh, may be variously mixeel and drawn into the lungs: Perseverance is required, and the degree of irritation should be carried as far as pos- sible. Yet, to avoid coughing, wrapping the throat with flannelj- Jmpregnated with any of these substances in a warm state, is strongly recommended ; there is a constant inhalation ; keeping a phial of ether open in the room will also assist. If we had proper apparatus, many of the gases might afford great relief. We must also assist the patient with other remedies. Digitalis (fox-glove) promises to be of great utility here. In the West-In- dies it is unfortunately the case that we Can never depend on the efficacy of this medicine, or of squills, certainly two of the most powerful we know of: They maybe exhibited in these forms;* the * Powdered fox-glove, one grain ; squills, one grain; powdered cinnamon, with soap : Made into a bolus; to be taken morning and evening. Tincture of fox-glove, fifteen drops; oxymel of squills, one drachm : Morning and evening. * Dried squills, three grains; asifcetida, ten grains: Made into.pills; to be taken hivi-v the day. - • «7 .squills act by determining to the skin, a thing to be constantly kept in view in this disease, but the effects are yery problematical. What we look on as a crisis in this complaint is the formation of a favourable expectoration. We are too apt to hurry oh the natu- ral process by stimulating medicines ; one. of these is gum ammo- niac ; this should never be given till expectoration is fairly establish- ed, as below.* We are to keep in mind that a fever, with a putrid tendency, accompanies this affection in the majority of cases; the critical eva- cuation by expectoration must therefore be most carefully distin- guished from those by perspiration anel stool, which come on at a latter period, and arc the salutary efforts of nature to dissolve the fever; the progress of each must be marked; a strong purge given incautiously will instantly stop the expectoration, anel be followed by deatn ; if the bowels arc not so free as we would desire, it is pre- ferable to delay any medicine till the spitting is well established. If the matter coughed up is thin and frothy, and gives no relief to the symptoms, we may prognosticate great danger ; still more so, if it, resembles pieces of rotten spleen, thick, and of an offensive s.mell; this termination is frequent,in Jamaica, and always fatal.—^. If the disease docs not yield, and there be no indications of a fa- vourable crisis, symptpms of a putrid nature become manifest, indi- cating spcecly dissolution, v/c arc forced to have recourse to bark in every shape, especially in the form of a glyster; small doses of squills may be joined with the bark, to obviate its effects in the expectora- tion: Wine, snake-root, and other stimulating remedies, must be freely given ; the camphorated julep, made with vinegar, ought in this stage never to be omitted. If the disease puts on a remittent form, bark becomes highly ne- cessary. Blisters to the tops of the shoulders have a most singular effect hi relieving the congestion of the lungs; the garlic prepared in this formf is highly extolled bv many; the balsam oi lolu with honey4 D 2 * Gum ammoniac, two drachms 5 one pint of boilirig water $ rubbed gradually in a incrtar; strain; add oxymel of squills, half a drachm; honey, six ounces; latidarmm, one drachm: A spoonful frequently, to promote expectoration. f Tnke three fresh roots of garlic, sliced across; five ounces of honey ; three ofvinefar; swim a cup with this in a bason of boiling water for one hour: A table-spoonful of this occasionally, with a little brand}'. X Take four ounces of balsam of tolu; a pint and a half of cold water; allow to boil in a vessel ol-water for twenty-four hours; strain, and add as much,syrup, honey, or 6"tli ^"ingredients', so as to rcnkeit pleasant: This is justly cck'br"te 1 as a pectoral 2S A vast number of emollient pectoral preparations m*y be nWe up, and olven verv freely as auxiliaries in the recovery of the pa- tient; the nerroes'repose great faith in their virtue, especially if recommended bv their own Doctors, and we should never refuse their admission,' after we sec that the disease is likely to have a fu* voitrable termination. INFLUENZA. \ Like all epidemics, this disease exhibited various degrees of morbid affection ; a slight febrile attack, heaviness of the head, watery ey s, and cough, which hardly incapacitated the patient from his ordi- nary pursuits, and terminated by a critical sweat on the second day, was the simplest form it assumed ; Many white people hue! it in this manner. In the healthy and vigorous constitution it was introduced by chilliness, succeeded by fever, a rapid, but not full, nor regular pulse, extreme thirst, a sense of stricture in th» throat, with hoarse- ness, and soreness in the part, which, when inspected, appear., c^ very red; the breathing laborious and anxious, the'expectoration Mnall and viscid, with very troublesome efforts to evacuate it, and of a dirty yellow cast; from the nostrils and eyes a thin discharge, which hicrustcd as the disease advanced; the countenance was bloated, and the light unpleasant to the eyes; bowels costive, urine high-coloured. In the robust subject the incipient inflammatory stage was violent and rapid, and it usually lasted from twenty-six to forty hours : If bleeding and other remedies had not been used in time, the debility became so great as to render it inadmissible; the pulse feeble and irregular, the patient seldom complained of rain, but the senses were impaired, with delirium at night, a rat-* ding noise, with ineffectual efforts to expectorate; the matter from the nose'got darker; a remission of fever would be followed in a few hours by a paroxysm severer than the previous ones, with wanderings; the horizontal position created a sueden sense of suf- focation, and the attendants were oblige el' to raise the body.' Death happened generally on the fourth day. With children the* ..yir.ptoms were most fatal ami dUtvobLiu^: L'm.Lie to explain their ' ■«gr feeling'?, the hurried and convulsive movements of the muscles, the uncountable pulse and constant'fever; showed too plainly the rapid progress it was making. They refused all medicines, and left us little else than spectators of their untimely fate." But those that suffered most were people advanced in life, and particularly so if they previously had been liable to pulmonary at- tacks. The type was milder; and thereby threw us off our guarel. Many complained of acute pains in the shoulders and limbs, as if they had been beaten, with sudden stitches in the side, impeding respiration; the anxiety was singularly severe, and accompanied by a degree of nervous irritation, which produced tremblings all over the be>dy; the breathing was quick and imperfect, with a rat- tling noise, but little expectoration, frequent fainting fits, and cold sweats ; the state of the pulse varied every half-hour, and the fever was irregular; the countenance much bloated, sometimes also the lower extremities: In such cases life was extinguished from tha accumulated fluid, which interrupted the circulation of blood through the lungs. In many instances the negroes dropped down dead while complaining to their master. The insensible state of the lungs and' insidious nature of the complaint had caused effusion, before they were aware of their danger. Baffled in the seemingly best directed efforts to conquer this fatal epidemic, I anxiously had recourse to a vievy of the parts after death, as the only certain m of obtaining a knowledge of the means requisite to stop its ravages.*. I have opened between forty and fifty bodies of negroes that fell a sacrifice during the different epklemics, and must say that I have obtained that kind of inform* ation which has enabled me to prosecute a plan of treatment with, much moie confidence, I should mislcadjf I sard with much more" success. These dissections rather go to prove that the effects" of irritation on such delicate organs are rapid and extensive, and put at defiance any feeble relief that may result from the remedies we oppose to them. In children the throat, windpipe, and lungs allowed evklent marks of increased action ; the trachea was in several cases seen to be covered with a distinct membrane, like what occurs in croup, though not of so fine a consistence; the Jungs universally redder, and water in the chest in small quantities; where the head yvas opened there appeared several spoonfuls of * These dissections v.'cre made by; a physician who witnessed -three epidemics in this itlunU, ' $0 water in the ventricles, 'ami-the-brain being removed, if ran but from the spinal canal when the subject had been vigorous, but sank in spite of our exertions; the bronchi-.e were choked with a thick viscid matter that adhered like bird-lime.;, the vessels and Substance of the lungs had every indication of congestion, without ulceration, and when, cut into abb wed blood, mixed with u:r; ad- hesions of a recent date were found ;. the heart flaccid, and the coronary blood vessels distended with blood, their internal coats of a deep scarlet colour ; the pericardium had more or less fluid, and so had the two cavities of the chest j pieces of the lungs -sank in water when tried, and resembled the Hver more than any thing else; the other viscera generally soiind. In these pdtiehts-, where early assistance,had not been given, the thoracic viscera were in a state of incipient gangrene from inflammation; mucus of a-darkish co- lour and offensive smell, and water in the chest. With those ad* vanced in life, ; nd where the debility from thq beginning had been shrch as not to warraut bleeding, the hppcaranqes were miich less; varied; the matter, secreted was of a thin.watery consistence, tho lungs pale and flaccid, and in such a state that one might thrust his finger into any part of them; the veins, gorged with blood,- of a pitchy nature; the right side of the hoart enormously distend- ed, with loose coagula; fluid mixed with floating lymph was never absent, and the pericardium full of serum ; when the head .and ab- domen were examined, water was always found there. Thc.general result of these numerous dissections which I have now stated will, I trust, enable us to understand the fatal nature of the deran^e-s merits in this disease, and the. great care and discrimination re- quired-tin .suiting, our practice to the various constitution's of pa- tients.-? As to the variety of opinions regarding its nature, whe- ther epidemic or contagions, it is of little consequence, to deterrhine in this place : As an apology for ignorance, most say it depends on an epidemic constitution of the atmosphere, and, when you ask what that means, they gravely tell you an epidemic constitution of .the atmosphere, and there they very wisely leave "you to your medita- tions. The prognostic to be formed depends on such a variety of cir- cumstances, that I think it better to omit it altogether than .n . The view which we take of the nature of influenza will contri- bute'much tic direct cur treatment; the ncnwts-imtafion,viih 34 which it is combined, is a remarkable fact, rnd has rot attracted that attention it deserves from the influence it exerts over the life ef the subject; early congestion, with a tendency to decomposition, is discoverable in every case. These two facts arc important, as they prove the origin of the disease to reside in the nervous system itself. The irregular pulse, sudden debility, appearance of the blood, want of acute pain, anel state cf the -parts, after* death, shew the action to have been one su( generis; very unlike pleurisy, which, in a great measure, h under the command of the lancet. I appeal on the present occasion to those professional men, who arc conver- sant with the admirable productions of Doctors Plouquer, Clutter- buck, and Baillou. If the analogy is not very striking in the his- tory of the dissections they give of fever, attended with ereat ner- vous irritation, and those recently mentioned, most important vis- cera were found in a state approaching mortification, and complete congestion, yet during life wc had no reason to suspect that such Extensive injury was proceeding, being marked by no symptoms of inflammation. Late experiments by an eminentphj-siologist prove the powerful influence the nervous has over the sanguiferous sv - tem. - Many years ago in England, I satisfied myself also of their intimate relation by'nuriierous trials on the living 'subject. The ac- tion is quite peculiar, and unfortunately bleeding williiiot put'a stop to it, as the fatal issue can too often testify. Cure. ""- In our indications of cure we should therefore ever keep iri mind, that the slightest degree of "inflammation in such-delicate or- gans should not be allowed to go on unrestrained; the central and principal function of the system is interrupted, and rapidly followed by congestion, which hurries the patient to the" grave. When the person is of the robust constitution I have already described, and is attacked suddenly, and we see him early in the complaint, bleed- ing in the first operation; I always prefer small quantities at a timej and frequently repeated, to the free evacuation some make use of; the* state of the pulse is no guide here, it varies every half? 'hour, the strongest faint during the operation.- The blood dfa\vn varies in every cup, and that is one strong reason why it should be taken away in small quantities; the jugular vein is preferable to the arm, and the patient cannot see what is withdrawn. The tem- poral artery is still better, and in eases where there is a necessity for 32 tostng blood, but we are prevented by syncope, any f;*-!ntiiy mny be obtained without being followed by the disagreeable accident;* the extent of depletion cannot be fixed by any directions but de- pends entirely on the constitution of tbe individual. The general plan of always ordering blood-letting, until a medical person ar* rives, is the most injurious thing possible, and attended with fatal consequences. The purge next to Ik1 administered should not be strong, a mixture of Glauber and Epsom salts or nut oil, with eight grains of antimoniul powders, or fifteen grains of James's powders by itself, with plenty of sage-lea, fomentations to the chesty and mild diluent'drinks ; frictions, of warm spirits and'turpentine all along the neck anel back; the legs should be placet!, in water as hot as can be well borne, and kept there for a length of time ; the Vapour bath is a good ad.lition, followed by strong, stimulating frictions. If, after waiting some time to seethe effects of this treats ment, a gentle perspiration comes out, 'the,bowels'answer;freely* and the expectoration increases, we shall have little further tr uible j but if debility, dyspnoea, and fever persist, we must lose no tim;v; the practice of giving repeated doses of medicines that excite nain sea, and determine to the skin, is highly pernicious after the first or seccihd day; I have already explained myself on this subject r. heir treating of pleurisy. We see nature occasionally,terminate by a critical sweat, anel we vainly imagine that our coarse imitation will do so likewise. How often do we see the patient flooded by sweat, and every symptom existing in its most aggravated form ! When the skin is dry, small doses of D vci's powders, Mindere- rus' spirit, or anthnonial wine, if jnd'ci m.sly given, are valuable. Stitches of the side and difficulty of breathing must be opposed by blisters to the chest; one a, foot long and four inches broad, placed along the back-bone between tbe shoulders, I have always foun J highly serviceable; it seems to stimulate the origin of the nerves thcy the deeree^ui' nervoirtf iuitatiou, will ir.uuencc the coagulation, * 33 nerves and secreting ducts, and stimulate them to proper action; a; sponge, moistened with aromatic vinegar, should be constantly kept to the nostrils, anel the alternate use of every substance previously mentioned should be most diligently persevered in ; also the sti- mulating expectorants. Mercury is a favourite with many, so as to excite salivation; they say that none die after the mouth is affected ; the truth rather is, -that few will die if they live to that period, whatever their treatment.may have been. We had better, therefore, not trust the life of our patient to the doubtful chance of havino- a salivation raised. Every medical man must acknow- ledge the utility of mercury, from its peculiar action on mucous membranes; given as an alterative, combined with squills, it should seldom be omitted; it will reduce that thickened state, which re- mains after inflammation, and probably prevent a relapse, which is both common and fatal. If we are correct in our opinion of this disease, we need not dread tbe inflammatory symptoms, nor the use of opium in an early stage. It is. particularly indicated in this epidemic, from the .orcat nervous irritation that exists. I have ever experienced the h st effects from it, given both in a solid and liquid form, com- tined'with other antispasmodics, and that to a considerable ex- tent.* If we have occasion to relieve the bowels at an after period, it must be done.by clysters of a stimulating nature ;f strong purges sink the patient very sudden.l). When the powers of life are low, we musl apply the strongest external and internal stimulants we can command ; but the sensibility is often so completely gone, that they do not differ in their operation from so much cold water. When die disease had gone on for some time before it was ob- served', or the patient was of a weakly or eljderly constitution, one was crreatly perplexed in what mode to proceed; the debility forbade ni:v stron.o- evacuations, and the'.dyspnoea threatened instant suffo- cation. Our only rational mode cf proceeding was to stimulate the action of the vessels locally, as I have already pointed out; ex- pectorants, and every rerrieely that'c6uld sustain the activity of the * Opium, four grains ; camphor, ten grains; asafcetido, half a drachm: Made jijto pills, and given during the day. f Forms. - - ' - . E 34 system; but the accumulation of fluid was so general and rapid, that little could be hoped from any exertions. DYSENTERY. This is a very common and fatal disease amongst the negroes. From the sudden alternations of temperature and their mode of life, the equilibrium, which I have already mentioned as existing in the action of the external surface and that of the intestines, is readily overthrown, and followed by severe and extensive de- rangements of that important part. It assumes every degree of severity from the simplest to the most malignant form. In. the mildest state the person is suddenly attacked during the night with severe griping pain anel commotion in the bowels, a frequent desire to go backwards, without being able to pass any thing, or, at most, a little mucus, tinged with blood, which varies in quantity; there is thirst, parched skin, and faintness ;• urine generalty scanty. If taken in time, these symptoms soon eeru:e, and nothing remains but a discharge of mucus, which they call while flux. In the more urgent form there is sudden and great prostration of strength ; in fourteen hours the stoutest negro is scarcely able to help himself; anxiety is great, nothing but pure blooe! is passed, sometimes to the extent of one or two quarts; the tormina arc incessant; by obeying every inclination to go backwards the parts become excoriated, and a prolapsus of the rectum increases the miserable sufferings of the patient; one fainting fit succeeds another, and death unexpectedly happens on tbe third or fourth day ; when protracted, every evacuation is putrid in the extreme, and he cannot be approached without the greatest disgust. The causes of this loathsome disease are numerous—obstructed perspiration; from alteration of temperature, unwholesome food, noxious exhalations: When it prevails epidemically amongst nc^roes^ there is a peculiar constitution of the atmosphere: Though a com* inon opinion, I believe it to be an erroneous one, that pears and other fruits are the chief cause of this disorder. A diarrhoea, as I shall afterwards show, is the means'by which nature rrets rid of a surfeit produced by these substances : This, from neglect or bail $5 treatment, may assume a dysenteric form, but that is merely acci- dental: The pear season and the epidemic constitution generally coming together have caused the error now alluded to: Those who partake freely of fruits have been preserved from the attacks of the disease. I have examined the bodies of many who have die>d of this com- plaint, and uniformly found the mucous or internal coat in "a very diseased state, inflamed to a great extent, covered with blooely mucus, very seldom any ulceration ; the liver seldom or ever dis- eased ; the other coverings of the intestines more or less affected ; o frequent large collections of worms, of the round kind. I have rarely met with scubala? or small hardened pieces of lbeccs, so corn- men in other varieties of dysentery. In my examinations of the healthy structure in the negro, I have always found a much greater proportion of mupjus secreted, in the internal surface of the intestiRes. This I conceive tp be a provision of nature to guard against the effects of those suelden revulsions un- avoidable in a warm climate. The number of blood-vessels that ramify on the interior must be greater, and from this we can ex- plain the vast quantities of pure blood which many pass without being in great danger. 1 he^c and other considerations have led me to look upon this epidemic as extremely different in its nature from the dysentery of Europeans. With them dissections show an opposite state after death. The increased morbid activity of the liver, and its vitiated secretions, require a mode of practice ciuite peculiar; the quantity of mercury administered would never suit the constitution of the negro. With the latter it is a complete catarrh of the intestines, anel this should be constantly kept in view in our treatment of it. The following remarks may guide us in judging how the complaint will terminate. Young women in the prime of life suffer much les* than men. This I have hael confirmed by many experienced prac- titioners. It may be owing in some measure to the activity of the uterus ; children have it milder; but with women after the men- strual period has ceased it is fatal. Blood passed at the commencement in considerable quantity, jpllowed by mucous stools, with a relief of symptoms, is favour- able. Blood late in the disease, if it appears a second time, is bad. Worms passed upwards or downwards are favourable, E2 36 A red tongue with severe tormina is dangerous. If the tongue becomes foul during the progress of the disease, a remission may be looked lor. . Thirst, with a remission of pain, is good. _ . If a warm perspiration breaks out after faintness, the complaint will abate. Delirium is always fatal, especially with severe purging. Severe tormina at on advanced state indicate the retention ef fieccs. If there is great debility, and a saline oily purge produces a free, evacuation, we may hope for a change, though late in the disease. Citre- The indications of cure aro obvious to mitigate the increased morbid, mucous secretion, ar.el excite by every means in our power the strong sympathetic action of the intestinal canal. When the subject is seen early, a puke should precede every rem eel}', 15 or 20 grains of ipecacuanha, with a copious allowance of warm drink. Dr. Grainger speaks high'y of the gamboge or yellow thistle, when no other emetic is at hand. I can speak very favourably of its effects, and. the safety of its operation. A drachm anel a half bruised in half a pint of boiling water, and allowed to cool, will answer every purpose; and may be repeated if required. I nave witnessed excellent effects also from a table spoonful of mustard,. powdered and mixed with warm water. I would prefer this on many occasions to every other, from its peculiar salutary actions on the intestines as a purge. I have constantly made use of the following in preference to every other at the commencement.* By being gradually exhibited, we obtain copious stools, and relieve the tormina; the jalap in this country is seldom to be trusted Ho, and, when combined with other remedies, ac:.s violently on the intestines,; already too irritable. At night, if there appears a want of due ac- tivity on the surface, Dover's powdersf may be used, with copious- draughts of warm vervain and ginger tea. * Beat up four raw eggs, with Jamaica pepper, or wild cinnamon cod. fur- drachms of Epsom suits, and four table-spoonfuls of cold drawn nut-oil.'-witl-; sugar: A w'ure-ylassful of this every hour, till free operation of the bowel-; \;<;:--~ irec'v m-ueihisinou:? drinks.- ' *"* I- lice forms of medicines at the end, 37 ; The warm bath must never be omitted, with long and repeated fomentations to the bclry. We should particularly enjoin the patient not to yield to every slight call, but to restrain the inclination, as he will thereby not only have much pain saved him, but obtain a more complete evacuation. Negroes are very apt to indulge in this way ; they keep straining for flours, so great is their anxiety to get rid of the disease. If next morning we find the bloody evacuations to have dimi- nished, and the mucous elischarge established, the patient will soon recover, and gentle astringents, with mild nutriment, will perform a cure ; the repetition of the saline oily purge is, however, generally necessary; sago, arrow-root, flower pap, mulled Port wine, with Jamaica pepper, or wild cinnamon, opiate elraughts at bed-time, and gentle clysters, are all that are required. This is a state- ment of the sufficiently simple mode of proceeding in the more com- mon cases we meet with. If our efforts to cut short the disease are not successful by the third or fourth day, it is in vain that we persist in the use of those substances that determine to the surface. Our plan must be altered, and our attentions devoted to the removal of the more urgent symptoms, directed by long experience. The great exhaustion and frequent stools lead the attendants to use opiates, stimulating food, and astringents of the strongest kind. At an early period of the disoreler this is almost certain destruction, and it is by far too common a practice with the natives of this coun- try; after the second or third day it is impossible to procure na- tural evacuations without the use of laxatives, the intestines being in that morbiel state. The virtues of toasted rhubarb, so much trusted to and boasted of, I have ever found to be a weak, trifling medicine, and absolutely hurtful in the early stages; besides it is seldom that we can procure it fresh in this island ; repeated small doses of ipeca- cuanha, with chalk powdered, followed by the saline oily purge, gives great relief at the commencement. If there is great irritation at the stomach, we must not attempt strong emetics nor purges; draughts of chamomile-tea or mustard and water, weak broths with an opiate, and a blister to the stomach, clysters with an opiate, »vill often answer our purpose on this occasion. When severe griping, frequent scanty stools, with spasms of the intestines, and cold elarnvnj' sweats, with hiccup, continue to annoy 'he subject, we iv.n-.i have recourse to opiates, combined with cam- 3S phor,* ov in a liquid form. Medical men entertain a great dread of the effects of opium in this disease; this may be very propen where there exist hardened faeces and fever, but in the negro race we have no reason to apprehend any such things, or at least very rarely___many is the miserable hour I conceive I have saved my. patients from its liberal use, particularly in solution as now men- tioned; it is astonishing the relief they experience from it; when spasms and debility, after the operation of a purge, have reduced them to a low state, sitting over the steams of warm water gives ease to the severe tormina; clysters of any mild mucilaginous sub- stance. A late writer has extolled greatly the effects of ipecacuanha in that form. In the first stages I have repeatedly tried it,f and with evident success; a blister to the abdomen, when the pain is severe, is absolutely necessary, as is also the use of a tight band- age, and frictions of strong spirits and camphor. Whcm the disease from the beginning shows, as it frequently dees, a putrid tendency, we must avoid the use of all strong purges: Manna, sweet oil, but particular clysters, arc indicated; a solution of aloes:}: will prove of service. Many in this stale give bark along with the saline purge, and after a few evacuations commence the bark clysters, mixed with sweet oil anel laudanum ; snake-root, wild. cinnamon, the pepper infusion,$ Madeira wine, mulled brandy, must not be withheld; when great debility cataplasms, warm tur- pentine, frictions, and blisters, arc all to be employed alternately. When hiccup comes on, and wc conceive the patient to be in the lowest possible state, it is astonishing how much relief is felt from a copious alvine evacuation ; so far from sinking he hourly gains strength, and ultimately recovers. After the worst symptoms of dysentery are over, the alvine excretion is very often still kept up by the irritability, which the viscera have acquired during the dis- order, and the tendency of the humours to these parts ; the belly is puffed, and the former symptoms threaten to return after using * Take :::c grains of opium, as many tahlc-spoonfuls of cpld water, rub the opium in a mortar for ten minute^ pour off the top part and strain ; a wine- glassful of i>weet spirits of nitre may he added : A table-spoonful of this mixture to be given when spasms of the bowels severe. See forms of medicines at the end. t Three drachms in a quart of water, and boiled down to a pint, may be re-, peated twice during the day, when the stools arc offensive. J Aloes pounded, two drachms, dissolve;! in warm. v.aler: Starch, as much as :orms a clyster. ■> • -* * "-''J-pcpp-r, bruised and infused, may be swallowed in Madeira wine. 3£ the least exertion; small doses of rhubarb and ipecacuanha, with opiates, will remove these; the bowels must be strengthened by every means in our power, and the country remedies arc here pe- culiarly valuable j the most dangerous period being passed, they assist in restoring the former healthy action, but are by no means of material consequence in curing the disease, as many conceive, and are. highly pernicious when given in too early a staere; such as act by their mild lubricating qualities are sago, flour, arrow-root; the leaves and seeds of the vangloe or zezegary, emulsion of the cocoa-nut, ochra seeds, and the like. As gently astringent, toast and water, with elixir, vitriol, parched rice and water,* guava buds, and fhiir, also the pomegra- nate, with cinnamon and Port wine, infusion of Jamaica pepper, and bruised country pepper, logwood decoction, lime-water, with a solution of cashew gum, white vitriol; J- lime-juice and salt is a favourite remedy with many \% chalk mixture arid cinnamon when clysters are required. The above substances may be combined as suits the inclination. Opiates should be added. Each clyster should never weigh more than half a pound. As tonic compositions, the contrayerva,§ coccoon antidote, the adrue,|f bitterwood, tincture of steel, Jamaica bark, and many- others. The recovery in this complaint is extremely slow, and relapse follows the least irregularity; the bowels retain a morbid, irritable state, which is affected by every change of weather; a tin-lit band- age, three or four times twisted round the belly, proves of o-rcat support, so much so that the Turks, from long observation, say it prevents an attack of the disease; warm clothing, particularly on the feet, must be used for a length of time ; this direction neo-roes are very negligent of, and relapse, which happens from it, termi- nates in water, which collects in the belly ; the appetite is voracious in some cases, and if not restrained they will devour such a mass of victuals at one meal'as to induce a return of every bad svrnp- fom, and it passes through them in an almost undigested state.' Let them eat little and often, with high-seasoned dishes, well prepared; * Forms at the end f Ditto. t Ditto. ) Ditto. |j Ditto, 4Q all old salt meats are to be avoided ; the bowels must be kept open by small doses of rhubarb, and all the stimulant class of aromatics the country produces. The continuance of bad stools with grip- ing pains, want of appetite, and emaciation, shew that the internal coat has become diseased, or ulceration taken place. We should lose no opportunity of getting immediate assistance, as a long course of remedies must be tried and directed with no cosamou skill. DIARRHOEA, &c. This disease and dysentery are so connected that many consider them as modifications: The one frequently terminates in the other from bad treatment, and other causes. The former differs so far, that it seems to consist in irritation, not amounting to inflammation, in the muscular coat of the intestines, which hurries the contents through in an irregular manner: There is no fever, no blood, mucus, nor tormina; the stools are of a watery nature, and con- sist of dissolved fasces, which are passed with much flatus. In speaking of dysentery, I have alluded to the common mistake most persons fall into in supposing the avocado pear, and other fruits, to be the causes of that disease; it is far otherwise. At the commence- ment of a sugar-crop, I have seen one half the negroes affected with looseness for a few weeks. Indeed the inconsiderate nature of some of these people is such, that when the returns of the season bring with it any new production, they absolutely gorge themselves every day until the novelty wears off; any thing eatable, which they can obtain free of cost, is voracfously swallowed, until such a mass has accumulated, that it is surprising the intestines do not burst: Nature, however, is extremely kind to these creatures, ard a spontaneous diarrhoea carries off the offending materials, and, unless the subject interferes by using astringents, no danger is to be apprehended : When we suspect the presence of crude acrid ingesta in the stomach and bowels, a smart emetic, followed by a piiro-c, and an opiate at nig]it, will.answer every purpose. Lime-water, with cinnamon and the cashew gum solution, is a good restorative. If obstructed perspiration cause the irritation, Mindererii^ s^imf, 41 antimonial powder, sage^ vervaih-tca, with the warm bath, i-.juA the use of an opiate, will be sufficient. Diarrhoea from teething- should not be checked unless severe'; strong purges in every case are contraindicatcel. iljr.v i).. CHOLERA MORBUS. '»*' We selelom witness this tlisor'der amongst negroes. Excessive vomiting and purging, but not of a bilious native, cnsv.e from eat- ing poisonous fish, crabs, and other substances. It is somewhat singular that the poison of fish is deposited in the liver, entrails, anel fat. If these lie separated, the remainder maybe eaten with safety. Salting destroys the moVt poisonous fish : The black-backed sprats, which are in general very injnrkms, if laiel one night in salt pickle, may be eaten with safety : Fish are poisonous at certain seasons, and hot ai others. The fish found in the West-Indies to be most de- leterious are the barracuta (pe-eca major), king-^sh (xiphias), ca- valiee '(scainbt r\ rock-fish (pecca marina), smooth bottle-fi. u (ostracion glabe'ium) ; the yd low-billed sprat in particular i-; to be dreaded, producing convulsions and sudden death. The large white land-crabs, when they feed on the leu res of tne Man- chioneal-trce, are productive of violent cholera in a few hours; 1 have known people break out into large zvheah; and a yellow suf- fusioVi to take place universally over the body, which remained for several days. All fish without scales, and of a very large size, arc suspicious. The cause of the poisonous qualify is quite unknown ; the longer tne fish remains out of the water, the more virulent doer it become. The idea of copperas banks is too ridiculous to merit 'mention; the weakest solution of that niiiieral causes instant death 'to ali fisln Many jtidgc of the poisCnerus quality by giving the entrails; to dogf; anel fowls; if it dots not injure them, they deem it safe ; this 'Is dangerous. What will act severely on the human species Las often bo effect em them, anel vice versa. Parrot? bones, for iu-tanee, mashed up and given to a dog, will excite convulsion anel ravin'- 'madness; the negroes are well aware of this. 'Sheep cat the Maa- iliioiical apple with -impunity; and parsley is a eicac.lv poison .o 43 parrot*. The test of placing a silver «rocn in the pot where the fish Iks been boiled is equally to be distrusted. When we are convinced of the subject being poisoned, an emetic «f the strongest kind must be given. Sulphate of zinc, fifteen grains, is the best, followed by an oily purge, and plenty of diluent liquors* Xceroes have great faith in strong peppers with rum, and with good reason. If vomiting is severe, opiates and clysters. Dr. Wright highly extols the virtues of salt and lime-juice: It should therefore never be omitted in our plan of relief. The sto- mach and bowels remain long in a state of great debility, and con- sequcnt'y require constant attention. White people who have suf- fered will find it necessary to visit a cold clia.atc, in order to ic-store their wonted vigour. ■CHOLIC, "V 'oroes are ^really troubled with these pains in their bowels. With some it amounts to symptoms that resemble the dry belly ache, but this last disease is totally unknown to them in any severe form : Dram-drinkers and coppersmiths have been found to have attacks of it, and opiates arc requisite in the first stage, before any purgative, to remove the constipation. These cholicky pains be- came habitual, and invade suddenly, with vast commotion in the bowels and eructations. The sole and favourite remedy of negroes is Cayenne pepper and lime-juice, anel it fulfils every purpose. When there is constipation to any extent, an opiate and laxative clyster give great relief, with warm fomentations. The various pre* purations of aromatic stimulants are afterwards most beneficial. PAIN IN THE STOMACH.—INDIGES- TION. Much caution is requisite to distinguish real from pretended complaints. It is an expression with the negro for any disorder 4$ and none is more familiar to the ears of the planter. The disposi- tion e>f the subject, anel his appearance, are our chief guides--- Pleurisy, I have already said, invades in this insidious way, and diseased liver shows itself by the same symptoms. . We cannot get a clear explanation of the case, but are left greatly to conjecture. The pit of the stomach is pointed out; brcathlessness in walking up an ascent, bad appetite, and swelling of the stomach after food ; vomiting, and the food taken passing quickly, and in an undigested ftate; bowels irregular, and countenance of a pale, sickly colour. The spleen is rarely the cause, the liver much more frequently, espe- cially if the negro lias been given to the practice of dram-drinking; the strength of the spirits more than the quantity is what injures so materially the coats of the stomach, ami the liver is invariably in- volved; a bareness may be.felt below the ribs when a full respira- tion is made ; pain extending along the right side to the shoulder; towels Very costive, and light-coloured stools. An alterative course of mercury, with frictions to the side, is the only remedy, with whatever improves the functions of digestion. The induration has commonly proceeded so far that dropsy of the belly is the fatal consequence. I have remarked in another part of this work that negroes are more liable to disease hi cold climates. They are extremely subject to abscess of the liver in Europe, a thing unknown in Africa. If the patient is a female, the above symptom must be referred to obstructeel menstruation, or to their final cessation: This I shall treat of afterwards when on the dis- eases of females. Worms lodged in the upper part of the intes- tines and stomach create appearances of a similar nature to those I'.ow mentioned. .After various applications we are surprised to find a fit of sickness and vomiting expel by the mouth several of these in a living tc te, the patient gets immediate relief, and we can direct our future treatment with more confidence. Should the case turn out to be one-of mere ineiigestion, from the presence of acid in the ■ftoi-iaeh, a gentle puke, with thirty grains of rhubarb, afterwards the chalk mixture, and the favourite pepper meelicine of the negroes, V.ill be sufficient. Chalybcates and bitt-.rs are also proper in the fcUiV. F st i% DIRT-EATING., _- - y '< This is one of the most nerions complaints connected with a efe- ranged state of the stomach and digestive organs, The countenance and complexion become so changed, that the, disease is obvious at first sight; the colour, from a deep black, np-i preaches a dirty light bro\vnvor lemon yel.low : the skin feels-rough^ is dry, and cold to the touch -x the white of the eye of a dusky yel- low ;* the eye lids puffed, face bloated and dejected" ; the gums Jose their red colour, are pale and flaccid ; inside of the lips and, tongue nearly white ;- the hair loses much of its colour, and acquires, a lighter shade; there is a constant, uneasy pain at the stomach, attended with nausea and vomiting; the pulse grows weak, small* and contracted'; the heart b ats in a troublesome manner on the Last exertion, and, the puliation is felt over the upper part of thq abdomen; the larg? vossds of the n,>ek throb violently a.iid visibly ; the mesenteric glands get enlarged, anel cause the belly to swell ; the feet are bloated, and finally water is effused either into ihc chest or abdomen, winch terminates the life o£ the wretched in- dividual. The various kinds of earth (hey cat have different ejects ; the white clay, when burnt over a strong fire, is not nearly so perni- cious as the others ; the great absorbent power it is possessed of preventr. serious injury; in. tunc, however^ it operates in. unequally fatal manner; the streaked clay, containing a mixture of red and white earth, is the most speedily fatal, anel it is generally swallowed* so to speak, in a raw state, I have known negroes, who had thq craving sensation in the stomach, continue the practice for a long lime, without any visible injury to their health. They, however, selected a species of earth, which experience had taught them to be possessed of a highly absorbent quality. The opportunities I have had of examining bodies, where the subject had died from this custom, have been numerous, and fer- tile rake of example it should be made a general rule to open the body of every one who falls a sacrifice to it. The stomach is found; enlarged., the eor.ts thickened and whken- <■<.], but the glands were not in any instance that I recollect diseased. f h.,»e. preserved many specimens of portions of the stomach of such 43 subjects, in ord t to prove that the disease does not necessarily dev pend on any disorganization of this organ. The liver is genen rally paler, fheciel, occasionally hardened ; the bile e>f a thin, watery consistence ; the glands of the intestines, enlarged and hardened; the veins unusually clistended with blood, which, when analysed, was found to have proportions wry different from those pf persons in health, , In our prognosis, and treatment we must be entirely guideel by the particular circumstances which attend each case. In. those instances where there is original disease in the abdo- minal viscera, external appearances, exactly resembling those at- tending dirt-eating, arc found to prevail, and; we are apt to accuse a poor wretch of this abominable practice, when in all probability he has no itlea of it. This requires proper discrimination, and I.) be made by a professional pi-rsor. The great uneasiness caused by the disorganisation of any of dietie. viscera begets a desire to. swallow substances, that may afford temporary relief: hence most of the above-mentioned subjects resort to dirt-eating, as giving par- tial ease. It soojr grows upon Uiein, and, when combined with the previous malady, inv»rjab,fy proves fatal. When the existence of such a case is ascertained.,- the patient should be removed from every means of. pio'curing his favourite antidote, and an alterative course of mercury, with other suitable remedies, immediately en-. tered on, and persevered in for a length, of time. By this means. \ve may save the life of a valuable slave, who would-have soon fallen a sacrifice to this unhappy propensity. Whcmdirt-er.ting occurs in women, it has been compare-el to the chlorous or green sickness of Europeans. The comparison i.s quite erroneous. They have little or no analogy in reality. Green sick- ness is a compUunt, for very obvious reasons, almost unknown amongst young negro women ; and the remedy is obvious to every one, , \Yomc-n, who indulge in this dreadful custom, soon lose their monthly period ; and hence the effect has been mistaken for the cause, When the monthly evacuation ceases at the natural period, from the uneasy sensations, some ignorant Guinea women, by the ill advice of their seniors, adopt this practice, as the mode of relief, and of recalling what nature can no longer support; the con- tinued us.e of the cortfrayerva bitters, with steel elmps, occasional nnart purges, and exercise, will generally remove tiie consequences attendant on this critical period. These are preferable to the ad- 46 Hnistr-.tion of mercurial preparations, always dangerous at that lime of life. It is a common practice with negro women when pregnant to Invc small cakes of baked earth, which they eat when troubled with eructations or acidity at the stomach : They do not conceal it* but look on it as a privilege of their peculiar situation. Acidity does certainly prevail to a great extent in pregnancy, and hence the cause of their using it with seeming impunity, but it should always be strictly prohibited. The power of imitation in children is so strong, that they adopt the custom without being aware o( the effects. When children take to dirt-eatings the cause should be most strictly inijuired into, and from this alone the manager is often enabled to stop its further progress. Should it arise from a bad dis- position, if not too far gone, the subject must be made to work, and confined at night in a room, with a wooden flooring and ceiling; frequent pukes may be administered ; small doses of asafcctida, tar-water, ley-toddy, made of salt of tartar ; some give warm coiv's urine every morning till it pukes; repeated doses of a weak, warm solution of salts are s.rfe; animal food should be offered regularly, and a proper person should see that it is eaten twice daily. The other children oh the estate should be taught to hold the subject in abhorrence. I would always recommend that every one v ho dies of this practice should be opened, and the body not al-1 lowed to be given to the friends for burial, but interred in some spot, as a warning to others. The dread they entertain of this I have known from experience to work more beneficial effects than the sum of medical prescriptions. Mercury should always-be re- jected in the case of children ; the consequences are speedily fatal; there is no remedy I can specify as being particularly indicated as an antidote to this abominable habit; the prudence and experience of every planter will guieie him much more efficaciously than any medical assistance. Formerly whole gangs of newly-imported negroes resorted to this custom with the most fatal consequences, particularly those of the Angola country. Novv-a-days it more fre- quently originates from melancholy, revenge, obeah, dissatisfaction, unhealthy climate. In such instances'all our efforts are unavailing; the subject obstinately refuse* to confess his propensity, and sinks in spite of every assistance afforded him. Change of r.sid- the assistance of those who foi'iri too numerous a body, by promising to perform a ejuiek anel certain cure. Strong astringent injections from the first,- pills of mercury, so as to in- duce salivation, constitute their chief means of relief. The patient, creading detection, keeps at his work, though labouring under the greatest debility ; and too often it is not until matters have gone beyond any remedy that the'trife natiive of the case is disclosed. Negroes have a pernicious custom of constantly handling the parts, which, when joined with tlie ilnnalaral length of the foreskin in many of them, causes severe inflammation, that ends in adhesion, and prevents cleanliness, of all things the most requisite in this disorder.* Many negro boys have a trilling habit of pulling forward their foreskins, and even of tying knots on them; At that early period little injury is feltj but, when the genital organs arc developed at * As to the practice of circumcision, it is without doubt a most abominable and indecent custom, and only fitted for the vilest and most detruded of ov: species. Many defend it on the principle, that in a warm climate die />,-« shin is .loIitraH;/lunger, and requires hmphtntion; the fit-* is unfounded i n'l cadd on'y have ori::inHtwl irom the mqst. partial observation. Those acquainted with' tlic mere cIcu.tks of piysiology will agree -.utl. me in saying that it is injurious to the work 0. propagmuori, and ot course contrary to nature. If it vt-n- to b*» rrac ti,ed in a warm climate on the eighth clay, as the Jews do, cases of locked iiw wopM- more frequently happen : This is not the only instance where phv4c{d fact ■" at variance with the numerous and superstitions preiu.lV-s 0f r)'ur i n, ?,'*j ■•pecies. m puberty, thickening and contraction are found to have taken place to such a degree, that the skin cannot be drawn further back than the point of the penis. When young negroes have connection with women in this situation, irritation to a great extent follows; a Constant discharge from beneath the foreskin takes place, and, being unable to reach the parts frorii whence it originates, ulcera- tion and sores to a great size are formed, with a general inflamma- tion of the" gliths penis, Which, unless speedily obviated, terminate in mortification; This diseased state of parts is Very often met with in negroes, and theV generally entertain such ali aversion to any operation^ that we are compelled to insist on its being done. ,A simple incision in many eases will prove sufficient; at other times circumcision is absolutely necessarv. Introduce a director; and, with a pair of sharp-pointed scissors, at once divide the foreskin to the extent required ; thdn, with a scalpel and forceps, cut round each side; the frae-niim prccputii Heed not be divided: When the bleeding ceases, the skin should be retracted, the parts carefully cleansed, and any sores dressed with tincture of myrrh and lauda- num, then replaced, and dressed with a piece of fine rag, spread with Cerate dipped in a mixture of myrrh duel laudanum; the penis is to be tied up with a bandage); the urine to be made seldom; the second or third day rnatter will form, and considerable swelling ensue; bathe the surface with warm milk and water, and nature will soon perform a cure. Many negroes ■ entertain a most destructive opinion, which is of African origin, that, by having connection with a sound Womair, they will get rid of the disease; the consequences of this idea are seriously extensive, and therefore it should be made a general rule, jand strictly observed, to keep such people in confinement, in se- parate rooms from the women', during the period of their euro. Treatments We should keep in mind that when the infection has once taken place, it ought to have its natural course, and that the only thinp-s .to be dreaded are gleet and strictures. It is the practice of sonic; who aim at popularity, to attempt tbe "cute at its first appearance: Hy stimulating and astringent injections the discharge is often speedily suppressed; but the consequences are such as should make us cautious how we trust to its efficacy. Injection of sweet oil and laudanum, eclcj washing of the part*, 9 $0 gentle purges, mucilaginous drinks, ochru-tcn, barley-water, cashew gum solution, with milk, young buds of the cotton-tree, the zeze« gary, &c. Many order nitre-tea, when there is heat of urine, which is erroneous, for it not only increases the quantity of urine, but also the irritation on. theinflameel or ex cor kited urethra. Sit- ting over the steam of warm water, frictions of camphor and opium, with sweet oil__these are necessary at this period. If there should be swelling of the penis, anel also in the groin, cold poultices, mixed with sugar of leael or nitre, are, to be frequently renewed; a suspensory bandage to be worn, and perfect rest; an opiate of fifty drops of laudanum, anel an ounce of camphor mix- ture at bed-time; the use of mercurial ointment to these sympathetic swellings in the* groin is not advisable; cold applications are much to be preferred. After the running has persisted for several days, and the thickening matter and inflammatory symptoms abated, we must alter our plan, anel have recourse to local stimu- lating remedies, in order to prevent the formation of a gleet. Those recommended in the article injection (see forms of medi- cines) may be tried ; they must be thrown up at least six times daily, if we arc to expect any service from them ; great attention should be paid to this operation; it should never be left to a patient himself, unless he has had much experience: We may order day after day the strongest injections, and be surprised that they produce' iio change; the cause will uniformly be found to arise from the care- less manner in which they are usetl. The patient, with the thumb and two fore-fingers of* both hands, should hold the penis in the position of half-crcction, gently stewping, and tlie operator, ap- plying the syringe steadily, throw up the contents. A sense of coldness near the seat of the rectum will tell tlie patient if the liquid has gone up properly; it should be retained a few minutes before urine is voided. The balsr.m of capivi twice daily, the Ca- nada balsam, pills made of hog gum, lime-water, a pint daily, with cashew gum solution, are usually joined as internal remedies, and with good effect. It is seldom this disease resists the continued application of these remedies very long, otherwise we may begin to suspect the existence of a previous infection, the formation of stric- tures, or a general bad habit of body. In the latter case, the Peru- vian bark, the Lisbon diet drink, stomachic medicines, cold bath- ing, frequently changing the nature and strength of the injection^ or a nuld alterative course of mercury, with op'm- and camphor, 5\ should be bad recourse to, and continued for some time. If, fwom mucus mixed with blooel, and the urine being passed irregularly, we suspect the presence of strictures, a small-sized bougie, ;meared with sweet oil, should be introduced, previously bent to the shape of the passage, and held a few seconds before the fire. No force rnust he used; the patient placed against a wall in the standing posture, the body gently bent forwards ; he is very apt to faint if it be. the first, time a bougie has been passed; this must be guarded against; if no resistance is experienced, gradually press until only an inch is left; keep it in that state three or four mi- nutes : Jf, on withdrawing it, indentations are perceived, or it is twisted and bent back on itself, the existence of strictures is indi- cateel ; but there are so many sources cf fallacy, that the opinion of a professional person should ever be recjuired. The spasmodic state e>f the urethra and neighbouring parts will often excite violent spasm, so as to prevent the passage of any cub- stance; previously injecting a solution of opium, sitting over the steam of warm water, are necessary in that instance. Sometimes the introduction of a bougie for a few days will remove all dis- charge, and any tendency there may be to the formation of stric- tures. The bougie should never be passed quite into the bladder, • after the first trial to ascertain the seat of the disease, but only carried a small distance beyond the stricture, anel worn for half an hour at each introduction; the size must be gradually increased, but not too rapidly; the practice should be persisted in for a length of time, and, if the least return of obstruction again appeals, a re- newal is necessary. When, from the long duration of the disease, even the smallest bougie cannot be made to pass, the caustic one is our only remedy. It would, however, be improper in a popular work of this nature, if I mentioned any thing regarding the appli- cation of this powerful, but dangerous, means of relief, which should never be entrusted but to the hand of the most skilful. When' the in- troduction of a bougie does not indicate the presence of stricture, a long course of remedies has produced no visible effect, anel the patient's health is declining from a constant watery discharge or weeping, attended with revere and constant pain of the back, we may safely infer that the disease is not altogether of a local nature, nor to be treated by load means. There is a remedy, which acts both in a constitutkmal anel local manner, z;u\ although not much em- ployed in this part of the world, has been proved, bv the cxperi- U 2 .no once of the ablest practitioners, to be a safe and efficacious medi- cine, wh.cn prudently administered, particularly in gleets of long stiindiii'T. It is the tincture of cantharides, which ought always to be used as prepared by the London apothecaries,' merely from its uniform strength. Fifteen drops of this may be given three times daily in cold water, and gradually increased to half an ounce in the day: The moment any heat or irritation in making water is perceived, it must be stopped for a time, and if necessary renewed afterwards. If the tincture of steel, Peruvian bark, and other stomachics, are combined, and we are not anxious to augment the dose too ra- pidly, a change will soon be evident in the general state of the sys- tem, and the discharge will rapidly diminish. The extent to which I have seen this drug given in England, anel the beneficial results, from very great experience, enable me to speak in the most decided manner as to its superior powers, anel to regret that so lit- tle advantage has been taken of it in the negro practice of this, island. I will enlarge on its utility when treating of ulcers. Ex- coriations anel superficial u'cers on the glans are frequent conco- mitants of gonorrhoea ; when alternating with swelled testicles, anel a renewal of the discharge or intermittent fever, strictures are al- ways the cause, anel these must be removed before they will yield ; otherwise a solution of opium, calomel, and lime-water, or any a-tringent application, wiil bo sufficient to perform a perfect cure___ In women the disease is of a much milder nature, and frequently confoundetl with leucorrhcea or •whites. Astringent injections, lime-water, cold bath, &c. arc proper, but, when the discharge docs not proceed from any organic disease of the female parts, the tincture of cantharides will restore the natural and healthy action. The means recommended to restore the strength of.the digestive organs are requisite here; a Burgundy pilch plaster, or one of hog gum to the back, a tight bandage worn round the loins, w ill prove serviceable. The early sexual inter- course women have in warm climates renders them* liable to this obstinate complaint, which is not unusually followed by a prolap- sus of the womb and schirrus, with abortions. That form of the u-ncrcal disease, attended with chancre and buboes, is extremely rare amongst negroes; indeed, I have the testimony of some old experienced practitioners in this island, wherein they mention that during the course of many years, they could not remember ever 53 having seen a case of it. Late experiments at home render the use of mercury extremely doubtful in cases of chancre. We should never proceed to salivate a patient, who has sores on the penis, without regular advice. The' simplest soothing applications will, in a few days, change the character of an angry-looking sore. DISEASES OF THE EYE. Ophthalmia or inflammation of the eye is not uncommon, but seldom equals in severity the dreadful forms of it observed in other warm climates, It comes on with heat, pain, redness, intolerance pf motion and light, a copious discharge of a watery humour, that is very acrid, and excoriates every part. Febrile symptoms occasion- ally are present. The swelling spreads in every direction. The eye-lids arc ©edematous, and prevent us from obtaining a view of the eye. If only one is affected, it generally happens that inflam- mation succeeds in the other. As this proceeds, a secretion of a purulent-like matter takes place from the surface. The agony of the patient is extreme. Jf we can at this period obtain a sight of the ball of the eye, the part usually transparent is muddy, or co a creel with small white specks, that denote the commencement of suppuration of the cornea, which allows a portion of the iris to protrude, and thereby obliterates the pupil. When we have not been able to see the eye-ball till the inflammation has abated, we arc often astonishcel to find a substance protruding, of a dark co- lour, to a greater or less extent. Such a termination is generally attended with total loss of vision, and requires immediate surgical assistance. • ' ' Treatment, In plethoric constitutions, and when the inflammation runs hi*rh, bleeding is requisite, either from the jugular vein or temporal arte- ry} cr ty' cupping the temples; the latter is to be preferred. If we can see any enlarged blood-vessels on the ball of the eye, they should be divided. An active purge is to be given, and repeated eyery second day. Washes of a cooling and astringent nature are 51 to be freely urcd, as v.kite vitriol, sugar of lead, of each eight "rains, three wine-'dasafuls of water. The patient to lie on his back, and apply it to the eye by means of pieces of linen yp.it. Alum, half a drachm, Mindc'renis' spirit, half an ounce, to be mixed and freely used. Weal: spirits and water, or vinegar and water, are also proper; the alum poultice, made with the white of eggs or milk, wrapped in linen, and frequently renewed ; where pain is severe, forty drops of the vinous tincture of opium should be added. Its in- ternal use wifhajscvbe of service. The alternate ujse of hot and cold replications has succeeded, when singly they give no relief; when there is great p.ain of the head and continuance of the in-. flamrnation, a blister to the neck, one on each temple, or behind the cars, and k< pt discharging by some stimulating "dressing ; when the chronic state supervenes, the vinous tincture of opium, cold-bath, and all local strengthening'medicine-, may- be fV-eeiy used. After the termination of ophthalmia by ulceration and protrusion of the iris, opacities of the cornea arc most to be dreaded. When films ensue, as a consequence of injury done to the front of the eye, thev are much more easily removed than those that arc the result of inflammation. (foulard's water, mixed with white vitriol anel blue stone, according as the case may require; finely pounded glass, with salt or alum blown into the eye; two grains cf corrosive sublimate to a wine-glass, or come of lunar caustic; the speck to be touched with this three times daily by means of a fine camel hair pencil; a few drops of the juice of the ivild celandine or parrot- weed (bacconica fivUseais), is a favourite country remedy, and, J*'om many trials I have made of it, seems worthy of confidence. The, gall' of fMi and of others dropped into the eye is greatly spoken of. It causes great uneasiness at first, which soon nbctes." It appears to act in the same manner as a weak solution of lunar caustic. Whcn.opacity is the result of previous diseased action, our hopes of cure are much, less certain ; the morbiel growth- requires to be removed bv the knife, or diyidmg-thc blood-vessels goin<> to it. The coals of the eye become'greatly'relaxed, and the strongest astringents necessary. Tlie solutions of lunar caustic and corro- sive sublimate must be increased in strength, according to the feel- ings cf the patient-; a piece of the former, pointed and hold to the spot for an instant, using immediately sweet oii to prevent undue irritation, is a powerful remedy. The natives, in cases of ivfeafc relaxation, apply a diluted infusion of the strong binJ-r,ciWr 55 They have a variety of juices-from varioils plants that are in great esteem with them. In obstinate cases we should never refuse the trial of them, but our artificial preparations are much rather to be depended on. In consequence of ophthalmia anel other causes, there often grows from the internal angle of the eye a preternatural ash-co- loured triangular membrane, thatsjrailually extends over the trans- parent part of the cornea, and impedes vision ; it is called a ptery- gium. The point of the triangular plexus of loose vessels is always directed to the centre of the cornea,' the complaint is common amongst negroes, and attacks both eyes; if neglected, it increases to that extent that vision is nearly lost. The number of invalids from this cause is immense, wherears, if taken in time, and the morbid growth removed by means of the knife, the patient would experience but little inconvenience. It is the duty of every one, when such a formation takes nlace, to-call in surgical assistance. LOCKED JAW. This horrible disease, proceeding from the most trilling causes, carries off many valuable negroes. I do not believe in the common opinion, that the African race is more obnoxious to it than Euro- peans. It is more frequent with them, from their being more ex- posed to the exciting caa.ses, as cold, wounds of the feet, splinters of -wood, &c. When the disease originates from wounds, it -generally shows itself about the eighth- day, and with a gradual aggravation of the symptoms. Wrhere the cause appears .to be exposure to ce>ld, or some discharge suddenly suppressed, the symptoms invade much earlier, and with more immediate violence. These are so obvioiu •;s not to require any description. A few years ago I published in the Fdinburgh Medical Journal the result of several cases of locked jaw and trismus nascentium, with a minute description of the appearances on dissection. Since that period I have not omitted any opportunity of continuing the in- vestigation, and have been enabled to axM the result of several other rnorbid examination?, \vH?h have in a <±-'eat mvji-r.irc confirmed iriy former statements, 56 Whatever mtiy have caused the excitation, the deranged actiori is quickly propagated to the origin of the nervous system, and there creates an accumulation of bloexl, followed by extensive serous effusion on the surface of the brain anel spinal marrow, mixed with poag.ulable lymph, iiulicating the presence of previous inflamma- tion;, tlie functions of the nervous, system are speedily interrupted} and followed by the mOst alarming anel fatal symptoms. Such morbid changes I have uniformly found to prevail in a greater or less degree in every case that I haVe examined, and, although our hopes of cure are diminished, the mean's of relief are of a more local nature. The greut practical distinction necessary to be kept in view is whefe the disease is the result of cold, or is caused by extensive la- cerations and punctured wounds. , In the former carie our plan of cure should be continued with the greatest energy* as oitr hopes of relief are much more certain-. If the patient is strong and plethoric, anel has been attacked after exposure to cold, preceded by drunkenness, blood to a consider- able extent is to be drawn, and repeated if necessary, judging by the state of the pulse; three grains of opium with twentv of cam- phor, made into pills, may be swallowed ; in two hours a strong drastic purge, followed with a clyster of asafcctiela and Glauber's ?alts. If the spasms are severe, and invade suddenly and generally, no time should be lost in administering the cold affusion. Strip the patient, and. suddenly dash a pailful of water over the body, rub him dry, rind eiideavtfur to induce a copious perspiration; one hundred drops of laudanum may be repeated with brandy strongly spiced ; if tjie spasmodic state of the abdominal muscles" is severe, frictions with oil, turpentine, luuekinum, and camphor, should be long and sedulously persisted in ; they are attended with the Great- est relaxation of every symptom; Cupping along the back part of the neck; an extensive blister should seldom be omitted; warm fomentations to the feet, cataplasms of pepper anel mustard," mixed with an ointment made from the juice of the dumb-cane. It is in this species of locked jaw .from cold that affusion of wa- ter is of the most essential service. It may, at the commencement, be repeated every two hours, and is usually followed by a relaxation Of the spasms. My worthy friend, the lute Dr. Wrfoht .rave me fnany solutarv directions as to the Use of the cold oifosion ** It «-,d latterly his particular desire that it should more especially betru tcj $7 io in cases not originating from wounds, and .be. combined with cv?rv other remedy. Brandy mixed with strong mustard is an excellent sudorific. Immediately after its application, repeated and luge doses of camphor, dissolved in a small quantity of spirits, pills of strong-Cayenne pepper, mixed with concrete salt of-harts- horn-and wild cinnamon, will promote that state of activity and perspiration that often proves critical at this stage of the disorder. Ether, hartshorn, and sweet spirits of nitre, may enter into the list of remedies. Musk and castor, formerly so much boasted of as pow- erful antispasmodics, are-of little essential service in any disease. This I can assert from many experiments made on the healthy subject. Strong and repeated drastic purges have been highly recom- mended by an eminent physician as a specific in locked jaw. Sug- gestions from such authority extend their influence in a vapid man- ner. I have therefore in a former publication endeavoured to show that the worthy gentleman has mistaken cases of spasmodic iileus for tetanus, anel these arising in a cold climate. Often have I seen pills made of scammony, gamboge, calomel, and jalap, ex- hibited to such an extent, as to deter others from their further use, when a few grains cf opium, or a clyster of asafce'tida and castor- oil, with laudanum, would cause them to operate in the most vio- lent manner, after they had lain long in the bowels without pro- ducing a single motion. It may appear singular to say that opium will act in this man- ner, yet when the intestinal tube partakes, of the general spasmodic state of the system, it will be found to be quite indispensable, so afi to secure the operation of the simplest cathartic. This-fact should never be lost sight of by those who administer active pkrgatives in such cases, and the remark will be found to hold good in all ner- vous disorders, especially the dry belly-ache, when it attacks white subjects, as also in many inflammatory affections. Opinm, wine, and other stimulants arc the remedies we are to look to with the greatest confidence. The extent to which opium has been given is wonderful, anel appears more so to those who know its violent effects on the healthy body; half an ounce of laudanum has been given at once, and as a first dose, with a re- petition every second hour, and the patient has recovered. I once saw a elesperate case, where a hundred grains were given every Half-hour, and without anv visible effects worth mentioning \ the H 68 quantity when great does not certainly produce a proportional effect; wc must regulate its administration from very eareful ob- servation; two or three ounces of strong rum* brandy, or wine, should be given along with it; hmdarium? tvi ii is prepared on most estatt&j must never be trusted to, the strength is so various; if we cannot get the solid form to be swallowed* the aqueous Solution al- ready alluded to should be given without delay; it may be pre- pared as we want it, and with a less quantity of water thrin usual, aelding brandy* in which camphor is dissolved, with other stimxi- htnts : The most beneficial- effects are felt from uying it jusj. after the patient has tried tire cold affusion, as it is most hkely to excite that salutary hcnt which cftcn resolves the spasms. Much discre- dit has of late been attached to the colel affusion, and which has indtccd : ome practitioners to lay it aside altogether; iis injudi- cious application? ratlic'f than tlie remedy itself, has been the cause pf this-, and such has in general betn the case with every means: of relief of a popular nature;-the numerous instances on record, where the disease was put are tiotj horrcwr, on this accouiH to intermit cur exertions; tlioi to may coincide with the secret workings of nature, and accelerate her progress; and, if they arc in opposition, her efforts will prove a barrier sufficiently strong to counteract their baneful influence. Many experienced practitioners ad\iac the immediate use of, mercury in idiopathic tetanus, or vyhere it docs not arise from ex- ternal' injury done to the body; the effects are powerful, but for my own part I would much rather prefer it when wounds and lacera- tion of the parts have preceded the symptoms; if it is tp be given, no time should be lost; three grains or more, made into pills, with opium and camphor, or frictions with the ointment. Many have gone r,o far as to give a scruple of calomel every day, with the view of exciting a rapid salivation, but this is improper, anel induces the mo: t alarming consequence. The life of the patient is not out cf ci ;nt each dressing the foot or injured member ■soaked for ten minutes in water, as warm as can well be borne; hmk and wine are.-to he administered freely, with food of the vno«t nutritious qurdicv. so as to excite tlie general and healthy action f '- 11 2 Go o fthe system to. the formation of an early suppuration. Most per* s/ms are contented with this mode of proceeding, and undoubtedly it is productive of the greatest advantages, saving the lives of many individuals : Still, in every case that has-been entrusted Jto my care, I have invariably made it a rule to add the general and powerful effects of mercury, combined with. opium anel camphor, and, ac- cording to .the general mode of medical reasoning, every confidence may be placed in its active assistance. When the fleshy parts arc much bruised and lacerated, attempts by stitching and adhesive bandages to induce a union by the iivn\ intention, as surgeons.call it, are in general nugatoiy, if not da - gerous. Wash the par*.-, free from all sand, &c. and replace then., if possible, in their nature! situation, using freely a mixture oi 'op's ai and oil, a dressing of fine lint; the next day, if from appeal: ices there is no prospect .of saving the injureda^fostance, iiiinc^'i the wound be in what is termed a green state, a.large pouli.:: , as al- ready mentioned, with fomentations, will be reqimitc. maternally opiates, bark, and wine,;, .the natural efforts of the coniitution will often restore extensive injuries that at fit.t sight stcmed he»pe!ess; judgment, therefore, on every case should only be passed by those whose experience authorizes.it. Hitherto we have enly considered the prophylactic plan: A much more serious affair presents itself; when the symptoms have actually invaded, the wound must be examined. What we have most frequently to complain of is a total want of inflammation and suppuration in the part, and every effort must be used to indues this in as speedy a manner as possible. A strong solution of lunar caustic, corrosive sublimate, or butter of antimony, must be applied to the wound ; if cieeo, a piece of lint dipped in the same, and pushed up with a probe; let this be suc- ceeded by the warm bath anel fomentations, e.r, what ;s still better warm oil, then a large poultice with turpentine, adung bruised peppers, mustard, to be renewed five or six times can;.-, pincine the leg in warm water after each removal. ' Mercin / must be immediately commenced, and our i/.most endeavours "exerted to excite a rapid salivation, frictions with the ointment, if th? patient cannot swallow pills, anel even stronger, preparations, are requisite •'* * Connive sublimate, one gram and a half, mate into four tf\h, ui,h cr-ri end camphor, and taken during the day, using r.iso .nercuriai frictions- wh^ fpcedy salivation is required, mercurial fumigations are advisable U°nS' Wtle* ... Gt, opium as before advised to a great extent, with camphor dissolved in brandy or rum. When opium produces unpleasant consequent ( s, iroin tlie extent to which it is given, camphdr will be found a most valuable substitute; a scruple, dissolved in a small quantity of spirits, may be taken every third hour during the day, folding narrowly its effects. Ether and other stimulants can be added,, as they are indicated. Our chief hope rests on the relief to be "ob- tained from the warm bath. • The patient is to be put into if np \o the chin, and kept there from ten to .lAecn minno.1--., and to be re- peated according-to the urgency of the convulsions, rubbing the bedy for a .length of time after each t eeratic n ; bark, wine, highly nourishing diet, must form a ncces.sury part in the treatment. Some years ago an .American physician imagined he had elisco- vcred a certain antidote in tincture of can'Ja ii.us, given in lu'rge doses, but, like most ethers, it has been fennel useless. Ine.erei ;t is a melancholy fact in the history of disease©, that the r.oie nu- merous is the list of-remedies, the less confidence is to be placed in apy of them. When the form of tetanus is of that nature as tj allow the subject to survive die fifth day, we fondly attribute his re- covery to our anxious interference, and celebrate the wondc-iful virtues of some particular drug-as a sovereign cuie in every case that may happen hereafter. To combat such assertions wou.d be the height of folly. They only afford a repetition of numerous instances, where nature is deprived of her proper merit, and these pretenders know full well that she is of long suffering, and in- sinuates her claims by no boisterous acclamation, otherwise thousands would every day be made to blush for their insolent ar- rogance. W O II M S. Of all complaints this, is the one the planter should make him- self most completely master of, from its varied appearance, fatalitv and being so much under his power by judicious management. It has been very properly observed that there is not one symptom, with which the animal economy may be affected, which worms~are not capable of exciting. To attempt a description would be im- Gfe possible. I shail enly mention the mode of attack at different per vunh of life. Negroes at a very late period cf life are much plagued wi'.ti them, though scklora dangerously. I have known many'cases where tluw seemed to be habitual: They are generally vomited, the per- son feels a- gnawing acntc pain it the pit of the stomach, and can tell from experience the cause of his sickness. Indigestion and an irregular s-tate of die bowels are constant attendants. The taenia or tape-worm k not imcemmon in adults. It is more generally pat set downwards than by vomiting, anel not suspecteei until some portion appears. I remember a singular case some years ago, where, from the anomalous symptoms, T judged that worms in the stomach were the cause. After giving some sweet oil and turpen- tine, the patieut was instantly seized with the most extraordinary feelings. She vomited, and discharged nearly three feet of the worm. By using gentle means the whole was extracted entire, anel it measured three yards in length. In children we may suspect worms when there arc indigestion, irregular watery stools, griping, frequent vomiting, foetid breath, dull, bloated countenance, pot-bellies; in those of a fairer com- plexion the dark ring beneath the eyes may be trusted to, sleepi- ness, and at times voracious appetite, anel the food taken passed quiekly. When the proper remedies have been omitted, the worm fever ensues, and in the strangest forms, so as to deceive the most experienced. Dry, burning skin, delirium, tossing, breath lessness, wit!) cough of a peculiar sound, violent vomiting and purging, though oftent»r- constipation, symptoms of pleurisy (which I have already alluded to), convulsion fits, and various forms of tetany. it is no criterion of our opinion being erroneous that worms are not passed at the time we give the remedies. The action of anthel- nienthics is very capricious. It may be weeks before any are voided. I have known infants not more than six weeks old pass worms. The u ode in which worms are generated in the body is still mysterious. The quantity of viscid vegetable food favours their production. Many suppose the ova are contained in these sub- stances. The Foolas, an African race, and those around the Cape of Good Hope, attribute the frequency of tape-worm amongst them to tlie gr-eat use they make of a milk diet. Negro children art :mr?e>kd, by their mothers with milk, and this too when they are fa? advanced, and the nouii^nment is no longer fitted for the body 63 (such a practice I have no doubt is a cbrrmfon 'caiise of worms, an?'. is one amongst many other reasons why we should insist on then Weaning their children at an earlier period. The prognosis in thi- compluiut i.s so deceitful, that the trfost extensive experience fails u& in our jud$irreftt. When purgatives pass through at ail earl, period, hud any worms are voided, the patient is Safe. If ail the symptoms indicative of worms subside without any beinc evacuated, the person will have a relapse *oon, or die -suddenly. If vermifuges ■pftt a Stop to dmrrhfl&a And fever, trie rehniiinticii tvill be favour- able. Those tli&t have fits, but void no wwras, die suddenly. Sleepi- ness after Worm symptoms and great yawning denote disease of the head, ami is always fatal; pot-bellied as they are called, with- out other sigffis of worms, arc not inlhllible precursors. Many no- gro children wlso have naturally this appearance enjoy the best health ; it disappears as they ailvaivce in life.* - If, after a course of medicines, symptoms of internal commo- tion ensue, without a favourable discharge, unless nature be assisted by further remedies, the patient will die suddenly. Chihlren seem- ingly irt the best health will be instantly Seized with convulsions, and expire. Worms will erawl out after death from the month and rectum. I am quite at a loss how to explain th6 fatal termination in manv instances from so simple a cause in appearance. I have opened the bodies of many who have died of wormy complaints, anel found hot the smallest approach to diseased structure in any part. As an exception \o this remark, I must mention the result of several dis- sections of negro children, where, from the great degree of tlro\Vsi- ness arid other -symptoms, disease of the heael WAS indicated ; water was found ih bo'usiderable quantity iii the ventricles, and flowed also from the spinal marrow. The effect of long continued irrita- tion ih the intestines induces ibis chronic hydrocephalus, whieh I shall show, when speaking '-f water in the liead, carries off Many more negro children than people are at* all aware of. Masses of these animals have been taken. ou*t alive sixteen hours' after death.. The mesenteric glands are scarcely ever affected. When the sub- ject has-complained long, and been greatly reduced, the ventricles of the brain were filled with water. This i-i what might have been expected from the long continued irritation in th? bowels, and it k "* Wlnterijottcrdj on tiid Eareict ol Africa, vol. ?. 64 n mode of termination that we may always look for in the diseases of children. ' s Treatment. In adult persons, as vermes are usually loelged in or hear the stomach, a vomit should be given as soon as any symptoms appear. Gamboge th'stle, a drachm of the seeds; expressed juice of the reel-head or bastard ipecacuanha, three tea-spoonfuls; blue vitriol, twenty grains ; a pint of water; a wine-glassful every ten minutes, till it operates; afterwards a purge of six grains of gamboge, twenty of aloes or calomel and jalap, and cream of tartar. When they have operated, a table-spoonful of pure spirits»of turpentine; two of sweet oil, with molasses, should be given ; the expressed juice of the aloes or sempervive may be substituted for the oil, drinking freely of strong eontrayerva bitters, vervain tea, and lime- water, which acts chemically on the mucus in which they are in- volved. If, no benefit is derivetl from these medicines, the vomit may be repeated next day, with a strong purge, then castor-oil and sempervive juice, with decoction of worm grass. The,moat serious mistake arises from abaneloning the use of these remedies too speedily; we lose hopes, or conceive our opinion, to be erroneous: Now the action of anthehnenthics is so uncertain, that we never can promise relief from the same one in two successive ca^es, and great part of cur success will depentl in varying these in every pt^sible form. Negroes troubled with worms in the stomaelr have an idea, which is of Afiican origin, that the strongest spirits drank in an undiluted slate will operate a certain cure, I have known-more than one case, where sudden death was caused by an overdose be- ing taken from the anxiety of the patient to get rid of his unplea- sant feelings. Many Africans consider it as a sovereign remedy for every complaint, and it is privately given in their most acute disorders. Children are troublesome patients; the degree of feverish- rest- lessness and irritation excited prevents them taking the medicines we wish, and in proper quantities. When tlie sympoms seem miouii- vocal, with irregular fever, a gentle puke of ipecacuanha, cr a miid solution of blue vitriol, as1 already directed, will be of advantage. Cowiteh, with a few grains of calomel, for three night-, aelding tlie sempervive juice, if they will'swallow it, then- nut-oil or emul- 65 sion of the seeds, will often bring away masses of these animal?! The worms in children arc of the smallest kind, anel lodge in the' lower part of the intestines; clysters are therefore indicated; a table-spoonful of turpentine, one of nut-oil with table salt, or a so- lution of aloes, in warm water, sweet oil, three spoonfuls, Epsom salts, a spoonful; to be thrown up very gently, and kept up by means of a cloth for ten minutes; ':Iiis last direction must not be omitted ; the materials have time to operate, by being directly ap- plied to the parte, and the superior intestines are affected sympathe- tically ; when children are cror,j, frictions of turpentine, mixed with the sempervive juice, and rubbed for a length cf time on the belly, generally produce several evacuations in three or four hours, and this will be found a very valuable method of introducing pur- gatives, when causes prevent their being swallowed; the frictions must, however, be long and gently continued; it is much med by savage nations, and is worthy our imitation; the negroes are en.• ceedingly fonel of it. When the disease is attended with fever, warm bath, fomenta- tions to the belly, large, coarse aloetic plasters to the stomach, small blisters, cataplasms, injections of turpentine and laudanum, a few grains of salt of steel, with two or three of blue vitriol, have been found efficacious in such cases. When the small' worms are voided, lime-water with salt and asafoetida forms a good injection; mixed with milk, it is good as a tonic. , ,. ■ . I once tried the effects of cowitch mixed, as I thought, with plenty of mudikige, as an injection, in a ce.se of ascandes. Though manv worms were voided, the poor child was so much tortured for three or four hours afterwards, that'I heartily repented of the experiment, and have never ventured on a repetition of it. I have seen tincture of steel, powdered tih; mixed with molasses, pink root, have excellent effects in expelling worms, when cithers have: failed. To the planter the most important consideration is the preventative means. On this he cannot bestow too much atten- tion, and the numerous deaths we every day witness prove too clearly the negligence of those who are entrusted with the care of th-in. A spoonful of cowitch, followed next morning by a dose of nut-oil, given once in a fortnight, occasionally once a month, is the general mode of using worm medicine as a preventative on most States, The iuefficacyof such a mode of proceeding could easily be I (Xi pointed out, an.1 tiie dangerous results proved from the numerous deaths that happen on properties where it is accustomed to Ix.- given with the MvaU's! regularity; the increased quantity of mucvus with which the internal coats of the intestines are lined, augmented by the viscid nature of their daily food, cmses an accumulation of matter that protects and favours the development of the nidus of the worm in a remarkable manner. A spoonful of cowitch mixed with molasses, and given once a month, when diffused over so large a surface, offers but a trifling antidote, and will generally deceive the expecta- tions of such as trust the lives of children to its operation. Itr. administration should therefore form a part of the duty of those who have the immediate management of a property, and be as regularly attendcil to as the return of apparently more import- ant concerns. At present on many properties I know it to be utterly neglected, not so much from indolence as from a conceived contempt of its advantageous consequences; and, indeed, considering the nume- rous deaths that happen on estates from worms, where the medicine is given in a partial manner, they have some foundation for their opinion, and it will continue to prevail unless more active measures are adapted. In addition to its being generally given, those subjects should be selected, who seem more predisposed to generate worms by their weakly habit of body, and being 'ilffed. With them the remedies must be longer continued, and in larger quantities; their evacua- tions particularly attended to, and a diet of animal food for some time. In judging of the presence of worms, we arc not altogether to be led by the enlarged state of the belly, for it has been remarked that many negro children have at an early age a prodigious en- largement ; they do not attribute it to worms, nor any internal disease; no attention is paid to it ; as the subject advances in life it gradually disappears; a person in the habit of seeing children in a naked state can readily distinguish this affection from the swelling that takes place as a consequence of worms ; in the former it is lower down, to the feel soft anel yielding, the skin is of a heal- thy appearance, and there is always a strong curvature in the lower part of the spine; in the latter the tumefaction commences from the pit of the stomach, and in general all over the abdomen ; it is reuse, i'-.-ch hot, and increases much aifor meals ; the child other- fj7 wise has symptoms indicative of constitutional disease; the eyes heavy anel face bloated. As a preventative plan I would strongly urge the following cne, which has been sanctioned by long experience as the me-t effec- tual. Every month let the children and other, negroes suspected cf worms be collected in die morning; to the expressed juice of the reel head or wild ipecacuanha a third part of molasses is to be added, being just suffered to boil, and then skimmed; from one to three tea-spoonfuls, according to the age, may be given as a vomit; it operates briskly and safely, drinking freely of beverage; the sub- jects may then go to their work, anel. in the evening they are to have a mixture of cowitch and syrup ; the spicula of six pods mav be given to adults with impunity for a dose; indeed the onanlity given at a time is generally too small, as it rarely irritates the in- testines ; in gross habits a few grains of calomel are to be added with good effect; next morning a purge of cabbage-bark is to be taken, thus prepared—two ounces of well-dried bark, to be boiled from three pints to two, strained and sweetened with sugar, from one to three table-spoonfuls according to the age; when well prepared, its effects are speedy and perfectly safe. Many entertain a prejudice regarding it from cases where it has operated with violence ; this is ownW to the peculiar state cf (he patient's body at the time, which inay happen with all purges, but oftener to its being used in a green state ; the cowitch is to be repeated for three nights, followed in the morning by a dose of oil, or the fresh nuts bruised and made into an emulsion instead of the cabbage-bark. As a general mode of treatment these directions are sufficient; we may vary them to any extent we please; the puke of redhead may be omitted in those of a. tender age, but it is absolutely necessary to the mere advanced, as the worms are lodged much nearer, if not actually, in the sto- mach : I have often seen masses vomited in a living state. For the cabbage-bark other purges may be substituted with equal atU vantage. There are many country plants that excite the action of the intestines in a rapid manner, but they are so unequal in their. effects, and the doses to uncertain, that we should never adminis- ter them to children : what will operate gently in one case will produce the most alarming symptoms in another; much likewise depend: en the time of the year and state of the plant we make vse off I 2 68 lint the remedy on which the greatest reliance is to be placed, and of the effects of which I can speak with the greatest confidence, is the expressed juice of the aloes (sempervive). It is a most va- riable laxative in cases of obstinate worm fevers in children, and operates in the gentlest manner. A tea-spoonful cf the juice to a iable-spoonful expressed from the fresh leaf, mixed with two parts of castor-oil or sweet oil, and sweetened with molasses. 1 ma: t into that callous state, that a permanent ulcer is the consequence; whereas, if timely dressings and bandages had been applied, the subject might have recovered completely. Where the ulcer discharges a thin, watery humour, the granula- tions are pale, and no attempts are made at cicatrization by the powers of the body, we should endeavour to move the. system by internal means. When mercury disagrees with the patient, or it^ use is contra-indicated, I have ever derived the best assistance from the tincture of cantharides, taken for a length of time: Of the vir- tues of this preparation I have.already made mention when on the subject of gleet and obstinate gonorrhoea: It operates powerfully in these cases, if carefully used, and not tried too far ; the like success has attended it in ulcers having the character just described. I have experienced its good effects on a large scale in one of the London hospitals several years ago, and have every reason to be satisfied where it has been tried with negroes in this island. Fifteen drops may be given twice daily, and the dose increased gradually to thirty, watching carefully every symptom; a week or a fortnight will often elapse before any sensible effects are produced ; a slight beat and irritation in making water show that the -yt-m is jrene- O 106 rally affected ; it is now to be stopped, and, if no amendment i.s per- ceived, we can renew it in a week or ten days. I have repeatedly known it continued for a month without any change in the bodily health, but ultimately to prove beneficial : At ether times, after using it for a few days, strangury anel other un- pleasant effects have followed : the utmost caution therefore is re- (.uisite in its admini-irntion, which should be directed by a well- informed person, to assist the operation ; every additional remedy is to be employed at the same time, a decoction of the country woods, bark, wine, and, above all things, the patient is to be interdicted the use of salted meats; these are too often in a putrid state, for which negroes have-a strange partiality; the diet is to be regulated, and every care taken to avoid spirits and any irregularities ; indeed, unless the strictest discipline i.s maintained with such people, our be-t-uirocted efforts will be unavailing, even dangerous : Their night rumblings and parties prove the destruction of thousands, and are only to be avoided by having them properly secured. I do not by any means approve of tbe plan commonly adopted of confining them in the stocks or shackles; it is injurious to their health, and apt to increase the ulceration, and also creates unneces- sary discontent. When, therefore, it can with safety and propriety be dispensed with, simple confinement in a room is to be preferred. 1 wish, to be particularly understood with regard to the kind of ulcer- most likely to be benefited by the medicine alluded to : They are Mich ns have a thin, acrid discharge, a pale or irritable charac- ter, and shew no disposition to heal kindly, also where there is a ge- neral bodily derangement. I do not mean to say that the tincture of cnnthaiides will promote the cicatrization of the ulcer: Our ob- ject should be to create healthy granulation, and, when this, is ob- tained, it is to be laid aside, and a totally different course pursued: Let it. therefore always be kept in remembrance, that every ulcer should be brought as quickly as possible to this state, so that we may not lose any lime m having recourse to tbe- invaluable assistance to be derived from proper pressure and bandages. INDOLENT ULCERS.— tinder this term, without regard to medical accuracy, I include all such as are of a chronic charac- ter, or that, having been previously in a sloughing or irritable state, have become filled with healthy granulations. The number of these to be met with on some estates is an object, •bo- ought to excite the most serious consideration. Negroes in the prime of life arc classed as invalids,, and exempted from wolk, when, by proper applications, they might be made of permanent service to their owners. From what I have observed, I cansot help expressing my senti- ments regarding medical practitioners; they are certainly a great deal too negligent in their attention to this important branch of their profession : The interest of those that employ them is their primary object, and they never can forward it more effectually than by regtnarly inspecting such as are laid up with sores. Experience will teach them to pronounce iu a summary manner as to the na- ture of the dressings, which may produce the greatest benefit; anel the simpler these are, anel the more they accord with the ideas of the negroes, the greater will be our success. Some look on this department as beneath their notice, and only fit to be entrusted to old women and nurses. A medical man, sincere in the desire for the advancement of his profession, would never regard 'any trou- ble that might, ensue from attendance to these numerous cases. .. Negroes have an idea .that no remedy will heal their sores, un- less they are allowed to have their own way : In general they have po anxiety to heal the ulceration, and continue to dress with some favourite bush for a length of time. In some instances the sore fills up with a broad, superficial, tender skin, the leg acquires a thickened state, and the disease breaks out with tlie slightest irrita- tion : They dislike all bandages and adhesive dressings: The greatest impediment to success is this prejudice, which is universal, and renders.it necessary for some confidential person.constantly to superintend them : They are also too. fond of washing and rubbing their sores, leaving them .exposed-for a length of time, or partially covering them with filthy rags, which adhere to and increase the ulcer. We should always,-if possible, endeavour to prevent an. ulcer healing by a broad, superficial cicatrix; the leg gets permanently enlarged) and a return of the disease is inevitable, rendering the person an invalid for life : How many objects of this description everywhere present themselves to our view, who otherwise enjoy good bodily health,, and our regret must be increased when we know that most of them might have been prevented or cured, had judicious applications been tried in time? The plan of treating ulcers by adhesive plasters and bandages, as recommended by Mr. E'aynton and other surgeons, 1ms been 108 justly called one of the greatest improvements in modern surgery; It is somewhat singular that so few have availed* themselves of its assistance in this part of the world, especially for negroes, who fur- nish numerous and obvious ewes, where it might be employed with ihe best effect. I do not know of another occasion in any depart" ment of our profession, where more certain means of relief could be held out than what are offered by this simple improvement, and those, who feel anxious for the reduction of the enormous list of such as are invalided from sores, cannot possibly have tliCT* views more completely forwarded than by exerting every endeavour to get it carried into the most perfect execution. If this were to liecome general, I have no doubt but that in n short time we should have the satisfaction of seeing thousands re- stored to such a state as to enjoy the blessing of health, and prove of service to their masters. Instead, therefore, of pursuing any longer the present method of simply dressing and keeping clean ulcerated negroes, and allow- ing the process of nature slowly to effect a filling up of the parts with a broad surface, when once we get a sore into a healthy, quies- cent state, and the surface equally elevated with the surrounding parts, we ought to bring the edges as near to each other an possible, so as to diminish the extent of ulcerated surface, and imitate the natural contraction which is observed iiv healing parts, rendering) the cicatrix as straight and narrow as we can : This is best performed by slips of adhesive strap, assisted by proper bandages. The plaster is to be prepared by melting in an iron- ladle four ounces of common diachylon, with half a drachm of yellow resin ; it is to be spread quickly upon pieces of calico, by means of ;i spatula: As there is a considerable degree of dexterity required in this operation, which few are possessed of, I always prefer what is sent from England ready spread. When the nicer is in a proper state, small slips- are to be cut, of an inch broad, and convenient length ; to make it adhere quickly, it should be gently heated; one end is then to be applied to the sound skin, about two inches from the lower part of the ulcer; we are to endeavour to brin^ the edges nearer by gentle compression, and drawing the plaster over the part; the other end is to be laid down in the manner slips are. to be used, until the whole surface is covered; a piece of calico, three or four times doubled, must be laid over the affected part, and a calico bandage, two inches in breadth and three or four yards in 109 length, or rather as much as will be sufficient to support the limb from the foot to the knee, should be applied, with as much firm- ness as can be borne by the patient; it is to be passed first round the ancle-j-oint, then once or twice round the foot, and afterwards up the limb, till it reaches the knee, observing that each turn of the bandage should have its lower edge so placed as to be about'an inch above the lower edge of the fold next below : Much of our suc- cess depends upon the proper application of this bandage, for unless it be even, and the compression regular, it will rather injure the patient; a littlo attention and experience will enable every one inv a short time to acquire the necessary dexterity. If there is any pain or inflammation in the limb, the bandages may be moistened with cold water, and renewed as often as the heat of the parts in- dicates. The dressings are to be renewed only once in twenty-four hours, provided the discharge is not acrid* or i,n large quantities. I have frequently, in cases where tlie ulcer was extremely indolent in its nature, only removed the calico bandage, and washed away any slight discharge, allowing the adhesive strap to remain for two days. If this plan agree with the patient, at every dressing wo will find the sore to have contracted, granulations of a firm, fresh, red appearance to have arisen, and the health otherwise much im- proved : The cicatrix, instead of being broad and pale-coloured, will be straight and narrow, and the new formed substance little liable to become again the seat of disease. Before a trial is determined on, the age, habit ofbody of the patient, duration, and situation of the sore, arc all to be taken into consideration ; an indiscriminate re- liance will ultimately bring it fn'to disrepute; the advice therefore of a medical person should be requested in the selection of proper cases. To those of judgment and experience there will be no occasion to repeat what has been so often mentioned in the course of this work, with regard to the absolute necessity of restraining negroes while under medical care from indulging in their usual vicious ha- bits. Those with sores are not considered as requiring any par- ticular attention, and on many estates they are allowed a degree of liberty that defeats every attempt at a cure: They go on from day to day, and their being exempted from any laborious occupation render*; them the less anxious, about having the parts healed up. Unless a reform takes place m a radical manner in the manage- ment of such patients, no permanent advantage will arise from any hi fhode of treatment. I do not recommend strict confinement, and would abolish entirely the practice of placing them in the-stock*. What is required is to prevent their irregular habits and night wanderings, to which all of them are so much addicted." When rfodcr the plan of the adhesive strap and bandaging, every atten- tion is to be paid to their diet, and it will prove of the greatest service to allow them plenty of fresh -provisions. Salted meats are highly injurious, and generally in a rancid state: What we do furnish them' with should be of the soundest kind, niid'not in large quantities, but merely sufficient to season- their vegetable' messes^which they know so well how to prepare. : ,,? '- '* Negroes from their occupations are liable to cuts and severe wounds. They' have an abominable custom of stuffing these with lint anel laudanum, which entirely prevents their healing by the first intention, as it is called. Sores frequently have their origin from this cause. When a cut is clean, and no ragged edges,-a . t t ? CO O ' stitch should be used to bring the parts into contact,* after which slips of adhesive plaster arc to be applied, and the wound not opened till the third day, when, if necessary, they may be removed, and the parts will generally be found united. MANAGEMENT OF ^REGNANT WOMEN, AND DISEASES OF'CHILDREN. It is the obvious policy of all West-'India proprietors to render negro women the objects of their peculiar care, so ao to ensure their becoming mothers, and rearing a healthy offspriug. The irregular habits and dispositions of these people present lasting, obstacles to this desirable purpose, which, however, it is the serious duty of all, who are entrusted with the management of them, to obviate as far as lies in their power. Every encouragement is to be given to such as settle early- in life, and raise a numerous family. The great reasons why tlie strength even on the bcrt rnannged estates is not kept up from the increase of children, as in other countries, are evident to every observer. On some properties (ionic prevail more than others, but the following will be found to be the principal: Hereditary leprous affections, -which appear at and tu before the age of puberty; the early and promiscuous intercourse of the young females ; their great aversion' to become early mothers inducing attempts at abortion; obstinate menstrual obstruction; mismanagement in previous labours; locked jaw, and suckling the infants for too long a period ; and we may add, where it is esta- blished as a custom on many propeities, their early exemption from labour. On each of these I will say a few words. Leprosy, although uncommon in a severe form amongst the, negroes of this island, nevertheless shews itself, as I have already mentioned, in a modified manner, and to a very great extent in the present generation : Such cases are generally looked on as the effects of the venereal disease, and are most erroneously treated ac- cordingly ; the child thrives, and appears healthy, till near the age of puberty, when there come on swelling of the bones, ulceration in the throat, with loss of the palate, and other serious symptoms, which resist every plan of treatment. The number invalided from this cause is great. For further information the reader is referred. to that part of this work, which treats on the constitutional disor- ders of negroes. The early and unbounded indulgence in venereal pleasures is a common cause of sterility. The parts are left in so morbid anel relaxed a state as to be unfit for impregnation ; the uterine and va- ginal vessels are distended, and a perpetual discharge, or fluor al- bas, is the consequence, and it is not till many years have elapsed^ and they become attached to a particular person, that they begin to breed, bringing to life a weakly, diseased offspring, that perish in a short time, or prove incapable of propagating their own race. The mothers, by their having previously contracted disease, and injured their constitutions from excess at an early time of life, cease to breed and menstruate long before the regular course of nature ar- rives. Many young females, from peculiar prejudices and an aver- sion to relinquish their former habits, whenever they find them- selves pregnant, endeavour to procure abortion by every means in their power, .in which they are too often assisted by the knavery of others. The effect of these repeated miscarriages operates dread- fully on the tender frame of the mother, and not unusually termi- nates in death, or incapability of future impregnation. V From the rough treatment the mother meets with in difficult la- bour, the parts are occasionally so severely injured, with prolapsus cf the womb, that she is rendered incapable of breeding again: The- US bones of the pelvis arc partially separated, and the ligaments thrown into an inflamed state, with weakness in the loins. Planters every where find pregnant women most difficult to ma- hage. They have so many prejudices, so many wants, that it is im- possible to satisfy them : Their situation they well know prevents any chastisement from being had recourse to, anel in consequence they arc extremely insolent, and it requires great forbearance to submit to their conduct. A little policy is absolutely requisite, and much firmness in insisting on their performing whatever duties are required of them. Most of them, when they miss the regular roturn of their monthly sickness, report themselves pregnant, and require an ex- emption from the regular labour in the field. On many estates by particular orders this is immediately granted, and after the fourth month, no work whatsoever is required from them, but they are allowed to sit down, and bring forth the child, which too often proves the offspring of a very lengthened pregnancy. Indulgence of this kind, though it may arise on the part of the proprietor from a sincere desire to benefit his slaves, is totally misplaced, not only by its introducing habits of idleness, but also from its mate- rially injuring the person to whom it is granted. Nature does not require such exemption from exercise during that state, and, in truth, with most of them those hours that we conceive to be passed in ease and relaxation are employed in carrying heavy loads of provisions, or in distant journics, for the advancement of their own interest. If we think proper before the fourth month of pregnancy to Separate them from such as are engaged in the most. laborious duties on the property, whatever we exact from them should be of a constant nature, avoiding of course stooping and the raising of heavy loads: This may be farther diminished as the woman ad- vances; but, to the latest period, she ought to be regularly seen, and made to use gentle exercise: These considerations are liable to many exceptions, and it rests entirely with the discriminating judg- ment of the manager to determine in whose favour they are to be made. If the woman is well disposed, for advanced in life, has borne many children, or is liable to miscarriage, early indulgence dught seldom to be withheld. In a first reported prco-naney greafc caution Is required to prevent abortion. When women find they are mistaken in the idea of their being with child, or arc cleterrflihcd to impose on their overseer, they pre- tend to say they have had an abortion, or tlmt their belly hai 113 wasted, and they have lost their reckoning; they produce some bloody discharge in evidence, and seldom fail to establish their im- position : This is practised by some for a length of time, and, un- less put a stop to, is attended with very dangerous consequences: A faithful midwife, who will not connive at their proceedings, is the only person to put a check to it, and, when the guilty are de- tected, the punishment ought to be exemplary : When repeated instances occur we should be on our guard, anel, when the woman has been any time pregnant, what is passed must be brought for in- spection. Bleeding is a favourite practice with some, and they have it per- formed secretly. I am always averse to it, except in cases where women have previously had miscarriages at a certain period, when it may be useful. We are not to judge of the period of pregnancy from the mere appearance of the mother: This is most deceitful; some do not show belly, as they call it, till a few months before they are deli- vered, while others, from a peculiarity of constitution, seem far ad- vanced even at the fourth month. Immediately after conception the womb descends into the vagina, and from this most women date their reckoning, though they are often mistaken a month or six weeks; but it soon ascends again, and emerges from the pelvis. In the first pregnancy the abdominal muscles yield less readily, and the bulk is much less forward, than on future occasions; about the fourth month the womb ra.w be felt through the abdominal inte- guments, springing out of the pelvis ; in the fifth month mid-way between the pubis and navel; in the sixth as high as the navel; in the seventh half-way between the navel and pit of the stomach, and in the eighth quite at the latter place; at the ninth the womb begins to subside, so that at the time of parturition it is not higher than at the seventh month ; this shews a disposition in the uterus to act favourably, for if it remain high and tense previous to delivery, the labour will be very tedious and dangerous. Fortunately for this race cf people cases of bad labour are rare, for when they do hap- pen the termination is generally fatal. To describe the different Stages, and the efforts made by nature to expel the child, would be superfluous here: It will be sufficient to caution the midwifs against trusting too much to her own exertions, and neglecting the appli- cation for other assistance, to which they have a great aversion. Jf the child presents itself irregularis convulsions threaten, the labour P 114 pains suddenly cease, with considerable dischargo of blood, not io moment is to be lost in sending"for a medical person ; the midwife should be strictly forbidden even to attempt turning the child when it presents itself unfavourably, or to use any violent means for dilating the parts and hurrying on the labour; the natural pains are to be waited for; no active stimulating drinks of any kind, a few drops of laudanum at most; the membranes are not to be ruptured too soon : Thousands are sacrificed from an officious interference ; they have no confidence in the workings of nature on this or on any other occasion. The after-birth, if it does not immediately comC away or yield to gentle measures, is not to be rudely handled, for fear of hemorrhagy; a few hours delay is of no consequence, but after this period proper assistance is to be called : They have a cus- tom of tying a string to the funis or cord, and fastening it to the woman's toe, at the same time obliging her to retain her breath, or blow strongly into her hands': When this fails they apply a tight bandage, and endeavour to excite vomiting and sneezing, make her stand upright, and shake her violently, giving her large draughts of r.olel water to drink : Ali such proceedings are to be avoided : When, from debility and other causes, a sand-glass contraction, as it.is called, takes place in the vvomb, with retention of the placenta, there is extreme danger, and the best assistanee often proves unavailing. As to the question regarding the propriety of having a lying-in hospital on every property there can be no doubt, and it ought to be' enforced on every occasion: The superior accommodations, the ejuiet so necessary for the mother and infant, the cleanliness which can be observed towards them, regular diet, and the dressing of the Umbili- cus, are objects of the first importance. I would recommend that the lying-in room be separated from the hospital for the sick : This is a point of the greatest consequence ; if possible, the house of the mid-' wife should be adjoining, and if she is a careful person the entire ma- nagement of them may be left to her care ; an ample supply of child- bed linen is to be furnished them, particularly bandages for the navel;' the frocks are not to be made too long, as they are apt to be soiled by the urine and fasces; fires made in the middle of the room are strictly to be forbidden, and abstinence from every kind of spirits' and other irregularities. They are extremely addicted to gossip-' ping, and the use of strong liquors, which they even administer to' their infants. Notwithstanding the obvious advantages held out by the institu- 113 tion of a lying-in hospital on every estate, separate from the other establishments, yet the prejudices of these we have to deal with are of so old and deep-rooted a. nature, that they prove superior to every exertion of authority, and any attempts at reasoning are fruit- less and inconsistent with the mental capacity of such uncultivated people. ... When an unfortunate case happens on a properly in which the mother has been obliged to remove to this habitation, the clamour is so great, and the dread of future mischance so strongly impressed on their refolds, that nothing but compulsion will enforce our or- ders. On many, estates, where lying-in hospitals, are ordered as part of the arrangement, I have known this to; happen, and be fol- lowed by the most dreadful consequences. When there is not a regular place for this purpose, I have always recommended a plan, which, though net so certain in its.cflectsj is preferable to allowing them to be delivered in their own houses. • « . The midwife on every estate should have a house built for her, of superior construction, with one or two spare airy apartments, with regular fire-places and chimnics, and other necessary accomr modations, such as bedsteads and curtains : To these apartments the pregnant woman is to be removed shortly before the expected time of her delivery,, and placed under the sole direction of the grandee, as they call her. If she is a person of respectable charac- ter, I have never found the smallest objections to this change : They may be indulged with their own furniture, and it will be no loss to the property, if we allow some one of their own choosing to attend tjiem in the latter stages of pregnancy, and for several days after they are brought to bed. Here they have an opportunity of seeing their friends, and receiving those congratulations, that arc so nu- merous on such occasions, and may yet be kept under a proper de- gree of restraint. Childbed fever is almost totally unknown amongst negro women, as are likewise other dangerous symptoms, common to Europeans at this period : After-pains are, to be relieved by oil and an anodyne draught; a tight bandage should be applied to the belly; the diet of the mother ought for some time to be extremely simple ; wine in n diluted state will be beneficial to those of a weakly habit of body. It is an African custom not to permit the infant to suck the mo- ther immediately after birth, but to give it to some other woman for three or four days, until the mother's breast become quite di<=- P2 116 tended; some allow the first week to pass over before it is given to the mother; the injurious nature of this practice need not be point- ed out, and must be strictly prohibited. With most women in twelve or eighteen hours there is a copious supply of milk ; warm fomentations will hasten its descent, .should- it be backward. The abundance of this secretion in negro women is astonishing, and proves occasionally distressing,: Some I am certain could afford a supply for three infants at one time, without injuring their consti* tutions : To relieve the uneasiness it causes they actually gorge their children with it, and frequently excite bowel complaints ;Trom this arises that eruption so prevalent with children; few are without it, and the mothers pay no attention to it whatsoever, as it wears away in a few months. The most distressing consequence is mammary abscess. From the violent distention of the parts inflammation ensues ; a painful hard swelling, which suppurates; from the ulcer there issues a con- stant discharge, not only of matter, but of milk ; this weakens the patient greatly, anel all our efforts cannot stop its progress. When any hardness is perceived, with throbbing pain, let the breast be suspended, and cold applications made use of; rags wet with Gou- lard's extract; cold poultices and nitre; frictions, with oily mix- tures; all irritation, from allowing the child to suck, is to be care- fully avoided; when the mother loses her child while yet young, the breasts are to be regularly drawn for some days, otherwise dan- gerous symptoms will result from the sudden revulsion of so great a secretion : Many have excoriations of the nipple, which prevent their nursing, and the child, when kept too long at the breast, oc- casionally destroys it altogether; in such cases nipple-glasses must be provided. The dangerous consequences that ensue to nursing mothers, from allowing infants with yaws to suckle them, I have already particularly pointed out, when speaking of that disgusting disease : L'lceration, and even death, have been known to follow it. The only other observation I need add regarding breeding wo- men is the length of time they continue to suckle their children : If permitted they will extend it to two years, or until, in their own phraseology, the child can bring its mother a calabash full of water. Among most savage tribes this custom prevails, owing no doubt to the whole care of the children devolving on the mother, who is afraid to be burthened with a second offspring before the first can dispense with her continued attention. In the second chapter of. 117 fho Alcoran it is ordered that women shall suckle their children tico entire years, if they will suck so long.- This may be proper in a prudential point of view, but it proves Mahomet to have been but a poor physician. The mother's health is greatly injured ; if she is liable to any constitutional disease, it will most certainly be called into action; there are numbers that" never recover from keeping the child too long at the breast; they fall into a consumption or emaciated state, m which they linger for a few years. Nature never intended a woman to nurse more than twelve months; the rapid growth of the child, the develdpomcnt of the teeth, and altered state of every function, plainly indicate that food of a very different nature is now the proper stimulus for its farther improvement; besides, wc know that nature has fitteel women to become again pregnant in time months after delivery. In the West-Indies the exemption they obtain from labour is a sufficient inducement to make them continue this injurious custom. After ten or twelve months all in- dulgence ought to be stopped, and we are to insist on the child be- ing weaned, and even long before that period of its being accus- tomed to food of another description, Trea tment of Infan ts. When the labour has been tedious, the child appears weakly, and the signs of life are obscure, we should caution the midwife never to divide the navel-string until respiration has fairly com- menced, and by no means to hasten the separation of the placenta. Numbers that ore said to be still-born I am convinced might bo saved, if speedy assistance were given. The causes of the apparent Cessation of life in now-born infants are various : Weakness of the vital powers.; the introduction of some of the waters into the wind- pipe; congestion by a twist in the navel-cord; it is to be well cleansed ami wrapped in warm flannel,- the chest rubbed with strong warm spirits, and hartshorn poured on the face and temples; if these means fail we must introduce a small pipe into the nostrils or mouth, and endeavour to inflate the lungs: .This plan must be pursued for a length of time, and assisted by the warm bath : When the breathing is laborious, and there is rattling, we are to suspect the presence cf some fluid in the trachea; the infant is to be held in a situa- ion so as to have it evacuated as speedily as possible 118 When the navel-string is to be cut, let it be divided at one stroke, by means of a clean sharp razor (which the midwife is to keep constantly in a proper state for that purpose), about two fingers' breadth frotn the body : Care must be taken to separate it from the body by the intervention of fine soft rag-; a mixture, of one part laudanum, one of turpentine, and two of sweet oil, spread on a piece cf surgeon's lint, which, to please, their fancy, may be partially burnt: over this a moderately tight bandage is to be placed; irmd the parts noi dressed till the second day, when the same appli- cation is to be re-newed, adding more turpentine and a little pow- dered bark ; it must be dressed every day afterwards, till the ninth or tenth, when the bandage is to be Considerably tightened, to pre- vent umbilical rupture : This is very common with negro children, and sometimes it acquires the size of erne's fist; it originates entirely from neglect of due pressure; some prejudiced negro women en- courage it from an idea that the larger the rupture is, the genitals will become proportionably greater. When the milk of the mo- ther docs not come down freely, and the meconium has not been jinssed by the infant, a little sweet oil and syrup will be of service, with one or two drops of laudanum : This is always to be preferred to the usual negro plan of putting the child to the breast of a wo- man that has old milk ; sometimes a severe purging follows, as might naturally bo expected. They have, an abominable way of cramming tbe poor infant, shortly after it comes into the world, wkh oil, rum, sugar, and other mixtures, to carry off' the matter lodged in the intestines; the injury sustained from this mode of proceeding is serious; the natural milk of the mother is quite, sufficient for this purpose on every occasion : Unless we have a sensible midwife, who is superior to and can overrule these prejudices, the mortality will still conti- nue great amongst negro children : The clothing for the first cm-lit or ten days ought to be very light, and easily taken off; the infant is rather to be kept warm by gocd coverings, for they get so quickly soiled and wet, that they require to be shifted several times a-day; This is a most important consideration in tile prevention of locked jaw, and the mother should have no excuse on the ground that she has not a sufficient supply. Sudden and early exposure to the breeze and external air, and hot confined rooms, are to be strictly guarded against. In damp situations and rainy weather a fire isin- 'iisner.sable, but it should always be made in an adjoining room. jU§ TRISMUS NASCENTIUM, OR LOCKED^ JAW OF'INFANTS. ' This disease, from many considerations, is the first to attract our attention, and it has been calculated that nearly' one-fourth of the ne- gro children born in the West-Indies die from it: After the ninth day we seldom find any one attacked with it, but if it invade on that clay, the subject may linger till the fourteenth; there is no great variety in the symptoms; the infant on the sixth or seventh day refuses the breast, and appears uneasy, with frequent yawning? and stretchings; the body and limbs become quite straight, but convulsions do not always appear; the first approach of these is indi- cated by the fingers being bent inwards, the nails becoming livid, sud- den twitches of the- head, and a fixed look in the eyes; after a short time these increase, and rapidly destroy the infant; the jaw is not al- ways fixed ; I have seen the child suck till within a few hours of its death ; the spasms seize every part of the body Indiscriminately, in the most partial manner, and we qre often astonished to see death ensue after they have commenced but a few hours, without any de- gree of violence. The disease has no "right to be called jaw-fall, for that symptom rarely supervenes; and when it does, it is only dur- ing the last'stages, and in consequence of paralysis. The discrepancy, which prevails amongst the best medical au- thorities as to the cause or causes of this fatal malady, is the best proof of our ignorance regarding its origin, for no two agree in opinion, although they have had the amplest opportunities of judging. The majority are in layour of the irritation being produced from bad treatment of the navel, and say, that where the dressing has been' properly attended to, no case of the kind has occurred: But how will these reasoncrs explain the fact, when in Africa the disease is unknown, and the navel treated by tie actual cautery, anel little or no attention afterwards paid to it? I have myself examined the bodies of many who have died after the funis has dropped : 'Healthy siuopuration had been established, and none but the most ignorant could attribute death to so trifling a cause. The wood smoke is a.' favourite idea with others Of experience, particularly with Dn Clarke, in his Treatise on West-India Diseases; but, rs Dr. Win-, 1^0 tcrbottom justly remarks, this custom is prevalent all over Africnj where the disease is unknown ,• and, fie adds,. ne>t»a single instance of trismus, in infants, or of tetanus in adult1-, occurred during his residence in Africa, and to the natives it was quite unknown. No greater reliance is to placed in J.he opinion of those who refer the complaint to retention of the meconium as a general cause. I have known many instances where the greatest punctuality was observed in keeping the bowels in a free state, yet it proved unavailing. Wet clothes too long retained about the infant, sudden exposure to the breeze, a damp situation, and giving old milk to the new- born child, have each been considered by various individuals as exciting causes, with what justice it i.s impossible to say. To no one set of causes can it therefore be referred; each of these has been avoided by those interested at different times, but still the mortality has, not abated hi the least. It will prevail on a particular estate, and yet be totally unknown on the adjoining one: In one year many will be cut off, whilst in others it will be comparatively rare: In some parts of this island it is stated to be very uncommon, and there are districts where scarce a child can be raised ; in towns less of it is seen than in the interior : Some particular families are subject to it; I have known several instances where a negro woman has successively lost every child by it, and where, from the anxiety ami respectability of the parents, no care was omitted that might exempt them from the attack. In such '■uses, I have recommended removal to the lowlands previously to the woman being delivered, and complete success has attended the measure. It may therefore be tried with such people as a mat- ter of experiment-, for we ought in such distressing circumstances to catch at every expedient that promises the most distant hopes of relief. When on the subject of locked jaw, I mentioned that in several instances I had examined the body after death, in order if possible to ascertain the manner in which the complaint acts in disorganizing the delicate internal strtfetuve:.' In every examination more or less* redness and enlargement of the blood-ve-'els was found in the spinal canal, and on the surface of me cerebellum or little brain, with a ten- dency to watery- effusion: The course of the nerves also exhibited evident marks of increased action. I made a particular point of carefully dissecting the navel, and in none of the subjects that came under my notice was there the slighte-t appear; ree of any tiling 121 that could warrant me in referring the disease to thai quarter. JT have also repeatedly opened this part, without examining any other; and where death had not taken place till the ninth day not only ^vas healthy matter found, but the healing process nearly com- pleted. Whenever an infant dies before or on the ninth day, it is inva- riably ascribed to trismus Now there are many other causes which operate equally obscurely, but fatally, at this tender age ; and, as the last stage of ail infantile diseases is attended with convulsions, they are promiscuously classed under one denomination. This is acorn- tnon mistake with all popular reasoners, which must make us re- ceive with some limitation the reports of extensive mortality. As to the treatment, when the symptoms have invaded, little is to be expected after this period from any of our remedies : Every case invariably proves fatal on the third Or fourth day. If we suspect the bowels to be affected, a tea-spoonful ofsweet oik, or a solution of manna with syrup, and a few drops of laudanum, may be given; a small blister to the nape of the neck, frictions vvith oil of amber, warm spirits, turpentine, &c. to the throat and jaw, and also all over the back and abdominal muscles: The warm bath is what I chiefly rely on ; the infant is to be kept there for ten minutes at a time, and wrapped up carefully when taken out; two drops of laudanum every three hours will perhaps be of service. Where suspicions of locked jaw are entertained, Dr. Wright, in his notes to Grainger, says a grain of calomel every third hour is to be repeated: In such a case any thing ought to be tried, but I doubt greatly whether my friend Dr. Wright ever experienced any benefit from following this pre- scription. I have been informed from the most respectable autho- rity of some practitioners having given three drops, of laudanum and one grain of calomel every day, for the first nine days, to infants born on properties, where they could not rear a single child, and yet trismus has ensued on or before the ninth day, and proved equally fatal as formerly.* A French writer remarks, that in many of their Q » It has been affirmed, as a medical axiom, by those of the highest authority, that in tetanus and fevers, when the patient's constitution is affected with mer- curial action, no further danger is to be apprehended : The following casq, which, with other observations, will appear in a future publication, is a melancholy prouf of the contrary. Since the previous part of these pages went to the press, a singular case ha^ •u-.-ii-v«.l to ~i '.;: this parish, which it iv..y b? useful U communicate.—August,. V22 colonies the mortality is immense, so much so as entirely to do away with any attempt at rearing the offspring of their slaves. From an idea that the action of the external air is pernicious to the in- fant, they anoint the surface vvith oil, for the first nine days, and much success is said to attend their practice: Although the theory may be incorrect, the effects in preventing the admission of damp and chilly breeze> will operate as a preventative to this fatal com- plaint : In situations, therefore, where these causes cxerc an active influence, the use of oily frictions ought to have a fair trial, com- bined with othor remedies and preventative means. I have with this intention made use of it, but have no positive evidence to lead me to say with any marked advantage : The subject is open to so many sources of fallacy, that little reliance is to be placed on any of our practical deductions. The great source, from whence we are to look for a diminution of the mortality from this disease, must originate from a strict adherence to every direction to prevent the action of the exciting causes, for, after these have established their influence, all our efforts are vain. In situations where the complaint is prevalent, the establishment of a lying-in house, and the utmost perseverance in all our propo* sals, are matters of the greatest consequence. A midwife, of a trusty and upright disposition, will prove invaluable: Indeed, every thing depends on this point being obtained, anel, if we adopt the plan of removing the pregnant women to a suitable room in her vicinity, it is a matter of greater necessity. She has it in her power to prevent all those causes from operating, which I have already mentioned as giving rise to this affection — regularity in dressing the navel, and evacuating the meconium, fre- quently shifting the wet clothing, and avoiding sudden exposures to a damp, cold atmosphere, or wood-smoke. 1820, William Otto, a stout tradesman on Dove-Hall estate, had a rusty nail run into the sole of his foof, nearly an inch in depth ; it was removed, andtiie wound properly dressed with lauelanvm ; mercury was given immediately, combined with opium, in small does, so as to affect the niouff), and larg'! poultices were applied to the foot; he complained of some stiffness in the jaw on the third and fourth day ; these symptoms, however, went oft'entirely; suppuration of a healthy nature was completely established in the wound, and the mercury affected the mouth to such a degree that it vyas deemed proper to stop it, and continue only a pill of opium and camphor regularly; things, went on favourably till the thirteenth day, r>.j further danger being entertained in conseejuence of the favourable appearance's, #hen strong spasmodic twitches attacked him, and in twenty-four hours ho died, In spite of every remedy applied in the most careful manner; the jaw was not firmly closed p.t any time. * 123 HYDROCEPHALUS* OR WATER !X THE HEAD. Soon after my arrival and commencement of practice in this island, I was not a little astonished to find the partial degree of at^ tention that was given to the disorders of negro infants and children, and how little they seemed to be understood by the generality of practitioners. It is a known and valuable fact, that almost all the diseases of infants, of an internal nature, terminate in the destruc- tion of the functions of the head: The superior developement of this part, and the peculiarities of its anatomical structure, would na- turally lead us to expect such ah occurrence. An early attention is therefore necessary to prevent this fatal de" termination, for such it always proves. I confess I find it very dif- ficult to explain to a person not of the medical profession the modo of attack of this insidious disorder: The utmost attention and ob- servation of ever}- symptom are requisite, in order to discover the thrcntenings of such a tendency, and the varied shapes it assume:. at the commencement baffle the longest experience: This is aug- mented from the secluded state in which negro children are generally kept, and the very imperfect relation we can get of the symptoms from those who attend them. The earliest symptoms are an unwillingness and uneasiness in raising the head, and a desire to lie down again immediately; the child is constantly drowsy, peevish, has irregular flushings of fever, and requites some exertion to rouse it from an apparent state of stupor; there is vomiting, loss of appetite, beating of the temporal arteries, an aversion to light and sounds, the bowels for the most part costive; if the child can explain its feelings, the head is referred to as the most affected part. After these symptoms have continued for a longer or shorter period, a remarkable transition takes place, which denctes what is called the commencement of the second stage. The patient screams without bein.o- able to assign any cause, and starts suddenly in its sleep; there is considerable dilatation of the pupils, which do not contract on exposure to light; there is double vision, torpor, slow, unequal 'pul-.e. and belly mest obstinately costive; a fatal termination is iii- Q3 V2l ojicated when the pulse returns to a febrile state, uncommonly quick and variable, coma, squinting, and convulsions. There is great irregularity in the succession of these symptoms, or what have been called the stages of the disorder: A child will be suddenly seized with convulsions, whilst apparently in good health, anel be destroyed in four days; at other times no very urgent symptom will show it- self till a few hours before death. The obscurity of this subject is much increased by our seeing the patient so seldom, anel obtaining at best but an inaccurate report of what may have passed since the last visit: The general duration is from three to four-weeks, dating from the first symptom. When recoveries have actually been effected in hydrocephalus, after effusion of water has taken place, we ought probably to attri- bute them more to the efforts of nature than to the interference of art; but by an early recourse to antiphlogistic'means, during the-in- flammatory stage, we may sometimes succeed in removing the dis- order: In most instances it is to be regarded' as difficult of cure, and the chance of this, is in proportion to die duration of the symp- toms. When the patient cannot bear to be raised up in bed without great uneasiness, it is a bad symptom ; so is deafness, which is often mistaken for stupor. When the dilatation of the pupil of either eye, or sejuinting, is very apparent, or the pupils of both eyes are much dilated, a fatal termination is denoted. Apoplectic stertor, coma, with loss of sight, enlargement of the head, cold extremities, difficult respiration, intermitting pulse, are unfavourable. The op- portunities I have had of watching this complaint in negro children have not been numerous. The symptoms are not of such an urgent nature as to create immediate alarm, and therefore a medical man loses the only period at which he could offer any hopes of relief. In most of the cases my distinguishing the disease was merely acci- dental, and from observing a repetition of those indications which I well knew from a melancholy experience to;be so fatal to Euro- pean children. That it is- a frequent cause of mortality amongst negro children I have not the smallest doubt, and also in general but little attended to. To the constant and long-continued irritation, produced bv worms lodged in the intestines, I attribute the origin of this com- plaint on most occasions: The sympathy that exists between the ^:;uthy functions of the int-jstines and brain is so strong, particularly I cLj in children, that we need not be astonished at such a trifling cause in appearance exciting these fatal consequences. The singular prevalence of worms in the negro race affords the best argument in support of my opinion as to the frequent occur*' rence of water in the head. ' I have opened but few subjects where the disease was of an idiopathic nature, but in these the presence of water and enlarged blood-vessels denoted clearly the previous in- flammatory action. I can, however, sjx?ak with more confidence of those cases of sudden death which originate from worms. I have preserved a detailed account of many of these morbid examinations, which it is unnecessary to bring forward here. The result suffi- ciently proves that in every instance, where the head was opened, more or less water was found in the ventricles of the brain and spi- nal canal, according to the duration and severity of the previous symptoms. Treatment. In the first stage this must vary according to the symptoms which are present. If there be any increased inflammatory action in the vessels of the brain, local bleeding will be necessary: Leeches are not to be procured in this country, and therefore we must resort to cupping the temples, or opening the jugular vein, which is by far the most efficacious in this complaint: If the patient is eight or ten years cf age, opening the temporal artery will be advisable. The repetition of blood-letting must be regulated by the conti- nuance of the symptoms of increased activity. Purgatives are par- ticularly indicated, as worms are always to be suspected as the exciting cause, and the determination to the head is also thereby lessened; small doses of calomel, aloes, gamboge, nut-oil, will be' proper, and to be repeated at short intervals, according to the na- ture of the evacuations; frictions all over the belly and clysters occasionally. In- every stage of the disease, let the cause have been what it may, blisters appear to be highly advisable, from the great discharge thev occasion from the vessels-of the head, ami with this view we should apply a cap blister over the whole head, keeping up u copious discharge from it as long as we can; when it heals, fresh ones may be put on the forehead, occiput, and sides of the head in succession; a few powdered blister flies mixed with the dressing, to keep up a proper irritation. I would recommend a mixture cf mercurial ointment to the blistered surface. i'iti Cold applications to the Lead, as linen cloths wetted in vincgal and water, are to be renewed as often as they become warm and dry. The use of mercury, so as to excite what is called the mer- curial action in the system, was formerly strongly recommended, but it Is how abandoned by the generality of practitioners for the mode of treatment I have pointed out. Fox-glove is a very doubtful re- medy, and, indeed, in this island no confidence can be placed in any preparation of it, as it speedily loses its peculiar virtues, Negro children are much less liable to those fatal complaints that carry off so many of the same age in cold latitudes. After speaking of trismus and water in the head, any further remarks need only be of a Very general nature. Their disorders, although not often fatal, require much attention and experience in order to treat them judiciously ; close and repeated observation being the principal means of supplying the want of that assistance, which the personal information of adult patients generally affords. Little is to be learned from the state of the pulse and urine, much more from examining their eyes, tongue, breathing, particu- larly eructations, stools, and the feel of the belly, restlessness, and startings during sleep: Eruptions of the most varied nature are common to infants, and are seldom attended with any dangerous consequences. It ought to be a general rule to wash the body daily in tepid water, and to pay great attention to the state of the bowels. Active preparations of sulphur or other remedies that determine to the surface are alwavt to be avoided. The red gum appears over all the body shortly after birth, and the more copious the less danger is to be apprehended from it. Crusta lactea^ or milk blotch, is not confined to the sculp merely? but universally pervades the body. Few negro children, as 1 have already mentioned* are without it; the mothers pay no attention to curing it, it being in their idea a symptom of good health ; it is kept up by their giving the infant more milk than it can actually digest, and nature takes this method of relieving herself; as the child ad- vances, and teeth appear, it gradually wears away. Excoriations and running's behind the ears are never to be hastily dried up on any account, as convulsions will follow. H'atery gripes, Sec---Bad milk; weak digestion, too mUeli animal .'•'id. creating acidity, are the usual ca-.iscs : The \c<^ are drawn up V27 to the belly, which is hot and swelled; the infant often places its hands there, and leans forward; the stools are green and watery, excoriating the parts, and passed with much wind; eruptions not unusually come out, and give relief to every symptom ; a gentle puke, if the case is urgent, afterwards small doses of rhubarb) mag- nesia, with a few drops of some essential oil, followed by the chalk mixture ; changing the mother's milk ; but more particularly a diet of sago, arrow-root, and soup, are indicated. The stomach cough, as it i.s called, and difficulty of breathing, vvith whfoh many children are seized, with fetid breath, arises in most cases from a disordered state of the bowels. Tlje oppression at the chest is often so severe as to excite considerable alarm. Blisters and pec- toral remedies are tried without benefit, when probably a puke or gentle purge would have removed every symptom of complaint; the former is attended with the best effect in such cases. Convulsions___The causes of these arc numerous: Dentition, sudden striking in of eruption.-;, acidity, and particularly worms: They are exceedingly alarming, and require speedy assistance. We must inquire into every symptom that lias preceded the attack. Immediate immersion in the warm bath, anel a laxative clyster, a tea-spoonful of hartshorn, and frictions with warm, stimulating sub- stances over the body; if teething is suspected, the gums are to be divided; if a rash suddenly repelled be the cause, blisters and re- peated warm fomentations ; instead of the warm bath the dashing of pailfuls of cold water over the patient's body is more generally re- sorted to, to relieve present fits, when other remedies fail; the suc- cess attending this plan I have often witnessed in a remarkable manner. Inward fits are much spoken of by nurse*. The child appears as if it were asleep, but the eyelids are not quite closed, and if you observe them narrowly you will see the eyelids twinkle, with the whites of the eyes turned up. There is a kind of tremulous motion in the muscles of the face and lips, which produces something like a simper or smile, and sometimes the appearance of a lauglj. As th» complaint increases the infant's breath seems now and then to stop* for a time ; the nostrils are contracted; there is a dark circle about the eyes and mouth, which comes and goes by turns; the child starts, especially if you move it ever so gently, or if you make the bast noise near it, it heaves a deep sigh and passes wind, which -ives relief for a while, but presently it relapses into the dozing; 128 at other limes it struggles hard before it cart pass wind, and seeni;- as if falling into convulsions. Sensible nurses do not give any re- medies for these symptoms ; they take up the child when it sleeps too long, and rub its body smartly, holding it before the fire, and moving it up anel down in their arms : This generally causes a dis- charge of flatus, which removes every symptom. The facility with which the period of dentition passes over is a singular fact in the history of the negro race. Seldom or ever doe? it become the subject of a practitioner's consideration, but as the colour approaches the white, infants suffer more severely from it. Scarification and opiates are effectual remedies. 12$ REMARKS o x- The Constitutional and Hereditary Disorder.; of Negroes. The delicacy of organization rcrtdcrs the human species liable to a great variety of derangements in the action of the various org ins which compose the body. Some of these are of so acute a nature as to terminate existence in a short time, while others attack more insidiously, and arc opposed in their progress by the preservative powers of the system. Climate, food, and occupation cause the cha- racters of these to vary in every region of tlie globe. Iii each country they have a peculiar appearance and mode of trcitment, and not a few* of the numerous errors on this subject h.a-c originated from our indiscriminately applying the knowledge we have obtain- ed of our own to those of a different race of people, and in distant parts. All being subject to disease, and anxious for the re-esta- blishment of health, are apt to transfer their own knowledge as ap- plicable to the cases of others. Medicine, therefore, must be al- ways a popular science, anel influenced by popular prejudices. According as these have happened to prevail, it has been under the dominion of such as assumed superior sanctity of life, of witch- craft, or barefaced'quackery. In all its revolutions it has never failed cf being associated with ignorance and error. This was never more completely exemplified than in the history of constitu- tional and hereditary disorders; their every day occurrence at- tracts common attention, and the slow progress they make, and the varied symptoms they assume, are apt. to lead the most cautious and experienced into error. In Europe, where they have been investigated by men distin- guished for their talents, the laws they follow have been ascertain- ed, and means of relief adopted, founded on lengthened experience but in this1 quarter of the world the case is sadly different. No medical authority that 1 know of has even attempted an explana- tion of their hereditary disorders. A few general statements are nil that can be found, ajid these mostly rest on hearsay evidence, It VM) Yet how could it be otherwise? Where are the individuals who have shewn themselves capable of conducting such an inquiry, which, besides the rare qualification of a spirit for observation, re- quires a lengthened residence, continual intercourse, and even per- sonal sufferings, before we can presume to. say we have even made an attempt at accuracy ? All we are at present possessecf of are the hasty, superficial remarks of transient voyagers, who visited such shores for any other purpose but that of the advancement of know- ledge. 1 cannot prpmise that any thing like an exposition of-this im- portant subject will be found, in (these few pages. J\ty residence has been too short in this island,, and my experience too limited, to allow me to say that I have made any advancement in this in- quiry worthy of being recorded. All I shall endeavour to do at present is to shew that the popular opinion on this point is gene- rally erroneous, and that the facts lead to very different conclusions from those at present entertained; that the terms poxed, rotten, ulcerated, and the like, are improper, and proceed from our adopt- ing a theory, the prosecution of which is attended with fatal con- sequences. To recede in our pretended knowledge of any point is painful to most persons, except to candid minds, who consider it a real advancement. Among such we shall find those to be the pest informed who confess they know the least. The constitutional disorders, incident to cold and temperate cli- mates, are of a very different nature from those that afflict the Afri- can race. Consumption, madness, gout, scrophula, and its numerous con- sccHienecs, with various other organic hereditary derangements, arc almost strangers to jthe inhabitants of tropical climates. There leprosy, and its dreadful effects, rage in a manner but little known to European physicians, who, reasoning from their previous and local information, transfer their ideas to objects that have in reality no relation to them. Before the introduction of the venereal disease, leprosy was referred to as the source of every cutaneous, affection. This made the venerable professor. Pitcairn, who lived, before Jfprosy was quite exploded, or before it was thought useless tp consult the older writers, .obsprve .that since the. introduction of the Neapolitan disease leprosy was no more mentioned. Syphilis has now entirely usurped its place. Every symptom, that seems the result of a disordered constitution, is refei i ed to that 131 origin, and with this melancholy addition that mercury can obviate its progress, and even eradicate it entirely. To such a height has, this arrived as a popular opinion, that no miserable creature can present himself, exhibiting the slightest indication of a general aft- fection, but it is instantly placed to the account of venereal, infec- tion, and he must undergo a course of mercury ; and if that is not sufficient, a second is fo be'trice!, and a third, but more generallv the death of the patient saves all further ill-directed efforts. ( shall chiefly endeavour to shew the mistaken idea that is entertained with regard to this important consideration, as the present mode of proceeding affects the lives of thousands of our fellow-creatures. I cannot accomplish this more effectually than by exhibiting in a brief manner the nature and progress of leprosy, as described by the best authors. It-would not be attended with any practical advantage to enter on the present occasion into an investigation of the nature of the dif- ferent modifications cf leprous affections, as described by various medical authorities. The confusion now prevalent'has been intro- duced, as I have already mentioned, by travellers and others, not possessed of professional habits, who have applied the most impro- per names to mere varieties of the same affection, which assume an altered appearance at different stag's. It requires the medical reader to be possessed, of the most extensive information and dis- criminating judgment, to enable him to form any thing like an accurate idea of this complaint. With the popular reader any such attempt would be fruitless, and only increase the confusion. As to its being contagions', it is a matter of opinion entirely. The se- clusion of such miserable objects, who, fortunately for this island, are now rarely to be met with in a virulent state, would suggest itself at once as the obvious policy of every humane proprietor. The hereditary nature of the disorder, which no one questions, is an- other reason for enforcing this injunction. Such chronic diseases as leprosy, which seem to arise spontane- ously, and which never yield to the unassisted powers of the con- stitution, must have* their origin in climate, predisposition in the patient's constitution, peculiarity of diet, or probably in all. . If the first and third causes only exist, we may hope for relief from change of climate and mode of living; but if the disease never occurs, except where there is an original predisposition, the cure can cnlv be pc-mir-nent fts long as the patient is removed from the K 2 ISO rxeilmg cr.i?ces. As lb? prcdi:.pe:-:t:on v.: born vvith the patient, rtlie inference follows that he must have derived it from his parents: Pushing this idea too far, we form extravagant notions of heredi- tarv dkea^cs: Wc do not consider that unless the complaint can be traced back to our first parents,- and thus involve us all, it must have originated in one whose ancestors were free from it. Leprosy originates in some instances with an individual, and ceases with him, and cannot be traced to his immediate offspring: More fre- quently it is quite the reverse. In all those cases, where I have had an opportunity of making correct observations, they have been attacked at or before the age of puberty, when they seemed to have derived the disease from their parents, and at a much later period of life, and in very different forms, when it originated with rhoin.-clves ; this last, however, appears to be a very rare occurrence. From the best information we can procure, it would appear that children and adults are attacked with the disease, yet their parents and grand-parents have been free from it. From whence could this predisposition have originated but from the parents? This is not peculiar to leprosy. The English consumption will prove fatal to many a numerous offspring, whose parents will survive thc;n to an advanced age. To produce a still more familiar in- stance, how frequently do we find a striking resemblance between tlie brothers anel sisters of a family, yet none of them shall show any similitude to cither parent, and this when the chastity of the mother has been above all suspicion. From this it follows that no constitutions, but such as are pre- disposed to it, will produce the disease: That though, the predispo- sition is more to be apprehended in those who are born of leprous parents, yet it is not a necessary consequence of such an event, and it is often found in those who arc born of healthy parents. If, as it has been asserted, the disease is much less frequent with those who use a generous diet, it is probable that where a predisposition exists, it may be prevented from coming into action by climate or liberal nourishment. This question is extremely doubtful. When the disorder can be traced to a diseased parent, the dread- ful symptoms break out at an early period, and in the most varied fonm If before puberty, the genital organs are never developed, nor is the per.soil capable of propagating his species. If children of evidently diseased parents escape at the age of puberty, wc have. w-very reason to hope ti.-it they will remain sc for life. 133 Dr. Hcberdcn, who had frequent opportunities of observing the disease, mentions that be never heard of any one contracting the disease from a leper by contact, though he witnessed the daily com- munication of lepers with persons who were not affected with the disease. He mentions instances of leprous husbands cohabiting seve- ral years with healthy women, and having children' by them^ without communicating the disease, although the children have inhe- rited it. . In such families some of the children have tlie disorder, while'others escape. lie knew, of a family where the father lived and died a leper, and of two sous and two daughters who survived him, though at present each of them is advanced in years, the young- est daughter alone has shewed that she inherits the disorder. The eldest son, though sixty years of age, has never discovered in him- self the least symptom of it, yet his only daugnter, about eighteen years of: age, has been for some time affected with it. Thus suppressed, but not subdued, we see that lite glomes of the complaint may lie dormant a whole generation, and awake with full vigour in the succeeding one. The forms, which it assumes in certain persons in a particular dis- trict of country, are of the most opposite nature and appearance, and would lead one to imagine they had a distinct origin. The bones of the palate and soft parts will be entirely destroyed, and here the ravages seem to stop. With others the fingers drop off, and the body is covered with dreadful -ulcerations and large fleshy swellings. The skin has a singular, mottled appearance, and is thickly set with Jaro-e white scales, i Dr. Maundrell, in fiis journey from Aleppo to Jerusalem, says it not only defiles the whole body with a foul scurf, but also deforms the joints, particularly those of the wrists and ankle?, making them swell with a gouty, scrophulous substance, very loathsome to look upon ; their legs resemble those of old battered horses that are often seen in the drays in England. Where the pvedisjiosition is strong, but by a generous diet and other means care is. taken to avoid die exciting causes, the here- ditary tendency will only manifest itself in the most partial manner, as by a few discoloured spots or distortion of the bones of the leg. Children of a weakly habit ofbody, even although every care be taken of them, infallibly get tlie disorder when predisposed to it. The rich arc not attacked by this distemper. It confines itself to |hc poor. Those who can afford fresh meat and other necessaries during the year remain free from it, and it is somewhat singular 134 that during vears of scarcity, and where families have suddenly , been reduced from afluence to a comparative state ot poverty and misery, the complaint has manifested itself amongst such as thought themselves entirely exempt from it. In countries where a gradual improvement has taken place in the manners and mode of living, this most disgusting of disorders has greatly abated, and is to be found only among the most wretched* and even then in a milder state. As to the causes, they are reckoned of the most opposite nature. Every nation where it prevails at- tributes it to those that are the most obvious. A Uiet of fish or milk, and the use of stagnant water, have alternately had their. share of blame. That excellent observer Dn Hillary, in his Treatise on the Dis- eases of Barbados, has justly observed, that although this disorden, as well as the venereal disease, be situated in the constitution* the latter is cured by the different preparations .of mercury, yet with the former, so far from being cured, every symptom is aggravated by mercurials. It seems to abate the distemper for a little time, but it soon returns with almost double force' and violence, and ul- timately destroys the patient. Antinionials, which ore of little service in the venereal disease, operate powerfully when given early in leprosy. These few observations will I trust convince every one of the varied modifications which this disorder assumes, and of the per- manent misfortunes entailed on a distant progeny. From the best authorities I can with confidence affirm, that no advantage will re- sult from the administration of mcrcuriaL preparations: On the contrary, the complaint will be rendered more inveterate : To this fact I particularly wish to direct the attention of those entrusted with the care of such miserable objects. If we examine the particulars that are detailed of those cases of lues venerea, which have been accurately observed and described by men of excellent experience, as they have occurred in Europe, we shall not find any correspondence with- such as have now been mentioned either in themselves or offspring. The constitutional svmptoms of the venereal disease, if not speedily checked, in n short time destroy the life of the individual; the ulceraticivis marked by so positive a character, that there can be no doubt regarding it. Proceeding in a uniform course, it daily ghins ground, and shows no tendency to ths formation of healthy grnnw^tiens. unlike that cf leprc-.v. which 185 tantalizes the patient by frequently shewing a disposition to putor^ the kindest appearance of healing, and then breaking out vvith its for- mer virulence. In the history of the venereal disease we do not find any instance where, the hereditary affection manifests itself at the age of puberty, without previous constitutional derangement, to agreatet or less extent, and that of the most obvious nature. Children born of parents, who actually labour under the disease, show symptoms within a very short period, and these generally prove fatal, although every exertion be used. Ulceration does ap- pear at the age of puberty, hut it can be referred to a very different cause from that of syphilitic infection. Let us now attend to the manner in which leprosy attacks those resident in the colonies, and who have derived the tendency from persons of African origin. That severe and disgusting form of it, which I have already spoken of, is now. rarely met with in this island. Some practitioners have informed me, that although they have resided many years in the country, they have never met with a single instance of it. In the other islands I understand it rages with great violence, and, where intercourse with the negro nice has taken place, it has ap- peared in those of fairer complexion. The children, the produce of a diseased parent or parents, are born to all appearance of the most healthy structure, and remain so for some years after birth. About eight or nine they begin to pine awav, the belly becomes prominent, they complain of severe pains in the. bones and joints, the latter swell, and are stiff and pain- ful when moved : . The throat is: affecteef at a later period; the uvula ,and glands or almonds of the throat become enlarged permanently, and covered with superficial ulcers; every slight variation in the temperature causes them to inflame and enlarge;, gargles anel blis- ters give no relief; the voice is hoarse and guttural; the internal part of the nostrils gets, enlarged, an(l. » sore is formed, which no efforts, can heal; a,-superficial- white-coloured spot appears on the roof of the .mouth, which gradually, spreads with deepening ulcera- tions : These symptoms,, with swelling, and distortion of bones to a greater or less degree, show themselves in those unfortunate beino-s, who are born with a strong predisposition, or where the exciting causes have been allowed to act in an unrestrained man- ner : .. They commence at the age of eight, and as late as puberty. If they remain free till this period 1ms passed, they are very seldom 136 RTterwards attacked with it in any form whatsoever; nnd, if in any* it is in that of the elephantiasis or big leg, rarely the coco-bay or joint-evil. According as the complaint is.restrained by proper remedies, warm clothing, and generous diet, it proceeds with corresponding rapidity. Where the hereditary tendency Is not strong, and cnre has been taken of the subject at an early period,* its progress will be stopped for a time, anel if near the age of puberty altogether overcome. At other times an ulcer will break out in some part of the body, and remain permanent, leaving the patient, however, free from other constitutional symptoms. ' A more melancholy fate generally awaits theso miserable crea- tures. The soft parts of the nose and palate swell, inflame, and ulcerate; tubercles in various parts of the body, particularly the forehead and bones of the feet, vvith the most, excruciating torture; the uvula and spongy bones of the none and palate come away in succession; the ulceration extends in ovci-y direction with extensive loss of substance, and frequently alarming hemorrhagy; the cha- racter of the ulceration has no resemblance to that of the venereal, no hardenc d elevated edges, nor strongly adhering white-coloured slough. Contrary to it also, it at times stops in its progress, as- sumes a healing aspect, and for a while deceives the credulous sub- ject with the hopes of renovated health; suddenly a relapse comes. on, and the patient sinks under the weight of accumulated misery. In some of a good habit of body, after the soft bones of the nose and palate have been destroyed, the parts heal up, and the disposition is not renewed. If the severe courses of mercury were less in fashion, we might have more cases of this comparatively happy termination, but these, repeated in so severe and irregular a manner, do away with all hopes of this nature; they are often per- sisted in, though the ulceration be extending, while the body iW under the mercurial influence."''The repeated fatal terminations while under this mode of treatment arc awful lessens, that are thrown away on most practitioners. So far from convincing them of'their 6rror, it is commonly answered, that from not beginning the Use of mercury at a sufficiently early period, the disorder had been allowed to get too far before their exertions could be of use. The number and die rapid succession, in which HinVc seen somrf patients- undergo these mercurial courses, has often astonished me* 137 and I would not gain credit if I related what has been told me by some old practitioners of -this island. I trust sincerely, that after the recent and severe blow which has been given in Europe to the specific virtues of this mineral, our practice in the constitutional disorders of negroes will lose that empirical character which it now possesses, and hereafter be established on principles deduced from a knowledge of the progress of the morbid affection in the human body. A practice founded on these will ever be exempt from the daily revolutions introduced by fashion and prejudice. In those instances, where the bones of the palate are not the seat of disease, other parts of the body are attacked ; ulcers of the most obstinate nature ap- pear; when one dries,, another breaks out, and so they proceed for many years, the patient's body having hardly a spot free from marks of constitutional ravages. If the complaint has been long settled in one leg in the form of ulceration, anel that be amputated, death ge- nerally follows at no distant period. Caution, therefore, is requi- site in inquiring into the previous habit ofbody and diseases of the subject, whose limb is to be removed. In many cases the bones become distorted and swelled, and the seat of dreadful pain ; those of the leg will be bent in the most singular way, and persons, previously well formed, become quite crooked, as is the case with ricketty children in temperate latitudes. If the sub- ject so disposed to diseased action in the bones chance to get yaws, that morbiel poison never fails to aggravate every symptom, and rouse the hereditary disposition to its fullest action : Seldom docs the person survive these combined misfortunes, or, if he does, he presents a body distorted into the most fantastic shapes : These are called the effects of yaws, anel are adduced by many as proofs of the dreadful ravages which that disease is capable of producing. I suspect we should be more correct if we said that such severe effects have resulted in constitutions where the yaws happened to he combined with a strong disposition to activity, in consequence of on inherited disposition. I do not mean to deny that yaws will not excite severe and per- manent derangement in the system : This is too well established by numerous, miserable examples; but at the same time it must be ad- mitted that, where the disease comes into action, combined with a strong hereditary tendency to leprosy, the latter will in consequence be roused in a more severe.manner than if it had not been combined with vaws?. and will leave more marks of permanent diseased action. 138 Hereditary and original leprosy occasionally attacks the toes and fingers ; ulceration commences with spots over the body, joint after joint drops off, and if not of an aggravated form it will stop here, and leave the patient in good health. This is called coco-bay or joint-evih, and is not near so frequent as formerly. Some boast of curing it by arsenic and hlue vitriol, and should its progress Uap-r pen feo cease naturallyWhile using these remedies, a thing not un- common, 'the merit is awarded as usual, to their exertions.. It is said to be infectious, but as to this I cannot speak. As such patients frequently get large families, it might be suspected that they would also inherit the complaint, but it is not the case. Some of the children born of such parents remain healthy through life; others are early attacked with bone-ache, or ulceration of the throat; few with the joint-evil, as it affected their parents. The big foot in very often observed to attack the offspring of such parents after the age of puberty. I never heard of one who had got the elephantiasis before that period, which is somevyhat singular, and not easily ex- plained. 1 These observations contain a description of the modified forms, in which leprosy now shews itself among the descendants of the Afri- can race in this islands It is to be hoped that in a short time they will entirely disappear, as they remove from the original can c of'infection, and avoid whatever seems to bring the latent tendency into action, popular opinion I know* however, is greatly at va riance with the statement now made. Our endeavours arc always well bestowed in attempting to. remove such differences, but paiv ticularly so on the present occasion, where it is not a matter of mere opinion, but involves, by the practice which follows it, the lives of thousands of our fellow-creatures. Let us therefore briefly see whether the constitutional symptoms of the venereal disease have ever assumed such an hereditary destructive character, .or whe- ther ill-cured yaws entail such permanent misery on distant genera- tions; for to these two sources most persons arc in the habit ot refer- ring all- the ■symptoms already described as those of modified leprosy. All writers of authenticity, who have treated of the diseases /i" Africa, mention that the venereal disease in a severe form .is no where to be found amongst the natives, and when it does appear it is to be referred to infection communicated by Europeans. Dr. WTinterbottom, whose work excels all others, savs thai gonorrhoea is the pnly form in which he has seen »*> and chief,v 1% among those who live near the trading places. Constitutional symptoms never came under his observation during his long re-^ sidence in Africa. I have inquired of many who have long practised in this island as to the occurrence of chancres and buboes with symptomatic ulceration, and find that their appearance is ex- tremely rare in the negro race, and that when the importation of slaves was permitted, seldom was there any other form of it seen than that of gonorrhoea. I can add my own experience in testimony of this, which, though trifling when compared with that of others^ goes to prove the abdve obscrVatibn in every respect. I'cannot call ft> my recollection a siilgle instance of real chancre or secondary ul- ceration, which exhibited the true Venereal character. : ■' '. " " "' No-professional reader, therefore, and nbhe but tlie most pre- judiced'of those of a popular description, will refer these severe symptoms to so trifling a cause*. If constitutional appearances fol- low the use of mercury when leprosy cannot be suspected, we may attribute the symptoms to the action of the mineral itself, which every medical man knows occasionally excites the most extensive1 derangement of the osseoffs system. The children born of diseased parents remain fine healthy subjects till the age of puberty, or near It, when the fatal disorder first appears, a thing quite urikiiown with regard to the venereal disease, when the infant is attacked shortly afte" birth with severe affections, the unquestionable result of the pa- rent's imprudence, or exhibits'some shocking deformity, which is referable to a similar origin. Some negro children, born of diseased parents, never show any symptom of a morbid nature as long as they live, while their brothers and sisters are miserable victims of its ra- vages. Young persons will suffer severely, while no disease has been foaffifest in either parent: In such cases it can be readily traced to a o-eheratioh farther back. From the most unquestionable autho- rity it has been proved that the complaint will be dormant for a whole generation, and then breitk out with fresh vigour: This is very different from the laws which the syphilitic poisort follows. Children by the same parents will be affected during the course of their lives with very different forms of disease, some having it in one wayj and some in another, and others escaping it altogether. The ulceration, in its progress and character, has no resemblance to the venereal; the edges are not elevated nor contorted; there is no deep loss of substance, and it frequently stops of its own accord, S2 MO and assumes a yen- altered appearance, a circumstance unknown in the other disease. The severe form of lues venerea is unknown to the inhabitants of these regions, and the efforts of the system are capable of over- coming it without the aid of mercury. The symptoms I have enumerated, so far from being capable of being cured by mercury, are generally aggravated by its administration. This reasoning will I trust serve to convince most of the dan- gerous practical consequences that result from referring every un- toward constitutional symptom to venereal origin. Throughout they have no analogy, and could only have been mistaken by those who superficially transfer their prejudices to others in affliction. The yaws is the second source from whence such numerous ma- ladies are conceived to originate. There is much more reason to accuse this than the venereal disease ; yet still the application is too indiscri- minate. When yaws have infected a weakly, diseased habit of body, it is seldom that the subject ever recovers completely ; the eruption either recedes too rapidly, or some constitutional symptoms break out, such as bone-ache, pains, swellings, ulcers, sore-throat, or con- tracted and distorted joints, rendering the object an invalid for life : These are commonly termed the effects of ill-cured yaws, and are too generally to be met with. I shall not in this place further dispute the point whether in reality these are relics of yaws, or merely symptoms called into action by the existence of a morbid poison in the body of a diseased subject. When such painful derangements are present, we may allow Che trial of a mild alterative course of mercury, with other remedies combined, provided it has not been previously exhibited. Dr. Home, a gentleman of great experience, and who has made many excellent observations on the diseases of this island, has re- ' marked that when he first came to Jamaica, it was the universal practice, as soon as the yaws appeared, to give twenty-five drops of a solution of two drachms of corrosive sublimate in eight ounces of strong rum in the morning; the eruptions soon disappeared, but the greater number of those afflicted with it had gnawing pains or ulcers on their body, or the disease returned : " When this was the case, the second eruption was longer of coming to a height, and re-. quired more mercury to clear the skin : They would even relapse a third and fourth time. I have succeeded with a few of such ulcerated V atients by means of salivation, lime-water, and the use of the couu- w try woods. I have left many worse than when I found them ; nor can I pretend to better success with those who have complained of. pains in their bones, which have generally ended in nodes, exostoses, and caries." This is a candid confession from a most excellent authority, and shows clearly the danger of exhibiting mercury at an early period of yaws. I trust I have sufficiently insisted on this while speaking of that disorder, and proved that as a morbid poison, like all others capable of being overcome by the efforts of the, constitu- tion, it will, in spite of our pernicious interference, have its regular course sooner or later. The practice I understand is still adhered to by many who wish to establish a character of a popular .nature, at the sacrifice of the health and lives of their fellow-creatures. How they can reconcile it-to their consciences 1 cannot say, except an utter ignorance of the course it pursues be any extenuation of their fatal plan of treat- ment. I have already adduced the authority of Dr.. Hillary and others, who. lived'at a period when mercury was a universal favourite, to show that, in any preparation, it aggravates leprous affections.— Those dreadful symptoms, observable in patients who have had this mineral given to them at an early period, are not the effects of yaws so much as of the constitutional disposition called into immediate action by its imprudent use. The conclusion I therefore come to is this, that when the yaws have gone through the different stages, the relics, as they are called, are to be referred to the morbiel poison having acted on a diseased body ; and, secondly, that where mercury has been early and im- properly used, and followed by permanent constitutional affections, it is to be blamed either from its own pernicious action on the system, or from having given activity to an hereditary leprous tendency. I feel little anxiety at the idea of this reasoning being termed hypothetical, provided it convince those who are in the habit of in- discriminately using it with such patients. Many have rtow got such an opinion of the effects of salivation, that if we do not give them mercury, they procure it from those who are too apt and 'ready to take'advantage of their inclination : They use it secretly, and persevere in their ordinary occupations while under its active influence, until they are past all remedy. Having spoken'thus much of the nature of these affections, it will be expected that I should treat largely of the means of relief. On this I am sorry to say I must be very brief, anel for the b-.st reason, for in truth I do not know what to,recommend with any prospect of certain success. There are many things celebrated as specifics which in reality have no virtues, and numerous histories of surprising cures, where nature ought to have had the merit. Such affections are too often incurable, arid if, we can prevent them from proceeding further we may.be perfectly satisfied. , • - The high price of bark, and the shameful adulteration practised on it by the various and upright tribes of wholesale and retail- merchants, induced me at an early period to seek for substitutes produced in this island, which might be procured in a state of pu- rity. The result of these inquiries was published in a late number of the Edinburgh Medical Journal, to which the professional reader is referred. Since that period I have had further occasion to confirm my opinions, therein stated, by satisfactory additional experiments; and, if health and greater experience are afforded me, I shall be able: shortly to produce a body of evidence that will greatly affect the present boasted claims of the specific powers of the Peruvian bark. I have examined many of the parcels sent out to this island, and have been astonished at the extent to which the fabrication has been carried, consisting chiefly of some inert powder that resem- 150 >t bled the genuine bark. Wc need not therefore be surprised ht the daily complaints which reach pur ears regarding the inefficacy of this substance in stopping the attacks of fever. When first in- troduced into practice a few drachms were considered sufficient to check the most obstinate intermittent, but now it may be given in ounces, and pounds thrown in, us it is elegantly termed, and, after swallowing an immense quantity of what proves to most stomachs exceedingly nauseous, the poor patient may think himself well off if he gets rid of his fever with impaired digestion. As a tonic, strengthening anel nourishing remedy, it is universally given in every case of debility, let it proceed from what it may, without re- gard to the complaint or situation of the individual. The day will come, and probably is not far off, when our successors will justly. ridicule the- superstitious reverence in which the virtue: of this drug have been held; The substitute, which T have used most extensively in fevers and deranged action of the stomach and bowels, is the quassia or bitter- wood. I have repeatedly given it in powder by itself, and com- bined with bark in the intermittent of white people, and never found that the least unpleasant symptom resulted ; on the con- trary, the patients expressed themselves highly satisfied, and got rid of their fever in a short time. In cases of debility, after severe illness, I have always preferred the use of it to bark, especially with negroes, combined with various other substances. I have made sevel'al other trials with the bark of the lilac or hoop tree and the neeseberry bullet-tree, and have good reason to think thcy would prove serviceable. Fevers, however, of an original type, arc so rare with negroes, that my opportunities of observation have been very few. I have succeeded in stopping intennittcnts by means of preparations made from tmroasted coffee, which I haw detailed at length in the publication alluded to; WILD CINNAMON; This should be kept on every estate. The negroes are exces- sively fond of it, and place the greatest reliance on its virtues : The berries arc to be preferred when they can be had. In cholic pains, to which they are so liable, it is a sovereign remedy, mixed with bird-peppers, and made into pills ; in dysentery, when the action of the intestines has become languid, it is a good stomachic; a ;:?von$ tincture can be mad? 1-;th spirit*, vhi< h wc may combiry 151 with other substaivccs, such as the coccoon antidote, the contrayer- va, and the various peppers of the country : These things ought to be prepared and kept in readiness on every property, and given to such as complain of their stomach and belly hurling them, and who prove on every occasion a numerous and troublesome' set of people to the planter. Most persons at present adopt a plan of giving these people neutral salts, and on some places they huyc got into such a habit of this, that nothing else vvill satisfy them : They term it washing their belly, and, when any great feast is going forward, it is a common practice amongst them to take a tremendous dose before the appointed day, with the'view of removing all obstruc- tions to the enjoyment of it. The substances I have mentioned are much to be preferred, and we can quicker; their operation by the addition of any purgative, CAPSICpM PEPPERS. The various species of this plant afford an excellent remedy for many of the disorders incident to the negro race, and deserve to be extensively cultivated. I have made several experiments with them on my own person. Twenty grains, made into pills, anel taken within the space of half an hour, have raised th? pulse fifteen and even twenty beats, and kept it so for three or four hours : The sensations were those of slight intoxication, a remarkable fulness in the head, and throbbing in the arteries, which were followed by a profuse perspi- ration'and re-mission of the previous symptoms. I never found it to■ "affect the urinary, nor leave debility in the digestive, or- gans. I have repeated the exhibition of this substance in much laro-er doses to negroes and the brute creation, and have found the same effects to follow. Combined with equal parts of the wild cinnamon, or concrete salts of hartshorn and camphor, it proves a delightful stimulant iii nervous debility and irritation. The indiscriminate use of wine and spirits in cases of great debility, and the faith we repose in their exhilarating qualities on the stomach and intestines, prevent our substituting'what would much more efficaciously remove the most alarming symptoms, and do away with that dangerous nervous irritation that constantly follows the administrat.on of sp.ntuous liquors, more particularly in a diseased habit of body. In the low .rate, from the long continuance of the nervous fever already mc^ 152 tioned, I have been obliged from mere necessity to have recourse to these remedies, when wine could not be procured, and I now feel so convinced of the efficacy of their action on the debilitated sys- tem, that I never hesitate a moment to administer them in prefer- ence to any other remedy. They also quiet the irritable state of the stomach, so obstinate in the fevers of tropical climates, anel in- duce a pleasant, critical perspiration, which gives relief to every utir pleasant symptom. If the powder made into pills cannot be swal- lowed, the tincture, as mentioned in the forms of medicines, can be substituted. The diluted juice of the capsicum is a sovereign remedy in diseases of the eye, attendetl with a relaxation of the coats. CABBAGE-BARK. Many entertain a very strong prejudice against this remedy, as well as the bastard ipecacuanha or red head, from reported instances where they have operated with severity, and even produced fatal effects. My own experience of their .utility, compared with that of others, has been but partial. I have, however, the testimony of tjiose who have had forty years' experience in the practice, to prove that, when properly administered, in the way I have already mentioned, they seldom or ever saw any injurious consequences, and no greater ilegree of harshness or violence in their action than what attends all cathartic medicines. The only caution, necessary to be given as to the cabbage-bark, is to have it well dried before we make use of it: From not attending to this, it has fallen greatly into disrepute, and is considered by some as a dangerous substance. There is a pre- valent but erroneous idea, that there are two kinds of cabbage-bark j red and white, and that the latter is poisonous: The difference which certainly does exist arises merely from the local situation of the tree: This is well known to carpenters and Others, who are in the habit of using the timber, which proves durable;, takes a fine polish, and is much in request. As to the great powers that have been attributed to it in expelling worms, I doubt much their existence any further than what belongs to all purgatives. Com- bined with the inspissated juice of the various species of the con- volvulus the operation is speedier and more effectual. The bastard ipecacuanha or red head does certainly at times operate violently, but s.o do all emetics. I haye often tried the 153 *pork freed, an ounce of the dried root, infused in a pint of wino'j three spoonfuls are a sufficient dose: When properly prepared 1 never saw any bad consequences from it. The seeds of the gam- boge thistle I have already spoken of when on the subject of worms. COFFEE. ... v From the suggestion of a foreign medical journal I was induced fo try the effects of this substance in intermittent fevers, havin'r na- turally myself a great aversion to bark. I first ascertained it'r, effects on the body in health. An ounce of dried unroasted coffee was infused'in a pound of Water, aiid boiled down to four ounces: One ounce was taken every quarter of an hour; at the end of the hour the pulse had increased six beats, and continued so'for some time; Experiments were afterwards repeated on the extract, de- coction, and powder,-with' various-results. The sensation which was felt after these trials was that of fulness, anel of rather a pleasant nature, which continued occasionally for an hour or so. Satisfied with these results, I waited for an opportunity of putting them intd execution on some diseased subject, who I little imagined woulcl prove .to be myself. I-was seized, in consequence of exposure to an unhealthy atmosphere, with a-regular tertian intermittent fever. I took a purgative, and allowed the disease to go on for fourteen days, without any further medicine, for the very smell o::' bark excited instant vomiting. I then tried the decoction of coffee: An ounce, three times daily, prepared as above : By tlie next time the paroxysm was expected I had taken six ounces of the powdered coffee, made into decoction : The fit came on as -usual, but was epiite trilling. I continued the medicine for-a, week longer, and the fever never returned. I enjoyed good health for six months, when, from my professional duties leading me to be expo.ed at a:; unseasonable time, 1 got my old companion back again. I immediately took the coffee decoction, and had only three attacks oi the dhc.;-c. '" A young gentleman, lately come to the island, was attacked with intermittent fever, which he imprudently allowed to go on for six weeks. He applied to me. I gave him the coffee decoction, pre- pared bV myself, but so disguised that he could not detect it. After regularly using it for six thvys the fever left him, and never :v!urhrd to my knowledge. A negro woman had been subject to an intermittent fever for sk months, which she attributed to tli-e situation of her hou^e b°;m; U 154 extremely low and. swampy. She had used bar1: and snake-root without being able to get rid of it. The e\:rnct of the coffee, along with a scruple of the powckr, was giv .! i >r ten days. The lever ceased to trouble her, and the remedy was continued for some time afterwards. I could mention several oth-r cases that have been successfully treated in this manner by cvfo-e, which seems to prove, that by itself, or in conjunction with other substances, it may-prove serviceable in intermittent fevers: I have not been able to determine the doses accurately. CONVOLVULUS, OR BIND-WEEDS. Frcm this extensive tribe of plints a strong drastic purgative can be procured. Four years ago I sent home various specimens of the inspissated juices, some of which were given me, and others I prepared myself. They were found by the gentleman to whom I sent them to be of a very active nature, and acted violently, un- til, from repeated trials, he learnt how to regulate^ the dose, and moderate the effect:,, by combining other substances. From the sea-side potatoe-slip I have prepared an extract bear- ing every appearance of scammony. In doses of twenty^-.-ains, with aloes, I have found it quick and safe in exciting the action of the intestines, and it might prove of service if cultivated. From the Indian creeper and Spanish arbour-vine I have pro- cured, by evaporation, an inspissated juice, which has answered all the purposes of the stronger purges. Instead of giving large doses at once, seven or eight grains are to be repeated every two hours. till complete operation is obtained. CHINA-ROOT AND SARSAPARILLA. It is somewhat surprising that medical men and others trust urgent cases to the uncertain qualities of this simple mucilaginous plant. How it has kept its ground so long I am at a loss to dis- cover. Its innocent demulcent properties are the most that can be said in its favour. Gallons are drunk with the view of remov- ing inveterate cases of conceived lues venerea, bone-ache, ill-cured yaws, and other constitutional symptoms. The regulated diet and care the patient takes of himself while using it are the causes of the. apparent success attending it. Nothing in reality can be ex- pected from so trifling a remedy. DUMB-CANE. I have made numerous experiments on the virtues of t'n> plant, and obtained some singular and unexpected results, but, being confined entirely to the brute creation, I see no necessity for men- tieiung them at present. Internally to the human subject, I have lKver ventured on it. An ointment, made with hogs' lard and the cxpre- sod juice, is very useful as a stimulant application, and as a cataplasm in cases of debility ; it irritate?-, but does not b'istcv, the tkin. At times I l.nve o'^sei v.-.d that it h is much more acrid quali- ties than at others, particularly after rainy weather. HOG-GUM. This should be kept on every property, being a favourite with negroes, and of service to them in their obstinate rheumatic disoiv ders. It forms an excellent substitute for Burgundy pitch, which •is always adulterated. Spread on leather, and applied to con- tracted and paroed limbs, it proves of benefit, by exciting a gentle stimulus in the weakened part. In lumbago it is good. ZANTKOXYLUM, OR PRICKLY YELLOW WOOD. From the valuable communication of Mr. Fclsted on this subject, T was induced to repeat several experiments on its effects when taken internally. I procured the juice from the tender roots in a fresh state. A tea-spoonful was swallowed every half hour. Three were taken when I found it to. operate powerfully. From the first dose in ten minutes the pulse had increased six boats ; from tbe second and third it rose to fifteen, and continued so as long as I made any observations. I found for the first half hour an unusual sensation in the throat anel stomach, by no means pleasant; this increased, and was-followed .by a strong desire to vomit, with a sense of oppression ; drowsiness came on, and a re- markable ser.se of distension in the head, with slight giddiness and >mperfect vision. Being near evening I laid down, and quickly fell asleep ; but it was greatly disturbed by dreams, and sudden starting?, such as I uniformly experience after taking opium. Ihc Lowels were moved in the same manner as if I had taken a purga- tive. All the next day I felt uneasy, drowsy, and nervous, which gradually wore awav.' I afterwards took fifteen grains of the pow- du.-d root, arr.l repeated the dose three times within the hour. U 2 15(\ 1'lfccts, nearly similar to those in the previous experiment, follow- ed, but in a much milder degree,-unattended with any desire to vo- mit. I gave a negro three large spoonfuls, one every twenty mi- nutes, of the expressed j uice ; the pulse was evidently increased, but I could not observe any other symptom, as he fell asleep in a slioit time. lie said that his bowels were not moved. A negro womun, who was troubled with regular returns of the dry belly-ache (a dis- ease extremely rare with them), took four spoonfuls, one evjry fifteen minutes, and a dose of oil after the first; next day sin.' ex- pressed great relief, much more so than on any previous occasion. I informed her of the remedy, and she tells mc- that whenever he," complaint returns, with any decree of severity, she m-ver iaiis to experience the most immediate ease from her cruel disorder. ii the colicky pains, so troublesome to negroes, I have several times used it with the most speedy and marked effects. The doses go-, n to them must be much larger than to white persons. The roots are covered with a light, soft, powderv substance, of a yellow coldkir, and an agreeable scent. After cubing away the earth that surrounds them, they are to be cut and washed. The farinaceous covering is to be carefully scraped off, and dried by exposure to the sun. If put into well-stopped bottles, it will keep for some time. The dose is various. I have uniformly given fifteen grains every twenty minutes, made into a bolus: Three of these generally were sufficient. Three tea-spoonfuls of the ex- pressed juice of the fresh roots : This may be preserved in rum, along with syrup. A decoction may also be made. Its effects in cleansing the foulest sloughy ulcers have been long known, and it is greatly used by the negroes for that purpose, com- bined with other country remedies, particularly the bitter cassada, scraped and made into powder: Powdered bark and myrrh can be added, as the case may require, 1^7 Weights. Half a scruple contains ten grains. One scruple ......... twenty grains. Half a drachm ......... thirty grains. One drachm ......... sixty grains. Four drachms ........, half an ounce. Eight drachms ......... one ounce. Measures. The pound or pint contains sixteen ounces. The gill ......... four ounces. The ounce ......... eight drachms. The drachm ......... one hundred and sixty drops. By a table-spoonful is meant half an ounce. By a glass or cup full three ounces. By a tea-spoonful about one hundred and twenty drops. Every impression on the thin weights stands for a grain. 158 Doses of Medicines for Adults. i To ch.'blren of one year old, one-sixth c.-f what i? mentioned; to those of three years, one-fourth; of seven years, one hull"; oi incecn years of age, two-thirds. Aloes—five grains to one scruple. Antimonial powder—six to twelve grains. -,--------- wine—sixty drops. Asafcctida—ten grains to half a drachm. Balsam of capivi—one tea-spoonful. Bark—fifteen grains to one drachm. Calomel—four to.eight grains. Camphor—four to twelve grains'. Capsicum pepper—fifteen grains. Cinnamon—one tca-jpoonful. %l Elixir, vitriol- of—twenty drops. ----—, sacred—two drachms to half an ounce. -----, paregoric of—thirty to sixty drops. Cantharides, tincture of—fifteen to sixty drops. Gamboge—three to twelve grains. Ipecacuanha—ten to fifteen grains, as a vomit. Laudanum—fifteen to eighty drops. Magnesia—half a drachm to one drachm. Mustard; as a vomit. Myrrh—ten grains in powder. Nitric acu:—two drachms to one quart of water, to be mcasurrs in a .vmc-^Jass. Nitre—-ten to fifteen grains. Oil of peppermint—ten to fifteen drops." Opium, in pill—one to three grains. Squills—a tea-spoonful. Pills, mercurial—ten to fifteen grain?. Powder, Dover's—ten to twenty grains. -------, James's—live to t.velve .vuin-s. Rust, iron cf—ten grains to half a drachm. Rhubarb—ten grain? to half a drachm. Suits, Glauber's—half an ounce to one ounce. ----, Pp^om—force 1-cn~spoon.fi >!;, di^-Ived iu coin vbvtr V>9 Salt of tartar—five to twenty grains. ■----of steel—three to ten grains. Sulphur—halfva drachm to one drachm, Spirits of hartshorn—two tea-spoonfuls. ------of lavender, the same. Sweet spirits of nitre, the same. Spirits of Mindererus—two table-spoonfuls. Squills, vinegar of—sixty drops. Tartar emetic—two to three grains. ------, soluble—half an ounce. Tincture of bark—two tea-spoonfuls. ---------- steel—twenty drops. Vitriol, white—ten to fifteen grains, as a vomit. .-----, blue—one grain and an half? as a vomit, in water. IdO Forms of Medicines LAUDANUM, . SLICED opium, 10 drachms; rum, proof 22, one pint: Digest for three days in the hot sun-shine, and strain. I would always recommend having laudanum procured from home, as the strength is much more ac- curate and regular than what we can prepare., and the cases in which it is generally required are of an urgent nature. VINOUS TINCTURE OF OPIUM. Extract of opium, one ounce ; bruised cinnamon, a drachm; white wine, a pint: Macerate for eight days, and strain.^ AQUEOUS SOLUTION OF OPIUM. Opium, six grains ; water, three ounces : Bub them together in a glass mortar for ten minutes ; strain, and add a wine-glassful of sweet spirits of nitre, if necessary : A table-spoonful a dose. This preparation vvill not keep, and must be made as required. ANTIMONIAL WINE. Tartar emetic, two scruples; boiling water, two ounces ; Madeira wine, eight ounces : A tea-spoonful, so as to excite vesting. DOVER'S POWDERS. Vitriolated tartar (sulphate of pot-ash), three drachms; opium and ipecacuanha, of each a scruple : Grind them to a fine powder: Dose, ivn to fifteen grain?. EFFEUVESCING MIXTURE. Salt of tartar, two drachms; water, half a pint; two table-spoon fob. to one of stii-ened lime-juice : To be taken while effervescing. If it be required to prove a laxative, a small spoonful of Ep^um. eafo i" to bo \ ridded. } 161 TARTAR EMETIC SOLUTION. Tartar emetic, four grains; warm water, half a pint: A wine-glass- ful every fifteen minutes, till it operates, upwards or downwards. A table-spoonful, with a few drops of laudanum, will act as a sudorific. PAREGORIC ELIXIR. Flowers of benzoin, three drachms; opium, two drachms; oil of ani- seed, half a drachm; proof spirits, a pint; Allow to digost for several days, and strain i An ounce of hartshorn may be added^ SACRED ELIXIR. Sliced rhubarb, ten drachms ; aloes, six drachms; dried orange-peel, an ounce ; spirits, two pints : Digest for several days, and strain : Dose, a table-spoonful. TINCTURE OF CANTHARIDES. Bruised cantharides, one drachm ; spirits, a pint: Digest for several days, and strain: Dose, 15 drops, it i^ preferable to have it ready pre- pared from Europe. TINCTURE OF CAPSICUM. Bird or other peppers, an ounce ; spirit-., a pint and a half: Macerate for ten days. Excellent in sloughy sore - on the throat. CAMPHORATED MIXTURE. Camphor, a scruple ; strong spirits, a tta-spoonful; SUg.lr, half an ounce; water, a pint: Dissolve the camphor first in the spirits, and then add the other ingredients. SPIRITS OF CAMPHOR. Camphor, four ounces; spirits, two pints. We may ..ei J olive or palm oil, so as to form an excellent liniment. LIGNUMVIT/E MIXTURE. Of the o-um, a drachm and a half; .sugar, one table-spoonful; cashew- gum dissolved, three table-spoonfuls; water, half a pint: Dose, a wine- glassful—morning and evening. This is considered one of the best form? of exhibiting the gum guiacum for chronic rheumatism. lGiJ TINCTURE OF LIGNUMVIT-JE. 0.f the gum, six ounces ; spirits, a pint and a half: Macerate for ten days : Dose, a table-spoonful in milk or water. A tea-spoonful of spi- rits of hartshorn may be added. ALTERATIVE TINCTURE. Gum guaiac, ten drachms; snake-root, three drachms; pimento and opium, of each a drachm ; spirits, a quart: Digest, add half a drachm of corrosive sublimate. Dissolved in an ounce of spirits : Dose, two table-spoonfuls in the lignumvitoe decoction. ELECTUARY OF GUAIACUM AND BARK. Bark, an ounce ; gum guaiac, half an ounce ; rust of iron, two drachms; syrup, as much as to give consistence: Dose, a dessert-spoonfui twice daily. SPIRITS OF MINDERERUS. Carbonate of ammonia (smelling salts), two ounces; strong distilled vinegar is to be added until all effe.vescence ceases: Dose, half an ounce. It is preferable to obtain this from Europe; it is a cheap medi- cine. ALTERATIVE DIET DRINK. Sarsaparilla and lignumvitse chips, of each eight ounces; water, two gallons; boil to one ; strain, add a quart of sugar, and an ounce of anti- tnonial wine. Dose, half a pint daily. NITRIC ACID. Two drachms to a quart of water sv/eetened, and taken occasionally; it should be sucked through a quill. STEEL BITTERS. Salt of steel, 120 grains; the dried rind of two Seville oranges; a pint of rum, with a few shavings of bitterwood; place the whole over ihe fire for a few minutes: Dose, three table-spoonfuls. CONTRAYERVA BITTERS. Take a large handful of the roots, infuse them in a pint of wine, add 163 dried orange-peel, or, if put in rum, add three drachms of salt of steel to a quart: A large spoonful every morning in a pint of the bitter, wood infusion. COCCOON ANTIDOTE. *■' . - •.-■'-'■. Slice a few of the kernels ; add the powdered Bark Of the wild cinna- mon ; a pint of runn It operates likewise as a purge. PEPPER MIXTURE. Three spoonfuls of bruised bird-pepper; same of wild cinnamon pow- dered ; two drachms of salt of steel; infused in a pint of rum: Dose; a table-spoonful in bitter-wood. Good in cases of dirt-eating and cachexia. STOMACHIC POWDER. Prepared chalk, rust of iron, and rhubarb, of each equal parts : Dose, a spoonful twice daily in syrup of ginger. Another. Myrrh, one drachm ; salt of wormwood, half a drachm; salt of steel, 12 grains; water, six ounces; syrup of ginger. In cases of debility this may be taken during the day in three doses. STOMACHIC PILLS. Powdered aloes, eight drachms; salt of steel, two drachms; syrup.of ginger as much as sufficient; Make into 36 pills: Two occasionally. BILIOUS PILLS. Gamboge, jalap, calomel, and aloes, of each 10 grains; oil of pepper- mint, a few drops: Form into ten pills : Three for a dose. INJECTIONS, &c 1. White vitriol, 20 grains ; sugar of lead, GO grains; laudanum, a tea-spoonful; add mucilage of cashew gum: Water, a pint. For go- norrhoea, &c, 2. Calomel, two drachms; lime-water, half a pint; cashew gum solu- tion, four ounces. 3. Alum, a drachm; water, six ounces. X2 16F 4-. Corrosive sublimate, two grains; lime-water, six ounces: Muci- •|age. Very efficacious in obstinate gleets. GARGLES. 1. Bruised bird peppers; strong vinegar, a pint; culinary'salt, a spoon* ful. Useful in sloughy sore-throats. 2. Nitric acid, a drachm ; water, a pint. 3. Sage-tea, a pint; vinegar, six ounces, boiled, with a few penguin- apples. 4-. Bark, an ounce, made into decoction; elixir of vitriol and tincture of myrrh or alum, as much as to make it astringent. 5. Strong infusion of the wild cinnamon with the pepper tincture. 6. Mercurial gargle. Corrosive sublimate, four grains ; dissolve in a pint of water, with mucilage ; add honey. 7. Four grains of lunar caustic, dissolved in a wine-glassful of water ; twenty drops of oil of vitriol in half an ounce of honey; two grains of corrosive sublimate. Any of these substances may be employed in cases of ulcerated throat; a piece of rag tied on a probe, and dipped into the mixture; the parts are to be touched several times daily, using some simulating gargle at the same time. LOTIONS. 1. One or two grains of corrosive sublimate to an ounce of water, with alum ; Goulard's extract, two tea-spoonfuls ; vinegar, four ounces ; six ounces of water, with a few spoonfuls of laudanum. 2. Blue vitriol and alum, of each three ounces; elixir of vitriol, one ounce ; water, three. 3. Lunar caustic, four grains ; alum, three drachms; water, four ounces. 4. Ten grains of corrosive sublimate ; two ounces of diluted muriatic acid; a quart of water. 5. Blue vitriol, two ounces ; oil of vitriol, a drachm ; a quart of water. 6. Fresh made lime, three ounces; carbonate of ammonia, two scru- ples ; verdigrease, four grains ; water, six ounces. CLYSTERS. 1. Mucilage, a pint; salts, an ounce; castor-oil, three table-spoon- fuls. 2. Soap, half an ounce; table salt, a spoonful; mucilage. 3. Powdered aloes, half an ounce, dissolved in a pint of boiling water. 165 4. Turpentine, two table-spoonfuls; castor-oil, the same; starch, so a§ to thicken it. 5. Expressed juice of the sempervivum, a wine-glassful; thin gruel, a pint. 6. Asafcctida, two drachms ; warm water, a pint: Rub them together. 7. Logwood decoction, arrow-root, made into a starch, four ounces; thrown up as a clyster; of an astringent quality. 8. Tobacco, two drachms ; boiling water, a pound: Infuse for ten minutes, and strafn. 9. Bruised root of ipecacuanha, two drachms ; boil in a pint and a half of water down to one half; strain. 10. Bark, three drachms; mucilage, sufficient to form a clyster, with 40 drops of laudanum. io6 List of Medicines necessary to be imported Aioes, socotrine. Alum. Antimonial powder. Bark, Peruvian. Calomel". Camphor. Cantharide's. Corrosive sublimate. Cream of tartar. Dover's powders. Elixir of paregoric. Flowers of sulphur. Gamboge. Honey of squills. Ipecacuanha. Jalap. Myrrh. Nitre. Nitric acid. Oil of peppermint! Opium. Ointment, mercurial. Red precipitate. Rhubarb. Salt of hartshorn. Salts, Glauber's. ----, Epsom. Medicines, which sOon lose their virtues in a warm climate, such as Bark, Blister-Flies, Rhubarb, Jalap, Fox-Glovef and Squills, should be or- dered to be put into small ounce bottles, well secured. On large estates a cupping glass, made without springs, and three .spare glasses, with a pump-handle, as made by Mr. Evans, of London, "Salt of steel. ---of tartar. Spirits of Mindercru*; Sugar of lead* Sweet spirits of nitre. Tartar emetic. Turpentine. Tincture of digitalis. Tincture of cantharides. Tincture of opium (laudanuni.) Tincture of steel. Verdigreasel Vitriol, blue. -----, wrhite. -----, oil of. Vitriolic ether. Yards of adhesive strap. Syringes, male and female. Clyster syringes for adults, and , children. Lancets. Scales and weights. Pestle and mortar. Surgeons' lint. Trusses. Bougies. Finals, tissorted. J67 List of Medicines, &e. which are produced in the Country, and ought to be kept on every estate. Aloes, or sempervive plant.—This is easily propagated, and grows on, the most rocky situations ; the fresh or inspissated juice. Bark, cabbage.—This should be well dried before it is made use of either in powder or decoction; the tincture also proves purgative. Bark, Jamaica.—The tree is scarce in some places. Bitterwood.—A very common tree. Balsam of tolu.—When pure it is of the tenacity of bird-lime, with a »>V.i?ant smell; the best is contained in small round calabashes, semi- transparent. Capsicum peppers.—Dried and in tincture ; mixed with blister-flies, they assist greatly in exciting external irritation. Cashew gum.—When pure it is nearly transparent, and brittle ; abun- dance can be procured in the month of July. Cinnamon, wild.—A common large forest tree; the bark and dried berries make a good tincture. Cowitch.—When we preserve it in a dry state, it is to be packed closely in barrels. Castor-oil.—The nuts are to be planted in gullies and sheltered situ- ations, as they are liable to be destroyed by breezes ; an emulsion of thq full nuts may be substituted when the oil is not to be had. Contrayerva—-The roots and stalks. Coccoon antidote.—The kernel. Cyperus (adrue).—The roots sliced and made into decoction, Dumb-cane.—Expressed juice made into an ointment. Ginger.—Dried root, and mixed with syrup. Hog-gum.—The free grows in mountainous situations. Indian arrow-root.—The greatest quantity is to be procured, when it is dug, in the month of January. 168 Lignumvitae.—Grows chiefly in a lowland situation; the gum and wood. Liquorice, wild.—Infusion of the leaves and tops. Logwood.—Decoction of the chips. Lily root.—Excellent for poultices. Prickly yellow wood.—Rodts covered with a fine yellow substance, which is to be scraped off and dried; also fresh juice, which will keep for some time in rum and syrup. Ringworm-bush__Fresh expressed juice. Sago.—Made in the same way as arrow-root. Tamarinds.—The preserved fruit. Tobacco.—Fresh and dried leaves. Vervain.—Best made into a tea. Vangloe or zezegary.—The seeds and tops have the same quality aS ochro. Yellow thistle.—Seeds as an emetic. Worm-grass.—Decoction of the plant. There are many plants that go by this name; the real species, as described by Browne, is not com- mon in this part of the island. ERRATA. Page 1, line 21, for « will" read " shall." 13, line 13,/>r " this" raztf " the." 15, line 21, for " and" raze? " when." 22, line 38, for " blister" «?** " blisters." 23, line 8, frr " if they be" read " it may be." note 2d, line 3, /or " gum ammonia," read " gum ammonia"* cum." 36, note 1st, line \, for « cod," W " add," and tfefe the comma, inserting one at cinnamon. 54, line 23, for " some" read " the same." 56, line 26, after " is" insert a comma. line 27,/or " where" read " whether." 86, line 28, for " poison" read " poisons." 106, line 8, insert a full point after the word person, and begin « n»'" with a capital T. Dele the semicolon. 108, line 37, after " end" insert " then." insert a semicolon «/ter " down." for " in the," reac? " in this." t Med, Uist, no n~4<23t IS£0 r.Xr.^u'-W.'r:: .-.:.■: -f - *«*-■* J - >. •" ■■.:." .t-''.:-J " .- :,::. .':.! .:. i • 2*-f"- ":X-i yi-ii :'•/ '^''* -:> ,"■" i:.':^lff!ii,Mii».v!:'.~ i;.' -v.:.-;; y;Vv .-.Tij'v i;^, '.'•■-■■' rv':>-:^'-' j.^"^. jri --v- . ■-•.-- ■■'"!.' ' ; -.„"; -v.: ■,■•■<• .-.'iX ^Kv?:""!! pi^is^ilSii- ... ■'|*Siy'.JiM!it :i!.!rs*il28i(£'HSi