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PHYSICIAN  FOR  SHIPS;
00 NTAIKINO
MEDICAL ADVICE
SEAMEN AND  OTHER  PERSONS AT SEA,
TREATMENT  OF  DISEASES,
AND ON THE
PRESERVATION OF HEALTH
IN SICKLY CLIMATES, AND ALSO IN CALIFORNIA.
          By USHER PARSONS, M. D.,

Late Surgeon in the U. S. Navy, and President of the Rhode Island Medical Society ; Honorary Member of tht
         Massachusetts, New Jersey, Philadelphia, and South Carolina Medical Societies.
FOURTH EDITION.
2.9/^
          BOSTON:

PEINTED BY DAMRELL & MOORE,
       No. 16 Devonshire Street.

            1851. 
Pi v\ y\ <u >f
VW  6
       Entered according to Act of Congress, in the year 1850,
                     BY USHER PARSONS,
In the Clerk's Office of the District Court of the District of Massachusetts.
  Sold by Joseph Burnett, apothecary, Brewers, Stevens & Cushing, and Benjamin
LoriDg & Co., Boston ;  by William C. Taber, New Bedford ;  Henry Whipple Salem •
Joseph  Balch and 0. W. Parsons, Providence; B. 0. B<txi>r,  New  London'-  E.  &
Q. W. Blunt, and Thomas & Maxwell, New Yurk ; Joseph B. Stansbury, Baltimore. 
PREFACE.
  Former editions of this work contained extracts from reviews of it
inserted in medical journals, in which learned men of the profession
extolled its value to the full  measure of its deserts.  Having now
reached the fourth edition, the character of the work is too extensively
known  and established to need any such high commendations, and
the pages they occupied are therefore  filled with more useful matter.
  The chapter containing  advice to Invalids who seek health in  a
warmer climate has been improved ; — a new chapter of several pages
on California has been added,  containing advice to persons bound to
that region, both by sea and overland, for the preservation of health
and cure  of disease on their way and while employed at the gold
diggings ; — the medicine chest has been revised and improved, and
the chapters on ship-fever and on cholera  have been enlarged, and
several additions and improvements made in other parts of the work.
  The contents of the medicine chest and the directions for treating
diseases being made to correspond, it is recommended to captains
and others who intend to consult the  book for advice, to  have their
chest put up  according  to  the prescribed  Hst, as they will then be
sure to find the articles they need, and, if guided by the book in pre-
scribing, to avoid the incumbrance of many others that are useless.
This  advice, however, is not  intended to  hinder  the  captain from
adding such medicines as he, from long use, is partial to.
   The author would recommend to captains and mates of vessels to
give the book one perusal.   They will thereby become familiar with
its contents, and able to refer to it more readily, and perhaps to pre-
scribe by it many times from memory.
  The diseases are classed into general and local; the first including
fevers, scurvy, jaundice, dropsy, dyspepsia,  epilepsy, apoplexy, lock-
jaw, small-pox, and measles.  The second class is subdivided into
diseases affecting particular portions of the  body, as of the head, the
neck, the  chest, &c. &c.   This is done  with the view to  assist  the
sailor in referring to an  account  of his  disease.  If ignorant of the
name of his complaint, and therefore unable  to refer to it  by the
index, he  certainly cannot be ignorant of the part of his body  that is
disordered, and if it be the head, or neck, &c , he has only to turn over
the pages  till he arrives at the one headed with diseases of that part. 
4
PREFACE.
  The book being intended exclusively for seafaring people, nautical
diseases only are included.  A great number of complaints incident
to the human body, being thus  left out, enables the sailor to refer to
an account of his disorder more readily, at the same time that it les-
sens the expense of the book.
  In  describing the causes, symptoms, and  treatment of  diseases, I
have  avaUed myself of  the  assistance  of a variety of authors.  In
giving the symptoms, those only are mentioned, that are  most con-
stant, obvious, and invariable.  The pulse, which is the grand index
to constitutional affections with an experienced physician, is little
understood by  others, and  is therefore  referred to in this book in
such diseases only as where the morbid change it undergoes is great,
and obvious to  a common observer.  In these diseases it will be ad-
visable for the  person who prescribes, to compare the pulse  of the
patient with his own, or  that of some other healthy person.   Any
unusual frequency, great  irregularity, or other deviation from health,
wiU then be readily discovered.
  In mentioning the  causes of disease, the  most common only are
noticed.  A knowledge  of these wiU be attended with the double
advantage of  enabling the patient to determine the character  of his
complaint, and  of guarding against their influence in future.
  In directions  for the treatment, many valuable remedies are omit-
ted ; some, because they  would increase the  list of articles in a med-
icine chest, and make its expense  objectionable, and others, because
they would be unsafe in  the hands of the inexperienced.  Thus, ar-
senic for fever and  ague, corrosive  sublimate for syphilis, and some
other complaints, and the concentrated acids in a variety of diseases,
though  very  valuable in the hands of a physician, are  unsafe for
others to prescribe,  and, in the medicine-chest of  a merchant vessel,
are even dangerous. 
THE
PHYSICIAN  FOR  SHIPS.
OF INTERMITTENT FEVER, OR FEVER AND AGUE.

                      SYMPTOMS.

   It  consists of regular  fits  of  fever, between each  of
which  there is a distinct and perfect  intermission.   The
fits usually commence in  the  morning.   They recur gen-
erally  every other day — sometimes  daily, and in a few
instances every third day only.
   Each fit consists of three stages, termed the cold, hot
and sweating stage, which run their course in this order of
succession, generally  in  the  space of from  three  to six
hours.
   The cold stage commences with languor, sense of debil-
ity, yawning and stretching,  and aversion  to  exercise.
The face and extremities  become  pale ; the skin over the
whole body seems constricted, as  if cold had been applied
to it, and  resembles goose-flesh.   The pulse  is small, fre-
quent and irregular.   At length chills come on, with pain
in the head, back and loins, followed by universal shaking,
and sometimes by vomiting.
   Hot stage.   After  a longer or shorter continuance of
the shaking, the heat of the  body gradually returns, at
first irregularly by transient flashes, soon  however becom-
ing steady  and intense.  There  is redness of the skin,
increase of pain  in the  head, thirst, a quick, strong and
hard pulse — sometimes delirium.
         l* 
6
INTERMITTENT FEVER.
  Sweating stage.  At length a moisture breaks out upon
the face and neck, which is soon followed by universal per-
spiration.   The heat now  descends  to its  usual  standard,
the pulse is  diminished in  frequency, and becomes full and
free, and all the other  symptoms of fever  disappear, leav-
ing the patient, however, a little debilitated.

                       CAUSES.
  Debility, induced by a poor diet, by great  fatigue, long
watching, depressing passions of the mind, and preceding
disease.   Cold, united with moisture, in whatever way
applied  to the body.   These, however, only  predispose to
the disease,  since a  more efficient cause  is  necessary  to
bring it on ; and  this is  exposure to marshy exhalations.
In proof of this,  there are  large  districts of country  in
which the disease never appears, however  great  the expo-
sure of the inhabitants  to the first mentioned causes ;  while
there are others, having marshes and much stagnant water,
in which the disease is so common, that in  the season of it,
very  few escape an  attack, especially those who  labor
under any previous debility.

                      TREATMENT.

  The first  step in the cure  is to cleanse the  stomach and
bowels.   This sometimes  arrests the disease  of itself, and
always renders the operation of other remedies  more safe
and certain.   Twenty-five grains of ipecac, or four grains
of tartar emetic, answer the  purpose very  well, and should
be given at the commencement of the cold stage.   During
its operation, the  patient may  drink freely of warm  water
or weak  chamomile tea.   If the emetic fail of acting down-
wards and clearing the bowels, it should be followed by a
dose of calomel, four grains ; or of blue  pill, six grains,
taken at bed time.
   Having cleared the stomach and bowels, we are to com-
mence on the day following with tonics.   Formerly bark
and wine were  the   remedies chiefly re'ied  on, assisted
sometimes  by tincture and decoction of  bark and  other 
INTERMITTENT  FEVER.
7
bitters.   But  since the discovery of the essence of bark,
in the form of quinine, these more  disagreeable medicines
are laid aside.   The quinine may be given in doses of four
grains, in pills, or dissolved in water, or mixed  in molasses
or jelly,  every four  hours, during  the  intermediate day
between  the fits of ague and fever.   But on the day fol-
lowing, when the attack may be expected, the dose should
be  doubled,  and  should  be  taken every two instead  of
every four hours, commencing at sunrise  and continuing
till the time of the expected fit has passed by.  This course
will, in a majority of cases, prevent the fever and ague fit
entirely, and if it  should, we have  then only to return to
two grain doses of quinine, and continue  them once in four
hours for four or five  days, when, with nourishing diet and
some mild tonic, as elixir vitriol, or decoction of  quassia,
three times a day for  two or three  days, the patient may
be considered as cured.
   But should this course fail to prevent the  expected ague
fit on the second  day after the emetic, we should  then
give another dose of calomel or blue pill, and proceed with
the repetition of the same course as before.
   When quinine cannot be procured, or is of a bad quality,
or has been long used to no effect, other tonic bitters are
to be substituted, and taken in  the same manner ; as de-
coction of bark, columbo, gentian, quassia, &c.   Also char-
coal, finely powdered, may be taken in substance, a table-
spoonful  in gruel.
   Opium has  been highly recommended  in intermittents,
and well deserves a trial, since  its exhibition does not in-
terfere with the other remedies above mentioned.  It may
be given in  doses of  thirty or forty drops of the tincture,
laudanum, at  the  commencement of the  first cold  fit,
succeeding that in which  the  emetic was administered.
If the first dose fail  to  induce warmth in the space of
ten or fifteen minutes, give thirty or forty drops more.
The  tendency of this medicine is to shorten  the fit and
render it less' likely to return.
   Durino- the fit, the patient should take freely of warm 
8
REMITTENT FEVER.
drinks, and  during the intervals or between the  fits, sub-
sist on a nourishing and easily digested food.
  It is of the first importance that sailors, who are obliged
to wood  and water, or perform other duties on shore,  in
situations favorable to the producing  of fever and ague,
should exercise the  greatest caution in  their diet and
regimen.  As a  preventive it  is advisable for persons  in
such situations to drink freely of strong  coffee, to avoid
exposing themselves to sudden changes of temperature,  or
to evening  air, and if possible  return  to the ship before
dark.  They should wear warm clothing, indulge in a plen-
tiful diet of flesh highly  seasoned;  observe cleanliness,
preserve a healthy state of the  bowels, avoid exercise and
all stimulating drinks.
                OF REMITTENT FEVER.

                      SYMPTOMS.

   This disease  partakes in some degree of the nature of
intermittent fever,  being  generally produced  by  similar
causes.  There is however this difference between the two,
that in intermittent fever, the fits return at stated periods,
and on subsiding leave the patient entirely free from all
febrile symptoms ;  while in the  present  disease, there is
only an abatement between the fits, and an irregularity in
the time of their recurrence.
   It is impossible to describe all the symptoms of remit-
tent fever, since  they vary according to the situation and
constitution of the patient — the season of the year — the
treatment adopted, and  many other  circumstances,  too
numerous  to mention.  Sometimes bilious symptoms pre-
dominate, sometimes  nervous, and at  others putrid  — nor
is  it uncommon  to find a succession of these ;  or even a
complication of them in the same  person at the  same time.
Hence this disease has often been termed mixed fever.
   It is most prevalent in warm climates,  where great heat 
REMITTENT FEVER.                 9
and moisture  rapidly succeed  each other — and particu-
larly in marshy situations, abounding with wood and water.
Some eminent writers include under this  fever, the yellow
fever of the West Indies, of New Orleans and Charleston ;
also, the Bulam fever, which is so destructive of life at the
mouth of the Gambia, and along the whole coast of Western
Africa,  from  the river Senegal  to Liberia, and also the
fevers of Bengal and  Batavia,  all of which  are highly
malignant;  but the propriety of it is doubtful.

                      TREATMENT.

   It should be treated according to its predominant symp-
toms, or in the same way as that fever is  treated to which
this at the time bears the nearest resemblance.    One rem-
edy, however, seems well adapted  to every form of this,
and almost every kind of fever at its commencement, and
that is  an emetic.  Take thirty  grains of ipecac, or four
grains of tartar emetic; and,  during its  operation, drink
freely of warm water  or weak chamomile tea, or  toast
water.
   Should vomiting, however, already have  existed in any
considerable degree, the emetic may be omitted.
   Bleeding  is  proper  in the  early stage of the  disease,
provided there be a hard, full pulse,  with great heat of
the skin and severe headache.
   A dose of calomel should, in  all severe attacks, be given
early and repeated often, proportioned, however, in quan-
tity and  frequency of repetition, to the  severity of the
attack.   Mild  cases of  simple  remittent, as it  appears on
the Lakes and along the coast of Maryland and  Virginia,
might require a dose of four  to six or eight grains,  once
daily, assisted with a little oil or salts, and after the opera-
tion of the medicine each day, a dose of  powder of nitre,
ten grains,  dissolved  in  a wineglass  of water, may  be
given every three hours, alternated with  a  tea-spoonful of
spirits of nitre in the  same quantity of  water.   One  or
the other  of these medicines  taken every  hour  and a half.
should be accompanied with the free use of cooling drinks 
10
REMITTENT FEVER.
   Should the pain be severe after the first bleeding, a blis-
 ter may be applied  to the back of the neck, and the head
 be constantly wetted with cold water and vinegar.   Great
 heat of  the skin,  whenever it  appears, and  in  whatever
 part, should be frequently sponged with cold water.   In
 the early stage of the fever, great heat of the skin may be
 treated  with  cold  water,  dashed  on the  whole surface,
 copiously.
   In a few days there will  be an abatement of the fever,
 and whenever this is perceptible, quinine should be given
 every four hours, beginning with doses of about two grains.
 Should the fever, under this treatment,  assume the inter-
 mittent  form, Avhich it is liable  to do in places where the
 latter prevails, then it  is to be  treated  in like manner as
 directed for that disease.
   Wherever this disease is prevalent, the same preventives
 should  be  taken, and  the  same regimen  adopted, as are
 directed under  the  head of intermittent fever; as,  also,
 under the head of advice to strangers in hot climates.
   This  is the most common fever in tropical climates.   It
 is not  frequent at sea, but generally attacks men when
 they get into harbor, particularly such as are sent on the
 business of wooding and watering, and  are thus  exposed
 to the  noxious effluvia by which it  is produced.   It is of
 very frequent occurrence in the  West Indies — on the sea-
 board and banks of the rivers of the Southern States —
 on the  coast of Guinea in Africa, and the warmer latitudes
 of the East Indies.
   The higher the  latitude it occupies, the  milder are its
 symptoms.   In 1813, it prevailed in the squadron of Com.
 Perry, on the south side of Lake  Erie, to such an extent
 as to attack  one man out of four of all  the  crews.   Its
 character, however,  was so  mild,  that one death only oc-
 curred.   We noticed that changing our anchorao-e from a
leeward to a windward shore, or sailing out into the middle
of the lake, would  in two days arrest the progress of  the
disease, and materially improve the health of those already 
LOW TYPHUS, OR SLOW  NERVOUS FEVER.      11
OF THE  LOW TYPHUS, OR SLOW NERVOUS FEVER.

                      SYMPTOMS.

  It commences  slowly and  imperceptibly, with general
languor, dejection of mind, loss of appetite,  alternate chills
and flushes, dulness and confusion of thought.  In a day
or two there  is a giddiness  and pain in the head, with
aching pains over the whole body, nausea ; frequent, weak,
and often  intermitting pulse.  At first the tongue is moist,
but afterwards becomes dry, brown, and tremulous ; there
is little thirst,  and the urine is  pale and watery.  As the
disease advances, the heat and other symptoms of inflam-
mation increase, the urine becomes  high colored ; some-
times diarrhoea and immoderate sweating ensue ;  there is
a low, muttering delirium, a starting and  twitching of the
tendons ;  sometimes a coldness of the extremities, convul-
sions and  death.

                       CAUSES.

  Weak and delicate habit of body ;  poor living ;  warmth
of climate ; depressing passions of the mind, as grief, fear,
anxiety ;  excessive venery, intemperance.
  It may  be known from putrid or malignant fever, by the
attack  being  more  gradual, and the symptoms  milder;
from inflammatory fever, by the smallness and weakness of
the pulse, and by its more mild  accession.
  About  the 7th, 14th, or 21st day from  the attack, the
disease usually abates,  and  the  patient from  that  time
slowly recovers.

                     TREATMENT.

  Commence  this by cleansing  the  stomach and  bowels
with a mild  emetic and cathartic combined, as follows:
  Take ipecac, thirty grains, and calomel five ; mix them,
and give the dose in any convenient vehicle.  Or mix four
grains of tartar emetic with  two table-spoonfuls  of Epsom 
12         PUTRID, MALIGNANT SHIP FEVER.
in half  a pint of water, and give a wine glass every half
hour till it  operates.  If this fail to move the bowels once
or twice, take some other mild  purgative, and repeat it as
often as there is the least tendency to costiveness.
   If the disease be not arrested by this treatment within
the first three days, apply blisters to the legs, and mustard
poultices to the  soles of the feet.   If after this there be
much stupor, blister the back of the neck.
   The pulp of an orange, or roasted apples, will be both
cooling  and agreeable to the stomach.
   For common drink, he may take toast-water, lemonade,
cider, or soda water and thin gruel.
   One  of  the  best remedies  in the early stage of  the
disease, after the stomach and bowels have been moved by
medicine, is  cold affusions.  The cold water should be
dashed on  from a pitcher or bucket, wherever the heat of
the skin is  above the natural standard.   If  this heat how-
ever be confined  to particular parts of  the  body, the cold
water may  be applied to them alone, with a sponge or  wet
cloth.
   The patient should be kept  as  quiet  as possible, and
with a view to promote perspiration and induce sleep, may
take every  evening a Dover's powder, of eight grains,  (or
two pills) and have warm poultices  renewed to  his feet.
   During  the  day-time, administer  the following drops :
— Take spirits nitre and antimonial solution equal  parts,
mix them, and give two tea-spoonfuls every three hours, in
toast-water.
         PUTRID, MALIGNANT SHIP FEVER.

                      SYMPTOMS.

  The attack of this disease is very sudden.   The patient
is hardly able to stand, and from the  first moment seems
ready to faint without  any apparent cause.   There is an
intense pain in the head, strong  pulsation and throbbing
in the temples — sometimes  delirium — sickness at the 
            PUTRID, MALIGNANT SHIP FEVER.         13

 stomach, followed by  a vomiting  of  black  matter.   The
 tongue is at first white, but afterwards appears black and
 chapped, and the teeth are covered with a black crust —
 the breath is hot and offensive.   The fever continuing to
 increase  still more in violence, symptoms of putrefaction
 show themselves; the stools are dark, very offensive, and
 pass off insensibly; blood is effused under the skin, form-
 ing purple spots ; bleeding occurs from different parts of
 the body ; the pulse sinks  and intermits; the extremities
 grow cold ; hickups ensue and death.
   This fever may be distinguished from inflammatory, by
 the smallness of the pulse ; — the great dejection of mind ;
 — the sudden  and extreme debility ;  the putrid smell of
 the breath and  stools — and by the purple spots.   It may
 be known from low or nervous fever, by the suddenness
 and violence of the  accession — the intensity of heat and
 thirst, and the high  color of the  urine ; — from yellow
 fever by the matter vomited  being void of bile ; by ab-
 sence of  yellowness in the  eyes, and by reference  to its
 supposed causes.
   It is however sometimes the case, that  this is  blended
 with two or three other fevers, particularly the  remittent,
 when it  constitutes the fever  of  Batavia,  Bengal,  and
 Bencoolen.

                        CAUSES.

   The room, or atmosphere in which a person laboring
under  the disease is confined ; — foul  air, occasioned  by
the confinement of a large number  of  persons in a narrow
place not properly ventilated, as in crowded hospitals, jails
or ships, especially where cleanliness is neglected ; — ex-
halations  from  putrid   vegetable  or  animal substances.
Sailors are more liable to its attacks in long voyages.
   It is  sometimes caused  by putrefaction taking place in
filthy ballast.   In the  frigate General  Greene an instance
of this kind occurred, and  a loss of forty or fifty lives was
the consequence.  The same thing  occurred  also on board
the frigate  Philadelphia.   In  both these instances, the
          2 
14         PUTRID, MALIGNANT  SHIP FEVER.
disease was entirely arrested  by deserting the berth-deck
and bringing the crew upon the gun and spar-decks, where
there was a constant current of air.
   This fever is  not  confined to hot climates, though from
the more sudden process of putrefaction of animal and
vegetable matter in warm  places, and  from the debility
and consequently greater susceptibility of the  system to
the disease, it oftener appears in hot than in  cold climates.
   Great mortality has been caused  by this fever among
emigrants from Liverpool and other European ports, from
being crowded and not cleaning and airing the ship properly.

                     TREATMENT.

   In  this disease we should resort to proper remedies at
the very onset.   It will  be best  to  give  at first a light
emetic, unless  vomiting already  exists.    A  purgative
should  next be  given,  of  calomel and jalap ten grains,
each.   This  should  be repeated, if necessary,  every six
hours, till it acts as physic.  If three or four doses fail to
operate, give oil or salts  to assist the  operation.
   It is better not  to  take  blood unless in  a strong and
hearty man, or unless there is much headache, and only at
the beginning of the fever.  When  headache  is  severe,
leeches, if they can be had, should be applied to the tem-
ples.
   Whenever  the surface is unnaturally hot, cold water
should be applied ; the head, neck, arms and body, should
be washed all over, if possible, every  day, with cold water,
or spirit and water.
   As soon as there is a slight abatement in the violence of
the fever, give  two grains of quinine in solution or pill,
every four hours.
   Also, give wine or  brandy.  Brandy is quite as good
as wine, on  every account  except taste.   Begin with  a
tea-spoonful of brandy in  a wine glass  of water, every hour.
This will often quiet the  raving.   If it seems  to be well
borne, increase to a table-spoonful every two hours.
   Instead of the quinine, we may use  elixir vitriol; giving 
PUTRID, MALIGNANT SHIP  FEVER.         15
 ten drops every four hours, in water enough to make it
 taste pleasantly sour.
   Purgatives should not be commonly given after the ear-
 ly part of the sickness, unless the bowels are not naturally
 opened.   Castor oil  is the best.  Calomel and jalap may
 be given, if the bowels are  bound.   If the belly is swelled
 up with wind, give a tea-spoonful of spirits of turpentine,
 with a table-spoonful of castor oil.  Pills and irritating
 purges should not be used.
   When the patient  is not  disposed to sleep, give Dover's
 powders, eight  grains  (two pills)  at bed  time, or four
 grains every six  or eight hours.  This should not be done
 at the beginning of  the disease, nor when there  is much
 delirium.
   When the patient  is very stupid or very  wild, mustard
 poultices may be applied to  the feet and ankles, not keeping
 them on long enough to  blister.
   Persons have sometimes  been brought to, and  have re-
 covered, after they have been unable to swallow, by means
 of hot flannels and hot  bricks  placed outside, and injec-
 tions of brandy and water to the bowels.
   The  sick should be lightly covered.   All their clothes
 and sheets should be  changed, if possible,  every day.  All
 that passes from the bowels, should be removed immediate-
 ly.  A little chloride of lime should be  sprinkled about
 the  room twice  a day.    Ledoyen's disinfecting  liquid
 purifies the air much more  perfectly, and does not leave a
 bad  smell of its own.   A few drops  of it sweeten the air of
 a small room immediately.   It  may be used altogether, if
 it  is to be had.   The air of the  room ought to be  changed
 as thoroughly as it can be.   If  proper ventilation  were in-
 troduced  on shipboard,  this fever would be  much less
 frequent and much less fatal.
   On the appearance of this, or  any infectious di70rder,
 in a garrison, hospital, ship, or  other place where  many
persons are crowded together, every apartment should not
only be cleansed  and  aired, but  fumigated daily, with the
following preparation: 
16         PUTRID, MALIGNANT SHIP FEVER.
Put into an  earthen vessel  a handful of table salt, and
  pour into it  sulphuric acid sufficient  to  moisten it
  throughout.  Let it remain in the apartment  half an
  hour, with the doors and  hatches or  windows closed.
  Or,
Where this  is  inconvenient, burn, by means  of a hot
  iron, sulphur or gunpowder, previously wet with vine-
  gar ;  or sprinkle chloride of lime on the floor and on
  the hammock or bed.
  It is proper here to introduce some remarks  on the
nature, and best mode of treatment, of  this fever in its
more malignant form,  as  it  usually  appears  during the
sickly season in the ports of the  Bay of Bengal, and the
coast of Malabar from Bombay to Cape Comorin, in Bata-
via, Bencoolen  (in Sumatra), and Borneo. These remarks
were derived chiefly from Drs. Clarke and Johnson.
  " The fever attacked  in  various  ways, but commonly
began  with chills, pain and sickness at stomach, vomiting,
headache, &c.   Sometimes, without  any previous indispo-
sition,  the patients fell  insensible;  as they  began to
recover from the fit they  complained sorely of  pain in the
stomach  and  head; and after  vomiting a considerable
quantity of bile, they soon returned to their  senses.
  " In whatever form the disease  appeared at first, the
pulse was small, feeble, and  quick, — the pain at the sto-
mach increased,  and the vomiting  continued.  As the
paroxysm advanced, the  countenance became  flushed, the
pulse  quick and full, the eyes red, tongue  furred, thirst
intense, headache violent, succeeded by delirium, and the
patient became unmanageable ;  but a profuse sweat break-
ing out in twelve or fourteen hours generally mitigated all
the symptoms.
  " In the remissions, the  pulse, which was  before fre-
quently 130, fell to 90.   The patient returned to his sen-
ses, but complained of great debility, sickness at stomach,
and bitter taste.   This interval  was very short, and suc-
ceeded by  another paroxysm, in which all  the former 
           PUTRID, MALIGNANT  SHIP FEVER.         17

symptoms  were  aggravated,  particularly the  thirst,
delirium, pain in the stomach, and vomiting of bile.
   " The unfavorable terminations were generally between
the third and seventh day.  Sometimes there was yellow-
ness of the skin,  as  in common yellow  fever  and black
vomit.  A torpid, or irregular  state of the bowels com-
monly preceded this fever."

                      TREATMENT.
   The treatment recommended by Dr. Johnson, and which
the surgeons of our  navy have, while  in  Bengal, found
most successful, is as follows.  First, open a vein, and let
the blood flow  until  it relieves the headache, pain and
sickness at the stomach,  and vomiting.   Meanwhile  give
a  dose of 20 grains of  calomel,  with half a  grain  of
opium (or 30 drops of laudanum).  If this is immediately
rejected, the dose may be  repeated.   This medicine acts
like a charm, and after a few hours should be followed by
a  dose  of  gentle  physic, castor oil or salts.    The more
copious the discharge from the bowels, the less the danger
there is of a return of vomiting.   Should the above men-
tioned symptoms return, the bleeding may be repeated.
   Immediately after the operation of the cathartic, five
grains of calomel should be given every four or five hours,
combined  with the opium, or  laudanum,  as above, until
the mouth becomes affected, from which time there is great
reason to expect a recovery.  It is of the first importance
to affect the  gums with  the mercury as soon as possible,
and to this end, if the five-grain  powders do not produce
this effect  immediately, we should assist them by rubbing
in mercurial unction on the inside of the thighs two or three
times a day.
   The patient should be removed to the most airy part of
the  ship,  have  his  feet  bathed  frequently with warm
water, and his head with  cold vinegar and water.  " Gen
erally on the third day,"  says Dr. Johnson, " I found the
gums affected with mercury, and  then I felt the patient's
danger to be materially lessened."
   Cold water and cold gruel are of service from the first,
and may be drank freely, unless they excite vomiting.
           2* 
18                 YELLOW FEVER.
   Emetics Dr. Johnson  condemns in  every stage of this
fever, on account of the great irritability of the stomach.
When sickness at the stomach has subsided and mercurial
action commenced, it may be advisable to give  quinine,
one grain twice or thrice a day.   He does not believe the
fever to be  contagious, unless patients  are  crowded to-
gether,  or cleanliness and ventilation are neglected.
   As a preventive of the disease when vessels lie in sickly
ports, he insists strongly on abstinence from all stimulat-
ing liquors, on very moderate use of animal food, on avoid-
ing exposure  to the air on shore in the  morning  and
evening, particularly the latter, and abstaining from  vio-
lent exercise in the sun.   If compelled to wood and water
in a marshy, noxious atmosphere, the safest hours of the day
for it  are from three to six o'clock in the afternoon.
   As cooler weather approaches, these remittent fevers of
the Bay of Bengal assume an intermittent character.
             OF THE YELLOW  FEVER.

                       SYMPTOMS.

  In general it begins with  short  alternate chills and
flushes  of  heat, seldom, however,  with those rigors and
shakings that mark the commencement of most other fevers.
These  are  immediately  succeeded  by violent  headache,
pain in  the  back, universal  debility, and  sickness and
anguish at the stomach.  There is commonly, in the begin-
ning, much bile on the  stomach, which is thrown off  by
vomiting, either spontaneous, or excited by an emetic.   In
the course  of the disease, however, it  is not common  for
the stomach  and bowels to  be  loaded with bile ; there is,
on the contrary, rather a deficiency  of it, particularly in
the most violent and  dangerous cases, as  is indicated  by
clay-colored stools.
  The eye  in a few hours takes a yellow tinge, which soon
after extends more or  less over the face and whole skin
This is a symptom so striking  and  constant, that it gives 
YELLOW FEVER.
19
name to the disease.  Its first appearance on the skin is
under the ears.
  One of the most tormenting  symptoms is a  constant
wakefulness.   It is seldom  that  even delirium  comes to
the relief of the  patient to make him forget  himself for a
moment;  but he  continues  broad awake, night  and day,
with his  reason  and senses sound, in a state of the most
uneasy agitation.
  One distinguishing and alarming symptom is a constant
vomiting, which  usually commences within the first twenty-
four hours, and about the third day ends in what is called
the black vomit.
  Upon the first attack, the skin is extremely hot  and dry,
but  the external heat  soon becomes very little above  the
natural standard in health,  and   the skin  feels  soft and
moist.   The pulse, which is at first hard  and frequent,
is  afterwards so variable as to be no sure index of dan-
ger.  The degree of thirst is less in this than in most
other fevers, and  there is no uniformity in the  color of
the urine.
   Sometimes there is a remission  after thirty-six  or forty-
eight hours from the attack, but the symptoms often recur
with redoubled violence.
  In the latter  stage the debility is extremely great, and
the  breath highly  offensive ;  bleeding sometimes  occurs
from the  mouth or nose, the pulse sinks, swallowing  be-
comes difficult, and death ensues.

                        CAUSES.

  This disease,  though strongly  resembling the Bilious
remittent fever in  many of its symptoms, yet differs from
it in this, that the air of woods and  marshes is not neces-
sary to produce  it.   It however often arises from the foul
air  of a  ship, either from infectious effluvia, or  from  pu-
trefaction that takes place  in neglected holds.   A fit of
intemperance, or  too  much exercise  in  the heat of  the
sun, serves  to hasten its attack.
  It is remarkable with regard to it, that it is confined almost 
20
YELLOW FEVER.
entirely to those who have recently arrived from a cold or
temperate climate.  It appears also, that those persons who
have been exposed to unwholesome air in the neglected
holds of vessels in cold climates, are more particularly the
subjects of yellow fever, when they arrive in a hot climate.
Those strangers who are young and plethoric are most apt
to be attacked.
   It may be distinguished from Remittent fever, to which
it bears the nearest resemblance, by reference  to its causes,
as above mentioned.   Some writers, however, contend that
they are identical.
                     TREATMENT.

  The mere name  of yellow fever  is sufficient to damp the
spirits of sailors. We should, however, not despond because
the  fatality of the  disease is discouraging, but rather re-
double our diligence in observing what assistance and relief
nature may  receive.
  It is proper in all fevers of warm  climates  to commence
the  cure by cleansing the stomach and bowels.  In yellow
fever, however,  there  is such  constant irritability of the
stomach and inclination to vomit, which we find difficult to
check, that  taking an emetic may  be omitted.   During
the  spontaneous vomiting, that  occurs early, the  patient
may drink freely of chamomile tea.
  As a cathartic, the  most effectual medicine is calomel,
which  may  be taken in syrup, or mixed with crumbs of
bread, in  a dose of twenty  grains.   If this fail  to open
the  bowels, the dose should be repeated, or some other
purge administered, such  as is most agreeable to the pa-
tient, within two or three hours after the first.  Sometimes
a third and  even  a fourth  dose may  be  required.   The
advantages  calomel  possesses over other  medicine, are,
that it is less offensive  to  the taste,  and less bulky, on
account of which, and of its greater weight, it is less likely
to be thrown up by vomiting.
  With regard  to bloodletting, a remedy in high  repute'
with Dr. Rush and some others, the most that is said of it by
a great majority of those practitioners, who have treated the 
YELLOW FEVER.
21
disease in ships and in the West Indies, is, that where the
patient is young and corpulent, and there is a hard throb-
bing pulse with violent pain in the  head and back, it may
be advisable  to draw a small quantity of blood in the first
twelve hours, but that it is not safe to take any after this
period.
  Cold water applied externally is a powerful remedy, and
sometimes arrests  the disease at the onset.  When, there-
fore, a person is attacked, and there is an unnatural heat
of the skin, cold water should be  dashed over him from a
butket or -pitcher.  Where the heat is confined to particu-
lar  parts, the  water should  be  applied to these with a
sponge or towel.   The  head will probably  require this,
more than any other part.
  The great object in the cure of this fever is to bring the
stomach  to bear quinine.   The only obstacle to  its admin-
istration  is  the disposition  to vomit,  which is  the most
Fatal symptom of the disease, and  the principal part of the
management consists  in the prevention or removal of it.
The stomach is therefore to be treated with the utmost ten-
derness,  and only such medicines and  drinks given as are
very  grateful.   To quiet  the stomach,  the  effervescing
mixture* is highly recommended, and may be given  every
hour, and to each dose  may be added 30 drops of lauda-
num.  Or instead of these, we may give  the chalk mixture
in table-spoonful doses every half hour, and oftener if the
stomach  rejects it.
  But the  most effectual remedy for allaying  vomiting
is a large blister applied over the stomach, and  this must
be  laid  on  early, or as soon as  the  vomiting  has com-
menced.
  No other internal medicine need be recommended, for
whatever power of retention the stomach may have  should
be  employed upon quinine.
   To take inflammation from the vital parts, blisters may
be  applied not only over the stomach but to the  legs.  To
hasten the drawing of them, the parts may be previously
* See Appendix. 
22
YELLOW FEVER.
rubbed with  peppered vinegar or  other strong stimulants.
With the same view warm  mustard  poultices*  should  be
applied to the soles of the feet every twelve hours.
   It is very desirable in this fever to excite a mercurial
action, so far at least as to induce a coppery taste, and some
spitting, but this cannot be done by mercurial pills or other
internal.medicines, for reasons above stated, viz. the neces-
sity of appropriating the retentive power of the stomach to
quinine.   The object must therefore be attained by the use
of mercury externally.   To this end rub a portion of mer-
curial  ointment, of the size of a nutmeg, on  the inside of
the thighs every eight hours, and dress the blisters, if there
be any drawn, with the same  substance.
   So soon as the bowels have been moved and the stomach
will  admit of  it,  administer quinine,  in two-grain doses,
every two hours.
   When the  stomach becomes perfectly  quieted, it will
afford the patient  great relief to procure perspiration and
sleep,  for which  purpose a powder, consisting of calomel
and camphor, of each  two grains, and opium one grain, is
to be administered in the evening.
  After  the first purging, the  bowels  must be moved
every day, but as the stomach will not bear strong purga-
tives in every case, the  effect, for  the three  or  four first
days at least, must be produced by clysters of salt water,
in connection with the calomel.
  From  the  first  hour of  the attack, the patient should
abstain from  solid  food, and subsist on  sago,  gruel, or
barley-water.   His drink may be  lemonade, toast-water,
tamarind-water, orange-juice, &c.
  The same directions are to be observed  in  regard  to
cleanliness, &c, as are given  under the head  of Putrid
Fever.
* See Appendix. 
INFLAMMATORY FEVER.
23
      OF ACUTE OR INFLAMMATORY FEVER.

                      SYMPTOMS.

  It commences with general weariness and anxiety, suc-
ceeded by dizziness, chills, and pains over the whole body
but more particularly in the head and back.  These symp-
toms are followed by redness of the face, throbbing of the
temples, great restlessness, intense  heat, unquenchable
thirst, and nausea.   Light is offensive, the skin is dry and
parched, the  tongue becomes of a scarlet color  at the
sides, and  furred with white in the middle; the pulse i3
full, hard,  and quick ; the urine red and  scanty, and the
body costive.   When blood is drawn, it exhibits a yellow-
ish or buffy crust on its surface.
   When the disease is not arrested at the commencement,
it usually goes through its course in about fifteen days and
terminates critically, either  by a perspiration,  diarrhoea,
bleeding at the nose, or the deposite of a copious sediment
in  the'urine.  In  some  instances it however terminates
fatally.  High fever with  stupor and  delirium  denotes
danger, but picking the bed-clothes, twitching of the ten-
dons and involuntary evacuations, portend death.

                        CAUSES.

   Exposure of the body to sudden  alterations of temper-
ature, particularly to cold and moisture after being  heated ;
intemperance ; violent exercise.
   This may be distinguished from all other fevers by the
strength and hardness of the pulse, the whiteness of the
tongue, and the other  symptoms of  high fever just  men-
tioned.

                      TREATMENT.

   In this  and all  other fevers attended with a  hard, full,
and quick  pulse, bleeding is of  the first importance, and
should be  employed as  early as possible.   The quantity of
blood  to be taken, must  be  in proportion to the strength 
24
INFLAMMATORY FEVER.
of the patient and violence of the disease. _  From one to
two pints may serve for  a sailor's constitution at the first
bleeding; but if after this, his pulse  should  again become
hard  and frequent, and  other symptoms of fever return,
it will be necessary to repeat  the operation  a second or
even  a third time, which may be  done  at intervals of
twelve, eighteen, or twenty-four hours from each other, as
symptoms may require.
  The next step after the first bleeding, is to cleanse the
stomach and bowels, which may be  done  in the following
manner:
  Take tartar emetic, five grains ; Epsom salts, two table-
spoonfuls :  mix and dissolve them in a pint of water: give
a third of this solution every half hour.   If the  first and
second dose produce  the desired effect, the  third may be
omitted.
  Or, take  a common emetic, and in twelve hours after a
dose of salts or some other active cathartic.    During the
operation  of the medicine upon the  bowels, the patient
may take freely  of gruel or barley-water.
  To obviate a  tendency  to costiveness, allay thirst, and
promote a gentle perspiration, the patient  may drink free-
ly of toast-water, flaxseed-tea, or barley-water, acidulated
with cream of tartar.    If this mixture be not sufficiently
laxative to  produce  two or  three motions of the bowels
every twenty-four hours, administer  the cooling mixture  *
in doses of a table-spoonful every three hours.
  Where the bowels are sufficiently loose and require no
laxative medicine, instead of the foregoing, give the fol-
lowing mixture :
   Of antimonial solution and spirits of nitre equal parts:
give two tea-spoonfuls every three hours in toast-water.
  For the  purpose of  allaying inordinate  heat of the skin
of any part, sponge it frequently with  cold water.
  If  heat and thirst continue very great, the patient may
take  powder of nitre  ten grains, every three hours, and
drink freely of cold water.
* See Cooling Mixture in the Appendix. 
SCURVY.
25
  From the first attack, warm poultices, made of pounded
bread, should be applied to the feet, morning and evening.
  If there be a tendency of the disease to any particular
organ, as  the  brain, which will be known by the presence
of great pain of the head  or  delirium, or to the chest,
which  difficult breathing will indicate, a blister should  be
applied to the neighborhood of  the part affected.
  Opium  is so doubtful a remedy in acute fever, that no
preparations of it should be prescribed, unless by a regu-
lar  practitioner of medicine.
  Throughout the whole course of the disease the patient
must abstain from solid food and animal broths, supporting
nature with gruel  and preparations of barley, sago, &c.
His bed should be  lightly  covered with clothes, and  his
apartment preserved of a moderate and equable tempera-
ture.
                     SCURVY.

                      SYMPTOMS.

  It  commences  with  unusual weariness, dejection  of
spirits, sluggishness, and offensive breath.   The gums be-
come soft, livid and swollen, are  apt to bleed from  the
slightest cause, and separate from the teeth, leaving them
loose.   About  the same time the  legs swell, are glossy,
and soon exhibit foul ulcers ; the same appearances follow,
on other depending parts of the  body.  At first the ulcers
resemble  black blisters, which spread  and discharge  a
dark colored matter.  Unless the general habit  be now
corrected by proper diet and  regimen, these ulcers in-
crease, great emaciation ensues, bleedings occur at  the
nose and mouth, all the evacuations from the body become
intolerably fetid, and death  closes the scene.  During the
progress of the disease, the pulse is generally natural, but
towards the fatal  termination,  it becomes weak  and re-
mitting.   The appetite continues very little impaired, and
          s 
26
SCURVY.
in some  cases the patient, even within a few hours of his
dissolution, is more eager than ever, in his calls for food.
His mind  remains sound, for the most part, to the last.
The fatal termination, though gradual in some instances, is
generally sudden,  and is  frequently  accelerated  by  at-
tempts to move the patient on shore.

                        CAUSES.

   Cold,  moist air; the long continued use of salted pro-
visions, or other food that is hard of digestion and affords
little nourishment; deficiency  of  vegetables;  want of
cleanliness ;  indolence ;  depressing passions of the mind;
smoking and  chewing  great  quantities of tobacco; the
putrid stench of bilge water.

                      TREATMENT.

   This is to be managed by pursuing a course of diet and
regimen directly opposite to that which  induced the dis-
ease.   Where this can be done, medicine is almost un-
necessary. Among the most celebrated and infallible rem-
edies, are succulent fruits, of which oranges, lemons, limes
and apples, are the best.   Unfortunately, however, these
articles are with difficulty preserved on long voyages, and
consequently least  likely to be  found  when most wanted.
Perhaps then  no article  after these is  so valuable  in long
voyages, both for its efficacy and  imperishable quality, as
potatoes, which have  moreover the  advantage  of being
cheap and  easily supplied in almost every port.  I rarely
used any other remedy in a man-of-war, and always laid in
a stock of them with the hospital stores, purposely for the
cure  of  scurvy.    Whenever a scorbutic patient  reports
himself unfit for duty, I direct  him to  abstain from  all
salted food, and to commence eating raw potatoes scraped
and mixed with vinegar, to the quantity of from  one to
three pounds  of the  potatoes  a day, according as  they
may agree with his stomach  and  bowels.   The dish ia
very agreeable, resembling salad or sliced cabbage.  With
the same materials  I dress scorbutic ulcers, and find it as 
SCURVY.
27
valuable and  as conducive to healthy action as any  ap-
plication I have used.
   It is probable that cabbages, turnips, &c, are  equally
as valuable as potatoes.   A preparation of cabbage, called
krout, is a highly reputed anti-scorbutic, and can be kept
for years.  All vegetable acids, as lime juice, tamarinds,
cider,  pickles, &c, are  excellent remedies ;  also  all sac-
charine fruits, as pine  apples, raisins, and  figs.   When
neither vegetables  nor lemon juice  can be  procured, take
three or four  times a day, Nitre in doses of ten grains,
dissolved  in  vinegar and sweetened.   If the  vinegar of
the ship be exhausted, use in place  of it the concrete salt
of lemon  or tartaric acid dissolved in water.
   So  sudden is the salutary effect of  an anti-scorbutic
diet, that the worst  cases of scurvy are very perceptibly
relieved by it, in the first twenty-four hours.
   Such is the general treatment to  be  adopted  in scurvy:
but particular symptoms will require  a separate manage-
ment.   Pains of the belly must be allayed by emollient
drinks, as barley-water,  or sago, and by opiates; difficulty
of breathing by the pectoral mixture ; * diseased gums are
to be washed with sal nitre so far diluted with water as to
be  agreeable  to the  taste, or with  decoction of bark  or
quassia, or a weak solution of alum ; — the rigidity of the
muscles, particularly the contraction of the hams,  and the
livid hardness of the calves of  the  legs, may be removed
by warm bathing and emollient poultices ; costiveness may
be obviated by a solution of  cream of tartar.
   It  is very  remarkable  that this  disease should at  the
present day be suffered  to prevail in merchant ships, often
to the  destruction of half their crews, when preventives
are so well known and so easily supplied.  In crossing the
Atlantic in a frigate in 1818, we  fell in with a  French
ship bound from South America to  Havre, where  this dis-
ease had prevailed to such a degree, that one third of  her
crew were dead, another  third  at the  point of death, and
the other survivors  more or less diseased; all which  ca-
lamity might have been prevented by a supply of  potatoes
• See Mixtures, in the Appendix. 
28
JAUNDICE.
and lemon juice of the value of five dollars, or perhaps
half that  value of tartaric acid or the  concrete salt  of
lemon.
   One  of these acids  should be  introduced  into every
medicine chest in large quantities,  since it is imperishable
by long keeping, and may be carried to sea for years, and
serve as a last resort when every other acid and anti-scor-
butic in the ship is exhausted.   It has the further advan-
tage  of being cheap, and  less  bulky and incommodious
than other acids of equal value.
   An excellent wash for scorbutic  ulcers is made by dis-
solving a large table-spoonful  of  nitre  or  saltpetre, in half
a  pint of vinegar, with which cleanse the ulcers twice a
day.  I may further add, that where a crew is threatened
with this disease, it is of the  first  importance  to preserve
the ship clean and dry, and  to keep the crew  in gentle
and pretty constant exercise.
                     JAUNDICE.

                       SYMPTOMS.
   Loss of appetite — aversion to exercise — yellowness of
the eyes, and subsequently, of the whole skin.  The urine
is highly colored  and tinges the linen  yellow ; the  stools
are white, or of a clay color.  The patient complains of a
bitter taste, nausea and sickness at the stomach.   Gener-
ally there is  costiveness, which, however, is  occasionally
interrupted  by diarrhoea.   Frequently a  sense of uneasi-
ness and darting  pain  is felt under the short ribs of the
right side and at the pit of the stomach.

                        CAUSES.

   The immediate cause is an obstruction to the passage of
bile, from the liver into the intestines, on account of which,
it is thrown back into the circulation and diffused  over the
body, imparting to it the yellow color  above  mentioned.
This obstruction may proceed: — 1. From the lodgment  of 
JAUNDICE.
29
a stone in the gall-duct.   This variety of jaundice may be
known  from the others, by occasional  acute  pains under
the short ribs of the  right side.  2. It may proceed  from
indurated  mucus, lodged in the passage of the gall-duct.
This variety follows a sedentary habit, debility, a long con-
tinued  mercurial  course for the venereal disease, and is
generally unattended by pain.  3. The  obstruction  may
proceed from an  enlargement of the  liver, as in what is
called the ague-cake,  which often succeeds the intermittent
or remittent  fever, or from that chronic inflammation of
the liver which is occasioned  by hard drinking.  In this
variety of jaundice,  the enlargement of the liver can be
felt, which  distinguishes it from other varieties.  There
are other kinds of jaundice, but they rarely occur among
sea-faring people.
                      TREATMENT.
   Of the first variety.   If pain and inflammation exist in
considerable degree, bleed and  bathe  the part with warm
water ;  in addition to which, employ the remedies recom-
mended in the second variety.
   Second  variety.   Administer an  emetic every other
morning, and if it fail  to move the bowels, give on the
intervening days a mild cathartic, of  calomel and jalap
mixed in syrup or other convenient vehicle, and repeat the
dose  every  three hours, till it operates.   Or, blue  pills,
three or four, with castor oil, a  table-spoonful.  Or, calomel
alone, twenty grains.
   A tumbler full of  sweet oil, taken in the course of an
hour after the calomel or the blue pill, is found to be a  very
valuable remedy.
   The  warm bath, by  its  relaxing powers, proves  very
useful in jaundice, and should be employed frequently.
   Exercise of the jolting kind, as running, dancing, jump-
ing a rope, is very serviceable.  To those who reside  on
shore, riding on horseback is an invaluable remedy.
   In the third variety.   Where the liver is enlarged, mer-
cury should be employed, as recommended under the  head
of chronic affection of the liver.
   The diet should be  light and nourishing.
         3* 
30
DROPSY.
                      DROPSY.

                       SYMPTOMS.

   General  Dropsy  commences with a watery swelling in
the lower extremities, and first appears  towards  evening
in the feet and ankles, afterwards gradually ascending and
occupying the  thighs, trunk, and even head.   The swell-
ing is not elastic, but pits, when pressed with  the fingers,
and the pits are slow in filling  up.   When it has become
very general, the belly swells, the breathing is  difficult and
accompanied by a cough with a watery expectoration.  The
urine is scanty and high colored ;  sometimes, however, it is
of a pale whey color  and copious.  There is costiveness ;
paleness of the  skin, and oftentimes insatiable thirst.

                        CAUSES.

   An hereditary predisposition to the disease ;  certain
organic diseases, as of the heart  and liver, producing an
obstruction to the  free  circulation of  the blood — preced-
ing disease, as  jaundice,  diarrhoea, dysentery, eruptions,
&c. —watery diet.
 ^ A favorable result may be expected, when the cause of the
disease is easily removed, when the constitution  is very little
impaired, the appetite remains entire, and the respiration
free.   Unfavorable, when there is the reverse  of these,
when the heart or  liver is diseased, — when  the  emacia-
tion is great,—the thirst  insatiable — and where  there is
drowsiness.

                      TREATMENT.

   The principal indications in the  cure of Dropsy are,
   1.  To evacuate the collected fluid.
   2.  To prevent its reaccumulation.
   The fluid is  evacuated,
   1.  By emetics, which  may be  taken every second or
third  day.
   2.  By cathartics, taken on intervening days. 
INDIGESTION.
31
   3. By diuretics, as  digitalis,  squills,  nitre, spirits of
nitre, in the following manner :
   Take digitalis, one grain, nitre ten grains, in syrup of
squills, a tea-spoonful;  every four hours.   Or,  take syrup
of squills, and spirits of nitre, of each a tea-spoonful; mix
and repeat the dose every four hours.
   4. Mercury; so exhibited, as to affect the  gums and
produce a spitting.  This may be combined with the digi-
talis and squills, in the following manner :
   Take calomel, one grain, digitalis in powder, one grain,
mixed  in  syrup of squills a tea-spoonful,  and repeat  the
dose every four hours,  till the mouth is affected, and  the
swelling subsides.   While  taking  the mercury, emetics
and cathartics may be omitted.
   5. Sudorifics ; as Dover's powders,* every four hours,
accompanied by diluting drinks, as toast-water,  &c.
   To prevent  the  reaccumulation of water, the patient
should subsist on a light, nourishing, high-seasoned diet; —
take bark or quinine, or quassia, and other strengthening
bitters, — use exercise, friction and cold bath.
   Other remedies  might be mentioned, as scarifications,
blisters, bandages, &c, but the above are sufficient to keep
the disease in check, when it appears on  board ship,  till
medical advice can be obtained from shore.
  Dropsy of the chest, belly, &c,  are treated of, under
diseases of those parts.
          OF DYSPEPSIA OR INDIGESTION.

                       SYMPTOMS.

  Want of appetite, — rising of food and wind from the
stomach, — acidity of the stomach, — heart-burn, — flush-
ed countenance  after a full meal, — sense of distension in
the stomach and bowels, — sometimes rumbling and pain,
• See Powders. 
32
INDIGESTION.
— costiveness, which  is  now  and then  interrupted by
diarrhoea, — dryness  and whiteness of the tongue in the
morning,— paleness of the urine.   There is general debil-
ity, languor and aversion to motion, dejection of spirits,
disturbed sleep and frightful dreams.

                        CAUSES.

  Whatever debilitates the system in general or the stom-
ach in particular, as opium, — spirituous liquors, — hot and
strong tea or coffee, — tobacco — long  continued vomiting
excited by too  powerful  emetics,  or long protracted sea-
sickness,— poisons, — sedentary  life, — depressing affec-
tions  of the  mind,—excessive  evacuations, — diseased
liver, — excessive venery.

                         CURE.

  The first and most important step is to avoid whatever
may have tended to give rise  to the disease and continues
to aggravate it; until this is  done,  medicines will be of
very little service.
  The remedies then are,
  1. Emetics.  One of the gentle  kind should be the first
medicine given, and if afterwards nausea  return, accom-
panied by rising from the stomach  of imperfectly digested
food, or acid substances, the emetic after four or five days
should be repeated.
  2. Purgatives of the stimulating  and  gentle kind, as
powders of rhubarb  and  magnesia, of each  15 grains,
which may be taken whenever there  is a tendency to cos-
tiveness.   If the bowels  be difficult to be moved, add to
the medicine two or three grains of calomel.   Or, in place
of this, take the common aloetic pills, or blue pill.
  3. A nutritious, easily digested diet.  In  these respects
animal food is  preferable, but in  consequence  of its ten-
dency to induce costiveness, an  occasional meal of lio-ht
vegetable food may be serviceable, and a moderate use*of
sub-acid fruits, as apples, pears, &c.   The meals  should be
taken at stated periods, and at intervals of three or four 
FITS.
33
hours.  The drink  should be in small quantity, and such
as does not become acid.   Watch  the effects of the differ-
ent kinds of food and drink, and select that which best
agrees with the stomach.
   4.  Exercise.   If  on shore, walking, riding on horse-
back, or in a carriage, and these in succession, as  are most
easily borne.   Be engaged in some active  business or
amusement, which will employ the mind.   Travelling will
therefore be very beneficial.
   5.  Cold bathing and shower baths, — salt water is pref-
erable.  Rubbing the surface with salt and brandy mixed.
   Lastly.  Tonics, particularly vegetable bitters, as Peru-
vian bark, quassia, cascarilla,  &c, taken in the  following
manner :
   Quassia, cascarilla, or  gentian decoction,* a wine glass
in every four hours, or a few minutes before eating. After
taking it for a few days, its  efficacy  will  be increased by
the addition to each dose, of ten drops of elixir vitriol.
   Occasional symptoms may require additional remedies.
   Acidity^ of the stomach and heart-burn can be removed
by chalk or magnesia.  Occasional pains of the stomach and
bowels, which usually depend on windy distension, may be
relieved by a few drops of peppermint.  Diarrhoea, when
it occurs, may  be treated by small  doses of rhubarb and
alum combined thus:
   Take  rhubarb, five grains, alum two grains, every three
hours, till the diarrhoea is arrested.
    OF EPILEPSY, OR FITS WITH CONVULSIONS.

                       SYMPTOMS.

  The patient,  if standing, is suddenly  thrown to the
ground in  convulsions.   During  the fit, there are strong
contractions of the limbs, twistings of the body, distortions
* See Decoctions. 
34
FITS.
of the countenance,  grinding of the teeth and  clenching
of the hands.   These continue for a few minutes with such
violence, that two or three persons are not sufficient to hold
the patient;  the fit  then subsides, but shortly after is re-
newed.   After three or four returns, they  cease altogether
and leave the patient senseless, generally in a profound
sleep.  Commonly the patient has no warning of the fit, yet
sometimes it is preceded  with pain in the  head, unquiet
sleep, noise in the ears ;  in some instances, by a sensation
of cold air commencing in one of the limbs, and gradually
creeping upwards till it reaches  the head, when the patient
falls in a fit.   In those who are much subject to fits, they
sometimes occur in sleep.

                        CAUSES.

  Irritation of body or violent excitement  of mind.   But
these causes rarely take effect, unless there exist a strong
predisposition  to the  disease, either  hereditary, or from
debility, with  great  mobility either natural or  acquired.
Perhaps no  class of people of equally hardy constitutions
are so subject to this disease as  sailors.

                      TREATMENT.

  The only thing to be attempted  during the fit, is  to
protect  the  patient  from  bruises, which his  strong  con-
vulsions are apt to occasion.   Some physicians are inclined
to bleed, but this  is difficult  to do on board ship, and ex-
cepting in the robust and plethoric is not advisable in any
situation.
  When  restored to his  senses, attend to  the exciting
cause of the fit, and remove or avoid it.   In almost all
cases, it is advisable after a fit, to  move  the patient's
bowels, with a draught of  salt water, or some other purga-
tive.  He should avoid  a costive habit, and  abstain from
ardent spirits, with all other strong stimulants.
  When  the  patient is warned of an  attack, it  may in
some instances be averted by vomiting or purging.
  Where  the  fits recur very often, I have always been
able to suspend them by exciting mercurial action. 
APOPLEXY.
35
  In  cases where  the  fit commences with a sensation of
cold air, creeping along one of the limbs towards the head,
apply a string  around the limb, and  direct the patient to
draw  it tight, when  the  sensation is first felt, by twisting
a stick, which  is  to be worn  in  the string ready for the
purpose.  I have  commonly used a field tourniquet, and
have  seen a  patient avert fits for  months, who, without
this apparatus, was attacked by them three or four times a
week.  The  pressure need not be  continued more than a
minute.   The apparatus may be so applied, as to occasion
no impediment to  exercise  or labor.   Those who are sub-
ject to this disease should  never  be sent aloft, nor indeed
on shipboard.
                   OF APOPLEXY.

                       SYMPTOMS.

  Total  suspension of  the  powers of sense and  motion,
accompanied by  snoring — foaming at  the mouth,  and
grinding of the teeth — the eyes are prominent and fixed,
and the pupils dilated — the pulse is very little disordered.
  Persons, from fifty  to sixty years of age, are most liable
to it,  particularly those who have short necks, with large
heads, and who indulge in the luxuries of the table.
  The fit  is usually  induced  by some violent excitement
of body or mind, long stooping, derangement of the stom-
ach, overloading  it  with pastry, fumes of poisonous  sub-
stances, foul airs, &c.

                      TREATMENT.

  When the patient is seized, take from him a pint  and
a half or two pints of blood.    The  difficulty of  starting
blood in a fit of apoplexy, may make  it necessary to open
veins  in both arms,  and both feet, at the  same time.   The
head is to be shaved,  and bathed with cold water and vine-
gar, the feet and legs bathed in warm water, and a drastic 
36
LOCKED-JAW.
purge administered, of calomel, forty grains ; or calomel
thirty, jalap twenty, mixed.   If this course fail to render
the patient sensible, a large blister must be  applied to the
head and the bleeding repeated.
  The rare occurrence of this disease  among sailors, ren-
ders it unnecessary to say more of it here.
           OF TETANUS, OR LOCKED-JAW.

                       SYMPTOMS.

  It commences with a sense of stiffness in the back part
of the neck, rendering  the motions of the  head difficult
and painful.  This is soon succeeded by difficulty of swal-
lowing ;  pain, often violent, about the breast bone and
thence shooting to  the  back;  rigidity of the lower jaw,
which increasing, the teeth become so closely set together,
as not to admit of  the  smallest opening.   If the  disease
proceed  further, a   greater number of muscles become
affected,  and the body  is  forcibly bent either backwards
or forwards.  At length  the  trunk,  limbs, and  counte-
nance are distorted  to a most painful and shocking degree.
A remission of  these symptoms  occasionally takes  place
every ten  or fifteen minutes, but they are renewed with
aggravated  force by the slightest causes, even the least
motion of the  patient, or  the touch of an  attendant.
Finally, a  general  convulsion  puts  a  period to a  most
miserable state of existence.
  The duration of lock-jaw is various.

                       CAUSES.

  The disease  is very common  in  hot climates, and  is
most frequent when a  scorching sun  is  succeeded by a
heavy rain or dew.
  But besides exposure  to sudden changes of temperature,
it is often caused by a wound of a nerve or tendon,  or by
a fractured bone. 
SMALL POX.
37
                      TREATMENT.
  Give opium in  large quantities, as  four  or  five grains
every  hour,  or three  drachms of  laudanum  every half
hour.  When  the patient can no  longer swallow,  inject
laudanum, a table-spoonful in warm  water, every hour,
and direct it to be retained as long as  possible.
  With the first dose of  opium give twenty grains of calo-
mel, and follow it  every six hours by a dose of five grains
till the mouth is affected.
  Use warm and  cold bathing in succession.  If the dis-
ease proceed from a wound, enlarge it pretty extensively,
and pour into it hot spirits of turpentine, or burn the wound
with an iron, brought to a white heat.
                    SMALL-POX.

                       SYMPTOMS.

  It begins with pain  in  the head and back, sickness at
the stomach, and chills.   In this stage, it may be mistaken
for  rheumatism or pleurisy.  About the fourth or fifth day,
it breaks out in small  pustules upon  the face, breast, and
neck, and on the ninth, tenth, or eleventh day, the pustules
are at their full size, when they  begin to dry and scale off:
this is the milder stage or distinct small-pox.  In the more
aggravated kind,  called  the confluent, the pustules are
more  thick and red, and running into  each other, spread
over the whole body.   They are not at their full size till
the fifteenth or sixteenth  day.   The  eyes  are completely
closed, the fever runs high,  and the danger is very  great.

                      TREATMENT.
  When the disease breaks out in  a vessel,
  1. Keep the patient as cool as possible, with light  cover-
ing to the body, and if the weather be hot, bathe the skin
frequently  with cold water.                      m m
  2.  Preserve a loose state  of the bowels,  by admmister-
         4 
38
MEASLES.
ing a dose of salts, or cream of tartar, or some other mild
purgative, every other day.
   3.  Abstain from animal food, spirituous liquors, and all
stimulating  or  acrid substances,  subsisting on  rice  and
molasses, barley, flour, gruel, &c, and  sweet or subacid
fruits.
   This course is to be pursued as long as there is much
fever, or until the  pustules  are filled and begin to turn
yellow; the  patient may then return to nutritious diet, and
take tonics, such as decoction of bark or quassia, and elixir
vitriol.
                    MEASLES.

                      SYMPTOMS.

   Slight fever ; cough ; hoarseness ; difficult  breathing ;
sneezing; sense of weight in the head ; sickness at the
stomach; dulness of  the eyes ;  drowsiness ; itching of
the face.  On the fourth day small red  points appear, first
on the  face, and subsequently on the  lower parts of the
body.    On  the  fifth or  sixth  day,  the  lively  red  is
changed to  a brown, and in a  day or  two, the eruption
entirely  disappears.

                      TREATMENT.

  Abstain from animal food and spirituous liquors ; adhere
strictly  to a low, unseasoned diet; keep in a  moderately
cool atmosphere, and  preserve a loose state of the bowels
by taking castor oil,  or cream of tartar, or sulphur and
cream of tartar mixed, or small doses  of Epsom,  or Ro-
 •helles.
   OF INFLAMMATION OF THE BRAIN, OR BRAIN
                       FEVER.

                       SYMPTOMS.
  Very  severe  pain in the head ; extreme sensibility to
light and sound; wild expression of countenance ;  staring 
DISEASES  OF THE  HEAD.
39
of the eyes ; peculiarly hard and rapid pulse;  restlessness ;
parched tongue ; turgid and flushed face : a rapid flow of
ideas.

                       CAUSES.
   Exposure  to  excessive heat, or  to  sudden changes of
temperature ; coup de  soleil, or stroke of the sun, from
subjecting the head uncovered to its vertical rays ;  violent
exercise;   the  abuse of spirituous liquors ; external vio-
lence,  &c.
   It may be distinguished from madness, by the symptoms
of fever and the violent headache which  attend it; from
the deliriums of inflammatory and typhus  fevers,  by refer-
ence to its causes, and  by its sudden accession after expo-
sure to them.
   Active   inflammation of  the  brain  usually  terminates
fatally, and within four days.   In a few instances, it ends
favorably, in inflammation of some other part, or by some
evacuation.

                      TREATMENT.

   Depletion  is the principal remedy.  From one to  two
pints of blood should be taken  at the  first bleeding,  and
this operation repeated  at intervals  of a few hours, till the
delirium is overcome.
   Cathartics, of  the  active kind, are  to  be  employed, as
the following:
   Calomel twenty grains, or calomel  and jalap,  salts  two
ounces.
   After the bowels have been freely moved, give a solu-
tion of tartar emetic, one  grain every four hours, or of
antimonial solution one table-spoonful.
   The heat of the  head must  be  allayed by cold water
applied with towels, and the neck may be blistered.  Blis-
ters  should also be applied to  the ankles.  The  feet may
be bathed in warm water, and poulticed with mustard-seed,
spread over Indian or rye meal poultices.
   The patient must subsist on  toast or barley water,  and
gruel. 
40
DISEASES  OF THE HEAD.
                 CATARRH, OR COLD.

                       SYMPTOMS.

   Inflammation of  the  internal surface of the  nose  and
 throat, with a sense  of fulness, and an increased  discharge
 from the nose, of an irritating watery fluid.  There is  usu-
 ally a sense of weight and pain in the head, oppression of
 the  chest, watery inflamed eyes, soreness of  the  throat,
 and sometimes cough ;  cold  shiverings succeeded by tran-
 sient flashes of heat.

                        CAUSES.

   Exposure of the body to sudden changes of temperature,
 wearing damp clothes, &c.  Sometimes it is epidemic,  and
 is then called influenza.

                      TREATMENT.

   An emetic is a very efficacious remedy.  If the patient
 be averse to this, administer  a dose of salts, or some other
 cooling purgative.
   Preserve an uniform temperature of  the body, neither
 very warm nor cold ; drink freely of warm flax-seed  tea,
 barley or  toast-water, with cream of tartar dissolved in it.
   Bathe the feet in warm water on going to bed, and avoid
 exposure of the body to cold  the day following.  Keep the
 feet continually warm.
   When the  cough  is very troublesome, and  prevents
 sleep, take pectoral  mixture,* two tea-spoonfuls  on going
 to bed, in a large draught  of barley-water,  or  flax-seed
tea; or, take  Dover's powder, eight grains,  in  pills; or
the cooling mixture, a  table-spoonful  every three hours,
 adding to the last dose in the  evening (which is  to be taken
on going to bed,) fifteen drops of laudanum.
* See Mixtures in the Appendix. 
DISEASES  OF THE  HEAD.
41
  OPHTHALMY, OR INFLAMMATION OF THE EYE.

  There are two kinds. — 1.  A disease of  the  eye-ball.
2. Of the eye-lid.

                      SYMPTOMS.

  The former commences with itching, burning, and a sen-
sation, as if sand or sticks were lodged under the eye-lid.
The white of the eye turns red, and swells, and there is an
increased sensibility  of  the organ  to  light and motion.
When the inflammation runs very high, a slight fever at-
tends it.

                      TREATMENT.

  When occasioned by the presence of irritating particles,
these must be immediately removed.
  Unless the ophthalmy be very violent, general bleeding
is hardly ever necessary.   In  all severe cases, however, if
leeches can  be obtained, apply three or four  on the tem-
ple, near the eye, every morning.
  Take  an  active purgative of calomel and jalap, every
third or fourth day, till the  inflammation abates; or salts,
an ounce and a half; or the cooling mixture.
  To take off the heat of the eye by  evaporation, apply
frequently to it a soft  linen rag, dipped in  water, at first
blood warm, but afterwards cold.
  After two or  three  days, if the inflammation  continue
active, apply in the same manner the following:
  White vitriol and  sugar of lead, each two grains, disolv-
ed in a gill of pure water, or rain water.
  If  the itching and  pain  be great, add to the mixture
laudanum, two drachms.
  If  the inflammation be not reduced within three or four
days from the attack,  apply blisters behind the ears.
  From the first attack, abstain from stimulating food and
drinks,  and keep the eye lightly covered.
  In slight cases of ophthalmy, it may perhaps be sufficient
          4* 
42
DISEASES  OF THE HEAD.
to take some mild purgative, and use  the  above applica-
tions for the eye.
   In  the other species of  ophthalmy, there is _ usually a
small  ulcer at the roots of  the  eye-lashes;  this may be
touched with a little warm  citron ointment, or with alum-
water, by means of a hair pencil.
              BLEEDING AT THE NOSE.

                      TREATMENT.

   During the bleeding, sit in a  cool  air, with the head
raised, and wet  the neck frequently with cold water.   If
this fail to stop the bleeding, sit on cold wet  clothes, with
the skin in contact with them, or in cold Avater.
   If  the  bleeding still continue,  apply astringents to the
inside of the nostrils, as the following: —
   Powder of  alum, a  tea-spoonful dissolved  in one gill of
water.  A rag  may be dipped in it, and introduced into
the nose.   Or, apply in the  same manner, white vitriol,
one drachm, dissolved in a gill of water.
   Persons subject to this complaint should avoid a costive
habit, and move the  bowels frequently, by a draught  of
sea-water  or  a dose of salts.   If this  be insufficient  to
prevent its return, let blood from  the arm.   Abstain from
stimulating food  and drinks,  and avoid every occasional
cause, as  violent exercise, tight neck-cloth, stooping pos-
tures, and external heat.
                     HEADACHE.

  The most usual causes are indigestion, foul, or over-load-
ed stomach, long exposure to the sun, rheumatism, intem-
perance, too  great a determination of  blood to the head.
Generally, however, it is only a symptom of other diseases,
as of fever, catarrh, dropsy, &c. 
DISEASES  OF THE  HEAD.
43
                      TREATMENT.

  Where a headache is symptomatic of some other disease,
it will  readily cease on removal thereof, as in the case of
fever.
  When a foul stomach or the presence of indigestible sub-
stances is apprehended, take a gentle emetic, and if cos-
tiveness exist,  remove  it by some  mild laxative, or the
cooling mixture.  (See Appendix.)
  If too great  a determination of blood to the head be
suspected, bleed, and subsist on a low diet.
  If the headache be  rheumatic, apply blisters to the ex-
tremities, or to the back of the neck, and move the bowels
by common cathartics.
  In  cases of  slight headache,  it may be sufficient to
bathe the feet in warm water, and wet the head with ether
or spirits.
                    TOOTHACHE.

                      TREATMENT.
  If the tooth be much decayed, extraction is the only
sure remedy.   When this is impracticable, the pain may
sometimes  be relieved, by  applying  to  it pills, made of
opium  and camphor, equal parts; and oil  or  essence of
peppermint sufficient to moisten the  mass.   Or,  apply
elixir paregoric or laudanum on cotton.
  If the pain proceed from a cold, or be a rheumatic affec-
tion, scarify the gum with a lancet or sharp pen-knife, and
apply a blister behind the ear.
                      EARACHE.

                       CAUSES.
  Whatever induces other inflammations ; more frequently,
exposure of the ear to a current of air, or to a cold damp
wind. 
44
DISEASES OF  THE THROAT.
                     TREATMENT.

   Syringe the ear with warm water, and fill it with lauda-
num or sweet oil, covering the part with flannel.  If this
fail to relieve, apply a blister behind the ear, take a cathar-
tic, and steam the ear, by holding it to the mouth of a jug
filled with hot water.  When the pain, instead of abating,
increases for three or  four days, the  formation of matter
may be expected,  and should be encouraged by the fre-
quent application of warm poultices.
   When matter begins  to be discharged, syringe the ear
frequently, with warm water containing a little soap.
            DISEASES  OF  THE THROAT.

   INFLAMMATION OF THE THROAT, OR QUINSY.

                      SYMPTOMS.

   The throat internally, is red and swollen. There is gene-
rally some fever, a constant flow of viscid spittle, and pain
in swallowing.   When the  inflammation  is not subdued
withm five or six days from the first attack, a tumor con-
taming matter will appear in the throat, and break.

                        CAUSES.

   The usual causes of inflammation ; particularly sudden
cold; occasioned  by omitting  some part of the covering
usually worn about  the neck ;  by sleeping in a damp bed!
or wearing wet clothes.

                      TREATMENT.

   As it is important to prevent the formation of matter in

iL^tease.           ^ *"** be active^nd early in

   If the symptoms be severe, bleed  freely and administer
a dose of salts.  Bathe  the feet in warm sea water  Wear 
DISEASES  OF THE  THROAT.
45
flannel or a stocking around the neck ;  or mash roasted or
boiled potatoes, and apply them in a stocking, as warm as
the  patient  can   bear.    Gargle  the  throat every  ten
minutes, with a mixture of warm vinegar and water sweet-
ened ; or, with warm vinegar containing table-salt dissolved.
   If this treatment fail to reduce the inflammation within
the first forty-eight hours, the bleeding and purging are to
be repeated,  and a blister applied to the throat.
   Abstain from solid food and stimulants.
   If matter  form,  the   difficulty  of swallowing will  be
increased, and  the patient in some danger of  suffocation.
In this case,  the suppuration must be hastened  by inhaling
the steam of  warm water, from  the nose of a tea-pot, and
the application  of large poultices around the throat.
   Those who have had this disease  once, are  more liable
to subsequent attacks.
   In slight  cases of sore throat, it may be sufficient  to
wear flannel, or  hot roasted potatoes  around the throat,
and preserve an open state of the bowels.
                        MUMPS.

   This commences with slight  fever, followed, in two  or
three days, by a swelling under  the ear.   In severe cases,
the testicles are affected, and sometimes the brain.
   It usually requires nothing more than the application of
flannel  to the part  primarily affected, a gentle laxative,
and a low diet.   When the case  is very severe, or when
the testicles  and  head are  affected, use bleeding,  purg-
ing, &c.
                        CROUP.

                       SYMPTOMS.

  This is an inflammation of the trachea or windpipe, and
is mostly confined to children.   There is a hoarseness, par-
ticularly in  coughing, the sound of which  has been com- 
46
DISEASES  OF THE  THROAT.
pared to the barking of a young  dog, or of air passing
through a brazen tube.   There  is difficult breathing and
dry cough, which in severe cases increase till the patient
is worn out, or till suffocation takes place.
  When it occurs on board  ship, administer  an  emetic,
employ  the general  treatment  recommended in  quinsy,
and apply a blister to the throat.  The emetic consisting
of antimonial solution and squills, mixed; a table-spoon-
ful may be repeated every half hour until it vomits.
     CHRONIC BRONCHITIS AND LARYNGITIS.

  This disease seldom occurs among sailors ;  but as those
who are  affected with it  on shore find  great benefit in
change of residence from a cold to a warm  climate during
the winter, and are much in the habit of  taking passage
in ships for Cuba and  the other West India Islands, and
for the south of  Europe, some notice  of  the  disease from
one who has seen many cases of it, may be acceptable to
such passengers  while on board ship.
  This disease is  more prevalent among clergymen, lawyers,
and other public speakers,  than  among  laboring  classes.
It is called Laryngitis, when the  pain, soreness and tick-
ling exist  in the  top of the windpipe, where it is most prom-
inent, and the disease  extends upward, so as to be visible
in the throat.  It is called Bronchitis,  when  it  extends
downward to the sternum, and  along underneath it, pro-
ducing soreness  and pain.  Both  forms of  the  disease  are
attended with coughing, but  in  Laryngitis, the  tickling
sensation which causes it, is seated in the  top of the throat;
in Bronchitis, the irritation seems lower down, even in  the
lungs ; the cough  is severe, and  causes  the  disease to be
confounded with consumption, from which it may, however,
be  distinguished by the healthy natural sound of the chest
on  percussion, and by  the absence of those  respiratory
sounds known  to physicians as signs of  consumption • by
the patient's ability to lay on either side, and by the' ab- 
DISEASES  OF THE  THROAT.
47
sence of copious expectoration of pus, especially in  the
early stages.
  There is, however, both in Bronchitis and  Laryngitis,
expectoration of specks of pus  mixed  with much glairy
mucus, and occasionally there will be streaks of blood.
  These two diseases sometimes succeed  to  severe  and
long protracted cold, but more  commonly  they come on
spontaneously, and oftentimes so insidiously that the exist-
ence of the clergyman's sore throat is often not suspected
until it has made great inroads upon the mucous surface of
the throat  in the form of small  excavations, sometimes as
large as a  split pea, and the whole surface appears rough,
as if  pitted with small-pox, some specks  being very high-
colored, and others presenting a foul whitish  appearance.
Its prevalence among ministers  more than any others, is
not satisfactorily accounted for; and perhaps it is,  after
all, more apparent than real — for, with them, it is always
sooner  known, and  more  generally  from  its disabling
them for their public duties.  It is  doubted which sex suf-
fers most  from it, but the  age  most affected is between
twenty and forty.   Although the surface of the air-pipes
shows more of the affection, yet it is believed  that muscu-
lar debility of the vocal organs is often present.
   The  affection that appears on inspection of the throat, is
probably but a small part of what  actually exists ; it ex-
tends downwards towards the lungs, and the  chief source
of danger  is, that it will run  into consumption, and  some
eminent writers even maintain, that tubercles  in the lungs
coexist with the throat affection, but this is doubtful.   An-
other mode  of fatal  termination is disorganization of the
throat itself, either the cartilages composing the larynx or
prominent part, or of the pipes that extend into the lungs.

                      TREATMENT.
   Rest of the vocal organs  is indispensable ;  leeches  over
the part most  affected ; a blister applied to the top of the
sternum or breast bone, and repeated as often as it heals,
which is preferable to a continued one.   Inhalation of the
steam from simmering  tar, through a tube attached to the 
48
DISEASES  OF THE  THROAT.
nose of a teapot half filled with tar, which may stand over
a blazer ;  or the tar may boil in like manner in a plate,
and the patient inhale the steam diffused through his apart-
ment.  The vapors of iodine and of chlorine are often used
with advantage ; to the former may be added tincture of
conium, as directed in several medical works.
  Topical  applications in solution may be  applied with a
swab, or, what is better, by sewing a brush of lint  to the
end of the finger of a glove, which is then drawn on the
index finger of the right hand ;  the patient is made to gar-
gle, with warm water, and the lint being  dipt in the solu-
tion, can be  readily applied to the  larynx.  The best so-
lution to apply is nitrate of silver, two grains to  an ounce
of water, which may be  repeated once a day, one in alter-
nate weeks.
  Among the gargles that I have tried with most success,
is the following : —R.  Tr. myrrh and ether, of each half
an ounce ;  honey, one ounce ;  and  strong sage  tea, four
ounces.
  The internal use of tar water, to the extent of from one
to two pints a day, is serviceable.   The daily evaporation
of alcohol over the throat is by some highly recommended.
  A sea voyage to a warm climate during the winter, is
among the  best remedies.
   PUTRID SORE THROAT, OR SCARLET FEVER

                      SYMPTOMS.
  It commences with cold shiverings — sickness and vom-
iting — heat  and  restlessness — great debility — flushed
face — hoarseness and sore  throat.   Upon inspection, the
internal surface appears of a fiery red  color, which soon be-
comes darker and is interspersed with specks, of some shade
between a light ash  and dark brown.  There is considera-
ble fever, which increases every evening — a small and ir-
regular pulse, and oftentimes diarrhoea.  About the second
or third day, large scarlet colored patches or stains appeal* 
DISEASES  OF THE  THROAT.
49
upon the neck and  face, and  afterwards  over the whole
body.   After continuing about four  days,  they depart
with a scaling of the skin.   In bad cases, the ulcers in the
throat corrode deeper  and deeper, debility increases to
complete exhaustion, and the parts mortify.  The patient
expires usually before the seventh, often as early as the
third  or fourth day.
   This disease is epidemic,  often spreading through  a
whole village.  Long exposure  to a humid atmosphere, and
a debilitated habit, predispose to an attack.
   This kind  of sore  throat may be  distinguished from
quinsy, or common sore throat, by the  eruption or specks
above  mentioned, by  the weak fluttering pulse, general
debility, and by the scarlet spots that  appear on  the skin.
Each of these diseases, however,  often partakes  so much
of the character of the other, that  it is  not always easy to
distinguish  them.   It may be known  from croup, by the
absence of a croaking  hoarseness,  and by the presence of
visible  inflammation  and specks  above mentioned.   The
putrid  sore  throat prevails mostly among  children, and
rarely appears on board ship.

                      TREATMENT.
   In the treatment of putrid  sore  throat, bleeding and
active purging would  be likely to increase  the  debility,
which is already  very great.  The stomach and bowels
must however be  cleansed ; for which  purpose, take ipe-
cac, twenty-five grains, adding to it  five grains of calo-
mel, or some other purgative in small quantity.
   The principal indications of cure then are,
   1.  To counteract the putrid tendency that prevails.
   2.  To wash off frequently  the  acrid matter from  the
throat;  and, lastly, to obviate debility.
   To correct the putrid tendency, Peruvian bark, quinine,
mineral acids, and Cayenne pepper, are among  the most
valuable remedies.   They may be taken in the  following
manner:
   Take powder of bark, two table-spoonfuls,  Cayenne pep-
          5 
50
DISEASES  OF THE  CHEST.
 per, one table-spoonful;  to which add three gills of boiling
 water, and after boiling it in a covered  vessel ten minutes,
 add one gill of vinegar.  Administer  two table-spoonfula
 every two hours.   Or, take decoction of bark, or of quas-
 sia two table-spoonfuls,  with ten drops of elixir  vitriol,
 mixed, every two hours.
   To cleanse  the throat, use gargles of salt dissolved in
 vinegar ; — or elixir vitriol, a tea-spoonful to half a pint of
 warm water, sweetened, every ten  minutes.   Inhale the
 steam of warm vinegar and water from the nose of a tea-
 pot.  Breathe the air, made by burning  nitre,  thus :
   Close the  patient's room,  and upon  a  chafing dish of
 coals, throw powder of nitre  half an ounce ; which will fill
 the room with a thick white  cloud, that will last for some
 time.   This process  may be frequently repeated in the
 course of the day.
   If any particular symptom of an  alarming nature arise
 during the progress of the disease, as diarrhoea,  bleeding,
 &c.,^ it must  be  checked immediately.   For  diarrhoea,
 administer opium and lime water, or powder of alum three
grains.  Bleeding  is also to be  treated with astringents,
both locally  and generally, as directed under the heads of
 different kinds of bleedings.
                      PLEURISY.

  Pleurisy, pneumonia, peripneumonia, and lung fever,
are names given to inflammations of the lungs themselves,
or of the membrane  that covers them and  lines the cavity
of the chest.   It  is however improbable  that  either the
lungs or this membrane are ever inflamed to a great degree
separately, the disease of one  being generally more5 or
less extended to the other.  On this account, and  because
the symptoms  and treatment of the two diseases are nearly
the same, they are both  included here under the head of
pleurisy.  I may remark, however, that painful breathing
belongs more to pleurisy than to peripneumonia, whilst the
latter is, of the two, more likely to prove fatal. 
DISEASES  OF TnE CHEST.
51
                       SYMPTOMS.

  It  commonly commences  with the usual symptoms of
fever, accompanied or succeeded by a sense of weight, and
afterwards pain in  the  chest.   This  begins in one side,
ordinarily about the  sixth or seventh  rib, from which it
shoots towards the breast-bone and shoulder-blade.   The
breathing is  short and difficult, and the pain is increased
on drawing in the breath.   There is constant inclination to
cough, but every effort is interrupted by the pain it occa-
sions, in  consequence of which, viscid  mucus  collects in
the  air-passages,  and causes  a sort of wheezing  called
rattles.
   The disease begins to subside from  the fourth to the
seventh day  : if not so  soon as the latter period, the case
may be  considered dangerous.   The abatement of the in-
flammation is marked by an amelioration of all the distress-
ing symptoms, and a copious expectoration.

                      TREATMENT.
   The great  remedies in pleurisy and peripneurnony, are
bleeding, blistering and purging.  In severe cases its rapid
course and fatal tendency  require that these  should be
employed with  promptness and energy.   Blood is _ to be
drawn from  a large  orifice in the arm, till the patient is
relieved of  his pain  and difficult breathing, provided the
quantity for  this be short of two pints.  If the  first bleed-
ing  fail to relieve, or if  after relieving, the pain  and diffi-
cult breathing  return, the  operation  should, after twelve
hours, be repeated.
   Move the  bowels as early as  convenient, by a mild lax-
ative, as salts, one ounce, or by the cooling mixture."
   Immediately after the first bleeding, apply a large blis-
ter upon the side, near the seat of the pain.
   Bathe  the feet in warm sea-water, and apply  warm poul-
tices to them.
* See Mixtures in Appendix. 
52
DISEASES  OF THE  CHEST.
  Take very freely of warm barley-water, or flaxseed tea,
made agreeable with sugar.
  If the above fail to relieve the pain and other symptoms,
within the first thirty-six hours,  move the bowels again by
the cooling  mixture, taking a wine-glass full  every hour,
till  it operates.   Another blister may be  applied to the
chest, and the bleeding repeated even a third time.  As soon
as the pain is relieved and expectoration has commenced, give
Dover's  powders, eight  grains, in  pills, or pectoral  mix-
ture, a table-spoonful, every three hours, and continue the
warm drinks.
  Preserve  a constant warmth of the  skin by keeping  in
bed, and a uniform temperature of the apartment.  During
convalescence, the patient may subsist  on a generous diet,
and use wine.
                   CONSUMPTION.
   The  great  length  of time necessary  for  consumption
to develope itself and become confirmed, might lead one to
suppose that it can hardly occur on shipboard  during a sin-
gle voyage, and consequently that medical advice would be
unnecessary, in a book  like 'this, which is merely intended
to afford advice to sailors while at sea, and out of the reach
of physicians.   Consumption, however, has time to  com-
mence, in a single voyage ; and when it is considered that
it is in the first stage only, that advice and medicine are sure
to prove  beneficial,  the  necessity of making the sailor
acquainted with the nature of the disease will be admitted.
   But another reason for introducing some account of con-
sumption is, that persons laboring under the advanced  sta-
ges of it, are not unfrequently sent to sea, with the hope
of deriving benefit from sailing, or from change of climate,
and to such, while on ship board, the following sketch may
be acceptable.
                       SYMPTOMS.
   The tubercular consumption, which is  by far the most
common kind,  may be divided into three stages or periods. 
DISEASES  OF THE CHEST.
53
In the first stage, the disease is slowly developed, ordina-
rily without being noticed.  In this period it is very impor-
tant to recognize it, but the physician is not often con-
sulted so early.  The first symptoms are a short, dry cough,
the breathings being more easily hurried by bodily motion,
the patient becoming languid, indolent and  dyspeptic, and
gradually losing his strength ;  at length, from some fresh
exciting cause, the cough becomes  more considerable, and
is particularly troublesome during the night; breathing is
more anxious ;  sense  of straitness and  oppression across
the chest is experienced ;  an expectoration takes place, at
first of frothy  mucus, which  afterwards becomes copious,
viscid and  opaque.   These  symptoms may be gradually
progressing for months.   The emaciation and weakness go
on increasing ; a pain arises in some part  of the breast, at
first unsettled, but afterwards fixes in one  or both sides, is
increased by coughing,  and sometimes  becomes so acute
as to prevent the patient's lying upon the affected side.^
   The  disease  now passes to the second period, in which
it is easily  recognized.   Purulent  matter, resembling that
made by a common ulcer, is coughed up.   To distinguish
whether it be such, or only mucus, mix some that is raised
in the morning, in salt water ; if mucus or common phlegm,
it swims and holds together ; if pus, it sinks,  and on stir-
ring,  separates into particles ;  purulent  matter  is^ also
opaque, has a greenish color, and is  sweet to  the patient's
taste.  Hectic  fever  takes  place, known by a flushing of
the face, by a hard, quick and frequent pulse, beating more
than one hundred in a minute, and by high-colored urine.
The  hectic  has an  exacerbation or increase  twice in the
day; the first  time about noon, which is inconsiderable,
and 'soon suffers a remission ;  the other  in the  evening,
which  gradually increases until  after midnight.   Each ot
these fever-fits is preceded by chills, and terminates in pro-
fuse  perspiration.  In  the morning, the patient is better,
and thinks  himself well.  The  cough and  difficult breath-
ing now go on increasing, and oftentimes there is a hoarse-
ness  or shrillness of the voice.  After this stage is well
5* 
54
DISEASES  OF THE CHEST.
established by the appearance of the  above symptoms, the
patient may die in six or eight weeks.  He is, however, able
to go  about, and when the expectoration  of pus is first
established, the  appetite that was lost in the first stage of
the complaint, returns.  During the fever fits, a circum-
scribed redness appears  in each  cheek, but at other  times
the face is pale, and countenance dejected.
   The third period is that of general exhaustion, the  coun-
tenance is  peculiar, and easily recognized by all.  The
cough becomes  more  hard  and difficult, especially in the
morning, when it often produces vomiting ; emaciation is
extreme ;  diarrhoea comes on, and generally alternates with
melting sweats ; the legs swell; little ulcers appear in the
throat; still  the appetite often  remains  entire,  and the
patient flatters  himself with hopes  of speedy recovery,
and is forming  plans of interest or amusement,   when
death puts a period to his existence.
   Females are more liable to the disease than males, partly
from their more delicate organization, and consequent ina-
bility to withstand vicissitudes of temperature, partly  from
errors in  dress, particularly of the chest, by compressing
it, and of the feet, by imprudent exposure.
   The age most  susceptible, is between twenty and forty.
It rarely  proves fatal before the age of fifteen, and the
general average of tables showTs the greatest number of
deaths happen between twenty and thirty ; the next in pro-
portion, between thirty and  forty, and then between forty
and fifty.
   When the disease first appears, there is always consid-
erable hope that if properly treated, it may be  stayed in
its progress ; and if this can be done once, and the patient
in some measure  improved in  health, a repetition of the
same course of treatment may again succeed, from time to
time, until the patient has turned  the age of thirty,  when
the danger will,  ever after,  be  constantly lessening.
   Spitting of blood  sometimes induces the  disease  or is
the first symptom noticed.   In other cases it occurs in the
course of the disease, and sometimes terminates it. 
DISEASES  OF THE CHEST.
55
                        CAUSES.

  Particular constitutions  are  more liable to consumption
than others, as where an hereditary predisposition exists, or
particular formation of body, marked by long neck, prom-
inent shoulders and narrow chest.  The remote causes are,
constitutional irritability of the lungs ; a scrofulous habit, in-
dicated by a clear skin, fair hair, delicate rosy complexion,
large veins, thick upper lip, and weak voice.  In such sub-
jects tubercles form in the substance of the lungs, resembling
in color and consistence crumbs of hard  cheese, from the
size of a pin's head, to that of a large pea.  These tubercles
may remain dormant for  many years, and probably even
to old age, but they are liable any time to undergo changes
that will  induce consumption  either  by  softening into a
matter resembling pus, or  by exciting inflammation in the
surrounding substance, and  in either case causing ulcers
that are difficult to heal, and  may extend and involve a
large portion of lung, and finally prove fatal.  In some rare
instances, they heal, and present  a light-colored puckered
scar.  Many  of these tubercles may ulcerate together, and
form one large  cavity.   The more  immediate or exciting
causes are preceding disease — as spitting of blood, pneu-
monia, catarrh, venereal  disease,  fistula — depressing pas-
sions of the mind — intemperance — profuse evacuations,
as diarrhoea; or a large ulcer.

                      TREATMENT.

   In the first stage,  and before hectic  fever begins, or
much emaciation appears, and before the lungs are much
affected, which a physician can ascertain by examining the
chest, there is  good reason  to hope that  the  disease  may
be removed, or may at least have its progress stayed.
   The treatment may require  to be modified at the outset,
 according  to the prevailing symptoms — bleeding at the
lun^s or  the  long  existence of catarrh,  or a recent  lung
fever, may require  the  use of some of  the remedies men-
 tioned under those  heads. 
56
DISEASES  OF THE  CHEST.
  I will mention a few of the most approved  remedies in
the early stage of consumption.
  1. Sailing and change of climate;  these are so impor-
tant  that I have appropriated a separate  chapter  to their
consideration.
  2. Exercise in the open  air, and travelling on horseback
and in open vehicles. Long journeys are best, if the patient
can bear them.
  3. Light  emetics, repeated every second or third day;
white vitriol, in doses of 15 grains dissolved in half a tum-
bler  of warm water.
  4. Mild laxatives every  other morning; the best article
is probably Epsom  salts in small doses.
  5. A nourishing, easily  digested, unstimulating diet —
as milk, cheese-whey, eggs, broths, jellies, porridges, pud-
dings, &c, and other kinds of food which the  patient finds
by experience to agree with him.
  6. A stimulating plaster worn between the shoulders.
  7. Expectorants  and anodynes, Avhich will  allay cough-
ing,  and promote expectoration.  Among the best of these
is the pectoral mixture, or Dover's powders, 8 grains,  in two
pills.   They should be accompanied with the free use of
gum water,  flax seed tea, &c.
  8. A new medicine, called hydriodate of potash, in stea-
dily  repeated doses, and  the application of an  ointment
made of the same, over  the diseased lung  at  the part
affected.
  9. Inhalation of fumes  of tar, of  chlorine and  burnt
sponge.
  10. Leeches applied over the part of the diseased lung
most affected.
  11. Cod liver oil seems to take the lead of  all remedies
hitherto discovered.  Patients  embarking for a  warmer
climate  should  take several bottles.  Dose is one to two
table-spoonfuls twice a day.
  If spitting of blood from the lungs occurs at an early
period, there is with it a tendency to inflammation.   This
must be prevented  by measures of  the most  active kind.
If the constitution do not positively forbid it, general bleed- 
DISEASES OF THE CHEST.
57
ing should be employed, especially if the pulse be quick,
although  the  patient may be feeble, since the weakness
induced by spitting blood is not occasioned by the quantity
that is  lost.  Blistering  should  then  be  employed ;  the
patient should be confined to a mild diet and quietude, and
should avoid speaking, coughing, &c.   The  bowels are to
be moved with cooling  laxatives, as Epsom  salts, and the
patient kept in  a uniform  temperature,  of  from sixty to
sixty-five  degrees, and take  half a  grain of opium in the
evening.  After  the above evacuations have been made,
astringents  and  refrigerants  will be  proper;  and when
spitting of blood occurs in the latter stages of consumption,
these are principally to be relied on.   The astringents are
elixir vitriol and  alum ; the former in doses of twenty-five
drops, in  a  gill of water, every three hours ; the latter in
doses of six grains.  As a refrigerant,  common salt is a
very effectual remedy, and should  be given when spitting
of blood  has  commenced, in doses of two  or three  tea-
spoonfuls.
   In the latter  stages of consumption, nothing more can
be done than  to  palliate distressing  symptoms.  For the
cough, take pectoral mixture  and opium pills.
      SPITTING OF BLOOD, FROM THE  LUNGS.

                      SYMPTOMS.

   Sense of weight and oppression in the chest;  dry tick-
ling  cough;  difficulty  of breathing; flushed and anxious
countenance  ; sense of  pain and heat referred  to  the
breast-bone ;  saltish taste in the mouth ; constant inclina-
tion to hawk  and cough, by which blood from the lungs is
raised.   In   this  respect it differs from  the vomiting of
blood, the blood  in  that  case being raised  from the sto-
mach without cough ; it is  moreover sometimes clotted,
and often mixed with alimentary matter. 
58
DISEASES  OF THE CHEST.
                         CAUSES.
   It may proceed from  excess of blood, from a peculiar
 weakness  of  the  lungs,  hereditary predisposition, or bad
 formation of the breast.  It is often occasioned by exces-
 sive drinking, running, wrestling, singing, or loud speaking.
 Sometimes it is the effect of a long and violent cough, and
 is then the precursor of consumption.

                       TREATMENT.

   Administer  table-salt,  two  or three tea-spoonfuls ;  or
 alum, fifteen grains.   One  of  these remedies  will be suffi-
 cient to arrest the bleeding, for a short time.
   Draw blood  from the arm on the first attack, and repeat
 the operation  whenever there is any hardness  of the pulse
 or other symptoms of inflammation, or any return of the
 disease, provided the quantity of blood already lost be not
 very great.
   After bleeding, open the bowels with a dose of  Epsom
 salts, or cream of tartar.
   Refrigerants  and  astringents are then to be taken, as
 elixir vitriol, ten  drops, in  a  glass of water, every three
 hours; or  nitre, ten grains, dissolved  in  a glass of water,
 every three hours, adding to each  dose, ten drops of lauda-
num.  Also draughts of cold water with lemon juice.
 ^ Carefully avoid heat,  speaking,  coughing,  and  every
 kind of bodily exertion.  Use a light vegetable diet.
                        COUGH.

   Commonly, this is only a symptom of some other disease,
as of catarrh, consumption,  &c.  In  such cases it is to be
regarded in the general treatment of those complaints. In
some constitutions, however, there is such irritability of the
lungs, that  cough is excited on the least exposure to change
of weather ; and in such,  it often remains after  every
other symptom of a  catarrh is removed.    When long pro-
tracted and violent, there is always reason to fear the con-
sequences,  since it is often the precursor  of consumption. 
DISEASES  OF THE CHEST.
59
                      TREATMENT.

  If the cough be violent, the patient young  and pletho-
ric, bleeding will be proper;  and it will be unsafe in such
cases to administer opiates, to quiet the cough, till this is
done or the stomach  and  bowels  cleansed.  In ordinary
cases purging alone is often sufficient to prepare the sys-
tem  for opiates,  and this  may  be induced  by salts;  or
sulphur, with cream of tartar, half an ounce of each, mixed
in molasses, and taken in the evening. The cooling mix-
ture is good.
  Emetics are among the most  effectual remedies for a
cough, and one alone is often sufficient to  remove it, with-
out the aid of other medicines.
  In long protracted coughs it will often be necessary to
excite a counter-irritation by a blister  or irritating plaster.
Burgundy pitch, spread  on a soft leather, of  the size of
the hand, and applied between the shoulders, will serve for
this purpose : — Or, take common pitch of  the ship, spread
in like manner, and sprinkle on it two or three grains of
the powder of tartar emetic, and  apply it  over the breast
bone.  An  irritating plaster should  be renewed  once  a
fortnight.
  Opiates, combined  with sudorifics,  may  be taken  on
going to bed, in  the  form of  pectoral mixture, a table-
spoonful ; or Dover's powders, eight grains, in pills, accom-
panied by warm drinks.
  Wear flannel next the skin — avoid exposure to  sudden
changes of temperature, and abstain  from ardent  spirits,
and all strong stimulants, and from animal food.
                     ASTHMA.

                       SYMPTOMS.

  Tightness across the  chest;  difficult breathing;  wheez-
ing- sense of suffocation; cough, occurring in fits  ; gasp-
in-'for breath, that obliges  the person  to sit up  until 
60
DISEASES  OF THE CHEST.
towards morning, when the symptoms  abate and sleep fol-
lows.   The fits recur for several nights, gradually losing
their violence.  There is not much danger in asthma, some
of the French call it a lease for long life, yet it is apt to
appear as a symptom of  a dangerous disease of the heart.

                      TREATMENT.

  To prevent asthmatic fits,  avoid improper or  too much
food, especially suppers, exposure to damp cold air, fogs,
great heat, or sharp vapors  of  any kind.   When  a fit is
expected, emetics may ward it off; expectorants should fol-
low, as syrup of squills, antimonial solution  and paregoric,
equal parts, garlic, strong coffee, ether.  Smoking  cigars
made of stramonium gives great relief.  Bleeding will give
temporary relief, and in full  habits  may be tried.  In a
saturated solution of  nitre  or  salt-petre,  immerse some
pieces of paper and let them dry, and then burn them near
the patient, so that he may inhale the fumes.
               DROPSY OF THE  CHEST.

                       SYMPTOMS.

 ^ Difficulty of breathing, particularly on any sudden exer-
tion, as in ascending a hill, or stairs, or running ; it is  also
great during  the night, while  the  body is in a horizontal
posture ; distressing sense of weight and oppression at the
chest;  palpitation of the heart, sometimes so great as to
be seen and heard ; irregularity of the pulse, often inter-
missions ;  paleness of the face; dropsical  swelling of the
extremities;   scarcity  of urine;   sudden  starting from
sleep ; fluctuation of water in the chest.

                      TREATMENT.

  Employ the same medicines, that are advised  under the
head of dropsy. 
DISEASES  OF THE BELLY.
61
  OF TYMPANY,  OR WINDY DISTENTION OF  THE
                       BELLY.

  The wind may collect within the intestines ;  or without
them, in the cavity of the  abdomen.   In either case the
belly, usually in a few hours, becomes greatly distended,
tense,  and elastic, like  a  drum-head.   Sometimes the
swelling is gradual in its  progress  and preceded by rum-
bling of the bowels.   There is diminished  appetite, thirst
and emaciation.  Unless the constitution be much impaired,
the disease is generally curable.

                      TREATMENT.

   The  objects are, 1. To evacuate the air;  and 2. To
prevent its re-accumulation.
   The first object  is gained by heating medicines, as ether,
anise-seed, peppermint, cayenne pepper, ginger, nutmeg,
&c,  and by  opium ;  thus,  paregoric two tea-spoonfuls,
essence  of peppermint  twenty  drops, powder of ginger
half a  tea-spoonful, mix  in  sugar, and  take  every three
hours ;  or, powder of rhubarb  and ginger, of each five
grains ; nutmeg, two grains ; opium, half  a grain, mixed,
to be taken every three hours.
   To prevent the  re-accumulation of air, after it has  been
once discharged,  use tonics,  as decoction of gentian, and
avoid all food apt  to produce wind.  It is a disease of rare
occurrence.    In  forty years' practice, I never have seen
more than three cases.
     ASCITES, OR DROPSY OF THE ABDOMEN.

                      SYMPTOMS.

  A  slow,  gradual swelling of  the abdomen.  When
severe, there is thirst, scarcity of urine, and  some degree
of fever.
          6 
62
DISEASES  OF THE  BELLY.
                        CAUSES.

   The same as general dropsy, but the most usual is a
 diseased liver, occasioned either by the sudden application
 of cold, when the body has  been heated, by a long pro-
 tracted fever and ague, or  remittent fever,  or by hard
 drinking.
   It differs from tympany, in being almost invariably con-
 sequent to some constitutional disease;  is more slow and
 gradual in its attack, the belly is not so elastic, and there
 is a sense of fluctuation,  and  generally some  dropsical
 appearances in the lower extremities.

                      TREATMENT.

   The general treatment  may be the same as is recom-
 mended under the head of general dropsy,  to which may
 be added locally a tight-laced waistcoat, or tight bandages
 round the abdomen.   This will  serve to keep  the disease
 in check, till the vessel arrives in port, where, if the swell-
 ing be  very great, it may be advisable to evacuate the
 water by  an operation, which should be performed only
by a skilful practitioner.
   The reaccumulation of water is to be prevented by the
means recommended under the head of general dropsy.
                   OF  THE LIVER.

      ACUTE INFLAMMATION OF THE  LIVER.

                      SYMPTOMS.
   Pain in the  right side, under the short  ribs, which is
increased by pressure ;  sometimes it extends to the chest
then resembling pleurisy, and often there  is pain in  the
right shoulder ; irregular state of the bowels ; inability of
lying on the left side; dry cough.
   The  inflammation, if not reduced by the seventh or tenth
day, usually ends in the formation  of  matter.    In  the
former   case, a bilious  looseness  ensues ;  if an  abscess 
DISEASES  OF THE BELLY.              63
form, it may break inwardly into the chest or abdomen, or
outwardly through the skin.    The most frequent cause is
the hot and unhealthy climate of India and China, and the
neighboring islands.

                       TREATMENT.

   Every exertion  should be made to reduce  the inflamma-
tion, as early as possible.  Bleed, and purge freely with
calomel or blue  pills, No. 2, with a table-spoonful of castor
oil; apply  a large blister over  the liver, or part affected
with soreness ;  and  abstain from solid food and stimulants.
In India, a salivation should be  produced as soon as possi-
ble, with calomel  and opium.
   If an abscess  form  and  break, the patient's  strength
must be supported by quinine, or decoction of gentian and
elixir vitriol, 8 drops to a dose.  When this disease has once
attacked  a person in hot climates, as India or China, he
will often  require the use of the blue pill, or of calomel,
for years after.   A change of  climate is indispensable for
 the restoration  of health.  If the abscess point outwardly,
 and threaten to break  through the  skin, the part should
 be poulticed.
     CHRONIC  INFLAMMATION  OF  THE LIVER.

  The  attack  of this is  generally so  gradual, and  the
symptoms at its commencement so obscure, as to pass long
unnoticed.   There  is dejection  of mind; a loss  of ap-
petite ;  rumbling in the  bowels;  sense of weight and dis-
tention  in the  stomach;  obstinate costiveness; clay-col-
ored stools ; jaundice; and oftentimes an enlargement ot
the liver, that can be felt.
                      TREATMENT.

  Induce a slight spitting with mercury,  applied by fric-
tion   and  given internally;  thus, calomel_pills,  or six
grains of  blue  pill, every night and  morning, and  rub 
64
DISEASES  OF THE  BELLY.
mercurial ointment, of the bulk of a nutmeg, on the in-
side of the thighs, every evening.
  Apply to the part a plaster of mercury or of pitch, of
the size of the hand and thickness of a dollar.
                    SEASICKNESS.

   With very few  exceptions, this attacks all persons, on
their first voyage; and  the  degree of it is generally in-
versely proportioned to  the size of the  vessel, it  being
most violent where  the  vessel is small, and least  so in
large vessels, on which the waves make but  slight impres-
sion.   Some persons, however, are  more  liable to  sea-
sickness than others.  Those in the  prime of life, and  of a
fair, light complexion, have been remarked to be most  sus-
ceptible of  its attacks, while old persons, and those of a
dark complexion, suffer least.  The duration of sea-sick-
ness is very uncertain, being generally not above a day or
two; but in many cases it continues  for weeks, or even
months, and there  are some  seamen who always suffer an
attack in tempestuous weather, even after having followed
the sea for many years.

                      TREATMENT.

   Though time is  perhaps the only cure, various  reme-
dies  have been directed to alleviate this complaint.  In
slight but lingering cases, in which  nausea and headache
continue a long time, without  vomiting, it will cut short
the  symptoms to  cleanse  the  stomach  and bowels by a
draught of  sea-water; and  a tea-spoonful of ether, in a
glass of water, will often relieve slight cases.   The little
food taken  at a  time should be  eaten cold and  highly
seasoned,  and the patient should keep upon  the  deck,
with his face to the windward.
   In severe cases, when no longer able  to keep upon the
deck, try a recumbent posture,  resting the head  on a
book, or other hard substance, and  continue as much as
possible in  a uniform position, with  the  eyes closed  and 
DISEASES  OF THE  BELLY.
65
the thoughts engaged on some interesting and agreeable
subject, till  sleep comes  on, or  till vomiting has  ceased.
When the system has in this manner become accustomed
to the rolling in one posture, and sickness has ceased, try
another.  In this  way the rolling of the ship will cease
to excite vomiting  in a much shorter time than when the
posture  is continually changing.
   Dr. Johnson  ascribes   sea-sickness  chiefly to  the im-
pression produced  on the optic nerve, and transmitted to
the brain, by the  continued motion of  the  vessel, sails,
shrouds, &c, and thinks  that by keeping  the eyes closed,
this  disagreeable nausea is frequently  prevented.   Dr.
Maxwell regards it as a disease of debility, and recom-
mends  stimulants,  such  as  brandy, and either  to  walk
about, or to  keep in a horizontal posture.
                 ON THE  STOMACH.

       INFLAMMATION OF THE STOMACH.

                      SYMPTOMS.

  Fever; anxiety; heat and pain in  the  space between
the pit of the stomach  and  navel, increased  when  any
thing is taken into the stomach; vomiting; great thirst;
hiccup;  coldness of  the  extremities; small, frequent,
hard, and  contracted pulse;  prostration  of   strength;
cold, clammy sweats.  One of the most certain signs of
this disease, is  the sense of pain which the patient feels
upon taking any kind of food or drink, especially if it be
too hot or too cold.
                       CAUSES.

  Cold liquids, drank when the  body has been heated by
exercise ;  the operation of poisons  taken into the stomach,
as arsenic, or of acrid substances acting chemically there ;
something acting  mechanically and lacerating the coats of
the stomach ;  transfer of  gout from the toe.
         6* 
66
DISEASES  OF THE  BELLY.
                     TREATMENT.

   As twelve hours" may, in some instances, carry off the
patient, no time  is to be  lost in applying the remedies,
which are :
   1.  Copious  bleeding;   to  this  the smallness  of the
pulse will be no objection,  for it will become fuller by the
loss of blood.
   2.  A  large blister, or mustard plaster, applied over
the stomach.
   3. The  use of the warm  bath,  even  until  fainting
comes on.
   4. Mucilaginous drinks in very small  quantities, and
often, as flax-seed tea, barley-water, and gum  arabic, dis-
solved in water, with a few drops of laudanum.
   5. Clysters of warm water.
 ^  Where poisons have been taken intentionally, or by ac-
cident, as  opium, arsenic, corrosive sublimate, verdigris,
&c, administer an emetic immediately, of the most active
kind, as white or blue vitriol, fifteen  grains, or so much
as can be heaped on a ten cent piece, dissolved in a gill
of water, adding twenty grains of ipecac :  drink freely
afterwards  of diluting liquors, as barley-water, toast-water,
flax-seed tea, and milk.
                VOMITING  OF  BLOOD.

                       SYMPTOMS.

  Vomiting  of large  quantities  of  clotted  blood,  and
sometimes  mixed with  alimentary matter, generally unat-
tended by cough, and preceded by a sense of  weight and
dull pam, or anxiety, a little below the pit  of the stomach.

                        CAUSES.

m  Generally, some external violence ;  or some mechanical
injury to the stomach itself, or some  great strain of the
body. 
DISEASES  OF THE  BELLY.
67
                       TREATMENT.
  If  accompanied  by heat of the  skin, or other symp-
toms of fever, or if the disease  can be traced  to violence
or exertion, bleed  and keep the patient cool, avoiding all
causes of  irritation.   Unless the bleeding from the stom-
ach become alarming  from its quantity, it will be advisable
not to arrest it-by astringents, but suffer it to stop of  it-
self.  The day following, give a mild laxative, as of cream
of tartar, castor oil, or a  small dose  of  salts, to remove
the blood  from the bowels.
   Subsist  for two or three days on light food, as barley,
rice, fresh broth, etc.   When inflammation has subsided,
give decoction of bark, or quassia, in a dose of two  table-
spoonfuls every three  hours, adding to each dose ten drops
of elixir vitriol.


                OF  THE INTESTINES.

       INFLAMxMATION OF THE INTESTINES.

                       SYMPTOMS.
   Severe pain in  the abdomen, increased upon pressure,
and shooting in a twisting manner round the navel; hard-
ness  of the  abdomen; obstinate  costiveness.  There  is
sometimes  vomiting or straining at stool, according as the
inflammation happens in the superior or inferior portion of
the intestine.  The pulse is quick, hard and  contracted,
and the urine high-colored, and there are other symptoms
of fever, with great prostration  of  strength.

                        CAUSES.
   All those inducing  inflammation of the stomach, also
strangulated hernia, colic, long-continued costiveness.
   It  is  distinguishable from colic by being accompanied
with fever, and by increase of pain from  pressure.

                       TREATMENT.
   The indications of cure are,
   1.  To  reduce  the inflammation by bleeding  once  or
           6« 
68              DISEASES  OF THE BELLY.

twice from the arm, by a large blister laid over the belly,
by  the warm bath, and by total  abstinence from stimu-
lating articles of diet or medicine.
  2. To  move the bowels  by gentle purges, as  castor
oil,  salts,  or cream  of tartar; and  by clysters  of salt
water.
 CHOLERA MORBUS, OR VOMITING AND PURGING.

                       SYMPTOMS.

   A frequent discharge of bile by vomiting and purging,
 accompanied by pain and distention of the stomach, thirst,
 great anxiety, cramp in the lower extremities, cold sweats,
 hiccups, and not unfrequently death within the space of
 twenty-four hours.

                        CAUSES.
   Exposure to excessive heat, or sudden  transitions from
 heat  to  cold; hence more frequent in  autumn from ex-
 posure  to cold  evening  air, after very hot  days ; large
 quantities of food of  difficult digestion ;  the colder fruits,
 as  cucumbers, melons, &c. ; active  and violent  purges;
 poisons ;  putrid animal food, as lobsters;  exposure to the
 effluvia of putrid animal and vegetable substances.
   When it terminates favorably there is  a gradual dimi-
 nution of the symptoms, especially  of vomiting, followed
 by sleep or a gentle moisture on  the  skin.  The disease,
 when protracted to  the fifth, sixth, or seventh day, seldom
 proves fatal.
   Unfavorable symptoms are strong cramps in the legs or
 arms; convulsions; great  prostration of strength; cold,
 clammy sweats ; intermitting pulse ; foetid vomiting ; and
 great distention of the abdomen.

                      TREATMENT.

   The first thing to be done is to remove offending sub-
stances from the stomach and bowels.  This, however  has
in most cases been already effected by nature.   If vomit- 
DISEASES  OF THE  BELLY.
69
ing and purging have therefore occurred frequently, en-
deavor  to allay the  existing irritability by opium, and di-
luting drinks.  Begin with one tea-spoonful of laudanum,
mixed in gruel or  tea, and  repeat  the  do3e every half
hour  till the vomiting is arrested.  An excellent remedy
is powdered  sugar,  chalk, and gum arabic,  rubbed to-
gether — a  table-spoonful of each in a  gill of water till
they form a sort of cream, add four tea-spoonfuls of laud-
anum, and give a table-spoonful every half hour till  the
sickness abates ;  give at the same time thin gruel, arrow-
root, or chicken-broth frequently, but in very small  quan-
tities.   Laudanum  and spirits of hartshorn, equal parts,
mixed, are to be rubbed over  the stomach constantly.
   When, in  spite  of this  treatment, the  vomiting con-
tinues unabated for two  or  three hours, administer lauda-
num in  clysters, thus : —
   Take laudanum, a half table-spoonful;  water, one pint,
mixed ;  inject one  half,  and  direct the  patient to retain
it as  long as possible ; when discharged, administer  the
remainder.   A large blister should now be applied over
the stomach, the feet and legs bathed in warm salt water ;
hot applications made to the feet;  opium  given  in pills,
in a  dose  of five  grains  every hour, and the  diluting
drinks continued.  The effervescing mixture * should now
be given every hour,  adding to each dose twenty drops of
laudanum.
   After the  vomiting is allayed, give a mild purge, such
as is most agreeable to the patient.
         SPASMODIC OR ASIATIC CHOLERA.

  As this disease commonly proves fatal  even in^ the
hands  of skilful physicians on  shore  and  in hospitals,
where  every known or supposed remedy is  at hand, dis-
couraging must be the prospect of  treating it successfully
on shipboard, by persons  who  are  comparatively ignorant
of its nature, and of the virtues of medicines.  Still it
                     *  See  Appendix. 
1
70             DISEASES OF THE BELLY.

is the author's  duty to furnish the best advice  he can
upon the subject.
  Cholera may be divided into three stages.
  1st. A premonitory or threatening stage ; 2d.  When it
is fully formed ; 3d. A stage of collapse, or sinking.
  The first stage usually consists in a loose state of the
bowels, which may continue  several days, but  is often of
very  short duration ; sickness or  uneasiness of stomach,
gripes, or severe pain at the pit of the stomach, are fre-
quently  added.   The matters  passed  are  such  as are
observed in ordinary diarrhoea and vomiting ; slight cramps
may also be felt, and loud quirking of the bowels.
  The second is characterized by frequent  vomiting and
purging, almost  always  of a pale,  whitish fluid, in  great
quantities;  by painful  cramps of feet, legs, hands, arms,
belly,  or other parts;  a painful  burning  at  the  pit  of
the stomach ;  the features are contracted and sharp ; the
eyes sunk  and  surrounded by a dark circle ;  apprehen-
sion, languor and  suffering  are depicted in  the face ; the
pulse, scarcely quickened, is feeble ; the surface, especially
hands and feet, colder and perhaps of a darker color than
natural;  there is great  thirst, while drinks of every kind
are generally vomited almost as soon as taken ;  the breath-
ing is slow, or not much  disturbed ;  the voice feeble, whis-
pering, husky; the secretions in general are suspended;
urine is not, apparently, formed ;  hiccup is not unfrequent;
there is great tendency  to sinking, and the person seems
older than he really is.   In some  few cases, there is not
purging;  in some, scarcely any vomiting  or cramp, the
disease being chiefly marked by a painful load, or tightness
of chest and stomach, and a rapid sinking.
  The third stage, that of collapse, gradually succeeds to
the  second.   In it the person seems to relapse into a state
of tranquil  heedlessness ; he will  answer questions cor-
rectly, even just before death, but with slowness ; the pulse
is lost at the wrist and other parts ; the dark or blue  color
is more decided, yet in many this symptom is  not observed;
the  vomiting and purging cease, or become less frequent;
" the skin is very cold, and  generally  damp, giving to the 
DISEASES  OF THE BELLY.
71
touch the sensation felt from handling a frog; " the tongue,
which is often furred, is cold ; even the breath is cold; the
fingers, hands and other parts lose their usual plumpness,
and become shrivelled ; the patient tosses about incessantly,
the breathing becomes laborious, and death takes place, in
most cases, without any  struggle.
   Such is  the usual  course of the disease, if left to  itself,
many varieties occurring in quickness and intensity.   The
first stage  may be so short  as to  seem wanting, or consist
only in pain and  cramp  at the  pit of the stomach.   The
second stage may not endure an hour, or extend to two or
three days.  The entire may end in  death in two or three
hours, or not for several days ;  a long premonitory  stage
is not always followed by a mild form of cholera.
   When medicine is administered, and in  rare cases with-
out it, the  progress is not so certainly towards death.  In
general a speedy convalescence may be  predicted if  atten-
tion be given in the first stage.  A large proportion of
deaths is clearly owing to the want of immediate assistance.
   If the first stage has  been neglected, either by reason
of its  shortness, or its  not  causing alarm, not an instant
should be lost; the friends of the patient must not yield to
the same fatal  listlessness that is  observed to seize on the
person attacked. By proper means it is still probable that
the natural tendency to collapse may  be averted, the  evac-
uations checked, the spasms moderated, and health restor-
ed.  These changes may, as in the first stage, be speedy,
the return  to health being often preceded by tranquil sleep
and free perspiration.
   Treatment in the first stage. — If it consist in  purging,
with occasionally slight vomiting, give a pill or a powder of
calomel and opium, four grains of the former to one of the
latter, and  repeat as often as the stomach rejects it ; and if
the stomach retain it, repeat it every hour until a bilious
discharge is produced,  or the  patient  falls  asleep.  In
order  to hasten the sleep and to stay the rolling and quirk-
ing of the  bowels, the patient should remain  in one pos-
ture in bed, warmly  covered with blankets, and  take no 
72
DISEASES  OF THE  BELLY.
 drinks except a swallow of toast  water or warm tea and a
 table-spoonful of brandy, with half a tea spoonful of  lau-
 danum  every fifteen minutes.   Should  the  disease  not
 cease in an hour or two by sleep, but tend towards the sec-
 ond stage,  with  increased  frequency   of   discharges,
 give three to five grains of acetate of lead, or  of powdered
 alum, every two hours, and apply strong  stimulants over
 the  abdomen, as a plaster  made  of  mustard  and pepper-
 sauce or sharp vinegar, and rub the extremities with mus-
 tard and Cayenne, or with  spirits of turpentine.
  In the  second stage. —  There should be  administered
 injections of thin starch or  gruel, containing two tea-spoon-
 fuls of laudanum to a pint, and repeated often ; the calomel
 and  opium repeated, mustard applied  extensively by mix-
ing it in  spirits of  turpentine and pepper-sauce,  and rub-
bed  in hard over the  limbs and trunk; cloths dipped in
hot water  should be constantly applied, of greater heat
 than the attendants can bear their hands in ; pieces of ice
 or cold water may be swallowed often.
   Treatment of the third stage will be a continuation of that
of the second stage.   Cayenne may be added to the calomel
 and  opium, or  aqua  ammonia,  (hartshorn)  half a  tea-
spoonful in cold water, ether a tea-spoonful.
  The disease is not contagious, but endemic.   It is apt to
spread among a crew or other community, because they
are alike exposed to one and the  same atmospheric cause,
but they do not communicate it to each other.
                        COLIC.

                      SYMPTOMS.

  The principal symptom  is pain about the navel, gener-
ally violent, shooting  and twisting, occurring in  fits  dur-
ing which the  patient  is  disposed  to  bend  down  and
press upon the part.  The bowels  are commonly costive
sometimes there is nausea with vomiting, and bitter taste in
the mouth. 
DISEASES OF THE BELLY.
73
                        CAUSES.
  Cold applied to the surface of the body, especially to the
feet and belly ;  crude or indigestible food ; redundance  of
bile ;  obstinate costiveness ;  flatulency ; ccrt.iin  metallic
poisons,  as  lead and  copper.  Those whose  bowels are
easily  disordered,  are  liable to  an  attack  of colic, from
remaining in a room newly painted.

                       TREATMENT.
  The  first step  is  to allay the pain by opiates.   Give
opium and powder of camphor, of each two grains, mixed,
or laudanum and spirits of  camphor of each a tea-spoonful,
every half hour,  till the pain  is relieved.
  Immediately after the second dose  of opium, give a pur-
gative of castor oil, three table-spoonfuls, and if it fail to op-
erate in  three hours, give a fourth table-spoonful.  Or, give
such other purgative as is most agreeable.  It will aid the
operation of the medicine to dash cold water on the abdomen.
  In obstinate cases it  will be necessary  to give still more
active cathartics,  as calomel and jalap powders,  repeated
0ften — spirits of turpentine added to castor oil is good, and
to administer injections of salt water.
   Should vomiting ensue, and the pain still continue, apply
a large blister over the abdomen, and immerse the patient
in a warm bath.
  For  a slight wind colic, a little spirits of camphor, or a
few drops of peppermint, will often be sufficient.


             DIARRHOEA, OR LOOSENESS.

                       SYMPTOMS.
   Frequent and  copious evacuations  by stool, generally
with  o-riping ;  oftentimes there is nausea  and vomiting;
thirst*; bitterness and dryness of the mouth. If the disease
continue, it produces great emaciation.
                          CAUSES.
   The application of cold to the surface of the body,  espe-
cially if accompanied  with moisture ; acrid,  indigestible 
74
DISEASES  OF THE BELLY.
 food ;  great quantities of acid or cold fruits;  putrid sub-
 stances.  In the Mediterranean, it is often caused  among
 sailors by drinking freely of new wine.
   The crew of the frigate Java,  while  lying  at Syracuse,
 1816, were put upon  the use of new wine,  in place  of
 spirits, and nearly every man suffered an  attack of diar-
 rhoea. In other warm climates, as the  West Indies,  spruce
 beer, and other fermented liquors, often  occasion it ; and
 in all climates, the sudden change from the long continued
 use of salt  provisions to fresh meat and vegetables.

                       TREATMENT.
   The cure consists,
   1.  In obviating the cause.
   2.  In suspending the inordinate action of the bowels.
   3.  In restoring their strength and healthy action.
   Irritating causes  are   often lurking in the intestinal
 canal, and must be removed :
   1.  By a  cathartic, as rhubarb, magnesia, or  castor oil,
 in a common dose, or by a draught of sea-water.
   2.  By diluting  drinks, as  flour gruel, flax-seed  tea,  or
 barley-water.
   After the bowels  have been  cleansed  by  a cathartic,
 their inordinate  action is to be suspended :
   1. By opium, conjoined with some medicine that will pro-
 duce sweating ;  thus, opium, from one to two grains, ipe-
 cac, three grains, mixed in syrup, or molasses, and taken
 every three hours;  or  Dover's powders, eight  grains  in
 two pills.
   In  plight cases of diarrhoea, it will  be sufficient, after
 cleansing the bowels, to take an opium pill in  the evening,
 or twenty drops of laudanum.
   2. By astringents, as kino, twenty grains ; or lime-water,
from four to six table-spoonfuls ; or rhubarb, three grains;
 or powdered alum, two grains every three hours.
  # When the disease  proceeds from some error in diet  it
will often terminate in a short time of itself, or perhaps the
most^ that may be  required in such cases will  be a  gentle
laxative and gruel.
   To restore the strength: 
DISEASES OF THE BELLY.
75
  In severe cases where debility of the parts exists, their
strength may be restored ; 1. By a decoction of bark, and
other vegetable bitters, as gentian in decoction, &c.   2.
By moderate exercise.   3. Light nutritive diet, and port
wine should be substituted for malt liquor3, as a common
drink.
  The water of particular places often causes diarrhoea in
ships' crews.  The frigate Guerriere took a supply of water
from the river Neva in Russia, and when it was used by
the crew, about every sailor in the ship was affected with
purging.  In  this  instance and  some other similar ones,
I found that a pint of  quick lime  poured  into each water
cask  corrected  its  purgative quality.    Soaking  burnt
bread, or quenching burning coals in it, produced the same
effect.
  The last of the  ebb-tide furnishes  water,*both at Cron-
stadt and Canton,  that is not purgative.
                      DYSENTERIA.

                        SYMPTOMS.
   Severe gripings, often preceded  by loss of appetite ;
sickness at the stomach ; costiveness, and chills ; frequent
inclination to go to stool;  heat and irritation in the funda-
ment ; appearance of stools various, being slimy,  some-
times bloody,  in this respect differing from those in diar-
rhoea, which are like common stools, only of a thinner con-
sistence.    Sometimes hardened  lumps  are discharged in
the slime, and then the patient is momentarily relieved of
his gripings. In some cases a film of hardened mucus is dis-
charged, Resembling a coat of the  intestines.  There  is
violent straining at  stool, and the patient feels a bearing
down, as if  the bowels were  falling  out, and  sometimes a
part of the intestines is actually protruded.  Great debility
very soon ensues, with a quick  and  weak  pulse.   Some-
times it terminates fatally, and it is most severe when epi-
demic.  In India  and the neighboring islands, it differs in
character from the common cases of temperate regions, the 
76
DISEASES  OF  THE  BELLY.
 liver being more affected, and pouring out an excess of bile,
 often with blood, whence it is called bloody flux.

                         CAUSES.
   It may be occasioned by whatever obstructs perspira-
 tion, as a damp bed, wet clothes, &c; also by unripe fruits;
 bad air ;  moisture succeeding intense heat;  unwholesome
 or putrid food ;  the effluvia of vegetable  or animal sub-
 stances,  in  a  highly  putrid  state.   Persons  living  in
 crowded apartments, as in ships, are more liable to attacks.

                       TREATMENT.
   Cleanse the bowels with calomel, ten grains, mixed in a
 table-spoonful  of oil.  In mild cases  with oil  alone, two
 table-spoonfuls, to which add one tea-spoonful of laudanum.
   Follow the use of the above medicine, with frequent and
 copious draughts of diluting drinks, as flour gruel, barley-
 water, flax-seed tea, &c.
 ^ After clearing the bowels, give Dover's powder, in pills,
 eight grains every three hours, and a table-spoonful of oil
 every day, until the disease yields.
   In severe  cases,  where great pain  and  inflammation
 exist, after the stomach and bowels are  cleared, a blister
 may be applied over the abdomen, and fifteen  or twenty
 drops of laudanum given every hour in the patient's drink,
 till relief is obtained.  In less severe cases, instead of the
 blister, it may be sufficient to bathe the bowels with hot
 peppered vinegar, or hot water.
   Bleeding is a doubtful remedy in dysentery, and unless
 the case  be  severe  and the constitution vigorous, should
 not be employed.
   When there is great pain in the lower part of  the abdo-
men and fundament, and the evacuations frequent  admin-
ister  clysters of flax-seed  tea,  or barley-water,  one  pint
and laudanum a table-spoonful.   Half of  this  is to be
injected at a time, blood warm, and retained by the patient
 as long as poss  le.
   From the  first attack the  patient should abstain  from
solid food, and take  freely of gruel,  barley-water, arrow- 
DISEASES  OF THE BELLY.
77
root, flax-seed tea, or solution of gum arabic.  The pulp of
a roasted apple, or other ripe fruit, may be taken.
  At a more advanced period of the disease, when the fre-
quency of the evacuations seems rather to proceed from a
weakened and relaxed state of  the bowels, than from any
active inflammation, the decoction of gentian, or  of quassia,
may be given, every three hours, beginning with a dose of
a table-spoonful and increasing gradually.   It may be mix-
ed in gruel or barley-water ; or give one grain of quinine,
every three hours.
   When  the pain and  inflammation  are  abated and the
stools are more natural, commence with animal broths, as
of mutton, chicken, &c, at first thin and  unseasoned, but
gradually increasing their richness as the disease declines.
   Since the first  edition  was printed, I have accidentally
met with a prescription in the hands of an irregular prac-
titioner which,  so far as I have  known,  has  never yet
found its way into  any  printed medical  book — I have
made repeated trials of it, as have my professional brethren,
and no medicine  in our  hands has, in  all common cases,
ever proved so successful.   It  is this.  Mix with a small
phial of water, as much sulphate of zinc or white vitriol, as
the water will dissolve ; take one part of this and five parts
of laudanum mixed — give  to an adult fifteen drops  every
three hours, increasing the dose  one drop daily — a dose
of oil should precede the  use of it, and should be repeated
every other day, without omitting the drops.
   In  India,  where the  disease  is very prevalent and
destructive, large doses of calomel, say twenty  grains, are
given with  a grain of opium, every six hours, and once in
twenty-four hours a dose  of castor oil.
   When  this disease  appears on  board ship,  it is of  the
first importance  to prevent its being  communicated to all
hands on board;  to do  this, the most assiduous attention
should be paid to cleanliness.  The evacuations of the sick
must be  immediately thrown  overboard, and the buckets
washed.   Those who are well should avoid  the ni^ht air as
much as possible, shun putrid smells, and avoid all commu-
nication with the sick, and the privy to which the sick go.
          7* 
78
DISEASES  OF THE BELLY.
                         PILES

   Are painful  swellings at  the  lower  extremity of the
 intestine or fundament, either internal or external.  The
 internal are most painful, especially while at stool.  When
 external, they vary much in size, being sometimes as large
 as a  nutmeg.   Frequently they  break  and  discharge
 blood, which relieves the pain: the swelling, however, does
 not  then entirely disappear, and  soon increases again to
 its former  size.
                        CAUSES.

   This complaint may proceed from habitual costiveness,
 plethora, hard riding on horseback, strong  aloetic purges,
 or sitting on damp  ground.

                       TREATMENT.

   As costiveness is the most frequent cause of piles, this
 must be obviated by mild laxatives, and none appears to be
 more efficacious  than  the  use of  the powder of sulphur
 combined with an equal quantity of cream of tartar, mixed
 in molasses,  in  a  dose of  a  table-spoonful every even-
 ing.   Or,  take  a gill  of sea-water every evening.   An-
 other excellent  internal remedy  is balsam of  copaiva
 twelve  drops, given twice  in twenty-four hours, dropt
 on sugar  or  in a  glass of water.   Aloetic purgatives
 should be avoided, and all family pills.
   As an application to the tumors, various  ointments and
 washes are recommended, among which are the following.
   Sulphur  and hog's lard, equal parts, well mixed ;  nut-
 galls and hog's lard, equal parts; mercurial  ointment, or
 fresh butter ;  also,  tar-water, alum-water,  decoction of oak
 bark, lead  water.   A favorite  application with many sai-
 lors is wet  oakum.
   If the piles continue  after the above treatment, and are
very painful, apply  leeches to the part, or if they are not
to be  had,  make  a  small puncture  in the  tumors with a
lancet, and after discharging their contents, apply warm
poultices to the part. 
DISEASES OF  THE  BELLY.
79
  When the  bleeding  piles return  periodically, once in
three or four weeks, the discharge may be considered salu-
tary, and should not therefore be stopped, unless it becomes
so excessive as to weaken the patient, in which case the
decoction of  gentian or  of quassia  may  be  taken  in
doses of three table-spoonfuls every two hours,  adding to
each dose ten drops of elixir vitriol.  Alum or lead water,
dissolved, added to a decoction of oak bark, is to be applied
to the part,  and injected  in  small  quantity into  the intes-
tine, by means of a penis-syringe.
  In some instances, a falling down of the intestine will be
a troublesome attendant on  the  piles, in which case the
intestine must be immediately replaced after every evacua-
tion, by pressing gently upon the  part with  the fingers,
until it is reduced ; and its return must be prevented by
astringent applications, as alum  dissolved in vinegar, de-
coction of oak bark, sugar of lead dissolved.
  All the known causes, particularly costiveness,  both dur-
ing the disease and afterwards, must be studiously avoided.
                       FISTULA.

  When the  tumors mentioned in  the foregoing disease
have been suffered to inflame to a considerable degree, and
by intemperance or ill  treatment to ulcerate, a  fistula is
formed.  In almost  all cases of this disease, whether in-
duced by piles, or  other  causes, the  knife of a surgeon
will be requisite.  While at sea, however, and out of the
reach of surgical aid, the patient, immediately on  the least
apprehension of a  fistula, should keep his bowels open with
mild  laxatives of  cream of tartar  and sulphur,  or small
doses of castor  oil taken every day ; should avoid every
thing of a stimulating nature in food  or  drink,  and take
great care to  irritate the part as little as  possible, apply-
ing at the same time lead-water externally. When in spite
of this the inflammation proceeds on to ulceration, and pus
is discharged from the fundament in such large quantities 
80
DISEASES  OF THE BELLY.
as to debilitate the patient, he  should  take bitters and
wine, and support his strength with rich diet, till  he can
reach medical aid.
                HERNIA,  OR  RUPTURE.

   The  part in which hernia most  commonly appears is
 the groin.   Generally the  tumor takes a direction towards
 the scrotum, but sometimes it pushes into the front of the
 thigh ;  the  former is called inguinal, the  latter femoral
 hernia.   The contents of the tumor are a part of the intes-
 tine, or a portion of the omentum or caul, or both together.

                        CAUSES.

   The  most frequent causes in  adults are blows, violent
 exertions of strength, as lifting or carrying heavy weights,
 straining at stool, jumping, running,  &c.   When a rupture
 is produced by bodily exertion, the tumor is formed sud-
 denly, and is generally  attended with a sensation of some-
 thing giving way at  the part, and with  considerable pain.

                       TREATMENT.

   Reduce  the  tumor immediately by the hand.   For this
 purpose the patient should  be placed on his  back, and  the
 foot  of  the bed  be elevated about  twenty inches  higher
 than the head,  the thighs should be bent  toward the body,
 and that on the  same side with the rupture, inclined inwards.
 The pressure, which  is  made on the tumor by the hand of
 the operator for its reduction, should always  be  directed
 upwards and outwards for  inguinal hernia, and first back-
 wards and then upwards in femoral hernia.  If the tumor
 be not  sooner  removed, the pressure may be continued
 half  an  hour, but no violence is to be used, as it will tend
 greatly  to aggravate the  inflammation,—and  the pres-
 sure, when it becomes painful, should <br the  same  reason
 be discontinued.   Should these efforts fail of  success  the
patient must be bled, and then  another trial be made'and 
        DISEASES OF  THE URINARY  ORGANS,  &C.    81

on failure of this also, use the warm bath, and repeat the
effort while the patient lies in the water.   The next reme-
dies  to be  employed  are, the  coldest applications to the
tumor, as ether  or  pounded ice, and where these cannot
be obtained, a mixture of equal parts of nitre and common
salt,  in the proportion of half a pound of the mixture to a
pint  of water, kept constantly applied to the  tumor.  Final-
ly, try an injection of tobacco made by boiling one drachm
of tobacco in a pint of water for ten  minutes.    When all
these means fail, if a surgeon can be had competent to per-
form  the operation  for  strangulated  hernia, he  should be
called, and always within the first twenty-four hours.
  With the view of guarding  against the dreadful conse-
quences of a strangulated  hernia, a ruptured person should
immediately procure a well-adapted  elastic  spring truss,
and wear it during the day,  without intermission.
DISEASES OF  THE URINARY ORGANS AND  GENITALS.
            OF THE URINARY  ORGANS.

         INFLAMMATION OF THE KIDNEYS.

                      SYMPTOMS.

  Fever, pain in the small  of the back and thence shoot-
ing downward ;  drawing up of the  testicles; numbness of
the thigh ; vomiting ; commonly at first a deep red color of
the urine, which becomes pale and colorless as the disease
increases, and is discharged very often with pain and diffi-
culty ; costiveness and some degree of  colic ; pulse fre-
quent, hard and small.
                        CAUSES.

  Acrid substances acting on the kidneys ;  external injury ;
lon^ continued and violent  exercise on horseback ;  violent 
82
DISEASES  OF THE
exertions, strains, &c; but the most frequent cause is cal-
culi or gravel, lodged in the  kidney, or in the duct that
leads from it to the bladder.

                      TREATMENT.
  1. Bleed from the arm, and repeat the operation ac-
cording to the urgency of the symptoms.  2. Administer
cathartics of the oily kind,  as castor or sweet oil, and give
clysters of barley-water, or  flax-seed tea.   When the pain
is very great, administer a  tea-spoonful of laudanum in the
clyster.   3. Give copious draughts of diluting drinks, as
flax-seed tea, and thin gruel, &c.   4. Let  the warm bath
be repeated according to the violence of  the pain.  The
back should be bathed with flannels dipped in hot water.
         INFLAMMATION OF THE BLADDER.

                       SYMPTOMS.

   Fever, acute pain, tension and tumor  in the region of
the bladder, frequent and  painful discharges of urine in
small quantities and inflammation in the fundament; some-
times there is complete obstruction to the passage of the
urine; severe  cases are attended by vomiting.

                        CAUSES.

   Mechanical injury ; gravel; the  inflammation of a severe
clap extended along the urethra to the bladder;  in some
persons sudden cold will cause it.

                      TREATMENT.

   In severe cases adopt the same treatment that is recom-
mended in inflammation of the kidneys.   In slight cases,
proceeding from cold, or a clap, it may be sufficient to open
the bowels.  Inject the  urethra and bladder with flax-seed
tea, or barley water, milk warm.  Five or six penis-syringes
lull are to be frequently thrown in  at a time, in order that
some may pass into the bladder, where it is to be retained 
URINARY  ORGANS  AND GENITALS.         83
as long as possible ; and some kind of fluid  is to be drank
in frequent and  copious draughts.  After the bowels have
been moved, laudanum  may be given in doses of  forty to
sixty drops.
 BLEEDING FROM THE BLADDER, OR BLOODY URINE.

                       SYMPTOMS.
  When not the effect of violence, it is preceded by a sense
of weight and pain in the loins.  It is  distinguished from
the high colored urine attendant on many diseases, by the
deposit of a coagulum on the bottom of the vessel, and by
its staining linen of a red color.

                        CAUSES.
  It is most  frequently caused  by gravel in the kidneys,
but sometimes arises from external violence or great exer-
tion.
                      TREATMENT.
  If the disease be the consequence of injury, bleed  and
give a dose of Epsom salts, or  of cream of  tartar; also,
frequent and  copious  draughts of flax-seed tea, or barley-.
water, elixir vitriol, twenty-five drops every two hours,  and
an opium pill or sixty drops  of laudanum, every four hours,
till bleeding is arrested.  If the  discharge of blood be very
great, give alum four grains every two hours, dissolved  in a
gill of water,  or sal nitre ten grains.
  If no violence has been sustained to cause the discharge
of blood, a vein  need not be opened, but the other  treat-
ment must be adopted.
             INCONTINENCY OF URINE.
                       SYMPTOMS.
  In  this disorder the  urine  passes  off involuntarily by
drops, but does not exceed the  usual quantity, as in  dia-
betes, nor is the disease  attended with pain.  It is rather
troublesome than dangerous. 
84
DISEASES  OF THE
                        CAUSES.

   Sometimes it proceeds from  blows and bruises, or is the
effect of fever,  or of strong stimulants on the bladder.  In
old people it may often be owing to a palsy of the neck of
the bladder.
                      TREATMENT.

   The most proper remedies are general tonics, as quinine,
or bitters, elixir vitriol and cold bath.   Perhaps the most
effectual remedy ever used is a blister applied to the lower
extremity of the backbone. It sometimes cures cases of long
standing in  twenty-four hours.   Until these or some other
means succeed,  the patient  should wear a  sponge or blad-
der, to prevent  excoriation of the parts.
   OF STRANGURY, OR  SUPPRESSION OF URINE.

   It is called supp?-ession, when there is an entire stoppage
of urine ; and  strangury, when  there  is a frequent incli-
nation to void it, and it is discharged in  drops, with pain
and difficulty.
                        CAUSES.

   This complaint may proceed from  a  variety of causes;
as inflammation of the kidneys or bladder ; gravel, or small
stones obstructing the urinary passages ;  a spasm or con-
traction of  the neck  of  the  bladder ;  acrid injections;
cantharides,  either taken internally  or absorbed  from a
blistering  plaster.   The  particular symptoms attending it
commonly designate the seat of the disease.

                      TREATMENT.

  In all cases of suppression of the urine, it will be  advisa-
ble to bleed from the  arm, in quantity proportioned to the
strength of the  patient, and the urgency of the symptoms.
This should be  followed by gentle purgatives of salts oil
or cream of tartar, by warm injections of barley-water or 
URINARY  ORGANS  AND GENITALS.         85
flax-seed tea, by the warm bath, the patient sitting up to
the middle in water, and  by flannels dipped in hot water,
and  applied to the abdomen.  Administer repeated doses
of opium, or of laudanum a  tea-spoonful, mixed in warm
drink, and repeat the dose every half hour, till it relieves.
The  application of ice to the feet and legs is highly recom-
mended.
   If a suppression of urine do not yield to the  above treat-
ment, introduce a catheter or bougie, as directed under the
head of Operations, and draw off the water.
   The  diet, during  the  continuance  of the  complaint,
should be  of a light kind, and taken in  small quantities.
               GONORRHOEA, OR CLAP.

  This  disease is communicated from one individual to
another by sexual intercourse, and is generally considered
a local affection.  It sometimes commences in two or three
days after the infection has been received, and at others,
not before  the  lapse of several weeks ; but it commonly
makes its appearance in  between six and ten  days.   The
first symptom  is an  itching at the  orifice of the urethra,
or urinary passage, and shortly after, there is a discharge
from  the part, of a thin, transparent  matter, which  soon
becomes white, and afterwards changes to a yellow or green
color.  A slight degree of redness and inflammation begins
to appear about the lips of the urethra,  and  a  heat and
smarting pain  in  most  cases  are felt in every attempt to
make water.   There is commonly a sense of fulness about
the end of the  penis, and frequently a soreness  along the
course of the urethra, accompanied  with more  or  less pain
in erection.
  In  severe cases the  erections  become more  frequent
and lasting than in health, particularly when the patient is
warm in bed, and the penis is curved downward with con-
siderable pain, which is called chordee, and this  is some-
times attended with a slight bleeding at the time of pass-
ing the urine.
             8 
86
DISEASES  OF THE
   When inflammation runs high, the heat and scalding of
 the urine, as well as the chordee, are extremely  trouble-
 some ;  there is a constant  inclination to discharge urine,
 which is  often attended with  much difficulty, and some-
 times it is rendered only by drops.   There is also a sense
 of pain, heat,  and  fulness  about the  testicles and  funda-
 ment, and  the running is very copious, of a  greenish and
 sometimes a bloody color.
   But in ordinary  case3, where proper attention is paid to
 the disease, few or none of the last  mentioned  symptoms
 occur,  the disease  merely consisting in a slight  heat  and
 scalding in making water, and  a running, all which  gradu-
 ually subside in ten or fifteen days.
   In consequence of violent inflammation, the prepuce or
 foreskin sometimes  becomes so swelled, that  it cannot be
 drawn back ; which symptom is called a phymosis: or that
 being drawn behind the glans or head of the penis, it  can-
 not be brought forward ; which is  known by  the name of
paraphymosis.   The treatment of these will be given here-
 after.
  A swelling of one or both testicles often arises in gonor-
 rhoea, in consequence of  cold, severe  exercise or  astrin-
 gent injections.  (For the  treatment of this,  see Swelled
 Testicles.)

                      TREATMENT.
  On the first  appearance of the clap abstain from every
kind of high seasoned food, as well as stimulating liquors, and
subsist on a mild, easy diet, as of milk, vegetables, broths,
puddings, rice, &c.,and commence taking freely  of barley-
water, flax-seed tea, or a solution of  gum arabic, or water
gruel.  Avoid all severe exercise, particularly walking,  or
riding on horseback, as well as venereal  intercourse,  and
even lascivious  thoughts.
  During the  inflammatory stage use injections of a mild
and  soothing kind, as flax-seed tea,  new milk, or  barley-
water, blood warm,  repeating them  as often as every two
or three hours.   In this stage,  also, it is of importance  to 
URINARY ORGANS  AND  GENITALS.         87
move the  bowels every two  or three days, with  a mild
purge, as castor oil, cream of  tartar, or salts.
  If chordee be troublesome,  take a grain of calomel and
opium, on going to bed, and apply frequently to the extrem-
ity and along the underside of the penis, rags wet with a
solution of sugar of lead, made with one drachm of the lead
to a pint of water.                                   .
  When the inflammation runs very high, is  attended with
great pain and a constant inclination to make water, inject
flax-seed tea and laudanum into the rectum, in the quan-
tity of one gill of the former to a tea-spoonful of the latter,
and continue the diluting drinks above mentioned.
  With this treatment relief will be obtained immediately,
and  the inflammation, in  most cases, subdued in two or
three  days.  After  Avhich, instead of the above,  it  will
be advisable to use  for  the urethra one of  the  following
injections :
   Sugar of lead and  white vitriol, of each six grains, water
one puit;  or ten grains of either may be used separately.
   These injections should  be  used cold every three or four
hours.   If employed before inflammation be  subdued, they
are apt to cause a swelling of the testicles.
   There are many practitioners, even at the present day,
who  maintain that   gonorrhoea, or clap, and the venereal
disease  or pox,  are  one  and  the same disease, arising
from the same infectious matter;  and recommend the use
of mercury alike in both.  On this subject, ten years very
extensive practice  in these complaints, on  board ships ot
war, and thirty on shore,  have served to convince me, that
the  two diseases are essentially different,  and that a mer-
curial action, which  may in some cases be necessary in the
 cure of pox, is of no sort of utility in  gonorrhoea.
   Another mode of  treating  clap, and which I have more
 jrenerally  adopted of late years, is to give balsam copaiva,
 twenty drops, three  times a day,  on  sugar  or dropped on
 the  surface of a wine-glass of water,  to which a tea-spoon-
 ful  of spirits of nitre may be added —this, with a very
 abstemious course of living  and  mild  laxatives  daily  as
 Epsom  salts, will  alone  effect a cure without the use of 
88
DISEASES  OF THE
injections.   Where the  stomach recoils  at  the  taste of
copaiva, it may be taken inclosed in capsules.
                        GLEET.

  When a clap is neglected, or ill treated, or the patient
irregular in his habits, it may  continue  for many months,
and on subsiding  leave  a weakness and mucous discharge
from the urethra, called  a gleet ;  it is unattended by pain
or scalding, in making water, and is  the consequence of
relaxation.
                     TREATMENT.

  It may be treated by stimulating diuretics, as balsam of
copaiva, and spirits of nitre, in a dose of twenty drops of
the  former, to a tea-spoonful of the latter, in a wine-glass
of water, three times a day ;  by injections of blue or white
vitriol and alum dissolved in water, made of such strength
only, as to irritate the part in a slight degree.   They are
to be  used four  times a day,  and continued many  days
after the running has ceased.  Cold water or ice should be
applied near to the seat of the affection, night and morn-
ing.
  Gleets  often, if not  always, are  owing to  a  stricture
or contraction of  the urethra.
                     STRICTURE.

  Another evil to be apprehended  from the long continu-
ance of clap, especially if it has been attended with inflam-
matory  symptoms,  or  has  recurred frequently, is the
taking place  of stricture in the urethra, causing a partial
and sometimes total closure of the passage.  This complaint
is particularly apt to follow those cases of clap, which are
apparently cured, but which  break  out from time to  time
in consequence of some  irregularity in the patient's habits
as drinking freely of  stimulating liquors, taking too much
exercise, venereal gratification, &c. 
URINARY ORGANS AND GENITALS.          89
                     TREATMENT.

  The daily use of a bougie.  Previous to its introduction,
it  should  be  slightly curved,  and covered with  oil,  to
prevent irritation.   It ought to be worn  at first for about
half an hour, gradually increasing  the time, from day to
day.  The size of the bougie is also to be increased, as the
resistance to its passage becomes diminished.
  In those cases where a bougie, even of the smallest size,
cannot be  passed, as likewise in those of such long stand-
ing as to preclude the hope of a recovery from its use, re-
course is to be had  to the application of caustic, which is
to be trusted only in the hands of a surgeon.
  Where  stricture  is apprehended, before going  to sea
consult a surgeon, who may, by bougies, open the urethra,
and thus remove all danger of stoppage whilst at sea.
OF  TDE  GENITALS.
        SYPHILIS, OR VENEREAL DISEASE.

                      CHANCRE.

  This  disease is induced by the operation of a specific
poison, generally  imbibed from  an affected person during
sexual  intercourse, and circulated through the whole sys-
tem.  In almost every case it first appears in  the form of
an ulcer or chancre, about the glans or head of the penis,
frequently near the frenum or string.   Generally a small
itching pimple, containing a watery matter, is first discover-
ed,  which soon bursts, and leaves a circumscribed painful
sore, but sometimes the first  appearance is an abrasion of
the  skin.  The ulcer assumes  a foul and  rough appear-
ance, with hardened edges, discharges a  foul greenish
matter,  and differs from other ulcers,  in its total indisposi-
tion to heal.  The period of the appearance of chancre, after
         8* 
90
DISEASES  OF THE
receiving the infection, varies from five  or six days, to as
many weeks.
TREATMENT.
   This may be divided into general and local.  In  the
 former, which is by far the most important, mercury is not
 indispensably necessary, especially when the disease is re-
 cent.   On the first appearance of chancre, the patient
 should take a dose of physic of a cooling kind, as salts or
 oil, and abstain from all stimulants, and from animal food,
 for several days.  He should, on the day after taking the
 physic, apply the stick of caustic  to the  surface  of the
 chancre; the physic and caustic may be repeated two or three
 times on the succeeding days.   After each touch of  the
 caustic, the chancre should be dressed with lint, besmeared
 with soft  ointment,  or  with tallow or oil; and a soft rag
 wet several times a day in lead water  should  be applied
 over the part. In most cases this will effect a cure without
 the aid of mercury.
   But if,  from neglect of any part of the treatment or any
 other cause, the disease will not yield, — and one sign of
 this will be the appearance of a bubo in  the groin, —°then
 the patient must resort to the use of mercury.   The best
 form of this will be the blue pill at night and morning, and
 if it excites diarrhoea, ten drops of laudanum may be tak-
 en at bed-time.  A calomel  pill of two grains may be taken
 instead of the blue pill.
   With the view of  hastening mercurial action  in the sys-
 tem, blue  ointment may be used in  conjunction  with the
 pills, and indeed, after one or two doses of the pills, it may
 be well to trust to the ointment alone.  It may be used by
 rubbing a tea-spoonful of  it on  the  inside of the thighs
 every day, for the space of five or ten minutes, continuhV
 to wear the same drawers.   This course is to be continued
 until some impression is made on the system, known by an
 uneasy feeling at the back of the head and neck  a slight
 coppery taste  and  clamminess of the mouth, and fetor3of
the breath, with  perhaps a slight  tenderness of  the "urns
Any action beyond this, such as salivation, or spitting and 
URINARY ORGANS AND GENITALS.        91
sore mouth, will do more harm than good.  The slightest
constitutional impression that can be made is the best; and
when this  once appears, stop the mercury in every form
for two  or  three days, when a blue pill  or  two may be
given to  preserve the slight mercurial action, which should
be continued a week or ten days.   After this time it will
be best to discontinue the  mercurial  course entirely for a
week or two, even though the local disease be not cured,
for the reason that  the long continued use of  mercury in-
jures the constitution.   It may, however, be  resumed in
the same manner, and if necessary, for the same length of
time, or until the local affection  has entirely disappeared.
   During a mercurial course, abstain from high-seasoned
food and spirituous liquors, and subsist on an easily digest-
ed diet, as  fresh meat, broths, porridges, tea and biscuit,
rice puddings, and fruit; preserve  a pretty uniform tempe-
rature, and  keep the clothing dry.
   If unluckily salivation  be produced, or soreness of the
gums, use a wash of weak solution of  alum, and take sul-
phur and cream of tartar every evening.
   I  have  been thus particular about the use of mercury
in syphilis, because I think it is likely to be used too indis-
criminately.   In former editions  of  this book, I recom-
mended it in all cases of chancre ;  but I am now convinced
that in recent cases of chancre, it is almost always best to
dispense  with  mercury;  and even in cases of bubo, if re-
cent, it would be advisable to defer its use, provided there
is any prospect of soon arriving  in  port, where  medical
advice can be obtained, and  where the patient can be less
exposed  to  wet and  cold  while under the mercurial in-
fluence, and to adopt in the mean  time the other remedies
before mentioned.   But in the commencement of  whaling
or other  long voyages, it may be unsafe to defer the use of
mercury  as  here directed.
  Avoid irritating  the part by exercise, by sexual inter-
course, and  even by lascivious thoughts.
  In Ion"  voyages, as in whale-ships,  persons who have
thought  thcm'sclves cured, may  find the  disease  breaking
out upon them again in the form of ulcers on  the skin, or 
92
DISEASES  OF THE
in the throat, or in hard  swellings on  the bones, as the
shins or forehead.   In all  such cases the  constitution is
seriously affected, and even life endangered unless means
are used to eradicate the poison.   Mercury properly used
will  stay  the  progress of  the  disease, but, as before sug-
gested, might injure the constitution if long continued.  A
comparatively new  medicine, called Iodide of Potassium,
and which I have added to  the list of medicines in the chest,
will cure  better than mercury, with little or no liability to
injure the constitution.  It should be given in from five to
ten grain doses twice a day on  an empty stomach, in a
wine-glass of water for two or  three weeks, and then sus-
pended for  a week.   This will  serve  as a safeguard  to
keep the disease in  check,  if not to effect a cure.   If sore
throat, or running from the nose, or pain in the stomach or
forehead,  occurs while the  patient is taking it, it should be
stopped for a while.
                      PHYMOSIS.

   Not unfrequently it happens from neglect of large chan-
cres on the  head of  the penis,  that  the  prepuce  or  the
foreskin becomes  inflamed, and so contracted round  the
head of the penis  that  it cannot  be  drawn back, so as to
expose the  chancres  to view, and admit of their being
dressed.   In such cases the general treatment recommend-
ed for chancres is  to be continued as above directed,  and
warm water, containing a little soap, to be injected  several
times a day, between  the  skin and head of the penis, for
the purpose of cleaning the part, and allaying inflamma-
tion.   Warm  poultices, made of flax-seed and  pounded
bread,  should be applied to the part.  Occasional attempts
may be made to draw the skin back, and the penis  be  sus-
pended against the body.   If the  inflammation be great,
lose a pint of blood, and take a dose of salts.   When these
means  fail  to  reduce  the inflammation, and large ulcers
exist under the skin, which cannot be  brought to view, the
stricture  may be  divided with a sharp instrument  or'scis- 
           URINARY ORGANS AND  GENITALS.        93

sors, its whole length, and  the  part bathed frequently in
warm water, and poulticed three times a day, for two days ;
after which, dress  the wound with  lint and simple salve,
and the chancres as formerly directed.
  When the stricture or  contraction is caused by the in-
flammation and discharge of a virulent gonorrhoea, it is to
be treated in the same manner  as above directed.
                  PARAPHYMOSIS.
  This is  a contraction of the prepuce or foreskin, back
of the head of the penis, so that it cannot be brought for-
ward.  It is induced by the same causes as the preceding
disease.
  The same  means are to be employed to reduce the in-
flammation as in phymosis, adding the frequent application
with rags of sugar of lead, dissolved in  water, one drachm
of the former to four ounces of the latter. This and other
cold substances are to be applied to the head of the penis,
and  occasional  attempts  are to be made to draw the  skin
over the part.
  If, notwithstanding this  treatment, the swelling increase,
there is danger of mortification; the skin must therefore
be divided by making an  incision  upon each side with a
lancet, and the wound be  treated  as  directed after the
operation for phymosis.
                         BUBO.

  A bubo is generally the consequence of chancre, though
sometimes it is the first symptom  of the venereal.   It is a
hard, painful tumor, seated generally in the groin.  If not
subdued the inflammation ends in the formation of matter.

                       TREATMENT.

  As the ulcer formed by a bubo, that is suffered to break,
is troublesome and difficult to heal, it is of the first impor-
tance to subdue the  inflammation early, before matter has 
94
DISEASES  OF THE
formed.   This  must  be effected, 1.   By  purgatives, as
salts, or  a draught of sea-water, taken every two or three
days, and subsisting on a light diet, as broths, gruel, sago,
barley, rice, puddings, &c.   2.   By rubbing the inside of
the  thigh and  leg with mercurial  ointment, in quantity
equal to  the size of a nutmeg, three times a day, continu-
ing it with occasional omissions, as hereafter directed,  till
the bubo is nearly dispersed.  3.   By cold applications to
the bubo, as Epsom salts, laid on in a small bag, and frequent-
ly moistened with  cold water and vinegar, or by  a solution
of salt and nitre in vinegar and  water, used very cold, and
applied with  rags  every hour.  When these means fail to
arrest the progress of the inflammation, we may hasten the
formation of matter by applying caustic to the centre of
the swelling, and when  matter has formed, a soft poultice
may be applied, till the  abscess is about to break, when a
small puncture  is  to be made with a lancet, in  the  most
depending part, and simple  ointment applied on lint.  If
after some days the swelling continue, apply over  it a thick
covering of mercurial plaster, spread on soft leather, leav-
ing an orifice in the centre over the  sore for the  discharge
of matter and the introduction of lint.
   A mercurial action is generally  deemed necessary in
buboes, but as  they are a long  time  in subsiding, not un-
frequently some months, a constant mercurial action, kept
up all this time, might create  an unnecessary debility of the
system ;  besides this, it sometimes happens, that from the
long continued action  of mercury  upon the system,  the
sore turns to  what  is termed a mercurial ulcer,  and is then
aggravated, rather  than benefited, by  the  medicine.   In
buboes of long  standing, therefore, after having  excited a
slight mercurial action  by friction, as above directed, and
continued it for some days, omit the unction for a week or
ten days, and then return to it for five or six days only at
a time.   The degree  to which mercurial action "should be
excited, need be only till a copperish taste and some fetor
of breath appear.   The same  precautions are necessary in
regard to exposure  to cold and moisture, that are mention-
ed in the treatment of chancres. 
URINARY ORGANS  AND  GENITALS.         95
                SWELLED TESTICLE.

  It may be induced  by any of the common causes of in-
flammation, but is more frequently brought on by the use
of strong urethral  injections, or incautious introduction of
bougies.   It  often  follows a  sudden suppression  of the
gonorrhceal discharge  from cold ; sitting on wet grass often
occasions it.
                      TREATMENT.
  The patient should  confine himself to a spare diet, and
remain in a recumbent posture, with the part suspended or
triced up, by means of a bag-truss or bandage.  The bowels
should be moved by  a dose of salts, and if inflammatory
symptoms run  high,  general  bleeding will be necessary.
One of the best local  applications is Epsom  salts, laid on
the part  in  a small bag, and  frequently moistened with
cold water.   A  strong solution of sugar of lead may be
applied cold, every ten minutes,  by means of rags,  im-
mersed in the liquid.
  When the disease proceeds from the sudden suppression
of a clap, a return of the running is to be favored by injec-
tions of warm flax-seed tea.
  Should the swelling continue increasing and matter ap-
pear to be forming, the part is to be bathed and poulticed.
            DROPSY OF THE SCROTUM,

  Is an accumulation of water, first perceived at the bot-
tom of the scrotum, which gradually increases, and gives
the part a pyramidal shape ; a distinct fluctuation is gene-
rally to be distinguished.   There is no pain or discolora-
tion, and  in viewing the  parts  near to a strong  light a
transparency is observable.

                     TREATMENT.
  At the  commencement of the disease, and when a small
quantity of fluid only is collected, it may sometimes be dis- 
96
DISEASES  OF THE
persed by cold  and stimulating applications, as sal ammo-
niac, dissolved in vinegar and spirit;  nitre, or Epsom, or
table-salt dissolved in  the  same fluids, applied coM very
frequently with soaked rags.   In general, however, it will
eventually become  necessary to evacuate  the fluid by an
operation.
 DISEASES OF THE LIMBS AND LARGE JOINTS.

                    RHEUMATISM.

  There are two kinds :  acute, which is inflammatory, and
of short duration ; and chronic, which is of long duration,
and accompanied by debility.

           SYMPTOMS  OF ACUTE  RHEUMATISM.

  They commence  with  slight fever; very soon followed
by an inflammation, sharp pain, and swelling in the neigh-
borhood of one or more of the large joints, and this pain
increases  when the patient  becomes warm  in bed.   It
is variable, shifts from joint to joint, and leaves the part it
occupied, swollen, red, and tender to the touch. The joints
most subject to  this disease, are  the hip, loins, back, and
shoulder.   The  pulse  is full and  hard, the  tongue has a
slight whiteness, the urine is high colored, the blood, when
drawn from a  vein, exhibits a light colored  crust on  its
surface ; costiveness prevails ; and sometimes there is pro-
fuse  sweating without  relief.

                        CAUSES.

  Obstructed perspiration,  occasioned  by wearing wet
clothes, lying in damp linen or damp rooms, or by being
exposed  to  cold air, while  heated  by  exercise.   Sailors
are  particularly liable to this complaint, on account  of
their frequent calls  upon deck in rainy weather, and sleep-
ing in wet clothes.   Often it attacks sailors on their ap-
proach from a warm to a cold climate. 
LIMBS  AND  LARGE  JOINTS.
97
                     TREATMENT.

  This is to be commenced by bloodletting and purging ;
the quantity of blood to be taken  from a sailor, may be
between  one and two pints, according to the strength  of
his constitution and the violence  of the attack ; and if the
symptoms continue unabated, the  operation may be re-
peated on the  following day.   As a cathartic, give a dose
of salts,  or of castor oil, or flowers  of sulphur  and  cream
of tartar, half an ounce  of each mixed with molasses,  or
the cooling mixture.  When the bowels have been moved,
take Dover's  powders,  eight to twelve grains, or two  to
three pills,  every  four hours, and  drink  freely  of warm
herb tea  and toast-water, or barley-water and gruel.   An-
other remedy of  great value  in  acute  rheumatism,  is
opium, one grain, taken  every three  hours, keeping  con-
stantly warm  in bed, and drinking  freely of  herb teas,
until the pain is  carried  off by profuse sweating.   This
course should be preceded by a cathartic.
  When fever has subsided, and the  pain is confined  to
one part, blisters will prove  useful.   Warm fomentations
tend rather to aggravate  the pain of acute rheumatism.
The patient should subsist on  a low diet, abstain from
stimulating  drinks, and  preserve  an open  state of the
bowels by occasionally  repeating  the  purgatives  before
recommended.
  When the inflammatory symptoms have subsided, the
patient  may return to  a  generous diet,  and  the use  of
wine and strengthening medicines.
  In approaching a cold  climate, the master  of a vessel
should attend  to the clothing of his crew, and see that  its
warmth  increases   in proportion to  the  coldness  of the
weather; he should also prevent the men's sleeping  on
damp beds or in wet apparel.   If woollen  shirts are  best
for sailors in all climates, they are  more particularly so in
approaching from a warm to a cold  one.
9 
98                 DISEASES OF THE
               CHRONIC RHEUMATISM.

   It may be either a consequence and termination of the
 acute  rheumatism, or it  may be  independent of it.  In
 the first case, the parts which were affected with inflamma-
 tion, are left  weak, stiff,  in some instances swelled; and
 the  pain, before movable, is  now  usually confined to par-
 ticular parts :  sometimes, however, it still shifts from joint
 to joint, but is unattended by any inflammation  or  fever.
 When not  the  consequence  of acute  rheumatism, it  is
 most commonly met with in people at the decline of life.
 The pains are felt in the large joints, which are increased
 upon motion,  and  relieved by artificial warmth ;  the part
 affected is pale and cold, even when the other parts of the
 body are warm.

                      TREATMENT.

   This  must  differ  from  that which is  recommended in
 acute rheumatism.   General bleeding, as well  as  much
 purging, will be inadmissible.    The part affected may be
 rubbed several times a day with volatile liniment, or with
 spirits of camphor, and  the  part rolled in flannel.  In
 long continued and obstinate rheumatic  affections, leeches
 applied to the  part will be serviceable, as also blisters kept
 constantly running.  A valuable application to the part is,
 a plaster of common pitch, spread as thick as a  dollar on
 soft  leather, and sprinkled over with tartar emetic, five
 grains to a surface as large as the hand.
   These  local applications must be  accompanied  with
 such internal  medicines as are best adapted to stimulate
 and  warm  the system, and alleviate pain.  Gum guaia-
 cum is one  of the most powerful  general stimulants, and
may be taken  in doses  of  fifteen  grains, or a  small tea-
spoonful  of  the powder mixed with sugar, molasses, or
gruel, every three  hours.   Or  take of  the  tincture of
Guaiacum from two to four tea-spoonfuls, in wine or gruel;
wine of Colchicum, three times a day, in doses of twenty
drops, and increasing one drop a day. 
LIMBS  AND  LARGE JOINTS.
99
  The diet should be rich and stimulating ;  flannel worn
next the skin ;  and  exposure  to  cold  night-air, wearing
damp clothes, and wetting the  feet, should  be carefully
avoided.
  To relieve pain and promote sleep, take  Dover's pow-
ders, eight grains, or two p'lls, on going to bed.
  In the winter  season a warm climate would  prove highly
beneficial.    Such persons as  wish  to  make  the tour of
Europe, would find Italy a suitable  residence — Barcelona,
Valencia, in  Spain, and the whole shore of France, from
Pau to Piedmont, are good ; also Madeira, the West Indies
and Florida.
                       SPRAINS

  Are violent stretchings or  twistings  of joints, followed
by painful swellings.  They are often attended with worse
consequences than broken bones, on account of their being
more neglected.  When a bone is broken, the limb is kept
easy, because it is  useless;  but when a joint  is sprained,
it is still used, by  which it may finally be rendered in-
curable.
  The most essential  measure is  perfect rest; and to in-
sure this, if the case be  at all serious, the part may be
confined by a pasteboard splint.   Warm bathing generally
gives  more relief than  cold.   If inflammation run high,
or a large joint is  affected, leeches or  bleeding and gen-
eral cooling measures must be adopted.    Afterwards lini-
ments  may  be useful, moderate  exercise, and bandaging
with flannel.
      DISLOCATIONS  OF  THE LOWER JAW.

  The lower jaw may be disjointed by yawning, or  blows.
It is readily known  by the patient's inability to shut his
mouth—a want of correspondence of the patient's teeth
__hanging  down of the chin, which is sometimes turned 
100
DISEASES  OF THE
to one side — inability to speak distinctly, or to swallow
without considerable difficulty.
   The bone may be replaced by sitting the patient upon a
low stool, so that an  assistant  may hold the head  firmly
against his breast.    The operator is then to thrust  his
two thumbs, previously wrapped in linen, far back into
the patient's  mouth, and, applying the fingers to the jaw
externally, is to press it strongly downwards and back-
wards, by which the dislocated heads of the jaw may be
easily forced into their proper cavities.
        DISLOCATION  OF THE  SHOULDER.

  The humerus or upper bone of the arm  may be  dislo-
cated  in various directions;  it happens, however, most
frequently downwards, and very seldom directly upwards.
From the peculiar  structure of the joint, as well as from
its exposure  to  external  injuries, this  bone is  the  most
subject to dislocation of any in the body.   A dislocation
may be known by a depression or cavity on the top of the
shoulder, and an inability  to move the arm.   When it is
downward or forward, the arm is lengthened and a swell-
ing is perceived under the arm-pit;  when it  is backward,
there appears a protuberance behind the shoulder, and the
arm  is thrown  forward  toward the  breast.   The two
shoulders should be carefully compared.

                      TREATMENT.
  A bandage or strong  belt  is to be  passed under the
arm-pit of the injured side, and carried over to the  oppo-
site shoulder.  A common roller towel or strip of  sail cloth
will answer.   A second belt or strong handkerchief  is to
be tied round the  dislocated arm, just  above the elbow.
By the latter of these, a gradual extension must be  made
by one or two persons, in a direction obliquely downwards
and  outwards ;  the  body being at the same  time kept im-
movably fixed, by assistants drawing the former belt in an
opposite direction.   After this extension has been kept up 
LIMBS  AND  LARGE  JOINTS.           101
for a short  time, during which it should be gradually in-
creased in force, the  operator is to lift the head of the
bone into its cavity.
          DISLOCATION OF THE  ELBOW.

   The bones of the fore-arm may be dislocated  in almost
any direction.  When this is the case, a protuberance or
hard swelling may be observed on the side of  the  arm to
which  the  bone is pushed.   It may be  known  by the
patient's inability  to bend  the  arm, and  by comparing
its shape with the other elbow.
   Extension  is  to be made by assistants pulling gradually
in opposite directions, while the operator returns the bones
into  their proper  place.   Afterwards the arm  must  be
bent and suspended for some time with a sling about the
neck.
   Luxations of the wrist  and fingers  are to  be reduced
in the  same manner  as  those of the  elbow ;  viz., by
making an extension in opposite  directions, and thrusting
the head of  the bone into  its place.
           DISLOCATION OF THE  THIGH.

   When the thigh bone is dislocated forward and down-
ward, the knee  and foot are  turned  out, and the leg  is
longer than the other;  when it is displaced backward, it
is usually pushed upwards at the same time, by which the
limb is shortened, and the foot is turned inwards.
   When the thigh bone is  displaced forward and down-
wards, the patient, in  order to have it reduced, must be
laid upon his back, and  made fast by bandages or held by
assistants, while by others  extension  is to be  made  by
means of slings fixed about the thigh, a little  above the
knee.  While  the extension  is making, the operator  must
push  the head  of the  bone  outward, till  it enters the
         9* 
102  DISEASES OF THE LIMBS  AND  LARGE  JOINTS.
socket.   If the dislocation be  outward, the patient must
be laid upon his face, and during the extension, the head
of the bone must be pushed inward.
DISLOCATIONS OF THE  PATELLA, OR PALM-BONE
                    OF THE KNEE.

   The patella may be thrown out of its place either side-
ways or upwards ; in the  latter case, the ligament with
which it is connected is broken, and the bone  is drawn up
several inches among the muscles of the thigh.  The nature
of the case can be distinctly ascertained, both  by the sight
and feeling.
                      TREATMENT.

   In the dislocation sideways, the  limb must be  firmly  ex-
tended ; when, pressure  being made upon the protruding
edge, the bone immediately regains its former  situation.
 ^  When the dislocation  is upwards, it is to be  treated pre-
cisely as a transverse fracture of the bone  ; which see.
        DISLOCATION OF  THE KNEE-JOINT.
  The principal bone below the knee may be partially dis-
located,  either inwards,  outwards, or  backwards.   In
either  case it is  obvious to the  sight.  It very  rarely
occurs.
  Extension is to be made  upwards,  by the thigh, and
downwards, by the leg, while the bones  are replaced by
pressure with the  hand.
           DISLOCATION OF THE  ANKLE.
  A dislocation of this joint may take place, either inwards,
outwards, or forwards. 
FRACTURES.
103
  The two former cases may be  ascertained by the incli-
nation of the foot,  and by the unnatural protuberance on
one side, and deficiency on  the other.   When the end of
the bone of the leg is forced forwards on the foot, the
instep will  be  observed to be considerably shortened,  and
there is a great and unusual projection of the heel.
  The bone  is to be replaced by extension, made in the
same manner as in dislocation of the knee.
  DISLOCATION OF  THE  THUMBS,  FINGERS, AND
                        TOES.

  These are to be replaced by making extension, at the
same time gently bending the joint, and applying pressure
with the thumb upon the end of the  bone that is out of
place.
        FRACTURES, OR BROKEN BONES.

                GENERAL REMARKS.

  In the fracture of a large bone, the patient should be put
upon a light, unstimulating diet, and if young and plethoric,
he may be bled.   He  should  be  kept dry  and clean,
that  the parts  which bear hard upon the bed may  not
be galled.   While at  sea, where  the  ship is rolling, it
will be indispensably necessary for  him to swing in  a cot.
It has been customary with many to keep the limb contin-
ually upon  the  stretch, but this  posture is uneasy to the
patient  and unfavorable to a cure.  It will be preferable
to keep the limb a little bent, either by  laying the patient
upon the side, or by making the bed so as to favor this pos-
ture.   The dressings of the fracture should be re-applied
every three or  four days, or oftener if they  become  loose,
and the lint  should  each time  be  wet with some cooling
wash, as a  solution of sugar of lead, or vinegar and water. 
104
FRACTURES.
     FRACTURE OF THE BONES OF THE NOSE.

  When the bones of the nose are broken in, they may be
raised to their place by means of a quill, or other instru-
ment introduced  by the nostril, and in general they will
retain their situation, without any further assistance.
          FRACTURE OF THE LOWER JAW.

   The nature of the  injury is obvious to the sight.   The
parts being accurately replaced, and kept firm by an assist-
ant, a thick pad of lint should be placed over the seat of the
fracture, and a bandage applied, by means of which the
jaw may be  firmly held  upwards and  backwards ; for this
purpose the  most effectual is a bag or  purse, to receive the
chin,  with four  tapes, or  ends, attached to it; the two
inferior of which are tied over the top of the head, and the
two superior carried back of the head.
   During the cure, the patient should be kept quiet, and
not suffered  to exercise his jaws in chewing his food.
FRACTURES OF  THE CLAVICLE, OR COLLAR-BONE.

   The existence of its fracture may be known by tracing
the collar-bone along with the fingers, when one of the
fractured ends will be found to project over the other, and
a  crackling noise of the bones will be" perceptible.

                      TREATMENT.
   The arms and shoulders of the  patient are to be firmly
drawn backwards by an assistant, when the fractured ends
immediately come  in  apposition.   The  part  is now to be
covered with a thick  adhesive plaster, or  one of  common
pitch, and a bandage is to be applied to retain the  bones
in their place;  The bandage should be long, and commenc-
ing with it on the part injured, is to be  carried under the
arm-pit  across the back, and over the other shoulder ; then 
FRACTURES.
105
under the arm-pit of that side,  and back over the injured
shoulder ; thus describing on the back the figure oo .  The
turns should be repeated two or three times, and be drawn
with considerable tightness, and the arm should  afterwards
be supported with a sling from the neck.
              FRACTURE OF THE RIBS.

  The characteristic mark of a fracture of the ribs is the
crackling or grating of the bones, which may be distinctly
felt and heard, upon  the  patient's coughing, or during a
deep inspiration,  and  by a sharp pain of  the part, at the
same moment.

                      TREATMENT.

  In this, the principal attention is to be  directed to the
general symptoms.   Bleeding in almost all cases is neces-
sary, and  such  other means  should  be adopted  as are
calculated to  allay inflammation, as gentle  purging, and
abstinence from the use of stimulants.   An adhesive plas-
ter may be applied over the fracture, and the body tightly
encircled with a broad bandage.
 FRACTURE OF THE ARM, BETWEEN THE  SHOUL-
                 DER AND ELBOW.

  This fracture is simple and easily recognized.   In order
to bring the fractured extremities into their place, a slight
extension should be made, with the  elbow bent  at a right
angle.   The arm  is then  to be encircled with a piece  of
soft flannel, or cotton, and  two splints applied, one  on the
inside, and  the other on the outside of the arm.  They may
be made of pasteboard or thin slips of wood, an inch and a
half broad, and to extend the whole length of the bone,  to
be bound on with a bandage.   The forearm should be sus-
pended by  a handkerchief  from the neck, in such a man- 
106
FRACTURES.
ner that the wrist may be more supported than the elbow,
so that the weight of  the arm,  counteracting the contrac-
tion of the muscles, may serve to keep the ends of the bone
in their proper place.
   The bones  should  be retained  in. their  place  for two
weeks, by which time  they will  be unite 1.
            FRACTURE OF  THE ELBOW.

  The fracture of this  is readily known.   The  piece of
bone will be found drawn  upward.   It  is to be replaced
and  confined  by  a  bandage  rolled  round  the limb, as
directed in fracture of the patella, and the arm should be
kept nearly straight, by  means of a splint bound upon the
inner side, and extending nearly  to the hand and shoul-
der.   By persevering in this, the knob of bone forming the
elbow, will be  joined  to the arm from which  it has  been
broken.
  FRACTURE OF THE BONES OF THE FOREARM.

  The existence of a  fracture of these bones  may be
known, by tracing the course of the bones with the fingers,
from the  elbow to the wrist, comparing  the  limb  with the
other, and by  the crackling or grating of the ends of the
bones against  each other.
  The same treatment is required  as  in fracture of the
arm between the shoulder and elbow.   The  splints should
be laid one  on the inside, and the other on  the outside of
the arm  ; so that both  bones  may be  at  once effectually
compressed; that on the inside  should  reach to the palm
of the hand, by means of which the  wrist  will  be kept
steady, and the bones prevented from rolling  on each other.
They may be confined by a bandage rolled round the limb,
and the arm worn in a sling.   The  splints should be loos-
ened every day, and the arm bathed in  cold water or vine-
gar. 
FRACTURES.
107
  FRACTURE OF THE BONES OF THE  HAND AND
                      FINGERS.

  The fractures of the bones  of  the ; hand  are  readily
replaced, and may be easily preserved in their natural sit-
uation by accurately adapting a pad or cushion to the palm
of the hand, and applying a bandage  over all, beginning
at the wrist, and extending it to the fingers.
  When the fingers are broken, they are to be neatly set
with pieces of pasteboard, moistened;  over which a small
roller is to be applied.
         FRACTURE OF THE THIGH-BONE.

  The existence of this fracture  may be known by the
crackling or grating of the broken ends, made in moving
the limb, and by a projecting point that may be felt on the
inside of the thigh.   Also, by  the inability of the patient
to cross the injured limb over the other.

                     TREATMENT.

  The patient should, if possible, be* moved to a  cot, since
a common fixed berth  will hurt  the limb during the motion
of the ship,  and a hammock  is rendered objectionable by
its curved shape.   The patient thus  conveniently situated,
a gentle extension  is to be made by an assistant, while the
operator replaces the bones in exact apposition, and applies
over the limb a soft rag wet with a strong solution of sugar
of lead ; and over  this, the many-tailed bandage, made in
the following manner :—take common  rollers or  bandages
of cotton, two inches wide, and  of  sufficient length to pass
round the limb, and lap over, two or three inches ; spread
as manv of these by the side  of each other, as will extend
from near the groin to the knee.  Another bandage of the
same kind is  then  to be laid across, and stitched  to them.
The whole are now to be placed under the  thigh in such a
manner, that the cross bandage shall stretch along under 
108
FRACTURES.
the bone, and each of the tails is to be brought separately
over the limb, beginning at the  one next the knee, and
crossing it  by the one opposite.   When  all the tails are
thus brought over, and made fast with pins, three splints
are to be applied, one on each side, and a  third on the top,
that on  the outside being of sufficient length to reach from
the hip  to the knee.   These being tied firmly with  tapes,
the limb may now be placed, either in a  straight position,
or in a fracture box, shaped like the roof of a house, with
the knee bent to a considerable angle, which is preferable;
or the thigh may be laid smoothly upon  a pillow, on one
side, a  little out from  and  higher than  the  body.   The
limb must remain in this position for several weeks.  If
possible a surgeon should be called soon after the fracture,
as it may lead to the prevention of a crooked limb.
   Fractures of the bones of the leg beloio the knee, are to be
treated  in nearlv the same manner as the above.
FRACTURE OF THE  PATELLA, OR  PALM-BONE OF
                     THE KNEE.

 ^ The fracture is generally transverse, and rarely longitu-
dinal.   In the former case the upper portion  is drawn up
several inches among the muscles of the  thigh.

                     TREATMENT.
 # In the longitudinal fracture, continued extension of the
limb and the application of a bandage to the  knee will be
sufficient to  effect a speedy union.
  In cases of transverse fracture,  owing to the great sepa-
ration of the divided portions, it is extremely difficult, and
nearly impracticable to  effect  a union by bone.   The frac-
tured portions being made  to approach each other as nearly
as possible, the middle of a bandage of considerable length
is to be applied over the  upper part of the patella,  and
being carried round the thigh  just above the joint,  it is to
be crossed under the ham,  and carried  round below the
knee, so as  to draw the fractured  portions together, and 
FRACTURES.                  109
having thus described the  figure 8  around the joint, it is
to be firmly secured and daily increased in tightness.
  As it will be necessary  to keep the limb constantly ex-
tended, a splint, lined with  tow, wool, or cotton, may be
applied under the ham, and made fast  to the limb with
tapes.
  A fracture  of  that projection of bone that makes the
elbow, may be treated in nearly the same manner.
             DISEASES  OF  THE SKIN.

                    ERYSIPELAS.

                      SYMPTOMS.

  It begins with symptoms of fever, confusion of the head,
sometimes delirium, sickness at the stomach.  About the
second or  third day, the skin of some part of the body,
generally the face, becomes inflamed.  The redness com-
mences  about the eyes and nose, or one of the ears, is
attended with itching and  burning, and extends from the
forehead to the  mouth.   If the disease continue, the whole
of the head becomes inflamed, and often one or both  eyes
are closed.  As the redness extends, it frequently leaves
or is  abated in the part  it at first occupied.  After a
longer or  shorter time, the redness terminates  in small
watery pimples, or  in a scaling of  the skin.   The fever,
however, does not always at this period suffer a remission,
but on the contrary, is frequently aggravated, and some-
times  the patient expires about  the ninth or eleventh  day.
                      TREATMENT.
  Reduce the inflammatory state of the system by cooling,
or mercurial purges, as calomel, from six to ten grains with
as many grains of jalap, or  by the  cooling mixture  (see
Appendix)  a table-spoonful every  three  hours,   lake
diluting drinks, as lemonade or water, containing cream ot
          10 
110
DISEASES  OF THE  SKIN.
tartar, barley-water, &c. ; avoid stimulating food or drinks.
Evaporate spirits on the part by frequently applying it with
a soft rag.
  As soon as the bowels have been moved,  if the disease
continue to increase, it is recommended to give quinine two
grains,  every  two  hours,  in a draught of water, till the
inflammation and extent of the disease manifestly lessen.
The room should be kept cool and dark, and the patient still.
                        ITCH.
   One of the best medicines for this complaint is sulphur,
which should be used both externally and internally.  The
parts most affected may be rubbed every night  with oint-
ment, made of flower of sulphur two ounces, and hog's lard
or butter rubbed together ; chloride  of lime, a table-spoon-
ful, dissolved in  a wine-glass of water, may be rubbed over
the pimples.  As much flower of sulphur as is requisite to
keep the bowels  open, may be taken every night.   It will
be necessary to observe cleanliness,  and  after the  disease
is  removed, to  fumigate the  clothes with sulphur, or to
immerse them in water.
                   NETTLE  RASH.
  This resembles the eruption produced by the stinging of
nettles ; there is itching, and the eruption comes and recedes
with quickness ; rubbing or scratching brings it out.
  It  is caused by swallowing  cold drinks, or crudities,
when heated, also by sour milk and rancid cheese  and bv
shell fish.                                            J
  The treatment may be simply magnesia,  or  a  Rochelle
powder, followed by a cup  of tea without milk.
           PRICKLY  HEAT.  (Lichen  Tropicus.)
  This is among the primary effects of a hot  climate, and
may be called one of the miseries of a tropical  life, which 
^VOUNDS.                   Hi
assails at all, and particularly the most unseasonable hours.
" Many a time (says Dr. Johnson) have I been forced to
spring from the table and abandon the repast, which I had
scarcely touched, to writhe  about in the open air for a
quarter of an hour; and often have I returned to the charge,
with no better success, against my ignoble opponent!   The
night affords no asylum.  For some weeks, after arriving
in India, I seldom could obtain more than an  hour's sleep
at one time, before  I was compelled to quit my couch with
no small precipitation,  and  if there were any water at hand,
to sluice it over me for the purpose of allaying the  inex-
pressible irritation !  But this was productive of temporary
relief only; a more violent paroxysm frequently succeeded."
It may  be  entirely  absent while we  are sitting  still, but
appears on the least exercise, or on taking any thing hot or
stimulating.
   The only means, says Doctor Johnson, which I ever saw
productive of any good effect in mitigating its violence, till
the constitution got acclimated, were light  clothing, tempe-
rance in eating and drinking, rest in the heat of the day,
open bowels, and last, not least, a determined resolution
to resist, with stoical apathy, its first attacks, by which the
enemy will generally sneak off, and leave us victorious  for
the time.
                     WOUNDS.

   As an enumeration of the many classes into which wounds
are divided by surgical  writers, would confuse  those for
whom this book is intended, they are here included in three
divisions, viz., Incised wounds, or simple cuts,  made with
a sharp instrument;  Contused ivounds, or bruises, includ-
ing gunshot and lacerated wounds; Punctured wounds,
or those produced by a sharp-pointed instrument, as a nail
or dirk.

            INCISED WOUNDS,  OR CUTS.
   The first  object of attention in cuts, is to stop the bleed-
in^.    In wounds of the  limbs,  where  the  bleeding  is 
112
WOUNDS.
 alarming, a tourniquet or bandage is to be applied above
 the part in  the following manner:  a strip of canvass or
 strong cloth, an inch and a half wide and two yards long,
 is to be  passed  twice round the limb, the best place being
 about the middle of the  arm or thigh,  and tied in a hard
 knot; introduce between the turns of the bandage a stick
 three or four inches long, and turn it like a screw, till the
 twisting of the bandage arrests the flow of blood.  A strong
 pocket handkerchief, passed twice round the limb and tied
 in a hard knot,  may answer the same purpose.*
   We then wash and cleanse the wound, in order to ascertain
 where the  bleeding orifice of the vessel  is.   It may be
 necessary, for this, to slacken the tourniquet, so as to make
 the blood flow again ; then, screwing it again, take up the
 artery, if there  are suitable instruments onboard—if not,
 try the following :  take  a sewing needle and insert the eye
 into a handle, like an awl, hold the point of the  needle in
 the flame of a candle till it is red-hot,  then cool  it slowly,
 which will take  out the temper of it, so that it can be bent
 into a fine hook ;  with this transfix the end of the bleeding
 vessel, and hook  it out, so as to  admit of  a thread being
 put round it and tied.   This is the most effectual way of
 stopping blood,  if the vessel be large ; and which  I have,
 in  the absence  of the  proper instrument, more than once
 used with success.  The next surest way will be, to take a
 large wire, or even a common board  nail,  and heating it,
 sear  the vessel.  If the  artery be very small,  cobwebs or
 scrapings of sole-leather, or sponge or flour, may be pressed
 against the  bleeding vessel, and pressure applied with a
 bandage.
   The wound is then to  be  dressed by bringing  its edges
 accurately together, and confining them with slips of adhe-
 sive plaster  three or four inches long, laid  across the cut.
 A narrow slip of lint or rag, spread with simple ointment, is
 to be laid over the wound on the adhesive plaster ; lint or

  *  The author has  the satisfaction of learning, that the New Bedford
and Nantucket whalers, in most cases, have in their medicine chests a first-
rate tourniquet. This fact, with many others, speaks well for the liberality
of their owners. 
WOUNDS.
113
tow then applied to absorb the discharge,  and, lastly, a
bandage rolled on to confine the dressings.  An assistant
is then to make pressure on the wound, while the tourniquet
is  gently slackened.   The tourniquet is, however, to be
continued loosely  round the  limb, ready for  use, in the
event of a  return  of bleeding.   The dressings  may be
renewed in three or four days, excepting  the adhesive plas-
ter, which should be continued till adhesion  of the wound
has taken place,  or for six or seven days.
   It will be advisable to move the bowels with a mild
cathartic, as cream of tartar, and to subsist  on  a light,
unstimulating diet.
   If an artery  is wounded where no tourniquet can be
applied, the bleeding must be stopped by filling the wound
with bits of sponge or dry lint, and applying pressure ; the
lint or sponge not to be removed till it suppurates and can
easily be taken out.   If the bleeding artery can be taken
up and tied, it should be  done; and  if not, the  bleeding
orifice  may be seared with a large wire heated.
   In slight cuts, a tourniquet will not be  required.   In
other respects the above treatment should be adopted.   If
the wound gapes open, a stitch may be taken in it.
  Contusions or Bruises, and Lacerations, as well as
Gunshot Wounds, are more painful than  incised ones;
are swelled, ragged, and not attended with much bleeding.
  The principal objects in the treatment, are to moderate
inflammation, and to accelerate the healing process.   The
first  is to be effected by warm poultices made of Indian
meal  and flax-seed,  or pounded  biscuit and flour  boiled
together, applied every three or four hours,and by bathing
the  part  in warm water.  When inflammation has abated,
the healing of the wound may be promoted by dressing it
with lint, spread with  basilicon.
  If the  form of the wound will admit of its edges being
drawn towards each other,  their approximation should be
supported by adhesive plasters and bandages.          ^
  If the  wound be attended with great swelling and pain,
10* 
114
BURNS AND SCALDS.
the patient must be bled and purged, in proportion to the
violence of these symptoms,  and  stimulants of every kind
avoided.   A few drops of laudanum may afford relief.
  Punctured Wounds are frequently produced by nails
or sail needles, and Stabs  are sometimes made by  knives
or dirks.   The consequences may be lockjaw or extensive
abscesses.
  The most effectual way  of preventing these evils is to
enlarge  the opening with a lancet or sharp knife, and thus
convert  the puncture into a simple cut, which is to be dressed
accordingly.   When this is not done,  the part should be
kept still, and dressed frequently  with warm poultices.  If
the  wound be  deep and unattended with much bleeding,
there will  be danger  of violent  inflammation, that may
require bleeding and purging to subdue it.
                BURNS AND SCALDS.

   The part should be immersed in cold water or other cold
fluid immediately, and continue there till some raw cotton
is brought, and ready for  application to the burn.   This
article will allay the inflammation, and if seasonably used,
will even  prevent the  formation  of  blisters.  It may be
renewed every twelve hours, care being taken to  preserve
the skin  from injury.  If the pain be excessive, give a
grain of opium every half hour, till it is  alleviated.   If no
cotton can be  had, continue cold applications and  apply a
poultice made of scraped raw potatoes.   Should the burn
be very severe and  extensive, it may be  necessary to
administer gentle laxatives and to abstain from stimulants.
   Should the  burn  be  deep, apply soft  poultices  made of
Indian meal or pounded bread and flax-seed, or flour, and
after the inflammation has abated, the healing of the ulcer
may be promoted by dressings of simple  ointment, made
of spermaceti, olive, or sperm oil and beeswax, equal parts,
spread on soft lint,  over which a bandage  may be applied
moderately tight.   When fungus or proud flesh appears, it 
CHILBLAINS,  &C
115
may be touched with blue stone.   The blisters  occasioned
by burns should not be opened immediately, as  the access
of air Avill cause deep ulcers.  After a day or  two, they
may be punctured with a lancet, or needle, and  the skin
suffered to remain on.
   A liniment made of lime water and oil shaken together,
and  applied, with a  feather  or soft  rag,  to ulcers from
burns, will be useful.   A cooling ointment for burns may
be made by melting together  sperm or olive oil, beeswax,
and  spermaceti — and while liquid, add half the quantity
of lead water, made  by dissolving 4 or 5 grains of sugar
of lead in a wine-glass of  water, and  stirring  it into  the
ointment whilst it is cooling.
           CHILBLAINS, OR FROST BITES.

  When the extreme  parts  of  the  body are exposed to
severe cold, they are first affected with numbness, and af-
terwards with swelling and  inflammation, and  sometimes
mortification.
  Immediately on perceiving the numbness, the^ patient
should immerse the part in cold water, or rub it  in snow,
and on  no account approach the fire, till its feeling is re-
stored.   He  should also abstain from  stimulants  and
warm drinks.
  When these precautions have been neglected, and a
hi"h  degree of inflammation has ensued, the  part should
be°dressed,  at first with  cold and afterwards  with warm
poultices, till the inflammation is subdued, when the ulcers
may be dressed with some mild ointment.
                       ULCERS.

                      ioned by t
                    xnere is a teuw
the scratch of a pin may produce an ulcer of great mahg-
  These may be  occasioned by wounds, bruises, burns,
frosts &c    Where there is a tendency to  scurvy, even
nuaio, tvv^.       _   _______J.,,,,, „„ ,,l„a». nf rrrpai, mall.or- 
116           BITES  OF THE VIPER, &C.
nancy.  Old sailors, whose constitutions are much impaired
by intemperance, are often  afflicted with obstinate ulcers
on the skin.  The longer such  sores continue, the greater
will be the length of time necessary to heal them. ^
  Recent and healing ulcers should be washed daily, and
dressed with mild ointments applied on lint;  all sources of
irritation should be avoided ;  the part kept still and in a
horizontal posture.   If the  ulcer be of long standing and
slow in healing, the edges of it  may be drawn toward each
other,  by means of straps  of  adhesive  plaster.  If the
ulcer be on the leg, a bandage  should  be applied over the
adhesive straps  from the foot  to the knee, with  as much
firmness as the patient can  bear.  The edges of the ulcer
should be occasionally touched  with blue  stone.  If a high
degree of inflammation and swelling be induced in an ulcer
by cold or  other causes, it  should be bathed  with warm
water,  and poulticed frequently.
    BITES OF THE VIPER, SNAKES, ADDERS, &c.

   The symptoms that  usually follow are a swelling of the
part, faintness, giddiness, vomiting, difficulty of breathing,
cold sweats, convulsions, and sometimes death.
   The most effectual way of obviating these symptoms, is
the immediate cutting  out of the  part  or burning it with
fire.  Where this is not done  salt may be applied to the
part and  the wound sucked for  a long  time, the  mouth
being defended by oil.  A tight ligature should  at  the
same time be kept on the limb, above and near the wound.
It is recommended by  some to apply hot spirits of turpen-
tine to the part.  The Indians burn gunpowder on  the
part bitten.
   In the south of France the bite of the scorpion is  not
dangerous, rarely worse  than the sting of a wasp.   In
tropical climates it is  much more deadly, and  is to be
treated like viper bites.   The viper bite is often  attended
with danger, especially in the summer,  and when the rep-
tile is strong and enraged. 
OF PERSONS APPARENTLY DROWNED.      117
                   GUINEA WORM.

  In Guinea and in some parts of the East and West In-
dies, foreigners, as well as inhabitants, are often troubled
with the Guinea worm, which  the  celebrated Dr. Lind
thus describes ;  " This is  a  white, round, slender  worm,
often some  yards long,  lodged  in  the interstices  of  the
muscles, commonly  in  the  legs, feet, or hands;  when it
attempts to escape through the skin, it occasions a swelling,
resembling a boil, attended with great pain, until its little
black head appears  in a small watery bladder, on the head
of the  boil.  When this bladder breaks, the head of the
worm is to be secured  by tying it to a small roll of linen,
spread with plaster  ; and part of the  worm is  once or twice
a day  to be drawn  forth,  with  care not to break it,  and
wrapped round this roll, until it be brought away entire ;
then the ulcer heals soon ;  but if part of the worm breaks
off, the portion remaining in the flesh can be extracted only
by painful  and tedious suppurations in different places."
       OF PERSONS APPARENTLY DROWNED.

  When the body is taken out of the  water, it is to be
stripped  as  soon as  possible, wiped perfectly dry, and
then laid between two blankets.  The head is to be covered
with warm  flannels, hot substances applied  to the feet,
belly,  and breast,  and the body constantly rubbed with
the hands.
  The lungs are to be inflated  as soon as possible with a
pair of bellows, by  inserting  the pipe in one nostril, while
the other nostril and mouth  are kept closed, and blowing
forcibly.   When the  breast  is swelled by it, the bellows
should stop, and an  assistant should press  the  belly up-
wards  to  force the  air  out.   This  process should  be
repeated,  twenty or  thirty times in a minute,  so as to
imitate natural breathing  as nearly as  possible.   It a  bel-
lows cannot be procured, some person should blow into  one 
^
118              POISONS SWALLOWED.

of the nostrils through a pipe  or quill, whilst the other
nostril and mouth are closed  as  before.  During this time
a large quantity of  ashes, or  water, should be heated, and
as soon  as it is milk warm,  the body placed in  it; the
blowing and  rubbing continued as before, and, when the
ashes or water are cooled, more is to be added, so that the
whole may be kept blood-warm.  When signs of returning
life are apparent, the frictions  must be  continued, but
more  gently.   These methods are to be continued three or
four hours.  When the patient  can swallow, he is to take
some  warm spirits.
               POISONS SWALLOWED.

  When laudanum, opium, or morphine, or other poisonous
vegetable substance  is swallowed, a stomach pump should
be used immediately, by which fluids  may be pumped into
and out of the stomach.  In case a pump is not to be had,
the stomach should be excited without delay by emetics, to
throw off its contents, such as white vitriol,  or blue vitriol,
fifteen to twenty grains, or about  a tea-spoonful  dissolved
in half a tumbler of water, and assisted by passing a finger
or feather down the throat, swallowing warm water, and if
necessary, repeating the emetic.   He should not be allow-
ed to sleep,  but kept constantly in motion, have the head
dashed with cold water, and the  whole surface rubbed and
stimulated with small rods or twigs.  After the first effect
of the poison has subsided, give a dose of Epsom.
  If mineral or other poisonous acids have been swallowed,
give magnesia, or soda, or saleratus dissolved in water; or
if these cannot be had, shake  a piece of hard or shaving
soap in water,  and give the water to drink, afterwards thin
gruel, rice water, or starch.
  If  arsenic or corrosive  sublimate  has been swallowed,
beat up the  whites of half a dozen eggs  in water, and give
them, or starch made of  a similar  consistence ;  milk with
wheat flour  stirred in it, will be useful.  A medicine called
the hydrated peroxyde of iron is a known antidote to arsenic, 
OPERATIONS.
119
but this cannot be obtained on board  a ship, nor is  arsenic
likely to be taken there.
  Poisonous Fish are often taken, especially on the shores
of South America.  The usual symptoms are irritability of
the skin, swollen eyelids, difficult breathing, and  convul-
sions.
  The treatment consists in emetics of ipecac, or white
vitriol, followed by castor oil.
                 OPERATIONS.

         BLOOD-LETTING FROM THE ARM.

  The operator and patient being placed in proper relative
situations, which it will be needless to describe, a ligature
or narrow bandage is to be passed  round the arm, just
above the  elbow, so  as  to  compress the vein about two
inches above the part  from which the blood is to be drawn;
and having been suffered to  remain some minutes, in order
for  the  vein to become  distended, the thumb of the left
hand  should be pressed upon the vein made choice of,
about two  inches below  the point  where the  orifice is to
be made.  The operator is now to take the lancet, previous-
ly bent  nearly to a right angle, between  the finger and
thumb of the right hand, leaving at least half the blade un-
covered.  He is then  to rest his hand on the three remain-
ing fingers, while he  pushes the point of  the  instrument
cautiously through  the integuments into the vein;  when,
having thus pierced its coats, he is to carry it forwards in
a direction rather obliquely,  until an orifice of sufficient size
is made.
  When a sufficient quantity of blood has been drawn, the
ligature is  to be untied, and the lips of the wound being
carefully brought together,  a small piece of folded linen is
to be  applied upon the orifice, and secured in that situation
by a roller,  passed  alternately  above and below the  elbow,
so  chat  when  applied it may describe the figure qo by
crossing at the bend of the arm. 
120
OPERATIONS.
  Faintness, which sometimes occurs during bleeding, may
be removed by a draught of cold water, or by taking a
horizontal position.
  If the blood runs slowly, immerse the hand in very warm
water.  The  ligature  applied above  should not press so
hard as to stop the pulse.
  Every direction given for blood-letting  in the arm, is
applicable to the foot, the bandage to be placed an inch or
two above the ankle.
        OF THE APPLICATION OF LEECHES.

  The manner of applying these is too well  known  to
require a description.   Success is rendered more certain,
by previously drying them, or allowing them to creep over a
dry cloth; the part also, to attract them, may be moistened
with cream, sugar, or  blood, or punctured with a needle.
          OPENING A TUMOR OR ABSCESS.
  The opening should be made in the most prominent part,
and if it be on a limb, the incision is to be made lengthwise,
and not across the limb.   The part should be covered with
plaster to exclude air.
                   AMPUTATION
  As accidents  sometimes happen at sea,  in situations
where it is impossible to obtain a surgeon, and which require
the immediate amputation of a limb, it is proper to say a
few words on that  subject.   To perform  the  operation is
one thing, to know when it ought to be performed is another.
Any man  of common dexterity and firmness, can cut off a
leg, but to decide upon the necessity of doing so, requires
much judgment; instances having  occurred where, under
the  most seemingly desperate circumstances, the patient 
OPERATIONS.                  121
has,  through fear or obstinacy, refused to submit to the
knife, and yet afterwards recovered.
  Although in many cases much doubt may exist in deter-
mining whether it is proper to amputate or not, yet in others
all difficulty vanishes, as when a ball has carried  away an
arm.   Suppose for  a moment, while rolling in a heavy sea,
during a gale, the lashings of a gun give away,  by which
a man has his knee, leg, or ankle completely smashed, or
either of these parts is crushed by a fall from a topgallant
yard.  The great laceration of blood vessels, nerves, and
tendons, and the crushing and splintering of the bones,
almost necessarily  resulting  from such accidents, render
immediate amputation an unavoidable and imperious duty.
   If  there are none of the regular instruments on hand,
you must provide the following, which are always  to be had.
   A  razor, opened  straight, and made fast at the joint with
twine ; a carpenter's tenon saw ;  a darning-needle inserted
into a handle like an awl, one third of it towards the point
to be heated red in the blaze of  a candle, and  suffered  to
cool very slowly  so as  to draw  out the temper,  and  then
bent  like an awl; in the place  of a tourniquet,  a handker-
chief and stick;  a  piece of cotton or leather,  five inches
wide  and twenty long, slit up the middle to half its length ;
a dozen  ligatures, each a foot long, made of waxed thread,
bobbin,  or  fine  twine; several narrow strips  of sticking
plaster ; dry lint;  a piece of linen large enough to  cover
the edge of the stump, spread with simple ointment, or lard ;
a bandage three or four yards long, the width of  the hand;
sponges and warm  water.

                 AMPUTATION OF THE ARM.
   Give  the patient 60 drops of laudanum, and seat him on
a narrow and firm table, of a convenient height, so that
some one can support him by clasping him round the body.
Place the handkerchief and stick as high up  on the arm as
possible, (the stick being very short) and so that the knot
may  pass on the inner third of it.   Your instruments having
been regularly placed on a table  or waiter, within reach  of
your hand, while some one supports the lower  end of the
          11 
122
OPERATIONS.
 arm, take the razor and make one straight cut all round the
 limb, through the skin and fat only ; then cut these up from
 the flesh one inch higher, let the assistant hold them back,
 while you cut through the flesh at one sweep, down to  the
 bone.   The assistant next puts on the  slit  piece of linen
 astride the bone, and pulls back the  flesh from  the  bone
 while you saw as high up as possible  without wounding the
 flesh.   With the curved needle or pincers, you then seize
 and tie up every vessel that bleeds, the larger ones  first •
 when this is done, relax the stick a little ; if an artery springs
 tie it as before.   The wound should now be gently cleansed
 with a sponge and warm water, and the stick  be relaxed.
 If the  arteries are  evidently  all  tied, bring  the flap of
 skin over the end of  the  stump, draw  its edges too-ether
 with long strips  of sticking plaster, leaving the  ligatures
 hanging out at the angles, lay the piece of linen spread with
 ointment  over the strips, a pledget of lint over  that, and
 secure the whole by the bandage, when the patient may be
 carried to bed, and the stump  laid on a pillow.
   The handkerchief and stick are to  be left  loosely round
 thelimb, so that if any bleeding happens to come on, it may
 be immediately tightened by the person who  is watching by
 the patient, when  the dressings are to be taken off, the°flap
 raised, and the vessel sought for and taken up, when every
 thing is to be placed as before.
   In sawing through the bone, a long and free stroke should
 be used to prevent any hitching, as an  additional security
 against which, the teeth of the saw should be well sharpened
 and set wide.
   The most painful part of the operation will be the first
incision through the skin ; the  sawing gives  no pain.
  If by any  means  there  is  a difficulty  in  applying a
ligature round the artery, pass the crooked needle with a
strong  thread round the end of it, and tie it;  the less of
fleshy substance  included in the thread, with  the arterv
the better.                                           J'
  The bandage  that  is put round the stump, should  be
rolled round from above, downwards, so as to support  the
fleshy part, and the straps of plaster that hold the flaps
together, in order that the skin of the two opposite sides of 
OPERATIONS.
123
the stump may be preserved in exact contact.   These band-
ages should not be disturbed for four or five days, by which
time there is reason to hope that the stump has formed a
firm adhesion.   In changing  them, they should be  well
soaked with warm water, then plasters, lint, and bandages
are to be applied, and changed again every two days.  In
ten days the ligatures may be drawn away.
   Amputation of  the thigh is performed  in the same
manner as that of the arm.

   In amputating the forearm, and leg, in which there
are two bones, a sharp penknife will be wanted to divide the
flesh between the bones,  after having made  the  circular
incision with a razor, down to the  bones.  The slip of cotton
or leather, that is to serve for a retractor of the flesh during
the sawing, should be divided at one end into three instead
of two  slips, and the middle slip  is to be  passed between
the bones, which with the other two will hold the flesh back
out  of the way of  the  saw.  In  other respects,  the
operation should be  performed  as in the arm,  already
described.

   Amputation of  fingers  and toes  will  require  a
penknife.  Draw the skin back and make an incision round
the finger,  a little below the joint it is intended to remove ;
turn back a little flap to cover the stump, then cut down to
the joint, bending it so that you  can cut through the liga-
ments  that  connect the two bones,  the under one  first.
The head of the bone is then to  be turned out, while  you
cut through the remaining soft parts.   If you see an artery
spirt, tie it, especially in the great toe, but generally it will
soon stop bleeding of itself.  Bring down the flap and secure
it by a sticking plaster, and a narrow  bandage over the
whole.

         INTRODUCTION OF THE  BOUGIE.

   The  patient  may  either stand or  lie ; a middle-sized
bougie is to be well covered with olive oil, and the penis 
124                 OPERATIONS.

taken in the left hand ;  the point of the instrument should
then be very cautiously introduced into the urinary passage ;
when  it meets with obstruction, it must be gently moved
backwards and forwards several times.  If unsuccessful,
the bougie is to be withdrawn, and after an hour or two a
smaller one tried.   In some  cases  a  middle-sized bougie
will pass, when a smaller one cannot, and therefore that size
should be always tried first.  If introduced  for a stricture,
it should be  repeated morning  and evening, and  remain
from a quarter of an hour to an hour.
          INTRODUCTION OF.A  CATHETER.

  In introducing the catheter, the patient may lie with his
head and knees raised.  The catheter must be well covered
with olive oil, and the penis held in the left hand, while the
point of the instrument is cautiously introduced into  the
urinary passage, gently moving it backwards and forwards,
till it enters the bladder, which may be ascertained  by its
having overcome all resistance ;  then the wire inclosed in
the catheter being drawn out, the urine will flow off, when
the instrument may be withdrawn.
      CLYSTERS, HOW TO BE  ADMINISTERED.

  These may be administered with a pipe or tube, inserted
into the neck of a bladder ; or a  syringe, an instrument
with which every medicine chest should be supplied.  The
fluid  to  be injected  being introduced  into  the bladder
through an opening made in the side, which is to be tied
up with a piece of twine, the pipe is to be well oiled, when
the patient himself may introduce it into the fundament.
He should  then hold  his breath, while  the bladder is
gradually pressed from the top to the  tube, till  all the
liquid is injected.  The point of the pipe should be direct-
ed backward a little, rather than  in  the  line of  the body.
Every medicine chest  should be  supplied with  a  pewter
syringe. 
DIRECTIONS
FOR PRESERVING THE  HEALTH OF SEAMEN AND PASSENGERS,

       IN MERCHANT  VESSELS, IN SICKLY CLIMATES.
              PRELIMINARY REMARKS

  The foregoing pages contain some brief instructions for
the treatment of diseases, when they have actually appeared
on ship-board.   A long sea service has,  however, convinced
me,  that on board merchant vessels,  prevention  is more
important than cure.  In vessels exclusively devoted to the
purposes of commerce, the necessities of the sick can hardly
be looked for.  In long voyages especially,  in  which it is
important that the ship  be as perfectly filled with cargo as
possible, little room can be spared for  the  accommodation
even  of healthy seamen.  When disease  occurs during
such voyages, it  is peculiarly  distressing.  Conveniences
are unprovided — attendants cannot be spared from  the
crew — and the patient is liable to error in the selection of
his remedies.   But if there be any marine service in which
the occurrence of disease may be  in  the  surest manner
prevented, it is in the merchant service of this country.   In
the first place, voyages in general are performed in a length
of time  which can  be tolerably  well calculated  on;  the
means necessary for the prevention of diseases can therefore
be accurately estimated, and most of them  are of such a
nature, that, if not necessary for one voyage,  they will  be
in readiness for another.
  In the  next place, the nautical skill of  our seamen is
such, that a few men only are found necessary to take every
care  of large vessels.   This very circumstance is of great
consequence, in the prevention of disease ; for as a general
rule, prevention is easy in proportion to the fewness of the
individuals,  among  whom it  is to be attempted.   The
          11* 
126
REMARKS.
 exception will be in those voyages in which from unusual cir-
 cumstances the  duty of men is very constant and severe.
 The unusual circumstances alluded to, are storms in latitudes
 and seasons which are ordinarily temperate — the employ-
 ment of old vessels for long and fatiguing voyages, in which
 the  labor  of pumping,  &c,  is  almost  incessant — and
 voyages so calculated, that  the  American coast shall be
 made in the winter or early spring season, when the exposure
 of the men is necessarily very great, and endured under
 circumstances  extremely  favorable to  the  production of
 disease, viz., the return from a long voyage with perhaps a
 short allowance  of provisions, and almost certainly  with a
 very scanty supply of clothing.  Except the concurrence of
 many, or all these circumstances, which indeed is very rare,
 prevention, as was observed, will be most certain  among
 small crews.
   Furthermore, men are  more regularly employed.  Indo-
 lence, therefore, which is among the predisposing causes of
 nautical disease, is not a habit of the crew.  The men can
 be kept cleaner, for their habits can be more easily observed.
 Their berths are more easily  cleansed and their apartments
 ventilated.   Finally, the means of prevention which are to
 be found in diet, can with greater certainty, because with
 less expense, be provided.   Those  articles which are  not
 usually employed  except during  disease, may be more
 readily and willingly laid  in, and the attention  of officers
 more certainly directed to the use of preventive and cura-
 tive  methods.   In all this the seaman has principally been
 regarded.   But the owner is not altogether without interest
 in the  discussion.   It is of importance to him, if his crew
 be small, that their health  be  preserved.   The loss of a
 man, with the sickness of three or four, may frustrate  the
 best concerted voyage.    These considerations  alone  are
sufficient to establish the truth of the importance of prevent-
ing disease on board merchant vessels.
  It may be further added, that the means of  prevention
are readily understood and easily applied.  It is of no  con-
sequence that the commander is not a medical man ; for if
he, his owners, and his crew perform their various 'obliga- 
DIRECTIONS.                  127
tions to each other, disease at sea must be of rare occurrence.
What these obligations are, may, in some measure,  be
gathered from the following pages.   In offering them I
have to acknowledge myself indebted, for many useful sug-
gestions, to the writings of Drs. Lind, Turnbull,  and Sir
Gilbert Blane.

                    Directions, $c.

   The  only very fatal  diseases incident  to seamen are
fevers, fluxes, and scurvy, in hot climates ;  and pulmonary
affections and scurvy, in cold climates.  If I were to  add
any other complaint, says Dr.  Blane, to those just  men-
tioned, as most prevalent, and peculiar to a sea-life, it would
be those foul and incurable ulcers, which are so apt to arise
at sea, particularly in a hot climate.   The slightest scratch,
or the smallest pimple, more especially on the lower extrem-
ities, is apt  to  spread, and to become an incurable ulcer,
so as to end in the loss of a limb.   The nature of the  diet
and the malignant influence of the climate, both conspire in
producing them.
   The distinguishing characteristics, causes, and treatment
of these diseases, are given in the former part of this work ;
the object, more immediately before us, is to prevent them.
The records of nautical medicine furnish abundant evidence,
that if proper precautions are taken in manning, victualling
and governing a  ship, the  diseases, which may, in some
measure, be considered as peculiar to a sea-life,  would  be
unknown.   The subject is, therefore, addressed  alike to
captains, owners, and crews.               >
    It has been  remarked,  that the prevention of diseases
has relation only to external causes that affect health ;  and
some of these will now be considered under the three heads

          1.  Air.—2. Aliment. —3. Clothing. 
128
DIRECTIONS.
                          AIR.
1. On the air of tropical climates, as a cause of disease
                    among seamen.

  In treating on air, as a cause of nautical diseases, it will
be considered under two general heads, viz., as constituting
climate, and as the peculiar atmosphere of the  internal
parts of ships.  Over the  first we  have no  control.   The
hot and oppressive atmosphere of the healthiest West India
stations,  and the  deleterious effluvia  from morasses and
marshes of the unhealthy ones, are equally uncontrollable.
Whether  these, however,  shall act as causes of disease on
ship-board, depends very much on crews, but still more on
their commanders.   The state of the air at sea is likewise
beyond control.   It may be damp, wet and  cold,  and the
demand for almost perpetual exertions on the part of the
seamen be too imperious to  be evaded under the  wish  to
preserve the  health of  the crew.  But even under these
circumstances disease isnot a necessary occurrence.  Means
may be, and are occasionally adopted,  which result in a
remarkable exemption from disease, where to escape seemed
impossible.
  As far as climate is concerned, or may become a  cause
of disease, nothing is more obvious, in  inquiring into the
means  of prevention, than  the importance of removing men
as far as possible from its influence.   The methods by which
this may be effected are not quite as evident as the impor-
tance of the rule.   Some  of these methods will  now be
stated.  Experience has abundantly established the fact,
that, except the scurvy, all the diseases incident to vessels
are more apt to arise in a harbor than at sea, and particu-
larly the  destructive  fevers,  peculiar  to  hot climates.
While riding at anchor in a harbor, situated in such climates,
the habits of seamen  are necessarily, in some measure,
altered.   The regularity of sea-duty is broken in  upon, a
sudden and great change is made in the diet, a temperature
very different from the coolness of sea-air is endured.   The
harbor may have in its neighborhood, or on its very shores, 
AIR OF TROPICAL CLIMATES.
129
 extensive marshes, from which the heat of the sun  is con-
 stantly raising deleterious effluvia.   The  sun  is at times
 pouring an intense heat on the men while at work, and their
 duty often calls them on shore, for the purposes of wooding
 and watering.  In such climates, more particularly in  the
 West Indies, spirituous liquors and unwholesome fruits are
 generally easily  obtained, and at  times  the  men, from
 eluding the vigilance of their officers, sleep in  a state of
 intoxication on the ground on shore.   There are also in such
 climates  sudden changes, from excessive heat  to cold or
 cooler air, and  generally at night a cold damp air is  experi-
 enced.   There is something so refreshing  in this change
 that the chances of diseases are frequently willingly run,
 rather than submit to a caution which seems to  require too
 great a sacrifice of personal comfort.  The evils, however,
 which  would seem to be the  necessary consequences of
 circumstances, just enumerated, may be avoided, and  the
 diseases, of which they seem almost necessary causes, may
 be prevented.  " I have known," says Sir Gilbert  Blane,
 " a hundred yards in a road make a difference in the health
 of a ship at anchor, by her being under the lee  of marshes
 in one situation, and not in the other.  Where  people at
 land are so situated as not to be exposed to the air of woods
 and  marshes, sbut only  to the sea-air, they are equally
 healthy as at sea.  There was a remarkable instance of this
 on a small island, called Pigeon Island,  where forty men
 were employed in making a battery, and they were there
 from June to December, which includes the most unhealthy
 time of the year, without a man dying, and with very little
 sickness among them, though they worked  hard, lived  on
 salt provisions,  and had their habitations entirely destroyed
 by the hurricane.   During this time near one half of the
garrison of St. Lucia died, though in circumstances  similar
in every  respect, except the air of the place, which blew
from woods and  marshes."   Facts similar to these are to
 be found scattered through all the books which have been
written for the preservation of the health of seamen.  The
practical advantages to be derived from them are plain and
obvious to the most common understanding.  Diseases  of a 
130
DIRECTIONS.
fatal  nature, occurring in a climate and  harbor such as
have  now been alluded to, are to be  checked, where  it is
possible, by altering the anchorage ; and it appears that in
some instances a very small alteration will be found  quite
sufficient.   If  circumstances prevent this, other means of
prevention must be resorted to.
   It is a well  known fact, that in the climates  alluded to,
the winds, after the first hours of the morning, blow from
the sea towards the land, and  that the land breeze, or the
breeze  off shore, takes place in  the evening, and  con-
tinues during the night.   During  the day, therefore, the
sailor is in little danger of disease from the effluvia from
shore.  He is  chiefly to be on his guard against the night
air.   He will  best  do this  by carefully avoiding to sleep
on deck ; and  by attention to  his  clothing.   Other means
of great importance are  those medicinal articles which
are known to give  and preserve the  tone of the system,
and which  experience  has satisfied us, will  protect  men
against fevers.   Such  are the Peruvian  bark, and other
bitters, the capsicum,  and other spices,  common to the
climates under consideration.   In  those seasons, there-
fore,  which  are known to  be unhealthy, these  means
should be  early resorted to, and the  consequences will in
general be  the safety of those  who must be, in  some
degree, exposed to  the  influence of the  causes  of disease.
   Having  now stated the methods by which the health of
seamen may be preserved in situations which expose them
to the  influence of noxious effluvia  from morasses,  and
marshes, I shall in the  next place speak  of the sensible
qualities of  the air  of  hot  climates, in  their  connections
with disease.
   " If  I were  required," says Blane, " to fix on  a cir-
cumstance the most  pernicious of  dl others to Europeans,
particularly those newly arrived  in  the  West Indies, I
would  say, that it  is  exercise in the sun."   The  same
remark is repeatedly made by  Johnson, on the climate of
India,  Batavia, Java, and the  southern  coast of China.
Heat is not only by itself a very powerful  cause of febrile
diseases, but the  exhaustion  which it induces in laboring 
AIR OF TROPICAL  CLIMATES.
131
 men  exposes  them  strongly  to  the temptation of  the
 excessive use  of spirituous  liquors, which, next  to heat
 itself, is one of the most  hurtful practices that can be in-
 dulged.   Another excess to which  seamen are exposed in
 hot climates, is in the use of the various fruits which  are
 common to  such  climates.  It is hardly possible  to deter
 men  from  these  practices,  and  their consequences  fre-
 quendy  are, fevers  and  fluxes, of a very severe  nature,
 and occasionally of  a fatal issue.
   One of the  principal means of diminishing  the chances
 of disease, which may arise from the  action of excessive
 heat, is to employ, as far as it  is practicable, the natives
 of hot climates  in the hard labor  that  may be  required
 for the ship on shore.  More especially,  let  these  men be
 employed to procure wood  and  water,  should these be
 necessary on ship-board.   Of  all  occupations, the  most
 pernicious is that of clearing a foul  hold, in tropical parts,
 and therefore ships  requiring it, should be sent to a more
 northern  and cooler port, and  on no account employ the
 crew in such duties, where natives can be  had.   In seasons
 peculiarly unhealthy, let  natives be  also  employed in get-
 ting the  cargo on board.  In this  way, opportunities  for
 procuring spirituous liquors will be much  diminished, men
 will more rarely be  found  exposed, while drunk, to the
 burning  heat of the sun on shore.   Fevers, which  are
 among  the  most dangerous and  fatal  diseases  of  hot
 climates, will be  less  frequent.   There  is a peculiar  im-
 providence,  and want of all caution, to be observed in the
 character of sailors.    The chances  of disease  and death
 are most willingly incurred, for they are never adverted
 to.  It requires more  than precepts  on the part of officers,
 to keep the men  out of the way of evil.   The secret of
 preserving health, under the exposures now under consid-
 eration, is to  put the men  as  far  as possible  out of the
influences of the causes of disease.   If anchoring ground
is occasionally to be  changed, because the present one  ex-
poses a crew to the  destructive  air and morbid effluvia of
a low putrid marsh, the officers of a ship in hot  climates 
132
DIRECTIONS.
 are, as far as  practicable, to remove men from  all other
 causes of disease.
   But as  wooding  and watering in  sickly  climates  are
 sometimes the unavoidable  duties of crews,  it  may be
 expected that  those  who undertake them, should be fur-
 nished with some advice for their preservation.
   " I would advise,"  says  Dr. Lind, " all  who  are  em-
 ployed in  cutting  down  woods, or  in other laborious and
 dangerous services in hot climates,  during  the heat of  the
 day, to have  their  heads covered  with  a bladder dipped
 in vinegar, and to  wash their mouths often with vinegar,
 never to  swallow their spittle, but  rather  to chew a little
 rhubarb, or some other bitter, and  spit it out frequently;
 to  stop their  nostrils with a small  piece of linen, or tow
 dipped in camphorated vinegar ; and to infuse some bark,
 garlic, and  rhubarb  in brandy, of  which a dram is to be
 taken either by itself, or diluted with water, morning and
 evening.
   " In the evening, before  sunset, they should  leave off
 work, and not  return to their labor in the morning, till  the
 sun has  dispersed  the unwholesome dews  and  vapors.
 For their safety during the night, they should  retire to a
 close hut, as the dews may penetrate a tent, and here, in
 the absence  of the  sun, a constant fire  should be kept;
 or if that be found impracticable, the apartment in which
 they lie should be well fumigated with gunpowder, as fire
 and smoke will afford  them   a most excellent defence
 against the noxious qualities  of  the  night air.   The smok-
 ing of tobacco  in their huts, and chewing of garlic, and
 not sleeping on the  ground, are  circumstances  which will
 also contribute  to their preservation.
  "If, from a neglect of  these  precautions, the nocturnal
 chill fog has  made an  impression  on the  body, a vomit
 should  be  immediately administered  near  a fire, and a
 plentiful sweat excited after it, which will often prevent
 fatal consequences.   If any symptoms of a low fever still
 continue, as a  headache,  sickness of the stomach,  chills
 &c, a blister ought immediately to be applied, as these
complaints, though so slight  as  not  to confine the  patient 
AIR  OF TROPICAL CLIMATES.          133
 to his  bed, are deceitful, and often terminate in a fatal
 malignant fever.   If this fever  can be  brought  to  in-
 termit, let quinine  be immediately taken,  to the quantity
 of 4 grains  or 2 pills  every two  hours, and  the patient
 quickly removed into a better air."
   When  a  vessel arrives  at a port, in the latitudes now
 under  consideration, whether  the voyage  has been long
 or short,  the men  should  be  instructed  not  to  indulge
 freely  in the  various  fruits  peculiar to  such  climates.
 The  exception  to  this rule will  be found in  those cases
 in which scurvy  exists  in the vessel.  They are  more
 especially to  avoid the  free  use  of spirituous liquors.
 They should avoid  all unnecessary exposure to the  night
 air, particularly  sleeping uncovered  on deck, after  the
 fatigues of the  day.  They should never  sleep on shore,
 and as  far as  their duty  permits, be  as little exposed as
 possible, during unhealthy seasons, to the  excessive heat
 of a tropical sun.   These methods of prevention are ex-
 tremely simple.   They can be very  easily adopted, and
 their objects to the merchant  service, I again repeat, are
 extremely important.   Suppose for a moment, that a large
 proportion of a small crew is swept off by the diseases of
 a hot climate ; new men must be shipped, a most  difficult
 and expensive  alternative ; the  vessel  must be delayed in
 port;  all the  incidental expenses  necessarily increased,
 and very frequently the  principal objects  of commercial
 enterprise defeated.
   Notwithstanding,  however,  the use  of  such means of
 prevention,  as circumstances admit of, should the febrile
 diseases of  hot  climates occur,  how  are they  to be
 known,  and how are they to  be treated ?   It would be
 useless  to enter on a detail of  the symptoms of such dis
 eases;  they are most generally recognized at a very early
 stage of them, by the captain, or the crew themselves, and
 their violence, rapidity, and frequently fatal termination,
 very  soon discover their true character.'   If the disease
 occur in port, recourse should at once be  had to a phy-
 sician of the place.   When a physician cannot be obtained,
lose  no  time in applying the  remedies laid down in the
          12 
134     PREVENTION OF  CONTAGIOUS DISEASES.

former part of this work.  If, notwithstanding the treat-
ment, one  or more cases should prove fatal, means should
be at once adopted, to prevent  the propagation of  the dis-
ease among the crew, by infection.  This may be attempt-
ed in the following manner.

Means to  prevent the  spreading of contagious or infec-
                 tious diseases in a ship.

   1. Let  the sick be  separated  from  the  healthy;  and
thus  attempt to  prevent  its progress,  by cutting off all
intercourse with each other.
   2. Articles of clothing, bedding,  &c,  have been con-
sidered as dangerous vehicles of infection, as the persons
of men.   " It should be made a strict and invariable rule,
that in case of death from fever and flux, every article of
the description mentioned, be thrown overboard with  the
bodies of those dead of these diseases."
   3. Should the sick  recover,  as they might  not be able
to spare these articles of clothing,  &c, they should be
smoked,  and then scrubbed and washed, before the men
join  their  messes, and return to duty.   In ships of  war
and  transports,  this direction  should be  most  carefully
observed,  " because their hammocks will  frequently be
brought in  contact with those of the other men, by being
stowed with them in the netting."
   4.  As infection sometimes adheres to the timbers of a
ship  for  a long  time,  such  cause of disease  should be
thoroughly eradicated as  soon as the  disease itself disap-
pears.  This  can only be  effectually  accomplished  by
fumigation.   For  this purpose,  pots  of  charcoal  and
sulphur may burn between  decks, after having carefully
shut the hatches.   Dr. Blane  remarks,  that  an action
with an enemy has been known to purge  a ship from infec-
tion.   Fires  should  be  more  frequent between  decks
during the  prevalence  of infection.   The  decks,  beams,
&c, should be washed and sprinkled with chloride of lime
or hot vinegar.  The  fume of pitch, tar, and other resin-
ous substances, has a more poAverful effect than any other
smoke ; and  besides  what is thrown upon the fires, it 
SIGNS  OF AN  UNHEALTHY COUNTRY.      135
  would be useful to throw pitch upon a red hot iron, or to
  immerse  a  loggerhead  in  a vessel  where there is  pitch
  or tar.
    5. Whitewashing  the decks  and beams  with  quick-
  lime, has been  found  extremely  useful in  eradicating
  infection.
    6. Let the  air of the well and  the hold be carefully
  attended to, and such  means used as will best  tend to
  purify it.  This may be done by  letting down into  the
  well and hold a grate or pot of fire  daily, and  allowing it
  to remain there  for an hour, and by frequently sprinkling
  a solution of chloride of lime between the timbers  and
  under the timber boards.
    7. The ship should above all things be kept  well aired,
  and  as  dry as  possible.   Dr.  Blane  recommends  that
  scuttles  be  cut  in the  sides of frigates destined for  the
  West India station,  in order that a free circulation of air
  may be maintained through the decks, whenever necessary.
  Some captains, who  have been  convinced by  experience
  that a moist or wet  state of a ship  is the most frequent
  cause of disease, are in the practice not only  of abstain-
  ing from pumping in water  in order  to sweeten their ships,
  but bail out the water from the well, when the pumps will
  not exhaust it all, and never let their vessels make above
* five inches.   Where, however, from previous  neglect, or
  unavoidable leakage, a ship  becomes very putrid bcdow, it
  may be advisable to  pump  in  water, in order  to  remove
  these causes of  disease from the crew.

              Signs of an unhealthy country.

    In giving directions  for the preservation of  seamen in
  hot and  sickly climates, it will  be  proper to enumerate  the
  most certain signs  or proofs of  an  unhealthy country —
  extracted from the writings of Dr. Lind.
    " The first  proof of an unhealthy country is a  sudden
  and great alteration in the  air at sunset, from  intolerable
  heat to a chilling cold.  This is  perceived as  soon as the 
1
136       SIGNS OF AN UNHEALTHY COUNTRY.

sun is set, and for the most part is accompanied with a
very heavy dew.   It shows an unhealthy, swampy soil, the
nature of which is such, that no sooner are  the  sunbeams
withdrawn, than the vapor emitted from it renders the air
raw, damp, and chilling, in the most sultry climates;  so
that even under the equator, in some unhealthy places the
night, air is cold to a European constitution.
   " The second is, thick, noisome fogs, arising chiefly after
sunset from the valleys, and particularly from the mud,
slime, and other impurities.   In hot countries the scent of
these fogs may be compared to that of a new cleaned ditch.
Diseases, therefore, arising from this cause, generally take
place in the night, or before sun-rising.
   " The third is, numerous swarms of flies, gnats, and other
insects,  which  attend  stagnated air, and unhealthy places
covered with wood.
   " The fourth is  when all  butchers' meat soon corrupts,
and in a few hours becomes full of maggots ;  when metala
are quickly  corroded  on  being  exposed  to the open air;
and when a corpse becomes intolerably offensive in  less
than six hours.  These are proofs of a close, hot, and un-
wholesome spot.   In  such places, during excessive heats
and great calms, it is  not altogether  uncommon  for for-
eigners,  especially such as are of a gross habit of body, to „
be seized at once with  the most  alarming and fatal symp-
toms of  what is called yellow fever, without any previous
complaint of sickness, or other  symptoms of the disease.
There has first been perceived an uneasy itching sensation,
commonly in the legs,  and upon pulling down the stockings,
streams of thin dissolved blood followed ; a ghastly, yellow
color quickly diffused itself over the whole body ;  and the
patient  has been carried off in less than forty-eight hours.
   " The fifth is, a sort of sandy  soil, commonly a small,
loose, white  sand, such as  that at Pensacola,  Whydah,
and the  Island of Bona vista, which is found by experience
to be injurious to  health." 
AIR OF TEMPERATE  CLIMATES.         137
2.  On the  air of  temperate  climates, more particularly
      sea-air, as a cause of disease among seamen.

  In the preceding pages, some of the diseases of hot cli-
mates were mentioned, and the means of prevention pointed
out.   The following section will be  principally devoted to
the consideration of the influence of cool air over the health
of seamen at sea.   This cause of disease will be found to
act most  powerfully, when assisted  by  the  debilitating
effects  of unusual fatigue, and of the unwholesome diet a
crew is at times  obliged to use, in the course or near the
close of a long voyage.  Men who have in a great measure
recovered from some of the severer diseases incident to a
sea life, by the help of mild, warm, and dry weather, even
though  the diet  has remained the same, have sunk with
astonishing  rapidity,  and died, merely  from entering  a
higher latitude in a cold season.  The necessary exposure,
incident to  ordinary ship  duty, in the cold and damp air
into which they have newly, and perhaps suddenly arrived,
has as  suddenly been followed by an  astonishing fatality.
It is therefore of the last importance that men situated as
those alluded to, should, as far as  possible, be  removed
from the influences of cold and moisture.
   The diseases by which  most suffering may be endured
under  these  circumstances, are, complaints  of the chest,
rheumatism, and the scurvy.   The first, from the imperfect
means  of relief afforded on shipboard, and  the  perpetual
new exposures of a sea-life, will in many cases become a
chronic complaint, and from the diseased condition of the
lungs induced by it, be followed by consumption.  Hence
we  actually  find that a large  proportion of the deaths
which happen in our marine hospitals, are from pulmonary
consumption.   Chronic rheumatism,  if  not so  fatal,  is
hardly a less distressing complaint than the one just men-
tioned.  Men are  disabled by it, they are rendered unfit
for duty ever after, and this too, generally in the prime of
life.   The consequence is, that they  either become the
permanent residents of a hospital, or lead  a useless, va-
         12* 
138
AIR  OF TEMPERATE  CLIMATES.
 grant life in the streets.  The scurvy, which occurs in all
 climates, though more frequently in the cold and temperate,
 will be considered hereafter, when speaking on the subject
 of diet.   To prevent these diseases  will be a much easier
 task than to cure  them.  When  a man falls  sick at sea,
 nothing is more common, than either to consider his com-
 plaints imaginary, or to take up  the  impression that the
 disease, from some fancied resemblance, is exactly similar
 to one casually observed by the patient, at some  previous
 time, in some one or more of his shipmates.   The next step
 is most vigorously to adopt  the treatment which in such
 case was found to be salutary.   " A man who had been ex-
 tremely ill of the fever of Calcutta, suffered a relapse at sea;
 calomel had been prescribed by a physician in the first attack
 with advantage, and the same remedy was now freely used
 by the man himself at  sea.   He recollected also that he
 had seen a  severe  case of  fever  treated  successfully by
 dashing pailfuls of  sea-water over the patient, and at four
 in the morning, went on deck and  submitted for some time
 to the same treatment.   His superior officer remonstrated,
 and forbade the men to continue or repeat the operation.
 The calomel and cold affusions, however, were repeated at
 the same time the next  morning.   Delirium and violent
 fever followed, and although  the patient survived  the first
 consequences of the treatment, he ultimately sunk exhausted
 under the disease."
  In temperate climates, coughs and colds, pain in the side,
 difficulty of breathing, with heat of the skin, and thirst,
 are common complaints of sailors, and  seem to be caused
 as follows.  The apartments  in which sailors sleep are ex-
 tremely liable to become  heated at night, in consequence
 of the number of men sleeping in them at the  same time,
 and from  their necessary closeness at such  periods.  In
 order to avoid the  evils which would follow from  allowing
 a free current of  air through  the berth-deck at night, the
 avenues to the air are  closed, and the sailors  take their
watch on deck  in a full  perspiration, or at least in a state
which renders them peculiarly susceptible of inflammatory
diseases.   Hence the inflammatory affections of the lungs 
AIR OF TEMPERATE  CLIMATES.         139
under consideration.  The most obvious causes are here
principally alluded to ; the symptoms  and treatment are
given in the  former part of this  work.   How are we to
prevent these evils ?  To diminish the number and lessen
the violence of lung diseases, inasmuch  as  they proceed
from the causes now mentioned, it  would  seem  principally
necessary to  diminish the exposure of  men to  cold, es-
pecially after being in a situation  with regard to warmth,
of all others the most favorable for the production of _ these
affections.  To keep the berth-deck cool  at night, without
exposing the  men while  asleep to a free current of air,
the air-pipes lately  invented by a Mr.  Sutton, are admira-
bly contrived.  They consist of tubes leading from the berth-
deck and hold, .into  the open air.   Wind-sails need  not be
mentioned, as they have been in use time out of mind. " The
extreme of cold ought equally to be avoided during sleep.
Many pulmonic affections are caught by men falling asleep
in the open air, on  their watch."  If men must be turned
out at night, to take their watch, and in case of sudden
squalls, storms, &c, they may be still farther exposed, they
are to be guarded  from the evil consequences which may
ensue, by proper clothing, particularly by flannel worn next
the skin, and by overcoats of tarpaulin or India-rubber, the
cheapness of which at the present day will enable the offi-
cer of the deck and the helmsman to be always provided
for stormy weather.  This will be an  essential precaution
against such  inflammations, in cold climates and seasons.
Another, however,  equally important,  is to change  the
clothing when wet; for which purpose every sailor should
be provided with at least two or three changes of clothes,
 and should avail himself of  every fair  day to dry them.
 Other means for lessening exposure to damp air, whether
 warm or cold, have been particularly mentioned in the for-
 mer part of these directions.
   With regard to rheumatism, the same causes operate in
 producing It, as catarrhal affections.    More  frequently,
 however, it is induced by wearing wet clothes and sleeping
 in the cold.   Persons who are thus exposed, while under
 the influence of mercury, are more likely to suffer, and are 
140                  DIRECTIONS.
with great difficulty relieved.   As a preventive of rheu-
matic attacks, thick flannel, constantly worn next the skin,
is  highly important.  Being a bad conductor of heat, it
prevents the body from experiencing such sudden changea
of temperature, as it does when cotton or linen are worn.
                         DIET.

  Diet is properly divided into solid food and drink.   Of
the former, the chief articles given  out for a ship's compa-
ny, are salted meat, biscuit,  and pease.   The first, though
unavoidably used in this state, may be  considered, more
than any other article employed, as the cause of disease;
and as it cannot be corrected either  by the biscuit or pease,
it requires either to be  abridged in the  quantity used, or
else to be  conjoined with such  vegetables as are of a cor-
recting nature.   But as a sailor's life in a merchant vessel
is a hard one, and those subjected  to it require a large
proportion of animal  food,  the quantity usually allowed
cannot well be diminished.    The only alternative, then, is
to qualify the salt provisions by such vegetables as correct
their bad qualities,  particularly that of producing scurvy.
These  vegetables are, all the succulent or juicy fruits ; and
such should be laid in, as are capable of preservation during
sea voyages.    Among the  best are lemons  and oranges.
Since the  juice of the former  of these  articles has come
into general use in the British  navy, scurvy has quite dis-
appeared.    " The  power it possesses over this disease,"
says Sir Gilbert Blane, ': is peculiar and exclusive, when
compared  to all other alleged remedies.    Its efficacy may
also be stated as singular, when  compared to  that of  any
other remedy in any other disease.  It is a certain  pre-
ventive as well  as cure ;  no other remedy yet  known, can
ward off this  dreadful scourge of mariners, for an indefi-
nite length of time, under the  use of salt provisions."
   In the former part of this work  I spoke particularly  of
this acid in a concrete state, as being valuable both for its
antiscorbutic  qualities, and  imperishable nature.   In the
latter  respect it is worthy  of  a place in every medicine 
DIET.
141
chest.    The  article  is, however, expensive, and  on this
account, may be objected to.  In  this case I would strongly
recommend supplying ships on long voyages, with the lemon
juice, as is done in the British service ;  since as much can
be laid in for a  trifling sum, as will be  adequate to every
medicinal purpose, and without its  taking up much room.
The quantity which, in the  British navy, has  been found
sufficient to ward off the scurvy during a six months' cruise,
is one ounce to a man per day.  At this rate a gallon would
serve for ninety-six days, which  is  but little short of the
average length of East India passages.
  In concluding the subject of animal food it may be well
to describe a new  method for preserving fresh meat, which
was proposed by  a  Mr. Appet, and has been found, by
ample experience, to be perfectly successful.  The method
is as follows:—" The fresh meat is put into a pot, the bones
being first removed, to  be boiled  in the ordinary  way.
When it is about three-fourths boiled, it is to be taken out
and put into jars, which are filled up with broth made from
other portions of the same meat.   The jars are then corked,
luted, and put into bags ; they are newly placed in a boiler
of cold water, heat is applied till the water boils, and the
boiling temperature is kept up for an hour; the fire is then
extinguished, the water then drawn off from the boiler, and
the bottles or jars taken out, which completes the process."
For the sick and convalescent a sufficient quantity of pro-
visions thus prepared, might be supplied with little expense,
and hereafter, it may be managed on a larger  scale,  so as
to render fresh provisions occasionally available to the whole
of a ship's company.
  The next article of sailors' diet to be considered is bread.
It is given at sea in the form of hard biscuit.  By long
keeping, these lose   much  of  their nourishing principle,
and in warm climates they are liable to become acrid and
produce  complaints of the bowels.    To avoid  the danger
of sickness from this source, it would be better that only
a certain quantity of biscuit should be carried to sea, and an
equal or greater proportion of flour, of which bread could
be made.  Flour, by being well  pressed and rammed, will 
1
142                  DIRECTIONS.

keep as long as biscuit, and can be stowed in one-fifth part
of the space.   Thus the freight of it would be less than
that of biscuit;  and it could be baked as  occasion might
require.   This plan  of baking  at sea  has  been con-
stantly practised  in the  French  navy; and has likewise
been adopted  in the British service at different times, un-
der peculiar circumstances, when the superior advantages
of it have been very apparent.   What is  chiefly wanted,
to render it  complete, is a substitute for yeast; and such a
substitute may be formed in the following manner: " Let
a quantity of yeast be spread thin upon boards, and exposed
to a moderate degree of heat, so that the humidity may he
evaporated, and that it may be left in  a dry  granulated
state.   It  must then  be put into phials well corked  and
sealed.  Let there be next a strong solution of honey, or
molasses and wort, into which throw a small proportion of
the above powder, and in the ninetieth degree of Fahren-
heit a  brisk fermentation will be soon  excited, perfectly
qualified for every purpose  for  which wort is  employed.
Bread made in this  manner will possess every  advantage
of that baked on shore ; and  the  trouble  attending the
preparation of it will be  very trifling,  compared with the
benefit which both  the healthy and sick will derive from it."
   Upon the articles of pease, or beans, we have little to
say.   They are evidently very nutritious, and agree well
with the stomach of a seaman, whose digestion  is strong.
   Indian meal, rice, barley, raisins,  and molasses, are arti-
cles much used at  sea, and make up an agreeable variety.
To these, potatoes are  a most valuable addition, as they are
known to keep a great while in warm climates,  and, as we
have observed while speaking on scurvy, are in their raw
state an excellent antiscorbutic.
   " One article Ave must not omit to mention here as being
a good  one, in so far as  it  renders  that part of the diet,
which consists of grain and vegetables, more palatable, and
thereby induces the  seamen to eat  more ;  this is butter.
The principal objection to it is its tendency to  rancidity,
and to corrupt in a warm climate ; but even this  inconve-
nience may be counteracted by proper precaution.   By the 
DIET.
143
following method it may be preserved sweet, and in a solid
state, during a three years' tropical station, provided it was
originally in this condition.   Instead of firkins, let it be
put in waxed canvass bags, containing each about fifty
pounds weight.  Let these bags be thrown into casks con-
stantly kept filled with salt water, which should be renewed
once or  twice a  week,  according  to  circumstances, by
drawing  off the  old from a cock fixed near the lower end,
while the new water is admitted from a bunghole made in
the upper end.  By this plan, the butter will be preserved
always sweet."
   The above remarks on the salutary effects  of acid fruits
and juices  in sea diet, may lead one to attach an undue
importance  to them at all times, and to use  them freely,
even in sickly ports.   In such  situations it must be recol-
lected that scurvy is not to be apprehended, and that large
quantities of fruit, especially if cold or unripe, are often-
times productive  of cholera morbus, fluxes, and  fevers.
This circumstance was particularly mentioned, when speak-
in"- on " the air of tropical climates as a cause of disease."
  °From the consideration of seamen's food, we  proceed to
that of drink; and first of  water.
   " Water  is  the best, and certainly the only natural drink
of man.    It has been considered by many as one of the
prevailing causes of scurvy, when of a bad  quality.  As
the health  and  comfort, therefore, of the men at  sea de-
pend so  much on its purity, particular attention should be
paid to this beverage.   Spring water is preferable to  any
other for sea  use, seeing that is less apt to be impregnated
with  decayed vegetable  and animal  substances, than  run-
ning and stagnant waters.   This preference is more espe-
cially to be attended to in warm climates, where every thing,
it may be said, teems with life, and where the  materials
of putrefaction  are so abundant.  Where river water must
be taken, which often happens in warm climates, although
it may be drawn as near as  possible to its source, yet cer-
tain  precautions  should be employed before it  is used.
These consist in throwing a handful  of lime  into each cask,
or dissolving two ounces  of alum to  a hundred gallons, or 
144
DIRECTIONS.
passing through  it a red  hot iron  several  times, or even
throwing into it a little burnt biscuit."   Water, however
pure it may be  collected, is always apt to corrupt when
kept in wooden vessels, and this is one of its greatest incon-
veniences at sea.   Different methods have therefore been
fallen  upon, either to  prevent this corruption, or to coun-
teract it when it  has taken  place.   The former  consist in
various modes of preparing the  vessels that hold the wa-
ter ; and it must be observed, that  there is a great differ-
ence  in this respect, between a new  cask made of moist
wood,  and  one that has been  hardened and seasoned by
age and use.
   One method of preparing the vessel is by firing the cask,
when putting  the staves  together, until a  charred coat is
extended over its whole surface.    This will preserve the
water pure and sweet for  any length of time, and will have
the same  effect as another improvement, that of filtering
it  through  charcoal, which  has been found to correct the
most putrid state of the fluid, and to render it wholesome
and pure, although somewhat insipid.   The most common
expedient, however, for the purification of water, has been
by quicklime.
   This is equally effectual,  whether slacked or unslacked;
but should  always be carried slacked to sea, to obviate the
danger arising from heat, which is apt to ensue on its being
touched by water in its unslacked state.
   To counteract the bad taste of water in a state of putre-
faction, vinegar  and other  vegetable acids  are usually
employed.   A still better method is, to put two  ounces of
chloride of lime into 60 to  100 gallons of water; after a
day or two the water, when allowed to stand awhile in an
open vessel, will be freed  from its putrid smell.
   Various methods have been used for purifying water by
filtration.    The dripping stone is often used for this pur-
pose, but for a large crew the quantity it affords is insuffi-
cient.  Pouring it through gravel, or a layer of gravel and
charcoal, will  afford a more  abundant  supply, and be
equally serviceable.
   A very  simple filtering machine is mentioned by  Dr. 
DRINK.
145
 Blane.   li Let the narrow mouth of a large funnel be filled
 with a bit  of sponge, over which let there be a layer of
 clean gravel, or of sand, covered with flannel, and over the
 whole another layer of sand.   Muddy or offensive  water,
 being poured into this, runs or drops out clear; and care
 must be taken to change the sand, sponge, &c, frequently,
 as they will become loaded with the impurities of the water."
   These  remarks on  the  purification  of water, we shall
 follow with directions for distilling sea-water, for the ben-
 efit of those who have used or lost all their fresh water at
 sea, and may not have taken  the precaution of carrying
 out a still-head.
   "When sea-water is boiled in a close covered pot or ves-
 sel,  it may be observed, that the steam arising from it is
 converted into fresh water  on the inside of the cover of the
 pot.  From a pot of thirteen inches diameter, by frequent-
 ly removing the cover, and pouring off the water collected
 upon it, a gill of fresh water may be procured in an hour.
 The cover of the  pot should be at least five or six  inches
 above the surface  of the sea-water, to prevent its boiling up
 to it.
   " Let us suppose  a ship  at sea to be in distress for want
 of water, having eight men on board, and that the pot for
 boiling  their provisions can contain five and a half gallons,
 being twelve inches in diameter; by the following simple
 contrivance, with only a tea-kettle, a musket, and a cask,
 one  gallon of fresh  water  may be procured every three
 hours, which is a pint for each man.
   " File off the handle of  the tea-kettle, and fix the head
 of the kettle, when inverted, into a hole made for that pur-
 pose in the cover of the pot;  this will prove a complete  still-
 head.  Take the barrel of the musket out of the stock, and
 after unscrewing the breeching-pin, pass the barrel through
 the cask by two holes made on each side, with a proper de-
 scent for the  distilled  water to run  off; then stop up  the
 holes in the  cask,  and fill the cask with cold sea-water ;
 which  will be  a refrigerator or  cooler  to  condense  the
 steam.  In order  to carry on the distillation,  they should
be joined, by  inserting the spout of the tea-kettle into tha
          13 
 146                   DIRECTIONS.

 nper end of the musket-barrel; all  the joints and places
 from whence the steam could escape should be luted or
 stopped up ;  a paste, composed of equal parts of chalk and
 meal, moistened with salt water, will do this effectually, and
 may be easily obtained; the tea-kettle and cover of the
 pot should also be kept down by a weight, to prevent the
 steam from forcing them up.
   " If  the  cask should be too near the fire, the musket-
 barrel, in which the steam is condensed, may be prolonged
 by the addition of the barrel  of  another musket, or by a
 wooden pipe.  If the  barrel of another musket be used,
 whose bore is not large enough to receive the extremity of
 the former, one end of it should be heated in the fire, and
 dilated with a marline spike.   If a wooden pipe be used it
 should  not  be bored  with a hot iron, as  it is found by ex-
 perience that burnt  wood will impart a permanent  disa-
 greeable taste to the distilled water.
   " If  we may suppose a ship at  sea to have no tea-kettle
 on board, then let the wooden hand-pump, with which the
 water or beer is pumped out of the casks, be cut through
 obliquely, and joined so as to  form an acute angle.   One
 end of  this tub should be fixed into  the hole made in the
 cover of the pot, the other should be fastened  to the musket-
 barrel.   By this nearly the same quantity of water may be
 procured as by means of a  tea-kettle.
   '< It may justly be supposed, that the  coppers used for
 boiling  the provisions will, in every ship, contain more than
 the proportion of two quarts of water for every person on
 board;  if these  were  furnished  with proper still-heads,
 they would  be sufficient to yield in distillation the propor-
 tion of  three pints of fresh and wholesome water for  each
 man.  In a British ship, called the Dorsetshire, by means
 of a tea-kettle and musket-barrel, twenty-two quarts of sea-
 water yielded nineteen quarts of fresh water in four hours,
 at an expense of ten pounds  of wood."   When sea-water
has thus  given off two-thirds of its  bulk, the remaining
third will  be too salt for distillation, and should be thrown
away, and the vessel  should  be replenished from the sea.
  " The distilled sea-water is purer than spring, river, and 
CLOTHING.
147
even rain water.   The  taste which it  receives from  the
distilling vessel is, in some measure, lessened by throwing
away the first running  from the still;  and  is wholly re-
moved by keeping the water for some time, or exposing it
to the air, when it will  be found an excellent well-flavored
water, which will keep  perfectly sweet for many years, if
put into clean vessels.
  " In cases of extremity, such is  the  constitution of our
body, that thirst may be alleviated, and the morbid conse-
quences, arising from a want of water, obviated, by wet-
ting the skin or surface of the body with sea-water, which
becomes  thus absorbed, and answers, in some degree, the
common purpose of drink.
  " The  pernicious  effects of  ardent  spirit in  very hot
weather, and when heated by exercise,  have  already been
adverted to.  In  such  situations, molasses and water, tea
and sugar,  small  beer, lemonade, soda  water,  or water
slightly acidulated with vinegar  or  cider, are most condu-
cive to health."
                    OF  CLOTHING.

  The chief object ofattention in a seaman's clothing is to
guard  against moisture.   This moisture, according to the
climate he is in, must be accompanied either  by heat or
cold.   A covering, therefore, which will protect the body
in both situations, is the  great object to be aimed at; and
no substance is so well calculated for this purpose as wool-
len.   By its  use the suppression of the discharge from the
skin, the great source of all  inflammatory diseases, is pre-
vented, and the skin itself being kept as it were moistened
by its own secretion, the natural heat is thus retained, and
the access of the  external air prevented.
  Although in the warmer  climates this covering is less
necessary for the sake  of warmth, yet it  is well known,
that exposure of  the  body is apt to produce a  general un-
easy irritation upon it, and  even  to lay the foundation of
many  dangerous affections.   Besides  this,  the excessive 
148
DIRECTIONS
discharge of the skin, which then takes place, is absorbed
by this  covering, and thus the after consequences of cold
are avoided.  Even the night damps, in such  situations,
are greatly counteracted;  and  the dry  bellyache, and
many other complaints,  seldomer  occur in the West India
service, than they  did  before woollen was preferred  to
cotton or linen.   From  the  advantage of such clothing, it
is of  great  importance  that every seaman should have a
proper supply of it, and that the captain should lay in a
small supply for his crew, suited for the station to which
the ship is destined.  This subject merits particular atten-
tion from the captain, for in general, sailors are too indo-
lent and improvident to  suit their dress to  circumstances,
unless they are forced to it; " nor is  anything  more com-
mon,  than to see  some of them with linen trowsers in the
severity of winter, and a pair of greasy woollen ones in the
hottest of summer."
  In  hot climates, the dress should  be white, even to the
hat and shoes.   In cold  climates a kind of cloth called
Fearnought is very suitable.  After  a rain, both clothing
and bedding should  always be  dried, and whenever the
weather will admit  of  it, bedding should  be aired every
day.
  On the subject of cleanliness  of  person and clothing,
nothing need be here said,  since  every commander  of a
merchant vessel must be fully sensible of its importance.
                    CONCLUSION.

   The foregoing directions, for the  prevention of disease
among seamen, may be briefly comprised in the following
particulars:

  In hot climates.   1. In choosing anchorage to the wind-
ward of the land.
   2. In keeping the ship dry, clean, and ventilated.
   3. In preventing the  crew from  sleeping on  shore or
on deck. 
FOR THE PREVENTION  OF DISEASES.       149
  4. In their avoiding violent exercise under a scorching
sun.
  5. In employing  natives to wood and water the ship.
Where these duties must necessarily be performed by the
crew,  use  the  precautions  recommended  under  such
circumstances.  See page 132.
  6.  In  avoiding entirely  the use  of all stimulating
liquors, and in abstaining from the free use of cold fruits,
and especially those that are unripe.
  7. In adapting  the  dress to the  temperature of the
weather ; wearing flannel, however, next the  skin  at all
times.
  8. When  disease of  a malignant   character has  al-
ready appeared on ship-board,  in arresting  its progress
among the crew by the " means " formerly recommended
" to  prevent the  spreading of contagious diseases  in  a
ship."   See page 134.

  In cold  climates.   1. In wearing flannel next the skin.
  2. In preserving the  lodging  rooms, whether  berth-
deck, cabin, or forecastle, of an equable and rather cold
temperature.  In  this way the  sudden  transition  from
heat to cold, so often experienced, when called out to take
watch on deck, and which is one of the most  productive
causes of disease in cold climates, will be avoided.
  3. In dissipating the moisture of the lodging apartments
every day with fires, and in scraping and holystoning the
deck instead of washing.
  4. In changing the clothing when wet, and  in keeping
the bedding dry and well aired.
  5. In avoiding ardent spirits.
   While at sea, in all climates.   1.  In using  freely  of
vegetables  and  other antiscorbutics, particularly vinegar
and  lemon-juice.   An ounce of the latter per  day to a
man, or a  pint for twelve days, will,  as I have formerly
observed,  (p. 140,) prevent the  scurvy during the longest
sea-voyages, even when confined to a diet of salt meat.
  2. In using pure and wholesome water.
  3. In observing cleanliness in person and clothing.
          13* 
150
SEASONS  OF SICKNESS, ETC.
THE SEASONS  OF SICKNESS, AND THE DISEASES
  INCIDENT  TO  STRANGERS IN DIFFERENT  SEA-
  PORTS IN THE WORLD.

   To owners and masters  of  vessels, who are  fitting out
ships for foreign voyages, it may  be of some importance to
know particularly  when  and where  diseases  are most
prevalent;  and  to  travellers  who  contemplate  visiting
foreign  ports and wish to arrive in thein in  a healthy sea-
son, this  subject  must be  particularly  interesting.   The
account  here  furnished is very imperfect,  and is  princi-
pally taken from the writings of  Lind and Turnbull.

Seasons of sickness, and the diseases in the seaports of the
      United States, and the British ports eastward.

   New  England and Eastward.   In the summer and au-
 tumn, there are a few cases of inflammatory fevers, occa-
sionally a case of low typhus  and some bowel complaints.
Bilious remittent fever occurs very rarely, and still more
so intermittent fever.  In the heat of summer, the yellow
fever appears once in twenty or thirty years, in one or two
of the principal seaports.
   The winter season is most sickly, and the prevailing dis-
eases are  inflammations of the chest, as pleurisies, catarrhs,
sore-throat,  &c.   Rheumatism and  frost-bites  are very
common disorders.   The greater  number of deaths are oc-
casioned by pleurisies and consumptions.

   Middle and Southern States.   Travelling  along  the
seaboard,  from New Jersey to Virginia, where  the heats
are  greater, and  the soil  more  moist,  especially in  the
neighborhood of woods or  stagnant water, we find agues,
fevers, and  fluxes, of very frequent  occurrence among
strangers.  The agues  are apt to terminate in liver com-
plaints and dropsies.  The  winter season  is, however, less
productive of inflammatory complaints  here than in New
England. 
DISEASES  IN THE  WEST INDIES.         151
  In Carolina and  Georgia, we find the summer and au-
tumnal diseases last mentioned, much more obstinate, acute,
and violent.  In  the  months  of July  and  August, they
sometimes  partake  of the  nature  of West India fevers.
The winter season is healthy.
  In East and West Florida, the summer diseases approach
still nearer to those of the West Indies.   In some seasons
the excessive heat, with the concurrence of other circum-
stances, produces the yellow  fever.   In  other  seasons,
however, there is quite an entire exemption from this and
all other  violent fevers, from Carolina  to New Orleans.
Pensacola  seems to be  rendered  unhealthy by its sandy
and barren soil.   In Mobile, intermittent fevers are  very
prevalent  in the  months of July, August, and September.
The winter seasons  are  generally healthy in the Floridas.

Most  unwholesome  seasons, and the diseases in the  West
                        Indies.

   Comparative degree of health in the different islands.
" The  most healthy of all the English  possessions, in this
part of the world, is the Island of Bermudas ; next to which
is the Island of Barbadoes, if we except that spot of ground
upon which Bridgetown, its  capital, is situated.   The air,
in many parts of  St. Christopher's, is  also pure.  That of
Antigua is bad, and that of Jamaica is reckoned still  more
unhealthy ; though much less so   than it formerly was.
The  color  of  the European inhabitants in  the island of
Montserrat, is a  proof of the salubrity of its air ; the  same
may be said  of  Nevis.   In general, the rainy season in
those islands happens  in August, September, October, and
November.  In the settlements on Grenada, the Grena-
dines, and particularly at Tobago, the health of the inhabi-
tants  has  been  little  attended  to.  In the island of St.
Vincent, the town of Kingston is rendered very unhealthy
by an adjoining morass.
  With respect to the settlements  of other European na-
tions, we shall briefly  observe, that  the French settlement
of Cayenne has proved very  sickly.  The climate of St. 
152           SEASONS OF SICKNESS,  ETC.
Domingo is also unhealthy; that of Martinico less so.  At
Gaudaloupe,  Martinique, and most of  the  other French
West India islands, there are low, swampy  grounds, com-
monly called Basse Terre, which are particularly unhealthy.
   The Dutch settlements at Surinam,  St.  Eustatia, and
Curracoa, are all very unhealthy.
   In different parts of the Spanish  West India dominions,
the air varies greatly in  p)oint of purity, according to the
situation of the places.   The port of Havana, in Cuba, is
sickly, while  the highlands are not.
   The most frequent  and fatal diseases  in the  West Indies
are,
   1.  Fevers, viz., the bilious remittent  fever  and the yel-
low fever.  The former is here so violent and  rapid that it
often proves fatal between the third and seventh day.   It
chiefly prevails during the months of June, July, and Au-
gust, beginning  to abate in  September.  The  latter, or
yellow fever,  is the most fatal disease of the West Indies.
Its attack is  so sudden and  violent, that oftentimes the
patient is thrown down, almost insensible, without any pre-
vious complaint.   Vomiting and headache attend him till
within a few  hours of his death, when he  experiences a
slight abatement of his distress, but soon after  relapses and
dies, not unfrequently in between twenty-four and  thirty-
six hours from the commencement.
   2.  Dysenteria, which, in point of frequency, comes next
to fever in the East and West Indies.
   3.  Dry bellyache or colic, which occurs often.
   4.  Tetanus or lock-jaw.
   5.  Fish poison, which  is of frequent occurrence.
   " It is a general  observation that women  enjoy much
better health  in  the West Indies than  men, and are not
so subject to  the yellow fever as  they are, owing, probably,
to their more  temperate way of living."
   The following  table recently drawn  up by the British
commissioners of health, is extracted  from  the London
Quarterly Review, of July, 1840, and exhibits the annual
ratio of mortality per one thousand mean strength of Brit-
ish troops in the British West India islands. 
ANNUAL RATIO OF MORTALITY.
By fevers. Diseases of the lungs. " of the liver. " of the sto- ) mach and bowels. ) Diseases of the brain. Dropsies. All other diseases.	1	o	n H	o e5	05 Tl H	o	o si	e3 •l-t o	a .3 a o	0] pi <1		o 'a §
	11, 8,7 ,5 5,3 2, ,6 ,7	52,9 6,4 1, 8,9 4,4 1,2 2,9	61,6 11,5 1,1 17,19 4,7 7,7 1,8	104,1 H, 2, 24, 5, 3,5 3,2	26,3 6,6 4,5 16,1 4,6 ,8 2,9	11,2 10,5 1,6 24,2 2,8 1,6 3,	11,8 15,8 1,4 20,8 3,3 2,4 3,	63,1 12,5 1, 39,3 4,3 2, ,6	49,3 8,3 1,7 70,3 5,3 ,7 1,8	14,9 9, 2,8 9,2 1,9 1,4 1,4	42,1 9,5 2,2 10,3 2,8 ,9 3,2	101,9 7,5 1, 5,1 2,6 1,2 2,
Total.	28,8	77,7	105,5	152,8	61,8	54,9	58,5	122,8	137,4	40,6	71,	121,3
CO 
154          SEASONS OF  SICKNESS, ETC.
The Western shore of South America and  the Islands of
                      the Pacific.

  In turning Cape Horn, whether outward  or homeward
bound, inflammatory affections are very common, as rheu-
matism, catarrhs,  pleurisies and pneumonias, all which
should be carefully guarded against by warm clothing.
  The coast of Patagonia is healthy, and nearly so is the
coast of Chili, particularly  Valparaiso ; but the inland is
less so.   Santiago, situated ninety miles inland from Val-
paraiso, is remarkable for the extreme heat of the day and
coldness at night.   Remittent and  bilious fevers are here
very frequent.
  Lima is tolerably healthy, much more so  than places of
corresponding latitude on  the western shores  of  Africa.
The air is too arid, and  is unfavorable to pulmonary dis-
eases ; it is moreover enervating and injurious to persons
who reside  here  for any  length of time.   The remarkable
property of the atmosphere to  dry up  moisture, (as is
evinced in the manner of curing jerked  beef merely by
hanging it in the open air,) is probably one  cause of there
being no malignant diseases arising from putrid exhalations.
  Coquimbo, situated three degrees further north, is very
healthy.  From Guayaquil to Panama, the  coast  during
the wet season is rather  unhealthy, fevers and fluxes and
liver complaints being the  prevailing disease.  But as a
general remark, it may be  said  that the whole  western
coast of America is  quite  free from all malignant fevers,
and from the destructive  fluxes that prevail  in correspond-
ing latitudes in the .other hemisphere.
  All the islands lying in  the eastern longitudes of  the
Pacific, as the  Sandwich, Fejee, Friendly, Society, and
Gallapagos, and all others near them, are very healthy.
Essex Bay, situated in the Gallapagos, is often visited by
whalemen.   Emigrants from Guayaquil have made settle-
ments there.
  Payta, an  island only three days' sail from Callao, has 
IN CALIFORNIA.
155
a clear, dry atmosphere, and regular winds that moderate
the extreme heat of the day, and the changes of tempera-
ture are very slight.   It is the port of Piura, a city having
a population of 4000, and derives its name from the purity
of its air.   The cruising ground of whalemen is directly
off this port, and in consequence of  its  excellent climate,
fine market, and easy access, is much frequented by them.

Diseases of Persons on their way to California, both by
   Sea and Overland; also after their Arrival; with Di-
   rections for their Prevention and Treatment.

   The former editions of this  book were silent respect-
ing climate and  diseases  on the  Pacific coast,  north  of
Panama.   Vessels rarely  touched at any  of the ports,
which  are few and  far between, and  the  population  in
them  comparatively small, having declined ever since the
country became  independent  of Spain.   Within the last
two years, however, the gold fever has become epidemic
throughout the Union, causing a rush  of people to  Cali-
fornia, who, being strangers to its climate, and ignorant of
the perils and vicissitudes to be  encountered in going, and
after their arrival, stand in great need of advice for pre-
serving their health.   Having  been  at  much pains  to
collect information, we  shall give  advice to persons  cross-
ing the isthmus  of Panama to San Francisco and to the
gold placers ; also to those  who take an overland passage,
commencing with the Gulf of Mexico.

 The  sickly  season in  the  Gulf of Mexico,  the  Bay  of
           Honduras, and the Musquito shore.

   Vera Cruz and  Tampico  are apt to be very  sickly,
especially  during the  rainy  season;  the same remark
applies to nearly all the  ports at the  mouths  of rivers;
also to those in the Bay  of Honduras and in the Gulf of
Nicaragua, especially to Chagres.   During the periodical
rains, the  attending  sickness is much  more violent m the
hot,  marshy,  and woody places on the  contment, than 
156          SEASONS OF  SICKNESS, ETC.
upon the  neighboring  islands.   The inland provinces are,
however, more  healthy than the seaboard.   Some of the
harbors are fatal from want of due ventilation.   Vessels
are in  danger of tempests and shipwreck if anchored in
open roadsteads  on the one hand, and on  the  other of
consuming sickness  when  secured from tempest by sur-
rounding  highlands.   This is  the  case with port Maho,
near the  island of  Ruattan,  and partially so  in  other
ports.
  The  Bay  of  Honduras  and   the  Musquito  shore,
although  very  unhealthy, are  less so  than  Carpenter's
River, and Rio Morte, or the River of  Death in  the Gulf
of Mexico.  This  was so  named  by the  Spaniards, from
the death of all of that nation who at different times have
attempted to make a settlement upon  it.   The  English,
however,  have since,  by settling  on  a differenc spot of
ground, been more fortunate, and call it the new river.
  The diseases in the sickly ports in the  gulfs and along
the Atlantic shores to Chagres, are so near  akin to those
of the West Indies that it is  unnecessary to repeat them.
The means of  prevention are laid down  on  page 148.
  There is every reason to hope that within a brief year
or two, a railroad will be constructed across  the  Isthmus
of Panama  from  Chagres, when directions for travellers
to preserve their health, now  so   necessary, will not be
needed.
  Travellers should remain as  short a time at Chagres as
possible, and must  urge  the  boatmen onward ;  take but
little baggage, and in packages of not more than  fifty
pounds each, and keep their eyes upon it;  take  two or
three days' provisions ; avoid drinking much  of the moun-
tain and river streams.   Ale, claret, or  port  wine may be
mixed  with the water  in small  quantities ; but brandy is
too heating.   They should  avoid the heat  of the  sun, and
the night  air, and excessive  fatigue;  abstain from fruit,
excepting an orange or two in the  morning ;  keep as dry
as  possible, and wear flannel next  the skin.   In the dry
season, leave the boat at  Gorgona, but at other seasons
keep on eight or ten miles farther to Cruces, where mules 
ON THE WAY TO CALIFORNIA.          157
are obtained for crossing to Panama, the distance to which
is thirty or forty miles.
  Arrived  at Panama, they will find a more  salubrious
climate  than they left on  the other side of the isthmus.
" The morning is  always  clear  and beautiful, with a fine
air from the  sea ; the thermometer during  the  hottest
part of  the day 80° to 85°, relieved by a  refreshing sea-
breeze, which usually  sets in about noon and continues till
sunset,  followed by nights  cool  and comfortable.  This
continues about six months, from the beginning of  the dry
season, when the rainy season approaches, and although it
rains  every day for at least  four months, yet the after-
noons are usually clear and pleasant.   The atmosphere is
of course sultry during this season, but with proper care
is not unhealthy.
   " The so-called  Panama fever  occurs rarely,  unless
previous disease has wasted the  powers of  life, or fatigue
and long exposure to  the hot sun or  rain, and  an undue
indulgence in the  fruits of the country, have predisposed
the system to an attack."
   On leaving this for San Francisco be  sure  to go by
steam.  The calms that  befall  merchant vessels,  and the
danger  to health  and life resulting from  them, are very
much to be dreaded.   Perhaps  there is no coast of  the
world where  steam is so  decidedly preferable to sails, as
on the Pacific, and especially along the  coast of  Central
America and Mexico, from Panama to San Francisco.
   On leaving Panama and turning Point Igaera, the first
port two  hundred miles  distant and  near the shore is
Esparsa, a small  town in Central America.   Nieoya, a
hundred miles farther, is a more inland town, on a river
running into a deep bay of that name.
   Realejo  is situated two hundred  miles farther along the
coast, and  four or five miles from the  ocean.   It will be
noticed  more hereafter, as connected with the overland
route through Lake  Nicaragua.   There are some small
towns  along the  coast before we  reach  Tehuantepec, in
the gulf of that name, 600 miles from Realejo, and 1200
from Panama.  It is also connected with  another over-
         14 
158           SEASONS OF  SICKNESS, ETC.
land route.   It is  a dangerous harbor, on account  of
shoals  and strong currents, and  is dreaded by navigators.
  Acapulco is  300 to 400 miles farther along the coast,
and 1,500 from Panama.   It is represented as the best
harbor and neatest  city on the whole coast.   It is about
280  miles in  a southerly  direction from  the  city  of
Mexico.
  Zacatula  is  the  next  important  town, on a  river  of
that  name, about 180 miles from  Acapulco ; and after
passing some small settlements,  we reach Port St. Bias,
an important  place, connected  with  another   overland
route, and also for  ships to  obtain  supplies.   Over one
hundred miles north of this is Mazatlan, at  the  entrance
of the Gulf of California.   It is  a neat place of much
trade, having some  handsome  stores and dwellings.   It is
the principal commercial port  of Mexico on the  Paoific,
with a population of some  10,000.   It is connected  with
an overland route.
   Cape St. Lucas is on the opposite side of the mouth of
the gulf, and is the terminus of the  California  peninsula
or cape.   The coast of this cape has some small Catholic
missionary stations, but there is  no place  of commercial
importance until we reach San Diego.
  San Diego,  the  first town belonging to the United
States, and situated near the boundary line, is on a  neat
little bay, and the  place is destined to grow  rapidly, now
that it is ceded to Yankees.
  The next place  deserving notice  is  Santa  Barbara,
which  ranks  in importance with San  Diego.  They were
formerly noted places of trade in hides and tallow, and
are destined  to revive  by  the ready sale of  all the
provisions they  can supply  to  shipping or  send to  San
Francisco.
  The next place is Monterey, now  a military post.   It
presents  a neat appearance  from the sea, and is a more
desirable  residence than  San   Francisco,  beino-  more
exempt from the sudden transitions and chilling blasts and
having good water.   Prior to the  gold-digging, it was the
seat of government.   The harbor  is rather too open for 
ON  THE WAY  TO CALIFORNIA.          159
safety.^  A few  hours'  sail from this  brings us  to San
Francisco.
  The diseases  to which persons are  most liable on  the
passage from Panama to San Francisco, vary  according
to the length of  the voyage,  which depends chiefly upon
the choice of vessel, whether  steamer  or sailer; also
whether crowded or otherwise.   In steamers the passage
is so short that scurvy has no time  to produce its  victims.
Touching  as they do at  several ports for vegetables, the
passengers are supplied sufficiently  to prevent their  suffer-
ing from  this disease.   The fevers, too,  which occur  in
crowded sailing  ships in the dead calms they encounter on
this voyage rarely occur in steamers,  whose voyage from
port  to port is comparatively  short, and  will allow the
vessel to be often  cleansed and ventilated, and preserved
healthy.  Hence with ordinary care, the occurrence of
fevers and scurvy, which are  most to  be  dreaded, may be
entirely excluded from steamers, whilst in  sailing vessels,
especially if crowded with passengers,  they will hardly
escape sickness  and loss of life, if long becalmed.
   Sailing vessels  for  such long voyages should be well
supplied with vinegar, lemon-juice  and potatoes.   On en-
tering any port  for supplies, the free  use of fruit  should
be  prohibited,  or fluxes  are  sure  to  follow.   Passengers
on going  ashore at any of the  ports  should avoid fatigue
in the  middle  of the day, and  not  only the free use of
fruit, but also ardent spirits.  As the  wind rises  in  the
evening,  and cools the  air, additional  clothing will be
needed.
   Before  entering  the Bay of  San Francisco, it will be
proper to allude to the  overland  routes at other  places
besides Panama.
   1. From Musquito Gulf  up  the river San  Juan, and
through  Lakes  Nicaragua and Leon, to Realejo on  the
Pacific.   This route will afford an  outlet to a rich country
surrounding the lakes.  But  it is very hot and unhealthy
on the San Juan, and infested with insects.
   2  From  the Gulf of Mexico near Vera Cruz  by the
river  Coazacualo to  Tehuantepec, in the gulf of  that 
160          SEASONS  OF SICKNESS, ETC.
name on the Pacific ;  the distance being 130 miles.  It is
unhealthy, like the other routes.  The line of a proposed
communication is  198 miles.  The river Coazacualo  is
navigable for large vessels 30 miles, and for  small vessels
15 miles beyond.  The distance from New Orleans by the
Tehuantepec route is  1700  miles less than  by  way  of
Panama, and from New York it is 1100 miles less.
   3.  From Vera Cruz, or from  Tampico through the city
of  Mexico,  200  miles,  and  thence  to Acapulco,  240
miles.
   4.  From  Vera  Cruz or  Tampico to  Mexico,  thence
through Valladolid, Guadalaxara, and Tepic, to Port  San
Bias, Lat. 21° 30', a distance of 600 miles.
   Or, 5.  From  Tepic  to Mazatlan, at the mouth of the
Gulf  of California.*
   As prevention is better than  cure, travellers over these
roads should abstain from walking in the heat of the day,
avoid  great  fatigue, be temperate in  meats  and  drinks,
avoid  ardent  spirit,  and  whenever  indisposition  begins,
stop  and subdue it at once by rest  and mild treatment.
   To those who take the overland route from the Western
States through Santa Fe to  S. Barbara, or through Mis-
souri  and Utah, or  any  route  still farther north,  a small
quantity of  medicines  should be  taken with  the book.
The following  articles  will suffice  for a company of from
ten to twenty men.  Alum,  1 oz. ; blister plaster, 4 oz.;
blue pill, 1 oz. ;  blue  vitriol, 1-2 oz. ;  calomel  and jalap
powders 20, of 10 grains each; cream of tartar, 6 oz. ;
Dover's powders  50,  of 5  grains each;  10  emetics  of
ipecac, 20   grains each;  laudanum, 2 oz. ;  sal  nitre, 4

  * There will hereafter be many overland travellers on all these routes
from the Gulf of Mexico, and  also from the Mississippi, to California,
who will need medical advice.  Such should provide themselves with
this or some other similar book as a travelling companion, to which they
can refer when attacked by disease in situations where a physician is not
to be consulted.  Such  persons  should each take with them a few medi-
cines, say one dozen blue pills, some mild cathartic  pills, two or three
emetics, an ounce of laudanum, and  two or three dozen quinine pills of
three grams each. With these few articles, under the directions of the
book, the bowels may be regulated, and the progress of fevers or fluxes
can be  stayed, until a physician can be obtained,  and in most cases the
necessity for one may be obviated. 
IN CALIFORNIA.
161
oz. ;  simple  ointment,  6  oz. ;  quinine in pills,  100, of
5 grains each ; Epsom  Salts, 8 oz. ;  super-carbonate of
soda,  4  oz.;  sugar  of  lead, 1  oz. ;  tartaric  acid, 1
oz. ;  tartar emetic,  12  doses,  6  grains each;  white
vitriol, 1 oz. ; simple cathartic pills, one  box.    One  of
the tartar emetic doses of six grains  may be  dissolved in
half  a pint  of  water, and given as a substitute for  anti-
monial wine, in cases  and doses where that  medicine is
prescribed in the book.
  The above medicines may be packed in  a small tin box,
9 inches long, 6 wide and 6 deep,  which would include
the book.  If any of the medicines should be exhausted,
they may be replenished at Santa Fe, Salt Lake, and at
military stations.

         Climate and diseases of San Francisco.

  Having  traced  the shore of  the Pacific from  Panama
to San Francisco, and  alluded to the several overland
routes, we  shall proceed to notice the climate  and diseases
of this important city, and of the Sacramento  valley and
gold placers.   Medical men here  are numerous,  who can
be  consulted whenever  disease  actually  occurs.   But
newly-arrived  persons, whether  by  sea  or  land,  have
always suffered more or less  from fatigue and privation,
and  need advice to prevent the  diseases to  which  their
constitutions are now peculiarly susceptible.
   Passing  into the Straits  of  San  Francisco from the
Pacific, we  emerge from them after leaving San Solito on
the  left, and a little farther on  reach the  city of San
Francisco on the right, at the entrance into a bay of that
name.
   The  Sacramento  and  San  Joaquin  valley,  through
whose centre the  rivers of that name  run,  north  and
south, is 500 miles long and 30 to 40 wide. The entrance
to it 'is  40 to 50  miles in a  N. E. direction  from  San
Francisco.    The  chain  of mountains that  separates it
from the Pacific is 40 to 50 miles broad.   On the opposite
or east side of  the  Sacramento  valley, are the  lofty snow-
capped chain  of mountains called Sierra Nevada.   The
          14* 
 162          SEASONS OF SICKNESS,  ETC.

 melting snow from these, and the  torrents of rain during
 the rainy season, have  formed tributary streams  and
 ravines that  open into the great valley; and it is on these
 streams and  gullies and canons, at various elevations from
 the Sacramento and San  Joaquin rivers, that most of the
 gold is dug.
   No other country presents  such a diversity of features,
 soil, and climate, as California.  Yet, with the exception of
 the mountain regions of perpetual snow, the average  tem-
 perature of the Pacific coast is less severe than that of the
 Atlantic coast at corresponding degrees of latitude.  The
 rainy season corresponding to our winters, is from Novem-
 ber to March or April inclusive, but in some years it falls
 very abundantly nearly every day, and in others sparingly,
 " while several consecutive seasons have been known to elapse
 with  scarcely any rain.  "   During the rainy season the
 temperature is agreeable,  and were it not for the mud, " the
 deep,  filthy,  and adhesive mud," which interferes with all
 cmfortable locomotion, thi3 season would be decidedly pref-
 erable.  It is also the best season for mining, so far as health
 and, perhaps, average  success too,  depend.   In the gold
 regions the month of October is the  best in the year, and
 November, if perchance rain is  delayed.   The monthly
 mean temperature at San  Francisco for six winter months,
 in 1847-48, was as follows : October 57°; November 49°;
 December 50°; January 49°;  February  50°;  March 51°.
  The dry season proper at San Francisco is from  March
 or April to November.   The mornings are  then generally
 clear and intensely hot, until the middle of  the day, when
 the  sky becomes overcast and  gloomy,  a strong north-west
 gale sets in from  the ocean, raising  a cloud of clay  dust
 that is exceedingly annoying.    It is often  accompanied at
 ^i  * ii1 bj a  thick' drivinS f°g> and the thermometer rap-
 idly falls some forty  degrees  or more, making the  nights
 most gloomy  and uncomfortable.
  Sound, robust constitutions,  and prudent livers, with plen-
ty to eat and  drink and wear, enjoy good health here, the
 bracing air from the sea inducing a vigorous appetite.  But
 with those who have newly arrived, worn down by fatigue 
IN CALIFORNIA.
163
or privation or ill health, or who live imprudently, the case
is different.   The brackish water of the city induces bowel
complaints.   Sudden changes  of diet and  indulgence in
fruits, and the sudden checks of perspiration, cause fluxes
and mild typhus fevers, and if  badly clothed, rheumatism,
catarrhs and pleurisies.   But miasmatic diseases, says Dr.
Leonard,  are not seen  here unless contracted elsewhere;
and in this respect San Francisco and other seaports dif-
fer from the interior, where marshes cause fever and ague.
 In the Sacramento and  San Joaquin valleys (which are one
only in name) the shores of the rivers are flat and marshy,
overgrown with thule, a sort of light cane or rushes, and
trees are scarce until far up the valley.   The summer and
autumn  are hot and dry, the thermometer raging from 80°
to 120°, with scarcely any breeze ; and in winter and spring
it is damp and rainy, the mercury seldom falling below 36°,
or rising above 60°.   The extremes of heat and cold in
July are greater in  the canons or ravines than in the val-
leys.  The intensely hot  rays  of the sun through a dry,
clear atmosphere, are reflected from the sides of the ravines
and  mountains, whilst  the snow-water from the  mountain
tops  raises the water in all the streams one or two feet dur-
ing the night and imparts a chill to the atmosphere.
   There has been and still is a vast amount of sickness in
the great valleys, — diarrhoea, dysenteria, intermittent and
remittent fevers, — and many are sick from  typhus, which
these induce.   Scurvy is also very common.  Large num-
bers  are  constantly returning with  constitutions broken
and wasted, and many more would come if they were able.
   A recent letter from  Dr. B. Coit to Dr.  Johnson states
that  the sickness in the interior has been appalling ; but this
has ever been  expected  by  the  reflecting as inevitable,
crowding  as emigrants do into  a malarious  country in the
heat of  summer,  with systems  already  reduced  by long
voyages or journeys.  No  young  men  who have  been
delicately reared, or have not been inured to labor, should
think of trying their hand at gold-digging.   The majority
leave with broken health and spirits, and much depends on
chance, hard toil often failing of any adequate return.  Few 
104
SEASONS OF SICKNESS, ETC.
who work in the mines ever carry  home  their usual full
health.   Besides the above-mentioned diseases the miners
are often  afflicted with scurvy, resulting from the use of
salt meats with scarcity of fresh vegetables.   It should also
be mentioned that there is a great liability to get poisoned
by coming in contact with a species of ivy,  and also by a
shrub, probably  the  dogwood.   Their effects, says  Dr.
Leonard, are sometimes very severe  and unmanageable.
  A few words of advice must close.   " Diggers of expe-
rience in the mines travel by night during the  dry season,
to avoid the rays of the sun.   Their hours of labor are from
daylight to about 10 or 11 A. M., and from 4 P. M., un-
til dark.  Individual efforts, as a general rule,  are less likely
to succeed  at  the mines than  small companies  provided
well with clothing and provisions.   Salt pork  is more likely
to produce scurvy than salt beef or fish.  Dried apples or
other  dried fruits for stewing, and above all, fresh lemons,
are excellent, where so much  salt meat is unavoidable.
Bread from wheat meal, Indian  corn meal,  rice and molas-
ses, potatoes and cabbage to eat  raw, mixed with vinegar, as
a salad, are very valuable  preventives of scurvy.   Choc-
olate is  better than tea or coffee.
  A  log-house and  plenty  of provisions laid by  in Octo-
ber, with suitable clothing,  including  a good blanket, are
indispensable.   The  days on which the cessation of storms
permits  work are both the most comfortable and healthy to
gold-diggers.
  Whenever  sickness does occur, however mild, abandon
labor  at once,  and if in the canons  of the  river, gain a
higher locality ;  consult a physician, and  keep quiet, and
avoid powerful medicines.
  For much of the foregoing information I am indebted to
my esteemed friend, Dr. J. P.  Leonard, an  accomplished
physician who has visited the diggings.

        Diseases in the seaports of  Great Britain.

  Diseases along this coast vary very little from those in
the northern ports of the United States, excepting that in- 
         ON THE  WESTERN SHORE OF AFRICA.      165

termittent fevers are frequent, which are attributed to fogs
and_ east winds.   "An east wind here is usually accom-
panied by a cold,  damp, and unwholesome vapor, which is
observed to affect both animal  and vegetable health, and
in many places to  give rise and obstinacy to intermitting
fevers, as also to produce frequent relapses."  In the south-
ern part of England, particularly in the British Channel,
pleurisies  are  less violent  than in North America.   The
complaints most frequent and troublesome, are  typhus, or
common fever,  intermittents, rheumatism, catarrhs, and
consumption.

    Sickly season, and diseases of the  Mediterranean.

   The most fatal disorders  to strangers on board ships, are
consumptions.   This applies more particularly to the crews
of men  of war, or vessels stationed for a long time in this
sea.   In some  of  the islands,  particularly Minorca and
Majorca, pleurisies are very prevalent in winter.  Catarrh-
al affections and rheumatisms are frequent in every port
in the Mediterranean.
   In the summer season, the  neighborhood of marshes is
sickly, especially the  Pontine marshes near the Tiber in
Italy, where intermittents and bilious remittents are very
fatal.
   The African shore of the Mediterranean, excepting when
the plague prevails, is very healthy, from the  straits  to
Tripoli.   From Tripoli to Alexandria, Jaffa, and  Smyrna,
some of the ports suffer more or less every year with the
plague.   " It is said to be most prevalent soon after the
inundation of the Nile, or rather its recession.   Next to the
plague in frequency, comes sore eyes.  It is called Egyp-
tian ophthalmy.  If less fatal than plague, it is more dis-
tressing, and is as  frequent among crews in vessels at an-
chor,  as among the people on  shore.   Besides these epi-
demics  that are peculiar to this  country, strangers are apt
to be seized in the summer season  with bilious  disorders,
fluxes, and fevers." 
166           SEASONS  OF SICKNESS,  ETC.
   Sickly season, and diseases on the  Western shore  of
                        Africa.

   The new colony of Liberia, and other settlements  along
this coast, and the constantly  increasing intercourse with
them for  the  purposes of trade, require a  particular  ac-
count of their  climate and diseases.
   The British settlements  in Western Africa are Sierra
Leone, Gambia, the Isles de Loss, Cape Coast Castle, and
Accra.  They are scattered  over a  line of coast, which,
from St. Mary's  on the Gambia to Accra, is nearly 1600
miles in extent, and  which  everywhere  exhibits  the  same
remarkable hostility to foreign constitutions.   The coast is
generally low ; its elevation from Senegal to Sierra Leone,
a distance of 100 miles, being only  a few feet above  the
ocean ; its rivers are  sluggish and flooded during rains,
when the mud  they deposit, and the moisture they supply,
give rise to an interminable wilderness of forest and brush-
wood, among which lies rotting the decayed vegetation of
many centuries.
   In the Sierra Leone command, are comprised the stations
of  Sierra  Leone, the Isles  de  Loss,  and the  Gambia.
The peninsula of Sierra  Leone  occupies an intermediate
position of the British settlements along this coast,  being
about 300 miles to the south of the Gambia, and 1100 to
the north of Accra, and  comprehends a tract of land  ex-
tending about eighteen  miles from  north to south, and
twelve from east to west.
   St. Mary's, near the entrance of the Gambia, is fatal to
foreigners, by reason of the  great degree of heat, (the
thermometer often indicating 100° in the shade,) and  the
putrid exhalations arising from its  shores.   The  rainy sea-
son commences in  July and continues about four months,
and the diseases that accompany and follow it, are intermit-
tent, remittent,  and continued fevers, dysenteria, and
cholera-morbus.   These prevail at all seasons among recent
visitors, and in a milder form often attack seasoned resi-
dents. 
ON THE WESTERN  SHORE  OF AFRICA.      167
  Free Town, the  capital of Sierra  Leone, is about six
miles from the mouth of the Bunch River, on the south
sido, and from 40 to 70 feet  above the general rise of the
river, which is here about ten miles across.   No situation
could be more  unfavorable for foreign  constitutions; the
supply of good water  being  the  only thing  in its favor.
The  rainy season lasts from June to October, and is intro-
duced and closed with tornadoes.   In one year there were
fifty-four of these ;  no part being more liable  to them than
this and the grain coasts.
  The temperature at Sierra Leone, is generally not higher
than 95°, but the tranquil state of the air makes it  very
sultry and oppressive.    The mean temperature is about
83°.   Continued and  remittent fevers, (commonly called
yellow fever,) intermittents, dysentery, cholera-morbus, en-
largement of the spleen, and  chronic inflammation of the
liver, are the most common diseases, and are annually fatal
to about two-fifths of the whites.   Of these, about  four-
fifths die of fevers, arising from  the  same causes, though
of various types.
  After  passing Sierra  Leone, the country is hilly and
woody.   As  we approach the Bay of Sherbro, it grows
more level.   The distance here is about 80 miles ; within
which empty four considerable rivers.   This bay is formed
by a range  of low islands, whose south-east extremity
touches the continent, and leaves it obliquely, opening wide
to the north-west.   The  country  is low and swampy, and
though a sandy beach edges the land, the  soil is a  deep
and  heavy clay.   For more than 70  miles  beyond, the
country is low and  swampy, with  many  rivers, until we
arrive at Cape Mount.   This mountain is on the south side
of a  large river of the same  name.    The elevation  soon
lessens, and in a few miles the same lowness is seen.  The
country is thickly wooded.   Cape  Mezurado is about 50
miles beyond Cape Mount, and  is  the  southern barrier to a
river bearing the same name.   These rivers overflow dur-
ing the rains.
  The Grain Coast begins at the  Mezurado, (6° 30' north
latitude, 10° west longitude,) and terminates at Cape Pal- 
168           SEASONS  OF SICKNESS, ETC.
mas, (4° north latitude, 7° 20'  west longitude.)  The land
is uniformly low, with thick woods, and many small streams,
navigable only by canoes.  The coast is shelving,  and the
swell  from the  Atlantic renders the shore  generally im-
practicable.
  The villages are on the sea side, near the streams.   The
soil is deep, rich, and heavy.  "The  plain becomes almost
an  entire morass during the  rainy  season, hence rice is
mostly cultivated and eaten by the natives.  Occasionally,
one or more trees rise high  above the  rest, and form the
most striking landmark.   Places designed for the growth
of farinaceous vegetables or roots, have their exuberant,
but now withered productions, towards the end of  the dry
season, set on fire, and  the seeds are  then put into the
ground."    The quantity of rain is nearly the same  as in
the part of the coast last described.    This  season begins
in June, and lasts about four  months, with almost contin-
ued thunder and lightning, the wind being generally south-
west.   After this is about a month of fogs, with  an almost
tranquil atmosphere.
  The prevailing diseases of Liberia  are  fevers and fluxes,
and diseases of the  liver.    Almost  every foreigner is
attacked with fever within the first  nine months, varying
in type and severity according  to the  prudence he exer-
cises in his diet  .and regimen,  and  in  the other known
measures that experience has taught as  being effectual in
preventing or mitigating its force.  In reflecting upon the
sickness and loss of life sustained by this colony since its
commencement, it  affords some  relief to know  that  it is
every year becoming more healthy.
  Ivory  Coast  commences at  Cape  Palmas, and extends
to Cape Lahou, in 5° north latitude.   It is, like  the Grain
Coast, low and swampy;  toward  the  Gold Coast  it is more
level, like table-land.  For 700 miles  from Sherbro to Cape
Lahou, there is a uniformity  in soil and seasons, in the
luxuriance of the vegetable kingdom, in the natural  scen-
ery, and in the character and severity of diseases.
  The Gold Coast  runs about  500 miles, to Rio Volta.
Apollonia, the first settlement, is in a rich, fertile country. 
ON  THE WESTERN  SHORE  OF AFRICA.      169
Next to it  are Axim  and Hollandia, belonging  to  the
Dutch ; Dixcove, Succondee and Commenda, belonging to
the English; also Anamaboo, and beyond this the Accra
country, where English, Dutch, and Danes have settle-
ments in a  finely cultivated and  comparatively healthy
country.  The rains commence in May and terminate in
the beginning of August.  Between Accra and Bio Volta,
which terminates the Gold  Coast, are the settlements of
Prampram  and  Ningo, the  soil of which is light, sandy,
and well cultivated by the Dutch.
   The Slave Coast commences at Rio  Volta, and extends
to Biaffra, in latitude 3° north.   The  whole coast is  low
and swampy, indented by creeks and rivers, the largest of
which are the Formosa, old and new Calabar, the  Croos,
and Del Rey rivers.  Owing to the extensive trade through
them in palm oil,  ivory, and ebony, these rivers  are more
frequented than any on the coast.   The climate is so un-
healthy that, on  an  average, not more than one  half of
those here employed in trade ever return.   " The necessity
for vessels to proceed some  distance up  these  rivers, in
order to enter on  the field of traffic, brings them within the
sphere of action of the malaria, generated  from  the mud,
ooze, and  decaying matters which continually cover their
banks.   These sources of disease are  greatly  multiplied
both during  and after the rainy season."    The prevailing
diseases are  continued and remittent fevers, dysentery, and
cholera-morbus.
   There is a great sameness in the soil and face of country
along the coast of Africa, from the  mouth of the Senegal
to Cape Lopez, in latitude 3° south, and  consequently  a
great sameness in the nature of the diseases, being mostly
comprehended under the names of  fevers  and  fluxes.
Those who arrive on  the western coast of Africa, between
the Senegal  and Benguela, and especially between Gambia
and  Cape Lopez, are subject  within the first nine months,
and more frequently within as many weeks, to the endemic
yellow fever, to bilious  diarrhoea, to cholera-morbus, and
dysentery.    If a bilious diarrhoea or cholera precede an
         15 
170          SEASONS OF  SICKNESS, ETC.
attack of fever in a new comer, (commonly called the sea-
soning,) both diseases may be comparatively mild.
  Fevers are the most  destructive diseases, and  equally
fatal with those of the West Indies.   The worst forms in
the two regions resemble each other so closely, as to have
given rise to the opinion that the malignant yellow fever
of the West  Indies, was imported from the island of Bu~
lam, latitude 11° north.    No doubt, however, the disease
is of local origin in both regions, since they both abound
in those marshy miasms which are now generally acknowl-
edged to be its sole cause.   There are, however, milder
grades of fever, as intermittents  and simple  continued,
which rarely prove fatal, though the former  are often found
to leave a disordered state of the liver, called  ague-cake.
Among the natives, fever is very slight, appearing under
the form of  a headache, or disordered stomach or bowels,
and is of short  duration.
  Dysentery is also common, and in new comers very
acute.  It  is most frequent on the Gold Coast, probably
owing to the scarcity of good water.
  Complaints of less magnitude, but very troublesome,  are
the dry bellyache, prickly heat, Guinea worm, and stroke
of the sun.
  The fatal  diseases prevail mostly during  the rains, and
for some time after they have ceased.  The rainy season
begins in Senegal early  in July, and continues till the end
of October ; at Gambia, a week or  two sooner ;  at Sierra
Leone and Liberia, at the beginning  of June ;  and along
the  coast  of Guinea, about the middle  of May.   These
rains  last about four months, with  almost continual thun-
der and lightning, the  wind being generally south-west.
To the rain  season succeeds  about  a month of  fogs, with
an almost tranquil atmosphere, arising from exhalations.
This is the most noxious  season.  But for the almost daily
tornadoes, which carry before them the stagnant pestifer-
ous air in  a tumultuous  sweep, much of the coast would
probably be  uninhabitable.
  The following table exhibits the dreadful mortality that
prevails in the Gulf of Guinea, as well as at Sierra Leone. 
ON THE WESTERN SHORE  OF AFRICA.      171
Within a few years past the British government has taken
possession of the island of Fernando Po, in this gulf, and
made it the head quarters of its military establishment in
this  section of the African  coast.  The waste of life  at
Cape Coast Castle, and at other stations  along the main,
made it necessary.   Happy would it be were  this island
free  from tropical diseases.   Its commanding situation for
the suppression of the slave  trade through  the gulf, ren-
ders it a most  desirable possession for the English, who
are so heartily engaged in endeavoring to stop the traffic
in human flesh.   Would to God their noble philanthropy
were backed by other nations of Europe, instead  of being
thwarted by the French, Spanish, and Portuguese flags.
But  Fernando Po was formerly very sickly,  and it is to be
feared will  ever remain so under its new possessors.
   From Biafra south  to Cape Lopez,  and the Portuguese
and  other settlements along the coast of Loango, Congo,
Angola, and Benguela,  the salubrity of the climate varies.
St. Paul de Loango is tolerably healthy, St. Salvador the
most so in  this division of the globe, whilst Benguela is
very sickly. 
TABLE
Exhibiting the annual ratio of mortality per 1000 mean strength of British troops in the United Kingdom
  at home,—in the  Mediterranean, and in the African  Colonies,—extracted from the London  Quarterly
  Review. July, 1840.
	o be .a M ii o '3	MEDITERRANEAN.			AFRICA.				o Pi c3 Fh Cm O O IO M	C3 C CO CO w 4-3 X/l
		03	u C3 u r2	a o i—i « a to es OS n > <	a o u u 02	0 O r> a S3 aj SO U O CO &	CO o w o o 0 <+-! o CD P< 03 o	CO . ^ tM O ~ g £& CO 03 3°		
By fevers. Diseases of the lungs. " of the liver. " of the sto- ) mach and bowels. ) Epidemic cholera. Diseases of the brain. Dropsies. All other diseases.	1,4 7,7 ,4 ,8 1,2 ,7 ,3 2,8	2,9 6,0 1,1 3,6 ,8 ,4 1,5	9,3 5,3 ,4 2,1 2,2 ,5 ,3 1,4	13, 4,8 ,8 3,5 1, ,6 1,5	410,2 4,9 6, 41,3 4,3 4,3 12,	382,6 1,6 14,3 220,6 1,6 3,2 44,4	1,9 3,9 1,1 3,1 1,3 ,6 1,8	1,2 2,4 1, 2,3 ,6 ,5 .1,8	1,7 5,6 4, 10,6 1,1 2,7 ,3 1,4	2,2 3,4 4, 13,9 ,3 ,7 ,9
Total.	15,3	16,3	21,5	25,2	483,	668,3	13,7	9,8	27,4	25,4
 
SICKLY  SEASONS  IN THE  EAST INDIES.     173
                  AFRICAN ISLANDS.

 Of the Canaries, Cape de Verd Islands, the Island of St.
   Thomas, Princess, Fernando Po, St. Helena, Cape of
   Good  Hope,  Madagascar, Mascarenhas,  Mauritius,
   Eastern shores of Africa.

   The Canaries are remarkable for their healthiness.
 The  Cape de Verds are rather  unhealthy.   St. Antonio
 and  St. Nicholas are the only two islands in that cluster,
 where  strangers  are  exempted  from a general sickness
 during the rains.   These generally begin in July, and
 continue  till  November.   Sickness is particularly violent
 in the island of St. Thomas, Princess Island,  and  Fer-
 nando Po.
   In St. Helena foreigners enjoy good health.
   At the Cape of Good Hope, the settlements are fruit-
 ful, pleasant and healthy.   Passing these,  we come to the
 large island of Madagascar, where, during the rains, which
 continue  from November till March, this  island is  very
 unhealthy, particularly the Bay of St. Augustine and Fort
 Dauphin, the two places where ships commonly anchor.
   The same may be said of Mascarenhas, Mauritius, and
 the barren island of Diego Reys.
   As to the eastern shores of Africa, we shall only remark
 that  Mozambique is reckoned unhealthy ;  the country of
 Quiola much more so;  but  the city of  Maradoxa and
 Melinda are  said to be tolerably free from  disease.

                     East Indies.

   In all  parts  of the East  Indies situated near large
swamps and  the banks  of muddy  rivers and  stagnant
waters, mortal diseases are  very prevalent.
   " The English have four presidentships, or governments,
namely, Madras, Bengal, Bombay, and Bencoolen.    For-
merly Madras was the most healthy of these, but latterly
it is least so,  with the exception  of Bencoolen, which has
always been the most  sickly.    Bengal  is  very  sickly
         15* 
 174     SICKLY SEASONS  IN THE  EAST INDIES.

 during  the  rainy season, which commences in  June and
 continues till  October.  The  remainder of the year  is
 healthy.  Calcutta, belonging to  this presidentship, built
 literally on a swamp, on the east side of the Hoogly, and
 surrounded  to  this  moment by immense lakes  at a few
 miles distant, has, by the draining of that part of the city
 inhabited by Europeans, become as healthy as any country
 of the same  latitude on  earth.  There are several  other
 places in this vicinity that seem to have been made healthy
 by  being cleared, as  Fultah, Barrackpore,  Serampore,
 Chandernagore, Chinsurah.   But  other places continue
 sickly."
  Bombay is more healthy than  Bengal, and in general
 the whole coast of Malabar is  tolerably exempt  from dis-
 ease.  The same may be said of Surat and Tellicherry on
 the same coast.  The  rains begin  in May or June, and
 last four months.
  Manilla, in the island  of Laconia, is remarkable for its
 healthiness.   Tranquebar, a Danish settlement, is likewise
 healthy.  Pondicherry, the capital of the French in India,
 is far from  being unhealthy.   The  same may be said of
 Goa, the residence  of the Portuguese  viceroy  in  India.
 Batavia, the capital  of the Dutch dominions, is annually
 subject  to a fatal and consuming  sickness.  The  rains
 begin in June, and sickness in July.
  The diseases which rage  during the wet season, and for
 some time after it,  in the unhealthy parts of India, are
 malignant and bilious fevers.   Foreigners, especially such
 as live intemperately, are also subject to fluxes  and to an
 inflammation of the liver.   This last is almost peculiar to
 India, and  principally to  the Coromandel  coast.  The
 diseases of the liver are generally preceded by fever, diffi-
 cult  breathing,  and violent pain in the right side.  The
fevers of Bengal are attended with violent bilious  symp-
 toms.
  Genuine idiopathic inflammation of the liver is ten times
more prevalent on the coast of Coromandel than on the
plains of Bengal;  whilst on  the  other hand intermitting 
ON  CHOICE  OF CLIMATE,  ETC.         175
and remitting fevers are ten times more frequent in the
latter place.  This is attributed to the greater heat, being
ten degrees higher on the Coromandel coast.
 ON CHOICE OF CLIMATE, AS A REMEDY FOR CONSUMP-
   TION, WITH  DIRECTIONS  TO PATIENTS IN THEIR
   TRIAL OF IT.

   Change of climate stands at the head of remedies for
 consumption in its  first  stage, and as a palliative in  its
 second  stage.  Not that any climate  possesses  specific
 virtues in this disease, for statistics of health and mortality
 show that there is no immunity from consumption in any
 quarter of the globe.  But some climates are more salutary
 to weak and irritable lungs  than others; and experience
 shows  that persons dwelling in northern latitudes,  may,
 generally, under the advice of a physician, and with direc-
 tions how to profit by its advantages and avoid  its disad-
 vantages, derive great benefit from a change to a milder
 climate during the winter season.  My purpose is to give
 a comparative view of some of the usual places of resort.
   The  climate of the Northern and Middle States varies
 so little in  respect  to  latitude, and temperature in mid-
 winter, that a removal from one  place to another would
 promise little benefit; less, in fact, on such considerations,
 than some favored positions compared with others do in the
 same State.
   South Carolina and Georgia hold a middle rank between
 New England  and Cuba, and  have proved highly bene-
 ficial to patients from the North, who labored under chro-
 nic bronchitis, and bleeding  from the lungs,  and  also in
 cases of incipient consumption.  I have  rarely, if ever,
 been disappointed in finding the invalids, I have sent to
 those places,  benefited by the change.   Aside from the
 favorable change  of  atmospheric temperature, there is a
 satisfaction to the patient in knowing  that the facility of
 communication with those places, enables him often to hear
from home, and  to  return by land, if desirable, a  anj 
176
ON  CHOICE OF  CLIMATE
moment.   Farther south, the most eligible place is St.
Augustine, which  is resorted to by great numbers  from
the North, and in most  cases  with  decided advantage.
The accommodations for invalids are not so good as  may
be  desirable, but  they  are  undergoing  considerable im-
provement,  and all necessary comforts are obtained at a
reasonable price.   Occasionally  there are sudden changes
of  temperature, and even  severe frosts, which require
more care and circumspection on the part of invalids, than
are requisite in any of the  West India islands; less so,
however, than Carolina or Georgia.
  The West Indies are resorted to during the winter sea-
son, by invalids from all parts of the United States, partly
on  account of their intertropical and equable heat, and
partly  on account of the frequent intercourse kept up with
those   places for purposes of trade.   In the  disordered
state of the respiratory organs, which I have mentioned,
and in more advanced stages of consumption, they gener-
ally prove beneficial.   Some of them,  however, are more
eligible than others.  Jamaica,  from its size, differs  from
others, in  presenting more variety of climate and scenery.
Of all the small islands, St. Kitts for its high, and  Bar-
badoes for  its  low  land,  are  deserving  of preference.
A change of residence from  one island to another is, per-
haps,  better than remaining stationary,  affording  as  it
does the advantages of sailing, and variety and novelty of
scene.  Santa  Cruz has the  advantage of English society
and customs,  and is often  selected by invalids  from the
Northern  and  Middle States.  The thermometer  ranges
between 76° and 84° during the winter, and usually stands
at 80°.   The island being very small, its air is oceanic
and refreshing, showers are  frequent, winds gentle and
grateful;   and  exposure  to  air pleasurable  by  day and
night.   The water is not always pure  in this and many  of
the islands, rain water being the  chief supply.   Milk  is
scarce and dear;  but tropical fruits are  delicious and
abundant.
    Cuba is, however,  the more  general place of  resort for
persons laboring under  pulmonary diseases.  The country 
AS A REMEDY  FOR  CONSUMPTION.       177
around Matanzas is thronged by invalids during the winter
months.   Many of the  permanent  residents are  either
American or English, as are also the families and servants
in many of the hotels  and boarding-houses.  The climate
is mild and equable during  the winter,  but is occasionally
visited by a chill from  the north.
   The weather  in  Cuba  from November to   May,  is
uniform in its temperature, and is usually characterized by
a  pleasant and  healthful degree of dryness.  It is this,
denominated the  dry  season, which proves particularly
agreeable and beneficial to consumptive invalids.
   The rainy season, comprising  the period  from May to
October, is rather too  debilitating and  warm to be agree-
able to persons of a tuberculous habit;  and yet those who
have resided in the island for years in  succession,  do not
consider  the rainy season  calculated  to undermine the
general health, or to  exert an unfavorable influence on
tuberculous lungs.
   " There are  two  classes  of  consumptive complaints,"
said the late  lamented  Dr. Fisher, " to  whom it should be
recommended to try  Cuba.    The first class  would be
those who, in consequence of a hereditary taint,  are  pre-
disposed to the disease, and who had shown symptoms of
the existence of crude tubercles in the lungs ; and the
second class would be those  who have tuberculous deposits
in the lungs, which tubercles may have advanced  to the
state of softening — provided this state  should be confined
to one lung, while the other lung is comparatively  free
from the  disease ;  and provided also that the general tone
and functions of the digestive  and other  organs of the
body are healthy.
   " Individuals  of the  first class, by taking  up their
residence  in  Cuba before the  disease  has  advanced be-
yond  the state mentioned, and  by observing, in the most
rigid manner, the laws of health,  may live and enjoy a
comfortable  degree of health there, even to an advanced
period of life.   They should engage in some active busi-
ness which would require them to be  much in the open
air and to take constant and pleasant physical exercise. 
178           ON  CHOICE OF  CLIMATE
   " In selecting a residence in the city or in the country,
 they should be particular in securing a  dry and healthy
 one; and,  under all  circumstances,  they should  guard
 themselves  against the effects of a change of the weather
 from hot to cold, and against the debilitating and enervat-
 ing influences of the summer and rainy season.
   " This season is much less favorable to  the safety of the
 phthisical invalid, than the other portion of the year; and,
 in consequence of its depressing influence  on the  vital
 powers, it is recommended that the invalid should, as often
 as every two or three years, spend the summer months in
 a northern climate ; by doing which the system regains its
 accustomed tone and vigor, and is prepared to withstand,
 for a lengthened period,  the enfeebling influences of inter-
 tropical climate.  I became acquainted  with  many indi-
 viduals of this  class, during  my stay in  Cuba,  who had
 resided in  the  island  many years,  and who  enjoyed a
 firmer state of health at that time than they had for a long
 period previous to their leaving the United States.
   " With respect to  the second class  of  consumptive pa-
 tients who  may with advantage  visit Cuba, or  those  in
 whose lungs tubercles not only exist, but  are in the com-
 mencing process of softening, I would remark, that they
 should arrive in the island in November, or after the rainy
 season is  passed, and  remain until May ; during  which
 period they will experience and enjoy all the advantages
 of a uniform temperature of summer heat.   This season is
 usually characterized by a dry atmosphere, and a range of
 temperature from 74° to 82°.  The heat,  which otherwise
 would be oftentimes oppressive, is tempered by the  trade
 winds or sea breezes, which blow in a gentle gale from the
 east constantly  during the day.   These,  which are most
 agreeable in their effects  on the system, sometimes change
 suddenly from the east into the north, and then  sweep over
 the island, causing the mercury to fall rather suddenly in
 the thermometer as low as 68° or 65°.  This change in the
 temperature, and the peculiar chilliness of these ' Northers'
are seriously felt by the inhabitants, and  particularly by
invalids, and render a change of  clothing  and even  a fire 
AS  A REMEDY FOR  CONSUMPTION.         179
 necessary.   These winds are the only circumstances which
 render a winter's residence in Cuba  at all  disagreeable ;
 and as they are of short duration,  their unpleasant effects
 can be and should be guarded against by those whose lungs
 are invaded by tubercles, whether in a primary or a  sec-
 ondary degree.  The class of patients now under  consid-
 eration, on  arriving in Cuba, should not remain long at the
 place  of debarkation, but should seek some boarding place
 in the  country, where they can have the advantage of pure
 air, pleasant scenery, and constant exercise on horseback.
 They should make it a  rule to rise at  an early hour  and
 ride some miles every morning, taking care to return home
 before the heat of the sun becomes too  oppressive.   From
 ten o'clock  in the morning, until five in  the afternoon, they
 will find it more agreeable to remain  within  their  cool
 apartments, reading, writing,  or engaged in some pleasant
 amusements which require gentle exercise of body.  After
 five o'clock, they can exercise again by riding or walking
 until evening.  As it is  important that the patient  should
 have his mind  constantly and pleasantly occupied, so  that
 he  shall even forget that he is an invalid, I would advise
 him to engage in some  agreeable pursuits  that may divert
 his attention from  his  malady; and  especially would  I
 advise  that he should not associate with  those  who,  like
 himself, visit the island on account of pulmonary complaints.
 It is too frequently the case, that consumptive patients in
 Cuba resort in numbers to a few boarding  establishments.
 It would be much better for them if they  would not  thus
 associate.  For being together, and having nothing to oc-
 cupy their minds during  many hours in the day, they are
 naturally prone to converse on the subject of their maladies,
 and oftentimes imagine that they are rapidly passing to  the
 grave.   This very thought has an influence in depressing
 the vital powers, and in hurrying on the disorder to a more
 serious sta^e.  Patients of the  class I am now  speaking of,
 should, therefore, if  possible, often pass from one place to
 another, and remain but a short time at one boarding house.
In thus moving about the  island, they will necessarily be
much in the  open air, and take the very kind of exercise 
180
ON  CHOICE OF  CLIMATE
which is the most beneficial.   Their minds will also be oc-
cupied  by agreeable and interesting objects,  and  their
general  health  promoted.   These  consumptive  patients
should make their arrangements to leave the island in the
month of May.  Those from New England should proceed
from Cuba to some southern port, and travel leisurely, and
not reach home  till the middle or last of June, or until the
east winds are over, and summer is fairly commenced.  In
what I have  said respecting the classes of  consumptive
persons who may be recommended to visit Cuba, you will
observe that it is of great importance to the  patient that
the exact pathological state of his disease should be  deter-
mined.   Many,  very many persons, are sent to the  island
who are in  the last stages of  the disease, and whose lives
are shortened  rather than prolonged by leaving home.  No
patient, whose lungs are  more seriously diseased than has
been indicated, should leave his home and friends ; and no
medical man can be justified m recommending him to do so."

                       EUROPE.

   The climate of the south of Europe, has for ages  been
associated in the minds of medical men with relief for pul-
monary  diseases.   Marseilles, Montpelier, Hyeres, and
Toulon,  were formerly the  resort of the  afflicted.   But
these places, says a distinguished writer,  (Sweetser,) are
all liable to  cold, dry winds  from  the north and north-
west.  Hyeres,  situated  nine  miles  east, of Toulon, being
sheltered from these winds by  a range of hills,  is preferable
to the others.   The place is often selected by the  invalids
of France, but the advantages of its  climate are inferior to
those of many other places, and  would scarcely justify a
voyage to it from America or England. .
   Nice, in Piedmont, enjoys a mild,  warm climate, but for
many patients it is too exhilarating and exciting.   A lofty
range of mountains shelters it from the north wind, but dur-
ing the early spring it is unsafe on account of  the  chilling
north-east and east winds.  The atmosphere is generally clear
and somewhat dry.   The  thermometer during the coldest 
AS  A REMEDY  FOR CONSUMPTION.        181
 months seldom falls, save at night, to the freezing  point;
 and the mean temperature of winter is about 48°.   It has
 long been much frequented by the English, who are suffi.
 ciently numerous in winter to form a society by themselves.
 They reside mostly in the rear of the city, in a part more
 sheltered by the hills.   They informed me, when I  visited
 the  city in  1820, that  this  part is  decidedly better  for
 invalids.
   Genoa,  Leghorn, and Florence, are inferior to Nice as
 a winter  residence for  those who suffer from pulmonary
 affections.  They however abound in objects  of interest to
 travellers, particularly Florence,  and afford agreeable and
 che'ap accommodations.   A  few  weeks' residence late in
 the spring may prove advantageous.
   Pisa is a pleasant  city, situated on the Arno, which  di-
 vides it into two nearly equal parts. The streets are mostly
 wide and  straight, and handsomely paved.   The two most
 beautiful of them are the Lungo l'Arno, which are  broad,
 quiet, and clean, extending along the curved and  handsome
 quays, on one side  bounded by the river and guarded by a
 wall breast high, on the other lined by fine ranges of lofty
 buildings.  Silence and serenity are striking characteristics
 of this city, and its scenery is soft and varied.   There are
 many noble structures, beside the leaning tower, to denote its
 former grandeur, when it was the  capital of a great repub-
 lic, and the residence of  a hundred and fifty  thousand in-
 habitants.   It has a large English society, a  botanic gar-
 den, university, extensive library, observatory, and museum
 of natural  history.  Pisa  has long had the reputation  of
 possessing, for  consumptive patients, one  of the most fa-
 vorable climates in  Italy.   Its climate is genial, but rather
 oppressive and damp.  It is softer than that of Nice, but
 not so warm ; less  soft,  but less  oppressive  than that  of
 Rome.   For invalids who are almost confined to the house,
 or whose  power of taking exercise is much  limited, Pisa
 offers advantages over both Rome  and  Nice, or any  other
 place probably in the south of Europe ; and from what I
saw during a visit there,  I should  prefer it to any other in
a majority of cases.  Living is cheap, and the hotels and
              16 
182          ON  CHOICE OF  CLIMATE, ETC.

lodging houses are very comfortable.   The northern bank
of the river  enjoys a milder temperature during the cold
season than the opposite side, and should be  preferred by
the invalid.
  Rome.   The climate of Rome  is  mild and soft,  but
rather relaxing and oppressive;  in its physical qualities,
Sir James Clark considers  it one of the best in Italy.
One peculiarity of it, deserving notice, is the  stillness of
its atmosphere : high winds being  of rare occurrence.  To
an invalid who is anxious for tranquillity, and takes an
interest in the  fine arts and in Roman  history, no place
can be compared with  Rome.   The quiet  and solemn
majesty that  pervades the city, the melancholy grandeur
of its ruins, the pomp and solemnity of papal processions,
all have, as it were, a sedative  and tranquillizing effect on
the mind of an invalid.  Consumption in its early stages
is  generally  benefited by this  climate, especially  in  mid-
winter, and it  occurs less frequently here than in most
other  cities in the south  of  Europe, and is remarkably
chronic  in its course.    It  is also  peculiarly favorable
for . chronic  bronchitis.  The water  is  very  pure,  milk
abundant, and all the necessaries and comforts of  life are
easily  and cheaply procured.  The  pleasantest lodgings
are in  the  Piazza di Spagna, or somewhere in its  immedi-
ate vicinity.
  Naples, for  those  in health, or laboring under  slight
debility,  and who require  mental amusement  and recrea-
tion more than a mild and equable  climate, is  a delightful
residence, but for consumptives it should certainly not be
chosen for a winter  abode.   High  winds  prevail there
more  than at Rome, and those coming from the sea are at
certain seasons keen  and chilling.  1 found  during a resi-
dence  of  summer  months  that  it  is  cooler and more
equable, excepting when  the  sirocco wind from Africa
prevails, than  Rome, or almost any other  Italian  city.
This is owing to the cooling breeze from the West, which
draws  into the bay.
   Malta is not  considered  a good winter  residence for
consumptive patients. 
CONCLUDING  REMARKS.
183
              THE  WESTERN ISLANDS.
  If required to state what place of residence appears,
on the  whole,  best  suited  for  pulmonary complaints,  I
should, from  all I have  been  able  to  gather, decide in
favor of Madeira.  The  mildness of the winter and cool-
ness of  the summer, and slight difference of  temperature
between  day and night, render  it the most salubrious
climate  of the northern  hemisphere ;  " and there is no
place,"  says  Sir  James Clark,  " on the  continent of
Europe, where the pulmonary invalid could reside with so
much [advantage during the whole year."   The same
author   thinks,  that  " were  the  accommodations  for
strangers  equal at Teneriffe, and the means  of communi-
cation  between  it  and  Madeira more frequent,  many
invalids might benefit greatly by passing the winter partly
at Funchal   in  Madeira, and  partly at  Santa  Cruz in
Teneriffe, which is about four degrees further south."
  The Azores,  situated five degrees further  north,  and
further  removed from  any continent, enjoys a climate
more purely  oceanic, mild, humid, and equable, and better
suited for bronchitis, than even  Madeira.
  Comparing Madeira with  the  Canaries and Azores, we
find a gradual transition  from the humid, soft, and equable
climate  of the  Azores,  to that  of arid and  rocky Tene-
riffe, where  the want of rain during the  greater part of
the year, renders much  of the island  dry  and  sterile.
Madeira presents  an intermediate climate between  the
two, and  has the  advantage  of a  cooler summer than
either.  They all abound in tropical fruits  and vegetables
of all kinds,  in eggs  and fowls, and in  all the necessary
comforts that an invalid requires.  There is  good English
society, and  frequent communication between them  and
both the continents.
              CONCLUDING REMARKS.

  I have  ever felt sensibly the weight  of responsibility
hat  a physician incurs in deciding on the  propriety and 
184
CONCLUDING REMARKS.
expediency of a sea-voyage,  and change of climate,  in
cases of threatened consumption.   On  the  one hand  it
seems like  banishing the sufferer from home and kindred
for an  uncertain boon ;  and on the  other it  may prove a
fatal error  to  dissuade  from a trial  of perhaps  the  only
remedy that could benefit.  There  are also many other
circumstances to be weighed beside  the actual condition
of the lungs.   Ample  pecuniary means, the feelings and
habits of the individual, the  sex, taste for travelling, and
for mental improvement,  condition  and attractions  of
home, and a  variety of other considerations are  to be
taken into  account.   Granting  all these to be favorable,
what  are the  period and  circumstances  in which benefit
may be expected ?  I answer, that  when the symptoms
have  but recently begun to  declare  themselves, and are
slight, some trifling, not  very  marked disturbance  of
respiration, commencing emaciation, some cough,  bleeding
from  the  lungs, there  is  a  reasonable  hope of benefit,
even though there be  some purulent expectoration.   Life
may be protracted, and a repetition every winter  may
carry the  patient  along through the  period of life most
susceptible  to  confirmed consumption.   Again, if percus-
sion  and auscultation  show that  the  disease is limited  to
but a small portion of the  lungs, then change of climate,
and the  sailing or journeying, one  or both necessary  in
effecting it, may assist the  constitution to bear up  under
such  limited disease, and prevent  its  farther increase.
Furthermore, when the  disease is manifestly chronic in its
nature,  even  though  the disorganization of  the  lungs be
further advanced, the subject would probably be rendered
more  comfortable, and live longer, in a mild and equable
climate, than in one more  severe  and variable.   Finally,
change  of  scene, and the  buoyancy of  hope inspired by
the prospect  of travelling, will have  a salutary influence,
independently of a mere change of temperature,  and this
should induce  the  patient to  change  his residence  often,
while  absent from homo, temporarily at  least, rather than
to continue in the same city.
  Travelling itself should be so conducted by the invalid, 
CONCLUDING  REMARKS.
185
that neither  his mind or  body  be overwrought.   The
former should be amused and pleasantly excited, but not
fatigued.   "  Italy,  in a particular manner, so abounds in
objects awakening the most eager curiosity, and interest-
ing associations, that  there is  constant hazard  of undue
mental and physical exertion.   Constant sight-seeing is
wearing  to those in health, and  much  more  so to the
invalid, and may unfit the  body for quiet rest  at night.
The exercise of the body  too  should be  pleasantly ex-
citing, but never exhausting, and not suffered to encroach
on  the usual hours of sleep."   The churches  of Italy,
with the  exception of St.  Peter's, are cold and damp, and
should be avoided.
   Flannel should be worn next the skin, and thick-soled
shoes, or what  is better, shoes with  false  soles of  cork.
The patient should  always have  an overcoat at hand.   He
should avoid lofty mountains and the damps of evening —
subsist on a light and nutritious diet— should take break-
fast previous to setting out  in the morning,  and bread and
milk, or  macaroni  and fruit at noon, and  a plain  meal
about sunset, and not take a hearty one  just before sleep.
If only a predisposition to consumption exists, solid animal
food, and the light  wines, if they agree with the patient,
may  be  taken  in  moderation.    But when symptoms of
consumption are manifest,  and  especially if there  exists
any  inflammatory tendency, both  wine  and solid animal
food should in most cases be avoided.   The  best vehicle
for travelling is one's own carriage, by which the routes,
stopping  places, periods  of travelling  and rest, may be
adjusted  to the  patient's  strength  and convenience.   The
diligence travels all night, and at  a very slow pace ; the
vettura is still more objectionable.  It will be advisable to
change  the  conveyance  by land to water, as  often as
convenient.
   Pulmonary invalids should bear in mind the advantages
of sailino- over  those of land travelling.   The vicissitudes
of heat  and  cold  are  less  during the  twenty-four hours,
the rolling of the  vessel produces a sedative effect upon
the pulse and lessens  inflammation, the  fumes of tar
           16* 
186
CONCLUDING REMARKS.
emanating from the seams and cordage of the ship, acting
upon  the secretions in the lungs, improve the expectora-
tion, various kinds of bodily and mental excitement  are
excluded; and on the  whole, so  far as my observation
has extended, patients,  if not annoyed  by sea-sickness,
will, in a majority of  cases, find themselves benefited
during their outward bound passage.
  Invalids  who go to tropical climates  during the winter,
should in most  cases return  during  the  summer season.
They  should not return  direct to New England,  till after
the month  of May; they would do better to land at a
southern port and approach the north gradually.  I have
known many persons complain of increased cough, and
sometimes have bleeding at  the  lungs the  moment they
arrived on soundings, if  previous to the first of June. 
APPENDIX.
TABLE OF WEIGHTS AND MEASURES EMPLOYED
                   IN MEDICINE.
A pound, lb. j
An ounce, § j
A drachm, 3 j
A scruple, 9 j

The gallon,
The pint,
The fluid ounce,
The fluid drachm,
contains
contains
J
12 ounces,   §  xij
 8 drachms,  3  viij
 3 scruples,  3   iij
20 grains,   gr.  xx

  f eight pints,
 J sixteen ounces,
  j eight drachms,
  [ sixty drops.
   When medicines are directed in the quantities of a table-
spoonful and a tea-spoonful, it is to be understood that the
spoons are of middling .size, the former equalling about half
a fluid ounce, and the latter a fluid drachm.
   Sixty drops of water, one hundred drops of spirits and
tinctures, and  one hundred and twenty of  alcohol, are
equal to a drachm by measure.
   The doses prescribed in this book, are intended for male
adults.   Boys from fourteen to eighteen are  to take only
three-fourths  the quantity;  from ten to thirteen or  four-
teen, one-half only.
              MEDICINE  CHESTS.

   There is no part of the supplies of a merchant vessel in
which such want of system exists, as in the medicine chest.
It is true that  there  is a medicine chest on board each
vessel over a certain size, and that there are  medicines in
it, and this answers all the requirements of the law.  Bat 
188
APPENDIX.
let a physician, who is acquainted with the medical wants of
seamen,  examine the chest, and he will report that bulky
articles of trifling cost  occupy most of the  room, to the
exclusion of  other articles, absolutely  necessary in case
of sickness.   The  reason offered for  this, when  the
apothecary is not afraid of offending his customers by giv-
ing it, is, that owners, from being in the habit of obtaining
chests for certain  sums, are unwilling to  give more at the
suggestion of an  apothecary;  and that it  is  necessary
for  the chest  to  exhibit  large  quantities of medicine  in
order to give satisfaction.  It would, however,  be incon-
sistent with  the fair  and humane character of  Ameri-
can  merchants,  to withhold their consent to any improve-
ment suggested  by a disinterested person, acquainted with
nautical  diseases.
  But the impositions most to be complained of are prac-
tised by foreign apothecaries, who not only put  up wrong
proportions and  unnecessary kinds, but cheat in the price
and quality of the articles.
  To correct  such abuses and make medicine chests more
uniform  throughout the merchant  service,  the  following
list of articles is made out, with the proportions and quan-
tity  necessary for each, according to the size of the vessel,
and also the ordinary prices in the seaports of the United
States.  To this list is prefixed the law,  &c. 
APPENDIX.
189
     THE LAW RELATING TO MEDICINE  CHESTS.
   " Every vessel of one hundred and fifty tons or upwards, navi-
 gated by ten or more persons in all, and bound on a voyage beyond
 the  United States, and  every vessel of seveaty-five tons or  up-
• wards, navigated by six  or more persons in the  whole,  and bound
 from the United States to any port in the  West Indies, is required
 to have  a  chest of medicines, put up by an apothecary of known
 reputation, and accompanied by directions for  administering  the
 same.    The chest must also be examined at least once a year, and
 supplied with fresh medicines.
   " In ease of dispute, the owner must prove the sufficiency of  the
 medicine chest.  It  does not lie with the  seaman to  prove its  in-
 sufficiency.
   "If a  vessel has  a suitable medicine  chest on board, it  would
 seem that the ship  is not to  be charged with the  medicines and
 medical  advice which a  seaman may need.  But  the ship is still
 liable  for  the  expenses of  his  nursing,  care,  diet,  and lodging.
 Accordingly, if a seaman is put on shore  at a hospital or elsewhere,
 for his cure, the ship is chargeable with so  much of the expense as
 is incurred for nursing, care,  diet,  and lodging ; and  unless  the
 owner can specify the items of the charge,  and show how much was
 for medical advice, and how much for ether expenses, he must pay
 the  whole.   The seaman is to be cured, at  the expense of the ship,
 of a sickness or injury sustained in the ship's service; but if he con-
 tracts a disease by his own fault or vices, the ship is not chargeable.
 A sick seaman is entitled to proper  nursing, lodging, and diet.   If
 these cannot be had, or are not furnished on  board the  vessel,  he
 is entitled to be taken on shore to a hospital, or to some place where
 these can be obtained.   It is often  attempted to be shown, that  the
 seaman was put on shore at  his own  request.  This is no defence.
 He is entitled  to be put on shore if his disease requires it; and it is
 seldom that proper care can be taken of a seaman on board ship.
  " If a seaman requires further medicines and medical advice than
 the chest and  directions can give, and is  not  sent ashore, it would
 seem that the  ship ought to bear the  expense; but this  point has
 never been decided.  If the medicine chest can furnish all he needs,
the ship  is exempted."—Dana's Seaman's Friend. 
                           CONTENTS OF  A MEDICINE  CHEST.
PROPORTIONS ACCORDING TO THE NUMBER  OF PERSONS IN A  SHIP,  AND THE FAIR PRICE OF EACH MEDICINE.
to
o
NO.	NAMES.	Fron lb.	16 to 40 men. oz. $ cts.		
~1	Alum. Ammonia. See Hartshorn.		4		6
2	Antimony (or Tartar Emet-ic), in 4 grain powders, for emetics and solutions ;	1			
	also for cough and fever	>			35
	mixtures, &c. No. 50, 30,				
	and 20, according to No.				
	of men.	J			
3	Balsam Copaiva.		8		60
4	Blister Plaster. (In roll.)		6		55
5	Blue Pill. (In mass.)		4		35
6	Blue Vitriol.		h		4
7	Calomel Pills,2 grs.each.No.	I		1	50
	200, 100, 80. (Tin box.)				
8	Calomel.		1		20
9	Calomel & Jalap Powders,10	}			50
	grs. each, No. 40, 25, 10.				
10	Camomile Flowers. (Box.)		8		30
11	Castor Oil.	1			30
12	Camphor, Spts.	1			50
13|	Caustic.		j i		25
From 8 to lb- men,
lb.  oz.   $  cts.
25
Less than 8 men.
lb. oz.  $  cts.
15
DOSES INTERNALLY GIVEN.
4 grs. of powder, made into a pill.
f Dissolve each in 4 table-spoonfuls  of
( warm water.
20 drops on sugar or water.


One pill for syphilis; four as a cathartic.
  As an emetic in case of swallowed poi-
  son, 15 grs. in a glass of water.

1 or 2, morning and evening, insyphilis.

  20 to 30 grs. for a cathartic in malig-
  nant fevers, and cholera of India, and
  the West Indies, and Africa.
One to three table-spoonfuls.
A tea-spoonful. 
NOTES AND DIRECTIONS CONCERNING  EACH MEDICINE.
No. 1 Is chiefly useful externally to stop bleeding, and for fungous ulcers; for gargles for sore  throat, by  dissolving a tea-spoonful in a tum-
       bler of water.  Internally, in obstinate diarrhoea, in pills.

    2 As an emetic take one table-spoooful every 15 minutes, until  it vomits.  In lung fever and pleurisy, and other high inflammations, two
       tea-spoonfuls.  In coughs and fevers, one tea-spoonful.  See  " Pectoral" and " Cooling Mixture," in the Appendix.
Balsam Copaiva, given chiefly for gonorrhoea, and gleet; dose 20 drops, three times a day, dropped on the surface of a glass of water, or
  into sugar.  It is good in piles.
Useful in local pains and inflammations, particularly about tho lungs ;  may  be spread on cloth or leather, very  thin, and applied near
  the part affected, and allowed to remain twelve hours.
Useful in biliary obstructions, especially after having had bilious fevers in tropical climates.  Also in syphilis, morning and evening, in   ►£
doses of 3 or 4 grs.  When taken as a cathartic, it should be followed soon after with other physic to assist its operation
May be taken night and morning, in cases of syphilis that absolutely require it.  Most recent cases can be cured without mercury.
In the fevers and fluxes of India, Western Africa, and the West Indies, large  doses  of 10 to 20 grains are given at the onset of the dis-
  ease, and salivation is hastened by frequent small doses.
Useful to touch old ulcers with;  a solution of it may be drawn into the nose when bleeding ; sometimes given as an emetic.                 ^
Given when very strong cathartics are required, as in brain fever, and commencing jaundice.
Useful in a recovery from fever, and in other cases of debility.  Made like other herb teas.
Several extra bottles of this should be taken on long voyages.  A tin canister is safer at sea.
The gum loses fast by evaporation.   It is best to mix it in less spirit than will dissolve it. and replenish the bottle with spirit.  It is a
  useful medicine in typhus fever, and for colics.  Also for liniments, for rheumatism, mixed with olive oil and ammonia, equal parts.
13 This is chiefly used to touch chancres with.
CO 
16
 14 Cream of Tartar.  (In box.)

 15 Dover's Powders (made into
      pills), 4 grs. each.   Nos.
      230, 115, 60.
    Elixir Vitriol.  (Glass stop-
      per.)

 17 Flax Seed.   (In box.)

 18 Gentian, in coarse powder.
      (Box, or jar, or paper.)
 19 Gum Arabic.
 20 Hartshorn, Spirits of.
 21 Iodide of Potash.
 22 Ipecac, in  emetics,  20 grs.
      each.   Nos.  24,  16, 10,
      according  to  the  size of
      the  chest.
 23 Laudanum.
 24 Mustard, 4 boxes, £ lb. each
      Do.      do.    2   do.
 25 Nitre Sal, powdered.

26 Nitre,  Sweet Spirits of.

27 Ointment, simple.
28 Ointment, Mercurial.
From 16
 lb.  oz
TABLE CONTINUED.
to 40 men. $ cts.		From 8 to 16 men. lb. oz. $ cts.			
	30		8		17
1	25				70
	10		4		10
	20	li			17
	17		8		
	17 40 40		2 8 1		10 25 40
	60				40
	40		6		30
	88 17		6		44 10
	40		8		25
	38 45	1	4		38 30
Less than 8 men.
lb.  oz   $ cts.
to
to
20
20
20
DOSES GIVEN INTERNALLY.
 | A tea-spoonful or two in water or mo-
 \ lasses.

 (1  pill in fever,  and for coughs and
 \ colds, and 2 or 3 in rheumatism, every
 (four hours.

8 to 10 drops in a gill of sugared water.
  A tea-spoonful to a quart of water for
  teas.

 ' A table-spoonful to a pin£ of hot water,
  and boiled 20 minutes.
The same as flaxseed.
10 drops in water.
Dose 4 or 5 grains, twice a day, in water.

 f The best emetic is half of an Ipecac,
 ( and half of a Tartar emetic dose mixed.
30 to 80 or 100 drops.
', 5 to 10 grains in half a gill of water ; in
 fevers and scurvy, every 3 or 4 hours.
 A tea-spoonful in a wine-glass of water
 in fevers. 
NOTES AND DIRECTIONS.
No.14 Cream of Tartar makes a cooling beverage in fevers;  useful laxative mixed with sulphur.  Dose a tea-spoonful.
15
Dover's Powder is very Improperly omitted in many medicine chests.   It is very useful in rheumatism, and severe colds and pleurisies,
  and in typhus fevers.   Dose 1 pill, and for rheumatism 2 or 3 pills every four hours, and especially at bed-time.  If desired, to give
  with calomel or camphor, the pill may be mashed into a powder.
Elixir Vitriol is valuable in the decline  of fever, and in  typhus fever when the stomach can bear it.  10 grains of nitre added to 10
  drops, is excellent in scurvy.  A drop of it added to quinine and water, dissolves the former.  The vitriol phial should have a ground
  glass stopper.
17 Excellent in coughs, lung fever, clap, catarrh, and for boiling with meal or pounded bread for poultices.

18 Gentian may be made into decoction like quassia; is useful as a tonic ;  steeped in spirit with orange peel, it makes a good bitter.

19 Gum Arabic, same as flax-seed tea in preparing and using

20
Hartshorn mixed with sweet or sperm oil, and shaken, makes a good  liniment for rheumatism ; adding spirits of camphor, makes it
  opodeldoc.  Good to apply in sore throat and old sprains.
Iodide of Potassium ; is useful in old venereal eruptions and swellings, and ulcers.
Ipecac is better as a common emetic than tartar emetic, but a mixture of the two is still better.  Useful in the beginning of all fevers,
  excepting, perhaps, the yellow fever.  Mix in a gill of water, and take half at a time, waiting 20 minutes between.
Laudanum may be replenished by an ounce of opium to a pint of spirit, and letting it steep 10 days.
There is great deception in mustard.  Inquire for Underwood's superior.  The smaller vessels can be supplied from ships' stores.
Nitre is useful in all fevers, and in some inflammations ;  10 grains dissolved in water, or half an even tea-spoonful; the same mixed with
  10 drops of elixir vitriol or other acid is useful in scurvy.

Spirits of Nitre, given in fevers and gonorrhoea, colds and dropsy.
Made easily on board by melting spermaceti, olive oil, and beeswax together.
Mercurial ointment is apt to separate in hot weather, which  may be prevented by inverting the vessel every few days.  Used to assist in
  raising mercurial action, the bulk of a nutmeg to be rubbed inside the thighs.
to
CO 
						rABLE CONTINUED.				
NO.	NAMES.	From 16 to 40 men. lb oz. $ cts.				From 8 to 16 lb. oz. $			men. cts.	Les lb.
29	Opium.		1		45.		h		25	
30 31	Paregoric. Pearl Barley.	1 H			38 20	1	8		25 16	h
32 33	Peppermint, Essence of. Quinine Pills, made with conserve of roses, 2 grains each. No. 60, 40, 30, ac-cording to No. of crew.	1 f	8		23 90		6		20 70	
34	Rhubarb, Tincture of.	l			40		8		22	
35	Salts, Epsom.	2			18	2			18	1
36 37 38	Soda, Supercarbonate of. Squills, Syrup of. Strengthening Plaster. (In roll.)	1 1 }	8		25 35 25		8 8 6		17 24 20	
39	Sugar of Lead.		6		15		3		8	
40	Sulphur, Flour of	1			20	1			20	
41	Tartaric Acid. Tartar Emetic. (See Anti-mony.)	2		1	25	1			67	
42	White Vitriol.		6		15		2		6	
	Total Price.			$17	11		$11		24	

than 8 men.
 oz.   $> cts.
50
DOSES GIVEN INTERNALLY.
Two grains, or one small sized pill.
  A tea-spoonful to two  or  three  in a
  wine-glass of tea or water.
  A table-spoonful  to a quart of water,
  boiled an hour.
Dose 30 drops.


  Dose 1 or 2 pills  as a  tonic,—but in
  intermittents 3 to 5 pills.


1 to 2 table-spoonfuls, as a cathartic.
1 to 2 table-spoonfuls.
  Haifa tea-spoonful in a glass of cold
  water.
A tea-spoonful in coughs and dropsy.
  2 to 3 grains mixed with jelly, in long,
  protracted  diarrhoea.  1  grain  to  an
  ounce of water for eye-wash.
2 or three tea-spoonfuls in molasses.
  Half a tea-spoonful with as much soda,
  to make soda-water ; the same quantity
  in scurvy.
     (10 to 15 grains as an emetic; 4 grains
  3 I | as an eye-wash ; or 2 of this and 2 of
     (lead in half a pint of water.

~60l 
NOTES AND DIRECTIONS.
No.29jUsefu) in pain, in toothache, but not in headache.  Tn all severe colics it should be given freely at first.  Useful in rheumatism.
30 Paregoric, mixed with an equal quantity of antimonial wine, is good in coughs and colds.   See Pectoral Mixture.

SljPearl Barley requires long boiling; it is useful in bowel complaints, fevers, coughs, and colds.
Is less used than formerly, and might be left out of the chest.
33
Quinine  should, for small vessels, be  made into pills of 2 grains each.  It is prepared for taking by putting 40 grains into as many table-
  spoonfuls of water in a phial, anil adding 4 or 5 drops of elixir vitriol.  A table-spoonful is a dose of 2 grains.   Quinine pills • one pill
  as a tonic, and two every six hours in intermittents.
Rhubarb, tincture of, is good in chronic diarrhoea, in tea spoonful doses.  As a cathartic in 1 to 2 table-spoonfuls                             £
There should be at least 50 lbs. of salts, extra, on board whale ships, kept in a pail or box, to replenish the bottle.
Soda, supercarbonate, is useful for acid s'omach ; with equal quantity of tartaric acid, it makes soda powders.                               &
Squills is useful in coughs, but its place might well be supplied by syrup or molasses, with sharp vinegar and the juice of garlic or onions
--      X
Strerg'heuing plasters are useful in weakness of the back.
Lead, some imes called acetate of lead, or sacl.arum saturni, is useful in bleeding at the lungs and  the bowels; dose 2 to 3 grains rolled
  iuto a pill with crumbs of bread ;  applied externally in inflammations.
Sulphur is useful in piles, and in salivation ; also io itch ointments.
Useful in scurvy as a beverage;  with soda, it makes soda powders.
White Vitriol, 2 grains, with sugar of lead, 2 grains, and 6 ounces of rain or  soft water, makes a good wash in  inflammation of the eye,
  and a good injection in gonomioea   A tet-spnuuful  dissolved in half a pint of warm water is a good emetic for ejecting  poison from
  the stomach.  It will also stop fjr a time alarming bleedings from the lungs,  when other medicines fail. 
196
APPENDIX.
INSTRUMENTS,  UTENSILS, DRESSINGS,  &c.

ARTICLES PROPORTIONED TO  THE NUMBER OF THE CREW.
		$ c.		$ c.		$ c.
Lancets.	No. 2	50	No. 2	50	No. 1	25
Penis Syringes.	2	25	2	25	1	13
Bougies, small size.	3	36	2	25	2	25
Gum Elastic Catheter.	2	50	1	25		
Clyster Syringe, 12 oz.	1	75	1	75		
Cotton Bandages, 12 ^						
feet long, 3 inches >	6	36	3	18	2	12
wide. )						
Patent Lint.	4 oz.	25	2 oz.	15	1 oz.	8
Clean Hags.	lib.	17	4 lb.	10	Jib.	6
Cotton Batting, for}						
burns, and for dress- >	1 lb.	20	£lb.	12		
ings. >						
Adhesive Plaster, spread.	lyd.	36	iyd.	20	|vd.	12
Sheep skin, for plasters.	No. 1	25	a	15	i"	10
Splints, for fractures.	No. 5	50	4	40	2	20
Tooth drawer.		1,00	1	1,00		
Curved Needles, and ) Waxed Threads. )						
	No. 2	20	2	20		
Scales and Weights.		1,00		1,00		
1 Field Tourniquet.		25		25		
Spare phials, with corks.	No. 4	20	3	15		
Spatula.		15		15		
Graduated Glass.		15		15		
Medicine Chest and) Furniture. j						
		4,00		4,00		2,00
		11,40		10,20		3,31
Medicines.		17,11		11,24		6,60
$28,51       $21,44       |9^T
                    HOSPITAL STORES.

,n^0'2 l^; Lemon Juice; Chloride of Lime, in a bucket, say
30 lbs., 20 lbs., 10 lbs., according to the size of vessel.  Also, Wine;
lea; and Sugar; and Fowls.  Also, Opodeldoc, 1 doz. bottles 
APPENDIX.
197
   PREPARATIONS OF MEDICLNES AND DRINKS.
            DECOCTIONS, TEAS, GEUEL, &c.
  Decoction of  Gentian.  Take of gentian in powder one
ounce, water one pint and a half.  Put the gentian into a
tin pot, and pour the water on it heated.   Cover the vessel
and boil for ten  minutes.
  This decoction is given in all cases where a bitter tonic
in considerable  quantities is requisite.   The dose is from
two to four table-spoonfuls.

  Decoction of  Oak, Peruvian, and Cascarilla Bark, and
of Nutgalls, may be made in the same manner.

  Barley-water.   Take of pearl barley three table-spoon-
fuls.   First  wash the barley from the mealy matter that
adheres to it, with some  cold  water; then boil  it a little
with about half a pint of water, to  extract the  coloring
matter.  Throw this away, and put the barley thus purified
into five pints of boiling water ;  which is to be boiled down
to four pints  and  strained.   This  decoction is to be used
freely, as a diluting  drink in fevers and inflammatory com-
plaints.
  Flax-seed  tea.  Take of flax-seed  or linseed, whole or
powdered,  two table-spoonfuls.   Water, three pints.  Boil
one hour and strain.   This is  an excellent  drink, in cases
of clap or  other inflammation in the urinary passages,  and
also for coughs and other inflammations.   It may be ren-
dered agreeable by sugar and lemon-juice.

  Directions for making arrow-root, also water-gruel, from
oat-meal, four,  or Indian-meal.    Take  two large table-
spoonfuls of either of the above  articles.   Water, half a
gallon.  While  the water is heating, rub the flour or meal,
&c, in half a pint of cold water, adding a little at a time,
then mix it with the hot water, stirring it at the same time,
and boil fifteen minutes to half an  hour.

  Toast-water.   This is made  by steeping slices of  soft
fresh bread in water, first toasting the bread till browned
           17* 
198
APPENDIX.
thoroughly, and then putting it into  the water  while  hot.
When soft bread cannot be had, the hard kind must answer.
                     SOLUTIONS.

  Solution of Cream of Tartar.   To an  ounce of cream
of tartar, pour one quart of hot water, to which add a little
loaf sugar.   This is an agreeable beverage in fevers  and
inflammations, and is a mild purgative.   It may  be  ren-
dered still more agreeable by the addition of a little orange
peel.
  Lime-water.   Take of quick-lime, half a  pound, water
three  pints ; mix and cover the vessel for three hours, occa-
sionally shaking it; then pour off the liquor and keep it in
a vessel  closely stopped.   Its dose is from  one-eighth to
one-fourth of a pint.

  Solution of Alum, or Alum-water.  Dissolve one drachm
of alum in half a pint of water.

  Solution of Sugar of Lead, or Lead-water.    Dissolve
ten grains of sugar of lead in half a pint of water.  This
makes a good eye-water, and wash.

   Tar-water.  Take of tar one  pint, water one gallon.
Boil them together fifteen minutes, frequently stirring them.
Afterwards pour off the water for use.   This is a valuable
application for the piles.
                     MIXTURES.

   Cooling mixture.   Take of Epsom salts one ounce and
a half, nitre twenty grains, tartar emetic four grains; mix
in one pint of water.   This is a cooling  laxative or mild
purgative, and may be given in doses of from one to three
table-spoonfuls, every hour or two.

  Pectoral or  Cough mixture.   Take  of paregoric two
parts, syrup of squills and solution of  antimony, of each, 
APPENDIX.
199
one part, mixed.  This is an excellent mixture for a cough,
and  may be taken  in doses of two tea-spoonfuls on going
to bed, accompanied by a large draught of flax-seed tea,
or crust-water sweetened.

   Chalk mixture.  Take of prepared chalk, or common
chalk, finely powdered, two table-spoonfuls, loaf sugar  a
table-spoonful, gum  arabic in  powder  two table-spoonfuls,
water one pint; rub them well together till they resemble
thick cream ; add two tea-spoonfuls of laudanum.    Dose,
a wine-glass every half hour in cholera-morbus.

   Effervescing mixture.   Dissolve  salts of tartar, half a
tea-spoonful in two  table-spoonfuls of pure  water.   Then
add lemon-juice, half a table-spoonful, and take it while  it
effervesces.  This is valuable in some fevers.

   Dover's powders.  This powder will be found already
prepared at the apothecaries' shops, where it should be put
up in doses of fifteen grains each.  It may be mixed and
taken in warm tea.   It is useful in some cases  of  fever,
rheumatisms and   other  inflammations.   When   taken,
large draughts of warm tea or other diluting drinks should
accompany it.

   Emetics, directions for taking.    Mix  the ipecac, or
the tartar emetic powder, in  four table-spoonfuls of warm
water, and take one of them.  A table-spoonful  of the
remainder is to be taken  every  ten minutes till vomiting is
induced.   After vomiting has  commenced, warm water is
to be  drank  freely  after each  operation.   Should the
vomiting  continue  too long, its  operation may be turned
downward by  a draught of warm  salt-water.    Should
cramp of the  stomach ensue, flannels dipped in  hot water
are  to be  applied over it, and  twenty or  thirty drops  of
laudanum given.
   Cathartics or  Purges, directions for  taking.  Salts
may be taken in dose of two table-spoonfuls, dissolved in
half a pint of warm water. 
200
APPENDIX.
   Castor Oil, in dose of two table-spoonfuls.

   Calomel and Jalap may be mixed in syrup or molasses
in a table-spoon.

   Blistering plaster.  Spread the plaster nearly as thin
as a wafer, on soft leather, four or five inches square, and
apply to the  side, neck or other  part, previously rubbing
it  with spirit or vinegar.   After remaining  on twelve
hours, or till  the blister  is drawn, the water  is to be let
out, and  a plaster  of basilicon, or  of simple  ointment,
applied.
   The blister plaster should be preserved for use a second
or third time.
            CATAPLASMS  OR POULTICES.

   Mustard poultice.  Take pounded bread, with a small
 proportion of pounded flax-seed, boil ten or fifteen  min-
 utes, and spread it on  rags  nearly an inch thick, to cover
 the  soles of the  feet;  then sprinkle on the  powder of
 mustard-seed, and apply as  warm as the patient can bear.
   Emollient poultice for sores and inflammations.  Take
 of Indian meal,  or  pounded bread, and powder  of  flax-
 seed  or  common flour, equal parts, boil them together,
 and spread the mixture  more than half an inch thick on
 rags, and apply them  warm.  They should be renewed
 every three or four hours.

   To preserve  eggs at sea.  Say  about  one hundred
 dozen.   One bushel  of stone lime, when  slacked,  one
 pound cream tartar, one  quart of fine  salt.  Mix these
 with  water  until the mass  comes  to the consistency of
 thick cream;  have your cask tight, cover the  bottom of
 it with this material, and then place  the  eggs on the end ;
 after  having laid one  tier,  cover them with the mixture
 and place another tier.  This will preserve  eggs  good a
year.  The  cask should be  inverted once in  two or three
weeks, to keep the yolk from settling down so as to touch
 the shell. 
APPENDIX.
201
 _ Milk,  how to preserve at sea.   Provide a quantity of
pint or quart bottles, (new ones are best;) they must be
perfectly sweet and  clean, and perfectly dry before they
are used.  Instead  of drawing the milk from a cow into
the pail,  as usual, it  is to be milked into the bottles.   As
soon as any of them are filled sufficiently  they should be
immediately corked  with the best  kind  of  new corks,  in
order to keep out  the external air, and  fastened  tight
with packthread or wire.   Then  on the bottom of an iron
or copper boiler spread a little straw; on that lay a row of
the bottles, and  some  straw between,  to  prevent  their
breaking; and  a layer of straw over them,  to be covered
with another layer of bottles, till the boiler is nearly filled;
then fill  with  cold water, and  gradually  apply heat till
it begins to  boil, when the fire is to be withdrawn.   The
bottles must remain undisturbed till quite cool, then taken
out and  packed in hampers with straw or saw-dust, and
stowed in the  coolest part  of  the  ship.  Milk thus pre-
served may cross the Atlantic and return as sweet  as
when first drawn from the cow.   \_N. E. Farmer, 1835.

   For making  spruce   beer.    Take  three  gallons  ol
water, blood warm,  1^ pints of molasses, 1 table-spoon of
essence of spruce, 1 do.  of ginger.  Mix well together,
and add  one gill of yeast.   Let it  stand over night and
bottle it in the morning.

   To preserve cabbages, $-c, fresh  during a voyage.   Cut
the cabbage so as to leave about two inches or more of the
stem attached  to  it; after which  scoop out the pith to
about the depth of an inch, taking care not to wound or
bruise  the  rind.  Suspend the cabbages  by means of
a cord tied round the stem, so that that portion of it from
which the pith is taken, remain uppermost, which regularly
fill  every morning  with fresh  water.  By this simple
method,  cabbages, cauliflowers,  &c,  may be preserved
fresh during a long voyage.

  Inebig's portable soup.  Take four pounds of lean beef
free of fat, and separated from the  bones; chop it fine like
             17 
202
APPENDIX.
sausage meat, mix it with two quarts of cold water, warm
it very slowly until it boils briskly one minute ; then strain
it through a towel.  Evaporate the fluid by placing it in a
pan over a kettle of hot water  or sand  until moisture  is
entirely dissipated.   It is then cut in pieces and inclosed
in a tin box for preservation on long sea voyages.  A piece
of this  as large as a cent,  boiled  in a pint and a half of
water,  and seasoned  and thickened to suit the patient's
taste or condition, is highly recommended.*
                  CHLORIDE OF LIME.

   This disinfectant  and  purifier of both air  and water,
 should be supplied for every vessel, large and small, more
 especially if destined to warm latitudes.
   Chloride of lime  is a grayish-white powder, varying  in
 strength, and becoming moist by exposure to air.   When
 very pure, it is  nearly all soluble  in water, and  may be
 sprinkled upon the floor of any foul apartment, when it will
 soon remove offensive  smells arising from animal  or vege-
 table putrefaction.   The addition of a small quantity  of
 diluted sulphuric acid will  evolve its virtues with double
 rapidity.   To one gallon of water, add a pint of bleaching
 powder and  one ounce of elixir vitriol, and  it will be of a
 proper  strength for  correcting the putrid smells  of apart-
 ments,  and  of  animal putridity.   The  same effect  will
 result without the acid, but will require more time.  It is
 much used in privies and docks, where  the powder itself
 may be sprinkled.   The solution may be sprinkled between
 the  timbers in the hold of a ship, and on the berth-deck,
 on  hammocks  and  in berths.    Foul ulcers and wounds
may have their dressings wet, and it may be sprinkled on
the  surface of a dead body which it is desirable to pre-

  * An article called portable soup is sold in the shops, being in pieces
shaped like a dollar, only being thicker, and resembles common  slue ■
being in fact somewhat akin to it in its nature, excepting that clue is
made of tainted scraps of sheepskins, sinews and ligaments, boiled along
time and strained, and then evaporated to hardness.  Common portable
soup 1 have often tried on board ships of war, but was never satisfied with
it. it very soon offends the stomach. 
APPENDIX.
203
serve on board for interment on shore, or some of the pow-
der may be thrown into the coffin.
  It  may be  advantageously used for purifying  offensive
water, a property which makes  it invaluable in long voy-
ages.  For this purpose, from  one  to  two ounces of the
powder may  be  mixed in sixty-five  gallons  of  water.
After  the  purification  is  effected,  the  water  must  be
exposed for some time to the air, and  allowed  to settle
before it is fit to drink.
  The  best way  to carry chloride of lime is in covered
buckets.
                    FUMIGATIONS.
   The forecastle and  other lodging apartments of a mer-
chant vessel  should be fumigated as often as practicable,
and especially in hot climates.   One of the most simple is
the
   Vinegar fumigation.   Immerse a hot iron in vinegar,
at the same time closing the hatches.
   Another.  Sulphuric acid, or oil of vitriol, sal nitre, or
saltpetre, of each one  ounce.

   This quantity is  sufficient for an apartment twenty feet
square.
   The sulphuric  acid is  placed in a glass or china vessel,
and the nitre gradually added: in order to have an abun-
dant extrication of nitrous fumes, it is necessary to raise the
temperature  of the  acid by means  of a lamp, or by placing
it on hot sand.
   This air may be  respired with perfect safety, and even
with advantage in  fevers; it should therefore always be
preferred where the sick remain in the room.
   On the whole,  decidedly the best agent for  destroying
infections and  bad odors, with which I am  acquainted, is
the solution  of nitrate of lead, sold under the name of
Ledoyen's disinfecting fluid.   Unlike the chlorides, it has
no unpleasant smell  of its own, while a few tea-spoonfuls, 
204
APPENDIX.
sprinkled about in a room, will immediately decompose the
floating effluvia in the atmosphere, and  not  only destroy
the unpleasant odor, but seem to spread a cleansing and
purifying influence which is delightful and  healthy.  It is
somewhat more expensive than the chloride of lime ;  but
much more  real disinfecting power is contained in the
same bulk.   It comes in bottles of one  or two pints, and
may be had at most of  the  apothecaries.  Every vessel
carrying many passengers should be provided with it.
   Chloride of lime  sprinkled on  the floor of the apart-
ments will remove unpleasant effluvia.
                    VACCINATION.

  Every captain bound on a long voyage, should see that
his men are secured, before sailing, against small pox.
  If he chooses, he can vaccinate them after leaving port,
but in taking virus with him for this purpose, he should
remember that it will not keep on quill points at sea but a
very few days.   A piece of scab hermetically sealed in a
glass  bulb  or very small phial may keep three months.
Signs of vaccination having taken, will be apparent about
the fifth day. 
APPENDIX.
205
                UNITED STATES LAW
Requiring the Ventilation of Passenger Vessels, and for other Pur-
  poses —passed May 17,1848.

   Section 1. Vessels having sufficient capacity according to
law, for fifty or more passengers, (other than cabin passen-
gers,) shall, in voyages between the United States  and
Europe, have on the upper deck for their use a house over
the  passage-way leading to  their apartment  below deck,
firmly secured to the deck or combings of the hatch, with
two doors, the sills of which shall be at least one foot above
the deck, so constructed that one door or window in such
house may at all times be left open for ventilation ; and all
vessels having the capacity  to carry one hundred and fifty
such passengers or more, shall have two such houses ; and
the stairs or ladder leading  down shall be furnished with
a hand-rail of wood or  strong  rope.   Booby hatches may
be substituted for such houses in vessels having three  per-
manent decks.
   2. Such vessels having the legal capacity for more than
one hundred such passengers, shall have at least  two ven-
tilators to purify the apartments occupied by such passen-
gers, one aft and the other forward, leading into the  apart-
ments ; one of them shall have an exhausting cap  to carry
off the foul air, and the other a receiving cap to  carry down
the fresh air ; which said ventilators shall have a  capacity
proportioned to the size of the apartments to be purified —
that is, for  two hundred passengers it shall  be twelve
inches diameter, and so in proportion to larger or smaller
apartments ; and shall rise  at least  four  feet six inches
above the  upper  deck.  Other modes of ventilation of
equal  efficacy shall be  deemed  a  compliance with  this
section.
   3.  Such vessel shall have  one  caboose or  cooking
range equal to four feet long and one foot six inches wide,
for every two hundred passengers, and in this proportion
for a greater or less number of them.
  4. Also, on  leaving port, for each passenger  at least
fifteen pounds of good  navy bread, ten pounds  of rice,
         18 
206
APPENDIX.
ten pounds  of oatmeal, ten pounds of wheat  flour,  ten
pounds of peas and beans,  thirty-five  pounds of potatoes,
one  pint of  vinegar,  sixty  gallons of  fresh water,  ten
pounds of good salted  pork, and a sufficient supply of  fuel
for cooking ; and where any one or more of the specified
articles cannot be conveniently had, an equal quantity of
the others may be substituted therefor;  and one pound of
either of said articles may be  substituted for potatoes ;
one-tenth of the aforesaid provisions to be delivered week-
ly, commencing  on  the  day of sailing, and  daily at least
three quarts of water,  and sufficient fuel for cooking;  and
if the ship sails without the  above amount of supplies,  and
the passengers be put on  short allowance during any voy-
age, the  master  or owner shall pay to each of  them,  for
each and every day they are put on short allowance, three
dollars.
   Passengers  may, with the consent of the captain, supply
themselves with the above  articles;  or may supply an
equivalent in other  kinds of food ;  and if this by accident
prove insufficient, and the captain furnish comfortable food
to such passengers  during the residue of the voyage,  this
in regard to food shall  also be a compliance with the terms
of this act.
   5. For the  maintenance of good discipline and  to pro-
mote health, the captain  shall  have his rules and regula-
tions posted  up during  tho voyage — shall  cause  the
apartments to be kept in a clean and healthy state;  the
owners are  required to construct  the  decks and  other
parts so  that  they  can be thoroughly cleansed, and shall
provide a safe and  convenient privy for  the exclusive  use
of every  one hundred such passengers, and when  the
weather is such  that the passengers and bedding  cannot
be mustered on  deck,  the  captain shall  cause  the deck
occupied  by such passengers to be cleansed with chloride
of lime, or some other  equally efficient disinfecting agent,
and at such other time as the captain may deem necessary.
   6. The captain and owner, by failing to provide what is
specified  m  the three first  mentioned  acts,  shall sever-
ally forfeit and pay to the United  States  $200 for each 
APPENDIX.
207
and  every  violation;  and $50 for any  neglect or vio-
lation of the fifth article.
  7.  The collector of the customs  at  any port in the
United States where any vessel so employed shall arrive,
or is  about to depart,  shall cause such  examination, and
report in  writing,  whether the provisions  of  the  first,
second, third and fifth sections of this act have  been com-
plied  with in respect to  such vessels; and if so complied
with,  and approved by such collector, it shall  be deemed
as conclusive evidence thereof.
  8.  When the height or distance between the decks shall
be less than six feet, and not less than five feet, there shall
be allowed to each  passenger sixteen clear superficial feet
on the deck,  and if the height or  distance between the
decks shall be less than five feet, there shall be  allowed to
each  passenger twenty-two clear superficial feet on the
deck; and by any violation of this  act,  whether outward
or homeward  bound, by taking more passengers on  board
than  this  section allows, said master shall be  guilty of a
misdemeanor,  and  upon conviction  thereof shall be  pun-
ished for a violation of this  act; and in computing the num-
ber of passengers on board such vessel,  those  under the
age of one year shall be excluded from such computation.
  The  act  passed  previous  to the  above,  (February,
1847,) which  limits the number of  passengers  to two for
every five tons of the vessel, and the regulations in regard
to the requisite supply of  water, provisions, &c, are still
in full operation.   The number of tiers  of berths is limit-
ed  to two ; each berth  to be at least six feet long and
eighteen inches wide for each passenger, and elevated six
inches at least from  the  deck ;  the  berths  are not  to
encroach  upon the space allotted  to  each  passenger.
(Such is the construction of the act  by Secretary Walker,
dated March 17, 1847.)
  The penalty for carrying or bringing more passengers is
a fine of fifty dollars, and imprisonment not exceeding one
year for each  passenger  taken on board beyond the com-
putation of two passengers to five tons of such ship or ves- 
208
APPENDIX.
sel;  and if the number illegally brought exceed twenty, it
shall work a forfeiture of ship.
  The above is the substance of the United  States laws
on the subject of carrying passengers, abbreviated in words
as contained in the Merchant's Magazine. 
INDEX.
Abscess, how to open  ....
Acute rheumatism      ...
Africa, diseases on the Western shore of
Ague and fever    .
Amputation.....
           of the arm  ...
                 fingers and toes
Anchorage in sickly ports to be changed
Angina, or quinsy    ....
Ancle, dislocation of    ...    .
Anthony's Fire, St.....
Apoplexy.....
Application of leeches
Arm, dislocation of      ...
     amputation of   .
     blood-letting from .
     fracture of      ....
Arteries, wounds of     ...
Ascites, or dropsy of the belly  .
Asthma  ......
Barley-water, how to make
Beer......
Bellyache, or colic    ....
Belly, diseases of  .
      dropsy of.....
Bilious colic.....
       fever.....
       remittent fever  .
Bite of snakes,  vipers, &c.  .
Bladder,  inflammation of
Bleeding, how to stop, in wounds
          at the nose
          how to perform in the arm .
          how to perform in the foot
Blister, directions for applying and dressing
Blood-letting......
Blood,  spitting of.....
       vomiting of           ...

                 18*
120
 96
166
  5
120
121
123
130
 44
102
109
 35
120
101
120
119
106
111
 61
 59
197
201
 72
 61
 61
 72
116
 82
111
 42
119
120
119
119
 57
 66 
210
INDEX.
flux. See Dysenteria the nose . the clavicle or collar bone the lower jaw the elbow . the fingers and hand the knee (palm-bone) the ribs..... Bowels, diseases of ... Bougies, how to introduce . Brain, fever or inflammation of Bread, how to provide yeast for Bruises or contusions Bubo, venereal .... Butter, how to preserve sweet Cabbages and cauliflowers, to preserve a California, diseases of Catheter, how to introduce Chagres, diseases of ... Chancre, venereal dropsy in ... Chilblains or frozen limbs Chloride of lime .... Cholera, Asiatic or spasmodic Cholera Morbus .... Chronic Bronchitis Rheumatism Inflammation of the liver Clap...... Climate, choice of, in consumption . Clothing, directions concerning Clysters, how to administer . * . Colic...... Collar bone, fracture of	; sea				
 
INDEX.
211
Consumption......
            choice of climate in
Contusions or bruises.....
Contagion, means to  prevent the spreading of
Convulsions or epileptic fits   .
Cough      ........
Coup de soleil, or stroke of the sun
Croup      ........
Cuts........
Diarrhoea  or looseness      .  '   .
Diet, directions concerning   .
Directions for preserving fresh meat  .
          for the prevention of disease among seamen
Diseases on the Western shore of Africa
           the coast  of England
           United States       ....
           East Indies       .....
           Mediterranean      ....
           West Indies.....
"Diseases of hot climates, directions for preventing
           cold  climates, directions for preventing
           the head   ......
           the throat.....
           the chest  ......
           the belly    .....
           urinary organs and genitals
           limbs and large joints  ...
           skin......
           fundament.....
Dislocations of the lower jaw    ....
                  shoulder   ....
                  elbow.....
                  palm-bone of the knee
                  thigh.....
                  knee-joint
                  ancle.....
                  fingers and toes
Dress in warm climates     ....
         cold climates.....
Dropsy, general      ......
        of the belly.....
              chest       .....
              scrotum       •
Drowned  persons, means of recovering
Dry bellyache......
Dysenteria.......
Dyspepsia or indigestion     ....
Earache........ 
212
INDEX.
 Eggs, how to preserve at sea
 Elbow, fracture of    ...
 England, diseases on the coast of
 Epilepsy......
 Erysipelas, or St. Anthony's Fire
 Eye, inflammation of      ...
 Falling down of the fundament
 Feet, frozen.....
 Fevers, intermittent or fever and ague
        bilious remittent
        low typhus or  slow nervous
        putrid, malignant, jail or ship
        yellow     ....
        acute or inflammatory
 Fistula......
 Fingers, amputation of
         fractures of
         dislocation of     ...
 Fits, epileptic      ....
     apoplectic.....
 Flax-seed tea, how to make
 Fractures, general remarks on
 Fracture of the arm
               nose
               clavicle or collar-bone
               lower-jaw
               elbow
               hand and fingers
               knee, palm-bone of
               leg   .
               ribs
               thigh
 Fresh meat, how to preserve
 Frost-bitten limbs     ....
 Fruit in hot climates, bad effects of
 Fumigation      .....
 Fumigation of ships
 Fundament, diseases of.  See Piles, Fistula
      falling down of the fundament
 Gleet.....
 Gonorrhoea   .....
 Groin, rupture in, or hernia
 Guinea worm      .
 Gunshot wounds
Headache    .....
Head, fever of
Health, directions for preservation of
Haemorrhoids, or piles
and 
                            INDEX.                       213

 Heat, prickly    .                                          110
 Hernia, or rupture      .     .              .'.*.'     80
 Hospital stores   ...                                jog
 Indigestion   ...                          *    '     31
 Incised wounds   ...                                j ■, ■,
 Inflammation of the eye     ...          .            41
                    brain.......     38
                    intestines or guts   ....       67
                    bladder......82
                    liver......       62
                    lungs, or pleurisy      ....     50
                    kidneys......       81
                    stomach......65
                    throat, or quinsy   ....       44
 Inflammatory fever........23
 Intermittent fever........        5
 Intestines, diseases of  .     .    .     .     .    .    .    .     67
          inflammation of......       67
 Introducing bougies........123
            the catheter......124
 Itch...........110
 Jaundice.........       28
 Jaw, locked, or tetanus.......36
      fractured........104
      dislocated.........99
 Knee, disjointed........102
 Kidneys, inflammation of......81
 Lacerations.........113
 Laryngitis      .........46
 Law relating to medicine chests.....189
     requiring ventilation  .......    204
     No. of passengers allowed according to tonnage    .      206
     regulating quantity of provisions      ....    205
 Leeches  or blood-suckers, how to apply       .    .    .      120
 Leg, fracture of.........107
 Letting blood, directions  for......119
 Limbs and joints, diseases of    ......     96
 Limbs dislocated or disjointed.....      99
       fractured or broken......106
       frost-bitten       .......115
 Lime juice, the importance of in long voyages  .     .     .    143
 Lime water, how to make    ......      198
 Linseed tea, how to make.......197
 Liver, disease of    .......           62
 Looseness   .....•••••     73
 Locked-jaw   .                        ....      36
 Lungs, inflammation of, or pleurisy   .      ....    50
Lungs, consumption of.......      52 
214                       INDEX.

Measles.........          Jj8
Meat, fresh, how to preserve......141
Measures and weights, table of.....18?
Mediterranean, diseases on the shores of        .     •     .165
Medicine chest, contents and price of        .    •    •      196
               law relating to  ......   189
Medicines,  directions for mixing and taking  .    .    .      191
Milk, to preserve at sea.......2°1
Mumps       .........       45
Nervous fever.   See  Typhus......11
Nettle Rash.........110
Nose, bleeding from   ....     ....    42
     fracture of........106
Operations      .     .     .    .     •     •     •     •     .119
Ophthalmy, or sore eyes......       41
Palm-bone  of the knee, dislocation of      ....   102
                      fracture of    .    .    .    .      108
Paraphymosis.........93
Penis, diseases of  .......           85
Phthisis pulmonalis, or consumption.....52
Phymosis.........       86
Piles...........79
Pleurisy      .........       50
Pneumonia      .........    50
Poisons, swallowed.......118
Poisonous fish   .     .     .    .     .     .     .     .     .119
Pox, small    .........       37
     venereal    .........    89
Preservation from disease when  wooding and watering  .      132
            of health of seamen     .     .     .     .     .125
Preparation of medicines     .     .    .    .    .    .      197
Prevention of diseases in tropical climates       .     .     .   127
                        cold and temperate climates   .       38
Preventing the spreading of diseases in a crew  .     .     .134
Putrid fever.........       12
      sore throat     ........    48
Quinsy, or  sore throat   .......       44
Rish, Nettle.........110
Ratio of mortality of British troops, in the  British West
      India L-lands     .......      153
Ratio of mortaliry in the  United Kingdom, Mediterranean,
      and  in the African colonies    .     .     .     .     .172
Remittent fever    ........        8
Resuscitation  of  drowned persons     .     .     .     .     .117
Rheumatism, acute.......       96
liheumaiism, chronic........98
Ribs, fracture of   .......          107
Running, or clap........85 
INDEX.
Rupture, or hernia
Salt water, how to freshen  .
San Francisco, diseases of
Scalds and burns
Scalding of the urine
Scarlet fever
Scrotum, dropsy in .
Scurvy     ....
Seasons of sickness in different countries
Sea sickness
Serpent, bite of
Sickly country, signs of
Signs of an unhealthy country
Shoulder, dislocation of
Skin, diseases of
Sleeping on deck to be avoided
Small pox     ....
Snake, bite of
Sore throat, or quinsy
            putrid
Sores or ulcers
Spitting of blood
Sprain.....
Stabs  .....
Stomach, diseases  of
         inflammation of  .
         pain of
St.  Anthony's Fire
Stoppage of the  urine
Stroke of the sun
Strangury, or stoppage of urine
Stricture in the urinary passage
Sun, stroke of
Suppression of urine
Swelled testicle
Syphilis or venereal   .
Table of weights and measures
Testicles, swelled
Tetanus, or lockjaw
Thigh, fracture of
Throat, diseases of .
        sore
Thumb, dislocation of
Toes, dislocation of
Toothache    .
Tourniquet, how to apply  ■
Tumors, how to open
Tympany, or windy dropsy 
216                   v    INDEX.
Typhus fever, low........11
Ulcers..........H5
Unhealthy country, signs of......135
Unhealthiness, seasons of     •w.....150
Urinary organs, diseases of     ......     81
Urine, stoppage of .....••            84
       bloody, discharge of     ......     83
       incontinency of   ......            83
Urethra or urinary passage, stricture of    ....     88
Vaccination   .........      204
Venereal disease or pox.......89
Venomous creatures, bites of      .     .    .    •    •      116
Ventilation of ships.....•     •     .139
Viper, bite of     .    .    •     •     •    •    •    •      116
Vomiting of blood   ........     66
Vomiting from sea sickness   ......       64
         and purging          «v.....68
Water in the belly......»       61
             chest........60
             scrotum   .......       95
Water-gruel, how to  make      .    .    .    .     .     .197
Water, how  to purify   .......      144
       how  to correct its purgative quality     .     .     .     73
       salt,  how to freshen   .     .     .    .    .    .      145
Weights and measures      .    .     .     .    .    .     .187
West Indies, diseases of.......157
Wind colic.........72
Windy dropsy........       61
Worm, Guinea.........117
Wounds.........Ill
       of arteries........113
       bruises.......           113
       gunshot.........113
       incised or cut.......113
Yeast, how preserved for sea......142
Yellow fever.........       18
THE END. 
 
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