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CLINICAL TREATISE,

&c.

CHAPTER I.

INTRODUCTORY.

THE difficulty that is met with even at the commencement of a work like the present is inconceivably great, and can only be felt by those who have given to this subject great attention, and have essayed to embody their ideas upon paper. This difficulty arises from the adaptation of the word Fever,' to numerous diseases differing amongst themselves, both in their symptoms, their pathological characters, the sources whence they arise, and the countries in which they exist. Were we to request a man, who had travelled from the equator to the poles, and studied what is called fever in every country, to give us a description of this malady, we may easily conceive his answer—he would tell us that each case required its own description.

The difficulty is still further increased for want of something with which we are to compare the diseases that form the subject of this treatise. Suppose we take the fevers of England and France commonly called essential, those described by authors under the name of typhus, or typhoid, gastro-enterite-adynamique, dothinenthérie, enterite-folliculense, maladie tyhoïde, &c.; we shall find the medical world split into factions about their nature, their situation in the economy, and the causes which have produced them. Whilst some give to them" a local habitation and a name," attributing them to an

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inflammation of the mucus follicles of the gastro-intestinal mucus membrane, others, acknowledging the existence of this inflammation as an essential part of these diseases, do not consider that it enjoys so exclusive a character in the production of all the morbid phoenomena; on the contrary, observing that the local affection is quite disproportionate in many cases to the violence of the symptoms, they believe that the causes, whatever they may be, have operated much more generally, both upon the blood and perhaps also upon the nervous system, though the effects produced may in the present state of our knowledge escape our observation.

A third party, and in England a far too numerous one, pertinaciously stick to the opinions of their predecessors, and confound, under the name of a typhus, a synocha, or a synochus, a variety of different affections. They see a patient who labours under a heated skin, a quick pulse, thirst, and headache; these symptoms in their ideas constitute a disease, and that disease is designated by a name. In the language of Fordyce, they say, "that fever is a disease which affects the whole body; it affects the head, the trunk and the extremities; it affects the circulation, the absorption and the nervous system; it affects the skin, the muscular fibres, and the membranes; it affects the body, and it affects the mind." What is this it, this fever, but an immaterial being, a word like honour in Falstaff's catechism-air? I have introduced this last opinion of the nature of fever (if it indeed deserve the name) to show the extreme ambiguity of the word as generally used, and shall at once dismiss it without any further remark. The others are those of the first men of the age, and refer to one disease only, a disease characterized by a certain train of symptoms and pathological appearances, of sufficient frequency in modern times, and certainly not uncommon amongst the ancients.

If we meet with these discrepancies, these doubts, and these difficulties, in a disease so near home, and which has been so ably, so zealously, but nevertheless up to this moment unsucessfully studied, may I not well say, that the subject before me is one of difficulty? Far from the great arena of medicine, where every one actuated by a noble emulation strives to gain

the palm; where his struggles, instead of being checked, are aided by those of his rivals in the race, and every effort makes him wiser, if not more successful, I have been, alone and unaided, without the benefit of the opinion of others, occupied in a similar pursuit; without that advantage which books on most other subjects confers, by acting as guides to the steps of the uninitiated, but which on this served only as lights to render the darkness of the prospect more visible.

Countless authors have written upon diseases of hot and marshy countries in different parts of the world, and the endemic and epidemic febrile diseases of the West Indies reckon not a few amongst them. The differences of opinion here have been, and still are, even greater than those which obtain respecting the fevers of England and France; for we have no longer a regular series of symptoms, which, though somewhat modified in different cases, yet for the most part bear the stamp of individuality; on the contrary, we see the skin sometimes intensely hot, at other times much below the usual temperature; sometimes yellow, at other times pale, or livid; the tongue is occasionally red, occasionally broad, moist, and white as a snow-ball; the pulse as rapid as 130, or even quicker; in another case it does not exceed seventy strokes in a minute. There may be acute pain in the epigastrium, or the patient may bear great pressure over this region without suffering even the ordinary inconvenience. There may be coma and delirium from the first, or he may preserve his mental faculties entire until the last. Again, the type varies as much as the symptoms: we have the most fatal diseases intermittent, we have others continued. Can we wonder that there should exist differences of opinion respecting diseases apparently so dissimilar? These differences of opinion may be reduced to three. 1st. That all these diseases are essentially the same, and arise from causes in their immediate neighbourhood. 2nd. That these diseases are divided into two classes, into those of an intermittent and those of a continued type; the first arising from marsh, the second from solar heat. 3rd. That these diseases are of three kinds: intermittents, arising from marshy exhalations,-the continued, from insolation

and others from an imported source, and being eminently contagious.

Before we even discuss these opinions it will be necessary to examine the causes of disease, as they exist in the places where these endemics are found.

I shall continue throughout this work to use the word fever, for fault of a better designation for the diseases I shall have to bring to view. I apply it to the group of symptoms, whatever they may be, which it may perhaps be necessary for me to state here I do not consider as essential, but merely sympathetic of the disease, which, as I hope to prove, has well-marked seats in the economy and causes which will not be denied.

The generally-acknowledged causes of the West India fever are those I have just mentioned-malaria from swamps and other sources, solar heat, and contagion. A short description of St. Lucia will show that the two first exist in this island in a great degree; the latter I have never witnessed.

CHAPTER II.

TOPOGRAPHY OF ST. LUCIA.

THE island of St. Lucia is in 14° north latitude; it is fortyfive miles in length from north to south, and about twelve in mean breadth. Like the others in this archipelago, it presents very distinctive evidence of volcanic origin; viewed from the sea it appears to consist of numerous conical mounds, and resembles somewhat a hay-field when the hay is in cock. A chain of hills of considerable elevation commences at the northern and terminates at the southern extremity, dividing it into a windward and leeward side; it is further intersected by smaller ranges running from east to west, forming corresponding valleys, through each of which runs a river or rivulet, having its origin in one of the loftier hills of the central chain.

The greater number of these valleys on the leeward side are in a state of cultivation more or less complete; others are so narrow, and their inclosing hills so steep and high, as to lose the name of valley in that of ravine. To windward the valleys are broader, and the cultivation is less extensive.

These hills, some of which are 3,000 feet above the level of the sea, are covered with brushwood and forest-trees to their summits; they are composed of a volcanic conglomerate, and are barren and sterile, except where patches of a rich vegetable soil are lodged amongst their crevices and protected from the autunnal rains by some natural buttress. The valleys are extremely fertile, being covered with a coat of alluvial soil, in some places several feet in thickness; they are little elevated above the level of the sea, from which cause, and also from the mouths of the rivers being dammed up by the sandbanks formed by the currents of the ocean, giving rise to lagoons, or, in the language of the country, marigots,-they are particularly liable to inundation during the season of the heavy rains.

To windward the trade-wind blows with its accustomed freshness and regularity, but it is either prevented from reaching the leeward side by the central chain of hills, or else, finding a passage through their gorges, it rushes down the valleys as through a funnel or chimney; thus to leeward there generally is a succession of calms and strong currents of air alternately. The fall of rain throughout the year in St. Lucia is greater than that of any of the neighbouring islands, Trinidad alone excepted, and the atmosphere is always charged with moisture: during the driest period a pair of boots are covered with vegetation within twenty-four hours after being cleaned. Fahrenheit's thermometer remains generally stationary at 85o in the shade of a very cool house; it seldom exceeds 94°, and never perhaps falls below 75°. Though the changes of temperature as evinced by the thermometer are neither great nor sudden, the effects upon the feeling of a fall of only 5° is equal to that of 15o in England.

Little is known respecting the electrical states of the atmosphere in these countries, and nothing of them as agents in the production of disease. The quantity of dew which nightly