A BRIEF
HISTORY
OF THE
LATE EXPEDITION
AGAINST
FORT SAN JUAN,
SO FAR AS IT RELATES TO
THE DISEASES OF THE TROOPS:
TOGETHER WITH
SOME OBSERVATIONS ON CLIMATE,
INFECTION AND CONTAGION;
AND SEVERAL OF THE
Endemial Complaints of the West-Indies.
By THOMAS DANCER, M. D.
PHYSICIAN TO THE TROOPS ON THAT SERVICE,
KINGSTON: 
Printed by D. DOUGLASS & W. AIKMAN, and sold by them at the
Royal Gazette Printing-Office, and at WM. AIKMAN's Shop in
Kingston; by Alexander AIKMAN, at the Printing-Office in
Spanish-Town; and by JAMES FANNIN, Printer in Montego-Bay.
MDCCLXXXI. 

 

TO
HIS EXCELLENCY
GENERAL DALLING,
GOVERNOUR OF THE ISLAND OF JAMAICA,
CAPTAIN-GENERAL, VICE-ADMIRAL,
AND CHANCELLOR OF THE SAME,
AND THE TERRITORIES THEREON DEPENDING;
THE FOLLOWING PAGES,
On the HISTORY and DISEASES of the
LATE EXPEDITION against FORT SAN JUAN,
ARE HUMBLY INCRIBED,
BY
HIS EXCELLENCY'S
MOST OBEDIENT AND DEVOTED SERVANT,
THE AUTHOR.

 

[ v ]
INTRODUCTION.
IT is not the design of the author of the following pages
to write a full history of the expedition: The object and
conduct of that service, with every thing respecting the mi-
litary department, he is totally unqualified to judge of,
and will therefore no further enter into his considerations,
than as they are connected with his design; which is to
explain the causes of that general sickness and mortality
that prevailed among the troops; and to make a few obser-
vations on some of their diseases. The sickness or health
of troops, however, depends so much on their situation and
movements, that he will be obliged to take some account
of these; and it is therefore proposed to give first a succinct:
history or journal of the campaign, and then to make some
general remarks on the endemial diseases of soldiers in the
West-Indies.

CORRIGENDA.
Page 19—line 14—Read, many of which, instead of, witch many, &c. Ibid.
line 10—Dele, bring. Ibid.—line 15—For, made, read, were. Ibid.—line
19—Dele, the comma after the word hospital.
Page 31—line 12—For infected, read affected.
Page 34—line 6—For fœtid, read fœtid.
Page 40—line 1—For from, read by.
Page 44—line 6—For was, read were.
Page 50—line 9—For evacuations, read evacuants.
Page 51—line 7—For for, read and that.

A BRIEF
HISTORY
OF THE
LATE EXPEDITION, &c.
THE circumstances of time, command, number
of troops, and their embarkation to go upon a
SECRET EXPEDITION; from its having been
framed in this country, but more especially
from its fatal issue, and the private misfortune it has occa-
sioned to many, in the loss of friends; are so well known,
and will have so lasting an impression, that it will be here
quite unnecessary to mention them. It will be sufficient,
for the fake of more general information, just to observe,
that in the beginning of the year 1780, a small army,
consisting of about two hundred Regulars, of the 60th
and 79th regiments, one hundred men of Major DAL-
RYMPLE's Loyal Irish corps, and two hundred Jamaica
Volunteers,

8 BRIEF HISTORY OF
Volunteers, were sent by his Excellency GENERAL DAL-
LING, under the command of Colonel JOHN POLSON, up-
on a secret Expedition against some part of the SPANISH
territories in South America.-This little army having
embarked on board several transports, we set sail from
Port-Royal on the 3d of February, under convoy of the
Hinchinbrooke frigate, and directed our course first for the
Musquito Shore.
ALTHOUGH the autumn and winter of 1779 had been
in Jamaica very sickly, and many of the troops had died;
it must be observed, that those sent upon service being all
selected, were at the time of our departure in general good
health, and continued so during the voyage:—two men
only died on the passage, both of them convalescents from
long fevers; one of them, having a return of fever, with
symptoms of immediate putrefaction, died in a very short
time; the other, being very weakly, and not able to scuffle
amongst the men upon deck, remained constantly in his
birth, and, from lying always on the same side, got a mor-
tification in the hip, which, notwithstanding the instant
and free use of bark, and wine, &c. Soon carried him off.
This case deserves to be noted, because such accidents are
very liable to happen to men in that situation, and, in the
bad air of a ship's hold, will always prove very dangerous,
if not incurable.
THE

9 THE LATE EXPEDITION. 
THE Penelope transport having run aground, a poor
man of the Volunteers on that occasion had the misfortune
to have his skull dangerously fractured; the fracture ran
across both the sagittal and lambdoidal futures; and, by
means of the trepan, a number of fragments of the os oc-
ciputis were extracted, and a considerable part of the dura
mater, & sinus longitudinalis, exposed.—The operation
was performed under every possible circumstance of disad-
vantage; but, by the Angular care and attention of Mr.
Watson, surgeon of the corps, he recovered, and continued
pretty well for some time, 'till, being seized with the flux,
he afterwards died.
On the 14th of February, we arrived at Cape Gratias a
Dios, where the soldiers being disembarked, were encamped
on a large plain, about a mile from the sea, called Wank's
Savanna. The soil of this plain is very swampy, affording
water at only a foot or two below the surface.—Between
this savanna and the sea runs a pretty large river, called
also Wank's, surrounded by Scot's grass, mangroves, and
other woods, to a considerable distance, so as to generate
an unwholesome air, and to seclude from the camp the sa-
lutiferous sea breezes. Our men must have inevitably be-
come very sickly, had they remained long in this place;
but besides that our stay was short, the season was then
fair: the water, which contained a very strong chalybeate
impregnation, might perhaps have been also of use to
them, 

10 BRIEF HISTORY OF 
them, by carrying off the bile, and by a tonic power in
bracing up the solids. To many indeed the water gave
a diarrhœa, which, notwithstanding the means made use
of for restraining it, persisted while they continued to
drink it.
WHILST at this place, we had a few intermittents, but
our whole number in the hospital did not exceed thirty,
till the arrival of Captain Dalrymple and Mr. Schomberg
from Black River, with a party of men of the 79th regi-
ment, who were almost all of them in a most deplorable
condition, from old intermittents, dropsy, and flux: we
had also a few other fluxes, which, upon enquiry, I found
had been brought from Jamaica, and two of the number
died.
ON the 10th of March, our troops being reimbarked,
we in a few days took our departure from Cape Gratios a
Dios, and, after anchoring at several places on the Mus-
quito Shore, to rendezvous with the Indians who were to
proceed with us on the Expedition, we arrived on the
24th of March at the river San Juan; our men in general
good health, and in great spirits, from the idea of being so
near to the destined service.
ABOUT two hundred regulars, being disembarked from
the transports, with the necessary equipment of ammuni-
tion 

11 THE LATE EXPEDITION.  
tion and stores, proceeded immediately up the river with
the Indians in their several crafts, a particular kind of
boats so called: It being then the latter end of the dry
season, the river contained very little water, and was full
of shoals and sandy beaches, which rendered our passage
exceedingly difficult: The men were frequently obliged
to quit the boats, and unite their most strenuous exertions
in getting them along through a number of mallow chan-
nels, previously explored by Indians, sent before for that
purpose. This labour continued for several days after we
left the mouth of the river, till we arrived in deeper wa-
ter, when we made a quicker progress: but our men were
much exposed to injury, from the fun's rays beating vio-
lently upon them for seven or eight hours every day, be-
sides a still more intense heat reflected from the many na-
ked shoals, covered with a whitish sand, which rendered
the air sometimes intolerable. This violent insolation du-
ring the day, was followed by as dangerous an exposition
to the heavy dews at night; and it was surprising that the
men continued so well; for as yet we had but few, and
those trifling, complaints.
I CANNOT omit the occasion of doing our Indians the
justice to mention their spirited exertions and perseverance,
in the arduous enterprise of rowing up the boats such a
length of way against the many obstacles we met with:
we were no less obstructed by currents, than by shoals;
B 
and 

12 BRIEF HISTORY OF 
and the rapids or falls occasioned us still greater difficulty;
but the Indians have a singular address on these occasions,
and I cannot help thinking that we were greatly indebted
to them: for the soldiery, partly from ignorance in those
matters, and partly from that indolence which was the
natural effect of their situation, were frequently of very
little use: The stress of this business, therefore, lay chiefly
upon the former; and this accounts for their complaints
coming earlier on, than those of the soldiery.—It must be
observed, that the Indians are not a hardy race, especially the
true unmixed ABORIGINES of the country. The Cape In-
dians, who have an admixture of negro blood, seem to be
superior to those mentioned ‡, both in the powers of mind
and body; they are in general taller, more muscular, and
have an aspect expressive of a greater share of intelligence:
However we explain it, the fact was, that they did not fall
ill so soon as the others. Those Indians who could be spar-
ed from their boats, proceeded on before us, and were no
less active than dexterous in procuring us plenty of game,
and fish, which contributed not a little to the support of
our mens health, under that share of fatigue they sustained,
and the exposition they were subject to.
On the 9th of April, we arrived at a little island in the
river, called St. Bartholomew, which was fortified by a
small horse-shoe battery, mounting nine or ten swivels,
and
‡ Vide in the Abbe REYNAL'S History of the Indies an account of this. 

13 THE LATE EXPEDITION. 
and defended by a garrison of twelve or eighteen men.—
This island was possessed as a look-out, but being previously
reconnoitered, Captain DESPARD, with a party of men,
was sent through the woods to surprise them: After a few
shots, they endeavoured to fly; but were prevented in their
retreat by the Indians, who were ported higher up for that
purpose.-On this occasion, only two men received any
hurt: one was shot in the abdomen; but the ball having
parted through his cartridge-box, did not penetrate the
cavity:—the other had three fingers of one hand very
much shattered, but soon recovered the use of them.
A much more melancholy accident happened to one of
the men on their march through the woods: a snake, hang-
ing from the bough of a tree, bit him as he parted along,
just under the orbit of the left eye, from which he felt such
an intense pain, that he was unable to proceed; and when
a messenger was sent to him a few hours afterwards, he was
found dead, with all the symptoms of putrefaction; a yel-
lowness, and swelling over his whole body; and the eye,
near to which he was bitten, all dissolved.
The snakes of this country are very numerous, and of
several kinds *, most of which are esteemed highly poison-
ous,
* PISO reckons about twenty different species in BRASIL; which I should
suppose are most of them also inhabitants of this part of the coast.
This part of Natural History, though in the highest degree interesting to
the human species, has not been sufficiently cultivated; We are still, in a
great 

14 BRIEF HISTORY OF 
ous, but not equally so: The Indians seem to dread most
a small one, called by them tomagass.—The most ordinary
kind, called (from the manner in which it is marked) the
Barber's Pole, is not so virulent as the former. The com-
mon remedy, and the only one that I could learn of, is the
antidote, or† calabash coccoony as it is called here, and I
presume
great measure, unacquainted with these noxious animals; and it is an object
that claims the attention of natural inquirers, to investigate more particu-
larly the species and distinctions of these reptiles, together with the proper
antidotes against their several poisons.-I shall here subjoin a sketch of the
general arrangement of the serpent tribe; for which I am obliged to the Re-
verend Mr. Roberts, a gentleman completely versant in all the departments
of natural knowledge.
The celebrated LINNÆUS has arranged the serpents into six genera, viz.
1. CROTALUS, which is distinguished by having the scuta of the abdomen
and tail terminated by a rattle: This genus contains five species, all
venomous.
2. BOA, which is known by having the scuta of the abdomen and tail termi-
nated without the rattle: It contains three species, which are all inof-
fensive.
3. COLUBER, of which he enumerates ninety-seven species, sixteen of them
are poisonous:—This genus is known by the abdomen being covered
with a scutum, and the tail with scales.
4. ANGUIS, having both the abdomen and tail covered with scales.—There
are sixteen species of this genus, but none of them poisonous.
5. AMPHISBÆNA, containing only two species, both harmless:—The abdo-
men and tail of the animals of this genus are marked with rings.
6. CÆCILIA, containing two species, both harmless;—they are known by
their being covered with wrinkles.
Note, Those serpents that are venomous are furnished with fangs, somewhat
resembling the tusks of a boar:—they are moveable, and inserted an the
upper jaw.
† This plant is best described by Brown, in his Natural History of Jamaica,
under the name of sevillea: the seeds or kernels of this plant are frequently
used by the negroes in a spiritous infusion, which makes a strong bitter, and
a large 

15 THE LATE EXPEDITION.
presume the same as ULLOA calls the habilla, or snake bean.
This, as well as other antidotes that have been celebrated,
may be possessed of some virtues, but are not of that esta-
blished efficacy to be with safety depended upon: it may,
therefore, not be improper, in this place, to suggest the
means to be pursued under such a misfortune.-Suppose
any one so unhappy as to be wounded by any of these poi-
sonous reptiles, the most (if not the only) effectual remedy,
is, an immediate excision of the part; or, if that should
not be practicable, to scarify the parts about the wound,
and, by suction, or cupping glasses, if they can be procured,
to extract the virus before it passes forward into the blood.
—It is to be observed, that, notwithstanding the direful
effect which those poisons exhibit when they enter the sy-
stem, that they have no action or influence in the mouth
or stomach; and the wound may therefore be sucked with
great safety by another person‡——A burning-hot iron
C 
applied
a large dose proves both emetic and cathartic:—it is called by the negroes
the antidote, as they entertain the same notion with the Indians, of its alexi-
pharmic virtues.—There is no doubt of its being a very useful medicine, and
worthy to be introduced into the officinal list, if the seeds did not lose their
qualities by keeping: but how far it may be justly considered as either a ge-
neral or specific antidote, it is impossible to determine, as we have no other
evidences than the testimony of the Indians and negroes, who, in their opi-
nions concerning the medicinal efficacy of plants, &c. are chiefly guided by
superstition.-These seeds being of a very oily nature, the negroes fre-
quently burn them as lights; and Mr. Roberts has discovered a mode of
making from them a most excellent kind of candle, not inferior even to wax,
or spermaceti.
‡ The MARSI and PSYLLI, two ancient nations, were possessed of this se-
cret.—It is probably by absorption that the snake stones act, if they have any
action at all.

16 BRIEF HISTORY OF 
applied to the part, may be used in the place of excision,
but perhaps with a less certain effect: besides, it is seldom
that such a means is at hand on such an emergency, and
there is no time for delay; for if once the poison is ab-
sorbed, and has passed onward into the circulating fluids,
local remedies can have no effect. The use of olive or
common salad oil in the bite of the viper ‖, is very univer-
sally known, and should not be omitted to be applied to
the parts, after what has been recommended. Emetic and
sweating medicines have also been esteemed useful, and should
be employed: reflecting the latter, they should be continued
so as to prolong the sweat for a considerable time.
On April the 11th, we came in sight of the castle of
San Juan, and on the 13th the siege commenced, which,
with so small an army, was not carried on without much fa-
tigue and difficulty.-Added to the hard labour of throw-
ing up batteries, and the common military duty of main-
taining a number of guards and ports, the men had to
transport all the ammunition and stores, by a very bad road,
through the back woods, from the landing place two or
three miles below the castle.
For some time, the animation excited by prospects of
victory and success, enabled our men to resist every impres-
sion from the fatigue and labour they underwent: but at
length the seasons, or bad weather, setting in, the whole
army,
‖ Vide MEAD on Poisons. 

17 THE LATE EXPEDITION. 
army, both the soldiers and the Indians, began to fall sick,
especially the latter, who suffered more from their own in-
humanity, and want of care towards each other, than from
any other cause; as, though absolute fatalists, it is a kind
of custom amongst them, never to regard or pay any atten-
tion to their sick, further than to place them under some
tree or hut, and giving them water.-Such was the in-
dolence, obstinacy, and infatuation of this people, that no
representation or remonstrance that was made to them,
could prevail on them to unite their endeavours for the
building a house or hut for the reception and accommoda-
tion of their sick friends, who, lying under fevers and
fluxes, exposed to all the inclemencies of the weather, de-
rived little advantage from the assistance of medicine, and
many of them, as might be expected, died.—The dissatis-
faction and desertion of these allies, soon after the surrender
of the castle, delivered me from any further trouble con-
cerning them: and I have only to add respecting them,
that I remarked nothing very peculiar in their complaints,
except that they were in general more inflammatory.
THE hills which our army occupied, afforded so many
favourable and secure ports, that our men were very little
exposed, and met with very few accidents; two or three
only were killed, and not above nine or ten wounded.
In the number of these, we had one case which was very
remarkable, and I shall therefore give the history of it.—A
sailor 

18 BRIEF HISTORY OF 
sailor of the Hinchinbrooke being a little intoxicated, pursued
down the hill, under the enemy's fire, a hog that he had en-
deavoured to kill. He received two or three shot; but one
of them took a very extraordinary course, which I believe
most people would think fatal. The ball entered by the
groin, and traversing the pelvis, came out through the
glutei muscles, near to the knob of the ischium. The
spermatic cord was very much contused, and inflammation
was come on before I saw him; so that, although I suspect-
ed great danger would arise from a subsequent mortification
of the testicle, followed perhaps by a fatal hemorrhagy from
the vessels, I could not then make use of either the knife, or
the needle. As to the injury of the viscera, I could not then
judge, but it did not afterwards appear, either by his stools
or urine, that they had suffered any accident. The gan-
grene and hemorrhagy, as was apprehended, came on, and
threatened great danger; but the latter being restrained by
styptics, the only means that in that case could he employ-
ed, he took large quantities of bark and wine, along with
the best nourishment that could be procured for him; and
he recovered.
THE Castle having surrendered on the 24th of April,
we hoped that our victory would furnish us, not only with
accommodations, but with many useful supplies, that might
tend, in some degree, to stop our increasing sickness; but,
alas! the wretched state of the garrison, provided with no-
thing 

19 THE LATE EXPEDITION. 
thing that could lend either them or us the least comfort;
and the inconvenient structure of the place, which was
worse than any prison, and, as one would suppose, calcu-
lated only for the purpose of breeding infection, disap-
pointed us in those flattering expectations. Our men,
therefore, now falling down in great numbers, added to all
their other misfortunes, had no proper hospital for receiv-
ing them;-the wretched houses or sheds to which we were
obliged to give that name, being from their situation not
only so nigh the river, but under the Castle-hill, and to-
tally secluded from the sea-breezes;-from the dirt and filth
surrounding them, consisting chiefly of semi-putrid skins,
yielding a most intolerable stench;-from the insufficiency of
the roofs, which many of them kept out very little rain;
made them, I will not say merely an improper hospital, but
a certain grave to almost all who entered them.—Add to
what has been mentioned, the circumstances of a most un-
healthy climate; the seasons, or incessant rains, alternating
with the most extreme heats; the want of hospital, neces-
saries, and accommodations, and sometimes of medicines,
and it will not be wondered at, either that the troops be-
came so sickly, or that so few recovered *.
D 
MANY
* The history of all West-Indian armaments unhappily correspond too
much with that we are now giving of the Expedition against Fort San Juan.
I need not mention the fatal affair at Bocca Chica, so pathetically related by
THOMSON, in his SEASONS.
When o'er this world, by equinoctial rains
Flooded immense, looks out the joyless fun.
And draws the copious steam; from swampy sons,
Where 

20 BRIEF HISTORY OF
MANY of the afore-mentioned circumstances may seem,
to those unacquainted with the particulars of the service,
to have been remediable: The question may, in the first
place, be asked, Why, as there was no building fitted for
the
Where putrefaction into life ferments,
And breathes destructive myriads; or from woods,
Impenetrable shades, recesses soul,
In vapours rank and blue corruption wrapt,
Whose gloomy horrors yet no desperate foot
Has ever dar'd to pierce; then, wasteful, forth
Walks the dire Power of pestilent disease.
A thousand hideous fiends her course attend,
Sick Nature blasting, and to heartless woe,
And feeble desolation, casting down
The towering hopes and all the pride of Man.
Such at of late, at Carthagena quench'd
The British fire. You, gallant VERNON, saw
The miserable scene; you, pitying, saw
To infant-weakness sunk the warrior's arm;
Saw the deep-racking pang, the ghastly form,
The lip pale-quivering, and the beamless eye
No more with ardour bright: you heard the groans
Of agonizing ships, from shore to shore:
Heard, nightly plung'd amid the fullen waves,
The frequent corse; while on each other fix'd,
In sad presage, the blank assistants seem'd,
Silent, to ask, whom Fate would next demand ?
——Nor is the mortality amongst our brave troops at the Havannah yet for-
gotten:—The affecting letter of an officer on that service, which so well de-
scribes out unhappy situation at San Juan's, I mall here take the liberty to
quote from Doctor Lind :—" I think myself extremely happy in being among
" the number of the living, considering the deplorable condition we are now
" in: Out of 100 men which I landed, I have only now 33, left in my com-
" pany. Our regiment has lost 8 officers, and 500 men. Out of 17 battali-
" ons, we cannot muster 600 men fit for duty:—they died chiefly of intermit-
" tent fevers and fluxes."
-The late dreadful mortality of the troops at Lucia, as well as at other
parts of America, serve to evince the insalubrity of these climates, and the dif-
ficulty attending all military operations in this part of the world. 

21 THE LATE EXPEDITION. 
the purposes of an hospital, was not one erected? To this
I must, answer, that although the unhealthiness of these
houses were represented to the Commander-in-chief, and
his orders obtained for building a proper hospital, these
orders could never be carried into execution; the sickness
becoming so general, that there was neither artificer to
work, or soldier to assist him: Necessity then compelled us
to make use of places that became a source of contagion, and
precipitated those who went into them out of the world.
—As to hospital accommodations, such as bedding, and
the several articles of sugar, oatmeal, &c. we had them in
an abundant quantity, but not at our hospital, where they
were wanted: there being not a sufficient number of craft
for transporting the ammunition and stores up the river; a
certain quantity only of each could be put on board, which
in many cases was not competent to the exigencies of the
service; and the sickness increasing, rendered our future
supplies from the transports still more precarious. So ge-
neral was the illness at this time, and ever afterwards, that,
independent of the few who were well enough to do gar-
rison duty, we had not orderly men sufficient to assist the
sick.—The deplorable situation of such a number of men
labouring under such complaints, and lying in such places,
without the requisite assistances, and the use of the neces-
sary means for preserving † cleanliness, and a sweet air, can
be
† Nihil tamen æque morborum phalanges in castra invehere posse credide-
rim, quam castrorum sordes et neglectam munditiem: Divino edicto olim Is-
raelitis interdicibantur, ne intra castra alienas fæces auderent deponere;—
fed, &c.-Vide Rammazini de morbis artisicum. DIEUTERONOMY. 

22 BRIEF HISTORY OF
be easily judged of: The fevers and fluxes, therefore, that
in the beginning were dependent on climate, &c. and af-
fecting only individuals, became afterwards evidently con-
tagious, and seized almost every one who came within the
infection ‡: few of those who arrived in health (though
this number was very small) escaped for many days the
reigning malady.
THE weather clearing up for a short time, gave us san-
guine hopes that our men would now recover, but most of
them relapsed again upon the return of the rains; and at
length, in the month of September, the army, so much
exhausted by sickness, returned down the river, leaving only
a proper garrison at the Castle. The use of a better nou-
rishment, which the harbour afforded, particularly fish and
turtle, it was hoped might be of great use to convalescents;
but the contrary event happened. The inordinate appetite
which attended people reduced by long sickness, being too
freely indulged, was productive either of indigestion and
crudities in the primæ vice, or a too sudden and general im-
pletion, which proved very injurious to them; and a bet-
ter food, instead of promoting their health, served rather
to hasten their exit.
The
‡ Authors are not generally agreed, whether intermittents are properly con-
tagious.—Clegborn, Littsom, &c. think they are infectious:—the dysentery
and remittent fever, into which they are frequently changed, are unquestion-
ably so. 

23 THE LATE EXPEDITION. 
THE sickness and mortality of the troops still continu-
ing, I presume it was thought necessary to decline the fur-
ther prosecution of that service; at least till a proper rein-
forcement should arrive, and the seasons become more fa-
vourable. The remainder of the army, therefore, embarked
for Bluefields, an English settlement about twenty leagues
to the northward; but the exhausted and debilitated state
which most of the men were in at the time, rendered the
situation and air of a ship's hold very mortal to them, and
a great number of them died on their passage.
A total loss of my own health obliged me about this
time to apply for leave of absence; and I have therefore
nothing further to add on the subject of the campaign, but
to acknowledge, not in my own name only, but in that of
many, the assiduous and humane attention of our Com-
mander-in-Chief* to every thing that could tend to the
recovery of the sick, and health of the army: but all the
offices of the kindest humanity, all the efforts of the best
informed judgment, neither the benevolence of the heart,
nor the skill of the mind, could avail against the united
opposition of so many formidable enemies †.
* Colonel KEMBLE of the 1st Battalion of the 60th Regiment.
† Among these, the climate must be considered as the principal one. The
country is overspread with wood: or the sides of the river are numberless
stinking marshes; and the rains fall in torrents through the greater part of the
year.-From the month of April, when the castle surrendered, till October,
when the army returned down the river, and for some time after this, the
rains continued, with now and then a lucid interval of a few days, to fall in
prodigious quantities, and sometimes with the most dreadful thunder storms.
Carpenter's river, or Marina, the nearest settlement on that part of the coast,
is reckoned by the Spaniards another Rio Morte. The torrents of rain to which
Carthagena is subject, fall, according to RESNAL, from the month of May
till November.-Vide Hist. Ind. and Wafer's account of Darien.
E 

 

OBSERVATIONS
ON
Climate, Infection, and Contagion. 

 

[ 27 ] OBSERVATIONS ON CLIMATE &c.
CLIMATE.
THE effects of different climates in producing dis-
eases of a different nature and tendency, has been
remarked in all the ages of mankind, and treated
of with great judgment, even by HIPPOCRATES, the fa-
ther and founder of physic.—" Quicunque artem medi-
" cam, inquit, integri consequi volet, hæc faciat opportet.
" Primo quidem temporum anni, rationem habeat; nulla
" enim in re similia sunt sed multum differunt; turn ipsa
" ad invicem, turn in propriis permutationibus, deinde
" etiam ventos calidos et frigidos, qui unicuique regioni
" sunt peculiares," &c.-The observations of authors on
this subject amount to this, that in cold climates, people
have a greater degree of tone, or that their fibres are more
tense and rigid; and that, in consequence of this, they are
more subject to inflammatory complaints, or such diseases
as, in their nature and cure, require a treatment, as blood-
letting, and other evacuations, whose effects are, to dimi-
F 
nish 

28 OBSERVATIONS ON
nish this tone or tension of the fibres; while, on the other
hand, from the natural property of heat *, people in all
warm climates become very much relaxed, and are subject
to diseases, not of the aforementioned inflammatory kind, but
to those of a putrid tendency †.—The diseases, then, of
cold climates are principally, inflammatory fevers, coughs,
consumption, rheumatism, pleurisy, &c.; but, in warm
ones, the fevers are of the bilious, remittent kind ‡, fre-
quently becoming putrid: and these are not only the most
ordinary kinds of fever, but the diseases which most ordi-
narily happen: For it may be observed, that although we
cannot, in the West Indies, boast of equal health with
those in northern climates, we can yet ever, that we are
subject to fewer diseases.-Diseases of the inflammatory
class, as well as of every other kind, do indeed occur in
warm climates, but not so frequently, or with so much
violence. Upon the whole, the catalogue of maladies in
the West Indies is much less than in Europe; but then the
fevers,
* Calor si nimius est, corpus effeminat, nervos emollit, stomachum solvit
obnoxium morbis pestilentibus corpus efficit.——CELSUS de Medicina.
Calor acris vi fua relaxante corpus debilitat.—Systematis, turn sensibilita-
tem, turn mobilitatem auget.—fluidorum tenuitatem et acrimoniam auget,
Diss. Med. BOWDLERI.
† Wilson on the influence of climate.
‡ The remitting fever is truly one of the fixed, regular epidemics (endemics)
of the island of Jamaica, and is more or less prevalent in the months of Oc-
tober, November, and December. I look upon it to be the same as that of
Minorca, Sumatra, Java, and of other parts of the East and West Indies.
NASMYTH in LIND'S Ess. &c. 

29 CLIMATE, &c.
fevers, which constitute the greater part of this catalogue,
are, from the effects of climate, and the difference of con-
stitution, of a much more dangerous tendency.
WHATEVER influence heat* may have, either upon the
solids or fluids in the human body, in altering their natu-
ral condition, we know, that it is greatly increased by the
union of moisture. People, during the hottest seasons, and
in the hottest climates †, often preserve a moderate share of
health; but, after heavy falls of rain, they in general become
sickly.—This is a fact well known by all those who have
inhabited the West Indies, and other warm climates.
IT is not, however, either heat or moisture, simply con-
sidered, that produce fevers ‡, but, along with these, sensible
qualities
* Heat alone has certainly the effects before-mentioned: but the judicious
Doctor NASMYTH, who to the many opportunities he had of determining this
question, joined a very particular attention, has observed, " That the incon-
"veniences and diseases arising from more heat, are far less considerable than
" has been imagined."-Vide LIND'S Essay, &c. p. 56.
† The temperature of the air in South Carolina and Georgia, in summer
time, according to the experiments of Mr. EllIS, much exceeds that of the
human body; yet the inhabitants bear it with health and unconcern.
GOLDSMITH'S Nat. Philos.
Some curious experiments have lately shown, that the human body is ca-
pable of sustaining a surprising degree of heat, without any considerable an-
noyance of the functions.-Vide Philosoph. Transact.
‡ Calores sane summi fine febre. Pestis enim sub maximls ciloribus extin-
guitur. Nec humore abundantes, illico febris est. Æstivas imbres fore ubique
salubres; civitates quoque salubres juxta flumina fitæ, &c.
Drummond de feb. arcend. &c. 

30 OBSERVATIONS ON
qualities of the air; and, originating from them, these is
another cause of disease, which, though of a Ltant nature,
acts upon the human body with much more force and acti-
vity: This cause is, the poisonous effluvia or miasmata a-
rising from the ground, in all woody and marshy situations,
particularly in warm seasons, and in warm climates.‖ The
endemical or prevailing diseases of people inhabiting all
such soils, especially during such seasons, prove beyond a
doubt the existence of these miasmata †; and it is more
than probable, that all fevers of the intermittent and re-
mittent kind, depend constantly upon such a cause.—Heat
and moisture may separately have their effects upon the hu-
man body; but it is their influence, when united, that raises
these noxious exhalations, which produce the fevers, and
other endemial diseases of warm climates. It is heat acting
upon moisture that generates these miasmata; and therefore
it is in autumn, after the heavy rains which fall in that
season, that such diseases most prevail. Rain alone, or in-
undations of water, seem not, without the assistant energy
of heat, to have any effect: for, it is not till after these
have parted off, and the humid surface of the ground be-
comes
‖ In regionibus septentrionalibus, ubi frigora intensa et continua sunt, fe-
bres intermittentes nunquam incidere; contra in plagis meridonalibus, ubi
calores magni sunt præcipue in æstate et autumno grassari observavit Lancisius
denexiis Palud. effluv. lib. i. c. 5.—Grieve de feb. int.
In locis palustribus, in aquæ stagnantis vicinio, juxta lacus sordentes fossaq.
febres intermittentes endemicæ sunt.
† CULLEN'S first lines Pr. Phys. 

31 CLIMATE, &c.
comes exposed to the sun's action, that this process, so fa-
tal to the human species, begins *: then the infection in
all such places rages; and it frequently happens, that the
inhabitants are universally affected.—Many such unhealthy
situations are there in this island, which being, on account
of a greater degree of moisture, more fertile, are more cul-
tivated and inhabited, but not without shewing effects that
prove the truth of what has been observed † .
The influence of these miasmata seem to be in propor-
tion to the proximity of their source; for, according as
people inhabit places that are near to, or far off from the
scarshes, they are more or less infected.-The same cir-
cumstance also occasions a variation in the type of fever;
the nearer the patient resides to the infectious fomes, the
less his fever is disposed to intermit, and is more commonly
a quotidian; when living at a little greater distance, the
fever is generally a tertian; and when still more remote, a
quartan.-It is also worthy of remark, that the action of
G 
these
* PROSP. ALPIVUS de marbis Ægyptiorum, mentions, that during the in-
undations ut the Nile, people are very healthy; but as soon as the inundation
ceases, and the muddy surface of the earth is subjected to the influence of the
sun, then the epidemical diseases of that country begin.-This fact, long
taken notice of, is recently confirmed, in the account Mr. ROLLO has given
of the sickness of the troops at St. Lucia.
Vide LANCISIUS de nox. Palud. effluv. SENAC de recondit. feb. nat. p. 35.
† Many of these places are taken notice of by LIND, in his " Diseases of hot
"climates" particularly Greenwich, which proved so unhealthy, that it was
found necessary to remove the naval hospital to Port-Royal. 

32 OBSERVATIONS ON
these effluvia seem to be confined within very narrow limits,
except when transported by winds to a greater distance.—
Many curious facts prove incontestibly the truth of these
observations *; and a proper regard being had to them, may
be the preservation of innumerable lives.
SUCH is the operation of heat and moisture in producing
febrile contagion; but there is still to be taken notice of,
another species of contagion, which, for the sake of dis-
tinction, is more strictly and properly so called:—This is,
the effluvia of the human body, or the odour arising from
other substances that have been impregnated with it. The
human body, confined long together within its own atmo-
sphere, and not having its perspirable matter carried off from
it, can, as we know from a great many instances, produce a
contagion capable of affecting others, though the person
himself remains in health †: but such a contagion is much
more likely to arise from the body when diseased: And in
this manner the plague, small-pox, and nervous and putrid
fevers, are produced and propagated.‡ To what circum-
stances
* LIND'S Eff. &c.-ROLLO on the diseases of the army at Lucia.
BOWDLER Diss. de Intermitt.
† This has been evidenced in a number of cases, particularly in the well-
known one of the prisoners at the Old Bailey.
‡ PISO denies the influence of contagion in hot climates, even in the dy-
sentery.—" Hæc excretio, inquit ille, licet pari vehementia per omnes Indias
sæviat, nunquam tamen in Brasilia morbi epidemici instar, grassatum alioque
per 

33 CLIMATE, &c.
stances it may be owing, whether to a greater degree of
heat in volatilating and subtilizing matters more, or to the
constant breezes, which prevent any stagnation, I know
not; but so it happens, that contagion operates much less,
in warm, than in the temperate climates. This is particu-
larly observable in fevers, which are seldom contagious
not even the highly putrid one, called the yellow fever*.
In the case of fluxes, however, where the contagious matter
is more predominant, it acts more generally, and produce-
a disease fatally infectious. There is so near an affinity be-
tween the intermittent and dysentery, that they frequently
interchange and alternate with each other, so as to give a
suspicion of their arising from a common cause: in both
cases, there is a copious secretion of bile, which, in con-
currence with other causes, may sometimes determine the
disease in one way, and sometimes in another; producing at
one
per contagionem migrasse constat."-Vide PISON de utriusq. Indiæ re medica.
& naturali.-BONTIUS, who treats of the diseases of the East Indies, is
of a different opinion, and has evinced, by several examples taken from a num-
ber of others, that epidemical diseases occur there, with all their proper sym-
ptoms, &c. spread by contagion.-Vide BONTIUS de epidem. et contag. in
Indies, morbis.
* HILARY'S diseases of Barbadoes.
It is very singular, that the putrid yellow fever, though never contagious in
the West-Indies, is yet extremely so (according to Lining) in Carolina:—Vide
Ess. Phys. & Lit. Nay, further, it would seem, that although the contagion
does not operate in the West Indies, there is nevertheless one produced; for
some wearing apparel, belonging to a patient who died of the yellow fever,
being sent from Jamaica to his friends in America, they fatally infected them
with the same disease.——Vide LIND'S Ess. &c. 

34 OBSERVATIONS ON
one time an intermittent, and at another a dysentery †. In
whatever manner the latter disease may be produced, among
individuals, it no sooner arises than a fatal contagion is ge-
nerated, which universally infects those who come within
the sphere of its influence, and chiefly by means of the
fatid stools ‖, that seem in this disorder to constitute a dan-
gerous fomes.-By a fomes is meant, any thing which, by
accumulating and retaining the infectious matter, renders it
more active and virulent: Thus, not only the stools of the
diseased, but their apparel, the bedding and furniture, with
the very walls of the apartment in which they lie, are con-
taminated, and acquire the power of affecting others, even
more than the emanations proceeding directly from the hu-
man body.
The nature of contagion is altogether inscrutable, but
the properties of it, which have been enumerated, are con-
firmed ‡, by a number of melancholy, and not less curious
incidents.
† PRINGLE'S diseases of the army.
‖ Some secretions are more apt to convey infection than others; the stools
seem most commonly to communicate the taint; next to these the breath, and
lastly, the effluvia of the body.-LIND'S Ess. &c.
ALEXANDER is of opinion, that marsh miasmata are not putrescent, but an-
tiseptic; and he infers, therefore they are not hurtful: but the conclusion is
both against reason and fact.— He is also of opinion, that the faces never ge-
nerate contagion, though he admits that they are very effectual in propagat-
ing it.
‡ Of twenty-three men who were employed in repairing some old tents that
had belonged to sick people, only six survived the infection which they im-
bibed.-Pringle. 

35 CLIMATE, &c. 
Incidents. Causes that are not visible, or very obvious, are
not apt to strike mankind in general with much force; and
it is difficult to persuade many people of the existence or ef-
ficacy of such latent powers: But there is the most absolute
demonstration to be given of what has been mentioned, and a
knowledge of these circumstances will tend, in many cases,
particularly in camps, towards the prevention of the most
fatal disorders. 
In the preceding sheets I have shewn, that all the causes
of a bad climate, infection, contagion, &c., prevailed in an
eminent degree at SAN JUAN'S; and that, along with these,
every thing conspired to give them their full force and ac-
tivity; I shall now, therefore, proceed to consider the dis-
eases themselves, so produced, and to make some observa-
tions on the principal complaints of the West Indians.
H 
OF
Five or six people died in succession, who were put into the apartment of
one who had died of a bad fever, notwithstanding the utmost pains being ta-
ken to purify it.—It was at last found necessary to plane the floor, and new-
plaster or white-wash the room.-Brocklesby.
A whole nation of Indians in Nova Scotia, called Mismacht, were destroyed
by some infected blankets which they had picked up at Chebreto, after the de-
parture of the Duc d'Anville's squadron.—-LIND'S Ess. Traite de malad,
des gens de mer, par POISSONIERE. 

[ 36 ] 
OF THE FEVERS, &c.
IT is not my present design, to attempt a full treatise on
WEST INDIAN diseases: —having so little to add to what
the many excellent authors on this subject have already de-
livered, I should esteem it an undertaking equally vain
and useless: I mean, therefore, to confine myself to a few
of the most important circumstances, relating to those dis-
orders which prevailed among our troops on the late EX-
PEDITION:—These were chiefly, as we have before seen in
the narrative of the campaign, intermittent and remittent
fevers, and the dysentery or bloody-flux, the constant en-
demics of every part of the West-Indies, particularly of the
most unhealthy parts, and during the unhealthy or rainy
seasons. These complaints, though not essentially differ-
ing from those of the same kind in Europe, are neverthe-
less attended with some peculiarities, and require some va-
riation in practice.
A redundant secretion of bile ever attends this class of
diseases in every climate, but remarkably so in all hot ones;
and has been always supposed to have a great influence upon
the disorder in its progress. It is also supposed, that the bile
is frequently vitiated in its quality, and being reabsorbed
into the system, carries along with it a putrid ferment, that
causes

37 OF THE WEST INDIES. 
causes an immediate and total dissolution of the fluids, as
in the yellow fever.
THIS preternatural secretion of bile in hot climates,
which has been observed even from the time of Hippocrates
and the commencement of physic, is with great difficulty
accounted for, and I shall not attempt it * : It is sufficient
that we know the fact; and I shall therefore confine my
enquiries to the effects of it, and consider only what influ-
ence the quantity and state of the bile may have in produc-
ing fevers, &c. or in changing their proper nature. From
the constancy of this symptom in most fevers, the ancients
were of opinion that they arose from this source:—Bile was
considered by them as the immediate cause of fever; and
this opinion has almost universally obtained, through all
succeeding ages to the present time †.
An enquiry into the truth of this doctrine, is a subject
worthy of a fuller discussion than can be here admitted of;
but I shall state a few circumstances relating to it.—Bilious
congestions, or bile on the stomach, is the almost universal
and constant complaint of the inhabitants of hot countries,
even in a state of health, or when they labour under no o-
ther disease; and all the effects that generally arise from it,
when other causes do not coincide, is an impaired appetite,
a little
* Set M'LURO'S Experiments on the Bile.
Experiences chemiques sur la bile de l'homme, par Mens. CADET.
† MEAD'S Monita & Præcepta.—— SENAC de recond. feb. nat. 

38 OF THE FEVERS
a little nausea, principally in the morning before the tak-
ing in of fresh aliment; vitiated digestion; now and then
a diarrhœa; or sometimes, on the contrary, a costiveness of
the bowels ‡. These complaints take place in proportion
to the excess of bile on the stomach, and are sometimes in
a considerable degree; but still they subsist without fever,
—It is plain, therefore, that a redundant secretion of bile,
cannot be considered as a direct and immediate cause of fe-
ver, although, by diminishing the tone of the stomach, it
may dispose the body to be more forcibly acted upon by the
proper febrile causes: And hence we see, that people who
have recovered from a fever, are exceedingly liable to relapse,
from this disordered state of the stomach.
IT may be further observed, that bile is often not only
very innocent in the stomach, but even, when absorbed and
mixed with the fluids, produces none of those dire effects
of which it has been accused:—jaundice is not attended
with fever, nor does it seem to give any disposition to-
wards it ‖.
IF 
‡ HIBEERDINE observes, that the bile, being a useful secretion, may, like
the saliva, be sometimes increased in its quantity, without any detriment to
the health. It is not lively (he adds) that the health should depend on any
precise quantity of bile, for sometimes there is none poured out for many days;
and, vice versa, the healthiest person may, by going on board a ship, become
in the space of a few minutes deluged with bile, without feeling any conse-
qences after he goes on shore.-Med. Transact. vol. 2.
‖
‖ Sed si febris causa sit bilis, quandem peculiarem eamq. insolitam sibi ipsa
idsciseat necesse est; nam exundat sæpissime Ano et Cato absq. ulla febris in-
saltu; nee vero in earn magis proni sunt qui ictero laborant.
SENAC de recond. feb. nat. 

39 OF THE WEST- INDIES.
If the bile should ever be the cause of fever, it must be
owing to some foreign and acquired property, not to an ex-
cess of the natural secretion; for bile, as we have seen, is
not only a fluid absolutely necessary to the functions of the
stomach, but, when in its natural state, appears to be of a
very innocent quality, producing no immediate bad effects
though mixed with all the other fluids of the body. It is,
however, supposed, that the bile is of a very putrescent na-
ture *, and susceptible of a high degree of acrimony;
which being diffused over the system, produces in certain
fevers a total dissolution of the fluids;-All the writers
who have treated of that species of putrid remittent, called
the yellow fever, have assigned for the cause of it, a cor-
rupted putrid bile absorbed into the system †: But, with
all deference to the many excellent authors who have en-
tertained this opinion, I must beg leave to state some diffi-
culties attending it.
MANY alterations happen in the state of the bile, as well
as in its quantity, without any considerable effect upon the
health. The change of the bile which is most obvious,
and which most commonly occurs, is that of acidity. In
some cases it has proved so corrosive, that when vomited it
has excoriated the mouth, and destroyed the enamel of the
teeth; but this has happened without any other consequence
I 
or
* From the experiments of Sir JOHN PRINGLE, it would seem that this no-
tion is in a great measure ill founded.
† HILARY on the diseases of Barbadoes.

4o OF THE FEVERS
or effect upon the general health: what has been so often
affirmed, of the putrid nature of it under some fevers, is
totally devoid of proof, and the opinion has probably been
drawn merely from some unusual appearances in it, from
an admixture of other matters *,
ANOTHER circumstance of difficulty respecting this the-
ory, is, that as dissections have never shewn any obstruction
of the gall-duct, as in the case of jaundice, how should the
bile be more than usual absorbed? † It is even allowed,
by those who adopt this notion, that the icterical colour of
the body, or yellow suffusion under the skin, in some bad
fever, proceeds more from a putrid dissolution of the blood
and exudation of the serum, than to a proper jaundice or
admixture of bile with the fluids ‡ .—There is no doubt
but the notion of these fevers originating from the bile,
took its rise from the yellow tincture of the skin; but this
we see is owing to another cause: we see, that the bile is
not absorbed in an uncommon quantity, nor does it appear
certainly; that the bile suffers any material change from its
natural state; why then should the bile be suspected on this
occasion?—- But, admitting every thing that has been said
concerning the bile, we may still doubt whether the effect
is not taken for the cause. An increased secretion of bile,
and a vitiated state of it, may attend fevers, without being
the
* HIBBERDINE in the Medic. Transact.
† MONRO'S Diseases of the Army.
‡ LIND'S Diseases of hot Climates. 

41 OF THE WEST-INDIES. 
the cause of them: The bile will be subject to alterations
similar to those which happen in all the other fluids, and may
verge towards putrefaction; but this is not observable in
the incipient state of the disease; it is only in the progress
of it, and when a general putrescenee comes to prevail.
FROM what has been said, is it not more probable that
the nature and termination of these fevers depend either on
some peculiarity in the contagion, or on some particular cir-
cumstances in the system, as a high degree of phlogistic
diathesis, a scorbutic tendency, &c.-Many facts relat-
ing to the yellow fever seem to confirm this opinion,
for it attacks chiefly those of a sanguine and plethoric
temperament, and especially those coming newly from Eu-
rope, or a cold climate. Further, the practice of blood-
letting, so much decried in the West-Indies and other hot
climates, has in this case been found of the utmost utility.
HILARY * employed the lancet very freely in the beginning
of this fever, and repeated it even after some appearance of
dissolution in the fluids: whence the necessity or propriety
of this, but from the circumstances suggested? It is there-
fore sufficiently clear, that it is not the state of the bile,
but the condition of the habit, which gives this putrid
type to the fevers of hot climates.
Before I dismiss this subject, I must beg leave to men-
tion another opinion that obtains pretty generally respecting
the
* See Diseases of Barbados.

42 OF THE FEVERS
the bile; which is, that the use of certain foods and liquors
have the effect of increasing and vitiating this secretion.
The possibility of this cannot be denied, but there are no
facts to ascertain it †. The disagreement of certain foods,
nausea, and consequent vomiting of bile, is no proof of it,
for the bile discharged might have been before present in the
stomach.—Malt liquors are more especially criminated with
this quality; but the disagreement of them may perhaps be
rather owing to their viscidity, rendering them of difficult
digestion in weak stomachs. The nausea they in such ca-
ses excite, may also beget a more plentiful effusion of bile
into the stomach; but I am inclined to suppose, that when
drank only in quantities proportioned to the digestive pow-
ers, they have no such effects as has been imagined, and e-
ven prove, in many instances, highly medicinal.
HAVING digressed so far, to examine into the question
concerning the influence of the bile in generating fevers,
or in determining their particular nature and tendency, I
shall now go on to make some more particular observations
on the several species of fever incident to our army.
INTER-
† It has been imagined by some physicians, that aliments differ in their ef-
fects upon the bile; some increasing its acrimony, &c—but what they have
said seems to me loose and inaccurate.-Whether there are any such sub-
stances that have peculiar properties with respect to the bile, I dare not de-
termine. 
CULLEN'S Mat. Medica. 

43 OF THE WEST INDIES.
INTERMITTENT FEVER.
OUR fevers were principally of the intermittent kind,
especially upon the commencement of our sickness;
and being attended with all the usual symptoms, I shall not
detain my reader by the history of what is so universally
understood. Not to dwell upon minutiae, or matters that
are uninteresting, I shall omit every thing that experi-
ence did not lead us to pay a particular attention to,—In
the first place, I have to observe, that our intermittents
were chiefly of the quotidian or tertian form, especially
the latter:-—quartans we had no example of that I can re-
member. This type of an intermittent is every where less
frequent than the preceding, and in the West Indies is, I
believe, rarely met with, unless among children; and in
their case proves very obstinate, continuing sometimes for
years, in spite of every means that can be employed. The
attack generally came on after some unusual degree of sa-
tigue, or exposition to the bad weather, with all the ordi-
nary symptoms of this kind of fever, pursuing its progress
through the several stages of the cold, hot, and sweating
fits: In the quotidians, which partook more of the nature
of the remittent, the cold fit was not always so consider-
able, but in the tertians was long protracted, and very se-
vere; so that it was sometimes with great difficulty that a
patient was conducted through it *.
K 
A
* Authors are disagreed with respect to the most dangerous period of the
paroxysm. It is the prevailing opinion, that the cold fit is commonly most
fatal; 

44 OF THE FEVERS
A JAUNDICE, or universal yellowness; now and then.
came on, which, though not symptomatic of any putres-
cence, was generally a bad prognostic, as hardly any such
cases ultimately recovered †.
Obstructions of the viscera, particularly of the spleen ‡,
was the consequence of this fever, when long continued;
but the frequent termination of it into a remittent or dy-
sentery, prevented these from happening very often.
THE ordinary eruption of pustules about the lips and
nostrils, or boils breaking out over the surface of the body,
generally indicated a crisis or solution of the fever, though
the patient was not afterwards secure from a relapse.
As I recollect no other circumstances of peculiarity in
the history of our intermittents, I shall proceed to make
some observations on the treatment of them.
TREATMENT
fatal; but others affirm, that patients dying with an intermittent, generally
go off during the hot fit:—it was the cold fit that proved fatal with us.
See MORTON, LIND, &c.
† This was instanced in the case of a very worthy gentleman, Captain BER-
TRAND of the Jamaica Volunteers, who died soon after this appearance came
on; as also in the much lamented Mr. GASCOIGNE of the LXXIXth regiment,
who, after going through every stage of the epidemic, the intermittent, re-
mittent, and dysentery, at last yielded to the common fate.
‡ The liver, according to almost all authors, is the viscus most generally
affected (vide SENAC): but I do not remember to have seen in our hospitals
any case of protuberance and hardness on the right side, or in the hepatic re-
gion: the spleen seems to be most commonly and soonest affected. 

45 OF THE WEST-INDIES. 
TREAMENT OF INTERMITTENTS.
In Europe it is of great importance to distinguish be-
tween intermittents of the different seasons: The vernal
are in general more easily removed, and blood-letting proves
a principal means of cure *; but in the autumnal agues,
this remedy is used with greater caution.
THE same caution is required in all hot climates, on ac-
count of the putrescent disposition of the fluids: but per-
haps this may have been carried too far: Instead of to-
tally relinquishing the lancet, as is the practice of some
physicians †, it may be only necessary to use it more spar-
ingly. There are few fevers in which it is not, during
some periods of the disease, more or less admissible ‡: but
strict regard must be always had to the symptoms and con-
stitution of the patient, as these only can determine the
proper quantity of blood to be drawn: this must be always
less in hot than in cold climates, though it is not easy to
establish any certain proportion. The symptoms principally
indicating venæsection in intermittents, especially in hot
climates,
* SYDENHAM.
† The English Physicians in the West-Indies are exceedingly cautious in
bleeding; while the French, Spaniards, and Portuguese practise it very freely,
as in Europe.-LIND'S Ess. &c.
The Abbe RAYNAL says, That so rapid is the progress of nature in the hot
climates, that it is frequently necessary to bleed fifteen or eighteen times in
the first twenty-four hours:—He very properly subjoins, that the priest, law-
yer, and physician are generally called at the same time.-Hist. of Indies.
‡ CLEGHORN found, that blood-letting was not only admissible, but ever
necessary, in the intermittents at Minorca.

46 OF THE FEVERS
climates, are local affections, as pleurisy, pains in the head.
&c. which often accompany them: but even here, local
bleeding may prove more beneficial. The tendency of in-
termittents to change into remittents of a putrid kind, or
into dysentery, should inspire us. with still greater timidity
respecting the use of the lancet, and on this account blood-
letting was very seldom used in the intermittents which
the troops laboured under at SAN JUAN'S.-There are,
however, some cases, in which bleeding may prevent the
fever from becoming remittent, and even change it to a
regular intermittent; but these depend on a phlogistic
diathesis, and seldom occur in hot countries, unless a-
mong negroes. The most eligible period for using the
lancet, when it is required, is during the hot fit, when all
the inflammatory symptoms are most exasperated; but as
this is a remedy so seldom judged necessary, let us go on to
consider those which are esteemed of more importance.
Among these, vomits, from their general utility, and the
time at which they are commonly given, in the first place
claim our attention.
THE state of the primæ viæ in fevers, renders the use of
emetics absolutely necessary for the purposes of evacuation.
The bile, and ether secretions, together with the aliment-
ary contents of the stomach, under the increased heat, and
other circumstances in the system depending on fever, may
be changed in their nature, and rendered highly acrimoni-
ous, if not putrid, so as net only to give in the beginning
a great 

47 OF THE WEST-INDIES.
a great degree of stimulus, but to make a deleterious im-
pression on the brain and nervous system.
HOWEVER important it may be to procure a free discharge
from the stomach, this is not the chief action of emetics;
they are possessed of virtues that render them still more be-
neficial; they cause a determination to the surface of the
body, and thereby remove the spasm on the small vessels;
or, to speak more intelligibly to a reader unacquainted with
medical science, they produce a sweat, and a solution of fe-
ver.—This effect of emetics has been long known *, though
not sufficiently attended to till of late; SYDENHAM, who
conceived of emetics as evacuants only, stood surprised at
their good effects, even when they produced but little vo-
miting: Their operation in this way is, however, now suf-
ficiently understood, and the practice of giving them in small
doses †, to procure nausea only, is become universal, after
having first evacuated the stomach by a free and full dis-
charge.—The utility of this practice is so well confirmed
by general experience, that, like all other established reme-
dies, it is liable to abuse: It is sometimes perhaps carried
too far, and in that case it proves extremely debilitating;
besides, the antimonial preparations employed for this pur-
pose are too irritating for some stomachs, and much mis-
chief will accrue where they are not judiciously dosed:
The clamour against excessive bleeding is outrageous, but
L 
hardly
* See WEFFER.
† CULLEN'S First Lines.- LETTSOME on Fevers. &c.

48 OF THE FEVERS
hardly any one thinks of the possibility of vomiting a man
to death.—There is, therefore, some nicety in the admini-
stration of emetics, which we found by experience in the
fevers at SAN JUAN'S; for the stomachs of the patients were
frequently so irritable, as not to bear them. In this case,
more advantage is derived from lenient cathartics, given in
small and repeated doses, till the desired effect is produced.
I SHALL not enter into a general disquisition concerning
the use of cathartics in intermittents; but it may be proper
to observe, that excessive purging, like all other evacuations,
is in hot climates very debilitating; for which reason, the
neutral salts, cr. tartar, tamarinds, manna, &c. have been
long preferred by good practitioners, to others of a more
heating and acrid quality *. I beg leave also to suggest,
that, when given in small doses, they may possibly act up-
on the skin in a way similar to emetics; at least, the use
of them in this manner is preferable to that of giving them
in full doses, as they agree better with the stomach, and
procure ultimately more copious evacuation, with less fti-
mulus and agitation.
THE English HIPPOCRATES (SYDENHAM) first recom-
mended the use of opium in intermittent fevers, a practice
that has been since found, by the experience of others, and
particularly
* In regionibus calidis, cathartica refrigerantia, fructus, sales neutri, &c.
præscribenda quia valde irritabilis est tubus intestinalis.
BRANDRETH de feb. intermit. 

49 OF THE WEST-INDIES. 
particularly the immortal LIND, to be of the highest uti-
lity. It has been observed, that opium given before the
accession of the paroxysm, will sometimes stop it *; but
the more eligible and approved method, is to give it at the
end of the cold fit; and the effects produced by it are, an
abatement of all the symptoms during the hot fit, a more
plentiful sweat, and a more complete intermission †.
These good effects I have seen follow from the use of opium
very frequently; and one would be inclined to suppose, that
whatever advantages attend the practice in cold climates,
much greater would follow from it in warm ones.
OMITTING the consideration of several other remedies,
I shall conclude what I have to say on intermittents, by a
few thoughts on
THE BARK.
So much has been written on the virtues of this medi-
cine, and to remove every objection to the use of it, that
it is scarcely possible to add any thing on the subject: I
shall therefore take notice only of a few circumstances re-
lating to its administration.-—Much has been said by many-
excellent writers ‡ against the use of the bark previous to
evacuations,
• BERRYAT.——GREOORY'S Prælectiones.
† Hoc (sc. Opium) tempore caloris exhibition, vim febris frangit, duratio-
aemque contrahit, capitis dolorem delirium et id genus alia prævenit.
BEANDRETH. - LIND.
‡ VAN SWIETEN, &c. &c. &c. 

50 OF THE FEVERS
evacuations, or the removal of bilious congestions in the
primæ viæ; but in the fevers of hot climates, there is fre-
quently no time allowed for these: such is the force and
violence of the symptoms, that if the bark is not given im-
mediately *, the patient infallibly falls a victim to delay.
In such cases, therefore, these objections must be fet aside;
and experience has amply evinced, that they are without
foundation †. It is, notwithstanding, proper to join eva-
cuations with the bark, when you cannot use them previ-
ous to it; and by this means the objections, if of any force,
are in some degree removed.
Another difficulty attending the administration of the
bark, is the irritable condition of the patient's stomach,
which renders him insusceptible of a proper dose, and
sometimes hinders him from taking it at all. I shall say
nothing of the well-known methods of combining it with
opium, aromatics, &c. but, as these will not always suc-
ceed, the only remaining alternative is that of clysters, fo-
mentation, &c. these are often efficacious: But, as I cannot
quit my view of military hospitals, I must observe, that these.
modes of exhibiting it are in an army frequently impracti-
cable. I take the liberty, therefore, to propose the method
of sprinkling it plentifully over the surface of the body;
if there be any moisture on the skin, a great part of it will
adhere,
* CLARKE'S Diseases of long Voyages. CLEGHORN'S Dis. of Minorca.
† MONRO'S Diseases of the Army. CLEGHORN'S Diseases of Minorca.
It was the custom of these practitioners, to give the bark with purging salts, &c. 

51 OF THE WEST INDIES.
adhere, and a sufficient degree of absorption take place, to
render it beneficial. The efficacy of the bark jacket * has
been long known; and I can therefore see no objection to
this practice, but the great consumption of bark it might
occasion. To this it may be answered, that it is only re-
commended, where it cannot be more effectually employed
in smaller quantities; for life is more estimable than a few
pounds of bark.
EXPERIENCE has lately determined, that the efficacy of
the bark in a great measure depends upon the time of giv-
ing it: it was originally given during the paroxysm, but it
was soon found to be much safer and better in the inter-
mission: still it is enquired, at what time of the apyrexia
ought it to be given? The idea of its efficacy depending
on its antiseptic † properties, &c: has induced most practi-
tioners to throw it in as early as possible after the intermis-
sion commences: but, considering fever according to the
Cullenian theory, as arising from debility, and that the
bark operates as a tonic ‡, the proper time of giving it is
consequently at that period when the atonia begins to take
place, viz. just before the paroxysm. Fact has demon-
strated this beyond a doubt ‖; and it is a maxim of great
M 
importance
* MORTON. † Sir JOHN PRINGLE. ‡ CULLEN'S. Mat. Med.
‖ Doctor HOME produces some experiments to the contrary of this; but it
is probable that they were not instituted with sufficient care: However that
might be, two or three exceptions cannot invalidate a general fact. See
Clinical Observat. and Exper. 

52. OF THE FEVERS
importance to be attended to in the administration of this
useful medicine.—The patient, however, is not always able
to take the bark in considerable doses; and it is therefore
requisite, in order that a due quantity of it may be taken,
to anticipate the return of the atonia:—In the quotidian *,
it is necessary to give it almost as soon as the intermission
comes on; but in the tertian, &c. there can be no occasion
to nauseate and harass the patient by hourly doses of a dis-
agreeable medicine during the whole interval, especially
when we consider, that, by previously loading the stomach,
we are prevented from giving it in full doses, at the time
when it is capable of producing the greatest effect.
THE virtues of the bark, like those of every other me-
dicine, are transitory; and, to perpetuate its good effects,
it is necessary to continue its use, or repeat it from time to
time: when this is neglected, fevers that were stopped are
liable to return†, and, from the debility already occasioned
by previous sickness, they often put on a bad appearance,
and become more unmanageable.
I HAVE only one more circumstance to add, viz. that as
bitters of every kind have, in some degree, the same powers
as
* CULLEN'S Materia Medica.
† It has been long a received opinion, that the moon has a great influence
upon the plants and animals of our earth; and a very ingenious writer has
endeavoured to confirm this opinion by a variety of observations: He says,
that at the full of the moon, fevers are more disposed to return, and that the
bark should be repeated in particular at that time.
Vide WILSON on the influence of climate.

53 OF THE WEST-INDIES.
as the bark, they may be sometimes vicarious to it: In a
scarcity of bark, I found, that an infusion of camomile
flowers, made in a slight decoction of the bark, answered
almost as well as the bark itself. MEAD'S powder ‡ has
also, on some occasions, proved more beneficial than other
bitters, or than even the bark.
REMITTENT FEVER.
THIS fever, in its mode of attack, and in most circum-
stances, greatly resembles the intermittent; but having only
an abatement of its symptoms, or no perfect apyrexia ‖, it
partakes more of a continued nature, and therefore has in
it more danger.The symptoms are likewise in this fever
more violent; at least the patient becomes, in the progress
of the disease, sooner exhausted, and the fluids tend more
quickly to putrefaction. A universal yellowness sometimes
comes on, constituting what is then called the yellow fe-
ver; concerning which I have before had occasion to make
some remarks: and as we had few, if any, examples of that
particular species of remittent, I shall not now repeat what
was before mentioned. A yellow suffusion did indeed at-
tend many of our fevers, both remittent and intermittent,
but this was evidently icteritious, and not proceeding from
a dissolution of the fluids: A degree of putrefaction also
came on in the latter stage of the fevers, but seldom with
those hæmorrhages, and other direful symptoms which ac-
company the remittent called the yellow fever.
AMIDST
‡ This consists of camomile flowers and alum. ‖ Intermission. 

54 OF THE FEVERS
AMIDST such a multitude of sick as we had at the castle
of San Juan, in the number of which were almost all the Fa-
culty themselves, it was impossible to be very minute in
observations on particular cases. To shew an equal huma-
nity towards all; a partial neglect towards individuals was
indispensible †; and therefore, an infinity of circumstances
in the practice of physic might have escaped my attention:
as for example, I was never able to determine any thing
precisely concerning the critical days; the existence of which
in these fevers has been so often asserted and denied.
TREATMENT. The intermittent and remittent, being
so nearly allied as to their symptoms, cannot differ much in
their cure: but as in the remittent there is greater danger,
there is also required more vigilance and circumspection.
This is particularly necessary with regard to bleeding and
the use of vomits. Venæsection may be hazardous in in-
termittents, but is in general much more so here, from the
quicker progress of the fluids towards putrefaction. Pro-
blematical, however, as it may seem, there are certain cases
which require bleeding on this very account. In plethoric
patients, and where the symptoms run very high, the early
and discreet use of the lancet will promise more advantage
in mitigating the violent reaction or ardency of fever, than
it can possibly do hurt by debilitating the patient: the pu-
trefaction,
† Mais il arrive souvent que le nombre des malades est si grand dans une
armee, &c. qu'ils font dispersees en tant d'endroits differens qu'il est impossible
que les medicins se portent partout & puissent donner leurs soins a chacun d'eux,; 

55 OF THE WEST-INDIES.
trefaction, instead of being accelerated, is by this means re-
tarded. It is only in this way that we can account for the
successful effects of bleeding, even in the yellow fever *.
GREAT caution is also necessary in the exhibition of vo-
mits; for it sometimes happens, that the stomach is so much
weakened by spontaneous efforts, and becomes so irritable,
that the use of them is highly dangerous.—Infusions of
camomile flowers and opiates are found the best means of
allaying these efforts, and to prepare the stomach for receiv-
ing gentle laxatives: These are to be given as soon as pos-
sible, to carry off the bilious colluvies in the first passages;
but those of the most agreeable kind are to be chosen, as it
is necessary to give them in repeated doses. An obstinate
spasm on some part of the bowels, seems to be sometimes
induced by their acrimonious contents, which lenient me-
dicines are insufficient to remove; but, on the other hand,
drastic ones would be highly improper, In these cases, I
have found a few grains of calomel combined with opium
the most efficacious means of procuring the needful evacu-
ations. Great attention is required to regulate these as
soon as they come on, encouraging or restraining the stools
according to circumstances and the strength of the patient.
Cordials are frequently necessary, to support the vis vitæ
while this operation is going on, and to hinder it from pro-
ceeding too far, which may produce a fatal debility. The
bark likewise is to be given as early as possible, or as soon
N 
as
* Vide HILLARY'S Diseases of Barbadoes.

56 OF THE FEVERS
as the stomach, being cleared of its irritating contents, is
rendered capable of bearing it, either in substance, or in
any other form. The danger that sometimes results from
delay, has been before mentioned with respect to intermit-
tents, but here it is still greater; and if we are determined
to proceed in the slow methodical way, of always vomiting,
purging, &c. and then waiting for obvious remissions, the
death of the patient will frequently disappoint our expecta-
tions *. The serpentary has been found in general a very
useful addition to the bark, and an excellent succedaneum
where the bark could not be internally made use of. HI-
LARY, in the putrid yellow fever, found it impossible to
give the bark † in any form; and therefore, of necessity,
depended on the serpentary, which he says proved no less
successful. 
AMONGST the other cordials necessary to support the
strength of the patient, wine is the most important, and
chiefly deserves our consideration ‡; but the administration
of
* In locis adustioribus, autumnale tempore paroxysmis sane paucis, quam-
plurimum periclitantur, febricitautes; hic igitur ubi primum potest, quam-
vis obscuriores sint remissiones, cortex adhibendus est Peruvianus.—Brandreth.
See also CLARKE'S Dif. long Voyages — PEREIVAL'S Essays. Medic. Transact.
HUCK in PRINGLE.—CULLEN'S First Lines.
† PERCIVAL supposes, that this disagreement of the bark was owing to
the fætor which arises from an admixture of it with the bile; and as acids
have the effect of neutralizing the bile, he thinks, that by a combination qf
these with the bark, it will be rendered less disagreeable to the stomach,
‡ In febribus malignis, vino nihil datur excellentius; in iis morbis restau-
rare vires; spiritus erigere; circulum sanguinis liberum reddere transpira- 

57 OF THE WEST-INDIES,
of it is attended with some difficulties. The nature of the
delirium must be carefully distinguished; and the dose re-
lative to the symptoms and constitution of the patient,
must also, by careful observation, be found out before we
proceed in the free use of this best of all cordials. For
want of such a judicious discrimination, much hurt may
be sometimes done by a medicine otherwise calculated to
produce the most happy effects. The pulse affords the
truest indication for the continuance of it: if from being
feeble and quick, it becomes fuller and slower, especially
if the patient, being delirious, becomes more coherent or
disposed to easy sleep, there is the fullest proof of its be-
nign influence; but when it is given improperly, the pa-
tient, if not delirious before, frequently becomes so, or
still more disturbed; and his pulse is at the same time not
only more full, but much accelerated.
HAVING already too much exceeded the bounds of this
subject, I have only to observe further, that respecting the
choice of wines to be given in fevers, claret is the one
most generally useful, having the greatest cordial effects,
with the least stimulus; but when the vis vitæ is much
depressed, and a greater stimulus required, Madeira wine
will be preferable, as it contains a greater portion of ar-
dent spirit †.
DYSENTERY.
tionem movere; expedit. et in eo versatur omnis alexipharmacorum virtus.
HOFFM. Op. tit. V. p.353. Vide GIILCHRIST, HUXHAM. &c.
† Vide NEWMAN on Wines.

58 OF THE FEVERS
DYSENTERY.
THIS disease, in certain seasons of the year, and in
certain situations in the West-Indies, is commonly
endemic, and, from its contagious nature, often becomes e-
pidemical, especially in towns, camps, and hospitals, where
it proves of all others the most dreadful distemper. The
stools of the diseased, which are always extremely fætid,
seem to be, as has been before observed, the principal fo-
mes and means of infection ‡ ; and by this, as well as seve-
ral other circumstances, the dysentery is easily distinguished
from diarrhæa. Of the dysentery also there are several
species, which in practice it is requisite to attend to: but
it is the epidemic contagious dysentery that is here the
subject of consideration. This is the general companion
or follower of intermittent fevers, attacking people during
the same season of the year, and sometimes alternating
with them: Thence the opinion, that the two diseases
spring from one common parent, which has been generally
supposed a putrescent bile ‖. That bile is not the cause
of fevers, has been already demonstrated *; but still it is
not impossible, that a certain state of bile, produced by fe-
ver,
‡ Cette maladie infecte biento; toute une armee; les exhalaisons putrides
des matieres fæcales infectent furtout les soldats sains lorsqu'ils se servent
des memes latrines. V. SWIRTEN.
‖ It is reasonable to believe, that the dysentery is owing to a cause little
different from that which produces bilious fevers: The ancients attributed
both to an abounding and corrupted bile. PRINGLE Dis. Army. ZIM- 
MERMAN, p. 23.
* See page 37. &c. 

59 OF THE WEST-INDIES.
ver, may have a considerable influence in bringing on this
complaint. However certain that may be, it is evident
that a specific contagion is afterwards generated; and is it
not therefore more probable, that fever has only the effect
of subjecting the patient to the influence of a new infec-
tion. It is perhaps impossible to determine this question,
but there is an obvious, though inexplicable union be-
tween the two diseases.
To avoid as much as possible a beaten tract, and to keep
this publication within its intended limits, I must omit
the historical detail of this, as I have done of the disorders
before treated of, and proceed to a few remarks on the me-
thod of cure, which will comprehend every thing essential
that my experience qualifies me to take notice of.
THE treatment of the dysentery was formerly but very
ill understood; and, notwithstanding a better method of
cure has been of late discovered, the disease may still, in
some degree, be considered as the opprobrium medicorum:
at least, the efforts of physicians to prevent the spreading
of this infection, particularly in camps and hospitals, have
in a great measure been unavailing. The several means by
which the progress of this disease is most effectually re-
strained, have been amply treated of by all the writers on
camp diseases, and need not here be described, further than
by observing, that they chiefly tend to the preservation of
a pure air, by keeping the patients, and the apartments in
O 
which

60 OF THE FEVERS
which they lie, as clean as possible, and by expeditiously
removing the infectious fæces to a proper distance.
All practitioners seem agreed, that vomits are the me-
dicines first indicated in this disease: The nausea and
spontaneous discharge of bilious matters from the stomach,
and the febrile state of the body in the commencement of
this disease, clearly point out the propriety of emetics;
but I here consider them as operating in full doses, and
not in small quantities, as will be presently described.
With respect to bleeding, it has been formerly esteem-
ed a sort of maxim, that " Dysenteria quâ dysenteria, venæ-
sectionem indicat nunquam" but, like all other general rules,
this will admit of exception, even in the contagious dysen-
tery of hot climates, which is not unfrequently in the be-
ginning attended with some inflammatory symptoms ‡.
The pulse, heat, &c. and not the tormina or gripings, af-
ford the truest indication for the use of this remedy; for
the pain of the bowels seems generally to depend more on
spasm, and an increased peristaltic motion, than on any
considerable degree of inflammation.
To remove this spasm, which is the principal cause and
support of the disease, no means have yet been found so u-
niversally beneficial as the use of laxatives. 
UNDER
‡ PRINGLE, p. 236. CLEGHORN Dis. Minorca. MONRO'S Dis. Army,
p. 6. LIND'S, Dis. hot Clim. p. 249. ZIMMERMANN, p. 179.

61 OF THE WEST INDIES. 
Under this head, perhaps, small doses of emetics are to
be considered, though it is probable they have here, as in
fever, a double action, affecting both the bowels and the
skin *. Ipecacuanha in particular has been celebrated for
its antidysenteric virtues, and is unquestionably one of the
best medicines; but, considered as a purgative, it is too li-
mited in its operation, and should not be given till others of
a more active though mild nature have been employed; such
as, the purging salts, tamarinds, and cr. tartar, &c. Upon
the repeated use of such gentle purges during the first stage
of the disease, principally depends our future success †;
but regard must always be had to the strength of the pa-
tient, and his capacity for bearing evacuations.
To enter into a full detail of the various other modes of
practice, and medicines made use of in the cure of dysen-
tery, would be a subject for a much larger work than the
present one; and therefore, omitting the consideration of
diluents, demulcents, astringents, bark, clysters, &c, all of
them in their proper place remedies of great efficacy and
importance, I shall conclude the cure of dysentery by a
remark or two on the diaphoretic practice, and the use of
opiates.
Some
* See PRINGLE.
† Purgantia fere sola medicaments sunt quæ, hodie ad dysenteriam depellen-
dam necessaria existimantur.-WARDROP de DYS. Malig.
Fide also ZIMMERMANN, PRINGLE, MONRO, &c. &c. who trusted the cure
of dysentery chiefly to the use of evacuants.

62 OF THE FEVERS
SOME authors have denied the existence of fever in dysen-
tery; but it would seem that they have never met with the
epidemic kind: for the contrary has been almost Universally
observed, and SYDENHAM considered it as a fever turned
inwards upon the bowels. It is from hence, I presume,
and from the effects of cold air, in constringing the fur-
face, and determining to the bowels, that the diaphoretic
indication has been drawn. Experience has sufficiently
demonstrated the good effects of this practice in cold cli-
mates, where the circumstances indicating it prevail in a
greater degree; but in the West-Indies, I apprehend it is
necessary to put some restrictions upon it. There is no
means of preserving a pure air about the patient, but by a
free exposition to the breeze, which will always have the
effect of counteracting the operation of sweating medicines,
or endanger the bringing on of a greater degree of spasm *
Forcible remedies of this sort should therefore be avoided;
but, as a gentle moisture, kept up constantly upon the skin;
serves greatly to diminish the impetus upon the bowels, and
alleviate the tormina, the use of a flannel shirt may be of
great utility, as this defends the patient from the action of
the air, which is of necessity admitted for carrying off the
contagious effluvia.—Many other remarks might be made
On this subject, but I proceed to opiates *.
IT
* To the diaphoretic method of cure may perhaps be referred the practice
principally followed at St. Lucia, which consisted in giving antimonials with
opium. Vide ROLLO's dis. of army at St. Lucia. 

63 OF THE WEST-INDIES,        
IT was formerly thought, the violent pains and incessant
motions, could only be mitigated by the use of opium; but
experience teaches, that whatever temporary relief opiates
may afford, they ultimately do harm, by increasing the very
symptoms they are intended to remove †.  More benefit is
derived in the beginning of this disease from laxatives, di-
luents, and fomentations; but, notwithstanding the general
complaint of the inefficacy and  hurtful qualities of opi-
um, there is no practitioner that can do without it: it is
sometimes absolutely necessary as a palliative, till other me-
dicines arrive at their effects; and in the latter stage, after
the full use of evacuations, it will prove the best means of
allaying irritability ‡.
HAVING now, in as concise a manner as I have been
able, pointed out some of the most essential circumstances
inducing and relating to the diseases of the troops at SAN
JUAN, I have only to implore the candour of my readers,
to judge as favourably as they can of so imperfect a publi-
cation.
† Almost all authors are agreed, in thinking opium hurtful in the begin-
ning of this disease. See ZIMMERMAN, PRINGLE, MONRO, TRALLER,
DEGNER; MOSELEY Treatise on the Dysentery of the West Indies.
‡ WARDROF.