/ If I x- IN8TR XTCTTON S / TORftklE CAPTAINS & MEDICAL DOCTORS TRANSPORTING CHINESE COOLIES FOR ACCOUNT OB / THE ASIATIC COMPANY o v Messrs, TORIUES, FERRAN n ** e instructions by recommending to the Captain to act for the best in the cases which are not provided for, and also the same, should 13 circumstances require a variation from the directions which we have given. We wijl now hear of the medical department, that is to say of the means which our experience has taught us to be the best. Second Article. MEDICAL DEPARTMENT. In the first place, we will ask of the medical men, not to con- sider these medical instructions as invariable rules from which they should have no right to depart; we are aware that ships have not always on board very efficient Doctors; that occasional- ly the Captain is obliged to act as Doctor: and moreover a well educated Doctor will always gladly receive the results of the ex- perience of others. The preceding will be our excuse for writing in language that may seem rather trifling, as we repeat that we write especially for the assistance of the Captain. It is much better to preveut sickness than to have to cure it. It is with that idea that we have here stated the hygienic rules that we consider best calculated to attain our end. This second article shall be entirely dedicated to the treatment of the mala- dies with which the Coolies are most frequently attacked during the voyage. The maladies are from their commencement sometimes very serious, and the greatest care will not sometimes suffice to counter- act their effects; fortunately however, this is not the rule, but the exception. We must therefore be careful to detect the malady in its incipient stage; it must be combatted from the beginning. That seems very simple, and would undoubtedly be so. if we had to do with men who valued their lives, and who would be willing to submit to the privation of food, in order to arrive at a cure of their maladies; but it must be remembered that the Coolie prefers sickness and even death, to the fact of submitting to a regimen; he will therefore conceal his sickness as far as possible, and when he is discovered, he will even then manage to elude the prescrip- tions. To obviate this trouble, the Doctor should each day examine all the Coolies, one by one; he should also recommend that sen- 14 tinels should be placed so as to notice all those who go to the water closet, so as to examine more critically all those who dur- ing their stay on deck should be obliged to go frequently to the water closet. You must also have recourse to the youngest to inform the Captain of any sickness with which any of them should be attacked; the policemen, the interpreter, the barbers and the masters of the mess should likewise be urged to this work of humanity. The maladies of which wc are about to treat, are only those to which we attribute the mortality during the passage; they are: 1st Dyspepsia; 2d Scurvy; 3d Diarrhoea; 4th Dysentery; 5th Anasarque or Dropsy of the skin; 6th Gastric fevers; 7th Affec- tions of worms; 8th Ulcers; 9th Apthalmia; 10th xVuemie; 11th Nostalgia or home sickness; and 12th a delirium which induces them to commit suicide, and which much resembles delirium tre- mens of drunkards, the itch and the scurf. DYSPEPSIA. SYMPTOMS. This malady which is nothing more than a depraved digestion, is known by the following signs: no appetite, or out of order; heaviness and tension of the region of the stomach after having eaten; belching, with the taste of the food recently taken; flatu- lency, moroseness, drowsiness,inclination to indigestion, and to the presence of much mucus in the stomach, which is indicated by the coating of the tongue. CAUSES. When the Coolies first engage they think of nothing but eat- ing, which they do to excess; as soon as they get the opportuni- ty, they swallow their fcod until their stomach becomes extended until the fibres of that organ lose their contractive faculties.— This is a fact to be noted, because it is in opposition to the opin- ions of those who have given their attention to Coolies; they sav they should not be allowed to drink water, but tea; we at- tribute one of the causes of dyspepsia to the abuse of tea, want of exercise, &c. 15 TREATMENT. You must first examine the tongue; if it is coated you should administer an emetic of ipecacuana, if there is also diarrhoea, or stibiated tartar where it is not accompanied with diarrhoea. It is especially when the patient shall have an inclination to vomit, or that he shall actually vomit, that it is necessary to commence the treatment by an emetic ; but if the symptoms indicate con- stipation, it is better to administer an ounce and a half of Epsom salts. If then you notice much weakness you should give a decoction of Peruvian bark, two or three cups full a day ; but should the inclination to vomit continue you should prefer a decoction of Columba; you may likewise give bitter chicory, gentian, &c. The food should be light but nutritious. Exercise is most important; should the weakness be very considerable, you should prescribe lemonade made of sulphuric acid, subcar- bonate of iron in doses of 8 grains, 40 centigr. twice a day morning and evening, beer, wine, &c. SCURVY. SYMPTOMS. This affection is usually pretty well known amongst sailors, but we think we ought to recall here the principal symptoms, so as to enable you to judge of the relationship which exists between this disease and the other affections with which the Coolies are often attacked during their sea voyage. The patient is dejected, the gums are swollen, he feels them itching, and they easily bleed: the breath is fetid, respiration is weak and even painful with the least effort, the complexion is pale, the face bloated, and the legs swollen, and there is a depression of spirits. As the sickness progresses, there is frequent bleeding at one or more parts at a time, and it is found very difficult to stop it; the weakness is constantly on the increase; the patient faints with the least motion, his legs become covered with livid spots and palish colored spongy ulcers; and finally there is a great tendency to gangrene, though it does not follow that inflammation should precede it. We have underlined the symptoms which belong to masarque 16 or dropsy of the skin, after which come the spots on the skin. and the ulcers so hard to be cured, as we have noticed by those which several of our Coolies have on their arrival at the Island of Cuba. CAUSES. We will repeat that we have the greatest confidence in a strict attention to the hygienic rules which we have set forth; the infraction of these rules will cause evils that will quickly in- duce scurvy in the coolies. Dyspepsia will be one of the first affections which will induce a disorder in the blood, or either its dissolution, the diminution of its vitality, and the tendency to putridity. The less proximate causes are, damp and cold air, vitiated air, the use of salt meat, etc. TREATMENT. There is no doubt that the best means are pure air and fresh provisions; but this can only be obtained on getting ashore; and again we must say that it frequently happens that the disease has made such headway that these advantages have very little- effect. It must be understood that this affection will attack men who are unacclimated to the sea air much sooner than those who are accustomed to sailing. This will explain the advanced stage of the complaint with the Coolies after a passage of four months. The difficulties caused by the circumstances should induce us to employ all the means in our power to guard against an evil which it is almost impossible to cure on board, especially "when • the hygienic means wdiich we have recommended have been ne- glected. On this point, we will remind you of cleanliness, ven- tilation, exercise, amusement, and frequent baths; and the pro- priety of giving good water and fresh vegetables as soon as they can be procured. CURATIVE MEANS. The curative means will be a spoonful every three hours of the following potion: Rain water........................180 grammes. Alcohol of Cocklearia, or scurvy grass. . 15 " Lemon juice...................... 60 " Opium............................5 centigr. Syrup........................... 60.00 " Alcohol of Cinnamon................ 7.00 " Mis 17 You may also give with advantage from 120 to 150 grammes of lemon juice mixed with a little syrup, in two doses, that is to say, one-half in the morning, and the other in the evening, the lemonade made with sugar and water, and as much sulphuric acid as is necessary to give it an acid taste. Of the decoction of bark twice a day; you may make a gargle of alum dissolved in water; with a solution of nitrate of silver in rain water (5 centi- grammes of nitrate of silver to 30 grammes of water); you may touch the ulcers of the gums with a brush dipped in muriatic acid, being careful not to allow it to touch the teeth. We will treat of the ulcers in a separate article, consequently we will say nothing about them here. We desire it to be well understood that the affection of which we have just been speaking, is about the point of departure of all those with which the Coolies are attacked, or that at all events it very frequently complicates them, and that consequent- ly you must pay the greatest attention to the means of preventing it, as well as to its cure as soon as it makes its appearance. DIARRH05A. SYMPTOMS. Is it necessary to name the signs by which Diarrhoea is known? We think not; and we will confine ourselves to saying that when a passage occurs without its being preceded by colics, and es- pecially when the evacuations do not weaken the patient, we should consider this state as a natural benefit, and that it is suf- ficient to moderate their food, to cure this slight affection. But when the passages are preceded by colics, and that they weaken the patient, you must then hasten to cure it. We will not speak of the various signs, such as the variety of the color of the passages, by which you may ascertain the degrees and the divers forms of this disease, because we have always observed that Diarrhoea with the Coolies is invariably the effect of the same cause, and that there is no other distinction to be made than that of a more or less severe attack. CAUSES. We find that the same causes which produce Scurvy are also those which predispose to Diarrhoea; repeated indigestions are 3 18 the cause that hurtful and irritating matters eollect in the stomach and in the intestines. Amongst the various causes we count es pecially food undigested, worms, and the repercussion of the itch- or other affections; the weakness caused by the decomposition of of the blood which no longer possesses the qualities necessary to excite properly the nervous system, which causes disorder in the functions of the intestinal canal. There are a great many other causes which we would recapitulate, were it our intention to write a complete treatise on this affection, but we believe it use- less in a mere memorandum of the value of the one we are wri- ting. TREATMENT. When the patient has still some strength left, we make him swallow two spoonfuls of castor oil, with an addition of 30 drops of Sydenham's liquid laudanum; our object is to carry off the matters or foreign substance which are in the intestines. Imme- diately after the effect of the purgative, we give two pills every day, (one morning and evening), composed as follows: Gummy extract of Opium.......... 10 Centigrammes. Calomel......................... 20 do. Ipecacuanna in powder........... 20 do. Soft extract of Absinthe, sufficient to make ten pills. You should continue the dose until they cause the Diarrhoea to cease, or at all events until they modify the passages. We have sometimes increased the dose by one pill for great opium smokers. When the Diarrhoea continues, we are inclined to believe that there are worms, or a spasmodic state; for the first we use six grammes of powder of semen contra oi worm seed, and two gram mes of Colombo, the whole mixed and diluted in a cupful of de- coction of camomile, of mint or of tea; we continue this dose for three days, also continuing the pills. When we have to combat the spasmodic state, we give 15 centigrammes of camphor in the morning, and the same at night; the patient crunches thia dose between his teeth, and then drinks several swallows of water, so as effectually to swallow the whole. We recommend this method very strongly, it having succeeded with us in cases where we have 19 been unable to discover the cause of the continuation of this af- fection. The method we have just described will succeed almost invari- ably if the disease is taken in time, and when you can limit the diet to what is merely necessary, that is to say to sago, arrow- root or biscuit soups; but there are, of course, cases where it be comes necessary to suspend this method, and give an emetic of ippecacuanna and six pills, of 10 centigrammes each, of extract of ratania. If after trying these means for four days, you do not succeed in curing the patient, it will be necessary to have re- course again to the first method, which in our opinion is the best. After the suppression of the Diarrhoea in its chronic form, you should make the patient, or rather the convalescent, take ferru- ginous preparations; we give the preference to sub carbonate of iron, which we administer in a dose of 5 decigrammes morning and evening, diluted in a little water or wine; occasionally we have recourse to a decoction of bark; we also willingly give a cup of camomile or of mint during the entire treatment, immediately after the pills. We increase the food by degrees, giving soups, biscuit, ron-t meat. of each 1 gramme. Kitchen salt ) Mix and shake well. What we have said will show that there is no time to be lost in commencing to treat for anasarca from the very first moment that it makes its appearance, so as to prevent the phenomenon which we have just described; and we think that it will but seldom make its appearance, when we are careful not to neglect the means indicated. There is yet another symptom, less grave, than the one of which we have been treating, but which however should be noticed by us; it is a paralysis more or less complete of all the limbs. Tnis state is induced by the compression of the spinal marrow by liquid. We continue in all these cases the diuretic wine so as to force the urine, and at the same time we give 5 centigrammes of al- coholic extract of nux vomica, of which we increase the dose 5 centigrammes every second day until we reach 25 or 30 centi- grammes a day, divided into three doses. Exercise is very necessary; friction with spirits of camphor with an ointment of veratrine all over the neighborhood of the vertebral column, (30 centigrammes of veratrine well mixed with 30 grammes of grease.) The food should be dry but nourishing, and it should be modi- fied in all cases of derangement of the stomach. 25 In the same way that a looseness of the bowels is injurious when exagerated, so a costiveness is no less so; but we dread the former most, because it weakens the patient too much: in that case you must cease the diuretic wine, and treat the patient as you would for diarrhoea, but still continue the nitrate of potash in a decoction of rice. GASTRIC FEVERS. Gastric fever is the fever we have met with most often with the Chinese Coolies; it varies according to the various substances which are contained in the stomach: it is of a saburral form when the matters which occasion it are of indigestible substances; it is of a mucous form, a bilious or a wormy form, when they are of mucous, bile, or worms; it may become inflammatory, nervous or adynamic in particular cases. SYMPTOMS. Tongue furred, yellow or brown, loss of appetite, frequent in- clination to vomit, weight and fulness of the stomach, oppression, headache, the pulse very frequent but not hard, the skin hot and dry. These are the principal symptoms, to which may be added others which proceed from causes which cause the form to vary. CAUSES. The saburral deposits, (vitiated matters which proceed from indigestion), or other matters collected in the stomach and the intestines, and which cannot be elaborated by the digestive pow- ers, cause a Diarrhoea or other malady of the intestinal canal, or which by a sympathetic effect, bear on the vascular and nervous system. It is easy to account for the formation of saburral deposits with the Coolies, for their gluttony renders it impossible for the digestive faculties'to suffice in elaborating the immense quantity of food which they swallow; it follows therefore that a portion of this food remains undigested, and becomes a foreign body from which issue morbid phenomena. There are other injurious matters which form in the interior, owing to disorders in the functions of certain organs, such as the liver, the paucreas and 4 2t. other parts: we will not wait to detail these causes, we merely -uite the fact. A wet atmosphere and incessantly changing, an intense and prolonged heat, and the habitual use of food difficult of digestion, are secondary causes, to which we may add home sickness and want of exercise; but the causes may not stop with producing this fever; they may produce other evils, which will depend on the causes from which they proceed. TREATMENT. What we have just said in regard to the causes of this malady', will show very plainly that for the purpose of curing it, it is necessary to get rid of whatever is contained in the digestive tube. The furred state of the tongue, indicates that the stomach is the seat of the substances of which you must get rid; it will there- fore be an emetic of ippicacuanha, or of tartar emetic that you should give at first; (1) and if you should judge that the cause of the disease is in the intestines, you must prefer a purgative of castor oil or of epsom salts, (60 grammes of either one or the other.; When the fever continues after the use of the evacuating medicines, it must be inferred that there is an inflammatory or nervous complication; if the pulse is full and hard, you should bleed: but you should, wdiilst the blood is flowing, make sure whether the pulse is getting very weak, in which case you must [1] \V