Fak Ie Tanagth ct taht

a Wat Mein Wy

Ki

Sai

Cc

Le af We B K AN

We ACCOUNT os, AA fr

NATIVE AFRICANS

SIERRA LEONE;

TO WHICH IS ADDED,

AN ACCOUNT

OF THE

PRESENT STATE OF MEDICINE AMONG THEM,

Come fanciul ch’a pena ; af Volgela Lingua e snoda; : : ; Che dir non sa, ma I piu tacer gli e Noia

Cosi’! desir mi mena

A dire: Mi palpita il cor! ee eniees che un primo. Errore

Punir non si dovea ; che un Ramo infermo Subito non recide saggio Cultor.

ma forse diran

| BY : THOMAS | WINTERBOTTOM, M. D.

PHYSICIAN THE COLONY OF SIERRA LEONE,

EE

VOL. ID.

LONDON: .

PRINTED BY C, WHITTINGHAM, Dean Street ;

AND SOLD BY JOHN HATCHARD, 199, PICCADILLY, AND J. MAWMAN, POULTRY,

ee

13803

WEN Clann ae

CONTENTS.

VOLUME II. CHAP. I.

Introduction—Origin of Medicine—First Physicians—Union of Medicine and Magic—Practice of Medicine in Africa—

General Division CHOCHLHTH HSH AEH HHH THGHHEHGH OSH HE HHHRTEH ETH HHO DED

CHAP. II. GENERAL DISEASES. Fever—Remedies for the Thirst, Vomiting, and Head-ach which attend it—Remittents—Mode of Cupping —Intermit- tents—Enlargement of the Spleen—Cdema of lower Extre- mities—Mania—Idiotism—Epilepsy—W orms—Lethargy

CHAP. III.

Venereal Disease—Gonorrhea—Phlegmone Testis—Hernia— Coup de Soleil—Tooth-ache—Scurty—Ear-ach—Dysen- tery on board of Slave Ships; on Shore—Diarrhea— ORG CHS Quasabissonanadaeet saveesensvecsserares secvesveces sosceveee

CHAP. IV.

ELCPRGNHGSTS.00ccvsssrerrerceccecvercencenspnceacsesscscocesces eoe0se

CHAP. V. —Dracunculus or Guinea Worm—Chigresssecsessesessserevesceessos

CHAP VI. Enlargement of the Scrotum—Enlargement of the Legs— Gout—Rheumatism—P leurisy—Diseased Liver—Scrophu- la—P hthisis— Anorexia—Spitting of Blood .s.scoreceeees .

CHAP. VII. Diseases of the Eyes—Nyctalopia—Case of Croup—Sore Throat—Corpulency—Small Pox—IJnoculation—Measles

Page

50

110

127

CONTENTS.

CHAP. VIII. Page

Yatvs..s FOOTCHOOSECOEHGAR AFL HEHT FORESEES OHSS SESETTEHEAEEHHOEGEOCH CEG TEBECEESE 139

CHAP. IX. Herpes—Krakra—Moitled Appearance of Skin—Effects of Fish Poison—Nostalgia eet eeaeoneee eee eeeseaeeetes * STOOP ORSSHOS8GR088 163

CHAP X. ie Bite of Snakes—Of Scorpions—Of Tarantulas .1.0sss00ssseceeee 176

CHAP. XI. Burns and Scalds—Ulcers—Recent Wounds—Fraciures «++... 193 —

CHAP. XII. THE DISEASES OF WOMEN-WITH THE SEXUAL PECULIARITIES IN AFRICA.

Aysteria—Catamenia—Labours—Expulsion of the Placenta— Abortion—Miscarriage—Milk Breasts—Pendulous Bel--

LeS——SUCKING 00 caesenvocecersvaccctusenvocssses ercoe eeerececese 205

CHAP. XII: THE DISEASES AND MANAGEMENT OF CHILDREN. Treatment after the Birth—Locked Jaw—Method of carrying Children—Eruptions—Indistinct Articulation—Tinea Capi- tis—Weakness—Wasting —Diarrhea—Protrusions of the Navel—Richets— Prolapsus Ani—Dirt-eating—Large Bel-

lies feecsove eeosess eesecoes @ceecreesaeeoteosedesuseaessebeeeecoesans IgG

Appenpix. No. J. An Account of Circumcision as itis prac- tised on the Windward Coast of Africd .sievecsessansessesess 299

AppeNDIx. No. Ul. An Account of the African Bark ...... 243

AppenpIx. No. III. Remarks suggested by the Perusal of Mr. White's Work on the regular Gradation in Man .....0+. 254

AppenprIx. No. IV. Remarks of Professor Blumenbach .

Upon ESTOS ocrevercracccncscsceresevcconsseccnsavsvevceseeses 275

AN ACCOUNT OF THE

PRESENT STATE OF MEDICINE

AMONG THE NATIVES

OF

SIERRA LEONE.

CHAP. I.

INTRODUCTION. ORIGIN OF MEDICINE. FIRST PHy- SICIANS. UNION OF MEDICINE AND MAGIC. PRAC- TICE OF MEDICINE IN AFRICA. GENERAL DIVISION.

WHE following attempt to sketch a history of ' the present state of medicine among the natives of Africa, and to give some account of: _ those diseases to which they are more peculiarly liable, was undertaken during the calamitous and’ distressed state to which the colony of Sierra’ Leone was reduced, in consequence of the depre- dations committed there by the French, in the year 1794. Tt was resorted to with the view of restoring some degree of activity to a mind broken down by sickness, and afflicted by the VOL, Ul. B

Q

scenes of distress which daily presented them- selves. This account must unavoidably prove very defective ; partly from a want of knowledge of the different languages spoken by the nations who are the subject of it, and partly from the great unwillingness which they shew to disclose the secrets of their medical art. ‘The inconve- niences which are produced by the former circum- stance, are but imperfectly remedied by the assist- ance of an interpreter ; and the difficulties which result from the latter are well pomted out by Dr. Rush, who is so deservedly eminent as a physician and philosopher, in his Inquiry into the Natural History of Medicine among the Indians of North America*. ‘ By what arts,” says-he, “ shall we persuade them to discover their remedies? and how shall we come at the knowledge of facts in that cloud of errors in which, the credulity of the Europeans, and the superstition of the In- dians, have involved both their diseases and re- medies? These difficulties serve to increase the importance of our subject. If I should not be able to solve them, perhaps I may lead the way to more successful endeavours for that purpose.”

An inquiry of this kind, were the obstacles which oppose its prosecution entirely removed, would no doubt prove sufficiently interesting. We are indebted to the experience of nations, more rude than those of Africa, and inhabiting countries which possess fewer natural advantages, for some of our most valuable remedies. We have

* Medical Inquities, vol. 1.

3

therefore some reason to hope, that as Africa, though hitherto too much neglected, has already enriched many European arts by its productions, so it may have in store for future observers some articles which may become important acquisitions to the materia medica ;

Some “ herbs, and potent trees, and drops of balm,

Rich with the genial influence of the sun,

‘To brace the nerveless arm, with food to win

Sick appetite, or hush th’ unquiet breast *.” Considerable pains have been taken to discover those remedies upon which the natives place their chief dependance for the cure of diseases; and to prevent, as much as possible, any ambiguity arising in default of scientific names, as many of the na- tive names of vegetables, &c. as could be pro- cured, have been inserted. For the Linnzan names of medical plants which have been men- tioned, I am indebted to my learned friend Dr. Adam Afzelius, demonstrator of botany in the university of Upsala, who has kindly promised to supply such as are wanting, in the elaborate work which he is now preparing on the natural history of Sierra Leone.

Although the present account relates chiefly to the Timmanees and Bulloms, who inhabit the banks of the Sierra Leone and its neighbour- hood, yet the customs of other nations, par- ticularly those dwelling to the northward of that river, will be occasionally noticed, where an op- portunity has occurred of observing any striking

* Akenside,

4,

differences between them. Indeed it is highly probable that the same medical customs will be found to prevail, more or less, for several hundred miles along the coast of Africa, as a very great similarity of manners prevails among the inhabi- tants, although divided into so many different nations.

The origin of medicine has probably been the Same in every country, and its progress towards perfection has been equally slow and gradual in all. ‘To relieve the body from sickness and pain must early have excited the attention of mankind. The rudest nations we are acquainted with have a knowledge of medicine. Pliny observes, that if at any time there have been people without phy- sicians, yet they have not been without medi- cines; and the science remained at Rome, even after the physicians had been banished from the city. It is in the savage state, or the state of nature as it is called, that that part of medicine which attends chiefly to accidents is more pecu- liarly requisite*; for men, whilst engaged in hunting wild beasts, or while roaming over an uncultivated country, covered with impenetrable forests, are more exposed to wounds, bruises, and other accidents, than those who live in a more civilized state; hence it is probable that some degree of medical experience must have been coeval with the origin of mankind. Quintilian

* Medicina quondam paucarum fuit scientia herbarum, quibus sisteretur fluens sanguis, vulnera coirent paulatim. Seneca Epistol. 95.

5

remarks, ‘“ Medicina ex observatione salubrium atque his contrariorum reperta est ; et ut quibus- dam placet, tota constat experimentis. Nam et vulnus deligavit aliquis antequam hec ars esset : et febrem quiete et abstinentia, non quia rationem videbat, sed quia id valetudo ipsa coegerat, miti- gavit *,”

As it is more obscure in its nature than other arts, so medicine has been slower in its progress, In some instances we are said to have been in- debted to the practice of animals for the know- ledge of particular remedies; in other instances to accident, or to a fancied resemblance between a plant and the disease it was supposed to cure t+. Even at this time many medicines are retained in the materia medica of European nations from some such fanciful notion of their virtues. Among the many histories of accidental discoveries of

* Institut. IT. xviii.

+ Pliny says “* Hippopotamus in quadam medendi parte etiam magister exstitit. Assidua namque satietate obesus, exit in litus, recentes arundinum czsuras speculatum: ‘atque ubi acutissimum yidet stirpem, imprimens corpus, venam quandam in crure vulne- rat, atque ita profluvio sanguinis morbidum alias corpus exonerat, _ et plagam limo rursus obducit.

Simile quiddam et volucris in eadem gypto monstravit, que vocatur ibis: rostri aduncitate per eam partem se perluens, qua reddi ciborum onera maxime salubre est. Nec hec sola a mul- tis animalibus reperta sunt, usui futura et homini ; for which con- sult Pliny Lib. viii. c. 27.

In another place he observes, < Torpescunt scorplones aconiti tactu—Auxiliatur his elleborum album—Tangunt carnes aco- nito, necantque gustatu earum pantheras :—at illas statim liberari morte, excrementorum hominis gustu, demonstratum.—Puden- dumque rursus, omnia animalia, que sint salutaria ipsis, nosse, preter hominem.” L, xxvii. ¢ 2.

6

remedies, that of the purgative effects of helle- bore by Melampus bears at least an air of pro- bability, as also does that of the Peruvian bark.

From history we learn, that the practice of medi- cine formed a part of the duties of religion among the chief nations of antiquity ; perhaps from this consideration, that the priests of the gods were alone thought worthy to practise an art so much beyond the reach of human genius to discover, and of which they boasted that the gods them- selves were the inventors. Kings were formerly instructed in this art, and philosophers considered medicine as one of the chief objects of their atten- tion ; among others, Aristotle is said to have prac- tised medicine before he applied to the study of philosophy.

The first account we have of physicians is con- tained in the sacred writers, where they are also said to be embalmers of the dead. The “ art of the apothecary is also frequently noticed ; but though they might occasionally have practised physic, they appear to have been chjefly venders of drugs, myropolz ; and afterwards, when physic became a distinct branch of science, this art fell into contempt, and probably became that of a mere perfumer, unguentarius *.

At the same time quackery may have drawn its origin: a kind of gypsies or fortune-tellers, called by the antients agyrtz, zruscatores +, prestigiatores, &c. pretended to cure diseases by

* Cic. Offic: i. 42. ¢ Calepin Dict. und, Ling.

7

charms, and by a variety of mysterious ceremo- nies. These people also, like the greegree men in Africa, or the obia professors in the West Indies, wreaked their vengeance upon those who offended them, by the recital of magic verses. “ Irritat, mulcet, falsis terroribus implet.”

In all the uncultivated nations of antiquity, me- dicine has been held in the highest esteem, and even considered as a divine art. Homer often speaks of the peculiar respect paid te those who were skilled to dress a

Wound with drugs of pain assuaging power;

an art which had not been neglected by the haugh- ty * Achilles.

Medicine, as well as many other useful arts, ap- pears to have been very early cultivated in Egypt, as is evident in the sacred writings. Homer calls Egypt the land of physicians, and says,

Egypt teems with drugs, yielding no few, Which, mingled with the drink, are good, and many Of baneful juice, and enemies to life.

‘There evry manin skill medicinal

Excels, for they are sons of Pon all f.

Pliny also says, medicinam A‘gyptii apud ipsos volunt repertam: alii per Arabum, Babylonis et Apollinis filam: herbariam et medicamentariam a Chirone ; hence it appears that we are indebted,

* See the story of Democedes, related by Herodotus, iii, 129 also Ecclesiasticus, ch. xxxviii. t+ Odyss. iy. 288, by Cowper.

8

for at least the rudiments of this art, to the Afri- cans, despicable as their knowledge of it may ap- pear to us at present. :

_ This union of medicine with the ceremonies of religion, which occurred during the early ages of mankind, among all those nations of whom we have any records, is also found to prevail amongst all those with whom navigation has lately made us acquainted; and both appear to have been universally connected with those superstitious practices, the magicz vanitates, which from time immemorial have kept the minds of mankind in a constant state of alarm. Pliny, speaking of this triple union, says of magic in particular, “ Natam primam e medicina nemo dubitat, ac specie saluta- ri irrepsisse velut altiorem sanctioremque medici- nam: ita blandissimis desideratissimisque promis- sis addidisse vires religionis, ad quas maxime eti- amnum caligat humanum genus*.” ‘The depen- dency of medicine upon magic, or at least upon the same disposition of mind, is not yet broken, and if formerly they “ with incantation staunch’d the sable blood,” the same natural effect is ffre- quently, at the present day, attributed to causes equally trifling and ridiculous. ‘The Druids were priests and physicians among the Gauls and an- cient Britains. In North America, the priests of the Indians are at the same time their physicians. . and their conjurors ; whilst they heal their wounds, or cure their diseases, they interpret their dreams,

give them protective charms, and satisfy that de-

* Lib. xxxis c. 1s

9

sire which is so prevalent among them of search- mg into futurity *. It is curious to remark, that the same notion respecting medicine prevails among the islanders of the South Seas. At Ota- heite, a physician is called tahauwamai, a word compounded of tahauwa, a priest, and mai, pain. Thus we see that all nations, while in similar states of cultivation, possess nearly the same ideas, though cut off from all communication by im- mense tracts of ocean. Respecting the practice of medicine in Africa, there is reason to imagine that it is not at pre- sent in a progressive state of improvement, but that it remains nearly as it was some centuries ago. ‘This arises chiefly from their great repug- nance to change customs which long usage has rendered venerable. They plant their rice, build their houses, and manufacture their cloth in ex- actly the same manner as their forefathers, and they answer every objection, by saying it is “ country fashion.” This attachment, however, to long established customs, though probably strengthened in tropical climates by the enervat- ing power of heat, is not peculiar to the Africans : it is observed to prevail in all countries parti- ally civilized. Thus the manners and customs of the Asiatics, as described in scripture, are nearly the same as those which are observed in the East

at the present day t. * Carver’s Travels in North America. + Spirit of Laws, xiv. 4. VOLWI, C

10

- ‘The notions respecting the effects of medicine are, in Africa, so much blended with a regard to magical ceremonies and incantations, that it is often difficult to discover on which they chiefly rely for success. Although they imagine that every disease attended with danger is occasioned by witchcraft or poison *, yet they readily admit that sickness may occur independently of these causes. In support of this opinion they argue, that if a vessel of any kind be filled with clean water every day; and be not washed out, it must at length become foul; hence, say they, arises the necessity of washing the stomach from time to time with some medicine, although unattended with any operative effects. Another reason why they suppose the stomach to be the chief seat of disease, is the loss of appetite, which so frequently attends it, and which is to them the most alarm- ing symptom. When the body is disordered, from whatever cause, they do not believe that it can be again restored to health simply by its own powers, or by the powers of nature as they are called, of which they have not the smallest no- tion.

In collecting medicines for use, they pay no regard to the phases of the moon, nor do they refer any of their diseases to the influence of this

* The Bulloms have a saying among them, that a Bullom man cannot die unless his death be occasioned by poison or

witchcraft. Van Helmont appears to have entertained the same notion, when he says, Deus non fecit mortem.

DE LITHEASI, C. Vv.

fh.

planet. Those who live upon the coast are of opinion, that people can only die at high or low tide. The influence of the tide upon departing lite has long been credited ; Piso says, during the six hours of the increase of the tide, diseases are exacerbated and pains are greatly increas- ed; but that they gradually abate during the reflux. The same author appears firmly -per- suaded that men die only during the ebb tide. Dr. Haller supposes that Piso was the first who formed this opinion; but Aristotle fell into the same error, and asserts that no animal dies dur- ing the increase of the tide *. : _ It is very common for those who are indisposed, to go and reside for some time in a distant vil- lage +, in order to take medicines from some one who has acquired celebrity for the cure of a par- ticular disorder; this is frequently some old wo- man, to whom even Europeans will often trust themselves in preference to their own country- men f. | |

* Haller Bib. Med. Pract. iii. 1.

+ Jeremiah xlvi. 11.

} Atkins gives an instance of this adherence to the supersti- tious practices of the natives, in a governor of Cape Coast Cas- tle, General Phips. “‘ The general,” he observes, “ has taken a consa, which by the negroes is understood a temporary wife ; she is a mulatto-woman, beget by a Dutch soldier at des Minas, by whom he has four children, of fair flaxen hair and complexion. He dotes on this woman, whom he persuades now and then to our chapel service, and she complies without devotion, being a strict adherer to the negrish customs. I attended the illness of one of her children, and afterwards on the General himself, who, on both occasions, I found, was so weak or so wise, as to give the preference of fetishing to any physical directions of mine,

12

In prosecuting the inquiry into the diseases of the Africans, I shall consider,

1. General diseases, to which both sexes are liable.

2. The diseases of women, with the sexual pe-

culiarities in Africa. 3. The diseases and management of chil- dren.

wearing them on his wrists and neck. He wasa gentleman of good sense, yet could not help yielding to the silly customs created by our fears.” Having given this instance of the governor’s weak- ness, it may not be improper to notice what this writer further adds on this subject, which may serve as a proof of the good understanding of his lady. ‘‘ He cannot persuade this woman to leave the country, though he has stole or forced her consent for all the children, in regard to their education ; she still conform- ing to the dress of her country, being always barefoot and fetished with chains and gobbets of gold, at her ancles, her wrists, and her hair; to alter which in England, she thinks, would sit awkward, and, together with her ignorance how to comport herself with new and strange conversation, would, in all likelihood alienate her hus- band’s affections.”

13

CHAP. II. GENERAL DISEASES.

FEVER. REMEDIES FOR THE THIRST, VOMITING, AND HEADACH, WHICH ATTEND IT. REMITTENTS. MODE OF CUPPING. INTERMITTENTS. ENLARGEMENT OF THE SPLEEN. CDEMA OF LOWER EXTREMITIES.

' MANIA. IDIOTISM. EPILEPSY. WORMS. LE- THARGY.

Bec is the most frequent and most fatal disease to which Europeans are subject upon this coast; it is less common among the Africans, who also suffer less from its attacks. In them, it is generally the sequel of a debauch, and very frequently follows the excessive intemperance in which they indulge at the funeral of their friends. It is a common remark among them, that one ‘ cry’ is generally followed by several others ; for when any person of consequence dies, several others fall sick, and often narrowly escape with their lives. Even this they attribute to witch- craft, though it evidently depends upon their own misconduct. They have no idea of the nature of fever, as a general disease, nor have they any word in their language to express it, but name it from any of its urgent symp- toms, as sick head*, sick belly, &c. On that account it has been supposed that the Africans are not liable to the attacks of remittent fever, an opinion which is contrary to fact. It is not

* Head-ach in Bullom is, Bul nek-kée-ay ; in Timmanee; Ro-

bimp rob4ng. Sick belly, in Bullom, is Koonay nekkeeay ; in Timmanee, Koor Rob-bang.

wet

14

uncommon to see the natives affected with slight, but distinctly formed paroxysms of fever, which sometimes terminate within twenty-four hours, and are considered as common head-achs. I have known instances where repeated paroxysms have occurred, and where the remittent fever has run its course precisely as it would have done in any European who had resided long upon the coast, and who by undergoing the seasoning, as it is termed, had assimilated himself to the climate. It may not be improper here to remark, that what is termed seasoning among Europeans, an idea peculiar to themselves, apes merely the first severe fit of illness, chiefly fever, which a person suffers after his arrival in a tropical climate ; suc- ceeding attacks of fever are usually experienced in a slighter degree, though in this respect there is great difference, for some have repeated attacks as severe as the first. “Those Europeans at Sierra Leone, who longest resisted the power of climate in producing sickness, suffered more, and were more dangerously affected, than those who sick- ened soon alter their arrival. People of fair com- plexions appeared to be more liable to fever, and to suffer relapses from slighter causes, than those of darker complexions, but they experienced, upon the whole, less severe attacks than the latter, From a few instances it appeared that the cli- mate was more inimical to men above forty-five, than to those who were younger. Women en- joyed a tolerable state of health, nearly as good as in Europe; their complaints were in general less severe than those of the men, but the state of

15

convalescence was slower, and they were more liable to be harassed with pac of irritability or of erethism*.

Dr. Clark, of Dominica, speaking of the yellow fever which prevailed in that island in the years -1793, 4, 5, and 6, observes, “ the new negroes, who had been lately imported from the coast of Africa, were all attacked with it. The negroes who had been long in the town, or on the island, escaped.”

_ Another accurate observer, Dr. Chisholme, of Grenada, remarks, that, “ although it is probable that the negro race possess something constitu- tional, which resists the action of contagion in a very great degree, still it must be admitted that their necessary temperance must have contributed much in the present instance to their exemption from, or to the mildness of, the disease when it appeared among them.” ‘The effects of tempe- rance, as a prophylactic, are strikingly demon- strated by the same author: “ Whilst the pesti- lential fever raged here,” he observes, “‘ the utility of these means was remarkably illustrated by the almost total exemption of the French inhabitants from the disease. ‘Their mode of living, compared : that of the English, is peornes ate and regular . Gian anes on degree +.”

* Vide

+ Dr. Chisholme, in the work quoted above, entitled, “An Essay on the malignant pestilential Fever introduced into the West Indian Islands, from Bullom, on the Coast of Guinea,” endeavours to prove that the disease was of African origin. But notwith- standing the instances adduced by Dr. Chisholme, of several

persons who were seized with a dangerous fever soon after they had visited a vessel called the Hankey, which arrrived at Grenada

ts, vol. vill.

16

When the thirst is very distressing in fever, the pith of aspecies of reed called cattop, (Timmanee) sinkwonnyee or kaymanghee, (Soosoo) wisha,

(Bullom) is bruised, and after being boiled for a

from the island of Bulama or Boullam ; and notwithstanding the sickly state in which this vessel is said to have been on leaving Bu- lama, and during the passage to the West Indies, yet there is rea-

son to suspect that the disease in question, if really imported into ~

those islands, did not originate from the island of Bulam. In other instances we find every specific contagion produces a disease suz generis, differing only in greater or less degree of violence, or at most possessing such slight deviations as are occasioned by par- ticular states of the atmosphere, or peculiar modes of living. But in the instance of the pestilential fever described by Dr. Chis- holme, we should be induced to suppose that the contagion had not merely acquired a greater degree of virulence, but had been converted into a different species.

The fever, which carried off so many of the settlers at Bulama, precisely resembled the endemial remittent fever of Sierra Leone, a sketch of which, at some future opportunity, may perhaps be laid before the public ; but the fever described by Dr. Chisholme differs so essentially from that which occurred at Sierra Leone, that it cannot be recognised as the same disease. Besides, about the same period, a fever similar to that of Grenada showed itself in the other West India Islands, and in America, particularly at Philadelphia, where no rational cause could be assigned for its appearance, which would not have been the case had it been im- ported.

Dr. Chisholme has committed an error, of not much conse- quence, indeed, in supposing that the Hankey and another ship, the Calypso, were chartered by the Sierra Leone Company (page 83); and further, (in page 86) he adds, ‘* Capt. Coxe (of the Han- key) finding the water at Bullam unwholesom his ship to Bissao, where there is a Portugu supply. The ship was navigated by about lye seamen, most of whom had not experienced sickness, and had been probably procured from Sierra Leone.” The Hankey had no communi- cation whatever with Sierra Leone, nor do I believe she ever had a person on board from that place. The other vessel, the Ca- lypso, after leaving Bulam, called for refreshment at Sierra Leone, where she remained about six weeks, during which time upwards of forty of the crew and passengers died of the remittent fever, though unattended with any appearance of peculiar malignity.

roceeded. a ettlement, fora

“<i

17

little time in water, the decoction is used as thé common drink; it is very acid, and is very effec- tual in quenching thirst. They employ, for the same purpose, the delicious fruit of the ana- nas; which clears the mouth from sordes, and makes the tongue and gums as red, as if the blood _ were ready to burst forth:

Vomiting is one of the most distressing symp- toms which occur in fevers: to alleviate or re- move it, they drink a warm infusion of the com- mon red pepper, or capsicum, or they swallow a few pods of it gently bruised. The juice of the lime is also frequently taken with the same intention, or they use the expressed’ juice of the medulla, or scraped stem of the cattop, to which’ is sometimes added a decoction of the leaves of a tree called by the Bulloms and Timmanees yuffo.

Head-ach is another symptom’ of fever which frequently causes much uneasiness and distress to the patient, and, en that account, cephalics form a most numerous class of remedies’ in the African materia medica: infact, there are but few plants, particularly. such as possess a degree of aroma, which ‘they do not suppose to be good for the head. Almost the whole of these remedies’ are applied externally, chiefly to the forehead ; the only thing used internally being an infusion of the scoparia dulcis, which is sometimes drunk warm like tea. The most celebrated of their external applications are the following. 1. Abank (Timmanee). The leaves are bruised between two

VOL. I. D

18

stones, and formed into a kind of paste with water, which is rubbed upon the forehead twice a day, and repeated for at least.a week. |

2. The leaves of a plant called cooteé (Tum- manee) are bruised and made into a paste with water, and applied in the same manner as abunk. This herb has a very delightful odour, resem- bling that of the anthoxanthum odoratum, which imparts the fragrance to new mown hay, and is used by the natives to smell at.

3. The leaves of the lime bush, when beaten in a mortar, are afterwards heated in an iron pot and applied hot, wrapped in a handkerchief, to — the forehead ; they are much commender for their tert in this complaint.

4. A remedy, the reverse to the above, con- sists in applying the cold leaves of the plantain tree to the forehead, which are renewed as often as they grow warm. The grateful coolness of these leaves frequently produces a temporary abatement of the excruciating pain which attends the exacerbation of their fevers*.

5. Comamboy (Timmanee), mamboy (Bullom). The seed, which is as large as a chesnut, is finely scraped, and rubbed over the forehead : as it is. of a very hot and acrid nature, if it be too long.

applied, it produces nearly the same effects as cantharides. .

* Professor Thunberg, speaking of the ricinus, says, “ the leaves of the shrub dried, and applied round the.head, were

affirmed to be serviceable in the head-ach,” probably from their coolness.

A

19

6. Apuntokellee (Timmanee), Issumpellén (Bul- lom), Santay (Soosoo), mimosa involuta*. The whole of the leaves and smaller branches are bruis- ed, and applied cold to the forehead, as a poultice. A decoction of it is also frequently used to bathe the face and gums when painful and swoln.

7. Mabunk (Timmanee). The dried leaves of this plant are powdered, and applied to the fore- head, softened with water.

8. Matakkee (Timmanee). This is used in the same manner as the above; it is a hot, acrid plant, and is frequently applied to the head to kill. vermin. — 9 .

9. Abak (Timmanee). The dry leaves are powdered, and used like those of matakkee.

10. Manai (Timmanee). The fresh panicles _ of the plant are rubbed over the forehead.

11. Mattopper (Timmanee). This isa warm, aromatic odorous plant, having a strong, bitter taste: the leaves are applied to the forehead as im the preceding instances. ‘The red berries of this tree somewhat resemble cherries, and are eagerly sought after by a species of dove with a bright green plumage. |

12. Tunkamtntoo (Timmanee). The leaves are boiled in water, and used warm for washing the forehead.

_ * The bark of this tree is used to make a coarse kind of mat.

‘t+ The bark of mattopper is used by the natives to dye lea- ther of a red colour. The bark is beaten small, and infused in water gently heated, and the leather is suffered to remain a few hours in the mixture.

20

13. Mapéor (Timmanee). A species of af- zelia. The leaves dried in the sun are powdered, and mixed with water so asto form a cataplasm, and applied cold to the forehead.

14, The leaves of a plant, called by the Soosoos makootay, are applied in the same manner as those of mapéor., x

15. Agbunto (Timmanee). This is a very warm aromatic plant, resembling thyme im taste, An infusion of the whole plant is drank warm for the purpose of producing perspiration, and at the same time the leaves are rubbed upon the fore- head, A decoction of the leaves of the two following plants are used solely for bathing the forehead.

16. Quéequee or lees aes (Timmanee).

17. ‘Teechee (Timmanee).

18. Teeboorakee (Timmanee), is a plant used for the cure of head-ach when accompanied with sore throat; it has an aromatic taste, and resem- bles sage in smell, and appears to be chiefly used as a sudorific. |

When the head-ach proves obstinate, and does _

not yield to these means, they have recourse to cupping, which is the only method of drawing blood they are acquainted with, Prosper Alpinus asserts, that the Egyptians used to draw blood from both the arteries and veins, a practice un- known upon the western coast of this continent. Cupping is generally performed by some old wo- man; who makes first a number of small inci- sions, with a sharp pointed knife, in the skin,

a ii el a Gag eis ae ar ae

21

upon the temples or forehead, as near as possible to the seat of the pain. She then places over the incisions a cup, formed of a small gourd cut in two, the air being first rarefied by burning a little dry grass or cotton in it.

It is a custom with some, dhe affected with head-ach, to lie upon the hearth before a large fire, having a heavy stone laid upon one side of the head. A similar practice seems to be fol- lowed by the Mongearts, a nation of Africa, who “im head-ach bind the head with such extraor- dinary violence as to force out the blood from the forehead *.”

Intermittents are very uncommon among the Bulloms and Timmanees, many of them having never seen the disease, except perhaps among Europeans. Hence they have no specific name for an ague, but generally term it the “ shaking sickness.” In the Foola country, intermittents are more usual than in the Soosoo or Man- dingo countries, and they are said to be rather frequent at Teembo during the rainy season, The Mandingos and Foolas call this disease gondeea, and the Soosoos term it foorakee. When it occurs, their mode of cure consists in exciting a profuse perspiration; this is done by causing the patient to sit over a large pot in which some leaves have been boiled, the steam being confined by a large cotton cloth thrown over the patient’s head, and reaching to the ground. Among the

* Saugnier and Brisson’s Voyages to the Coast of Africa.

22

Soosoos it is usual to boil the leaves of a species of bean tree called killéeng, previously bruised, with which the body is bathed as a cure for this disease.

Aguish complaints are equally uncommon among the negro slaves in the West India Islands. Dr. Curten, physician at Rio Bueno, Jamaica, speaking of the negroes, says, “ I have not met

among them with a pure tertian intermittent in

the whole of my practice, though white people

are often affected with them. I have been in-

formed by practitioners of forty years experience, that it isa rare occurrence among negroes; that they have not met with more than one or two instances in the whole of their practice; and that even these few have been confined to mu- lattoes and house negroes, or those who live in the same manner as white people*.” The Nova Scotian blacks settled at Free Town are, however, very liable to agues: the only difference between them and Europeans in this respect is, that the former appear to suffer less from the disease, and that in the remittent fever, the remissions are more perfect among the Nova Scotians, and more dis- posed to assume the form of an intermittent.

The Africans are very seldom affected with en- largements of the spleen, or ague cakes, as they -are called in the fenny counties of England. They arise from the frequent repetition of itermitting fevers, and prove fatal to Europeans, by laying

* Ed. Med. Com. Vol. V. Dec. II.

23

the foundation of dropsy, and other diseases. Dr. Isert observes, that, “a negro will scarce ever be found troubled with this complaint, though almost half the Europeans on the coast have it, or at least think they have it*.”

* The tumefied bellies, with which Europeans are sometimes » affected in Africa, arise chiefly from enlargements of the spleen, which admits of extension to an immense bulk. In some in- stances it reaches as low as the crista of the ilium, and projects considerably into the right side of the abdomen. ‘The chief un- easiness which it excites in the patient, whilst its bulk continues moderate, is a sense of weight scarcely noticed, but generally increased by lying on the right side. In process of time, when intemperance joined with repeated attacks- of fever, which are permitted to run their course, have increased its bulk consider- ably, dyspeptic symptoms are added, in consequence of the pressure on the stomach. ‘The liver also, though untainted with disease, suffers in its turn, chiefly from the mechanical obstruc- tion it receives from the spleen, and partly. from its connection with the stomach. Hence arises that dirty, yellow tinge, so visible in the countenances of Europeans who have resided long in Africa. Symptoms of irritation occasionally harass the patient, and are always attributed to the tumor; but seem to be less connected with it than with some recent debauch. Enlarged spleens are frequently met with in children, in whom they seldom occasion much inconvenience, but, in process of time, either totally disap- pear, or become so much smaller as not to attract notice. The only medicine which I have found serviceable in this complaint, is the sal cathart. given in proper doses to keep the bowels mode- rately open: bitter tonics were also of use in strengthening the constitution and diminishing its irritability. Mercury has little effect in reducing these tumors, and such is the irritability of the system, that even small doses are apt to affect the mouth speedily, and distress the patient greatly. Enlargements of the spleen have: been referred, by those who are prejudiced against it, to the use of Peruvian bark in febrile complaints; on the contrary, they afford the strongest testimony in support of the efficacy of that invaluable medicine. Among 'the numerous instances of remit- tent and intermittent fevers, at Free Town, which were cured by a liberal use of the bark, there did not occur, at any period, a single

QA

C&dematous swellings of the lower extremities, _ in. consequence of the debility induced by frequent repetitions of the remittent and intermittent fevers, are not unfrequent complaints about Sierra Leone. They are also said to be frequent upon the Coast of Angola, and to prove soon fatal: upon the Windward Coast they generally succeed the remit- tent fever, but further south they are more usually the consequence of fluxes. For the cure, they heat in an iron pot-a quantity of the leaves of a tree called by the Bulloms dee or lay, by the Timmanees malip, and by the Soosoos loogree ; when sufficiently warm, the leaves are applied to the leg, which is rubbed at the same time down- wards with some degree of force. A decoction of the same leaf in water is often used warm as a fomentation, or bath, for the legs. The leaf of the malip has aslightly acid, astringent taste.

‘The castor nut, ricinus, is likewise much re- commended for anasarcous swellings: the leaves, which are very mucilaginous, are steeped in hot water, and then wrapped round the leg as warm as the patient can bear, and repeated before they lose their heat. After the leaves have been thus applied for a quarter or halfan hour, the limb is well dried, and the patient is put to bed, where a copious perspiration of the part generally ensues. Together with the above methods, active purga- tives are occasionally used.

f

instance of visceral obstructions ; these always arose from neglected’ attacks of fever, in which the bark had been totally omitted, or exhibited irregularly and in insufficient quantities.

Q5

The téma, or poison tree, though so much dreaded when taken internally, is greatly cele- brated as an external application in dropsical swellings of the limbs: the bark of the tree is powdered, and moistened with cold water, so as to form a cataplasm, which is said to cause the water to exude from the limb, and speedily to remove the disease, though it does not appear to be pos- sessed of any caustic quality.

The leaves of comamboy (Timmanee), mamboy (Bullom), are beaten in a mortar, and applied cold to the legs in cedema. Care must be taken not to continue them too long, lest the part be blistered.

Persons who have fallen into a bad state of health without any evident cause, or who are convalescent from fever, &c. but still continue weak and debilitated, are washed very early every morning with a decoction of the leaves of these three plants, called goguoy, bomboy, wurraree : this is always applied cold.

Mania is a disease which very rarely, if ever, occurs among them, nor could I make them com- prehend the meaning of the term; the only idea they can form of it is, when_they “ lose their - head,” as they term it, in the delirium of drunk- enness.

Idiotism is not a common disease, though I have seen two or three instances of it, one of which appeared to have arisen in consequence of repeated attacks of epilepsy.

An instance of epilepsy occurred to me in a man about fotty years of age, remarkably robust VOL. I. 4B |

>

26 | ind fleshy, who had been affected with it from childhood. His faculties did not appear to have suffered from these attacks, and he said he knew many who were affected with the same disease. The Soosoos call this complaint kdoleekoolee ; the Foolas, kreekreesa; the Mandingos, téeree ; and the Timmanees, catéok; they do not attribute it to any particular cause, and consider it as incurable.

Worms of the intestines are well known among the Africans, and considered as a very frequent cause of diseases, particularly in chil- dren. The Timmanees and Bulloms do not dis- tinguish the different species of worms by par- ticular names, but use the word abilloo, worms, or abilloo rokéor, “worm sickness,” to denote the whole. Among the Foolas and Mandingos, the various kinds are very accurately distin- guished ; the ascarides, or maw worms, are called by the Soosoos, koolee; by the Foolas, toomboo ; and by the Mandingos, nyaallee. ‘The lumbrici, or long worms, are called by the Foolas and Soosoos, tonnangho, and by the Mandingos, shoondee. The Foolas name the tenia or tape

<worm, neagoodmee ; the Mandingos and Soosoos call it calligbay.

The Foolas are peculiarly subject to thei bie worm: this they attribute to their living so much upon milk, which, as it is very plentiful among them, constitutes a large portion of their diet. Dr. Sparman says, in the country round the Cape of Good Hope, the inhabitants are much troubled with

27 worms, especially with the tape worm. He does not undertake to determine what may be the cause, but thinks it probable that a milk diet con- tributes somewhat.

The slaves, who are brought down to the water side by the Foolas for sale, are always infested with the tape worm; this probably arises from the very scanty and wretched diet with which they are fed in the path, as they term the jour- ney, and which, from the distance they are brought inland, often lasts for many weeks, at the same time that their strength is further reduced by the heavy loads they are obliged to carry. Dr. Hasselquist says, that the lower classes of the mhabitants of Grand Cairo are very subject to the tape worm, which he attributes to their very poor diet : the Turks, who live better, are much less affected with this disease.

The Foolas are of opmion that people who drink rum are never troubled with the tape worm, and when they come down to the sea side among Europeans, those who are affected with tape worms sometimes venture to ask for this hercu- lean remedy. Indeed, so high an opmion do they entertain of the medical virtues of this liquor, probably because they are so strictly forbidden its use, that they imagine it enters into the com- position of every medicine made use of by Euro- ‘peans; in consequence of which, when labouring under any very serious sickness, they prudently decline asking any questions respecting the com-

23"

position of the medicines administered unto them. Some of the Mahommedans suppose that worms were originally produced by the “ devil spitting upon Adam’s belly.” They have a number of remedies for the cure of worms, which are chiefly of a purgative quality: the following are those most generally used.

1. Tongbee, (Timmanee) ; téngbee, (Bullom) ; tchadokee, (Foola), A decoction of the leaves of this plant is taken every morning as a vermiluge ; it produces no sensible effects, but the patient is directed to avoid drinking cold water after it.

2. Serigbailee, (Soosoo); leligunt, (Timmanee) ; Connarus africanus, Four or five kernels of the seeds are powdered, and taken for one dose, every morning, mixed with boiled rice. They produce no purgative effects.

3. The young leaves of a plant, called by the Timmanees kanonter, are bruised, and mixed with rice or fish. This medicine is particularly re- commended against the lumbrici: it is said to be a very effectual remedy, though unattended with any sensible operation. The dry or fresh leaves are used indifferently.

4, The bark of a tree called by the Timmanees, argé], and by the Bulloms, coontang, is beaten toa fine powder and boiled with a small quantity of the piper ethiopicum. A little of this decoc- tion is taken every morning mixed with rice, and proves gently purgative; this is a very cele- brated vermifuge, Where this medicme cannot

29

be given, as to children, on account of its nauseous taste, or where the stomach cannot retain it, a strong decoction of the same isused as a wash to the belly every day. In enlargements of the ab- domen in children, also, when suspected to origi- nate from worms, the bark of argol is reduced to a fine powder, and applied externally as a cata- plasm. The seeds of the fruit of the papaw tree, taken internally, are said. to be useful against worms. |

The Africans are very subject to a species of lethargy, which they are much afraid. of, as it proves fatal in every instance. The ‘Tim- manees call it marree, or, ’nluoi, and the Bul- loms, nagonlde, or kadeera: it is called by the Soosoos, kee kéllee kondee, or sleepy sick- ness, and by the Mandingos, seenoyuncaree, a word of similar import. This disease is very fre- quent in the Foola country, and it is said to be much more common in the interior parts of the country than upon the sea coast. Children are very rarely, or never, affected with this complaint, nor is it more common among slaves than among free people, though it is asserted that the slaves from Benin are very subject toit. At the commence- rnent of the disease, the patient has commonly a ravenous appetite, eating twice the quantity of food he was accustomed to take when in health, and becoming very fat. When the dis- ease has continued some time, the appetite de- clines, and the patient gradually wastes away.

30

Squinting occurs sometimes, though very seldom, in this disease, and in some rare instances the patient is carried off in convulsions. Small glandular tumors are sometimes observed in the neck a little before the commencement of this complaint, though probably depending rather upon accidental circumstances than upon the disease itself. Slave traders, however, appear to consider these tumors as a symptom indicating a disposition to lethargy, and they either never buy such slaves, or get quit of them as soon as they observe any such appearances. ‘The dis- position to sleep is so strong, as scarcely to leave a sufficient respite for the taking of food; even the repeated application of a whip, a remedy which has been frequently used, is hardly suffi- cient to keep the poor wretch awake. ‘The repeated application of blisters and of setons has been employed by European surgeons with- out avail, as the disease, under every mode of treatment, usually proves fatal within three or four months. The natives are totally at a loss to what cause this complaint ought to be attri- buted ; sweating is the only means they make use of, or from which they hope for any success : this is never tried but in incipient cases, for when the disease has been of any continuance they think it in vain to make the attempt. The root of a grass, called by the Soosoos kallee, and the dried leaves of a plant, called in Soosoo fingka, are boiled for some time im water, in an

t

31

iron pot; when this is removed from the fire, the patient is.seated over it, and is covered over with cotton cloths, a process which never fails to excite a copious perspiration. ‘This mode of cure is repeated two or three times a day, and is persisted in for a considerable length of time, until the disease be carried off, or appears to be gaining ground. No internal medicines are given in the complaint. .

CHAP. III. GENERAL DISEASES.

VENEREAL DISEASE, GONORRHG@A, PHLEGMONE TESTIS. HERNIA. COUP DE SOLEIL. TOOTH-ACH. SCURVY. EAR-ACH. DYSENTERY, ON BOARD OF SLAVE SHIPS,

AND ON SHORE. DIARRH@A. COLIC.

HE venereal disease is frequently met with among the natives, though there is great reason to believe that in every instance it had been first communicated by Europeans. ‘The African physicians boast that they are able to cure this disease in all its forms, and in every stage, for which purpose they employ avariety of ~ remedies, chiefly sudorifics or violent purgatives. It is said that they possess a plant, which, when chewed and swallowed, produces the same effects upon the constitution as mercury, exciting sali- vation, loosening the teeth, and causmg a feetor of the breath. ‘The Sumatrans are said to possess a similar specific, and to cure this disease “‘ with the decoction of a China root, called by them gadoong, which causes a salivation*.” In the present in- stance + the medical skill of the Africans has met * Marsden’s History of Sumatra,

+ Dr. Chisholm, enumerating the medical plants of Grenada, observes “the venereal virus has its antidotes ; among these may be mentioned euphorbia tithymaloides, the mal,nommé of the

33

With more applause than it deserves, as Tam con- vinced that they are not acquainted with any vege- table which possesses properties resembling rher- cury, and when they excite a'salivation, which they do imevery case of syphilis, it is only by means of mercury procured from Europeans. Dr. Rush appears to entertain a similar opinion respecting thé insufficiency of many of these boasted’ reme- dies. Speaking of the venereal disease among the Indians of North America, he says, ‘that he doubts much of the efficacy of somié Indian remiedies for this disease, as the lobelia, ceanothus, and. ranun- culus, spoken of by Professor Kali) He has béen informed) he adds; that their chief remedy is 2 decoction of the pine ‘treé used plentifully, ard that several of them die in this diséase.

The Foolas and’ Mandingos have a’ disease which they call LAANDA, of a very infectious na- ture, and’ which bears a’ striking resemblance to the venereal diseasé, though they consider them as essentially diferent. The laanda makes its’ ap- ago upon the glans or so like a com-

ev PNs

sion, ail hi disease sometimes abet s the throat, "destroying the bones of the nose and palate.

French ; that singular plant saururus cernuus, the herbe 2’ colet ‘of. the F are ; lobelia sy philitica ; ; and costus spicatus, a new spe- cie’’.” It is to be regretted, the ingenious author does not mén- tion eithér the niodé of action’ of these plants, or thé stages of the” disease in which they are employed.

: aie: of the malignant fever ofthe Weit Be VOL: F

34

_Gonorrheea is the most usual form of the venereal disease which occurs upon this coast, and it appears to be rather more frequent among the Soosoos and Mandingos, than among the Bulloms and Timmanees. They very unfortunately en- tertain an erroneous and cruel opinion, which prevails among the lower classes in Europe, that having connection with an healthy woman frees the infected person from the disease.

The Bulloms and Timmanees call this disease kennia, the Mandingos call it corrosilla, and the Soosoos, soogoqtia, or “a sickness caught at night.” For the cure, they rely chiefly upon purgative remedies, which are generally of a drastic nature. A number of limes are cut in two, and boiled with water in an iron pot, until one third of the quantity be evaporated: when cool, a cup-

full of this decoction is ordered to be taken two or

three times a day, or oftener, until it purge briskly. This medicine is violent in its operation, and being continued in the manner they direct, reduces the patient’s strength consider ably.

“Another celebrated remedy for ee is. obtained from a shrub, called by the See bul- lanta; by the Mandingos, earragasakkee ; by the Bulloms, chuck; and by the Tine tooma. An handful of the leaves is beaten ina mortar with a couple of limes, and the whole is infused for some hours in hot water. Of this infu- sion the quantity of a tea-cup-full is taken three or four times a day: it is an active purgative without producing much griping. A hitle of the

35

same infusion is occasionally injected warm into the urethra; it produces but a slight degree of pain. The milky juice of a plant called by the Soosoos, gang-gang; by the Bulloms,semm ; and by the Timmanees, prang or owan, proves when taken to the quantity of a large table-spoonfull, violently emetic and purgative without gripe, and is frequently used as a cure for gonorrhea.

In order to abate the ardor urine in gonorrhea, they drink an infusion of the scoparia dulcis ; chunkaprum *, (Bullom); karee, (Timmanee) : it is taken cold and has a sweet mucilaginous taste.

As an injection they frequently use an infusion of a shrub, called by the Bulloms and ‘Timmanees, nangka; and by the Soosoos, menneh; this is blown into the urethra through a small reed, one end of which is inserted into the urethra. Except gonorrhoea I never met with any affection of the urinary passages, such' as gravel, calculus, &c. A friend of mine, however, met with an old person, who appeared to be much affected with gravel or stone, and to whom he taught the me- thod of making and using lime water, for which he was very thankful. Mr. Bruce says, “ gravel is universally the disease with those who use water from draw wells, as in the desert,”

PuLecmMone TEsTis, swelled testicle, or, as it is

' * Chunk is the proper name of this shrub, but prum, which signifies a dove in Bullom, is commonly added, because doyes feed upon it, aud are so remarkably fond of it, that the natives place traps to catch them under these shrubs.

36

improperly called, hernia humoralis, is not an unfrequent consequence of gonorrhea, and it ap- pears to he more common among the Foolas, Mandingos, and Soosoos, than among the other nations ; owing, perhaps, to the wide and loose drawers Ce the former people wear. It is observed of the highlanders, that they are very liable to the same complaint, from wearing no breeches ; and Mr. Lempriere, in his Tour from Gibraltar to Morocco, speaking of the diseases of the Moors, says, “ The cause of hydrocele so frequently occurring in this country, seems to be in agreat measure the loose dress of the Moors, and the great relaxation which is induced by the warmth of the climate,” to which he adds, “ their indulgence in certain pleasures, and the applic cation ofthe warm bath immediately after.” To cure this complaint, the affected part is exposed to the yapour arising from a hot infusion of the leaves of the lime tree, or of those of the bullanta, in water, while the body is covered by a large cot- ton cloth, to excite a general perspiration. ‘They also use a decoction of a plant called by the Tim- manees, améss; and by the Bullqms, nollee or countopil, which is applied hot, as a fomentation tothe part.

A decoction of the three following plants is also administered for the cure of gonorrheea and swelled testicle, 1, Ronnetookee, (Soosoo). 2, Kundee, called by the Timmanees, killepa. 3. Dan- dakka, called by the Timmanees, amelliky,

37

An infusion of the bark.of amelliky is much com- mended in the cure of gonorrheea ; it 1s a strong bitter, and acts very powerfully as a diuretic.

The Soosoos frequently employ the root of a vine called kingkreesha, in decoction, as a cure for the venereal disease, but Iam uncertain m what stages they use it, or whether it be in gonorr- hea only. It is called by the Bulloms ’n-kay, and by the Timmanees ti-kep. It has a fruit the size of an orange, covered with a thick rind of a yellowish colour, containing a number of large seeds, involved in a white gelatinous matter of an agreeably sweet taste, and frequently eaten by the natives. |

An infusion of a plant, called by the Soosoos, nehree; by the Mandingos, nehtee ; by the Tim- _ manees, mabie ; and by the Bulloms, beé ; the mi- mosa edulis, locust tree; is used in gonorrhea, and frequently proves emetic. The fruit of this tree is eaten, and soap is made from its ashes.

It has been supposed that in those countries where oil is used im large quantity as an ar- ticle of diet, hernize are uncommonly prevalent ; this opinion, however, appears to be hypothetical, and founded upon the supposed relaxing pro- perties of oil, rather than upon what really hap- pens, as this disease is by no means so frequent among the Africans as it is among Europeans. I have only seen one instance of it which was of the congenite kind, in a boy about five or six years old, The Soosoos call it kayakai; the Bul- — loms, kokee.

38

They do not in general distinguish very accu rately between phlegmone testis and hernia: the latter disease is called by the Bulloms, rookra- koonee, rookra signifying the testicle, and koonee the belly : the Soosoos call it quorriakyaky ; the Mandingos, contakya; and the Timmanees call it grotoorakoor akoor. They employ the bark of a tree called cup-a-cup which is beaten small, moistened with water, and applied warm as a Ca- taplasm to the tumor. ‘This is repeated several times a day ; at the same time an infusion of the same bark is administered internally, though it does not appear with what view this is done, as the bark has no other sensible effects than those of an astringent: brisk purgatives are also oc- casionally administered. The natives have an idea, that if cold water be poured upon the head in this disease it would be attended with fatal effects. ‘

The coup DE soLeiL, or sun stroke, is very com- mon in the hot countries of Europe, and in the southern provinces of America; yet, notwith- standing the long continued and excessive heat of the climate, it is a disease entirely unknown to the Africans. ‘They expose the head unco- vered to the perpendicular rays of a scorching | sun, during the greatest bodily exertions, with perfect impunity; and children not a month old are exposed, whilst sleeping behind their mothers backs, to the full heat and glare of sunshine, with- out appearing to suffer in the least. This pro-. bably depends upon the great relaxation of the

39

system, by which a) general, and profuse perspi- ration immediately follows the least exertion, and which tends, by promoting an equable circulation, to prevent local congestions in the brain and other viscera, at the same time that it cools the surface by evaporation. The great uniformity in the state of the atmosphere has also a powerful effect : a greater or less degree of haze generally prevails in it, which, without intercepting the rays of heat, renders them more steady and uniform in their effects. ‘The coup de soleil appears to pre- vail ,chiefly im those countries where the alter- nations of heat and cold are considerable, and where the atmosphere is occasionally obscured by clouds ; a portion of this moveable curtain being, for, a moment, suddenly removed, the rays of the. sun are concentrated as in the focus of a burning lens. It is said that in the year 1743, between the 14th and 25th of July, upwards of eleven thousand persons perished in the streets of Pekin from this cause. i

Even Europeans are not liable to sun strokes in Africa, though it be common to see sailors rowing boats during the hottest season, with no other protection from. the sun’s rays than a thin handkerchief folded round the head, the rest of their dress consisting only. of a pair of trow- sers.. Where Europeans are said to die from this cause in Africa, and perhaps it may be added in the West India Islands, it is usually in conse- quence of the brain being atlected with inflam- mation from the abuse of those destructive liquors,

40

ardent spirits. Persons in an infirm state of health who expose themselves for a considerable time to the rays of the sun, sometimes feel a considerable degree of fulness and tightness 1n ‘the head, accom: panied: with a pulsation of the vessels of the brain, so strong that it is heard'by’ the patient : this is followed by no other bad consequences than a severe head-ach, and may be renioved by retiring into the shade, using a half erect posture, and. occasionally folding a cloth round the head wetted’ with cold’ water’ or viriegar and water.

In the Recueil de Questions proposées’ a° une Societé de Savants, Professor’ Michaelis asks if pains of the teeth, and decayed teeth, be more rare in Arabia than in Europe; ashe entertamed an opinion that the use’ of coffee may have produced a'con- siderable change in 'the teeth, and may have occa sioned disorders | in. them: which were nearly ‘un known before. The natives of Africa; though they have fine teeth, yet are frequently: affected with ‘roorH-acu, and very willingly have recourse to Europeans to have them extracted, an art of which they are totally: ignorant: Tooth-ach’ is called by the Bulloms, kot nekkeeay ; and''by the Timmanees, attunk arrobang.

The: Foolas, owing to their ‘constantly rubbing them, have very’ decayed teeth, and tooth-ach is just'as common among:them as it is in’ England.

- The juice of the gang-gang, Soosoo, or’ milk tree, called by the Timmanees prang, is recom- mended-as a cure for tooth-ach: A few drops of this

Al

juice are diluted with water and rubbed upon the © gums, anda single drop is put into the tooth when hollow, with the view of destroying the nerve. It is with the juice of this acrid plant that the Foolas poison their arrows: a single drop introduced into the eye excites most excruciating pain, and is followed by loss of sight. The inner part of the bark of the red water tree is some- times scraped fine, and applied to the gums in tooth-ach ; it is very acrid, and when chewed pro- duces some degree of torpor, or slight paralysis of the tongue.

An infusion of a plant, called by the Timmanees talanee, is used warm to wash the mouth ; this is frequently repeated ; they also inhale the steam of it when boiling. A decoction of the same aoe is drank in pains of the bowels.

A decoction of the dried leaves of a plant, called by the Timmanees anint, is frequently used. warm, to gargle the mouth in pains of the teeth and gums.

APTHOUS ULCERATIONS of the mouth and gums, attended with a spongy and bleeding state of the latter, and looseness of the teeth, are cured by a gargle composed of a decoction of the leaves of kankeebombo, Soosoo ; it is used likewise against pains of the teeth. Scurvy is a disease with which the Africans are wholly unacquainted. Dr. Trot- ter observes, “ From all my enquiries I was not able to learn that such a disease as scurvy was ever seen among the natives of Africa on shore ; but I verily believe it has occurred more

VOL, I. @

4g frequently in Guineamen than has been sup- posed *.”

For pains oF THE EAR, the leaves of 4 plant, called by the Timmanees kakak, are bruised, and after being infused in hot water are used as a fomentation. Ai

DysENTerY is one of the scourges with which ships in the slave trade are frequently punished, causing them to lose aconsiderable part of their unfortunate cargo. When the disease prevails on board these vessels, crowded as they are with slaves, language is inadequate to convey a just idea of the loathsome state to which the poor wretches are reduced. A surgeon of a Guineaman, describing the mortality which oc- - curred among the slaves, says, “ out of the car- goes of several vessels, consisting of six or seven hundred (slaves) each, one buried two hundred and fifty, one two hundred and twenty, one an hundred and fifty, one sixty, and our ship eighty- two slaves, most part of them having died of this terrible disorder+}.” Philips in his voyage to Gui- nea informs us, that out of a cargo of seven hun- dred slaves which he took on board, three hun- dred and twenty died of different diseases before he reached Barbadoes, which, he humanely ob- serves, “was to his great regret, after enduring much misery and stench so long among a parcel of creatures, nastier than swine: no goldfiner, he adds, can suffer such noisome drudgery as they

* Observations on the Scurvy. + Ed. Med. Com. vol. ix. Dee. 1.

43

do, who carry negroes, having no respite from their afflictions so long as any of their slaves are alive.”

A young man, whe has no immediate prospect of settling in his profession, is often allured by fair promises to become surgeon of a Guinea ship; but ere long the bright prospect vanishes, and he finds that he has been cruelly deceived, and de- plores, when too late, his degrading situation. If he possesses sensibility, his feelings are constantly on the rack ; if his constitution be weak, his health is ruined, and he narrowly escapes with life. His attention to the poor creatures under his care must be unremitted ; in fact, when sickness pre- vails he must almost wholly reside between decks, in their place of confinement, where the tempera- ture is about 100° of Fahrenheit’s scale, and where “‘the effluvia are so intolerable, that in a few mi- nutes you may have the condensed vapour from your face in great quantity. He is not always at hberty to exert his medical talents, but must implicitly. obey the orders of the captain, who, having made several voyages to the coast, presumes upon his being competent to the cure of all their diseases.. Thus, when he has toiled night and day, when his mind is harassed with distress, and his body ex- hausted with fatigue, if, notwithstanding his ut- most efforts, sickness continues to prevail, the master of the vessel, whose character is perfectly congenial to the trade, attributes every misfortune to the machinations of the doctor and devil*.”

* Trotter’s Observations on Scurvy.

AA,

During my residence at Sierra Leone, several instances occurred of surgeons of vessels in the slave trade being obliged to run away from their ships, owing to the cruel treatment they had re- ceived ; and in one instance, which I witnessed, the chief and second mates, surgeon, and several of the crew, were obliged to take refuge in the colony from the fury of their persecutor.

This picture, which is drawn neither through prejudice nor malice, will, it is hoped, render me- dical men cautious how they engage in this ini- quitous traffic; and if attended to, may prevent some aged parent from having his grey hairs brought with sorrow to the grave by the untimely loss of a darling son, or, what is still more to be dreaded, from seeing him return with a depraved heart and a ruined constitution.

Dysentery is by no means so prevalent a dis- ease to the northward of Sierra Leone* as upon the Gold Coast, where the badness of the water renders it very frequent. ‘The natives of the Gold Coast have the credit of bemg very success- ful in the cure of this complaint. ‘The chief medi- cine which they use in it is lime juice, to which is added some of their favourite capsicum or red pepper: this latter is so highly esteemed by them,

* Les habitans de Quoia assurent qu’ils ne savoient autrefois. ce que cétoit que la dissenterie ; & quelle est venué chez eux de Sierra Liona. L’an 1626, huit mois aprés le depart de ? admiral Lam, cette maladie se repandit dans le royaume de Sierra Liona & les pais circonvoisins, & fit de si grands ravages que le terre de- meura plus de trois ans sans culture, chacun pensant plus a mourir

-qu’a se fournier de vivres,’ Dapper Descr. de P Afrique.

AS

that it is used not only as a seasoning to their food, but enters largely into the composition of their medicines, and always constitutes the chief ingredient in their enemas. Marchais* says, “on the Gold Coast the cure of colic is.a calabash of lime juice mixed with red pepper, and drank night and morning for several days:” in pains of | the stomach, he adds, “they bind it tight with a cord.” Their mode of administermg an enema is by means of a gourd scooped hollow, the small end of which is inserted into the anus, and by means of a long small tube fixed to the opposite end of the gourd, the contained fluid is blown into the rectum: this operation is generally per- formed by some old woman, whose services in this way are often ealled for by Europeans.

In the neighbourhood of Bassa, and upon the Kroo coast, they use for the cure of diarrhcea and dysentery a plant which they call doy, and which the Timmanees call amelliky; nauclea sam- _bucina. A few of the leaves are eaten together with a little Malaguetta pepper, after which some warm water isdrank. ‘This remedy is highly extolled by them. |

To remove the tormina which occur in dysen- tery, they use a warm infusion of a plant, called by the Foolas, malanga; by the Soosoos, melleé ; and by the Timmanees and Bulloms, nangka.

But their most celebrated remedy, and one which deserves more particular attention from Europeans, is the bark of a large. tree, called by

* Voyage en Guinée.

46

the Foolas, béllenda; and by the Soosoos and Mandingos, bémbee ; rondeletia africana. dt is employed either in powder mixed with boiled rice, or is used in a strong infusion. ‘This bark is an agreeable astringent, possessing somewhat of a

Saeoin taste. |

A quantity of this bark was sent to me at Free Town, from the Rio Nunez, where it had been used with very great success in an epidemic dy- sentery which prevailed among the slaves in the factories cf that river. I had not an opportunity of trying its effects in dysentery, as a case of that disease did not occur in the colony from the time I received the bark until I left the country ; but in several instances of diarrhoea it shewed itself very effectual. After my arrival in London I gave some of it to my friend Dr, Willan, who made trial of it in agues, fevers, sore thr oat and dysentery, very much to his satisfaction.

Pars OF THE BOWELS, somewhat resembling co- lic, frequently occur among the natives In the month of December 1793, upwards of thirty of the natives were suddenly affected at Bance Island, in the river Sierra Leone, with a species of colic, probably arising from the badness of the water, though they attributed it to the effects of witch- craft. In all these cases bitters are the remedies to which they have recourse.

An infusion of the bark of argol (Timmanee), coontang (Bullom), is much celebrated, taken in- ternally ; it is likewise applied hot as a — tation to the belly.

AZ A decoction of the bark of tookindoo (Tim- _ manee) is employed in pains of the bowels. This is a powerful bitter, and is taken every morning sweetened with honey; it proves gently purga- tive: the Bulloms call it lakoona.

The leaves of tokakellee (Soosoo), bruised and infused in cold water, are used in griping pains of the bowels. The infusion is very rough and astringent, and proves gently emetic and pur- gative.

The water which oozes from the trunk of the plantain when divided, is astringent, and is some- times employed in diarrhea.

An infusion of the dried bark of sangbanee (Timmanee), is used in griping pains of the bowels.

A warm infusion of the inner bark (liber) of romday (Timmanee) dried and powdered, is used in this complaint. |

When these pains of the bowels are accom- panied with frequent griping stools, a decoction of the fresh root of a plant, called by the Timma- nees afoam, is mixed with boiled rice, and taken night and morning.

The root of béndeky (Soosoo), arrhee (Tim- manee) is scraped fine and boiled in water; it is a pretty strong bitter, and much used in pains of the bowels. When the decoction is made strong, the quantity of an ordinary teacupfull proves pur- gative, without exciting griping.

A decoction of nassum (Timmanee) is also re-

48

commended in this complaint and proves gently opening, as also does a decoction of the root of a plant called by the Soosoos wee ener ee and by the Bulloms lok.

The Soosoos cure pains of the bowels by a decoction of a grass which they call toongee; the same is also celebrated as a cure for impotency m men.

in colic pains a little of the bark of a tree, called by the Timmanees obéck, and by the Mandingos borrakillee, previously dried im the sun and powdered, is sprinkled upon the rice which they eat at their meals.

The Soosoos frequently use the followmg cu- rious remedy, they take two leaves of a plant called koomesé-so; by the ‘Timmanees, bia-by ; and two leaves of another plant called in Soosoo aboossoo, in Timmanee makunt, which are first bruised and then infused in water, wherein three lighted coals, or rather pieces of ignited charcoal, have been quenched ; the water is then poured off and drank. |

The Africans do not in general make use of very complex remedies, but the following, which is an exception, is greatly celebrated by the Soo- soos, and in the number of ingredients may almost vie with the most celebrated compositions of anti- quity*: the leaves of 1. Tengbay. 2. Ballica-

* The mithridate was at first composed of no more ingre- dients, than the above African remedy ; it is said to-have con-

AQ

sooree-sooree. 3. Morkay or Tamarind. 4. Kan- keebombay. 5. Quorree. 6. Kebbay. 7. Koo- lee-yim-ma-bay. 8. Nintee. 9. Morronday. 10. Whee-yung-yay: all boiled in rice water, and used as common drink for the cure of pains of the bowels attended with feverish symptoms.

sisted only of twenty leaves of rue, two walnuts, two figs, and a little common salt.

Bis denas rute frondes, salis & breve granum, ‘Juglandesque duas totidem cum cerpore fieus,

VOL. Il, fi

50

CHAP. IV.

GENERAL DISEASES.

‘

ELEPHANTIASIS.

LEPHANTIASIS, orlepra Arabum, has been

so called from the resemblance which the diseased skin, particularly that of the legs and feet, bears to the tuberculous, chopped, and rug- . ged hide of an elephant. This similitude has been rather fancifully extended by Aretzeus in his ele- gant and accurate description of this disease. It is moreover called leontiasis, from the thickened state of the eyebrows, and the rugose appearance of the forehead, especially towards the temples and angles of the eyes, which was compared to the countenance of a lion when enraged. Celsus calls it elephantia, and by others it is termed ele- phas*. The Arabians made a distinction be- tween elephantia or elephantiasis, and elephas; in the former, the disease is spread over the body, in the latter, it is confined to the leg, which be- comes enlarged, with varicose veins, a great. thick- ening of the skin, and a prodigious deposition in the adipose membrane. This dreadful dis- ease, which at one time excited such a general

* Lucretius ; Est elephas morbus, &c.

~~

51 aiarm in modern Europe, frequently occurs in Africa, where, according to the testimony of the ancients, it primarily originated. Lucretius says of it propter flumina Nili Gignitur, Kgypto in medio, neque preterea usquam *.

Pliny says the elephantiasis did not appear in Italy before the time of Pompey the Great, and that it was brought thither from Egypt; to which country, the same author adds, the disease is pe- culiar. As the complaint began in the face, and disfigured the whole visage, but. particularly the nose}, it excited general consternation ; however, the disease was at that time soon era- dicated from Italy. In the Mosaic writings, only that species of the disease is described which is called leuce, consisting of “ insensible white spots, smooth, shining, and not’elevated{.” The opi- nion that it originated in Egypt seems confirmed by its being called the botch of Egypt. It was carried from thence by the Israelites into the land of Canaan, where it probably was not before

‘ye WAR fae

Ove a facie sepius incipientem, in nare primum veluti lenticul: m ox inarescente per totum corpus, maculosa, variis coloribus, & inzquali cute, alibi crassa, alibi tenui, dura alibi, ceu scabie aspera: ad postremum vero nigrescente, & ad ossa carnes apprimente, intumescentibus digitis in peédibus manibusque. JEgypti peculiare hoc malum: & quum in reges incidisset, populis funebre. Quippe in balineis solia temperabantur humano san- guine ad medicinam eam.

t Dr. Willan’s Lectures. Plin. lib. 26. c. ¥, ,

58

known. From Palestine it was brought into Europe. by those who returned from the crusades. Upon its first introduction into Europe this disease spread with astonishing rapidity; in the ninth century” there were throughout Christendom 19000 hospi- tals for Jepers. In the year 1227, Lewis VIII,

king of France, bequeathed legacies to 2000 hospitals for leprotis patients in his own kingdom, which was one third Jess than it is at present.

This is not a solitary instance of a new disease making suddenly an almost universal ravage, and in process of time becoming milder. A si- milar progress was observed in the venereal disease, The small pox likewise, when first carried to America, was infinitely more de- structive than in Europe, from whence it was imported, than it is in America at the present day, It may be further remarked, that in the time of Moses the disease must have been quicker in its progress than it is at the present time, since the changes which occurred in seven, or at most in fourteen days, were thought sufficient te decide upon the nature of the disease. .

This disease appeared in the island of Java about the year 1661, where it seems to have beéh introduced and diffused by contagion. A predisposition to it was supposed to hae been forméd ‘by the ‘diet ‘of the inhabitants, consisting of salt, putrid fish, and other indigestible foods, with high seasonings of every kind, but:especially pepper; this they eat by handfuls, “ atque ad

\

53

libidinis pruritum excitandum aro quotidie in cibis utuntur *,’ ) | F

The first well marked case of the disease, which occurred to me in Africa, was that of a Foola man named Mamadoo Minnioo Casoo, who came with Mr. Watt and my brother from Calleesar, near Teembo, to seek medical advice at Sierra Leone. This person was about 50 years of age, tall and thin, but muscular, and had a very great flow of spirits. The only visible appearance of disease in him consisted in several discolourations of the skin, of an irregular figure, rather larger than a crown piece, and of a light cop- per-colour +. These discoloured patches were upon

~ * Bonetus Medic. Septent. lib, vi.

+ This disease is very frequent in the French colony of Cay- enne, ‘where, from the coppery appearance of the diseased skin, it bears the name of malrouge. It affects the European as well as negro inhabitants, but more frequently the latter, and as held in the utmost horror by all. ‘The chief diagnostics of this diease are thus described by Bajon Nachrichten zur Geschichte von Cay- enne. The spots arenot citcumscribed, or well defined ; they are not of a bright red; they are ‘extensively spread over the body, and mixed with yellow spots; they appear upon the forehead, ears, hands, shoulders, loins, legs, and feet, and although they may have been of long standing, they still continue to spread. But the symptom most to be depended on is their insensibility. If on the contrary.a person be affected with spots or patches, which are of a lively red, and ‘bounded by a circle ofa still higher colour; if while they spread, the middle of ithe spots reassumes the natural colour of the skin; if they be sensible, and especially if attended with violent itching, they are not symptoms of the mal rouge, but merely of herpes. Besides the mal rouge, Professor. Sprengel enumerates the following as varieties of lepra: 1. The northern leprosy, in Norway termed radeseuche; in Iceland, liktraa. 9, The disease of the Crimea. 3. The Aleppo boil. 4. The erisi- pelas‘of Asturia. 5, Pellagra. poate .

54 the arms, trunk of the body and legs: Owing to the different shades of their colour contrasted with the black skin, the. spots appeared slightly ele- vated round the edges, though this was not, perceptible. to the touch. When the finger was slightly rubbed over them, they felt ra- ther smoother than the other parts of the skin, which, however, was as soft and smooth as the skins of the Africans are in general. When closely viewed with a.small convex lens, these discolourations did not appear to differ from the texture of the surrounding sound skin, nor did there appear to be the slightest elevation in them. The number of patches upon the trunk were six, the same number upon the arms, and as many upon the legs and thighs.

A very slight change of colour had taken place upcn the edge of the upper lip, near the angle of the mouth, but so trifling that it would per- haps have escaped my notice had he not pointed it out himself. A very small part of the right ala nasi likewise appeared thickened and disco- lJoured,

The parts of the skin, thus discoloured, were totally devoid of sensibility, which the man no- ticed himself, saying he could not feel if they were either cut or pimched. When a pin was run through these discoloured spots he complained of no pain until it touched the muscular parts below,

The disease was of eight years standing when Tsaw him; it made its first appearance on the

55

outside of the fore arm, but he did not notice it until after he had received a smart blow upon the part, though he did not attribute the disease to this cause. After the patch upon the arm had acquired nearly its present size, almost two years elapsed without his observing any further appear- ance of disease. At the end of this time a simi- lar appearance took place upon the outside of the leg, which continued to increase very gradually m size; and a twelvemonth elapsed without his perceiving any further increase of the disease. Two large patches then shewed themselves upon the right breast, one above, the other below the nipple; about the same time other discolourations appeared upon the trunk, legs, and arms, at first small, but gradually mcreasing ~insize. No new spots have appeared for two or three years past until about three months ago, when the ala nasi became affected, and about two months since it made its appearance upon the lip. These last appear to him to increase in size, but the others seem nearly stationary.

He feels no pain nor uneasiness, except at times slight formications over his body in differ- ent parts of the skin. His appetite is very good and all the functions natural. He has had four children, who all died before he became affected with this disease. His wife, with whom he still cohabits, is not affected, nor has she, he says, any apprehension of catching the disorder. By an- cient writers this complaint has been called saty-

56 riasis, ob inexplebilem coeundi libidinem*. This was denied by my ‘patient, who said it did not occur in his country to those affected like him ; but he appeared:a little offended that a diminu- ‘tion of his powers should be suspeeted.

This person was remarkably communicative, and possessed a cultivated mind. He informed ‘me that'this disease is very frequent in the Foola country, where ‘it is greatly dreaded on account of the horrid -ravages it makes upon the bodies of those affected with it. They consider it as a disorder admitting of long life, but that it ulti- mately proves fatal. They use several remedies, chiefly infusions of vegetables taken internally and. applied as baths, but seem to receive little advan- tage from any ofthem. They consider this disorder as hereditary, though the offspring of deceased pa- rents are not always affected with it, but sometimes escape during their life ; and they are rarely or ne- ver affected with the disease until after puberty. He mentioned an instance of aman whom he knew, whose hands had dropped off at the wrists in con- sequence of this disease, and who had married a woman afflicted with the same complaint, though in a less degree, no other being willing to marry him. They had from this marriage three sons, who are now alive and grown up, but only one of them is affected with elephantiasis.

* By Galen it is also called satyriasmos, from the face being. madg¢ to resemble that of a satyr.

57

Although the disease be not always regular in its appearance and progress, they distinguish three species of it, to each of which they give a distinct name. The first is called by the Foolas, dama- dyang ; by the Soosoos, dhay ; and by the Man- -dingos, koonah: this is commonly the first appear- ance of the disease, and is the mildest form in which it appears. The skin is merely disco- loured and insensible, as in the case above-men- tioned.

2. Didyam*, called by the Soosoos quolla karree, and by the Mandingos bagheé. In this species the disease is more advanced ; in addition to the insensibility and discolouration of the skin, the joints of the fingers and toes are affected with spreading ulcerations; they become considerably enlarged, and at length drop off. The lobes of the ears are much thickened and enlarged, and discharge a thick viscid matter. The lips are much swoln, and the ale nasi are tumefied and ulcerated. The first species of this disease is sometimes cured, or rather checked in its progress, by art or nature. The second also, though more rarely, is sometimes prevented from spreading.

The third species is called barras; by the Soosoos, daghee; and by the Mandingos, daa. This stage _of the disorder is chiefly characterized by the voice, which becomes hoarse and guttural, the patient usually speaking through his nose, as in ozzena, because of the great and spreading ulcer-

* This word is sometimes written sghidam; and by Niebuhr, dsjuddam or madsjurdam.

VOL, I. I

38 ation in the throat and fauces. The progress of the disease is now very rapid, and when the voice becomes nearly unintelligible, death is supposed to be not far distant*. Together with the affec- tion of the throat and nose, the neck is much tumefied ; the ears are more and more ulcerated, the legs and feet, deprived of the toes, enlarge greatly, and entirely lose their form. ‘The whole

of the skin is also much thickened, and affected in -

various parts with foul ulcerations. The species of the disease, called alopecia, is unknown here: the beard and hair upon other parts of the body are neither changed in their colour nor fall off, though the parts upon which they grow be dis- coloured by the disease. In the patient above- mentioned, his face not being affected where the beard grows, and those parts of his body where the discolourations were, being quite smooth, it afforded no opportunity to observe what change the hair would have undergone.

There is a disease called by the Soosoos yabba séray, which appears from the description of the natives to be a variety of barras. It is said not to be infectious; it appears first in numerous small pustules about the neck or arms, spreading from thence to various parts of the body. When scratched, the pimples came off in scales, and

* This stage of the disease is very accurately described by

Galen: ‘ Elephas, est affectus qui cutem crassam atque inequabilem .

reddit, livor adest tum cuti, tum oculorum albis, exeduntur partes manuum, ac pedum summe, ex quibus sanies livida, ac fortida emanat. Galeni Isag. 172.

ee ee

59 they sometimes discharge a little watery fluid. If . the skin of the affected part be cut, no blood issues, nor is any pain felt. These eruptions pro- duce intolerable itching, which is not increased by being in bed or in the cold. When they affect the head, the hair is changed te a dirty white, and falls off. The disease is said to be curable if taken in time, but its appearance always excites a great alarm. It does not affect either hands or feet, and is said to prove fatal in little more than a year. It sometimes produces a tumefaction of the nose, lips, and ears, but never affects the throat.

As my patient staid only a few days at Free Town, being obliged to return with the embas- sador sent by the Foola king, I had not an opportunity of trying the effects of medicine ; nor could I venture to trust him with an active remedy, where a mistake in the dose, &c. might have been attended with unpleasant consequences, I gave him therefore a bottle of vin. antimon. with directions to take a tea-spoonful twice a day; and some flor. sulphur. to take occasionally as a laxative, hoping that, as it affects the odour of the perspiration it might also act upon the skin*, Had he continued for any length of time,

* Niebuhr says that a negro, who had been attacked at Mokha with the species of leprosy called bohak, which, he adds, is nei- ther contagious nor fatal; and perhaps resembled that of the Foola above-mentioned, except in the colour of the spots, which were white. His complaint was alleviated for a time, though not cured, by the use of sulphur.

60

it was my wish to have tried the mineral solution (of arsenic*) and in case of failure of success to have used the julep. sublimat. notwithstanding the use of mercury is condemned in this disease t. Upon.the island of Bananas I saw two other cases of elephantiasis ; in one, a man, the leg was chiefly affected, being much tumefied, the skin thick, hard, and deeply furrowed, though without any ulceration or discharge; the toes were not affected. In the other case, a woman of middle age, who had laboured under the disease several

* Arsenic is considered as a specific in this disease by the Hin- doo physicians, among whom it has long been a secret remedy. Its preparation is thus described : «‘ Take of white arsenic, fine and fresh, one tola (or the weight of 105 grains troy) ; of picked black pepper six times as much: let both be well beaten at intervals, for four days successively, in an iron mortar, and then reduced to an impalpable powder in one of stone with a stone pestle, and thus completely levigated, a little water being mixed with them, make pills of them as large as tares or’small pulse, and keep them dry in a shady place. One of these pills must be swallowed morning and evening with some betel leaf, or in countries where betel is not at hand, with cold water: if the body be cleansed from foulness and obstructions by gentle cathartics and ea before the medicine is administered, the remedy will be speedier.” An instanee is given of a cure being obtained in aes ee by the above plan. Asiat, Researches, vol. ii.

+ About two years afterwards this old man paid a second visit

to Free Town; he was much pleased with his medicines, which.

he had taken with great regularity, and even flattered himself that he had got rid of his complaint ; but after eating some kind of food which had disagreed with him, he had been affected with a swelling of his belly, from which he recavered with some diffi- -eulty, After this, his former complaint returned, and when I saw him his fingers had become affected with slight ulcerations, espe- cially about the roots and edges of his nails. The discoloured patches had Se no material change, nor had any fresh ones appeared.

61

years, the face was the part chiefly affected, though the skin of her whole bedy was rugose and much thickened. Her voice was very hoarse, and her throat, on inspection, appeared inflamed with erysipelatous inflammation, but not ulcerated. With respect to the general appearance and defor- mity of her countenance, she much resembled a person in the most confluent small pox when the face is most swoln, though the tubercles on her face were not numerous, nor much elevated above the skin. ‘This was the only instance which occurred to me that bore any resemblance to the facies leonina of authors. Her hair was not in the least altered, neither were the jomts of her fingers or toes affected. There were no disco- loured patches visible upon’ her skin. She was wife to a very celebrated man, well known by the title of Lord North, and conscious of her dignity, she did not like to be too closely examined.

Another instance of this disease, in a woman ‘about forty years of age, came under my nctice. The chief appearance consisted in irregular patches of a light copper colour spread over her body, especially upon the breast; these parts were per- fectly insensible when the skin was pierced by a pin. She had lost some of the joints of her fingers and toes, but they were healed when I saw her, and did not shew any disposition to break out again. She had borne two children since the spots first appeared.

A slave trader, who had been brought up to medicine, informed me that he had seen three

62 instances of elephantiasis in the Mandingo coun- try, two of which were men* and one a woman. In all these cases, the disease shewed itself by discolourations of the skin, which were followed by tumefaction, and ulceration of the fingers and toes, all of which at length dropped off. In the woman, the disease appeared to be subdued, or to have received a check during the space of two years that she resided at his factory ; this he attributed to her having a more nourishing diet, while with him, than she had been accustomed to before. Another case of this disease occurred to myself at a town belonging to Manga Dooba, near the False Cape (Sierra Leone). The patient was a young man, about twenty-two years of age, tall, and of a robust form; he had been affected with elephantiasis for several years. Neither his father nor mother, nor any of his relations as far as he could remember, had been ever afflicted with this disease. One striking peculiarity oc- curred in this person; almost the whole of his skin had suffered a change of colour from black to a very light brown or copper colour. Very little of the original colour now remained, except — one large spot round the umbilicus, and another upon his back and legs. . Every part of his body was sensible when pricked with a pm. He had

* Tt is said by Piso, that men are more subject to elephantiasis than women, which accords very well with my experience ; De Cognose. & Cur. Morb. iii. 65. The same has also been remarked by Archigenes: Apprehenduntur autem hac affectione viri magis — quam femina. JMtii Tetrab. 4. s.i.c. 120,

63 lost the first jomts of the thumb, fore, and little fingers of his right hand; and also the first and second joints of the thumb, and of all the fingers of the left hand. The remaining joint of the ring finger of the left hand was much swoln, though he said it was subsiding, that finger having been the one last affected. ‘The ends of the stumps of the fingers were all healed over, but had all of them small conical projections like the end of a sugar loaf. The fingers and toes are always much swoln, and almost lose their form before they ulcerate and drop off, or before the disease cuts them, as they term it; but this tumefaction very soon afterwards subsides. He complained of much pain in his fingers and feet, especially towards night ; his toes were not affected, but his ancles were rather enlarged, and bore the marks of large ulcers upon them, which were now healed up. ‘The edges of these cicatrices appeared of a darker colour than the middle part, and seemed to be somewhat raised and puckered all round. His skin appeared in many parts very foul, as if from cutaneous eruptions just healed, but was not. covered with scales. ‘These defoedations were chiefly visible upon the arms, legs, and neck; other parts of his skin, though changed from their original colour, still retained their smoothness. Several little pustules containing a whitish fluid, were observable about his shoulders, which he sai broke out into superficial ulcerations and healed after some time, leaving an ugly scar behind. Upon the fore finger of the right hand was one

64

of these ulcerations, which at first view appeared as if the cuticle had been accidentally abraded, but upon a closer inspection: the edges appeared covered with a foul thin crust. This man was not, at the time, under any course of medicine, nor did he make any application to the sores: cow’s dung is most commonly used as a plaister for them. A year had elapsed since his fingers” - dropped off, and the disease did not appear when I saw him to be making any further progress. Neither his face nor throat were af- fected, nor was his hair in the least altered. He was remarkably cheerful and active, dancing, tumbling, and running about with the most per- fect unconcern. oe ,

When the disease has been stationary -for a length of time, these discolourations frequently begin to disappear, and the skin gradually regains its former sensibility. ‘They look upon the dis- ease as cured or put a stop to, as soon as the skin has recovered its pristine hue, and expect a return of the disease only when the skin again. changes its colour. At Wankapong, in the Soo- soo country, I saw a man who had lost the fingers and thumbs of both his hands by the elephantiasis, and all his toes except the great ones*. Discoloured patches had appeared in various parts of his body at the commencement of the disease, and conti-

* —__. sepe hominem paullatim cernimus ire,

Et membratim vitalem deperdere sensum :

In pedibus primum digitos livescere, & ungueis,

Inde pedes, & crura mori: post inde per artus

fre alios traetim gelidi vestigia lethi. | Luer. lib. 5. 525.

65

nued during the whole of its progress, but when I saw him, 1796, they had disappeared, his skin being of the natural colour, and smooth., The disease had begun ten years before I saw him, but during the last six years it had become sta- tionary, and he considered himself cured, without apprehending any relapse. Some people com- plain, that im these discoloured places, though insensible to the prick of a pin, there is occa- sionally great pain, which they compare to the sensation excited by boiling water, or the appli- cation of a red hot iron.

This disease does not appear to be so common among the Bulloms and Timmanees as among the Mandingos and Foolas, &c. neither do the former distinguish the different stages of the complaint. The Bulloms call it ghell, and the Timmanees, arroom. When affected with this disease they abstain from eating the flesh of the wild hog, but eat freely of every other kind of food. They appear to follow the advice of Aretzeus, in using many and various remedies; but with him also they consider the disease as incurable *. They, however, assert, that a people who live < far, very far inland,’ in a country called Bamballee, pro-

* Tn the West Indies, “ the leprosy, the most dreadful of all - diseases, is said to have its indigenous remedy, known to few besides the Aborigines of the islands. This remedy, | am in- formed, is the saururus cernuus of Linnzus, the herb a colet, and aguarima of M. Desportes. The Caribs are said to use it suc- cessfully, externally and internally, in this deplorable disease.” Chisholm on the Fever of Grenada.

WOR. IK K

66

bably Bambara, can cure it ; but this rests upoti no firmer foundation than their idea respecting man-eaters, a denomination applied by them to people living at the same distance, and of whom they have as little knowledge.

Although the flesh of snakes be frequently eaten by the natives of Africa, it is not taken in a medical view, nor have they an idea of any me- - dicinal powers in these reptiles. ‘The ancients were firmly persuaded that such food possessed uncommon virtues, and Pliny attributes the lon- gevity of the inhabitants of Mount Athos, who - he says reached the advanced age of 140 years, to their eating vipers. The Greek physicians also attributed to this diet very wonderful effects, and recommended it as a certain cure for ele- phantiasis; Galen* in particular, has recorded several instances of its efficacy, and gives par- ticular directions for its preparation. In South America lizards are strongly recommended in the cure of cancer, and several instances are recorded of their wonderful effects in this and other diseases. “ They cut off the head and tail of the animal, take out its entrails, skin it, chew it, and swallow it directly, while still bloody, warm, and in some degree alive.” It is about eight or ten inches long, and probably is the same with the small brown lizards, which imhabit dwelling houses within the tropics. From one to three each day is aproper dose. ‘The patient feels a considerable

* Galen de Arte Cur. lib. il.

67

degree of heat: over the whole body after eating the lizard, followed by sweating and a degree of salivation. It might be worth while to make trial of this simple remedy in the elephantiasis, as we have hitherto none which can be depended on in this dreadful disease*. Vide Aetii Tetrabi. San en 70: f

The Africans know of no cause to which they

can aitribute this disease; and it may be ob- served, that of all the causes assigned by authors, there is none which can be deemed perfectly satis- factory. Climate, diet, and suppression of perspira- tion from cold, have been considered as the princi- pal causes. But we find that this disease occurs ih a great variety of climatest, even in the finest of the world. It takes place in nations using the most opposite modes of diet; it is found more frequently im warm than in cold cli- mates; nor do we find in England that glass- makers, who are perhaps more than others ex- posed to the effects of suppressed perspiration, are peculiarly liable to this disease. Eunuchs are said not to be affected with it, which has occa- sioned some to have recourse to the opera- tion of castration}. Piso says, “ castratio pre- terea, ut singulare remedium, antiquis probata est §.”

* Fed. Med. Com. Dec. IT. vol. v.

+ Regio vero hujus mali inductrix est tum quz valde calida est, tum que vehementer frigida est. Aetii Tetrabibli iv. sermo i. c. 120. ‘

{ Mangeti Bibl. Chir. ii. 16.

§ Piso de cognose. & cur. Morbis, lib. ili. c. 63.

68 _ Neque enim temere reperias, inquit Archigenes, ullum aliquem castratum elephantiasi laboran- tem, neque item facile mulierem. Acti Tetrab. iv. ser.i. c, 120. Dr, Rush is of opinion that “ the leprosy, elephantiasis, scurvy, and venereal disease, appear to be different modifications of the same primary disorder *, The same causes produce them in every age and country——They all sprung originally from a moist atmosphere and unwholesome diet: hence we read of their pre- vailing so much in the middle centuries, when the principal parts of Europe were overflowed with water, and the inhabitants lived entirely on fish, and a few unwholesome vegetables.—— The elephantiasis is almost unknown in Europe. The . leprosy is confined chietly to the low countries of Africa.” In a note he adds, “ the same diet, and the same dampness of soil and air, produced the same effects in South America.” These ob- servations do not exactly apply to this disease m Africa: the Foola country, where the elephan- tiasis is rather more prevalent than upon the low swampy coast, is in general hilly, particularly about Teembo. The land, as has been already said, is well cultivated and clear of wood. The air is remarkably dry, insomuch that the paper, which was so damp in the Rio Nunez as scarce to bear ink, became quite dry and stiff before Mr. Watt and my brother reached Teembo. They could

* Elephas, lues venerea, & struma, aliquid habent cognatum & cuyyzves, tres has hydras unus alexicacos Hercules hydrargyrosis vincit & opprimit. Ballonti, lib. i, Epid. & Ephem, p. 15.

69

not prevent the tobacco leaves, which they carried with them, from falling to powder, though it was wetted frequently. Salt continues dry in the open air, and iron, which rusts in a very short time at Sierra Leone, whatever care be taken to prevent it, is not in the least affected when ex- posed to the air in the Foola country. The water which they drink is excellent.

In the early stages of this disease, the only pa- thognomonic symptom of it appears to be insen- sibility of the diseased skin, whether there be tu- bercles, or merely discoloured patches ; but this appears to be carried too far when it is asserted that a sharp instrument may be run to the bone without exciting pain; for as the disease -often spreads very slowly, the insensibility is at first probably confined to the skim, and goes deeper by degrees. Other symptoms generally enumerated, as the falling off and change of colour of the hair, the unctuous appearance of the skin, the soreness of the throat, and hoarseness, are not always present, even in the advanced stages of the disease.

A just distinction has not yet been made be- | tween lepra and elephantiasis, as the description of these diseases by different authors may be mu- tually mistaken for each other. It is likewise usual to apply the term lepra to every obstinate erup- tion of the skin; hence herpes, impetigo, ichthy- osis, and a variety of other skin complaints, have been included under it. The same has been done with regard to elephantiasis. Dr. Haller, speaking

70

of this disease, in which he says “ tubercles appear over all the body, and break out into ill con- ditioned ulcers corrupting the bones,” adds, “ is not this the yaws of the English?” ‘Through inat- tention, enlargements of the legs, with thickening of the integuments, from whatever cause they originated, have been considered as elephantiasis. Boerhaave enumerates among the symptoms of the advanced stage of scurvy, sicca & lenis elephantiasis ; and Van Swieten is of opinion that the elephantiasis as described by Aretzeus bears a great resemblance to scurvy. Dr. Hillary has committed a similar error in his account of the diseases of Barbadoes: under the title elephan- tiasis, he describes very accurately a disease which is endemial in that island, and therefore called the Barbadoes leg, but which bears no other resemblance to thé true elephantiasis than the increase of bulk in the limb. In the West Indies, elephantiasis is very frequent among the slaves, by whom it is called cacabay. This is very well described by Dr. Hillary, under the titles lepra Arabum, and leprosy of the joints, where, it is evident, he describes only different stages a the same disease.

In those countries where this disease occurs frequently, the natives are much alarmed at the appearance of any eruption. Mr. Bruce informs. us, that the sight of a pimple upon his body will give an Abyssinian a serious alarm, and cause him to keep closely within doors until it disap

pears.

71

Notwithstanding the custom which has pre- vailed among many nations, where elephantiasis is frequent, of secluding from society the un- happy persons affected with this disease, it re- mains doubtful whether it be ever communicated by contagion *. The Africans deny that it is con- tagious, and make no scruple to eat out of the same dish, and even to sleep in the same bed with a person labouring under elephantiasis. “They likwise assert that it is incapable of being com- municated by coition; neither do they believe that it is hereditary, but, they consider it is a sickness sent by God. In the case of the wo- man whom I saw on the island of Bananas, I was requested not to permit her to breathe upon me: this was, however, evidently occasioned by her disgusting appearance, as those who con- stantly attended upon her did not harbour any fears of being infected.

From the description of this disease in the Mosaic writings we may collect, that, although it was considered by the Jews as hereditary, they did not think it contagious. For though strictly forbidden by the law, lepers were permitted to

* Archigenes observes, “‘ Est autem gravis morbus, & prope €x eorum numero qui incurabiles existunt, & gravis quidem est ipsi zgro, intolerabilis autem conspicientibus, utpote qui ipsum omnino aversantur, adeo ut et plerique ex necessariis 8 domes- ticis egri ipsius conversationem devitent. Etenim suspicionem de se prebet malum tanquam sit contagiosum. Atque ego sane malum esse affirmo cum ipsis conversari; inquinatur enim aer quem inspirando adtrahimus ex ulcerum feetore, & ex vitiata spiritus exhalatione. Aetii Tetrab, iv. ser, i. c. 120.

72 dwell among them; and we find the people commanded at different times to put out of the camp “ every leper, and every one that hath an issue, and whosoever is defiled by the dead.” Hence it would appear that they were more afraid of legal pollution than of infection, other- wise the dread of so loathsome a disease would have rendered this command unnecessary. More- over, When this disease is mentioned in the Scrip- tures, it is generally classed with other things which they held to be unclean, and would defile any who touched them. Eventhe dead bodies of those who had been affected with it were buried apart: king Uzziah, after having lived in a se- parate house, was not even buried in the sepul- chre of the kings, “ because he was a leper.” The curse of David upon Joab was a wish that there might not be wanting in his house “ one that hath an issue, or that is a leper, or that Jeaneth on a staff, or that falleth on the sword, or

that lacketh bread,” all which were odious in the

sight of the Jews. The four lepers who sat at the gate of Samaria during the siege, appear to have had it in their power to enter either into the city or the camp of the Syrians; and our Saviour ate in the house of Simon the leper with his disciples. Naaman the Syrian we find conversing freely with his master, which would not have been the case had there been any dread of infection. Josephus also observes, that in many nations, lepers were so far from being despised and shunned, that they frequently were imvested with the highest. offices

73

an the-state, and permitted to enter the temples. ‘The Jews knew of no cure for this disease, though some have said that the leprosy of Naaman was _cured by the sulphureous quality of the waters of Jordan, and that many received benefit from them in Jeprous diseases. ‘This, however, is con- tradicted by our Saviour, who says, “many le- pers were in Israel in the time of Elisha the pro- phet, yet none of them was cleansed but Naa- aman the Syrian.”

Herodotus says, if any of the Persians be af _ fected with lepra, or leuce they can hold no com- munication with those who are well *.

This disease was considered as contagious by the Greek physicians. Aretzeus says, that the mi- serable patients were banished into deserts, or to the tops of mountains, where the kindness of friends occasionally alleviated their distresses ; though perhaps more frequently they were de- serted. Galen was so fully persuaded of its.conta- gious nature, that he says, a leper having infected some of his friends, the rest, in order to avoid danger, built for him, upon a hill just without the village, a hovel to dwell im, seen by Galen, when a young man, in Asia. Ceelius Aureli- anus, whose description of the symptoms of ele- phantiasis is lost, a circumstance the more to be reeretted, as he was an African, and no doubt had _ often seen the disease im his own country, ob-

* Clio, 138. + Lib. ii. de Medic. Simpl. Facult.

VOL, I. L

7A ‘serves, “ Some advise, that a person labourmg under this disease should be turned out of the town if a stranger, or if an inhabitant, be ba- ‘Nished to some distant part; others advise the patient to be totally abandoned *.”

The Chinese, we are informed by Sir G. Staun--

ton in his Account of the Embassy to China, sup- pose this disease to be infectious. “ It is likely,” says this ingenious author, “ that the general use of linen, to which Europe is supposed to be in- debted for its present exemption from leprous

affections, will be adopted by the Chinese, in the’

course of their increased commerce and connec- _ tions with Europeans. Leprous disorders are those alone for which any hospitals are regularly erected in China, on the principle of their being too infectious to admit of versons affected with them having any communication with the rest of society.”

Mr. Maundrell, in his Journey from Ae to Jerusalem, thus describes the leprosy: “ When I was in the Holy Land, I saw several that laboured under Gehazi’s distemper—particularly at Si- chem (now Naplosu) there were no less than ten that came a begging to us at one time. Their manner is to come with small buckets in their hands, to receive the alms of the charitable ; their touch being still held infectious, or @t least un- clean. ‘The distemper, as I saw it in them; was very different from what I have seen it in Eng-

\

* Lib. iv. c. 1.

7 ees

75

land ; for it not only defiles the whole surface of the body with a foul scurf, but also deforms the joints of the body, particularly those of the wrists and ankles; makine them swell with a gouty scrophulous substance, very loathsome to look upon. I thought their legs resembled those of old battered horses, such as are often seen in drays in England. The whole distemper indeed, as it there appeared, was so noisome, that it might well pass for the utmost corruption of the human body on this side the grave.” Van Egmont says there is at Damascus an hospital for Turkish lepers, but adds, “ the leprosy here is very different from that known in our country, the patients being frightful spectacles; their sallow ghastly faces, and small hollow eyes, terrifying the spectator. This distemper, it seems, penetrates to the very bone, infecting every part of the body; and the only alleviation is frequent bathing *.” |

Niebuhr describes three species, or rather stages, of leprosy, which he does not say is infectious. In some places he informs us they take precau- tions against this disease; as at Abuschahr, they send to the island Bahrajn, all those affected with leprosy, and those who had dangerous ve- nereal complaints. At Basra also, and at Bag- dad, lepers were shut up in places appointed ; - but this was not observed with much care, as they were allowed every Friday to ask alms in

* Travels through Europe and Asia Minor, ii. 251.

76 the public markets *. Mr. Forskal likewise says this disease is not contagious, even if any one sleeps with an infected person. At Damascus, as he was informed, there are two parts of the city appropriated to lepers, one for Mahometans, the other for Christians, in which likewise obstinate venereal complaints are included. As the pri- soners marry, when a child is born among them, it is taken from the mother, and given to an. healthy nurse. If after three mouths the child shews no symptoms of leprosy, it.is brought wp in the city; if the disease appears, it is restored. to the parents, and the nurse has no apprehension. of being infected from it.

In South America, where this disease is. fre- quent, Don Ulloa informs us it is universally believed to be infectious. “ The inhabitants of Carthagena, together with those in the whole: extent of its government, are very subject to- the mal de san lazaro, or leprosy, which seems still to gain ground. Some physicians attribute the prevalence of it to pork, which is here a very common food; but it may be objected, that in other countries, where this flesh is as frequently eaten, no such effects are seen, whence it evi-. dently appears that some latent quality of the — climate must also contribute to it. In order to stop the contagion of this, distemper, there is, without. the city, an hospital called San Lazaro, not far from the hill, on which is a castle of the

* Niebuhr Descript, de PArabie.

77

same name. In this hospital all persons of both sexes labouring under this distemper are confined, without any distinction to.age or rank, and if any refuse to go, they are forcibly carried thither. But here the distemper increases among them- selves; they being permitted to intermarry, by which means it is rendered perpetual. Besides, their allowance being here too scanty to subsist on, they are permitted to beg in the city; and from their intercourse with those in health, the number of lepers never decreases, and is at pre- sent so considerable, that their hospital resem= bles a little town. Every person at his entering this structure, where he is to continue during life, builds a cottage, called in this country Bugis, proportional to his ability, where he lives in the same manner as before in his house, the prohibi- tion of not going beyond the limits prescribed to him, unless to ask alms in the city, only excepted. The ground on which the hospital stands is sur- rounded by a wall, and has only one gate, and that always carefully guarded. Amidst all the inconveniences attending this distemper, they live a long time under it, and some even attain to an advanced age. It also greatly increases the natural desire of coition and intercourse of the sexes; so that, to avoid the disorders which would result from indulging this passion, now almost impossible to be controuled, they are permitted to marry *.”

* Ulloa’s Voyage to South America.

78

Dr. Bancroft says, leprosy is very common in Guiana, and is deemed infectious, ‘Those affected with this disease are separated from society. The same author adds, however, that he has known leprous slaves, who have privately coha- bited a long time with their former wives during the course of this disease, without communicating the infection. Lepers, he adds, are notorious for their salacity and longevity *

Dr. Heberden, who had frequent opportunities of observing this disease in the island of Madeira, is of opinion that it is not so contagious as is commonly imagined. He never heard of any one contracting the disease from a leper by con- tact, though he has witnessed the daily commu- nication of lepers with persons unaffected with the disease. He has also known several instances of leprous husbands cohabiting for several years with healthy women, and having several children -by them, without communicating the disease, although the children have inherited it. In such families, some of the children have the disease, while others escape. Dr. Heberden adds, that he knew a family “whose father lived and died a leper; and of two sons and two daughters who survived him, though at present each of them is advanced in years, the youngest daughter alone has shewed she inherits the disorder ; and what I think worthy of remark is, that, although the eldest son, at present between sixty and seventy

* Hist. of Guiana.

79

_ years of age, has never discovered in himself the least symptom of it, yet his only daughter, now about eighteen years old, has been affected there- with several years. ‘Thus suppressed, but not subdued, we see that the fomes morbi may lie dormant a whole generation, and awake with full vigour in the succeeding one.” Med. Trans. vol. i. p. 32. There appears a striking resem- ‘blance between these opinions and those com- monly entertained in England respecting scro- phula and some other supposed hereditary dis- eases.

Mr. Savary gives an affecting description of the sufferings of those who labour under this dis- ease, which frequently occurs in the fine climate of Greece, and of the islands of the Archipelago. He says, “it is infectious, and is zustantly com- municated by contact. ‘The victims, who are attacked by it, are driven from society, and con- fined to little ruinous houses on the highway. They are strictly forbidden to leave these mise- rable dwellings, or hold intercourse with any person. Those poor wretches have, generally, beside their huts, a small garden, producing pulse, and feeding poultry, and with that support, and what they obtain from passengers, they find means to drag out a painful life, in circum- stances of shocking bodily distress. ‘Their bloated skin is covered with a scaly crust, speckled with red and white spots, which afflict them with intolerable itchings. A hoarse and tremulous Voice issues from the bottom of their breasts.

80 Their words are scarce articulated, because ‘their distemper inwardly preys upon the organs of speech. ‘These frightful spectres gradually lose the use of their limbs. ‘They cowtimue ‘to breathe till such time as the whole mass of their blood 1s corrupted, and their bodies are entirely in a state of putrefaction.. No sight can be more painful or shocking than that of a leprous. person ; no torments are equal to what he endures. ‘The richvare not attacked by this distemper: it con fines itself to the poor*, chiefly to the Greeks.

* Prosper Alpinus attributes the frequency ‘of this disease in Egypt to the wretched diet, and stagnant water made use of by the poorer sort of inhabitants. De Medic. Egyptiorum, lib. 4. 56.

Galen entertained ‘nearly ‘the same opinion ; he says, In Alex- andria quidem elephantis morbo plurimi corripiuntur propter victus modum, & regionis fervorem. At in Germania & Mysia rarissima hee passio videtur. Et apud Scythas lactis potatores nunquam fere apparuit. In Alexandria vero plurimum gene- ratur ex. victus ratione. Comedunt enim farinam elixatam, & Jentem, & cochleas, & plura salita, & nonnulli ex ipsis carnes asininas, & alia quedam que crassum & atre bilis humorem -generant... Nam cum. cireuimstans aer calidus ‘sit, motus humo- rum agitur versus cutem. Huic igitur morbo, quas antea dix- imus conferunt purgationes. Quod si & zxtas & victus permiserint, sanguis prius’mittendus est. “Galeni de Arte Cur. lib. ii.

In Hindostan, where elephantiasis has Jong been known, and where it rages with great violence, it is attributed to the unwhole- ‘somre diet of the natives, who are accustomed, after eating plen- tifuily of fish, to swallow large draughts of milk. The use ‘of ‘provocatives is also blamed. ‘This disease is said to be extremely contagious, and to be hereditary. It is thought to be the judham (or juzam, as the word is pronounced in India) of the Arabs, or khorah of ‘the Indians. In Arabia it is also called d’atil aul, a name corresponding with the leontiasis of the Greeks’.

1 Asiatic Researches, vol.1i.

81

The distemper never appears among such of the Turks as are rich enough to afford themselves fresh meat, rice, and pulse through the year ; nor among those Greeks who inhabit the moun- tains, and whose food consists partly of milk, fruits, and herbs. For the course of an hundred years, during which the French have been settled in Candia, none of them have ever been attacked by the leprosy *.”

* Letters on Greece,

VOL, I. M

82

CHAP. V.

GENERAL DISEASES.

-- DRACUNCULUS, OR GUINEA-WORM. -CHIGRES.

RACUNCULUS, vena medinensis, or Gui- nea-worm *, is not often met with upon the Windward Coast of Africa, but appears to be nearly confined to that part of it called the Gold Coast. i The inhabitants of the river Gambia, and they who live between that river and the Sene- gal, are said to be affected with the Guinea- worm, but at no other time than the dry season, when the water is bad. Moore mentions an instance ef a woman who had, within two months, a worm a yard long extracted from each knee, and soon afterwards another from the ankle f. A slave trader in the Rio Nunez informed me

* History of Gambia.

+ The frequent occurrence of the disease upon the coast of Guinea has occasioned this name to be applied to it. Kem- mersamius, an old writer, says, it is very frequent at Del Mina, on the Gold Coast, and the adjacent country, and that the natives are more affected with it than the Germans who trade there. As something marvellous is expected from a fo- reign country, and, according to the old proverb, ex Africa sem- per aliquid novi, the same author adds, that those persons whe only sail past these places feel an itching in their arms, legs, and thighs. Mangetus Bib. Chir. i

83

that the inhabitants of the kingdom of Bouree, a country from which much gold is brought, and situated about four days journey from ‘Teembo, towards Tombuctoo, are greatly troubled with the Guinea-worm, which he has often seen in the slaves brought from that country. It does not appear that the disease could have been there eaused by drinking bad water, as he says the natives of Bouree take only the water of springs. Whites as well as blacks are affected with the dracunculus, though more frequently the latter, as they use fewer precautions against it. ‘That this disease originates upon the Gold Coast, from the badness of the water seems probable from the worm being seldom found in those parts, where, to guard against it, they take the precau- tion of boiling the water they drink*. It is not equally frequent on all parts of the Gold Coast, but is most prevalent where they have the worst water. At Annamaboo the Guinea- worm is very often met with. Dr. Trotter, speaking of the bad water at Annamaboo, says, ** This water was taken from a stagnant lake, and so full of animalcules, that when strained threugh a stone, and kept a few hours, it again

* Mr. Park says, the Guinea-worm is very common in certain places, especially at the commencement of the rainy season, and is attributed by the negroes to the badness of the water. ‘‘ They allege,” he observes, ‘‘ thatthe people who drink from wells, are more subject to it than those who drink from streams. To the same cause they attribute the swelling of the glands of the neck, (goitres) which are very common in some parts of Bambarra.”

84

exhibited the like number of living atoms. It had likewise the effect of producing the Gui- nea-worm among the negroes first purchased, who had no signs of it till living on this wa- ter for some months*.” At Cape Coast the

Guinea-worm is less frequent than at the above- -

mentioned place, and Dix Cove is least of all affected with it. At Whidah, where they have good water, this complaint is not known, but at Akra +, which is only sixty miles from thence, it is very common. Loefler{ observes, that “this worm is most prevalent in the English and Dutch settlements on the coast of Africa.” He adds, “ out of two hundred and twenty slaves, which were bought at Cape Mount, Cape Mezu- rado, and Cape La Hou, only one was affected with Guinea-worm, which occurred in the great toe. On the contrary, among sixty slaves which were bought at St. George del Mina, a third part laboured under this disease ; and among six hun- dred slaves bought at Angola, not a single in- stance of it occurred.” The Guinea-worm is also unknown in the islands of Saint Thomas and: Prince. Barbot. says, he was assured that the natives inland, at the distance of forty or fifty leagues from the sea coast, are unacquainted with the Guinea-worm ; he further adds, that it is most

* Observations on the Scurvy.

+ Isert Reise nach. Guinea,

% Chirurgische Wahrnehmungen. in Archiv. der Pract. Arz- ney kunst.

85 frequent about Kormantyn and Apam, and that Akra * is most free from it. The Guinea-worm is little known in the West India Islands, except among slaves lately imported from Africa. Dr. Rouppe +, however, asserts, that it is very fre- quent in the Dutch island of Curacoa, where he wishes to prove that it is contagious, and that sailors become frequently affected by being “ con- nected with Europeans and Negroes who have the disorder.” “'That it is contagious,” he adds, “is very evident, as it never is in a house without infecting the whole family, because these little animals, and their seed, are carried about in the bodies of the living from place to place, and com- municated from one to the other. Some of the inhabitants of this island, people of credit, have told me, that this disorder is not of very long standing amongst them, and that it was brought there by the negrees who came from Guinea. Dr. Chisholm also, in his Essay on the Malignant Pestilential Fever of the West Indies, classes this disease among the epidemics of the island of Gre- nada. Upon this subject, he observes in a note, « it will appear singular to the European reader, that the dracunculus, or Guinea-worm, should be classed among the epidemics of Grenada; but, however strange it may seem, it is nevertheless

* Tt is observed by an old writer, that those who touch at Mourée, on the Gold Coast; are sooner affected with this dis. ease than those who visit Akra. Dapper Description de lA- frique.

+ On the Diseases of Seamen.

86

fully established by innumerable facts. One very extraordinary instance will suffice to show the propriety of considering this disease as one of the epidemics of the dry season. On the estates of Edmund Thornton, Esq, situated in the district of St. George’s Parish, called Point Saline, al- ready described, and at the farthest extremity of it, the negroes are attacked regularly every year, about the beginning of November, with symp- toms of the Guinea-worm. In the month of January, the disease spreads throughout the great- est part of the gang, and in the month of March it entirely disappears; and they continue ex- empted from it till the followimg November. The cause of this singular disease on the estates I have mentioned, seems to be confined to the water of some wells, which have been dug in the substance called tuf, (a soft rocky substance, probably of volcanic origin, and perhaps the tuffa of the Italians) of which the whole gang drink, there being no springs or rivulets in the district, and unfortunately no cisterns to collect and preserve the rain water. This has been ren- dered evident by what has happened on some neighbourmg estates, the negroes of which, till of late, were as subject to this distressing com- plaint as those belonging to Mr. Thornton. The

wells were filled up, cisterns built, or wells dug

in places not subject to the fluence of the flow ~ and ebb of the tide, and at the return of the usual period of the appearance of the Guinea- worm, nothing of the kind happened. They

4 it a

87

have ever since (three years now) continued ex- empted from the disease. In the water which contains the embryos of the dracunculi, the naked eye distinguishes innumerable animalcules, darting in every direction with astonishing force and rapidity ; these, on being subjected to exa- mination in a small microscope, exhibit a very extraordinary figure, differing from any animal-

cules hitherto described.” The curious appear- - ance of these animalcules has induced many writers to believe that they are changed into the Guinea-worm when received into the stomach ; but there is greater reason to believe that they are hatched from the ova of musquitos. They are seen in myriads in rain water, when per- mitted to stagnate, and are found in abun- dance in the rain water tubs at Free Town, where the Guinea-worm has never occurred. Mr. Bruce says, “the worm known to the Ara- bian physicians, under the name of vena medi- nensis, and by the natives called pharoum, or Pharaoh’s worm, is so named from the city of Medina, where Mahomet was buried, and which is distant from the sea about three days journey. They believe ‘that this malady, as well as the small pox, and several others, were not known before the time of that impostor. Aga Thareide, the Gnidian, has, however, spoken of it several centuries before the Christian sera, as an ende- mial disorder on the coasts of the Red Sea. It is common also in Arabia the Happy, Arabia the Desert, on the coasts of the Persian Gulph, and

88

in the peninsula of India. It prevails likewise on the coasts of Africa, and in all the low and burnt border of land which surrounds that part of the world, from the ocean to the Mediterra- nean. It extends to the interior part of the country, to Arfour, Sallee, Bargina in Nubia, and even as far as to Egypt.”

<‘ In all the countries of Asia and Africa, which I have already named, the inhabitants drink stag- nated water, because the tropical rains which fall from the mountains are collected in the plains among the sands. SBassora, and. the coasts of Persia, are, indeed, on this side of the tropic, but the inhabitants have nothing to drink except water of that kind, which they find among the sand. The people in the mountainous parts, near those countries which I have mentioned, are not acquainted with this worm, neither is it known in Abyssinia, andthe elevated part of Arabia the Happy, but those who descend from thence to live on the borders of the sea, where the country is dry and sandy, as is the case with Nubia, are much troubled with it *,”

It is said that at Bokhara, the present capital of Usbec Tartary, one hundred and thirty-eight miles southwest of Samarcand, the ancient ca- pital of that country, the inhabitants are much subject to the Guinea-worm, owing to the bad water they drink.

According to Niebuhr, this worm occurs very

_* Travels in Abyssinia.

89

frequently in Yemen, in the peninsula of India, and at Gambroon, or Bender Abbas, in Persia. It is called at Loheia, ark ; and at Haleb (Aleppo) ark el insil. A merchant of Mecca, whom he met with at Bombay, called it farentit ; and at Abuschahr, near the Persian gulf, it is called peju and naru, though he apprehends the three last words may not be Arabic, but Persian or Indian. They attribute it in these countries to drinking bad water, for which reason many of the Arabs filter, through linen, the water whose qua- lities they are not well acquainted. with.

The dracunculi are said by Professor Pallas to be found no where more abundantly than in Russia; and the celebrated Weikard found them in great numbers in the canals of Peters- burg, and in the river Neva. There is a dis- - ease in Russia called wolosaz, with which the Moors are affected, and which has been called the hair disease, because they imagine that hair cut off, and thrown into water, is changed into worms, which insinuate themselves into the bo- dies of those who bathe there, and thus produce ulcers. Gmelin saw a worm of this kind, which was about six inches long, as small as a hair, and was probably a gordius. In the lakes and marshes in Siberia, especially between the rivers Irtisch and Obi, the gordius is found in abundance. It is said also to abound in the waters of the Swedish province of West Gothland *.

* Finke versuch einer algemein. Medic. Pract, Geographie.

NOU. 1E. N

90

- The opinions of authors have varied consider--

ably respecting the nature of the dracunculus’; some have supposed it to be merely a vem, and hence it received the name it bears among the Arabian writers; others imagined it to be a nerve or tendon * ; and several of the moderns, among whom was the celebrated Ambrose Pare, thought that it consisted only of coagulated pus, an opinion which scarce requires to be formally contradicted. The most just, and generally re- ceived opinion at present is, that it is a real ani- mal. As suchit is thus accurately described by Sau- vages, “ vere vermis est rostello barbato, pi- lis tenuissimis, cum puncto atri coloris, & oris ves- tigio quodam: in cauda ‘etiam punctum foraminis est instar ani—patria est terra zstuosa, tor- rens, ceelum intemperatum, solum arenosum, ste- rule salsum, aqua destitutum, ubi aqua ex cisternis hausta, eaque saepe impura, verminosa bibitur.’” Nos. Meth. Bajon also observes,. “it is a real worm, in which irritability and sensibility are very evident. When divided transversely, it ap- pears to consist of five or six pretty strong threads, united by means of a very fat cellular texture, like a strong glue +.” Many instances. are also recorded wherein the worm was observed. to move about briskly, after having been ex-

* In quodam Arabiz loco, ut aiunt, in tibiis hominum dra- cunculi vocati nascuntur, nervosa natura, colore,. crassitudineque lumbricis similes. Multos sané audivi, qui sese vidisse eos di- cerent; ipse vero nunquamn vidi, neque de ortu, neque de essentia ipsorum gtidquam exacte conjicere possum.” Galen de Locis affectis, lib. vi. c. 3.

+ Nachrichten zur Geschichte von Cayenne.

a

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91 tracted from the body, and put into a vessel full of warm water.

Different opinions are likewise entertained re- ‘specting the mode in which this worm is received into the body, each of which has difficulties not easily solved,_—tIf, because the disease is almost exclusively found in those countries where the water is bad, it be supposed that the worm is received into the stomach with the drink, either in the oviform or animalcular state, it may be ob- jected, that every person who makes use of this water in its pure or raw state is not affected with the disease. Moreover, it has never been found in animals, whether in a wild or domestic state, though drinking of the same kind of water. The Guinea-worm is rarely found in deep seated muscular parts, a circumstance which militates against this opinion; and there is, I believe, no instance on record of its having been observed in any of the abdominal viscera.

If, on the contrary, from its more frequent occurrence in the inferior extremities, than in other parts of the body, and from its superficial situation, it be supposed to be insinuated by puncture through the integuments, either as an egg or animalcule, this implies such a degree of defective instinct, as is seldom or never ob- served in animated nature. In other instances we find the parent insect deposit its ova in situ- ations where the young, when hatched, can not only procure food, but have also a retreat secured, in which they may undergoa further change. Astruc

QZ

supposes that the Guinea-worm would change into a fly, or butter-fly, and adduces in support. of this opinion, the worms found in the amyg- dale of stags, in the nostrils of sheep, and upon the backs of oxen, which afterwards leave these situations, and are changed into flies. But here the analogy fails, for the Guinea-worm, whether it leave its nidus to enter into the chrysalis state, or as a perfect animal, to propagate its species, almost certainly dies.

Mr. Bruce is of opinion, that the guinea-worm is not produced from the ova deposited in stag- nant water, taken into the stomach and hatched there ; but thinks he has discovered the insect by which it is produced, “ Iti resembles,” he says, ‘a bug; has its two fore feet armed with claws, and its trunk with a kind of forceps, for the pur- pose of tearing and wounding. This insect is found in stagnant water; it attaches itself to the legs and arms, which are the parts of the body most usually naked in warm climates and sel- domest washed, and there deposes its eggs m the cellular tissue, until they are hatched by the warmth of spring.” There is reason to think this opinion ill founded, for we find, in general, some degree of proportion exist between the young and the animal which gives it birth; but in the present instance, the disproportion between an insect the size of a bug and a worm a yard long is too striking to pass unnoticed.

The dracunculus is always situated in the cel- lular substance, between the skin and the mus-

cee os

naa

Cen ae

eee

93

cles, most frequently of the feet and legs ; but it is sometimes met with in the arms, hands, thighs, body, and even in the head. The worm is gene- rally about the thickness of a crow’s quill or a piece of cat-gut, of a white or bluish colour, and shining like a tendon. It is in general from a foot to three or four feet in length.

It sometimes happens that there is more than one worm in the body at the same time. Rhazes* mentions an instance of a person who was cured after having forty of these worms in his body : Avicenna also asserts, that though the patient have forty or fifty worms in his body at one time, he may be cured; which shews that the disease, _ when treated with care, is not fatal, and seldom even dangerous.

The situation of the dracunculus is sometimes so superficial that its convolutions may be dis- tinctly perceived underneath the integuments. In such cases, if an incision be made over the middle of the worm, it may frequently be extracted double: where this cannot be done, the worm must be divided, and the ends be drawn out sepa- rately, as different wormst. A curious case is related by Bajon, of a negro girl, about six or seven years of age, who had one of these worms in her eye. It was situated between the tunica albuginea and sclerotica, being about two inches long, and not thicker than a common thread :

* Friend Hist. Medic. p. 149. + Loefler Chirurgische wahrnehmungen.

94 it moved very briskly, and in a serpentme direc- tion about the eye. The patient experienced no pain from the motion of the worm, nor was the eye affected in its appearance, though it was con- stantly weeping. He extracted the worm by seizing it in the middle with a pair of forceps, and drawing it double through a small opening — made with a lancet in the tunica adnata. ‘The patient was cured in twenty-four hours. A similar instance occurred to him in another negro girl, somewhat elder than the last: the eye was in- flamed and painful, and in it he discovered a worm rather larger than the one before men- tioned, which moyed in the same manner © round the globe of the eye. He was not per- mitted to extract it, as in the former case; nor did he learn how the case terminated*. In the Edinburgh Medical Essays, (vol. vy.) a case is related, in which, from five or six ulcers on the legs, in the space of eight weeks, were extracted “ thirty yards of the dracunculus, after which the ulcers healed, and cicatrised with no trouble:” one of these worms was three yards and a half in length. When the animal has reached a certain size, it begins to excite some degree of disturbance and uneasiness in that part where the head is nearest to the surface, generally where a bone is least covered with flesh. A slight degree of heat is felt in the part, succeeded by a small, hard, and inflamed tumor, resembling a common boil,

* Nachrichten zur Gesch. von Cayenne.

, 95 attended with much pain, and larger, or smaller, according to the size of the worm. ‘These symp- toms are for the most part preceded by a febrile attack, accompanied with rigors. ‘(he tumor gra- dually increases in size, becoming more pointed : the skin assumes a shining red colour, and is atte- nuated, a fluctuation bemg felt beneath it. At this period the disease has no other appearance than that of a boil, and it is only in those countries where it is endemial that they suspect it in its early state. Whenever the tumor bursts, the head of the worm shews itself like a black speck, and the disease is evident. As soon as a part of the leg begins to swell, and becomes painful, the natives of Africa endeavour to’ promote sup- puration as quickly as possible: with this view, the inhabitants of E] Mina apply a cataplasm of the leaves of the volkameria acuminata, beaten up with a few pods of red pepper, which is re- peated every day until the skin breaks. About Akra the natives bruise the leaves of the cissus quadrangularis, which they apply every day to the tumefied part. The next point of practice is the same in every nation where this disease exists, and was first described by Leonidas, who was a surgeon at Alexandria, about. the end of the fifth century *. As soon as the

_.* De Brachiorum ac Crurum Dracunculis. Leonidz, cap. Ixxxv.

Qui appellantur dracunculi lumbricis similes sunt, & aliquando magni, aliquando parvi reperiuntur, frequentius quidem in cru- ribus, quandoque vero & in musculosis brachiorum partibus consis- tentes. Nascuntur autem hi in Ethiopia ac India, in pueris preci-

96

head of the worm appears, it is laid hold of, and gently rolled around a piece of stick until the pa- tient feel a little pain, when they desist from winding, and cover the wound with a soft leaf or piece of plaster. ‘The same operation is re- peated every day with great caution, until the whole be extracted. If by too much haste or violence in winding it, the worm be broken, and the end cannot be again recovered, the part in- flames, and becomes intolerably painful; an at- tack of fever supervenes, frequently attended with a train of alarming symptoms, until suppu- ration again take place, and the end of the worm

pue, estque ipsorum generatic non dissimilis lumbricis latis ventris. Sub cute enim moventur nihil molestie afferentes, verum temporis progressu circa dracunculi extremitatem locus suppuratur, & cutis aperitur, ac dracunceli caput exeritur. Quod si dracun- culus attrahatur vehementem dolorem inducit, prasertim si nimia tractus violentia fuerit ruptus: nam quod relinquitur, molestis- simos dolores infert. Proinde ut ne recurrat animal, valido filo’ brachium constringere oportet, & quotidie hoc moliri, ut dracun- culus paulatim progrediens constrictione quidem intercludatur, nequaquam autem abrumpatur. Locus item aqua mulsa, & oleo in quo absinthium aut abrotonum coctum est, aut alio quodam’ ex his que ad alvi lumbricos descripsimus, irrigandus est. Om-. nia tamen acria vitanda, propter periculum inflammationis. Ca- taplasmata quoque laxatoria ac suppuratoria e farinis com aqua. mulsa & oleo preparata adhibeantur. Quod si dracunculus sponte progrediens facile extrahi poterit, nihil amplius faciendum est. . Sin ad suppurationem vertetur, a cataplasmatis, & aque mulsz ac olei rigatione non est discedendum. Nos vero emplastrum e baccis lauri, post cataplasmatum ablationem, imponere solemus, facta vero suppuratione, cutis per longitudinem dissecetur, & dracunculus denudatus auferatur, & cutis linamentis inditis dis- paretur, & reliqua curatio suppuratoria adhibeatur, ita ut ani-~ mali suppurato & extracto, ulcus incarnetur & ad cicatricem. per- ducatur. Aetii Tetrabil. 4. s. 2.

97

be protruded. Nothing further is practised during the extraction of the worm than to plunge the limb into cold water occasionally, which is the most effectual means of relieving the pain, but never applied until the suppurative process be completed. When the worm is wholly ex- tracted, the wound generally heals without fur- ther trouble: but the repeated occurrence of this disease may perhaps occasion the ulcerated legs so frequently seen upon the Gold Coast.

The general health is not affected by the dra- cunculi, however numerous. Several remedies are recommended to promote their quicker expulsion. Professor Gmelin recommends a solution of cor- rosive sublimate in brandy, given internally in the usual dose. This remedy, however, is said — by Loefler* to have had no good effect in the cases in which he used it ; on the contrary, the slaves lest their appetites, becoming lean and dejected. . From other internal remedies he ex- perienced as little benefit, and none from the use of aloes, which has been particularly recom- mended. Of external applications, he found mercurial frictions rather prejudicial, inasmuch as they increased the tumor, and therefore rendered the extraction of the worm less easy. He perceived most benefit from rubbing the part with volatile liniment, which dispersed the tumor, and dimi- nished the pain.

* Chirurgische Wahrnehmungen.

VOL, Il. oO

98 Another very celebrated remedy consists of bruised garlic, flour of mustard, . black pepper; flowers of sulphur, each one ounce, mixed in a quart of spirits ; of this a wine glass full is to be taken every other morning for nine times. Ac-

cording to Dr. Bancroft, the most successful mode:

of treating this disease is to apply a cataplasm of onions.and bread boiled: in milk to the swelling, and when the head of the worm appears to secure it by a piece of cotton, without making any at- tempt to extract the body. At the same time he orders half a gill of the abovementioned mixture (omitting: the flour of mustard) to be drank morn- ing and evening, by which means, in a day or two,

he adds, the worm will be found coiled up under:

the poultice. ‘he same author mentions another kind of worm found in Guiana, resembling a bean, but, more slender and poimted; which is bred in

the muddy stagnant waters in the woods, and in-

serts itself into the flesh, chiefly about the ankles: when,.extracted it leaves a sinuous callous ulcer, which. is difficultly cured *.

. How long the Guinea-worm may lie concealed

in the body is not certainly known, but it fre+ -

quently remains several months there without exciting the smallest degree of pain, or raising any. suspicion of its presence. Dr. Isert; whilst in the island of Martinico, e7ght months after his return from Africa, having fatigued himself very

* History of Guiana, 389

99

much with walking, was affected with a consi- derable swelling of his left leg. He could attri- bute this to no particular cause. The swelling continued for, thirty-six hours,‘ and then disap- peared. A fortnight afterwards, having walked the whole day, and waded much in the water, he observed upon the same foot which had swelled before, a. small vesicle, and on: opening: it, was surprised to. find a. gordius medinensis; this he attempted to draw out, but could only obtain a few inches on account of the excessive pain occa- sioned by the trial. Hence also, probably, was excited a degree of symptomatic fever, which con- tinued the whole night. After this he treated the worm. in a very simple manner, winding it every day upon a roll of linen, and covering the whole with a cloth, which enabled him to continue his usual walks. He attributed the speediness of the cure, which was completed in eight days, though in Africa. it usually takes up some months, to his-using so much exercise, and wading at the same time in the water. The worm was one of the largest he had seen: it measured two ells in length, ae was of the thickness of a straw *.

A similar instance is noticed by Dr. Ritepipes < in a Dutch man of war, which came from Cu- racoa to Holland, before she went to the Medi- terranean. Neither ii Holland, nor in the island, nor in her whole voyage, did any symptom of these worms appear ; but after a short stay in the

* Reise nach Guinea.

100

Mediterranean, above a third part of the crew was confined to their hammocks by them, nor were the sailors. only troubled with them, but the officers likewise.” Niebuhr also relates, that Mr. Cramer perceived four of these worms in his feet, and one in his hand, more than five months from the time of leaving Arabia; but as he lived only ten or twelve days after the discovery, none of them had time to come out. A remarkable instance is related of a person at Rochelle, in France, who had never been in Africa, but was affected with a Guinea-worm, owing to his having drank some water on board a ship, which had been brought from the coast of Guinea*. ‘“ One of our sai- lors, says Loefler, who had slept several nights on shore in Africa, was affected, whilst in Eng- land, a year afterwards, with a Guinea-worm in one of his legs; it was broken in the extraction, and produced suppuration, and several indurated tumors. By means of incisions and emollient cataplasms the patient was freed from every symp- tom of the disease +.” This disease occurred in amore severe manner to Mr. Bruce, upon his return from Abyssinia, which he thus describes: “ I was not affected with this malady in Arabia, though I resided there some time in the maritime regions; nor do. I think that I contracted it in Abyssinia. I am

* See Professor Finke’s elaborate and interesting work, Ver- such einer algeria medicin. praktisch. PEcetaphic, vol. il. Ds oo.

+ Chirurgische wahrnehmungen.

‘101

rather of opinion, that it began when I was cross- ing the desert ef Nubia, and the country of the Funges. On the first of April, five months after my departure from Nubia, I felt an itching above the thick part of my leg, and having scratched it a little, it began to swell, as if stung by a gnat, and the worm appeared then to be per- fectly white. Next morning, this small wound was alittle inflamed. I felt neither pain nor itching from it, and the worm made no attempt to come forth. From this period to the second | of May, I applied nothing to the sore, which was very moist by an abundant discharge of a wa- tery humour.

I embarked then to return to Europe, and having passed great part of the night on deck, when I attempted to retire, I found my knee so stiff, that I could not walk. I undressed myself, and observed upon the rotula a tumor of the size of an egg, which had scarcely any inflamma- tion, but was exceedingly painful. By the ad- vice of some Arabs, I applied a cataplasm of lint- seed, and after a night passed in the greatest agony, about an inch and a half of the worm came out, of a livid transparent colour, but different from what it had appeared te be at first. During the two following days, it continued to come out about an inch every day. The swelling and pain encreased every moment, in such a manner, that though the wound was in the interior part of the calf of the leg, four inches below the knee, the

102

thigh, leg, and foot were so much swelled that I could not support the bed clothes without crying — out through pain. The inflammation was. not considerable any where but around the sore, which was of a deep red colour, ang discharged a quantity of matter.

After four days, the surgeon of the ship bere the worm, by taking off the cataplasm. of. lint- seed too hastily, and that night the whole leg, from, the rotula to the heel, swelled so much that it. all-appeared to be of the same thickness. . In this painful situation I continued for fifty-eight days. After. using several remedies, .and cata- plasms of emollient herbs, without any success, and after suffermg a great deal, I observed a part of the tumor a little more elevated than the rest. Having pressed, it, with my finger, it discharged about three ounces of matter, and continuing to press my leg in the like manner with my fingers, at certain intervals, the rest of the worm came out ; the wound, closed the same night ; the pain decreased, and no more swelling appeared, but at the knee. Several tumors were observed afterwards below the.rotula, and I apprehended that they, would form there:a collection of. matter, but in a, short time they disappeared, and Ty knee recovered its strength, though very slowly.” . This worm) was about,two feet inlength. Mr. Bruce says, the Ba- nians, inthe East Indies, are the only people who have.the art of making this worm come forth quickly of-itself. He has seen them apply cataplasms of

103

certain leaves to those who were attacked with this disorder, and has observed the next morning the whole worm under the cataplasm, while the leg was very little affected. These leaves are said to grow only on the coast of Malabar, and the knowledge of them is carefully concealed.

_ The following case of Guinea-worm which oc- curred in the person of a surgeon in the East India company’s service, though defective im not pointing out where the disease was acquired, and _ in’some other particulars, contains much’ curious information *.

<« About the end of November, 1791, 1 perceived an unusual stiffness and soreness in the inferior part of the gastrocnemii muscles of the right leg, at that part: where the tendons of both gastroc- nemii unite to form the tendo achillis. This sore- ness was never acute, consequently did not occa- sion particular inconvenience, or prevent me from walking. Several days afterwards I observed a swelling in the part; but this was not attended by an increase of pain, nor discoloration. A few days after the occurrence of the swelling, a small: reddish-coloured pustule, with a black point in the middle, appeared on the inside of the leg, about an inch above the malleolus internus, on the fleshy part of the leg, and behind the tibia. This pustule appeared to contain a watery fluid. _ At the same time, I felt very distinctly, under _ the skin, a round firm ‘substance, and: was~able

*' Ed. Med. Commentaries, Dec. 1, vol. viik

ee ee

«? 104 to trace the animal with my finger to a consider able distance, extending in convolutions obliquely towards the posterior and upper part of the leg. Though the disease was now evident, yet I did not think it necessary to use any remedies with a view to expedite the animal’s progress; nor, indeed, was I acquainted with any medicine or application which could produce that effect. I concluded that he would work his way out, and that it would be most prudent to leave him un- molested ; but, on the night of the 17th De- cember, a few days after the appearance of the pustule, though I went to bed otherwise in per- fect health, I awoke, at two in the morning, with a sensation of intolerable itching over the whole surface of the body. ‘This sensation was so ex- tremely urgent, that I could not refrain from scratching violently. Soon afterwards, I felt an excessive heat and pricking in my face. On looking in a glass, I remarked a redness and flush- ing over my face, and the muscles of the face were swelled and convulsed. On those parts of my skin, where I felt the itching, I could discover with my finger, a thickening, as it were, of the skin ; it felt asif full of hard bumps. While puz- zled to account for these symptoms, which I had never seen, nor read, nor heard of, I was attacked. with excruciating pain in my belly, accompanied by violent retching, vomiting, and loose stools. A little bile and acid matter were rejected, by vomiting. But as very little bile, notwithstand- ing the violent retching, was brought up, or

105

passed downwards, these symptoms could not have been occasioned by an unusual quantity or acrimony of that fluid. The vomiting, as nearly as I can. guess, continued with very little inter- mission above half an hour, during the whole of which time the pain continued with unabated severity. [hese symptoms were succeeded by violent rigors, which continued for some hours, and resembled the cold stage of the paroxysm of an intermittent unusually severe. When the vomiting ceased, I went to bed, and was well covered with blankets. The sensation of cold gradually abated, and I fell asleep. ‘The coldness and shivering were not followed by any preter- natural degree of heat of which I was sensible ; but when I awoke in the morning, I felt a mois- ture on my feet. In the course of the night, the pustule had burst, and a white firm substance appeared in the spot which the pustule had occu- pied, but so deep that it could not be laid hold of. The animal had changed his situation during the preceding night, and had buried himself very deeply among the muscles. He had effected this so completely, that though I felt him with my finger to a great extent on the 17th, yet, on the morning of the 18th, there was not the small- est portion perceptible ; nor could I discover the least trace, on the strictest examination. I felt no inconvenience from the attack, which I have described, on the following day, except a little weakness ; nor had I afterwards any return of VOL. I. P

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these distressing symptoms. On the night of the 18th, a considerable inflammation appeared surrounding the ankle, and I found it necessary, on the 19th, to refrain from walking, and to con- fine myself to a horizontal position. On the 22d, I drew a small thread across the surface of the sore, so as to touch the extremity of the animal, which felt hard, and firmly fixed in the flesh. In consequence of this irritation, he threw up a con- siderable quantity of a watery fluid. Some time after this, he entirely disappeared, and the mflam- mation abated, A troublesome sore remained, with a bloody ichorous discharge, which conti- nued until the beginning cf February, 1792. It then healed, except a small point. At this time the animal made his appearance, and I was enabled to secure him with a thread. He was wrapped round a small bit of stick, and pulled twice a day, im the common manner. At the expiration of twenty days, the extraction was completed.

The animal was upwards of two yards in length, and of the thickness of a crow quill.

iter the half was extracted, he gradually dimi- nished in size. I found that his progress was quickened by the application of the aloe leaf, as hot as it could be borne, to that part of the leg which was hard, swelled, and painful. The same effect was produced by hard friction.”

This complaint, according to Ulloa, occurs also im South America, but not so frequently “ as. the

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leprosy, itch, and herpes ;” it is there called .co- brilla, or little snake, which they suppose has imsinuated itself beneath the skin. “ The external indications of it are, a round, inflamed tumor, of the thickness of a quarter of an inch, attended with a slight pain, but not vehement, and a numb- ness of the part, which often terminates in a mor- tification.” The natives first examine where, ac- cording to their phrase, the head is, to which they apply a small suppurative plaister, and gently foment the whole tumor with oil. The next day the skin under the plaister is found di- vided, and through the orifice appears a kind of white fibre, about the size of a coarse sewing thread, and this, according to them, is the cobril- la’s head, which they carefully fasten to a thread of silk, and wind the other end of it about a card, rolled up like a cylinder. ‘The fomentation with oil is continued, and the worm is rolled round the cylinder every day, until the whole be ex- tracted *.

There is a complaint with which negroes in the West Indies are frequently affected, and which bears a faint resemblance to the last, in being produced by an insect burrowing under the skin: when properly treated it is of no importance, but when neglected it frequently endangers the loss of toes and feet. This insect is called clugre +,

* Ulloa’s Voyage to South America, i. 46. + Malis Americana Sauvagesii. It is said to disappear during the rainy season, at which time the negroes are free from them.

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pulex penetrans ; it is a very small black insect, somewhat resembling a flea, but much smaller. It is found about the hearths of houses which are ill swept and dirty, and chiefly affects those who go with naked feet, and are not very cleanly. ‘This msect generally msinuates itself under the skin between the toes, where it forms to itself a small bag, like an hydatid, about the size of a pea, in which it deposits its innumerable ova. ‘The cure consists in extracting this bag whole by means of a sharp pointed instrument, which is done by the negro women with great dexterity. If this bag be carelessly burst, each ovum, when hatched, forms for itself a fresh bag or nidus, An uncomfortable degree of itching is the only symptom which indicates the early state of the disease. Ligon describes this curious insect as “ not much unlike a louse, but no bigger than a mite that breeds in cheese, his colour blewish: an Indian has laid one of them on a sheet of white paper, and with my spectacles on I could hardly discern him; this vermine will get through your stocken, and in a pore of your skinne, in some part of your feet, commonly under the nayl of your toes, and there make a habitation to lay his offspring, as bigge as a small tare, or the bagge of a bee, which will cause you to go very lame, and put you to much smarting paine,

“The Indian (negro) women have the best skill to take them out, which they do by putting in

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a small poynted pinne or needle, at the hole where he came in, and winding the poynt about the bagge, loosen him from the flesh, and so take him out.——I have had tenne taken out of my feet in a morning, by the most unfortunate Yarico, an Indian woman *.”

* Ligon was at Barbadoes in the year 1647,

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CHAP. VI. GENERAL DISEASES.

ENLARGEMENT OF THE SCROTUM. ENLARGEMENT OF THE LEGS. GOUT. RHEUMATISM. PLEURISY. - DISEASED LIVER. SCROPHULA. PHTHISIS. ANO=- REXIA. SPITTING OF BLOOD. |

T is not uncommon to meet with persons on the coast labouring under a prodigious Ev- LARGEMENT OF THE SCROTUM, which to those unac- quainted with medicine, gives the idea of an im- mensely large rupture, and has occasioned tra- vellers to assert that the Africans are very liable to be affected with ruptures. It is called by the Bulloms, kok ; by the Timmanees, ka-rot ; and by the Soosoos, key-key. Upon the Gold Coast this disease, sarcoma scrotale is very frequent, and about E] Mina it is called dekapatrosé, where it is sup- posed to be occasioned by drinking palm wine to excess. ‘This opinion, though grounded only on popular prejudice, appears strengthened by the complaint being most prevalent where palm wine abounds most. The Bagoes, a nation which in- habits the south shore of the Rio Nunez and Ca- patches, where the palm tree grows in great plenty, are more subject to this complaint than the Nal- loes, who live on the north side of the same river, and have not so many of the palm trees among

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them. It must however be remarked that the Bagoes labour under a scarcity of good water, especially during the dry season, the ground being very low and swampy, and the water brackish : the Nalloes, on the contrary, have an abundance of good water. It is therefore more probable that this complaint originates from the bad qua- lity of the water, as it occurs sometimes among the Mahommedans, who religiously abstain from palm wine. I have seen three instances of the disease, two of which were old men, apparently near fifty years of age: in neither of them could the tumor weigh less than forty or fifty pounds. When the patients sat upon the ground, the tumor rested ‘upon a cotton cloth, which served also to sup- port the troublesome weight when they moved. The complaint had been in both cases of many years standing, and had encreased very gradually, indeed almost imperceptibly. It was attributed to drinking too freely of palm wie. The third imstance occurred in a handsome young man, about twenty-two years of age, tall, and re- markably well formed ; the disease had advanced im him more rapidly than usual, as he had been affected with it only four years. The tumor reached nearly as low as his knees, when he stood erect, and might probably weigh twenty pounds. The penis was entirely concealed in the skin of the scrotum, as in a large hydrocele. ‘The testes were distinctly to be felt at the upper part of the tumor, pressed close to the penis, and were of the natural size. The spermatic cord was neither

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enlarged nor painful. The lower part of the tumor had acquired an almost cartilaginous hard- ness, and the surface was deeply furrowed : on the sides, the integuments were apparently much thickened, and there seemed to be an obscure degree of fluctuation within. This induced me to push in a trocar, which he readily allowed, but nothing issued except a few drops of blood. He experienced no pain from the complaint, unless after it had hung down for a length of time, without its usual support, when he felt some un- easiness from its weight. _

This disease is said to be endemic among the inhabitants of Bambarra, and among the Man- dingos in the kingdom of Barra. Dr. Schotte * observed the same complaint in a negro at Se- negal, about fifty years of age: the scrotum weighed at least half a hundred weight; it mea- sured eighteen inches in diameter, and two feet and a half in length. The swelling had begun twenty-five years before, by an almost im- perceptible enlargement of the testicles, devoid of pain. In Galam the rich mhabitants are peculiarly subject to this disease; and when they ride on horseback, the tumor is placed in a wooden case fixed to the fore part of the saddle. .

The sarcoma scroti is supposed generally to be hereditary ; and is referred to the great quantity of pepper which is used in seasoning their food.

* Philos. Trans. vol. xxii.

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diment along the whole coast; but if the disease originated from this cause, the instances of it ought to be much more numerous *.

Upon the Gold Coast prodigious ENLARGEMENTS OF THE LEGS are often met with, which the natives attribute to the same cause as the last complaint, the immoderate use of palm wine; some of them being in the habit of drinking, upon an average, two gallons of this wine a day. ‘The disease is frequent among the Bagoes, much less so among the Nalloes, and is said to be totally unknown among the Mandingos and Foolas. In the neigh- bourhood of El Mina, it is called appakoo- kooa; the Bulloms call it oo-beng oo-hin-tay ; the Timmanees, kat-tuk ka-budy-a. They pay scarcely any attention to this complaint, as it does not affect the general health, and they use no remedies whatever. It generally affects but one leg, and seldom rises above the knee: the swelling is hard and firm, does not pit on pressure, and. is entirely free from pain. It does not diminish the activity of the person, though it should render his leg as thick as his body. It is said to affect only those who have used palm wine immode- rately, but it is more probably caused by the stagnant water which they are obliged to use.

This complaint appears to be exactly the same as that which occurs at Cochin,.a Dutch settle- ment in the East Indies+, upon the banks of a river, in a low situation, supplied with bad

* Baldinger Medicinische Bibliothek ii. band. 4 stuck. + Obsery. on the Dis. of the East Indies, &c. VOL, It. Q

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water. ‘This is supposed to cause the enormous swellings, to which the natives are subject, and which are called in India Cochin legs. Dr. Clark observes, no European becomes affected with this disease, however long he may have re- sided there. “ The natives of Cochin,” he adds, “are extremely healthy; neither is the bulk of their legs the least inconvenience to them. No pre- ternatural weight is to be observed: they are strong bodied, and enjoy as much agility as if they were totally exempt from this unseemly de- formity *.”

Notwithstanding the excesses committed by the pagan nations of Africa im the use of spi- ritucus liquors, and the mcitement which they have to excessive venery from a plurality of wives, I have never heard of an instance of cout among them, nor is it probable that they are ac- quainted with the disease. The Mahommedans are greatly debilitated by their frequent appli- cation to aphrodisiacs, and seldom fail, when they meet with European surgeons, to ask them for provocatives, or, as they phrase it, medicines “to strengthen the back.” ‘This demand is oftener made by them, than by their neighbours who use rum. A similar enquiry, as travellers ob- serve, is usual among the Turks and Arabs. Dr. Rush informs us, that he has heard of two or three instances of gout among the Indians of

* See “ Observations on the Diseases which prevail in long voyages to hot countries,” by J. Clark, M. D. to whom we are indebted for an improyed practice in the fevers of tropical climates.

Sales ae ein seer ae > la emt ae Ie ae cs

Se eas

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North America, but only among those who had learned the use of rum from the white people. It does not appear how drinking of rum can occasion gout, otherwise than by the genera! debi- lity it induces. Dr. Rush observes, that the reason why the gout does not appear more fire- quently among the class of people who use the greatest quantity of rum in our own country is, that “the effects of this liquor upon those en- feebled people are too sudden and violent to admit of their being thrown upon the extremities, as we know them to be among the Indians ; they appear only in visceral obstructions, and a com- plicated train of chronic diseases. Thus putrid, miasmata are sometimes too strong to bring on a fever, but produce instant debility and death.” It may, perhaps, give some support to this opi- nion, to observe that few of the inhabitants of this part of Africa arrive at old age. They turn old much sooner than Europeans, and appear in a state of decrepitude when the latter have scarcely reached their grand. climac- teric. Mr. Adanson makes the same remark : « the negroes of Senegal,” he observes, “are really old at the age of forty-five, and oftentimes sooner : and I remember to have heard the French inha- bitants of Senegal say several times, that, accord- ing to the best of their observation, the negroes of that country seldom lived to be older than sixty *.” From a want of fixed data, it is impos- sible for the most part to determine their ages

* Voyage to Senegal.

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with any degree of precision. One instance only of longevity can be given with any degree of accuracy; this was in a person named Addoo, of considerable consequence, who resided in the river Sherbro, and who remembered, when a boy about fifteen years of age, to have been in the island of Barbadoes. This occurred during the reign of Queen Anne, or, as he expressed it, ** when the king of England was a woman ;” con- sequently he must have been (mm 1796) near one hundred years of age. He is still alive.

In a climate so intensely hot as that of Africa, it might be supposed that the natives would en- - joy an immunity from the racking pains of rHEU- MATISM, Which is by no means the case. They bring on these pains through the incautious man- ner in which they check perspiration, by throwing themselves upon the ground, and sleeping, after being fatigued by violent exertions in dancing, &c. Not unfrequently they sleep all night in the open air, especially during moon-light, exposed to the chilling dews which fall, and covered only with a thin cotton cloth. The pernicious effects of dew have already been noticed, although po- pular prejudice has referred them rather to the ac- tion ofthe moon’s beams, it having been said, though without foundation, that animal substances, ex- posed to the light of the moon, very speedily cor- rupt. This appears to have been a very general error among the vulgar of all nations, except per- haps the Africans, who do not ascribe to the moon any influence on the human body.

Their favourite mode of cure for rheuma-

V7 tism is by exciting a very copious and general perspiration: with this view the earth-floor of a hut is made very hot by live coals, and when these are swept off, the floor is covered thickly with the leaves of amelliky, nauclea sambucina, previously sprinkled with water: upon these are laid a mat and a cotton cloth for the patient to recline on, and he is carefully covered up with cloths, to promote the sweat. Professor Finke, in his learned work (Versuch einer allge- meinen medicinisch practischen Geographie) ob- serves, that the best physicians are to be found at Cape la Hou, whither they come from the country of Saku. In several chronic diseases, especially in rheumatism, they practise a curious operation, that of exciting an artificial emphy- sema, of which Gallandat * was an eye-witness. When they find that the remedies employed have no effect upon the disease, they make, with a sharp instrument, an incision upon one or both of the patient’s legs, through the skin into the cellular membrane. Into this wound they introduce a hollow reed, or the stem of a pipe, and blow as much air as they think neces- sary, or as the patient can support. ‘The wound is then covered with a piece of strongly adhesive plaister, and a mixture composed of pepper, lime juice, brandy, and certain herbs, is administered to the patient. He is next ordered to run as vio-

* Abhandl. aus der Naturgeschichte, prakt. Arzneyk. hind Chirurgie ; aus den schriften der Haarlemer, u. s. f. gezogen. 2 ter band. ;

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lently as he can, and when overcome with fatigue, to betake himself to bed, where he remains a few days, being kept all the time in a profuse sweat. During this process a calibash full of the above- mentioned drink is administered every day, until the artificial tumor has disappeared, and the pa- tient feels restored to health. The tumor gene- rally begins to decline perceptibly about the third day, and on the 9th, 10th, or 11th days, it is no longer to be seen. Sometimes this ope- ration is repeated in the same patient, of which Gallandat relates instances; he adds, that se- veral negroes, whom he knew, assured him that they were cured by this means. In lumbago they drink a warm infusion of the root of a plant called by the Foolas gully-gully ; by the Soosoos garan- gantang, and by the Bulloms ogboog: it gene- rally excites a copious perspiration.

Mr. Lucas, in his Communications to the Afri- can society, observes, “ the diseases that are most frequent in Fezzan are those of the inflammatory and those of the putrid kind. The small pox is common among the imhabitants; violent head- aches attack them in summer, and they are often afflicted with rheumatic pains. Their old women are their principal physicians. For pains of the head they prescribe cupping and bleeding ; for pains in the limbs they send their patients to bathe in the hot lakes, which produce the trona, (mineral alkaly) and for obstinate head-achs and strains, and long continued stiffness in the mus- cles, they have recourse, like the horse doctors of

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Europe, and the physicians of Barbary, to the application of a burning iron. The use of the strongest oils, and the most powerful herbs, is also frequent ameng them.”

When the pain is confined to any particular spot, it is bathed with a decoction of the leaves and pods of the red pepper bush, or capsicum, used. warm.

In pains of the neck, attended with stiffness and rigidity of the muscles, they apply as a cataplasm to the pained part a quantity of the leaves of the malip or plum tree, steeped in hot water: this is frequently repeated: and generally found very effectual.

‘When, in consequence of rheumatic pains, a stiffness of the joints remains, the leaves of a plant called by the Soosoos makootay, are bruised, soaked in hot water, and applied to the affected parts.

In deep seated pains of the limbs, contusions, or sprains, they apply the leaves of a plant called by the Soosoos karee, and by the Mandingos _bannee: these are first bruised in a mortar, and heated over the fire before they are applied.

In pains of the side, either from rheumatic affection of the muscles, or pleurisy, they use the root of ayol bruised, and applied as a cataplasm ; it contains a white juice, which is very acrid, and is capable of exciting blisters.

PLeurisy is a very rare disease among the na- tives, unless from external violence. An instance of peripneumony occurred to my knowledge,

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though I did not see the patient. It happened to a native greatly addicted to drinking spirits, and who had brought on the complaint by sleeping in the open air after intoxication. It terminated fatally in a few days, and to his friends very un- expectedly.

It has been remarked that black people brought to Europe are very liable to aBSCEss OF THE LIVER, a disease which occurs very rarely in Africa, and perhaps never idiopathically.

Scropuu.a, and its frequent concomitant, con- sumPTION, are the diseases to which black people often fall victims in cold and variable climates: of the former complaint, only one or two in- stances occurred to me in Africa, and of the latter, as an idiopathic disease, I do not recollect to have seen a single case. An mgenious writer, speaking upon this subject, says, “our Indians are so tender, and habituated to a certain way of living, that they do not bear transplantation ; for instance, the Spanish Indians, captivated in the St. Augustine war, anno 1702, and sold for slaves in New England, soon died consump- tive *.” Consumption is a very rare disease in the neighbourhood of Sierra Leone, but appears to be more common among the Foolas and Man- dingos; it is called by the former nation do- eer6o, by the latter togo-sedaiya, or the “ cough sickness ;” the Susoos call it tago-myee, a word. of the same import.- In this disease, which they

* Gorden’s Polit. Summary, i. p. 174.

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look: upon as incurable, they attend most to regi- men, and especially prohibit the use of fat meat. They do not suppose the disease to be infectious, but are of opinion that it often vai from father to son.

At Teembo, as in all large towns, this disease is very frequent. The place is indeed much more unhealthy in proportion to the number of its inhabitants, than other African cities. The cause of this, as assigned to me by a Mandingo, was, the many mixtures of different and very distant people, with which the capital is always crowded. Another cause probably is, the very confined situation of Teembo. It has been supposed by many, that a hot country is favourable to con- sumptive patients, but I have found the reverse of this to be true. Among the Nova Scotia settlers at Free Town, consumption occasionally appeared, as a sequel of other diseases; and in every instance, the fatal period occurred much sooner than it would have done in Eng- land.

A very celebrated remedy in this disease is ‘the bark of a tree, called by the Foolas and Man- dingos yay-goo; and by the Soosoos cambay'; it is a very powerful bitter: a decoction of the bark is mixed with rice, of which they eat every morning three handfuls.

In cases of coven, attended with a sensa- tion of soreness at the-breast, they use an infu- sion of the bark of the yutfo; this is given

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129 only every second morning, and proves gently emetic. | tl

The following medicines, which are the chief remedies they employ in pectoral complaints, act either as emetics, or by exciting a slight degree of nausea. 1. Fundéoba, Timmanee: an infusion of the bark is drank every morning, and is much commended as an expectorant; in taste, it very much resembles juniper.

_ 2. Mabamp, Timmanee, tamarind tree : an in-— fusion of the leaves in boiling water is drank when cold, every morning, to promote expecto- ration in cases of shortness of breath; it tastes slightly acid, with a degree of astringency.

__ 8: Bissay or Bissaing, Timmanee: an infusion of a handful of the leaves of this plant in boiling water, taken in the quantity of a tea-cupfull, produces full vomiting three or four times, after which it proves smartly purgative. It is a very strong and dur- able bitter, without possessing astringency. Some- times they add to this plant an handful of the leaves of one called bakkarawéotoo, to increase its émetic powers.

The milky juice of gang-gang taken in the quantity of half a table-spoonfull, proves gently emetic and purgative; when it has sufficiently operated, the juice of a lime immediately puts a stop to its action.

The bark of malip, or plum tree, is boiled in water, and frequently exhibited as an emetic; this effect is rendered more certain by the addi-

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tion of a little of the bark of, the kola and _ trees.

A decoction of the bark of a tree, called by the Timmanees moot, and by the Bulloms ’n-chok, is frequently used as an emetic, or, as they term it, to clean the stomach. The fruit of the same tree, when very young, is eaten in the morning, to remove nausea and sickness. From the seeds of this tree the natives obtain a kind of butter, as has been already mentioned.

A decoction of the leaves of the lime bush, called by the Timmanees limree, is frequently drank warm, in the morning, in the quantity of a tea-cupfull, when it proves emetic, and frequently purgative. This fragrant tree is greatly esteemed by the natives, and enters into the composition of several of their medicines, It was equally cele- brated among the ancients. Virgil thus describes - its virtues : quo non presentius ullum,

Pocula siquando seve infecere noverce,

Miscueruntque herbas, & non innoxia verba, Auxilium venit, ac membris agit atra venena, Folia haud ullis labentia ventis ;

Flos ad prima tenax: animas & olentia Medi Ora fovent illo, & senibus medicantur anhelis *.

Pliny likewise speaks of it in terms of praise, « Malus Assyria, quam alii yocant medicam, ve- nenis medetur, Odore precellit foliorum quoque, qui transit in vestes una conditus arcetque ani- malium noxia ft.”

* Georg. ii, 127. + Lih. xit, ¢. 7!

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In cases of loss. of appetite, they use a decoc- tion of the leaves of dakéona, so called by the Soosoos and Timmanees, and by the Bulloms lakéona: it is a very powerful bitter, somewhat resembling wormwood, and is drank every morn- ing. It is frequently mixed with honey, and taken as an aphrodisiac.

When, together with a loss of appetite, there is a bitter taste in the mouth, accompanied. with other symptoms of bile, a decoction of the leaves of bullanta is recommended to be drank every morning,

When the stomach is affected with indigestion, and oppressed with a sense of weight, they make use of a decoction of the roots of the following plants: 1, Morronday, 2, Bangbee, 3. Demba- eeree. 4, Dundakky. 5, The young palm-tree: the roots are cut small, and a few unripe limes are added, together with a little honey or sugar; this medicine is given by cup-fulls, and Sl a briskly purgative,

When any thing taken disagrees a the sto- mach, or when a poison has been swallowed by design or accident, they use a very powerful purgative, called by the Soosoos, tolmghee: the outer skin of the root, which is a powerful astrin- gent, is carefully scraped off, and thrown away ; the inner part is cut into small pieces, and boiled with rice, or made into broth, with a fowl, which is drank until the desired effect be produced.

Upon the island of Bananas they have a very

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violent purgative, which they call pulga-pootoo, or white man’s physic; pootoo signifying a white man ; it is the same with the physic nut, jatropha cureas, in the West Indies, from whence it has probably been brought by Europeans. The purgative quality of the nut resides entirely in the corculum of the seed, and when this is re- moved, the cotyledons may be eaten with impu- nity, in any quantity : they resemble a sweet al- mond in taste, Five whole kernels are a sufficient dose for a strong man; in irritable and weak stomachs, when taken in greater quantity, they not only prove violently purgative, but produce severe vomiting, attended with a burning heat of the fauces, Ligon says, “ I myselfe took five of them, and they gave me twelve vomits, and above twenty stooles*.” ‘The tree is chiefly used on the Bananas to make fences—According to Dr. Wright, a decoction of the leaves is often used with advantage in violent belly-achs, attended with vomiting.’ It is easier on the stomach than any thing else, and seldom fails to effect a discharge by stool. Lond. Med, Journal, vol, vill.

A captain of a vessel informed me, that having been seized with a spitting of blood, attended with a tickling cough, slight fever, and much rest- lessness and anxiety, he went on shore, among the natives on the Leeward Coast. The head- man of the village was at the same time his host

* Hist, of Barbadoes.

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and physician ; he spread for him upon the floor of a hut, several beds, telling him that when tired of one he must remove to another, until he felt a disposition to sleep. An infusion of a plant was occasionally administered, which excited gen- tle vomitmg, and his diet consisted of fish, and strong soups joined with mucilaginous herbs, by which means in less than three weeks he was per- fectly restored to health.

CHAP. VII. GENERAL DISEASES.

DISEASES OF THE EYES. NYCTALOPIA. CASE OF CROUP. SORE THROAT. CORPULENCY. SMALL- POX. INOCULATION. MEASLES.

spans of the EYES very rarely occur upon the coast of Africa, notwithstanding what has been alledged respecting the pernicious effects of rice, their favourite food. Bontius says, those who sail to Amboyna, Banda, and the Mo- luccas, are frequently affected with weakness of sight, and even total blindness, which is re- moved by a change of air, or a better diet. The inhabitants of these islands, he adds, attribute this complaint to the eating of hot rice ; hence the Javanese and Malays always expose the rice, when just boiled, to a current of air. These nox- ious qualities of rice are. attributed by Bontius to its growing in wet and swampy places, whereby it incorporates some marshy or feecu- lent substance, more penetrating in hot than in cold rice ; though, he says, the odour of even dry and raw rice oppresses the head, and induces a de- gree of somnolency. It may be perhaps alleged that, asthe rice grows inthe neighbourhood of Sierra Leone in dry ground, and even upon the sides of

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steep hills, it does not acquire these noxious qua~- lities, of which the natives have not the smallest dread. Whether under weakness of the eyes, Bontius includes also, the disease of nyctalopia, or night blindness, which not unfrequently occurs in warm climates, is uncertain, Of this latter complaint, three or four instances came under my observation, not among the natives, who do not appear to know the disease, but among the children of the Nova Scotia settlers in Free Town. Two of these instances occurred in the same fa- mily, all the individuals of which were remarkable for a peculiar prominence of the globe of the eye, and a dilated pupil; in the other cases, no pecu- liarity was observable, nor could the’ disease be attributed to any certain cause. It was of no long continuance, and appeared to. be carried off by the exhibition of emetics and’ calomel purges. | Pliny takes:notice of this disease, and recom- mends goat’s liver to be eaten as a cure. Speaking of these animals he says, tradunt & noctu non mi- nus cernere, quam interdiu: ideo si caprinum jecur vescantur, restitui verspertmam aciem his, quos nyctalopas vocant. Lib. viii. c. 50.

The inhabitants of Syene in Egypt are, accord- ing to Mr. Bruce, affected with a weakness and soreness of the eyes, terminating m blindness ; this is thought to be occasioned by the hot wen of the desert.

The natives of Issinee, on the Gold Gaus where rice is very little used for food, are liable to inflammations of the eyes, which is attributed

a eo

129 to the great heat and glaring light of the rays of the sun reflected from the sandy soil *.

I have never seen an instance of blindness among the native Africans, except in very old people, who are not often affected with it; nor has an instance of obstinate opthalmia ever oc- curred to my notice. Their principal remedy for opthalmia, when it does occur, is pan-a- pannee (Timmanee), tontay, (Soosoo). The fruit, which is the part made use of, is shaped like a pear, but having a longer neck. When used, the apex is cut off, and a drop of the juice is pressed from it into the eye: I once saw it applied ; it seemed to produce sharp pain, which continued only a few minutes. It is much com- mended in dimness of the cornea, and is also employed to remove specks or films. The juice is of an acid, and very astringent taste.

When the inflammation of the eye is very severe, it is usual to drop into it some milk from a woman’s breast.

Another very celebrated remedy in opthalmia is a species of reed called by the Timmanees cattop ; oo-shaa, (Bullom) ; kaymanghee (Soosoo). The stem is roasted over the fire, and a few drops of the juice, when milk warm, are squeezed into the eye. It produces a very acute pain for a ‘short time. I saw it of use in scrophulous inflam- mation of the eye, opthalm. membran. The juice

* Tsert. Reise nach Guinee.

» VOL. I. S

130 is of an acid sweetish taste, and the stem is often chewed by the natives to quench their thirst. The leaves of this plant, first bruised in a mortar, and then heated over the fire, are applied hot to contused parts.

In slight cases of opthalmia the eye is washed with a decoction of the leaves of mekkamaken- Zee,

A warm decoction of the leaves of a plant, called by the Timmanees .yabakyaba, is used to wash the stye on the eyelids, hordeolum.

I have reason to suspect that an instance of the croup occurred at Free Town, m a stout boy about fifteen years old, a native of the Kroo coast ; but unfortunately the disease was neither suspected, nor was danger apprehended until the fatal termination took place, which was within forty-eight hours from his first complaining. There was a degree of ‘tumefaction of the throat externally, reaching to the ears, and affecting a portion of the parotid gland om each side: he complained of an acute pain m the throat, rendering deglutition difficult; but there was not any appearance of inflammation in the in- ternal fauces. His voice was little affected, but his respiration became very difficult before he died. His pulse was small, but not much acce- lerated, nor was there any preternatural heat of the skin. The restlessness attending this com- plaint was so great, joined to an impatience of confinement, that he could not be prevailed upon

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to continue in bed, but walked about until within a few minutes of his death, which in a great mea- sure took off the attention of those about him. Upon examining the seat of the disease after death, which was readily allowed by his coun- trymen, who seemed pleased that any attention was paid to the deceased, there was nothing more to be seen than a slight degree of redness in the upper part of the larynx, immediately below the epiglottis.

In sorz-THROAT, generally of the inflammatory kind, when attended with much tumefaction of the tonsils, and difficulty of swallowing, they use the young leaves of a small tree, called by the Soosoos wubbay, by the Timmanees apel, by the Bulloms pil, and by the Kroos gheang: these are beaten up with some grains of malaguetta pepper, mixed with a little water, and given as a drink. This tree bears bunches of berries, resembling those of the common elder, at first red, but afterwards turning black. They contain a single seed, which is almost as hot as pepper. When the bark is cut, there exudes a gummi- resinous juice as red as blood.

In so hot a climate, it may appear strange for

POLYSARCIA OF CORPULENCY to occur as a disease.

Among the Bulloms and Timmanees, the young people, especially the females, are rather full- formed and plump, than corpulent, but old per- sons are in general thin. Among the Mandingos corpulency is more frequent, and they endeavour

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to obviate it by an infusion of the bark of a tree, called by the Bulloms bal, by the Soosoos shookay, and by the Timmanees obiss ; it is bit- ter, but has no sensible effect. This tree pro- duces a rough brown plum, which has a sweet taste, and is often used to make a kind of beer. The unripe fruit has a narcotic quality, and induces considerable nausea... Brisk purgatives are occasionally employed with a view to diminish corpulency. Profuse sweating is also made use of for this purpose, and the patient sits over a de- coction of ginsee-ginse, while the steam is confined — by a thick cotton cloth thrown over him. The same infusion is used, when cold, as a wash for the body durmg the day.

The smauu Pox, from the concurrent testimony of authors, is a further addition to the diseases — supposed to have originated in Africa, terra ferace veneni. Whether it first began in Ethi- opia or Arabia is uncertain; but from the lat- | ‘ter country it was imported into Europe. Dr. Friend supposed that this disease took its rise in Egypt, because Rhazes informs us that a phy- sician of the name of Aaron, who ‘was born at Alexandria, and practised in. the reign of Mo- hammed, about the year 622, had treated of this disease; but its origin is carried farther back by Professor’ Reiske, who says he read ‘the following words in an old Arabic manu- script, in the public library at Leyden. “ This year, in Qne, 572, the birth of Mohammed, the

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small pox and measles made their first appearance m Arabia*.” Dr. Mead adds, respecting the small pox, “I really take this disease to be a plague of its own kind, which was originally bred im Africa, and more especially in Ethiopia, as the heat is excessive there ; and thence, like the true plague, was brought into Arabia and Egypt +.” However just these speculations may be, it is certain, that at the present day, the small-pox is so far from being endemial on the western coast of Africa, on the windward part of it at least, that it is always imported thither by Europeans. It is called by the Timmanees oo-burhbo, by the Bul- loms ka-bumbo, by the Soosoos kaka, and by the Mandingos cassimasinghee. It is about twelve years since its last appearance in the river Sierra Leone, or on the Bullom shore. It was very fatal in the higher branches of the river Sierra Leone, in the year 1773, and about seventeen years ago it appeared in the river Sherbro,’ where it proved very fatal, especially to old people.

It is upwards of twenty years since this disease shewed itself in the Foola country: the Foolas say it was at that time imported by an Ame- rican vessel, which came to Rocundy, and add, that many of the old people ‘fell a sacrifice to it. Among all the tribes near the coast there is a great similarity in the mode of treating the small pox. From the time of the eruption,

\ i * Mead’s Works, + Ibid. ?

134 which is. generally towards the end of the third day, the patient is- not washed until the sup- puration be completed ; for they suppose if cold water were used to wash a person in this disease, it would throw the matter upon the internal parts, and prove fatal. As soon as matter appears in the pustules, it is let out by a sharp pointed stick, the pustule itself is removed, and after being well washed with warm water, the sores are sprinkled with the fine meal of the pigeon pea, called by - the Bulloms see-ti’l. This practice of removing the pustule, however, is not general ; im some parts of the country, they merely let out the matter, and then wash the pustule well with warm water ; and as often as the pustule fills with matter, it is opened and washed. ‘Their hope of preventing the face from being marked, rests upon their washing and emptying the pustules very diligently. The appearance of this disease excites a general alarm: when any one, is seized with it, he is immediately removed to a place built for the purpose in the woods, where no person is allowed to visit him, but such as have had the disorder. A quantity of fine sand is spread upon the ground, oa which are jaid cloths to serve for the patient’s bed. The diet is restricted to milk, thin soups, and Jean meat ; nothing cold is allowed for drink. The chief medicine made use of is an infusion of a plant that tastes like sorrel, called by the Man- dingos santoo, by the Foolas folleree, and by the Soosoos da; hibiscus, tea plant. When the pus-

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tules are dry, and, begin to desquamate, the patient is washed, and his body anointed with some soft ointment.

The practice of inoculation is totally unknown m the neighbourhood of Sierra Leone, where, if ever practised, it has been by Europeans alone. The small pox is said to do little mischief in Morocco, “ because of the temperance of the cli- mate, and the abstinence of the people.” They are acquainted with meculation in the interior parts of the country *; but the Moors do not inoculate, “except those who live on the moun- tains, the Brebes and the Shellu of the south (or - aborigines)—— hence it may be concluded that the small-pox was known in Africa before the invasion of the Arabs, and that the mode of com- municating it by insertion must have been more ancient in these countries than Mahometanism ; because, however powerful the ascendant of reli- gion may be, it is very slow in rooting out the prejudices and customs of nations +.” In the Mes dical Observations and Inquiries, vol. i. it is as- serted, upon the testimony of some negroes in America, that imoculation is commonly practised in Africa, so that old people seldom have the disease ; it is added, “ they generally inoculate all their young, as soon as the infection comes into the neighbourhood.

In the regimen

* Mr. Park informs us that the negroes on the Gambia prac- tise inoculation for the small-pox. ~

+ Chemier’s present State of Morocco.

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under it, they only abstain from all flesh meat, and drink plentifully of water acidulated with the juice of limes, which grow large and plentifully m their country.” Inoculation has been frequently prac- tised to a considerable extent on board of slave vessels, and though no instance has fallen under my observation, it has always proved successful. An ingenious writer observes, that “ the small pox in cold countries is more fatal to blacks * than to whites. In the Boston small pox, of 1752, there died whites in the natural way about one in eleven, but one in eighty by moculation ; blacks in the natural way, one in eight ; by inoculation one in twenty. In hot countries it is more fatal to whites than blacks. In Charles Town, South Ca- rolina, when the small pox prevailed, 1738, it was found, upon a. scrutiny, that in the natural way, of 647 whites died 157, one in four; by inocula- tion of 156 whites, died nine, or one in twenty ; of 1024 blacks in the natural way there died 138, one in seven and half; of 251 blacks, by imocu- lation there died seven, one in thirty-six.” The same author, speaking of the manner in which the North American Indians treat this disease, says, « their principal remedy is sweating in huts warm- ed by heated stones, and thereupon immediate — immersion in cold water. In intlammatory and eruptive epidemical fevers, e. g. small — this practice depopulates them ”

* An affecting instance of this is related in Cartwright’s His- tory of Labradore. + Douslas’s Polit. Survey, ii. 398.

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Notwithstanding THE MEASLEs are said to be of African origin, I could not obtain from the natives any satisfactory account of the disease, because it is difficult to make them comprehend by words alone the object of your enquiry. I was informed by a native in the Rio Pongas, of Portuguese extraction, who spoke remarkably good English, that they have sometimes an eruptive disease ap- pearing among them as an epidemic, which he called fundoo, in Soosoo foondaing. He said, it is preceded by a sensation of cold, followed by heat, and attended with a cough and watery eyes; it is not dangerous, and runs its course in a few days. For the cure, they rub the body all over with the fine flour of rice, which is sometimes mixed with honey. This person’s character for dishonesty induced me to pay little credit to his account ; but I have been assured by a captain of a vessel, a man of probity and good informa- tion, who had been frequently on the coast, that the measles were once brought on board a slave. ship in which he was,