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William Loney RN - Background

Home-Loney-Background-Niger expedition-Medical history Section 4 * Chapter 3

MEDICAL HISTORY
OF THE
EXPEDITION TO THE RIVER NIGER
DURING THE YEARS 1841-2
.

CHAPTER II.
HISTORY OF THE FEVER.
Section V.


Illustrative Cases of the Fever.

Case I. Iddah, in the kingdom of Eggarra, River Niger.

Sept. 4th, 1841. John Peglar, Stoker, anno aetatis 22. Complained yesterday of general uneasiness, for which he had a dose of calomel and James’s powder, which afforded him some relief; but he was lying on the lower deck during part of the night, his hammock having accidentally got wet. To-day has headach and heat of skin. Eyes suffused. Pulse 100, rather full. Tongue moist, loaded, reddish, and indented round the edges. Bowels open.
      Emittr. statim sanguis e brachio.
      Postea sumat pilulam calomelanos, gr. iij. opii, gr. ½, omni horâ.
11 p.m. Partial syncope was induced by the bleeding. Inclines to sleep. Skin clammy. Headach easier. Eyes less suffused. Complains of thirst. Tongue foul. Pulse less frequent, still firm.
      Contin. pil. calomel, et opii.

Sept, 5th, 3 a.m. Has slept at intervals during the night. The bowels have been purged. There is no complaint of pain, but he is drowsy and not easily aroused. Pulse softer.
9 a.m. Has been quiet and easy since last visit. Slight mercurial fetor of mouth. Bowels again opened, stools dark, scybalous. Pulse small, soft, and regular. Tongue loaded in the centre, moist round the edges, less red. The blood drawn yesterday exhibits a small proportion of crassamentum, and is neither buffy nor cupped.
      Omittr. calomel, et opium.
      ℞. Quinae disulphatis, gr. iij.
      Julepi camphorae, ℥j. M. Sumat omni horâ.
M. Has been in low state for the last hour. He is now very restless and falters in his speech. Muscles of the pharynx convulsively affected on his attempting to swallow. Complains of spasms of the abdominal muscles. Pulse small, soft. Skin moist; clammy. Tongue moist, protruded from the mouth with difficulty.
      Abradatur capillitium. Applicr. emplast. lyttae nuchae.
      Contr. quinae disulphas cum camphorâ.
      Capiat vini rubri ad libitum.
8 p.m. The power of articulation is nearly gone. The motions of the pupil are languid. Perception remains, without the power of expressing his desires, further than opening the mouth when he wishes to drink.
Contin. omnia.

Sep. 6th, 3 a.m. Takes wine when given him, but he seems to be quite insensible.
      Rept. vinum.
8.30 a.m. Wine has been continued all night. Blister has risen well. He seems to possess consciousness, but has no power of expression. Arms are spasmodically extended, and he moves them about with a sawing motion. Deglutition very difficult. Pulse small and thready. Respiration short and frequent. Has vomited some bile of a green colour. Hands rather cold, feet warm.
      Continr. vinum.
Vespere. Continued in a low state all day, wine was given every hour, which in all probability protracted his existence. He died, however, at seven this evening.

Sectio Cadaveris.

The examination of the body was conducted by Dr. Stanger and myself. With the exception of the mark of the blister, the exterior of the body presented no unusual appearance.
Abdomen. Peritoneum sound. The stomach contained an ounce of yellow-coloured fluid. There was a yellowish tinge over the whole of the viscera. The mucous lining was generally softer than natural, and near the pyloric orifice there were small patches of effused blood, and minute points of ulceration. The upper end of the duodenum exhibited marks of inflammatory action. The lower part was deeply tinged with a yellowish-green colouring. No unusual appearance in the ileum, except near its lower end, where points of ulceration again occurred. As also in the colon, patches of Peyer distinct, but not otherwise altered. Liver natural. Gall-bladder filled with tar-coloured bile. Spleen, pancreas, and kidneys healthy. No unusual appearance in the chest. Head not examined.

Case II. At Iddah, River Niger.

Sept. 4th, 1841. William Oakley, Gun-room Cook, anno aetatis 38, a Negro, born on the west coast of Africa, but he has been several years in England. Was placed on the sick list yesterday with symptoms of bilious dyspepsia, for which a purgative was given him. He has had shivering, followed by heat of skin and diaphoresis. Complains now of severe headach. Vomits ingesta. Pulse frequent, soft, full. Bowels open. Tongue foul, moist.
      Admov. emplastrum lyttae nuchae.

Sept. 5th. Febrile accession, which commenced yesterday afternoon, subsided about one this morning. Blister rose well. Has no complaint. Pulse 90, soft. Bowels open.
      Capiat pulveris Jacobi veri, gr. iv. secundâ quâque horâ.

Sept. 6th. Slept occasionally during the night. No return of fever, headach gone. Complains much of debility. Tongue loaded in the centre, moist, and red round the edge. Bowels have been opened this morning. Pulse 100, small, regular.
      Omittr. pulv. Jacobi.

7 p.m. A febrile paroxysm came on about two hours ago, which, however, has only caused slight headach. Bowels have been again freely opened.
      Abradatur capillitium.
      Lotio frigida capiti.

Sept. 7th. Slept well. Fever subsided during the night, slight headach continues. Countenance improves. Has no local pain, but complains of general soreness, which he attributes to being confined to bed. Tongue still foul. Skin rather hot; dry. Pulse 100, small.
      ℞. Aquae ammoniae acetatis.
      Mucilaginis acaciae, ãã ℥iij.
      Spts. aetheris nitrosi, ℥ij.
      Tincturae opii, ℥ j. M.
      Fiat mistura, cujus capiat aeger cochleare magnum omni horâ, donec ciet diaphoresin.

Sept. 8th. Rigors returned last night, and were followed by calm and placid sleep. Skin moist. Pulse 90, soft. Bowels open.
      Maranta arundinacea pro prandio.
      Contin. mistura pro re natâ.

Sept. 9th. Complains to-day of pain along the spine. No fever. Slept well. Tongue foul, moist. Bowels open. Is very weak and giddy on attempting to rise.
      Contin. maranta arundinacea.
      Habt. jusculum gallinae pro prandio.
      Omittr. mistura.

Sept. 11 th to 24th. Slight returns of fever, after long intervals, were experienced during this period. Debility continued until within the latter three or four days, after which he returned to his duty.

Case III. At Iddah, River Niger.

John Robertson, Stoker, anno aetatis 30, of stout, muscular form, temperament phlegmatic. Complains of intense headach, pain along the spinal column, heat of skin, nausea, and a sensation of fulness about the stomach. Countenance anxious. Tongue moist. Pulse small. States that he has been unwell for the last day or two, but not sufficiently so as to cause him to apply for medical assistance.
      Abradatur capillitium.
      Lotio frigida capiti.
      Capiat pulveris Jacobi veri, gr. v. omni secundâ horâ.
      Bibat aqua hordei, pro potu ordinario.
9 p.m. Diaphoresis general over the body. Headach and other symptoms much relieved. Bowels have been opened. Pulse softer, less frequent. Temperature in the axilla, 101 Fahr.
      Contin. lotio capiti.
      Rept. pulv. Jacobi verus pro re natâ.

Sept. 6th. By reason of an increase of headach during the night, a blister was applied to the nape of the neck, which has not yet risen. He slept at intervals and still inclines to dose. Countenance improves. Tongue dry in the centre, moist at the edges. Pain of legs only complaint. Bowels slow. Pulse 80, soft.
      Capiat magnesiae sulphatis, ℥j. in aquae purae, ℥iij.
      Omittr. pulveres Jacobi.
Vespere. Rigors, with heat of skin, towards the evening. Bowels have been freely opened. Is thirsty; has a strong desire to sleep, but is restless in bed. .Headach relieved, but he complains of irritation from blister sore, and of slight strangury.
      Rept. pulv. Jacobi.

Sept. 7th. Slept at intervals during the night. In consequence of nausea, with epigastric uneasiness, a blister was applied to the epigastrium in the morning. Complains of pain of the back part of the head. No oppression of eyes. Countenance improves. Is troubled with occasional spasms of the lower extremities. Pulse 80, soft and regular. Bowels opened several times. Stools dark and watery. Has a desire for food, and has taken a little tea with relish.
      Capiat maranta arundinacea pro re natâ.
      Omittr. pulveres.

Sept. 9th. Did not sleep well, not owing to any local pain, but to a feeling of general uneasiness. Is oppressed. Countenance pale. Tongue cleaning. Pulse soft, regular. Bowels open.
      Continr. maranta arundinacea, cum vino.

Sept. 10th. Very slight fever; was somewhat incoherent on one or two occasions during the night, but that symptom has completely disappeared. Has no complaint of pain, and has taken his arrow-root with relish. Bowels opened once this morning. Pulse soft, regular, 84. Slight yellowness of conjunctiva.
      Rept. maranta arundinacea.

Sept 11th. Had a dose of muriate of morphia last night, after which he slept well. Skin dry. Bowels opened this morning. Pulse 90, soft, regular. Tongue dry in the centre, moist round the edges.
      Capiat pulv. Jacobi veri, gr. iv. omni secundâ horâ.
      Habeat jusculum gallinae.

Sept. 12th. There was a very slight febrile exacerbation yesterday, attended by low delirium, small sharp pulse. Wine was given at short intervals with marked benefit. To-day he is somnolent. Skin is cool. Has no complaint of pain. Urine copious, and high coloured. Pulse small. Conjunctiva tinged yellow.
      Continr. jusculum et vinum.

Sept. 13th. Occasional incoherence during the course of yesterday, with somnolency. Countenance pale and languid. Pulse irregular.
      Continr. eadem.

Sept. 14th. The pulse, which had been low during the day, sunk considerably last night. Ammonia and wine were freely given. Frictions and hot applications to the stomach and feet were also resorted to, which had the effect of rallying him. He slept towards the morning. Skin is now moist. Tongue dry, parched in the centre. Pulse small.
      Repr. ammonia et vinum.

Sept. 15th. Continued in a low quiet state during the whole of yesterday. He makes no complaint, but labours under great depression. Is more feeble than he was yesterday. Tongue moist. Pulse small.
      Continr. vinum et ammonia.

Sept. 16th. Rallied for a little yesterday afternoon, after repeated doses of wine and ammonia, aided by friction over the surface of the body, and warm applications to the feet. Pulse 110, small. Tongue loaded, moist. Countenance pale. Bowels opened this morning.
      Repr. eadem.

Sept. 17th. Has been gradually sinking since yesterday morning. Countenance cadaverous. Pulse irregular; low delirium.
      Continr. omnia.

4 p.m. Expired at the confluence of Niger and Tchadda.

Case IV. At lddah, River Niger.

Sept. 5th, 1841. John Burgess, Seaman, anno aetatis 24, of a plethoric habit, temperament sanguineous. Complains of headach, with which he has been troubled for the last day or two. Pulse small, frequent. Skin hot. Bowels opened yesterday. Tongue fold in the centre, clean and indented round the edges, and tremulous when thrust out of the mouth. States that the headach came on when he was employed in the hold two days since, but, thinking that he would soon get rid of it, did not complain until now.
      Abradatur capillitium.
      ℞. Calomelanos, gr. iij.
      Opii in pulvere, gr. 1/6, omni horâ.
      Aqua hordei pro re natâ.
      Lotio frigida capiti.

Sept. 6th; Pain of head much relieved, but there is still slight vertigo on rising. Complains of a sense of heaviness and oppression. Countenance flushed. Skin moist. Pulse 90, soft, regular. Tongue fold, indented at the edges.
      Emplast. lyttae nuchae.
      Continr. calomel et opium.

Sept. 6th. Vespere. Has been troubled with uneasiness at the pit of the stomach, and slight vomiting. Experienced a febrile accession in the afternoon, preceded by shivering. Pulse soft. Ptyalism has been produced. Tongue moist. Bowels open.
      Applicr. cataplasma sinapeos epigastrio.
      Omittr. calomel et opium.

Sept. 7th. The epigastric uneasiness was relieved by the sinapism, but returned towards the morning, and again disappeared after taking some arrow-root. Odour of skin offensive and peculiar. Slept indifferently. Countenance now rather flushed. Skin dry and hot. Vertigo on raising the head from the pillow, but there is no actual pain of the head. A full inspiration is made with ease. Pulse 90, full, soft, easily compressible. Bowels open during the night. Stools watery. Tongue white in the centre, moist round the edges.
      Repr. calomel et opium.

Sept. 8th. Passed a good night. No increase of febrile action since last report. Tongue foul, moist. Pulse 80, soft and regular. Bowels freely opened. Has taken some arrow-root with relish. Six pills have been swallowed. Skin moist, moderately warm.
      Continr. pil. calomelanos et opii.

Sept. 9th. Fever, in a low form, returned this morning at three o’clock. He has been troubled with vomiting, and has been occasionally incoherent. Countenance confused. Eyes languid. Perspires on the upper part of the body. No complaint, except of slight headach. Tongue moist. Pulse 100, small. Mercurial fetor of mouth.
      Emplastrum lyttae nuchae etiam epigastrio, et nisi alvus plene soluta fuerit post horas duas, injicr; statim enema emolliens.
      Horâ decubitus capiat solutionis morphiae muriatis, gtts. xxx. in aquae purae, ℥ss.
      Omittr. pil. calomelanos, &c.

Sept. 10th. Had a restless night, in consequence of irritation from blisters. Skin cool. Pulse 90, soft. Urine copious, easily coagulable. Has no pain, except from strangury. Tongue cleaning. Expresses a desire for food. Bowels opened by enema.
      Hab. juscul. gallinae pauxillum.

Sept. 11th. Slept well: experienced a feeble exacerbation of fever this morning, unaccompanied by shivering or pain. Bowels open. Tongue moist. Skin rather dry.
      Capiat pulveris Jacobi veri, gr. iij. quâque secundâ horâ.

Sept. 12th. Is quite rational and free from pain. Has had no return of fever. Slept well. Debility only complaint. Pulse 90, small, regular. Skin and tongue moist. Countenance rather pale.
      Continr. maranta arundinacea cum vino.
      Capiat mist, camph. cochleare magnum omni horâ.

Sept. 13th. Slept badly. Is quite coherent. Voice tremulous. Skin slightly tinged yellow. Tongue foul, moist, and indented at the edges. Bowels opened yesterday. Pulse irregular.
      Continr. camphora et vinum.

Sept. 14th. Rested very indifferently during the night. The surface became generally cold about one in the morning, but the heat was restored by warm applications to the abdomen and feet. The incoherence returned. The pulse became low and irregular; wine and other stimuli were given without producing reaction, and he gradually sank. At 6.30 a.m. he expired.

Sectio Cadaveris.

The examination of the body was conducted on shore, at the confluence; but we were obliged to hurry over the latter part of it, as some of the natives from the neighbouring village began to look into the tent.

The exterior of the body was plump, limbs well developed, the countenance shrunk. The features were not otherwise altered.

An incision was made from the chin to the symphysis pubis. The thorax and abdomen were laid open at the same time. The peritoneum was not altered further than a yellow tinge imparted to the omentum; and there was general congestion in the portal system. Considerable arborescence over the exterior of the stomach. On opening it, four ounces of yellow-greenish bile were found. The mucous coat generally was softened, and there were several dark livid patches, more especially near the pyloric orifice, where they were arranged in parallel streaks. Liver of a pale gray colour; and little blood appeared in cutting it into slices. Gall-bladder distended with bile, of the colour and consistence of tar. Spleen large, soft, and congested. Several livid spots were seen in the duodenum, as also in the lower portion of the ileum. Peyers glands were enlarged. The kidneys and urinary bladder were natural.

Lungs crepitous. Heart flabby, with masses of coagulable lymph occupying the cavities. Valves sound.

Dura mater sound. Ramollissement observed only in the corpus callosum. There was a small quantity of serum in the base of the brain, and an unusual proportion of fluid in the ventricles. No subarachnoid effusion.

Case V. At Iddah, River Niger.

Sept. 6th, 1841. James Worwood, Quarter-master, anno aetatis 28, of a robust habit of body, temperament sanguineous, states that for the last four or five days he has had an attack of intermittent once during every forty-eight hours; and that he was so well during the intervals that he did not think of complaining until now. He further states, that he suffered from tertian ague, for two years, when he was about twelve years of age, at which time, he was employed in a barge on the river Thames. Greenhithe, in Kent, was then his usual place of residence.
Capiat quinae disulphatis grana. decern bis in die.

Sept. 8th. The period of the paroxysm, 11 a.m. has been anticipated by the quinine. No complaint, except of slight headach.
      Capiat pilulas purgantes, ij.

Sept. 10th. Had a rigor of more than usual severity last night, the approach of which he felt at noon. He now perspires gently. Slight headach, with a sense of debility at the pit of the stomach. Bowels opened. Tongue white. Skin cool. Pulse 80, soft.
      Continr. quinae disulphas.

Sept. 18th. Paroxysms at least every alternate day, increasing in duration, of a lower type, and merging into the form of remittent. He was therefore discharged to H.M.S. Soudan, at the confluence, for a passage out of the river. This man recovered shortly after leaving the river, and rejoined the Albert in October, at Fernando Po.

Case VI. At Iddah, River Niger.

Sept. 7th, 1841. James Sims, private Marine, anno aetatis 26, complains of headach, with intolerance of light, and heat of skin. These symptoms were preceded, in the forenoon, by a sense of heat and uneasiness in the epigastrium. Countenance anxious. Tongue foul, moist. Has vomited occasionally.
      Abradatur capillitium.
      Applicr. lotio frigida capiti.
      ℞ Pulveris jalapae ℈j.
      Potassae supertart. ℈ij. calomel, gr. vj.
      Fiat mistura statim sumenda.

Sept. 8th. Slept at intervals during the night. Had again an attack of headach with general fever during the early part of this morning, which are now subsiding. Complains of thoracic pain, increased by a full inspiration. Bowels have been freely opened. Pulse 90, small, regular. Respiratory murmur clear, and distinctly heard all over the chest.
      Admovr. emplast. lyttae thoraci.

Sept. 10th. The fever remitted yesterday forenoon, but again came on in the afternoon, followed by uneasiness of the chest and cough. The latter symptom has yielded to ipecacuan and henbane combined; was restless in the night, but slept during the latter part of the morning. Has no complaint of pain, skin cool. Pulse 84, somewhat firm. Bowels opened during the night. Tongue dry in the centre, moist round the edges. Skin moist.
      Continr. pil. hyosciami et ipecacuanhae.
      Capt. marantae arundinaciae pauxillum.

Sept. 12th. The fever continued throughout a great part of yesterday, and towards the evening there was an exacerbation, followed by symptoms of sinking with incoherence. Wine was freely given with decided benefit. Continues in a somnolent state. Countenance pale. Skin cool, rather dry. Pulse 84, small. Tongue brown and parched.
      Continr. vinum pro re natâ.

Sept. 14th. Suffered from an increase of symptoms on the evening of the 12th, and also yesterday evening. On both occasions he was much troubled with spasms of the legs. Rested badly during the night, but had no pain. Moans incessantly. Pulse 90, small, soft. Tongue moist, clean. Slight yellowness of skin. Bowels open.
      Continr. vinum.
      Habt. jusculum gallinae pro re natâ.

Sept. 15th, 16th. Slight febrile accession on the evening of the 15th, and in consequence he slept badly; was quiet during the day on the 16th, with general diaphoresis over the body. Tongue still cleaning. Pulse regular, soft.
      Continr. vinum et jusculum gallinae.

Sept. 17th. Return of fever during the night, and there is still slight headach. Countenance improves. Tongue cleaning. Bowels open. Pulse regular, small.
      Continr. eadem.

Sept. 18th. Improves; but as he is likely to be for some time longer unwell, and consequently unserviceable to the expedition, he was this day discharged to the Soudan for a passage out of the river.
This man improved rapidly when the Soudan left the river, and rejoined the Albert at Fernando Po in October. He was, however, occasionally troubled with intermittent several months afterwards.

Case VII. Iddah, River Niger.

Sept. 7th. Henry Gibson, private Marine, anno aetatis 22, of a slight make, and has sometimes complained of his chest. Was attacked last night with epigastric uneasiness, attended with giddiness and general listlessness. A purgative was then given, which has acted well. Tongue is now white, moist. Pulse 82, regular.
      Quiescat.

Sept. 8th. No complaint. Pulse small. Seems indifferent about everything, and answers questions in monosyllables. Skin moist. Tongue tremulous. Eyes wild. Bowels reported slow.
      Capiat pilulas purgantes ij.
      Abradatur capillitium.

Sept. 10th. Bowels opened by the pills. Continued in the same indifferent state during yesterday, and says he is quite well. Pulse small. Countenance languid.

Sept. 22d. Up to this period he has been considered convalescent. In the morning, however, he had rigors, followed by general fever and headach. Skin hot. Pulse small, frequent. Bowels slow.
℞. Pulv. jalapae, ℈j.
      Potassae super tart. ℈ij. M. ft.
      Pulvis statim sumendus.

Sept. 23d. Improves.
      Habt. jusculum gallin. pro prandio.

Sept. 27th. Fever in a low form, returned in the course of the night; symptoms are now subsiding.
      Continr. jusculum.
      Capiat quinae disulph. gr. viij. bis in die.

Oct. 4th. Has had occasional returns of low febrile action since last report, but the accessions are less intense and shorter than before the exhibition of the quinine. Pulse small. Complains of debility.
      Rept, quinae disulphas etiam jusculum gallinae.

Oct. 5th. Rested badly during the night, having an exacerbation of fever, which has not yet abated. Tongue foul. Bowels regular.
      Admovr. emplast. lyttae nuchae.
      Omittr. quinae disulphas.

Oct. 7th. Blister rose well, and he remained quiet and easy during the whole of yesterday. Headach, however, returned towards the evening. He was restless and occasionally incoherent towards the morning. Tongue foul. Bowels open.
      Capiat pulv. Jacobi veri, gr. iv. Omni secundâ horâ.

Oct. 9th. Diaphoresis, with general abatement of symptoms, followed the exhibition of the James's powder, and yesterday evening there was a decided improvement. Last night, however, he has not slept well. The countenance is anxious; there is no complaint of pain, but muscular tremors are general over the body.
      ℞. C amphorae, ℈j.
      Opii, gr. iij. M. bene et divide in pil. vi. quarum capiat aeger unam omni secundâ horâ.

Oct. 12th. The muscular tremors subsided on the 10th, and he has been again quiet and quite easy, having no complaint but of debility.
      Repr. quinae disulph.

Oct 14th. Has been quite easy, but was occasionally incoherent during the early part of the morning. Bowels have been opened. There are yellowness of skin and great debility. Pulse small, irregular.
      Capt. vinum album pro re natâ.
      Repr. camphora et opium.

Oct. 16th. Incoherence and restlessness continue. Evinces great disinclination to take wine or medicine. Slight febrile blush of countenance. Pulse small. Tongue loaded, moist.
      Admovr. emplastra lyttae pone auris.

Oct. 17th. Blisters rose well. Symptoms improve. Bowels freely opened during the night. Countenance still anxious. Says he is much better; and he is much more coherent. Pulse small, more regular.
      Continr. jusculum et vinum.

Oct. 27th. Gradually getting stronger; although he has had occasional returns of fever, his appetite improves; but the debility is still very great.
      Continr. vinum, jusculum, et quinae disulphas gr. x. bis in die.

Nov. 10th. Has been troubled with intermittent, which prevents his gaining strength. It has assumed the tertian form.
      Continr. quinae disulph. cum gentianae infuso bis in die.

Nov. 30th. Intermittent gradually abating. He continues, however, very weak, and has no inclination to move about. Pulse small.
      Continr. eadem.

Dec. 6th. Has been troubled for some days with a diarrhoea. He looks thin and emaciated.
      Continr. omnia.

Jan. 29th, 1842. Continues weak, and has had two or three dysenteric attacks; he is therefore discharged to the hospital at Ascension.
This young man rallied considerably after he had been in the hospital about six Weeks. Unfortunately symptoms of abdominal dropsy appeared during the month of May, for which he was once tapped. Dysentery supervened early in June, and soon proved fatal. The following is the report of the post-mortem examination, in which I assisted Mr. Robert Fairservis, the surgeon of the hospital:

The exterior of the body presented extreme emaciation. Tension of the abdominal parietes, with distinct fluctuation perceptible on handling.
An incision was made, extending from the chin to the symphysis pubis. Eight pints of straw-coloured fluid escaped on the peritoneal sac being opened. In this fluid large flakes of coagulable lymph were found floating, and bands of the same product were adhering to the inner surface of the membrane itself. Adhesion had taken place at various points.
The stomach contained a quantity of fluid tinged with bile. Mucous tunic softened, livid. Duodenum livid and ulcerated in one point. Brunner’s glands not altered.
Ileum. The lower, foot and a half reddened, tunic soft, small ulcerated patches increasing near the caput caeci. Peyer’s agminated glands enlarged. Mesenteric glands indurated and enlarged.
The colon, particularly the arch, exhibited several ulcerated masses, with rough and elevated edges. This appearance was less marked near the sigmoid flexure, but again increased at the upper part of the rectum.
The liver was shrivelled, hardened, and covered with deposits of lymph, and on slicing it only slight bloody oozing followed. Spleen enlarged, soft. Pancreas small and shrivelled.
Chest. Extensive adhesions between the pulmonary and costal pleurae of both sides. Slight effusion in both sacs of the pleurae. Lungs tubercular. The small masses in the upper part of the right side were passing into the condition of softening. The lower parts of both lobes were hepatized.
Heart was small, flabby. Valves sound. No other unusual appearance in the chest.

Case VIII. On the passage from Iddah to the Confluence of the Niger and Tchadda.

Sept. 8th, 1841. William Merriman, Gunner, anno aetatis 32. Complained yesterday of general coldness and a creeping sensation over the body. Rested indifferently during the night. Bowels have been opened by a gentle dose of medicine. He now has slight headach. Skin moist. Pulse 80, soft.
      Capiat pulv. Jacobi veri, gr. iv. omni secundâ horâ.

Sept. 14th. Diaphoresis, followed by a remission of all the symptoms, followed the exhibition of the James’s powder; and for the last three days he has felt quite well until now; he is restless and uneasy. Complains of thirst. Countenance anxious.
      Capiat quinae sulph. gr. x. bis in die.

Sept. 25th. After having been quite free from fever since the 16th, he experienced a relapse of fever last night. His countenance is languid and heavy, and he is indifferent in his manner, and has no local pain. Pulse 80, soft, regular. Bowels slow.
      ℞. Pulveris jalapae comp. ʒj.
      Calomelanos, gr. vj. M.
      Ft. pulvis statim sumendus.

Sept. 26th. Bowels have been freely opened; stools reported of dark colour. Has a feeling of general soreness, but there is no local pain. Passed an indifferent night. Complains of coldness along the spine. Pulse 80, regular, small. Skin cool.

Sept. 27th. Headach having come on about midday yesterday, a blister was applied to the nape of the neck, which has risen well with relief to pain. A purgative was given, which has acted freely. Pain supervened upon the cold sensation along the spine. The abdominal uneasiness also increased, but gave way to the application of a sinapism. Has a feeling of general exhaustion, but is comparatively easy. Skin moist, cool. Pulse 66, of good volume, regular. Conjunctiva jaundiced. Tongue foul, indented round the edges. Is inclined to sleep.
      Capiat marant. arund. pro re natâ.

Sept. 28th. Was troubled with frightful dreams, and slight return of the headach and spinal pain during the night. Complains of slight pain in the region of the kidneys. Urine copious, high coloured. Conjunctiva yellow. Skin dry. Tongue foul, moist. Pulse 90, full, soft. Bowels slow.
      Capiat olei ricini, ʒvj.
      Continr. maranta arundinacea.

Sept. 29th. Bowels were freely opened by the castor oil. He slept a good deal yesterday, but rested only indifferently during the night. Headach and spinal pain abated. Pulse 80, soft. Tongue foul, moist. Skin and conjunctiva continue yellow. Is very weak. Skin dry.
      ℞. Pulveris Jacobi veri, gr. iij.
      Quinae disulphatis, gr. vj. M. Ft. pulvis sumendus ter in die.
      Habt. jusculum gallinae pro re natâ.
      Hora decima, p. m. Capiat solutionis morphiae muriatis, gtts. xxx. in aquae menthae, ℥j.

Sept. 30th. Gentle diaphoresis and general relief to symptoms produced by the medicine. A calm placid sleep followed the exhibition of the morphia. Skin moderately warm. Pulse 100, small, soft. Tongue still loaded.
      Repr. quinae disulph. &c.

Oct. 1st. In consequence of a return of headach during the night, a blister was applied behind each ear with good effect. To-day is less weak, and a gentle moisture is kept on the surface by the powders. Bowels open. Conjunctiva still yellow. Pulse 80, small. Tongue foul, moist.
      Continr. quina, &c.
      Capiat jusculum gallinae pro prandio.

Oct. 2d. No fever since last report, but did not sleep well, possibly owing to the morphia having been omitted. Debility only complaint. Bowels regular. Tongue cleaning.
      Continr. omnia.

Oct. 3d. Slept well, after having taken a dose of morphia last night. Has taken breakfast with relish. There is a gentle diaphoresis. Has no local pain, but is weak and giddy on attempting to rise. Pulse 80, regular. Tongue cleaning.
      Omittr. pulvis Jacobi veri.
      Capiat quinae disulphatis, gr. viii. bis in die.

Oct. 23d. Continued improving slowly until to-day, when he complains of pain stretching from the right to the left hypochondriac region. Countenance oppressed, yellow. Bowels rather slow.
℞ Calomelanos, gr. iij.
      Opii, gr. 1/6 M. fiat pilula omni secundâ, horâ sumenda.
      Admovr. cucurbitulae cruentae lateri dolenti.

Oct. 24th. Slept well. Slight cough, with expectoration. Pain of sides a good deal relieved by cupping. Bowels open. Urine very copious, high coloured, and depositing much sediment. Tongue furred. Pulse 80, small.
      Repr. calomel et opium.

Oct. 25th. Does not feel so well to-day, having passed a bad night. Complains of pain of both shoulders, and of headach. Odour of the skin is strong and peculiar. Countenance sallow and oppressed. Slight mercurial fetor of mouth.
      Continr. calomel et opium.

Oct. 26th. Became restless, and was occasionally incoherent during last night. Complains of general soreness. The mercury has been discontinued on account of ptyalism having been produced. Bowels rather confined. Tongue covered with a brown fur, and rather dry. Pulse 108, weak. Skin moist.
      Injiciatur statim enema domesticum.

Oct. 27th. The ptyalism is rather profuse, but there is a decided improvement in the symptoms. Complains of weakness. Bowels twice freely opened after the administration of the enema. Tongue foul.

Oct. 28th. Seems better. Has no local pain. Countenance sallow. Conjunctiva also deeply tinged. Mouth still tender, but improves under the use of the alum gargle. Bowels confined. Tongue coated, moist. Pulse 110, weak.
      Repr. enema domesticum.
      Habt. jusculum gallinae pro re natâ.
      Capiat vini albi ℥j. bis in die.

Nov. 4th. Ptyalism disappearing. Has been annoyed by general pain, which attacked him last night about ten p.m. Complains again of a dull pain of the right hypochondrium, stretching upwards between the scapulae. Great depression of spirits. Bowels slow. Tongue furred. Pulse 96, very feeble.
      Rept, enema. Continr. vinum.

Nov. 8th. Bowels were opened after the enema, was given, but considerable exhaustion followed, requiring the exhibition of brandy and water, with camphor and ammonia, which relieved him. He has gained a little strength within the last day or two. Countenance still sallow. Pulse 100, small. Bowels opened this morning by castor oil. Appetite improves.
      Capiat acidi nitrici, gtts. vj. in aquae purae cyatho ter in die.

Nov. 11th. Complains of uneasiness of abdomen, which is distended; but there is no evidence of the presence of a fluid. Bowels slow. Urine copious. Tongue dry, brownish. Has vomited a quantity of bile.
      Reptr. enema domesticum.
      Continr. omnia.

Nov. 22d. Continued to progress very slowly, and as there was little probability of any amelioration as to the state of his health taking place in this climate, he was this day sent on board of the Warree schooner, for a passage to England under the care of Dr. Stanger.
This man ultimately got well, and is now serving as a gunner on board one of Her Majesty's ships.
Had there been an opportunity to send him out of the river after the first relapse, he would not in all probability have experienced any more return of the fever; or, at all events, the type of the relapses would have been less virulent, and would have assumed at an earlier period the form of ague.

Case IX. On passage from Iddah to the Confluence of the Niger and Tchadda.

Sept. 9th. William Moffatt, anno aetatis 27, Sapper; was received from the Amelia tender, with general symptoms of the prevailing fever. He states that he has been overwhelmed by a feeling of general oppression for the last twenty-four hours. Complains now of nausea, and of very slight headach. Had some uneasiness of the abdomen during the night, which has however disappeared. Pulse 100, small. Bowels slow.
      ℞ Calomelanos, ℈j.
      Opii, gr. iij. fiant pil. x. quarum capiat aeger, i. omni tertiâ horâ.

Sept. 10th. Slept well. Bowels not yet opened. Has no complaint of any kind. Pulse 72, regular, soft.
      Continr. pil.
      Capiat magnesiae sulphatis, ʒvj. in aquae, ℥iv.

Sept. 11th. Bowels have been opened during the night, and he slept indifferently. Slight rigors towards the morning. Skin dry, yellow. Pulse 100, small. Tongue loaded. No pain. Vertigo on rising from the pillow.
      Omittr. pil. calomel. et opii.
      Capiat pulv. Jacobi veri, gr. iv. omni secundâ horâ.

Sept. 12th. Has been restless during the night. No complaint of pain. Countenance yellow. Extreme indifference to everything. Pulse 88, of moderate strength. Tongue foul and tremulous. Skin again dry.
      Repr. pulv. Jacobi.
      Capiat jusculum gallinae pro re natâ.

Sept. 13th. Countenance improves. Skin moist, cool. Slept well. Tongue cleaning, still tremulous. Pulse regular, small. Bowels open.
      Omittr. pulvis Jacobi.
      Continr. jusculum gallinae et maranta arundinacea.

Sept. 15th, 16th. Does not sleep well, but makes no complaint. Is extremely indifferent; and evinces a disinclination to take anything. Countenance placid and natural. Skin yellow. Tongue cleaning.
      Continr. omnia. Hora decima.
      P.M. Capiat haust. morphiae muriatis, gtts. xxx. in aquae menthae, ℥j.

On the 18th he was discharged to Soudan. He continued free from pain; but was described by Mr. Loney, the assistant-surgeon of the Dolphin, as in a sinking condition when he was received on board that vessel, at the mouth of the river. He sunk gradually, and expired at sea, on the 26th September.

Case X. At the Confluence of the Niger and Tchadda.

John Langley, First Engineer, anno aetatis 36, of a full habit of body, temperament phlegmatic. Has never been in a warm climate before.

Sept. 20th. Has been unwell for a day or two, having had occasional headaches, and a sensation of cold over the body, with flushings of the face. His tongue is foul and tremulous; thirst urgent. Pulse small, frequent.
      Abradatur capillitium.
      ℞ Calomel, gr. iij.
      Opii, gr. 1/6j. M. Ft. pilula omni secundâ horâ sumendâ.

Sept. 21st. Although he slept indifferently, he feels much relieved this morning; headach and the other disagreeable symptoms having disappeared. Skin moist. Tongue foul, but moist. Pulse 90, soft. Bowels slow.
      Capiat pilulas purgantes duas, et nisi alvus plene soluta fuerit, post horas quatuor magnesiae sulphatis, ℥j.

Sept, 22d. Bowels have been freely opened; and, in consequence, his rest was interrupted. The countenance is more anxious and flushed. Pulse excited. Tongue the same.
      Repr. calomel et opium.

Sept. 24th. Fever remitted, after lasting twelve hours; and ptyalism was produced yesterday afternoon: the mercury was therefore omitted. He did not sleep well last night, by reason of a return of headach, which however was relieved in the morning by a dose of opening medicine. Pulse 80, soft. Conjunctiva yellow. Stools dark. Urine of a high colour. Skin moist. Tongue foul, moist, and indented at the edges.
      Jusculum gallinae pro re natâ.

Sept. 27th, 28th. No return of fever since last report; but he is extremely pale and weak. Pulse and skin natural. Bowels regular. Tongue cleaning. Has a strong desire for a glass of beer.
      Hab. cerevisiae, Hss.

Oct. 2d. Complains of vertigo, with oppression about the forehead and pain of the eyes. Tongue foul. Skin dry. Bowels slow.
      Capiat pilulas purgantes, ij.
      Omittr. cerevisia.

Oct. 3d. Bowels only once opened. Slight accession of fever during the night. Complains of headach. Skin moist. Pulse 80, moderately firm. Tongue moist, cleaning.
      Admovr. emplastrum lyttae pone auris.
      Capiat magnes. sulph. ℥j.

Oct. 5th. Bowels were opened by the salts, and yesterday forenoon was passed in comparative comfort, after the blisters were dressed. The fever, however, returned towards the afternoon, and subsided early this morning. No symptom remains, except a confused feeling of the head, without pain.
      Admovr. emplast. lyttae nuchae.

Oct. 7th. Blister rose well, and the oppressive feeling in the head was thereby removed. Countenance improves. He has no complaint of pain, but sleeps badly. Skin moist. Tongue cleaning.
      Horâ decimâ, p.m., capiat sol. morphiae muriatis, gtts. xxx. in aquae purae, ℥j.

Oct. 9th. He was much excited by an accident that happened yesterday. He, however, passed a good night, after taking a dose of morphia. Urine copious, of a high colour. Tongue cleaning.
      Hab. jusculum gallinae pro prandio, et vini albi, ℥j. bis in die.

Oct. 18th. Continued gradually to improve, but was somewhat excited on leaving the ship this morning. He sleeps indifferently, and the skin is dry. Tongue foul.
      ℞ Calomel, gr. iij.
      Pulv. Jacobi veri, gr. iv. M. ft. pulvis quâque tertiâ horâ sumendus.

Oct. 20th. Diaphoresis general over the body. Complains now only of weakness. Stomach was irritable during the night, but was stayed by the application of a sinapism.

Oct. 24th. Sleeps well, and improves generally. He complains of pain in voiding the urine, which is copious. Appetite good. Tongue cleaning. Bowels slow.
      Magnes. sulph. ℥j.
      Capiat quinae disulphatis, gr. x. bis indies.

Nov. 30th. Throughout the month he has been slowly progressing in convalescence, but has occasional attacks of ague.
      Continr. quina.

Dec. 5th. Discharged to duty.
Mr. Langley was for many months afterwards afflicted with ague, especially during the early age of the moon. He is now first engineer in H.M. S. Thunderbolt.

Case XI. At the Confluence of the Niger and Tchadda.

Sept. 21st. Daniel Carlton, Sapper, anno aetatis 34, well formed, temperament leuco-phlegmatic. Has always up to this period enjoyed good health.

While dressing for divisions yesterday, was seized with pain of head and limbs, and general prostration. He had a purgative, which has acted freely. He slept badly by reason of headach. This morning his countenance is dejected. Tongue foul, moist. Skin moist, hot. Has vomited bile.
      ℞ Calomelanos, gr. iij.
      Quinae disulph. gr. iv. quatĕr in die.

Sept. 22d. Passed a restless night, in consequence of headach, heat of skin, and dyspnoea. At present there are general febrile symptoms, without local pain. Bowels open.
      ℞ Calomelanos, gr. viij.
      Quinae disulph. gr. vj. M. statim sumend.

Sept. 23d. Rested indifferently, not from any particular pain, but from general uneasiness. Headach returned late in the morning. Pulse 80, small, soft. Tongue white, tremulous. Bowels freely opened.
      ℞ Pulveris Jacobi veri, gr. iv.
      Calomelanos, gr. ij. M. ft. pulvis sumend. omni secundâ horâ.
      Capiat morphiae muriatis solutionis, gtts. xxx. H. S.

Sept. 25th. Was quiet and easy during the greater part of yesterday. No return of dyspnoea. Slight fever in the evening. Had a dose of morphia last night, and rested well after it. Tongue cleaning. Skin moist and cool. Pulse 74, regular.
      ℞ Pulv. Jacobi veri, gr. iv.
      Quinae disulphatis, gr. vj. M. ft. pulvis sumend. omni quartâ horâ.

Sept. 26th. Experienced an exacerbation of fever towards last evening, followed by headach, which is however now abating. Bowels slow. Tongue foul, indented at the edges.
      Continr. pulveres.

Sept. 27th. Remission of febrile action followed early in the forenoon of yesterday. Countenance improves. Skin moist, yellow. No complaint but of debility.
      Omittr. pulvis Jacobi veri.
      Continr. quinae disulphas.
      Jusculum gallinae pro prandio.

Sept. 28th. No return of fever since last report. Has had refreshing sleep at intervals. Countenance improves, as also the state of the tongue. Bowels have been opened. Pulse 72, soft and regular. Skin cool and moist. Some scalding in making water.
      Capiat nitratis potassae, ℈j. in aquae cyatho parvulo ter in die.

Oct. 6th. After an absence of a week, the fever again returned slightly yesterday; the paroxysm was however only of slight duration, and to-day all the symptoms have disappeared.
      Omittr. vinum.

Oct. 7th. Headach came on early this morning. Slept badly, and in consequence he feels to-day a good deal exhausted. Pulse very feeble. Tongue loaded. Bowels rather slow.

Oct. 9th. During the whole of yesterday he was free from complaint of any kind, except debility. An accession of fever is just coming on, attended by headach, and considerable heat and dryness of the skin. Bowels slow.
      Capiat calomelanos, gr. viij. et postea infus. sennaE cum magnesiaE sulphate doneC alvus plene respondt.
      Continr. quina.

Oct. 12th. Bowels copiously moved. No return of fever, but complains of want of sleep and great debility. Tongue moist, cleaning.
      Continr. quina.
      Capiat cerevisiae, Hj. in die et H. S. morphiae muriatis solutionis gtts. xxx. in aquas, ℥j.

During the latter part of October and the whole of November, be continued slowly to gain strength, under quinine, wine, and beer, with fresh food. During December he was much troubled with intermittent, which however disappeared towards the beginning of the year 1842.

Case XII. On the passage from the Confluence of the Niger and Tchadda to Egga, in the Nufi Country.

Sept. 23d, 1841. Mr. W.H. W- [William H. Wilmett], Clerk, anno aetatis 19, of a slight form, and nervous temperament. Felt the approach of fever yesterday, denoted by languor, slight headach, occasional chills, and desire to expose himself to the sun. To-day there are heat of skin, eyes suffused, tongue foul, tremulous. Bowels have been freely moved by a laxative given last night.
      ℞ Quinae disulphatis, gr. iv.
      Pulv. Jacobi veri, gr. iij. M. ft. pulvis sumend. quâque tertiâ horâ.
      Abradatur capillitium.
      Emplast. lyttae nuchae.

Sept. 24th. Headach relieved by blister. Skin moist. There is still considerable febrile action. Is restless. Tongue moist. Pulse regular, soft.
      Repr. pulveres.

Sept. 25th. The fever abated about mid-day yesterday, but returned early this morning. He slept at short intervals, and was much disturbed by dreams; awaking in a chilly state. Pulse soft. Bowels slow.
      Repr. pulveres.

Sept. 26th. Bowels opened. Was talking in his sleep. There is considerable heat of skin. Tongue foul. Complains of vertigo and indistinct vision. Pulse small, feeble.
      Applicr. lotio frigida capiti.
      Repr. pulv. Jacobi cum quina.
      H. S. capiat morph. muriatis sol. gtts. xxx. in aquae, ℥j.

Sept. 21th. Slept well during the night. Skin cool, moist. No pain of head, but he is giddy on attempting to rise. Pulse 80, small, soft.
      Repr. morphia.
      Omittr. pulv.

Oct. 3d. Only slight return of febrile action for three days, and for the last forty-eight hours there was a complete intermission. Last night, however, he was suddenly struck, as if by an electric shock, with tremors, followed by vertigo; and he was occasionally talking during sleep. Complains of weakness. Bowels slow.
      Capiat pilulas purgantes, ij.

Oct. 4th. Is quite coherent, and says he slept well during the night. To-day he has only slight headach. Tongue foul. Skin cool. Bowels well opened.
      Repr. pulv. Jacobi et quinae.

Oct. 5th. During the night delirium came on most suddenly: a blister was applied to the nape of the neck, which has risen, and he is now calm and soothed. There is considerable heat of skin, and the pulse is small and frequent.
      Capiat misturae salin. diaph. ℥j. omni horâ donec ciet diaphoresin.

Oct. 7th. Fever considerably abated. Skin moist. Was talking during sleep in the night; but he soon afterwards was quiet, having taken a dose of morphia.
      Continr. mist, salin. ut antea.

Oct. 8th. Delirium returned yesterday afternoon. He persisted in reading aloud, and two nurses were in close attendance upon him. At twelve p. m. he cautiously opened the window of the cabin and jumped overboard. Two of the Africans followed him, and succeeded in saving him, although the current was strong and the night extremely dark. He was well rubbed and enveloped in warm flannels; an opiate was then given, and he fell into a calm and placid sleep. To-day he is somnolent, but is easily aroused.

Oct. 14th. Fever has quite left him, but he is very weak, and still occasionally incoherent. Bowels rather slow. Takes arrow-root and other nourishment.
      Capiat magnesiae sulphatis ℥j.

Oct. 20th. Is still very weak, and is occasionally incoherent; but he answers questions in general in a rational manner. A blister was applied to the head last night, and he has in consequence slight strangury this morning. Bowels open.
      Capiat nitratis potassae, ℈j. bis in die.

Oct. 23d. Return of delirium; no fever. Blister reapplied to the nape of the neck. He is now quite cool and calm. Bowels regular, pulse small.
      ℞ Camphorae, gr. iij.
      Opii, gr. ss. sumend. ter in die.

Oct. 26th. Half a grain of the muriate of morphia has been given nightly, with a good effect. To-day he is restless and sometimes incoherent. Bowels open; tongue clean. Pulse 100, small and weak.
      ℞ Infus. gentian, comp. Hj.
      Quinae disulphatis, ℈ij. M. Sumat cochleare magnum ter in die.
      Capiat vinum et jusculum gallinae pro re natâ.

Nov. 4th. Up to this period he continued quiet, but his strength gradually diminished. At 4 p.m. yesterday, his respirations were hurried, but neither percussion nor pressure on any part of the chest produced pain. In short, he declared himself quite easy, and that he only suffered from what he styled a "general botheration." During his mental aberrations he has always spoken of some previous misfortunes or unheard of disease. Bowels have been opened by a dose of castor oil. Tongue furred. Pulse frequent, small. Appetite indifferent for the last two days.

Nov. 5th. 3 a.m. On Mr. Thomson being called up this morning he found him labouring under difficult and short breathing. But he made no complaint except of pain from blister sores. Pulse weak.
3.30 p.m. Gradually sunk, and expired at this hour.

CASE XIII. On the passage from the Confluence of the Niger and Tchadda to Egga.

John M'Clintock, Stoker, anno aetatis 23. Complexion fair, temperament leucophlegmatic. Is well formed, and has in general enjoyed good health; has never before been in tropical climates.

Was yesterday affected with the usual symptoms of the prevailing fever, which he says remitted towards the evening, but have returned this morning with severity. He has now headach and pain of back; tongue foul, indented at the edges. Has vomited a quantity of bile. Bowels slow. Eyes suffused; heat of skin with dyspnoea.
      Totum corpus aquâ tepidâ cum aceto abluatur.
      ℞ Calomelanos, ℈j.
      Opii, gr. iv. M. que divide in pilulas decem, quarum capiat aeger unam quâque secundâ horâ.

Sept. 25th. Passed a good night. To-day there is a decided remission of the symptoms. Skin cool. Pulse regular. Tongue loaded. Bowels freely opened. No complaint, except of the back, which is weak in the lumbar region.
      Affricr. spina ung. antim. tart.
      Hab. marantae arundinaceae pro re natâ pauxillum.

Sept. 26th. Return of febrile action yesterday forenoon, which remitted towards the evening. Was troubled with vomiting during the day. Slept badly from general uneasiness. Has no headach, but is giddy on attempting to rise. Countenance anxious; tongue furred in the centre, moist round the edges. Is thirsty. There is slight mercurial fetor of mouth. Pulse 88. Skin cool. Bowels have been freely opened.
      Capiat pulv. Jacobi veri, gr. iv. omni secundâ horâ.
      Capiat nitratis potassae, ℈ss. ter in die.

Sept. 27th. There was no remission of symptoms until yesterday at noon. Pulse 76, of good volume, and regular. Slept well during the night. Has no complaint of pain, and the vomiting has ceased. Skin cool and moist; tongue cleaning. Bowels opened this morning.
      Affric. spina in toto cursu ung. antim. tart.
      Abradatur capillitium.

Sept. 28th. Return of rigors yesterday at 4 P.M., the effects of which continued until early in the morning. Slept at intervals; was slightly incoherent during the night. Pulse 90. Skin clammy. Bowels opened this morning. Tongue cleaner. Vomiting has returned.
      ℞ Pulv. Jacobi veri, gr. iv.
      Quinae disulph. gr. vj, M. ft. pulvis sumendus ter in die.

Sept. 29th. Was troubled a good deal with nausea and retching yesterday. To-day he has no complaint, but feels languid and weak. Countenance however improves. Bowels slow. Skin moist, clammy. Pulse 72, soft and regular. Tongue loaded in the centre; moist.
      Capiat olei ricini, ʓ vj.
      In aquae menthae, ℥ j.
      Continr. pulveres quinae.

Sept. 30th. Experienced an accession of fever last night of short duration. Had a dose of the muriate of morphia at 10 P.M., which produced sleep. Has no pain except from the eruption along the spine, caused by the ointment of tartarized antimony. Is giddy on attempting to rise. Countenance still oppressed. Conjunctiva yellow. Profuse diaphoresis. Bowels opened last night. Tongue clean but rather dry. Pulse 78, soft and of uniform strength.
      Continr. pulv. quinae, &c.
      Hab. marant. arund. pro re natâ.

Oct. 1st. Had no fever yesterday, but he was restless during the night. No complaint of pain; feels weak. Pulse 70, regular. Tongue foul, moist. Skin clammy. Bowels slow.
      Capiat pilulas purgantes, ij.
      Repr. maranta arundinacea.
      Omittr. pulveres quinae.

Oct. 6th. General improvement, although he still continues very weak, and takes only a little nourishment.

Oct. 7th. Was suddenly seized last night with a fit of vomiting, which exhausted him much. The feet and hands became quite cold, and the pulse was scarcely perceptible at the wrist or temples. Warm applications were put to the feet. Brandy with hot water was given, and he rallied in the course of the night. To-day there is slight fever.
      Repr. pulveres quinae.

Oct. 18th. Is still very weak, but is upon the whole improving, and takes nourishment with relish. Functions of bowels and bladder regular. Urine very copious.
      Continr. pulveres.

Oct. 24th. Complains much of debility. Has no local pain. Skin cool and moist. Fainted this morning on attempting to rise from his hammock. Bowels open. Tongue clean. Pulse 80, moderate.
      Capiat cerevisiae, Hj. in die.
      Continr. maranta arundinacea et jusculum gallinae.
      Capiat quinae disulph. gr. x. bis in die.

Oct. 30th. Gets strength daily.
Continr. omnia.

Nov. 20th. Was advancing rapidly in convalescence, having been in the habit of taking a short daily walk; on the 18th he was sent on board of the ship from the hospital at Fernando Po, and on the evening of the 19th I was horrified to hear that he had met with his death in a scuffle.

CASE XIV. On the passage from the Confluence to Egga.

George Syme, Quarter-master, anno aetatis 40, of a stout make; sanguineo-bilious temperament. Has been some years on the coast of Africa, and has suffered there from fever.

Sept. 25th. First felt the approach of fever yesterday after a heavy shower of rain. To-day he has heat of skin, foul tongue, headach, and a sensation of cold along the spine. Pulse small, hard. Bowels slow.
Capiat magnesiae sulphatis, ʓ vj, repetendas si opus sit.

Sept. 26th. Febrile accession yesterday of only short duration. Complains of slight epigastric pains. Tongue loaded in the centre, moist round the edges. Is restless.
      ℞ Tinct. opii, gtts. xxx.
      Spts. aetheris nitrosi, ʓss.
      Aquae menthae, ℥j. M. ft. haustus statim sumendus.

Sept. 27th. Did not sleep in consequence of an accession of fever, which lasted until the morning. Complains of headach and a sense of heaviness about the stomach. Skin dry. Pulse 96, soft and regular. Tongue loaded in the centre, moist, and indented at the edges. Bowels slow.
      Applicr. sinapisma epigastrio; postea capiat pilulas purgantes, ij.

Sept. 28th. Slept well during the night, and has had no return of fever since last report. Has no complaint but of debility. Gentle diaphoresis. Bowels freely opened. Pulse 74, soft and regular.
      Sumat jusculum gallinae pro re natâ.
      Capiat quinae disulphatis, gr, viij. bis in die.

Sept. 29th. Was disturbed during the night by one of the patients near him, therefore he did not sleep well. Countenance improves. Has no complaint of pain, but he is weak and giddy on attempting to rise. Tongue cleaning. Pulse 72.
      Continr. jusculum.
      Rept. quina.

Sept. 30th. Experienced a return of fever yesterday early in the afternoon, which lasted only three hours. Slept well; no complaint. Pulse 80, soft, of good volume. Skin cool. Bowels open.
      ℞ Pulv. Jacobi veri, gr. iv.
      Calomelanos, gr. iij. M. ft. pulvis statim sumendus.

Oct. 1st. Fever returned last night, and lasted until the mornrng with considerable severity. To-day he has no complaint. Pulse regular. Skin cool.
      Reptr. quinae disulphas.

Oct. 2d. Was suddenly seized yesterday with general tremors followed by great depression. He is still low, and the surface of the body, particularly towards the extremities, became cold. The natural heat was restored by friction and hot applications, and the administration of internal stimulants. The pulse is now gradually rising. Has beeft troubled with diarrhoea.
      Reptr. marant. arund. cum vino.

11 A.M. The feet and hands have now become of a livid colour, which is extending upwards. No complaint but of diarrhoea. Pulse small, feeble. Countenance cadaverous.
      Contr. vinum, &c.

4 P.M. Continued sinking, the lividity continuing to extend until this hour, when he expired; declaring to the last that he felt well.

Sectio Cadaveris.

The examination of the body was conducted by Dr. Stanger and myself. As we were at Egga, and afraid of offending the prejudices of the people, the operation was gone through rather hurriedly.

The exterior presented no unusual appearance, except of lividity over the extremities and part of the chest.

The thorax was opened in the usual manner. There were considerable old adhesions between the pulmonary and costal pleurae of both sides. Portions of the depending parts of the right lobes were indurated.

Abdomen. There was a biliary tinge over the peritoneum and the surface of the intestinal canal. Liver gray-coloured, of the usual size, anemious. Gall-bladder filled with bile, of the colour and consistence of tar. Mucous lining of the stomach softened and abraded; livid patches surrounding the pyloric orifice; some of inferior size were dispersed over the great curvature. The duodenum exhibited the same lesion and one ulcerated point. Ileum presented a livid dark appearance, about a foot in extent of its lower end. Several small bloody coagula under the mucous tissue near the caecum. Some livid marks, with slight abrasion of surface, were also seen in the colon. Spleen was large, soft, gorged with blood. Kidney rather larger than usual, otherwise healthy.

Case XV. At Fernando Po.

Dr. T- V- [Theodor Vogel], anno aetatis 36; a native of Germany, nervoso-bilious temperament. Left the river in the Wilberforce, labouring under the prevailing fever, and has been at Fernando Po ever since; and, although he has occasionally walked out, he has been in a state of considerable debility.

Nov. 30th, 1841. Complained to Mr. Thomson this morning of dysenteric symptoms, with which he said he had been troubled for a day or two previously. He has frequent desire to go to stool, with pain and heat at the rectum. Stools scanty and of a beefy water colour, with small portions of scybala. Experiences pain along the colon, immediately before and after evacuation. Tongue covered with a brownish fur, edges red.
      ℞ Olei ricini, ʓiv.
      Tinct. opii, gtts. xxv.
      Aquae menthae pip. ℥j. M. ft. haustus stat. sumend.

Dec. 1st. Was somewhat easier after the action of the castor oil; but there is still great irritability of bowels. Stools frequent; less tenesmus. Pulse small, feeble.
      ℞ Calomelanos, gr. iss.
      Pulv. ipecac, gr. ij.
      Opii, gr. 1/3. M. ft. hujusmodi pilulas duodecim, quarum sumat aeger j. ter quaterve in die.

Dec. 2d. No alteration.
      Continr. Pil.

Dec. 5th. The disease advancing and the stools becoming bloody; half a grain of the acetate of lead was added to each of the pills; still experiences uneasiness along the colon, before and after the stools; the pain, however, is not increased by pressure. Pulse small, feeble.
      Repr. pilulae.

Dec. 7th. Bowels were opened only four times yesterday; motions scanty, and not bloody. Skin hot and feverish. Tongue coated, margin red. Pulse 90, full.
      Continr. pilulae sine plumbi acetate.

Dec. 8th. Frequent attempts at stool, attended with much pain and tenesmus. Strains much. Pulse small.
      Capiat olei ricini, ʒvj.

Dec. 10th. Bloody stools returned yesterday; and the acetate of lead was again added to the pills, with the effect of restraining the hemorrhage. Is very feeble.
      Reptr. pil. pro re natâ
      Capiat marant. arund. cum vino pro re natâ.

Dec. 11th to 14th. Stools less frequent, but still very bloody. Extreme weakness. Emaciation of features, and the voice is feeble.
      Omittr. pil.
      Injicr. enema emolliens cum opii tinct.

Dec. 15th, 16th. Stools frequent, scanty, bloody. Extremities have been getting cold for the last twenty-four hours. Warm applications have been had recourse to without effect.
      Continr. marant. arund. cum vino.

Dec. 17th. Gradual sinking during the night: faeces passed involuntarily. At 11.35. a.m. expired.

Sectio Cadaveris.

The exterior presented general emaciation, and shrinking of the muscular system.

Thorax. On raising the sternum and opening the left pleural sac, a pint of straw-coloured serum was found. On slicing the lungs tubercles were seen, some in the stage of induration, and others had so far advanced as to form a degree of softening around them. None had coalesced. Lower margins of the lobes indurated.

Stomach. Lining membrane soft, with patches of chronic inflammatory action. The same pathological appearances in the duodenum. The lower end of the ileum, throughout an extent of twelve inches, was in a state of complete ulceration. Peyer’s elliptical patches were enlarged, elevated in the edges, and ulcerated. The colon exhibited a mass of ulcerations, with elevated edges; which, in some points, had penetrated to the peritoneal coat. Nothing unusual was observed in any of the other viscera.

Case XVI. On passage from Confluence to Egga.

Sept. 22d. Mr. W. H-, Mate, anno aetatis 28, form slight, temperament phlegmatic, was received yesterday from the Amelia tender, with the general symptoms of fever. He complained of vertigo, restlessness, heat of skin, and general uneasiness, with great debility. Pulse 80, soft. Tongue foul. Bowels had been opened during the day. A dose of quinine and James’s powder was given, which produced diaphoresis and general relief.
      Capiat jusculum gallinae pro re natâ.
      Repr. pulveres quinae et Jacobi ter in die.
      H.S. capiat morphiae muriatis sol. gtts. ℥x. in aquae menthae pip. ℥j.

Sept. 23d. Slept well. No return of headach. Took some breakfast this morning with relish. Pulse 80, soft, small. Debility only complaint.
      Continr. pulveres quinae, &c.
      Reptr. jusculum gallinae.

Oct 1st. The debility has continued. During the night he has had shivering, and complains this morning of headach. Is so weak that he cannot turn himself in bed.
      Reptr. pulv. quinae et Jacobi.

Oct. 2d. Perspired freely. Fever has remitted, leaving him in a state of extreme weakness. Has a desire for drink. Tongue loaded, rather dry. Bowels open.
      Continr. eadem.

Oct 3d to 8th. Is quite easy, but the debility is very great. The skin is abraded over the sacrum. Bowels rather slow.
      Capiat olei ricini, ℥iv. in aquae menthae, ℥ss.
      Continr. quina et nutrimenta.

To Oct. 21st. Gets strength very slowly, notwithstanding he has a most nourishing diet, with wine and beer. Sore on the sacrum in a sloughing state.
      Reptr. nutrimenta et quinae disulphas.

To Oct. 30th. Improves slowly. Slight heat of skin and flushing of face yesterday after dinner, which continued until the evening. Sore on the sacrum looks healthy. Tongue foul. Pulse 92, feeble.
      Capt. infus. gentian. ℥j. bis in die.

Nov. 20th. Gradual improvement, although he experiences occasional flushings over the body, which however do not in any material degree interrupt his progress in convalescence.

Dec. 20th. Discharged to duty.


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