Mr. Lempriere assigns, as the general cause of febrile epidemics in Jamaica, the action of heat on moisture;' and he points out the following as the most noxious sources of exhalations, on the plains and sea-coast:

1. The action of a powerful sun on lagoons, or extensive pieces of stagnant water; affording growth to vegetable productions, and from which constant, moist, and unhealthy exhalations arise.

2. The exhalations of swampy ground, or earth which is con stantly moist, without being covered with water.

3. The exhalations of muddy banks of rivers, which have been overflowed in consequence of the heavy rains, and afterwards exposed to the action of the sun.

4. The exhalations of flat land, near the influx of rivers to the sea, produced by occasional inundations, and the washing up of dead vegetable matter.

5. The exhalations of flat land of a quality to retain moisture, for a considerable time after the falling of the rains.

6. Another cause may be attributed to large tracts of land being covered with brush-wood, particularly in the Savannas; which from retaining moisture long, from the dead vegetable matter concealed in these small woods, and from their obstructed air, produce exhalations, which give rise to disease in a bad form, particularly when they are first cleared, and the ground is more directly exposed to the action of the sun.'

The first part of the work treats of the diseases which are endemic in Jamaica; it contains a great variety of information, and may be read with much advantage by persons who are in terested in the local circumstances of the island. To readers in general, it will be less acceptable; and we shall therefore pass on to the second part; only remarking that the author's account of the situation and healthiness of the military posts seems to 'merit the attention of government,

Mr. L. considers the yellow fever, which he calls the tropical continued fever, as an epidemic disease long-known in the island, and not contagious. We must submit, in our opinions on this subject, to the decision of authority: but we think that Mr. L. has not stated the origin of contagion quite correctly he supposes it to originate in the effluvia of animal matter, in a state of putrefaction: but he does not say whether he means this of dead or of living animal matter. Febrile contagion appears to arise from the confined effluvia of living persons. Whether that state of the constitution, which produces such effluvia, should be denominated putrid, is a different question. Mr. Le observes that typhus very rarely occurs among the inhabitants of Jamaica, though the Negroes live in close and filthy apartments:-but we apprehend that the white people are exempted from such causes of typhus; and we know that the Negroes

are

are less liable to the action of contagion than whites, from the history of the Philadelphia fever.-There is more weight in his observation that the tropical fever has been chiefly confined to newly-arrived Europeans.-We shall add his principal reasons for denying that this epidemic was infectious.

Negroes are seldom attacked by fever in this form, unless they had visited Europe, and had newly arrived; yet they are equally subject with the white inhabitants to the endemic remittent of the country. White natives of the West Indies, with the same exception, are equally exempted from its attack; as also are Europeans who have resided some time in a tropical climate, and who have experienced one or two attacks of the common remittent. These circumstances deny it to possess the infectious influence of a contagious fever; and as a further proof, I may adduce, that in no instance under my observation, did any attendant upon the sick labouring under this disease, take this fever, except persons under particular circumstances of constitution, to be hereafter noticed; though many of them remained in the sick rooms, until after the patients' death. In no instance were the nurses of colour affected by it; and in the few instances where orderly men attending on persons ill of this disease were seized with fever, it never failed to put on the remittent form, which certainly in many cases owned a bad type, and sometimes proved mortal; but which prevailed a distinct yet cotemporary disease with the continued endemic; affecting not only Europeans of long residence, but even the natives themselves with uncommon malignity; any other debilitating causes, as well as the fatigue and want of rest arising from attending the sick, would have excited the same fever; which must prevail on occasion among the attendants of the sick in common with others.'

Mr. L. accounts for the great prevalence and fatality of this fever, in late years, from a state of the atmosphere particularly favourable to its progress.

The disease among the sailors, which occurred about the same time, was totally different, according to our author: it was the typhus, generated during the voyage, by the number of troops crowded on board the transports; and communicated, by the usual mode of infection, to ships which had previously arrived in port. Mr. L. says that this fever was not communicated to the inhabitants of the coast-towns:

Therefore it appears that there were two distinct fevers at Jamaica, which proved very fatal to newly-arrived Europeans-The one, extending its influence to those who had resided a year or more in the country, without having experienced any sickness, or much relaxation from the climate; but acting with more force on persons

<* This remark, which previously has been made by Dr. Jackson, when treating on the fevers of Jamaica, has been fully confirmed by my own experience during the present war.'

of

of full habits, who lately had arrived from Europe, especially those between the age of sixteen and forty; on men more than women; and on those even more than on children, or on persons who had passed their fiftieth year, and to which Europeans have ever been subject on their first arrival in the West Indies. This disease arises from the action of very powerful marsh miasma on constitutions not assimilated to the climate; which, aided by the predisposing causes of the intense heat that prevails during the hot months most productive of this form of fever, by intemperance, and by exposure to the sun these circumstances combined, produce the tropical con

tinued fever.'—

The other, was the common typhus fever *, produced by causes existing in the ships, or derived by them from places where it already existed; having invariably shewn itself before the vessels arrived at a tropical port, where it then in some degree changed its form, and acquired some of the symptoms of the tropical endemic, gradually losing its contagious property; the force of which seemed to be diminished by the climate, as its influence did not extend, but in very few instances, beyond the original source of the disease; and in no instance did it extend to situations out of the direct and constant line of communication with the shipping: except in that of the Irish brigade, who probably carried the fomites in their clothing; to destroy which, or stop the progress of the disease in any way, but very inadequate means had been adopted.'

Mr. L. imputes the unusual prevalence of the yellow fever, in 1793, and the succeeding years, to the action of a very hot season, after uncommonly heavy rains, on the constitutions of a great number of Europeans, newly landed on the island, in consequence of the war. We shall state his view of this. interesting subject, in the words of his conclusion:

It appears from what has been said, that previous to the general appearance of the continued fever in Jamaica, a morbid state of the atmosphere had been induced, by the profusion of rain which fell in the May season of 1793, followed by an intense and oppressive heat; and that a change of weather during the subsequent cooler months, checked the progress of this fatal disease, which again returned after the following spring, with new vigour; and although in the spring season of 1794, there did not appear any thing extraordinary, such as might be expected to influence the diseases of the following season, yet from the type which the endemic remittent put on among the residents, and from its general prevalency, there did not remain a doubt of the continuance of that morbid state of the atmosphere, which had given rise to the continued form of the endemic among newly arrived Europeans.

It also has appeared that the unusual mortality which visited the island of Jamaica of late years, is to be attributed, in a very great

Denominated Ship, Jail, and Hospital Fever, by authors, according to the local circumstances attending its generation.'

REV. SEPT. 1799.

degree, to the many strangers who arrived in the island together, and at improper periods of the year; to the long passages and delays of convoys bringing troops from unhealthy situations in Europe; and more particularly to the diseases generated among the troops and seamen, on their passage to Jamaica, arising from the defect of proper arrangements on their passage, and continuing with much mortality for a short space of time after their arrival.'

We shall extract the whole description of the symptoms of the yellow fever, as it is the best that we have yet seen; though its length will constrain us to abridge our account of the remaining contents of the work:

The first attack of the continued fever is most frequently sudden and in the morning, and when the person considers himself in a high state of health, being usually robust and plethoric, and but lately arrived from Europe; sometimes a slight rigor precedes the attack, but more frequently it is absent; and the febrile symptoms usher in the disease with more, violence than they put on at any future period: the head becomes affected with a most acute intense pain which extends over the forehead, and through the optic nerves, conveying the idea of the upper part of the head being tightly girded with a cord, which, from the severity of pain, sometimes obliges the patient to scream aloud; a pain nearly as acute, occupies the lumbar region, and extends downwards to the thighs, accompanied by great anxiety and restlessness, and with a peculiar appearance in the countenance rot admitting of description; the frequent action of the eyelids upon exposing the eyes to a common day light, demonstrates an aversion to light, equal to that which prevails in violent ophthalmia, but without pain or inflammation: the pulse is marked by an increased action, in which might be observed a small degree of irregularity, each alternate stroke conveying the sensation of fullness and collapsion; an obstinate costiveness generally attends these symptoms.

Profuse but partial sweats sometimes occur about twelve hours after the first attack, and a slight abatement of some symptoms may be observed; yet they seldom afford much relief, or amount in the least degree to a remission, the affection of the head generally continuing nearly with equal violence; at this time either a total solution of the disease takes place, or the febrile symptoms go off and give place to others of a more serious kind, or continue with little variation for twenty-four, or thirty-six hours longer, when in general they totally disappear, and are followed by others of a more alarming

nature.

These symptoms, which usually follow the febrile state of the disease, may be said to constitute its second stage, and are of such kind that nothing but a previous knowledge of this fever, so as to enable the practitioner to discriminate the disease before this period, could persuade him to believe his patient yet in danger.

In thirty-six, but more frequently in forty-eight hours after the first attack, the febrile symptoms having totally disappeared, all the pains usually go off also, the skin becomes cool though not open,

the pulse assumes a character not more frequent than natural, but still retaining a something, which to an intelligent observer, from experience, denotes danger; the thirst has abated, the tongue becomes moist, and the patient imagines himself so much better as to have lost all former apprehensions, and now considers himself in a state of convalescence.

In this state, bark has been administered in substance by those unacquainted with the disease, and in some instances several doses have been retained, though more frequently but small doses of the decoction can remain on the stomach.

The patient will now sometimes call for nourishment, and take small portions of chicken broth, or sago, or other light articles, without vomiting. In this deceitful interval of disease, symptoms arise which to those familiar with this fever denote the greatest danger.

The pulse, though not more frequent and sometimes less so than in a natural state, yet betrays a peculiar vibrating action, with alter nate fullners and collapsion, having also some irregularity in the strokes, which however does not amount to an intermission : the skin, though cool, yet possesses a husky dryness on it, which conveys a disagreeable sensation when touched; and the countenance bears an unmeaning kind of smile, with a frequent sarcastic grin: the eyes appear suffused with a mixed red and yellow, and look despondent; and a fullness becomes observable about the face, parotid glands, and neck; and upon careful examination, a slight yellow suffusion, blended with a red blush, will now be found to have commenced immediately under the ears, as yet covering but a small portion of the face and neck, while the whole surface of the body exhibits an appearance as if recovering from Mosquitto bites, which however is soon succeeded by a general yellow suffusion. During this fallacious stage of the disease, though there be not any marked injury of the intellectual faculty, yet there is a hurry or anxiety (without apparent uneasiness) in every thing the patient says or does; he seems particularly happy in conversing with his friends, but his answers in conversation are given as if in haste, and his medicine and his nourishment are taken in the same hurried kind of way.

In the course of twelve or fourteen hours from the cessation of the febrile symptoms, a slight vomiting comes on, but sometimes so small in quantity as not to be considered equal to what had been received into the stomach; but which may be distinguished from a return of the aliment by its consisting of a clear, watery, but ropy fluid at this time the patient becomes restless, sighs frequently with laborious respiration, and complains of a gnawing uneasiness at the stomach, similar to cardialgia. Notwithstanding this, he continues to consider himself better; but every succeeding hour increases these symptoms, and the vomiting becomes large and frequent; that which is now thrown up is more ropy than hitherto, and when suffered to subside, leaves a brown dirty matter on the bottom of the vessel in which it had been received; the uneasiness, or rather pain of the stomach increases, and is relieved only by a severe fit of vomiting; the restlessness amounts to a degree of unmanageableness that renders it difficult to keep the patient in bed, though unat

D 2

tended