We observed here, for the first time, three remarkable circumstances shewing the increase of heat. I had carried with me several steel plates for making screws of different sizes. The heat had so swelled the pin, or male screw, that it was cut nearly one-third through by the edge of the female. The sealing-wax, of which we had procured a fresh parcel from the India ships, was fully more fluid, while lying in our boxes, than tar. The third was the colour of the spirit in the thermometer, which was quite discharged, and sticking in masses at unequal heights, while the liquor was clear like spring-water.
Masuah is very unwholesome, as, indeed, is the whole coast of the Red Sea from Suez to Babelmandeb, but more especially between the tropics. Violent fevers, called there nedad, make the principal figure in this fatal list, and generally terminate the third day in death. If the patient survives till the fifth day, he very often recovers by drinking water only, and throwing a quantity of cold water upon him, even in his bed, where he is permitted to lie without attempting to make him dry, or change his bed, till another deluge adds to the first.
There is no remedy so sovereign here as the bark; but it must be given in very different times and manners from those pursued in Europe. Were a physician to take time to prepare his patient for the bark, by first giving him purgatives, he would be dead of the fever before his preparation was completed. Immediately when a nausea or aversion to eat, frequent fits of yawning, straitness about the eyes, and an unusual, but not painful sensation along the spine, comes on, no time is then to be lost; small doses of the bark must be frequently repeated, and perfect abstinence observed, unless from copious draughts of cold water.
I never dared to venture, or seldom, upon the deluge of water, but am convinced it is frequently of great use. The second or third dose of the bark, if any quantity is swallowed, never fails to purge; and, if this evacuation is copious, the patient rarely dies, but, on the contrary, his recovery is generally rapid. Moderate purging, then, is for the most part to be adopted; and rice is a much better food than fruit.
I know that all this is heterodox in Europe, and contrary to the practice, because it is contrary to system. For my own part, I am content to write faithfully what I carefully observed, leaving every body afterwards to follow their own way at their peril.
Bark, I have been told by Spaniards who have been in South America, purges always when taken in their fevers. A different climate, different regimen, and different habit of body or exercise, may surely so far alter the operation of a drug as to make it have a different effect in Africa from what it has in Europe. Be that as it may, still I say bark is a purgative when it is successful in this fever; but bleeding, at no stage of this distemper, is of any service; and, indeed, if attempted the second day, the lancet is seldom followed by blood. Ipecacuanha both fatigues the patient and heightens the fever, and so conducts the patient more speedily to his end. Black spots are frequently found on the breast and belly of the dead person. The belly swells, and the stench becomes insufferable in three hours after death, if the person dies in the day, or if the weather is warm.
The next common disease in the low country of Arabia, the intermediate island of Masuah, and all Abyssinia, (for the diseases are exactly similar in all this tract) is the Tertian fever, which is in nothing different from our Tertian, and is successfully treated here in the same manner as in Europe. As no species of this disease (at least that I have seen) menaces the patient with death, especially in the beginning of the disorder, some time may be allowed for preparation to those who doubt the effect of the bark in the country. But still I apprehend the safest way is to give small doses from the beginning, on the first intermission, or even remission, though this should be somewhat obscure and uncertain. To speak plainly; when the stomach nauseates, the head akes, yawning becomes frequent, and not an excessive pain in the nape of the neck, when a shivering which goes quickly off, a coldness down the spine, a more than ordinary cowardliness and inactivity prevails, (the heat of the climate gives one always enough of these last sensations); I say, when any number of these symptoms unite, have recourse to the powder of bark infused in water; shut your mouth against every sort of food; and, at the crisis, your disease will immediately decide its name among the class of fevers.
All fevers end in intermittents; and if these intermittents continue long, and the first evacuations by the bark have not been copious and constant, these fevers generally end in dysenteries, which are always tedious and very frequently prove mortal. Bark in small quantities, ipecacuanha, too, in very small quantities so as not to vomit, water, and fruit not over ripe, have been found the most successful remedies.
As for the other species of dysentery, which begins with a constant diarrhœa, when the guts at last are excoriated, and the mucus voided by the stools, this disease is rarely cured if it begins with the rainy season. But if, on the contrary, it happen either in the sunny six months, or the end of the rainy ones immediately next to them, small doses of ipecacuanha either carry it off, or it changes into an intermitting fever, which yields afterwards to the bark. And it always has seemed to me that there is a great affinity between the fevers and dysenteries in these countries, the one ending in the other almost perpetually.
The next disease, which we may say is endemial in the countries before mentioned, is called hanzeer, the hogs or the swine, and is a swelling of the glands of the throat, and under the arms. This the ignorant inhabitants endeavour to bring to a suppuration, but in vain; they then open them in several places; a sore and running follows, and a disease very much resembling what is called in Europe the Evil.