On the diseases which prevailed among the British troops at Rangoon

ON THD DISDASDS lvH¡Otf PREVAILED AMONG TIIE BRITISH TROOPS AT RANGOON. Bv G. W/\DDELL, M. D. Presented Jaly l,1826. .æ ON my return from the,Burman.empire, where I had been present with the army during the whole of the late war, I inter¡ded, so far as nry experience anrJ information would enable me, to have laid before the Society a general account of the diseases ryhich prevailed amo.ngstthe British troopsin the first and second campaigns; but having found the materials would exceed the limits of an €ssay designed for the reading and cliscussion of an evening, I shall confine rnyself, in the following pages, (after premising a few remarks on the ¡nedical topography of the town and its vicinity,) to the consideration of the health of tbe troops during the first twelve or fourteen months after tl¡eir occupation of Rangoon, and to the more pa.rticular descri¡rtion of the tliseases rvhich occurred in tbe ' Lospitals c¡f ¡r detachment of Buropean aud native artillery untler my inrmediate charge. ON THE DISEASUS OF RANGOON. 24I The geographical position of R.angoon is laid elorvn in Lat. L(Y 47'N. Long. 96e 9' B. The town, or fort, stantls on the north L¡ank of o river of the same name, ¿rbout 26 rniles above rvhere itf¿llsinto the Gulf of Martaban. In length it extends along the liver uprvards of a mile: its breadth is 600 or ?O0 yards; and it is eucornpassed rvith teak-rvood tinrl¡ers and planks 10 err L2 feet high' baving one gatervay on the soutl¡ern, eastern, and l'estern face, and trvo on the nortlrern front. The north sitle of the stockade is strengthenerl rvjth a l.rroad, l¡ut norv sl¡allorv fosse, over rvhich tl¡ere is an e¿rrthen mountl and a wooden bridge. From each northern gatewây a goocl bliclc rootl lsads along a gentle, lrr.rt irregular rising grorrnd ; ancl these gradually eonverging toget.het', terminate aú different points, at the temace of'the Shoe-tlagonpagotla, 2f, miles to tbe north of the to¡vn. The space intervening bets'een these roads being pretty clear of rvood ancl jungle, ryas selected for tlre quarterirrg of the troops. l'he houses and pagodas trpon the'eastern ¡'oad rvere allotted for tlre accommodation of the Bengal lloo¡ls, anrl those on the ryestern road $ere consigned to the i\ladras division of the ä,rffiJr rr,hile tlre artil.lery ¡rar'ks of both pre. sidencies rvcre formerl on ôn open plain in the centre. 1'he ground sloped considerably towards tbe rve.steln side of tlris tliangle, anr.l the i\'ladras lincs leaned on a thick wood, rvhich extended to, and closed in u¡ron tbe nortlr and north-east of the Great Pagoda; but on the eitstern side, particir: LL 242 oN THD DrsEAsEs oF RA,NcooN. larly as it approaches the l)agon Pagoda, the land springs rvith almost precipitous abruptness from the adjacentlevel; and when at an elevation ofnearly 200 feet above the surface of the river, the vierv stretches, in a S.Iì. direction, to a great distance over lorv rice ground, in rvhich the rvindings of the Rangoon and Syriam rivers can be seen for several miles. During the rvhole of the war,this part of the country rvas left uncultivated; and in the rainy seasons, constiúuted an extensive morass, coveredwith rank grass ancl broad-leaved rvater plants. lVithin the parallelogram formed by the stockade, the houses are disposed in regular order, and the streets, for the rnost part, cross each other at right angle.s. l'he streets, in general of srnall rvidtlr, are forrned of pounded bricks, rvith a rise in the rniddle, so as to throrv off the r:rin into rvatercoulses olì either side. On the arrival ol' the expedition, and during the first rain,v season, they rvere mnch out of contlition, and extretr¡ely dirty; l-¡ut rveresubsequently put into goorl repair by the military Cr.¡nrmandant of tl¡e torvn. 'fhe l¡etter sort of l¡ouses are substantiall.v built of rvood, sripported by colonnades of teak pillars, antl rooferl rvith shingles ol tiles, from 6 to l0 f'eet high. '['he hóuses of the lorver classes are raisecl on bamboos about trvo feet from the ground ; the rralls are of mats, manufactured from the same usef'ul leerl; the roof is covered in with a thatch of palrnetto leaves, antl the llooring is formecl of boarcls, or s¡rlit cilne. l3esicles the Custom llouse, tlrere ale & f'erv othc¡' Itrich bnildings in the tc¡rvn, ON TIIE DISAÄSES OF BANGOON. 243 erected by foreigners. At the rvest eud of the f<rrt, and running in a direction parallel to tlre river, .is the long, and now po¡rulous suburl¡ of Tackally, many of the houses of rvhich rise on piles from the steep and rnutldy bank of tbe stleam. On the eastern extremity, and trlong tbe rvhole southern front of the stockade, are numerous honses, most of them suppot'ted on piles rvithin.high water mark, and communicating rvith each other by elevated rvooden platforms, or by means of planks and boles of trees laid encl to entl upon the slimy beach. I'owar<Is the concl¡rsion of the year. 1824, rvhen the inhabitants, rvh<¡ had llecl into the intelior of the country on the capture of the place, returned to theil homes, this part of the torvn l¡ecâme densely peopl.ed : and rvlrat frt¡m the peculiar odor of the exhalations from the rnud of the river-tlre effiuvia of animal anrl vegetable substances in process of deconr¡ro,sition, palticulally putrid lìsh, nhich the lJurruese are accustomed to use largely'in the prepalation of their favorite dish Balachong--tlreir practice of depositing the refuse of theil domestic ecoriomy near their doors, and of relieving nature close to, or under their houses-the air here d u ring the ebb ticle rvas haldly respirable by lnngs unused to breathe so impure an atmosphele. The rivel opposite the torvn, fronr bank to banh, is BB0 .vards rviele: its channel' is deep, ancl its sides and bottom covered rvith so.ft urud. During the rainy season, tl¡e current runs down at the rate of 6 or 7 n¡iles an hottr, and the t, t,2 244 oN THE DtsEÅs¡:s or RANcooN. tides aie felt only to a short distance above the town. In the dry nronths, the current is-;rnuclr less rapid, and the ticles exter¡d tlleir influence along the Panlang river to rvhere it branches off fi'om the Erarvnddy, a distance of 60 or 70 miles. In the springs, the tide rises to rvithin a eouple of feet of the platform of tbe l{.ing's lYharf, rvhich st¿nds uprvards of 20 feet above lorv rvater level. T'he rvater of tl¡e l'iver is rnore or less turbid accorcling to tlre season ; but, except in the ltot months, rvhen it becomes br¿ckish cluling the flood tides, it is sufficiently rvholesome. i\!ost of the varieties of fish rvhich are common to tlre Ilooghly and tlre Ganges are found here; and afier tl¡e estal¡lishment of a legular l¡azar by tlre natives of the country, rvere alrvirys ¡rrocurtrble in ¿rbttndance, and at a reasonal¡le late. 'l'he rvater supplied to the tr.oops rvas chiefly drarvn fì'om rvells; ancl so fär as my orvn observation goes, the quality of'this lvas tolerably good : sever¿l rneclical officers rvere, lrorvever, of a differerrt opinion, ancl set down, as acause of the fatal dysentery rvhich affected. the army, the use of tl¡e rvater derivecl from tlre spring. Along the Bengal lines to tlre eastrvard are several tanks, of which one is a lake in size, and of much picturesque beaut"v. Frorn the nurnber of kilns rvhich s[udded the country in their neigtrboulhood, it rvould appear that those reservoirs h¿ve been originally dugfor the salie of the material for brick-making tbey afforclerl, to supply tlre lar.ge clenrand for bricks in the erection of their sacred ON THI} DTSNASES OF ßANGOON. 246 buildings. The smaller ones dry u¡l during the hot reason, but the lake contains rvater the c'hole,vear, and is rvell sto'cked rvith fish. 1'horrglr soft and rvell tasLetl, this rvater rvas only usecl for rvatering cattle aud washing clothes. It might be expected tbat I should say something here regarding the mineral spring near tbe north side of the l)agon Pagoda; but having nbsetved, in a circular lettel of the Society, tl¡at or¡e of its membels had sent a portion of it to Calcntta for chenical analysis, I concluded'tt¡at the examination had been anticipated by indivicluals more qualified to conduct it th'an myself, ond thaÍ, any enquiries on uty ¡rart rvould l¡e uncalletl I'or. lt does not appear, horvever, that any ex¡rerinrents l¡ave yet been made with a vierv to asertain the constituent ingredients of this rvater, beyond rvhat were instituted by Captain Cox; çvide Journal of a Residence in tbe Burn'lan Empire,) to rvhom, anrl for a mineralogical descri¡rtiou of the surrounding couutry, I beg leave to refer. ln March ancl April, rvhen f.lre water is in its most concentrated state, its sensible properties are these-colourlessn and rvithout smell-taste porvelfully acid, and subastringent. Clothes dipped into it are corroded and destroyed. I have made use of tlris rvater as a detergent lotionfor foul ulcers, with atlvantage; but in this respect its virtue is inferior to tl¡at of the solutit¡ns of sulphate of copper and nitrate of silver. 246 ON THE DISEASES OF ßANGOON. Clin¿øte.-Though Ava has l¡een celeÌrrated, and rvith justice, fbr the salubrity of its climate, by alrnost all travellers rvbo have visited the country i !et, orving to the arrival of tbe âl'my at an unfavoral¡le season, antl othel câuses heteafter to be mentionetl, oul' tloops suffered as much f¡'onr sickness as they ditl at \Valcheren, or, unrler more nearly similar circunrstances, at Carthagena. I.Iere, as in Bengal ancl southe¡'n lndia, the cliniatic -vear nray be tlivided into the coltl, the hot, antl rainy seasons. In the cold season, rvhich commences with ir{ovemller, and tetminates torvards the end <¡f' February, tlre davs are agreeably ltat'm ; the atmosphere is ¡rure, dense, and dry, and the nights are cold ancl deu',v, rvith heavy morning fbgs. A rnode¡.¿rte N. lV. rvind plevails throughont, and the mnge of the therrnometer in the sl¡ade is f¡'om 60 to 86. March and April are the hottest months ; yet there is perhaps in tbis period a greater thermometrical range than at any other. In rny house, rvhich rvas built of rvood, rvith a thatch of palm leaves, an<l stood, unshelteretl by trees, in the artillery ¡:ark, the thertnorneter, betrveen trvo and tbree in the afternoon, during these months, r'ose to gB ancl I01, and at four or five in the rnorning fell to 75 au<l72. 'fhese diurnal var.iations of temper.at,ure did not, lrolvever, prove injurious to health: on the contraly, the grateful coolness of the nights, by admitting of .sounrl and refre.slring.sleep, rnacle oN 'IHE DISEASES Or RÀI!üGoON. 247 large compensation for the oppression anel languor experienced f'ronr the heat of tlre day. The air is excessively dr,v ; a light tl'emulous haze appears in the atrnosphere, and the shy is rvithout a cloud. The wind is generally fïonr the N. W.; but during the l¡ottest hours c¡f the drry, it not unfrequently veers all round the compass, forming rvhillwinds of dust, and entlaugering by its violence tl¡e roofs of the bouses. The first shorvers f'all early in May, and continue to f'all lreavy at tinres dnring the month, by rvhich tiu:e the face of the country, ftom being palched antl rvithered, is rapidly clothed rvith a rich antl luxrrriant herl-rage. About the end of the first rveel< in .Iune, the regular rains may l¡e said to set irr ; and tlrey finall,y cease al¡out the lOth or 15th of October. ln 1824, tlre quantity of rain that f'ell at lìangoon rvas astonishingly great, conrparetl rvith tl¡at rvl¡ich falls in ordinary seasons in llirrdoostan; and often', cluring the months of July and i\ugust in purticular, continuetl rvith l¡ut little internrission to pour clt¡rvn in deluging tor.- rents for several days äntl nights together. In the rainy montllsr tlre ruutations of ternpelature ¿re frequent antì sudrlen. lletween the showers tl¡e air is hot, close, and moist; an âtuìosphere of steam seems to float alound, aucl rve b¡'eathe as íf immelsed in a va¡rour [¡ath: all at ouce the sky is .overcasl, the rain ilescends hetvily, accompanied with a coltl, r'uslring rvind, ancl the thel'momete¡' sir¡ks l0 or 12 degrees. A danrp unpleasant chill is the consequence, and people are compelled to 248 oN THE Drsuasns oF RANcooN. lay asíde their iiglrt cotton for their tvûrrner rvoollen clotl¡es. Again the rain eeases, the sun breaks forth, the rnuggy rveather returns, and tlie cottotis are lesutnerJ. In such a country, and at such a season, it is obvious that troops engaged in active military operations conld not long rvithstantl the encloachments of clisease ; ancl so, iudeed, it happenerl. From Jttne lo October, inclusive, the principal diseases rvl¡ich ¿ffected the Buropearr part of the fbrce rvere dysr,,ntery and lemittent fever. I)ysentery, renrittent ¿rnd inte¡'mittent fevers, prevailed extensivelv amongst tlre sepoys and native ftrllorvers, ancl rnany cases of cbolera oecut'tecl amongst both. Hospital gangrene and scurv-v broke out in r{rrgust and September', and shall bê noticecl, at some length, under their respective heacls. 'l'he ¡r¡,r'exial epidernic rvhich visited Calcutta in ìVIay, ancl spreacl over a great portion of lnclia duling the trvo succeeding months, also pre' vailed at lìangootr in June and July; but as this disease has alreacly attr'âcted as much attention as its patlrological importance appeals to met'it, I shall here pass it over witlr tbe single rernark, that it chiefly afl'ectecl the ofËcers of tlle ârrtlJr of n'hour but f'erv escapecl, ancl in r¡o instance did I hear of its having plovetl fatal, [n the rnontlr of August, there tvas an alanning moltality anrongst the ¡nen of tbe i\fadras .Duro¡rean regiment, from a disease rvhich, in its progressand terr¡ination, rvas said to have borr¡e a strong sirnilitude to the lleliberi of Oeylon ; of this, horvever, I do not s¡reakfrom per- ON THE DISEÂSES OF NANGOON. 255 not the less great; a fact mainly to l¡e attril¡uted to the rvantof thosecomfortsin diet and clothing rvith which tlre l¿tter u'ere fnrnisl¡ed, aud li'om rvhich religious prejudices and otller reasons excluded the fot'mer. C¿usns. On the capture of Rangoon, the enemy rryithdrew into the rvoods aud jungles' a few miles to the north and rvest.of tt¡e towtt, and torvartls the great Syriam Pagoda on the eàst, where they c<lnstructed a line of stockatles, rvith the vierv of cutting offour comnruuications rvith the peacealrly disposed inhallita¡rts. To destroy these strong holds' it l¡ecarne necessary from time to time to send out detachtneuts of troops, rluring lhe rains, rvhen the country rvas becoming daily mole and more unst¡itable for rr¡ilitary movemeuts; on rrybich aceount the soldiers became unavoidably exposed to difficulties and hatdships of the most arduousand trying nature : -at one time, forcing their passage through ¿ dense jungle, rvhich but for the hand of the pioneer, would have been impenetrable, antl in which intense heat rvas ttntempererl by a breath of air; at another toiling over a mnrshy plain, up to their ancles and knees in rrater; no$ drenclred with rain, and chilled rvitl¡ cold ; and ar¡on scorcb' erl by the rays of a burnin€l sun. lf to tbese cir' cumstances, it be added, that the troops tYêre nrproviderl with camp equipage of any descripüion, 256 oN TFrE DrsEAsEs oF RANcooN. tlrat their provisions rvere of an unrrholesome kintl*; and tl¡at the ordinary duties of sentry and picquet sulrjected them much to the influence of atmospherical vicissitudes, rve shall l¡e at no loss tc¡ account for the invasion, and rapid spread of this destructive malady. Tnn¡,rMsxr. Tl¡ere are ferv cliseases, in t'hich delay in the application of the rernedies is protluctive of \rorse consequences than in dysentery; and hence, rvith soldiels, rvho are ever known to sul¡mit reluctantly to the restraints ancl privations of an hospital, it often happens that tl¡e success of the treatment is nearly in an i¡rverse ratio to the rnildness of the early symptorns. The remark applies with peculiar force to the cases wlrich occurred in this couf¡. try dnring the first four or five months. fn almost daily ex¡rectation of being called upon to oppose the enemy, and unrvilling to exchange their rationIiquor, and the freeclorn of their lines, for the regimen and co¡rûnement of an ill-provided hospital, there rvere ferv whoapplied for relief, till the severity of the syrnpto¡ns ¿nd constitutional derangen¡ent lelt them no alternative. l'he most tractable cases rvere those in which the pulse r,vas full, strong, and frequent, rvith mueh pain and tenderness al¡out the central part, or over the whole abdomen i ¡rrgent tormina antl ,tenesmus; biliotrs and ,lrloody stools. lYhen such patients presented f.hemselves, . Vide Scurvy, ON TÍID DTSEÀSES Otr' BANOOON. 257. tlre practice \ryas to take 20 or 25 oz. of blood from the arm, and to exhibit 20 grains of ealomel.' Four hours after', a dose of castor oil, or salts and senna rvas given, by the operation of which the stools became copiousr'and the griping and straining rvere diminisl¡ed. The abdomen was fomented u'ith rvarmwaterforhalf an hour, ancl a large l¡lister subsequently laid over it, while the scruple doses of calomel rvere directed to be continued every four hours to the third or, fourth time. After the lapse of 12 or 16 hours, it was usually found that the pulse had fallen to its natural standard, and that the tormina and tenesmus were consiclerably abat. ed; in rvhich case, the dose of calomel was reduced to five grains, and given in combination rvith three or four grains of antimonial porvder, and half a grain of opium eveiy four hours till the mouth becarne sc¡re. W'hen this effect was speedily induced, the patient's safety was ensul'ed. I'rom tl¡at hour the fixed pain in the abdomen rvas entirel¡/ removed, or at least was no longer complained of; the griping ceased; the stools assum'ed a more healthy aspect; and were pâssed s'ith but little exerertion i in short the patient was convalescent. Tl¡is rapid introduction of mercury into the system rvas apt, no doubt, (and the objection has been strongly s¡rged by some rvritersr) to excite painful swelling of the mouth and fauces, and severe ptyalism ; but compared rvith the magnitude of the benefit received, and when the inrportance of. cutting short the disease at an early periort is considered, these un'' ùt{ 2õB.: ONìTI{E: DISEASES OF RAIIGOON. pleasant consequences were of small rvei.efrt in the balance. lVhenno febrile svrnptotrrs u'ere preserrt, and'yet much sense of soreness in the al¡donren complained of, rvith urgent tornrina anrJ leuesnrus, the same mocle of treatment rvas pursued, rvilll the exception of V. S. lreing: omitted,. aurl tlre firet, dose of calomel accompanied rvith trvo grains of opiumì ar¡ additio¡r \\,íìrrantecl lrv the less degree of inflammatory action present, and the sotrtlring effect it prodnced on the borvels ¡rrevious,to tl¡e adrninistratíon of the purgaiive, Frictions rvith mercurial liniment on the tbighs and bell,v lvere employed, rvhen from tlre violence of the symptoms, and the tardy operâtion of tile rnedicines, the most energetic measures became necessary; and ryl¡en fi.om idiosJ¡ÐcÍa*sy or other cause, the mercury failed to affect t,lre svstern, the prognosis was generally unfavoral¡le. \{hen tl¡e disease'was of amore chronic nature, anrl had existed for a week 6¡ {,rvo, instead of the ecruple doses of calomel, I preferred giving at ûrst thelìxtr.. Colocynth. C. and Pil. Hyd.of each t0 grains, and repeating it, if required, for the full evacuation of the intestines, clirecting the medieine noted l¡elorv to be afterrrards take* every four hours till the mouth was affected, or the disease gave way*. Sueh rvas the basis of the treatment in tbe abovo . .ll. Submur. Hydrarg. pulv. A¡¡ti¡qen,iøo gr. iv, tpecao grii.. Opii. gr, ss. fi. pil ii. ON lHE DISDASES OF'EAÑGOON. 259 states of the disease. With'regald to the subortlinate remedies employed, tbey wire such as were calculated to allay particrrlar sytnptoms, and restore the tone and furrctions of tbe stomach and bowels. Stranguly antl tenesmus tïere relieved by sitting over the steam of hot lvater, nnd by the use of opiate e¡remas and suppositories. I'he sense of scaldÍng lreat. in tbe rectunt u'¿s dimiuished or removed o-y the carb<lna.te of magnesia given in doses of one or trvç {¡'unt* ; atrd rvhen the continuance or return of gri¡ring seemecl to indicate the existence of fccal accumulations in the intestinal canal, purging clysters, and small doses of rhubarb and the neutral salts \r'ere nrost useful. Sudorifics, fi'om the irn¡rossibility of preserving in patients rryho at'e frequently ¡¡oing to stool, tltat equability of tempe' rature rvhich is necessary to tlre continued and. salutary florv of perspiration, clid not appear to be of much utility; but warm diluents copiously drank, and fl¿nnel rvorn next the skin, rvere important atljuvants in the crre. When the borvels remained in a loc¡se state, rvhich was generally the case afte¡' the r:ess^aticrn of tbe griping and tenesmus, tbe cure vas slolrly effected by ttre vegetable tonics antl astringents; uitlic acid ; port rvine; and sucb articles of nutriment as the scanty stores of the Corunr issariat I)epartment ¿dmitted of supply*. lVith regard to the treatnrent of Uol.onitis, I regret to say, tlrat my knorvledge is almost entirely of a negative cbarirctel. lllercurials, so eminently use' 'o Fo¡ ga ¡ccourt of tbe diet ôf the dic\ dde Scurvy. xx2 260 oN THE DrsEisps oF RANGooN. ful in other forms of tropical dysentery, are here of no avail, either in tl¡e acute or chronic, in the first or last stage of tbe <lisease. fn recent cases, rvhen there is a considerable degree of active inflammation, much cantion is required in the administration of purgatives, even a mediunl dose being apt' to <¡ccasion excessive irritation and hyper-catharsis. Ten grains of rhubarb, and four grains of lpecacuan, repeated if neces$âr'lr I found to be here a purgative both safe and efûcient. The pain in the abdomen was seldom so great as to call for the application of a blister, and in no case have I seen any material relief ol¡tained frorn its enrployment. In some instances,l exhibited clysters composed of two drams of the powder of lpecacuan and a pint of \ilaru) rice gruel, to which rrere added two drams of laudanum; but I cannot affirm I ever sarv any further good effects fi'om thenn than the tenrporary alleviation of the tenesmus, in producing which it is probable the Ipecacuan had no share. In the advanced period of the disease, rvhen yellorv, feculent stools, mixed with l¡lood and purulent matter, point out tl¡e existence of a low chronic ulceration of the mucolrs mem- 'l¡rane of the intestines, I have prescribed a course of laxatives rvith some advantage. One of the compound rhubarb pills given two or three times a day,seldornfailed to relieve the uneasy straining at stool, by facilitating tle expulsion of the morbid secretions, ancl by the gently stimulating and detersive properties of the rnyrrh and aloes it con' ON THE DISEASES OF Rd.NGOON. 28t tains. In the last stage, when the stools become liquid and putrescent, and the pnlse is small and feeble, opiates, wine, and nou¡'isbing diet may prolong for ¿ few days the life of the patient. At a subsequent period, when my experience of the disease had l¡ecome more extensive, I rvas ted to adopt, in fhe first or more inflamnratory stage, the practice of applying leeches to the perineum, and by this means the rnost deciderl relief was almost uniformly obtainetl. On ¡'ef'erence to tl¡e anatomical distribution of the veins in this part of the borly, it rvill readily be perceived horv directly tlre abstlaction of blood from t lre perineum must operate in depleting the vessels of the colon ; and I am confident the practice rvonld be' found of the higlrest utility, in all cases of dysentery where the great intestines are actively implicated in the disease. C.rsE o¡' GunNnn Rrcg¿.no lVrr,r.rÂi\rsoN. T[as admitted into hospital on the l6th June 182.-i, affected for the third or fourth time nitlr bowel complaint, and dietl on the Ztst Julyfollowing, His stools at first ¡vere of a yellorvish, cream color, and semifluid consistence, occasionally streaked with blood, and accompanied rvith straining. I3y this and previous attacks, his health had suffered much-lris face rvaq pale-his body attenuated, and his appetite inrpaired. Tlre rough- 262 ON THE DISEASES OF ßANGOON. est manipulation of his aÌ¡domen excited no pain ; lris pulse rvas soft and slorv; lris tongue cleau ; and his stools, rvhich had a greater or less consistency in proportion to their l¡eing less or more frequ.ent, nsually l'an ft'om tltree or frrur to seven or eight in the 24 hours. For some time he seemed to improve under the internal use of the vegetable tonics and astringerlts in conrl¡ination; opiates; small doses of rhubarb, and cathartic eneruata, as circumstances made them necessary. About tl¡e l4th of July, an unfavorable change took place: griping, of rvhich he had not l¡efore complained, norv caue on; the tenesmus increased.; the stools l¡ecame more freguent, and were of a dark red and rvatery appearance, anrl higlrly offensive odor ; pressure oÍr the left lurnl¡ar and iliac region rrracle l¡im shrink from pain; his pulse roõe in f requency, antl tlecreased in strength ; his spirits sunk, his appetite fc¡rsook lrim, antl his strength rapidly cleclinerl. On t.he morniug of the 2lst, he cornplainecl of exquisite pain and tenderness iu tl¡e pubic and left inguinal regions, rvhich he said bad come t¡n in tlre course of the pleceding nigh.t ; his extreurities rvere cold, and his pulse rvas hardly perceptil¡le at the rvrist. In this almost hopeless state, fomeutations, topical bleedingancl blistering, wer.e had recourse to rvithout effect, and l¡e expired about four o'clock in the afternoon. ON fHE DISEASES OF RANGOON. 263 Dissec tion on tl¿e ¡following lllorniing,-Smell of the body exceedingly offeusive;-extensive inflammation of the peritoneal coat of tlre intestines and abdominal parietes; effusion of coagulable lymph upon the surf¿ce of tlreborvels, and agglutination of their convolutions to eâch other;- rectum l¡lack antl mortifierl, rvith ru¡rture of its coat, and escape of its lrighly fetirt contents into the cavity of the abdomen;-innor rneml¡rane of the colon linêd with a thick lrloody mucus, and abraded and ulcerated through its rvhole exteut, In the caput, ccecum were several large dark spots, fi'om extravasation of blood; antl in common rvitlr the rest of tl¡e gut, this portion of it was greatly tl¡ickened in its substance. The ilium contained a quantity of pultaceous yellow feces, and rvas interntrlly souncl ; âs was also the jejununì, duotlenum, and stomach, The gibbous surface of the liver r¡'as of a paler hue than usual, but its concave side ryas of a l¡luish color.. The gall-bladder rvas nearly full of a black, viscid bile, rvlrich, rvhen allorvecl to fall in threads from the fingerc, a¡rpeared, in the liglrt, of a reddish l¡rorvn color. S¡rleen small, but healthy. Kidne¡,s and urínary lrladder in their natural state. Tho¡ax: Upwards of tl¡ree drams. of serum in the pericardiuur. Viscera sour¡d. Rgu¿.n¡is. In this case tl¡ere appears to have existed for several rveeks a:low chronic inflammation of the large.'intestines; whicb' r¡nder dietetic restrictions 264,. oN THE DrsDAsEs oF nÄNGooN. and medicul treatment seemerl to have be en suhsiding, rvhen from some unknorvn cause it unexpectedly assumerl the active form of tbe disease. The introd¡¡ction of spirituous liquors and improper articles of fbocl into regimental Ìrospitals, at all times so difficult of prevention, rvas at this time facilitated by the removal of the native seútries to meet the exigeneies of the public service; and I bave little douht t¡ut that spirits bad aetually been conveyed to this unfbrtunate patient by his wellmeaning, but misj udging cornrades. Guxunn B¡rpp¡ Kpex. Admitted ltth June; died 20th July, IB2õ. This rvas a case of the chronic disease, complicatedrvithædema of the lower extremities and bydrothorax. The stools fi'orn first to last rvere either of a yellow, frothy, and semifluitl aspect, or of a whitish clay color, and thin pultaceous eonsistence, attencled for the most part rvith straining, and the dischargeper dnum tlf a few drops of venous blood. He hatl seldom any griping, and never complainedof pain in his abdomen, even when strongly pressed by the hand. Abont ten or trvelve days after he came into hospital, he beearne affected with pains in his legs, and his feet begnn to ..rvell. 1'hesesymptoms \4'ere succeeded by ciiflicnlty of breallring rvben in a horizontal po' sition, wlrich gradually increased till he could only rest in the seu¡i-erect posture. The ædema at ON THE DISEASE,S OF RANGOOI{. 27I rvhen it began to put on a pale ancl flabby appearance, an ill couditionetl disclrarge took place, and he sunk eventually fi'orn exhaustion. ln the last case, the cure proceeded as favourably as courld have been clesired ; the cliarrhcea almost immediately ceased; the pulse becatne trrore full, antl sunli tcl its natriral standard of frequency ; his appetite returned; and.the stump continuecl to heal by the first intention, ancl when nearly cicatrized, the man \vas invalided, and sent to Bengal. These cases appear to alïord sorne encouragement to the performance of amputation in this malignant disease ; antl we ought nc¡t, therefore, to be deterletl by the clread of the le-appearance of gangrene on tÌ¡e face of tlre sturnp, frotn r.en:oving the linrb, rvhen by the extensive desiruction of the soft parts, and vehement constitutional disturbance' the patient's life is placed iu imnrinent danger. Jlven rvlten the operation fails to cure' the surgeon rvill at least have the gratification of rendering the last hours of the pirtient comparatively easy,by changing the agonizing pain of the morbid limb for the more endural¡le suffering o( a sinrple incised rvottnd.x * In recommending arnputation of the liurl¡ under the above eircumitances, f arn borne out by the expcrience ofnlr. Âssistant Surgeon Les' lie of t\e 6sth Rcgiment B, N' I. stationed at Penang. Of ¡rìne amputa" tions perfonned try that gentlernan for gangrenous uloer, during the months.of l\farch and April of the present ycar, five of the patients are stated to have cornplelely reeovered; anil there can be little tìout¡t ¡n¿- ny more mig'ht have been saved, had the operation been oftener resorted to. 272 oN THE DrsEAsEs oF RANGooN. ScuRvv. This disease did not sberv itself prominently amongst the European troops till towards the end of September ; and it rvas somewhat later l¡efore it l¡roke t¡ut atnongst the Native part of the force. . Duling the nronth of October, there rvere 16 ad' nrissions for tl¡e complnint into the -European hospital ot'the artiller'"vr of rvhich the sympto'.lls lvere tllese-srv<illen, loose, anrl liviel gums' rvitl¡ ulcetated or slouglring eclges, fetitl l¡rea[h, pain and hardness in the calves of the legs, contractions of the hams, and purplish discoloration of the skin, palticularly of the lower extremities. ''fo those affections were associated, in many instances, diarrhæa and ædematous srvellings of the feet. Ascites in one case supervened, and universal Anasarca in another. After the month of November, there were no adtnissions under the head of Scorbutus; but even so late as F'ebruary, a scorbutic diathesis lvas strongly marked in almost every case of l)ysentery ; and so slorv rvas the recovery, and so inelücaciotts rvere the remedies, that I gladly availed myself of an opportunity wlrich offered, ' about the mi<ldle of that month, of sending 17 of those patients to Mergnix. * ,4 seaport town, and the capitai of a province in the southernmosü part of the ßurman empire, rvhich had reccnttv been captured by a de. taehment of troops under Lieut. Col. i\liles. Here two fieìd hospitals were establishetl ; antl the air of the plaee beinc cool and salullriorrs, antl veEetables and otl¡er provisions aÞuadant, .tl¡e siok deriyed mucb boreût fro¡q tbe change. ON fHD DISEÄSES OF 8ÂNGOON. 273 Amongst the Natives of our Detachment, exclusive of those who belonged to the Train and Quarter-master's estal¡lishment, (of wlrom no returu is made in the hospital registers,) there rvere fi.om first to last, that is, from October till the final disappearance of the disease in A.pril follorving, 32 cases of scurvy; of these nine died, four rvere sent to Bengal, and 19 recovered. The same general symptoms characterized the disease in the case of 'the Natives as of the Europeans, with this diffbrence, that, in the former, tlysentery was less fi.equent, and the debility, loss of appetite, and bydropic syurptoms \üere more remarkable. ln all the wolst cases, the feet became ædematous; and horvever apparently mild tbe other symptoms rnight bave l¡een, this affe'ction rvas an almost certain prognostic of approaching anasarca, hydrothorax, and death. One man had his gums in an enonnously enlarged and fungous state; his teeth rvere loose, and his breath was insufferably offensive: yet this ¡ndividual complained more of the painful distension of his cheeks; and inability to eat, than ofany thing else; and he rvas one af tl¡e four who were sent to Bengal for their recovery. C.rusns. On the capture of the town, the system adopted by tlre enemy of compelling the inh¿l¡itants to rvithdraw into the interior of the country, and the rigilance they exerted in cutting <¡ff the supply of provisions, having throrvn the army upon its PP 274 oN THE DISEASES oF RANGooN. own resources for the means of subsistenòe, iÈ became necessary to issu'e the salt meat, biscuit, and rum which the shippins afforded, in daily rations to the troops. Unfoltunately tlre quality of the two first mentioned articles g'as of the rvorst kintl' The salt beef and pork, from being badly curetl and long keot, '!vas much tainted, ancl ofteu so firr advancer.l in a state of putricliti, as to be altog'ether ¿rr¡fit for use. 'fhe biscuit, c<¡arse and nrouldy f'rorn the first, became animated rvith i¡rsects, aud irfter two or three months \,vas served out to the troops, comminuted into fragments, or reduced to dust. Upon such a diet as this, unproviclecl with any of those grateful coirigents of salted food so long used in ships of war anrl merchantmen at sea, antl exposed to halassing or fatiguing duties, in an iuclement season, as rvell by night as by day, tlre disease in the long rirn rvas inevitable; and it is only surprising that it should have appeared at so late a period, and in so mild a forn¡. lt is in my experience tohaveseen this disease break out amongst the H. C. recruits, during tlreir passage t'o lndia, in less than three months from tlreirleaving -England ; and thattoo where the salted meat in use was of unexceptionable quality, and vúhen a sufficiency of potatoes, mustard, and vinegar was supplied along \rith it*. Yet rvhen . The confinetl airof the orlopdecþ allotted forthe accommodation of the recruits, the transitiou from an active to an inactive life, anil tlre non-observaÂce of persoua.l cleanliness, no doubt contributed materiallt ON THE DISEASES OF RANGOON. 276 we calculâte from the time of the amival of the armament at Rangoon, and allorv one month for its passage thitber fi'om Calctttta*, rve sball find that the "European troops actually subsisted on salt provisions f'or a ¡reriod of 6| months, it not being till the 2-1th of October: that fresh meat was regularly substitutedf. ]ìven the hospitel diet rolls f'or the lirst five months exhil¡it only a ÍDt'â.l{l'€ account of sago, arrowroot, wine, tea, aud sugart as nearly the rvhole sustenance of tl¡e sick'-On the õth of October, and from thencef'orwarcl, the hospitals were suppliecl wi¿lr freslr bread ; and af'ter the 19th of tl¡c' saûìe montlt, if rve except a sulüciency of recent vegeta.ble ftrod, the patients $'ere providerl rvith every requisite. The inlluenee of saltetl and putrescent animal cliet in tbe production of scurvy is not applicable to the case of the native troops and camp followers, rvho suffered fi'om tl¡e disease in equal measure rvith the fiuropeans. The d:rily rations furnislred to those cl¿sses by tlre Comrnissariat, consisted of rice and dall, rvith a modicum of salt and ghee. Such articles, it may be said, fbnn the cl¡ief fbod of those people in their own country, aud tho.t, though affording but little nutriment, are suited to their constitution here to the production of the disease. Thelaziest, the ñlthiest, and the lvornc¡¡, in partieular, were firsü affected. r I speak l¡ere ofthe l3engal troops only. f À.meal of fresh meat rui¡¡ht have been given previous fo this, and I believe rvas given, to the troo¡rs generally, about once a ¡uonth. fsptitpeae. spZ 276 oN TTIE DISEASES OF RANGOoN. and habits : and no doubt this is the fact; but it is at tlre sâme time rvell knorvn, tbat, they are accustomed to use greens anrl other pot'herbs in large quantity, an<l that the poorest of the Mussulman community can always command a curry of meat or of Êsh. At Rangoon, horvever, thesetlrings for a long period were beyond their reach, or attainable only in such small quantities as to operate in a very slight degree in retarding the approach of the disease. So far as I could leatn, the quality of the rice, dal, &c. issued by the Comrnissariat was good ; and hence the great exciting cause of the scorl¡utic affection rvl¡ich existed among thena. tive portion of the force cannot be referred to the use of a salt, putrescent, or vitiated aliment, but to defective nutrition, and the rvantof that vital principle contained in recent vegetable matter rvhich is eliminated during the process of rligestion and assimilation. CunB. The,only snbstance possessing aritiscorl¡utic virtues which was procurable on tlre first appearance of the disease, lvas vinegar; and this being brought largely into requisition, and convertetl into the Nitrous Vinegar of il'Ir. Patterson, rvas exhibited to the extent of 6 and 8 oz, a day.-To this remedy I gave a trial of somewhat more than a month, when a suppty of Lime Juice having arrived from Bengal, it rvas discontinued, In a few cases the uitlous vinegar excited an uneasy pun- ON THE DISEÁSES OF RANGOON. 277 gent sensation in tlre stomacb, and marle it necessaÌy to give it cliluted rvith w'ater; but in genelal it occasioned no inconvenience, even rvhen administered in doses of 2 oz. With regartl to its efficacy as a remedy in this complairrt, I have to state, that it seemed toansrver completely in those .Buropeans in whom the disease \l'as uncornplícatett rvith dysentery; but in no instance rvhere the lah ter disorder rvas present, did I observe any marked l¡enefit to result from its use.-ft is but justice, however, to mention, that its failure in such eases rvas in comrnon rvith the Liule Juice, and eveÌy other medicine ern¡rloyerl.-ln the month of September, the scorl¡utic patients rryere lil¡erally supplied rvith Hodgson'sale, and sprtrce beerx ; and in November, Pumpkins, Limes, and Oranges, rvere served out to them in small quantities,wlrich, though insufficient for the eure, appeared to have t[¡e effect of checking the disease, or renderingitstationary. 1'he l¡owel complaint rvas wholly of a chronic natnre; the purging was seldom of excessive freqnency; the stools were usuall-v of a sernifluid consistence, and of a green, yellow, or cream color : "som e degree of ten esmus w as gen erally p resen t ; an d sometimes a ferv drops of dalk bloocl rvere voided . As a grateful cordíal and restorative, tùe ale was highly acceptable to the patients; l¡ut the spruce beer was less relishcd, and from its aptìtude to run ínto thc acetous fermentation, it somctiøes occasioned griping in the borvels. T!¡e Lime Juice supplicd by tlre ßengal Comuissariat appeared to be slightly musty, antl of irnpaired acidity. 278 ON THE DISEASES OF ßANGOON. per anu?n, Torrnina, as an incidental symptom, rvas at times conrplained of, but rvas rarely urgent, or of long continuance. The otlrer symptorns rvere lividity, enlat'gement, bleeding, and occasiontlly sloughing of the gums; pain, hardness aud srvellinE in the calves of the legs ; ædema of the feet, l¡aleness ancl leucophle.gma.tic appearance of the eounte¡lance ; ger.reraÌ debility; appetite good. In the general plan of treatnrent, besides the antiscorl¡utics alreaclv noted, the medicines I found usef'ul in Scorl.¡ntic Dysentery, tvere the Calbonate of Mag' nesia, or small doses of'Rhubarb, to obviate the tenesmus or griping;-Opiates and anodyne Clysters. For the ædematous affectiorls of the feet, pediluvia, and frictions rvit,h stimulating liniments were ernploved; and a solutit¡n of' Aluru, or Port Wine ancl Vinegilr, was used ¿s a detcrgent gargle fbr the mouth. .I'he various astringents administered with a view to strengthen the borvels, and restrain the alvine evacuations, dicl not answer their indications; and I rvas of ten obliged to ornit them, in consequence of their cloying the stomach antl injuring the ir,ppetite. Amongst tlre natives of tl¡e artillery, the disease rva,s of a still less tractal¡le nature than amongst the Europeans: nor is ¿his difËcult to account fbr' While tbe Buropean sick rvere provided rvith almost ercry conrfort fï'om the month of October, the cliet of the native sick remained unimproved till ON TIIE DISEASES OF RANGOON. 2I9 January follorving, by which time the Burmese population, having l¡ecome pretty numerous in the town, hatl estnl¡lished a llazar, an<l brought to it daily their fish, vegetables, and fruit fbr sale; and it was still later befbre these comntoditiesbecame so cheap as to induce a naturally penurious people to lay out their money in'tbe purchase. Consistent rvith the vierv taken of'the exciting causes of the disease amongst tire natives, it was observed that metlicine had little power to effect its removal; for though the slighter and external synrptorns appeared to subside under the free employment of the Nitrous Vinegar. antl the solution c¡f Nitrate of Potass in Lime Juice, I conqider ttre lecovery to be mainly attributable to the anrelioration of diet, and the change from a lrot and noist to a cool and dry season. ' It might bave been supposed that Vinegar. and Lime Juice, in cornbination rvith the Nitrate of Potass, from the compound possessing diuretic as rvell as antiscorl¡utic properties, rvould have been peculiarly suited to the case of those in n'hom hydropic symptoms supelvened; but I caunot ss.y I ever saw any permanent beneÊt obtainetl frorn their use. At times indeed, the oppressed and laborious respiration rvould be relievecl, and an evident detumescence take place of the anasarcous srvellings. This, however, was but a short re- 280 oN TrrE DrsEAsEs or naNcooN. spite fi'om suffering:-the strength continued pro' gressively to decline; the dysprlæa and cuticular dropsy retnrned in an aggravated degree; the remeclies (including the auxiliaries, Squills, Digitalis, &c.) produced no effect, and the patients died with all tl¡e symptoms of lrydrothorax. I here close my remarks on the three principal diseases wtrich prevailed in the British army at Rangoon. Remittent and lntetmittent Fevers and Cholera remain to be considered, and will form the subjects ofa future Paper.