and with the greatest violence; whilst that of the SW is latest, and least felt. The climate of that part of the island exposed to the NE monsoon is hot and dry, and on the contrary the western coast, which receives the brunt of the early or SW monsoon, has a temperate and humid climate: the eastern coast resembling that of Coromandel, and the western that of Malabar. The interruption which the mountain ranges of the island presents to the course of the monsoons, causes deluges of rain to fall on one side, while the other is parched with drought.* With this introduction, which has been culled from the best sources, I will compare the above facts with the scanty statistical materials that we possess respecting the prevalence of Fever in this island.† The following statistics are deduced from the returns of deaths occurring among our troops. It appears that the endemic diseases, such as elephantiasis, are peculiar to the natives, and that dysentery, fever, and hepatic attacks, attack Europeans. Annual Ratio of Mortality per Thousand of mean strength. Kandy, C. Colombo, SW. Galle, SW. Trincomalee,NE. * Imperial Gazetteer, vol. i. p. 644, Blackie, Glasgow, Encyclopædia Britannica, 8th edition, art. Ceylon. † The disease called Beri-beri (Hydrops asthmaticus) is almost peculiar to this island; beri is a Singalese word for weakness, and by reduplication signifies great weakness: it is an acute dropsical disease. (Dr. Maynes' Expository Lexicon.) Elephantiasis and other cutaneous diseases are, with affections of the liver and intestines, common in this island. It must be remembered that the returns of mortality are confined to the English regiments doing duty in the island, and therefore must not be taken as a criterion of the general effect of the climate upon the more respectable classes, who refrain from committing those excesses to which the soldiery are addicted, and which tell upon them so fearfully, affording another illustration of the opinion that we set out with, and which Hippocrates entertained two thousand two hundred years ago. These few figures, when attentively considered, afford by their simple aid a great deal of information. We find that fever is most fatal among our troops in the central district of Kandy and the NE of Trincomalee. What, then, are the conditions bringing about this state of things? Kandy is situated in a basin, and on soil exceedingly pervious to wet; the range of the thermometer is from 54 to 87, and this high temperature acting upon a soil moist and containing the débris of vegetable matter, would naturally produce more cases of fever than in a more favoured locality like Galle: at Trincomalee, the temperature ranges from 74°30 to 91°-30, which excessive heat acts for months on any dead vegetable matter that the floods occasioned by the monsoon had left behind. Here we find stomach and bowel complaints rife. The situation of Galle does not admit of the three conditions necessary for the development to any great intensity of malaria; besides which, the mean daily range of the temperature, as at Galle, is but small. Trincomalee is also more subject to the invasion of cholera. Is it generated in this district, or is it wafted from Sunderbuns during the NE monsoon? -there is no interruption to such a course. The Sanatarium of Ceylon is Neevere Ellia, about 6,000 feet above the level of the sea. We find that Hippocrates implicitly believed in the possibility of pestilences being carried from place to place by means of the prevailing winds. The following anecdote is recorded of him at the same time, however, that I insert it, I must tell the reader candidly that many of the stories relating to the personal history of Hippocrates are not to be implicitly : depended on:-When the reputation of this physician had been spread abroad not only by the reports of his judicious treatment of the cases that were brought under his care, but by the praises bestowed upon him throughout the country by those who were fortunate enough to have been his pupils, his advice was sought by neighbouring princes whenever their cities were threatened with pestilence. On one occasion a plague invaded the country of the Pæonians and Illyrians, and the kings despatched ambassadors to Hippocrates, and requested him to come to their assistance; but he was not to be gained, for having learnt from these messengers what was the prevailing wind at the time of the plague in the country whence they came, he prophesied that the pestilence would invade Athens, and in that case he said he should have enough to do to take care of the students, and provide against the calamity by preparing the cities for the attack. With regard to the draining of swampy land for the sake of ridding the neighbourhood of fever, we must not forget to mention that the great Empedocles of Agrigentum, who flourished about 444 B.C., drained a pestilential marsh that was destroying the people of Selinus with fever, and rendering parturition difficult, (Τοῖς δὲ Σελινουντίοις ἐμπεσόντος λοιμοῦ διὰ τὰς ἀπὸ του περικειμένου ποταμου δυσωδίας, ὥστε καὶ ἀυτοὺς φθείρουσι καὶ τὰς γυναῖκας δυστοκεῖν.* This he effected by carrying two small streams through the swampy grounds, and thus drained off the water: this is recorded on some beautiful coins of Selinus, which are still extant+ He also blocked up some narrow valleys with walls, and thus secured a town from the noxious winds that affected its inhabitants and injured the fruit-trees. The effect of wind in driving pestilential emanations from one country or district to another is well known: the inhabitants to the leeward of a swamp may be affected by fever, whilst those on the opposite border escape altogether * Diogenes Laertius, London, 1664, p. 230. + Müller's Literature of Ancient Greece, p. 254. Annali dell' Instituto di Corresp. Archaeologica, 1835, p. 265. until the wind shall be in the opposite direction; then the first will be freed from their enemy, and the latter will in their turn suffer. A forest intervening between a pestilential marsh and a city often affords a protection to the inhabitants, and perchance the pestiferous air gets decomposed into innocuous gases during its enlargement among the trees, in a manner similar to the exhalations mentioned above when describing the effect of the lotus upon the stagnant lakes and lagoons of Ceylon. Miasma is also absorbed by water; and the intersection of a district by a river will afford protection to the inhabitants of the country living on the bank opposite to the one in whose neighbourhood the malaria is generated. Although the following exanthematous and other fevers can hardly be compared with the bilious remittent form that prevailed among the Thasians during this constitution, yet, in the absence of a true analogue, it may be interesting to discuss briefly the statistics of those fevers which infest our isles, and record what little is known as to the influence that weather and season exert upon them. I have selected small-pox, measles, scarlatina, remittent fever, and typhus fevers, and, as usual, have taken the Bills of Mortality as my guide, and whatever meteorological facts I have been able to obtain relative to the seasons and years over which the nosometrical observations have extended. Small-pox. The zymotic character of this disease seems to have struck Rhazes,* for he distinctly warns his patients during its prevalence against making use of "stagnant waters, and eating fruits and herbs that are blasted and mouldy." To persons of certain temperaments he prohibits grapes, because he observes "that they are liable to make the blood undergo fermentation." This author seems to have entertained the idea that the small-pox was prone to enter the system through the skin; for, after making the above remarks, he adds—“ If the air be very malignant, putrid, and pestilential, their faces may be * Rhazes on Small pox, translated by Dr. Greenhill, Syd. Soc., pp. 33, 38, 40. constantly bathed with Sanders water and camphor, which will have a good effect." As to the state of the air conducive to variola, he gives, as the result of his experience, that the latter end of autumn and the beginning of the spring are the seasons during which it is most prevalent; but that the summer is so also, when there are great and frequent rains, with continued south winds, and that it often becomes epidemic when the winter is warm and southerly. In tracing the progress of the small-pox epidemic that commenced in 1667, we find, from the works of Sydenham, that this disease did not make its appearance during the pestilential years that are celebrated in history as being those in which so many thousands were slain by the plague, but that, in 1667, at the approach of the vernal equinox, it began to show itself, and from that time until autumn (August?) it increased daily, until it had become thoroughly epidemic. From this time its vigour declined, and, as the winter approached, its ravages became less. With the beginning of the ensuing spring it returned from its retreat, took strength, and spread itself, until it became restrained, as in the year before, by the frosts of the winter: these checked its attacks. After this it came a third time, and showed itself strong in the early part of spring. It soon, however, began to flag, and became crippled, extending itself less than in the two preceding, and finally, in the month of August 1669, died away altogether, making way for an epidemic dysentery.* The experience of Rhazes and Sydenham seem to lead them to the same opinion with regard to the effect of the seasons upon this malady in an epidemic form. Both have observed that the spring and autumn are the most favourable for its development, although Rhazes very wisely adds, "that in consequence of the great diversities of countries and dwellings, and occult dispositions in the air, all these things admit of great differences, so that they happen in all seasons."+ * Sydenham's Works, transl. by R. G. Latham, M.D., Syd. Soc., vol. i. p. 721. + Op. cit. |