Part 2 — CHAP. XXI.

MEDICAL REMARKS.

Psorophthalmia — Plague — Small-pox — Guinea worm — Scrophula — Syphilis — Bile — Tenia — Hernia — Hydrocele — Hemorrhoides and Fistula — Apoplexy — Umbilical ruptures — Accouchemens — Hydrophobia — Phlebotomy — Remedies — Remarks — Circumcision — Excision.

From the following detached remarks, the result chiefly of personal observation, if the physiologist can derive any amusement, or the traveller the smallest mitigation of his personal sufferings, the purpose of committing them to paper is answered.

If any medical professor should chance to advert to them, the writer is too conscious of the superficiality of his own knowlege not to perceive, that little satisfaction will be derived. But persuaded, that the art of healing, even at this day, abounds little less in experiments than in the age of one of its brightest ornaments, who makes the confession, he is induced to believe, scarcely any fact relative to it, or any experiment, faithfully narrated, can be wholly destitute of its use.

Psorophthalmia.

It is remarked that in Egypt, but particularly in Kahira, the blind, and those who have defective vision, bear a large proportion to the number of the inhabitants. The fact observed, which cannot be disputed, has been explained in various ways. It has by some been considered as proceeding from the habitual use of rice. By others, as the effect of the subtle dust which floats in the air. Even the water of the Nile has been supposed to co-operate at least, if not to be the sole agent, in producing this remarkable disease.

To explore the origin of this or any other malady, all its appearances must first be accurately noted. The ophthalmia of Egypt leads us through a diversity of symptoms, from slight inflammation and defluxion, to the total and irrecoverable blindness occasioned by opacity of the Cornea. To enumerate them all correctly, and compare them in a variety of cases, must be the task of an oculist long resident on the spot, and accustomed to numerous patients. A transient observer, however diligent in his inquiries, may more easily prove the falsehood of the assigned causes, than trace the real one.

The Nile water, it may be supposed, when taken into the stomach, can have no effect on the eyes, but by first altering the state of the fluids, into which it, as well as other aliments, is gradually converted. Whether from mineral or vegetable impregnations, it could never operate solely on the eyes, without affecting any other part of the animal economy. The effect of opium is seen on the blood and muscular fibres; of mercury on the glands and lymphatics; of cantharides on the nerves: and too great a portion of these, taken into the body, may have a pernicious effect on the eyes, but always through the medium of other parts. The whole materia medica, perhaps, furnishes no drug or mineral that is known, when taken into the stomach, to have a local and partial effect on the eyes. Such an effect is even irreconcileable with the general and constantly observed operation of all remedies applied to the human body.

Besides, if the injury were solely or even in part to arise from the use of the Nile water, all those who drink it must be equally affected, allowing for the different degree of firmness in the stamina of each. But certain orders of men are rarely attacked by this disease, and they too who are continually using the river water both internally and externally.

Rice is one of the most nutritive and salubrious of the farinaceous aliments, and certainly does not operate to render the humours acrid, and thereby to inflame the eyes. It is used as a main article of food by the natives of a large portion of Asia, and forms no inconsiderable part of the consumption in other countries, without being observed to produce any such effect as is here attributed to it; and may therefore fairly be denied to have any such power.

Something more plausible indeed offers itself as to the injurious operation of an external cause. Nothing can be more subtle than the dust into which the vegetable soil of Egypt resolves itself when it becomes dry. This, during a certain portion of the year, is in a manner suspended in the air, from a cause which exists in few other countries, I mean the want of rain. It also contains a large portion of nitre, which is copiously produced in Egypt. This circumstance, however, is common to many other places. This light dust, doubtless of a very irritating quality, not only floats in the streets, but pervades the apartments of every dwelling, insinuating itself into the most artfully constructed inclosures: by it therefore the eyes may and must be in some degree affected. But Nature has not ordained that a part so much exposed should be destitute of its appropriate protection. The secretions of the lachrymal glands are, in general, abundantly sufficient to counteract the injury sustained by the action of corrosive or irritating substances on the external fabric of the eye, being always produced exactly in proportion to the circumstances that demand them, as daily experience confirms: yet it cannot be denied, that the continually repeated operation of an offending cause, when no remedy is applied, may be more than commensurate with the efforts of Nature to restore herself.

Such is precisely the condition of the Kahirines. The accommodating the quality of diet to the symptoms of derangement in the economy is a precaution unknown to them: and of their remedies, many are so prepared, or so administered, as to augment rather than to annihilate disease. No idea offers itself to them, but of topical applications to remove a local complaint. If any thing be applied in these flussioni (dysophthalmia) it is generally kôhhel (calx of tin mixed with sheep’s fat) or tûtti, a still more powerful astringent, applied in coarse powder, and naturally tending to increase rather than to allay the irritation.

When thus incommoded, the Egyptians of the lower class esteem water pernicious, and therefore rarely wash their eyes; but as the collected dust begins to cause an uneasy sensation, apply their fingers or a coarse cotton cloth to remove it. The higher orders, who are neat in their persons, and regular in their ablutions, are rarely observed to be greatly harassed by this complaint. And the progress of the disorder, when in its nascent state, has several times been stopped, under my observation, by the use of rose-water, solution of sacchar. saturn. &c. as in other places.

But as no single one of these causes, nor even all of them together, appear sufficient to account for all the phenomena, another, more powerful, is to be sought; and none suggests itself more opportunely than that alleged by Savary, who imagines that the defect of vision is principally brought about by the habit of being exposed to the nocturnal air during the summer, at which season a heavy dew falls, and a great transition happens from the heats of the day. In fact, if the face of those who sleep exposed be not completely covered, an itching and unpleasant sensation is always felt in the eyes at rising.

It is ordinarily experienced in the city, where, from being confined in the day, people feel most disposed to seek for coolness and refreshment on their terraces at night.

The Mamlûks, and higher order of Arabs, that is, Mohammedan merchants, and the superior rank of Copts and Franks, are least affected, as being cleanly, not exposing themselves to the night air without necessity, and being well covered. The Arabs of the desert are as free from blindness as any people. They never sleep with the face exposed, and have moreover the advantage of being devoid of the dust and other supposed causes of psorophthalmia in the city. The disorder appears no where so much as in Kahira, because no where are all the causes so much combined: yet it is seen in Alexandria, Damiatt, and in Upper Egypt, which shews that the cause is not confined to Kahira. Among the poorer class of all countries prevails a kind of insouciance. That of Kahira is particularly exposed to the changes of temperature and the nocturnal dew, and is ill clothed. Hence the disorder is mostly found among the populace. A disposition to inflammation often appears in the eyes of children, but yields to proper remedies. Hence it may be imagined, that with attention the Egyptians would not suffer more than other nations.

Some travellers have thought that the ophthalmic disease in Kahira was occasioned by the fetid exhalations of the Chalige, and the drains; and have even observed, that those who are most severely affected in winter, recover as soon as the water has filled the Chalige and the pools. This is also a common idea with the natives. “The stink blinds me,” is a frequent expression on coming into a place of fetid odour; and it may be remarked, that the ordinary maxims of indigenæ are rarely to be entirely disregarded. Whatever miasms however may issue from the canal, they cannot be equally dispersed over the city, as blindness is; and the Franks, Greeks, and other strangers who reside nearest this depôt of impurity, would be most affected if that were the cause. It may yet be one cause. Another I take to be the subtile dust above mentioned; but the most powerful, indiscreet exposure to the nocturnal air and dews. The collective influence of these is strengthened by the cloudless splendour of a vertical sun, reflected from the sterile expanse of sand, which offers no sombrous object on which the eye may repose itself.

These considerations, it may be acknowleged, do not carry conviction; but too many local diseases are yet unexplained, to leave any wonder if the cause of this should yet remain problematical.

Plague.

All the improvements in the art of healing which modern Europe can boast as its own, are the result of more frequent experiment, and more patient and minute investigation, than existed in the antient.

To conjecture ingeniously is a matter of small effort, and in treating of what is properly the object of experiment, it is not only of no value, but often of dangerous result. But it is suited to the indolence of the human mind, and flattering to personal vanity, which delights to perform much by a single energy. Hence, an hypothesis supported by some insulated fact, perhaps only by specious error, is often advanced with warmth, and the most important considerations militating against it, are forgotten, or warped to serve the purpose of the inventor. Thus the increase of the Nile was once confidently attributed to the Etesian winds; and the malady which has so often almost depopulated Kahira, is still by some imagined to proceed from the putrid deposition of its waters.

We have at length disposed ourselves to the habit of tracing the cause of disease, by combining a number of minute, and often varying, symptoms. A practice which, if correct in its detail, can never but be accurate in its deductions. Relative to the Plague, however, whose very name distracts the timid, and appals even the courageous, our reasonings and our deductions are quite of a different description. Respecting its cause, all is conjecture. No experienced or well-informed practitioner has watched the bed of the sick; none has accurately examined the different appearances which the disease assumes in different persons, nor even in its different stages, in the same person. Scarcely any, it is believed, has been tranquil enough to hear patiently from the mouth of the sufferer an account of his sensations, which, recounted by a third person, never fail to vary.

Where this malady appears, the physician and the priest, the pride of science and the security of faith, confident and boastful when the patient alone is threatened, are both equally alert in their efforts to escape. The ignorant and unreflecting Muslim, indeed, awe-struck, and resigned to the unalterable decree of Fate, hangs over the couch of his expiring relative. But the report, guided by prejudice, is likely to mislead, and the observation can be of little value when the sole sentiment is stupor.

Thus the Plague remains almost destitute of a local habitation, though it have a name in nosology.

Who can at this day determine, whether the pestilence mentioned by Thucydides be the same as that of Modern Egypt and Turkey? Or whether the epidemical diseases, which have for several centuries, at intervals ravaged different parts of the Turkish empire, have been all specifically the same? The Europeans frequenting the Levant, have written profound treatises on the plague, simply from having seen a quantity of dead bodies carried past the doors of their houses, which the double optics of fear have occasionally magnified from 500 to 10,000.

The facts that appear chiefly to be ascertained relative to the plague, are, 1st, That the infection is not received but by actual contact. In this particular, it would seem less formidable than several other disorders. 2. That it is communicated by certain substances, by others not, as by a woollen cloth, or rope of hemp, but not by a piece of ivory, wood, or a rope made of the date tree; nor by any thing that has been completely immersed in water. It would appear from the report of the Kahirines, that no animal but man is affected with this disorder; though, it is said, a cat passing from an infected house, has carried the contagion. 3. That persons have often remained together in the same house, and entirely under the same circumstances, of whom one has been attacked, and died; and the others never felt the smallest inconvenience. 4. That a person may be affected any number of times. 5. That it is more fatal to the young than the old. 6. That no climate appears to be exempt from it; yet, 7. that the extremes of heat and cold both appear to be adverse to it. In Constantinople it is often, but far from being always terminated by the cold of winter, and in Kahira by the heat of summer; both circumstances being, as may be conjectured, the effect of indisposition for absorption in the skin, unless it be supposed that in the latter case, it may be attributed to the change the air undergoes from the increase of the Nile.

The first symptoms are said to be thirst; 2. cephalalgia; 3. a stiff and uneasy sensation, with redness and tumour about the eyes; 4. watering of the eyes; 5. white pustules on the tongue. The more advanced symptoms of buboes, fœtor of the breath, &c. &c. are well known; and I have nothing authentic to add to them. Not uncommonly, all these have successively shewn themselves, yet the patient has recovered; in which case, where suppuration has had place, the skin always remains discoloured, commonly of a purple hue.—Many who have been bleeded in an early stage of the disorder, have recovered without any fatal symptoms; but whether from that or any other cause, does not appear certain. The same operation is reported to have been commonly fatal in a late stage. It is said that embrocating the buboes continually with oil has sometimes wrought a cure; but this remedy is so difficult and dangerous for the operator, that it would appear experiments must yet be very defective. The natives of Kahira are too supine to seek for any remedy, and too bigoted to avoid the danger.

The plague which happened in Egypt so early as the year 1348, when Constantinople was yet subject to the Greek emperor, and Egypt in possession of Mohammedans, may be supposed to have originated in the latter. But not to mention that there were many other places from which it might be brought, this single instance, not given in detail, is insufficient to overthrow the testimony of the modern inhabitants, who with one consent affirm, whether Mohammedans or Christians, that the plague is not endemial in Egypt, but that all the instances of it which they are able to trace are proved to have been derived from abroad.

The learned Dr. Mead has brought the plague from Ethiopia, where famine and the small-pox indeed carry off numbers; but where the plague was never known to exist. It is not remembered to have penetrated far into the Upper Egypt, except in some few instances, when it was known to have been carried thither by the boats from Kahira. No more is required to account for its introduction into Egypt at this day, than the admission, that it is never completely extinct at Constantinople, which, it seems, has scarcely been denied.

The imagination of one of our poets has drawn the pestilence from the filth of Kahira, and the mud of the Nile. But, not to mention that there is less disposition to fermentation and putrefaction in the atmosphere of Egypt, than in almost any other that I have heard described, Kahira is very far from being impure. No offensive substance remains in the streets twenty-four hours; and even what is left to annoy passengers in London and Paris for months, is there carried away and preserved for burning.

The mud of the Nile becomes dry in a very short space of time after the water has left it, except in the canal (Chalige) which is indeed not very odoriferous; but so far from emitting pestilential exhalations, that the Franks who especially dwell close to it, are never infected with the plague, and are in general among the most healthy of the inhabitants of that metropolis.

Small-pox.

The small-pox is a disease much dreaded by the people of Soudân, whether Moors or Negroes, and little less by the Bedouins of Egypt. The Christians of Kahira are many of them in the habit of inoculating. A few of the Mohammedans use the same practice. It is however almost impossible to persuade them to adopt our mode of treatment.

Independently of the general ill consequence of improper management of the patient, the chief reason of the extraordinary fatality of this complaint among the negroes, appears to be the thickness of the skin, which resisting the effort of nature to protrude the morbid matter to the surface, tends to throw it back into the circulation. A proprietor of slaves, who was rather anxious for the conservation of his property, than scrupulous in his attachment to religious prejudice, desired me to inoculate five of them. A strong dose of senna was administered as preparative, and they were afterwards restrained as to diet. Three of them had not in the whole forty pustules, and soon recovered. The other two suffered much; and the eruption, though not confluent, proved fatal to one of them. Whether he had caught it before, been improperly treated, or whether it was the effect of habit of body, was not clear. These were of the true negro cast, called, Fertît. They were all under twelve years of age.

Guinea Worm.

The Mohammedans of Fûr, and the Arabs, call the idolaters in their neighbourhood Fertît, (فرتيت à فرت improbus fuit). The disease called the Guinea Worm is known among them by the same name. It is extremely common, and very troublesome to the slaves, and sometimes to free persons. It is by some esteemed contagious, which however is rather surmised than certified. It consists of a whitish tumour, at first hard and painful. Often shews itself about the knee, in the fleshy part of the thigh, and in the foot, just below the instep. As it is matured, a small white worm appears, which is to be wound off by degrees, and in coming out is followed by the discharge of purulent matter. If broken in the extraction, it is sometimes very inconvenient, and often lasts four or even six months. There is no certain cure for this disease, which most frequently shews itself in the beginning of winter, after the rains; but generally disappears at the commencement of the hot season. It seems to originate in the water, which is replete with animalcules, and which no care is used to purify.

They find by the termination of the tumour the extremity of the worm, which they call wullad-el-Fertît, and in that spot, puncture the skin with a red-hot iron, which they conceive forces it out; but which always appeared to me a painful operation, without any kind of effect. There is observed in some individuals a greater disposition to this disease than in others, but it is not confined to age, sex, or colour.

Scrophula.

The scurvy is very uncommon in Egypt and Syria. In the former I saw no instance of it. In Dar-Fûr I have observed it in the gums, but never any general dissemination of scrophulous humour appearing in the blood. As the transpiration is seldom interrupted, and generally copious, it must doubtless carry off much of the acrid humours, and prevent their accretion. Salt provisions, which generate the scurvy in the North of Europe, are almost unknown; and much of the diet of the people consists of vegetables. All these circumstances have their influence, but none of them perhaps so much as the Nile-water, which is a perfect solvent; and by the change of its component parts during the increase, has a particular tendency to throw off impurities from the blood.

Syphilis.

The disease which attacks the principle of generation, and destroys, in its source, one among the few solaces with which human life is sparingly diversified, which the heroism and the philanthropy, or the ambition and the avarice, of Europeans have propagated wherever the malign destiny of other nations has ordained that their dominion should be established, does not appear in Egypt with all the terrors that mark its course in other countries.

The temperature, the air, the mode of living, perhaps simply the first, which maintains continued transpiration, render it much milder in its effects than with us, or even in the islands of the Archipelago.

The institutes of the Prophet, indeed, have tended to diminish promiscuous concubinage, yet there is no such deficiency as to impede the propagation of the disease, if it were as virulent as in other places.

Ulcers of long duration, noseless faces, and all the disgusting consequences of this malady are indeed occasionally visible. But they are in very small number, and notoriously the result of extreme negligence, and of repeated infection, where no means have been employed to exterminate it.

It may truly be esteemed fortunate that this disease prevails with no violence in Egypt, for its only certain remedy, mercury, is there found much less efficacious than in the more temperate latitudes. Administered even in smaller doses than in Europe, it is said ptyalism is either produced very early, or it passes off with the fæces, without any visible effect.

A Frank practitioner of Kahira, accustomed to the climate, ordered two drams of Mercury in thirty pills, with Gum Arabic and Syrup of Cichory, to be taken one a day. In this case, he declared, that the pills having been administered during the first seven days, and then, with the intermission of three days, two having been given each day for five days more, had produced no visible effect on the disease, but passed off by stool. In other cases he had known much smaller doses, in the space of two days, had caused inflammation of the salivary glands, and he was obliged to abandon the use of it, and have recourse to other means of cure.

The natives, who are unacquainted with the use of mercury, and indeed of minerals in general as employed internally, are yet provided, as they say, with efficacious remedies for the venereal disease. They use flax oil, fresh, as it is expressed, from the seed. A Greek, who was in the service of Murad Bey as a mariner, (galeongi,) and who was known to me in Kahira, had been infected, and on applying to a Frank physician, was told that it would be necessary immediately to use mercurials. The man was not inclined to confinement or to regimen, and went to a Copt at Jizé, who professed to relieve the sick. This man ordered him to take two coffee-cups of flax oil every morning fasting, and directed no regimen, but that of keeping himself warm. The Greek observed none, for he continued freely the use of aqua vitæ, and even sacrificed to Venus, (for persons who have been once infected and fully cured, are, it is said, in no fear of reinfection,) and was often in the heat of the sun. He had continued this method for two months, when a general eruption took place over his body, but chiefly about the head and glands of the throat. In this condition I saw him. His Esculapius ordered him to cover the pustules of his face with a kind of red earth, found in some parts of Egypt. They gradually became dry, and came off without leaving any mark. At the end of the third month from the time he had applied to the Copt, and one month after the appearance of the eruption, the man was in perfect health, and the skin had completely recovered its tone and polish.

In the cure of the simple gonorrhea, a decoction of mallows is commonly used, and they seem to place their chief confidence in diuretics. I never heard of an injection, but from those who were acquainted with European practice. Certain herbs and roots macerated, are applied locally in case of inflammation and tension (chordee).

Shankers, &c. externally, are repeatedly washed with soap and water, and then kept covered with the red earth above mentioned. I never saw the effect, but the cure is said to be rapid.

In Dar-Fûr I have not observed the venereal disease more formidable than in Egypt. I saw a few individuals who were mutilated in the organs of generation by its effects.

The old women, who are physicians in ordinary, use a decoction of certain roots, of which I never came at the knowlege, infused in bouza, which appear to operate successfully. Gleets are frequent; and continued indulgence produces early debility and impotence.

The great advantages of the étuves, or warm baths, is evident in very many instances in Kahira. But it is difficult to admit Savary’s assertion (vol. i. p. 108) in its full extent, viz. that they operate as a radical cure of the venereal disease. They doubtless assuage many of its graver symptoms.

In no country are pulmonary diseases more rare than in Egypt, which could not happen if the baths had any tendency to cause them.

Leprosy.

The leprosy is more frequent in Syria than in Egypt. It exists however in the latter country, with all its concomitants of swelled and distorted joints, a livid, spotted, parched, and cracked skin, &c.

I have seen it under all its forms of Borras, Jiddâm, &c. In Kahira there is no provision for the unhappy sufferers, who are allowed to beg about the streets, but forbidden by their religion from the contact of others, and excluded from society by an inefficient police. I have heard of a cure of the leprosy in its worst stage, by the use of corrosive sublimate in small doses. The natives seem not to know any specific.

In Dar-Fûr, the Borras, which is not uncommon, gives to the blacks the appearance of being pyebald, changing to white both the skin and hair. A case of, what I was convinced was Jiddâm, beginning in the hands, was cured under my observation by a slave, a native of the kingdom called Baghermi, but the means he had used he could not be prevailed on to disclose.

Bile.

Complaints proceeding from too copious secretion of bile are extremely common both in Egypt and Dar-Fûr. Murâr, the bile, or gall, is the generic name for all diseases of this kind, at least in their nascent state; for they are not solicitous in the choice of names, till distinct appearances teach them to seek a more characteristic appellation. There seems to be no efficacious remedy for these maladies, and therefore they take their course; and all the inconveniences consequent upon them are common, and increased by general inattention to diet.

The tuhhâl, or tehhâl, deriving its name from the spleen, morbus spleneticus, is very frequent. One of its outward symptoms is a tumor hard to the touch, but subject to increase and diminution, in the neighbourhood of the spleen, and general inflation in the supra-umbilical region.

In Egypt Christians and the less scrupulous Mohammedans use aqua vitæ to remove the present sensation. It operates as an anodyne, which is all they seek. In Dar-Fûr the leaves of senna pulverised, and, by admixture with honey, formed into balls, (the common cathartic,) is the only medicine administered with any salutary effect. I found James’s powder of great service to those with whom it operated as an emetic. The distention of the spleen prevents the stomach from receiving a proper quantity of food, yet the inclination for food is undiminished.

The liver being rendered incapable of its functions, by repeated extravasations of bile, the blood, which at all times circulates slowly from the spleen through that gland, now much retarded, occasions schirrosities of the spleen, and at length perfectly stagnant in and distending it, it becomes corrupted by the fæces contained in the colon near it, and begins to putrify. In this state the disease frequently terminates in death. But these schirrosities sometimes remain for years, without producing any very dangerous symptoms.

The passage of the bile into the intestines being intercepted, having passed from the gall bladder to the liver, it at length returns to the blood, which occasions the jaundice, another disease not uncommon among the Fûrians, termed by them Saffafîr, and, among the blacks, first visible in the eyes.

To alleviate the effects of any unusual increase of the cystic bile, the natrôn of the country is very efficacious.

Tenia.

From the nature of their diet, which consists in a great degree of vegetables and fruits, with a large portion of sugar, honey, &c. the inhabitants of Egypt, of all denominations, are particularly subject to the Tenia or tape-worm (Dûd Ar.) I have seen pieces of vast length preserved by the European physicians, who yet appear to have found no specific for it. The natives mistake the symptoms of this disease, ascarides, &c. for distinct maladies, and treat them accordingly. The commonalty, Jews, and devout Christians, who unremittingly use insalubrious food during their fasts, are most affected with it, though none are exempt. In those who are thus incommoded, a tumor commonly appears about the navel, and discoloration of the skin next the eyes.

Bruce seems to be of opinion, that the great prevalence of worms, with which the Abyssins are much afflicted, proceeds from the common use of raw meat. Not to mention that it is not yet proved that the habitual use of raw meat generates worms in the human intestines, that complaint cannot well be more common than among the people of Egypt, who never use meat but when fully prepared by fire.

Hernia.

Ruptures are common in Egypt, chiefly among the lower orders, particularly the boatmen, few of whom are seen without a greater or less degree of this dangerous accident, and to many of whom it is fatal. Their life is almost amphibious, and it may in some measure be the effect of the pendent situation of the parts; but it seems chiefly to arise from the exertions they are obliged to make in lading and unlading their boats, and propelling them, as frequently happens, by applying their shoulders. In the people of this city, who carry heavy loads on their backs, and raise great weights, it is also common. Clumsy and ineffectual trusses are made in Kahira, which rather distress and embarrass than relieve or secure the patient. The scrotum is sometimes cauterized, and with effect, if the intestines be not incarcerated. In Dar-Fûr this disease is uncommon; yet it is sometimes seen there.

Hydrocele.

The hydrocele is remarkably frequent in Syria, and, above all, in the town of Beirût. It is also frequent in Egypt, but most among the Christians of both countries. Some attribute it to the Nile water; others to the air; others to the use, or rather abuse of aqua vitæ; others to food of a particular kind: none of which seems to be the real cause. The natives of both countries have a method of inciding securely, which discharges the water, and of course produces temporary relief: but the malady is rapidly regenerated. The only radical cure is the actual cautery, which, though unskilfully, is yet successfully applied to such patients as are bold enough to encounter the danger.

Hæmorrhoides and Fistula in ano.

The hæmorrhoides (bowasîr) are very common both in Egypt and Dar-Fûr. In the latter, they cure them by the cautery. The Fistula in ano is also seen there, and is cured by a topical application, but without incision.

Apoplexy.

I have known two instances in Dar-Fûr of what appeared to me to be apoplexy. The one was of a male slave, about sixteen years of age, the other of a man about forty; both of them of plethoric habit. The boy dropped down senseless, after having been standing near a large fire in cool weather. Pulsation ceased, and a great hæmorrhage took place from the nostrils. After one hour and a half he expired. Bleeding was recommended to the proprietor, but the by-standers would not consent, saying it was Sheitân, the devil had possessed him. The man was dead before I saw him; much extravasated blood appeared about him. He had been at work in the sun. The coup-de-soleil, properly so called, does not often occur. When much exposed in walking or at work, they protect their head from the ill effect of the rays descending perpendicularly, by winding their shirt round it, and leaving the trunk uncovered.

Umbilical ruptures.

Among the slaves, and even free persons in Dar-Fûr, prominencies of the navel, and umbilical ruptures, of greater or less magnitude, are very common. Though the chord be remarked to be larger in the negroes than with us, this circumstance must probably be occasioned by ignorance, carelesness, or some mismanagement at the birth. It does not appear to be attended with positive inconvenience. The chord, when divided, is here cauterized as in Egypt.

Accouchemens.

The accouchemens of the Arabian females are remarkably easy. There are stories of the Bedouîn women sitting down near a water and delivering themselves. Certain it is, that both the Mohammedan and Coptic females in the cities and towns are equally averse from the attendance of a man on these occasions; and however unskilful the accoucheuses may be imagined, few accidents have place.

The women of Fûr, in like manner, are assisted by their own sex, and are seldom long confined: yet nature seems to render child-bearing more difficult to them than to the Egyptians, and their care after delivery is not always such as to prevent both the mother and the child from suffering. I have known several instances where cold caught after the accident has proved of serious consequences to the mother.

Hydrophobia.

The rabies canina, or hydrophobia, is either very unusual or entirely unknown both in Egypt and Fûr. I never heard of an instance of it in either country, which appears not entirely unworthy of remark, not only as multitudes of dogs are found in each, which in many instances can have no access to water, to the want of which was once vulgarly attributed that dreadful malady, but as one fact more in the series which must finally conduct us to its cause.

Idea of Orientals respecting remedies.

Among the inhabitants of Egypt and Africa the classification of remedies is remarkably simple. They have only two grand divisions, مبردات refrigerants, and حمه heating medicines. They esteem all the former beneficial, and the latter generally pernicious: so that if the most skilful physician were to prescribe for his patient what the latter supposed to possess an heating quality, it would be impossible to persuade him to use it.

Phlebotomy.

Scarification, or superficial incision of the skin, is commonly recurred to for various diseases, and at all ages, from two years till sixty. The head, breast, loins, legs, are all subjected to this simple and apparently little efficacious treatment. Sometimes, however, violent and obstinate pains in the head, proceeding from extraordinary exertion, and other causes, are removed by superficially inciding the skin, near the coronal suture, which occasions a sufficient discharge of blood.

The other mode of bleeding is by horns, prepared for that purpose, which operate on the same principle as our cupping glasses. These are applied in a very simple manner, and without occasioning any pain, remove such quantity of blood, as the operator judges necessary. Adhesion is produced by applying the mouth to the smaller aperture of the horn, which, when this is accomplished, is stopped. The incision is commonly made with a razor.

Bruises.

The bitumen found in the mummy pits is dissolved with butter by the Egyptians, and not only applied externally, but taken inwardly, in large doses, for bruises and wounds; it is said to have a surprising effect.

Petroleum.

Petroleum, which is brought from the western shore of the Arabian gulf, near to Suez, is taken inwardly as well as outwardly applied, and is much esteemed.

Bezoar.

The Orientals have still great confidence in the bezoar, or benzoar. For a small one they are, not unfrequently, contented to pay a sum equal to seven guineas. Even the European physicians administer it in some cases pulverised, as an alterative, and, as they say, with success.

Sal ammoniac.

Perhaps none of the drugs of Egypt is more extensively useful than sal ammoniac. That medicine seems, as it were, a specific, carefully provided, for the prevailing diseases of the country. Acting mildly, both as a carminative and diuretic, nothing is more effectual to remove the cephalalgia and lassitude often experienced during the great heat, which precedes the Nile’s augmentation, than a few drops of this spirit taken in water. Pulmonary complaints, occasioned by bad air, the suffocating heat of the southerly winds at certain seasons, and the ill effect of sudden transition from the burning heat of the sun to the chilling nocturnal dew, are often relieved by it. It might even be suggested, that as regular and continued transpiration seems very adverse to pestilential infection, a proper use of sp. sal. ammon. might not be wholly contemptible as an antidote to its infection.

Aphrodisiacs.

No part of the materia medica is so much in requisition as those which stimulate to animal pleasure. The lacerta scincus, in powder, and a thousand other articles of the same kind, are in continual demand. For this chiefly fields are sown with hashîsh, the bang of the East Indies. It is used in a variety of forms, but in none, it is supposed, more efficaciously than what is in Arabic called Maijûn, a kind of electuary, in which both men and women indulge to excess. The impotence of age, and the languor of satiety or disease, ponder in vain the oracles of the descendant of Ismaîl, for the invigorating influence of the benign deity of Canopus.

Characteristics of the negroes.

A great and striking difference as to the firmness and density of the skin, between the negro and the white, whether it may or may not be called specific, as far as relates to the animal, is the cause of several peculiarities, as well when they are in health as under the power of disease. In all cutaneous maladies, or such as ultimately relieve themselves by suppuration, the sufferings of the blacks are excessive. Blows of the whip, which in a white subject would become encysted tumors, discharge, dry up, heal, and disappear in a few weeks, often remain in a negro more than a year.

The bright red colour of the muscular fibres, an apparently stronger power of contraction, and the whiteness, solidity, and weight of the bones, constitute other peculiarities. The eyes have generally very distinct vision. There are few instances of myopes, and blindness is very uncommon. The teeth are white and firm; they rarely complain of odontalgia, and retain their teeth to old age. Both the Fûrians and neighbouring negroes are attentive to preserve them clean, which is done by rubbing them with the small fibrous branches of the tree called Shaw.

Natrôn.

Natrôn is much used as a veterinary medicine.

As often as the camels, horses, asses, sheep, &c. drink, a large piece of it is put into the trough of water. The natives conceive that it renders them more eager of their food, and thus tends to fatten them. Some camels refuse it, but in general they acquire a preference for that water which is most strongly impregnated. When they refuse it, the natrôn is pulverized, formed into balls, with the flour of maize, and forced down their throats before they drink.

For the human race natrôn is used to remove the head-achs, intermittent and remittent fevers, &c. which prevail during the rainy season. Two or three ounces of crude natrôn are dissolved in water, and taken fasting. It operates as a drastic purge, and with some as an emetic. With robust and plethoric habits, there seems to be no inconvenience from the use of it, but I experienced from it an unfavourable rather than beneficial effect.

Tamarinds.

The tamarind, Thummara Hindi[51] one of the most useful as well as valuable of the productions of the country, supplies the want of many others. In defect of lemons and other acids, this fruit, mixed with water, constitutes an agreeable and refreshing drink. When dried by beating in a mortar, it is formed into cakes, each of 2 or 300 drams in weight. The decoction of it is a mild cathartic, and also operates as a diaphoretic; and the natives attribute to it superior virtue as an antidote against certain poisons.

Lactation.

Savary remarks, that in Egypt each mother affords nourishment to her own infant, even in compliance with a command of the Prophet, and that this prevents many diseases. No doubt can exist that the milk of the mother, long secreted and reserved for the child, is the proper nourishment at the birth, and by its acrid quality tends to facilitate the evacuation of the fæces, accumulated during the period of gestation, much better than any thing that can be substituted in its room. But when this effect is once produced, in many cases the milk of any other woman may be better than that of the mother; nay, that of the mother may be insalubrious à principio; and it is as yet far from being proved, that the milk of the mother is in all cases the best possible milk for the child.

If the mother abstain not from the male embrace, and become gravid, the milk becomes, as is well known, poison to the offspring.—The Arabic language has even a single word to express, quæ lactans consuescit viro, which they conceive extremely injurious.

Opium (Ar. Aphiûm).

The use of opium, as is well known, is carried to excess in Constantinople. Some persons have so long accustomed themselves to that powerful drug, that a dose of two drams, or more, will have no effect in exhilarating them, or producing that agreeable stupor which they seek. In such cases, they will swallow, in a convenient vehicle, several grains, to the amount, it is said, of ten, of corrosive sublimate of mercury, as a stimulus.

This effect of opium, as an antidote to one of the strongest mineral poisons, appears incredible, and would scarcely have been related, but on authority the least questionable. A reflection has in consequence forced itself on me, which I offer as a query. Mithridates, king of Pontus, is said to have so fortified himself with antidotes, that when misfortune obliged him to have recourse to poison to terminate his existence, though repeatedly administered to him, under different forms, it had no effect. Pontus, at that time no less than at present, furnished the best opium. Could Mithridates have used any antidote so powerful? And was not this effect of that drug more likely to be known in its native country than any where else? It may possibly be replied, that mineral poisons were not then in use, and that to the small number of vegetable ones then known, many other antidotes, capable of producing the same effect, might have been found. It is not however enquired, whether single antidotes might not have been found to obviate the influence of distinct poisons, but what could produce so complete a change in the human body, as that no poison should have any effect on it?

Circumcision.

The practice of circumcision may be traced to such remote antiquity, that its origin baffles all research: yet apparently its history has not received all the illustration of which it is capable from a diligent collection of facts. It has been ascribed to the structure of the organs, in certain countries, which it is said impede coition, or facilitate the appearance of morbid symptoms. But what may have been perfectly true of individuals, it may perhaps not be permitted to assume with regard to a whole nation, much less with relation to the inhabitants of an extensive region.

Among the Fûrians circumcision appears to be no other than a religious ceremony, performed in compliance with an express command of the author of their faith; and it is very doubtful whether it was ever practised among them before their conversion to Mohammedism. It is now often neglected till the male have attained the age of eighteen or more years, and this omission seems to be considered by them as a matter of indifference; nor are there persons who habitually and regularly exercise that art, as in Egypt and other Mohammedan countries.

Excision.

The excision of females is a peculiarity with which the Northern nations are less familiar: yet it would appear, that this usage is more evidently founded on physical causes, and is more clearly a matter of convenience, than the circumcision of males, as it seems not to have been ordained by the precept of any inspired legislator. A practice so widely diffused, it may be said, was hardly invented but to remedy some inconvenience commensurate in its extent. But, if so, how happens it that one race of idolatrous negroes, near Fûr, has a habit of extracting two or more of the front teeth of children before puberty? That it is customary with another race, in the same quarter, to file the teeth to a point[52]? that other nations cut open a second mouth? and innumerable other singularities which prevail among savages, and are as little to be reduced to any principle of convenience or utility.

This excision is termed in Arabic Chafadh خفض, and the person who performs it خافضة. It consists in cutting off the clitoris a little before the period of puberty, or at about the age of eight or nine years[53].

Strabo is apparently the first who mentions this custom, which is nevertheless undoubtedly very antient. Lib. xvii.

—και τα παιδια περιτεμνειν, και τα θηλεα εκτεμνειν, &c.

By the terms very well marking the distinction between this operation and the circumcision of males.

The Mohammedans of Egypt conceive it to have no connexion with their religious creed. Similar are said to be the sentiments of the Christians of Habbesh. In Dar-Fûr many women, particularly among the Arabs, never undergo excision: yet it has not been my fate to see or hear of any of those κλειτοριδες μεγαλαι which are supposed to have brought it into vogue.

Thirteen or fourteen young females underwent خفض in an house where I was. It was performed by a woman, and some of them complained much of the pain, both at and after it. They were prevented from locomotion, but permitted to eat meat. The parts were washed every twelve hours with warm water, which profuse suppuration rendered necessary. At the end of eight days the greater part were in a condition to walk, and liberated from their confinement. Three or four of them remained under restraint till the thirteenth day.

It often happens that another operation accompanies that of excision, which is not, like the latter, practised in Egypt, viz. producing an artificial impediment to the vagina, with a view to prevent coition. This happens most frequently in the case of slaves, whose value would be diminished by impregnation, or even by the necessary result of coition, though unaccompanied by conception. But it is also adopted towards girls who are free; the impulse being too strong to be counteracted by any less firm impediment. This operation, like the former, is performed at all ages from eight to sixteen, but commonly from eleven to twelve; nor are they who undergo it always virgins. In some the parts are more easily formed to cohere than in others. There are cases in which the barrier becomes so firm, that the embrace cannot be received but by the previous application of a sharp instrument[54].

Among some tribes of blacks, there exists a practice of piercing the skin in certain forms by way of ornament.—Each of the punctures leaves an indelible scar, as distinctive as colour, which is not used. This practice, which is of the same description as that of some of the South-sea islands, is used on the face, breast, loins, &c.

The blacks who are castrated for the use of Kahira or Constantinople, undergo that operation in the Upper Egypt, before their arrival at the former; some families, there resident, having the hereditary exercise of this antient practice.

The numbers which undergo it are not very considerable, and it is fatal only to a very small proportion of them.

Those slaves which are emasculated for the exclusive use of the Fûrian monarch suffer within his palace.