ii. The spiny processes on the upper end of the tibia are not

included in the measurement of its length.

Immature limb-bones are recognised by the line which demarcates the extreme ends, or epiphyses, from the shaft (or diaphysis). Sexual differences are chiefly indicated by greater length, stoutness, and also by the development of osseous ridges in male bones.

10. The measurements of the long bones are used in estimating the _stature_. Special notice is to be paid to individuals of giant or of dwarf stature. In this connection particular mention should be made in the following instances:—

(_a_) Where the thigh bone measures more than 52 cm., or less than 36 cm.

(_b_) Where the shin bone measures more than 42 cm., or less than 28 cm.

(_c_) Where the fibula measures more than 41 cm., or less than 28 cm.

(_d_) Where the upper arm bone measures more than 37 cm., or less than 26 cm.

(_e_) Where the ulna measures more than 29 cm., or less than 20 cm.

(_f_) Where the radius measures more than 27 cm., or less than 19 cm. (only adult bones being considered, and the sex, where known, recorded).

11. Adult skulls will also excite attention when the horizontal circumference (measured in accordance with the directions provided above) is greater than 56 cm., or less than 47 cm.

VI.

INDUSTRY AND COMMERCE.[16]

_By SIR JOHN SCOTT KELTIE, LL.D., formerly Secretary, R.G.S._

The kind of information desired under this heading may be summed up in the three following questions, so far as uncivilised or semi-civilised countries are concerned:—

(1.) What are the available resources of the country that may be turned to industrial or commercial account?

(2.) What commercial products can find an available market in the country?

(3.) What are the facilities for or hindrances to intercourse between the country and the rest of the world?

Or, briefly, (1) Resources; (2) Wants; (3) Accessibility.

These include the questions of suitability for immigration and colonisation.

What is known as commercial geography is one of several special applications of geographical knowledge. From this practical point of view, therefore, the observations collected under other heads in this book will be of service, especially if the requirements of commerce are kept in view at the same time as the _desiderata_ of science. From this standpoint, the sections on Meteorology, Geology, Natural History, and Anthropology should be consulted. Even general geographical and topographical observations will be of practical service—the general lie of the country, its altitudes, and its character at certain altitudes, its mountains, hills, valleys, plains, rivers—if regarded from the special standpoint of habitability and possibilities of development.

The suggestions contained in this, as in the other sections of this manual, are meant both for the ordinary explorer or traveller who may have to pass rapidly through a country and for those who may have more opportunity for making leisurely observations. To the former the following brief hints may prove serviceable:—

Observe and note—

1. As regards RESOURCES:—

The extent or quantity, quality, facilities for raising or collecting, for transport and shipment, etc., of

(_a_) The natural products, such as minerals and metals, especially gold, silver, coal, iron, copper, tin, nitre, guano, phosphates, etc.; timber useful for various purposes; vegetable products, useful for food, fibres, dye-stuffs, or medicine—gums, resins, etc.; animal products useful for food, skins, fur, feathers; riverine or lacustrine products, useful for food, oil, or other purposes.

(_b_) Substances cultivated for food or for manufacturing purposes.

(_c_) Articles manufactured for clothing, for domestic, warlike, or other purposes.

(_d_) Native methods of developing resources, of carrying on manufactures, and of transport.

(_e_) Practicability of developing the resources of the country by European methods.

2. As to WANTS:—

(_a_) What particular things used by the natives could be profitably supplied from the outside?

(_b_) What do the natives lack that might be introduced and supplied from the outside?

(_c_) In all cases be particular to note favourite materials, shapes, colours, or other peculiarities, as of cloths, implements, ornaments, such as beads, anklets, etc.

3. As to ACCESSIBILITY:—

Note the nearest ports and railways; the character and connections of native roads, if any; the navigability of rivers, inlets and lakes for various kinds of craft at various seasons of the year; heights of passes, whether suitable for animals or only for porters, whether blocked at any season of year; routes likely to be suitable for railways.

In all cases where practicable, specimens of products should be obtained, in order that specialists at home may judge of their industrial or commercial value.

For those who may have more leisure for observation, some or all of the following detailed hints may be useful:—

MINERALS AND METALS.—It is not necessary to add much here to what has been said under Geology. If the traveller is not himself competent, or has no opportunity to test the value of these products, he should bring home specimens; this, if possible, should be done in any case. Under this section a look-out should be kept for any indication of naphtha, asphalt, or mineral oils. From the commercial point of view the important points are—

_Quality._—To what extent are minerals or metals, as gold, copper, iron, phosphates, mixed up with other matter? What is the yield per ton of ore? In the case of coal, how does it burn, and what is the percentage of ash? Next—

_Quantity._—Does the substance occur in sufficient quantity to make it worth expenditure of capital and labour? The information must be obtained by personal inspection. Finally—

_Locality._—Is the situation of the deposits easily accessible? How are they situated with reference to routes, existing or practicable? and how with reference to ports of embarkation? Could they be worked with the resources available in the country, or would labour and machinery require to be introduced? If worked in the country, is there any neighbouring market for the manufactured products? What are the native processes (if any) of obtaining and working minerals?

We must again refer to the section on Geology for further details, and the intending traveller would do well to take a few lessons before he leaves, so as to be able to recognise the most common and useful minerals and the conditions under which they usually occur; he will thus save much time and trouble.

VEGETABLE PRODUCTS.—The directions for observation and collection given under the Botanical section should be attended to; and it is important that the traveller should be able to recognise the chief classes of plants, so that specialists may be able to pronounce generally on their utility.

_Character of Surface._—The general character of the surface of a country, so far as its vegetation is concerned, should be clearly grasped. What proportion, or, if possible, what area is under forest? what under grass? what desert, or mountain, or marsh, or uncultivable? what under cultivation?

_Forests._—If of a generally forest or thickly-wooded character, are the forests extensive and dense, with much undergrowth, as in tropical South America? or easily penetrable, as the forests of Europe and North America? Or are the trees scattered, either in clumps, or singly, as in a great part of Central Africa? Do they prevail over the country generally, or are the river-banks only lined with dense tree vegetation? Are the forests only found in the low country, or do they cover the hills and extend up the mountains?

_Timber._—Ascertain the leading characteristics of the trees of the forests. What are the prevailing families, and, if possible, genera and species? What uses, if any, do the natives make of the woods? Which do they use for their houses, their furniture, their canoes, their weapons, their ornaments? How do the woods seem to stand tear and wear, the climate, the attack of destructive insects, immersion in water? Are there any woods that would do for such purposes as railway-sleepers or telegraph-poles in the conditions which prevail in the country? Any ornamental woods suitable for cabinet purposes?

_Fibres, Fruits, Chemicals, etc._—Are there any plants the fibres of which could be turned to account? Any fruits adapted to human consumption, and are they found in any quantity, or could they be cultivated?

Are there any trees or other plants suitable for drugs or chemicals—bark, leaves, juices, roots? What medicines, narcotics, or stimulants are used by the natives? how are they obtained and how prepared?

Are there any species of useful plants growing wild—coffee, sugar, cotton, vanilla, spices, etc.? Any trees producing gums that might be of commercial value, like gum arabic, gutta-percha, or caoutchouc? Or any whose fruits yield oil, like the cocoa-nut and the olive? Do the natives make use of these juices? What are the processes of extraction and preparation?

_Other Vegetation._—When there is an undergrowth, its character should be noticed, and the diseases, if any, to which trees are subject.

Note what other vegetation exists besides that of trees. Are there any plants like the turnip, the potato, the batata, which are useful as foods, or for other purposes? Specimens of any herbs likely to be useful should be obtained, especially if they are used by the natives for medicine, for dyeing, for poison, or other useful purposes.

Sometimes, as in Central and Western Australia, what arboraceous vegetation exists consists mainly of shrubs, the character of which should be noted. Do they hinder locomotion? Are their shoots useful for forage? Are they injurious to horses and cattle?

When there is herbaceous vegetation of any extent, what is its character? Is it tall and coarse and reedy, like much of the African grass? Or such as is found on the prairies and pampas? Or of a troublesome spinifex character, as in Australia? Or of a turf-like character, like the grasses of Europe? What are the components of this kind of vegetation, and how far is it likely to prove useful as fodder? What uses do the natives put it to, either for their animals or for manufactures? Do they use it for making mats or cloth? Are there any plants mixed with it injurious to animals? What is the condition of the grass at different seasons of the year? When is it at its best, its strongest, its densest? Is it liable to be parched up at any season? To what extent is its condition affected by the climate, by rainfall, by irrigation, natural or artificial? Is it easily removed, in order to make way for other cultures? Does it spread into the forest region, and has it any special characteristics there? How does it, as well as other useful vegetation, vary with altitude or other local conditions? Do the products change under different agricultural conditions? e.g., some are poisonous under certain conditions, not others?

_Marshes, Deserts, Irrigation._—Note if marshes or peat-bogs, or other special features of the surface exist to any extent, and whether the drainage of marshes is practicable.

Where deserts exist, note their character. Are they sandy, gravelly, rocky, salt? What is the prevailing rock? If the desert character of the land (as is generally the case) seems due to want of water, is there any artificial means likely to be available for supplying that want? Is there any storage of water and irrigation among the natives? and, if so, how is it accomplished? and what are the results? Are there any sources within reach, either above or underground, from whence a supply of water for irrigation purposes could be obtained? Indicate any exceptional defects of quality in the supply of water.

Note if any part of the country is liable to periodical inundations. At what periods of the year do they occur? Are these inundations destructive, or are they utilised for agricultural purposes? Would it be possible to regulate these inundations?

AGRICULTURE.—The general outcome of all these observations is the suitability of a country for agricultural development. What articles do the natives cultivate, if any? Has the cultivated land any special character, or is it simply the ordinary land cleared of trees or grass, or other wild growth? Note the methods and implements of culture used by the natives; the seasons of sowing and reaping, and preparing the crops for use. Do they depend for water on rainfall or irrigation? To what altitudes is cultivation carried, and what are the crops that prosper at these altitudes?

From the point of view of colonisation and agriculture, precise information as to the nature of the soil is desirable. The proportion or extent of a country suitable for agriculture might be noted. Observe, as precisely as practicable, the nature and depth of the upper layer of soil. The depth—it may be a few inches, or it may be two or three feet—can easily be ascertained. A general idea may also be given of its nature. Is it mostly vegetable mould, as it is likely to be in old forest or grass countries? or peaty? or marshy? If possible, also, ascertain the depth of the subsoil down to the rock or clay, or other permanent basis on which it rests. In a general way it might be observed whether the soil is sandy, gravelly, stony, calcareous, marly, clayey. Also is it compact, tenacious, or loose, and, above all, is it permeable or impermeable to water? Is the soil very dry or very moist? or what is its intermediate stage?

If the natives carry on cultivation, ascertain, if possible, the yield per acre of what they cultivate. Do they cultivate only for their own wants? If not, where and what is the nature of the market to which they send the surplus?

Does the country seem suitable for other cultures besides those carried on by the natives?

ANIMAL PRODUCTS.—If there are wild animals in the country, observe whether the natives hunt them for what they yield in the way of food or other useful products. Are there any ivory-yielding animals, or animals whose skins can be turned to profitable account? Could a sufficient supply for mercantile purposes be obtained by means of native hunters, if properly encouraged; or how would it be best to work such resources? Are there any laws or customs enforced by the natives in hunting wild animals? Are there any noxious wild animals, and to what extent do they affect human comfort and human life?

_Domestic Animals._—It is important to know what domestic animals the natives possess, how they are reared and fed, and what uses they are put to. Also whether the country is good for horses, cattle, sheep, and poultry, and approximately what is the extent, situation, and accessibility of the grazing-lands. Are the pastures perennial? To what extent do they depend on rainfall, or irrigation, or on intermittent streams? During what months of the year are they available? Are there any plants among the pastures injurious to animals? Are there any insects (like the _tsetse_) or other animals injurious to cattle or horses? Do horses or asses exist among the natives, and what uses are they put to? If not, would they be likely to flourish, if introduced?

_Fisheries._—Information concerning fish and fisheries is desirable; and among fish, from the practical standpoint, are included shell-fish (especially pearl shells), sponges, corals, and animals of the whale and seal kind. If the natives practise fishing, either in lakes, rivers, or the sea, ascertain the kinds of fish they capture, their methods and implements, and the particular seasons at which fishing is practised. Are the fisheries, whether worked by the natives or not, likely to be of commercial value?

TRADE.—Much of the information suggested above will be of service from the special commercial point of view, especially with reference to export. Information should be obtained concerning any manufactures carried on by the natives besides what has been suggested above—manufactures in metal, in wood, in clay, or stone; in materials derived from the vegetable and animal kingdoms, what they are, what uses they are put to, what processes are used, and to what extent, if any, they form articles of trade. With regard to the import market, what generally are the wants of the natives and what new wants might be created. If possible, some approximate estimate of the value of the leading classes of imports, if there are any, should be obtained.

Ascertain if any goods are brought into the country from the outside; if so, what they are, where they come from, and as accurate an estimate as possible of quantity, or value, or both. In the case of imports from civilised countries, are those of any particular country preferred, and, if so, why? Is it owing to anything special in quality, or pattern, or cost, means of communication, or in quantity available? Is there any special tribe of middlemen who prevent the inland people from coming into direct relation with traders? Probably a market could be created for outside manufactures which have not as yet been introduced into the country; or such manufactures might easily obtain a market in preference to those of native make. Note especially the patterns of articles of native make, as these are probably adapted to the conditions of the country, and should therefore be imitated or improved upon in the case of imported goods, the quality of the latter being better, and the cost, if possible, lower. British traders, especially, often incur serious losses by not ascertaining in advance what particular articles and what special patterns are in demand among natives. Note also whether European methods might not be introduced with advantage for the manufacture of native goods. Native usages as to credit ought to be ascertained, what safeguards are binding, what is the medium of exchange, etc. It would be useful to discover beforehand whether the importation of machinery and explosives is likely to be unimpeded.

CLIMATE.—This is an essential item, so far as the exploitation of tropical and semi-tropical countries by Europeans is concerned. Its main elements are determined by temperature, latitude, altitude, and rainfall; the character of the surface should also be taken into account. Under Meteorology, the main directions on the subject are given. The temperature at different seasons and at different times of the day (say 9 A.M., 3 P.M., and 9 P.M.) should be ascertained, and that at various altitudes. Rainfall observations are not of much service unless they can be obtained over a continuous series of years. Ascertain the distribution of rainfall over the year, and the limits of the rainy period of the year, when such period exists, and, if possible, the quantity which falls in the different months of the period; how does the rainfall differ with altitude and other topographical variations? If a country is subject to droughts, it is important to ascertain if there is any periodicity in these droughts, and how they affect the resources and prospects of the country, and the condition of the rivers. Would it be possible, by storage of water or other means, to counteract to any extent the bad effects of drought?

What effect has the rainy period and the drought period on the native inhabitants, and especially on Europeans? As far as possible, ascertain the birth and death rate per annum.

FACILITIES AND HINDRANCES TO COMMERCIAL DEVELOPMENT.—Under this head the first consideration is Accessibility or Means of Communication. Generally, the quickest, cheapest, and safest routes to a satisfactory market should be ascertained.

_Water Communication._—Observe what natural means of communication exist, what is the nature of communication between the country and the outside world. If communication by sea is of importance, how is the interior to be reached from the sea? Are there any deep inlets? Is there practicable river communication? For what sort of vessels is it adapted? Are there any obstructions in the river, and, if so, what is their nature, and how could they be surmounted? What is the width of the river, the depth of the water, and the force of the current, at various distances from the mouth, and at the periods of the year when the river is at its lowest and highest? Are there any lakes that could be utilised for communication?

_Roads._—If there are native roads, state precisely what is their nature under various conditions of weather; their width; what sort of vehicles, if any, they are suited for, and where they lead to. If the country is mountainous, ascertain the principal passes, what places they connect, their exact heights at the highest point (not the heights of the mountains), for what animals or vehicles they are practicable, or if only for porters, and what is their condition at various seasons of the year. If the natives have any vehicles, or vessels, or other means of transport, describe them.

_Railway Routes._—Observe, as far as possible, suitable routes for railway or canal communication, as well as for good roads, and whether any materials for railway construction are obtainable in the country. Possibly the country, if an inland one, could be connected by road or rail with some existing railway system. What are the nearest telegraph stations?

_Labour._—Another important consideration under this head is that of labour—labour for the varied enterprises connected with the development of a country’s resources. Is labour obtainable within the country itself? If so, to what extent, and on what terms? Are the natives industrious, and are they likely to labour under foreign superintendence? Does slavery or forced labour in any form exist? If not obtainable in the country, how may labour be most easily and cheaply obtained? Is the country suited to manual labour by whites? If there are only certain kinds of labour in which whites may engage, state what they are.

To what extent could machinery be used with advantage? Is there any water power available? or any animal power?

_Currency, Tariffs, etc._—Under this head also questions relating to currency should be included, or whatever other medium of exchange exists.

Another important consideration here is the question of tariffs, which, in one shape or another, exist in nearly all uncivilised and semi-civilised countries, from the hongo of Central Africa to the Customs duties of Eastern countries. Precise information concerning these, both as to exports and imports, is important.

Note, also, as precisely as practicable, the cost of living for Europeans settling down for a time, and the expenses involved in travelling through a country.

_Inhabitants._—Is there anything in the character of the natives—physical, mental, or moral—likely to affect commercial intercourse or the industrial development of the country? Any prejudices or superstitions that should be attended to? Anything in the attitude of natives to traders and settlers deserving consideration? Is the population nomadic or settled? What material, if any, do they use for smoking, and what is the nature of their intoxicating drinks, if they have any? Estimate, as nearly as possible, the population, the density per square mile, both for the country as a whole and for the chief centres of population. Ascertain the nature of any political or social organisation which exists. What are the terms on which land can be acquired? What are the prevalent crimes? Under the Anthropological section directions are given for ascertaining the leading racial characteristics of the people.

VII.

ARCHÆOLOGY.

_By D. G. HOGARTH, C.M.G., M.A., D.LITT._

This section is intended, not for experts, but for those travellers without special interest or experience in archæological work, who, finding themselves in districts where unpublished antiquities exist, feel it incumbent to record or rescue them. General hints, therefore, are subjoined on methods of recording, cleaning, temporarily conserving, and conveying monuments and objects of antiquity.

A.—RECORDING.

There are three ways of obtaining a record of a monument, all of which should be used if possible in cases of importance:—

1. Mechanical reproduction by photography, moulding, or rubbing.

2. Reproduction by planning, drawing, or otherwise copying.

3. Literary memoranda of characteristics, _e.g._, dimensions, subject, etc.

1. _Mechanical Reproduction._

_(a) Photography._—This subject has already been dealt with in Part II., and it is only necessary here to add a few hints, peculiarly applicable to the photography of objects of antiquity.

_Of inscriptions_ photography does not, as a rule, supply a useful reproduction, and unless time or other opportunity be wanting, it should not be the only mechanical process applied. If an inscription is at all worn, or the material on which it is engraved contains superficial faults, do not rely on a photograph; but if one is taken, try to dispose the object so that light falls on it from one side, with a slight obliquity from above. In the case of rock inscriptions or others still in their place on walls, etc., a photograph should be secured to show relative position and surroundings. An inscription on dark material will often need preparation with white chalk before being photographed to any good purpose; but the traveller who has opportunity to do that, will probably have equal opportunity to employ the better process of moulding.

For _sculpture_, photography will often be the only method of reproduction possible to the traveller. When that is the case he may be advised (1) to take his photographs on the largest possible scale; (2) to take the object from all possible points of view; (3) to do what he can to improve the light and relief of the subject. Small objects gain enormously by reflected lights carefully arranged to bring out their contours; if sufficient mirrors are not obtainable, strips of tin or even white paper will serve as reflectors. Backgrounds may be chalked or blacked as the case may be, but in the case of a relief this should only be done when the outlines are very clear. If a sculpture on rock or other material is much broken or worn, a good mechanical method of improving relief, which Professor Petrie recommends, can be used; this consists in dusting the face with powdery sand and then fanning it. The result, if carefully done, is to leave hollows and background in strong contrast to the surface of the relief. Highly polished or lucent surfaces should be dulled before photographing. Metal objects do not, as a rule, photograph very satisfactorily; and of coins it is much better to take a cast and photograph that. Perhaps it is not superfluous to remind the photographer to make notes of all colouring before leaving his subject. On preparing sculpture, etc., for photography there are valuable practical hints in Professor Petrie’s ‘_Methods and Aims in Archæology_,’ Chapter VII.

For _small objects of antiquity_, photography is not of much service unless a camera with very long extension can be used. If it be possible, the best way is to lay the objects on a sheet of glass raised about a foot from the ground on a frame, and arrange the camera above, so as to photograph downwards. This process obviates all ground shadows, and all pins or other supports for the objects, which appear sharply on the negative as if suspended in air.

For _buildings_ photography is, of course, the only method of mechanical reproduction possible.

(_b_) _Moulding._—This in almost all cases will have to be done by impressing _paper_. Only in the case of small objects will a traveller ordinarily be able to use either _plaster of Paris_ (if he can procure it) or _sealing wax_. As to the latter he may be reminded never to heat his wax by putting it in direct contact with a flame, or the impression will come out so parti-coloured or black as to be of little use; a card should be held over a candle or lamp, or, better, a spirit burner, and the wax rubbed upon the gradually heating upper surface till enough has melted on to the card without boiling. A useful impression may be obtained of coins, gems, etc., by pressing ordinary tin foil upon the surface; but great care must be taken afterwards that the impression does not get flattened out in transport. Mr. Petrie recommends floating impressed foil on water face downwards, and dropping hot wax upon it, as a solidifying agent.

As to the use of plaster of Paris it may be remembered that (1) the proper mixture is just as much plaster as will absorb the water, leaving none standing on the top; (2) the object must be well cleaned and soaped before being moulded; (3) the plaster must be applied _very rapidly_, in a thin coating all over the object at once: it can be backed with more plaster afterwards; (4) a surface of any size should either be moulded in sections, or, if done all at once, the plaster will probably have to be cut into sections afterwards for transport. To cut it, it is best to lay strings upon the object before moulding, which, later, can be pulled up through the plaster while still viscous.

_Paper moulding_ or ‘_squeezing_’ is, however, the ordinary process employed. Any fairly strong _unsized_ paper will serve more or less well, but a special ‘squeeze’ paper is procurable in most large cities where there are archæological museums (_e.g._, in London, from Nutt’s, 57 to 59, Long Acre, W.C.; in Paris, from Moreau’s, 11, Passage du Pont Neuf; in Berlin, from Ebers Brothers. It can also be got direct from the maker, Papierhändler Dorr, Spiesgasse, Strassburg.) Mr. Maudslay recommended in a previous edition a hand-made paper, used for packing oranges in Spain, and to be obtained of Messrs. Batalla, of Cacagente, near Valencia, through the agency of Messrs. H. King & Co., Cornhill. Failing these, the paper on which the commoner news-sheets are printed will do. The other implements needed are a sponge, and close-bristled, not very hard, brushes of two or three sizes, _e.g._, an ordinary clothes-brush, a nail-brush, and a tooth-brush, if no others are at hand, but special brushes with hand-straps on the back, or curved handles to keep the knuckles of the beater away from the stone, are preferable. In the case of an ordinary inscription, of not specially rough or uneven surface, brush and clean the stone thoroughly, and pick all accumulation out of the letters; then wet it thoroughly all over; lay the dry paper, cut to size, as flat on the surface as possible, and dab it down with a very wet sponge till thoroughly soaked; take the largest brush and pound the paper rather gently all over, till it partially adheres; then take smaller brushes and work the paper into all depressions with the maximum pressure you can exert; finally, hammer it with the large brush again, working systematically from top to bottom or side to side, not minding the surface becoming mashed, and driving the air-bubbles, which collect under the paper, before you and out at the farthest point. If the stone was thoroughly wetted before the paper was laid on, these ought not to be numerous or troublesome. Then, if the surface of the stone has penetrated through the paper at any point, lay a second sheet and, if necessary, a third, or more, and treat as the first was treated. Leave the sheets, if possible, to dry on the stone, and all will come off as one with a perfect reverse impression of the stone’s surface. Some soak the paper before laying on the stone, but if that is done and there be any wind, the paper, become very tender, will be apt to tear with its own weight while being laid on, and will be difficult to lay flat. If for any reason, _e.g._, overhanging of the stone’s face, it is difficult to make the paper adhere, the task will prove easier with small pieces. But whenever a surface is squeezed by sections, the operator must be careful to make the edges of his sheets overlap, so that later all can be gummed together as one sheet; to number the sheets according to a key-plan, recorded in his note-book, and to mark on the sheets themselves the lines of junction. All superfluous edges should be peeled off, as they are apt to lift in the wind and cause all or a part of the impression to become detached before it is well set, and weights should, if possible, be laid on the drying paper. If for any reason the paper cannot be left to dry in position, peel off carefully and lay out to dry reverse side uppermost. The impression, so taken, will be hardly less good. When dry, roll the squeeze inside a tin cylinder, and only very rough usage will harm it.

Squeezing sculptures is a more difficult matter. Mr. A. P. Maudslay gave very full directions in an earlier edition of these “Hints” which may be repeated here. After stating that all moulds of sculpture have to be made of many thicknesses of paper, with a good coating of paste between every few sheets (not only because of the great inequalities of surface, which break through the paper, but also in order that the mould, when dry, may be stout enough to keep its shape), he said:—

‘Paper can only properly be applied for the purpose of moulding when the carving is free from large contours and deep undercutting; but it is wonderful what accurate results can be obtained even when large curves and some undercutting have to be contended against. Where worn or splintered parts of a wood-carving, or fissures in a stone, or deep undercutting which is not essential to the design, occur, it is often of advantage to fill them up with clay or paper, to which a smooth surface can be given, so that the mould will come away free from them when it is dry; and careful notes and measurements will often enable one to restore the contour to a mould which has suffered some pressure in transport. In a properly-made mould the detail of carving is never lost, unless the paper itself is destroyed.

‘A shallow tin bath (or two made to fit inside one another), large enough to hold an open sheet of paper, is useful for soaking the paper in.[17] Twenty sheets or more may be placed in the water at once, and left there without harm for an hour or more; but a few minutes’ soaking is quite enough.

‘I have several times had to mould, in America, the whole of a monolithic monument—one as much as 25 feet in height—covered with carving and hieroglyphic inscription, and have been perfectly successful in reproducing it in plaster in England. Each face would be marked out into three or more sections, and each section would be moulded separately, great care being taken that each mould should considerably overlap the margin of the other, so that when each section is cast in plaster the edges of the cast can be cut away until the joint is perfect. And each section should also overlap at the top and sides in No. 1, and at the sides in No. 2, &c., for the same reason; and it is necessary to pay careful attention to the beating in of the paper near the sides and edges, as it is there that the layers are most likely to come apart when dry. These edges can be trimmed down afterwards, if found too bulky in packing.

‘The first sheets of paper should always be put on singly, and well beaten in. If the carving presents many sharp angles, the paper will again and again be broken away over them, and small scraps of paper may be used for covering them up, until the whole section is covered at least three papers deep in the thinnest place. The coat of paste should then be given. If the paste is laid on when the mould is too thin, it will penetrate to the stone, and prevent the mould coming off when dry. The paste may be put on warm, but if too hot it draws the paper from the stone (if it is a stone sculpture); air gets underneath the paper, and it is very difficult to get rid of it again. Avoid, in putting on the first papers, doubled edges or creases, and beat in well, so that the paper may work into the grain of the stone or wood. It is easy to spoil a mould by scamping the work in it, but not easy to spoil it by overbeating. After giving a coat of paste with a brush, it is advisable to work in the paste with the fingers, so as to be sure, from the smooth feeling, that it penetrates the paper over the whole surface.

‘After the first coat of paste has been applied, a good deal of time may be saved by employing an assistant to beat out the paper for the further thickening of the mould, for when thus beaten out, two or three thicknesses of paper can be laid on at the same time. Take about six sheets together from the water, fold them, and then double them twice, and slightly tear the wet doubled edges, so that when the sheets are laid open again there are a number of small slits in the paper; then lay them out together on any flat surface, and beat them out with a brush for a few minutes. It is easy to separate them again into the required number of sheets in thickness.

‘Another method which is equally good, if not better than the last, is, after making the tears in the doubled sheets as before, to unfold them, and then to roll them together and twist them up like a rope, and rub them well between the hands; then unroll them and beat them out for a moment, separating as many sheets as are required. Either of these processes loosens the fibre of the paper, whilst the slits prevent it stretching unevenly. After this treatment it feels to the touch more like wet leather than paper.

‘As the mould grows thicker the pulpy paper will, from the continual beating, find its way into, and fill up, the deeper cutting; but it should be most carefully watched that the mould is not left too thin over the more prominent parts of the surface, and, with a little practice, the thickness is easily judged by the touch. It is always well to use the fingers frequently both in pressing the paper into its place and working in the paste.

‘It is difficult to lay down any rule as to the thickness of a mould and the number of coatings of paste necessary. If the mould is of large size, and the carving presents prominent angles or large curves, it may need an average of thirty sheets in thickness to preserve its shape, and three or four coatings of paste; but if the carving is in low-relief on a flat surface, less than half the thickness will suffice.

‘In hot weather, out of doors, a mould will take about twenty-four hours to dry; but it should be covered up at night from the dew. In damp forests or in bad weather I have dried most of my moulds by building up large wood fires at the distance of a few feet from the sculpture.

‘It is best to take off a mould when it is cool—in the morning or evening. _Don’t be in a hurry about it._

‘If the mould is torn or broken in taking it off the carving, mend it with paste _at once_.

‘When a mould is taken off, lay it to dry in the sun on a flat surface, as there is usually some moisture left in it. If the mould is not flat in shape, support it carefully, so as to preserve the contours.

‘When the mould is quite dry, it is advisable, but not necessary, to give it, both back and front, one or more coats of boiled linseed oil. Heat this oil before applying it, and it will then soak in well, and use either a soft brush, and be careful, in oiling the surface of the mould, not to rub too hard. As the paper easily absorbs moisture, the moulds need to be carefully packed.’ Plaster casts can be taken very successfully from paper moulds. See directions for casting above.

(_c_) _Rubbing_ can only be practised on a fairly smooth surface, and has nothing to recommend it except the ease and celerity with which it can be done. The traveller may as well carry a little heel-ball in his kit. Any thin, tough paper will do.

2. _Other Reproductions._

_Planning_ and _drawing_ are dealt with in Vol. I. of these ‘Hints.’ _Copying_, as distinct from either, applies to inscriptions. A hand-copy of an inscription as well as a mechanical reproduction should always be made, partly because it has the better chance of surviving the accidents of travel, partly because, if a stone surface is at all perished, anyone with a keen eye and power of concentration ought to see more lettering on its worn parts than will appear on a photograph or ‘squeeze.’ The copy should be as near a facsimile on a reduced scale as time and other considerations will allow. It should be made on ruled paper, if possible on paper ruled in squares (_en quadrille_), and the relative position of the letters to one another must be kept as far as possible. All broken parts of letters are to be scrupulously copied (they can often be distinguished from stone-flaws by feeling along the bottom of the groove with a knife-blade; if that finds an even line, the groove is probably part of a letter), and all intervals where letters have perished beyond the copyist’s power to recover them should be measured, and by comparison of equal intervals containing decipherable letters in other parts of the inscription, the number of lost letters can be estimated. These should be indicated by dots in a shaded patch. Letters, about which the copyist is not quite certain, must be dotted or drawn in faint line. If a stone be imperfect at the sides, and there be any means of estimating its original breadth, the line of its true centre should be marked on the copy. Such an observation will be invaluable to the restorer of the text. All letters that have peculiar forms should be carefully drawn at least once, as specimens. If the text is grouped about, among, or in any relation to, sculptures, such relation should be indicated, even if the whole sculpture be not drawn. Marks of punctuation or division, ligatures of one letter with another, and ornate initials and finials, should be looked out for and noted. On beginning a copy it is well to transcribe first the most obviously easy parts of the inscription: they will give an inkling of the character of the text, teach the forms of lettering used, and accustom the eye to the inscribed surface. On finishing a copy, if there be time, read it over, try to translate it, and in the light of the probable translation, attack again the harder parts of the inscription. In the case of stones with two or more texts inscribed one over the other (as frequently happens on Roman milestones, which may be geographical documents of great importance), a ‘squeeze’ must be got at all costs, for an untrained copyist will make little or nothing of them, and find it very difficult to draw an accurate hand facsimile.

3. _Literary Memoranda._

It is impossible to make too many notes of a monument, and quite easy to make too few. The nature of the great majority of such notes must be left to the discretion of the traveller; but concerning all antiquities, from buildings to beads, it may be said that, at any rate, material, colour, dimensions, condition of preservation, arrangement of parts and character of ornament must be jotted down in the ever ready note-book. In the case of buildings, notes giving all dimensions are especially important, since the camera can seldom be brought to bear on all parts and details, and there is often not opportunity to draw out a plan on the spot. Of inscriptions certain facts must be recorded, viz., form of the stone; condition of its surface; the material and colour; on what sides complete, and on what not; actual dimensions; height of lettering; general character of lettering; whether well or ill cut, plain or ornate. Epigraphists’ notebooks are procurable in Germany and Austria containing divisions for the notes on all these points, together with a ruled space for the actual inscription. In the case of coins, the material, the ancient value, the weight (if possible), the state of preservation, and the images and superscriptions should be noted; of sculpture, the material, the dimensions, the degree of finish, and a minute analysis of the subject, the dress of the figure or figures, their gestures, attributes, and so forth.

B.—CLEANING AND CONSERVATION.

The traveller will not have occasion to render more than ‘First Aid’ to objects of antiquity, _i.e._ to clean them so that their true character may appear, and to consolidate them with a view to safe transport. He should do the least that is absolutely necessary, leaving all elaborate treatment to experts at home. The hints here given are therefore elementary, and concerned mainly with portable objects. In this connection these are best classified by the materials of which they are made.

(_a_) _Gold._—Gold requires no immediate treatment, unless it be laid over a core of other metal, _e.g._ copper or bronze, which has oxidised out through cracks. This oxide can usually be removed by picking or by sharp scaling blows with a small hammer and chisel. If it is obstinate, use dilute hydrochloric acid laid on with a brush. The proportion of pure acid should not be more than one part to ten of water.

(_b_) _Silver._—If in very much corroded condition, technically known as ‘dead,’ silver should be left alone. If there is only slight superficial corrosion, soak in a solution of common salt or lemon juice, or strong ammonia, and polish after a few hours. If there is a good deal of chloride on the surface, but the body of the metal seems sound, put zinc or iron in the solvent and the chlorine will pass over, leaving a powdery surface which can be brushed clean. Silver should never be packed in a tin box, even if wrapped up, or it will be found on arrival at home to be stained with a brown rust, very difficult to remove. Pack in wood or cardboard.

(_c_) _Copper and Bronze._—Both copper and bronze objects are best cleaned, if possible, with hammer and burin. Bronze, however, which the traveller will meet with most often, is frequently covered with a corrosion which cannot be scaled off at once, and calls for an acid solvent. Diluted hydrochloric (1:10) will act most quickly and effectually, but it leaves a white oxy-chloride coat, not easily got rid of either from the metal or the fingers of the operator, which it stains deeply. On the whole, we recommend that (1) if the bronze be badly cracked it be left alone; (2) if not cracked, but covered with very hard corrosion, soaking in a weak solvent like lemon-juice be tried; and (3) after that (or before, if the corrosion will yield to a tool at all) every effort be made to pick or flake off the corrosion, after which the object should be rubbed well with oil in the palms of the hands.

(_d_) _Lead and Iron_, after oiling, are both best left alone by the traveller.

(_e_) _Stone._—The traveller will seldom or never be under the necessity to treat stone surfaces, except in the case of inscribed marbles on which carbonate of lime has formed, or small objects attacked by salt. The former can be cleaned with strong acid; the latter must be soaked in water for long periods, and when drying laid with the most important surface downwards, so that evaporation into the air may take place through the less important surfaces.

(_f_) _Pottery and Terra-cotta._—The same enemies, carbonate of lime and salt, attack pottery and terra-cotta, and are met in the same way as in the case of stone; but the hydrochloric or other acid solvent should be weaker, and where there is colour be very cautiously used, if at all. In packing vases, it should be remembered that if many are put into one case without partitions, and one collapses, this will probably entail the breaking of the lot. Large vases should be filled with tightly rammed packing. Nothing of heavier or more solid material, _e.g._, stone, should be put in a case with pottery.

(_g_) _Wood, Ivory, and Bone._—These materials are generally found flaked, split, or scaly, and need consolidation before packing. The methods most likely to be open to the traveller are: (1) if the objects are not excessively tender, to dip them in melted vaseline, let this set, wrap in tissue paper and pack carefully in cotton wool; (2) if the objects are very tender or rotten with salt, to make a stiff jelly, drop them in before it sets, and convey them home in aspic. On the way the jelly will absorb the salt. In addition to either process, it is often well to bind the object in every direction and part with fine thread to keep it from splitting, or prevent the sections, if already split, falling apart and splintering or warping in different directions. If there is crystalline carbonate of lime on the surface of bone or ivory, it had better not be touched except by experts.

(_h_) _Papyrus._—Papyrus needs damping and flattening out as far as possible without breaking its fibre. Lay it between two damp towels, and after flattening, pack it between sheets of paper in close tin boxes, filling each box up tightly. But the traveller will be wise not to try too much. As soon as the edges of his roll or fragment cease to be brittle to the touch he had best leave the papyrus as it is without further unrolling, and pack very carefully away.

(_j_) _Glass, Glazed Objects, Pastes, Amber, Various Compositions._—None of these should the traveller try to treat. Glass must be left wholly alone if in a flaking state; other objects, if flaky or powdery, will, at least, be no worse for having been dipped in melted vaseline than they would be in any case, after transport.

No general hints can be usefully given about either the methods of discovering antiquities or those of detecting forgeries. It is not supposed that the travellers here addressed will undertake regular excavations. Should they propose to do so, they will need special training and much more elaborate instruction. Mr. Petrie’s ‘Methods and Aims’ will supply much of the latter, but the tyro excavator will not have Mr. Petrie’s success without serving a long apprenticeship.

The above hints will serve for the traveller who takes antiquities by the way and in the day’s work, having other objects more in view. For him the following list of necessities will suffice:—

1. Long extension camera and all photographic requisites, including, if possible, a stand and frame for overhead photography (_v._ p. 52).

2. ‘Squeeze’ paper, brushes with hand-straps or curved handles, and tin cylinders for carrying the paper and moulds; heel-ball, sealing-wax, tin-foil, beeswax.

3. Planning and drawing outfit.

4. Notebooks ruled _en quadrille_, magnifying-glass and hand-mirror.

5. Small hammer and chisels for metal work, hydrochloric acid, ammonia, emery-paper, tissue paper, burin, plate brushes, sheet zinc, vaseline, cotton-wool (_not_ raw cotton-waste with hard seeds in it).

VIII.

MEDICAL HINTS.

_By the late WILLIAM HENRY CROSSE, M.D._

Revised and brought up to date by ANDREW BALFOUR, C.B., C.M.G., M.D.

The following hints, which were compiled by the late Dr. W. H. Crosse, formerly the experienced medical adviser of the Royal Niger Company, based upon previous editions of this work, have been edited so as to bring them up to date. A good deal remains as Dr. Crosse wrote it, but several sections have been almost entirely re-written, in order to bring them into line with modern views. New sections have been introduced and there have been numerous additions and corrections.

INTRODUCTION.

In the following pages the chief emphasis has been laid upon the care of the health in the tropics; but it must be remembered, that whilst by far the greater proportion of travellers go to the tropics, most of these hints for the preservation of health apply equally well for all climates.

Though many subjects have been briefly dealt with, certain matters have been rather more fully written up, such as the treatment of wounds. It is, in the author’s opinion, so important that the traveller should thoroughly understand what is meant by ‘surgical cleanliness’ that the usual methods observed by surgeons to ensure it have been plainly set forth. The author, of course, understands that in many cases it would be quite impossible to carry out the instructions in every detail, but it is hoped that a thorough knowledge of the principles underlying the correct treatment of wounds will assist the traveller in doing the best possible for his patient in any emergency, and under even the most unfavourable circumstances.

It is hardly necessary to observe that travellers in remote regions, and especially in tropical climates, are much more exposed to physical ills and diseases than most residents at home, and that they are more likely to be placed beyond the reach of skilled medical and surgical aid when it is most required. It is chiefly for the use of the non-professional traveller that the following pages have been written, and with this aim in view the symptoms and general treatment of the diseases and injuries with which he is most likely to be brought in contact are dealt with in simple, non-technical language.

Every traveller should supply himself with either Bernard Myer’s ‘Atlas of First Aid Treatment’ or Hastings Young’s ‘First Aid to the Sick,’ books of general utility. Travellers visiting countries with hot climates will find Garry’s ‘Some Factors Influencing Health in Tropical and Sub-tropical Climates’ a useful book, despite a few errors, while the small ‘Primer of Tropical Hygiene’ by Colonel R. J. Blackham, is a valuable guide to things hygienic as is Professor Simpson’s ‘Maintenance of Health in the Tropics.’

A few books may be mentioned as specially suitable for those travelling in the countries with which they deal, such as ‘Hints for Residents and Travellers in Persia’ by A. R. Neligan, ‘Health Preservation in West Africa’ by J. C. Ryan, ‘Hygiene and Disease in Palestine’ by Masterman, and ‘The Epidemics of Mauritius’ by Anderson.

Those who read German will find the ‘Gesundheitlicher Ratgeber für Auswanderer,’ issued under the auspices of the Institut für Schiffs- und Tropenkrankheiten in Hamburg, of considerable service, and if they intend visiting South America it is worth noting that from the same source a series of small books to guide the traveller in different parts of that continent will soon be forthcoming. This series will also include works on Mexico, Angola and Siberia. These German guides are obtainable from L. Friederichsen & Co., Hamburg.

Persons who intend to travel should undergo a thorough medical examination, in order to ascertain if they are likely to be able to stand the fatigues, exposures and privations to which they will probably be subjected.

Most people of good constitutions and regular temperate habits can, with care, maintain a good state of health in the tropics, and many of those who have been by no means strong at home are able with some extra caution to do well even in the hottest climates.

The intending traveller should attend a course of ambulance lectures in order to prepare himself for the responsibilities which he will have to undertake. As much time as possible should be devoted to discussing with some professional friend the uses, correct doses, and proper methods of prescribing and combining the drugs which are to be taken on the journey, and in becoming familiar with the position of the principal bones, vessels and other important structures of the human body.

A traveller should understand how to use the clinical thermometer, how to twist or tie a bleeding vessel, how to use the hypodermic syringe and the syphon stomach tube. He should learn how to cleanse a wound, how to treat a case of snake-bite, and should know the best way in which to set a broken limb. Such things are not easily learnt from books, and experience alone will give the necessary skill and confidence. Many valuable lives have been saved by travellers who have fairly mastered the rudiments of medical and surgical treatment, and who have been able in an emergency to give the necessary drugs, administer an antidote, or to stop severe bleeding.

The ideal traveller is a temperate man, with a sound constitution, a digestion like an ostrich, a good temper, and no race prejudices. He is capable of looking after details, _e.g._, seeing that drinking water has _really_ been boiled, and is willing to take advice from those who have made journeys in countries similar to the one in which he is about to travel.

A traveller should be supplied with suitable housing, food and clothing, and should have a proper supply of medicines, dressings, and medical comforts.

In selecting the drugs with which the traveller should be provided before leaving home care should be taken to see that only reliable products be purchased. In the tropics, and in exploration generally, the medical outfit is subjected to very severe tests, and it is a mistaken policy to economise on medicines. The latter should be as portable as possible and be properly packed.

_Risks to Health in a Tropical Climate._

Seeing that these hints will be chiefly required by travellers in tropical or sub-tropical climates, it may be well to indicate some of the chief risks which are to be met with in warm climates, and the best methods of meeting them.

It will be noted that any detailed reference to questions of outfit, such as the supply of proper food or clothing, is omitted, as these matters have been fully dealt with in ‘Hints on Outfit,’ published by the Royal Geographical Society uniformly with this ‘Hints to Travellers,’ and it is understood that this work will be consulted by all who read these hints.

_Chill._—The most prominent feature of a tropical climate is undoubtedly heat, and yet the greatest risk arises not so much from excessive high temperature as from a risk of chill, which is due mainly to the excessive perspiration which takes place. This must be guarded against by the use of proper clothing, the most important point being that the underclothing should be partly of absorbent material. For general use cotton is best, and the vest or undershirt should in the tropics be of the Aertex Cellular type. It is a mistake to wear wool next the skin in hot countries, for it soon gets sodden with perspiration and is irritating. A light flannel shirt worn over the open cotton mesh is probably the best arrangement though a mixture of wool and cotton may be employed for the shirting. This question is fully dealt with in ‘Hints on Outfit.’ It is particularly important to avoid sudden changes of temperature, and if exposed to the cooling sea breeze, special care must be taken as to proper clothing. Parke laid great stress on the importance of avoiding chills, draughts, or wettings. He remarked “In crossing Equatorial Africa the Relief Expedition found that every wetting meant an attack of fever.” The sea breeze, which is so refreshing and cool, by checking the perspiration, frequently acts as the exciting cause of an attack of fever. There is special liability to chill and subsequent fever when ascending an eminence, as the exertion causes profuse perspiration, and the cool breeze encountered on arrival at the top is very likely to produce ill effects.

On completing a day’s journey, the underclothing, at least, should be changed without delay, and the skin should be well dried by the free use of a rough towel. If at all possible a warm bath should be taken.

The cummerbund is a useful article of clothing, especially for men in the evening. It does away with the need for a waistcoat, which often proves hot and uncomfortable, and yet provides the necessary safeguard against chill to the abdominal organs.

A word as to the use of a flannel cholera belt, about which opinions differ. Experience in many tropical countries leads the writer to recommend its use at night, and at night only. Even so, it is unnecessary and uncomfortable in places where the nights are invariably hot and steamy, and is chiefly of value in dry, desert climates where there is a great difference between the day and night temperatures.

_Effects of the Sun._—It is difficult to overestimate the importance of the protection of the head from the direct rays of the sun. It is best, where possible, to avoid going out in the heat of the day, but where this is necessary the head should be protected by a suitable helmet, which should be light in weight and colour, which should be ventilated, and which should have a good protection for the back of the head. A large green leaf inside the helmet might be an additional protection, and a sun umbrella should also be used wherever practicable. A helmet should as a rule be worn when going out during the day-time in the tropics. Sometimes, however, the helmet is found very troublesome, as, for example, by the sportsman in the bush. He may then have recourse to a double Terai hat, or even to an ordinary wide-brimmed felt hat provided he inserts a crumpled-up handkerchief in its crown. This will usually afford a reasonable protection.

_Errors of Diet._—The lassitude which is often so much felt by Europeans resident in the tropics too frequently tempts them to the abuse of alcoholic stimulants and highly-spiced foods. The habit is a most pernicious one, for such indulgence is one of the most fruitful causes of the permanent ill-health so often wrongly attributed to the mere residence in a hot climate. There is no doubt that food should be taken with greater moderation in hot than in cold climates; heat-producing articles of diet, such as fat, should be taken in far smaller quantity, but an ample supply of vegetables is essential. The meals should never be heavy, especially during the heat of the day, and intervals of about four hours should always separate consecutive meals.

Cooking should always be conducted with great care in the tropics, for the stomach and liver are less able to bear any extra strain, such as would be induced by the attempt to digest imperfectly-cooked food. Parasites are often introduced into the system by insufficiently cooked food.

Natural milk must be boiled; condensed milk should be mixed with boiled water.

Excess in the use of alcoholic stimulants is one of the most fatal errors into which the tropical resident can fall, and their habitual use as beverages is totally unnecessary, tea, coffee and cocoa being the best beverages for ordinary use. A small supply of brandy, champagne, and port wine may be of service in certain cases of illness, but they are better regarded as belonging strictly to the medical equipment.

Avoid native drinks, as they will probably have been diluted with dirty water, or prepared in unclean vessels.

Great moderation in the use of alcohol is quite as necessary in arctic as in tropical climates. In the latter no alcohol should be taken till the sun has set, and even then the quantity should be strictly limited. There is no reason why a glass of light beer, a whisky and soda, or a little light wine should not be drunk with the evening meal. Alcohol taken at this time often promotes appetite and aids digestion, but alcohol between meals is bad, chiefly perhaps because the habit of exceeding the daily allowance is thereby apt to be engendered. It is largely a question of self-control, and it must be remembered that in the tropics self-control, so far as drinks are concerned, is very apt to weaken. Apart from the question of its habitual use alcohol is often of great service as a restorative, as, for example, after a fatiguing march, and especially if one has got wet and chilled. Champagne is possibly the best form to take on such occasions and it should be used as an apéritif or drunk along with food.

_Risks due to Drinking Water._—The use of water for drinking purposes must be attended with great care in all tropical climates. As the water of the lakes, streams and pools of these countries usually contains a large proportion of impurities, and the germs or parasites of many diseases, it should be strained and subsequently boiled before being used.

As, however, it is not always possible or convenient to incur the delay of boiling the drinking water and allowing it to cool, it is advisable that a _reliable_ filter should be taken.

Most filters—charcoal or otherwise—are merely death-traps, as the accumulation of germs and injurious matter within the filtering substance soon renders the water more dangerous than if unfiltered. There are, however, a few filters which, with ordinary care in cleansing, are in themselves efficient safeguards. The most highly recommended of these are the Pasteur Chamberland and the Doulton filters. In any case, spare filtering candles should be taken, and these should be cleaned and boiled at least every three days. It is recommended that the filter-makers should be consulted immediately the probable requirements of any expedition are known. It should be remembered that no filter combines rapid delivery of water with efficient sterilization. A mistake commonly made is to boil water and then filter it. This should never be done.

The drinking of very cold water, to which there is great temptation when one is exhausted by prolonged heat and copious perspiration, should be carefully avoided; thirst often induces tropical residents to have recourse to iced water, which is always apt to be dangerous if taken when one is heated. The drinking of copious draughts of water is also a habit to be deprecated; it certainly weakens the muscular energy, and as the water is rapidly lost by perspiration, the feeling of exhaustion is increased. Hot or cold weak tea, without milk or sugar, is one of the least injurious of all beverages.

_Precautions on the Voyage._

The traveller should endeavour to land in a perfectly healthy condition, and to this end he should on the voyage out take plenty of exercise, drink little or no alcohol, be moderate as to diet, and avoid much meat and rich dishes. Neglect of these obvious rules frequently ends in the traveller arriving in a flabby, bilious condition, in which state he is predisposed to attacks of malaria, dysentery, and other diseases.

Constipation is frequent at sea, and a seidlitz powder, a dose of fruit salt, or one or two cascara tabloids may be necessary. If constipation is severe, then one or two four-grain blue pills should be taken at bedtime, followed in the early morning by a seidlitz powder or some other saline aperient.

In order to avoid chill the traveller should be properly clothed during the evening or when there is a cool breeze, and should not stand in draughty doorways and passages on board. If he is proceeding to a country where there is endemic malaria he should begin his course of prophylactic quinine on ship-board, because even a single night spent ashore in a malarious locality may result in his acquiring infection. It is therefore advisable to begin taking quinine in the manner described on p. 207 at least two days before arrival at the place of disembarkation.

What is true of the journey out is of even greater importance on the voyage home. There is a serious danger of illness owing to chills contracted on board ship when leaving a hot climate. Quinine should be systematically taken as recommended on p. 208.

GENERAL HINTS.

_Never take a cold bath in the Tropics unless ordered to do so by a doctor._—In the case of persons who have already suffered from many attacks of fever, dysentery, or any disease of the liver or other important organs, warm bathing should alone be used. Bathing should never be resorted to during the period of digestion, _i.e._, three to four hours after meals. Wear warm clothes at night. Avoid the direct rays of the sun. Do not take too much animal food. Never begin work on an empty stomach. Never neglect a slight attack of fever or diarrhœa. Keep the bowels gently opened—once a day is quite enough—but avoid strong purgatives.

_Vaccination._

It is essential that all the members of an expedition should be re-vaccinated if they have not suffered from small-pox or been vaccinated within two years. A proper supply of vaccine should be carried on the journey. Heat and bright sunlight are very detrimental to vaccine lymph. Hence the proper transport of such lymph in hot climates is a matter of great importance and by no means always easy to arrange. Where a thermos flask is available it may be used for storing and carrying the capillary tubes, or they may be wrapped up in green leaves and inserted into a hollow bamboo, the ends of which are closed with cotton wool.

_Inoculation._

Owing to the prevalence of typhoid and paratyphoid fevers in hot countries it is essential that all persons, and more especially young adults, proceeding to tropical countries should undergo preventive inoculation. Two injections of the so-called triple vaccine, at ten days’ interval, are necessary, and both should be given shortly before leaving or, if arrangements can be made, one or both may be given on ship-board.

_Isolation._

On the outbreak of an infectious complaint, such as small-pox (which is very common amongst negro carriers), the sufferer should be promptly isolated, and one or more attendants should take charge of the case and not be allowed to come to camp. It is wise to select as attendants those who have either had the disease, or who are protected (as by vaccination) against it.

In Nigeria it was found most convenient to build grass huts, which were burnt to the ground, together with the clothing and bedding of the patient and attendants, on the termination of the outbreak.

All vessels which are not destroyed must be boiled thoroughly. The motions, etc., of patients suffering from typhoid fever, cholera and dysentery should be disinfected, preferably by boiling, or, better still, destroyed by fire.

_Transmission of Infection._

The traveller should remember that of late years the rôle of the healthy human “carrier” in the transmission of many communicable diseases has been established. This is true of such diseases as enteric fever and cholera, and when engaging servants, porters, and camp followers it is important to inquire into their previous history and, if necessary, to make certain that they do not harbour the specific organisms of such diseases.

DISEASES AND THEIR PREVENTION AND TREATMENT.

In the tropics, as elsewhere, the diseases to which the traveller is liable are due to widely differing causes, but in hot countries climatic conditions and parasites play a predominant part. Insects are very frequently to blame for the transference of the latter from the sick to the sound, both insects which are not themselves parasitic on man, _e.g._, the mosquito and the tsetse fly, and those which make man their host, _e.g._, lice and fleas.

It is useful for the traveller to bear diseases in mind from the standpoint of their etiology, as in this way he can more readily grasp the measures necessary for their prevention.

Accordingly, the following classification is given, merely as a guide, together with a few examples. The diseases themselves, for the sake of convenience of reference, are grouped alphabetically and are not classified in any way.

_Table of Diseases Classed according to Etiology._

A.—_Parasitic._

(i.) Due to “contact” either direct or through the agency of clothes, bedding, etc. Also due to direct inoculation through the skin or mucous membrane.

_Examples_: Many skin diseases, venereal diseases, small-pox, tetanus, and blood-poisoning (septicæmia).

(ii.) Due to “mouth to mouth” infection, through the agency of so-called “droplet” infection, expectoration, coughing, sneezing, etc.

_Examples_: Influenza, pneumonia, and pneumonic plague.

(iii.) Due to “droplet” infection, as above, or to infected scales from the skin, or to infected discharges from the nose, throat, or ear.

_Examples_: Measles, scarlet fever, small-pox, chicken-pox, diphtheria.

(iv.) Due to excremental infection through the agency of water, food, flies, fingers, dust, and soil.

_Examples_: Enteric (typhoid) fever, dysentery, diarrhœa, cholera, worm infections of many kinds.

(v.) Due to inoculation through the bites of insects, or the entry through skin abrasions of the infected excreta or infected crushed tissues of insects rubbed or scratched into these lesions.

_Examples_: Malaria, yellow fever, tick fever, sleeping sickness, filariasis, relapsing fever, typhus fever, bubonic plague.

(vi.) Due to invasion of the body by insects in their adult or larval stages.

_Examples_: Chigger, myiasis of various kinds.

B.—_Non-Parasitic._

(i.) Due to climatic conditions.

_Examples_: Heat stroke, diarrhœa in some instances, constipation in many cases, rheumatism, prickly heat, chilblains.

(ii.) Due to errors in diet.

_Examples_: Diarrhœa, beri-beri, scurvy, sprue(?).

(iii.) Due to poisons.

_Examples_: Scorpion sting, snake-bite, vegetable poisons.

(iv.) Miscellaneous.

_Examples_: Bed-sores, epilepsy, apoplexy, concussion of the brain, hay fever, and other conditions into the cause of which a mechanical element frequently enters.

It will be seen that some of these diseases, such as small-pox and diarrhœa, come under more than one heading, but this does not detract from the general utility of the above classification.

_Bed-sore._

When a patient is confined to his bed for a long time it is necessary to support the lower part of the back on something soft, such as a pad of wool, or an extra pillow, in order to prevent the formation of a bed-sore; pillows should also be placed under the hips and heels.

To harden the skin it is well to rub it with alcohol or to treat it with oil or white of an egg three parts, and spirits one part; zinc ointment is also useful for this purpose.

Besides pressure, the most frequent cause of bed-sores is constant moisture from the passage of urine and motions and consequent damping of the sheets. Great care must be taken to thoroughly dry the back after any evacuation; the lower part of the back should be dusted with a powder of boric acid and zinc oxide.

If a bed-sore is present the patient should lie on a circular pad with a hole in the middle, to take pressure off the bed-sore. The sore should be thoroughly cleaned twice a day with some antiseptic lotion, such as chinosol or permanganate, and subsequently dressed with zinc ointment or vaseline.

If the bed-sore is on the back, the patient should lie if possible on each side alternately, to relieve the pressure.

_Beri-beri._

In most cases this is a disease due to some deficiency in the dietary, which leads to a form of what is called peripheral neuritis. The name is possibly derived from a Cingalese word signifying “I cannot.”

_Symptoms._—Weakness of the legs and digestive troubles, abnormal sensations in the legs, frequently associated with swelling. The gait alters, and the arms and fingers may be affected. The condition is one of spreading paralysis, and in bad cases the heart is affected. In so-called wet beri-beri the patient becomes bloated as in dropsy, while in dry beri-beri he wastes away until he is little better than a skeleton. There is a “squatting test” which may enable one to recognize the disease at an early stage. The patient, with his hands on the top of his head, is unable to assume a squatting position and to rise from it unaided. If he is squatting and has to rise he accomplishes the act by climbing, as it were, up his own legs.

_Prophylaxis._—Avoid overcrowding, as this seems in some cases to predispose to the disease. Give the yeast extract known as “Marmite,” which is supplied in small cubes one-quarter ounce in weight. One should be taken twice a week, either alone or with bread or biscuit, or dissolved in warm water in the form of a soup. Lentils, other legumes, and oatmeal are useful. Eggs and fresh meat, when obtainable, are very valuable.

_Treatment._—This is chiefly dietetic. Give yeast, two ounces daily, along with milk and sugar, or marmite in one-cube doses twice a day. Eggs are specially useful, while fresh milk, legumes, and nourishing soups are all indicated. Only small quantities of food should be given at a time. Rest in bed is very important, and the patient must be careful when he is allowed to get up owing to the danger of heart failure. Tonics are required during convalescence.

_Blackwater Fever._

Blackwater fever is probably a pernicious complication of malarial fever, and derives its name from the colour of the urine. It must be remembered that dark-coloured urine is usual in all fevers; it is scanty during the height of the fever, especially if there is much sweating. If, however, it is obviously “bloody,” the case is more grave, but as a rule it is only men broken down in health, and those who have resided in blackwater countries, _e.g._, Tropical Africa, parts of India, the West Indies, etc., for at least a year, especially those who have taken their prophylactic quinine irregularly, who suffer from this complication.

The reason for the occurrence of this condition is not fully known. Some have ascribed the symptoms entirely to the taking of quinine, but as the fever often occurs where no quinine has been given this is impossible. At the same time it appears likely that in certain cases of malaria, owing perhaps to some idiosyncrasy, quinine may help to bring on the symptoms. It is possible that chill occurring during the course of a fever may lead to the production of blackwater fever. Those who have had one attack are particularly liable to a recurrence, and after two consecutive attacks return to a temperate climate is required.

_Symptoms._—In addition to the ordinary symptoms of malarial fever, the urine is dark, blood-like, and eventually porter-coloured; it is often scanty, and may become entirely suppressed. The skin is yellow, often a bright orange, there is frequent vomiting, often hiccough, and the vomited matter is usually of a green colour.

_Prophylaxis._—With our present knowledge all that can be said is that malaria prophylaxis is also the method to prevent blackwater. Such prophylaxis, so far as quinine is concerned, must be properly carried out. Those who take quinine regularly, and in sufficient doses, do not contract blackwater fever. Chill and excesses of all kinds must be avoided.

_Treatment._—Much the same treatment should be adopted as that fully described later for malaria. It is especially important to give an aperient at the beginning, and perhaps five grains of calomel is the best form. In every case, no matter how slight, it is essential to ensure, wherever possible, absolute rest in bed and skilled and careful nursing. If it can possibly be avoided a blackwater patient should never be moved from the place where he is taken ill. So long as he has a bed to lie on, a roof to cover him, and some sensible person to look after him who will carry out the doctor’s orders, he should be treated on the spot. It is better, when it can be arranged, for the nurse to go to the patient than for the patient to come to the nurse.

The chief aim should be to support the strength by fluid nourishment, and to secure free action of the kidneys. The former should be maintained by fluid nourishment given in small quantities at frequent intervals, such as milk, Plasmon, Benger’s food, Allenbury’s foods, invalid Bovril, Brand’s fever food, or Brand’s essence, Maggi’s consommé. A little Plasmon added to any of the meat preparations would be useful, while raisin tea is a valuable preparation.

In order to maintain free action of the kidneys, plenty of fluid should be given, such as barley-water made from Robinson’s prepared barley, flavoured slightly with lime-juice or lemons. Weak tea is useful.

Diuretics which stimulate the kidneys must be avoided. The most effective method of flushing the kidneys is by giving saline injections by the bowel, but these, as a rule, can be administered only by a medical man or by a trained nurse under a doctor’s supervision. It may, however, be stated that the amount usually given is six ounces of physiological salt solution (seven and a half grains of sodium chloride to the ounce of warm water). This is administered every hour, or even oftener, if necessary, in bad cases. In mild cases enemata every four or six hours will suffice. Other measures are the application of poultices or hot fomentations to the loins when suppression threatens, or when there is severe lumbar pain. Diaphoretics, so long as they do not depress the heart, are useful, and so is frequent sponging. Cold applications to the head and especially behind the ears alleviate headache.

The question of giving or of withholding quinine is an important one, but recent work on the subject indicates that in the absence of a medical man who can carry out blood examinations, it is advisable to give quinine as in the case of malaria.

Vomiting is often a serious complication, and the directions for its treatment, given under the head of malaria, should be carefully followed. If it cannot be speedily checked, feeding by the bowel must be carried out. _See_ Nutrient Enema, p. 259.

So long as plenty of urine is passed and sufficient nourishment is taken there is little cause for anxiety, though wherever possible skilled assistance should be obtained at the earliest opportunity.

After an attack the patient is very weak and anæmic. He requires careful feeding and tonics, especially iron and arsenic. It is advisable that he should be invalided out of the endemic area, and he should be specially warned as to the danger of getting chilled or wet.

_Bronchitis, or Inflammation of the Branches of the Windpipe._

_Symptoms._—When bronchitis exists, there is a good deal of coughing—at first dry, but afterwards accompanied by frothy expectoration—with a sensation of rawness and tenderness at the upper part of the breastbone.

_Treatment._—In the early stages of this condition, opium in some form or other will be found beneficial, and will often cut short an attack; for this purpose, ten grains of Dover’s powder, or fifteen to twenty minims of chlorodyne, may be given every eight hours for twenty-four hours, and then be gradually diminished.

If the breathing is difficult, poultices should be applied to the chest and ipecacuanha, half to two grains, and ammonia, should be given three times a day. Later, stimulating expectorants, such as ammonium carbonate, should be administered.

Inhalation of steam often gives great relief; and the effect is much improved if thirty drops of Friar’s balsam are added to a pint of hot water.

In tropical climates even an ordinary feverish cold very often tends to become malarial in character, therefore the use of quinine, in addition to the other treatment, is usually desirable, and five grains may be given thrice a day.

_Burns and Scalds._

Where an extensive burn or scald has occurred, the clothing of the injured part should be removed by cutting, so as to cause as little irritation as possible. If the burn is only slight, the surface may be covered over with lint smeared with zinc or boric ointment, or oil. If there is much blistering, or the surface is charred, the skin should be cleaned up as well as possible with boric acid lotion, and hot fomentations of the same applied for twenty-four hours. After this, the burn may be dressed twice a day with boric ointment spread on lint. Great cleanliness is an important factor in the successful treatment of burns. In a severe burn, stimulants must be given, and the patient put to bed with hot-water bottles, and active treatment of the burn should be left till the patient has somewhat recovered from the shock.

When there is great pain, chlorodyne or laudanum in full doses will be required.

_Cerebro-Spinal Fever._

This disease, also known as “spotted fever,” is of special importance at the present time to the traveller in Central Africa, where it is very prevalent amongst the natives, especially in Uganda. It may, however, be encountered in all parts of the world, and in the tropics is very frequently a malady of the dusty months.

_Causes._—The disease is very often transmitted from some carrier of the causative organism, which occurs in the throat and nose, and is distributed by coughing, spitting, or sneezing. Infected material, such as handkerchiefs, may play a part, and the spread of the disease is greatly favoured by overcrowding, especially of sleeping quarters.

_Symptoms._—In very acute cases the onset may be very sudden, the patient rapidly losing consciousness. As a rule the disease begins with headache, stiffness of the neck and chilly sensations. There may be vomiting, and the temperature is raised. The mind is often confused, and the patient may be delirious. The skin eruption, which occurs especially on the back and about the joints, and which is responsible for the name “spotted fever,” is not very frequently seen, and can hardly ever be detected on a dark skin. In very bad cases there is violent delirium, laboured breathing, and a purulent discharge from the nostrils. One of the most characteristic features is retraction of the head, while a dislike to light is common.

_Prophylaxis._—Avoid unnecessary fatigue and guard against overcrowding, faulty conditions of ventilation and those which tend to cause naso-pharyngeal catarrh. Persons who have been in contact with cases of the disease are probably well advised to wash out their noses with a dilute solution of permanganate of potash 1 in 1,000.

_Treatment._—In the absence of a medical man this can merely be symptomatic. Hot baths relieve pain and restlessness. Ice to the head, antipyrin, caffeine or aspirin relieve headache, and sedatives may be given for the insomnia and delirium. The patient’s mouth is foul, and should be carefully swabbed and kept clean.

_Chicken-Pox._

In the tropics this disease is very largely one of adults.

Incubation period, a fortnight to three weeks. Rash appears first day.

_Rash._—Pink spots, upon which blebs form after twelve to twenty-four hours. The blebs are at first transparent, but subsequently become yellowish, and after two to three days shrivel and separate, leaving a pink scar.

The symptoms are usually very mild, perhaps only slight fever, and possibly headache. The appearance of the rash is often the first symptom.

_Treatment._—Isolation, and light diet. Bed may not be necessary.

_Chilblains and Frostbite._

Chilblains are usually found on the fingers or toes—after exposure to severe cold—especially when tight gloves or boots have been worn. Certainly the best way to promote the formation of chilblains is to toast the semi-frozen fingers or toes at a fire or stove, before the circulation has been re-established.

When chilblains are threatened, the part should be well rubbed with snow, or with camphorated spirit. Sponging with hot vinegar is very effective. Chilblains are checked in the early stages by painting with tincture of iodine. Once they have developed a preparation containing carbolic acid is useful in allaying pain and causing them to disappear. Ulcerated chilblains should be dressed with boric ointment spread on lint.

Prolonged exposure to intense cold leads to development of frostbite. If the case is a bad one, or injudiciously treated, gangrene or death of the part always follows; if this is extensive, amputation may be necessary.

Frostbite should be treated first by vigorous friction with snow or pounded ice. The affected parts should then be well wrapped with cloths wet with cold water. It is extremely dangerous to bring them near a fire. Afterwards, the part should be wrapped in cotton-wool.

_Cholera._

Cholera is a serious acute disease, characterised by frequent watery motions, vomiting, cramp and collapse.

_Cause._—It is often contracted by drinking contaminated water.

Research has shown the importance of the cholera “carrier,” that is to say the person, usually a native, who harbours in his bowel the specific organism of the disease. He may be perfectly healthy and yet be able to transmit cholera to other people by infecting water or food. The rôle of flies, infected clothes and rags, and faulty conservancy methods must be kept in mind.

_Symptoms._—Giddiness, faintness, persistent vomiting and diarrhœa, great prostration, feeble pulse, cold perspiration, colic, intense thirst, and constant desire to pass urine. The vomit and motions rapidly become like rice-water in appearance, and the urine is more or less suppressed. There are severe cramps in the legs, belly, and other parts of the body. If then the pulse becomes weak, the temperature low, and the countenance dusky, the patient will probably sink. On the other hand, reaction may set in, all the symptoms abating, and the pulse, temperature, and colour becoming natural; the water is passed more freely, vomiting is less frequent, and the motions become more natural in colour.

_Prophylaxis._—Anti-choleraic inoculations are now practised. They not only afford a considerable degree of protection but lessen the risk of a fatal issue in the inoculated. Hence it is advisable to be vaccinated against cholera whenever there is risk of infection. The inoculation must be repeated after the lapse of four months if the epidemic still persists, as the protection afforded is only temporary. Persons travelling in regions where cholera is present in an endemic form should take a little lactic acid in tea, or add a little vinegar or thirty drops of dilute hydrochloric acid to every ounce of drinking water.

At times of epidemic prevalence it is essential that all water should be boiled. The practice of hand-shaking should be discouraged, indigestible diet should be avoided, and raw fruit, raw vegetables, and meat jellies should not be eaten. Lettuces and celery, being moist and eaten uncooked, are specially dangerous. Patients and contact cases must be isolated, and the former should be protected from flies. It is very necessary to maintain a strict supervision of cooks and cooking arrangements. All kitchen cloths should be washed in permanganate solution or boiled. Milk should always be boiled.

Cholera stools may be disinfected by adding a five per cent. cresol solution to them and allowing it to remain in contact with the stool for at least one hour. Quicklime is excellent as a disinfectant. Add together equal parts of fresh quicklime and water, dilute with three times as much water as previously used, add a quantity of this slaked lime equal to the amount of stool to be disinfected and allow it to remain in contact with the stool for one hour. When the ground has been fouled by dejecta or vomit, disinfect with cresol, or rake hot ashes over it or pour kerosene oil upon it and set the latter alight. Cholera-soiled clothing, bed linen and blankets should be soaked in a two and a half per cent. cresol solution.

_Treatment._—Isolate the patient, keep him warm, and give ice to suck. Apply hot bottle to the feet, and mustard leaves to the pit of the stomach.

It is advisable to clear the bowel of irritating material at the outset by giving half an ounce of castor oil with a teaspoonful of brandy. Drugs are of little use in cholera, but some like to give one drop of carbolic acid, together with twenty drops of spirit of camphor (or peppermint, or a little brandy), five grains of bismuth, and ten grains of soda, suspended in one ounce of gum water, every four hours. Chlorodyne may be given to allay severe pain.

Even in the mildest cases absolute rest in bed is essential, and a warm bed-pan should be provided.

In the early stages no food at all should be given, but plenty of fluid should be allowed, though it must be administered only in sips. Stimulants may be necessary. Later on fluid food such as milk should be given carefully, and the quantity gradually increased.

The special treatment for cholera can only be carried out by a medical man, and recourse should be had to his help at the earliest possible moment, as everything depends upon immediate treatment. If, after the acute symptoms subside, diarrhœa continues a dose of bismuth is often useful.

_Colic._

This is the name given to the well-known severe twisting or griping pains in the belly, usually due to excessive flatulence, and resulting from constipation, or some error of diet.

_Treatment._—Hot fomentations should be applied to the belly, or better still, the Instra, which is the best means of applying continuous heat to any part of the body. A turpentine enema (a tablespoonful to a pint of warm water) will nearly always cut short the symptoms; in the absence of turpentine, give warm water alone. A full dose of opium (20 minims) should also be given if the pain is severe, preferably in a tablespoonful of castor oil.

Bicarbonate of soda, carbonate of ammonia and ginger should be freely given in full doses, and the bowels should be well opened as soon as the severe pain has passed off.

_Concussion of the Brain._

This term is applied to the partial suspension of the functions of the brain, produced by the severe shaking of its substance by a fall or blow.

_Symptoms._—At first the patient lies in an unconscious condition, skin cold and clammy, pulse and breathing very feeble, and temperature extremely low; he can be slightly roused by shouting; he cries out if he is moved, or when painful applications are made, but quickly relapses into insensibility. The stage of unconsciousness may pass off almost at once, it may be prolonged for hours or days, or the patient may never recover from it. The second stage—that of reaction—is marked by returning consciousness and frequently by vomiting, the skin becomes warm, and gradually the patient recovers; on the other hand, inflammation of the brain may set in, or he may again become unconscious and die.

_Treatment._—Keep the patient perfectly quiet in bed, in a darkened room, give a milk diet, and if he is much excited, apply cold cloths or an ice-bag to the head. If there is much prostration apply a hot-water bottle, and restore the circulation by rubbing the limbs. When reaction sets in, give five grains of calomel.

Stimulants should be avoided in cases of concussion of the brain, unless the collapse is very alarming (when ammonia should be given), as they tend to cause too violent reaction, which might be followed by inflammation of the brain and its coverings.

_Constipation._

This condition is very frequent in tropical climates, where it is associated with sluggishness of the liver. One of the best remedies is the two-grain tablet of cascara, of which one may be taken three times a day. Rhubarb is also a very useful drug. In addition to this, an occasional dose of a saline purge should be used, or a large enema of soap and water may be given. Five grains of blue pill or three grains of calomel will be found to act as a very efficient aperient, especially if followed in about six hours by a saline such as fruit salt. Castor oil is a valuable remedy, but it must be remembered that in the tropics its effects are sometimes rather severely felt, and hence it is well to give it in somewhat smaller doses than those usually employed in temperate climates. Three-quarters of an ounce may be given where an ounce would otherwise be employed.

As a rule, the general health of people suffering from simple constipation is not seriously affected.

In cases of chronic constipation one of the anti-constipation products, otherwise known as the Aloin Co., given three times a day and gradually reduced, will be found useful.

In most acute diseases, such as malaria, pneumonia, etc., if constipation is present, it should be treated at once by means of suitable aperients.

_Note._—In peritonitis, _i.e._, inflammation of the bowels, hernia, and in some cases of typhoid, constipation is a leading symptom, and is accompanied by severe pain in the belly. On no account should an aperient be given by the mouth in these cases. If it is necessary to clear the bowels, this should be done by means of an enema.

_Coryza, or Cold in the Head._

When a cold is confined to the head it can usually be cut short by retiring to bed early, taking a ten-grain dose of Dover’s powder, followed by hot drinks to encourage the perspiration which the action of this drug produces, together with the use of as many additional bed-clothes as can be borne. Care must be taken to avoid chill on the following morning. Once it is established the condition is difficult to cure, but marked relief will often be afforded by washing out the nose with a solution made from naso-pharyngeal products. In fact, a simple nasal glass douche should form part of the traveller’s outfit, at least, if he is liable to bad colds in the head. In tropical regions five grains of quinine should be added to the dose of Dover’s powder. When there is a liability to colds in the head the use of preventive vaccines is recommended, but these should not be employed without the advice of a medical man.

_Cystitis, or Inflammation of the Bladder._

_Causes._—Injury or the result of operations, extension of inflammations such as gonorrhœa, retention and decomposition of urine; debilitated or gouty persons are especially liable to this affection.

_Symptoms._—Intense pain in the lower part of the belly, and in the crutch, continual desire to pass water, with frequent passage of small quantities. The urine is scanty, high-coloured, foul-smelling, and occasionally blood-stained, and there may be some fever.

_Treatment._—Hot baths, leeches, or fomentations to the crutch, and a sedative, such as opium (preferably given by the bowel), will be required. If the disease continues the bladder should be washed out through a catheter with weak boric acid solution, five grains to the ounce, or chinosol (1 in 2000), twice a day. Urotropin, ten grains, and copaiba or sandal-wood oil in ten-drop doses.

The diet should be restricted to milk.

_Dengue._

This disease, also known as dandy fever and break-bone fever, occurs in many parts of the world, and it is most common along littorals, probably because the Stegomyia mosquito which carries the infection is usually numerous in sea-coast places.

_Cause._—The organism of dengue fever is unknown, but the infection has been proved to be carried by at least one species of mosquito.

_Symptoms._—The incubation period varies from about five to ten days. The onset is very sudden, the temperature rising rapidly. Within an hour or two an initial rash appears, which varies in appearance and is transient. The patient suffers from severe headache and pain in the joints and back. Indeed, the condition closely resembles a sharp attack of influenza, but, as a rule, there are no signs of coryza. The eyes are very painful and insomnia is present. The high temperature lasts for three or four days, then drops, continues low from twelve hours to three days and rises again sharply. During the interval the patient feels better but the symptoms start again when the temperature rises for the second time. In the second stage the true rash of dengue appears, which is rather like that of measles, and it is followed by desquamation of the skin. The disease, though often causing great weakness, is very rarely fatal.

_Prophylaxis._—Protect against mosquito bites by using a proper mosquito net or by employing mosquito repellents such as “sketofax.”

_Treatment._—Light diet, rest in bed, phenacetin and aspirin for the relief of pain and headache. Cold sponging helps the febrile condition and the insomnia. During convalescence there is often much depression, and the patient benefits by being ordered tonics and a sound wine.

_Diarrhœa._

Diarrhœa, or looseness of the bowels, is one of the most common and one of the most serious ailments of the tropics, and should never be neglected. In many cases it is a sign of enteric fever, dysentery, cholera, or sprue, the symptoms of which are given below. Ordinary attacks are usually due to the presence of some irritant in the bowels, such as irritating sand, bad food, unripe fruit, or other poisonous material. Amongst African and other natives diarrhœa is often due to a faulty or ill-cooked dietary. The importance of flies in fouling food should not be overlooked.

_Treatment._—Begin the treatment by administering castor oil, fruit salt, cascara, or other mild aperient, to clear out the cause of the diarrhœa. If castor oil is used the following note as to its administration is likely to be of service. Place an ounce of brandy in a glass or cup. Carefully pour the oil into the centre of the brandy and then add one ounce of water. The mass of oil will then resemble the yolk of an egg enclosed in the white. Lime juice may be used instead of brandy. Failing these, black coffee helps to cover the taste and “feel” of the oil. Sometimes three grains of calomel with fifteen grains of sodium bicarbonate act better than castor oil. A warm-water enema of about a pint is useful.

If the diarrhœa continues, give chlorodyne (20 minims) and tincture of ginger (10 minims) in an ounce of water two or three times a day.

This treatment should not be persisted in for more than two days.

If the diarrhœa is persistent, an astringent is needed: five grains of tannin, or two or three grains of sulphate of iron may be given three times a day. Ten grains of quinine should be given each day.

All food should be semi-solid and tepid; milk diet, as recommended below for enteric fever, is the safest food, but soup thickened with rice or arrowroot is good. The patient should keep in bed and wear a flannel band round the belly. Sometimes in the tropics, as the result of excessive purgation, diarrhœa is very acute and may be alarming. In such cases a hot bath, stimulants and the administration of astringents are indicated.

If the trouble continues for more than a few days it is probably due to dysentery, or typhoid.

_Diphtheria._

Diphtheria is an acute infectious disease, the essential feature of which is a peculiar inflammation of the lining membrane of the mouth, nose, throat, and windpipe, characterised by the formation of a membrane upon the inflamed surface. Diphtheria occurs in the tropics but happily does not spread much in hot countries.

_Causes._—It may be contracted from some person suffering from the disease, from a healthy “carrier” harbouring the specific micro-organism (_Bacillus diphtheriæ_) in his throat or nose, or from infected milk, etc.

As the disease is a very grave one, and skilled treatment is often an absolute necessity, measures should be immediately taken to summon medical assistance on the first appearance of diphtheria, or the patient should be sent as speedily as possible to a place where medical aid is likely to be obtained; for if the breathing becomes so difficult that the patient gets blue in the face, an operation for opening the windpipe will be necessary.

Incubation period, two to six days or even longer.

_Symptoms._—Headache, discomfort, loss of appetite, sore throat, and sickness, with swelling of the glands at the angle of the jaw. On examination the palate and tonsils are seen to be swollen, with a white deposit of membrane upon the surface. The membrane may be thick and tough, and if stripped off will leave numerous small bleeding points.

The temperature may run up, and is irregular in type. The pulse is rapid and feeble, and the bodily strength is quickly lost.

If the nose be affected there is copious discharge from the nostrils, with difficulty of breathing and much discomfort. If the windpipe is affected the voice will become hoarse or absent, and there will be greater difficulty in breathing, accompanied by a loud crowing noise.

Diphtheria may be accompanied by cough and pneumonia.

_Treatment._—Isolation. Bed. If diphtheria anti-toxin is obtainable, it should be administered at the earliest opportunity, but this should only be carried out by a doctor.

Nourishing foods and stimulants should be given frequently in small quantities. The throat should be thoroughly and frequently washed out with chinosol (1 in 1000) or other antiseptic lotion. If the difficulty in breathing is marked, warm baths should be given at intervals of about four hours. A steam kettle should be placed near the bed. The expulsion of the membrane may often be aided and great relief afforded by the administration of emetics, such as ipecacuanha, but these must be given with care owing to the risk of heart failure.

_Complications._—Diphtheria may be followed by paralysis of the windpipe with loss of voice, or paralysis of other parts of the body, therefore great care should be taken not to allow convalescents to get up too soon, no matter how well they may appear.

_Dysentery._

This disease, which is due to an inflammatory condition limited as a rule to the lower or large bowel, may be the result of a variety of causes, but there are two chief types which must be clearly distinguished: (1) Amœbic dysentery, due to a protozoon or animal organism, (2) Bacillary dysentery, caused by certain micro-organisms belonging to the vegetable world.

Amœbic dysentery is much more of a tropical complaint than is bacillary dysentery, but the latter is also common both in tropical and temperate climates. Both forms are transmitted in much the same way and their symptoms are very similar. Hence from the layman’s point of view no good purpose is served by considering them separately, at least so far as methods of transmission and symptoms go. The treatment of the two forms, however, differs, and to carry out such treatment effectively medical skill is required.

_Causes._—Dysentery is conveyed by impure drinking water, contaminated food, infected flies, and possibly also by infected dust. In both forms, but especially in the amœbic variety, the so-called “carrier” plays an important part, because in the latter case the organism produces cysts which are passed by the bowel, and these cysts are frequently found in the dejecta of persons who have suffered from amœbic dysentery and who are either convalescent or possibly in quite good health. If these cysts find their way into food or water and are then swallowed they are capable of developing in the human intestine and producing dysentery. Carriers are also met with in the bacillary form of the disease. Dysentery may be provoked by chills, general debility and exhausting conditions, such as chronic malaria.

_Symptoms._—Diarrhœa with pains in the belly, straining and frequent desire to go to stool. The motions soon become small in amount, slimy, lose their natural colour, and contain more or less blood; when there is ulceration of the coats of the bowel, the motions are extremely offensive, and bleeding may be very free. There is heat, tenderness, and bearing down about the outlet of the bowel, with considerable prostration and probably some fever; there is frequently a constant desire to pass water. All these symptoms may be due to severe ordinary diarrhœa; but in the tropics it is best to treat them as if they were dysenteric. Some guide may be obtained as to the form of dysentery from which the patient is suffering by taking his temperature. As a rule there is little or no fever associated with the amœbic form, while in the case of the bacillary type the temperature is always raised and in severe cases may be considerably elevated. It is in this form that the small intestine is apt to become involved and then the condition is more serious.

One help in diagnosis, though not a very reliable one, is the character of the stool. In amœbic dysentery the blood is apt to be mixed with the dejecta and to be dark in colour, while the whole mass looks brown or greyish green. The stool of bacillary dysentery, on the other hand, has a whitish appearance, the blood in it is bright coloured and is often in the form of streaks or spots. The amœbic form is apt, if not promptly and efficiently treated, to be followed by inflammation of the liver, which may go on to liver abscess.

_Prophylaxis._—Avoid chill and debilitating causes of all kinds. In countries where there is a great difference between the day and the night temperature wear a cholera belt. Carefully protect food and water from contamination of any kind, and especially from flies. Doubtful water should be boiled or rendered sterile by some chemical method. All milk should be boiled. Care should be taken not to employ as cooks natives who have recently suffered from dysentery, and scrupulous cleanliness should be observed in the preparation of food. Unripe fruit and other materials apt to cause diarrhœa should be avoided. Camp conservancy methods should be carried out on approved sanitary principles which prevent the access of flies to human excrement and prevent the latter from being disseminated by wind or in any other way. All dysenteric stools should be carefully disinfected or burnt.

_Treatment._—The general treatment is common to both forms, the essentials being rest, warmth and suitable food. Put the patient to bed, apply a cholera belt and get the bowels open by an initial dose of castor oil. If there is much pain ten drops of tincture of opium may be added to the oil. The usual dose of the oil is an ounce, but if the patient is feeble or exhausted half an ounce will be sufficient.

As regards diet do not give any milk at first, and indeed if the case is recognized as being one of bacillary dysentery milk should not be given at all as it tends to favour putrefaction. Albumin water, rice water, chicken broth are required during the first twenty-four hours. Thereafter in the amœbic form milk diluted with barley water or with citrate of soda (three grains to the ounce) can be given. Soups are often useful, and at a later period custard, arrowroot and jellies are indicated. In the bacillary type arrowroot, meat and fruit jellies and beef-tea can be given from the outset. In both types the food should be given in small quantities frequently, and it should be neither too hot nor too cold. Alcohol is deleterious.

Fortunately we now have a specific drug for treating amœbic dysentery and that is emetine, which is the active principle of ipecacuanha. It is best given in the form of emetine bismuthous iodide, which is supplied in capsules and the dose of which is three grains per day for twelve consecutive days. The dose is best given in the evening along with a cup of hot tea on a full stomach when the patient is in bed. If it causes much vomiting it is well to give ten or fifteen drops of tincture of opium before administering the emetine. The latter can also be given by subcutaneous injection, but this method of treatment should only be carried out by a physician. Where emetine is not available ipecacuanha itself may be used and is given as follows:—

_Treatment by Ipecacuanha._—When the bowels have been opened, give twenty grains of ipecacuanha, either solid or mixed with a wineglass of water, or less; arrowroot, starch, or gum-water, which will help to suspend the drug. Of course, ipecacuanha will act more quickly if it can be taken suspended in a liquid, instead of in the solid form. To prevent vomiting, put a mustard leaf to the pit of the stomach. Absolute quiet must now be observed; darken the room, and allow no moving in bed or talking. Withhold food and liquid for at least two hours if possible, but if there is much thirst, teaspoonful doses of water may be given.

If there is no vomiting for an hour, probably a good part of the ipecacuanha has been digested; if it has been vomited, wait for half-an-hour, and then give another full dose. If vomited again, wait for two hours, and give twenty drops of chlorodyne, followed by twenty grains of ipecacuanha; the chlorodyne is to quiet the stomach, enabling it to retain the ipecacuanha. In about twelve hours from the first dose, repeat it in exactly the same way. If thirty grains are too much at a time, give twenty, three times a day, for not less than sixty grains should be given in twenty-four hours. The drug is not a dangerous one, and, if the patient can take it, too much can hardly be given. Between the doses feed the patient, giving but little at a time. If the ipecacuanha is going to do good, marked improvement should be apparent in four or five days; failure of the drug is often due to its not being given or retained in sufficiently large quantities.

In addition to the emetine or ipecacuanha treatment it is well, save in mild or trivial cases, to give a saline mixture once a day, for example one ounce of sodium or magnesium sulphate. Other methods which are helpful are enemata of warm water, hot hip baths, or a soothing injection made by soaking an ounce of linseed for several hours in two pints of warm water. Sedatives, such as laudanum or chlorodyne, should be used only in cases where there is severe pain, sickness and great distress. The full dose in ordinary cases is twenty drops three times a day, but if less is sufficient so much the better, and it is advisable to avoid these remedies wherever possible.

The object of treatment is not to block up the bowel—as might be done by giving large doses of opium or tannin—it is to cure the disease of which the looseness is only one symptom. The most favourable sign during an attack is a return of the colouring matter to the motions; this shows that the liver is again acting, and that the treatment is doing good. With the return of colour (which at first may be intermittent), the other symptoms, such as pain and bloody discharge, will abate, and the motions will become more solid and healthy.

In dysentery, as in severe diarrhœa, the patient should _not_ be allowed to get up to stool. A box cut across obliquely will make a rough slipper bed-pan; put sand in it, and pad the edges.

In bacillary dysentery emetine is nearly or quite useless, and recourse should be had to a saline treatment. A mixture containing sixty grains of sodium or magnesium sulphate, fifteen drops of dilute sulphuric acid, and five drops of tincture of ginger can be given in half an ounce of peppermint water, if necessary, every two hours at first, and then every four or six hours, until the stools are watery and bile-stained. An alternative method of treatment, but one which is not so satisfactory, is to give half-grain doses of calomel every hour for twelve hours on three successive days. The patient must, however, be watched for such symptoms as tenderness of the gums, salivation (_i.e._, great increase of the saliva), and a metallic taste in the mouth. Should such symptoms arise the doses must be reduced or the drug discontinued.

The general treatment is the same as that for amœbic dysentery. As colic is often very severe, turpentine stupes or poultices to the abdomen are often indicated.

A specific anti-dysenteric serum is now employed in cases of bacillary dysentery, but its administration requires medical skill.

When the acute dysenteric attack is over, bismuth may be given, and various astringent enemata may be tried, but these should not be administered in the absence of a physician. A simple form of enema, however, is one containing a teaspoonful of alum or ten grains of sulphate of iron to the pint.

_Enteric or Typhoid Fever, including the Paratyphoid Fevers._

It is impossible to give a full account of the enteric fevers here, and moreover the presence of a medical man, still more of a good nurse, is absolutely necessary for their proper treatment. The chief early symptoms, however, will be given, and a few hints as to their treatment. For all practical purposes paratyphoid fever may be considered as a mild variety of typhoid.

The disease is characterised by ulceration of the small bowel, with continued high fever, and is usually accompanied by diarrhœa.

_Causes._—It is generally caused by the drinking of impure water, but may also be transmitted by all the causes operative in the case of dysentery (_see_ p. 185).

The incubation period is from ten to fifteen days.

_Symptoms._—The early symptoms of the disease are often so slight that the patient will not believe he is really ill; he may just feel out of sorts, or complain of headache, but still go about his work. There may be diarrhœa, or occasionally constipation. After five or six days the patient is generally compelled to give up and go to bed, headache or diarrhœa, or both, being the chief complaint. The temperature goes up in a characteristic manner, rising a little more every evening till it eventually reaches 103° or 104° F. There may be some cough, and often this symptom is a very troublesome one.

The belly is usually distended and slightly tender, and there may or may not be the characteristic typhoid rash, consisting of rose-pink circular, slightly raised spots, about the size of a large pin’s head. They occur chiefly on the chest and abdomen, and come out on successive days, often only three or four at a time. These spots are frequently absent, and then one must be guided by the presence of other symptoms. They are difficult to be seen upon a dark skin.

_The possibility of enteric fever should always be remembered in cases where there is constant fever, unaccompanied by any definite symptoms, such as the recurrent shiverings of malaria, or the spitting of blood in pneumonia._

_Prophylaxis._—As for dysentery (_see_ p. 186). Preventive inoculation is very important and confers immunity for a considerable period (_see_ “Inoculation,” p. 168).

_Treatment._—Absolute quiet in bed. If constipated, bowels should be kept open by soap and water enema only.

Milk only (three to four pints daily) should be given during the whole course of the illness and till ten days after the temperature has descended to, and remained, normal. Stimulants, if pulse is feeble and rapid; opium only if there is much pain. If bleeding occurs from the bowel, an ice poultice or cold-water cloths should be applied to the belly; ice may be given to suck; opium and an astringent, such as tannin, administered by the mouth, or an opium enema be given. Milk should be given in small quantities only, and to each half-pint five grains of bicarbonate of soda should be added.

The motions must be burned, or carefully disinfected.

_Epilepsy._

_Symptoms._—This is the most common form of fits. There are three stages. _1st stage_—The patient falls down completely unconscious and without warning, the face is pale, the limbs become stiff and rigid, and the breathing ceases. _2nd stage_—Convulsive movements take place, the tongue being often bitten, the breathing becomes heavy and laboured, and the motions may be passed unconsciously. _3rd stage_—A confused mental condition, sometimes acute mania, usually sleepy for some time. In some cases the fit may only last a few minutes. They almost always recur.

_Treatment._—During the attack nothing can be done beyond loosening all tight clothing, and gently preventing the sufferer from injuring himself in his struggles. It is especially important to keep the teeth apart with a piece of cork or rubber to prevent the tongue from being bitten.

Bromide of potassium (ten to twenty grains) may be given three times a day as a preventive.

_Faintness._

Bending the head firmly down between the knees is the best and most rapid way of dealing with an attack. Another method is to lay the patient on a couch, loosen any clothing which is round the neck, bathe his face and arms with cold water, and fan him vigorously. Give three grains of carbonate of ammonia in an ounce of water. Alcohol may be given if the pulse is very weak, but sal volatile or carbonate of ammonia is more efficacious.

_Filariasis._

This term connotes several pathogenic conditions, but the most important form of filariasis in man is that due to a small blood-worm which is conveyed by the bite of one or other species of mosquito. The most important symptom of filariasis is the condition known as elephantiasis, but the presence of filaria in the blood also causes a febrile state and various other symptoms which need not be detailed.

_Prophylaxis._—Protect from the bites of mosquitoes, especially those which breed in the vicinity of human habitations. The most effective method of doing this is the careful use of a mosquito net.

_Gonorrhœa._

Gonorrhœa, or clap, is an acute inflammation of the urethra or pipe, attended with a discharge of more or less matter. It is nearly always due to direct contagion.

_Symptoms._—At first there is some itching about the end of the pipe, which is followed by a yellowish-white discharge. This lasts from three to five days. Then great pain is noticed on passing water, and the discharge becomes thick and yellowish-green in colour, with redness and swelling about the lips of the opening of the pipe. After a time the pain on making water disappears, and the discharge becomes thin and watery, a condition known as “gleet.”

_Treatment._—Forbid alcohol in any form. Give large quantities of liquid—water, weak tea, or milk—to thoroughly flush the system. Light diet and as complete rest as possible. Keep bowels well open with saline and other purges. Give sandal-wood oil or copaiba, twenty drops three times a day, and urotropin, ten grains twice a day.

If there is much pain in the acute stage, a mixture containing fifteen grains of bicarbonate of soda, and five drops of chlorodyne or laudanum, in an ounce of water, may be given twice a day. Except in very acute cases the pipe should be syringed out with a very weak solution of permanganate of potash, or better, a solution of protargol (quarter to two per cent.); later on, a lotion containing four grains of sulphate of zinc to one ounce of water may be used as an injection.

If the glands in the groin become tender and inflamed, they should be painted with tincture of iodine. If, in spite of this, the pain and swelling increase, they should be poulticed frequently, and treated as ordinary abscesses.

_Hay Fever._

This is a very severe catarrh which attacks certain individuals yearly, when grasses and other plants are flowering. It is most probably due to the irritation of the nose by pollen grains in the air.

_Treatment._—Exposure to the irritating substances which are known to provoke an attack should be avoided.

The nose may be syringed out with a lotion containing boric acid and bicarbonate of soda (five grains of each in four ounces of water), or one containing bicarbonate of soda and salt (five grains of each in four ounces of water), to which has been added two to four drops of carbolic acid. The interior of the nostrils may be anointed with vaseline. Menthol snuff is of great value. A substance called “Pollantin” has a specific action in many cases, but it should be employed only under medical supervision.

_Influenza._

Influenza has been introduced into many tropical countries, in which it has spread rapidly and caused in many instances a very heavy mortality. The actual cause of the disease is still a matter of dispute, but there can be no doubt that it is chiefly spread by personal contact.

_Symptoms._—What may be called the respiratory type is pretty well known to everyone, but it should not be forgotten that sometimes the main stress of the disease falls either on the alimentary or the nervous system, while there is also a type of what is known as febrile influenza in which the heat-regulating centre is greatly upset. In this latter form the temperature may be intermittent and it is then apt to be mistaken for malaria.

The respiratory type is the most important. Its incubation period is short, one or two days. The onset is sudden and is characterized by shivering, pains in the back and limbs, severe headache and a feeling of malaise. The patient may be giddy and suddenly collapse, his throat is often dry and sore and he has an irritating cough. His temperature rises and runs up to 102° to 104° F. His face becomes flushed, his eyes reddened and his tongue is furred. Constipation is common. Uncomplicated influenza, if promptly attended to, is not a very serious disease, and improvement usually sets in about the third day. The most serious complication of influenza is bronchial pneumonia, and in some forms of the disease the heart is very apt to be affected.

_Prophylaxis._—Isolation of cases; free ventilation; treat patients as much as possible in the open air. Nurses and those attending the sick should be careful about contracting infection from the patient’s invisible mouth spray. Indeed in some epidemics the use of face masks has been recommended.

_Treatment._—Rest in bed as soon as possible; free purgation at the outset; an early dose of twenty to thirty drops of laudanum (Tinct. opii) is often very beneficial but the drug must be administered with care. Aspirin in ten-grain doses thrice daily frequently relieves the more urgent symptoms. In cases where there is vomiting and collapse with high temperature a dose of fifteen grains of aspirin with half to one ounce of brandy and three drachms of liquor ammon. acetat. may act like a charm. According to our present knowledge, however, it would seem that drugs are of little use in influenza, and that the important thing is to ensure good nursing and to keep up the patient’s strength. Quinine in effervescing form is very useful for convalescent cases.

_Insect Pests._

(_See also Myiasis and Skin Diseases._)

These are best divided into the Winged and Wingless forms. Of the winged pests _Mosquitoes_ are undoubtedly the most important in the tropics, as they are known to transmit such diseases as malaria, yellow fever, dengue fever and filariasis. The anopheline mosquitoes are those responsible for transmitting malaria, and they can easily be recognized by the facts that their wings are usually spotted and that they appear as it were to stand on their heads when resting on any flat surface. The culicine mosquitoes, which include _Stegomyia fasciata_, the carrier of yellow fever, do not as a rule have spotted wings and they rest parallel to the surface on which they alight. There are also marked differences in the water stages of these insects which cannot, however, be here considered.

The best way of protecting oneself against mosquitoes is the proper use of an effective mosquito net, the mesh of which should contain at least sixteen holes to the linear inch. Mosquito boots or buskins are also useful, and in certain places hoods for the face and neck, such as the “Mosquinette” variety, will be found of value.

Repellent substances applied to the skin may also be employed. Cassia oil, with brown oil of camphor in vaseline, is useful. Vermijelli, containing a little citronella oil, is fairly effective but is not so pleasant to use. The irritating effect of mosquito bites may be diminished by the application of tincture of iodine. The same measures are effective in the case of some of the biting midges.

The insects generally known as _Sand-flies_ are really owl midges or moth flies, tiny and hairy insects which have been proved to transmit sand-fly fever (_see_ page 221). These flies breed in damp places where there is rotting vegetation, dark and damp cellars, cracks and fissures in the soil, tunnels, etc., and they are often very troublesome. The repellents mentioned above may be used to drive them away, as may eucalyptus oil, camphor and tobacco smoke. The ordinary mosquito net is useless against their attacks, and one containing twenty-two holes to the linear inch is required.

_Buffalo gnats_, which are often called sand-flies, are insects which breed in running water and amongst cataracts and rapids. They are formidable biters although they are not known to cause any disease. The same protective measures are indicated in their case as in that of owl midges.

_House Flies._—There are several species of these. They are definitely known to distribute certain harmful bacteria and protozoa and to contaminate food by carrying the organisms on their bodies, wings and legs, or depositing them by regurgitation or in their droppings. Hence it is very important to protect all food and drink from flies and to destroy these insects wherever possible. The subject of their destruction is too large a question to be dealt with here, so all that need be said is that the traveller should provide himself with wire mesh fly covers to screen food and also with pieces of mesh or calico weighted with beads, which can be utilized for covering vessels containing milk or other liquids. It is worth noting that ordinary fish netting hung over a tent door or used to screen the windows or doors of a house will effectively exclude flies, despite its large mesh.

_Tsetse Flies._—These are considered under Sleeping Sickness (_see_ page 234).

_The Congo Floor-maggot Fly._—It is the maggot or larva of this fly which is important, as in many parts of Africa it infests the floors of native huts and it is a blood-sucker feeding at night. So far as is known it does not convey any disease but it is an unpleasant visitor, and if its numbers are great they may extract comparatively large quantities of blood from their unconscious victims.

_Prophylaxis._—General cleanliness and enforcement of sanitary measures, the use of high beds, the scrutiny of sleeping mats and blankets in which eggs or larvæ may be concealed. Infected huts can be rendered habitable by firing the ground or by removing the surface soil, which can then be disinfected.

_Wingless Pests._—_Lice._—These are known to transmit typhus fever. Further, they often cause great cutaneous irritation and are loathsome companions. It is no easy matter to get rid of lice when infection is on a large scale, but very often this is not the case and it is possible to detect their presence only by careful examination. There is no real difference between head lice and body lice; they are simply varieties of the same insect. The presence of head lice may be recognized by the discovery of their eggs, which are known as nits and are minute, yellowish-white, goblet-shaped bodies about the size of a full-stop on this page. Examination for head lice is much facilitated by the use of a fine tooth comb. Persons suspected of harbouring body lice should be examined first for the actual bites of the insect on the skin. Their clothes, and especially their under-garments, should then be carefully examined, attention being more particularly directed to the seams and folds where the eggs, if present, are most likely to be found.

The best preventive measure against lice is strict personal cleanliness. Clothes should be frequently changed, and as frequently washed. The hair should be kept cropped short, especially at the sides and back of the head, and in the tropics it is very advisable to shave all hairy parts of the body.

Space does not permit a full account of how to deal with verminous persons and verminous clothing, but it may be said that the only reliable methods of destroying lice are by hot air, steam, boiling water, or hydrocyanic acid gas. At the same time it should be noted that the heads of those infested with head lice should be thoroughly combed and treated with paraffin, petrol, or white precipitate ointment, and then well washed with carbolic soap. The nits may be loosened by treatment with warm vinegar or acetic acid. In the case of body lice possibly the most satisfactory grease for application to the underclothing is one composed of crude unwhizzed naphthalene from the coke oven, four parts, and soft soap, one part. It is important that the proper type of naphthalene be used.

A useful palliative method is the ironing of clothing, especially along the seams, with heavy hot irons.

_Fleas._—Bubonic plague is known to be transmitted by fleas, and it is possible that they play a part in the transmission of that form of leishmaniasis which is known as kala-azar (_see_ p. 202). Fleas dislike powdered naphthalene and pyrethrum powder, and either of these may be applied to the clothes to ward them off.

A note on the troublesome _Chigger flea_ or _Jigger_ will be found under “Skin Diseases” (_see_ p. 228).

_Bed-Bugs._—The traveller sleeping in hotels or inns abroad is very apt to be attacked by bed-bugs, which harbour in wooden beds and bedding, crevices in walls, floors and ceilings, and other places which are dark and sheltered. Fortunately, so far as is known, the bed-bug does not carry any disease, but its bites are annoying, and its presence is a sign of insanitary conditions. It is difficult to protect oneself against bed-bugs without instituting a campaign against their hiding-places and breeding-places, but a skin ointment like vermijelli is useful, and powdered naphthalene or Keating’s powder may deter the insects to some extent.

_Note._—Keating’s powder, which contains pyrethrum, is slow in its effects, and therefore, if possible, should be shaken over the sleeping bag or blankets some hours before bedtime. If not, the pests will struggle through it and find renewed vigour on the sleeper. It is best in very bad quarters to rub the powder on the skin as well as to dust it over the bed. It will not kill a full-grown bug under an hour, but it is extraordinarily effective with fleas. It is important to obtain a good pyrethrum powder, as such preparations are frequently adulterated.

The _Itch Insect_ is the cause of the skin disease known as scabies. It is a mite, the female of which burrows under the skin to lay her eggs. The favourite site for her operations is between the fingers, but other parts of the body may be affected, and the rash produced may assume various forms, so that it is well in the case of any skin eruption in the tropics to remember the possibility of scabies.

_Treatment._—Its effective treatment is by no means easy, and would take much too long to detail here. All that can be said is that the skin should be washed well with soap and hot water, and that thereafter a liberal quantity of sulphur ointment should be thoroughly rubbed into the skin twice daily for three days. On the fourth day recourse should be had again to soap and hot water, if possible in the form of a hot bath. Meanwhile, clothing and bedding should be boiled or destroyed.

_Ticks._—The most important tick from the traveller’s point of view, at least, in Africa, is the species responsible for the transmission of tick fever (_see_ p. 242). It would seem that the fowl tick may occasionally attack man, and some believe that it may spread the infection of certain kinds of relapsing fever (_see_ p. 218). The larval stages of certain ticks are often very troublesome in many parts of the world, owing to their habit of burrowing into the skin of persons coming into contact with them.

_Treatment._—When a larval tick is found half buried in the skin, force should not be used in an attempt to remove it, because either the surrounding skin is unnecessarily damaged or, as is most probable, the head of the tick is ruptured, its rostrum or beak remaining buried in the skin. The result is severe irritation which may lead to septic infection. The best way, therefore, of dealing with a tick larva lodged in the skin is to dip a small camel’s hair brush in turpentine, benzene, petrol or paraffin, and apply it between the skin and the under surface of the tick. In a short time the tick will let go its hold and may be swept from the skin with the brush. Vaseline is also effective if smeared over the tick. To remove a rostrum which remains in the skin after a tick has been forcibly ejected, cocaine should be applied to the spot, and the rostrum extracted with needle forceps, iodine being thereafter applied. A special form of tick-case devised for dealing with this condition is upon the market, and is a useful addition to the traveller’s outfit.

_Ants._—These are often very troublesome owing to their depredations on foodstuffs, and it must be remembered that experimentally ants have been shown capable of carrying the organisms of typhoid fever and cholera, though under ordinary conditions they are not likely to be very dangerous in this respect. Some form of pyrethrum powder, such as Keating’s, will be found useful in checking the depredations of ants, or they can be prevented from getting at food on tables by tying paraffin-soaked rags round the legs of the latter. Powdered borax or paraffin are useful in dealing with so-called “ant-routes” into tents or houses.

_Iritis, or Inflammation of the Eyeball Itself._

_Symptoms._—In this there is pain, the vision is dimmed, and the transparent part of the eye is found to be cloudy. Skilled assistance is necessary.

_Treatment._—Apply hot fomentations and boric acid lotion; leeches or a blister to the temples are of service, and the pupil, which is contracted, should be dilated by dropping two or three drops of a one per cent. solution of atropine on to the eye twice a day or oftener till it is well dilated; only enough drops should be applied afterwards to prevent the pupil from contracting. Dark glasses may be worn with advantage. The bowels should be kept well open, and one grain of calomel may be given three times a day for a week, or longer if it does not cause a coppery taste in the mouth, with tenderness of the gums and excessive flow of the saliva. As the inflammation subsides a shade may be adopted.

_Night blindness and snow blindness_ are due to exposure to the glare either of the sun or of the snow. To avoid these complaints tinted glasses should be worn. Travellers in snowy regions should be provided with smoked glasses; if these get broken or lost, some opaque substance may be smeared over the surface of an ordinary pair, leaving a narrow horizontal slit of clear glass—in the Esquimaux fashion, as shown in the accompanying illustration. On snow it must be remembered that the perforated wire gauze sides are essential for protection from the reflected rays of the sun. Elastic may be substituted with advantage for the ordinary metallic attachments, between the glasses as well as around the head.

_Jaundice._

Jaundice, which is a condition in which the skin and mucous membranes assume a yellow colour, may be due to various causes. One of the commonest forms is that known as catarrhal jaundice, which is induced by chill, exposure, dietetic disturbances, etc. It should be treated by calomel and salines. Violent purges are to be avoided. Bismuth and bicarbonate of soda should be given, and the diet should be regulated and should consist of simple and bland articles of food, free, as far as possible, from fats.

There is a form of jaundice associated with infective conditions, such as the enteric fevers, dysentery, malaria, relapsing fever and yellow fever. In these cases the jaundice is to be treated like the catarrhal form, and the accompanying condition requires attention.

In addition to the above there is a camp or infectious jaundice, the nature of which is somewhat obscure, but which is associated with a considerable degree of illness.

_Symptoms._—The condition commonly begins with shivering, a rise of temperature, headache, giddiness, general malaise, sleeplessness, loss of appetite, nausea, and it may be vomiting. The tongue is coated, and there may be pains in the back and legs. The jaundice usually lasts from seven to nine days, and about the fifth day the temperature falls, though there may be a secondary fever.

_Prophylaxis._—So far as we know at present this is a question of enforcing good sanitary surroundings, and paying special attention to the hygiene of food and drinks, which should be guarded from the access of flies.

_Treatment._—This is entirely symptomatic and should be that of any ordinary febrile attack, together with the measures employed in catarrhal jaundice. There is a severe form of jaundice of an infective nature which is associated with the presence of a parasite in the blood, very like that of yellow fever, and which apparently is derived from infected rats. This form of jaundice is, however, not very common and need not be further considered, especially as it requires skilled medical attendance.

_Laryngitis, or Inflammation of the Upper Part of the Windpipe._

The organ of the voice is called the “larynx.”

When the windpipe is affected it is somewhat tender on pressure, there is hoarseness, cough, and pain in swallowing. Treatment similar to that for cold in the head may be adopted; in addition, the upper part of the front of the throat should be kept well poulticed for a day or two, and then wrapped up in cotton wool for some days longer. A piece of mustard leaf covered with six layers of a handkerchief and secured by a bandage, can usually be borne for a considerable time, and is often more efficacious than the poultice; when the smarting is great the mustard leaf should be removed and the tender part smeared with oil or vaseline.

Inhalations of steam are of use in promoting expectoration. Carbonate of ammonia, three grains, or bicarbonate of potash, five grains, with half to two grains of ipecacuanha, will help to promote secretion from the affected part. A teaspoonful of Friar’s balsam in a pint of hot water makes a good inhalation.

_Leeches._

Persons travelling in India, Ceylon, the Far East generally, and the Philippine Islands, are likely to make the acquaintance of the Asiatic leech, which is a very troublesome and indeed dangerous species of vermin. It is very small, only about an inch long, and of the thickness of a knitting-needle. It is able to penetrate through the interstices in clothing, and when in vast numbers it is a foe difficult to combat. The bites of these leeches are painless and much blood may be lost before their presence is discovered. It is very difficult to obtain any kind of boot or puttee which will keep these creatures at bay, and the traveller in these countries should be provided with a solution of salt or weak acid which, on application, causes the leeches to loose their hold. It is a mistake to try and drag them off the skin, as parts of their biting apparatus are apt to be left behind and set up inflammation and suppuration. Tincture of iodine should be applied to the site of a leech bite. In forest regions where these leeches abound protective measures must be taken at night, the best being the use of a properly adjusted mosquito net of very fine mesh.

The tropical water leech is found in the Azores, the Canary Islands, Africa, Palestine, Syria, Armenia and Turkestan. It may reach a length of four inches, and if swallowed with drinking water usually fastens on the mucous membrane of the mouth or throat. As a preventive measure drinking water should be passed through a piece of muslin or similar form of sieve.

_Leishmaniasis._

This condition is named after Sir William Leishman, who discovered the parasite producing it. There is a general and febrile form of the disease and also a form attacking the skin and mucous membrane of the mouth and nose, which is considered under Skin Diseases.

The systemic form of the disease is commonly known as kala-azar, which signifies “black sickness.” It is common in certain parts of India, notably Assam, but is found also throughout the Far East, and it occurs in Arabia, in the Anglo-Egyptian Sudan and in the Mediterranean area. A case has also been described in South America, in parts of which it is possibly more common than is generally supposed.

_Cause._—The parasite, which lives in the blood and tissues, is known, but its exact method of transmission to man is still in the realm of uncertainty.

_Symptoms._—The disease begins in an indefinite manner and then assumes the form of a continued fever, associated with enlargement of the spleen and liver and progressive emaciation. Bleeding from the nose is not uncommon, and in Europeans the peculiar earthy-grey colour of the skin is very striking. The disease lasts for months and even years and is very frequently fatal.

_Prophylaxis._—As we do not know how the disease is spread it is not easy to recommend preventive measures, and all that can be said is that every care should be taken to isolate the sick, to live under healthy conditions and to avoid contact with vermin of all kinds. As dogs may possibly be carriers of the disease they should be destroyed if proved infected.

_Treatment._—Antimony is the best and indeed the sole remedy, but it can be given only by a medical man, so that nothing further need be said here regarding it.

_Liver, Congestion of_:—

The _Liver_, which is mainly on the right side, lies below the right lung, and is protected by the lower ribs. In health it extends vertically from one-and-a-half inches below the right nipple to the lower edge of the ribs; in certain diseases it is enlarged, and its edge can be felt well below the ribs.

Congestion of the liver is frequent in the tropics, and is often due to malaria or dysentery. Very frequently it is caused by abuse of alcohol, over-indulgence in food, and the excessive use of hot condiments, or by constipation and want of exercise. In the tropics the liver is more easily affected by excesses than in temperate climates.

_Symptoms._—A furred tongue, sallowness of the face, headache, lassitude, disinclination for work, loss of appetite, tendency to vomit, occasional slight jaundice, and a sense of oppression about the region of the liver.

_Treatment._—Light diet, abstinence from alcohol and spices, and the use of calomel or other aperient will usually effect a cure. Ammonium chloride, five to ten grains, three times a day, should be given.

_Liver, Acute Inflammation of_:—

In this complaint there is severe pain, some fever, and frequently jaundice. The complaint is serious, as abscess of the liver frequently follows it, at least if it is due to amœbic dysentery.

_Treatment._—The patient should be put to bed, hot fomentations applied to the seat of pain, and the bowels well relieved. Emetine should be at once administered as for dysentery, or ten grains of ipecacuanha should be given three times a day. Ammonium chloride in full doses (twenty grains three times a day) often does good, and can be retained when ipecacuanha cannot, but it is unpleasant to take, so the dose should be given in one or two ounces of water. The wisest course for one who has had a severe inflammation of the liver is to get away to a healthy climate.

_Liver Abscess._

It is extremely difficult for the traveller to decide if abscess of the liver is present; it may be suspected if a patient, convalescent from dysentery, still remains feeble and ill, or if he has an irregular temperature, a muddy complexion, night sweats, wasting, and pain or uneasiness in the right shoulder. Sometimes a definite swelling can be made out. A dry cough is not uncommon.

_Treatment._—Emetine is the specific treatment for the prevention of liver abscess, and it would seem in some cases actually able to bring about a cure even when the abscess has formed. It should be given as for amœbic dysentery (p. 187), and it is essential that a patient with liver abscess should as soon as possible come under medical control, as it may be necessary to give emetine by the needle subcutaneously or even to inject it into the abscess cavity. Ammonium chloride may be given; the patient’s strength must be supported, and he should be as quickly as possible placed under the care of a surgeon, who will probably decide to operate. If this cannot be done, then the patient should not be interfered with surgically, for he will have a better chance of recovery if the abscess is allowed to burst naturally than he would if the traveller attempted to operate.

_Malaria._

Of all diseases in the tropics malaria is the one which is most likely to trouble the traveller. Hence it is essential that he should be well posted regarding it. In addition to the books which have already been indicated he will find the recently published ‘Malaria at Home and Abroad,’ by Colonel S. P. James, a work of much value and interest. It is true it is more especially intended for the medical man, but any intelligent layman can study it with interest and profit, and the chapters dealing with prophylaxis and treatment are specially valuable and well up to date. Here it is possible to give only a mere outline of the chief facts concerning the disease.

1. Malarial fever is caused by a small animal parasite which lives chiefly in the blood of patients attacked by it. 2. Under ordinary conditions in nature it can be conveyed only from one person to another by the bite of a mosquito which has previously sucked the blood of an infected person. 3. The parasite undergoes a series of changes in the mosquito’s body and eventually finds its way to the salivary glands of the insect whence it is injected through the mosquito’s proboscis into another victim. 4. There are only certain species of mosquitoes, belonging to the family Anophelinæ (from a Greek word signifying “harmful”), which can carry malaria, and it is only the females of these species which are affected as the males are not blood-suckers. Anopheline mosquitoes breed in shallow puddles and in almost all collections of stagnant or gently flowing water. It is therefore very dangerous to pitch camps close to stagnant pools, sluggish reed-grown streams or marshy places. 5. In the tropics one of the chief reservoirs of infection is the native, and more especially the native child, who frequently harbours the malarial parasite in the form which is adapted for life and reproduction in the mosquito and hence is a distinct source of danger. It is therefore inadvisable to camp in the vicinity of native villages or to spend a night in the neighbourhood of native habitations unless efficiently protected from the bites of mosquitoes.

_Symptoms._—Malarial fever presents itself under two chief forms, though it should be noted that malaria is one of the most protean of all diseases and may simulate any malady. (1) _Intermittent_ fever. In this disease the temperature may rise high, but returns each day to normal or lower; hence there is, after each attack, a period of complete freedom from fever. An intermittent fever or ague is usually less serious than a remittent fever, but it is harder to cure in the long run. (2) _Remittent_ fever. In this the temperature, though it varies, keeps constantly above the normal, and the higher the fever, and the slighter the difference between the extremes of temperature, the more serious is the condition of the patient. Where the temperature is remittent, and appears to be unaffected by quinine, the disease is probably not malarial, but may be a case of enteric fever, and should be treated as advised below under that heading.

The attack may be sudden, but it is usually preceded by a feeling of languor, yawning, and general discomfort; this is followed by the _cold stage_, which, in the tropics, is usually short, and in the more ordinary attacks is ushered in by a violent shivering fit or rigor, though this is not common in Central Africa. The sensation of cold is entirely subjective, for though the patient feels chilly and piles clothes upon himself his temperature will be found elevated. At this period violent vomiting is not infrequent. Then comes the _hot stage_, often of long duration, followed by the _sweating stage_, during which the perspiration pours from the patient and soaks everything on and about him. After this there is a period of remission, or intermission of the feverish symptoms with corresponding relief to the patient. Usually, after some hours, the attack comes on again, beginning with the cold stage, but if the fever is treated very early, the disease may now pass off. The whole attack lasts as a rule from six to ten hours, say one hour for the cold stage, three or four for the hot period, and two to four for that of defervescence. There is sometimes a feeling of pain and discomfort in the right side owing to the congestion of the spleen, which enlarges during the rigor.

There are three distinct species of malarial parasite, and each causes a different type of fever. According to the type with which the patient has become infected, the fever recurs after one, two, or three days. At the same time all kinds of febrile irregularities are met with, so that it is often impossible to diagnose the disease in the absence of blood examination for the detection of the parasite.

Anæmia is a constant feature of the malarial attack, as is but natural, considering the great destruction of red blood cells brought about by the parasites which have infected them.

_Prophylaxis._—Only those preventive measures which can be put into operation by the individual will be here considered. This may be called _personal prophylaxis_. By far the most important means of avoiding malaria is the proper use of an efficient mosquito net. The oblong type is best, and it should contain sixteen meshes to the linear inch. Round the foot of it should be sewn a stout layer of calico 2 feet in depth. This will permit of a foot of the material being tucked under the mattress while the upper foot remains in the form of a belt or zone round the bed. It is necessary, because in its absence the sleeper is very liable to be bitten through the mosquito-net mesh, with which his arms or legs are apt to come in contact. Care must be taken to see that the net is kept in good repair—a most important matter—and in very malarious countries it is advisable to provide every member of an expedition, native or otherwise, with a good mosquito net. In what may be called the dry tropics, the top of the net may be of mesh; in the moist tropics, it is best made of calico in order to keep off the heavy dews. The traveller often sleeps out on the deck of river steamers, and then it is certainly advantageous to have the roof of the net composed of stout calico, as sparks from the funnel are very apt to alight upon it, and naturally holes will be burnt much more readily in mesh than in thick cotton. It is foolish to sleep even for one night in a malarious locality unprotected by a net.

The net is for use during the period of sleep, but one is very apt to be bitten by infected mosquitoes just after sunset, and hence it is well to make use of some form of mosquito canopy. A good type is the so-called mosquito umbrella tent. Such a canopy may be arranged so that the evening meal can be taken in it. One servant will be inside the canopy and receive the dishes through a guarded opening from the attendant outside.

Other methods of protection exist in the shape of mosquito boots or buskins. The best type of mosquito boot is the form which reaches right up the thigh. They may be made of untanned leather or of stout khaki cloth. All mosquito boots and buskins should be provided with soles to protect the feet from wet and damp. In the absence of boots it is well to know that a mosquito will not bite through two pairs of stockings, one super-imposed over the other. This is a way in which women can protect their legs and ankles, or they can employ the buskin, leggings, gaiters, or puttees.

Mosquito veils have been mentioned, the best type being the “Mosquinette” hood.

Mosquitoes are apt to bite through chairs with cane seats or with perforated seats, and these should be guarded by a layer of brown paper, newspaper, or a cushion.

Repellent substances may be used, smeared on the skin. They contain essential oils, such as oil of cassia or eucalyptus oil. These repellents are effective only for a short time, but lessen in some degree the liability to infection.

The prophylactic use of quinine has recently fallen somewhat into disrepute, owing to its comparative failure in many of the war areas, but there can be no doubt that under conditions of civil life it is a valuable auxiliary method, if properly employed. One of the troubles about it is that quinine is rapidly excreted from the body, and hence after a dose it remains in the blood only a comparatively short time; for example, if the dose be taken at 6 p.m. it is very doubtful if enough quinine will be left in the blood at 2 o’clock in the morning to kill any malarial spores which may be introduced into it by an infected mosquito. The ideal method of taking quinine prophylactically would be to take a dose of 5 or 6 grains with the evening meal shortly before sunset. This will protect until it is time to get under the mosquito net. If for any reason it is impossible to employ the latter, then a second dose of quinine should be taken at midnight. This is difficult to accomplish, and hence something may be gained by taking a larger dose of quinine at night on the chance that some of it may remain in the blood for a longer period than would the smaller quantity. As much as 10 grains may therefore be taken under these conditions. Some persons, however, cannot stand 10 grains of quinine daily for a long period of time.

It is clear from what has been said that prophylactic quinine should never be taken in the morning, and also that it is merely an auxiliary method, and does not do away with the necessity of using the mosquito net. Sugar-coated tablets should be avoided, and care must be taken to see that the products or tablets which may be used are readily soluble. It is a good plan to crack the products before swallowing them. A good salt of quinine is the bisulphate, which is soluble and comparatively cheap. When the drug is given in powder, tablet, or pill form, it should be followed by a wine-glassful of water, and it is advisable to acidify the latter by a few drops of hydrochloric acid. There is no doubt that as a general rule quinine is best taken in solution, but in the case of persons travelling about this is not always easy to arrange, and if the above precautions be taken the solid form will generally be found effective. It is better to take prophylactic quinine in daily doses, because if an interval is allowed to elapse between doses one is apt to forget to take the drug at the proper time. Hence it is well to make it a kind of ritual to take the quinine along with the evening meal, for it is certainly an advantage to do so on a full stomach. It should be remembered that persons who take their quinine regularly do not suffer from blackwater fever, while the irregular taking of quinine certainly appears to favour the occurrence of the latter. It is better not to take prophylactic quinine at all than to take it in a haphazard and irregular manner.

_Treatment._—The three great principles of treatment are: (1) To open the bowels; (2) to produce perspiration; (3) to give quinine. The routine to be adopted is as follows. Put the patient to bed in flannel pyjamas, and covered up well with blankets; in all cases, save where there is diarrhœa, give an aperient, such as four grains of calomel, or two tabloids of Cathartic Co, or two Livingstone’s Rousers, and if this does not act, repeat the dose in about four hours. If free evacuation is not produced, a warm-water enema should be given. A hot-water bottle in bed is useful. Sponging with warm water often gives relief at the beginning of a fever, and tends to shorten the cold stage. At the same time hot drinks should be given, such as weak tea, in order to promote perspiration and cut short the hot stage, and at this stage, _i.e._, at the outset of the fever, 10 grains of Antipyrin, or 10 grains of Phenacetin, may be found useful for inducing perspiration, or four tablets of Warburg’s Tincture, which contains some quinine, may be substituted for them. Antipyrin and Phenacetin should not be given except in the earliest stages of the fever.

During the hot stage cold applications, such as cloths wrung out of cold or iced water and sprinkled with eau de cologne, vinegar or spirit may be applied to the forehead and behind the ears. The bed-clothes should be lightened and drink freely supplied, unless it seems to promote vomiting. If the temperature shows signs of getting above 105° F. sponge the patient with warm water or cradle the bed-clothes, as it is called—that is, remove them from contact with the body by some simple means. In the sweating stage strip off the soaked pyjamas and sheets and get the patient into warm, well-aired night-clothes and bed-clothes. If there is any tendency to collapse a little stimulant may be given—say, a dessertspoonful of brandy. In most cases alcohol is better avoided. If vomiting is bad withhold all food, and give bits of ice to suck if it can be obtained.

Whilst the above methods of treatment are important, it should be clearly recognised that the one drug which can alone counteract the malarial affection is quinine, and it is upon the proper administration of quinine that successful treatment largely depends.

This proper administration necessitates at the outset rest in bed, and it also necessitates a continuance of the drug for a sufficient length of time. For ordinary cases the best way is to give quinine by the mouth, and here again it is best given in solution, though it can be administered in solid form if the precautions above indicated are duly observed. Various doses have been advocated, but probably the best quantity to administer is 30 grains every twenty-four hours. This is usually given in three doses of 10 grains each, but there would appear to be an advantage in giving four doses instead of three, and Colonel James advocates the following times for administration, _i.e._ 12 midnight, 6 a.m., 12 noon, 6 p.m. He does so, because such a method of administration is likely to ensure that there shall be a sufficient concentration of quinine in the blood at the time when the youngest forms of the parasite are present. The patient should remain in bed, if possible, for ten days, or, if this is impossible, for at least half that period; and it is essential that the quinine should be given as soon as possible, and quite irrespective of the stage of the attack or the height of the fever. If its administration is followed by vomiting, give a small teaspoonful of bicarbonate of soda in warm water. If this is rejected repeat the dose, and then give some form of stomach sedative, such as bismuth, and dilute hydrocyanic acid or 20 drops of chlorodyne. A mustard leaf applied to the pit of the stomach is often helpful. Sometimes drop doses of tincture of iodine, well diluted, will check these troublesome symptoms. Under ordinary conditions this 30-grain quinine treatment should be steadily continued for at least five days, but in troublesome cases it may be necessary to carry on with it for as long as three weeks. Thereafter what is called the “after treatment” is begun and must be continued for a period of three months, in order to ensure, if possible, an eradication of the infection.

There are several ways of carrying out this after treatment, but one of the simplest and most effective is to administer 10 grains of quinine every day, the dose being taken an hour or two before the time at which the fever was apt to come on during the attack.

If, despite quinine treatment, relapses occur, the patient must go to bed and be treated as for the first attack, and the after treatment must again be carefully carried out.

Under certain conditions quinine has to be injected by the needle, either into the muscles or into a vein; but, as a rule, this should not be done save by the medical attendant. It should, however, be remembered that the drug may be given by the bowel, in which case twice the quantity of quinine which would be administered by the mouth should be given. It is only exceptionally that this procedure will have to be followed, but it is sometimes useful in the case of children.

The feeding of the malaria patient is important. Between the attacks of fever, or during the sweating stage, he should be given food in fluid form, such as chicken broth, eggs beaten up with milk, raisin tea, etc.; and as soon as his stomach will stand it, the diet should be increased. Tonics, such as iron and arsenic, are required during convalescence.

In cases where there is acute malarial poisoning, with temperature 106° F., or even higher, do not wait to undress the patient or get a bath; but empty gallons of water over him, one boy keeping the head constantly soused; while this is being done a bath can be procured and the patient then undressed, or, better still, have his clothes cut off, because it is dangerous to lift such a patient about too much. Remember that when a patient is very ill and weak, he should not be allowed to stand or sit up suddenly, as he may faint.

Delirium with high temperature, say 106° F. or over, is a certain sign that the fever is doing harm, and must be reduced.

The temperature and pulse should be carefully watched when the cold water treatment is employed.

_Malta Fever._ (See _Undulant Fever._)

_Measles._

Incubation period, ten days. Rash occurs on the fourth day.

_Rash._—Pink spots, round or irregular, slightly raised above the surface, tending to run together in patches over the body, leaving the unaffected skin between them clear. In the early stages often best marked on the face and behind the ears.

_Symptoms._—Fever, catarrh, congested eyes, running from the nose, sickness and cough.

_Treatment._—Similar to that of scarlet fever (_see_ p. 222). It is very important to guard against chill; to ensure plenty of fresh air.

_Complications._—Measles may be followed by pneumonia.

_Mumps._

This is an infectious disease, characterised by swelling of the salivary glands. Its chief importance to the traveller is that if once it makes its appearance it may spread rapidly through his native attendants, and that it is apt to be followed by inflammation of the testicle.

_Symptoms._—The invasion is accompanied by fever, which is usually slight, but is sometimes severe. There is pain just below the ear on one side, followed by a swelling which gradually increases, causing great enlargement of the neck and side of the cheek. In a day or two the other side of the face is usually affected, and sometimes the condition spreads under the lower jaw. It persists from seven to ten days, then gradually subsides. Inflammation of the testicle may be troublesome. It is usually one-sided.

_Treatment._—Rest in bed during the height of the disease. Get the bowels freely open and keep the patient on a light diet. No medicine is required unless the fever is high. Either cold or hot applications may be made to the swelling. If the testicle is involved it should be treated by rest and protection with cotton wool.

_Myiasis._

This is the name applied to the condition in which the larvæ of flies are found parasitic in the body. It may be cutaneous, nasal or intestinal. The last named is not of great importance. Different species of flies may be concerned; thus in Africa, one of the best known flies producing this condition is called on the West Coast the _Tumbu fly_. The fly itself is about the size of a small blue-bottle, and is yellowish-grey in colour. It has a fat white larva, which burrows under the skin and produces a small boil or wheal, in the centre of which there is an opening which, unless blocked up by discharge, looks black owing to the presence of excrement from the posterior end of the larva. The skin round the hole becomes inflamed and very itchy. The commonest site is the forearm, but in Europeans various parts of the body may be attacked.

_Treatment._—When small the larvæ can easily be squeezed out. They are, however, best extracted with forceps, and this is more readily done if a little chloroform is injected into the maggot before it is removed. Apply local sedatives, such as lead and opium and, after removal of the maggot, paint the skin with iodine. Indeed, if there is some delay in getting the maggot removed, it is well to apply tincture of iodine to the skin to prevent the occurrence of suppuration.

In Central and South America we meet with the so-called _Ver macaque_, which is the larva of another species of fly, and which gets under the skin in much the same way as does that of the Tumbu fly. It causes a great deal of pain, especially when it is moving about. It should be treated on the same lines as above.

The _Screw-worm_ is also met with in America, and is the maggot of a fly which lays its eggs on the surface of wounds and in the ears and nose of persons sleeping in the open air. The maggots burrow into the tissues and may bring about a very serious condition if not detected at an early date and removed.

_Treatment._—Injections of chloroform are one of the best ways of getting rid of maggots in the ear or nose, but medical attention is required. Wounds should be protected and kept clean. If infected they may be treated with turpentine, a painful but effective method.

_Ophthalmia, Simple._

Simple ophthalmia, conjunctivitis, or inflammation of the membrane covering the eye and the inner side of the eyelids, is usually due to cold or dust.

_Symptoms._—The affected eye is bloodshot and painful, waters freely, and cannot bear a bright light; there is a feeling of grittiness, as if the trouble were due to something between the eye and eyelid.

_Treatment._—The eye should be carefully washed, the eyelids being opened and clean, cold water allowed to run over them and over the eye; any particles of dust must be removed—for this purpose a small clean camel-hair brush will be found useful. A lotion should be made consisting of six grains of boric acid, or two grains of sulphate of zinc, to an ounce of water, and ten drops or more of this should be dropped on to the eyeball six or eight times a day. To prevent the lids sticking together during the night, they should be smeared with vaseline or a salve containing 4 grains of calomel to an ounce of vaseline. Sometimes hot fomentations give relief.

_Ophthalmia, Purulent._

This is a more serious inflammation, and is caused by some poison, _e.g._, germs carried by flies, or by the fingers from unhealthy sores and discharges. It may also result from injury, such as a septic wound.

_Symptoms._—The symptoms of simple ophthalmia are present, but are all intensified, the eyelids are swollen and the eyeballs red, there is a discharge of yellow matter or pus, and the patient feels ill. There is great danger of the affected eye infecting the sound one, therefore warn the patient not to touch the sound eye for fear of infecting it. There is also great danger lest the attendant’s own eyes should become infected.

_Treatment._—The patient should be kept in bed and the eyes should be shielded from bright light. Protect the sound eye (especially when the affected one is being washed) by placing a pad of wool or lint over it, kept in its place by strips of strapping so as effectually to close the eye and prevent infection. Thoroughly wash out the space between the eyelids and the eye, and remove any matter or foreign body which may be found.

When the inflamed surfaces are clean, wash them very thoroughly with a solution of corrosive sublimate, 1 in 5000, and finally smear a little vaseline along the edges of the lids, to prevent them sticking together. This treatment must be repeated as frequently as possible. Once a day the inflamed surfaces may be brushed over with a solution of nitrate of silver, 10 grains to the ounce, applied with a camel’s-hair brush, followed immediately by the application of a few drops of common salt solution.

Hot fomentations may give relief. When this is so, the eye should be kept covered with a pad of moist lint, which must be changed frequently. Benefit has followed the administration of very large doses of salicylate of soda.

_Piles._

Piles are very common in the tropics, and are often due to want of exercise, chronic constipation, dysentery, too free use of alcohol, and over-eating. No one who suffers from piles should become a traveller till skilled advice has been obtained.

_Internal Piles_, though not usually painful, are by their frequent bleeding a cause of anæmia and debility; they lie inside the orifice of the bowel, but sometimes they come down on straining, and are then nipped by the muscle surrounding the opening, and may swell up, become very painful, and bleed profusely.

_Treatment._—Keep the bowels freely but gently opened by taking cascara regularly; if the piles come down they should be returned, and an ointment of galls and opium or an injection of hazeline (one tablespoonful mixed with seven of water) used. Tannin, five grains to the ounce, or sulphate of iron, three to five grains to the ounce, may be used instead of hazeline. Hazeline suppositories are often of great use for internal piles, but ordinary suppositories do not keep well in very hot countries; if they are taken to the tropics they should therefore be specially made and packed. If the piles bleed profusely or cause great pain, an operation will be necessary.

_External piles_ do not bleed, but from time to time they become inflamed and swollen, causing great agony.

_Treatment._—The bowels should be kept well opened; the sufferer should lie with his hips raised; hot fomentations should be frequently applied, and the piles should be well greased. Glycerine of belladonna, smeared on a pad of lint, is a valuable application, as is dry calomel powder.

Some sedative, such as Dover’s powder, may be necessary to procure rest and sleep.

_Plague._

There are two chief varieties of plague, the bubonic and the pneumonic.

_Causes._—Bubonic plague, which is due to a small vegetable organism, the _Bacillus pestis_, exists primarily as a disease in rats and other rodents, such as the Manchurian marmot and the Californian brown squirrel, and is transmitted from these animals to man by means of the flea. It is the rat flea that is chiefly concerned in the spread of plague. Both the brown and the black rat are affected and, speaking generally, the black rat is the more dangerous, as it lives in closer association with man. It is now known that certain forms of merchandise, especially grain and, to a lesser extent, raw cotton, are more to be dreaded as vehicles of the bubonic plague infection than the infected human being.

The flea does not inoculate the bacillus by its bite. It sucks up blood containing plague bacilli. The latter multiply in the insect to such an extent that they block the entrance of the flea’s stomach and prevent it from feeding. The starved flea makes violent efforts to obtain more blood and, as a result, the contents of its gullet are discharged, together with the plague bacilli, upon the skin of the healthy person on whom it is trying to feed. If there is any little wound in this skin the bacilli gain an entrance and they set up the disease. Infection may also occur from the bacilli-containing excreta of the flea being voided on the skin and rubbed into wounds. When rats become ill or die the fleas leave them and attack man. It should be noted that the rat flea may remain infective for 43 days.

Pneumonic plague, although due to the same bacillus, is quite a different kind of disease, and is transmitted from the sick to the sound by droplets of sputum expelled in coughing, and probably also by the invisible spray which pneumonia patients discharge from the mouth. When the disease is epidemic domestic animals may suffer from it and become sources of infection.

_Symptoms._—Both forms of plague are characterised by sudden onset, sharp fever, giddiness, great weakness, a drunken gait, appearance and speech, and a tendency to heart failure.

In bubonic plague there is lassitude, headache and shivering, and the face is pale and anxious. The patient looks haggard, his eyes are often bloodshot, and his expression is frequently one of fear or horror. His temperature runs up to 102°, 104° F., or even higher, and his face gets hot and flushed. There is intense thirst, the tongue becomes dry and brown, the urine is scanty, and there may be delirium. About the second or third day the glandular swellings known as buboes make their appearance, usually in the groin, but they may occur in the armpits, the neck, and elsewhere. As a rule there is only one bubo, which varies in size. There may be a good deal of pain associated with the swelling, and sometimes it is very severe. The bubo, if not dealt with surgically, eventually softens and bursts, discharging matter and sloughs. In cases which are going to recover, improvement is noted about the fourth or fifth day, and is heralded by a profuse perspiration. In fatal cases, death usually takes place between the third and fifth days.

Pneumonic plague usually begins with shivering and vomiting. There is a cough, accompanied by breathlessness and blueness of the face, the sputum is profuse, watery and blood-stained, and as it is full of plague bacilli it is exceedingly dangerous. Very few cases of pneumonic plague recover.

_Prophylaxis._—Ward off attacks of fleas. A substance called pesterine is good for this purpose, and consists of kerosene 20 parts, soft soap 1 part, and water 5 parts. Powdered naphthalene and tricresol powder are useful. Attendants on plague patients should be protected from infection. They should wear puttees or gum-boots, gloves, and overalls, and those looking after pneumonic cases must wear masks, goggles, and overalls. There is a protective vaccine for plague, and those travelling in districts where plague is epidemic should avail themselves of its protective power.

_Treatment._—The only treatment which is of any value, and this only in bubonic plague and when given early, is the administration of plague anti-toxin, which should only be given by a medical man. The symptoms should be treated in order to relieve the patient’s distress. Belladonna and glycerine may be applied to the buboes, and they should be opened and carefully dressed once suppuration is established. Morphia is often required for the restlessness and insomnia, and cardiac stimulants are indicated in nearly every case.

_Pleurisy, or Inflammation of the Membrane Covering the Lung._

This is more a disease of cold climates, and is usually the result of chill following severe exertion.

_Symptoms._—Pleurisy is accompanied by less fever and general sickness than pneumonia; its characteristic symptom is the “stitch in the side”, which always accompanies it. There is also a short, dry cough, without expectoration, which the patient tries to restrain, as it “catches” in the side, and causes acute pain. For the same reason the breathing is shallow, as any attempt to draw a deep breath causes extreme suffering.

_Treatment._—The patient suffers greatly, therefore in the early stages treatment must be directed to the pain. If leeches are procurable, the application of half-a-dozen to the painful region of the chest is advisable. Mustard leaves or poultices should be applied over the part, or it may be painted with tincture of iodine; opium may be given to relieve the acute pain, in the form of Dover’s powder, fifteen grains three times a day. Five grains of quinine may be given twice a day.

_Pneumonia, or Inflammation of the Lungs._

It has been definitely proved that the black races are specially susceptible to the organism which is the cause of pneumonia, and it is a frequent source of invaliding amongst the native attendants of travellers in Africa and elsewhere.

_Causes._—As predisposing factors may be noted change of climate, chill, insanitary conditions of life, fatigue, and overwork. Malaria, syphilis, alcoholism, and excessive tobacco-smoking also play a part. The disease is believed to be spread by personal contact, but this has not been definitely established.

_Symptoms._—These usually begin with a severe attack of shivering; the temperature rises rapidly, the pulse and breathing are greatly quickened, and the patient is completely prostrated. The face is flushed, the skin feels hot and dry, and there is a short cough, dry at first, but afterwards accompanied by expectoration of a moderate quantity of slimy, rust-coloured, blood-stained, and almost frothless matter. Usually there is pain on the affected side, which in most eases is the right side of the chest, above the liver. In African natives heart failure is very common.

_Prophylaxis._—In order to prevent the occurrence of pneumonia amongst native followers good food should be provided, properly cooked; and it is important to see that they are supplied with sufficient blankets at night if travelling through cold regions. If it can possibly be avoided natives from hot, humid localities should not be taken to chilly, elevated and wind-swept places, as under such conditions they are very apt to contract pneumonia. Overcrowding in huts or tents should be avoided, and any sore throats which develop should be promptly treated.

_Treatment._—A patient attacked with pneumonia should take to bed at once. The affected side should be surrounded with a _large_ poultice. Five grains of quinine should be given every eight hours. If the heart’s action is weak, give some preparation of ammonia, as a stimulant, and administer alcohol, up to half an ounce, every two hours. Opium should only be given to calm the patient, as large doses do harm by checking free expectoration; if there is much distress, then ten or fifteen grains of Dover’s powder may be given.

An ice poultice applied to the chest will give great relief by lowering the temperature and diminishing the pain (_see_ page 274).

_Quinsy, or Inflammation of the Tonsils._

Apply poultices to the neck. Gargle with a hot, weak solution of permanganate of potash, or a solution of chinosol (1 in 2000), at least every hour. Administer quinine and iron as a tonic. Keep the bowels well open. Surgical aid is sometimes required in bad cases.

_Relapsing Fever._

This is the old “famine fever,” and it occurs in various parts of the world.

_Causes._—It is due to a corkscrew-shaped blood parasite, which is conveyed from the sick to the healthy by means of lice. Some hold that certain forms of this fever in Palestine, Cilicia, and Persia are transmitted by means of the common fowl tick, which often harbours in the cracks in native bedsteads and in crevices in the walls of huts and other dwelling places.

The true tick fever of Africa, which is also a relapsing fever, is considered separately. (See _Tick Fever_, p. 241.)

_Symptoms._—These differ a little in different parts of the world. The incubation period is usually from five to ten days. The onset is remarkably sudden. The patient has a chill or shivering fit, becomes giddy, develops a bad frontal headache, feels as if he had been beaten all over, and frequently vomits. He has often a difficulty in walking, and soon becomes seriously ill. Delirium is not infrequent. The tongue, unlike that in typhus fever, remains moist throughout the illness. Thirst, restlessness, and vomiting are very characteristic of the condition, and the urine is scanty. As a general rule recovery takes place, but sometimes the patient grows gradually worse and dies. As a rule, however, the temperature falls very suddenly, and the patient is better. After a week or so a relapse occurs. The temperature again shoots up, and remains up for several days. Then there is a second crisis, another relapse, and so on for perhaps three or four times. Most cases recover, and once convalescence is established the patient soon gets well.

_Prophylaxis._—The disease being lice-borne, it is necessary to take all steps to prevent contact with these insects (see _Lice_, p. 196). The organism has been shown to be capable of passing through intact mucous membranes and unbroken skin. Hence it is advisable to be careful when attending a case, for the organism has been found in sweat and tears, while the patient’s blood is, of course, infectious.

_Treatment._—Careful nursing and a light diet. Attend to the state of the mouth and of the bowels. The arsenic preparation, known as salvarsan (kharsivan), is a specific remedy, and can cut the disease short; but it can be administered only by a medical man. Otherwise there is no treatment save the symptomatic.

_Rheumatism._

This is a disease which frequently follows exposure to damp and cold, and is on that account not uncommon in the tropics. It is often hereditary. After one attack, rheumatism is always liable to recur in the same individual, and on this account it is necessary that persons liable to the disease should use special precautions.

_Acute rheumatism or Rheumatic Fever._—This is really an infectious disease due to a specific organism, and is quite different from the ordinary rheumatism of everyday life.

_Symptoms._—It begins by a shivering fit, with rise of temperature and general sickness, and the joints, usually wrists, ankles, or knees, become painful, tender, and afterwards swollen. It resembles other feverish conditions in the rapid pulse and breathing, the constipation, scanty and high-coloured urine, etc., but it differs from most of them in the presence of a profuse and sour-smelling perspiration, resembling the odour of butter-milk.

_Treatment._—The best remedy for acute rheumatism is salicylate of soda, of which fifteen grains should be given every six hours. The joints should, at the same time, be kept wrapped up in cotton wool, covered with oiled silk and a flannel bandage. This treatment will nearly always correct the acute symptoms in two or three days. If the symptoms subside sooner, the quantity of the salicylate should be diminished; if there is delirium, the dose must be lessened at once, for many people are very susceptible to salicylates and are easily affected by them, the delirium being characteristic. Dover’s powder may be given to relieve pain and to secure sleep.

_Chronic rheumatism._—In this disease there is chronic pain and tenderness of the joints, without fever.

_Treatment._—Bicarbonate of potash and salicylate of soda, each in five-grain doses, should be given every eight hours. Painful joints may be painted with tincture of iodine, rubbed with turpentine liniment, or bathed with hot water. The bowels should be kept well open, and alcohol and much meat avoided.

_Rupture or Hernia._

A rupture or hernia is a protrusion of some portion of the bowels under the skin, and is usually found in the groin. It is generally reducible, _i.e._, it can be pushed back into the belly. It reappears when the pressure is removed, especially if the patient coughs or strains. When reduced, a properly-fitting truss should be applied and worn during the day. It can be taken off at night, after lying down, but should be re-adjusted in the morning, whilst the patient is still in bed. No patient should go abroad without having an operation for the cure of the hernia.

The great danger of any rupture is that it may become irreducible—a condition which is very likely to be followed by constriction or “strangulation” and subsequent death of the ruptured part of the bowel. If unrelieved, this constricted condition is always fatal. The existence of strangulation is known by local pain and tenderness, development of severe colicky pains in the belly (especially about the navel), absolute constipation, vomiting, hiccough, and symptoms of collapse. When this condition is observed, the patient’s hips should be raised by supporting them with pillows, and the tumour should be only very gently kneaded with the view of getting back the protruded bowel. The treatment is considerably aided by immersing the patient in a warm bath, and giving about twenty drops of laudanum or chlorodyne. Ice placed round the swelling for half an hour or so is often very effective. If these means fail, surgical aid is absolutely necessary. _Purgatives should not be given._

_Sand-Fly Fever._

This disease, also known as phlebotomus fever, is very widespread and probably occurs in most parts of the world where sand-flies are found.

_Cause._—The organism is unknown, presumably being too small to be seen by the highest powers of the microscope, but it is known to be transmitted by what are called sand-flies or pappataci flies, tiny and very hairy midges which breed in such places as heaps of damp stones, bricks, and tiles, cracks in surface soil, the walls of old cellars, cracks and fissures in embankments. These little flies, which sally forth upon the blood quest towards evening, are voracious blood-suckers, and feed principally in the gloaming and at dawn. They chiefly attack the wrists and ankles, and can easily bite through thin socks or light cotton or linen clothing. It has been proved that the bite of one infected fly can convey fever. During the day they hide in dark places, and may be found in the dark corners of rooms. Their bites are painful, and when numerous the bitten part may swell badly. An attack by many flies effectually banishes sleep.

_Symptoms._—The fever is short and sharp—indeed, it is often called the three-day fever. The incubation period is four to seven days, and the attack is sudden, beginning with chilly sensations and a tired feeling. There may be rigors, but these are never so severe as the shivering fits of malaria. The patient becomes giddy, has a severe frontal headache with pain at the back of the eyes and pains in the back and legs. The condition, indeed, is very like an influenzal attack except that there is, as a rule, no coryza. The face is flushed and the eyes may be injected. When the latter is the case one can understand how the disease was originally given the name of the “dog disease,” as the appearance of the injected conjunctivæ resembles that sometimes seen in mastiffs and bloodhounds. There may be some sore throat, and sometimes there is a little eruption on the throat or palate. The temperature rises rapidly and may attain 103° F. It remains up for about twenty-four hours and then begins to fall, usually becoming normal on the third or fourth day. Sometimes there is a secondary rise of temperature. The patient may speedily recover or convalescence may be tedious, and the condition is sometimes followed by mental depression and the digestion may be upset. The fever is apparently never fatal but it is troublesome and debilitating.

_Prophylaxis._—Protect from the bites of sand-flies. This is best done by the use of a fine-mesh net containing twenty-two holes to the linear inch. It should be of the same general pattern as the net recommended under malaria (_see_ p. 206). Tobacco smoke keeps the flies away to some extent and repellents are useful, especially vermijelli, containing some oil of citronella, the preparation known as Sketofax, oil of cassia and oil of eucalyptus. A lump of camphor as a bed-fellow is also useful as the flies dislike its odour. The patient should always be placed under a fine-mesh net to prevent his being a source of infection to others.

_Treatment._—Rest in bed, light diet, and one full dose of laudanum, _i.e._, thirty drops, given as early as possible. Chlorodyne in the same dose may also be used. Quinine is useless and may aggravate the symptoms, but aspirin and the salicylates are helpful. If there is much pain in the muscles the application of hot sand-bags may afford relief.

_Scarlet Fever, or Scarlatina._

This fever is very uncommon in hot climates.

Incubation period, three to eight days. Rash appears second day.

_Symptoms._—The rash consists of numerous minute red spots, evenly distributed all over the surface of the body, upon a general rose-red blush. The area immediately surrounding the mouth is not affected. Shivering fits, sickness, high temperature, sore throat, headache, pains in the back. The sickness is very characteristic in children. After the rash has subsided, _peeling_ of the skin takes place, beginning on the face as a very fine powdery deposit. The process then spreads to other parts of the body, the last places to peel being the palms of the hands, the soles of the feet, and between the fingers and toes. The peeling process takes from four to six weeks, and the patient is infectious during the whole of this period.

_Treatment._—Isolation. Bed in an airy room. Light food. If the fever is high (104° F.), the body may be sponged with tepid water. If the throat is very inflamed, an antiseptic gargle should be used. As the course of infectious fevers cannot be cut short, the chief aim of treatment should be to avert complications and the return of distressing symptoms—over-treatment with drugs must be guarded against.

To prevent the spread of infection from the peeling surface, the body should be rubbed over with boracic ointment, or carbolic or olive oil.

_Complications._—As scarlet fever may be followed by heart, kidney, or ear trouble, the patient should not be allowed to get up until at least ten days after the temperature has become normal.

_Scorpion Sting and Spider Bite._

_Scorpion sting_ is not infrequent in hot countries, but is very rarely fatal in the case of the adult European unless several stings have been received at one time.

_Symptoms._—The usual symptoms in the adult are a brawny swelling in the region of the sting and more or less collapse. There is often severe pain of a throbbing nature, and there may be sickness and vomiting.

_Treatment._—Apply a tourniquet above the sting and incise the affected area; then apply an opium lotion. This is usually sufficient to afford relief and prevent extension of the swelling. A serum suitable for use in Egypt and the Sudan only, has been prepared for treating scorpion stings, and when it is available it should be used as soon as possible, as very favourable results have been reported from its employment. It can be obtained in Cairo or in this country from Messrs. Allen and Hanbury.

_Spider bite_ is not so important as scorpion sting, though poisonous spiders do exist in various parts of the world and belong to a genus found in Southern Europe, New Zealand, and various parts of North and South America. Many of these poisonous spiders are brightly coloured, their abdomens being spotted with vermilion. In Peru there is a so-called “pruning-spider,” which belongs to another genus and is also poisonous.

_Symptoms._—Locally a reddish papule appears, and there is sharp stinging pain. The papule is followed by a spreading inflammation which sometimes goes on to gangrene, though this is rare. The general symptoms are those of nervous exhaustion and there is high fever, rapid pulse, rapid breathing, and sometimes blood in the urine.

_Treatment._—Apply a ligature and suck the wound. Use permanganate of potash locally as in the case of snake-bite. The permanganate should also be given internally, one-quarter to one per cent. solution being given every hour or every two hours. Diffusible stimulants such as ammonia, caffeine, or camphor are useful as diuretics. A strict milk diet should be enforced during treatment.

_Scurvy._

This is one of the deficiency diseases. This is not to say that mere general starvation will produce it, but that it is due to the lack of certain substances in the diet. These substances are known to exist in fresh fruit and vegetables, and also to a lesser extent in fresh meat and raw milk, but their exact nature has not yet been determined. Travellers should remember that, apart from the actual disease, there is a scorbutic state in which the symptoms are indefinite, and which, if not recognized and promptly treated, will pass on to true scurvy.

_Symptoms._—Scurvy begins insidiously with progressive weakness, pallor, loss of weight, and stiffness in the leg muscles. Later the gums become affected, soft swellings sprouting up between the teeth. As the disease progresses the gums become swollen and spongy, ulcerate and bleed, while in bad cases the mouth becomes very offensive and contains large fungating masses. Other signs of scurvy are hæmorrhages under the skin and mucous membrane and in the muscles. Any injury is apt to be followed by hæmorrhage. Swelling of the legs is an important symptom, especially in the region of the ankles. If untreated, the condition becomes worse, the appetite is impaired, mental depression sets in, there is breathlessness on exertion, and night and day blindness. Death results from heart failure or some complication.

_Prophylaxis._—Ensure a good dietary containing sufficient anti-scorbutic elements. Wherever possible, fresh meat, fresh vegetables, and fresh fruit should be supplied. Lemon juice is valuable. It should be noted that it is four times as efficient as the lime juice which used formerly to be employed. The ration should be one ounce daily served with sugar. Germinating peas, beans, and other pulses contain the anti-scorbutic elements in large quantity. It is a simple matter to carry a supply of these pulses and to germinate them when required. The dry seeds must be whole, retaining their original seed-coat. In order to make them germinate they are placed in a clean sack and steeped in a vessel containing clean water, which should be occasionally stirred. Sack and trough should be large enough to allow for the swelling of the pulses to about three times their original size. In a hot climate six to twelve hours is sufficient for this soaking. Thereafter, lift the seeds out of the water and spread them out to a depth not exceeding two or three inches in some vessel which allows free access of air to them. Keep them moist by covering with sacking, which is wetted at intervals. The germination should reach the stage necessary within twenty-four hours in a hot climate, and the pulses should be cooked and eaten as soon as possible after germination. Care should be taken not to overcook them. At a pinch germination may be effected by placing the seeds between wet blankets, but this is a rough-and-ready method not to be recommended.

It is important to attend to oral hygiene, especially the regular use of the tooth-brush. Vegetables should never be overcooked. In the case of African native followers Kaffir beer made from germinated grain is of great value; one pint should be given daily per head. Potatoes and root vegetables are useful, and the onion is a valuable food in this connexion. Fresh meat is not so effective as either fresh fruit or vegetables.

_Treatment._—This is chiefly dietetic, and the same foods and substances as are mentioned under prophylaxis are used also for the cure of scurvy. In addition, scurvy patients should be kept in bed, given plenty of fresh air, and have the affected parts massaged. Tonics and mouth-washes are indicated, and a liberal diet with plenty of fat in it should be provided. Where fresh fruit cannot be obtained raw meat and raw fresh eggs in milk form a good substitute.

_Sea-Sickness._

Take a saline aperient on the day before embarking, and a light plain meal at least three hours before going on board. A cup of good tea or black coffee soon after starting is often of use.

Those liable to sea-sickness should go to bed directly they get on board: the head should be kept low and the room darkened. A mustard leaf applied to the pit of the stomach is of value in diminishing the tendency to vomit. An abdominal belt is useful from the gentle support it gives. A hot-water bottle may be applied to the feet.

A mixture containing fifteen grains of bromide of soda and five grains of antipyrine to one ounce of water is often of great value. The first dose should be given immediately the patient is in bed, and may be repeated every six hours if required.

Whitla states that the best of all remedies is bromide of ammonium. It should be given in twenty-grain doses for a day or two before embarking. Morphia may be found necessary: a third of a grain may be injected under the skin of adults, but it should on no account be given to children.

I have found that three or four drops of chloroform, dropped on to loaf sugar and sucked, often prevents vomiting.

Those who are vomiting severely should take plenty of hot water or milk, so as to prevent them from straining on an empty stomach.

Very often raisins or raisin tea can be taken when other nourishment is rejected. A recent method of treatment which has sometimes been found effective is to plug the ears firmly with cotton-wool, but this should only be done by a medical man. It is, however, worth trying.

_Skin Diseases._

_Boils._—Boils are very common in the tropics and occur especially in people who have been run down. They are most frequent during or after the rains and especially in the course of hot, damp summers. In Egypt the so-called Nile boil is quite a feature of the country. In the tropics boils are often multiple and a very favourite site is the buttocks. Any part, however, which is apt to be bathed in sweat is liable to infection. A boil on the face may apparently result from the bite of a mosquito or other blood-sucking insect.

_Prophylaxis._—Protect from insect bites and treat even the most trivial of skin lesions with tincture of iodine. Keep the skin clean and change the underclothing frequently. If a boil occurs cover it with a small dressing so that other parts of the skin may not be affected. A change of climate is often the only thing that will do good in the case of a person afflicted with crops of boils.

_Treatment._—It is sometimes possible to abort a boil by dipping a sharpened wooden match or a toothpick into pure carbolic acid and thrusting it repeatedly into the heart of the swelling. If the boil has somewhat developed hot fomentations and moist dressings should be applied and iodine should be painted on the skin round the boil. As a rule it is wiser not to open a boil, even when it has suppurated. It is best to let it burst and then to dress it carefully with a boric poultice, which should be frequently changed. Treatment with vaccines has come into vogue and is sometimes very helpful. Sulphide of calcium pills, one grain in each, three times a day, are often given and are said to have a prophylactic effect, but a preparation known as stannoxyl and used in the form of tablets is to be preferred. The usual dose is four tablets the first day, six the second, and eight on subsequent days. The drug is somewhat constipating. A remedy more easily obtained and which is said to be distinctly beneficial is dilute sulphuric acid. It should be taken in doses of twenty to thirty drops, well diluted, every four hours. The general health requires attention and lemon juice, plenty of green vegetables and tonics should be taken.

_Carbuncles._—A carbuncle is of the same nature as a boil, but is a more serious complaint, and it is distinguished from a boil by the fact that it opens by several mouths.

To promote ripening of the carbuncle and the separation of the core or dead piece of tissue, poultices and hot fomentations should be freely applied, and if the core can be seen it should be removed, if possible, by a pair of forceps.

To facilitate removal of the core it is sometimes advisable to cut through the skin separating the openings; there may be some slight bleeding, but it will cease after a short time.

Opium may be given to relieve acute suffering. The bowels should be kept well open. A generous diet must be given; tonics of iron, quinine and arsenic are needed, and alcohol may prove necessary.

Carbuncles rarely appear except in people much broken down in health, and their presence is an indication that the sufferer should return to his own country and seek skilled advice.

_Chigger._—The chigger is not itself a disease but is a sand-flea producing a condition known by the long name of dermatophiliasis. It is a veritable pest in parts of South America and all over tropical Africa. The insect is like the common flea but smaller, lives in dry sandy soil and sucks the blood of mammals, especially pigs. After impregnation the female burrows into the skin of a mammal or bird, and, nourished by blood, proceeds to ovulation. Her abdomen becomes filled with ripe eggs and enormously distended till it looks like a small pea. Eventually the eggs escape through the opening of the skin and hatch into larvæ which in due time become adult fleas.

_Symptoms._—In man the feet are the part most frequently affected, the chiggers being found between the toes and under the toe nails. When people sleep on the ground other parts of the body may become affected and large numbers of chiggers may be present at one time. There is itching and irritation at the place of invasion, and when the latter is examined a little dark dot will be seen. This is the posterior end of the female flea, which is lying head downwards in her burrow. If not removed suppuration occurs round her distended abdomen and the skin gets much inflamed and swollen. When the eggs have been discharged ulceration takes place and the flea is expelled. A small sore, however, is left which is very liable to get contaminated, and, if neglected, may lead to very severe complications.

_Prophylaxis._—Do not camp in the neighbourhood of native villages. Clean the camping ground thoroughly and, if necessary, fire it. As insecticides flaked naphthalene or a strong infusion of native tobacco are useful. The latter may be used inside boots or shoes. Walking bare-foot should be avoided, as should sleeping unprotected on the ground. In the case of native carriers or porters a daily foot-parade should be instituted. Some protection is afforded by smearing the feet, especially the spaces between and under the toes, with a preparation like phenofax or with a mixture of five drops of lysol or cresol and an ounce of vaseline.

_Treatment._—It is usually better to get a native to remove a chigger as long practice makes them very expert in the little operation. The latter consists in widening the skin orifice with a sharp clean needle, and freeing the flea from the surrounding tissues in order to get it out whole. If it ruptures forceps must be employed, and this is much more painful and difficult than extracting the entire insect. The infected parts should be carefully treated antiseptically.

_Fungus Diseases._—There is a great number of tropical diseases due to fungi but only a few can be considered here, and these only very briefly. (1) _Dhobie Itch_ is one of the best known and is so called because it was thought to be derived from clothes infected by the persons (dhobies) who washed them. The parts usually attacked are the groins, the upper part of the thighs and the armpits. The condition is due to a fungus like that of ringworm and the skin becomes red and raised and somewhat scurfy. Dhobie itch causes great irritation and is sometimes associated with considerable pain.

_Treatment._—Mild cases are best treated by using an ointment containing resorcin two drachms, salicylic acid ten grains, and vaseline and lanoline, of each four drachms. The parts may be painted with iodine but this is somewhat irritating. An ointment of ammoniated mercury, two to five per cent., is often effective. Bad cases require the application of araroba (chrysarobin) ointment, but it should not be used unless recommended by a doctor. Goulard water or Wright’s liquor carbonis detergens (one tablespoonful to two pints of water) are soothing applications.

(2) There is a fungus disease of the hairs, especially of the armpits and the pubis, which occurs in tropical climates and is often very troublesome. The hairs assume a coated, beaded or nodular appearance and the deposit on them varies in colour and may be black, yellow or red. The underclothing in contact with the affected parts becomes stained and when the disease spreads to the skin, as it often does, the latter becomes inflamed, thickened and painful.

_Prophylaxis._—Keep the axillae shaved. It is always well to do so in a tropical climate. Failing this, dust with a mixture of powdered sulphur and fuller’s earth, equal parts. Change the underclothing frequently and bathe the parts liable to infection.

_Treatment._—Apply twice daily a lotion containing one drachm of formalin in six ounces of rectified spirit, and at night rub in a two per cent. sulphur ointment. If these measures fail apply tincture of iodine, except in cases where the skin is involved. In such cases bathe with cold water and employ a dusting powder or a soothing lotion.

(3) _Ringworm_ of the head is a disease due to a fungus. The part for some distance round the affected area should be shaved, and any stumps of hairs pulled out. The skin should be lightly painted with tincture of iodine or strong solution of carbolic acid (one in ten of water); or sulphur, white precipitate, or mercurial ointment may be gently rubbed in.

_Kraw-Kraw._—This is a term commonly employed by natives of the West Coast of Africa to indicate almost any kind of itchy, papular, or pustular eruption. Many of these appear to be contagious, and most of them are best treated by opening up any pustules which may be present, removing crusts by boric poultices, and scraping ulcers. Then scrub thoroughly with sublimate lotion 1 in 1,000, dust with boric powder and apply a dressing of medicated vaseline. The application should not be disturbed for a week when, as a rule, the skin will be found to have healed up. Clothing and any other articles which have been in contact with the affected parts should be destroyed or thoroughly disinfected.

_Prickly Heat._—This condition is very frequent, especially in the moist tropics. It is due to free sweating, and is accompanied by intense heat and itching. The parts closely covered by clothing are specially apt to be affected. The skin becomes covered with numerous slightly inflamed papules, set close together, and the eruption may remain for months at a time, varying in intensity according to circumstances.

_Prophylaxis._—Avoid long drinks, warm clothing, too much exercise, and all conditions producing excessive perspiration. Sea-bathing should be avoided, and soap should not be used in the bath. One should sleep under as hygienic conditions as possible, with a well-ventilated bed and without unnecessary clothing. A dusting powder of equal parts of boric acid, oxide of zinc, and starch is useful.

_Treatment._—Ryan strongly recommends the so-called “Sulphaqua” bath charge, which is sold in packets ready for use. The above-mentioned dusting powder is helpful, as is the application of a lotion containing salicylic acid and spirit. Some prefer oily applications. Whatever is used, care should be taken to see that the bowels are well opened at the beginning of an attack, preferably by a saline purge.

_Ulcers._—Ulcers are often very troublesome to the traveller, as the healing process is frequently retarded by exposure, dirt and dust, and the chafing of clothes. Want of sufficient animal food greatly favours the spread of large ulcers.

A simple dressing of iodoform ointment, or ointment of boric acid, is effective when the ulcer can be protected, and rest can be given to the affected part. When the ulcer is deep and large it may be stimulated to heal by the application of lint or cotton-wool, moistened with carbolic oil, carbolic lotion, or other antiseptics.

Large, unhealthy ulcers should be well bathed with some antiseptic such as carbolic acid, one in sixty of water, or a solution of chinosol (1 in 600); and after the sore has been cleansed it may be lightly dusted with iodoform and then covered with a piece of lint moistened with carbolic oil or smeared with iodoform ointment and supported by an evenly applied bandage. Boric ointment, lano-creoline, izal ointment or other antiseptic dressing may take the place of iodoform ointment.

In addition to the above general account, certain conditions leading to ulceration require consideration.

_Oriental Sore._—This condition is commonly known as Baghdad Boil, Aleppo Button, Frontier Sore, etc. It occurs in various hot countries, such as Egypt, Syria, Asia Minor, Arabia, and Mesopotamia, and has been met with in Europe and Greece. A special form affecting both skin and mucous membranes is widely distributed in South America.

_Cause._—The cause is an organism to all appearance identical with that which produces leishmaniasis or kala-azar. Indeed, Oriental sore is a form of cutaneous leishmaniasis. In all probability infection is conveyed by sand-flies, but our knowledge is still defective on this point.

_Symptoms._—The incubation period varies from a fortnight to a year. The sore may occur on any exposed part of the body, but is most common on the forearm, hands, and face. Multiple sores are frequent. The first sign is a small red, scaly papule, which increases in size and eventually breaks down, forming a painless ulcer, with a hard, dry edge. Non-ulcerating forms occur, but are not common. The condition is very chronic, but healing usually sets in after six to twelve months. When the ulcer heals a white or pink scar is left, which is disfiguring.

_Prophylaxis._—Sleep under a sand-fly net, containing 22 holes to the linear inch. Warn against the danger of infection by personal contact and the risk of re-infecting oneself by scratching. It is advisable to paint the sites of all fly and insect bites with iodine as soon as possible.

_Treatment._—The best treatment at present known is intravenous injection of tartar emetic. This, of course, can be carried out only by a medical man. Good results have, however, been obtained by applying a 2 per cent. ointment of tartarate of antimony, and this method can be carried out by the patient himself. Local injections of emetine have been recommended, and there are various other ways of treating Oriental sore, but they need not be here considered.

_Tropical Ulcer._—This is a special and serious form of ulcer found in all parts of the world, and especially amongst East African natives. It is found chiefly in the lower third of the leg and in the region of the foot and ankle.

_Cause._—This is somewhat obscure, but it is believed to be due to certain organisms possibly acting in association with one another.

_Symptoms._—The condition starts as a small, tender, and often itchy papular bleb, surrounded by a dense inflammatory zone. An ulcer results, which is more or less painless, and one of the characteristics of which is the way it spreads and destroys all the tissues with which it comes in contact. It is often mistaken for a syphilitic ulcer, but it does not usually yield to anti-syphilitic remedies.

_Treatment._—The best remedy would appear to be formalin, though the iodoform ointment mentioned under ulcers may aid the condition. It can be effectually treated only by a medical man.

_Veldt Sore._—This condition, which is also known as Barcoo Rot, is frequently in evidence in countries with hot, dry climates, as, for example, Egypt, Palestine, South Africa, Mesopotamia, etc.

_Cause._—It is due to certain bacteriological organisms, and is apt to occur in persons who are debilitated, who are not receiving proper food, or who are living under conditions where it is not easy to keep clean. Some think the sores are commonest in men who have to deal with horses.

_Symptoms._—Veldt sores are most common on the hands and forearms. They begin as itchy papules, which become blebs, then pustules, and finally ulcers. They are usually multiple, and when they heal they leave areas of thin, glossy skin.

_Prophylaxis._—As for boils.

_Treatment._—The spread of ulcers can be checked by removing the hairs from their bases and round their margins. Very often the ulcer can be started on its healing process by employing dressings soaked in a solution of 1.5 per cent. sodium citrate and 20 per cent. common salt. Vaccines are often successfully used in this condition, and the stannoxyl mentioned under boils may be employed, as may a salicylic acid ointment, 20 grains to the ounce.

_Sleeping Sickness._

This is the old “Negro lethargy,” and must not be confounded with what is now called sleeping sickness in the British Isles and on the Continent, which is quite a different disease. True sleeping sickness is limited to Africa, and there are two chief types: that occurring in parts of the West Coast and the French and Belgian Congos, in Angola, in portions of the Anglo-Egyptian Sudan, in Uganda, and in parts of the Tanganyika territory; and that which occurs in Northern Rhodesia, Nyasaland, Portuguese West Africa, and the region of the Rovuma River.

_Cause._—The cause is a tiny animal blood parasite conveyed from the sick to the healthy by certain species of tsetse flies. In the tsetse fly the parasite, which is called a trypanosome, undergoes a definite development.

The two species of tsetse fly meriting special consideration here are _Glossina morsitans_ and _Glossina palpalis_. The former, as a rule, occurs in thin, deciduous bush, or low, comparatively open forest, while the latter haunts the neighbourhood of streams and lakes, and is rarely found any great distance from the water edge. These flies are about the size of a small blue-bottle, but are not so stoutly built and, when closed, their wings overlap and project beyond the end of the abdomen. _Glossina morsitans_ is brownish coloured, with bands on its abdomen. _Glossina palpalis_ is much darker, indeed almost black-looking. They have a quick and darting flight, and are attracted by rapidly-moving objects, like motor-bicycles and motor-cars. Once they alight they do not move about. As a rule they bite only during the day, but they may attack man on bright moonlight nights.

_Symptoms._—The incubation period is probably about three weeks. The fly bite may be painful; and causes a slight local irritation. The disease begins insidiously, with an irregular fever, and there may be a skin eruption. The fever comes and goes, and the patient gets weaker and suffers from headache. The glands in his neck and possibly in other parts of his body become enlarged and may be tender. The first stage of the disease is called trypanosome fever, and may end in recovery. More usually the central nervous system becomes affected, and then the symptoms of true sleeping sickness develop, slowly or with considerable rapidity. The patient becomes dull and drowsy. Both his speech and movements are affected. His face gets puffy, and he shuffles when he walks. He still has fever, continues to lose flesh, and gradually passes into a sleepy condition, which may be associated with convulsions. Saliva dribbles from the lips, and half-masticated food may remain in the mouth. The patient becomes helpless and indifferent to his surroundings, and either dies from coma or from some intercurrent disease, such as pneumonia or dysentery.

_Prophylaxis._—Personal prophylaxis consists in avoiding being bitten by tsetse flies. When passing through fly belts in affected areas veils and gloves may be worn.

_Treatment._—If taken in time sleeping sickness can be readily cured by the use of the arsenical preparation atoxyl, combined with antimony. The course of treatment, however, extends over a considerable period, and it must be carried out under the supervision of a medical man.

_Sleeplessness._

This is common in those broken down by malaria, dysentery or debilitating diseases; it is also induced by the irritation caused by mosquitoes and other pests, such as the itch parasite. It is at times due to errors of diet, prickly heat, mental worry and exhaustion, abuse of tea and coffee, coldness of the feet and indigestion, and as most acute diseases are worse at night, sleeplessness is very common amongst sick people.

_Treatment._—As far as possible remove the cause; kneading the feet and legs, or the application of a hot-water bottle to the feet, will often be of service. A cup of hot milk or soup should be taken at bedtime, and again on waking in the night. The bowels must be regulated and alcohol taken very sparingly.

The taking of sedative drugs should be avoided as much as possible. The least harmful of these is sulphonal in doses of from twenty to thirty grains, given several hours before bedtime, or bromide of potassium in twenty or thirty-grain doses given at bedtime. A warm bath at night often acts more satisfactorily than any other remedy. Only very rarely should chloral, chlorodyne, or opium be resorted to.

Regular habits and plenty of work are potent factors in the production of that healthy condition which predisposes to natural refreshing sleep.

The unfortunate man who has no hard work to do, who is without even a hobby to occupy him, and has no interest in life but the torpid condition of his liver, is a constant sufferer from insomnia. He should be purged and put on a light plain diet. Alcohol must be forbidden and plenty of exercise must be taken. A tumblerful of hot water is to be taken the first thing in the morning and the last thing at night.

_Small-pox._

Very prevalent in the tropics, hence the importance of revaccination before going abroad.

Incubation period, twelve days. Rash appears third day.

_Rash._—Before the appearance of the typical rash there are occasionally earlier rashes, viz., a diffuse blush covering the whole body, resembling scarlet fever, or a dark purple rash of effused blood beneath the skin of the lower part of the belly, or occasionally in the armpit. The small-pox rash proper consists of small red raised spots which first appear on the face, forehead, and scalp, subsequently coming out over the rest of the body, commencing at the top and working downwards. These spots become prominent, and have a characteristic “shotty” feeling under the finger. On the third day after their appearance a small bleb forms in the centre of each spot; it is transparent at first, but subsequently becomes yellowish, from the formation of matter in its interior. The centre becomes depressed on the sixth day, then the bleb breaks down, and discharges matter. Two or three days later the spot begins to dry up, and ultimately heals under a scab. During the period of most active inflammation the face may be very swollen and sodden.

The spots and pustules are not confined to the skin, but may occur on the roof of the mouth and in the throat.

_Prophylaxis._—This consists in efficient vaccination, and as travellers may themselves have to carry out the technique of vaccination, it is important they should know something about it. The usual faults in technique are a lack of cleanliness, resulting in sepsis, the use of too strong an antiseptic when cleaning the skin, over-heating of the lancet, needle or scarifier when purifying it, drawing too much blood, which washes away the lymph, exposure of the recently vaccinated area to the hot sun, and charring of the lymph in the capillary tube when sealing. All that is necessary is to clean the part to be vaccinated with soap and water, using a nail-brush, then rub the skin with alcohol, and when the latter dries proceed with the little operation. There should be four incisions, and the total area which will eventually be occupied by the vaccine vesicles should not be less than half a square inch. It may be noted that the vesicle is fully ripe on the seventh day after vaccination.

_Treatment._—Isolation, similar to that of scarlet fever. The body may be sponged and vaseline applied if there is much itching. The eyelids and eyes should be frequently washed with weak boric acid solution.

_Snake Bite_ (_see_ p. 281).

_Sprue._

This is a chronic form of tropical diarrhœa, often called “white diarrhœa,” the leading symptom of which is the frequent passage of large, frothy, and pale-coloured motions; dyspepsia, and soreness of the tongue and mouth, are also present, and there is marked anæmia and advancing debility. The disease may follow attacks of diarrhœa or dysentery.

_Cause._—The actual cause of sprue is unknown, but the disease usually develops in persons who have been for some considerable time in the tropics, and it is commoner in India, Ceylon, and the Far East than elsewhere.

_Treatment._—Put the patient to bed, give a simple aperient such as castor-oil, to clear out the bowels; allow only a milk diet, to which, as the symptoms begin to abate, meat juices and jellies should be cautiously added. If any other disease, such as scurvy, is present, it must be treated. Drugs are not usually of much service; however, a mixture containing bismuth, soda, and one drop of carbolic acid in an ounce of gum-water may be given three times a day for a week. The soreness of the mouth and tongue may be treated by the application of borax and glycerine, or mild antiseptic mouth washes, such as a weak solution of permanganate of potash, or a lotion of boric acid. Special symptoms, such as pain and collapse, must be treated as they arise. As soon as the patient is strong enough, he should be removed to a temperate climate.

_Stroke, or Apoplexy._

This disease is caused by the rupture or blocking up of one of the blood-vessels in the brain.

_Symptoms._—The person attacked falls down suddenly, and is unable to move one or more of his limbs. He may be quite insensible, or soon become so, or perhaps he is unable to talk. The mouth may be drawn to one side, and the tongue, when protruded, be pushed to the right or left. The condition is serious.

_Treatment._—Tight clothing must be removed. Six grains of calomel powder should be placed on the back of the tongue, and the patient kept lying on his back with the head slightly raised. Cold should be applied to the head and a hot-water bottle to the feet, the room darkened, and absolute quiet observed. An enema of hot water may be given, and while the patient is insensible the lips should be moistened only with water. Food may be given by the bowel on the second or third day. Stimulants are absolutely forbidden. If the patient gets over the attack he ought to be sent home.

_Note._—It must not be forgotten that many of the above symptoms might be caused by injury or poison.

_Sun-Stroke and Heat-Stroke._

These conditions are distinct. Sun-stroke, which is comparatively rare, is due to the direct action of the sun on the brain and spinal cord. Heat-stroke, on the other hand, would appear to be due to the lack of escape of heat from the body, owing to insufficient evaporation from the skin, and to the effect of muscular fatigue. As a result, poisonous substances accumulate and act detrimentally upon the nerve cells. There is also a deficient supply of oxygen to the blood. High relative humidity plays a very important part in producing attacks of heat-stroke. The milder forms are known as Heat exhaustion and Heat prostration; the severe form is often associated with true sun-stroke.

_Symptoms._—Heat exhaustion is really a form of faintness, and recovery soon takes place after a rest. The symptoms of heat prostration are giddiness, often associated with nausea. The patient is bathed in a clammy sweat, his pulse is thready, his breathing shallow, and, it may be, sighing. The condition may pass into unconsciousness, but the temperature is not raised, and death rarely results.

There are two kinds of true Heat-stroke; one a form with high temperature, the other what is called Heat cramp, which is common amongst ships’ firemen in the tropics. An early warning sign of heat-stroke is a desire for frequent micturition, and other premonitory symptoms are a dry skin, giddiness, drowsiness, headache, and intolerance of light. The pulse becomes quick and irregular, the skin is hot and dry, and the temperature elevated. The patient may become comatose, or exhibit delirium or convulsions. There is an asphyxial type, in which the face becomes cyanosed and the breathing is in abeyance.

_Prophylaxis._—Avoid severe exercise in a hot sun. Wear suitable clothing, which should be loose and easy, and protect the head, and especially the nape of the neck, from the sun’s rays. Dark or tinted glasses are useful. Water should be taken freely, and the bowels kept open; but alcohol must be avoided. Sniffing a mixture of water and vinegar and damping the face are helpful measures.

_Treatment._—In the case of Heat prostration the patient should be laid in the shade on his back, his clothes should be loosened, his limbs massaged, and, if he is collapsed, stimulants in the form of ammonia or camphor should be administered. The asphyxial type of heat-stroke can only be treated by means of artificial respiration, which may have to be continued for as long as a couple of hours. The ordinary form, which has been called the paralytic type, must be treated promptly and vigorously. One must aim at reducing the temperature, getting rid of the toxic material in the body and preventing heart failure. Probably the best way of treating the condition as an emergency is to lay the patient naked on an inclined plane and drench him with cold water. When doing so it is well to take the rectal temperature, and to stop this chilling process when the thermometer registers 102° F. After the drenching wrap the patient in blankets and apply hot bottles to the trunk and limbs. An ice bag, if available, should be applied to the head, which in any case should be swathed in cold cloths. It should be noted that in the absence of ice, a sheet soaked in cold water or dilute alcohol, over which a draught of air plays, is a useful substitute. A fan may be used to create the air draught. Auxiliary methods of treatment can be efficiently carried out only under medical supervision. As soon as the patient has recovered somewhat, a dose of calomel should be given, followed by salines.

_Syphilis._

Syphilis, or the Pox, is an infectious venereal disease, nearly always communicated by direct contagion. The course of the disease is marked by a primary sore, the chancre; early constitutional (secondary) symptoms, and late constitutional (tertiary) symptoms.

In primary syphilis the disease is limited to the part or organ originally infected, and the glands connected with that spot. After an incubation period of from three to six weeks a small painless pimple appears at the seat of infection; it breaks down, and forms a small ulcer from which oozes a little watery fluid. The base of the ulcer and the skin surrounding it are hard like gristle. The nearest glands, usually those of the groin, enlarge and occasionally become tender. Unless badly neglected, the original sore gradually heals and the glands resume their normal size. Secondary symptoms now make their appearance. These are fairly definite, and comprises (_a_) A skin rash, consisting of numerous irregularly shaped copper-coloured spots, spread over the face, upper part of the chest, the loins and the back of the arms. They do not itch. (_b_) Moist lumps and warts form in the crutch, around the scrotum (purse) and the outlet of the bowel. (_c_) Ulcerated sore throat. Large deep ulcers form on each tonsil, having ragged undermined edges. (_d_) Iritis or inflammation of the eye may also occur. These symptoms, even if untreated, tend to heal, but always leave more or less marked traces behind.

The discharge from either primary or secondary sores is infectious and may convey the disease, so that great care needs to be taken in handling such sores.

After an interval of apparent health, lasting perhaps only a few months, but often for a year or two, the tertiary symptoms or “reminders” make their appearance. These take the form of localised swellings, which soon break down, forming deep ulcers, and if untreated, produce extensive destruction of the part involved, with much deformity.

_Prophylaxis._—The methods available are now so well known that they need not be discussed in a work of this kind. Mention need merely be made of the fact that in some foreign countries, owing to unhygienic conditions, there is a greater liability to contract the disease by what may be called unusual methods, and therefore every care should be taken to prevent such sources of infection, as, for example, the contaminated seats of closets, etc.

_Treatment._—As soon as the disease is recognised, the treatment must be commenced.

Local treatment.—Keep the sore perfectly clean by washing it with an antiseptic solution such as chinosol (1 in 1000). Between the washings, dress it with a piece of lint soaked in “black wash,” or dust it with iodoform powder and cover it with a piece of lint smeared with boric ointment.

For the sore throat, use an antiseptic gargle (_see_ Ulceration of Throat, p. 244).

General treatment.—The patient must be put on a course of mercury at once. Calomel, one grain twice a day, or grey powder, one grain three times a day, must be administered, and continued until skilled advice can be obtained. The effect of the mercury must be carefully watched, and if the patient complains of soreness of the gums, a coppery taste in the mouth and excessive flow of saliva, the dose must be reduced or the administration of the drug stopped until these symptoms have disappeared. If the calomel or grey powder causes looseness of the bowels, five grains of Dover’s powder may be added to each dose.

In some cases, the addition of three grains of the iodide of potash to each grain of calomel does good from the very first.

For the later symptoms, continue the mercurial treatment, and give at least five grains of the iodide of potassium three times a day.

Since the above was written the whole treatment of syphilis has been revolutionized by the introduction of certain organic arsenic compounds as therapeutic agents. Of these the best known is the German salvarsan, represented in this country by kharsivan, the so-called “606.” Treatment with arsenic has now largely replaced the old method with mercury; but it cannot be carried out except by one having medical training, and so need not be further considered.

_Tick Fever._

One of the diseases which may be produced by the bites of insects is a form of fever, conveyed by the bite of a tick, which is common in many parts of Africa. This produces a series of symptoms which are similar to those found in the disease known as relapsing fever, which has been known to occur even in the United Kingdom, and which used to be called “famine fever” (_see_ p. 218).

_Cause._—The cause is a corkscrew-shaped organism found in the blood, and its vector is the tick above mentioned, which in its adult state and unfed is roughly about the length of a finger-nail, that is, four-tenths of an inch. It is of a greenish brown colour, and is covered by a leathery integument, which looks as if it was spotted all over and which is grooved in several places. When the tick is gorged, these grooves disappear. A gorged female tick may be well over half an inch in length, and very nearly of an equal breadth.

The tick lives in native houses and in rest houses, especially along caravan routes. At night it sallies forth in search of blood, but during the day it conceals itself in cracks and corners in the walls and floors, and sometimes in cracks in native wooden bedsteads. Its bite is painful, but the infection takes place not through the bite, but as a result of the infected excreta of the tick contaminating the tick bite. One tick is sufficient to cause infection.

_Symptoms._—The chief symptoms are those of a severe attack of fever, ushered in by a shivering fit and acute symptoms such as are usually found in cases of fever, for example, pains in the back and limbs, rapid pulse, and sometimes severe vomiting and diarrhœa, frontal headache, and painful bloodshot eyes are rather characteristic. The fever, which is of the relapsing type, generally keeps up for about a week, after which there may be an interval without fever for a few days, to be followed later on by another attack of fever. There are usually several relapses. As many as eleven have been noted.

_Prophylaxis._—Avoid sleeping in native huts and rest houses which have been occupied by natives. Do not sleep on the ground or on wooden native bedsteads. If the latter have to be used, their legs should be smoothed to prevent ticks from climbing up them. In badly infested places, it is well to employ a hammock. A mosquito-net is useful, as it excludes the ticks; and it is well to make use of a night-light, which also keeps them away. Packs and blankets should be periodically inspected to see that they do not harbour ticks. If one has to camp on an infected area, the ground should be fired and the floors of huts dug up and thereafter removed and buried or treated with fire, care being taken that the ticks do not escape during the process. Wandering ticks can be kept away from a tent to some extent by digging round it a trench and filling it with wood ashes.

_Treatment._—This is mainly symptomatic. Careful nursing is required together with a light diet. In some cases the arsenic preparation known as salvarsan (kharsivan) is found of value, but the specific treatment of this malady can only be carried out by a medical man. In many cases digitalis or strophanthus is required, owing to the risk of heart failure.

_Typhus Fever._

This disease is not so common in the tropics, but in certain sub-tropical countries, such as Egypt, it frequently occurs, and it is of course closely associated with military operations in the field.

_Cause._—The exact nature of the infection is as yet unknown, but the disease is transmitted by lice, both the head and the body louse having been proved to be carriers of the virus.

_Symptoms._—Incubation period 5 to 14 days, as a rule 12 days. Symptoms vary, but at first somewhat resemble those of an influenzal attack without the cold in the head. The patient is feverish and uncomfortable, but not until the third day do the typical symptoms of typhus make their appearance. Then the patient’s face becomes flushed and his eyes congested, his pulse rate increases, and very soon his temperature rises and runs up to 103 or 104° F. The rash, which varies in type, generally appears on the fifth day, being found first on the upper part of the abdomen. It does not occur upon the face, but is usually very profuse on the back. If the rash develops the patient becomes seriously ill, and all his symptoms are intensified. He becomes dull and lethargic, his mouth is foul, and his general aspect is somewhat like that of a drunken man. His voice becomes husky, his hands are tremulous, and his breathing is rapid. In the second week, in most cases, he becomes delirious or comatose, and lies in bed more or less like a log. In cases that recover, improvement sets in about the fourteenth day, and is usually rapid and complete. In cases which die the temperature remains high or rises, the general condition becomes worse, and death usually takes place from heart failure.

_Prophylaxis._—Get rid of lice according to the methods detailed on page 196. Those attending typhus patients should be protected from lice by wearing overalls, etc. Patients suffering from typhus should be thoroughly cleansed, their hair cut or shaved, and completely cleared of lice. Bedding and clothing must be disinfected.

_Treatment._—Good nursing is of more importance in this disease than the administration of drugs. The mouth must be kept in a good condition, and the food must be strengthening, nourishing soups being indicated. It is important to give the patient as much fresh air as possible, and as a rule he will require stimulants, especially heart tonics such as digitalis or strophanthus. Other measures can be carried out only under medical supervision.

_Ulceration of the Throat._

Gargle with a weak antiseptic solution such as permanganate of potash or chinosol. An astringent gargle may be made by dissolving five grains or more of tannin in two ounces of hot water. Sulphate of iron can be used for the same purpose, two grains or more to an ounce of water. If there is much pain, apply poultices to throat.

If due to syphilis give one grain of calomel and three grains of iodide of potassium, twice a day, in addition to the local treatment. Kharsivan, or similar treatment, is also indicated (_see_ p. 240).

_Undulant (Malta) Fever._

The term Undulant Fever is applied to Malta Fever partly because the latter is not a good name, as the disease occurs in various parts of the world, and partly because the term Undulant affords a good description of the type of the temperature curve.

_Cause._—The organism is a small bacterium, which is found in the blood and tissues. Although theoretically the disease can be spread like enteric fever or dysentery, in practice it is found that it is nearly always conveyed by infected goats’ milk. Goats are apt to harbour the organism and excrete it in their milk. It is also found in certain milk products, such as cream and cheeses which are not allowed to ripen. In addition to man and goats, cows, sheep, horses, mules and dogs, are all liable to natural infection.

_Symptoms._—Incubation period 5 to 15 days. The disease begins with headache, malaise, anorexia, and sleeplessness. The patient is usually constipated, and there is tenderness in the splenic region, the spleen being enlarged at an early date. The temperature rises gradually for three or four days in a step-like manner, and then falls by a similar descent, reaching the normal on or about the tenth day. At this early stage bleeding from the nose may occur, and profuse night sweats are not uncommon. The tongue is flabby and coated. When the temperature falls the patient feels better for a few days, but is still apt to suffer from night sweats, and continues to lose flesh. A relapse occurs, and is usually accompanied by joint troubles and sometimes neuralgic pains. A series of febrile waves continues to follow each other at short intervals, and the illness is a very wearisome one, running an average course of 60 to 70 days. It may, however, extend for nearly a year, and in some cases terminates fatally. The long course of the illness results in the patient becoming anæmic, and he often suffers from mental depression. There are irregular forms of the fever which are apt to be puzzling, and it is always well to remember that any cases of prolonged pyrexia from tropical or sub-tropical regions may be Malta fever.

_Prophylaxis._—Avoid drinking goats’ milk and eating the local products of such milk. If goats’ milk must be drunk it should be boiled. General hygienic measures are also important, and it should not be forgotten that the organism of the disease is found in urine, which should therefore be disinfected.

_Treatment._—This is for the most part entirely symptomatic. Medical attention and good nursing are essential. A vaccine has been introduced and is worth trying, but vaccine treatment is best left to an expert. It is sometimes necessary to give morphia for the joint pains and the neuralgia, but there is a distinct risk of the patient’s acquiring the morphia habit. Sleeplessness, which is often troublesome, should be treated as indicated on page 235.

_Urine, Retention of._

Retention of, or inability to pass the water may be caused by stricture, injury, shock, spasm, inflammation of some part of the passage, the effects of drinking, or by chill.

_Symptoms._—The bladder is unable to expel its contents and it gets fuller and fuller; it can be felt in its distended condition as a painful, soft swelling in the lower part of the belly, below the navel, underneath the skin and muscles. There may be fever, great pain and constant desire to pass water, with inability to do so. When the bladder becomes greatly distended, there is usually slight dribbling of water, which is somewhat misleading, as the case may be considered, not one of retention but rather of too frequent passing of urine.

_Treatment._—Give a saline purge such as Epsom salts, three or four teaspoonfuls, and let the patient sit in a bath of hot water. If not relieved very quickly, then pass a _clean_ catheter into the bladder, and allow it to empty itself (_see_ Catheters, p. 272). After the bladder has been emptied put the patient to bed and give a dose of opium or bromide of potassium to procure rest. When he desires to pass water again let him have another bath, and if this is not effectual, again withdraw the water through a catheter. Patient should be careful to ward off further attacks by avoiding chills, over-drinking, and other exciting causes. If there is inflammation of the bladder, copaiba or sandal-wood capsules should be used; if the urine is irritating, bicarbonate of soda must be given.

_Urine, Suppression of._

In this serious condition no urine is secreted by the kidneys, so that on passing a catheter the bladder will be found to be empty.

_Causes._—Shock from injury, inflammation and blocking up of the kidneys. Suppression of the urine is a common complication of severe cases of blackwater fever.

_Treatment._—Hot baths, hot poultices to the loins, free use of aperients, especially Epsom salts and other saline purges. Bicarbonate of soda in full doses. Keep the skin acting freely by means of sweet nitre, or Warburg’s tincture, or five-grain doses of antipyrine. Injections of hot water into the lower bowel.

_Worms._

Worms are introduced into the system chiefly by means of dirty water or imperfectly cooked food.

In the case of hook worms (ankylostomes), contaminated soil is the chief medium of infection.

Of the worms which live in the bowels the most important are the following:

_Tape Worms._—These worms may measure many feet in length; and their presence in the body can only be certainly known by the appearance of some of the segments or portions of the worm in the motions although hunger and dyspepsia may be complained of.

_Treatment._—Administer a good aperient overnight so as to empty the bowels; after the aperient nothing should be given by the mouth for eight hours, then give sixty to one hundred and twenty drops of the liquid extract of male fern in one ounce of thin gruel, milk, or gum water, and follow this up in four hours by a good meal, and an aperient to remove the worm, which should now be dead.

When the extract of male fern is not available, one tablespoonful of the oil of turpentine may be used in its place.

If later on fresh segments appear in the motions, then the treatment must be repeated.

_Round Worm._—The round worm resembles the garden worm and is several inches in length; it may be observed in the vomit but more commonly is seen in the motions. The symptoms are similar to those caused by the tape worm and the treatment is the same, except that, instead of the male fern, two to five grains of santonin should be given in a little milk; and the treatment repeated every other day for a week.

_Threadworm._—The threadworm is a small round worm usually measuring less than half an inch in length; it inhabits the lower end of the bowel and causes great heat and itching about the outlet, especially at night.

_Treatment._—Wash out the lower bowel and inject into it about a third of a pint of tea, or a similar quantity of water containing one teaspoonful of salt, tannin, or alum; then apply a little mercurial ointment around the outlet to diminish irritation. This should be done every third day till the worms have disappeared from the motions.

_The Guinea Worm._—The guinea worm often measures several feet in length; it chiefly causes trouble in the feet, ankles, and legs, where in order to obtain an exit from the body it penetrates the skin, causing a small ulcer at its point of exit.

Usually the presence of the guinea worm is attended with inflammation and the formation of matter.

_Prophylaxis._—Infected persons should be kept away from water supplies, and such sources of water supply as wells and water holes should be protected. In areas where guinea worm occurs, all water should be boiled. If this cannot be managed, it should be filtered through a piece of clean cotton cloth, as this will remove from it the small crustacean in which the larva of the guinea worm develops. Another method of treating infected water is by means of permanganate of potash, one ounce to every 2,000 gallons of well water. Caustic potash and quicklime are also effective.

_Treatment._—When the worm can be seen at the base of the little ulcer, it may be secured to a piece of match and a small portion may be wound on to the match daily. If attempts are made to forcibly draw it out, it will probably break and violent inflammation will result. During the time that the worm is being wound out, the part should be kept very clean and an antiseptic ointment applied.

There are other methods of treatment, but these can only be carried out under medical supervision.

_The Hook Worm._—This is the American name for one or other of the species of ankylostomes which infect man. The disease they cause is known as ankylostomiasis, and it is common in many parts of the world, especially in the tropics. It chiefly affects natives, owing to their habits; but it occurs also in Europeans.

_Cause._—Hook worms are small, almost cylindrical worms, which inhabit the human small intestine, to the wall of which they attach themselves by means of their mouths, which are furnished with formidable hooks and lancets. They suck blood, and the symptoms they produce are due in part to loss of blood, in part to the destruction of the lining membrane of the bowel, and possibly also in part to the effects of a poison which they are believed to excrete. Their eggs are passed in the excrement, and develop in the infected soil into larvæ, which are able to penetrate the unbroken skin if they come in contact with it. This is the most important route of infection, but it may occur also by means of infected drinking water and from contaminated food.

_Symptoms._—The most marked feature of the disease is anæmia, which is often associated with digestive troubles. Palpitation of the heart and shortness of breath are frequently met with. In bad cases the appetite is disordered or depraved. The patient becomes pot-bellied, and there is swelling, chiefly about the face and ankles. The face is frequently puffy, and the skin assumes a peculiar earthy hue. It should be noted that a very early symptom is what is called ground itch. This is a skin eruption, usually on the feet and legs, due to the irritation caused by the larvæ penetrating the epidermis.

_Prophylaxis._—The chief measure consists in preventing contamination of the soil by infected excrement. It is therefore important when camping to make proper provision in the way of latrines. Care must also be taken to prevent the fouling of water and food stuffs, such as vegetables, which are eaten uncooked. It is very dangerous to go about bare-foot in regions where the disease occurs, and camping sites should always be thoroughly cleansed.

_Treatment._—Efficient treatment can only be carried out in association with microscopic examination of the stools, and hence all that need here be said is that various worm medicines are employed, of which the most effectual are thymol and oil of chenopodium. These should be administered only under careful medical supervision. The anæmia has to be treated, and in the case of natives a nutritious and easily-digested diet is indicated; for example, for native coolies the following has been recommended: bread 1 pound, milk 2 pints, sugar 2 ounces, 2 eggs, and 4 bananas daily. Ground itch should be treated by an ointment containing zinc oxide and salicylic acid.

_The Bilharzia Worm._—This worm, of which there are two species, produces the disease known as Bilharziasis or Schistosomiasis, which occurs in one or other, or both forms, in various parts of the world, but is specially prevalent in Egypt.

_Cause._—The worms, which produce either urinary or rectal bilharziasis, live in parts of the human vascular system, where they produce their eggs. These eggs are furnished with spines, and hence cause irritation when lodged in the tissues. In the urinary form the eggs have a terminal spine, in the intestinal form the spine is lateral. These eggs are passed either in the urine or in the excreta and reach water, where they develop into larvæ. The larvæ enter special species of water snails, in which they develop, producing eventually tiny forms known as cercariæ. These cercariæ escape into the water and can penetrate the unbroken skin or intact mucous membrane. They thus get access to the bodies of persons who are bathing in the infected water, or who may drink it. Once in the human body, the blood carries them to the place where they develop into the adult worms, which eventually unite, and then the females begin producing the spined eggs.

_Symptoms._—In the urinary form the chief symptom is the passage of bloody urine, which usually shows itself about three months after infection, and is often associated with a good deal of irritation of the bladder and the pipe. The intestinal form may produce various symptoms. Sometimes a condition resembling enteric fever occurs, sometimes one like dysentery. Diarrhœa is common. The condition is chronic and, if untreated, sets up all kinds of secondary effects, which need not be discussed.

_Prophylaxis._—Carefully avoid any kind of personal contact with water which may by any possibility be infected from urine or fæces. Bathing, wading, washing in, or drinking any such waters, are all dangerous. Wherever possible, water which may be infected should be boiled. If this cannot be done, sodium bisulphate tablets may be used; two of the 16-grain water-purifying tablets in a quart water-bottle full of water are efficient. Filtration through a Pasteur-Chamberland or Doulton candle is efficient, as it excludes the cercariæ. Bathing water can be rendered safe for immediate use by the addition of undiluted Army cresol in a dilution of 1 in 10,000. If the water is kept overnight, 1 in 90,000 is sufficient, as the storage of water tends to diminish infection.

_Treatment._—Certain forms of antimony have been found to cure the condition, but can only be administered by a medical man. Indeed, either form of bilharziasis can be properly treated only under medical supervision. If this is not obtainable, some relief can be afforded by the use of urotropin and sedative drugs.

There are many other worm diseases which afflict man, but no good object would be served by mentioning them in detail. Most of them can be diagnosed with certainty only by a medical man using the microscope, and they all require scientific treatment which is beyond the scope of the ordinary traveller.

_Yellow Fever._

This disease, the “Yellow Jack” of naval historians, occurs, so far as is known, only in parts of the New World and on the West Coast of Africa. One attack usually protects permanently against a second.

_Cause._—Quite recently the organism has apparently been discovered. It is a corkscrew-shaped parasite which exists in the blood, and which is allied to, though not identical with, the parasites of relapsing fever and tick fever. The infection is conveyed from one patient to another by the mosquito _Stegomyia fasciata_, which is a black and white insect, commonly known from its striped legs as the tiger mosquito. Incubation period two to five days.

_Symptoms._—The onset of the disease is very sudden, the highest temperature being reached almost at once; then follows a period of remission or calm, the pulse becomes abnormally slow, and this stage is usually either succeeded by convalescence, or the symptoms become worse and the patient dies. Some of the symptoms much resemble malaria, but the rapidity of the onset, severe pain in the forehead, eyes, and loins, the early scantiness of the urine, the marked jaundice, the bright eyes, the narrow red tongue, and the absence of pain about the spleen are fairly characteristic.

There is considerable thirst and vomiting, and in bad cases the vomit becomes black, the colour being due to the presence of blood. (In ordinary malaria the vomit is yellow, or in severe cases, such as blackwater fever, it may be of a bright or dark-green colour.) In yellow fever, jaundice is developed about the third day, and tends to increase, whilst in blackwater fever it comes on very early and soon begins to abate.

An important diagnostic sign in yellow fever is found in the fact that the pulse does not increase in rapidity as the temperature rises.

_Prophylaxis._—Avoid being bitten by mosquitoes, employing the methods mentioned on pages 206, 207. It must be remembered that _Stegomyia fasciata_, unlike the anopheline mosquitoes, bites during the day, and therefore it is more difficult to avoid its unwelcome attentions. It usually breeds in the neighbourhood of houses, being what may be called a domestic mosquito; and it is of the greatest importance to abolish all potential breeding places or to protect them from the mosquito. Practically any vessel holding water may become a nursery for Stegomyia, and it is remarkable in what small quantities of water this mosquito will lay her eggs. Patients suffering from the disease must be isolated and kept under a mosquito net or in a mosquito-proof chamber, in order to prevent them from infecting mosquitoes, which they are capable of doing in the early part of the disease.

_Treatment._—Open the bowels well by means of calomel, six grains, followed by a saline purge and hot-water enema. Some prefer castor oil in large doses. Give ten grains of bicarbonate of soda three times a day. Give cooling drinks, such as fruit salt. Make the skin act. Apply hot fomentations to the back and mustard leaves to the pit of the stomach.

The question of feeding is very important. During the first two or three days of the fever the patient is better without any food at all. As he recovers his appetite returns, and great care must be exercised about gratifying it. Only the plainest foods in very small quantities should be permitted, the amounts being gradually increased, as otherwise relapses may occur. Stimulants are usually required in the later stages of the fever, but they must be carefully employed as they may tend to increase the vomiting. It is possible that the discovery of the parasite may lead to new and more efficient methods of treating the disease.

MEDICINES, MEDICAL APPLIANCES, ETC.

WEIGHTS AND MEASURES.

_Solids._

A Grain Symbol Gr. 20 Grains 1 Scruple { weights now ” ℈ 60 Grains 1 Drachm { rarely used ” ℨ 437.5 Grains 1 Ounce ” ℥ 16 Ounces 1 Pound ” ℔

_Note._—An ounce weighs not 8 but rather under 7½ drachms.

1 Gramme about 15½ grains. 1 Kilogramme ” 2 lbs. 3¼ ozs.

_Liquids._

1 Minim About 1 drop, or 0.06 c.c. Symbol ♏ 60 Minims One fluid drachm ” ℨ 8 Fluid drachms (480 Minims) One fluid ounce ” ℥ 20 Fluid ounces One pint ” O 1 Cubic centimetre 17 Minims.

A teaspoonful About one fluid drachm. A dessertspoonful About two fluid drachms. A tablespoonful About half a fluid ounce. A wine-glassful About two fluid ounces. A tumblerful About half a pint. A litre About a pint and three quarters.

All bottles containing drugs should be doubly labelled, and the labels should be varnished, otherwise they will probably come off in a damp climate. Poisons should be kept in bottles of a special shape.

Drugs in a liquid state are inconvenient for travellers. They are bulky, and require very careful packing and handling.

As far as possible, therefore, compressed drugs should be selected. These must be of good quality.

Tablets are often taken in the solid form, but they will act more quickly and certainly if dissolved or suspended in about an ounce of water.

Some preparations, chiefly those used for preparing lotions, etc., _e.g._, of chinosol, are also made in compressed form.

In regard to drugs, I have kept well within the maximum dose, so that there may be no trouble on that account. For instance, in certain cases a medical man would give sixty drops of laudanum for a dose, but I advise travellers rarely to give more than sixty drops in twenty-four hours. The urgency of the case must be the guide as to the quantity of the drug to be given. The smallest dose which is effective is the best.

A supply of antiseptic gauze, wool and lint is necessary. The compressed forms are very convenient.

All antiseptic gauzes and other dressings should be very carefully protected from the air in order that their properties may be preserved. They should be wrapped in oiled paper or india-rubber tissue, and kept in a tin box.

A supply of bandages will also be needed. Each bandage should be two inches in width by six feet in length.

_Dressing case._—The traveller should provide himself with a surgical dressing case. A suitable one should contain 1 pair of scissors, 1 pair of Spencer Wells’ artery forceps, 1 probe, 1 scoop and grooved director, 1 knife with two blades, 1 small saw with a detachable handle, and a packet containing silk, wire, needles, and pins.

All active poisons mentioned in the following pages are marked with an asterisk (*).

_Aloin Co. tablets._—One taken three times a day after meals, in chronic constipation, gradually reduced as bowels become regular.

_Alum._—Dose, five to ten grains. Is occasionally used as an internal astringent in the treatment of diarrhœa.

A solution containing five grains to the ounce of water may be used as a mouth wash for bleeding or inflamed gums, as a gargle for relaxed and sore throats, or as a lotion for inflamed eyes.

Ten to twenty ounces of a solution containing five grains to the ounce is sometimes used as an enema to check the diarrhœa in chronic dysentery.

The tablet of alum weighs ten grains.

_Ammonia._—Three preparations of ammonia, viz., Sal volatile, Carbonate of ammonia, and Liquor ammoniæ, are extremely valuable as stimulants, and in this respect they are to be preferred to alcohol. All three are similar in their action, and are useful on account of their stimulating effect upon the heart in cases of fainting, or collapse caused by snake-bite, bullet-wound, or other injury; they relieve spasm, and promote sweating in feverish states. They also cause free expectoration, and are therefore useful in the later stages of bronchitis.

The chief objection to these drugs is that their strength is rapidly lost, unless they are kept in well-stoppered bottles, and in the dark.

All preparations of ammonia should be administered in about one ounce of water.

_Sal volatile, or aromatic spirit of ammonia._—Dose, twenty to sixty drops for a single administration, or up to thirty drops if repeated frequently. This is the most convenient and pleasant preparation of ammonia, but is bulky. As a local application, it is of service in relieving the pain caused by the bites of certain insects, _e.g._, mosquitoes and fleas.

_Carbonate of ammonia._—Dose, three to ten grains.

_Liquor ammoniæ, or solution of ammonia._—Dose, five to twenty drops.

(_Note._—This is not the strong solution, which is always labelled “Liq. Ammon. Fort.,” and which is three times stronger than liquor ammoniæ.)

_Ammonium chloride._—Dose, five to twenty grains. This drug is chiefly used in congestion of the liver, especially where acute inflammation or abscess is threatened; at times it is useful in neuralgia and chronic bronchitis. It is also used for inflamed and relaxed sore throat, in the form of a gargle, five to ten grains to the ounce of water.

_Antipyrine._—Dose, five to ten grains. (Uses as Phenacetin.)

* _Araroba, Chrysarobin, or Goa powder._—Is not for internal use. One part of the powder mixed with one of acetic acid and fourteen of lard makes what is known as araroba ointment.

_Araroba ointment_ is useful in many skin diseases, such as psoriasis; it easily destroys the parasites in ringworm, dhobie itch, or kraw kraw. It is a powerful drug, and should be used only in small amounts, for if applied too freely it will cause some inflammation and pain. Care must be taken that it is not rubbed into the eyes.

* _Aromatic chalk with opium tablets._—Ten grains three times a day in severe cases of diarrhœa.

* _Arsenic._—Dose, one-sixtieth to one-fifteenth of a grain. Is a powerful and poisonous drug, and should be taken with caution. It is useful in chronic malaria, and in anæmia and debility, especially that following an attack of fever.

It is best combined with iron in tablet form—iron and arsenic tablet—two of which may be taken twice a day, after food, for a week. This is a good general tonic.

_Aspirin._—Dose 5 to 15 grains. Should be taken with a drink of water. Useful in rheumatic and febrile conditions; often relieves headache and the feeling of discomfort associated with chill. It is apt to be depressing in large doses, and some persons do not tolerate it well. Speaking generally it may be used in those conditions in which salicylate of soda is indicated.

_Bismuth carbonate._—Dose, five to twenty grains. Useful in dyspepsia, pain in the stomach, vomiting and diarrhœa. The drug is heavy, and therefore gum or starch water should be used to suspend it.

It is often combined with opium and bicarbonate of soda to check vomiting and diarrhœa.

Bismuth may also be used as a dusting powder.

_Boric acid, or boracic acid._—Chiefly used in solution, for its mild antiseptic properties, as a gargle, injection, eye lotion, or mouth wash. On the same account, it is used for washing wounds, or syringing out ulcers, or sore and inflamed ears. It is practically non-poisonous.

Lotions should contain from five to ten grains to the ounce. Boric ointment is a useful dressing for sores, burns, or wounds; it may be made by adding one part of powdered boric acid to nine of vaseline or fat.

Equal parts of finely-powdered boric acid, zinc oxide and starch makes a good dusting powder for moist eczema, bed-sores, chafes, and perspiring feet.

Boric lint (lint impregnated with boric acid) is useful as a dressing for wounds, ulcers, and abrasions.

Boric wool is absorbent cotton-wool impregnated with boric acid, and is the most generally useful antiseptic wool.

_Bromides._—The bromides generally used are those of potassium, or ammonium. Dose in either case, five to twenty-five grains. They are sedatives, and are used in convulsions, epilepsy, and delirium; they relieve headache, especially if taken with sal volatile, and may be combined with chloral (_see_ Chloral). The bromide of ammonium is less depressing than the bromide of potassium.

_Calcium sulphide, i.e., sulphurated lime._—Dose, a quarter to one grain three times a day. Useful for those who are suffering from boils or carbuncles.

* _Calomel, or subchloride of mercury._—Dose, two to five grains. Calomel may be used in almost all cases requiring an aperient; its action will be assisted by giving fruit salt, or citrate of magnesia, four hours later. In cases of insensibility or delirium it is specially useful, for the powder may be placed on the back of the tongue, and it will be swallowed unconsciously.

Four grains of calomel may usually be given with advantage, at the beginning of a malarial attack.

In syphilis, one grain may be given two or three times a day; but its action should be watched, and if it causes salivation, tenderness of the gums, and a coppery taste in the mouth, it should be discontinued until these symptoms disappear.

_Camphor._—Dose, two to five grains. Is a stimulant, and an antispasmodic; it helps to calm the nervous system. It is used in cholera and in fevers, and is taken for colds in the head.

Camphor is slightly soluble in water, and this solution makes a cooling lotion, which is useful for inflamed or painful parts. A lump of camphor is a good repellent for sand-flies.

_Spirit of camphor_ consists of one part of camphor in ten of alcohol; the dose is ten to twenty drops.

_Camphorated oil_ consists of one ounce of camphor in four ounces of olive oil, and makes a stimulating liniment for stiff and painful parts. A stronger liniment may be made by adding to this an ounce of spirit, and half to one ounce of solution of ammonia or oil of turpentine.

* _Carbolic acid, or phenol._—Dose, one or two grains may be given internally, well diluted, for acute diarrhœa, dysentery, and cholera. Is mostly used as an external application. Carbolic acid acts as a caustic, and may be applied on the end of a match in the case of boils (p. 227). A drop on a piece of cotton-wool applied to a hollow tooth quickly relieves pain.

It is much used as an antiseptic lotion for wounds and foul sores, and for cleansing hands and instruments before operation.

One part in twenty of water makes a strong solution for cleansing instruments and disinfecting dysenteric and other stools.

One part in sixty may be used for sponging or syringing sores and wounds.

One part added to nineteen of olive, or other oil, makes carbolic oil, which is a handy dressing for all kinds of wounds.

One part to nineteen parts of vaseline, or fresh lard, makes carbolic ointment.

_Cascara sagrada, extract of._—Dose, two to six grains. Is a valuable aperient, especially in chronic constipation. Cascara tablets, two grains each, are convenient, and one or two should be taken at night.

_Cathartic Co. Tablets._—A useful purge in cases of fever or liver derangement. Two or three for a dose when required.

_Castor oil._—Dose, one to three tablespoonfuls. It is a good aperient, but is not very convenient for the traveller, as it takes up much space, which could be better used for aperients which are not so bulky, _e.g._, calomel or cascara. The usual dose of castor oil should be somewhat reduced in the tropics, where it is often not so well borne as in temperate climates.

_Note._—The seeds of the castor oil plant should not be eaten, as they are poisonous.

_Chinosol_ is a drug which has many of the advantages of carbolic acid without its poisonous or caustic properties. It is so generally useful that, at any rate for explorers, it will largely replace carbolic acid. It is antiseptic and disinfectant in its action, can be used as a mouth wash or gargle, for sore gums and ulcerated throats; it makes a good lotion for washing the hands, instruments, or wounds, and may be syringed into fresh wounds or into chronic ulcers.

It is put up in the compressed form, each tablet weighing eight and three-quarter grains, and the strength of the solutions here given are calculated strictly from this weight.

One tablet dissolved in a pint of water makes a solution of 1 in 1000 (equal to about 1 in 40, carbolic lotion), which is the most useful for general purposes, such as an antiseptic wash for the hands or for disinfecting surgical instruments.

A tablet in two pints of water makes a solution of 1 in 2000. This may be used for washing fresh wounds, burns, and suppurating surfaces, or as a gargle for sore throat.

As a healing dusting powder, one part of chinosol may be mixed with ten of boric acid, and used in the same manner as iodoform powder.

To disinfect typhoid or dysenteric stools, dissolve four tablets in one pint of water and add the mixture to the vessel containing the motions.

* _Chloral._—Dose, five to twenty grains. Relieves restlessness and delirium, and produces sleep. Larger doses than twenty grains should not be given. In severe convulsions, due to certain poisons, _e.g._, strychnine, twenty grains or more of bromide of potassium may be added to the full dose of chloral, and given either by the mouth or bowel.

* _Chloroform._—Dose, one to five drops. Two to four drops can be given with advantage with almost any drug, as a flavouring agent, and on account of its antispasmodic action.

From two to four drops put on a piece of loaf sugar and sucked will often stop sea-sickness or other vomiting.

_Spirits of Chloroform, or Chloric Ether_, consisting of one part of chloroform in twenty parts of alcohol, is a convenient form in which to administer the drug. It is useful in sea-sickness, cramps and colic, and should be given in doses of twenty drops added to a teaspoonful of water every quarter of an hour, until six such doses have been given.

* _Cocaine._—A one per cent. solution may be used to diminish pain in the eye caused by injury or a piece of grit lodging under the lids. Two drops should be applied to the eyeball, and in about two minutes the application may be repeated; in another minute the sensibility of the part will be diminished, and a careful examination may be made for dust or other foreign bodies, which should of course be cautiously removed.

_Creosote._—Dose, one to two drops; is best given in a capsule. In many cases of indigestion it gives great relief if administered immediately after food. Creosote applied to a hollow tooth, upon a piece of cotton-wool, will usually relieve the pain.

_Cresol._—This is a valuable disinfectant which is found on the market under several names.

* _Croton Oil._—Dose, half to one or two drops, mixed with bread crumb or in a pill.

Is a powerful purgative not usually given to Europeans. Native carriers like it. Useful in the case of unconscious patients, given in butter.

_Copaiba, Balsam of._—Dose, five to twenty drops three times a day. Is best taken in capsules. It increases the expectoration, and is therefore useful in bronchitis; is a stimulating disinfectant to the urine, bladder and pipe, and is used in gonorrhœa and inflammation of the bladder. It may produce an irritating rash on the skin if taken in too large quantities.

_Emetics._—The following are the usual emetics:—

Common salt, two tablespoonfuls in half a pint of water. Mustard, one tablespoonful ” ” Ipecacuanha, thirty grains ” ” Zinc sulphate, thirty grains ” ”

In the absence of any of the above, give copious draughts of tepid water, followed by tickling the back of the throat with the finger or a feather.

_Emetine._—The active principle of ipecacuanha. Of great value in amœbic dysentery (p. 187).

_Enema._—_Nutrient enema_:

Two eggs, Half teaspoonful of salt, A wine-glassful of milk.

Beat up the eggs, then add the salt and milk, and mix well. Raise the hips and inject slowly through the long tube well up into the bowel.

_Nutrient enema_:

Benger’s beef jelly, two tablespoonfuls, Milk, about three ounces.

_Warm-water enema._ To relieve uneasiness of lower bowel, as in dysentery, piles, etc., half a pint or more of warm water, by the short tube.

_Soothing enema._ Laudanum, thirty drops; warm water about two ounces. A little thin starch water or gum may be added. Inject through the short tube, and repeat the injection in three hours if patient is not easier.

_Quinine enema._ Quinine, twenty grains or more; warm water, about two ounces. If the patient does not retain the injection, give a second one within an hour. Select a soluble preparation of quinine, such as the bisulphate or the hydrobromide.

_Aperient enema._ Lather soap in thirty ounces of warm water, using plenty of soap to make a good solution; or use plain warm water or weak gruel; the addition of one or two tablespoonfuls of oil is of advantage. Inject slowly into the bowel with short tube; if it does not cause uneasiness, inject the whole amount. The injection should be retained as long as possible.

_Epsom salts, or sulphate of magnesia._ Dose, two teaspoonfuls or more. Is a saline purgative, giving a copious watery motion, rapid in its action, and useful in fevers or congestion of the liver. It also increases the flow of urine.

Recently has been much used in dysentery (p. 189).

_Friar’s Balsam._—(Tinct. Benzoin Co.) Dose, thirty drops or more.

Internally is useful as an expectorant in bronchitis. Can also be employed as an inhalation.

Externally, lint soaked with it is an efficient dressing for wounds and sores. When first applied it causes a good deal of smarting, but this soon passes off.

_Gall and opium ointment_ is a useful application for piles.

_Gauze, antiseptic._ The best dressing for wounds is some form of antiseptic gauze. Cyanide gauze, which is impregnated with cyanide of mercury, is the most generally used.

_Ginger, essence of._—Dose, five to twenty drops. It is useful in cases of cramp, colic, and indigestion, especially if combined with five or ten grains of bicarbonate of soda and two or three drops of chloroform.

If there is much pain, ten drops or more of chlorodyne or laudanum may be added.

* _Goa powder._—_See_ Araroba.

* _Goulard water._—For external use only. Is astringent, and may be used as a lotion for inflamed joints. Is also useful as an injection in gonorrhœa and gleet, as a soothing lotion in herpes, shingles, eczema, discharge from the ear, and itching and chafes of all kinds. _It should not be used as an eye lotion._

Goulard water is made by adding one part of Liquor Plumbi Subacetatis Fortis, or Goulard _Extract_, and one of alcohol to seventy-eight of water.

One of the tablets of the subacetate of lead added to a quarter of a pint of water (distilled when convenient) makes a solution similar to Goulard water.

_Gum acacia_ is used for forming a mucilage with which to suspend such drugs as carbonate of bismuth. One part of gum to three of water should be made and strained before use. Starch may be used for the same purpose.

_Hazeline._—Dose, thirty to one hundred and twenty drops. It is a powerful astringent. May be applied freely to bleeding parts, such as the nose, gums, piles, or small wounds. One tablespoonful of hazeline to five of water may be injected into the bowel for bleeding piles. Hazeline snow is an elegant preparation for sunburn and other skin affections.

_Ichthyol._—An ointment containing twenty per cent. of ichthyol is very soothing in most skin diseases, such as eczema and psoriasis. The ointment is of service in reducing the pain and swelling of mosquito bites.

_Iodide of potassium._—Dose, five to ten grains in the later stages of syphilis.

* _Iodine, tincture of._—Dose, two drops in a teaspoonful of water; given every hour, is most valuable for obstinate vomiting.

Used externally, it acts as a counter-irritant, and should not be painted on too freely as it may cause blistering. Does good if painted over swollen joints or enlarged glands, but should not be applied if the skin there is broken. Tincture of iodine may be painted on the chest or over the liver or spleen if there is pain. It is a valuable application for all open, recent wounds, and may be painted freely over and round the raw surface. It relieves the irritation of mosquito bites.

Is very useful in certain diseases of the skin, such as ringworm, kraw kraw, and dhobie itch.

_Iodoform powder_ is a valuable antiseptic, and is used for all kinds of sores, or wounds, in which it rapidly promotes healing. One part of iodoform to eight parts of vaseline makes a good healing ointment.

_Ipecacuanha._—Dose, expectorant, half to two grains. ” emetic, fifteen to thirty grains. ” for dysentery, twenty to forty grains or more.

In small doses, _e.g._, a quarter to half a grain, is a stomachic and may check vomiting.

Was formerly much used in amœbic dysentery (p. 187). Its active principle, emetine, is now employed.

By causing free expectoration, it is very useful in bronchitis, and is then usually combined with ammonia.

Is contained in Dover’s powder, and in this form is useful in coughs and colds, as it helps to cause sweating.

_Iron._—Iron is much used on account of its tonic and blood-forming properties. It is especially useful in anæmia following fevers and other exhausting diseases, and it also gives tone to the nervous system.

Most preparations of iron are astringent in their action, some such as the sulphate and perchloride being more so than others; these are, therefore, useful in diarrhœa and in bleeding from the gums and bowel. Iron by its astringent action may cause constipation, and it may be necessary to add a small amount of an aperient, such as Epsom salts, to each dose.

The following preparations are those generally used:—

_Tincture or perchloride of iron, or tincture of steel._—Dose, five to fifteen drops in at least an ounce of water. Good blood tonic. Is very astringent, and is therefore useful in internal bleeding and looseness of the bowels. It is of value in erysipelas.

_Sulphate of iron._—Dose, one to three grains. Is a powerful astringent and blood tonic, and often does good in checking the looseness of the bowels which remains after an attack of dysentery.

_Iron pill or Blaud’s pill._—Dose, five to fifteen grains. Is one of the best tonic preparations of iron, as it is not very astringent. It is put up in tablet form.

_Solution of dialysed iron._—Dose, ten to thirty drops. Is a good blood tonic, and, unlike most preparations, is not astringent.

_Parrish’s food._—Dose, thirty to a hundred and twenty drops in water. Is a good preparation of iron for children.

_Iron and arsenic compound tablets._—A useful tonic in convalescence from malaria, one taken three times a day after meals.

_Mercurial ointment_ forms a useful application in certain skin diseases. As it is rather strong, it should be diluted with two parts of vaseline.

_White precipitate, or ammoniated mercurial ointment._—Useful in the case of head lice and several parasitic skin diseases.

_Naso-pharyngeal Tablets._—Useful in nasal catarrh and pharyngitis.

* _Opium._—Is a valuable drug, but it is also a poison, and great care should be observed in using it. Opium is narcotic and sedative in its action; it relieves pain of all kinds. Useful in diarrhœa, dysentery, cramp and colic. Promotes perspiration and checks vomiting. Sometimes it will cut short a cold or mitigate an attack of malaria.

_No preparation containing opium should be given to children without medical advice, and the same is true as regards persons suffering from kidney disease._

The chief preparations containing opium are:—

* _Chlorodyne._—The ordinary dose is ten to fifteen drops, but if there is great pain, then even thirty or forty drops may be given, but a second dose should not be administered for three or four hours; if two full doses have been given, do not give a third within at least twelve hours of the second dose, and do not give it at all if the patient is drowsy.

It is best not to give more than forty to sixty drops in twenty-four hours, unless there are very special reasons for giving a larger quantity. Is to be preferred to laudanum, as it is more palatable and more readily stops vomiting.

* _Laudanum, or tincture of opium._—The doses and uses are precisely similar to those of chlorodyne. Laudanum has been put up in the compressed form, and is very convenient for transport.

* _Dover’s powder, or compound ipecacuanha powder._—Dose five to fifteen grains. It contains opium and a small amount of ipecacuanha. Ten grains of Dover’s powder are equal to about fifteen drops of chlorodyne or laudanum. The tablet is an extremely handy preparation. Dover’s powder is especially useful in coughs and colds, the ipecacuanha it contains assisting the action of the opium. If a patient who is chilled is put to bed at once, kept warm with blankets and hot-water bottles, and is given ten or fifteen grains with a hot drink, he will perspire, and possibly the cold will be cut short.

_Peppermint, spirits of._—Dose, five to twenty drops. Is a valuable drug in cases of flatulence and dyspepsia, especially if combined with bicarbonate of soda; it also masks the taste of unpleasant medicines. For children, one drop of the spirit and one grain of bicarbonate of soda may be added to one teaspoonful of water, and this dose may be frequently repeated.

_Pepsin tablets_, a useful digestive product, taken with food when digestion is weak, or may be used to predigest it.

* _Perchloride of mercury tablets_, for making lotions for disinfecting wounds, etc.

_Phenacetin._—Dose, three to eight grains. Phenacetin is used for headaches, or for reducing the temperature in malaria and other febrile diseases, and to cause sweating. As it is very insoluble, it is best taken in the form of a powder, or in alcohol and hot water.

_Potassium, bromide of. See_ Bromides.

* _Potassium permanganate_ in solid form is a mild caustic, and is the active principle of Condy’s fluid, which contains about eight grains of the drug in one ounce.

It is disinfectant, deodorant, and antiseptic.

One part of this drug is soluble in about twenty parts of water.

One grain gives a purple colour to a gallon of water. Impure water turns the purple rapidly to a brown colour, therefore the permanganate is a rough test for the presence of organic matter in water.

A pale purple solution is useful as a gargle or mouth wash, also as an injection in gonorrhœa; wounds may be cleansed with a similar solution.

It is especially useful in poisoned wounds, such as snake-bites, and should in these cases be injected hypodermically (p. 281).

Is an antidote to poisoning by opium.

Of late years it has been extensively used in the treatment and prevention of cholera. The two-grain tablet is a convenient form for medication.

_Purgatives_ may be divided into the following classes:—

1. Laxatives.

2. Simple purgatives.

3. Drastic purgatives or cathartics.

4. Saline purges.

1. Laxatives slightly stimulate the movements of the bowel, but cause practically no increase of the intestinal secretion. Examples of this class are fruit, wholemeal bread, small doses of castor oil, figs, prunes, etc. These may be given regularly in slight cases of chronic constipation.

2. Simple purges are more powerful than laxatives, and in addition to stimulating the movements of the bowel increase the secretion. The result is a soft, easy motion. Examples: rhubarb, senna, cascara sagrada.

3. Drastic purgatives or cathartics. The drugs cause a profuse flow of the intestinal secretions, and, occasionally, of the bile, with greatly increased bowel movements. They cause a copious watery evacuation, accompanied by a good deal of griping. Examples: calomel, colocynth, aloes, podophyllin, croton oil, jalap and oil of turpentine; of these, podophyllin and aloes cause an increase in the flow of bile, with increased intestinal movements, so they may be said to act directly upon the liver. The result is a profuse, watery, bile-stained motion.

Calomel does not act directly upon the liver, but stimulates the upper part of the bowel, so that its contents are hurried along before the bile can be reabsorbed, and a loose, watery, bile-stained motion ensues.

The most useful purgative of this class is the pill containing colocynth, calomel, and hyoscyamus, of which five to ten grains should be given when there is a furred tongue, constipation, heaviness or weight over the liver, and dyspepsia and loss of appetite.

4. Saline purgatives. These cause a free secretion of the intestinal juices, and a copious motion, proportionate to the size of the dose, is the result. The principal saline purges are Epsom salts (_i.e._, sulphate of magnesia), Glauber’s salts (_i.e._, sulphate of soda), seidlitz powder, the various forms of fruit salts, and the aperient mineral waters, such as Rubinat, Hunyadi Janos, etc.

A saline purgative may be given in the morning, to assist the action of an aperient pill administered the previous night.

Saline purgatives are useful, too, in many cases of habitual constipation, and, if necessary, a small dose may be given every morning in a tumbler of warm water.

_Quinine._—Quinine is chiefly used for malarial fever, and the urgency of the case must be the guide as to the amount to be administered. It is seldom necessary to give more than ten grains three times a day; at times enormous doses, such as thirty grains three times a day, have been given with advantage, but such doses are rarely necessary, and in the absence of a medical man should never be given.

The administration of quinine sometimes causes headache, deafness, delirium, and partial or even complete blindness. In such cases the dose should be reduced or the drug withheld until these symptoms have disappeared.

_It has been stated that quinine causes blackwater fever; this, I believe, is absolutely untrue._ I have seen cases of blackwater fever, apparently resulting from the neglect of malarious attacks, which date the commencement of their recovery from the first administration of quinine.

Quinine is best given in solution; the nauseous taste can be somewhat disguised by adding chloroform water or essence of ginger or lime juice to the solution. Many men take the drug in a little beer or spirit for the same purpose.

Quinine pills are, as a rule, very insoluble, therefore they are not suitable for explorers. Quinine in the form of a tablet, or in a capsule, or wrapped in tissue paper, acts well, but even tablets should be cracked or crushed. Sugar-coated products are inadmissible in the tropics.

Sometimes, owing to frequent vomiting or other cause, the quinine administered by the mouth cannot be retained. It must then be given by means of an enema or by injection into the muscles.

If the traveller decides to give an intra-muscular injection of quinine, he should only give five grains at a time. The dose should be added to about a teaspoonful of water which should then be boiled and allowed to cool. The amount of water is of little importance so long as enough is used to dissolve the drug, and keep it in solution when the water is cool enough to be injected. The less fluid, however, injected the better.

Injections are best made deeply into the muscles of the buttock. This is a method best left to a medical man, as there is danger of injuring the sciatic nerve.

_The preparations of quinine._—Many preparations of quinine are made; they are all popularly known as quinine, their uses are similar, and the doses are as follows:—

Dose, one to five grains, as a tonic. ” five or more grains as a preventive of malaria. ” five to twenty grains, in fevers.

_Sulphate of quinine._—This is the preparation most commonly used; but it is very insoluble in water, and should be given along with a little dilute acid.

_Acid sulphate of quinine_, sometimes called bisulphate, soluble or neutral sulphate of quinine.

The acid sulphate is much more soluble than the sulphate, and is a more suitable preparation for administration by the mouth or for injection into the bowel.

_Hydrochloride of quinine._—Is a very soluble preparation, and contains a large percentage of quinine.

_Quinine hydrobromide._—Is more soluble than the sulphate, and less liable to cause headache and other quinine symptoms.

_Acid quinine hydrobromide._—Very soluble and non-irritating. Solubility, one in six of water.

_Tannate of quinine._—Is a weak preparation, but suitable for children. Solubility, one in ten of water.

_Acid quinine hydrochloride, or quinine bihydrochloride._—Is a very soluble preparation, and is suitable for hypodermic injection, but is somewhat expensive.

It is soluble in less than its own weight of water.

For administration by the mouth or bowel, the traveller is advised to take either the hydrochloride or the bisulphate of quinine.

For intra-muscular administration the acid quinine hydrochloride is generally used.

_Rhubarb_, either in form of compound rhubarb pill, one of the most useful of ordinary aperients, two to four for a dose.

_Compound Rhubarb Powder_, otherwise known as Gregory’s Powder.

_Sandal-wood oil._—Uses and doses as for balsam of copaiba.

_Soda, bicarbonate of._—Dose, five to ten grains or more. Five to ten grains dissolved in water may be given twice a day for acidity, flatulence, heartburn. Useful in dysentery to allay irritation of stomach; for this purpose five or ten grains may be given an hour before each dose of ipecacuanha.

If the urine is acid and scalding, give twenty grains three times a day. Bicarbonate of soda is given in cases of blackwater fever when the urine is not sufficient in quantity; in such cases at least twenty grains should be given every six hours.

_Soda mint tablets_, useful for relieving flatulence, one or two being taken after meals.

_Sodium salicylate._—Dose, ten to twenty grains. Relieves pain in rheumatic fever. Lowers temperature. Its action must be carefully watched, as too large doses may cause headache, buzzing in the ears, and even delirium.

_Sulphur._—An ointment containing one part of sulphur to nine of lard, grease, or vaseline, makes a useful application for itch and other skin diseases.

_Tannin._—Tannin is a powerful astringent, and may be used internally or externally.

In five to ten grain doses it helps to stop diarrhœa, bleeding from stomach, bowel, piles, and bladder. If there is continued bleeding, increase the dose to twenty grains, and repeat it as often as necessary.

_Voice tablets_, consisting of chlorate of potash, borax and cocaine are useful in cases of sore throat.

_Warburg’s tincture._—One tablet is equal to thirty drops of the ordinary tincture. Stronger tablets are also available.

To produce sweating, first open the bowels, then give four to eight of the tablets with a little hot spirit and water. If necessary, repeat the dose in three hours, and in either case withhold if possible food or drink till after this period has elapsed, but if the patient is very thirsty give hot drinks of weak tea or spirit and water. Keep him covered up and put a hot-water bottle in the bed.

Urgency of the case is a guide as to how many tablets ought to be given.

_Zinc oxide_ alone or mixed with an equal quantity of boric acid or starch makes a useful drying dusting powder.

_Zinc ointment_ contains three parts of zinc oxide to seventeen parts of lard or vaseline. This is a most useful application for burns, eczema, chafes and sores.

_Sulphate of zinc._—As a prompt emetic, give twenty to thirty grains in half a pint of warm water. If patient does not vomit give a pint or more of warm water and tickle the back of the throat. A second dose of the drug may be given.

Two grains to an ounce of water makes a valuable astringent lotion for gonorrhœa, raw surfaces, ulcers, and inflamed eyes and ears. The strength of this solution may be gradually increased to six grains to the ounce of water.

TEMPERATURE TAKING, HYPODERMIC INJECTION, BATHS, CATHETERS, STOMACH TUBES, ENEMAS, AND POULTICES.

_Pulse, Respiration and Temperature._

Normal pulse rate (adult) about 72 per minute.

Normal respiration rate (adult), 15 to 18 per minute.

Normal temperature, 98.4° F., but varying in health between 97.5° and 99°.

_Temperature Taking._

The temperature of the body may be taken in the armpit, the mouth, or the lower part of the bowel.

_In the Armpit._—Dry armpit well, put the bulb of the thermometer into it, and press the arm tightly against the body, so that the thermometer will be in close contact with the skin on either side for at least five minutes.

_In the Mouth._—Wash the thermometer in an antiseptic solution, dry it and place the bulb well under the tongue and close the lips on the stem; at least three minutes should be allowed. This is a more reliable way of taking the temperature than in the armpit.

_In the Bowel._—If the patient is very ill and light-headed, it is not advisable to place the thermometer in the mouth, and when a patient is having a cool bath to reduce his temperature a reading will be needed at least every quarter of an hour; in these cases it is best to pass the end of the thermometer, which has been previously greased, about two inches up the bowel, and to leave it there for at least two and a half minutes.

Do not trust in half-minute or minute thermometers, always allow the full time given above. Before taking a patient’s temperature see that the mercury in the thermometer is shaken down at least as low as 97° F. After the temperature has been taken, note it down carefully, wash the thermometer, and shake the mercury down to 97° F. If the thermometer is washed in hot water, the expanding mercury may break it.

_Hypodermic Injection._

The best place to inject is under the skin of the back or chest. The forearm is usually selected, but there are many objections to it. If the injection is made into the leg or arm, the point of the needle should be directed towards the body.

1. Surgical cleanliness must be observed. The hands of the operator and the skin of the patient at the spot chosen for injection must be properly cleaned with an antiseptic lotion, _e.g._, chinosol (1 in 1000) or carbolic acid (1 in 60). The site of injection may, as an alternative, be painted with iodine which, indeed, is the preferable method.

2. The hypodermic syringe and needle must be perfectly cleaned; if possible they should be boiled, or an antiseptic lotion, or alcohol (brandy or whisky) may be syringed through them.

3. The solution to be injected should be made in a clean, _i.e._, boiled, spoon, by adding the drug to boiled water.

4. Draw solution into the syringe, hold the syringe with the needle end pointing upwards, so as to allow any air to rise above the fluid, and push the piston up till all air has been driven out and the solution begins to come through the needle.

5. Pinch up the skin where the injection is to be made, push the needle well through and then under it, keeping the point slightly away from the skin until the needle is almost entirely covered. The point of the needle will now lie in the loose tissue—between the skin and the muscle—into which the fluid is to be injected.

6. Holding the needle firmly, slowly press the piston until the required amount has been injected; withdraw the needle slowly, keep the finger over the minute opening in the skin, so as to close it at once, and with another finger rub for a few seconds, where the fluid has been injected, in a direction away from the opening, to assist its absorption.

After giving an injection, wash out the syringe as before, dry needle well, and pass a piece of thin wire through it to keep it open. The needles are sent out with wire in them to keep the fine channel open; of course the wire must be removed before the needle is put on to the syringe.

As strong solutions of permanganate of potash attack the plunger of the piston, when this drug has been injected, the syringe should be well washed with water directly after its use.

_Hypodermic tablets._—Solutions for injection are best made from tablets which are specially prepared for the purpose. A hypodermic tablet should be dissolved in about ten drops of hot water, but as each contains a definite amount of the drug, it does not matter in exactly how much water the dose is dissolved. In injecting certain preparations of quinine, which are not easily soluble, so much water may be required that two or three separate injections are necessary; there is no objection to this, the important thing is to have the quinine really dissolved.

Usually only medical men should administer hypodermic injections. Frequently it is not necessary to give a hypodermic injection, for the hypodermic tablet will be absorbed, and act almost as quickly if placed under the tongue.

The traveller may be called upon to use one of the following hypodermic injections:—

Permanganate of potassium. _See_ Snake-bite, p. 281.

Morphia. An injection of a quarter of a grain of morphia may be necessary when there is much pain. The soothing action of opium and chlorodyne is due to this substance.

Strychnine. _See_ Snake-bite, p. 282.

_Baths, etc._

_Cool Bath._—Lift the patient gently in a blanket into a long bath containing water at about 90° F., add water as cold as can be obtained, keep the water circulating and running out; one boy must pour water on to the head all the time.

If a long bath is not at hand, put a blanket over a waterproof sheet, and let the patient lie on it; get six or eight boys to hold up the edges, and give patient his bath in that way.

A good plan is to dig a shallow trench in the sand and to spread a waterproof in it; it is less difficult then to keep the edges of waterproof up as the patient is lying in a groove. It is not necessary to make the bath really cold if the cool water can be kept running. I have hardly ever been able, in Africa, to get the water below 80° F.

Note the bowel temperature, and as soon as it falls to 101° F., remove the patient from the bath and put him between warm blankets, and feed with some hot soup. If there are any signs of faintness, ammonia, or equal parts of strong spirit and water, must be given. Weak spirit and water has little or no stimulating effect on the heart, therefore, in cases of fainting, shock, exhaustion, or collapse from any cause, give a little spirit, and give it strong.

_Wet Pack._—Slip a waterproof under patient, wring a sheet out of cold water and pass it under him and wrap him in it, cover with three or four blankets, and tuck him in. At first he will feel cold and chilly, but soon the surface vessels will dilate, and he will begin to feel hot, and very likely will sweat; keep him in the wet pack with the clothes carefully tucked in round the neck, feet and sides for about half an hour. Then partially dry the patient, and put him into bed between warm blankets and with hot-water bottles, and give hot drinks to encourage perspiration.

_Catheters._

At least six silk-webbed catheters should be taken as part of the equipment. The most suitable sizes are, 2, 3, 4, 6, 8, 10. They should be packed in a separate box, and should be kept dry with French chalk or any other dusting powder.

Before use the catheter should lie for at least a quarter of an hour in an antiseptic solution such as chinosol (1 in 1000), and the solution should be frequently syringed through it. The catheter should then be lubricated with eucalyptus, vaseline, or carbolic oil, or, better, with boric acid ointment.

Let the patient lie down, and thoroughly wash the genitals, especially the opening of the pipe, with an antiseptic solution, the operator having carefully cleaned his own hands. Then pass the catheter gently down the pipe and into the bladder. The silk-web catheters are so flexible that unless force is used they can do no harm; begin with a No. 8 size, and if this cannot be passed, try a No. 4.

After use, wash the catheter as before, dry with a soft handkerchief, and dust it with powder. On no account should the catheters be greased when they are being put away. Neglect of cleanly precautions in passing catheters may lead to inflammation of the bladder and even more serious mischief.

_Stomach Tube._

The stomach tube consists of a piece of india-rubber tubing about three feet long, with a funnel at one end. The method of passing it is as follows:—The patient’s jaws should be kept apart by a gag such as a piece of stick wrapped in lint placed between the back teeth on either side. The left forefinger should be passed into the patient’s mouth as far as possible and the tongue drawn forward; the rubber tube, oiled or smeared with vaseline or glycerine, should then be passed by the side of the finger and down the throat for about twenty inches, taking care to use no great force. The funnel is then raised and slowly filled with water; when all the water has run down, the funnel is lowered and the liquid in the stomach is drawn out by the syphon action of the tube. The process should be repeated till the water returning from the stomach is clear.

If the patient is unconscious the tube should not be passed except by a doctor.

_Enemas._

_Enema Syringe._—This is fitted with long and short tube. To use the long tube, slip it over the short one, which will hold it firmly. After use hang it up to drain, dry it well, but do not oil it; carry it loose rather than coiled up, so as to avoid risk of the rubber kinking at the flexed portions of the tube.

To give an enema, the patient should be placed on his left side, and brought close to the edge of the bed, with his knees slightly drawn up towards the belly. The pipe or nozzle of the syringe should be well oiled or smeared with vaseline, and then carefully introduced into the outlet of the bowel, and passed gently upwards for about three inches, great care being taken not to exert any force.

The higher up into the bowel a nutrient or medicinal injection is passed, the more rapidly will it be absorbed; therefore the long tube is to be preferred, and the hips should be raised on a pillow, to assist the patient in retaining the injection.

A nutrient or medicinal enema is usually small in quantity, about two to four ounces, in order to prevent its being rejected by the bowel, and is administered by means of a small ball syringe provided with a long nozzle.

Before giving a medicinal or nutrient enema, it is best to wash the lower bowel with warm water, and always see that the mixture to be injected is warmed to “blood heat.”

_Poultices._

_Linseed-meal poultice._—Mix four ounces of linseed meal into about half a pint of boiling water, constantly stirring until the mixture is smooth and even. A piece of tow, teased out to the required size, or a piece of linen or thin cloth, is placed upon a table, and the poultice turned out upon it; then spread evenly in a layer about three-quarters of an inch thick, leaving a margin of tow or linen about an inch wide all round. This margin should be folded over, and the poultice applied to the affected part—with the meal next the body.

An _Ice poultice_ is made by mixing pounded ice and sawdust, and enclosing the mixture in a waterproof material such as a mackintosh or gutta-percha.

TREATMENT OF WOUNDS AND INJURIES.

_By the late WILLIAM HENRY CROSSE, M.D._

In treating wounds, whether large or small, the great essential is absolute cleanliness, not simple cleanliness in the ordinary acceptance of the word, but absolute surgical cleanliness.

In the first place, it is as well to lay down the axiom that all inflammation and other complications of wounds, as suppuration and blood-poisoning, are due to germs, and germs alone. All cleansing operations and antiseptic processes are instituted with the sole idea of preventing the entrance of germs into the wound, either from the hands of the operator, the dressings, instruments, or the skin of the patient.

Antiseptics are chemical substances which have the power of killing germs outright, or so checking their growth that the cells in the blood can easily cope with them. The antiseptics that are mentioned in these notes are carbolic acid, chinosol, permanganate of potash, and boric acid.

Given the antiseptic properties of the substance, it seems a simple thing, by its application, to prevent germs either entering a wound or multiplying there, but in actual practice the germ-free cleanliness of a wound is a difficult thing to procure. The germs are everywhere—on the instruments which cause the wounds, on the skin of the patient, in the sweat glands of the skin, at the roots of the hairs, and on the hands of the operator, especially under the nails. Again, a great obstacle to the free action of antiseptics is grease or oil of all kinds. A fine coating of grease enveloping a germ offers great resistance to the action of antiseptics, and the object of the process of cleansing a wound described below is, first, to remove all the grease, and then to apply the antiseptic to destroy the germs. With care, a clean-cut wound should heal kindly, without the formation of matter.

_To clean and dress a Wound._

First cover the wound itself with a small piece of cotton-wool or lint, wrung out in an antiseptic solution; then thoroughly scrub the surrounding skin with warm water and soap (soft soap for preference), using a nail brush which has been previously boiled.

Shave the skin in every case, whether thickly covered with hair or not. This shaving is most important, as it removes all fine grease-coated hairs which might favour the growth of germs, and also scrapes off the surface dirt and dead scales of skin.

After shaving, again scrub with soap and water, and wash the skin with an antiseptic lotion, such as carbolic (1 in 60), or chinosol (1 in 1000).

Having cleansed the skin, now clean up the wound itself. Thoroughly wash the wound with an antiseptic lotion, either rubbed in with lint or wool, or injected with a _glass_ syringe.

All instruments, ligatures and needles should be boiled for at least five minutes in water (to which a little washing-soda may be added with advantage), and should then be dropped into an antiseptic solution. When boiling is not possible, they should be soaked in carbolic lotion, 1 in 30, for ten minutes, and then transferred to 1 in 60.

The hands of the operator must be scrubbed for some minutes with soap and warm water, and then in an antiseptic solution, particular attention being paid to the nails, which should have been cut quite short. Cleanliness of the operator’s hands is the first essential of successful treatment of wounds.

The edges of small, clean-cut wounds may be brought together with adhesive plaster, but larger wounds will need antiseptic silk or gut ligatures to keep the edges applied evenly.

Large ragged wounds, with much bruising; wounds containing dirt, sand, etc., or deep wounds such as those caused by bullets or spears, should not be completely closed. They should be cleansed, as above, dusted with iodoform powder, and a strip of antiseptic gauze arranged so as to reach from the surface of the skin to the deepest part of the wound. This, which serves as a drain for the discharges, should be renewed every day until healing is fairly established. If necessary, a few stitches may be inserted in the more superficial parts of the wound to bring the edges of the skin into contact.

The wound should be dressed with strips of antiseptic gauze, slightly moistened with whichever antiseptic solution is used, and over this should be placed a pad of antiseptic wool, which should be kept firmly and evenly in place by a well-applied bandage.

A wounded limb should be kept at rest, as far as possible, either by sand-bags or a splint.

(In the absence of other antiseptics, the wound, after thorough washing, may be dressed with carbolic oil or Friar’s balsam, or boric or iodoform ointment applied on lint.)

_Bleeding or Hæmorrhage._

General oozing from small vessels may be stopped by means of a pad made of a piece of antiseptic wool or gauze, firmly bandaged over the bleeding area.

When a large vessel, whether an artery or a vein, is cut across, profuse bleeding will take place, and immediate steps must be taken to stop this whilst suitable instruments are being obtained. (In bleeding from an artery, the blood spurts out in quick jerking jets; if coming from a vein, the blood flows in a steady continuous stream.) Pressure should therefore be applied, by means of the thumb or thumbs, or a tourniquet,[18] in the course of the vessel, either above or below the injury—nearer to the body than the wound if the bleeding is from an artery (Fig. 3), and beyond the wound if the bleeding is from a vein.

It will be found that the bleeding can be controlled more effectually, and with greater ease, if the vessel is compressed against a neighbouring bone.

No more pressure should be exerted than is just sufficient to stop the flow of blood.

Whilst pressure is being applied, the wound should be cleansed with some antiseptic lotion, and a wedge-shaped pad of antiseptic gauze applied and firmly held in position by a bandage.

Bleeding from the hand or forearm can generally be immediately arrested by forcibly bending up the forearm at the elbow-joint.

If these measures effectually control the bleeding, the pressure should be kept up for an hour or two, after which time it may be cautiously relaxed. If, after the removal of the pressure, the hæmorrhage seems to have ceased (as judged by the pad which has been kept in position not trickling with blood), apply a large pad of wool _over_ the original dressing, and bandage this firmly. Dress the wound very carefully on the third day.

If, on the other hand, in spite of the treatment, the bleeding continues, the pressure must be re-applied, and the cut ends of the bleeding vessel looked for in the wound itself, and either twisted or tied with a silk ligature.

To twist a vessel, seize the bleeding point between the blades of the artery forceps, then, by twisting the instrument round three or four times, the vessel will become blocked or closed, and the forceps may be taken off in the course of ten minutes. The other method is to tie the vessel with a silk ligature (previously boiled), making a reef or sailor’s knot, to cut short the ends of the ligature, remove the forceps, and let the vessel fall back into the wound. In any case cleanse the wound, and dress in the manner previously described.

The traveller who has taken the trouble to learn something about the treatment of wounds and severe hæmorrhage will, before his journeys are ended, probably have opportunities of saving the life of a comrade by his skill. Nothing can be more distressing than to see a man die from a hæmorrhage which anyone who has studied the subject a little would be able to control in nine cases out of ten without much difficulty. I therefore earnestly urge all travellers to gain as practical a knowledge of this subject as is possible, before leaving a civilised country.

_After-Treatment of Wounds._

A clean-cut wound, which has been completely closed and properly dressed, need not be dressed again until the fourth day; and the stitches need not be removed for seven days.

On the other hand, a ragged or dirty wound, or one in which it has been necessary to insert a piece of gauze for the purpose of drainage, should be syringed out and dressed daily from the first.

The important index to the state of a wound is the patient’s temperature. If, on the third day after the wound was first dressed, the temperature is normal, and subsequently remains so, the wound is probably healing well; but if the patient’s temperature is up to or beyond 100° F., and the part is painful, there is probably some inflammatory change going on in the wound. The dressings should be taken off, and the wound examined. If the surrounding skin is red and shiny, and the limb swollen and tender, some of the stitches should be taken out, and the wound well syringed with an antiseptic lotion. This, with a good purge, such as calomel or Epsom salts, will probably remove all signs of inflammation; but still the wound must be dressed daily. If, however, the temperature still remains high, 100° to 101° F., or more, and the patient is restless and light-headed, all the stitches should be taken out, the wound opened up, and hot fomentations, prepared with an antiseptic lotion, applied every four hours till the temperature comes down. Tonics of quinine and iron should be given.

_Erysipelas._

Erysipelas is a diffusely-spreading inflammation of the skin, caused by the presence and activity of germs, which enter through a wounded surface. It is most frequently due to want of cleanliness in the treatment of wounds. Bright’s disease and gout predispose to this complaint.

_Symptoms._—The disease begins with a vivid red blush, usually starting from a wound, and which has a great tendency to spread or to move from one part of the limb to another. The edge of the blush is sharply defined, and slightly raised above the surrounding skin; there is stiffness and heat in the part, with fever 103°-104° F., not varying much; rapid pulse, headache, loss of appetite, furred tongue and constipation.

_Treatment._—Isolate the patient and administer a good purgative. Give twenty drops of tincture of steel, with five grains of quinine in two ounces of water. Light diet. Stimulants will be necessary. Local treatment: flour, starch, or zinc oxide may be used to dust over the part, or zinc ointment applied on lint. The healthy skin just beyond the advancing edge may be painted with tincture of iodine.

_Cellulitis._—Occasionally the infection of the skin by the germs spreads to the tissue beneath, and is then called cellulitis, or phlegmonous erysipelas. In this condition there is more swelling than in simple erysipelas, and the skin is very boggy or doughy, and retains the imprint of a finger pressed upon it. The red blush is not so vivid, being darker and more purple, and there is no well-defined edge. If left untreated, the skin will break down and die, causing extensive destruction of the part.

_Treatment._—General treatment the same as for erysipelas. Locally, several incisions, each at least one inch in length, should be made into the swollen tissue where it is most boggy, and right through the skin, care being taken to avoid the larger blood-vessels; then hot fomentations of boric acid (five grains to the ounce) or other antiseptic should be applied, every two or three hours, till the swelling has subsided. The important point in the treatment of swollen and inflamed parts following wounds, when accompanied by continued or rising high temperature, is to relieve tension by making free incisions. Some knowledge of the anatomy of the parts is essential before using the knife. In any case, incisions in the arm or leg should be made parallel to and not across the limb.

_Blood-Poisoning._

If a poisoned wound is left without thorough local treatment, the poisons and germs contained in the tissues are taken up by the blood, and cause _blood-poisoning_. The symptoms of this condition are high temperature, delirium, headache, loss of appetite, vomiting, and occasionally bronchitis and pneumonia. Severe forms of blood-poisoning may lead to the formation of abscesses all over the body, with fatal result.

_Treatment._—The general treatment is the same as that described for erysipelas. The local treatment is to thoroughly open up and disinfect the poisoned part.

_Bruises._

A bruise should be treated by bathing with cold water, or the frequent application of wet cloths. The addition of Goulard water, gin, methylated spirits, eau de cologne, or vinegar, to the water, is beneficial.

_Sprains._

The affected joint should be raised on pillows, and treated in the manner advised for bruises, but if seen immediately after the injury, firm strapping with adhesive plaster and bandaging of the part is often equally serviceable. If inflammation develops, warm fomentations will be found soothing, leeching may be necessary, and free purgation always has a good effect.

The troublesome stiffness which often remains is relieved by friction and kneading with the hand. To regain the use of the joint, it should be gently moved each day; this movement is less painful if it is performed with the joint in hot water.

_Poisoned Wounds from Snakes, Animals, and Arrows, etc._

In cases of poisonous snake-bite, the marks of two fangs will usually be found.

_Treatment._—Tie a piece of tape, bandage, or cord a couple of inches above the wound, _i.e._, between the wound and the body; tie another piece still nearer the body, say three inches from the first. Cut across the wound or wounds to encourage free bleeding.

(If a medical man is present, he may think fit to inject anti-venomous serum as an antidote to snake poison.)

Dissolve as much permanganate of potash as possible in about a teaspoonful of water, stirring well to hasten its solution. Inject about five drops of this underneath the skin, on either side of the cut, by means of a hypodermic syringe. Some of the solution may be injected into the wound itself, or even a crystal of the drug may be pressed into the cut, or part of a crushed tablet of the drug.

It is best to keep a small bottle of the strong solution of permanganate always ready.

Give spirits strong, that is, one tablespoonful to one of water; at least four such doses in the first hour. Ammonia may also be given.

If the patient is heavy and stupid, give two tablets of strychnine (one-hundredth of a grain in each) in half a wine-glassful of water, by the mouth; or dissolve two in twenty drops of water, and inject well beneath the skin into the muscles of the back. If there is no improvement within an hour, give two more tablets; and if necessary, one or two more in another hour.

After tying up a limb for a poisonous bite, there will be great pain if the ligatures have been applied tightly; the parts will swell, become very dusky, and if the ligatures are left on too long, the blood supply will be cut off, and the parts will die. Therefore, when the ligatures begin to cause much pain, loosen the one next the injured part for ten seconds, then tie again at or near the same place, and loosen the other one for a similar period, and then re-tie; repeat this about every fifteen minutes. In the course of two hours, both tapes may be taken off. The object of tying up is to prevent much of the poison getting into the system at once.

_The first thing is to tie up tightly; next cut freely, and suck or squeeze out as much blood as possible, then treat with drugs._

(It is usually safe to suck a poisoned wound unless there are any abrasions or cracks in the mouth, tongue, gums, or lips, taking care to spit out the poison at once; but the mouth should be washed out immediately afterwards with a light purple solution of permanganate of potash.)

If the wounds are on the face, neck, or other spot which cannot be tied up, then it is best to cut out the part at once and wipe the wound well with the strong solution of permanganate.

In the treatment of snake-bite, pure carbolic acid, ordinary caustic, a red-hot wire, or even a burning stick may be applied to the wounds when permanganate of potash cannot be obtained. In some cases, where no other treatment is available, it is advisable to explode a pinch of gun-powder over the place of injury, or even to blow the parts away with one’s gun.

If a finger or toe is bitten by a snake which is certainly poisonous, and neither drugs nor fire are at hand, it would be best to amputate at once.

Wounds inflicted by poisoned arrows or other weapons, mad dogs, jackals, etc., should be treated in a similar manner to those caused by poisonous snakes.

_Drowning._

Death from drowning usually occurs in from two to three minutes after submersion, although people have been revived after a period of five or six minutes under water.

In treating cases of apparent death from drowning, the points to be aimed at are:—

First and immediately, the restoration of the breathing.

Secondly, and _after breathing is restored_, the promotion of warmth and circulation.

1. _To restore the breathing._

Roll the patient on to his face for a few seconds, placing one of his arms under the forehead; wipe away all weeds, mud, etc., from the mouth. (In this position water will more easily escape from the mouth, whilst at the same time the tongue will fall forward, and leave the entrance to the windpipe clear.)

Turn the patient on his back, on a flat surface, with the head a little higher than the feet.

Place a small hard pillow (or a rolled-up coat) _under the shoulder-blades_.

Draw the patient’s tongue forward, and keep it projecting beyond the lips.

Remove all tight clothing from about the patient’s neck and chest; also braces, belt, etc.

Kneel at the patient’s head, grasp his arms just above the elbows, draw them gently and steadily upwards above his head, and keep them stretched in that position for two seconds (Fig. 4). (By this means air is drawn into the lungs.)

Reverse the movement, and press the patient’s arms gently but firmly against the sides of the chest, keeping them in this position for two seconds (Fig. 5). (By this means air is pressed out of the lungs.)

Repeat these movements alternately and regularly, about fifteen times a minute, until natural breathing takes place, or as long as there is any hope of saving the patient. It may be necessary to continue the movements for as long as an hour.

While these movements are being carried out the wet clothing may be removed, the body gently dried, and the patient wrapped up in dry blankets.

2. _To promote warmth and circulation._

Rub the limbs and body vigorously with dry towels and flannels, always rubbing from the extremities towards the heart.

Apply hot-water bottles, hot flannels, or hot bricks to the feet, armpits, the pit of the stomach, and between the thighs.

Immediately the power of swallowing returns, administer hot coffee, spirits and warm water, etc.

Put the patient to bed between hot blankets as soon as possible.

_Fractures._

A _simple fracture_ is one in which, though the bone or bones are broken, the protecting skin is _not_ broken.

A _compound fracture_ is one in which the skin, etc., is broken or cut across, so that the fracture is more or less exposed to the air. The end of either fragment of the broken bone may protrude through the skin.

A _comminuted fracture_ is one in which the bone is broken into several pieces; such a fracture may be either simple or compound.

In a simple fracture great gentleness should be used in handling the parts, so as not to convert it into a compound fracture; therefore, do not undress the part; rather cut away the clothing.

A fracture which is compound is usually serious, for dirt and germs are liable to be carried into the wound and cause great mischief; in gunshot wounds, dirt or pieces of clothing may be carried into the wound.

The signs of a fracture are, firstly, the patient’s own feelings, _e.g._, the pain which is caused on handling the part, sudden loss of power, and the sensation of grating. Secondly, on examination, most if not all of the following signs will be observed: inability of patient to move the part below the injury, swelling, unnatural movement below the site of fracture, alteration in appearance of the limb.

In fractures of the upper or lower limb there is usually shortening, the spasmodic action of the muscles causing the broken ends to ride over each other, and the greater the obliquity of the line of fracture the greater will be the shortening and alteration in appearance.

A sensation of grating is usually conveyed to the operator when he attempts to move the parts; sometimes this grating can be heard, as well as felt. Comparison of the injured with the sound limb is of the greatest importance in detecting fractures.

_Treatment of Simple Fractures._

Directly a fracture of a limb is made out, a splint or splints of some kind should be applied to keep the parts fairly in position, and to prevent a broken end from being pushed through the skin. Cloths and bandages may be applied firmly round the injured part, and then extemporised splints, such as boards, straight sticks, umbrellas, or bayonets, should be applied and kept in position till the patient is in bed.

Splints suitable to the injury should be now made and well covered with wool, lint, or cloth, special care being taken to pad them well where they are likely to press upon bony prominences, such as the inner or outer ankle. The limb must next be straightened, and any deformity caused by overriding of the fragments must be remedied by steady pulling upon the parts above and below the fracture, in opposite directions, and the parts brought into good position by manipulating the bones at the seat of fracture. The prepared splints, extending well below and above the fracture, are then fitted to the limb with cotton-wool or lint, and secured by bandages.

If there is great swelling and tenderness of a limb, then it is advisable not to apply splints at once. Sand pillows should be made, or stockings nearly filled with sand and their mouths tied, and applied one on either side of the limb, to keep it absolutely still; the painful swelling may be reduced by applying ice or evaporating lotions. When the swelling is somewhat reduced, splints may be applied after proper manipulation.

Whilst the bandages should be firmly applied so as to keep the splints in position, they must not be bound too tightly, otherwise swelling and ulceration may be caused. If there is much pain and swelling after a fracture has been set, it will be necessary to loosen the bandages.

Union of the fractured bones is generally completed in about six weeks.

_Collar-bones._—Fracture of the collar-bone should be treated by placing a large wedge-shaped pad (about six inches long, by three in thickness at the upper end) in the armpit, and securing it with tapes tied over the opposite shoulder. The elbow should then be brought forward, and raised and well supported by a broad triangular bandage or handkerchief, used as a sling, and with the ends tied over the opposite shoulder. A flannel or other bandage should then be wound round the chest, so as to secure the arm from accidental movements.

_Ribs._—Fracture of the ribs may be treated by wrapping a flannel bandage round the chest pretty tightly, so as to limit the movements of breathing, which are very painful. The flannel should be secured by stitching, and the upper turns should be fixed by broad tapes passed over the shoulders and firmly stitched. Firm strapping of the side with adhesive plaster is still better. For this purpose about six strips of plaster one to two inches wide and eighteen inches long should be applied evenly round the side of the chest; each piece should be overlaid by the next piece above it for about half an inch. To secure rest for the affected side of the chest, the strapping should not only cover the broken bone, but should extend to about three inches above and below it, and should reach well beyond the middle line both in front and behind.

_Upper Arm._—Fracture of the upper arm may be treated by the application of several narrow splints reaching from the armpit to the elbow, well padded, and supported in position by a bandage carried from the fingers to the armpit. Care must be taken that the splints on the inner side do not chafe the folds of the armpit. The hand and wrist should then be supported in a sling, but the elbow must be allowed to hang free.

_Forearm._—Fractures of the forearm must be treated by two splints, each wider than the limb. The injured limb is allowed to hang down by the side, palm forwards. One splint reaching from the elbow to the finger-tips is applied to the back of the limb; the other is placed on the front, and only reaches from the bend of the elbow to the level of the ball of the thumb. The splints are secured temporarily by a couple of slip knots. Now bend the arm to a right angle, thumb uppermost, and bandage securely from the tips of the fingers up to the elbow.

_Thigh._—Fractures of the thigh are serious; they require the patient to be kept in bed till union has been effected, and they are more likely to lead to shortening and permanent lameness if not very carefully treated, and the assistance of a skilled surgeon is urgently needed. A long splint is applied to the outside of the limb, reaching from the armpit to beyond the foot, and secured above by a bandage passing round the body, whilst the foot and leg are firmly bandaged to it below.

_Leg._—Fractures of the leg should be treated by applying a splint on each side, long enough to reach from the knee to a little below the sole of the foot. They should be carefully applied with bandages, keeping the great toe in a line with the inner border of the knee-cap. When the accident occurs in the open air, the injured limb should be tied to the sound one, till the patient is brought to a place of security, the toes being prevented from pointing inwards.

_Lower Jaw._—Manipulate the parts into their normal position and mould a splint of gutta percha, or other material, as accurately as possible to the lower jaw. If a tooth is loose and prevents the two jaws meeting properly it should be taken out.

Apply the splint and keep it in position by a bandage, which should be split at the chin so as to encircle the point of the jaw; the ends of the bandage are also split as far forward as the angle of the jaw; two ends are tied behind the neck and two over the top of the head, as in the diagram, and these tied ends should be united by a bandage or tapes to keep them in position (Fig. 8).

In the absence of suitable material for making a splint, this bandage alone will have to suffice.

The patient must be fed on slops through a tube passed behind the teeth, or through a passage resulting from the loss of a tooth.

_Compound Fractures._—Clean up thoroughly as described in the treatment of wounds. Wash out with an antiseptic solution, dust with iodoform, apply an antiseptic pad. Set the limb in such a manner that the wound can be dressed daily without interfering with the splints.

If the bone is protruding through the wound, it must, if possible, be got back into position. If this cannot be done it may be necessary to saw off the end of the bone to enable the wound to be closed.

If the wound is large, deep, or dirty, it should be stuffed with antiseptic gauze so that free drainage may be allowed, and the gauze should be changed each day.

_After-treatment of Fractures._—Gentle movements may be cautiously begun, in the joints above and below the injury, in about three weeks. While these are being carried out, the limb must be firmly supported to avoid interfering with the healing processes going on between the ends of the bones.

_Dislocations._

Dislocations nearly always require skilled aid to reduce them.

_Shoulder-joint._—Patient cannot raise the arm to his head or perform any other shoulder movements freely. The shoulder is flattened, the elbow sticks out, and the limb is usually lengthened.

_Treatment._—The patient should lie down. The operator removes his own boot on the same side as that of the patient’s dislocation, inserts his heel into the patient’s armpit and draws the arm steadily down, at the same time pressing the heel in an outward direction; the dislocated bone should slip back into its proper position. Put a pad in the armpit and bandage the arm to the side for a week; support arm in a sling for another week or two.

_Elbow-joint._—Dislocation of the bones of the forearm backwards at the elbow-joint is fairly common.

_Treatment._—This dislocation can usually be reduced by placing the knee in front of the patient’s elbow, and making firm traction on the forearm—which is at the same time bent a little around the operator’s knee. The patient can be kept sitting in a chair while this is done, and the operator can get his knee into the required position by placing his foot on the side of the chair.

_Hip-joint._—Is the most common form of dislocation. The limb is shortened, bent at the knee and twisted inwards, the great toe of the injured limb resting on the instep of foot of the opposite limb. The outer side of the hip is swollen and distorted.

_Treatment._—Grasp the ankle with one hand and the knee with the other. Lift up the leg and bend it at the hip, then carry it as a whole away from the other limb as far as possible, rotate the toes and foot firmly outwards, and in that position bring the limb back parallel to the sound one.

_After-treatment of Dislocations._—After dislocations, gentle movement of the joints should be begun in two weeks, so as to prevent them becoming fixed.

POISONS.

It is impossible, in the small space available, to give anything like a detailed scheme of the treatment of the various poisons, but a few hints on the essential points must not be omitted.

I have therefore arranged a list of the commoner poisons, together with the special treatment appropriate to each. Following this are a few hints more especially adapted to the requirements of travellers.

Poison should be suspected (_a_) when severe and alarming symptoms of illness suddenly attack a person apparently in good health; (_b_) if the symptoms closely follow the taking of food, drink, or medicines; (_c_) if several people are attacked after having partaken of the same food or drink.

The points to be attended to in the treatment of cases of poisoning are:—

_a._ Remove as much of the poison as possible from the stomach. To do this, it is usual to give an emetic, such as mustard and water, or zinc sulphate, thirty grains; or to pass the soft rubber tube down the gullet, and wash out the stomach with water.

_b._ Counteract the effect of the poison by an antidote.

_c._ Keep up the patient’s strength till the poison is removed from the system.

_d._ Relieve pain.

Travellers may be poisoned in the following ways:—

1. By poisonous bites, arrow wounds, etc.

2. By eating food poisoned by natives.

3. By eating poisonous plants, etc.

4. By eating bad meat or fish.

The treatment of _snake-bites and arrow wounds_ has already been dealt with.

_Poisoned food and poisonous plants._—Food is occasionally poisoned by natives, either by adding strophanthus leaves or other poisons. The eating of such articles may be followed by severe pain, colic, vomiting, diarrhœa or other symptoms. The general line of treatment should consist in giving emetics promptly, washing out the stomach by means of the stomach tube, and administering large quantities of water, milk, or gruel. Distressing symptoms should be treated as they arise; thus, if convulsions occur, large doses of chloral or potassium bromide should be given; if stupor or drowsiness comes on, the patient should be forced to take hot coffee, stimulants, etc., and made to walk about. If collapse supervenes, stimulants should be freely given, the patient wrapped in blankets, and hot bottles applied to the feet.

_Poisoning by bad meat, fish, etc._—The symptoms of poisoning by bad meat, etc., are severe pains in the belly, cramps, and shivering fits, followed by vomiting and diarrhœa coming on soon after its consumption, occasionally within an hour or two. The vomiting and diarrhœa are usually alarming and very severe, causing great collapse, and unless urgent remedies are applied, death may occur. The bodies of patients may be covered all over with irritating blotches, red rashes or with nettle rash.

_Treatment._—Give an emetic at once. Administer a sharp purge to clear out the bowels. Use stimulants freely. Apply hot-water bottles and blankets. Give opium or chlorodyne, fifteen drops every four hours until the pain is relieved. Milk and gruel or arrowroot.

CANOEING AND BOATING.

_By J. COLES._

_Canoeing._

_Choice of a Canoe._—In making choice of a canoe the traveller must bear in mind that, in all probability, there will be rapids in the river, which will necessitate a portage being made, and that the canoe may have to be carried over rough ground for a considerable distance. For this reason, it is far better to take two canoes of moderate size than one large one, besides which, a small canoe is much more easily handled in bad water, and even should it become necessary to carry a large load, this can easily be done by lashing two small canoes together, at about one yard apart, and laying a platform across them, on which to place the stores, &c. This, however, should not be done in dangerous and rapid rivers. The following remarks do not, therefore, apply to large canoes, which, having nearly the stability of a boat, may be handled in the same manner.

_Paddles._—It will generally be found that the native paddles will be best suited for the work. The double-bladed paddle, such as is used with the Rob Roy canoe, is quite useless on a rapid and dangerous river.

_Sail._—The sail should be made of duck, or some such light material, fastened to a light yard at each end, and its hoist should be about twice its breadth; its size must be in proportion to the canoe, the hoist being about one-fourth of the canoe’s length. The mast should be as light as possible, with a hole at the top for the halliards to pass through freely. The end should be stepped in a chock in the bottom of the canoe (when in use), and it should be lashed to one of the stays, or cross-pieces of the canoe. The sail should never be used unless the wind is steady and abaft the beam, and the halliards should be taken to the after part of the canoe in order to stay the mast, and secured in such a manner that it can be instantly let go, when the sail will at once fall, and undue pressure on the canoe relieved.

_The Tow-line._—Too much attention cannot be paid to this important article. It should be light, but of the best material (such as the rope used by the Alpine Club), as its giving way at a critical moment in a rapid is sure to be attended with most serious results.

_Loading the Canoe._—The packages should not exceed 50 lbs. in weight, as they may have to be carried long distances over portages, and care must be taken not to overload the canoe. Natives, who are all good swimmers, and have nothing to lose by a capsize, are very apt to put more into a canoe than is safe, so that it is a matter in which the traveller should use his own discretion.

In ascending a rapid river, keep close to one of its banks, and endeavour to take advantage of eddies. It will often happen that, owing to the strength of the stream, no headway can be made with the paddles, in which case recourse must be had to poling or tracking. In the event of the former, the poles should be straight and tough, and as long as can be conveniently carried in the canoe. Natives generally stand up to pole, but this the traveller should not attempt to do, or he will in all probability either fall overboard, or capsize the canoe, or both. In tracking, as great a length of line as possible should be used, as a sheer of the canoe in a rapid, with a short line, will often end in a capsize. Only two men should remain in the canoe, one in the bow with a pole, and the other in the stern with a paddle to steer; this man should also have his pole handy. The line should be made fast to one of the stays in the bow of the canoe, and _never to a towing mast_, as in a boat; as in passing round bad corners, or places where there are snags, and where it is necessary to give the canoe a wide sheer, the leverage of the mast, if the line were fastened to the top of it, would pull the canoe over. The man in the bow, however, should always have his knife handy to cut the tow-line, should necessity arise for his doing so. In tracking, when a river passes through sandy soil, the men on the line should keep at some little distance from the edge of the bank, as it is likely to give way under their weight, and precipitate them into the river. Several men lost their lives in Fraser River, in the early days of the gold discovery, by neglecting this precaution.

In crossing from one bank of a river to the other above a rapid, be careful to ascend the river for a considerable distance before attempting to do so; and then make the crew paddle as hard as they can, keeping the head of the canoe, if anything, rather down the stream, as in the case of a rapid river you would only lose ground by trying to fight against it.

In descending a river, the traveller should keep a look-out ahead for snags and places where the river is narrowed in between hills, as in such places there is nearly sure to be a rapid which may be so bad as to render navigation impossible. In all cases before descending an unknown rapid, he should land and inspect it throughout _its entire length_ before attempting to run it in the canoe. When descending a rapid, care must be taken to keep steerage way on the canoe, as this will be needed to avoid rocks, or whirlpools. These latter are very serious dangers, as they generally do not remain fixed in one spot, but move about within a certain distance of a centre. There are, however, in most cases, short intervals when they break up, and that is the time to make a dash past them. To attempt this when they are in full swing could only end in the loss of the canoe and its occupants.

_Boating._

When a traveller has to proceed for some distance overland before reaching a river or lake he purposes to navigate, he must of necessity provide himself with a boat constructed in such a manner as to be easily transported, either by being built in sections, that can be put together and taken to pieces at pleasure, or by taking one of the collapsible boats, such as Berthon’s. If the former, he cannot do better than to have one built of Spanish cedar, on the same plan as that which was constructed for Sir H. M. Stanley, by Mr. James Messenger, of Teddington, with such modifications as may be necessary, when the means of transport, and the nature of his journey, have been duly considered. Collapsible boats, though very useful for ferrying across lakes or rivers, cannot, where a boat of other construction is available, be recommended for a continued exploration.

If the exploration is to be commenced at the mouth of the river, a whale-boat will be found to be the best form of boat for the following reasons. Being steered by an oar, it is more easily handled in surf or a rapid; it is generally faster than boats of the same size of ordinary build; it will carry a good cargo, sail well off the wind, and is the best boat built for crossing the bars of rivers, or landing through a surf. Such a boat can generally be purchased at foreign ports, with oars and sail, and should be well overhauled before starting.

Boat-sailing cannot be taught by any book, and certainly not by a few short notes of this description. The traveller, therefore, who intends using a boat for exploration, should gather some experience before starting, which can be done at any fishing village on the coast. This will be the more necessary if he intends to use his boat on a lake, or for sailing along the coast, from the mouth of one river to another, and the following hints may, it is hoped, be useful to those who have had but small experience in boat-sailing.

_When under sail_, never, _under any circumstances_, allow the sheet to be made fast; a turn should be taken round a cleat, and it should be held by one of the crew ready to let go at any moment. Do not let the crew stand up, or sit on the gunwale. When about to round-to, remember that you cannot carry the same canvas on a wind that you can before it. If caught in a squall, put down the helm at once, ease the sheet, and if the squall is a bad one, lower the sail while it is still shaking. When approaching a danger, such as a rock, do not stand on if you are in doubt about weathering it, but go about in time, and have an oar ready to help the boat round if she appears likely to miss stays. Never carry too much sail, as there is considerable danger in doing so, and a boat will often sail faster with a reef taken in, than she will when unduly pressed. If necessary to take in a reef when sailing _on a wind_, do not luff, but check the sheet, lower the sail sufficiently to shift the tack, gather the sheet aft so that the men may take in the reef without leaning over the gunwale, shift the sheet, hoist the sail, while the sheet is slack, and do not haul the sheet aft until the men are again in their places.

_Rowing._—This can only be acquired by practice, and though the traveller will seldom be called on to take an oar himself, circumstances may arise when he may have to do so, and we would, therefore, advise him to learn how to handle an oar before leaving England. Under ordinary circumstances, rowing on a river is sufficiently simple, and calls for no special instructions. The case, however, is very different when a river bar has to be crossed, or a landing made on a beach where a surf is breaking, and in either case it will be well to remember the following hints. On approaching the shore, a surf when seen from seaward never looks so bad as it really is. Where possible, a landing should not be attempted until opposite a village where the natives will be ready to assist the moment the boat touches the beach. When the surf is heavy, the boat should be backed in, pulling a few strokes to meet each heavy sea, and then backing in again until the shore is reached. The great thing to avoid is, letting the boat get broadside to the sea, as she will then capsize; a steer-oar should always be used, as a rudder is of little use in a surf, when backing in.

_In crossing a bar_, if there is a good, strong, fair wind, it will generally be best to cross under sail; but if the wind is light or variable, this should never be attempted. When rowing, the crew should be cautioned to keep their oars out of the water when the sea breaks round the boat, and to commence rowing again as quickly as possible afterwards. As even in the most experienced hands a boat will often be swamped on a bad bar, it will be well, before attempting to cross it, to prepare for a swim by removing all superfluous clothing, and see that everything that will float in the boat should be left free to float, while things that will sink, such as fire-arms, &c., should be securely fastened to the thwarts.

The remarks given on canoeing with regard to loading, to ascending and descending rapid rivers, are equally applicable to boating under similar circumstances, with the following exceptions. In towing, a short mast should be used to which the line is made fast; this is stepped in the same place as the mast, and should be stayed, so as to resist the strain of the tow-line. Paddles will often be found useful in reedy rivers where the oars get entangled. As a whale-boat empty will weigh about five hundredweight, more care must be taken at portages than in the case of a canoe, which can be lifted bodily over obstacles. The stems of small trees, or the oars should be laid down under the boat, and, where possible, sharp rocks must be avoided or moved out of the way. In a rapid, two men should be in the bow with poles ready to fend off from rocks, and the most experienced man of the crew should be in the stern with the steer-oar.

Although in the foregoing remarks special reference has been made to whale-boats, the hints given are equally applicable to boats of other construction, which should, however, for river work, crossing a bar, or landing through a surf, be fitted with a steer-oar in addition to the rudder. Awnings should be taken, but in rapid rivers, and when under sail, they cannot be used.

ORTHOGRAPHY OF GEOGRAPHICAL NAMES.

_By MAJ.-GEN. LORD EDWARD GLEICHEN, K.C.V.O., C.B., C.M.G., D.S.O. Chairman of the Permanent Committee on Geographical Names._

In 1878 the Council of the R.G.S., impressed with the necessity of endeavouring to reduce the confusion existing in British maps with regard to the spelling of geographical names, in consequence of the variety of systems of orthography used by travellers and others to represent the sound of native place-names in different parts of the world, formally adopted the general principle which had been long used by many, and the recognition of which had been steadily gaining ground, viz., that in writing geographical native names vowels should have their Italian significance, and consonants that which they have in the English language.

This broad principle required elucidation in its details, and a system based upon it was consequently drawn up with the intention of representing the principal syllabic sounds: this has long been known as the R.G.S. system.

* * * * *

The system thus drawn up was largely adopted by the War Office, the Admiralty, and other Government Departments and private societies. But it was never officially sanctioned, for India, China,[19] Egypt, and many of our Colonies had already their own system (or want of system) for spelling foreign words; added to this, the private firms of map-makers had their own views on the subject, and still spelt their names in a bewildering variety of ways.

The matter came to a head in 1919, when the Admiralty approached the Royal Geographical Society with a request for the authoritative spelling of names. A committee was accordingly formed, with representatives from all Government Departments, each of which bound itself to adopt the spelling recommended.

This “Permanent Committee on Geographical Names,” under the chairmanship of a Member of Council, R.G.S., at once got to work and proceeded to draw up:

1. A revised system of Rules and Alphabet, termed the R.G.S. II system, amplifying and improving on the old R.G.S. system of 1878. (This is given in the succeeding pages.)

2. Lists of doubtful names, with their correct spelling and other details concerned. (These will be published periodically, in the form of leaflets, in the ‘Geographical Journal.’)

3. Tables of Foreign Alphabets transcribed into the R.G.S. II system. (These will be published shortly in the R.G.S. Technical Series.)

It is hoped that the above procedure will gradually result in the correct and uniform spelling of foreign Place-Names throughout the Empire.

It must also be noted that the Government of the United States of America, after an exhaustive enquiry, has adopted a system in close conformity with that of the R.G.S., and has directed that the spelling of all names in their vast territories should, in cases where the orthography is at present doubtful, be settled authoritatively by a Board appointed for the purpose. The two great English-speaking nations are thus working in harmony.

RULES FOR THE SPELLING OF GEOGRAPHICAL NAMES FOR BRITISH OFFICIAL USE.

(_Termed the R.G.S. II system._)

1. The spelling of every place-name in an independent country or self-governing dominion using the Latin alphabet[20] shall be that adopted by the country or dominion, except in the case in which certain important localities have also, in addition to the official name, another customary name, notably different, in which case the name customary in British use (_i.e._, “conventional”) may be adopted (_e.g._, Geneva, Warsaw, etc., for Genève, Warszawa, etc.).

2. The spelling of such place-names in colonial possessions as belong to languages coming under Rule (1) will be spelt in accordance with that rule.

3. The accents and diacritical marks in official use by the above countries will be retained. Wherever it appears desirable, the pronunciation will be shown by giving the name as transliterated on the system below.

4. All other place-names throughout the world will (with the exception of “Conventional” names and some others) be spelled in general accordance with the following system, which is based upon, and differs only slightly from, the system long used by the Royal Geographical Society, from which are derived the War Office system, 1906,[21] and the system of the Intelligence Division, Naval Staff, 1917.[22]

The broad features of this system are—

(_a_) That vowels are pronounced as in Italian and consonants as in English;

(_b_) That every letter is pronounced, and no redundant letters are used.

The system aims at giving a close approximation to the _local_ pronunciation; but it is recognised that in some languages, notably Russian, Greek, and Arabic, the necessity for letter-for-letter transliteration often renders this impossible.

TABLE OF SPELLING AND PRONUNCIATION R.G.S. II.

a Long and short, as in _lāvă_ Somāli, Bukhāră.[*]

ä As in _fat_; rare; chiefly in Teutonic languages.

ai[‡] The sound of the two Italian vowels; frequently slurred over, almost as in Eng. _aisle_, _ice_ Wadai; Shanghai.

au The two Italian vowels; frequently slurred, almost as _ou_ in _out_ Sakau; Bauchi.

aw When followed by a consonant, or when terminal, as in _awl_, _law_ Dawna, Saginaw.

b As in English.

c Not to be used, but always replaced by Kandahar, Serang. _k_ or _s_; except in the compound _ch_, and in many conventionally spelt words, as Calcutta, Celébes.

ch As in _church_; never _tch_ or _tsch_ for this sound Chad, Maroch.

d[†][‡] As in English.

dh Soft _th_ as in _they_: a slight _d_ sound preceding it in Semitic languages Dhuvu, Riyadh.

e[‡] Long as in _eh_; short as in _bet_. (For the _e_ sound in the French _je_, see note at end on the “neutral vowel”) Gēlo; Mafĕking.[*]

(ee) Used for _i_ (q.v.) only in a few conventional names Darjeeling, Keelung.

ei[‡] The two Italian vowels, frequently slurred Beirut, Raheita.

(eu) Not used as a single sound.

f As in English; _ph_ must not be used for this sound (except in Greek; see _ph_) Mustafa, Maidan-i-Naftun.

g Hard, as in _get, gift_; never as in _gem, gin_ Gedáref, Gilgit.

gh Soft guttural, the Arabic _ghain_ غ Dagh, Baghdad.

h Used only when sounded; or in the compounds _ch_, _dh_, _gh_, _kh_, _sh_, _th_, _zh_ Vrh, Ahmadabad.

i Long as in _marine_; short as in _piano_ (not as in _pin_) Fiji; Kibonde.[*]

j As in English; except in transliteration of Russian, Bulgarian, and Chinese, where it equals _zh_, or the French _j_[§] Japan, Ujiji (Eng. _j_); but Jitómir, Jelezna, Jao-ping (Fr. _j_).

k As in English: hard _c_ should never be used (except in conventionally-spelt words)—thus, not Corea, Cabul, but Korea, Kabul.

kh Hard aspirated guttural, as in the Scottish _loch_ (not as in _lock_) Khan, Sebkha.

l[†] } m } As in English. n[†] }

ng Has three separate sounds, as in _vanguard_, _finger_, and _singer_. If necessary to distinguish, a hyphen may be placed, as in _van-guard_, _sing-er_ In-gássana; Bongo; Ng-ami, Tong-a.

o Long as in _both_[¶]; short as in _rotund_ Angōla, Kigōma; Angŏra, Hŏnŏlulu.[*]

ö As in German; equals the French _eu_ in _peu_; or nearly the English sound in _fur_ Gömle, Yeniköi.

(oo) Used for _u_ (q.v.) only in a few conventional names, chiefly Chinese Poona, Foochow.

oi[‡] The Italian vowels: sometimes slurred as in _oil_. If necessary for pronunciation, a hyphen may be inserted as in Tro-itskoi.

ou[‡] Dissyllabic, and not as French or English _ou_ Zlatoust.

ow Represents, as a diphthong, nearly the _au_ sound (above) only in the romanisation of Chinese. Conventional.

p As in English.

ph As in _loophole_; not to be used for the _f_-sound, except in Greek or conventionally Chemulpho; Paphos, Haiphong.

q Represents _only_ the Arabic Qaf (ق): i.e. a guttural _k_ Qena, ʿIraq.

qu Should never be employed to represent the sound of _kw_: thus, not Namaqua, Quorra, but Namakwa, Kworra.

r[†] As in English; should be distinctly pronounced.

s As English ss in _boss_, not as in _these_ or _pleasure_ Rosario, Masikesi.

sh } t[†] } As in English.

th Hard _th_ as in _thick_, not as in _this_ Tharmida.

u[‡] Long as in _rude_, or as _oo_ in _boot_; short as in _pull_ Zūlū; Rŭanda.[*]

ü Represents the French _u_, as in _tu_ (Fr.) Üsküb.

v } w } As in English. x }

y Always a consonant, as in _yard_; it should Kikuyu, Maya. not be used as a terminal vowel, _e_ or _i_ being substituted; _e.g._, not Kwaly or Wady, but Kwale, Wadi.

z As in _gaze_, not as in _azure_.

zh As the _s_ in _treasure_, the _z_ in _azure_, or the French _j_ in _je_; but for the sound in Russian, Bulgarian, and Chinese use _j_ (_vide_ note above under _j_) Zhob, Azhdaha.

NOTES.

The doubling of a vowel or a consonant is only necessary when there is a distinct repetition of the single sound, and should otherwise be avoided Nuulua, Loolmalasin, Jidda, Muhammad.

Accents should not generally be employed; but in order to indicate or emphasise the stress, an acute accent may be used Saráwak, Qántara, Tong-atábu, Paraná.

A long or short mark over a vowel (_e.g._ _ā_, _ŏ_) should only be used (and that sparingly) when without it there would be danger of mispronunciation Kūt, Hashīn, Angŏra.

Hyphens will not be used except to indicate pronunciation, and with the Persian _izafat_, _-i-_ Mus-hil; Pusht-i-Kuh.

[*] The long and short symbols given in this column are merely for explanation, not for use.

[†] See note at end on _Liquid sounds_.

[‡] Pronounced differently in Greek: see ‘Alphabets of Foreign Languages transcribed into English according to the R.G.S. II system’ (to be published in the R.G.S. Technical Series).

[§] This decision has been arrived at chiefly owing to the large number of English (and French) maps of these countries in which the _zh_ sound appears as _j_.

[¶] The true Italian _ō_ is broader than this: almost as in _broth_.

_Inverted Comma and Apostrophe._—The inverted comma ʿ is employed only to represent the Arabic _ʿain_, ع, and the Hebrew _ʿayin_, ע. The apostrophe ’ in foreign words indicates a liquid sound. (See below.)

_Liquid Sounds._—The occasional “liquid” or “palatalised” sound of _d_, _l_, _n_, _r_, _t_, etc. (as in _d’you_, _lure_, _new_, _clarion_, _tune_), is as a rule sufficiently represented by a following _y_; where, however, owing to a following consonant, or to the letter in question coming at the end of a word, the _y_ is inapplicable, the liquid sound will be represented by an apostrophe, thus: _d’_, _l’_, _n’_, _r’_, _t’_, etc.

_The “Neutral Vowel”._—The “indeterminate” or “neutral” vowel sound (_er_), i.e. the sound of _a_ in _marine_, _e_ in _often_, _i_ in _stir_, _io_ in _nation_, _o_ in _connect_, _ou_ in _curious_, _u_ in _difficult_, etc., _e_ in French _je_, or the often unwritten vowel (َ _Fat-ha_) in Arabic, etc., is represented as a rule by _a_: as in Basra, Hawiya; but sometimes by _e_, when the sound approximates more to _e_ than to _a_: as Meshed, El Gezira.

(In any guide to pronunciation issued by the Permanent Committee on Geographical Names, the “neutral vowel” is represented generally by the italic _e_: occasionally also by italic _a_ or _u_.)

This sound must not be confused with _e-mute_, where the _e_ is not sounded at all: as in Abbeville.

ON THE GIVING OF NAMES TO NEWLY-DISCOVERED PLACES.

The Council of the Royal Geographical Society would urge upon all travellers that in giving names to any new discoveries which they may make they should be guided by the following restrictions, which, until comparatively recent years, were commonly observed:—

1. That before putting forward any personal or fanciful name the traveller should do his best to ascertain that no local name exists, and where none is forthcoming should further consider whether one might not conveniently be derived from the vicinity, _e.g._, from an adjacent stream, or pasture, or glacier, or from some characteristic of the natural object itself.

2. That no one should commemorate himself in this manner.

3. That any new nomenclature which a traveller may desire to suggest should be put forward tentatively and subject to the approval (1) of the Administration of the region or country, if there is one; (2) of the Official Cartographer of the country, if it possesses a Survey Department, or of the State to which the region may belong; or (3) of the Council of the Royal Geographical Society.

FOOTNOTES

[1] Equivalents obtained by Mr. R. H. Curtis using Köppen’s method. See ‘Symons’s Meteorological Magazine,’ 40 (1905), p. 157.

[2] For comparison of scales see Table XXVI., Vol. I., p. 333.

To convert Centigrade readings into Fahrenheit the rule is “Multiply by 1.8 and add 32.” This can be done mentally in a moment, thus: “Multiply by 2, subtract one-tenth of the product, and add 32.” _E.g._, to convert 10° C. to F.: 10 × 2 = 20; one-tenth of 20 = 2; 20 - 2 = 18; 18 + 32 = 50° F.

[3] Travellers in tropical countries will do wisely to poison all their labels before using them, to preserve them from attacks of insects and mites. Washing with a very weak solution of corrosive sublimate is an efficient plan. A large number of labels, with the collector’s name printed on them, may be taken, and if made of strong thin paper they will not occupy much space. Bank-note paper is well adapted for the purpose. Any writing should be, if possible, in ink; if not, a very hard black pencil should be used. Some tie labels should be added, as paper coverings soon run short.

[4] There are plenty of good works on the use of the blow-pipe. The best are by Plattner and Scheerer, of both of which English translations have been published. Of Von Kobell’s tables for the determination of minerals, several translations have appeared. Brush and Penfield 1906 edition is a practical work. A very portable outfit may be obtained from J. T. Letcher, Truro, Cornwall.

[5] In high latitudes care must be exercised in distinguishing between true raised beaches and ridges of beach material pushed up by the pressure of shore ice in winter.

[6] In some valleys the lateral tributaries enter at a higher level than the floor of the main valley, owing to the overdeepening of the latter; this overdeepening has been attributed to four different causes:—(1) Inequality in the hardness of the rocks, especially when the main valley runs along the strike; (2) the presence of joints, or other lines of weakness; (3) increased erosion of the main valley by river action owing to the elevation of the upper end of the district, while the lateral valleys were merely tilted sideways, or were protected by the presence of ice or lakes; (4) erosion of the main valley by ice more rapidly than its tributaries, owing to the ice being thicker in the former. The problem is complicated by the fact that the upper end of the main valley is frequently a ‘hanging’ valley. Any evidence bearing on the formation of these ‘hanging’ valleys should be carefully noted.

[7] Travellers who intend to make collections of zoological specimens are advised to call on the Secretary of the British Museum (Natural History), Cromwell Road, S.W. He will be happy to supply any information required.

[8] General travelling outfit can be procured from Messrs. Silver & Co., 67 Cornhill, E.C.

[9] Ejector guns are apt to get out of order in sandy countries.

[10] The shafts of old golf-drivers, when shortened to about 2 feet 6 inches in length, make the most perfect handles for nets.

[11] All the above-mentioned articles for collecting insects may be procured from Mr. Janson, 44 Great Russell Street, W., or from Messrs. Watkins & Doncaster, 36 Strand, W.C., or from Miss E. M. Sharpe, 4 Barrowgate Road, Chiswick.

[12] Cf. British Museum ‘Handbook,’ p. 47.

[13] Cf. British Museum ‘Handbook,’ pp. 15-32.

[14] Much useful information may be found in the ‘Manual of the Mollusca,’ by S. P. Woodward, F.G.S., one of Weale’s series; an admirable book in a small form.

[15] More extended accounts of the departments of the Science of Man here noticed will be found in Tylor’s ‘Anthropology: an Introduction to the Study of Men and Civilisation’ (Macmillan and Co., New edition, 1895).

[16] Some useful training under this head can be obtained at the London School of Economics.

[17] In the case of sculptures, owing to their deep depressions, it is best to wet the paper _before_ laying on.—_Ed._

[18] A tourniquet is a special instrument devised for the purpose of applying pressure to the main vessels of the limbs; in its absence, one may be improvised by rolling a handkerchief into a narrow band, and inserting a stone or a cork between its folds to serve as a pad; the pad is adjusted over the spot where it is proposed to compress the vessel, and the ends of the handkerchief knotted loosely round the limb. A stick is now slipped between the knot and the limb, and twisted round until sufficient pressure is exerted to arrest the bleeding.

[19] As far as British officials were concerned.

[20] Including ‘Latin’ alphabets containing extra or modified letters, such as Česky, Croatian, Polish, Rumanian, etc. The pronunciation of these letters is given in the ‘Alphabets of Foreign Languages,’ etc., mentioned below (p. 301).

[21] ‘Rules for the Transliteration of Place-names occurring on Foreign Maps.’ Compiled in the Topographical Section, General Staff, by Alexander Knox, B.A., Map Curator. 1906.

[22] ‘Instructions for the Spelling of Place-names in Foreign Countries.’ Naval Staff Intelligence Division. 1917.

INDEX.

Abney, Sir W., Method of packing sensitive plates or films, 57; method of using camera in hand or on tripod adopted by, 54; reference to his work in photography, 59

Accessibility of a country, the, 139

Aertex Cellular clothing recommended for travellers, 164

Africa, weather services of, list of, 42

Agricultural development, suitability of a country for, 143

Algeria, weather service of, 42

Alps, Föhn of the, 5

Amber objects of antiquity, on cleaning and conserving, 158

America, weather services of, list of, 42

Aneroid barometer, 31

Animal products, on obtaining information concerning, 144

Animals, on observing habits of, 104; on preparation of skeletons of, 94

Anthropology, by Dr. E. B. Tyler, 106-129; “Notes and Queries on Anthropology,” reference to, 106; Queries of Anthropology, by Sir A. W. Franks, 129-132; Tylor’s “Anthropology,” reference to, 127

Anthropological Notes by Dr. W. L. H. Duckworth, 132-137

Antiquity, objects of, methods of recording, cleaning and conserving, 148-159; on literary memoranda of characteristics of, 156

Antiseptics, 275

Ants, 198

Apoplexy, symptoms and treatment, 237

Apparatus and chemicals for photographic development, 58

Archæologist’s outfit, 159

Archæology, article on, by D. G. Hogarth, 148-159; Petrie’s “Methods and Aims,” reference to, 149, 158

Argentina, weather service of, 42

Arm, fracture of, treatment of, 288

Arts and sciences, native, 113; queries on, 130

Asia, weather services of, list of, 42

Assmann’s aspiration psychrometer, 20

Atmosphere, humidity of, instruments for measuring, 18

Atmospheric conditions, ways in which a traveller may add to the knowledge of, 1

Atmospheric phenomena, on recording observations of, 10

Atolls or coral-islands, on the formation of, 77

Australasia and Pacific, weather services of, list of, 43

Ball, J., Preparation of dried plants, 99

Barometer vernier, diagram showing how to read, 27

Barometers, 25; aneroid barometer, 31; Collie portable mercurial barometer, 29; Fortin barometer, 26, rules for observing with, 27

Bartholomew’s “Atlas of Physical Geography,” vol. iii., Meteorology, reference to, 37, 41

Bates, H. W., and W. R. Ogilvie-Grant, article on Natural History, 82-105

Baths, directions for giving an invalid, 271

Baths, cold, in Africa, dangers of, 168

Batrachians, naturalist’s outfit for preserving, 85

Beaufort’s scale of wind force, 4

Bed-sore, treatment of, 171

Beri-beri, 171

Bilharzia worm, 249

Birds, hints on collecting, 91; instruments for skinning, 84

Blackham, “Primer of Tropical Hygiene,” 161

Blackwater fever, symptoms and treatment, 172

Bladder, inflammation of, 181

Blanford, H. F., portable thermometer screen devised by, 15

Blanford, W. T., and Prof. E. J. Garwood, article on Geology, 63-78

Bleeding or hæmorrhage, treatment of, 277

Blindness, night and snow, precautions against, 199

Blood-poisoning, treatment of, 280

Blow-pipe, reference to Plattner and Scheerer’s work on the use of, 67

Boating and Canoeing, note by J. Coles, 293-297

Boils, treatment of, 226

Bonacina, “Climatic Control,” 41

Bone objects of antiquity, on cleaning and conserving, 158

Bones of human limbs, on taking measurements of, 136

Botanical collecting, 99

Botanical seeds, on preserving, 102

Botanical specimens, on the selection of, 99; conveyance of, to camp or station, 99; drying press for, 100

Brain, concussion of the, symptoms and treatment, 179

Brazil, weather service of, 42

British Association manual “Notes and Queries on Anthropology,” reference to, 106

British Central Africa, weather service of, 42

Broca’s scale of colours of native races, reference to, 108

Bronchitis, symptoms and treatment, 174

Bronze objects of antiquity, on cleaning and conserving, 157

Bruises, treatment of, 281

Bubonic plague, causes, symptoms and treatment, 215

Buchan, Dr. A., and Dr. A. J. Herbertson, “Atlas of Meteorology,” reference to, 37, 41

Buffalo gnats, 195

Bugs, protection against, 197

Bulbs, on collecting and packing, 103

Burns and scalds, treatment of, 175

Burroughs and Welcome’s photographic exposure record, reference to, 56

Buys Ballot’s law, 40

Camera, photographic, 51; selection of, 51; hand-camera, 52

Camera level, circular cup form, 54

Camera-stand, 54

Canada, weather service of, 42

Canoeing and Boating, note by J. Coles, 293-297

Carbuncles, treatment of, 227

Catheters, directions for using, 272

Cellulitis, symptoms and treatment, 280

Centigrade thermometer readings, rule for converting into Fahrenheit, 13

Cerebro-spinal fever, 175

Ceylon, weather service of, 42

Charts, meteorological, of the N. Atlantic and Mediterranean, and N. Pacific, 41

Chemicals for photographic development, 58

Chicken-pox, rash, symptoms and treatment, 176

Chigger, 228

Chile, weather service of, 42

Chill in tropical climates, risks of, 164

Chilblains and frostbite, treatment of, 177

China, weather service of, 42

Chinook wind of the Rocky Mts., 5

Cholera, cause, symptoms and treatment, 177

Clap (_see Gonorrhœa_)

Cleaning and conserving monuments and objects of antiquity, methods of, 156

Climate, hints on recording observations concerning, 145

Climatology, “Handbook of Climatology,” by Prof. R. de C. Ward, reference to, 41; Hann’s “Handbuch der Klimatologie,” reference to, 41; Meteorology and Climatology, article on, by Dr. H. R. Mill, 1-50, list of works on, 41

Cloud and sunshine, on keeping record of changes of, 5

Clouds, types of, 6; on photographing, 7

Coasts, geological notes on, 71

Cold in the head, 181

Coles, J., his note on Canoeing and Boating, 293-297

Colic, treatment of, 179

Collar-bone fracture, treatment of, 287

Collie portable mercurial barometer, description and illustration of, 29-31

Colour photography, Ives’ method, 62

Colour of native races, Broca’s scale of, reference to, 108

Commerce, Industry and, article on by Sir J. S. Keltie, 138-147

Commercial development, on ascertaining facilities and hindrances to, 146

“Commission Internationale des Glaciers,” reports of the, reference to, 81

Communication between countries, on observing what natural means exist, 146

Concussion of the brain, symptoms and treatment, 179

Conserving monuments and objects of antiquity, methods of, 156

Constipation, treatment of, 180

Continental climate, 35

Copper and bronze objects of antiquity, on cleaning and conserving, 157

Coral-islands (_see Atolls_)

Coryza, treatment of, 181

Cranial measurements, on making, with illustrations, 135

Craniological descriptions, with illustrations, 133

Craniometer, Flower’s, 135

Crosse, Dr. W. H., and Dr. Andrew Balfour, Medical Hints, 160-292

Cuba, weather service of, 42

Currency existing in a country, on obtaining information concerning, 147

Customs of native races, 126; queries on, 130

Cyclones, description of, with diagrams, 32

Cystitis, causes, symptoms and treatment, 181

Daily range of temperature, 35

Daily synoptical weather-maps, 41

Darwin, Dr. Charles, and Prof. J. Phillips, article on geology by, in the “Admiralty Manual of Scientific Enquiry,” reference to, 68

Dengue, 182

Deserts, geological notes on, 75; on observing the character of, 142

Dew, on recording appearance and amount of, 8

Dew-point, means of finding, 18

Dhobie itch, symptoms and treatment, 229

Diarrhœa, 183

Diet in the tropics, errors of, 165

Diphtheria, causes, symptoms and treatment, complications, 184

Diseases, classification of, 170

Diseases and their Treatment, 169-274

Disfigurements, personal, of native races, queries on, 131

Dislocations, treatment of, 290

Dobson, Dr. G. E., his hints on preserving mammals and birds, 92

Doldrums, 37

Domestic animals, on obtaining information concerning, 144

Drowning, treatment of cases of, 283

Drugs recommended for travellers, 253

Drying-press for botanical specimens, description of, with illustrations, 100-102

Duckworth, Dr. W. L. H., his Anthropological Notes, 132-137

Dutch East Indies, weather service of, 42

Dwarfs, native, on the measurements of bones and skulls of, 137

Dysentery, symptoms and treatments, 185

Eikonogen photographic developing powder, 59

Elbow-joint dislocation, treatment of, 290

Emetics, list of, 259

Enemas, 259, 273

Enteric or typhoid fever, causes, symptoms and treatment, 189

Epilepsy, symptoms and treatment, 191

Erysipelas, symptoms and treatment, 279

Exposure tables, photographic, 56

Extra-European weather services, list of, 42

Eyeball, inflammation of the, 198

Fahrenheit thermometer readings, rule for converting Centigrade into, 13

Faintness, treatment of, 191

Fibres, on observing the nature of, 141

Filariasis, cause of, 191

Filters recommended for travellers, 166

First aid treatment, works on, 161

Fisheries, on obtaining information concerning, 144

Fishes, hints on collecting and preserving, 96; outfit for preserving, 85

Fleas and bugs, protection against, 196

Flies, house; tsetse; Congo floor-maggot, 195

Flower, Sir W. H., his directions for the preparation of skeletons of animals, 94

Flower’s craniometer, 135

Focus of camera lens, 56

Focussing cloth of camera, 54

Fog, on recording density and duration of, 7

Föhn of the Alps, 5

Folk-Lore Society, Handbook, 129

Forests, on observing the character of, 141

Fortin barometer, 26; rules for observing with, 27

Fossils, hints on collecting, 68, 104

Fractures, 286; simple, treatment of, 286; compound, treatment of, 289

Franks, Sir A. W., Queries of Anthropology, 129-132

Frost, on recording appearance of, 9

Frostbite, treatment of, 177

Fruits, on observing the nature of, 141

Fungus diseases, 229

Garry, “Health in Tropical Climates,” 161

Garwood, Prof. E. J. (_see Blanford, W. T._)

Geographical Names, R.G.S. system of orthography of, 300

Geography, Physical, Bartholomew’s Atlas of, vol. iii., Meteorology, reference to, 37, 41

Geological collections, hints on making, 65

Geological observations, 63

Geologist’s outfit, 64

Geology, article on, by W. T. Blanford and Prof. E. J. Garwood, 63-78; Dr. Charles Darwin and Prof. J Phillips’ article on, in the “Admiralty Manual of Scientific Enquiry,” reference to, 68

Giants, native, on the measurements of bones and skulls of, 137

Glacial action, on the evidence of, 74

Glacier movements, Gosset’s and Richter’s systems of measuring, 79

Glacier observations, memorandum on, 78-81

Glaciers, “Commission Internationale des Glaciers” reports, reference to, 81

Glass objects of antiquity, on cleaning and conserving, 158

Glazed objects of antiquity, on cleaning and conserving, 158

Gleet, 192

Gleichen, Maj.-Gen. Lord Edward, Orthography of Geographical Names, 298

Godwin-Austen, Lt.-Col. H. H., his notes on collecting mollusca, 97

Gonorrhœa, symptoms and treatment, 192

Gosset’s system of measuring glacier movements, 80

Guatemala, weather service of, 42

Guinea worm, treatment for, 247

Hæmorrhage, treatment of, 277

Hail, on recording occurrence of, 8

Hand-camera, the, 52

Hann’s “Handbuch der Klimatologie,” reference to, 41

Hawaii, weather service of, 43

Hay fever, symptoms and treatment, 192

Haze, on recording density and duration of, 7

Health in a tropical climate, risks to, 163

Health in the tropics, Simpson’s “Maintenance of Health in the Tropics,” reference to, 168

Heat-stroke, 238

Helm wind of the Eden Valley, England, and of Adam’s Peak, Ceylon, 5

Herbertson, Dr. A. J. (_see Buchan, Dr. A._)

Hernia, 220

Hip-joint dislocation, treatment of, 290

Hogarth, D. G., his article on Archæology, 148-159

Hongkong, weather service of, 42

Hook-worm, 248

Human body, diagram showing some of the principal organs of the, and the course of the main blood-vessels, 162

Human limbs, on making measurements of bones of, 136

Human skeleton, diagram of the, 285

Humidity, table of relative, 44-49; explanation, 43

Hut for sheltering thermometers, description of, with illustration, 16

Hygrometers, 18

Hypodermic injections, directions for giving, 269; different injections to use, 271

India, weather service of, 42

Individuals of giant and dwarf stature, on the measurements of bones and skulls of, 137

Industry and Commerce, article on, by Sir J. S. Keltie, 138-147

Infectious fevers, 169

Influenza, 193

Inhabitants, native, on observing the character of, 147

Injuries, treatment of, 275-292

Inoculation, 168

Insect pests, 194

Insects, outfit for collecting, 86; hints on preserving, 99

Instrumental meteorological observations, 11

Iritis, symptoms and treatment, 198

Iron objects of antiquity, on, 157

Irrigation, on, 142

Isobaric maps, 50, note on, 39

Isohyets, 40

Isolation of an infectious complaint, importance of, 169

Isothermal maps, 50, note on, 38

Itch, 197

Ives’ method of natural colour photography, 62

Ivory and wood carving of native races, queries on, 131

Ivory objects of antiquity, on cleaning and conserving, 158

Jaundice, 199

Jaw, lower, fracture of, treatment of, 288

Jigger or sand-flea, prevention against and treatment, 228

Kala-azar, 202

Keltie, Sir. J. S., his article on Industry and Commerce, 138-147

Kraw Kraw, symptoms and treatment, 230

Krōmskōp photography, 62

Labels for geological specimens, how to preserve, 65

Labour connected with development of a country’s resources, on obtaining information concerning the, 147

Lakes and tarns, geological notes on, 73

Languages, native, on, 110; on recording vocabularies of, 111

Laryngitis, symptoms and treatment, 200

Lead and iron objects of antiquity, on, 157

Leeches, treatment for removing, 201

Leg fracture, treatment of, 288

Leishmaniasis, 202

Lenses, camera, 54

Level, camera, 54

Lice, treatment for destroying, 196

Literary memoranda of characteristics of monuments and objects of antiquity, 156

Liver, abscess of, treatment of, 203; acute inflammation of, treatment of, 203; congestion of, symptoms and treatment, 202

Loess deposits, 76

Lungs, inflammation of the (_see Pleurisy and Pneumonia_)

Madagascar, weather service of, 42

Malaria, 204; methods of prevention, 206; symptoms and treatment, 205

Malta fever, 244

Mammals, instruments for skinning, 84

Mammals and birds, hints on collecting, 91; on preserving, 92

Man, early history of, in tropical climates, notes on, 76

Manufactures of native races, queries on, 130

Maps, isobaric, 50, note on, 39; isothermal, 50, note on, 38; rainfall, 50, note on, 40; weather, daily synoptical, 41

Maritime climate, 35

Marett, R. R., Note on Anthropology, 129

Marriott’s “Hints to Meteorological Observers,” reference to, 43

Marshes, on observing special features of, 142

Masterman, “Hygiene and Disease in Palestine,” 161

Maudslay, A. P., directions for making squeezes of sculptures, 151

Mauritius, weather service of, 42

Maximum thermometers, 23

McIntosh, J.: Hints on Photography, revised by, 51

Measles, rash, symptoms, treatment, complications, 211

Medical appliances, medicines, &c., 252-274

Medical guides suitable for travellers, list of, 161

Medical Hints, by Dr. W. H. Crosse, and Dr. A. Balfour, 160-274

Medicines, medical appliances, &c., 252-274

Metals of a country, hints on observing, 140

“Meteorological Observers, Hints to,” by W. Marriott, reference to, 43

Meteorology, Bartholomew’s Atlas of, reference to, 37, 41

Meteorology and Climatology, article on, by Dr. H. R. Mill, 1-50; list of works on, 41

“Methods and Aims in Archæology,” by Prof. Petrie, reference, 149, 158

Mexico, weather service of, 42

Mill, Dr. H. R., his article on Meteorology and Climatology, 1-50; “Realm of Nature,” reference to, 41

Minerals, Von Kobell’s tables for determination of, reference to, 67

Minerals and metals of a country, hints on observing the, 140

Minimum thermometer, 20; care of, 21

Mist, fog and haze, on recording density and duration of, 7

Mode of subsistence of native races, queries on, 129

Mollusca, S. P. Woodward’s “Manual of the Mollusca,” reference to, 97

Mollusca, land and freshwater, hints on collecting, 97

Money of native races, queries on, 131

Monuments and objects of antiquity, methods of recording, cleaning and conserving, 148-159; on literary memoranda of characteristics of, 156

Mosquito curtains, 206

Mosquitoes, propagation of malaria by, 204; protection from, 206

Mosquitoes and midges, protection against, and treatment of bites of, 194

Moulding, on obtaining records of objects of antiquity by means of, 149

Mountain-chains, geological notes on, 70

Mumps, 211

Myer, “Atlas of First Aid Treatment,” 161

Myiasis, 212

Mythology of native races, 124; queries on, 130

Names, on the giving of, to newly-discovered places, 306

Names, geographical, R.G.S. system of orthography of, 300

Native races, physical character of, 106, queries on, 129; Broca’s scale of colours of, reference to, 108; language of, 110; arts and sciences of, 113, queries on, 130; social life of, 118; religion and mythology of, 124, queries on, 130; customs of, 126, queries on, 130; mode of subsistence of, queries on, 129; ivory and wood carving of, queries on, 131; money of, queries on, 131; personal ornaments, disfigurements, &c., of, queries on, 131; skulls of, observations on, 132-136

Natives, wants of, hints on observing, 139

Natural History, article on, by H. W. Bates and W. R. Ogilvie-Grant, 82-105; “Handbook of Instructions for Collectors,” reference to, 87; where and what to collect, 89

Natural history specimens, hints on collecting and preserving, 87; outfit for, 88

Naturalist’s outfit, 82-86

Negretti and Zambra’s maximum thermometers, 23

Neligan, “Hints for Travellers in Persia,” 161

New Zealand, weather service of, 43

Night-blindness, protection against, 199

“Notes and Queries on Anthropology,” British Association manual of, reference to, 106

Ocean-Basins, on the permanence of, 76

Ogilvie, A. C., Memorandum on glacier observations, 78

Ogilvie-Grant, W. R., and H. W. Bates, article on Natural History, 82-105

Ophthalmia, simple, symptoms and treatment, 213

Oriental sore, 231

Organs of the human body, diagram showing some of the principal, 162

Ornaments, personal, of native races, queries on, 131

Orthochrome plates, 62

Orthography of Geographical Names, R.G.S. system of, 300

“Outfit, Hints on,” reference to, 164

Pacific, weather service of the, 43

Paget colour plate, 62

Papyrus, on conserving, 158

Parasites, diseases produced by, 170

Paratyphoid fevers, 189

Paste objects of antiquity, on cleaning and conserving, 158

Pasteur-Chamberland filter, 166

Peru, weather service of, 42

Petrie’s “Methods and Aims in Archæology,” reference to, 149, 158

Philippine Islands, weather service of, 42

Phillips’ maximum thermometers, 23

Phillips, Prof. J. (_see Darwin, Dr. Charles_)

Photographic apparatus and chemicals for development, 58

Photographic exposure record, 56

Photographic outfit, list of, with prices, 61-62

Photography, article on, by J. Thomson and J. McIntosh, 51-62; Sir W. Abney’s work on, reference to, 59; W. K. Burton’s work on, reference to, 59; Robinson’s “Pictorial Effect in Photography,” reference to, 60; photography in natural colours, 61; photography of object of antiquity, 148

Physical characters of natives, on observing the, 106; queries on, 129

Piles, internal and external, treatment of, 214

Plague, bubonic, causes, symptoms and treatment, 215

Plants, living and succulent, on packing, 103

Plattner and Scheerer’s work on the use of the blow-pipe, reference to, 67

Pleurisy, symptoms and treatment, 217

Pneumonia, symptoms and treatment, 217

Poisons, treatment of the various, 291

Pottery and terra-cotta objects of antiquity, on cleaning and conserving, 157

Poultices, directions for making, 274

Pox, 239

Precautions on the voyage, 167

Prickly heat, treatment for, 230

Psychrometer, Assmann’s Aspiration, description of, with illustration, 20

Pulse, normal rate of, 269

Purgatives, 180, 264

Queries of Anthropology, by Sir A. W. Franks, 129-132

Quinine, use of, for malaria, 265

Quinsy, treatment of, 218

Railways, inquiry as to routes suitable for, in new country, 146

Rain and dew, on recording prevalence of, 7

Rainfall maps, 50, note on, 40

Rain-gauge, 24

Raised beaches, 72

Ramsay, Sir A., reference to his views on the formation of rock-basins, 74

“Realm of Nature,” by Dr. H. R. Mill, reference to, 41

Recording monuments and objects of antiquity, methods of, 148-156

Relapsing fever, 218

Religion and mythology of native races, 124; queries on, 130

Reptiles, naturalist’s outfit for preserving, 85

Reptiles and fishes, on collecting and preserving, 96

Resources of a country, inquiry into, 139

Respiration, normal rate of, 269

Rheumatism, 219

Ribs, fracture of, treatment of, 287

Richter’s system of measuring glacier movements, 80

Richthofen, Baron F. von, reference to his description of loess formations, 76

Ringworm, treatment of, 230

Rivers and river-plains, geological notes on, 72

Roads, native, on observing the nature of, 146

Robinson’s “Pictorial Effect in Photography,” reference to, 59

Rock-basins, on the formation of, 73; reference to Sir A. Ramsay’s views on, 74

Round worm, treatment for, 247

Royal Geographical Society, on the giving of names to newly-discovered places, 306; system of orthography of geographical names, 300

Rubbings, on obtaining records of objects of antiquity by means of, 154

Rupture, treatment of, 220

Ryan, “Health Preservation in West Africa,” 161

Salvador, weather service of, 42

Salvin, O., hints on collecting reptiles and fishes, 96

Sand-flea (_see Jigger_)

Sand-fly fever, 221

Scabies, symptoms and treatment, 197

Scalds, treatment of, 175

Scarlet fever, or scarlatina, symptoms, treatment, complications, 222

Scheerer (_see Plattner_)

Sciences of native races, 113

Scorpion sting, 223

Screw worm, 212

Scurvy, symptoms and treatment, 224

Sea-sickness, treatment of, 226

Sensitive plates or films, 57; Sir W. Abney’s method of packing, 57; how to keep dry, 58; slides for holding, 54

Shaw, Sir Napier: “Forecasting Weather,” 41

Shoulder-joint dislocation, treatment of, 290

Simpson, Dr. W. J., “The Maintenance of Health in the Tropics,” reference to, 161

Skeleton, human, diagram of the, 285

Skeletons of animals, on the preparation of, 94

Skin diseases, 226

Skulls, human, observations on, 132-136

Sleeping sickness, symptoms and treatment, 233

Sleeplessness, treatment for, 235

Slides for holding sensitive plates, 54

Sling thermometer, 17

Small-pox, rash, symptoms and treatment, 236

Snow, on recording falls of, 9

Snow-blindness, protection against, 199

Social life of native races, 118

Spectacles for preventing snow-blindness, illustration of, 199

Spider bite, 223

Sprains, treatment of, 281

Sprue, symptoms and treatment, 237

“Squeezes,” on obtaining records of objects of antiquity by means of, 150

Stevenson thermometer screen, 14

Stomach tube, directions for using, 273

Stone objects of antiquity, on cleaning and conserving, 157

Stroke, 237

Sun in the tropics, effects of the, upon the human body, 165

Sunshine, cloud and, on keeping record of changes of, 5

Sun-stroke, symptoms and treatment, 238

Surface of a country, on observing the character of, 141

Surgical cleanliness, importance of, 275

Surgical dressing case recommended to travellers, 253

Syphilis, symptoms and treatment, 239

Table of relative humidity, 44-49, explanation, 43; showing pressure of saturated aqueous vapour in inches of mercury at latitude 45° for each degree Fahrenheit from -30° to 119°, 50

Tape-worms, treatment for, 246

Tarns, geological notes on, 73

Tariffs existing in a country, on obtaining information concerning, 147

Temperature of human body, normal, 269; taking the, different ways of, 269

Terra-cotta objects of antiquity, on cleaning and conserving, 157

Thermometer corrections, 12

Thermometer scales, 12; rule for converting Centigrade readings into Fahrenheit, 13

Thermometer screens, 14; Blanford’s portable, 15; for permanent station in hot countries, form recommended by British Association most suitable, 15; Stevenson’s, 13

Thermometers, on the care of, 13; boiling-point, 31; dry and wet bulb, table showing difference between readings of, 44-49, explanation, 13; maximum, 23, Negretti and Zambra’s form, 23, Phillips’ form, 23; minimum, 20, care of, 21; sling, 17

Thigh fracture, treatment of, 288

Threadworm, treatment for, 247

Thomson, J., article on Photography, 51-62

Throat, ulceration of the, treatment of, 244

Thunderstorms and hail, on recording the occurrence of, 8

Tick fever, symptoms and treatment, 241

Ticks, treatment for, 197

Timber of a country, on ascertaining the characteristics of, 141

Tonsils, inflammation of the (_see Quinsy_)

Tornadoes, making record of, 5

Tourniquet, description and use of, 277

Trade, on obtaining information concerning, 144

Trephine-holes in human skulls, 133

Tropical ulcer, 232

Tubers, on packing, 103

Tumbu fly, 212

Tylor, Dr. E. B., his article on Anthropology, 106-129; his “Anthropology: an Introduction to the Study of Men and Civilisation,” reference to, 127

Tyndall’s method of ascertaining velocity of glacier movements, 81

Typhoid fever, 189

Typhus fever, 243

Ulceration of the throat, treatment of, 244

Ulcers, treatment of, 231, 232

Underclothing recommended for tropical climates, 164

Undulant fever, 244

United States, weather service of, 42

Urine, retention of, symptoms and treatment, 245; suppression of causes and treatment, 246

Uruguay, weather service of, 42

Vaccination essential to travellers, 168

Vegetable products of a country, hints on observing, 141

Vegetation, on observing character of, 142

Ver macaque, 212

Vocabularies, native, on recording, 111

Volcanic rocks, on, 71

Volcanoes and volcanic rocks, on, 71

Von Kobell’s tables for determination of minerals, reference to, 67

Voyage, precautions on the, 167

Ward, Prof. R. de C., “Handbook of Climatology,” reference to, 41

Water, risks due to drinking, 166

Water communication of a country, inquiry as to, 146

Waterspouts, on the theoretical importance to determine direction of the whirl about the axis of, 5

Weather, hints on keeping a record of, 2; observations for forecasting the, 32-35.

Weather-maps, daily synoptical, 41

Weather services, extra-European, list of, 42-43

West Indies, weather service of, 42

Wet pack for invalid, directions for giving, 272

Whirlwinds, usefulness of making records of, 5

Wind, observations of direction and force of, 3; Beaufort’s scale of wind force, 4

Windpipe, inflammation of the, 174, 200

Wood, ivory, and bone objects of antiquity, on cleaning and conserving, 158

Wood carving of native races, queries on, 131

Woodward, S. P., “Manual of the Mollusca,” reference to, 97

Worms producing disease, different kinds of, treatment, 246

Wound, directions to clean and dress a, 275

Wounds, after-treatment of, 279

Wounds, poisoned, treatment of, 281

Wounds and injuries, treatment of, 275-292

Yellow fever, symptoms and treatment, 250

Young, Hastings: “First Aid to the Sick,” 161

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