Part 4

In making of these experiments, I remarked some inconveniencies, which I did not at first advert to, and which, at that time, I could not prevent. I intended, that each man should have got gently into the water, immersed himself all but his head, and so have staid until the motion of the water had ceased; then he was suddenly to have ducked his head under, and have continued to a few seconds of time, until I had noted the rise of the water; and, after his leaving the cistern, another was not to go in until the water was free from motion. Could these things have been done, as I projected, I could have recommended the foregoing table as sufficiently complete: but I must observe, that beside the men’s being of different sizes from what I had desired, they were in too much haste to be dismissed (with another dram after dressing); so that the water was not quite still when they got into the cistern: neither could I persuade all of them to lay themselves down gently, much less to keep their heads under water so long a time as one second: so that, in most of the observations, the surface of the water was far from being quite so still, as to render the measures perfectly exact, I being obliged to catch them, as it were, by taking the mean height between the librations. Moreover, the great area of the cistern was no inconsiderable bar to the accuracy I expected. However, as I do not recollect experiments of this kind any-where recorded, these, perhaps, may give some satisfaction to such persons, who may have the curiosity to desire some knowlege on this subject. Were I to make any more observations of this kind, I would chuse an upright parallelopiped, not above 18 or 20 inches in the side of the square; into which the person should let himself down by steps nailed to the side: for in so small an area the motion of the water would sooner subside; neither would the librations be any thing near so large as on a smaller surface.

One of the reasons, that induced me to make these experiments, was a desire of knowing what quantity of fir or oak timber would be sufficient to keep a man afloat in river or sea water, thinking that most men were specifically heavier than river or common fresh water; but the contrary appears from these trials: for, excepting the first and last, every man was lighter than his equal bulk of fresh water, and much more so than his equal bulk of sea-water: consequently, could persons, who fall into water, have presence of mind enough to avoid the fright usual on such accidents, many might be preserved from drowning; and a piece of wood, not larger than an oar, would buoy a man partly above water so long as he had spirits to keep his hold. Some things herein advanced will perhaps more readily appear from the following relation.

The Lords of the Admiralty have appointed, for the exercise of the scholars belonging to the royal academy at Portsmouth, a small yacht; wherein, during the summer months, those young gentlemen are taught the practice of working a vessel at sea, under the directions of one of the master-attendants, assisted by eight or ten seamen. The last time this yacht was out, which was about the beginning of last October, one of the scholars was ordered to heave the lead. The youth was about thirteen years old, small of his age, and far from being fat; as he was stepping on the gunnel, he fell over-board: the sea was rough, and the yacht had great way; so that he was presently at a considerable distance from the vessel. The skiff was immediately let down; but the painter not being fast, the rope run an end, and the skiff went adrift. One of the seamen jumpt over-board, got into the boat, brought her along-side the vessel, took in another man, and then went after the youth, whom they recovered, after he had been in the water more than half an hour. The young gentleman, relating the affair, said, that as he could swim very little, and judging he should sink if he strove against the waves, he turned on his back, and committed himself to their mercy. He kept himself perfectly calm; and observed, when a wave was likely to break over him, to hold his breath, and to spurt out the water forced into his mouth. His hat, which happened to be tied by a piece of string to one of his coat button-holes, he often held up with his hand, as a signal where he was. Just before the boat came up to him he began to be faint, his eyes became dim, and he thought himself on the verge of sinking. This youth, who, by his prudence, saved himself from drowning, must, at that time, have been specifically lighter than water.

VI. _An Instance of the Gut_ Ileum, _cut thro’ by a Knife, successfully treated by Mr._ Peter Travers, _Surgeon, at_ Lisbon. _Communicated by_ John Huxham, _M.D. F.R.S._

[Read Jan. 27, 1757.]

Lisbon, August 3d, 1756.

ANtonia Josée da Costa, one of the King’s messengers, was attacked by two men, and, after receiving two blows on the head, was stabbed with a knife in the right hypogastric region, about three fingers breadth above the os pubis; the external wound being larger, as the knife was drawn obliquely towards the navel, and might be an inch and half in length, the perforation thro’ the peritonæum about three quarters of an inch; the intestine ileum hanging out about ten or twelve inches, and quite pierced thro’, the wound in the gut being large enough to admit my fore finger. After clearing the grumous blood with warm water and Hungary water, the uninterrupted suture was made on both perforations; then dilating the common integuments of the belly, the intestine was reduced, leaving the ends of the two threads at the superficies of the wound; and the external incision was sewed up by the interrupted suture, and common dressings of lint and bandage applied. A clyster was given him immediately after the above operation, of oil of olives, the yolk of an egg, and warm water.

4th. This day I found he had passed in the most excruciating pains, attended with continual vomitings: his fever very high, pulse full and irregular: he was bled ten ounces this morning, and the like quantity this evening. The clysters were continued thrice a day, with a decoction of wormwood and camomile instead of the warm water, and an anodyne mixture of mint-water, liquid laudanum, and sugar, to be taken occasionally; also three ounces of syrup of rhubarb, with an ounce of the fresh-drawn oil of sweet almonds, to be taken, a common spoonful every two hours.

5th. The bleedings were continued twice this day, three ounces each time, and the clysters were administered as yesterday. His pulse and fever very high; he vomited some excrements; and towards night complained of a singultus.

6th. His bleedings and clysters were continued as before. Finding his singultus and vomiting so very troublesome, I ordered him Dr. Huxham’s tincture of the bark; which was taken, a tea-spoonful, six times a day, in a little mint-water; which indeed greatly relieved him: his singultus and vomiting became less frequent.

7th. I found his skin moist, and pulse softened. I remained with him about an hour, and found a plentiful perspiration throughout the body; on which I omitted his bleedings: the clysters were continued; and towards night he had a proper discharge by stool, very fœtid, and inspissated.

8th. I found, for the first time, he had slept last night, and seemed much in spirits: the symptomatic fever something lessened; and he had purged last night, and this day, eight times.

9th. He had five stools; his neausea much abated; and a gentle diaphoresis continued.

10th. The singultus ceased; his vomiting very little; his pulse low, accelerated, and thread-like in its stroke; his purging violent; and he greatly complained of a most acute pain of the wounded parts. A paper of the following absorbent powders was given him every three hours in rice-water. Crabs-eyes and red coral prepared, of each one drachm, crude opium two grains: these were made for three doses, and given as above.

11th. He slept well; less pain; pulse more equal; his diarrhæa much the same.

12th. The threads, with which I had made the suture of the intestine, came out of themselves: the wound well-conditioned; fever very little; his diarrhæa rather increased. He sent for me in the evening, being much alarmed, as he thought some liquids he had taken to have passed thro’ the wounded parts.

13th. Yesterday he complained of great pains in his belly: the discharge from his wound was laudable matter, and in good quantity.

14th. He rested well, and was seemingly well beyond expectation. His diarrhæa still continuing troublesome, he took the hartshorn decoction, with an addition of diascordium.

15th. I cut off the threads of the external wound, and continued dressings of digestive in the common method.

16th. He grew visibly better each day after; and on Sept. 7th I discharged him from any further attendance, his wound being intirely healed over, and he is in all respects very well, free from pain, or any inconvenience from the wound. He was kept seven and twenty days on chicken-broth, and never admitted to use any solids during that time: afterwards he was indulged with young chickens, &c.

VII. _An Account of a Visitation of the leprous Persons in the Isle of_ Guadaloupe: _In a Letter to Mons._ Damonville, _Counsellor and Assistant-Judge at_ Martinico, _and in the Office of King’s Physician at_ Guadaloupe. _By_ John Andrew Peyssonel, _M.D. F.R.S. Translated from the_ French.

[Read Feb. 3, 1757.]

+SIR+,

I Received the letter, which you honoured me with, and the order for visiting the persons afflicted with the leprosy. I was sensible of the misfortune of being ordered upon that commission: I say misfortune; for such you will perhaps think it, when you have read this letter.

It is now about 25 or 30 years since a very particular disease shewed itself in many persons in this island Grande Terre. Its beginning is imperceptible: there appear but a few livid-red spots upon the skins of the white people, and of a yellowish red upon the blacks. These spots in the beginning are not accompanied with pain, or any other symptom; but nothing can take them away. The disease increases insensibly, and continues several years in shewing itself more and more. These spots increase, and extend indifferently over the skin of the whole body. Sometimes they are a little prominent, but flat. When the disease makes a progress, the upper part of the nose swells, the nostrils are enlarged, the nose becomes softened; tuberosities appear upon the cheek-bones; the eyebrows are inflated; the ears grow thick; the ends of the fingers, and even the feet and toes, swell; the nails become scaly; the joints of the feet and hands separate and mortify: ulcers of a deep and of a dry nature are found in the palms of the hands and soles of the feet, which grow well, and return again. In short, when the disease is in its last stage, the patient becomes frightful, and falls to pieces. All these symptoms come on by very slow degrees, one after another, and sometimes require many years to shew themselves: the patient is sensible of no sharp pain; but feels a kind of numbness in his hands and feet. These people perform their natural functions all the while, eating and drinking as usual: and even when the mortification has taken off the fingers and toes, the only ill consequence, that attends, is the loss of those parts, that drop off by the mortification; for the wound heals of itself, without any application: but when it comes to its last period, the poor sick persons are horribly deformed, and truly worthy of compassion.

This shocking disease is observed to have several other unhappy characters; as, 1st, that it is hereditary, and that some families are more apt to be seized with it than others: 2dly, that it is infectious, being communicated _per coitum_, and also caught by keeping company with those so diseased: 3dly, that it is incurable, or at least that no remedy has yet been found to cure it. They have in vain tried mercurials, sudorifics, and every other regimen used in venereal complaints, under a notion, that this leprosy was the consequence of some venereal taint: but, instead of being of service, these methods rather served to destroy the patients; for, far from lessening the disease, the antivenereal medicines unlocked the distemper, the most dreadful symptoms appeared, and all those so treated perished some years sooner than the others, who did not take these medicines.

A very just fear of being infected with this cruel distemper; the difficulty of examining infected persons before the disease came to its state; the length of time of its lying concealed, by the care of the patients to keep it secret; the uncertainty of the symptoms, which distinguish it in the beginning; produced an extraordinary dread in all the inhabitants of this island. They inspected one another, since virtue and merit had no shelter from this cruel scourge. They called this distemper the leprosy; and consequently presented several memoirs to the generals and intendants, laying before them all these facts above-mentioned; their just apprehensions; the public good; the trouble, that this distrust caused in this colony; the complaints and hatred, that these accusations occasioned among them; the laws made formerly against such leprous persons, and their expulsion from civil society. They required a general visitation of all persons suspected of this distemper, that such, as were found infected, might be removed into particular hospitals, or into some separate places.

These memorials were sent to court, which, giving due attention to these just representations, issued orders for the required visitations in the most convenient manner, for the good of the public and of the state.

In the mean time, the post of physician-botanist become vacant in the island of Cayenne. The minister was pleased to name me for it; and altho’ this island was much more fertile in philosophical discoveries than all the others, he thought proper to change my destination, and sent me to this isle Guadaloupe; and did not forget the article of the leprosy in my instructions.

When I arrived at Martinico in 1727, Monsieur Blondel de Juvencourt, then intendant of the French isles, communicated to me both the orders of the court, and all the memoirs, that related to this affair. A tax was then laid upon the Negroes of the inhabitants of the Grande Terre, to raise a necessary fund for this visitation, thus made at the expence of the colony; and Mons. le Mercier Beausoleil was chosen treasurer of this fund.

Being arrived at Guadaloupe, the Count de Moyencourt, and Mons. Mesnier, ordinator and subdelegate to this intendance, communicated to me the order of the general and intendant. I began then to inform myself of the necessary instructions for acquiting myself of this dangerous commission, the disagreeable consequences of which I easily foresaw. I had so often heard of these leprous spots, that I judged it necessary to know, whether what was said was true: for I could not comprehend, that a disease, which has so dreadful an end, and the symptoms then so terrible, should continue ten or fifteen years without any other appearance than these simple spots; which, in themselves, had nothing very bad. I demanded an inquest to be made, in order to satisfy myself of this fact: several surgeons, as practitioners, and several honest inhabitants, as observers, were accordingly called together, who all proved the same fact in this inquest; which you, Sir, may, and must, have seen in the register of the subdelegation of this island. I am, most sincerely,

+SIR+, Your most humble and obedient Servant, Peyssonel.

August 10. 1748.

RESULT _of the_ VISITATION.

1st, NONE of the patients, whom we visited, had any fever; and they all declared, that they found no inconvenience nor pain; but, on the contrary, eat, drank, and slept well, performing every natural function; which was proved by their plumpness, which appeared even when the disease was most confirmed.

2. The disease began to shew itself in the Negroes by reddish spots, a little raised, upon the skin, being a dry kind of tetter, neither branny nor scabbed, and without any running, but of a livid-red, and very ill-conditioned. The Negroes sometimes bring these spots with them from their own country. The spots are constantly found upon every person troubled with this disease; and are in greater numbers, in proportion as the disease grows more inveterate.

3. Among the whites the disease shews itself at the beginning by spots of a livid violet colour, without pain; which are followed by little watery bladders, particularly upon the legs, which burst, and leave small ulcers with pale edges, and different in their natures from the common ulcers.

4. In proportion as the disease increased, the hands and feet grew larger, without any signs of inflammation; since neither redness, nor pain, nor any oedematous appearance accompanied it; but it was the very flesh, that increased in bulk. And this growth of the hands and feet was not attended with any sharp pain, but only a kind of numbness.

5. This bloated state of the hands and feet was succeeded by white deep ulcers under the skin, which became callous and insensible; and which emitted only a clear serous matter like water, and were but little painful. Afterwards the ends of the fingers became dry, the nails became scaly, and, I don’t know how, they were eaten away; the ends of the fingers dropt off; then the joints separated without pain, and the wounds cicatrized of themselves, without the least need of medicines. In the increase of the distemper hardnesses and lumps were formed in the flesh, the colour became tarnished, the nose swelled, and the nostrils grew wide: at last the nose softened like paste, the voice became hoarse, the eyes round and brilliant, the forehead covered with tetters and lumps, as well as the face; the eye-brows became very large, the countenance was horrible, the breath fœtid, the lips swelled, large tubercles were formed under the tongue; the ears grew thick and red, and hung down; and, such was the insensibility of all the parts, that we run pins thro’ the hands of several, without their feeling any thing of it. In short, we were assured, that these people perished by degrees, falling into a mortification; and the limbs dropt off of themselves, without any considerable pain, continuing still to perform well their natural functions.

6. These leprous people lived thus easy, if I may be allowed the expression, for several years, even fifteen or twenty; for the disease begins insensibly, and shews itself but very slowly.

7. Antivenereal remedies, which were ordered for almost every patient we saw, were of no service: if they sometimes palliated some symptoms, they very often hastened the progress of the disease: besides, we never found the parts of generation at all infected, nor any thing, that looked like the pox about them.

8. Some of these people had indeed particular symptoms. In some the hair fell off; which was replaced by a finer kind: in others, worms were found in their ulcers: want of sleep, or frightful dreams, afflicted some; while others quite lost their voice, or it became effeminate like that of eunuchs; and others, we found, stunk extremely.

9. Almost all of them, being desirous of concealing their disorders, endeavored to deceive us, by alleging false excuses for the causes of their sores and ulcers: the greater part of them pretended, that the rats had eaten off their toes, and that burns had caused their ulcers. These were the figures, that every where presented to us.

10. We were confirmed in our opinions by experience, supported by verbal process, that this was the state of the diseased; that the distemper could neither be the pox, nor the effect of an inveterate one: that it had no symptom of that disease; but that it had every character of what the ancients called leprosy, elephantiasis, or such other names, as they were pleased to give it. So that we do not hesitate to pronounce, that those infected with this disease, as we have described it, ought to be treated as leprous persons, and subject to the ordinances, which his majesty was pleased to issue against such persons.

11. Again, we are well assured, from our observations, that the distemper is contagious, and hereditary; and yet the contagion is not so active, nor poisonous, as that of the plague, small-pox, nor even as the ring-worm, itch, scald, and other cutaneous disorders: for, if that were the case, the American colonies would be utterly destroyed; and these persons so infected, mixed as they are in every habitation, would have already infected all the Negroes, whom they come near.

12. We believe, that this contagion does not take place but by long frequenting the company of the infected, or by carnal knowlege. Besides, we have observed, that even such long frequenting, or cohabiting with them, are not always sufficient to communicate the disease; because we have seen women cohabit with their husbands, and husbands with their wives, in the distemper, while one is sound, and the other infected. We see families communicate and live with leprous persons, and yet never be infected; and thus, altho’ experience, and the information of the sick, prove the contagion, we are of opinion, that there must be a particular disposition in people to receive the poison of the leprosy.

13. As to what regards the distemper’s being hereditary, it is assuredly so. We have seen intire families infected; and almost every child of a leprous father or mother fall insensibly into the leprosy; and yet, in several other families, we have seen some children sound, and others tainted; the father has died of the disease, and the children grew old without any infection: so that, tho’ it is certainly hereditary, yet we believe it is of the same nature with those in families troubled with the consumption, gravel, and other hereditary distempers; which are transmitted from father to son, without being so very regular, as to affect every one of the family.

14. We could never find out any certain rule of judging, at what age the disease shews itself first in those, who were begotten by infected parents: but we have, as far as we could, observed, with regard to women or girls, that the symptoms begin with the menses, and continue slightly till they have lain in of one or two children: but that then more visible, and indeed more cruel, symptoms appeared. As to men, or infants, there is no rule to know it in them.

15. For the explanation of the causes, symptoms, and what we think the most likely means of cure, we refer to a particular dissertation. Let it suffice here to observe, that we do not imagine, that the air, water, or manner of living, can produce it; for we have found as many sick in the low marshy places, as in more airy saline places: and if many Negroes were infected in the Grand Terre, where they drink the foul waters of ponds and lakes, we see an equal number ill in places, where they have fresh rivers and running waters; but they may prove proper causes for unlocking, and disposing persons to receive, the disease.

16. We believe, and are persuaded, that the origin of this disease among the Negroes comes from Guinea: for almost all the Negroes from the country told us they came from thence with these reddish spots, the first and certain signs of the distemper begun.