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With regard to the efficacy of such a provision, different opinions will be held. The people could not always be below decks, even supposing the air which was then breathed to have been completely purified. To be sure, according to a general order, those who were obliged to be on deck, and when en unhealthy stations, were to be supplied with respirators; and in these precautions Dr. M'William appears to think that moral influences also operated beneficially. He says "moral impressions are intimately connected with the maintenance of health as well as with the production of disease: a conviction that the ship herself is sweet; that there is nothing in her to generate disease, will, I am persuaded, go far to fortify many against the evils of the coast climate." But would not moral influences be by these means impressed, and with quite an opposite effect, seeing that the men were thus constantly kept in mind that pestilence surrounded them, and that the moment they happened to imbibe a mouthful of the tainted and unmedicated air they ran the risk of being infected? Indeed, the white portion of the crew appear to have been dispirited before they were taken ill; and not a few, it is remarked by the Doctor, as soon as they were seized became speedily despondent.
The number of whites engaged in the ill-fated expedition was 145; yet although they were all vigorous young men, there were no fewer than 130 cases of fever, 44 of which terminated fatally. The total of the deaths was beyond this number, and embraces several blacks; but these arose from accidents or are attributed to other disorders. Of 25 blacks brought from England, 11 were attacked by fever, but none died. Of the 128 engaged on the coast, not one was even attacked.
The river was entered by the expedition on the 13th of August. After six days delay, the voyage upwards was commenced. On the 27th it reached Ibu, 120 miles from the sea. On the 2nd of September they gained Iddah, 80 miles further. At this date disease does not appear to have yet distinctly manifested itself; but two days afterwards "fever of a most malignant character broke out in the Albert, and almost simultaneously in the other vessels." By the 17th the expedition had reached the junction of the Niger and Tchadda, 272 miles from the sea. Seven of the whites had been cut off by this time, and 60 were sick, the only chance of their recovery being held to depend on their escape to the sea air. It was therefore determined to send one of the vessels down the river; but she had scarcely departed when new cases broke out; so that it became a question whether the whole squadron should be withdrawn for the season. But as one vessel could still be made sufficiently effective for an effort to carry out the expedition, the resolve was finally taken that the Albert should make the best of her way upwards, and that the Wilberforce was at once to speed for the
ocean. The Albert advanced to Egga, which she reached on the 28th of September, this place being 340 miles from the sea; the Wilberforce in the meantime speeding down the stream. Matters may be said to have grown worse and worse the farther that the Albert advanced, and such hopes as they happened to entertain had to be relinquished, as the following passage will show:
On leaving the confluence on the 21st of September, it had been hoped that the violence of the fever was in a measure exhausted, and that the climate of the more open country, higher up the Niger, would be found sufficiently healthy to enable us to reach Rabba. The result proved otherwise. Captain B. Allen was taken ill on the evening of the same day; and when we arrived at Egga, not less than twenty more of the crew had been attacked, of whom two had died. On the 3rd October, Captain Trotter was seized with fever. Captain B. Allen was in a very critical state; and there remained capable of doing any duty, only one white seaman, the sergeant and one private of marines, Dr. Stranger, Mr. Willie, mate, John Huxley, hospital-attendant, and myself. Mr. Willie was already labouring under incipient fever, and could not be persuaded, even when very ill two days afterwards, to keep quiet. The season was advancing, and the river had already begun to fall. Dr. Stranger found by the marks on the shore that the water had fallen fourteen inches on the 29th September, and on the 5th October not less than three feet. Under such circumstances, to have endeavoured to proceed to Rabba would have been madness; and as there was no object to be gained by remaining longer where we were, it was resolved that we should withdraw from the river with all possible speed. The Kroomen having now cut a good deal of wood, we weighed on the morning of the 4th October, and dropped down with the stream some distance below Egga; and the next day, in the same manner, we reached the village of Eddogi. On the 6th, Dr. Stranger undertook to work the engines, with what assistance he could get from Mr. Brown, the only engineer who could move out of bed. The steam was accordingly got up, and we were soon making good way downwards. Mr. Willie being now too ill to have any charge, 1 was necessitated to attend to the duties of the ship, in addition to those of my profession.
On the 13th of October, at three in the afternoon, as the Albert was nearing Stirling Island, a steamer was seen coming up the river at full speed. In a very short time Captain Becroft from the Ethiope was along side, who conducted them to the open sea.
It will readily occur to any one that much must depend upon the haste with which the passage is made up the river, and the speed of the return, for purposes of trade. It appears also from a statement in the doctor's volume, that a steam-vessel could go 100 miles farther than Egga, and come back in about the fourth of the space occupied by the expedition. The importance of making the most of the time will be impressively gathered from the statement we now
In no case did the fever break out before the sixteenth day after commeneing the ascent of the river, or sooner than the twenty-first day from entering the river. The Albert, Amelia, and Soudan were twenty-three days inside the river before fever made its appearance, and the Wilberforce about two days less; therefore, as the invasion of the disease was nearly, if not wholly, simultaneous on board the ships, a case may be said to have occurred in the Wilberforce on the twenty-first day. Assuming that the poison was not inhaled until the vessel steamed upwards, which will reduce the period of latency to the shortest probable duration, and taking the cases on board the Albert, the ship the longest in the river, I find that out of fifty-five cases among the whites, and six among the people of colour entered in England, the days of seizure were as follows: on the 16th day, three; on the 17th, two; on the 18th, two; on the 19th, three; on the 20th, four; on the 25th, one; on the 26th, three; on the 29th, three; on the 30th, three; on the 31st, three; on the 33rd, five; on the 34th, four; on the 35th, two; on the 36th, one; on the 37th, six; on the 42nd, three; on the 45th, one; on the 47th, one; on the 48th, one; on the 51st, one; on the 60th, three: average day of invasion 33.286. Among the six people of colour, two were attacked on the 16th day, one on the 18th, one on the 21st, one on the 29th, and one on the 42nd day; making the average period of attack the 25th day, (25.200.) Bearing also in mind that about one ninth of the white crew escaped the river fever altogether; that the people of colour only who had resided for some time in a temperate climate were affected by it, but in small proportion and in a mild degree; and that the blacks entered in Africa did not suffer at all, we shall have some data for the selection of crews for future operations in the Niger.
Dr. M'William's facts are conclusive with regard to the crews who are fitted to navigate African rivers. But in reference to the time spent by the expedition in the river, and when the period is taken in connexion with the number of days that elapsed before the fever broke out, one cannot but entertain regrets. Still, we are not in a condition to censure the officers for apparent delay, not being aware of the various obstacles that intervened, and the interruptions occasioned by the precise orders for carrying out the objects of the rash undertaking. Passing from this part of the subject, let us for a moment attend to some of the facts as well as opinions connected with the fever itself.
Dr. M'William has established this fact, that one effect of the morbific influence which generally produces the Niger fever is ulceration of the intestines. Yet the disease does not seem to have the horrors which attend some other Tropical fevers, such as black vomitings. The patient has headache and flying pains, though generally not very severe; nor at first is he induced to apply for advice. In the course of twelve hours or more he grows worse and complains of cold. We must now allow the Doctor to describe at length the general characteristics of the disease ::
He would shortly express a wish to lie down; and would complain somewhat suddenly of increase of headache or giddiness, and intense heat of the skin, which had a dry parched feel, restlessness, intolerable nausea, and difficult breathing. The dyspnea in several instances, particularly in my own case, was extremely distressing, and continued from one to four hours, until relieved by spontaneous vomiting, or the occurrence of diaphoresis. Headache was with some the prominent symptom during the hot stage; and the fe elng was described as that of a cord being tightly girded round the temples. The thirst was very urgent; the tongue was foul in the centre, moist, clean, or reddish, and invariably marked by indendations on the edges. The countenance was more or less flushed; the eye occasionally suffused, and always looked wild. Pulse rapid, but small, frequently feeble; thirst urgent, bowels constipated, and urine passed often and in small quantity. There was in general tenderness of the epigastrium, sometimes acute, but often not discoverable unless upon pressure.
In some cases, coldness of the stomach was complained of some days before death. A subsidence of febrile action in general followed in from three to six hours; or at all events these symptoms, if continued beyond the latter period, became much mitigated. Diaphoresis came on, the thirst moderated, and the signs of oppression in a great measure disappeared. The principal complaint at this period was from the disagreeable odour of the perspiration, especially in those cases that subsequently prove fatal. I was not sensible of this peculiarity in the smell of the perspiration in my own case, but I perceived it very distinctly in several others. The sweating continued until from eight to twelve hours had been occupied by the whole paroxysm. The patient, although considerably exhausted, expressed himself as free from all trouble, and the countenance also indicated improvement. This seemingly favourable change did not last long, for the accession generally returned in from six to ten or twelve hours. Occasionally the respite extended to twenty-four hours. In a few cases there was a treacherous interval of fortyeight hours in the early period of the disease; but these invariably assumed afterwards a low malignant type. The fever in them seemed to have rested only to give strength for a fresh accession.
The accessions did not seem to observe any law of periodicity. They came on, disappeared, and returned, at all hours of the day and night. The evening, however, was a more common time of accession than any other; in which case, after the cold sensation had passed off, the paroxysm generally ran through its stages in the course of the night, and had suffered a considerable remission by the hour of breakfast (eight) the next morning.
In a few instances the remissions were as complete as in the interval of ague. These were, however, only exceptions to the general rule; for total absence of fever was indeed of rare occurrence during the course of the disease.
I cannot say that the influence of critical days was at all apparent, further than if no material improvement was evident by the eighth or ninth day the prognosis was then most gloomy. The patient became weak, irritable, and The remissions were most indistinctly exhausted, and extremely restless. marked; the skin was dry and constricted, the tongue parched, pulse small and irregular; the fever, in short, now assumed a low asthenic form.
sional symptoms of mental aberration would appear at this period: the countenance pale and shrunk; but not unfrequently the patient would talk most rationally upon the state of his mind, so far as regarded his eternal happiness. In several cases this stage was wonderfully protracted, as in case 12.
Local pain was seldom much complained of: indeed, with the exception of headache (often very slight) at the commencement of the paroxysm, there were several instances in which the patients expressed themselves as quite well, throughout the disease, although this ultimately proved fatal.
When the disease was about to take a favourable turn, the remissions became distinctly marked, and the intervals were lengthened. The countenance (the best criterion) assumed a natural expression, a certain look of convalescence, that one can only become acquainted with by experience, and contrasting it with that indicative of a fatal termination. The skin became moist, the thirst diminished, the pulse was more voluminous and softer; the tongue gradually lost its tremulousness, and could be more easily thrust out of the mouth it often continued a long time loaded, but the crust was less brown and more moist, and seemed to have lost its firm attachment to the organ. At this period diarrhoea was by no means uncommon, and also a copious flow of urine; which latter was a very favourable symptom. A strong desire for food was expressed by most of the patients who had advanced thus far; and I had more than once cause to regret having gratified it.
Such were the general characteristics of the fever as it occurred in the Niger: but the description is not to be regarded as applicable to all the cases, for, on board of the Albert alone, there were several in which there was neither complaint nor evidence of suffering of any kind. There was a disinclination to be spoken to, or to be in any way disturbed; and a listless expression of countenance, with a clammy skin and small pulse. The periods of exacerbation were so feebly marked as to be scarcely perceptible: food and medicine were taken when offered, but seldom or ever was anything asked for; and the invariable answer to inquiries after their health was, "I am very well." Constant watchfulness was the only appreciable symptom in these cases, which all terminated fatally, seemingly from mere exhaustion. It would have been interesting to have ascertained the nature and amount of the organic lesions in these cases; but, unfortunately, circumstances did not permit any of the bodies being examined.
Contingent symptoms.-Of the contingent symptoms, the most prominent were delirium, yellowness of skin, and convulsions, affecting various parts of the body.
Delirium was a very bad symptom in the fever of the Niger: of twenty-one cases in which it occurred, fourteen died; of whom one was drowned by eluding his nurse, and jumping into the river. It was not uncommon for patients, whether affected with delirium or not, to be haunted by dreams of a frightful nature, -as of being drowned, stabbed, or falling from a precipice. In the worst cases the mental aberrations were expressive of some personal misfortune, or unbeard-of disease. The imposition of the slightest restraint was always a heavy grievance. In one case the patient constantly harped upon his being condemned to everlasting punishment: when reason for a while resumed her authority, he would express shame and contrition for previous misconduct. The most solemn promises to behave well, if left