MEDICAL REMARKS.
Psorophthalmia — Plague — Small-pox — Guinea
worm — Scrophula — Syphilis — Bile — Tenia — Hernia — Hydrocele —
Hemorrhoides and Fistula — Apoplexy — Umbilical ruptures —
Accouchemens — Hydrophobia — Phlebotomy — Remedies — Remarks —
Circumcision — Excision.
From the following
detached remarks, the result chiefly of personal observation, if
the physiologist can derive any amusement, or the traveller the
smallest mitigation of his personal sufferings, the purpose of
committing them to paper is answered.
If any medical professor should chance to advert to them, the
writer is too conscious of the superficiality of his own knowlege
not to perceive, that little satisfaction will be derived. But
persuaded, that the art of healing, even at this day, abounds
little less in experiments than in the age of one of its brightest
ornaments, who makes the confession, he is induced to believe,
scarcely any fact relative to it, or any experiment, faithfully
narrated, can be wholly destitute of its use.
It is remarked that in Egypt, but particularly in Kahira, the
blind, and those who have defective vision, bear a large proportion
to the number of the inhabitants. The fact observed, which cannot
be disputed, has been explained in various ways. It has by some
been considered as proceeding from the habitual use of rice. By
others, as the effect of the subtle dust which floats in the air.
Even the water of the Nile has been supposed to co-operate at
least, if not to be the sole agent, in producing this remarkable
disease.
To explore the origin of this or any other malady, all its
appearances must first be accurately noted. The ophthalmia of Egypt
leads us through a diversity of symptoms, from slight inflammation
and defluxion, to the total and irrecoverable blindness occasioned
by opacity of the Cornea. To enumerate them all correctly, and
compare them in a variety of cases, must be the task of an oculist
long resident on the spot, and accustomed to numerous patients. A
transient observer, however diligent in his inquiries, may more
easily prove the falsehood of the assigned causes, than trace the
real one.
The Nile water, it may be supposed, when taken into the stomach,
can have no effect on the eyes, but by first altering the state of
the fluids, into which it, as well as other aliments, is gradually
converted. Whether from mineral or vegetable impregnations, it
could never operate solely on the eyes, without affecting any other part of
the animal economy. The effect of opium is seen on the blood and
muscular fibres; of mercury on the glands and lymphatics; of
cantharides on the nerves: and too great a portion of these, taken
into the body, may have a pernicious effect on the eyes, but always
through the medium of other parts. The whole materia
medica, perhaps, furnishes no drug or mineral that is known,
when taken into the stomach, to have a local and partial effect on
the eyes. Such an effect is even irreconcileable with the general
and constantly observed operation of all remedies applied to the
human body.
Besides, if the injury were solely or even in part to arise from
the use of the Nile water, all those who drink it must be equally
affected, allowing for the different degree of firmness in the
stamina of each. But certain orders of men are rarely attacked by
this disease, and they too who are continually using the river
water both internally and externally.
Rice is one of the most nutritive and salubrious of the
farinaceous aliments, and certainly does not operate to render the
humours acrid, and thereby to inflame the eyes. It is used as a
main article of food by the natives of a large portion of Asia, and
forms no inconsiderable part of the consumption in other countries,
without being observed to produce any such effect as is here
attributed to it; and may therefore fairly be denied to have any
such power.
Something more
plausible indeed offers itself as to the injurious operation of an
external cause. Nothing can be more subtle than the dust into which
the vegetable soil of Egypt resolves itself when it becomes dry.
This, during a certain portion of the year, is in a manner
suspended in the air, from a cause which exists in few other
countries, I mean the want of rain. It also contains a large
portion of nitre, which is copiously produced in Egypt. This
circumstance, however, is common to many other places. This light
dust, doubtless of a very irritating quality, not only floats in
the streets, but pervades the apartments of every dwelling,
insinuating itself into the most artfully constructed inclosures:
by it therefore the eyes may and must be in some degree affected.
But Nature has not ordained that a part so much exposed should be
destitute of its appropriate protection. The secretions of the
lachrymal glands are, in general, abundantly sufficient to
counteract the injury sustained by the action of corrosive or
irritating substances on the external fabric of the eye, being
always produced exactly in proportion to the circumstances that
demand them, as daily experience confirms: yet it cannot be denied,
that the continually repeated operation of an offending cause, when
no remedy is applied, may be more than commensurate with the
efforts of Nature to restore herself.
Such is precisely the condition of the Kahirines. The
accommodating the quality of diet to the symptoms of derangement in
the economy is a precaution unknown to them: and of their remedies,
many are so prepared, or so administered, as to augment rather than
to annihilate disease. No idea offers itself to them, but of topical applications
to remove a local complaint. If any thing be applied in these
flussioni (dysophthalmia) it is generally kôhhel
(calx of tin mixed with sheep’s fat) or tûtti, a still
more powerful astringent, applied in coarse powder, and naturally
tending to increase rather than to allay the irritation.
When thus incommoded, the Egyptians of the lower class esteem
water pernicious, and therefore rarely wash their eyes; but as the
collected dust begins to cause an uneasy sensation, apply their
fingers or a coarse cotton cloth to remove it. The higher orders,
who are neat in their persons, and regular in their ablutions, are
rarely observed to be greatly harassed by this complaint. And the
progress of the disorder, when in its nascent state, has several
times been stopped, under my observation, by the use of rose-water,
solution of sacchar. saturn. &c. as in other places.
But as no single one of these causes, nor even all of them
together, appear sufficient to account for all the phenomena,
another, more powerful, is to be sought; and none suggests itself
more opportunely than that alleged by Savary, who imagines that the
defect of vision is principally brought about by the habit of being
exposed to the nocturnal air during the summer, at which season a
heavy dew falls, and a great transition happens from the heats of
the day. In fact, if the face of those who sleep exposed be not
completely covered, an itching and unpleasant sensation is always
felt in the eyes at rising.
It is ordinarily
experienced in the city, where, from being confined in the day,
people feel most disposed to seek for coolness and refreshment on
their terraces at night.
The Mamlûks, and higher order of Arabs, that is, Mohammedan
merchants, and the superior rank of Copts and Franks, are least
affected, as being cleanly, not exposing themselves to the night
air without necessity, and being well covered. The Arabs of the
desert are as free from blindness as any people. They never sleep
with the face exposed, and have moreover the advantage of being
devoid of the dust and other supposed causes of psorophthalmia in
the city. The disorder appears no where so much as in Kahira,
because no where are all the causes so much combined: yet it is
seen in Alexandria, Damiatt, and in Upper Egypt, which shews that
the cause is not confined to Kahira. Among the poorer class of all
countries prevails a kind of insouciance. That of Kahira
is particularly exposed to the changes of temperature and the
nocturnal dew, and is ill clothed. Hence the disorder is mostly
found among the populace. A disposition to inflammation often
appears in the eyes of children, but yields to proper remedies.
Hence it may be imagined, that with attention the Egyptians would
not suffer more than other nations.
Some travellers have thought that the ophthalmic disease in
Kahira was occasioned by the fetid exhalations of the Chalige, and
the drains; and have even observed, that those who are most
severely affected in winter, recover as soon as the water has
filled the Chalige and the pools. This is also a common
idea with the
natives. “The stink blinds me,” is a frequent expression on coming
into a place of fetid odour; and it may be remarked, that the
ordinary maxims of indigenæ are rarely to be entirely
disregarded. Whatever miasms however may issue from the canal, they
cannot be equally dispersed over the city, as blindness is; and the
Franks, Greeks, and other strangers who reside nearest this depôt
of impurity, would be most affected if that were the cause. It may
yet be one cause. Another I take to be the subtile dust above
mentioned; but the most powerful, indiscreet exposure to the
nocturnal air and dews. The collective influence of these is
strengthened by the cloudless splendour of a vertical sun,
reflected from the sterile expanse of sand, which offers no
sombrous object on which the eye may repose itself.
These considerations, it may be acknowleged, do not carry
conviction; but too many local diseases are yet unexplained, to
leave any wonder if the cause of this should yet remain
problematical.
All the improvements in the art of healing which modern Europe
can boast as its own, are the result of more frequent experiment,
and more patient and minute investigation, than existed in the
antient.
To conjecture ingeniously is a matter of small effort, and in
treating of what is properly the object of experiment, it is
not only of no
value, but often of dangerous result. But it is suited to the
indolence of the human mind, and flattering to personal vanity,
which delights to perform much by a single energy. Hence, an
hypothesis supported by some insulated fact, perhaps only by
specious error, is often advanced with warmth, and the most
important considerations militating against it, are forgotten, or
warped to serve the purpose of the inventor. Thus the increase of
the Nile was once confidently attributed to the Etesian winds; and
the malady which has so often almost depopulated Kahira, is still
by some imagined to proceed from the putrid deposition of its
waters.
We have at length disposed ourselves to the habit of tracing the
cause of disease, by combining a number of minute, and often
varying, symptoms. A practice which, if correct in its detail, can
never but be accurate in its deductions. Relative to the Plague,
however, whose very name distracts the timid, and appals even the
courageous, our reasonings and our deductions are quite of a
different description. Respecting its cause, all is conjecture. No
experienced or well-informed practitioner has watched the bed of
the sick; none has accurately examined the different appearances
which the disease assumes in different persons, nor even in its
different stages, in the same person. Scarcely any, it is believed,
has been tranquil enough to hear patiently from the mouth of the
sufferer an account of his sensations, which, recounted by a third
person, never fail to vary.
Where this malady appears, the physician and the priest, the
pride of science and the security of faith, confident
and boastful when
the patient alone is threatened, are both equally alert in their
efforts to escape. The ignorant and unreflecting Muslim, indeed,
awe-struck, and resigned to the unalterable decree of Fate, hangs
over the couch of his expiring relative. But the report, guided by
prejudice, is likely to mislead, and the observation can be of
little value when the sole sentiment is stupor.
Thus the Plague remains almost destitute of a local habitation,
though it have a name in nosology.
Who can at this day determine, whether the pestilence mentioned
by Thucydides be the same as that of Modern Egypt and Turkey? Or
whether the epidemical diseases, which have for several centuries,
at intervals ravaged different parts of the Turkish empire, have
been all specifically the same? The Europeans frequenting the
Levant, have written profound treatises on the plague, simply from
having seen a quantity of dead bodies carried past the doors of
their houses, which the double optics of fear have occasionally
magnified from 500 to 10,000.
The facts that appear chiefly to be ascertained relative to the
plague, are, 1st, That the infection is not received but by actual
contact. In this particular, it would seem less formidable than
several other disorders. 2. That it is communicated by certain
substances, by others not, as by a woollen cloth, or rope of hemp,
but not by a piece of ivory, wood, or a rope made of the date tree;
nor by any thing that has been completely immersed in water. It
would appear from the report of the Kahirines, that no animal but man is
affected with this disorder; though, it is said, a cat passing from
an infected house, has carried the contagion. 3. That persons have
often remained together in the same house, and entirely under the
same circumstances, of whom one has been attacked, and died; and
the others never felt the smallest inconvenience. 4. That a person
may be affected any number of times. 5. That it is more fatal to
the young than the old. 6. That no climate appears to be exempt
from it; yet, 7. that the extremes of heat and cold both appear to
be adverse to it. In Constantinople it is often, but far from being
always terminated by the cold of winter, and in Kahira by the heat
of summer; both circumstances being, as may be conjectured, the
effect of indisposition for absorption in the skin, unless it be
supposed that in the latter case, it may be attributed to the
change the air undergoes from the increase of the Nile.
The first symptoms are said to be thirst; 2. cephalalgia; 3. a
stiff and uneasy sensation, with redness and tumour about the eyes;
4. watering of the eyes; 5. white pustules on the tongue. The more
advanced symptoms of buboes, fœtor of the breath, &c. &c.
are well known; and I have nothing authentic to add to them. Not
uncommonly, all these have successively shewn themselves, yet the
patient has recovered; in which case, where suppuration has had
place, the skin always remains discoloured, commonly of a purple
hue.—Many who have been bleeded in an early stage of the disorder,
have recovered without any fatal symptoms; but whether from that or
any other cause, does not appear certain. The same operation is
reported to have been commonly fatal in a late stage. It is said
that embrocating the buboes continually with oil has sometimes
wrought a cure; but this remedy is so difficult and dangerous for
the operator, that it would appear experiments must yet be very
defective. The natives of Kahira are too supine to seek for any
remedy, and too bigoted to avoid the danger.
The plague which happened in Egypt so early as the year 1348,
when Constantinople was yet subject to the Greek emperor, and Egypt
in possession of Mohammedans, may be supposed to have originated in
the latter. But not to mention that there were many other places
from which it might be brought, this single instance, not given in
detail, is insufficient to overthrow the testimony of the modern
inhabitants, who with one consent affirm, whether Mohammedans or
Christians, that the plague is not endemial in Egypt, but that all
the instances of it which they are able to trace are proved to have
been derived from abroad.
The learned Dr. Mead has brought the plague from Ethiopia, where
famine and the small-pox indeed carry off numbers; but where the
plague was never known to exist. It is not remembered to have
penetrated far into the Upper Egypt, except in some few instances,
when it was known to have been carried thither by the boats from
Kahira. No more is required to account for its introduction into
Egypt at this day, than the admission, that it is never completely
extinct at Constantinople, which, it seems, has scarcely been
denied.
The imagination
of one of our poets has drawn the pestilence from the filth of
Kahira, and the mud of the Nile. But, not to mention that there is
less disposition to fermentation and putrefaction in the atmosphere
of Egypt, than in almost any other that I have heard described,
Kahira is very far from being impure. No offensive substance
remains in the streets twenty-four hours; and even what is left to
annoy passengers in London and Paris for months, is there carried
away and preserved for burning.
The mud of the Nile becomes dry in a very short space of time
after the water has left it, except in the canal (Chalige) which is
indeed not very odoriferous; but so far from emitting pestilential
exhalations, that the Franks who especially dwell close to it, are
never infected with the plague, and are in general among the most
healthy of the inhabitants of that metropolis.
The small-pox is a disease much dreaded by the people of Soudân,
whether Moors or Negroes, and little less by the Bedouins of Egypt.
The Christians of Kahira are many of them in the habit of
inoculating. A few of the Mohammedans use the same practice. It is
however almost impossible to persuade them to adopt our mode of
treatment.
Independently of
the general ill consequence of improper management of the patient,
the chief reason of the extraordinary fatality of this complaint
among the negroes, appears to be the thickness of the skin, which
resisting the effort of nature to protrude the morbid matter to the
surface, tends to throw it back into the circulation. A proprietor
of slaves, who was rather anxious for the conservation of his
property, than scrupulous in his attachment to religious prejudice,
desired me to inoculate five of them. A strong dose of senna was
administered as preparative, and they were afterwards restrained as
to diet. Three of them had not in the whole forty pustules, and
soon recovered. The other two suffered much; and the eruption,
though not confluent, proved fatal to one of them. Whether he had
caught it before, been improperly treated, or whether it was the
effect of habit of body, was not clear. These were of the true
negro cast, called, Fertît. They were all under twelve
years of age.
The Mohammedans of Fûr, and the Arabs, call the idolaters in
their neighbourhood Fertît, (فرتيت
à فرت improbus fuit). The disease
called the Guinea Worm is known among them by the same name. It is
extremely common, and very troublesome to the slaves, and sometimes
to free persons. It is by some esteemed contagious, which however
is rather surmised than certified. It consists of a whitish tumour,
at first hard and painful. Often shews itself about the knee, in
the fleshy part of
the thigh, and in the foot, just below the instep. As it is
matured, a small white worm appears, which is to be wound off by
degrees, and in coming out is followed by the discharge of purulent
matter. If broken in the extraction, it is sometimes very
inconvenient, and often lasts four or even six months. There is no
certain cure for this disease, which most frequently shews itself
in the beginning of winter, after the rains; but generally
disappears at the commencement of the hot season. It seems to
originate in the water, which is replete with animalcules, and
which no care is used to purify.
They find by the termination of the tumour the extremity of the
worm, which they call wullad-el-Fertît, and in that spot,
puncture the skin with a red-hot iron, which they conceive forces
it out; but which always appeared to me a painful operation,
without any kind of effect. There is observed in some individuals a
greater disposition to this disease than in others, but it is not
confined to age, sex, or colour.
The scurvy is very uncommon in Egypt and Syria. In the former I
saw no instance of it. In Dar-Fûr I have observed it in the gums,
but never any general dissemination of scrophulous humour appearing
in the blood. As the transpiration is seldom interrupted, and
generally copious, it must doubtless carry off much of the acrid
humours, and prevent their accretion. Salt provisions, which
generate the scurvy in the North of Europe, are almost unknown; and much of the
diet of the people consists of vegetables. All these circumstances
have their influence, but none of them perhaps so much as the
Nile-water, which is a perfect solvent; and by the change of its
component parts during the increase, has a particular tendency to
throw off impurities from the blood.
The disease which attacks the principle of generation, and
destroys, in its source, one among the few solaces with which human
life is sparingly diversified, which the heroism and the
philanthropy, or the ambition and the avarice, of Europeans have
propagated wherever the malign destiny of other nations has
ordained that their dominion should be established, does not appear
in Egypt with all the terrors that mark its course in other
countries.
The temperature, the air, the mode of living, perhaps simply the
first, which maintains continued transpiration, render it much
milder in its effects than with us, or even in the islands of the
Archipelago.
The institutes of the Prophet, indeed, have tended to diminish
promiscuous concubinage, yet there is no such deficiency as to
impede the propagation of the disease, if it were as virulent as in
other places.
Ulcers of long
duration, noseless faces, and all the disgusting consequences of
this malady are indeed occasionally visible. But they are in very
small number, and notoriously the result of extreme negligence, and
of repeated infection, where no means have been employed to
exterminate it.
It may truly be esteemed fortunate that this disease prevails
with no violence in Egypt, for its only certain remedy, mercury, is
there found much less efficacious than in the more temperate
latitudes. Administered even in smaller doses than in Europe, it is
said ptyalism is either produced very early, or it passes off with
the fæces, without any visible effect.
A Frank practitioner of Kahira, accustomed to the climate,
ordered two drams of Mercury in thirty pills, with Gum Arabic and
Syrup of Cichory, to be taken one a day. In this case, he declared,
that the pills having been administered during the first seven
days, and then, with the intermission of three days, two having
been given each day for five days more, had produced no visible
effect on the disease, but passed off by stool. In other cases he
had known much smaller doses, in the space of two days, had caused
inflammation of the salivary glands, and he was obliged to abandon
the use of it, and have recourse to other means of cure.
The natives, who are unacquainted with the use of mercury, and
indeed of minerals in general as employed internally, are yet
provided, as they say, with efficacious remedies for the venereal
disease. They use flax oil, fresh, as it is expressed, from the seed. A Greek, who
was in the service of Murad Bey as a mariner, (galeongi,)
and who was known to me in Kahira, had been infected, and on
applying to a Frank physician, was told that it would be necessary
immediately to use mercurials. The man was not inclined to
confinement or to regimen, and went to a Copt at Jizé, who
professed to relieve the sick. This man ordered him to take two
coffee-cups of flax oil every morning fasting, and directed no
regimen, but that of keeping himself warm. The Greek observed none,
for he continued freely the use of aqua vitæ, and even
sacrificed to Venus, (for persons who have been once infected and
fully cured, are, it is said, in no fear of reinfection,) and was
often in the heat of the sun. He had continued this method for two
months, when a general eruption took place over his body, but
chiefly about the head and glands of the throat. In this condition
I saw him. His Esculapius ordered him to cover the pustules of his
face with a kind of red earth, found in some parts of Egypt. They
gradually became dry, and came off without leaving any mark. At the
end of the third month from the time he had applied to the Copt,
and one month after the appearance of the eruption, the man was in
perfect health, and the skin had completely recovered its tone and
polish.
In the cure of the simple gonorrhea, a decoction of mallows is
commonly used, and they seem to place their chief confidence in
diuretics. I never heard of an injection, but from those who were
acquainted with European practice. Certain herbs and roots
macerated, are applied locally in case of inflammation and tension
(chordee).
Shankers,
&c. externally, are repeatedly washed with soap and water, and
then kept covered with the red earth above mentioned. I never saw
the effect, but the cure is said to be rapid.
In Dar-Fûr I have not observed the venereal disease more
formidable than in Egypt. I saw a few individuals who were
mutilated in the organs of generation by its effects.
The old women, who are physicians in ordinary, use a decoction
of certain roots, of which I never came at the knowlege, infused in
bouza, which appear to operate successfully. Gleets are
frequent; and continued indulgence produces early debility and
impotence.
The great advantages of the étuves, or warm baths, is
evident in very many instances in Kahira. But it is difficult to
admit Savary’s assertion (vol. i. p. 108) in its full extent, viz.
that they operate as a radical cure of the venereal disease. They
doubtless assuage many of its graver symptoms.
In no country are pulmonary diseases more rare than in Egypt,
which could not happen if the baths had any tendency to cause
them.
The leprosy is more frequent in Syria than in Egypt. It exists
however in the latter country, with all its
concomitants of
swelled and distorted joints, a livid, spotted, parched, and
cracked skin, &c.
I have seen it under all its forms of Borras,
Jiddâm, &c. In Kahira there is no provision for the
unhappy sufferers, who are allowed to beg about the streets, but
forbidden by their religion from the contact of others, and
excluded from society by an inefficient police. I have heard of a
cure of the leprosy in its worst stage, by the use of corrosive
sublimate in small doses. The natives seem not to know any
specific.
In Dar-Fûr, the Borras, which is not uncommon, gives to
the blacks the appearance of being pyebald, changing to
white both the skin and hair. A case of, what I was convinced was
Jiddâm, beginning in the hands, was cured under my
observation by a slave, a native of the kingdom called
Baghermi, but the means he had used he could not be
prevailed on to disclose.
Complaints proceeding from too copious secretion of bile are
extremely common both in Egypt and Dar-Fûr. Murâr, the
bile, or gall, is the generic name for all diseases of this kind,
at least in their nascent state; for they are not solicitous in the
choice of names, till distinct appearances teach them to seek a
more characteristic appellation. There seems to be no efficacious
remedy for these maladies, and therefore they take their
course; and all the
inconveniences consequent upon them are common, and increased by
general inattention to diet.
The tuhhâl, or tehhâl, deriving its name from
the spleen, morbus spleneticus, is very frequent. One of
its outward symptoms is a tumor hard to the touch, but subject to
increase and diminution, in the neighbourhood of the spleen, and
general inflation in the supra-umbilical region.
In Egypt Christians and the less scrupulous Mohammedans use
aqua vitæ to remove the present sensation. It operates as
an anodyne, which is all they seek. In Dar-Fûr the leaves of senna
pulverised, and, by admixture with honey, formed into balls, (the
common cathartic,) is the only medicine administered with any
salutary effect. I found James’s powder of great service to those
with whom it operated as an emetic. The distention of the spleen
prevents the stomach from receiving a proper quantity of food, yet
the inclination for food is undiminished.
The liver being rendered incapable of its functions, by repeated
extravasations of bile, the blood, which at all times circulates
slowly from the spleen through that gland, now much retarded,
occasions schirrosities of the spleen, and at length perfectly
stagnant in and distending it, it becomes corrupted by the fæces
contained in the colon near it, and begins to putrify. In this
state the disease frequently terminates in death. But these
schirrosities sometimes remain for years, without producing any
very dangerous symptoms.
The passage of
the bile into the intestines being intercepted, having passed from
the gall bladder to the liver, it at length returns to the blood,
which occasions the jaundice, another disease not uncommon
among the Fûrians, termed by them Saffafîr, and, among the
blacks, first visible in the eyes.
To alleviate the effects of any unusual increase of the cystic
bile, the natrôn of the country is very efficacious.
From the nature of their diet, which consists in a great degree
of vegetables and fruits, with a large portion of sugar, honey,
&c. the inhabitants of Egypt, of all denominations, are
particularly subject to the Tenia or tape-worm (Dûd Ar.) I
have seen pieces of vast length preserved by the European
physicians, who yet appear to have found no specific for it. The
natives mistake the symptoms of this disease, ascarides, &c.
for distinct maladies, and treat them accordingly. The commonalty,
Jews, and devout Christians, who unremittingly use insalubrious
food during their fasts, are most affected with it, though
none are exempt. In those who are thus incommoded, a tumor commonly
appears about the navel, and discoloration of the skin next the
eyes.
Bruce seems to be of opinion, that the great prevalence of
worms, with which the Abyssins are much afflicted,
proceeds from the
common use of raw meat. Not to mention that it is not yet proved
that the habitual use of raw meat generates worms in the human
intestines, that complaint cannot well be more common than among
the people of Egypt, who never use meat but when fully prepared by
fire.
Ruptures are common in Egypt, chiefly among the lower orders,
particularly the boatmen, few of whom are seen without a greater or
less degree of this dangerous accident, and to many of whom it is
fatal. Their life is almost amphibious, and it may in some measure
be the effect of the pendent situation of the parts; but it seems
chiefly to arise from the exertions they are obliged to make in
lading and unlading their boats, and propelling them, as frequently
happens, by applying their shoulders. In the people of this city,
who carry heavy loads on their backs, and raise great weights, it
is also common. Clumsy and ineffectual trusses are made in Kahira,
which rather distress and embarrass than relieve or secure the
patient. The scrotum is sometimes cauterized, and with effect, if
the intestines be not incarcerated. In Dar-Fûr this disease is
uncommon; yet it is sometimes seen there.
The hydrocele is remarkably frequent in Syria, and, above all,
in the town of Beirût. It is also frequent in Egypt, but
most among the
Christians of both countries. Some attribute it to the Nile water;
others to the air; others to the use, or rather abuse of aqua
vitæ; others to food of a particular kind: none of which seems
to be the real cause. The natives of both countries have a method
of inciding securely, which discharges the water, and of course
produces temporary relief: but the malady is rapidly regenerated.
The only radical cure is the actual cautery, which, though
unskilfully, is yet successfully applied to such patients as are
bold enough to encounter the danger.
The hæmorrhoides (bowasîr) are very common both in
Egypt and Dar-Fûr. In the latter, they cure them by the cautery.
The Fistula in ano is also seen there, and is cured by a
topical application, but without incision.
I have known two instances in Dar-Fûr of what appeared to me to
be apoplexy. The one was of a male slave, about sixteen years of
age, the other of a man about forty; both of them of plethoric
habit. The boy dropped down senseless, after having been standing
near a large fire in cool weather. Pulsation ceased, and a great
hæmorrhage took place from the nostrils. After one hour and a half
he expired. Bleeding was recommended to the proprietor, but the
by-standers would not consent, saying it was Sheitân, the devil
had possessed him. The man was dead before I saw him; much
extravasated blood appeared about him. He had been at work in the
sun. The coup-de-soleil, properly so called, does not
often occur. When much exposed in walking or at work, they protect
their head from the ill effect of the rays descending
perpendicularly, by winding their shirt round it, and leaving the
trunk uncovered.
Among the slaves, and even free persons in Dar-Fûr, prominencies
of the navel, and umbilical ruptures, of greater or less magnitude,
are very common. Though the chord be remarked to be larger in the
negroes than with us, this circumstance must probably be occasioned
by ignorance, carelesness, or some mismanagement at the birth. It
does not appear to be attended with positive inconvenience. The
chord, when divided, is here cauterized as in Egypt.
The accouchemens of the Arabian females are remarkably easy.
There are stories of the Bedouîn women sitting down near a water
and delivering themselves. Certain it is, that both the Mohammedan
and Coptic females in the cities and towns are equally averse from
the attendance of a man on these occasions; and however unskilful the accoucheuses
may be imagined, few accidents have place.
The women of Fûr, in like manner, are assisted by their own sex,
and are seldom long confined: yet nature seems to render
child-bearing more difficult to them than to the Egyptians, and
their care after delivery is not always such as to prevent both the
mother and the child from suffering. I have known several instances
where cold caught after the accident has proved of serious
consequences to the mother.
The rabies canina, or hydrophobia, is either very
unusual or entirely unknown both in Egypt and Fûr. I never heard of
an instance of it in either country, which appears not entirely
unworthy of remark, not only as multitudes of dogs are found in
each, which in many instances can have no access to water, to the
want of which was once vulgarly attributed that dreadful malady,
but as one fact more in the series which must finally conduct us to
its cause.
Among the inhabitants of Egypt and Africa the classification of
remedies is remarkably simple. They have only two grand
divisions, مبردات refrigerants, and
حمه heating medicines. They esteem all the former
beneficial, and the latter generally pernicious: so that if the
most skilful physician were to prescribe for his patient what the
latter supposed to possess an heating quality, it would be
impossible to persuade him to use it.
Scarification, or superficial incision of the skin, is commonly
recurred to for various diseases, and at all ages, from two years
till sixty. The head, breast, loins, legs, are all subjected to
this simple and apparently little efficacious treatment. Sometimes,
however, violent and obstinate pains in the head, proceeding from
extraordinary exertion, and other causes, are removed by
superficially inciding the skin, near the coronal suture, which
occasions a sufficient discharge of blood.
The other mode of bleeding is by horns, prepared for that
purpose, which operate on the same principle as our cupping
glasses. These are applied in a very simple manner, and without
occasioning any pain, remove such quantity of blood, as the
operator judges necessary. Adhesion is produced by applying the
mouth to the smaller aperture of the horn, which, when this is
accomplished, is stopped. The incision is commonly made with a
razor.
The bitumen found in the mummy pits is dissolved with butter by
the Egyptians, and not only applied externally, but taken inwardly,
in large doses, for bruises and wounds; it is said to have a
surprising effect.
Petroleum, which is brought from the western shore of the
Arabian gulf, near to Suez, is taken inwardly as well as outwardly
applied, and is much esteemed.
The Orientals have still great confidence in the
bezoar, or benzoar. For a small one they are, not
unfrequently, contented to pay a sum equal to seven guineas. Even
the European physicians administer it in some cases pulverised, as
an alterative, and, as they say, with success.
Perhaps none of the drugs of Egypt is more extensively useful
than sal ammoniac. That medicine seems, as it were, a
specific, carefully
provided, for the prevailing diseases of the country. Acting
mildly, both as a carminative and diuretic, nothing is more
effectual to remove the cephalalgia and lassitude often experienced
during the great heat, which precedes the Nile’s augmentation, than
a few drops of this spirit taken in water. Pulmonary complaints,
occasioned by bad air, the suffocating heat of the southerly winds
at certain seasons, and the ill effect of sudden transition from
the burning heat of the sun to the chilling nocturnal dew, are
often relieved by it. It might even be suggested, that as regular
and continued transpiration seems very adverse to pestilential
infection, a proper use of sp. sal. ammon. might not be wholly
contemptible as an antidote to its infection.
No part of the materia medica is so much in requisition as those
which stimulate to animal pleasure. The lacerta scincus,
in powder, and a thousand other articles of the same kind, are in
continual demand. For this chiefly fields are sown with
hashîsh, the bang of the East Indies. It is used
in a variety of forms, but in none, it is supposed, more
efficaciously than what is in Arabic called Maijûn, a kind
of electuary, in which both men and women indulge to excess. The
impotence of age, and the languor of satiety or disease, ponder in
vain the oracles of the descendant of Ismaîl, for the invigorating
influence of the benign deity of Canopus.
A great and striking difference as to the firmness and density
of the skin, between the negro and the white, whether it may or may
not be called specific, as far as relates to the animal,
is the cause of several peculiarities, as well when they are in
health as under the power of disease. In all cutaneous maladies, or
such as ultimately relieve themselves by suppuration, the
sufferings of the blacks are excessive. Blows of the whip, which in
a white subject would become encysted tumors, discharge, dry up,
heal, and disappear in a few weeks, often remain in a negro more
than a year.
The bright red colour of the muscular fibres, an apparently
stronger power of contraction, and the whiteness, solidity, and
weight of the bones, constitute other peculiarities. The eyes have
generally very distinct vision. There are few instances of myopes,
and blindness is very uncommon. The teeth are white and firm; they
rarely complain of odontalgia, and retain their teeth to old age.
Both the Fûrians and neighbouring negroes are attentive to preserve
them clean, which is done by rubbing them with the small fibrous
branches of the tree called Shaw.
Natrôn is much used as a veterinary medicine.
As often as the
camels, horses, asses, sheep, &c. drink, a large piece of it is
put into the trough of water. The natives conceive that it renders
them more eager of their food, and thus tends to fatten them. Some
camels refuse it, but in general they acquire a preference for that
water which is most strongly impregnated. When they refuse it, the
natrôn is pulverized, formed into balls, with the flour of maize,
and forced down their throats before they drink.
For the human race natrôn is used to remove the head-achs,
intermittent and remittent fevers, &c. which prevail during the
rainy season. Two or three ounces of crude natrôn are dissolved in
water, and taken fasting. It operates as a drastic purge, and with
some as an emetic. With robust and plethoric habits, there seems to
be no inconvenience from the use of it, but I experienced from it
an unfavourable rather than beneficial effect.
The tamarind, Thummara Hindi[51]
one of the most useful as well as valuable of the productions of
the country, supplies the want of many others. In defect of lemons
and other acids, this fruit, mixed with water, constitutes an
agreeable and refreshing drink. When dried by beating in a mortar,
it is formed into cakes, each of 2 or 300 drams in weight. The
decoction of it is
a mild cathartic, and also operates as a diaphoretic; and the
natives attribute to it superior virtue as an antidote against
certain poisons.
Savary remarks, that in Egypt each mother affords nourishment to
her own infant, even in compliance with a command of the Prophet,
and that this prevents many diseases. No doubt can exist that the
milk of the mother, long secreted and reserved for the child, is
the proper nourishment at the birth, and by its acrid quality tends
to facilitate the evacuation of the fæces, accumulated during the
period of gestation, much better than any thing that can be
substituted in its room. But when this effect is once produced, in
many cases the milk of any other woman may be better than that of
the mother; nay, that of the mother may be insalubrious à
principio; and it is as yet far from being proved, that the
milk of the mother is in all cases the best possible milk for the
child.
If the mother abstain not from the male embrace, and become
gravid, the milk becomes, as is well known, poison to the
offspring.—The Arabic language has even a single word to express,
quæ lactans consuescit viro, which they conceive extremely
injurious.
The use of opium, as is well known, is carried to excess in
Constantinople. Some persons have so long accustomed themselves to
that powerful drug, that a dose of two drams, or more, will have no
effect in exhilarating them, or producing that agreeable stupor
which they seek. In such cases, they will swallow, in a convenient
vehicle, several grains, to the amount, it is said, of ten, of
corrosive sublimate of mercury, as a stimulus.
This effect of opium, as an antidote to one of the strongest
mineral poisons, appears incredible, and would scarcely have been
related, but on authority the least questionable. A reflection has
in consequence forced itself on me, which I offer as a query.
Mithridates, king of Pontus, is said to have so fortified himself
with antidotes, that when misfortune obliged him to have recourse
to poison to terminate his existence, though repeatedly
administered to him, under different forms, it had no effect.
Pontus, at that time no less than at present, furnished the best
opium. Could Mithridates have used any antidote so powerful? And
was not this effect of that drug more likely to be known in its
native country than any where else? It may possibly be replied,
that mineral poisons were not then in use, and that to the small
number of vegetable ones then known, many other antidotes, capable
of producing the same effect, might have been found. It is not
however enquired, whether single antidotes might not have been found
to obviate the influence of distinct poisons, but what could
produce so complete a change in the human body, as that no poison
should have any effect on it?
The practice of circumcision may be traced to such remote
antiquity, that its origin baffles all research: yet apparently its
history has not received all the illustration of which it is
capable from a diligent collection of facts. It has been ascribed
to the structure of the organs, in certain countries, which it is
said impede coition, or facilitate the appearance of morbid
symptoms. But what may have been perfectly true of individuals, it
may perhaps not be permitted to assume with regard to a whole
nation, much less with relation to the inhabitants of an extensive
region.
Among the Fûrians circumcision appears to be no other than a
religious ceremony, performed in compliance with an express command
of the author of their faith; and it is very doubtful whether it
was ever practised among them before their conversion to
Mohammedism. It is now often neglected till the male have attained
the age of eighteen or more years, and this omission seems to be
considered by them as a matter of indifference; nor are there
persons who habitually and regularly exercise that art, as in Egypt
and other Mohammedan countries.
The excision of females is a peculiarity with which the Northern
nations are less familiar: yet it would appear, that this usage is
more evidently founded on physical causes, and is more clearly a
matter of convenience, than the circumcision of males, as it seems
not to have been ordained by the precept of any inspired
legislator. A practice so widely diffused, it may be said, was
hardly invented but to remedy some inconvenience commensurate in
its extent. But, if so, how happens it that one race of idolatrous
negroes, near Fûr, has a habit of extracting two or more of the
front teeth of children before puberty? That it is customary with
another race, in the same quarter, to file the teeth to a
point[52]? that other nations cut open a second mouth?
and innumerable other singularities which prevail among savages,
and are as little to be reduced to any principle of convenience or
utility.
This excision is termed in Arabic Chafadh خفض, and the person who performs it خافضة. It consists in cutting off the clitoris a little
before the period of puberty, or at about the age of eight or nine
years[53].
Strabo is
apparently the first who mentions this custom, which is
nevertheless undoubtedly very antient. Lib. xvii.
—και τα παιδια περιτεμνειν, και τα θηλεα εκτεμνειν, &c.
By the terms very well marking the distinction between this
operation and the circumcision of males.
The Mohammedans of Egypt conceive it to have no connexion with
their religious creed. Similar are said to be the sentiments of the
Christians of Habbesh. In Dar-Fûr many women, particularly among
the Arabs, never undergo excision: yet it has not been my fate to
see or hear of any of those κλειτοριδες μεγαλαι which are supposed
to have brought it into vogue.
Thirteen or fourteen young females underwent خفض in an house where I was. It was performed by a
woman, and some of them complained much of the pain, both at and
after it. They were prevented from locomotion, but permitted to eat
meat. The parts were washed every twelve hours with warm water,
which profuse suppuration rendered necessary. At the end of eight
days the greater part were in a condition to walk, and liberated
from their confinement. Three or four of them remained under
restraint till the thirteenth day.
It often happens
that another operation accompanies that of excision, which is not,
like the latter, practised in Egypt, viz. producing an artificial
impediment to the vagina, with a view to prevent coition. This
happens most frequently in the case of slaves, whose value would be
diminished by impregnation, or even by the necessary result of
coition, though unaccompanied by conception. But it is also adopted
towards girls who are free; the impulse being too strong to be
counteracted by any less firm impediment. This operation, like the
former, is performed at all ages from eight to sixteen, but
commonly from eleven to twelve; nor are they who undergo it always
virgins. In some the parts are more easily formed to cohere than in
others. There are cases in which the barrier becomes so firm, that
the embrace cannot be received but by the previous application of a
sharp instrument[54].
Among some tribes of blacks, there exists a practice of piercing
the skin in certain forms by way of ornament.—Each of the punctures
leaves an indelible scar, as distinctive as colour, which is not
used. This practice, which is of the same description as that of
some of the South-sea islands, is used on the face, breast, loins,
&c.
The blacks who are castrated for the use of Kahira or
Constantinople, undergo that operation in the Upper Egypt,
before their
arrival at the former; some families, there resident, having the
hereditary exercise of this antient practice.
The numbers which undergo it are not very considerable, and it
is fatal only to a very small proportion of them.
Those slaves which are emasculated for the exclusive use of the
Fûrian monarch suffer within his palace.