/ MEDICAL - :• — AND TOPOGRAPHICAL OBSERVATIONS UPON THE MEDITERRANEAN ; AND UPON PORTUGAL, SPAIN, AND OTHER COUNTRIES. by g. r. b. Corner, m.d., u.s.n., SURGEON TO THE TJ. S. NATAL ASYLUM, AND HON. MEMBEll OE THE PHILADELPHIA MEDICAL SOCIETY. | * WITH ENGBAVINGS, HAS WELL, BARRINGTON, AND HAS WELL, 293 MARKET STREET. 1839. Entered, according to Act of Congress, in the year 1839, by Ha swell, Bar- rington, and Haswell, in the Clerk's office of the District Court for the Eastern District of Pennsylvania. TO THOMAS HARRIS, M.D, U. S. NAVY. Sir: After maturely reflecting to whom the Dedication of this Work ought to be made, I have concluded that no person has a juster claim to it than yourself; and the friendship you have so often manifested for me, your high professional attainments, and the great estimation in which I hold your reputation as a physician, and your character as a citizen, have de- termined me to pay you this small tribute of regard and respect. I am, respectfully, Your obedient servant, G. R. B. HORNER. August 1, 1839. CONTENTS. PAGE PREFACE 9 GENERAL OBSERVATIONS .... 11 Climate of the Mediterranean .... 13 Tides and Currents of the Mediterranean . 17,18 Diseases incidental to the Crews of Vessels cruising in the Mediter- ranean ....... 20 Pulmonary Diseases — pleurisy, pneumonia, bron chitis, asthma, phthisis, &c. 21 Treatment . . . . - . 22 Hepatitis and icterus, jaundice, ophthalmia, bowel affec- tions, diarrhoea, dysentery, enteritis, cholera 23 Asiatic cholera ..... ib. Small-pox ..... 2t> Fevers . . .... 28 Special observations upon the Mediterranean, and upon Portugal, Spain, and other countries .... 31 LISBON, And the Medical Institutions of Portugal 33 Climate ..... 35 Diseases ...... 36 Public Institutions .... 3? City Library . . . . \ . 38 Hospitals ...... ib. Medical Institutions of Portugal . 40 Salaries of Director and Professors . 42 Of the Students .... ib. Schools of Pharmacy .... 44 SPAIN 45 Seville, and its environs ..... 47 Public Institutions .... 48 Hospitals ...... 49 Climate 50 6 HORNER'S OBSERVATIONS. SPAIN — continued. Cadiz, and the country adjacent Public Institutions of Cadiz Hospiciisde Espositos Hospicis de Caridad The Female Hospital Hospicis de Viridas Hospital of St. Juan de Dios The Military Hospital and Medico-Chirurgical College The Academy of Medicine and Surgery . Climate ..... Diseases ..... GIBRALTAR . Climate and Botanical Productions Zoology — Birds — Fish Town of Gibraltar .... Hospitals — Civil and Military Diseases ..... Algesiras and Malaga .... Present Condition of the Profession of Medicine in Spain Royal Academies of Medicine and Surgery Libraries and Cabinets Revenue ..... Royal Colleges of Medicine and Surgery Of the Professors .... Of the Course of Instruction Of Exemptions .... Of the Students .... Of Examinations .... Oaths taken, and Modes of conferring Degrees Of Surgeon-Bleeders and Mid wives Of the Funds of the Colleges and Faculty Penalties for Practising without Licences . Medical Corps of the Spanish Navy . Medical Staff of the Army The Medico-Cirujanos Duties of the Military Faculty . Salaries, Allowances, Rank, &c. . Hospitals ..... Regulations respecting the Mineral Baths and Springs of Spain MINORCA .... Climate Minerals. — Geology Soil Botany Animal Kingdom Birds PAGE 52 55 ib. ib. 56 57 ib. 59 ib. 61 62 63 65 66 67 68 71 72 73 74 80 ib, ib. 83 ib. 86 87 88 90 92 93 94 97 ib. 98 98 101 102 103 108 ib. Ill 113 ib. 117 ib. CONTENTS. MINORCA — continued. PAGE Reptiles ... .119 Fish .... ib. Zoophytes, or Radiated Animals 122 Agriculture 125 Diseases .... 127 Mahon, and its Vicinity- 131 House of Charity ib. Foundling Hospital 132 Naval or Military Hospital ib. Lazaretto . . 134 Regulations of the Lazaretto 137 Of the Officers . 138 Table of the Charges for Vessels and Merchandis 139 ,, ,, for Foreign Vessels 140 „ ,, for Patents of Health ib. ,, Persons Employed in Lazaretto ib Quarantine .... 141 Purifications 142 MARSEILLES AND TOULON 144 Marseilles . ib. Climate 146 Toulon 147 Hospitals . 149 SICILY .... 151 Catania 152 Public Buildings . ib. Benedictine Convent ib. Antiquities 154 Mount iEtna 155 Syracuse . 157 Curiosities ib. Santa Lucia 160 Temperature 162 Diseases . 163 Vegetable and Mineral Productions of the Island in general 164 Animals . 165 GRAHAM'S ISLAND . ib. MALTA .... 167 Inhabitants 168 Population 169 Climate ib. Citta Vecchia 170 Valetta .... 171 Hospitals . 174 Military Hospital • . • 175 Naval Hospital » 176 8 HORNER'S OBSERVATIONS. CORFU 178 Town of Corfu 179 Climate . 180 ARCHIPELAGO 182 Climate . 183 Diseases . 184 Inhabitants ib. Antiquities 184 Population 189 Productions 190 SMYRNA, AND THE ADJACENT PARTS 191 Climate 192 Animals 195 Antiquities ib. Inhabitants 197 Hospitals . ib. Bagnios 198 Apothecaries and Physicians 199 Diseases . 200 PALESTINE .... 203 Scenery- ib. Botany 204 State of the Medical Profession 206 Apothecaries 208 Diseases . ib. APPENDIX .... 211 PREFACE. In presenting these Observations to the public, it may be useful and proper to state that they were made during two cruises to the Mediterranean. The first cruise was performed in the corvette John Adams, during the years 1831, 1832, and 1833; the second in the frigate United States, during 1836, 1837, and 1838. As I have been, then, for so long a time in that classic sea, and the countries encompassing it, the reader may think it strange that my investigations have not been more extensive, and the information acquired is not greater ; but these imperfections, I am sure, will be excused, when he is informed, that during the whole period I was trammeled with public duties, and had neither my own in- clination nor pleasure to consult. It not unfrequently happened, that where the largest field fur investigation was offered J had the least means of acquiring information ; and, on the contrary, when nothing of interest was presented, the greatest facilities were possessed. It has often occurred to me, that, when in a region where innumerable objects worthy of the fullest attention were found, a rain, a storm, a quarantine, or some urgent duty detained me aboard, and caused disappointment. The reverse of this has happened : the ships were at places where the weather was fair, there was no quarantine, and my duties caused no detention nor obstacle; but where there was nothing deserving particular atten- tion, or where already as much information had been elicited as was desired. For the above reasons my Observations are diffuse with regard to some places ; brief and restricted as to others : on one subject minute, on another general. But these remarks are chiefly in rela- tion to the countries which I shall sketch, and not to professional subjects which came directly under my notice, aboard, and which will be treated of more fully ; for, as a matter of course, every op- portunity is presented to the surgeon in a ship-of-war of acquiring information with respect to any subject connected with his duties, and relating to the patients under his charge. Having the exclusive 2 ]0 PREFACE. management of the medical department, he can pursue uninter- ruptedly any plan of treatment, without consulting the will of his patients, or having to contend with prejudice and fashion ; and he is not obliged to adopt modes of treatment better suited for ac- quiring popularity, than for ascertaining facts and improving his pro- fessional knowledge. The plan proposed is, first, to treat of the Mediterranean in a general manner, and to speak of the diseases which were most common in the two vessels while cruising on its waters; and, lastly, to give the topographical and professional observations made on some of its principal islands and adjacent countries. In undertaking a work which embraces so great a variety of sub- jects, I am aware of the difficulties to be overcome, and would be deterred from prosecutiug the task, were I not inspired by the hope of at least making known some facts deserving the attention of the reader, and of communicating information calculated espe- cially to interest the members of my profession. Should it prove a failure, it is to be hoped that the reader will ascribe it to the impedi- ments and difficulties above mentioned rather than to neglect : and should any inaccuracy be detected I trust that it will be attributed rather to erroneous impressions than to a disregard for what is cor- rect, or to a desire of misleading. G. R. B. H. MEDICAL A3.B TOPOGRAPHICAL OBSERVATIONS, ETC., ETC. GENERAL OBSERVATIONS. The traveller having left behind him the mighty Atlantic and entered the Mediterranean, is at once struck with the difference be- tween them. He finds himself transferred from a boundless, stormy, and agitated ocean, into a smooth and placid sea, encircled by many of the most beautiful countries of the world. Scarcely ever out of sight of land, he has always something to gratify the sight, excite pleasure, and remove the monotony of his voyage. At one time a craggy rock raises its head above the surface of the sea, and repelling the foaming w T ater from its base, warns the watchful mariner to change his course ; at another time a verdant, romantic island reminds him of its being the scene of some classic story. Here Stromboli disgorges a never failing stream of red hot lava, which slowly flows down her sides to be cooled in the hissing sea: there majestic JEtna elevates her snow-clad summit, and, obscuring the heavens with a dense, dark volume of smoke, shows that the Cyclopes still urge their Vulcanian tasks, and that the burning breath of Briareus is not as yet extinguished. Proceeding along the coast of Africa, he beholds the wild, rugged, undulating mountains of Morocco, and other Barbary states ; he passes Ceuta, Algiers, Bona, Bizerta, and Utica ; and, while thinking of the stoical and patriotic Cato, gets within sight of Carthage. But when he has reached it, he looks in vain for the temples, the palaces, the walls and towers of the former mistress of Africa, and sees only a miserable village. the broken arches of an aqueduct, and the solitary, half dilapidated tower in which Saint Louis, the pious king of France, terminated his glorious career and existence. Having passed the bay of Tunis, doubled Cape Bon, a mountain looking at a distance like an island, he crosses the Gulf of Cabes, goes by Tripoli and her forest of date trees, decorating the adjacent desert of drifting sands, and he soon reaches Egypt. There he beholds the modern, rising upon the ruins of the ancient Alexandria ; the needles of Cleopatra ; Pompey's Pillar — those splendid remains of 12 HORNER'S OBSERVATIONS. antiquity — and the famous Nile, overflowing its banks to fertilize the neighbouring plains. After leaving Egypt he proceeds to Palestine, views its rich and lovely hills and valleys, the scenes of so many events celebrated in both profane and sacred history. There, likewise, are beheld with delight the distant sky-blue mountains of Carmel, stretching from north to south, beyond the plains of Jaffa; and the still more lofty chains of Lebanon and Anti-Lebanon, partly capped with snow, and hiding their towering heads amid the clouds. But suppose that, instead of taking the route along the coast of Africa, he chooses that by the coast of Europe, his pleasure will be increased rather than diminished. The uninterrupted chains of mountains, and intervening valleys, will afford innumerable prospects of the most captivating sort; every scene will be varied and impos- ing — the eye will never become fatigued, the mind never satiated; nor will the imagination cease to be excited ; such is the host of inte- resting objects. Works of art are there mingled w T ith those of nature, and the superfluities of one supply the deficiences of the other. With the wonders of ancient, he sees displayed those of modern times : and whether he be an amateur of the antique or the modern he will be un- ceasingly receiving instruction, mingled with amusement. Having seen the romantic and picturesque coast of Spain ; admired, the lofty, jagged, deeply serrated mountains of Grenada ; having passed the barren ridges, the luxuriant, thickly populated vales of France, he next beholds the snowy summits of the southern Alps, then the more humble Appenines; and sailing on, along the coast of Italy, he passes Genoa, Leghorn, Rome, the former mistress of the world, and arrives in the Bay of Naples. On one side of this latter he witnesses the awful effects of the earthquake, which submerged beneath its waters half of the city of Baise, and left the other half in ruins ; and, upon the other side, he views Vesuvius, emitting from her unextinguishable furnace volumes of black, curling smoke during the day, and vivid flames by night ; and threatening, once more, to overwhelm with ashes and lava the delightful region around. From Naples he proceeds along the iron bound mountainous coast of Calabria, enters the Straits of Messina ; leaves the monster Scylla on the left, the foaming, whirling Charybdis on the right: he sails up the sea of Ionia, goes into the Adriatic, visits far-famed Venice, looks at the Tyrolese Alps, stretching their icy, dazzling white ridges from east to west ; and then comes down along the mountainous shores of Dalmatia and Albania to the western coast of Greece. Having visited Corfu, Cephalonia, Zante, and other Ionian isles, he doubles Cape Saint Angelo, and becomes quickly involved among the countless Islands of the Archipelago. Whether he be a theologian, historian, or physician, he will find himself surrounded by a multitude of the most attractive objects: in whatever direction his eyes are turned, they will most certainly rest on one which will call to mind some* incident related in Scripture, or in mythology ; some fact mentioned in the history of medicine, or in that of nations. On yonder isle, he will say to himself, were written the revelations ; on this one were worshipped Diana CLIMATE OF THE MEDITERRANEAN. 13 and Apollo ; beneath that rugged promontory the Persian was defeated by the Grecian fleet ; in this half deserted town the plague destroyed thousands of human beings; or on that gently sloping hill once stood the temple of Esculapius. In fine, let the traveller pro- ceed in any direction, he will still be instructed, he will still continue to be delighted. After this desultory introduction, I will now proceed with my observations; and the first subject on which I shall touch will be THE CLIMATE OF THE MEDITERRANEAN. From what has been said of the regions encompassing the Me- diterranean, it is evident that its climate is materially modified by that of the former, and that it is not, as may be supposed, perfectly uniform. Its great extent also causes a considerable variation; for from the head of the Gulf of Cabes to that of the Gulf of Venice, it comprehends fifteen degrees of latitude, and from its easterly to its westerly extremity forty degrees of longitude. Besides its extent, its irregularity, occasioned by the vast bays and gulfs opening into it, especially those to the north, which have mountains, promontories, and peninsulas between them, necessarily exercises a strong influ- ence upon, and occasions important differences in the climate. But these do not arise so much from the extent of the sea and its sinu- osities as from the remarkable features of the surrounding countries, and the difference existing between the southern parts of Europe and the northern parts of Africa ; particularly that portion to the eastward of Cape Bon. The lofty mountains bordering the European re- gions being more or less covered with snow and ice, have the air about their summits at a very low temperature, which from time to time descends to displace the heated air resting at their bases and on the surface of the water. This change in the relative position of the strata of the atmosphere, must of course cause frequent and sometimes very sudden vicissitudes in the temperature ; especially from a higher to a lower degree. On the contrary, the vast, arid, and burning deserts of Africa, whose sands reflect every sunbeam, and absorb every particle of moisture, must occasion, whenever the wind blows across them to the sea, corresponding vicissitudes from a lower to a higher degree of temperature. To show more accurately what this was, I subjoin an ab- stract of the register which was kept during the two cruises, with the exception of some months spent in cruising in different parts of the Atlantic. The variations in the temperature were found to be considerable in the same months of the different years, and were chiefly owing, as will be seen hereafter, when I treat of particular places, to the changes made by the vessels from place to place. This temperature, I should state, was taken at noon, below deck, and in the shade. 2* 14 HORNER'S OBSERVATIONS. 1831. 1832. 2833. 1836. 1837. 1838. Average. Maximum. Minimum. Medium June . 78 84 68 76 July . . 81^ U1 31 86 79 821 August ■ • ™tf 83 76 791 September • • 77ff 85 71 78 - October . 76 5 7 T 83 68 751 November . 62l°- 69 48 581 December ' ' ^Y 68 52 60 January - • «*ft 66 56 61 February . 61& 66 54 60 March . . . 62JL 68 51 59£ April » . . 63xo 70 57 631 May . '*3l 77 70 731 June . 76- 3 - 3 78 74 76 July . . . Spent in the Atlantic, save three days. August . 80 ^ 3 1 84 72 78 September . . 76 - 3 - '"30 84 66 75 October • ?3M 76 69 721 November . • 60 !r 74 67 70| December • 60ff 71 54 62£ January • • »A 64 42 53 February . 59 64 52 58 March . • 5 m 62 40 51 April . . 63ff 68 54 61 May . ' . 69|f 75 62 681 June • 78f| 86 78 82 July . . * 82|f 85 78 81$ August . 831f 96 80 88 September . '°30 83 75 79 October • /a 3T 77 61 69 July . . 78- 7 - ' * /u 23 83 70 761 August . 77^- ''31 82 74 78 ■•* September . • 78/ ff 80 76 78 October . 69§f 76 47 62^ November • 61^- 74 47 601 December . . 62ft 72 57 641 January R412 66 37 511 February • 54f| 62 42 52 March . . . 53If 65 42 531 April . • 60ft 62 43 521 May . • 65ft- 69 62 651 June } July > . August ) Were spent days. in the Atlantic with the exception of September • 72& 76 67 711 October • 66ft 75 65 70 November • 59ff 70 52 59 December • • 60ft 65 52 581 January } February > March > Spent in the Atlantic, wi th the exception of se teen days April . KG 2 3 . J^3o 64 52 58 May . . 64 72 50 61 June 71 6 1 * ' l 3 79 70 741 July . . . 75M 80 71 751 August • 76ft 83 73 78 September . 721f 81 67 79 CLIMATE OF THE MEDITERRANEAN. 15 From the above statement, respecting the temperature of the climate, it must be manifest to every one that it is not only tem- perate but moist ; owing to the constant and great evaporation which, from one year's end to another, takes place from the surface of the sea by the heat of the incumbent atmosphere. But the humidity is displayed in different ways, according to the season of the year; for in summer it is imperceptible, in a great measure owing to its great diffusion, and it can be detected only by the heavy dews at night, by the injury done such substances as are most liable to suffer from moisture, or by the use of hygrometers. Rain at this season is very uncommon in every part of this sea, and an almost unin- terrupted drought continues from the beginning of May until that of September. For instance; rain fell but once in the summer of 1831, not at all in that of 1832, three times in 1833, once in 1836, and five times in 1838. But in winter completely the reverse happens ; rain then falling very often, either in constant or interrupted showers, both during the day and night, but particularly in the latter. In the spring and autumn it occurs frequently and at intervals, or day after day, as in this country. As respects rain, therefore, at those seasons, there is nothing peculiar in the climate. The most remarkable phenomenon accompanying the rains is the want of electricity, or at least of the exhibition of it; for neither during showers nor constant rains is it often seen, and thunder and lightning are seldom witnessed. Thunder especially is uncommon. This indeed, is so very rare that, save at Smyrna and Alexandria, I never witnessed what may be properly called a thunder-storm — one attended with those terrible peals, and vivid flashes of light- ning, which are so often met with in the United States. An- other peculiarity respecting electricity is, that it is generally evolved in cold and not in warm weather; which is directly the reverse of what occurs in this country. In the winter, thunder and lightning in every part of the Mediterranean were more common than in summer; but these phenomena were oftener witnessed, in the northern than in the southern parts, and in the most mountainous regions. Before concluding the subject of humidity, it may be asked, to what should we attribute the dryness of the summer? This is a difficult question to answer, it being involved in uncertainty ; but the most correct reply I think is, that it is owing, at least in a great measure, to the very great elevation of all the countries bordering upon the Mediterranean, with the exception of a portion of Africa ; and likewise to the great height of most of the islands encircled by its waters ; as that of Corsica, Sardinia, Candia, and other islands ; particularly those to the eastward. The mountains, attracting the mists and clouds formed by the water evaporated, and retaining them, prevent their descent or diffusion over the sea, and necessarily hinder them from discharp-ins: the water contained m them, save about the mountains themselves. To this opinion may IQ HORNER'S OBSERVATIONS. be offered the objection, that the winter is as wet as the summer is damp, and that if the elevation of the coasts and islands have the effects stated during one season they should have similar ones during the other. This objection, however, I conceive has not much force, and may be easily set aside ; for it is a well established fact, and one of common observation in every country, that the water which is evaporated during winter, not being combined with as much caloric as that evaporated in summer, never rises to so great a height in the atmosphere ; and being suspended at a greater distance from the mountains it is therefore less under their influence, and is less attracted by them. This opinion, concerning the cause of the drought of summer, is also strengthened by the well known facts, that the greater the elevation of a mountain the more obscured in clouds it becomes ; and that rain oftener falls upon mountains than upon plains. Besides the peculiarities mentioned, there are others belonging to the climate : among the latter are the rareness of snow and hail, of water spouts, and meteoric appearances. Of these, the only ones I have observed were shooting stars. The ignis fatuus, and aurora borealis in no part of the sea did I ever witness ; and the absence of the former may be ascribed with good reason to the height of the adjacent land and the small quantity of marshy ground. The mirage is sometimes seen ; and I had once the pleasure of beholding about sunset the shadow of a vessel below the horizon perfectly depicted on the clouds intervening between her and the vessel in which I was sailing. But of all appearances the most peculiar are those of the clouds in warm weather, and particularly in the afternoon. They then become tinged with every colour which most gratifies the sight, and adorn the skies in the mostfantastic manner ; red, orange, yellow, blue, and all other colours, being mingled with the most exquisite beauty. The skies, also, are made still more lovely by the clouds assuming a variety of forms, as those of rocks, trees, men, beasts, and other animate and inani- mate objects. These beautiful skies, however, are lost in a great measure in winter; for they then lose their rich colouring, are often obscured, dull, heavy, and diffused ; and become even less handsome than those of the Atlantic. Winds. — By much the most constant are the northerly, and especially the north-west, which blows along the whole of the south of Europe, from Gibraltar to Greece, for a much longer time than any other wind, and often for many weeks together; but it is more violent, and blows longest down the Gulf of Lyons, and upon the coast of Spain. This wind is also very constant in the Adriatic, and on the western coast of Greece, where it forms one of the winds called. Etesian, of which there are two — the north- west, and the north-east — the former blowing on the western, and the latter on the eastern side of that country. These winds prevail in summer, and blow nearly the whole of it, generally for as much as forty days without cessation. In Greece they are preceded by CLIMATE OF THE MEDITERRANEAN. 17 the winds called prodramme, or forerunning winds, which have a duration often days ; and therefore the Etesian really continue un- interrupted for fifty days. With such constancy did the western Etesian blow last summer, that it took the United States seven- teen days to get from Baireut to Suda in Candia, and twenty days to go from the latter place to Minorca. The eastern Etesian varies during the winter, and the winds then blow frequently from the south-east and south-west. Next to the northerly, the southerly winds are most prevalent. The chief varieties of these are the south-easterly and south-westerly. At the western part of the Me- diterranean, the former are termed Levanters, and are remarkable for their dampness, the oppression in respiration which they oc- casion, and the mist, clouds, and rain, which accompany them. At the eastern part, on the contrary they are called siroccos, are distinguished for their great dryness; and are accompanied with a clear atmosphere, save that it suspends an impalpable sand, which very slightly diminishes its transparency, and tinges the air of a very light yellow color. The best presages of this wind are a dead calm, and a perfectly smooth sea. The south wind, from being attended with the same phenomena, is likewise termed the sirocco; and I have known the south-west wind to be so hot and dry in the Archipelago, as to be equally as disagreeable as either of them. At noon, on the 20th of August 1833 at Milo, while this wind was blowing, the thermometer was at ninety-six degrees, and in the afternoon, when put in a windsail, exceeded a hundred. Its dryness, moreover, was so excessive, that it felt like the blast from a heated oven, and had the same effect on leather as exposure to a fire. Besides these winds, there are others which prevail in particular parts ; for instance, at Trieste the borea, or bora, blows at intervals with tremendous violence. This wind varies from east to north, occurs at different seasons, and lasts usually several days. Its fury is so great that the vessels there are frequently made to drag their anchors, or slip their cables and put to sea. At the Dardanelles, also, the north-east wind blows for a very great part of the year, and almost the w r hole summer, to the great injury of commerce by the detention of vessels bound up them. By a Greek pilot I was in- formed that he had been two months going through them to Con- stantinople. Conjoined with the current, which runs at the rate of from three to five miles an hour, this wind renders it utterly im- possible for a ship of any size to get up the Dardanelles while it continues. The injury, however, to commerce, has of late been decreased by the introduction of steamers, which now ply up and down them regularly from Athens, Smyrna, and other places, and enable persons to get to Constantinople from either of those two cities in the course of thirty hours; a passage truly short, compared with that of a vessel impelled by sails, for which thirty days would be an average passage. Tides. — In most parts of this sea they are so low as to escape observation, rising only a few inches; and when there is any agita- 18 HORNER'S OBSERVATIONS. tion of the water it is difficult to distinguish their ebbing or flowing. At Gibraltar the spring tide rises five feet between twelve and one o'clock ; at the head of the Adriatic from one to four feet ; and at Smyrna to the same height. The tide at the head of the Adriatic is said to be more perceptible than anywhere else in the Mediter- ranean, and with the wind from the south rises from five to six feet. At Venice, it is high water, at the full and change, at nine o'clock in the morning. The rise in the Adriatic, so much higher than about Minorca, and other western parts of the Mediterranean, show that the tides of this sea are not at all influenced, save near Gibraltar, by those of the Atlantic. Currents. — There are a number of them in the Mediterranean, but the most important, and those which I shall notice, are the two great currents, the one running from the Black Sea through the Bosphorus, Sea of Marmora, and Dardanelles into its north-eastern part, and the other going in from the Atlantic through the Straits of Gibraltar. In addition to what I said of the former, I will only remark, that it continues until it becomes broken and diffused among the Islands of the Archipelago. The latter has the same rapidity as the other, generally running at the rate of from three to five miles an hour ; but it is stated, that when the wind has been long and strongly blowing from the westward, it has been known to go as fast as seven miles. This current, entering through the middle of the Straits, dashes along by Cabreta Point, which forms the wes- tern side of the entrance to Gibraltar Bay, and sending a side current into the bay to perform its circuit, sweeps onward by Europa Point, the southern end of the rock of Gibraltar, and keeps on directly up the Mediterranean, to be gradually lost along the coast of Spain. But, notwithstanding it has been said that this current is running constantly and invariably, yet there is the best testimony to prove that at times it has been wanting, and that instead of its setting into the Mediterranean, another current has been found running from this sea into the Atlantic. Several English captains of the navy were wit- esses of this fact, and of vessels having been carried by it without the Straits. Captain Mailing says he can bear testimony that he saw the current running out of them with much greater velocity than he ever found it running into the Mediterranean ; and Captain Liv- ingston, in 1822, observed the general current to be running west- wardly instead of eastwardly, for some hours, completely across the Straits, at the same time that vessels w 7 ere drifted from abreast of Tarifa, nearly as far out as Cape Spartel. That counter currents exist on the borders of the general one is a well-known fact, and a matter of common observation ; vessels going out of the Straits often taking advantage of them. One counter current runs along the coast of Spain, from near Malaga, west- ward to Gibraltar, and thence outward to Cape Trafalgar. The other one runs along the coast of Africa until it reaches Cape Spartel, and is there lost in the Atlantic. It is believed and asserted that an under current exists, and runs CURRENT OF THE MEDITERRANEAN. 19 beneath the surface of the upper, in a direction opposite to that going in from the Atlantic. The chief facts advanced for proving the correctness of this assertion are the following : A ship at anchor at Tarifa, found a current running outwards at the rate of five and a half miles ; another vessel at anchor under Cape Spartel, was obliged, from the existence of a similar current, to have a man at the wheel for steering her. In 1820, Captain Barret states, that when he was off Tangier Bay he found an under current to be drift- ing his vessel westward for three hours, while the usual current was going eastward. The Phoenix of Marseilles, in 1712, gave chace to a Dutch vessel near Ceuta, and overtaking her in the middle of the Straits between Tarifa and Tangier, fired a broad- side into and sunk her. A few days afterwards the sunken vessel made her appearance on the shore near Tangier, which is four leagues to the westward of the place where she went down, and in an opposite direction to the course of the general current. Lastly, a vessel some years ago was lost at Ceuta, and afterwards thrown up on the European shore at Tarifa, which is seventeen miles distant. These facts certainly tend to prove the existence of an under cur- rent, but they are far from being conclusive; for all the circumstances stated might have been, and most probably were caused by the counter currents first mentioned, or by the western current having ceased and the eastern having set outwards. The fact that a vessel was drifted to the west while the current was thought to be going to the east, may be rationally explained by a familiar observation, viz., that whenever a vessel is moving in one direction the water appears to be going in another diametrically opposite, and that the rapidity of the latter seems to be in a precise ratio to the former. It is true, there is a difference between a vessel floating down with a current and one impelled by w r ind or steam, and that the water will have more the appearance of receding from the latter than the former ; but. nevertheless, it will seem to recede to a certain degree, and sufficiently to cause deception. That vessels anchored or not at Tarifa, Tangier, or any other part of the two shores, find a current which sets outwards is probable, and indeed proved by many persons ; but such may be the case and yet an under current not exist. On the con- trary, this serves still further to prove that there is none, and that the surplus water of the Mediterranean has other means of making its escape. The two sunken vessels having floated outwards is the best evidence advanced ; but even this fact may be as well accounted for by supposing they were carried out at night by an eastern and general current as by saying that it was the effect of an under current; and it is strange that persons should thus set aside a well known fact in favour of a conclusion deduced from mere [supposition. No positive proof then is given respecting an under current, and no accurate means of ascertaining its existence have been devised, though it is possible that this might be done by letting down a 20 HORNER'S OBSERVATIONS. body of much greater specific gravity than water, by a line attached to a vessel anchored in the middle of the Straits. But even this experiment would be attended with great uncertainty, as the body let down, though an under current should exist, would, when sinking, first be drifted to the eastward by the upper, and then to the westward by the under current. Of course the effect of the latter would be counteracted by the former, and the body would strike the bottom in the very spot where it would have done if no current existed, unless the one or the other should be either the deepest or strongest. As to the explanation given by those who believe in the exist- ence of an under current being caused by the water of the Mediterranean containing more saline matter than that of the Atlantic, I will merely remark that it is as yet theoretical, since no decided proof has been given that such is the case. It appears to be founded on the supposition, that the western current running in from the Atlantic is owing 1o the very great evaporation from the Mediterranean, causing its surface to fall below the level of that of the ocean. If this evaporation is really so much greater than that in the Atlantic, and the rivers emptying into the ocean are so much larger in proportion than those emptying into the Sea, the water of the latter would certainly be salter and heavier. But, although there may be a disproportion between the rivers, a greater pro- portionable evaporation in the sea is improbable; certainly so in that portion of the ocean embraced within the same latitudes, and between the tropics, where the Sun possesses much more power, and must necessarily occasion greater evaporation than where it has less power. To what, then, ought we attribute the current going in from the Atlantic? This is not an easy question to answer; but the most correct opinion, I think, is, that it is owing to a number of causes, the principal of which are, the disproportion between the quantity of water evaporated from the Mediterranean, and that discharged into it ; the peculiar form of the entrance to the Straits, which somewhat resembles a funnel, and acts as a con- ductor — the impulse given to the w 7 aters of the Atlantic near them by the Gulf Stream, which sweeps across the ocean to be lost on the Coast of Africa ; and the prevalence of westerly winds, which have been known when violent and long-continued to almost double the usual rapidity of the current. DISEASES INCIDENTAL TO THE CREWS OF VESSELS CRUISING IN THE MEDITERRANEAN. In treating of this subject I shall only speak of the diseases which have come under my own observation. The first which will engage our attention are those of the pulmonary apparatus. From what has been said respecting the climate, it is apparent that these are not of rare occurrence, and especially during the DISEASES IIS THE MEDITERRANEAN. 21 winter, when such vicissitudes of weather occur, and so much rain falls, that all persons predisposed to them are sure to be more or less prejudiced. However, their occurrence depends much on the parts where the vessels may be cruising ; a great difference, as already stated, existing between the climate of the northern and southern portions of the sea, or between that on the coast of Africa and that on the coast of Europe. The pulmonary diseases met with were of every kind ; viz., pleurisy, pneumonia, bronchitis, asthma, phthisis, &c. During the last cruise, the number of cases of phthisis was very great, no less than eight of the men, and two of the officers having died of it, either on board the ship or on shore; save one of the latter, who died while returning home in another vessel. This number of deaths from phthisis was much disproportioned to that from other complaints, and although three of them originated in the United States; never- theless, it serves to prove, that, notwithstanding the climate of the Mediterranean is celebrated for its mildness, and suitableness to consumptive persons, it is not as beneficial to them as is repre- sented, and that not only they, but the well, should not think that while living in it they are out of danger, and will enjoy an ex- emption from this disease. Indeed, the climate, so far from being thought adapted to such patients, is believed by some persons to be decidedly injurious, and instead of putting a stop to the disease to hurry on its progress to a fatal termination.* Whether this belief is well founded is not positively proved ; but it is certain that, from the dampness of the atmosphere during cold weather, there is a strong tendency in scrofulous individuals to glandular en- largements, both externally and internally; and we, therefore, may cor- rectly infer that patients affected with tubercular consumption must be more injured than benefited by the climate. The glands most com- monly enlarged are those of the neck and groins, particularly the lat- ter, which appear in the shape of buboes, and are apt to be confounded with those arising from syphilis. These enlargements are at first indolent, then increase quite rapidly, become painful, attain considera- ble size, and suppurate or remain enlarged for an indefinite period. From syphilitic buboes they may be distinguished by their appear- ing mostly during cold and damp weather; arising without the persons having them being exposed to the causes of the former complaints; by their being unpreceded by chancres; being unat- tended, or not followed by ulceration of the fauces; and being often- times composed of several glands, forming flattened instead of hemispherical tumours. One of the most difficult cases to cure was situated in the left arm-pit ; it became fistulous, and was under treatment for more than three months. These enlarged glands are found in persons of all ages, in those of weakly and robust forms ; but most usually in persons of * See Appendix, A. 3 22 HORNER'S OBSERVATIONS. scrofulous diathesis. In one of the latter, who died of tubercular consumption, the glands of the neck were swelled, and three of the mesenteric so enlarged as to weigh about, as many ounces. Suppuration was the usual termination when emollient applica- tions were made, and sometimes this occurred spontaneously before the patients were admitted on the sick list, or after the glands had been so much reduced in size as to have allowed the persons to return to duty. Cases of this kind happened, although every means had been taken to discuss the swellings or to cause them to suppurate, and were attributed to the persons affected, when on duty having a full diet, drinking their allowance of grog, and producing irritation in the glands by the active exercise taken whilst engaged in their ordinary occupations. Treatment. — This varied according to the nature of the cases. Inmost of them topical applications, such as leeches, blisters, iodine ointment, and especially warm linseed 'poultices, were employed. The last named articles generally caused suppuration, and were not resorted to, commonly, until the other articles had failed in dis- cussing the tumours. The former plan of cure was the most certain and quickest ; it being an easy matter, in most cases after suppuration had been excited — the abscesses opened, to heal up the parts by continuing the poulticing until inflammation had been entirely subdued; and then using mild lotions, such as a solution of nitrate of silver, sulphate of copper, or sulphate of zinc : now and then it was necessary to use the former medicine in its pure state to remove fungous or callous edges. Blisters were often effectual ; but were objectionable from the pain caused by them, and the skin being indurated and much thickened by their repeated application. When these and other articles failed in completely removing the swellings, soap plaster, and compression by a hard pad fastened on by bandages, were found efficacious ; and, in some instances, where simple poultices were not able to excite suppuration, camphorated ones succeeded perfectly. These topical remedies not being as effectual as desired, the iodide of potash in solution, cathartics, the Lisbon and other diet drinks, sea bathing, and other constitutional remedies, were employed. Among the latter, the corrosive sublimate was used most efficaciously in the diet drinks. It was given in very minute quantities, generally in the proportion of a grain to a quart, so that it had only an alterative effect. In like manner the blue pill was administered. These methods of treatment, aided by an observance of regimen and other adjuvants, were successful, except in a few cases : but were not as much so during cold and damp as in warm and dry weather. Moreover, in the former, relapses were liable to take place, and during the latter, cures were effected with much more facility ; the remedies acting with greater efficacy, the swellings more quickly subsiding, and the ulcerations healing more rapidly. The diseases which I shall next notice are hepatitis and icterus. Both of these were frequently met with among the seamen, especially DISEASES IN THE MEDITERRANEAN. 23 those of the most intemperate habits, and during warm weather. Jaundice occurred either alone or in connexion with the other affec- tion ; it was sometimes mild, at other times severe, and required active treatment, being accompanied with febrile symptoms. One case terminated fatally ; the patient having suffered extremely from head-ache, followed by delirium and inflammation of the brain. This case originated in the Mediterranean, but the patient did not die until the vessel had nearly crossed the Atlantic on her return home. Of the treatment of these complaints I have nothing more to say, than that it was such as is every where found to be the most efficacious ; consisting chiefly of depletion in its primary, and of mercurial medicines, given, for the most part in alterative doses, during their secondary stage. Ophthalmia was a common affection, but most of the cases treated were easy of cure ; none of them being of the purulent kind, or such as occur so often in the surrounding countries, and especially on the coast of Africa. Bowel affections — diarrhasa, dysentery, enteritis, and cholera — were numerous. The two first diseases were mostly caused by bad water, and excess in eating fruits and vegetables after a long abstinence from them, and the crews had been living for some time principally on salt provisions. Ordinary cholera was often occasioned by the same excesses, but it was most apt to happen from eating largely of crude, acid fruits during hot weather. Asiatic cholera has, from time to time, occurred in our ships of war since its introduc- tion into the Mediterranean, which happened at the close of the year 1831 ; having gradually worked its way from Russia down the western coast of the Black Sea to Constantinople, and thence down the sea of Marmora and the Dardanelles to the eastern coast of Turkey in Asia. This disease did not become prevalent until several years after its first appearance, and has never pervaded the w r hole of the islands, nor all of the countries encircling this sea, at the same period ; but has gone from island to island, from country to country, without observing regularity ; attacking sometimes one place, at other times another; skipping over a part one year and devastating it the following. Sicily is the last island, Italy the last country, in which I have heard of its ravages. In Palermo alone, it is said, it destroyed twenty thousand persons. Several of our ships of war have had it aboard : the John Adams was the first, the Shark the last, vessel in which it occurred. It appeared in the former in the summer of 1831, at Constantinople; in the latter at Trieste, in that of 1836. As there are some facts connected with its occurrence in these vessels which are of importance, from their being calculated to throw additional light upon the cause of this disease, it may be well to communicate them. The John Adams having arrived at Constantinople on the tenth of August, anchored in the Sea of Marmora below the seraglio, 24 HORNER'S OBSERVATIONS. at a few cables' length from the city. Having been refused per- mission to go above the seraglio, and anchor in the Bosphorus at the mouth of the harbour, which is on the north side of the city, she remained where she was until her departure. As soon as she arrived we heard of the cholera being there, but that only a few cases were occurring daily. The people were found pursuing their ordinary occupations without the least appearance of alarm, and therefore none being excited on our part, save in a few individuals, the officers began, and kept up, the freest communication : no part of the city or its vicinity being left unexplored by them. Of the men. only the boatmen and some others were allowed to go ashore. From the tenth to the twentieth of August, the wind blew uninter- ruptedly from the north-east, the weather was fair, and the ther- mometer at noon averaged seventy-six degrees. On the twentieth and twenty-first the wind became light ; on the twenty-second it died away; a dead calm succeeded; the air was misty, the temperature rose to eighty-three degrees, the sun was shorn of its rays and assumed a pearly aspect ; every person aboard was complaining of languor, and unusual oppression. On the twenty-third, the wind arose, the thermometer fell to seventy-eight degrees by noon, and to seventy degrees by night, and the weather again became pleasant. Before day-break on that day the two first cases of cholera took place, terminated in death the following night, and were succeeded in quick succession by many other cases, so that the crew being filled with them the ship was obliged to hasten away from the in- fected place, proceed to the Gulf of Smyrna, land all the sick on Long Island, or the greater Dourlack, and remain until the disease had run its course. After its subsidence, and when time was allowed me to investigate its character, by inquiring into its nature, and reflecting on its causes, I came to the conclusion that it did not arise from contagion, but from some unknown constitution of the atmosphere, rendered more noxious and active by the changes in the weather of which I have just spoken. My opinion was based on the following facts: No person belonging to the vessel was near, or saw any inhabi- tant of Constantinople or of its vicinity who was, or to the best of my knowledge had been affected with the disease. The officers were the first who went ashore, wandering through the streets, the ba- zaars, and other places ; they mingled with crowds, formed of every class of the people, but chiefly of the lowest; which, as everywhere else, had suffered most from the disorder, and they yet were the last persons aboard who took it 5 and they were affected in the mildest manner. Their servants and the boatmen, who were similarly exposed, in like manner escaped with a few exceptions. Again, while the ship was at Long Island, the launch, with a crew of seventeen men, one of whom died of cholera, was sent frequently to Vourla for water, and though they without restraint asso- ciated with the people assembled there about the fountain, or crowding a grocery shop near it; nevertheless none of these DISEASES IN THE MEDITERRANEAN. 25 latter were infected with the disease. Lastly, many persons of both sexes, and both young and old, belonging to the adjacent country, frequently visited the island on business or to gratify their curiosity. Some of them came near, others walked through the ancient reservoir where all the sick were placed, and notwithstand- ing they were so exposed to infection, none of them contracted the disorder, nor communicated it to their friends and neighbours when they returned home. This opinion, with respect to the primary cause of cholera, has been more confirmed by what I have seen of it in this country, but particularly by what I learned regarding its occurrence in the Shark. Though I was not in that vessel at the time, yet from being one of three surgeons appointed by the commander of the squadron to inquire into the origin and character of the disease, I became possessed of all the important facts relating to these points. They were as follows. The vessel having arrived at Trieste, and having found the cholera prevailing there, was immediately put in qua- rantine. It having been recommended by the surgeon to keep her out of the place where quarantined vessels usually anchor, she continued where she was, and about a quarter of a mile from the city, holding no communication with it whatever. No one belonging to the vessel was allowed to go into the place ; and none of its citizens, nor other persons, were permitted to come on board of her. When she arrived, the wind was blowing from the north-west, across the head of the Adriatic, the weather was fair, and the disease was carry- ing off in the city five persons a day. Two or three days after her arrival the wind shifted to the north-east, and the weather became damp and chilly. The day after the change in the weather eighty deaths from cholera were reported, and the following day one hundred and forty in the city. In spite of the precautions taken, the disease, in about a week after she arrived, broke out among her crew, and forced her to flee from the place down the Adriatic. Seventeen cases occurred, and three persons died, and all within eighteen days ; at the expiration of which time the disease disappeared, no more cases taking place. These are the facts relative to the manner in which the disorder appeared aboard this vessel ; and what happened afterwards also is further evidence of the non-contagiousness of Cholera. Having left the Adriatic she proceeded to the Levant, joined the squadron at Jaffa, and communicated with the other vessels and with that town, and some, if not all her officers went up to Jerusalem. Notwithstanding every opportunity was offered for the disease spreading by contagion, yet it neither did so in the squadron nor in the country. Other facts might be adduced to substantiate the opinion expressed respecting the origin of this complaint, but as it was solely my intention to make known such of them as have came under my own observation, and it is not my wish to engage in an elaborate discussion of the subject in which so many arguments of a contrary kind might be advanced, I will here 3* 26 HORNER'S OBSERVATIONS. leave it, and proceed to the consideration of another disease of no less importance ; I mean the SMALL-POX. This curse and scourge of the human family is met with in all parts of the Mediterranean, but especially in the eastern extremity, where vaccination is either neglected, or is performed imper- fectly. It has often broken out in our ships of war, and it occurred twice in the United States while on her last cruise. She got it aboard the first time at Alexandria, in the fall of 1836, and the second time at Smyrna the following winter. In the first instance, a case of varioloid, induced by exposure to several persons recently affected with small-pox, occasioned one of this disease, which for- tunately did not spread farther, from the person having been immedi- ately sent out of the ship. In the second instance, the first case was one of confluent small-pox, and from that cases of every variety origi- nated. The crew thus became infected twice, although, of my own accord, and agreeably to an order from the JNavy Department, I had most carefully vaccinated the whole of them, with the exception of a few who did not require protection, from having had the disease, or having genuine scars of vaccination. The matter used was obtained from the vaccine institution at New York, was introduced into two punctures in the most careful manner, and yet did not cause a single genuine pustule on any one, whether he had or had not been previously inoculated or vaccinated. How then to account for this general failure I was at a loss, and did not know to what to ascribe it; whether to the impurity of the matter, the imperfection of the operation, or to some peculiarity in the constitutions of seamen. Of the same want of success in vaccinating I have heard several medical officers of the navy complain, and from what I have seen and learned from others, one might incline to believe that persons who have attained the age of manhood, and especially those who are advanced in life, lead hardy lives, and subsist on the coarsest food, lose their susceptibility to infection from the vaccine virus ; and of course are more difficult to protect from small-pox. Should this be the case, it shows the very great importance of vac- cination in youth, and particularly of individuals designed for service in the navy, who if left unprotected are not only liable to suffer from small-pox themselves, but when getting it to contaminate all about them who are not protected, and thus cause both individuals and the public service to suffer. The proper mode of vaccination, therefore, is a subject of deep interest. It concerns the welfare of all mankind, but more particularly that of seamen and soldiers, who being col- lected together in large numbers, and crowded in such a manner that if any contagious disorder attacks one of them it is almost sure to spread and infect all who are susceptible.* Certainly, as respects our ships of war, instances of this kind have frequently # See Appendix, B. SMALL-POX. 27 happened ; and sometimes they have been rendered so totally in- efficient by the small-pox getting aboard them, that they have been unfited for the service required of them either in time of peace or of war. The Macedonian, the ship in which I first saw service, was in this condition when returning from her cruise on the coast of Brazil, in the fall of 1828; and one of our corvettes, some years afterwards, I understood, having been despatched from that country to the Coast of Africa, was forced from the same cause to put back to Rio Janeiro, where the disease had been first received. Other such incidents as these might be cited, and they have so often come to the knowledge of our government, that orders for the vaccination of the crews of our men of war have been repeatedly issued ; but thus far it has been of little use, and it appears that to render it efficient some better method of performing it must be adopted. What this method shall be I leave to some member of the profession more able than myself to discover and to recom- mend. A few cases of other exanthematous complaints occurred, These were cases of miliaria, urticaria, and pemphigus; which were almost exclusively confined to warm weather. Erysipelas was very rare, but with herpes a number of persons were affected, and several in an obstinate manner. The worst of these cases, however, originated elsewhere, and merely seemed to be aggravated by the warmth of the climate; though by far the most severe was one in which nearly the whole skin on the back was affected : it was much worse during the winter, and was completely cured in the summer, — the perspiration at this time evidently having a beneficial effect. Ulcers, abscesses, phlegmons, and tumours, were common ; but not having been marked by any peculiarities they do not de- serve to be spoken of at large. The ulcers were generally upon the lower extremities, and the consequence of excesses ashore, neglected wounds and contusions, and varicose veins. The abscesses were in various parts of the body; sometimes in the loins, at other times in the perineum or wherever the cellular tissue is most abun- dant. The largest, and by much the most difficult one to cure, was situated about the left hip, extending from the loins to the thigh, and followed a chronic rheumatic affection. Paronychia frequently occurred in both ships ; but this, I long since observed, is a complaint to which seamen are as much sub- ject as seamstresses; and this may be, I think, most properly ascribed to the great use they make of their hands, and to keeping the fingers constantly irritated by pitch, tar, sewing canvas, hauling ropes., and other manual labour. Hydrocele, circocele, and hernia, were likewise met with, but not often. Of the three the last named was most frequently seen; but it did not occur as much from the relaxation produced by long con- tinuance in a warm climate as by falls and other accidents. Of 28 HORNER'S OBSERVATIONS. hydrocele only two cases occurred ; one in each vessel. Both of them were radically cured by simply laying open the sack, dis- charging its contents, putting a pledget of lint over the wound, and then applying an ordinary dressing. Each case got well within a few days under this treatment, and without my doing any thing else to excite adhesion within the sack other than applying the lint. Neuralgia was a common affection at certain times, and usually seemed to be owing to miasmata, it being frequently paroxysmal, attended with febrile symptoms, and yielding to tonic remedies. In addition to the complaints enumerated, many more of greater or less importance are incidental to the crews of vessels sailing about the Mediterranean, and among then are rheumatism and plague ; but as the first is a disease prevailing every where, and the second never came immediately under my notice, and will be spoken of when I come to write of the countries in which it prevails, I will say nothing more of them at this time, but will go on to speak of FEVERS. These form the most important class of diseases to which per- sons cruising in this Sea are subject during warm weather, and par- ticularly at the close of summer and the beginning of autumn. The fevers with which I had oftenest to contend were intermittents and remittents. The former were generally of the tertian type, and easily cured ; but their degree of obstinacy depended chiefly on their duration ; and on their being old cases renewed by ex- posure to cold and dampness ; or on their having been caused by malaria in the places visited by the ships. From this difference in the causes proceeded that between the cases in the two ships. Most of those in the John Adams, having originated prin- cipally from malaria, were more severe and more numerous in proportion to her crew; whereas, the cases in the United States having been chiefly old ones, renewed by exposure to the former causes, were comparatively few, and of a mild character, quickly yielding to the remedies employed. Enlargements, and other affections of the liver and spleen, rarely followed the cases in either vessel; and this may be correctly attri- buted to the salubrity of the sea air, and the patients not continuing long in the atmosphere in which the disorder was contracted. Among all the cases only one proved fatal, and that was of a deli- cate, over-grown youth, who had had the disease in Minorca, his na- tive place, and who having shipped before he had entirely recruited from a recent attack, and never having been before on a cruise, suffered extremely from sea sickness. Becoming much prostrated he sunk into a typhoid state, and had the fever in the most irregular form : he was landed and put under the care of a physician at Port Mahon, and there died. This case was a striking example of the injurious effects of sea sickness upon the stomach, and of the perfect torpidity it is FEVERS. 29 capable of causing in the brain. While he was aboard we were going from place to place, and he was better or worse accordingly as the ship was at sea or in port, and in proportion to the agitation occasioned by the wind and water. When in port he became better, and seemed in a way to recover; but as soon as he got to sea, and the vessel was uneasy, he sank into a typhoid condition, and we lost all hopes of his being cured. Like instances of the great injury done to the nervous system by the agitation of a vessel at sea might be mentioned, but the relation of this case will be a suffi- cient warning to persons subject to intermittent fever, and debili- tated by it or any other affection, not to expose themselves in- cautiously to sea sickness, which is not as deserving of ridicule and laughter as is generally thought, nor as beneficial as some believe. Remittent fever occurred in both vessels, but most frequently in the John Adams, from her being longest at places where its causes predominate, that is, in the eastern portion of the Mediter- ranean. This fever prevailed mostly in August and September 1833, while she was cruising in the Archipelago and engaged in convoying American vessels on their passage from Smyrna. Of the causes of the prevalence of the disease there I shall speak more at large when treating of that place. Cases also happened in the United States both there and in the Levant. In both ships the ordinary symptoms were, severe head- ache, pain in the loins, and along the course of the spine ; a hot, dry sallow skin; high coloured urine; a thickly furred tongue; injected eyes; great sensibility of the epigastrium ; a full, strong, and rapid pulse ; intense thirst ; at first costiveness, and, after taking cathartics, bilious stools. In the worst cases these symptoms were aggravated % there was pain in the right hypochondriurn ; the abdomen was tense, hard, tumid, and tender; the pulse extremely frequent ; the urine as dark as French brandy ; the eyes were jaundiced ; the tongue at first was covered with a yellow, then with a brown fur; the skin became of a saffron colour; the stomach rejected food and medi- cines ; and sordes collected about the teeth. Before dissolution, hiccup, foetid urine, insensibility, &c, occurred. From what I remarked in some of the last cases which came under treatment, I thought that this disease had a tendency to observe critical periods. Certain it is, that in several of them the fever went off on the third and fifth day, and in one case it subsided completely on the fifth, then came on again as violently as ever, and terminated in death on the seventh day. Autopsia. — This corresponded with the symptoms. The stomach and intestines were found more or less inflamed, the liver engorged and changed in structure, and the gall bladder filled with black, tenacious bile. Of the intestines, the duodenum was most affected — its lining being both much inflamed and thickened. In one per- son the liver was blanched and indurated, and had its pori biliarii obliterated in a great measure ; the -spleen was double its natural size and softened ; the kidneys were enlarged, and changed in 30 HORNER'S OBSERVATIONS. structure. But this person having been a hard drinker, I attribute these appearances chiefly to that circumstance. Other marks of disease indicated by the symptoms were discovered, but the prin- cipal were the first mentioned, which clearly proved that the parts most affected were the liver and the alimentary canal. Treatment. — Slight attacks of this fever readily yielded to mild cathartics — of which the sulphate of magnesia was most used in combination with tartar emetic — and to diaphoretics. The principal of these given were the acetate of ammonia, the nitrous powders, and tartar emetic, in solution with water, or united with the former medicine. This last combination I much preferred, having found it most certain to agree with the stomach, to produce perspiration, and diminish the fever. The common dose was a half ounce of the acetate of ammonia with one-eighth of a grain of the tartar emetic every hour. These medicines were aided by cool acidulated drinks, hot pediluvia, and sponging with cold water, which always afforded great relief to the patient. In severe cases the treatment was much more active ; venesection was freely employed ; leeches were applied to the epigastrium, cups to the seats of pain; opiates were given to soothe irritability of the stomach, and to procure sleep; and calomel in moderate doses, the blue mass, the diaphoretics mentioned, and other medicines, were administered. Blisters in the last stage, and after the subsidence of the fever, were now and then applied. Emetics and tonics were very rarely required, and seldom prescribed ; the first, only where the stomach was loaded with ingesta and much deranged ; the second, where the fever had subsided, the stomach was not irritable, and the patient was considerably exhausted. The tonic most used was the sulphate of quinine, in solution with the elixir of vitriol, gum arabic, and loaf sugar. This was the most agreeable and efficacious remedy of the kind — rapidly restoring strength, and hastening convalescence. In aid of this, in order to clean the tongue, gently evacuate the bowels, and restore the liver to the proper performance of its functions, the blue pill, in the quantity of five grains, once, twice, or thrice a day, was prescribed, and found to be highly beneficial. I here terminate what I have to say of the principal fevers which occurred in the two vessels. Besides these none worthy of notice were met with either in them or in others of the squadron : neither scarlet, nor yellow, nor typhous fever, were seen aboard of them nor ashore. These fevers may occur, but it must be very seldom ; for if they were common some knowledge of their existence would have been obtained. The climate of the Mediterranean being tempe- rate, never being extremely cold nor hot, at. least for a protracted pe- riod, seems incapable of producing either yellow or typhous fever aboard ship. The heat is not great enough, nor long enough continued to generate the miasmata in vessels which cause the former disease, nor is the cold so intense as to produce the latter by prostrating the vital powers, causing personal cleanliness to be neglected, ventila- THE MEDITERRANEAN, ETC. 31 tion to be discontinued, the pure air to be excluded, and the impure within to become still more charged with the noxious vapors pervading every ship, and with the poisonous effluvia arising from the bodies of the crew. But the exemption from these complaints may be ascribed, in part, to the great attention paid to keeping the holds and all other parts of the vessels perfectly clean, to thorough ventilation by wind-sails, and by opening the ports and hatches, both when the vessels are in port, and likewise when at at sea should the weather permit, and finally to purification by the free use of the cloride of lime and other disinfecting substances. With the preceding account of fevers, I close my notices of the diseases which, according to my observation, are incidental to vessels of war cruising in the Mediterranean. Many more occur aboard them, but those mentioned I believe to be the most general. Others might be spoken of, but as they are seen in vessels cruising in all parts of the world, had little or nothing remarkable in their symptoms or treatment, I will here end what I have to communicate regarding the general observations made by me in the Mediterranean. SPECIAL OBSERVATIONS UPON THE MEDITERRANEAN, AND UPON PORTUGAL, SPAIN, AND OTHER COUNTRIES. Having finished such general remarks as I had to make con- cerning the Mediterranean itself, I will now proceed to communicate the information acquired in relation to some of the countries adjacent to and bordering upon that sea, and respecting some of its numerous islands. The first country of which I shall speak is Portugal, which, although it does not border upon the Mediterranean, yet from its contiguity and general sameness of climate and productions with Spain, it may, I think, be treated of in this work without impropriety. My remarks, however, will be confined, in a great measure, to its capital, and the neighbouring parts, for I was not long enough in the country to pursue my investigations respecting it as far as was desired, or to warrant my undertaking to treat of its typo- graphy in a general manner. Therefore, concerning its climate, botany, mineralogy, zoology, &c, I shall say nothing, save, that in writing of its capital, of necessity, I cannot avoid touching on some of these subjects. Though the stranger, when he has reached the coast of Portugal is not surprised with magnificent prospects, yet, when he is enter- ing the Tagus, and about having the first view of Lisbon, he has many objects presented which will excite interest and pleasure. Before him is seen the current of the river, contending for mastery with 32 HORNER'S OBSERVATIONS. the tide of the ocean, and forming a rampart of foaming surf, extending from shore to shore. To the right are the distant mountain of Monchique, hiding its summit among the clouds ; and the high, precipitous promontory over-looking the bay of St. Ubes, on the south ; and the wide extensive beach of white, glittering sand on the north ; and to the left are the castle of St. Julian, innumerable villas, cottages, and finely cultivated farms spreading over the hills and valleys ; and towering above all, the famous convent of Signora de la Penna, standing on the highest peak of the mountain, called the rock of Lisbon, or Cintra. When he has entered the river, and is proceeding towards the city, his pleasure will not be diminished ; for the scenery on each bank is not less lovely than what he has just beheld. On the right bank are a range of lofty, undulating hills, forming, next the river, precipices of immense height ; clothed with the richest verdure, and crowned with villages, towers, and castles, displaying their ban- ners, and with their pointed, well trained cannon warning all hostile vessels to keep aloof. Upon the left bank are a range of hills similar to those of the other, but not so precipitous, and covered with a host of four winged wind-mills, groves of olives — and the vast city itself, with its countless churches, convents, pala- ces, and other public edifices, extending as far up the river as the sight can reach. Below the city the river is not over two miles wide at any part, but opposite to its eastern extremity it is about four miles, where it expands itself suddenly into a vast harbour, but with a corresponding loss in its depth — large vessels always anchoring on the northern side, and in the channel. All the country about Lisbon partakes of the character of that forming the banks of the river, being uniformly hilly ; but though well tilled, the land is not as productive some miles back of the city as near it, the soil being thinner and poorer, and yielding little more than long bearded wheat of very low growth ; the best of it not exceeding two feet in height. However, it grows quite thickly, and having large heads bears a much greater quantity of grain than it seems capable of doing on making a superficial examina- tion. Besides wheat the other products of the soil are rye, barley, Indian corn, pulse, oats, and a great many plants — as the common aloes, the cactus opuntia, wild poppy, and jessamine ; but none, with which I met, possessed decidedly medicinal properties. Olives, grapes, oranges, and lemons, are the principal fruits. Of trees the most common are the poplar, cork, elm, and chestnut. The first named is found chiefly in low grounds, the three last about the mountain of Cintra, where they are not only seen ornamenting the paths and roads winding around it, but growing spontaneously upon its sides. In and around the village of Cintra the chief vegetable productions mentioned are found most abundant; for there both nature and art have done almost every thing to render LISBON, AND THE MEDICAL INSTITUTIONS OF PORTUGAL. 33 it a delightful abode, either for those who are in the enjoyment of health or who are afflicted with disease. In fact, Cintra so far ex- ceeds in attractions any other summer retreat in the neighbourhood of Lisbon, that it is almost the only one mentioned or frequented ; and no other is considered either agreeable, genteel, or fashionable, by the nobility, gentry, or commonalty. There, as soon as the gaiety of the city is terminated, the wealthy flock to enjoy tran- quillity, and to recover their lost health and strength — and there those in moderate circumstances resort, from time to time, during hot weather to escape the noise, bustle, and heat of the city, and remain free of care and labour until business bids them return. The mountain of Cintra is several miles in length from east to west, and is from twenty-five hundred to three thousand feet high. Its loftiest parts are composed of vast rocks and heaps of granite, of a dark grey colour, great hardness, and often of a cuboidal shape ; being separated by vertical and horizontal fissures, after the manner of lava, when it has become cooled and lost its fluidity. On the top of the mountain scarcely any other plant is seen than a species of large fern, filling up the intervals of the rocks, covering every part on which there is the least earth, and even growing upon the bark of the cork trees. Their bark, becoming very rough and thick by age, moulders a little, and being capable of holding such dust and moisture as may fall upon it, affords suf- ficient nutriment for the fern to take root and live. The lower parts of the mountain are formed of rock and earth, which being cultivated in the best manner, screened by the shade of the trees, and irrigated by the numerous rills flowing in every direction to supply the fountains, aqueducts, and basins distributed around the mountain, produces most abundantly. It is thus that so strong a contrast exists between the upper and lower parts of the mountain; on the former little else than barren rocks, surmounted by the convent of Senora de la Penna, and the ruins of a Moorish castle, is to be seen, and on the latter are forests of elms, corks, and chestnuts ; groves of lemon, orange, and other fruit trees, and the most beautiful gardens, as those of the Marquis of Marialva, and Pennaverde, where the rose, the honey-suckle, geranium, and many other flowers, at all seasons of the year, are found blooming, and perfume the air with their sweet odours. LTSBON, * AND THE MEDICAL INSTITUTIONS OF PORTUGAL. This city, the Olisipo, surnamed Felicitas Julia, of the ancients, by some is believed to have been founded by Ulysses ; whereas, others attribute its origin to the Phoenicians. The last is the more probable opinion of the two, for the Phoenicians are well known 4 34 HORNER'S OBSERVATIONS. to have traded on the western coast of Spain, which then in- cluded Portugal. Lisbon is situated on the northern bank of the Tagus, in about latitude 39° N., and occupies a very large extent of ground, cover- ing hills and valleys, and spreading out along the river for full three miles. There are two ranges of hills ; one running nearly east and west, the other north and south. On the former, the principal part of the city is built ; on the latter the citadel, Convent of Grace, and other edifices of note. Between these two ranges of hills is a hollow, terminating at the river. At its northern end is the principal public garden, which is a square laid ofT into walks, shaded by a luxuriant growth of trees, affording a cool, defightful retreat, and decorated with flowers and a large hand- some new marble fountain, composed of two basins, one above the other. This fountain is ornamented with statues of sea nymphs, and has near it those emblematical of the Tagus and Douro, which are two giants holding overflowing urns. At the southern end of the hollow is the beautiful square called the Black Horse, from its having in it the famous bronze equestrian statue of King Joseph ; and between these two squares is that part of the city which suffered most from the awful earthquake of 1755 ; and having been regularly laid off and rebuilt by the celebrated prime minister Pombal, is now by far the most elegant quarter of the city. With the exception of this part, Lisbon may be termed both irregular and illy laid off, having generally crooked and narrow streets without side walks, and often abominably disgusting, from the custom of throwing into them filth of every description. According to what is stated in accounts of this metropolis, I should say, though dirty, that it is not near so much so as formerly ; and, indeed, it is thought at this time, comparatively, cleanly. However, there is still great room for improvement in this respect. The streets being precipitous, and the city so well supplied with water by the grand aqueduct of Don John the Fifth, it is not a little surpri- sing that they should be kept so uncleanly; and particularly in winter, when so much rain falls. It would seem that this city never was really well washed and cleansed but once, and that was during the earthquake mentioned, when the waters of the Tagus rushing back upon it, overwhelmed the lower parts, as far up as the public promenade described. The population is differently calculated, and is not correctly known; but may be safely estimated at 250,000 souls. Emigration has been so great that it is doubtful whether the number of inhabitants is increasing. The country being small, not very fertile, and much disturbed by intestine commotions, many persons have left it to seek their fortunes, and enjoy tranquillity, in other regions. The houses are all of stone, plastered over ; are large, strongly built, to prevent damage from earthquakes, and covered with brick tile. Few of them have courts, and none terraced roofs. They are commonly occupied as stores in the first story, and have the upper LISBON, AND THE MEDICAL INSTITUTIONS OF PORTUGAL. 35 stories inhabited by different families, who make use of the same stairs. The nobility and gentry, however, have distinct buildings, and many of them possess palaces of great size and considerable elegance. Some of the royal palaces, both within and adjacent to the city, are magnificent ; and, among them, the new one of Ajuda is the most remarkable. There are six of them altogether, including those of Ramellon and Cintra. As it is not my intention to give a very minute topographical account of the place, I will stop here, and speak of matters having more of a professional bearing. Climate. — This has been long celebrated for consumptive patients, and Lisbon is still a rendezvous in the winter for those from Great Britain. I have heard the climate much commended for its mild- ness ; and true it is, that during February and March of the past year, Fahrenheit's thermometer was never below 56°, but it rained almost incessantly for eight days in succession, and the atmosphere was so exceedingly damp from this and the strong winds which blow down the Tagus, and sweep across the land from the ocean, that both the city and country appeared to me very unsuitable for any one having an affection of the lungs. In summer, the temperature is in a ratio to that of winter ; but there is little rain, and the heat of the atmosphere is much abated from the strength of the sea breeze, which regularly begins in the morning and blows until the evening. There is also a difference in the temperature of the higher and lower parts of the city ; the former, being elevated several hundred feet above the level of the water, feel the sea breeze in full force, and are much cooler and more pleasant than the latter. For invalids, then, a residence must be chosen according to the season of the year, and to their complaints. In winter, consumptive patients should live near the river and towards Belem, the western end of the city, where the streets are wide, the sun has full power, and the northerly winds have little force from the elevation of the hills immediately back. In summer they may venture to the heights, but it is more prudent for them to choose a residence midway between the heights and the river, because they would not be, then, exposed to the transitions of temperature which take place there in the morning and evening. They would avoid the relaxing effects caused by heat and moisture, and escape the deleterious influence of the mephitic exhalations abounding below, in the level and illy- ventilated quarters of the city. When an invalid is affected with such complaints as do not require him to shun cold, and is not materially influenced by vicissitudes in the temperature of the air, he may safely live on any of the heights : but that along the sum- mit of which runs the street of Buenos Ayres is to be particularly recommended. The fineness of its air, its openness, and the charming prospect of the city, and of the river, and of its southern shore, make it the most delightful place of residence. During hot 36 HORNER'S OBSERVATIONS. weather all persons subject to fevers should especially avoid that quarter where the gorge or valley of Alcantara terminates the rivulet flowing down which discharges itself into it ; and a very extensive muddy flat is left exposed when the river is low and the tide ebbs. The most prevalent winds here are the westerly and northerly. During the rainy period mentioned the former prevailed, and appear to be, as regards moisture, what the easterly are in the United States. When the latter blow strongly, the snipping lying in the river are in great danger, for it is hardly possible for the cables and anchors of any vessel to withstand the force of the wind and current combined, and particularly when the tide is setting out, the current then being so rapid that no boat, however well manned, can stem it, and the water running at the rate of five miles an hour. Instances have been known of vessels getting adrift on such occasions, and being carried to sea in spite of every exertion to check their progress ; and although they are anchored off the city, and ten miles from the mouth of the river, yet as at such times it is of course necessary to cast a greater number of anchors, the cables are twisted and entangled in such a manner that hours and days are required to undo the knots, and clear them. The gordian knot was nothing in comparison with these knots, which the sword of no Alexander could loosen. The cables of hemp must be cut to pieces, those of iron must have their links undone, before they can be unravelled and the vessel again properly moored. As for the tides, the flood begins to come in at noon, reaches the city by one o'clock, flows until six o'clock, and then ebbs from that hour until one o'clock in the morning. The greatest height the flood tide attains is from eight to nine feet, but both this and the ebb tide must be necessarily influenced by the current and the wind ; the easterly increasing the ebb, the westerly causing the flood tide to rise much higher when they are violent. Diseases. — Not having been sufficiently long in Lisbon to acquire an extensive and accurate knowledge of its diseases, and those with which I met having been chiefly in the hospitals, I will not undertake to treat of them, either in a general or special manner, and will merely remark that in the hospitals are to be seen most of those incidental to temperate climates ; as fevers, inter- mittent, remittent, and continued, dysenteries, and hepatic affections; and likewise those most common in cold ones, as phthisis pulmo- nalis and other complaints of the chest. Of surgical diseases there is a great number ; and venereal disorders may be mentioned as the most numerous. Concerning the diseases incidental to ships I will say still less, as while the United States, the ship in which I visited the place, was there, her crew enjoyed excellent health, very few persons having been taken under treatment, and these for trifling and ordinary complaints, as catarrhs, rheumatisms, and other affections produced by cold and dampness. LISBON, AND THE MEDICAL INSTITUTIONS OF PORTUGAL. 37 Public Institutions. — The first of these claiming oar notice is the College of Nobles, which was founded by Pombal. It is a large and handsome edifice, standing on the heights ; and built of the mar- ble of the place — a hard and yellowish white lime stone forming the base of the hills, and susceptible of being worked into any shape. This institution is well organized, and continues to flourish notwith- standing political disturbances, and its name being liable to offend the democracy, which is now creeping into power, and daily threatens to overturn the monarchy and aristocracy. Much might be said of the religious institutions— but not as they now exist — the late edict having destroyed almost the whole of them, and the Portuguese now showing as strong an inclination to irreligion as once they showed to superstition. The only three of these institutions worthy of notice are the convents of St. Vincent, Belem, and Jesus. These, as all other, convents are entirely emptied of monks, friars, and priests, — save as many of the latter as may be required for church service, and are all remarkable for their great extent if not for the excellence of their architecture. Each one has a large church adjoining. At the Convent of St. Vincent, in a vault on a level w r ith the lower floors, are preserved the remains of nearly all the royal family from King John the Fourth, the founder of the house of Braganza, to Don Pedro the Fourth, late Emperor of Brazil. With the exception of the first named all are deposited in coffins, or trunks, covered with red silk and black velvet, and so perfectly preserved, that though they are very numerous the bodies are not in the least offensive. From this I should suppose they must have been well embalmed. The Convent of Belem has been converted into a Cazapia, or asylum for all destitute male and female children. They amount to one thousand in number, there being two hundred boys and eight hundred girls; among whom forty are deaf and dumb, The two sexes are in different parts of the house; and have distinct schools, both for the acquisition of the common rudiments of education, and for the fine arts, drawing, sculpture* &c. In a hall between the church and convent are the portraits of all the monarchs who have ruled Portugal, from Don Henrique the First to the present Queen, Donna Maria the Second ; excepting that of her uncle Don Miguel, who is looked upon as an usurper, and is not honoured with a place. The church is celebrated for contain- ing the remains of St. Sebastian, the unfortunate monarch who lost his life when defeated by Muley Molock, Emperor of Morocco, — . and whose remains were after many years disinterred and trans- ported to Portugal. This church is also remarkable for being a good specimen of Gothic architecture. In the Convent of Jesus is one of the finest libraries in the king- dom. It is contained principally in a grand hall, with an arched ceiling ornamented with fresco paintings, and lighted by twelve windows, placed between the ceiling and walls. The books amount to thirty-three thousand volumes, well bound, generally of 4* 38 HORNER'S OBSERVATIONS. large editions, arranged on from twenty to twenty-five shelves, running completely around the hall, and consisting of scientific, ecclesiastical, and historical works, by the most noted ancient and modern authors. To render it easy to get at the books above, a gallery has been made around the hall. This gallery has a stair- case at each corner, and a handsome balustrade on each side. The hall not being large enough for all the books, which are rapidly increasing in number from those daily coming in, many have been put in another part of the building, and adjoining the museum, which, besides a large collection of arms used by savages, contains a most valuable one from the mineral and animal king- doms. This musuem is divided into two parts, an upper and lower, the former being in the first — the latter in the second story. In the upper part are a great variety of shells, birds, and reptiles, finely preserved and arranged in separate cabinets, and some Mosaic tables of the marbles of Portugal. In the lower part is a collection of fish and wild beasts, and a cabinet of human mon- sters, the most horrid of which is a child without a head, another with flippers like a turtle instead of arms, a third with one head and two bodies united as far down as the navels, and having four arms and four legs ; and a fourth with two heads and one neck.* These monsters all appear to have been delivered at the natural period, and are preserved in alcohol. City Library. — This is the largest and most valuable in Portugal, and promises to be the finest in the world ; for it now contains one hundred thousand volumes, and is so greatly increased by the influx of books from the suppressed convents, that it has been recently removed to the spacious Convent of St. Francisco, where it is spread out in its numerous rooms and entries. It is designed to contain most of the books brought and coming from all the Con- vents of Portugal ; which are said to own a million of volumes. Beneath the library is the Academy of Fine Arts, and the Schools of Sculpture and Painting, of which there are a number of good specimens done by native and foreign artists. Hospitals. — Notwithstanding the disturbed state of the country, and the frequent changes in its government, the interests of humanity are not neglected at the capital. Though this has been of late the seat of constant seditions and the focus of revolutions, its hospitals, those never failing signs of benevolence and civilization, have remained unharmed, and are still the asylums for the infirm and miserable, the homes of all the maimed and wounded requiring the assistance of public charity. The principal hospitals in Lisbon, are the Estrellastar, or Military ; and that of Santo Jose, or St. Joseph. The former is situated near the beautiful church bearing the same name, in one of the most elevated parts of the city; and having a large yard in front, a lot of several acres at its back, its site may be considered excellent. This * See Plate I, figs. 1, 2. rro -X ££ JHonslers p7"&s-e7-uc0t est ffte> 7fziw&u77z, of ihe C0ni/e74l o/'Jesu^, L7S&&7&. lid. 3: 'M Ibisojio-w Mackerel ef&ikralita?-. LISBON, AND THE MEDICAL INSTITUTIONS OF PORTUGAL. 39 building is about two hundred feet square, two stones high, con- structed of stone ; is plastered externally and internally, has two courts, a high flight of hewn stone steps in front, and handsome marble stairs connecting the upper and lower story. In the latter, are the store- rooms, wards for prisoners, and the chapel, which contains several good fresco and oil paintings, and some fine specimens of gilded carvings about its altars. Beneath its floor are the vaults for the dead. In the upper story are the wards for the soldiers, the rooms for the officers, and other apartments. Each ward is capable of accommodating from thirty to forty patients, is furnished with iron bedsteads, and has a plank floor, which I think is preferable to one of brick or marble, and especially in the winter. All the apartments were in good order, and supplied with every- thing which could essentially contribute to the comfort and conve- nience of the sick, who were said to be a hundred and fifty in number. Those, who were not too much debilitated, and not forbidden to do so, were allowed to take exercise in the yard and courts, or in the entries, which, terminating in balconied windows, command an extended prospect of the city and country. The faculty consisted of one physician and of five surgeons, who attended the sick in rotation. In fine, this hospital being strictly military was remarkably quiet, clean, and well regulated; and for preserving order sentinels were stationed without and within. The Hospital of St. Joseph stands towards the eastern end of the city, in a closely built, but an elevated quarter. It has before it a large yard, well shaded by trees, and a spacious arched gate, ornamented on top by two marble statues ; one of which repre- sents a person with a surgical, the other a person with a medical disease, and holding a tablet, on which is the following inscrip- tion : — ." Monumentum hoc ad perpetuam memoriam restaurationis Portugal^, in hac die commemorata erectum fuit Anno Domini die decima quinta Septembris, MDCCCXI." On the western side of the hospital are the ruins of the church of St. Joseph, which was thrown down by the earthquake mentioned, and being left undisturbed must long continue a sad monument of that dreadful calamity. The hospital itself forms a hollow square, about the size of the largest squares in the city, is three stories high, made of brick and stone, has a grand flight of stairs composed of marble, and its walls on each side lined with blue porcelain tiles, which serve both for ornament, and to prevent the soiling of the walls by the crowd of persons constantly going up and down. The main entrance, which is at the foot of these stairs, is decorated without by statues of seven of the Apostles. Each statue has about it some emblem of the death suffered by the Apostle whom it re- presents. The wards are divided into medical and surgical. The two finest of them, in the second and third story, are fifty feet wide, 40 HORNER'S OBSERVATIONS. four hundred long, and extend from one end of the building to the other. Each of these two wards has its ceiling supported by twenty- six arches, resting on fifty-two columns, and is paved with bricks. The other wards are similar to the two described, and all in the house are plainly, but neatly furnished, and have hydrants supplied with water by the grand aqueduct. Food and medicine are served out with the utmost care and regularity. The former consists chiefly of soup, rice, and fowls, and is prepared in the kitchen, which is on a grand scale, and furnished with all the implements required in such an extensive establishment. The cooking is mostly done in burnished copper caldrons, and every article is served out under the supervision of a clerk, who sits with his account books before him, and behind a semi-circular table, which extends from one side of the room to the other, and separates the cooks from the servants. The hospital is attended by four surgeons and five physicians; between whom the wards are divided, and each one of them is required to visit his patients daily. The eastern side of the house is occupied by the Medico-Chirurgi- cal School of Lisbon, and contains its lecturing and dissecting- rooms and library, which is composed of several thousand volumes of medical, surgical, and other scientific works. The dissecting- rooms are in the first story, well aired and lighted, and plenti- fully furnished with subjects. There are two hundred students, and all of them have the privilege of attending the clinical lectures given by the surgeons and physicians, and receive theoretical and practical instruction at the same time. Subjects always numerous, the wards always well filled with patients, and the best oral instruction given, the students seem to possess every facility desirable for attaining a knowledge of their profession. The medical government of the hospital belongs to a council formed of a vocal, nominated by the corporation of Miseracordia, and acting as president ; of a vocal nominated on the part of the hos- pital to represent the establishment ; of one physician, and one surgeon taken annually from among the professors performing clinical service in the hospital; and of the school Director. Their secretary is the scribe of the hospital appointed by the council. Deliberations are held by order of the president, and the two vocals being present, questions are decided by a plurality of votes. This council is the arbiter in all disputes relative to service in the hospital. The school council has authority in everything relating to clinical exercises; has authority to select the patients whom they think most proper for the infirmaries, and have their requests concerning the economical and domestic management of these attended to by the former council. As to the economical government, it is con- ducted on a system of mutual compromises, and according to the regulations of the hospitals and the Miseracordia. Medical Institutions of Portugal.— 'These are now comprehended in the Medico-Chirurgical Schools of Lisbon and Oporto, formerly LISBON, AND THE MEDICAL INSTITUTIONS OF PORTUGAL. 41 denominated the School of Surgery; the Medico-Chirurgical Schools of the Insular, or ultra marine administration districts ; and the three Schools of Pharmacy, in Lisbon, Oporto, and Coimbra. The laws enacted by the Queen, Dona Maria, for the government of these institutions, were promulgated on the 29th of December 1836, and are enforced under sanction of the following decree, made by her, and issued by the Secretary of State for Home Affairs. Decree (translated). " Understanding that the Schools of Surgery in Lisbon and Oporto, destined especially to form a class of the Faculty, esteemed necessary and important, can be improved, not only with profit to public instruction, but with great utility to the Hospitals of both cities, I think proper to decree, in continuation of the general plan of studies, the part relative to these schools which has been offered me by the vice-director of the University encharged with that plan, and which has been signed by Manoel da Silva Passos, Secretary of State of Affairs in the kingdom. The Secretary of State of Affairs in the kingdom may in like manner make this known, and cause it to be executed. Palace of Necessidades, the twenty-ninth of December, one thousand eight hundred and thirty-six. "QUEEN. " Manoel da Silva Passos." Agreeably to the above decree, both the Medico-Chirurgical School of Lisbon, and that of Oporto, has a director, who is a member of the faculty, appointed by government ; nine professors, called Lent Proprietors ; four substitutes ; two demonstrators ; one keeper ; one guard ; and a porter. Two of the substitutes are physicians, and two surgeons, one of the demonstrators is a physician, and the other a surgeon. To these demonstrators are allowed substitutes, who assist them, and perform other services directed by the council of the school. This council is composed of the director, who presides ; of the professors, and their substitutes ; and has the scientific and economical inspection of the institution, under supervision of the minister of the kingdom, with whom the director corresponds immediately. The functions of the council in all things not expressed by the decree, are regulated by the statutes of the university con- cerning medical congregation, and by the rector. The book of the orders and employments of the school, and of the annexed establish- ments, are kept by the secretary under the inspection of the di- rector, who signs it, and transmits it to the administrator-general for its ultimate destination. One of these two schools is located, as already stated, in the hospital of St. Joseph at Lisbon, and the other in that of St. Antonio at Oporto. In each school the courses of study are the following : 42 HORNER'S OBSERVATIONS. During the first year, the student attends to Anatomy and Chemistry. During the second year, to Physiology, Hygiene, Zoology,andBotany. During the third year, to the Natural History of Medicines, Materia Medica, Pathology, External Therapeutics, and Clinical Sur- gery. During the fourth year, to Practical and Forensic Surgery, Mid- wifery, Diseases of Lying-in-Women and Infants, and Clin- ical Surgery. During the fifth year, to the History of Medicine, General Pathology, Pathology, Internal Therapeutics, Clinical Medicine, Public Hygiene, Legal Medicine, and Clinical Surgery. These different branches are divided among the nine professors, and constitute nine distinct series of studies. One professor super- intends the students of the first year, one those of the second, two professors those of the third, two those of the fourth, and three the students of the fifth year. Four of the professorships are reputed medical, and five of them surgical. Pathological anatomy is studied together with pathology, and demonstrated whenever suitable cases occur in the clinical wards. Two lectures are delivered weekly by the professor of clinical medicine, on legal medicine and public hygiene, without interruption of his clinical lectures. Salaries and Exemptions. — The director receives annually, 100,000 reis, or 250 crowns, which are equal, according to the present value, to 150 dollars. Each of the professors has a yearly salary of 700,000 reis, each substitute 400,000 reis, each demon- strator 300,000 reis, the keeper 240,000 reis, the porter 200,000 reis, and the guard J 00,000 reis. The professors, after ten years of faith- ful service, are granted annuities of one half the amount of their salaries ; after fifteen years of service they receive two thirds, and after twenty years the whole amount. The professors of the old schools claiming exemptions for services anterior to November 15, 1836, have their annuities regulated by the ancient law. No professor is entitled to an annuity until ten years of service from that date ; and after the lapse of this period all annuities will be regulated agreeably to the new law. Vacancies which occur in the profes- sorships are filled by the school council, after a public notice of sixty days. The appointment of the first body of professors was made by government. Candidates are required to produce certificates of the degrees conferred on them, and the letters of surgeons, which they have received. Substitutes become professors, and demonstrators substitutes, according to their seniority. Two substitutes act as se- cretary and librarian, and are nominated by government at the re- commendation of the director. The keeper is treasurer. He also serves as assistant in the anatomical theatre, has charge of the cabi- nets, keeps all the machines and instruments in order, and reports the faults of the students. Before appointment, he must have been a student in the school for at least two years, and he may be appointed or dismissed either by the director or the council. Of the Students. — Those persons who wish to matriculate for the LTSBON, AND THE MEDICAL INSTITUTIONS OF PORTUGAL. 43 first year, must furnish the director with certificates of their having attained the age of 14 years, and gone through certain studies in the lyceums. This regulation respecting the lyceums, will not be enforced until five years after their establishment ; and anterior to that period the ancient qualifications will hold good. The fee of matriculation for each year is 9600 reis, or $16 80. For the title conferred at the conclusion of the studies of the fourth year the same fee is paid, and for the letter received at the expiration of five years, and after the examinations, theoretical and practical, they pay the sum of $21 60 cents. Should the students attend subsidiary studies in other institutions, they pay no other matriculation fee than that above mentioned. Among the students are included the midwives, who are women, and for whose instruction there is in each of the medico-chirurgical schools a biennial, gratuitous, theoretical, and practical course of studies. Lectures designed especially for their instruction are de- livered by the professor of midwifery, who likewise instructs them practically in the infirmaries. In the hall of obstetrics, a place is expressly provided for their accommodation. Persons desiring to be midwives have to matriculate separately, to present certificates of knowing how to read and to write, and to undergo at the ex- piration of the biennial course a theoretical and practical examina- tion on the accidents and diseases which precede, accompany, and follow delivery, and on the method of treating them. The professor of midwifery, that of surgery, and one of the surgeons in the hospi- tal appointed by the school council, form the board of examiners. Approval depends on the plurality of votes. If the candidate pass, she receives gratuitously a letter of midwifery, signed by the se- cretary, approved by the director, and sealed with the seal of the school. Ultramarine Schools. — In each of the administrative ultramarine districts, at its Hospital of Miseracordia, there is a medico-chirur- gical school, having two professors ; one of anatomy, physiology, surgery, and obstetrics; the other, of pathology, materia medica, and therapeutics. The first named professor is the principal sur- geon of the hospital, and receives a salary of 750 dollars. He has an assistant, who, under his inspection, makes anatomical pre- parations, and is demonstrator and chief of the hall of dissection. For his services the assistant receives 450 dollars a year. The second professor is the principal physician of the hospital. He delivers, in addition to lectures on the above branches, a course on clinical medicine. His salary is the same as that of the first professor. A council, composed of these two professors, the assistant, and apothecary, has the inspection and direction of the school. The physician is the president, and the apothecary the secretaiy. This council examines the candidates, and confers letters of licen- tiate, granting permission to practise the profession; but only in prescribed places where there are no regular graduates. The instruction and examination of pharmaceutists take place in 44 HORNER'S OBSERVATIONS. these schools, and the students of pharmacy learn that science in the apothecary's shop of the hospital, under the inspection and in- struction of the pharmaceutist, who for his trouble gets 90 dol- lars a year. Midwives are instructed by the professor of surgery in the man- ner specified in speaking of the schools of Lisbon and Oporto. Schools of Pharmacy. — Annexed to each of the medico-chirurgi- cal schools of Portugal is a school of pharmacy, for which the Directors, Secretary, and Treasurer, perform the duties required of them in their respective offices. There is a third school of phar- macy at Coimbra. In each of these three schools there is a the- oretical and practical course of instruction; the first of which consists of botany, chemistry, pharmacy, and natural history of medicines; and the second of the exercise of pharmaceutical operations for the space of two years, either in the dispensary of the school, or in some other approved and accredited one. Chemical and botanical instruction can be obtained either from the professors at Lisbon, Oporto, or Coimbra. Lectures on the natural history of medicines and pharmacy are delivered by the professor of materia medica, in the period of two years, to the students of pharmacy; who after being examined in chemistry and botany are admitted as a separate class into the hall of materia medica. These students, likewise, are obliged before entering the schools to go through certain studies in the national lyceums. For matricu- lation and letters they pay the same fees as other students, and for their practical instruction the pharmaceutists of the schools receive the same compensation as those in the ultramarine districts. After having gone through the biennial studies these students are also exam- ined. In each school for this purpose is a special board, composed of the professor of materia medica and pharmacy, of his demon- strator or his substitute, and of the apothecary of the pharmaceuti- cal dispensary. Pharmaceutists who have not attended the theoretical and prac- tical courses prescribed, are admitted to examination by this board, upon producing certificates, signed by the authorities of the places to which they belong, of their being twenty years old, of the studies they have gone through, and of their correct habits. Before being ex- amined they have also to pay a fee of three dollars and sixty cents, and furnish testimony from the pharmaceutists with whom they lived of their good behaviour. Moreover, no one is examined who has not been practising pharmacy for eight years. To ascertain those entitled to examination, all the apothecaries keeping shops are obliged to send annually to each one of the three schools of pharmacy a register of the persons practising in their shops, with their names, and those of their places: the time of commencing practical study ; that which they have been studying ; and an ac- count of the progress each one has made. On the subjects of botany and chemistry they are asked only questions relating strictly to SPAIN. 45 pharmacy, but in the latter science are examined both as to theory and practice. Finally, letters of pharmacy are conferred on all found qualified. No school is allowed to confer one on any person who has not con- formed to the rules established, in every respect ; and no pharma- ceutist will be permitted four years after the publication of the above decree to open a new shop without having been examined and ap- proved in the manner specified. It must be evident that, under these wholesome laws and the patronage of government, the medical institutions of Portugal must improve and flourish. Objections may be made against them be- cause of their dependence on government. It may be said it would be better that they should subsist by their merits exclusively; it would be more profitable to the faculty, and more advantageous to the public to have them supported by the fees of the students, and for the professors, as in our country, to be compensated in a ratio to their popularity. I will not discuss any of these points, but will terminate this account by observing, that the profession of medicine bids fair in Portugal to attain the high rank, public esteem, and high respectability possessed in the other civilized countries which have properly appreciated its merits. SPAIN. Of this extensive country — in which are found so many objects deserving of attention, and of subjects worthy of inquiry — I shall not undertake either a minute or general description ; as I should, if I did so, go entirely beyond my prescribed limits, and should be obliged to rely rather on information received from others than on that collected by myself. For these reasons, after some general remarks, I shall proceed to speak merely of those parts with which I am best acquainted, and then communicate such information as I have been able to gather regarding the profession of medicine in this country. Spain, as is generally admitted, is naturally one of the most charming regions in the world ; and by her climate, soil, rivers, and mountains, her animal, vegetable, and mineral productions, is justly entitled to the reputation of being one of the finest kingdoms in Europe. The climate, however, is not uniform ; a great difference existing between that of the northern and southern provinces, and between that of the plains, valleys, and mountains, especially those of the greatest eminence, as the Sierra Nivada, or snowy moun- tains, running through Grenada, — the Sierra Morena, Montserrat, and the Pyrennees, some of which are so high that, even in summer, their tops are more or less capped with snow and ice. The temperature of the air, therefore, about these mountains is very 5 46 HORNER'S OBSERVATIONS. different from that of the low country, and must necessarily subject it to great vicissitudes of weather. Nevertheless, these mountains serve to moderate the excessive heat of summer, render the climate suited for the growth of a much greater number of valuable plants, supply an abundance of ice during the hot season, produce exten- sive forests of the largest trees, and maintain a race of hardv, athletic, active, and courageous men, for the cultivation of the soil, or for bearing arms in the defence of their country. Moreover, from the mountains proceed many copious streams of the best water, and many of the most precious minerals, as coal, sulphur, lapis lazuli, asbestos, cobalt, garnet, gypsum, a variety of marbles, saltpetre, muriate of soda, turquoise, lead, iron, copper, tin, silver, and mercury, which last is one of the richest sources of revenue to the kingdom, and forms one of the most valuable articles of exportation. Lastly, the mountains may be said to be advantageous from their being composed chiefly of limestone, which, mouldering away, is swept down by the rains; and being carried into the valleys, render them still more rich and productive. In fact, the soil of Spain owes its fertility, in great part, to the large quantity of lime it contains, and this may be said to be derived chiefly from the mountains. With animal and vegetable productions Spain is also bountifully supplied. All the domestic animals, as hogs, sheep, asses, mules, goats, horses, and cattle she possesses in the greatest abundance; and in rabbits, deer, partridges, woodcocks, and other game, she is not deficient. Her horses are famous for strength, swiftness, and beauty; and her sheep for their immense numbers, and the vast quantity of the finest wool, not only for domestic but foreign manu- factures. Before the commencement of the late w