LONDON

MEDICAL AND SURGICAL

JOURNAL;
EXHIBITING

A VIEW OF THE IMPROVEMENTS AND DISCOVERIES

IN THE

VARIOUS BRANCHES OF MEDICAL SCIENCE.

EDITED BY

MICHAEL RYAN, M.D.

MEMBER OF THE ROYAL COLLEGE OP PHYSICIANS IN LONDON, &C. &C.

AND

AN ASSOCIATION OF PHYSICIANS AND SURGEONS.

Quxrere verum.— Horace.

VOL. II.

LONDON:
PUBLISHED BY RENSHAW AND RUSH, 356, STRAND,
(near the king's college).

1833.
 Mr. Hamilton on the Medical Topography of Peru.
fctene ; <he infiltrated or effused blood is
absorbed with facility ; lacerated wounds of
the »kin are not so dangerous, and cicatrize
like ordinary wounds; finally, this plan re
moves danger from these various conse
quences, when it has not been able to pre
vent their coming on.
General remits. — The duration of treat
ment, that is to say, of the application of the
apparatus, is, in general, from twenty-five to
thirty-five days in simple fractures, and in
the most part of those which are complicated
with displacement inwards, outwards or back
wards, with infiltration or effusion of blood,
rupture of the lateral ligaments, of the apex or
base of the internal malleolus; from forty to
sixty days for those which are complicated with
serious injury to the soft parts, either inter
nally or externally, splinters, and sometimes
inflammation, suppuration, abscesses, &c.
from sixty, eighty, one hundred, or more
days, for comminuted fractures, or com
plicated with necrosis of the tendons and
bones. Convalescence generally requires
double the time of the treatment, whatever
may be the nature of the fracture.
In all cases, the foot appears more or less
carried inwards, or in the state of adduction,
after the removal of the apparatus. But the
action of the muscles, or, according to the
case, the application of the apparatus ex
ternally, suffice ; the first in a few days ; the
second in a few hours, to bring the foot into
its natural position.
Out of 207 patients, treated by this me
thod, 202 have been cured ; five only have
died, three from accidents dependant on the
disease itself, and two from complication in
dependent of it.
Of those cured, the limb has regained its
natural form, excepting two cases, in which
the heel remain a little elongated, and the
inferior extremity of the tibia Blightly pro
jecting forwards. All have recovered a free
use of the foot; one only having anchylosis
of that part with the leg.
Observation led Newton to dis
cover, that the refractive power of
transparent substances was, in gene
ral, in the ratio of their density, but,
that of substances of equal density,
those which possessed the refractive
power in a higher degree were in
flammable. Analogy enabled him
to conclude that, on this account,
water even must contain an inflam
mable principle. And Experiment
enabled Cavendish and Lavoisier to
demonstrate the surprizing truth of
Newton's induction, in their immor
tal discovery of the chemical com
position of this fluid.—J. A. Paris.
73
ON THE
MEDICAL TOPOGRAPHY OF SOME
PARTS OF PERU,
RELATIVE TO
DYSENTERY AND INTERMITTENT
FEVER.
BY MATHIE HAMILTON, Esq.
FORMERLY SURGEON TO THE POTOSI, PAZj
AND PERUVIAN MINING COMPANY, &C. •
The distance from the city of Arica to that
of Arequipa, via Tacna, is about three hun
dred English miles. The road or rather
tract (for in that country roads are few and
far between,) leads the traveller through a
continuous desert, with the exception of the
following narrow strips, or valleys, as they
are called by the natives, where water is to
be found, viz. Tacna, Samo, Loqumbo, Mo-
quegua and Tomba. Tacna is distant from
Arica fourteen leagues, to Samo from Tacna,
nine—Loqumbo from Samo, eleven—Mo-
quegua from Loqumbo, sixteen — Tomba
from Moquegua, twenty-five—and to Are
quipa from Tomba, twenty-five leagues. On
this part, as on other places, along the west
coast of South America, rain is not seen, and
no water is to be found, except where a
mountain torrent from the Andes gives a
passage to the melted snow from the Cordil
lera of the coast, and the rain, which, on
these sublime heights, falls in immense quan
tity during the rainy season. Several of the
above-mentioned water courses have to be
crossed by the traveller on his route from Ari
ca to Arequipa, if he go by the way of Tomba.
During the greater part of the year these
channels are easily forded, that of Tomba
alone is at all times of sufficient importance
to excite the curiosity and apprehension of
the traveller advancing towards it, and to
make him inquire at the first one he meets
from Tomba, " Como esta el Rio ?" how is
the river? Arica is situated at about 18 j
degrees south latitude. All the above-men
tioned places are north from Arica, and con
sequently within the tropic of Capricorn.
Intermittent fever is always to be met
with in Arica ; the single tertian is most fre
quently seen ; dysentery is not at all timet
met with—it is most prevalent in the months
of autumn and beginning of winter, viz.
March, April and May. The west coast of
South America, from the northern boundary
• We have copied this interesting paper
from our cotemporary, the Glasgow Medical
Journal, inasmuch as very little is at present
known on a very valuable part of our science,
namely Medical Topography; it is one
which we hope will soon be more fully and
completely studied than heretofore.—Eds.
 74 Mr. Hamilton on the Medical Topography of Arica.
of Chili, almost to Lima, a apace of more
than 1500 miles, is literally a desert, where
there is neither vegetation nor water, and
consequently no inhabitants, except at a few
points, such as above referred to ; but
wherever water is met with, there vegetation
is rank, and vegetable matter is more or less
in a state of decomposition.
From the time of Sir Francis Drake, until
lately, Arica was dreaded by all visiters, as
being extremely noxious to health. The
town is built close to the beach, and one
part of it stands on ground rather more
elevated than that which is next the sea.
Close by the town is the M6ro, a bold pro
montory, or headland, whose front presents a
white appearance, the effect of the dried ex
crements of myriads of birds that nestle
there, among which the condor • is occa-
"sionally seen ; the base of the Morn is
washed by the surf of the Pacific. At Arica,
the Seabreeze blows almost constantly from
the south-west. The Miiro is on the south
side of the town, and consequently the efflu
vium from it is wafted over the site of Arica ;
therefore we might expect, that if the in
salubrity of the place originates in the M6ro,
as some have supposed, the town must be
most sickly at the time when the southerly
winds most prevail, and vice versa ; but the
reverse is the fact
Arica, like all other places similarly situ
ated that I have seen, is most unhealthy at
the season when vegetation has come to ma
turity, and when moisture is most abundant.
The first chain or Cordillera of the Andes,
is distant from the coast of Peru, at the part
now under consideration, about 20 leagues,
and, strange though it may seem to some
who have not witnessed the phenomenon,
the space of about GO miles is all that sepa
rates winter from summer. The hot months
of November and the two following are de
signated the summer months, by the people
who live on the coast ; while the same period
is called winter by the inhabitants who re
side across the mountains ; and not without
reason, for almost every day after meridian
a tempest of thunder and lightning, accom
panied with rain, hail, or snow, which gene
rally continues till sunset, interrupts the
business of life in the Cordillera, and causes
the quebradas or ravines on the mountains
• In September, 1826, Captain W. G. C.
Kent, R.N. shot a condor, near to the Moro
of Arica. That gentleman had it conveyed
on board a vessel in the bay, and wished to
have it preserved, but owing to particular
circumstances it was thrown overboard. I
measured it, and when the wings were held
asunder the length from tip to tip was six
teen feet. This condor was larger than some
that are to be seen there, but much less than
one with which I had an encounter, one
morning before sunrise, on the summit of
the M6rn of Arica.
to convey a flood to the arid plains below ;
which flood in some places reaches the sea,
but in most cases is lost in the desert.
Arica is one of the places that are affected
by the water from these mountains, and it i»
experienced that intermittent fever and dy
sentery most prevail at that season, when,
owing to the heat and a greater supply of
water, vegetation is most exuberant, and in
the state of putrefactive fermentation. The
water from the Andes reaches the coast in
greatest quantity during the months of Fe
bruary and March, because, in these months,
the heat of the sun is most effective m melt
ing the snow in the early part of the day; so
that at this time, the rain which still falls after
midday, combines with the melted snow and
increases the flood below. Now, it is at this
time of the year, when intermittent fevers
and dysentery are most prevalent, in all the
places before mentioned. Of late years,
Arica has not been so unhealthy as it was
formerly in winter and spring. In proof of
this, I may notice, that about one hundred
persons under my charge arrived at Arica in
the month of July, and during a period of
four months subsequent to that time, not one
death occurred among them, and that too
after they had been nearly five months at sea ;
but had the same individuals been resident
in Arica the four following months, the re
sult would have been very different, Now,
however, even at the worst season of the year,
Arica is not so unhealthy as it once was.
The emancipation of the country from the
thraldom of Spain, has operated beneficially.
In former times, the water from the moun
tains was allowed to find its way to the sea,
by running along the almost level ground
in the vicinity of Arica. The consequence
was the formation of a swamp, whence exha
lations rose, bearing disease, misery and death
to the victims of resistless arbitrary power.
When the patriots first got possession of
Arica, they cut a considerable ditch, or chan
nel, on the north side of the town, to let the
water have free course into the sea. The
place was greatly improved, and rendered
much more salubrious during the interval of
time that elapsed, between the period when
the above-mentioned improvement was ef
fected, and the re-occupation of Arica by the
Spanish loyalists, who, with diabolical inge
nuity and perseverance, filled up, or other
wise destroyed the canal, and again Arica
became, what it had been for centuries be
fore, very unhealthy. The accumulation of
putrid animal matter, which operates so in
juriously in some of our towns is not known
there, and cannot influence the state of health.
The police establishment of Arica costs no
thing, and yet the scavengers of that place
are a very numerous and effective body, for
no sooner is any offal, or nuisance of an
animal nature exhibited, than some of these
functionaries pounce on it, turn it into food,
and thus prevent decomposition from being
 Mr. Hamilton on the Medical Topography of Arica.
effected through the medium of atmospheric
heat and moisture. So convinced are the
people of Arica of the beneficial services of
the gallinass. the black vulture of Linnaeus,
that a heavy mulct is exacted from whoever
is so cruel or so inconsiderate as to deprive
one of these birds of life. It is not improba
ble, that, after a short period shall have
elapsed, the town of Arica will be removed to
a short distance from its present site, which is
a bad one ; for the traveller who enters it
towards evening during autumn, when at a
short distance , has his olfactory nerves pow
erfully affected by a most loathsome stench,
worse than that of animal matter while un
dergoing the putrefactive fermentation ; a
dense white cloud, or haze, at the same time,
almost obscures the place from his view, and
if he knows the cause of the phenomenon, it
is apt to excite in his mind, emotions of a
melancholy kind.*
It has been observed, that people who are
resident in that part of Arica which is most
elevated, are not so subject to sickness as
those who reside in the lower portion of the
town. I believe this will be found inva
riably the case, wherever miasmatic influence
exists. Earthquakes are of very frequent
occurrence at Arica, but they are generally
slight ; houses are not often thrown down
there, as they are erected in such a manner
as to withstand shocks, which would have the
effect of involving in ruins elegant and
stately buildings, such as are to be seen in
Glasgow. I have noted that there is always
an increase of sickness subsequent to a smart
shock of an earthquake.
I will not here advert to the symptoms
and treatment of ague. To persons who visit
these remote regions for commercial pur
poses, and whose residence is to be but tran
sient, it is of most importance to know, that
disease of the kind alluded to, may, in great
measure, be prevented, by attending to the
following simple rules. Keep within doors
in the morning until at least one hour after
sunrise, and also during two hours subse
quent to the setting of that luminary ; main
tain, if .'possible, the moderate action of the
cutaneous vessels, together with that of the
biliary system, and nothing that I know is so
effectual in keeping the skin in a healthy
condition there, as bathing in the sea every
morning for a minute or two, say at eight
o'clock. And as a further prophylactic
* I anticipate that Arica is destined to be
come a place ofgreat commercial importance—
that a direct trade will ere long be establish
ed between it and the eastern world—that the
tin of Oruro, the silver of Potosi, and the
copper of Coquimbo, will be carried in ves
sels of the country to China, and exchanged
for the commodities that are at present ob
tained through the medium of capital and
shipping, belonging to the United States of
North America.
75
against Intermittent fever, I heartily coincide
with the late Bishop of Arequipa, who, when
asked what he could recommend to prevent
terciana, replied, " good bread, good beef,
and good wine."
Before leaving Arica, it may not be amiss
to notice, that immediately south from the
M6ro, about a mile from the town, there is
an ancient burial place of the Peruvians,
said not to have been used by them since
the time when the Spaniards first came to
that part of the world, where bodies which
were interred more than three hundred years
ago, are, in some cases, found entire. I
examined a number of these relics of former
ages, and found that the phosphate of lime
is all that remains of the bones, which makes
it difficult to remove them without breaking.
Some have the hair on the head entire, and,
in some, instances, even the features can be
distinguished. The place has been much
frequented of late years, and the ground
broken up since foreigners have had access
to it While I was at Arica, a gentleman
belonging to H. M. ship Blanche, succeeded,
after much trouble, in getting one of these
natural mummies taken on board the frigate,
and I have heard that it is now in the mu
seum of the University of Cambridge. Some
persons have lately destroyed a great num
ber of these curiosities by digging about
them, expecting to find treasure. I never
saw any thing taken out, except some of
the earthen vessels, which the ancient Pe
ruvians seem to have been accustomed to
put into the ground with their dead. The
soil consists of sand and nitre, which, with
a total absence of moisture, added to a hot
and dry atmosphere, has had the effect of
drying or extracting the fluids, and thus pre
venting the establishment of putrefactive fer
mentation.
Leaving Arica on the route to Tacna, the
traveller proceeds in a northeastern direction,
having the ocean on his left, and towards the
right the famed valley of Sapo. About a
mile north of Arica, it is necessary to pass
the river San Joseph, and five miles further
on is the river of Chaque Luta, which is only
a brook during the colder months, when
the frost is excessive on the mountains, but,
in the hot seasons, and when the rains have
fallen among the Andes, is often dangerous
to travellers, lives having been lost in it.
In February, 1827, the writer, while on a
professional visit to Arica, was nearly drowned
here, the animal on which he rode having
been baffled in its first attempt to get across.
On the following day, several military re
cruits were said to be lost at the same place.
They were on foot, and tied one to another
to prevent desertion, and, being overcome
by the impetuosity of the torrent, were
swept away and perished together.
The next thirty-six miles present a per
fect waste, where there is not a blade of ve
getation, nor a drop of water : at some places
76 Mr. Hamilton on the Medical Topography o/Tacna.
a peculiar hollow sound is produced by the
feet of the horse or mule. On arriving at
the Equesta, a height distant six miles from
Tacna, this town is seen for the first time,
and is a welcome spectacle to the exhausted
traveller, who now can direct his eye from
the pathless sand of the desert to the houses
and evergreens of Tacna, appearing like an
islet amid the immense solitude—another
Tadmore in the wilderness.
Tacna is an Indian town of some antiquity,
situated about midway between the base of
the Cordillera and the sea. The desert here
presents an inclined plane to the eye of an
observer, the town being fourteen hundred
feet above the Pacific The place is supplied
with water for all purposes by a river, which
issues from the Andes by the great gorge, or
ravine of Palca, the principal pass across the
western Cordillera from Arica to Bolivia, or
Upper Peru. It is obvious that, in such a
place, water from the river is indispensable
to the people in the valley, and must be
highly valued. Accordingly, the water is
apportioned to the proprietors, or holders of
the chaqueries or plantations, with strictness
and punctuality, by persons who are appoint
ed for that purpose. The course of the river
is changed every other day, so that irrigation
may be effected more completely. Except
in the event of an extraordinary flood, no
portion of the water of this river reaches the
sea. The irrigation of the chaqueries in the
valley takes so much of the stream, that the
remainder is either evaporated or absorbed
by the desert.
The productions of Tacna are a great
variety of culinary vegetables, with a little
maize andlucern, the principal food of horses,
mules, and donkies. Melons, pomegranates,
peaches, and other fruits, are to be had in
abundance. The olive, the fig tree, and the
vine also flourish here. A great part of the
vegetable productions of the place not being
consumed by the people, is allowed to de
compose, and miasmata, with their usual
concomitants, follow. The climate of Tacna is
delightful, the thermometer ranging between
70° and 90* in the shade, during the greater
part of the year. The proximity of the
Andes is the cause of this moderate heat
The mountain of Tarcora is situated imme
diately east of the valley of Tacna ; the sum
mit is a cone covered with everlasting snow,
and elevated nearly nineteen thousand feet
above the level of the ocean.
Intermittent fever is met with in Tacna at
all times, but more in some seasons than
others; it is generally most prevalent during
autumn. The tertian form is most frequently
experienced. I have seen some very old and
obstinate cases of quartan ague, but, in every
•uch case, I learnt, on inquiry, that the
patients had been exposed to other miasmata
than those of Tacna. Of several hundred
cases of intermittent fever which came under
my observation at this place, none exhibited
the quartan type of the disease except a few,
the subjects of which had been exposed to
the miasms of other districts. However, it
does not follow as a necessary result, that the
miasms of Tacna cannot produce quartan
ague. Pujos de sangre (dysentery) is often
met with here, as in all other places which
I visited on this coast. In many cases, it
was ascertained to be symptomatic of an affec
tion of the hepatic system, in others it was
idiopathic.
The province of Arica includes an extent
of territory greater than one half of Scotland,
and, in the year 1828, the population amount
ed to fourteen thousand, of which number
five thousand reside in the valley of Tacna.
It is a singular fact, that earthquakes are
neither so frequent here as at Arica, nor are
they so severe when they do occur. The
great earthquake of the 30th March, 1828,
which almost laid the city of Lima in ruins,
was felt at Tacna, but in a slight degree only.*
Samo and Loqumbo are two narrow straths
or valleys, separated from Tacna, and from
one another by a desert of about thirty miles.
At both places there is water from the Andes,
vegetation, and miasms, with their usual con
comitants, but not meriting further notice,
the population being scanty, amounting to a
few hundreds only.
A few hours after leaving Loqumbo, by the
lower route to Moquegua, the traveller,
while he is advancing over an extensive flat,
all at once sees an immense break, or chasm,
in the ground before him. When at the
edge of the precipice, it is found to shelve
down abruptly, both sides being perpendi
cular to the horizon, and extending longitu
dinally in both directions, farther than the
eye can reach.
A stranger, about to cross for the first
time, is apt to fear that further progress on
his journey is impossible; but, following the
example of the guide, he throws the reins on
the neck of his mule, which soon commences
making its way downwards. Putting one
foot circumspectly before the other, to ascer
tain that the ground is firm, the animal gets
to the bottom, by a sort of stair or declivity,
which runs slanting along the front of the
precipice. All the rider has to do is to keep
his seat, reclining well back in the saddle ;
if he wish to get down by himself he must
dismount before the mule begins to descend,
because, if he attempt to do so while the ani
mal is on the stair, which is narrow, it may
be thrown off its balance, and then both must
make a somerset to the bottom. The ascent
on the opposite side is effected with some
difficulty, and after riding the distance of a
musket shot another gap appears in view, to
the no small mortification of a stranger. This
break presents the same general phenomena,
• The city of Arica was totally destroyed
by an earthquake on the 8th of October,
1831.
 Mr. Hamilton un the Medical Topography of Moquegua.
hut is nut quite so deep, though of greater
breadth, and equally wall-sided as the one
already noticed, and lias to be crossed in a
similar manner. Some mighty convulsions
of nature must have been the agent by which
these immense cavities have been produced.
A few leagues in advance towards Moque
gua, the route lies over the tops of moun
tains, some of which seem to be of volcanic
formation ; and then the varied and magui-
6cent scenery of the valley of Moquegua
bursts on the sight, and, if seen when illu
mined by the rays of the setting sun, the
prospect is picturesque in the extreme.
The city of Moquegua is the capital of the
province, and is situated in the valley of the
same name. It is distant from Arequipa
about fifty leagues, and in 1828 the popula
tion of the town was 10,000. The vale of
Moquegua has long been celebrated for the
fertility of its soil, the industry of its in
habitants, and the deadly nature of its cli
mate. The river which flows through it is
the, only water, for irrigation and all other
purposes. The vine, the sugar-cane, and
other tropical productions are very abundant
Aguardiente (brandy) is made in great quan
tity. Sugar is also manufactured here.
Formerly one million of dollars was re
ceived annually by the people of this place
for wine and spirits, sent chiefly to the min
ing districts. The trade is still considerable.
The town is built in a hollow or pit ; so
singularly is it situated, relatively to the ap
proach to it from the south, that the travel
ler looks down on it without any previous
intimation of its being so near. The site
seems to be the very worst that could have
been chosen in the valley, in so far as salu
brity is concerned.
The Spaniards were very unforunate in
their choice of sites for some of their towns
in the New World; either from ignorance,
or motives not now ascertainable, they fre
quently fixed on spots which are very un
healthy, and more so than others in the im
mediate vicinity. Moquegua is a case in point.
According to a tradition, the original Spanish
inhabitants held a meeting, for the purpose of
fixing on a place for the establishment of the
intended city. The major part of the people
present were very desirous to have the town
built on a spot nearer the mountains, which
is much more salubrious ; but a few influen
tial individuals overruled the general wish,
and insisted on the erection of the city on its
present site, which is truly pestiferous.
Intermittent fever, in all its varieties, is
seen here, and also dysentery. The sickly
aspect of the people in general, is sufficient
proof to a stranger of the insalubrity of the
place, without the evidence that may be de
rived from seeing the hundreds of sick persons,
who, in some seasons, are rendered unfit for
locomotion by the poison of miasmata, which
here has a numerous population for its victims.
Persons going from Moquegua to Arequipa,
77
have the choice of two routes, that by Tambo,
or thai by Los Pueblos. By the latter route,
it is necessary to ascend as far as the line of
the Cordillera. This journey is not so dan
gerous to health, as that by the valley of
Tambo, but is more fatiguing, and rather
longer. The writer having heard much of
the notoriously pestiferous valley above men
tioned, it was determined to reach Arequipa
by that way.
The distance from Moquegua to Arequipa
by Tambo, is one hundred and fifty English
miles, and the only halting place between the
two cities, where food for cattle can be pro
cured, is in the aforesaid valley. On arriving
at the Moro of Moquegua, which is a height
overlooking the sea, and about midway be
tween the latter place and Tambo, the night
was passed in the open air, and without wa
ter. There is a small spring of excellent
water, nearly on a level with the sea, but the
descent to it being difficult, and very fatiguing,
the guides kept its existence a secret, and on
the following morning, grapes, which we had
carried from Moquegua, were used as a sub
stitute for water. From this place the conti
nent bends, the coast taking a northwesterly
direction ; and the tract towards Tambo
leaving the coast, a considerable elevation
has to be attained. When within a league
of the valley the ground begins to fall gradu
ally, a narrow pass leading to that part where
it is necessary to cross the river.
The sun had set before our arrival at the
pUce, where halting for the night was indis
pensable, and the mules having been two days
and a night without water, first rushed into
the river to quench their thirst, and were
afterwards turned into a small patch of alfalfa
(lucern).
Tambo is much dreaded by travellers, es
pecially at this season, (February,) both on
account of the river, to cross which is often
extremely hazardous, and also the notoriously
pestiferous climate of the valley. What first
strikes a stranger is the smell, similar to that
experienced at most places where vegetable
matter is being decomposed by putrefaction.
The next fact worthy of notice is, that at
this part of the valley of Tambo, there is no
marsh, but there are several cuts or canals
from the river, for the conveyance of water
to the sugar plantations in the vicinity. The
soil, at the place where we halted, seems to
be composed of decayed vegetable matter,
the accumulation of ages. A dense fog hung
over us, and the musquitoes were very trou
blesome.
This place is encompassed on all sides by
mountains, and it is probable that the miasms
are in a state of greater condensation, and
the poison more concentrated here than at
other places, where, though the remote cause
of ague exists, yet people may visit them with
greater impunity, than they can cross the
valley of Tambo.
Three or four families of Indians make up
78 Mr. Hamilton on the Medical Topography of Quebrada de Celsipedes.
the population. An Alcalde or Magistrate,
resides in one of the ranchas or wigwams.
He is a pot-bellied Indian, and presents that
bloated appearance sometimes seen where
intermittent fever abounds.
Sugar in considerable quantity is made in
this valley ; the plantations are lower down
nearer the sea than this spot.
It is worthy of notice, that in this country,
wherever sugar grows, there fever prevails to
a greater extent ; and according to the state
ment of those resident at such places, the dis
ease is more fatal, than where sugar is not
produced. In the language of these people,
** muy mortal es la Terciana de Tambo."
This may arise either from something more
deleterious in the miasms of places where
sugar grows, or from the people employed in
its cultivation being more exposed to the
poison.
Whatever is the cause, an attack of inter
mittent fever, is, in most cases, the result of
merely crossing this valley. Our party con
sisted of eight men, all of whom, except the
writer, were natives of Peru. They slept on
the ground during the night, partially shel
tered from the open air, and seven of the
party were attacked by the fever, at various
dates from the period of their exposure to the
miasms of Tambo. The time that elapsed
before the symptoms of the disease were de
veloped, varied in different individuals, from
three days to three weeks. The writer was
not taken ill until the day subsequent to that
of his arrival at Tacna, on his return from
Arequipa. It is observed, that those who
have not previously suffered from ague, are
seldom attacked while travelling in these
countries, though exposed to the exciting
cause.
The disease does not appear until after the
completion of the journey, when the excite
ment concomitant on travelling has subsided.
This was the case with the writer, who,
though he had been much exposed to mias
mata in Brazil, Bolivia, and Peru, yet was
not affected with ague, until after his visit to
Tambo.
Persoas who are attacked with ague while
on the road, are generally found to have been
previously subjected to the disease. It is
always peculiarly distressing in such cases,
in consequence of the impossibility of giving
the sufferer that aid, which, in more favour
able circumstances, humanity would dictate.
Sometimes the patient no sooner sees his fin
ger nails become blue, or touching his nose
with the back of his hand, and finding it
told, than, knowing what is coming, he slips
from his mule, and prostrates himself on the
earth. On the approach of the shivering fit,
he gives vent to his feelings in murmurings,
or uttering imprecations on his hard fate, he
implores assistance from those around him.
When, owing to the severity of the pa-
roxyms, the sufferer no longer can speak, he
may be seen bearing the ground with his
heels, moving them alternately with rapidity.
This last mode of exercise may seem some
what odd to the unscientific; but, in such
circumstances, it is not a bad expedient,
for maintaining the circulation in the inferior
extremities, which, as is well known, is a
desideratum during the cold stage of inter
mittent fever.
The river at Tambo emerges from between
the hills, where, during floods, it is straitened
in its channel. It is now more expanded
and divided into several branches, which, at
this season, are of sufficient magnitude to
excite apprehension in those who attempt to
gain the opposite bank.
Application was made to his sallow Wor
ship, the Alcalde before noticed, and half a
dozen tall Samboesc were procured, who, for
one dollar each, swam, or waded into the
river, and stationed themselves at different
points of the ford across the stream, in the
several limbs of the river in succession. They
served the double purpose of pointing out
the most eligible tract, and also, in the event
of an accident, were ready to give assist
ance. These people are excellent swimmers,
and are able to stand up to the neck in water
and stem a current, which a mule is often un
able to withstand. In this way, the river of
Tambo was crossed at four in the after
noon. The moon being full, it was found
expedient to travel all night. The heat,
during the day, at this time of the year, is
overcoming, especially while ascending the
celebrated defile, or Quebrada de Celsipedes,
a journey of sixty miles up hill, and in the
whole of which neither water, vegetation, nor
any living thing is seen.
This Quebrada is an extraordinary pheno
menon, even in this extraordinary country.
The ground rises by a gentle ascent from the
Arequipa margin of the river, and, when
distant from it about four hundred yards, the
traveller finds himself on a height, down
which is the way leading into an extensive
natural basin, which is contracted at its fur
ther extremity into a passage fifty or sixty
yards in width. The sides are hills of a
dark coloured sand, the ground is of the
same, at some places firm, at others so deep
as to cover the fetlock of the animals. The
breadth of the Quebrada varies frequently,
being in some places contracted to twenty
paces, at other parts it is five times that width.
The ground rises gradually, and at the out
let next Arequipa, which is the highest point,
the elevation is 9,000 feet above the sea.
The length of the Quebrada is twenty-one
leagues, and throughout the extent of twenty
leagues from the river of Tambo thereis no
way of escape, except by the two extremities.
The traveller, during this journey of sixty
miles, sees nothing which has the principle
of life, except his fellow-travellers, and the
animal on which he rides. Neither beast,
bird, reptile, nor insect is to be met with ;
not even a sound is heard, except that of the
 Mr. Hamilton on the Medical Topography of Arequipa.
occasional snorting of the mules, the voice of
the muleteer encouraging the animals, or the
roll of distant thunder. Hundreds of skele
tons of horses, mules, and asses, are the only
mementos of animated nature found in this
valley of death. Birds of prey, though not
seen nor heard by the traveller, must visit
the Quebrada, as the carcass of any poor
animal which is so unfortunate as to fall a
victim to the privations incident to the jour
ney is soon devoured.
The Quebrada is very tortuous. At the
height of about 7,000 feet a little water
issues fruin the middle of the road. This
water is salt, and is a source of great disap
pointment to the parched and almost worn
out animals, who eagerly draw in the in
viting, but deceitful, draught.
A few leagues more bring the traveller to
the cabin of an Indian family, where there
is a spring of fresh water, and one league
further on is the extremity of the Quebrada.
We arrived there at nine o'clock A.M., the
morning was fine, and the sky cloudless.
The scene presented to the observation of
those who are alive to such objects is truly
grand. The river Chile, after contributing
to the fertility of the country around Are
quipa, rolls its impetuous course 2,000 feet
below the outlet of the Quebrada. Beyond
the river are innumerable chaqueries (gar
dens), amid which the cemetery of the city
appears conspicuous, interspersed with shrub
bery, and pillars painted white. Further off,
on an inclined plane, the city is seen to great
advantage ; being remarkable for the extent
and solidity of many of its edifices, both pub
lic and private. It is also interspersed with
trees and shrubs, which, contrasted with the
whitened aspect of its buildings, more par
ticularly the convents and churches, with
their towers, under the rays of a tropical
sun, presented a novel spectacle. Beyond
all, at the distance of a few miles from the
city, the mountains of the western Cordillera
of the Andes rise like an enormous rampart
shrouded in eternal snow. Immediately be
hind the city the volcanic towers rise to the
height of 17,000 feet above the ocean, its
arid summit unlike the snow-capped peaks
of the Andes in its immediate vicinity.
The valley of Arequipa includes an im
mense space, extending towards the north of
the city, further than can be seen by a spec
tator, when placed at the outlet of the Que
brada. This valley is bounded on the east
by the Andes, and towards the west by hills
of inferior altitude. It is partially under
cultivation, more especially that part of it in
' .e vicinity of the city. A river is being
brought from the Andes, for the purpose of
rendering fit for cultivation the northern por
tion of the valley, which is at present barren
from a want of moisture. This great work
has been carried on during the last six years ;
the expense is defrayed by a joint stock com
79
pany, consisting chiefly of natives of the
country.
The city of Arequipa is erected on the
southern part of the above-mentioned valley.
Its population was said to be 60,000, but I
have reason to think that 40,000 is nearer the
number. The great square, where the public
market is held, is 7,500 feet above the ocean.
The ground rises gradually towards the foot
of the volcano, which, at the height of about
1,500 above the plaza, or square, springs up
wards in one stupendous column to the height
of 8,000 feet, the summit being 17,000 feet
above the sea. This volcano is allowed to be
the most perfect specimen of a natural cone
yet discovered on the earth. Its sides arc
covered by a dark coloured sand, which,
towards the higher region, being loose and
deep, is very annoying to those who attempt
the ascent, a feat hitherto only twice per
formed. I expected to have been able to
reach the top, along with U. Passmore, Esq.,
his Majesty's Consul in Arequipa—a gentle
man who, during his residence at that impor
tant station, has been distinguished not less
by an assiduous attention to the more imme
diate duties of the Consulate, than by a polite
attention to strangers, and devotion to the in
terests of science. Through the influence of
Mr. Passmore, the mules and Indians neces
sary for the ascent of the volcano were provid
ed by the Prefect, General la Fuente ; but
circumstances, over which there was no con
trol, prevented it.
Dysentery is the prevailing disease in Are
quipa. In some seasons its ravages are terri
ble. The number of persons affected is very
great ; and, according to report, the ratio of
mortality is much more than is witnessed by
those who inhabit more temperate climes.
Almost every stranger who visits this place is,
shortly after his arrival, affected more or less
with an attack of diarrhoea, which, if not im
mediately attended to, commonly ends in an
inveterate attack of dysentery, with great dis
charge of blood, and excessive tormina. If
the patient be not speedilycut off, the disease
is apt to assume a chronic form, and, in many
cases, is followed by intermittent fever.
Various causes have been assigned for the
prevalence of dysentery in Arequipa. Its
latitude is about 16 degrees south. The days
are generally very hot, and the nights always
cold. The town is distant from the sea 90
miles. During the day time, no Seabreeze
moderates the heat; but, every evening, a
strong current of cold air rushes down from
the snow-covered mountains in the vicinity
of the city. During winter and spring, the
cold at night is very severe. The houses
here are more substantially built than in most
other places, whether in the old or the new
world. This is necessary, to enable them to
stand against the earthquakes, which, though
not of such frequent occurrence as on the
coast, yet have five times destroyed the city.
For this reason, no wheeled carriages are al
80 Mr. Hamilton on the Mfdicul Topography of Arequipa.
lowed to be used within the city, because the
sound of them on paved streets, as heard by
people when within doors, is not dissimilar to
the portentous rumbling noise which is often
heard immediately beforea severe earthquake.
In these countries, it is the custom for people
to run from the house to the street on the first
appearance of an earthquake. The houses
here are generally well built, of grey granite,
and the roofs arched with the same, but the
windows are not glazed, and the inmates are
exposed to the groat and sudden change of
temperature experienced after sunset. The
comfort of a fire is not known as in Britain,
culinary operations being generally perform
ed in an out-house. Thus, it is obvious
that in such a place the functions of the cu-
ticular and biliary systems are very much
exposed to derangement.
The city, though standing on a declivity,
and during a part of the year washed by tor
rents of rain, is not kept so clean as it should
be, nor are those precautions used which
would be enforced by an efficient medical po
lice. The plaza mayor, or great square, is
the place where the principal market is held
every lawful day. Here an immense quan
tity of vegetables is exposed forsale ; and the
refuse of these, as also other matters, is per
mitted to accumulate and emit exhalations.
The rain which falls duringthehotter months is
the only means by which the town is cleansed.
The streets are intersected, as are those of
most Spanish towns, by a single ditch, or
canal, and these canals are not kept clean.
While a current of water is passing through
them, all is well ; but when that is not the
case, they are so many sources of malaria.
There is reason for believing, that by
means of the exertions of a well regulated
police, the city of Arequipa might be made
much more salubrious.
Intermittent fever is more fatal in Arequipa'
than is generally the case in that disease ; for
according to the experience of the writer,
ague was very seldom attended with fatal
consequences, if the disease were checked
' early ; and that in most cases is easily done,
by means to be shortly adverted to.
Intermittent fever is to be seen at other
places, not less elevated than Arequipa. I
saw persons suffering under ague on the banks
of the Pilcomyio, near its source, and also in
the valley of the Cachymio, at that part
where it is commonly crossed on the journey
from Potosi to the city of Chuquisaca. When
traversing the profound valley of the Pilco
myio, near to the remains of the celebrated
bridge of the Incas, I visited a small commu
nity of the aborigines of the country, and
found that both there, and also in the valley
of the Cachimyio, ague is endemic. Both
these rivers originate among the mountains
of the eastern, or great internal Cordillera of
the Andes of southern Peru. The Pilcomyio,
at the place above referred to, runs with con
siderable velocity along the eastern slope of
these Alpine regions, and 'is elevated 8,000
feet above the level of the sea. It should no
longer be a question whether ague can be en
demic in the vicinity of running water.
Intermittent fever, and also dysentery, are
very prevalent on the banks of the Tipuani,
at that part which is so justly celebrated for
the gold found in its channel. This is in the
province of Larecaja. The river runs along:
the eastern slope of the eastern Andes, and
ultimately joins the great river Amazon. The
gold washings are situated 400 miles from the
coast of the Pacific Ocean. The road from
the Pacific to the Tipuani is one of the worst
in the world ; ninety miles must be clambered
on foot, over precipices and frightful ravines,
which even a mule cannot pass. Fever and
dysentery make sad havoc in this region,
notwithstanding its elevation.
I believe that wherever vegetable matter is
decomposed by atmospheric agency, there
miasmata exist, which, if in sufficient quan
tity, excite intermittent fever in subjects who
are predisposed for the reception of the
poison.
In so far as my observation extends, mi
asms do not exist on that immense plane, or
table land, which lies between the western
and eastern Andes of Bolivia; but what is
called ephemeral ague may be seen. I have
witnessed ephemeral ague in the cities of
Oruro, Potosi, and Chuquisaca (la Plata).
The former city is elevated 12,400 feet above
the sea. The house where I lodged in Potosi,
(Achavel's,) in la Calle de Commercio, is
13,500 feet above the Pacific, and in it I have
seen severe ague. But intermittent fever is
not endemic in such places, because there the
climate is such as to prevent the formation of
miasmata. In these situations, the disease
appears in the persons of those only who have
been at other places exposed to their action,
and have previously suffered from intermit
tent fever. These fits of ephemeral ague are
generally induced by bursts of anger, error in
diet, or in fine by whatever has the effect of
diminishing the energy of the nervous system.
I am of opinion that the intermittent fever
of the south-west coast of America is an affec
tion of the nervous system—is a disease of
direct debility, originating in the poison of
vegetable miasms. It seems to operate more
especially on the subjects who are predis
posed to exhaustion, fatigue in travelling, de
fective nutrition, the depressing passions,
error in diet, or intemperance generally. The
disease is most apt to appear among those
who travel along the coasts of these regions.
The endurance of excessive fatigue and pri
vation, from deficient nourishment, want of
good water, sleeping on the ground, and other
annoying circumstances, predisposes the sys
tem for the reception of the poison, which,
unfortunately, is to be met with at the only
places where travellers can, in most cases,
halt during the night.
Troops are peculiarly exposed to ague and
 Mr. Hamilton on the Treatment of Intermittents.
dysentery in these countries. They are
obliged to travel on foot, often during the
day, under a tropical sun, carrying arms,
and sometimes baggage, and the commissa
riat department is not as it should be, which
circumstances, combined with the fact that
in moat cases the soldiers have been torn
from home and kindred, in a forcible man
ner, and without previous notice, produce
the most dismal effects, especially among
recruits.
Europeans, on their arrival from Europe,
are not so liable to be attacked by intermit
tent fever as they are after a residence of
some time in this country. Before the poi
son can take effect, it seems necessary that a
debilitating process must have been going on
—that the energy of the system must be re
duced—and then the effects of the poison of
miasmata are developed.
Ague is seldom met with among the crews
of the vessels of war of various nations that
now frequent the coast of Peru. Were the
poison of miasmata susceptible of being con
veyed by wind to even a fraction of the
distance mentioned by a late writer on ma
laria, we should witness its effects on board
the ships that come to anchor in the road
stead of Arica, where they, in some cases
remain during months, within one mile of
the land.
However, it is but fair to remark, that
perhaps the want of sufficient moisture in
the air is the reason why the miasmata on this
coast are not more transportable by the land-
breeze. Id the treatment of the intermit
tent fever of these regions, I would recom
mend the following mixture, which, in seve
ral hundred cases of ague, I have found to
be what some people would call a specific ; but
I do not like the term specific when applied
to medicine of any kind.
Take of the sulphate of quinine one
drachm ; muriate of ammonia twenty grains ;
concentrated essenee of ginger half a drachm ;
pure water thirty ounces. Any adult suf
fering under ague should take of the above
mixture a wine-glassful, or two ounces, every
half hour, commencing two hours before the
time when the cold fit is expected. Of course
it is recommended that four doses of the
medicine should be taken.
If the essence of ginger is not to be had. a
drachm of the powder of the same should be
used in its stead. If the ammonia cannot be
procured, then, in that case, acidum sul-
phuricum may be added to the water and
quinine, in the proportion of a drop of the
acid of the shops to every grain of quinine,
which makes a super-sulphate, which is
more soluble in water.
If quinine cannot be had, a tincture of the
red table bark ought to be used, putting one
ounce of the hark (well bruised) to two
ounces of brandy, or other spirit, as may be
convenient. One ounce of this tincture,
Vol. II.
81
along with two onnces of water, should be
taken as above advised.
It is necessary to be particularly attentive
to the state of the biliary system and ali
mentary canal. Where functional derange
ment of the hepatic system exists, the blue
pill is often beneficial ; but if there is an
organic affection, mercury is worse than use
less. Mercury cannot cure ague, but, in
some cases, it seems to have the effect of
assisting the operation of other medicines.
It would be out of place to enter here at
length into the treatment of ague. The
writer never gave arsenic ; the disease, when
not complicated, gave way to more safe
modes of cure. In some cases, cinchona in
any form could not be made to remain on
the stomach ; in some such cases, very strong
doses of a hot preparation of ground coffee
effected a cure. Coffee of most excellent
quality grows in the province of La Paz.
The coffee should not be boiled, as that pro
cess has the effect of depriving it of the
aroma. Four ounces of coffee, and Ibj.
water was the strength of the liquid given.
It was taken as hot as the patient could swal
low it, without sugar and milk, before the
accession of the cold fit. In all these coun
tries milk in any form is allowed to be ex
tremely injurious to persons suffering from
ague, and should never be administered.
In some cases of quartan ague, a combina
tion of the sulphate of quinine, with infusion
of quassia, seemed to be more effective than
the former alone, which might be a result of
its adulteration, which has been done to a
great extent by some unprincipled persons,
the temptation being great a few years ago.
Bleeding in the cold stage of ague, has not
come under the writer's observation. He
would be cautious in having recourse to that
operation in those countries, especially among
the natives on the coast. These people are
generally of a weakly habit of body, and en
dure blood-letting very ill; besides, they en
tertain notions inimical to the abstraction of
blood for any medical purpose. " La sangre
es la vida ;" " the blood is the life," is a com
mon saying among them.
The writer did not find it necessary to use
the lancet, except in a few cases, during the
hot stage only. The subjects of these cases
were chiefly Europeans, to whom there was
danger from cerebral congestion ; in such,
the abstraction of more or less blood, accord
ing to circumstances, proved decidedly useful.
Where sulphate of quinine is not procur
able, an infusion of cinchona, with carbonate
of potass, is an excellent remedy for ague.
The people in Peru are prejudiced against
the bark in the form of powder, and not
without reason ; for what is imported from
Europe is often adulterated, and what is made
in Peru is so often imperfectly pulverized as
to render it unfit for the purpose for which it
is administered.
Emetics, opium, and mental emotion sud-
?L> Cholera in Dublin.
tlenly induced, sometimes have the effect of
warding off a fit of ague, but these do not
cure the disease.
Tartar emetic should not be given. Ex
treme and continued nausea and retching are
often the result of a dose, and we know that
nausea is, in many cases, a most distressing
symptom attending the first stage of the ma
lady. Sulphas zinci, or ipecacuanha, are the
best medicines for exciting the acuon of the
stomach in ague.
I hold that opium should not be given in
the ague of Peru, except before the cold fit,
for the purpose of preventing it, and thus
gaining time; therefore opium should be
given in the form of tincture only, it being
more prompt in action. If the fit come on
after opium has been taken and retained,
then the hot stage is generally more severe
than if no opium had been taken, and in such
a case, there is greater danger to the cerebral
system.
I consider it worse than useless to give the
einchona in any form during the paroxysms
of the disease. The grand object which ought
to be kept in view, is to prevent the fits, cure
the disease, and strengthen the system gene
rally. The two former are, in most cases,
happily accomplished by the same means,
the antiseptic mixture before mentioned.
The strength is best supported by means of
such liquid nourishment, as chicken soup,
or arrow root. It is a good general rule by
which to adhere, in conducting the cure of
the intermittent fever of those regions, not
to allow the patient any solid food, but, if it is
possible, put an embargo on his teeth, until he
be completely convalescent. — Glasgow Med.
Journ.
Umrtrou #artrttal&j£urgual Sfauraal.
Saturday, Aug. 18, 1832.
CHOLERA.
We are happy to state, upon the
best authority, that cholera is very
much on the decline in Dublin, where
it is chiefly confined to the poor. It
is to be recollected, that diarrhoea
and dysentery are usually prevalent
at this season in Ireland, in conse
quence of the aliment of the working
classes consisting principally of the
potatoe in an immature condition.
In addition to this predisposing cause,
there are want of employment, po
verty, filth, inebriety, and the consti
tution of the weather. Our corre
spondents assure us, that there is no
proof whatever of the contagiousness
of cholera, and that, in its worst
form, it defies all remedies. The ex
hausted air-bath, the saline medi
cines, have proved equally useless.
A saturated solution of the chloride
of sodium, with an ordinary quantity
of the nitrate of potass, has arrested
the vomiting and diarrhoea in a most
remarkable manner in the Military
Hospital, near the Phoenix Park.
This plan of treatment is followed
up by proper doses of calomel and
rhubarb.
We are as much in the dark in re
gard to the pathology of the disease
as ever. In some cases, the gastro
intestinal mucous membrane was
highly vascular, in others inflamed ;
in some the liver was congested, and
again in many others it was remark
ably pale, and the gall-bladder filled
with a whitish fluid. This latter
fact is of great importance, inasmuch
as considerable stress has been laid on
the circumstance, that the gall-blad -
der has been very frequently found
full of viscid bile. Depletion has
succeeded occasionally, but in other
cases it appeared to hasten the ap
proaches of death. It should seem,
from the statements before us, that
the pathology and treatment of cho
lera are involved in as much obscu
rity as ever.
There is a marvellous story cur
rent, most convincing to the true