- 77 } SPECTATOR'S LIBRARY.

Medical History of the Expedition to the Niger during the years 1841-2; corn- prisingan Account of the Fever which led to its abrupt termination. By James Or- miston M'William, M.D., Surgeon of H.M.S. Albert. and Senior Medical Officer of the Expedition. With Plates Churchill.

TRAVZLII,

The Rhone. the Harm and the Gnadalquivir; a Summer Ramble in 1842. By Mrs. Romer, Author of ''Sturmer," &c. In two volumes Bentley. Frertorr. Gabrielle. or Pictures of a Reign; a Historical Novel. By Louisa Stuart Costello. Author of " A Summer among the Budges and the Vines," &c. &c. In three volumes.. Newby.

DR. DI‘WILLIAM'S ACCOUNT OF THE NIGER EXPEDITION.

DR. M•Wizmast was the senior medical officer of the rash and ill- fated expedition to the Niger ; which he volunteered to join im-

mediately on his return from the Western coast of Africa, where he had served as surgeon in the Scout. He accompanied the ex- pedition from its leaving England till the return of the Albert to Fernando Po ; having remained in the deadly river till the last ; and fulfilled the multifarious duties of commander, doctor, un- dertaker, and general superintendent, when nearly every White -and all the surviving officers and engineers were completely pro- strated by the Niger fever. Of his observations during the voyage Dr. M'WILLIAM kept a general and elaborate professional diary, -till the unceasing demands upon his time compelled him to curtail his journalizing : and it is from these materials that the Medical .History of the Niger Expedition is produced. The volume consists of three parts. The first gives a short account of the voyage, as well as a description of the scenery of the river, the behaviour and characters of the native chieftains, with the incidents that usually find a place in a real book of travels, and not a book made up by a literary craftsman. The second part -consists of an elaborate treatise on the Niger fever, followed by a

copious history of such cases as the opportunities of Dr. M`Wit.- Liam permitted him to record. The third part is of a miscellaneous character, containing the results of the scientific observations ; in- cluding a copious account of Dr. REID'S system of ventilation, suc- cessfully introduced into the vessels with the view of guarding against the fatal malaria. Our notice will be chiefly confined to the medical section of the volume. The following are the leading -statistics.

The number of Whites engaged in the expedition was 145: of these 130 were attacked by the fever, and 44 died. 0125 Blacks brought from England, 11 were attacked by fever, but none died.* Of the 128 Blacks engaged on the coast, not one was even at- tacked; a conclusive fact as to the crews who are fitted to navigate African rivers.

The expedition crossed the bar of the Nun branch of the Niger on the 13th August. After six days' delay, it commenced the voyage up the river ; and on the 27th it reached Aboh or lbu, 120 miles from the sea ; having taken fourteen days to accomplish that distance. On the 2d September, the vessels reached Iddah, above 200 miles from the sea. At this date, and if we read rightly on the next day, the crew were all in apparently perfect health ; but on the 4th, "fever of a most malignant character broke out in the Albert, and almost simultaneously in the other vessels." On the 11th, the first deaths appear to have occurred ; and by the 17th, when the expedition had arrived at the junction of the Niger and Tchadda, 272 miles from the sea, seven of the 145 Whites had died, 60 were on the sick-list, and it became obvious that their only chance of escape was the sea-air. One of the vessels accordingly returned ; but scarcely had she departed when new cases broke out, and "it became a matter of question whether the whole squadron should be withdrawn for the season : but as one vessel could still be made sufficiently effective for an effort to carry out the objects of the expedition, it was finally determined that the Albert was to make the best of her way up the Niger, and that the Wilberforce was at once to proceed out of the river." She accordingly steamed downwards with another cargo of the sick and dying ; while the Albert advanced to Egga, upwards of 340 miles from the sea ; which was reached on the 28th September, nearly seven weeks after entering the river.

" The only remaining engineer now began to feel the effect of the duties which of late had pressed hard upon him ; and on our anchoring at Eggs, he lay down, and shortly afterwards expressed himself as much better. Several of the other patients were in a very low condition, and one of the best seamen was in a state of great danger. • • •

"On leaving the confluence on the 21st September, it had been hoped that Abe violence of the feverwas in a measureexhausted, and that the climate cf the more open country, higher up the Niger, would be found sufficiently healthy to enable us to reach Babb& The result proved otherwise. Captain B. Allen -was taken ill on the evening of the same day; and when we arrived at Egga, mot less than twenty more of the crew had been attacked, of whom two had .died. On the 8d October, Captain Trotter was seized with fever. Captain B. Allen was in a very critical state; and there remained capable of doing any duty, only one White seaman, the sergeant and one private of Marines, Dr. Stanger, Mr. Willie, mate, John Huxley, hospital-attendant, and myself. Mr. Willie was already labouring under incipient fever, and could not be persuaded, even when very ill two days afterwards, to keep quiet. The season was ad- vancing, and the river had already begun to fall. Dr. Stanger found by the marks on shore that the water had fallen fourteen inches on the 29th Septem- ber, and on the 5th October riot less than three feet. Under such circum- stances, to have endeavoured to proceed to Itabba would have been madness; and as there was no object to be gained by remaining longer where we were, it • The total of the deaths was beyond 44, and embraces several Blacks ; but these arose from accidents, or ere atttibuted to other disorders, or to sequences of the fever. was resolv.d that we should withdraw from the river with all possible speed. The Kroomen having now cut a good deal of wood, we weighed on the morning of the 4th October, and dropped down with the stream some distance below Eggs; end the next day, in the same manner, we reached the village of Eddogi. On the fith, Dr. Stanger undertook to work the engines, with what assistance he could get from Mr. Brown, the only engineer who could move out of bed. The steam was accordingly got up, and we were soon making good way downwards. Mr. Willie being now too ill to have any charge, I was neces- sitated to attend to the duties of the ship, in addition to those of my profession."

And so it continued, or rather continued getting worse and worse, till, on October the 13th,

" At three in the afternoon, when near Stirling Island, a steamer was seen coming up the river at full speed, which we directly perceived did not belong to the expedition; but we were soon close to her, and in a very short time Cap- tain Becroft was alongside from the Ethiope—for such she was. He at once offered any assistance in his power; and it was finally arranged that he was to send his engineer on board the Albert next morning, and that the Ethiope was to return with us, taking the lead, as Captain Becroft bad a perfect know- ledge of the river."

In so minutely noting times and distances, we intend no censure to the officers of the expedition ; for there may be no ground for it. The length of time, according to notions of steaming in Euro- pean rivers, occupied in passing over so short a distance, may have been the result of obedience to instructions, or accident, or the necessity of the case. From the palavers and treaty we infer that some of the delay originated in fulfilling diplomatic orders : and, no doubt, it was essential to the scheme, to acquire the land on which

the tragic burlesque of " the model-farm, or normal school for Negro cultivators," was to be performed. Time was spent, too, though not much, in branch explorations. Accidents might also cause delay : the vessels were often aground, both in ascending and descending. We infer that the difficulties of the river-navigation were an inevitable cause of slow progress. On their first arrival, the vessels had to be cleaned and prepared : in ascending, their pro- gress was against the stream ; and they had to wait for wood for fuel,—the supply of this necessary article even detaining the Albert on her return a whole day at the mouth of the river, when time was so very precious. What result this delay produced, it is dif- ficult to say. From fever statistics collected by Dr. M‘Wiramkat it may be assumed, that the disorder does not develop itself under sixteen days from the first reception of the poison ; or more pro- perly, perhaps, that the system will resist for this time an ex- posure to the influences which produce the disease, and in some constitutions for a longer period. Yet fourteen days were spent in the Delta of the Niger, where LAIRD and others think the poison is received. After all, however, a delay somewhere was essential to the objects of this scheme of settlement ; and all that a more rapid progress could have attained would have been a further ascent, which might have been attended with still more fatal results. From the decrease of the water in the river, Dr. M‘Wizzmat seems to think they returned just in time to escape an involuntary settle- ment on a sand-bank, such as destroyed nearly the whole of Mr. LAIRD'S crew on the first voyage.

The facts and views respecting the disorder itself are full, but not very conclusive. The true Niger fever has none of the visible horrors attending the yellow and some other fevers of Tropical climates. There are no dreadful black vomitings ; no such terrible disorder of the secretions as almost to put on the appearance of decomposition before death. Making allowance for the different circumstances of climate and the fatal character of the disorder, it seems to us analagous to our influenza. The patient has head- ache or flying pains, sometimes severe, more generally alight, with a feeling of discomfort or malaise, but not continuous, nor sufficient at first to induce him to apply for advice. In the course of twelve hours or more, he gets worse, and usually experiences a sensation of cold, sometimes with a fit of marked shivering. Then follows

THE NIGER FEVER.

He would shortly express a wish to lie down; and would complain some- what suddenly of increase of headache or giddiness, and intense heat of the skin, which had a dry parched feel, restlessness, intolerable nausea, and difficult breathing. The dyspnea in several instances, particularly in my own case, was extremely distressing, and continued from one to four hours, until relieved by spontaneous vomiting, or the occurrence of diaphoresis. Headache was with some the prominent symptom during the hot stage ; and the feeling was de- scribed as that of a cord being tightly girded round the temples. The thirst was very urgent ; the tongue was foul in the centre, moist, clean, or reddish, and invariably marked by indentations on the edges. The countenance was more or less flushed ; the eye occasionally suffused, and always looked wild. Pulse rapid, but small, frequently feeble ; thirst urgent, bowels constipated, and urine passed often and in small quantity. There was in general tender- ness of the epigastrium, sometimes acute, but often not discoverable unless upon pressure.

In some cases, coldness of the stomach was complained of some days before death. A subsidence of febrile action in general followed in from three to six hours; or at all events, these symptoms, if continued beyond the latter period, be- came much mitigated. Diaphoresis came on, the thirst moderated, and the signs of oppression in a great measure disappeared. The principal complaint at this period was from the disagreeable odour of the perspiration, particularly in those cases that subsequently prone fatal. I was not sensible of this peMs- liarity in the smell of the perspiration in my own case, but I perceived it very distinctly in several others. The sweating continued until from eight to twelve hours had been occupied by the whole paroxysm. The patient, although con- siderably exhausted, expressed himself as free from all trouble, and the coun- tenance also indicated improvement. This seemingly favourable change did not last long, for the accession generally returned in from six to ten or twelve hours. Occasionally the respite extended to twenty-four hours. In a few cases, there was a treacherous interval of forty-eight hours in the early period of the disease ; but these invariably assumed afterwards a low malignant type. The fever in them seemed to have rested only to give strength for a fresh accession.

The accessions did not seem to observe any law of periodicity. They came on, disappeared, and returned, at all hours of the day and night. The evening, however, was a more common time of accession than any other;, in which ease, after the cold sensation had passed off, the paroxysm generally

ran through its stages in the course of the night, and had suffered a consider- able remission by the hour of breakfast (eight) the next morning.

In a few instances the remissions were as complete as in -the interval of ague. These were, however, only exceptions to the general rule ; for total absence of fever was indeed of rare occurrence during tLe course of the disease.

I cannot say that the influence of critical days was at all apparent, further than if no material improvement was evident by the eighth or ninth day the prognosis was then most gloomy. The patient became weak, irritable, and exhausted, and extremely restless. The remissions were most indistinctly marked ; the skin was dry and constricted, the tongue parched, pulse small and irregular ; the fever, in short, now assumed a low asthenic form. Occa- sional symptoms of mental aberration would appear at this period : the coun- tenance pale and shrunk; but not unfrequently the patient would talk most rationally upon the state of his mind, so far as regarded his eternal happiness. In several cases this stage was wonderfully protracted, as in case 12. Local pain was seldom much complained of: indeed, with the exception of he:dache ((Sten very slight) at the commencement of the paroxysm, there were several instnnces in which the patients expressed themselves as quite well, throughout the disease, although this ultimately proved fatal. When the disease was about to take a favourable turn, the remissions be- came distinctly marked, and the intervals were lengthened. The countenance (the best criterion) assumed a natural expression, a certain look of con. vslcseence, that one can only become acquainted with by experience, and con- trasting it with that indicative of a fatal termination. The skin became moist, the thirst diminished, the pulse was more voluminous and softer ; the tongue gradually lost its tremulousness, and could be more easily thrust out of the mouth : it often continued a lung time loaded, but the crust was less brown and more moist, and seemed to have lost its firm attachment to the organ. At this period diarrhoea was hy no means uncommon, and also a copious flow of urine; which latter was a very favourable symptom. A strong desire for food was expressed by most of the patients who had advanced thus far; and 1 had more than once cause to regret Laving gratified it. Such were the general characteristics of the fever as it occurred in the Ni- ger: but the description is not to be regarded as applicable to all the cases, for, on board of the Albert alone, there were several ru which there was neither complaint nor evidence of suffering of any kind. There was a disinclination to be spoken to, or to be in any way disturbed; and a listless expression of counte- nance, with a clammy skin and small pulse. The periods of exacerbation were so feebly marked as to be scarcely perceptible : food and medicine were taken when offered, but seldom or ever was any thing asked for ; and the invariable answer to inquiries after their health was, 1 am very well.' Constant watch- fulness was the only appreciable symptom in these cases, which all terminated fatally, seemingly from mere exhaustion. It would have been interesting to have ascertained the nature and amount of the organic lesions in these cases; but, unfortunately, circumstances did not permit any of the bodies being ex- amined.

Contingent symptoms.—Of the contingent symptoms, the most prominent were delirium, yellowness of skin, and convulsione, affecting various parts of the body. Delirium was a very bad symptom in the fever of the Niger : of twenty-one cases in which it occurred, fourteen died; of whom one was drowned by eluding his nurse, and jumping into the river. It was not uncommon for patients, whether affected with delirium or not, to he haunted by dreams of a frightful nature,—as of being drowned, stabbed, or falling from a precipice. In the worst cases the mental aberrations were expressive of some personal misfor- tune, or unheard-of disease. The imposition of the slightest restraint was always a heavy grievance. In one case the patient constantly harped upon his being condemned to everlasting punishment : when reason for a while re- sumed her authority, he would express shame and contrition for previous mis- conduct. The most solemn promises to behave well, if left at liberty, were not unfrequently made only to be broken whenever an opportunity offered for the exercise of the cunning so characteristic of this stage of the disease.

The inquiry into the causes of the fever, and the account of the morbid appearances on dissection, would have little interest for ge- neral readers. Of the various sequences of the fever it may suf- fice to say, that Dr. M'WILLIAM considers that it leaves the seeds of disorders behind it ; which are liable, under unfavourable circum- stances' to terminate fatally. Of the means of treatment, the only hopeful remedy is contained in the maxim of CELSUS, " pcssimum segro ccelum est, quod aegrum facit." When quoting this axiom, Dr. M`WJra eat appears to have little confidence in any prescription ex- cept change of air. Blood-letting and much mercury be discoun- tenances, as tending to reduce the patient too far. His main reliance seems to be upon James's powder as a diaphoretic, and quinine as a tonic, accompanied by milder purgatives and counter- irritants—as blisters, &c. Mild as many may think his treatment, we suspect it was quite active enough. If one may venture a con- jecture from the perusal of the cases, we incline to think that the disorder in all of them " ran its course "; that death ensued from the potency of the " poison"; or, what comes to much the same thing, recovery was owing to the powers of resistance in the con- stitution.

The notion that " seasoning," or having once had the fever, is an exemption from future attacks, is pronounced by Dr. M'W.u.maat to be quite unfounded. The failure of the expedition is equally conclusive as to the possibility of escaping the disease by precaution. For never were more precautions taken to preserve health than by Captain TROTTER in his minute and providetit regulations for the comfort of the men ; the ventilating apparatus of Dr. REID kept the air between decks constantly agitated, and by ingenious contri- vances, it was hoped, purified that which was renewed from the open atmosphere : nor were there any depressing moral influences at work till the fever broke out. Yet of one hundred and forty:five White men, only fifteen escaped the fever ; and of the three vessels the Soudan was in the river only forty days, and the Wilberforce

forty-five days. * What would have resulted, bad not the earlier . sick been sent away with prompt deciston or had any accident detained them in their descent, it is impossible to say. The Medical History of the Expedition to the Niger does not profess to give a narrative of the voj age, beyond what is necessary

• 'Unless it be borne in mind that an entire redistribution of crews took place at the confluence of the Niger and Tchadda, the sick being sent downwards and the sound drafted into the Albert, the statistical tables at pp. 126, 127, 128, will convey an erroneous idea ; as the Soudan, which was the shortest time in the river, would appear to have had all her crew sick. to " put the reader in possession of those circumstances of position and climate which could produce or modify disease." Indeed, Dr. MiWna.taat seems to intimate that a popular account may be expected from some other person. The first part of the work will therefore be found somewhat curt and rapid ; noticing only prominent points, and dismissing them briefly. In our estimation, however, the book is none the worse for this brevity ; and it will probably be found sufficient for the general reader, as the omission of all subordinate or collateral topics places the principal matters in a more distinct point of view. The length, however, to which our notice of' the main subject has extended, prevents any ex- hibition of this section.