Medical Notes. 589 



— by smoking — should be included as among the promi- 

 nent depi'essing causes. The tobacco of Peru, which is 

 that used bj every one on the Maranon, is greatly stronger 

 than the Virginia or the Havana, so much so as to make 

 old smokers of these varieties completely and steadily nau- 

 seated for a long time after they try the Peruvian leaf. 

 This tobacco, used mostly in the form of cigarettes, is the 

 constant companion, day and night, of the Maranon peo- 

 ple, particularly the whites and mestizos. Beginning at 

 the early age of four or five years, this habit is pursued 

 from dawn till midnight with an assiduity worthy of a 

 better object. Before the morning cup of coffee is the 

 cigar, and the last turning- over in bed is to throw away 

 the last cigarette. I have never seen ainong the most in- 

 veterate " chewists " or smokers of the " Old Dominion " 

 a more thorough slavery to this " soft, guileless consola- 

 tion " of the grown males — the young and the fair of our 

 land, of course, being out of the question. It is difficult 

 to believe that such powerful agents do not contribute to 

 unnatural impressibility, and tendency to depression of 

 moral and mental as well as physical exertion, which in 

 the tropics add to climatal causes of disease very consider- 

 ably. 



The women very commonly suffer from the results of 

 ignorance and imprudence at the monthly periods, and 

 leucorrhoea and uterine irritation are among the most fre- 

 quent of the Maranon complaints, and with difficulty man- 

 aged. The atonic condition of mucous membranes here, 

 among other modes, shows itself in these and other blen- 

 norrhagic discharges. Often among children, especially 

 females, at early ages of life, one encounters annoying 

 fluxes, which give a good deal of trouble in their cure. 

 Generally speaking, the prostration from attacks of dis- 

 ease is greatly disproportionate to the apparent violence 



