Epidemics on the Makanon. 605 



It may be stated that tympanites, which appeared after 

 the disease had existed two or three days, was not reHeved 

 by any of the usual carminatives given for such purpose. 

 Relief to the abdominal pain was frequently momentari- 

 ly obtained by bending the body forward, or pressing the 

 hands against the seat of pain. Belladonna and hyoscya- 

 mns were now and then given to prevent any griping ac- 

 tion of the quinia or calomel. In some of the cases, es- 

 pecially where the patients had previously suffered from 

 attacks of malarial fevers, quinia was the only medicine 

 given in the attack. To restore the apparently paralyzed 

 condition of stomach and bowels, the effect (or, possibly, 

 in some cases, the cause) of the prolonged constipation, or 

 the effect of great dilatation from flatulence, after the pa- 

 tient had " weathered the gale," the combination of strych- 

 nia and quinia was found very efficacious : these prepara- 

 tions were also used in conjunction with the various forms 

 of iron. It was found difficult sometimes to rid the pa- 

 tient of the feeling of physical depression referred to the 

 epigastrium, and the appetite was extremely capricious. 

 Convalescence was no doubt much hindered by the very 

 debilitating effects of the moist heat of this climate. 



With this somewhat diffuse account of the present epi- 

 demic, in which, out of some twenty-five cases, all occur- 

 ring within twelve days of each other, with the strongest 

 possible similarity of symptoms, there was no fatal one, it 

 may be suggested whether any causal relation links it with 

 the preceding influenza, or the somewhat obscure state of 

 health at Paranari. I have just learned from a young Pe- 

 ruvian who came here from the port of Urimaguas, on the 

 Fluallaga, that cases similar to those here now had occurred 

 there, and at Balsa Puerto, a small village some three days' 

 canoe -travel up a small stream to the westward. This 

 young gentleman came here sick with the complaint, and 



