94 THE ISTHMUS OF PANAMA. 



There is another class of causes far more nume- 

 rous, and perhaps more important ; by which I mean 

 everything calculated to excite fever after the sys- 

 tem has become predisposed to it. Foreigners resi- 

 ding in this climate usually become, after a time, 

 a good deal enervated ; they find they cannot per- 

 form near as much labor, either physical or men- 

 tal, as in a northern climate. An extreme degree of 

 lassitude overtakes them at times, and they feel it 

 almost impossible to perform any duties whatever. 

 This is the effect of miasma ; the system contains 

 the fuel of fever, which only requires to be ignited. 

 Now this is the state in which exciting causes are in- 

 strumental in producing the disease, and anything 

 may be deemed such that excites or taxes the system 

 to any considerable extent, as excessive fatigue, ex- 

 posure to the sun long continued, or a shower of rain 

 while perspiring, over indulgence in eating, and, 

 above all, in the use of stimulating drink. During 

 my services of nearly six months, as one of the Sur- 

 geons to the Panama Railroad Company, I never 

 saw a single case of fever from which I apprehended 

 a fatal result, but in persons of intemperate habits ; 

 and the only two patients, whose cases terminated 

 fatally, under my charge, had been immediately pre- 

 vious on a debauch. 



Of all the exciting causes of fever, I believe this 

 by far the most potent in its results, if not the most 

 common. I am aware that there are exceptions to 

 this — that there are those who bear up under the 

 influence of the use of stimulating drinks— but they 



