OP THE ISLANDS NEAR SINGAPORE. 
The reader having perused the note will now be able to follow 
me in my investigations on the fever of Blakang Math On June 
much distended, skin of the body dry, hot and rough, countenance anxious, 
eye sunken, and often as if glazed. The patient seldom complains, gene¬ 
rally when asked how he Is, says w pretiy well,” but when pressed, com¬ 
plains of great prostration of strength, and shews great apathy as to his 
fate. These symptoms increase in force, the headache is constant, at night 
there is often delerium and shortness of breathing, the tongue becomes dry 
and covered with a thick dark crust, th? lips are dry, articulation from the 
latter eauses is not distinct, the countenance shews more of the peculiar 
anxious cast. The eye is more sunk and has lost all its brightness, com¬ 
plete prostration of strength exists, the pulse is small, quick and compres¬ 
sible, varying from 110 to 120, The skin is dry and rough, sometimes it 
becomes yellow, vomiting occasionally occurs, diarrhoea is as often pre¬ 
sent as costiveness. The patient can be roused by a question asked in a 
loud voice and if that is, how do you feel ? 14 better,” may be the answer. 
Do yon feel any pain? 44 No” is generally returned. This state continues, 
when the patient may be noticed to breathe a little heavily, a slightcon vul- 
sive motion is observed in the limbs, and presently all is quiet, the soul 
having returned to Him who gave it. The principal symptoms are j im¬ 
mediate and excessive prostration of strength, an anxious countenance, 
great restlessness, dry tongue, very slight remission of fever, which is 
generally at its height at nightj with a want of acute symptoms, and an 
apathy as to his fate on the part of the patient, if any organ is more af¬ 
fected than another, it is the head, hence the Malay name for the disea< e 
is Dimam Eapielu, derived from dimam fever and KEtpiil4 the head, but 
all the post mortem investigations that 1 have witnessed never disclosed 
any organ in particular so much affected in appearance as to be consider¬ 
ed the cause of death. The duration of the disease is seldom more than 
9 days, it may be extended to 21, but generally 7 to 9 days may be said 
to be the mean of its duration in fatal cases} relapses are of frequent oc¬ 
currence, complete remission from all fever is seldom to be looked for, 
as in one-half of the recoveries it passes into intermittent fever before 
complete restitution to health takes place. The mortality in the hospitals 
here was in 4 years 23 in 79 cases, a 3 t 4 0 of those attacked. This is a fa¬ 
vorable return, from the circunstance that in this fever the longer the du¬ 
ration of the disease the better is the prognosis, and the majority oftbe pa¬ 
tients in the Hospitals having been attacked previous to their arrival in 
Singapore, had outlived the most dangerous epoch of the complaint. 
The disease is never sensibly developed immediately on the malaria hav¬ 
ing taken effect on the constitution of the patient, from 3 to 21 days may 
elapse, generally? to 10. Ships from Batavia in the favorable monsoon have, 
to all appearance, left with a healthy crew, and not till they had anchored 
in the Singapore roads has the fever broken out amongst the crew. 1 he other 
day a brig left Batavia with her men to appearance quite well} 10 days 
after, the Carpenter was taken ill on a Wednesday. I saw him on the Wed¬ 
nesday f'dlowing, for the first time, and found him suffering under Ja¬ 
va fever, but not in my opinion of a severe type. 1 ordered him Quin- 
nine with wine, to be given every 3 hours} but from some cause or another, 
on the part of those on board, the medicine was not administered, and 
when I saw him on the morning after, he was much w r orse, only having 
sufficient vitality to swallow some brandy and Quinine, when he expired. 
In the contrary monsoon vessels from Java have the crews attacked on 
the voyage, which generally lasts 21 to 30 days. Great mortality of course 
occurs, from which cause many vessels have been wrecked. Four or 
