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Health of the Navy - 1864
|► The Naval Surgeon||Errata Mediterranean Station|
SIXTY-SEVEN vessels of various classes were employed in the five different commands comprised in the Home Station during the year 1864. The mean force corrected for time was 19,630, and the total number of cases of disease and injury entered on the sick list was 21,028, which is in the ratio of 1071·2 per 1,000 of mean force, being very slightly in excess of the ratio of the previous year. Of these 636 were invalided, and 154 died, the former being in the ratio of 32·3 per 1,000, and the latter of 7·8. These ratios also show a very slight increase as compared with the preceding year. The numbers invalided and dead in the two years are very close, 625 having been invalided, and 153 having died in 1863.
The daily loss of service from febrile diseases, including the exanthemata, was equal to about thirty-nine men, or in the ratio of 1·7 per 1,000 of mean force; from diseases of the brain and nervous system the ratio was ·5; from diseases of the organs of respiration, 5·9; of the heart and blood vessels, ·7; of the alimentary canal, ·7; of the liver, ·1 ;of the genito-urinary organs, 12·4; from rheumatism, 3·4; diseases of the bones and joints, ·4; of the special senses, ·6; of the skin and cellular tissue, 11·2; from dyspepsia, debility, and headache, ·2; from wounds and injuries of various kinds, 5·8 ; and from hernia, ·1. The total average number of men sick daily was 932·2, which is in the ratio of 47·4 per 1,000 of mean force, being an increase of 2·4 per 1,000 as compared with the previous year.
The returns from forty-four of the vessels are rendered for the whole year, and for the remainder the periods vary from three to eleven months.
Fevers.- There were 350 cases of primary fever, 100 of ague, 199 of small-pox, twenty-three of measles, and twenty-five of scarlatina under treatment during the year, and of these two cases of primary fever, nine of small-pox, one of measles, and two of scarlatina proved fatal. The average duration of each case of primary fever on the sick list on board ship and in hospital was about twenty days; of each case of ague, between nine and ten days; of each case of smallpox between twenty-five and twenty-six days; of each case of measles between eighteen and nineteen days; and of each case of scarlatina between thirty-four and thirty-five days.
Continued and Remittent Fevers.- There was a slight increase in the ratio of cases of primary fever as compared with the previous year, but the mortality was less. The ships in which there were the largest number of cases were the Edgar, the Impregnable, the Pembroke, and the St. Vincent. One fatal case occurred in the Impregnable, and one in the Indus.
There were forty cases of primary fever in the Edgar, twenty-nine of which were of an ephemeral character, and nine of the remainder were of such severity as to necessitate their being sent to hospital. Four of these were cases of enteric fever contracted at Gibraltar, into which port the vessel had gone to coal during a cruise with the Channel squadron. The ship lay alongside the New Mole for four days, during which time the weather was fine, with frequent heavy showers. While there many of the men and officers complained of an offensive smell proceeding from the sewer, which empties itself into the basin near the Government offices, and an officer, who was put on the sick list at this time with symptoms of fever, attributed his illness to this cause. The surgeon (Surgeon W.H. Sloggett) of the ship, however, was rather inclined to attribute it to his exposing himself a good deal to the sun at Madeira, as he had not felt well since leaving that island. He says also:
"A medical officer was attacked two days after our arrival, and he also ascribed his illness to emanations from the sewer. On the day of our arrival he had got thoroughly wet while heated with riding, and this may have been the exciting cause of the febrile attack, in the progress of which enteric symptoms set in, and it became necessary to send him to Plymouth Hospital. This officer had suffered from dysentery in China, and during his service on board this ship had had repeated attacks of chronic dysentery. Two other cases of enteric fever were subsequently put on the list, which probably originated at Gibraltar. One was taken ill on the second day, and the other on the 8th after leaving Gibraltar, and while lying in the Tagus. Both were sent to Lisbon Hospital."
There were twenty-two cases of primary fever in the Impregnable, at Plymouth, but little information is given in connection with them, the great majority having been sent to hospital immediately on the invasion of the disease; this was done with a view to obviate the risks of keeping any suspicious cases on board a ship in which so many boys are congregated.
There was a fatal case of fever in connection with the Indus. The man died in Plymouth Hospital. The fever was of the enteric type, and was complicated with pleuro-pneumonia. The autopsy showed extensive pleuro-pneumonia of the right side; the mucous membrane of the ilium was congested, and one of Peyer's patches contained enlarged and tortuous vessels.
In the Pembroke, at Harwich, there were twenty-five cases of primary fever. The average duration of each case on the sick list was between seven and eight days; they are said to have been of a somewhat ephemeral character, but that in a few the pyrexial symptoms ran high. Fifteen of these cases occurred in the midsummer, and eight in the Michaelmas quarter of the year.
In the St. Vincent, at Portsmouth, there were fifty cases of primary fever, almost all of a mild ephemeral type.
Intermittent Fever.- One hundred cases of this form of fever were under treatment, being in the ratio of 5 per 1,000 of mean force, almost precisely the same rate as in the previous year.
Small Pox.- One hundred and ninety-nine cases of this disease were under treatment in the squadron during the year, and of these, nine proved fatal.
There were six cases of small-pox in the Adventure. The disease was introduced into the ship at Portsmouth, where it was prevailing epidemically on shore. In every instance it would appear there were marks of previous vaccination, and in all the disease ran a modified course.
There were fifty cases of small-pox in the Asia, at Portsmouth, two of which proved fatal. Twenty-nine of these occurred in the Lady quarter of the year, seventeen in Midsummer, and four in Michaelmas quarter. The first case that occurred was in the person of a seaman, who, it is stated, "said he had been vaccinated," but who subsequently died in Haslar Hospital, the disease assuming the confluent type. In the majority of the cases there were evidences of previous vaccination, and in all these the disease was of a mild character.
In the Aurora there were thirteen cases of small-pox, which were tolerably equally distributed throughout the year. The disease was originally contracted at Portsmouth. Almost all the patients had been previously vaccinated, and in nearly all the disease was modified in character.
Two cases of small-pox occurred in the Black Prince, the disease having been contracted at Portsmouth. Both assumed the confluent form. Whether the first man attacked had been previously vaccinated or not, is not stated; but with reference to the second case, the surgeon (Surgeon Wm. Telfer) says, "This man never having been vaccinated, and small-pox being prevalent at Portsmouth, I deemed it advisable to have him vaccinated, which was done on the 12th of July. The matter "took," and a well-defined vesicle appeared on the arm. On the evening of the 18th he presented himself, complaining of headache, pain of the back and limbs, and more or less febrile symptoms, which increased on the following day, and was attended in the evening by slight delirium; and on the 21st, the eruption of small-pox became general on the face, arms, and legs, and afterwards became confluent."
Two cases of small-pox appear in the returns from the Cambridge; in both, the disease was very modified, and both showed good vaccination cicatrices.
Single cases of small-pox occurred in the Colossus and the Dasher, the latter vessel being employed among the Channel Islands. No mention is made as to whether the person affected in the Colossus had been previously vaccinated or not; but in the Dasher, the patient had a very good vaccination mark, and the disease ran a mild course. In this instance the disease was contracted on shore, the man having, while on leave, resided in a house where several members of the family were suffering from it.
There were three cases of small-pox in the Defence, one of which proved fatal. The first case occurred in a petty officer who, while on leave, had slept in a house in Portsmouth in which the family had all recently suffered from small-pox. He had good vaccination cicatrices, and the disease ran a modified course. The second person affected was a seaman who, six days before being taken ill, had joined the Defence from the Duke of Wellington, in which ship there had been a number of cases of the disease. The man had never been vaccinated, and the attack was severe. The third and fatal case occurred in the month of December at Plymouth in the person of a seaman who had been drinking freely before being taken ill. He had a vaccination cicatrix, but the disease assumed the confluent form, and carried him off: On post-mortem examination of the body, he was also found to be labouring under tubercular peritonitis.
There were fourteen cases of small-pox in the Duke of Wellington at Portsmouth, two of which proved fatal. With reference to these cases, the surgeon (Dr. Hart Gimlett) of the ship remarks, "Variola, which was very rife in Portsmouth, attacked fourteen persons belonging to this ship, all of whom were vaccinated; that is to say, all of those taken to hospital when the eruption was diagnosed, for two of the number having died away from the ship, no information on the point was obtained. Some of those who had been vaccinated were much and deeply pitted, but all sent by me to Haslar recovered." Of these cases one occurred in the Lady quarter of the year, twelve in the Midsummer quarter, and one in the Christmas quarter.
There were five cases of small-pox in the Edgar, two of which occurred in the Midsummer, and three in the Michaelmas quarter of the year. With reference to this latter period, the surgeon remarks, "Small-pox which had been very prevalent and fatal in Portsmouth and the neighbouring towns since the previous autumn appeared in three of the crew, all of whom had well-marked vaccination cicatrices. The cases, which were mild, were sent at once to Haslar for treatment. A large number of men and boys, and nearly all the junior officers, were re-vaccinated (about seventy in all), of which two-thirds were successful. The lymph was obtained by letter from the National Vaccine Establishment, and I found in practice that the operation was more to be depended upon for success when done with lymph preserved in capillary glass tubes than with that on glasses or points."
In the Excellent at Portsmouth, there were twenty-eight cases of small-pox, one of which proved fatal. The staff surgeon (Dr. John Thomson (c)) says, "The disease was very common in the neighbourhood, and attacked a large proportion of the population; but it never appeared to me that the infection spread itself in the ship. Nearly all the cases which occurred took place either when the patient was on shore, and then he was conveyed to hospital without his having any communication with the ship; or on board, but then he had imbibed the poison from some one on shore labouring under the disease, and in general the removal to hospital took place at such an early period of the complaint, that infection is not usually considered to be very potent at that stage of the illness. All who were attacked seemed to have been vaccinated more or less perfectly, and that fact may account for the mildness of the form in which the disease exhibited itself in the majority of cases."
A single case of small-pox occurred in the Ferret while the vessel was refitting at Haulbowline. The person affected was a servant who had just returned from leave. No mention of previous vaccination or otherwise is made.
In the Fisgard at Woolwich, there were five cases of smallpox, all occurring in the Midsummer quarter. Two of the persons affected are said to have shown good vaccination cicatrices, but no reference is made to this point in the other cases. They all appear to have run a mild course. Smallpox was prevalent in Woolwich.
A case of confluent small-pox occurred in the Hawke, at Queenstown. The person affected was a mess servant; but no information is given either as to the probable source of the disease, or whether there were any evidences or not of previous vaccination.
There were two cases of small-pox in the Hector, both of a modified character, the patients being protected by previous vaccination. The disease was contracted at Portsmouth, and the source in each case distinctly traced.
In the Implacable, and in the Impregnable, at Plymouth, there were two cases of small-pox, all of a modified form apparently. In the Indus, however, at the same place; there were twelve cases of the disease, one of which proved fatal. The staff surgeon (Staff Surgeon John King) has the following remarks on these cases:-
"Of eruptive fevers, small-pox was the form of more frequent occurrence; but of this disease there were only twelve cases during the year, a small number out of the large body of men and boys employed, who have frequent access to the three towns in which cases of small-pox were not of unfrequent occurrence during the past year. No case of the disease could be traced to contagion, strictly so called; but some of the patients lived in localities where the disease existed at the time of their being taken ill. Of the twelve cases that occurred, seven of them appeared during the first quarter of the year, which confirms a statement I have somewhere heard made, that when there is a tendency to the disease becoming epidemic, it is in spring, or about the vernal equinox, which, if true, its spread, though highly contagious, must be influenced by certain states of the atmosphere. The patients were, with one exception, at once sent to hospital, on the appearance of the eruption with fever. The exception referred to was a man, one of a boat's crew, who took it very mildly, and he continued doing duty, taking no notice of the few pustules he had on his body until in an advanced stage, when some one noticing two or three spots on his forehead, suggested to him to show himself at the sick bay. Upon inquiry it was ascertained that there were two or three cases at the time in the neighbourhood in which he lived. His wife, far advanced in pregnancy, caught the infection at the time and died of it, first giving birth to a child covered with the eruption, who also died. The wife had no cicatrix on either arm, but stated that she had been vaccinated. The husband had a well-marked cicatrix from vaccination, and told me that when in China some years previously there had been an epidemic of small-pox in the ship in which he was serving, when he helped and attended some of his messmates ill of the complaint, yet escaped himself, until the present time, when from predisposition, and a certain state of the atmosphere, he at last imbibed the poison, without, to the best of his knowledge, coming near anyone who had the disease. One case proved fatal in hospital. The patient was about 45 years of age, and had the disease when young, being slightly pitted. There was a pretty well marked cicatrix on the arm. The second attack proved more severe, and the patient died from inflammation affecting the air passages, thus confirming a statement I have seen, that when the disease occurred in a confluent or semi-confluent form, in persons over 40 years of age, it almost invariably proved fatal. There was no instance of the contagion being communicated from one to another of the crew."
Two cases of small-pox appear in the returns from the Irresistible, at Southampton; but only one appears to have been an undoubted case. In that instance, the person had slept in a house a fortnight previously, where the disease, in a very virulent form, was prevailing. It is not stated whether he had been previously vaccinated or not. In the other and doubtful case the man presented himself with an eruption over the face and arms, and as he belonged to the same mess as the former patient, he was at once, for security's sake, sent off to hospital as a case of small-pox. There seems to have been some doubt as to the real character of the eruption.
There were two cases of small-pox in the Lion, stationed in the River Clyde; both presented evidences of previous vaccination; but one proved a very severe case indeed, ultimately recovering, however. The other was of the modified type.
In the Majestic, stationed in the River Mersey, there were seven cases of small-pox, one of which proved fatal; with that exception, all were of a modified character. No information with reference to previous vaccination, or otherwise, is given in connection with these cases.
Three cases of small-pox, of a mild character, appeared in the Osborne, the disease having been contracted at Portsmouth. No information is given with reference to previous vaccination, or otherwise. Single cases of the disease also occurred in the Pembroke, at Harwich, and in the Prince Consort. In connection with the former vessel no information whatever is given in reference to the case; excepting that it was of a somewhat doubtful character; but in the Prince Consort the disease appeared to have been contracted at Portsmouth or Plymouth; the patient showed good vaccination cicatrices, but the attack was a severe and confluent one. He ultimately did well.
There were two cases of the disease in the Royal Adelaide, at Plymouth; three in the Royal George, at Kingstown, Ireland; eight in the St. Vincent, at Portsmouth; one in the Squirrel, at Devonport; one in the St. George, at Portland; one in the Trafalgar, stationed in the Firth of Forth; four in the Victoria and Albert, seven in the Victory, and four in the Warrior, at Portsmouth, one case in the latter vessel proving fatal; and two in the Wellesley, at Chatham. The great majority of these presented more or less evidence of previous vaccination.
It thus appears that in 1864, as in 1863, there was no seaport in the United Kingdom free from the disease. It prevailed, however, more extensively and more destructively at Portsmouth than in any other locality, and a great majority of the cases occurring in the Home Squadron were affected there.
The Inspectors General (Drs. Deas and Burns) of Haslar Hospital, into which establishment sixty-seven cases were admitted in the first quarter of the year, make the following report with reference to that period:-
"In the beginning of January the epidemic of small-pox, which was falling on the inhabitants of Landport, began to show itself amongst the crews of some of the ships lying in the harbour. Cases began to come into hospital till the 20th of February, when, there being about fifteen under treatment, it began to make its appearance in the general wards of the establishment.
“Two foreign invalids, who had been in hospital respectively twenty-two and eighteen days, were seized with variola, one (who died and who had been vaccinated) with the confluent form; the other, who was discharged cured, with the mild form. During the month of March thirteen other cases were transferred from the general medical, and eight from the surgical, to the small-pox wards . . . . Up to the end of the month (March) sixty-seven cases were received into hospital (exclusive of the medical transfers); of this number four terminated fatally, fourteen were cured, and fifty remained for further treatment. Of the fatal cases three had been vaccinated; in all the eruption appeared on the second day; there was great and early delirium and severe salivation, with great affection of the mouth and nares. Facial intumescence was also a marked feature, which, when the disease was about to terminate fatally, subsided early.
The principles of the treatment which was followed were, to support strength when the powers of life began to fail, giving at the commencement, if any pyrexial action existed, salines. Sarracenia was tried, with doubtful benefit; it is still undergoing a further trial. A solution of india-rubber in chloroform, when applied to the fully formed pustules, was successful in preventing pitting. No particular constitutional treatment was required for the milder cases. Attention to diet and the bowels was all that was necessary.
Of the medical transfers the two that died were both vaccinated, and had all the symptoms peculiar to the worst forms of the disease. Thus it will be seen that, with the cases remaining from last quarter, there were altogether eighty-three cases of small-pox under treatment. Of this number six were not vaccinated, and seventy-seven had the marks of the operation on the arms. Of these numbers, three of the non-vaccinated and nineteen of the vaccinated cases assumed the confluent form. To remove the powerful stench arising in the wards, chloride of zinc and nitrate of lead in solution of salt were both used, with but partial success, the preference being given to the chloride of zinc."
In addition to the sixty-seven cases of small-pox admitted into this hospital in the Lady quarter of the year, seventy-nine were admitted in the Midsummer, thirty-seven in the Michaelmas, and fourteen in the Christmas quarter.
Measles.- The largest number of cases of this form of fever occurred in the Implacable and Prince Consort at Plymouth, and in the Trincomalee at West Hartlepool. In these localities the disease was prevailing on shore. In Table IV. a fatal case of measles appears recorded in connection with the Hogue at Greenock; the case appears to have been a somewhat doubtful one. The patient, a seaman, was placed on the sick list labouring under febrile symptoms of a somewhat violent character, and on the fifth day was discharged to sick quarters on shore, he having been delirious during the previous night. Soon after his admission to sick quarters a copious rubeoloid rash appeared over the chest and abdomen, rapid congestion of the lungs set in, and he sank comatose. The patient was discharged to sick quarters as a case of typhoid fever.
All the cases in the other vessels of the squadron were of a very mild character, some of them being apparently examples of rubeola notha.
Scarlatina.- Five cases of scarlatina occurred in the Boscawen in the early part of the year. The disease appears to have been brought on board the ship by boys who had been on leave during the Christmas holidays. The individuals affected were removed to hospital with as little delay as possible, and the disease did not spread.
A case of scarlatina occurred in the Defence at Portland. The febrile symptoms appear to have run tolerably high, but he was discharged to sick quarters on shore, where he made a good recovery.
Three mild cases of this fever appeared in the Excellent at Portsmouth. They were discharged to hospital immediately the eruption made its appearance, and but little information is given in connection with them.
In none of the vessels of the squadron did the disease appear in an epidemic form, as happened in the previous year, and it appears to have been almost altogether confined to the vessels employed at Portsmouth, Portland, and Plymouth. Two cases occurred in the Fisgard, four in the Impregnable, two in the Indus, one in the Irresistible, one in the St. George, five in the Victory, and one in the Warrior.
In Table IV. a death from scarlatina appears in connection with the Dauntless. It occurred in Haslar Hospital in the person of a seaman who bad been admitted at the close of the Christmas quarter of the previous year, and who, twelve days after his admission, was attacked with acute nephritis, which carried him off. A fatal case also occurred in the person of a boy of the Impregnable, who was received into Plymouth Hospital labouring under a severe attack of scarlatina. He was convalescing favourably, however, when he was seized with meningitis, of which he died. On post-mortem examination of the body the dura mater was found congested, the right hemisphere of the brain was covered with pus, and the substance of the brain presented many red points on section. The lateral ventricles contained only a small quantity of fluid. The liver was mottled in appearance, with small patches, apparently tubercular, on its upper surface, and extending inwards to the depth of half an inch. The lungs were healthy.
Diseases of the Brain and Nervous System.- The increase in the ratio of cases coming under this head, as compared with the previous year, is altogether attributable to a number of cases of vertigo which were placed on the sick list, and which occasioned a considerable loss to the service by invaliding. This affection chiefly prevailed among boys, and unfitted them for the service, from its incapacitating them for going aloft. An apparent discrepancy appears in Table I, under the head of Disease of the Brain, only one case of which is entered in the first column, while two men appear as invalided for it, and four died. This arises from the obscurity which frequently attends the first stages of cerebral disease, in consequence of which patients are discharged from the ship to which they belong to hospital as labouring under some other affection, the disease of the brain not fully developing itself until the person has been for some time in hospital, and not unfrequently not being discovered until after death.
There were forty-eight cases of delirium tremens on the Home Station during the year. Of these two occurred in commissioned officers; two in warrant officers; eight in petty officers; nine in able seamen; four in ordinary seamen; two in men belonging to the carpenter's crew; two in stokers; one in a pensioner; the rating of one person is not given; and seventeen in marines. Two of the cases proved fatal.
Diseases of the Organs of Respiration.- The ratio of cases of all forms of disease coming under this head, is almost precisely the same as in the preceding year. In 1863, the ratio per 1,000 of mean force was 185·1, in the present year it is 185·4.There were 325 cases of inflammatory disease, fourteen of which were invalided and seventeen died, the invaliding rate being fractionally below, and the death-rate fractionally above, those of the previous year; there is also a slight reduction in the invaliding rate, and a fractional increase in the ratio of mortality of phthisis.
Diseases of the Heart and Blood-vessels.- There was very little difference between the ratios under this head and those of the previous year. One hundred and eighty-eight cases of functional or organic disease of the heart were placed on the sick list, of which seventy-one were invalided and fifteen died.
There were four deaths from aneurism. Two of these occurred in men who were, at the time, absent from their ships, and but little information is given in connection with them.
A stoker of the Ajax was admitted into Plymouth Hospital in March 1863, complaining of pain across the loins, which he stated had existed prior to his entry into the service, and which he attributed to a fall on his back from the upper deck to the engine-room grating, which he had sustained in a merchant steamer in South America. There were numerous marks of cupping over the loins. The symptoms continued very obscure, the pain at times being said to be of a pulsating character, until the 13th of May, when an aneurismal bruit was heard above the umbilicus and some pulsation was evident. These symptoms became more marked as the case progressed, and the pain at length became so excruciating as to require repeated large doses of morphia to procure him a respite from his extreme suffering; emaciation increased, and he at length expired suddenly, on the 17th of January 1864. The report of the post-mortem examination of the body is as follows: "Body greatly emaciated; left pleura adherent, the right pleural cavity containing a clot of blood weighing forty ounces. The lungs were emphysematous. A large aneurismal tumour was found situated between the crura of the diaphragm, just above the origin of the coeliac axis, and over the seventh, eighth, ninth, and tenth dorsal vertebrae, which were deeply eroded by absorption, down even to the spinal cord. The aneurism had burst into the right pleural cavity through the diaphragm, by an opening about half an inch in diameter."
A petty officer of the Dauntless was admitted into Haslar Hospital, labouring under bronchitic symptoms of a very urgent character. The physical and rational signs of aortic aneurism were at once recognised; but little relief, however, could be afforded him, and he died two days after his admission, death being preceded by intense orthopnoea and a slight convulsion. The report of the autopsy is to the effect that the body was well nourished; the chest was small, and a bulging was observable over the right sterno-clavicular articulation. On opening the thorax the sternal end of the clavicle was seen to be carious, and there was a collection of pus mixed with blood all round the articulation. A large tumour about the size of au orange was situated on the ascending aorta and communicating with it, immediately below the origin of the arteria innominata. The valves of the heart were healthy. There was a considerable quantity of serum effused into the cavity of the pericardium. The aorta at its commencement was much dilated.
Diseases of the Alimentary Canal.- There was an increase in the ratio of all cases coming under this head as compared with the preceding year, but the invaliding and death-rates were almost precisely the same as in 1863. There were three deaths from these diseases, two being from peritonitis, and one apparently from obstruction of the bowels. One of the fatal cases of peritonitis occurred in a warrant officer, who was sent into Haslar Hospital labouring under dyspepsia of long standing. His symptoms gave evidence of the presence of an ulcer in the stomach, that organ being irritable in an extreme degree, and refusing to retain even the mildest food. There was much burning pain at the epigastrium and tenderness on pressure. On the day before his death he was suddenly seized with severe griping and spasmodic pains about the epigastrium; the countenance became pale and livid, the skin cold and clammy, and there was great tenderness on pressure over the abdomen. The pulse was 120, small and feeble. Some little relief was obtained by the measures employed to combat these symptom, but he gradually sank exhausted. The friends would not permit of an examination of the body, but there appears to be little doubt that death was occasioned by peritonitis following ulcerative perforation of the stomach.
A very rapidly fatal case of peritonitis occurred in a boy of the Warrior. He was brought to the sick bay in the morning, in a state of extreme prostration, and showing symptoms of peritonitis. It appeared that he had been moaning during the night, but was not discovered to be ill until he was required to get up in the morning. During the afternoon he rallied somewhat under the treatment to which he was subjected, but in the evening he sank into a semi-comatose state, and after a slight convulsion passed into a moribund condition, and died about eleven p.m. The surgeon, Surgeon (S.S.D. Wells) says: "On examining the body this morning, there were found old adhesions of the pleurae, and about an ounce of fluid effused into the pericardium. In the abdomen, the omentum presented patches of inflammation, and was adherent in those places to the peritoneal surface of the parieties of the intestines; there were patches of inflammatory redness on the intestinal peritoneum, and some of the contiguous folds were slightly adherent. There was very little serous effusion, and none of the flakes of lymph which are usually met with in such cases. The liver was large, and the gall-bladder distended with bile. The head was not examined." These appearances were certainly not such as, of themselves, to account for the extreme rapidity of death in this instance. In all probability the fatal event was accelerated by the great shock which the nervous system almost invariably sustains in cases of inflammation of the serous lining of the abdomen.
The fatal case of obstruction of the bowels occurred in a warrant officer, and was treated at his own home. Very few particulars are given in connection with it, and these are not of a very pertinent character. He had been subject, at different times, to severe attacks of obstinate constipation, and, on the occasion which terminated fatally, presented himself complaining of pain across the bowels, and constipation. For this he was ordered castor oil, and permitted to go to his home. On the following morning it was ascertained that the oil had had little or no effect; he had occasional severe darting pains across the abdomen, for which he was ordered turpentine stupes. There was no heat of skin or acceleration of pulse. In the evening vomiting set in, the pulse became small and weak, and he sank at half-past ten p.m. There was no examination of the body, it would seem, so that the cause of death must rest on mere surmise.
Diseases of the Genito-Urinary Organs.- There is a reduction to the extent of 15·5 per 1,000 of mean force in the ratio of all cases of disease coming under this head, as compared with the previous year, which is entirely referable to a diminution in the number of cases of venereal disease. The ratio of syphilis in 1863 was 104·2 per 1,000, and of gonorrhoea 32·4; in the present year the former was 96·6, and the latter 25·7. The total number of days' sickness from syphilis, on board ship and in hospital, was 71,481, which gives an average duration to each case of between thirty-seven and thirty-eight days. The average number of men daily sick from this disease was 195·8, which is 20·6 below the number ineffective in the previous year. The ratio of invaliding occasioned by it was precisely the same as in 1863.
The ships that appear to have suffered most from venereal diseases were the Asia, in which there were ninety-three cases of syphilis and seventeen of gonorrhoea; the Cambridge, 110 cases of syphilis and four of gonorrhoea; the Duke of Wellington, eighty-nine of syphilis and sixteen of gonorrhoea; the Edgar, 180 of syphilis and sixteen of gonorrhoea; and the Excellent, ninety-three of syphilis and sixteen of gonorrhoea. It thus appears that the Edgar, the flagship of the Channel Fleet, suffered much more numerically than any other vessel. The surgeon of the Edgar, who has studied these diseases very carefully, and has given much thought to their bearing on the welfare of the public services, makes the following interesting observations on syphilis and other nonspecific venereal diseases:-
"As contrasted with the year 1863, there has been a decided increase (which is, however, more apparent than real in reference to the Channel Station) in the number of admissions for venereal diseases generally, and especially for primary and secondary syphilis. The comparison indeed cannot be made without considering that the ship did not arrive in England from the Mediterranean until the first week in May 1863, up to which time there had been but 18 cases of syphilis, primary and secondary, and eight of other venereal diseases; total, twenty-six placed on the Sick List. In the remainder the year 110 cases of syphilis and 43 of other venereal affections, total 153, were admitted, and can be set against 180 of primary and secondary syphilis, and thirty-four of other venereal affections, total 214, occurring in the year 1864. From this it will be seen that the proportion of the whole number has been nearly equal in both the years of service in the Channel, though in the past year there has been an increase in the ratio of admissions from primary and secondary syphilis; and while the number of men sent to hospital from this cause alone amounts to four-sevenths of the whole number of hospital cases, one-seventh in excess of the number sent for all other diseases together, the loss of service on board has been nearly one-fourth of the total loss for the year.
"The attention of the Government having been at last happily awakened to the prevalence of venereal diseases in the Army and Navy, and to the necessity of preventive legislation to counteract the daily increasing ravages of syphilis in both services, they succeeded, during the last Session of Parliament, in passing the Contagious Diseases Act, which it is hoped will be of service in checking the disease at its source. I fear, however, that any enactments which do not compel the registration and regular inspection of prostitutes will fall far short of the good which might be effected by a nearer approach to the continental system, of the benefits of which our experience at Corfu, Malta, Hong Kong, &c. are tangible and positive proofs. As this is a subject which now engrosses a large share of public attention, and as the nature, treatment, and prevention of syphilis is now under the consideration of a Committee, including among its number many of the leading men in our profession, I may be excused from adverting to my own experience in former years as well as in the past, and in comparing the results of lengthened service in those places, where no legislation against syphilis existed with those obtained from a service in ports where beneficent though stringent enactments had almost eradicated the disease from among the population. The evil is so widely spread, of such magnitude, and bears so directly on our present and future race of seamen, that it is to be regretted that those religious philanthropists who exert themselves so earnestly and with noble zeal in attempting to check the sin of prostitution do not seek with equal earnestness to mitigate the dreadful ills resulting from the vice; that they do not see clearly how in syphilis the sins of the parent may be visited on the children, and through these indirectly on the third or fourth generation; that as patriots, earnest in upholding the honour and position of the country, zealous for the welfare and comfort of the sailor and soldier, it is their duty as much to assist in measures calculated to preserve their health, as to attempt by enforced morality, which fails in its object, to prevent their incurring those temptations which have always existed, and which must exist, in so large a number of men who are compelled by the nature of their vocation and habits of life to live in a state of forced celibacy. This must be the reflection of every one when we see that one-fourth of the sickness on the Home Station depends upon venereal diseases, and that a large number of our young and most efficient seamen are every year lost to the service: that many of these return to their homes with constitutions shattered by diseases contracted in our naval ports; incapable of supporting the privations of a life of toil, they become inmates of our hospitals or workhouses, until by an early death they pay their last penalty for indulgence in that sin to which, by the regulations and nature of the service, they are more exposed than men of the same class in the civil population, and the evils of which it should be the effort of a wise and humane policy to prevent. The evil, unhappily, does not rest here: it affects our whole seafaring population, and we may (if measures are not carried out to prevent such a calamity) one day have to recruit our seamen from among the scanty and sickly offspring of a tainted race instead of from among the numerous and healthy children of the hardy fishermen and sailors of our coasts.
"When surgeon of H.M.S. Calypso, in 1858, we lay at anchor in Honolulu harbour for three months: the men had almost unlimited night leave on shore, and as it was the winter season, when the port is frequented by a large number of American Whalers, the town abounded with native prostitutes, who at that time made it their practice to migrate to that port from all the other islands of the Sandwich Group, and to remain until the departure of the whale ships to their cruizing grounds in the spring. No legislative enactments were then in force for the prevention of syphilis, and out of 153 men and officers thirty-three were put on the list for venereal diseases, of which nineteen were syphilis and fourteen gonorrhoea. The effects of the disease were visible throughout the Islands, the population were rapidly diminishing, sterility was common among the native women; among those with families the children were generally few and stunted, and too many of them with constitutional syphilis visibly impressed on their persons. About eighteen months after this, with the same crew in the same ship, I visited Tahiti, where the ship was hove down, and remained three months; during which time the men lived on shore in tents or storehouses. We sailed thence for Valparaiso, but had only four cases of venereal disease, of which one was syphilis and three gonorrhoea. The French had enforced a system of inspection, and enforced cure and detention of prostitutes; so that had it not been for the occasional importation of the disease in whale ships, syphilis would have disappeared from the Island. The population was on the increase, and the children of the natives were numerous and healthy. Can there be a more convincing proof of the wisdom and beneficence of legislative enactments for the prevention of the disease?
"The registration and inspection of prostitutes, as enforced at Malta, Lisbon, &c., I believe to be the only really effectual means of preventing the disease; and although the new Act will, I doubt not, be of some benefit, its provisions should be more stringent, and there should be persons specially appointed to carry them out. If the whole country were divided into districts, in each of which there should be a Lock Hospital under the control of a well paid medical officer, who should also do the duty of inspecting all women who might present themselves, either voluntarily or by warrant, the benefit of the bill would be enhanced and rendered permanent in the improved health of the population. In every large garrison or seaport town, there should be a salaried medical inspector of the women, who would be responsible for the careful performance of his duties, and who would send in his reports to the Superintendent Inspector General. As yet, Portsmouth is the only town to which the provisions of the Act have been applied, and here only since the 1st December, I find on inquiry that the management of the women is entrusted to a few of the metropolitan police, whose duty it is to find out as far as they are able by private inquiry, any women suspected of having communicated the disease; whom they induce if possible, by persuasion, to go to the Lock Hospital for examination. They are there inspected by the house surgeon, who thus has a very large amount of important duty suddenly thrust on him, in addition to the increased number of patients in hospital, for whose care and treatment he is responsible.
"The possibility of hygienic measures on board the ship, in checking the spread of syphilis, is a subject of interesting and serious inquiry. First, as to men's leave. Commanding officers would strongly oppose any plan of substituting for the night leave which is now given whenever it is practicable, day leave at certain fixed times; and on those occasions on which I have seen permission given for the men to go on shore for the afternoon and to return in the evening, but few have cared to avail themselves of the indulgence. The men themselves would be discontented if they were thus deprived of their usual monthly leave of from twenty-four to forty-eight hours, and those who are determined to incur the risk of venereal contagion, would not be deterred even if compelled to return to the ship at sunset. Secondly, personal cleanliness; the means of personal ablution might and ought to be provided in all ships. In steam ships the baths could be heated by steam; and if every ship were fitted with a sufficient number, say six, with a constant supply of water, the men would soon learn to look on cleanliness as a duty as well as a pleasure. In the lower deck messes, where men wash in the large filthy tubs with water filthy with soap, and the accumulated dirt of their messmates, with no place of secrecy or retirement, it is not to be wondered at that they rarely wash their genitals; and I doubt not, many men have ulcers on the penis often for days, sometimes perhaps weeks, without being aware of them. Lastly, weekly inspection of men, though I do not believe this would have much effect in lessening the number of cases; it might be of benefit if properly and efficiently carried out, in preventing men going on shore when diseased, and neglecting to apply for medical aid until the disease has extended and the patient may require hospital treatment. I have myself on some occasions inspected the whole ship's company for venereal disease; but only when after being a long while in a home port, the ship has proceeded on foreign service, and the sick-list has been suddenly increased by the addition of men suffering from venereal disease, who had concealed it so long as they had opportunities of going on shore. Even in these cases, when most of the older, more respectable, and more intelligent men have seen the necessity of such general inspection, it has excited so much discontent as to convince me it is a measure to be carried out rarely, and only on urgent necessity. Having made numerous personal inquiries on the subject among petty officers and the most respectable class of seamen, married men whose general character not only entitles them to be heard with attention, but also gives them great though perhaps unseen influence on the lower deck, I feel assured that if the system of regular weekly inspection were commenced, it could not be carried out in the home ports, where to be of use at all, it must be general and regularly performed. On first leaving port, after being a long time in harbour, and when proceeding on foreign service, I think an inspection of the crew not only advantageous but essentially requisite, and if made so as to allow sufficient time for landing hospital cases before sailing, the advantages would in every way be still greater.
"The want of any continuous medical history of our patients is the first and greatest difficulty the naval surgeon has to contend with in investigating the pathology of the disease, and though this may be partially overcome by a regulation affecting continuous service men, there are so large a number of men who enter for short time only, and who leave the service for longer or shorter periods of years to re-enter when it may suit their convenience, that we can never have the same opportunities of observation as medical officers in the army, in proof of which I have only to state that, out of 277 individuals who have been affected with syphilis, between 11th July 1862 and 31st December 1864, only 137 remain on the ship's books, and of 134 cases of secondary syphilis occurring in 108 men, there have been sixty-three cases in forty-one men, of which I have been unable to obtain any precise history. Men sent to the naval hospitals do not bring back any record of their treatment when they return cured, so that even of those who continue on board, the information is very inexact and incomplete.
"Varieties of Venereal Sores.- In practice on board ship I divide all primary sores on the genitals, resulting directly from impure coitus into soft or non-infecting, and indurated or infecting sores; and although I do not consider it possible to decide with certainty in all cases as to whether a sore is infecting or non-infecting, as to whether a sore soft at the early period may not subsequently become indurated, and sometimes even if a sore which heals and remains free from subsequent induration, may not be really an infecting sore, and followed by constitutional syphilis, these exceptional cases are few, and when they occur I make it a rule to wait for some more decided symptoms of true syphilis before forming a diagnosis.
"As a rule, I look on induration of the base of a chancre as the first evidence of constitutional disease; but as phlegmonoid induration resulting from the application of caustics to simple sores will sometimes assume the character of true specific induration, in doubtful cases I wait until the inguinal glands become enlarged and indurated, which they invariably do at the latest, in three or four weeks from the time of infection of true syphilis, before commencing any specific treatment. I have lately witnessed a case of large soft elevated sore on the integument of the penis which healed under local treatment, but which in six weeks was followed by a syphilitic squamous eruption. Sores on the glans penis are not followed by induration, and those on the sheath of the penis rarely; when the latter do indurate it is but slight "parchemine," and may readily escape notice. I may state in conclusion, that I believe induration of the base of the sore to be the first symptom, but that multiple enlargement and induration of the inguinal glands on each side, with a peculiar rolling feel under the fingers, are the first pathognomomic signs of constitutional syphilis; I believe this condition of the inguinal glands is never absent.
"Period of Incubation.- The earliest period at which any man has ever appeared with the characteristic pustule of the early stage of soft sore has been on the fourth day, but men are so much in the habit of concealing their sores either from intention or neglect, that it is difficult to form a correct opinion. Men have often applied with chancres of both kinds of two months date, and have declared their ignorance of the existence of these sores until the day of application. "Phagaedena," or phagaedenic chancre. When phagaedena exists, it is, I believe, superadded to the original sore, whether infecting or non-infecting. In two years and a-half there have been but two cases in Her Majesty's Ship "Edgar;" in both very rapid loss of substance had taken place before application; one occurred at Corfu, and the other at Lisbon, and erysipelas prevailed on shore on each occasion, though there was no erysipelas on the genitals of these men, the phagaedena may have been induced by the action of the same or a similar poison. Both these men were treated with warm opiate lotions, ammonia and iron; they took no mercury nor other specific remedy, and neither have since suffered from constitutional syphilis.
"’Mixed sores,' that is, soft and hard chancre, will not unfrequently occur in the same person, and probably contracted at the same time; I sometimes also find that a man will be placed on the sick list for soft sore which heals under local treatment, and shortly afterwards the cicatrix indurates at the base, the inguinal glands multiply, become enlarged, and marble like, and other symptoms of constitutional syphilis follow in succession; in this case the inoculation must have been twofold, and it is a proof also that the incubation of true syphilis is of longer period than of soft chancre.
"In order to show the ratio of each kind of sore, I annex a Table, by which it will be seen that soft sores are as three to one of indurated.
"’Treatment, first, of soft, suppurating, or non-infecting sore.' I believe these are simple contagious venereal ulcers, to be cured on the same surgical principles as any ulcers on another part of the body; cleanliness, stimulants, astringents, opium, &c. I never give mercury, except as an alternative, or combined with a common aperient. 'Secondly, of infecting sores.' These, as a rule, will, I believe, heal under local treatment alone, and, with the help of mercury given internally, more rapidly than soft sores. In all cases of true infecting sores I give mercury, either in the form of bi-chloride, ½ gr. to 1/16 gr. three times daily, with iodide of potassium and extract of sarsaparilla, and continue this until the gums give the first evidence of the medicine having produced some effect on the system, when it is discontinued, to be resumed again if necessary. I am careful to avoid salivation, and sometimes give chlorate of potass at the same time when the patient seems peculiarly susceptible to the influence of mercury.
"’Suppurating bubo' has occurred in thirty-four men between 11th July 1862 and 31st December 1864; of these five have since suffered from constitutional syphilis; in three of these five there was indurated chancre; all the rest were sent to hospital, or treated on board, with soft sores: I believe induration existed in the other two, but have no recorded evidence in proof. The question as to the immunity from constitutional syphilis after a good large bubo may not be wholly decided; but when we consider how rarely suppurating bubo takes place in true syphilis, that it rarely exists with symmetrical multiple enlargement of the inguinal glands, and that when constitutional syphilis follows it may be the result of mixed infection, I think we may fairly conclude that the opinion of the older writers, as to its conferring immunity from constitutional symptoms, was erroneous. Syphilis did not follow because it had no previous existence.
"Under unusual or extraordinary causes of irritation, such as work aloft; a long march, &c., true syphilitic enlargement of the glands may possibly inflame and suppurate, in which case I believe constitutional symptoms will follow, though I am not prepared to express an opinion as to whether the suppuration may, by the elimination of a certain amount of materies morbi, lessen the severity and duration of the subsequent constitutional malady.
"Forms of constitutional or secondary disease:
"After induration and multiple enlargement of the inguinal glands, which I have already mentioned, the post cervical glands become enlarged and indurated; syphilitic roseola will appear on the skin, accompanied sometimes, but not always, with febrile symptoms. I have seen these so high as to mislead me as to the nature of the disease until the eruption has appeared, when the feverish symptoms subsided. A large number, the majority indeed, of syphilitic eruptions are attended with such slight amount of constitutional disturbance that the patient's attention is first directed to the rash on the skin; pains in the limbs will occur at any stage of the disease; true osteocopic pains not until a later period; tubercular and papular eruptions are the most common next to roseola; pustular syphilis I find the most troublesome and worst forms of the disease; ecthyma, rupia, and syphilitic acne are frequent.
"’Treatment.'- There are, I believe, many cases of mild constitutional syphilis in which the disease will wear itself out, and disappear in two or three years, while there are others in which the disease seems to exert its baneful virulence with tenfold vigour, and to resist almost all forms of treatment. Relapses take place year after year, the disease and the impaired constitution seem to act and react on each other until finally the internal organs become affected with syphilitic deposit, and the patient dies, worn out by constitutional syphilis. Though mercury is evidently not a specific remedy (for secondary eruptions often appear in men salivated by the medicine for the cure of primary sore) I believe it to be efficacious in prolonging the period of attack and in lessening the severity of the symptoms; it must, however, be given with care so as not to salivate. Iodide of potassium, cod liver oil, iron are most valuable as remedial measures. Dr. Marston, Assistant Surgeon of the Royal Artillery of this place, recommends the use of iodide of potassium in half drachm doses thrice a day, but I have been in the habit of giving only from five to 10 grains. In all cases of constitutional syphilis I support the system with generous diet with ale or wine, for I believe there are many men in whom the disease will wear itself out, and exhaust its violence on the system, which if kept up by tonics and good living will resist the disease until it is finally cured by medicine or eliminated by time.
"An ointment of calomel and opium or powdered calomel, I find useful as an application to the secondary ulcerations around the arms or round the genitals.
"Immunity from second attacks of syphilis
"Since the commencement of the Commission no man has been twice on the list with indurated chancre, and my personal experience is in confirmation of the opinion that a person is not liable to a second attack of syphilis. Men having once suffered from indurated chancre will often be placed on the list for recent sores, but these, in all cases, are soft chancres.
|ABSTRACT of Cases of Syphilis occurring on board, 11th July 1862, and 31st December 1864|
|Total cases of all kinds||428|
|Number of individuals affected||277|
|The difference arising from the same man being repeatedly on the list.|
|Soft or non-infecting||48|
|Secondary Eruptions, &c.|
|Cases following indurated chancre occurring on board||57|
|Ditto - - - soft chancre||10|
|Secondary cases, with no previous history||60|
"Gonorrhoea.- Men suffering from gonorrhoea so rarely apply to be placed on the sick list, that the number of admissions, during the year, has been comparatively few. The treatment I adopt is, brisk purging, by salines at first, after which, a mixture of balsam of copaiba, tincture of hyosciamus, liquor potassae, and mucilage, is given three times daily. Barley water is given freely, two to three quarts a day, and an antichordee pill, composed of camphor and opium, given at night. After the acute symptoms have subsided, I employ an injection of sulphate of zinc, three daily, or a weak solution of nitrate of silver. When copaiba purges, or causes an eruption on the skin, the powder of cubebs, in two drachm doses, is given three times a day instead. I do not find that smaller doses of these remedies have any decided benefit.
"Orchitis.- After the acute symptoms have been subdued, by means of leeching, fomentations, and the internal use of saline antimonials, I find the application of collodion, twice a day, over the scrotum, productive of marked benefit. Iodine paint, composed of one drachm of iodine, to one ounce of alcohol, is also found to be of great service in reducing thickening of the tissues. In obstinate cases, strapping of the testicle is often applied on board. The mean duration of treatment of each case, during the past year, has been sixteen days."
Wounds and Injuries.- Death was occasioned in four instances, by fracture of the skull; in two of these the injury was sustained by falling from aloft; in one, by falling from the upper deck into the hold; and in another, by falling over a precipice. A man sustained a severe compound fracture of the thigh, which terminated fatally; one man was killed by a railway train passing over him; and another by being crushed between two logs of wood, whereby the sternum and several ribs were fractured. One man sustained fatal fracture of the cervical vertebrae, by falling from aloft.
There were nineteen deaths from drowning. With respect to six of these, the particulars have not been given; one man was drowned while bathing; four, by the boat they were in having been run down by a steamer, and swamped, one man who was drowned is supposed to have jumped overboard; one fell out of a boat and was drowned; and one was drowned by falling into a dock; two men were drowned by being capsized in a shore boat; and three men were drowned by falling overboard.
Two men died from the effects of alcoholic poisoning; one man committed suicide by cutting his throat, and one by jumping overboard and being drowned.
A diver, while employed in thirteen fathoms of water, died from asphyxia and congestive apoplexy, in consequence of the bursting of the tube which had to convey fresh air from the pump to the helmet he wore. On examination of the helmet it was found that the escape-valve did not work freely.
The circumstances connected with the death of one man are not given.
The total number of deaths was 154, being in the ratio of 7·8 per 1,000 of mean force. Of these, 122 were caused by disease, and thirty-two by wounds and injuries of various kinds, and drowning. The ratio of mortality from disease alone was only 6·3 per 1,000 of mean force. As compared with the preceding year, there is an increase in the total death rate of ·8 per 1,000, the increase in the ratio of death from disease being 1·3 per 1,000.
Invalided.- Eighty-one persons were invalided for diseases of the brain and nervous system, thirty-nine of whom were epileptic subjects, and twenty-five suffered from vertigo; ninety-eight for diseases of the organs of respiration, eighty of whom were phthisical; eighty-one for disease of the heart and blood vessels; ten for diseases of the alimentary canal; eight for disease of the liver; fifty-two for diseases of the genito-urinary organs; seventy for rheumatism; one for gout; eighteen for diseases of the bones and joints; twenty-three for diseases of the special senses; forty-seven for diseases of the skin and cellular tissue; sixty-seven for diseases not classed; forty-seven for wounds and injuries of various kinds, and thirty-three for hernia. The total number invalided was 636, being in the ratio of 32·3 per 1,000 of mean force; being an increase as compared with the previous year, of 3·4 per 1,000.
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