► Royal Navy ► Naval Surgeon China ◄► Table 5
Statistical Report of the Health of the Navy - 1864.
AUSTRALIAN STATION
THE squadron on this station in 1864 consisted of seven vessels. Of these three were frigates, one being of the fifth rate, and two of the sixth-rate; there were three sloops, and one gun vessel. Besides this force there was a small detachment of marines stationed at Cape York. The mean force corrected for time was 1,160. The returns from six of the vessels are for the whole year. In the seventh they are only for six months. There were 1,608 cases of disease or injury under treatment, of which 24 were invalided, and 30 died. The sick-rate was 1386·1; the invaliding rate, 20·6; and the death-rate, 25·8 per 1,000 of mean force, so that there was an increase in the sick-rate, but a reduction both in the invaliding and death-rates as compared with the preceding year.The daily loss of service from febrile diseases was in the ratio of 2·6 per 1,000 of mean force; from diseases of the brain and nervous system, 0·5; diseases of the respiratory organs, 5·9; heart and blood-vessels, 0·7; alimentary canal, 3·3; liver, 0·1; genito-urinary organs, 1·4, entirely attributable to venereal disease; rheumatism, 4·8; diseases of the bones and joints, 0·2; special senses, 0·4; skin and subcutaneous cellular tissue, 9·9; diseases not classed, 1·5; and wounds and injuries of various kinds, 13·2. The average number of men daily sick was 58·6, which is in the ratio of 50·5 per 1,000 of mean force, a considerable increase as compared with the preceding year.
AUSTRALIAN STATION
Fevers.- There were fifty-six cases of primary fever under treatment, and of these one was invalided, and two had a fatal termination. The total number of days' sickness on board ship and in hospital resulting from them was 1,135, so that each case was a little over twenty days under treatment. Twenty-seven of the cases occurred in the Eclipse, twenty in the Curacoa, eight in the Harrier, and one in the Esk. There was no primary fever in any of the other vessels. With the exception of about two months, the Eclipse was employed during the whole year in New Zealand. During the Lady quarter she lay in the Waikato River, and while there the majority of her crew and all the marines were disembarked, and formed part of the naval brigade, co-operating with the troops against the Maories. By the middle of April they had all rejoined, in good health apparently, with the exception of one man who had contracted dysentery. Of the twenty-seven cases of fever that appear in the returns from this ship, twenty-four were of a more or less ephemeral nature, and three of the remittent type. The average duration of each of the cases of ephemeral fever on the sick-list was about six-and-a-half days, while each case of remittent fever was from nineteen to twenty days under treatment. The latter type of fever was characterised by much gastric irritability, and during convalescence pseudo-rheumatic pains were troublesome, and appear to have retarded recovery.
There were twenty cases of primary fever in the Curacoa. Eighteen of these are returned as continued fever, twelve of which occurred in men who had only recently returned from service in the field in New Zealand. In the majority of these cases the type was low, and convalescence exceedingly tedious. The average duration of each case on the sick-list was twenty-four or twenty-five days. The surgeon (Dr. Picken) of the Curacoa says:-
"Those who were attacked with fever were principally stationed on the banks of the Wipa, or in the vicinity of water, though the camps were generally placed on dry elevated ground. The disease from the first assumed a low form, and was generally attended with severe and persistent diarrhoea. Pyrexia never ran high, in some cases I may say there was scarcely any, the first symptoms being loss of appetite and complete prostration of strength, succeeded by confusion of ideas, and as the disease progressed, wandering and delirium. The tongue became black and dry, and sordes collected on the teeth. Stimulants early became necessary, and great attention was necessary with reference to diet. Quinine was administered throughout, and if necessary in combination with opium to check diarrhoea. The first symptom of improvement was cleaning of the tongue. Convalescence was slow, and return to health long protracted." With reference to the climate of the province of Auckland, this officer says, "Compared with that of England the summer is longer, and as a rule much warmer, especially during the day; but the nights are moderately cool, as there is generally a refreshing wind blowing. Winter is cold, and a great quantity of rain falls. Cases of fever and affections of the bowels are stated by various writers to be of rare occurrence. I can testify, however, to the contrary, especially where men are subjected to the fatigues and exposure of camp life. Fever and dysentery were common amongst the troops, and not unfrequently terminated fatally."
There were eight cases of primary fever in the Harrier, which vessel was employed, during almost the whole year, in New Zealand, where her crew and marines were for some time serving on shore with the naval brigade. One of the cases of fever was of an ephemeral nature, and was only five days under treatment, and another was of the simple continued type, being sixteen days under treatment. With reference to the remaining six cases the surgeon (Surgeon W.G.I. Ayre) makes the following remarks:-
"In four cases, one of which proved fatal, the fever was decidedly typhoid. In those in which recovery took place, the characteristic rose-coloured eruption, disappearing under pressure, was present, and there was more or less abdominal tenderness, and irritation of the bowels. In the fatal case no spots were seen during the progress of the disease, but the purging, profuse haemorrhage from the bowels, and extreme exhaustion clearly indicated the nature of the fever. The other two men attacked had no eruption on the body, but considerable prostration, and symptoms of gastric and Hepatic complication. Five of the men who suffered from fever had recently returned from service on shore with the naval brigade, and as fever was very prevalent amongst our men and the troops serving in the Waikato, it is probable these cases were contracted there."
The only case of fever in the Esk was of an ephemeral nature.
Diseases of the Brain and Nervous System.- There were seven cases of delirium tremens in the squadron. Two of these occurred in one person, a petty officer. Of the others one was in a warrant officer, one in a petty officer, and three in a seaman. A fatal case of apoplexy following a debauch occurred in the person of a seaman, who, having been found drunk in the streets by the police, was taken to the stationhouse. On the following morning he appeared to be quite well, but on being brought before the magistrate he fell down in the dock, rapidly became insensible, and in the course of a few minutes expired.
Diseases of the Organs of Respiration.- There is a considerable decrease in the ratios of cases and of invaliding under this head as compared with the previous year, but the ratio of mortality is high. There were no deaths from these diseases in 1863.
During the Michaelmas and Christmas quarters a considerable number of cases of sore-throat, of a specific character apparently, occurred in the Curacoa at Melbourne, one of which had a fatal termination. In that instance the disease was undoubtedly diphtheria. The surgeon remarks with reference to this outbreak:-
"Of nineteen cases of cynanche which are noted, nine occurred in the Michaelmas, and ten in the Christmas quarter. The first few cases occurred while we were in dock at Cockatoo Island, near Sydney. Boys and young gentlemen were the chief sufferers. Those attacked complained of slight febrile symptoms with sore throat, one tonsil first being inflamed, on which, in a few hours, a yellow spot would be seen, which increased in size until the third or fourth day, when the uvula and the other tonsil were usually involved. About this time the slough began to separate, granulation rapidly proceeded, and with a little stimulation cicatrization soon followed. The first case that occurred I called diphtheria. It terminated fatally after a few days' illness. The disease was rather prevalent in Sydney at the time, and from the similarity of the symptoms in all our cases, the only difference being in intensity or severity, I am of opinion that they were of the same specific character."
Diseases of the Alimentary Canal.- There is a considerable increase in the ratio of cases coming under this head as compared with the preceding year.
There were three cases of dysentery and twenty-three of diarrhoea in the Curacoa. Fourteen of the cases of diarrhoea occurred during the first quarter of the year, when the ship was at Auckland, where the disease, in a dysenteric form, was very prevalent, and caused much mortality amongst the children on shore. Some of the cases were tedious. The remainder of the cases of diarrhoea were scattered throughout the year, but the three cases of dysentery occurred in the Midsummer quarter, at the time when fever was prevalent amongst the crew as the result of exposure in camp. As has been stated previously, the troops suffered a good deal from fever and dysentery.
In the Eclipse there were seventeen cases of dysentery, and eight of diarrhoea. All the dysentery appears to have resulted from exposure in the field; with one or two exceptions, they were mild in character.
There was a fatal case of peritonitis in this ship, in the person of a mess servant, who had been subject to irregularity of the bowels since an attack of dysentery he had had in China; he was a spare thin man, and the exciting cause of the fatal attack is said to have been an unusually prolonged fast while on shore two days previously. The disease assumed a most virulent form, and on post-mortem examination of the body, the parietal and visceral surfaces of the peritoneum were found to be agglutinated to each other by soft unorganised lymph that contained in its interspaces or meshes thick purulent fluid, giving the appearance of large abscesses in several places.
There was one case of dysentery, and twenty-seven of diarrhoea in the Esk; the former disease occurred in a man who had suffered on two occasions from acute dysentery in China; it was found necessary to invalid him. The cases of diarrhoea appear to have been of some severity, the average duration of each on the sick-list being about twelve days.
The cases of diarrhoea in the Falcon were of a trivial character.
In the Harrier there were two cases of dysentery, and twelve of diarrhoea. One case of dysentery occurred in the person of a marine, who contracted the disease when serving with the naval brigade at Waikato; the other appears to have been a mild attack of dysenteric diarrhoea. The majority of the cases of diarrhoea were attributable to irregularities in diet, and were, on an average, not more than two days on the sick-list.
There were two cases of dysentery, and nine of diarrhoea, in the Miranda. One of the cases of the former disease was contracted while on service in the field; in the other instance, however, there was no such exposure to account for the attack; both made good recoveries. The cases of diarrhoea were of a trivial character.
In the Salamander there was one rather severe case of dysentery in an officer who had previously suffered from the disease in China; the inflammatory symptoms seemed to be confined to the caput coecum coli, which part of the bowel had been chiefly affected in the former attack. There was nothing of importance in the cases of diarrhoea that were under treatment.
A fatal case of enteritis occurred in this vessel in the person of a marine, who, after repeated exposure to cold and wet, was seized with severe diarrhoea, for which he neglected to apply for advice until ten days had elapsed; two days afterwards the symptoms assumed an inflammatory character, and rapidly proceeded to a fatal termination. The following report of the post-mortem examination of the body, with remarks upon the appearances, is by the surgeon (Dr. Alexander Rathray) of the vessel:-
"Autopsy, sixteen hours after death. There was considerable lividity of the surface, especially of the extremities and abdominal parietes. The abdomen was much distended, tense, and tympanitic, and on opening it the vessels of the omentum were found to be tinged and darkly congested; the mesentery was darkly congested, and this increased in intensity towards the ileum; the stomach was empty and collapsed, but otherwise normal; the duodenum was normal; there was congestion of the jejunum, gradually increasing in intensity towards its lower part, and its mucous membrane was covered with a dirty yellow mucus; the ileum was deeply and darkly congested in all its coats, and along its whole extent of a deep port wine colour; the ileo colic valve was normal, but congested in its upper surface, and less so on its lower aspect; the caput coecum coli, as well as the ascending transverse, descending and sigmoid flexure of the colon were enormously distended with gas; the first and last containing about four quarts each of thin yellow feculent matter; the rectum was normal, except at its upper part, where, as it bends over the bony rim of the pelvis to join the sigmoid flexure, a ring of inflammation about an inch broad, and of a deep purple colour, encircled the gut, the sigmoid flexure for five or six inches above it being congested. No trace of softening, gangrene, perforation, or peritoneal effusion could anywhere be detected. The liver was darkly congested, especially along its anterior edge; the kidneys were deeply congested; the pancreas and spleen somewhat but less congested; the diaphragm was displaced upwards by the distension of the abdomen; the lungs, heart, and other organs were healthy.
"The post-mortem appearances thus showed:-
"1st. That the vessels which supply the abdominal viscera, including the portal circulation, and the majority of the viscera themselves, were much and darkly congested.
"2nd. That in two places this vascular disturbance had gone on to inflammation; these centres of derangement being:-
"a The ileum; of which about three feet in length of its lower part was deeply inflamed in all its coats.
"b The rectum; of which a ring, an inch broad at its upper part, was inflamed and distended to about four inches in diameter, the gut above being enormously enlarged, and the rectum below contracted, and normal in hue.
"These appearances throw light on the case, and clearly explain the cause and course of the disease. A fatal termination where so much of the bowel was involved was therefore not surprising. The small intestine, especially at its lower half, the ileum, was evidently the primary and principal seat of disease, while the inflammation at the upper part of the rectum was doubtless a secondary affection of comparatively recent origin, and a minor affection; the occurrence of which, as it did not result from continuity of tissue, is to be explained by supposing it to have been caused, either-
"a By pressure - first, of the inflamed small intestine, or the gut as it bends sharply into the pelvis. When inflamed the intestines appear to lose their tone, and hang like a dead weight in the abdominal cavity, a fact which may be felt by those who have suffered from this disease; or,
"b By metastasis, from contiguity of tissue; the rectum as it bends over the sacrum being within a couple of inches of the lower end of the ileum and caput coecum, all three being bound down to the back of the pelvis, and their vessels consequently anastomosing. Moreover, the two mesenteric arteries which supply both, and the portal system, permits a free anastomosis of both arteries and veins of the two inflamed parts.
"c Or, as is most likely, from both; the former (a) having weakened or predisposed to the latter (b) or exciting cause.
"That pressure of some kind was exerted on this part of the rectum was evident from the symptoms, e.g., first, the retention of so much fluid faeces, and flatus in the colon; and, second, from the circumstance that enemata larger than a quart could not be taken by the rectum.
"The secondary or rectal inflammation accounts for some of the symptoms, e.g., 1st. For the pain in the left iliac region, which did not appear till a late stage of the disease, when it was superadded to the hypogastric pain; 2nd. The desire to evacuate manifested some hours before dissolution, at a period when the colon was evidently paralysed from over distension. The desire could therefore only be in the rectum, and allied to tenesmus, such as is common in dysentery where the rectum is involved; 3rd. The irritability of the lower gut, towards the close of the disease, when even small enemata were rejected."
Diseases of the Genito-Urinary Organs.- The ratio of cases of disease coming under this head was much below that of the previous year. With the exception of some cases brought from England, all the syphilitic disease was contracted at Sydney. One man was invalided for syphilis in its secondary form. He had been under treatment for what appears to have been a urethral chancre, which was however healed, and he had been a month at duty when he was reentered on the sick-list with general febrile symptoms; these terminated in a syphilitic eruption over the body and limbs, which ultimately extended to the face. He suffered much from pains in the head, became weak and cachectic, and at last quite unfit for further service.
Rheumatism.- One hundred and twenty-two cases of Rheumatism were under treatment in the squadron during the year, which is in the ratio of 105·1 per 1,000 of mean force, a great increase, as compared with the preceding year. Some of these had a syphilitic origin; but in many instances they were mild forms of lumbago, or more or less trifling articular pains. Two men were invalided for this disease, which in both cases had a syphilitic origin.
Wounds and Injuries.- There were fourteen deaths from wounds sustained in action. One man was crushed to death by falling under the revolving crank of the engine of a colonial steam gunboat; and one man sustained a fatal fracture of the skull by falling from aloft. A man was washed off the flying-jib-boom in a gale of wind, and drowned. A man died from the effects of an over-dose of opium, supposed to have been taken with a suicidal intention; and the cause of death in one instance has not been ascertained. There were thirty deaths altogether, which is in the ratio of 25·8 per 1,000 of mean force, being, although still very high, below the death rate of the preceding year. About two-thirds of the deaths, however, were the results of wounds and injuries of various kinds and of drowning, so that the ratio of mortality from disease alone was only 9·5 per 1,000.
Invalided.- One man was invalided for the sequelae of fever; two for epilepsy; three for phthisis; one for dysentery; one for disease of the kidneys; one for syphilis; two for rheumatism; two for diseases of the bones and joints; one for amaurosis; one for abscess; one for ulcer; three for dyspepsia and debility; one for worms; two for the effects of wounds; and two for hernia; making altogether twenty-four, being in the ratio of 20·6 per 1,000 of mean force, which is nearly one-third less than the invaliding rate of the previous year.
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