Health of the Navy - 1864
Health of the Navy - 1864
► Royal Navy
► Naval Surgeon
Cape of Good Hope and East Indies ◄► Table 5
Statistical Report of the Health of the Navy - 1864.
THE squadron on the China Station, in 1864, consisted of twenty-nine vessels, in which were comprised one line-of-battle ship of the second rate; one frigate of the fourth rate; one of the fifth; and six of the sixth rate; four sloops; eight gun-vessels; two steam-vessels; three gun-boats bearing medical officers; one surveying vessel; one troop-ship; and one receiving ship, permanently stationed at Hong Kong. There were likewise ten or eleven small gun-boats, without medical officers, and from which, consequently, only returns of invaliding and death were obtained. Besides the force employed in the ships, there was a battalion of marines serving on shore, in Japan. The total mean force corrected for time was 5,390, and this number is taken in computing the ratios of invaliding and death; but in computing the ratios of cases under treatment in the squadron, it is necessary to deduct the force employed in those gun-boats in which there were no medical officers, which will give a mean force for that purpose of 4,890. The total number of cases under treatment was 8,222, of which 283 were invalided, and 13 died. This makes the ratio of cases 1,681·3; of invaliding 52·5; and of mortality 24·3 per 1,000 of mean force, being a reduction in the ratio of cases, as compared with the preceding year of 577·3; of invaliding of 11·5; and of mortality of 7·4 per 1,000. Twenty of the vessels of the squadron were on the station during the whole year, and the remainder for periods varying from six to ten months.
The daily loss of service from febrile diseases was in the ratio of 3·8 per 1,000 of mean force; from diseases of the brain and nervous system, 0·2; of the organs of respiration, 5·1; of the heart and blood-vessels, 0·7; of the alimentary canal, 7·4; of the liver, 0·4; of the genito-urinary organs, 20·8; from rheumatism, 5·1; from diseases of the bones and joints, 0·3; of the special senses, 0·8; of the skin and cellular tissue, 14·8; from diseases not classed, 2·1; and from wounds and injuries of various kinds 8·6; making a total daily loss of service equal to about 393 men, or in the ratio of 72·8 per 1,000 of mean force, which is a reduction as compared with the preceding year, to the extent of 4·8 per 1,000.
.- During the twelve months 264 cases of continued or remittent fever, 155 of intermittent fever, 150 of smallpox, two of measles, and two of scarlatina, were under treatment in the squadron; and of these, six cases of primary fever, sixteen of small-pox, and one of scarlatina proved fatal. The average duration of each case of primary fever on board ship and in hospital was ten days, of ague between eight and nine days, of small-pox between twenty-four and twenty-five days, of measles between sixteen and seventeen days, and of scarlatina fifty days.
Continued and Remittent Fever
.- There were no cases of primary fever in the Adventure
, or Swallow
There was only one case of primary fever in the Algerine
, but it was of great severity, and proved fatal on the thirty-ninth day. The details furnished in connection with it are unfortunately of a very meagre character, but from what may be gathered from them, the fever appears to have been of the remittent type. It was characterised chiefly by great debility and drowsiness, and complicated for a time with very free epistaxis. At one time the patient improved so much that he was able to get out of his cot without assistance, and frequently, in violation of all orders, would go on the lower deck, where it is imagined he was guilty of some indiscretion in eating or drinking, for there was a sudden relapse of all his symptoms in a more aggravated form, great irritability of the stomach set in, he became weaker every day, was delirious at night, passed his evacuations involuntarily, and finally died.
In the Barrosa
there were eleven cases of primary fever. They were all, however, of an ephemeral nature, the average duration of each case on the sick-list being between four and five days. The vessel was employed in Japan during the whole year, and nearly all the time at anchor in the harbour of Yokohama.
There were two cases of primary fever in the Conqueror
, and of these one proved fatal, in the person of a seaman who had been invalided for chronic diarrhoea of long standing, and not being in a condition to leave with the other invalids had been detained on board. He had exposed himself incautiously to cold while perspiring profusely, and on the following day appeared restless and feverish, with flushed skin and suffused face, thirst, vomiting, and pains in the limbs. During the two following days these symptoms continued, increased, and assumed a low form. On the fourth day the face was swollen, there were sordes on the lips and gums, and the tongue was coated with a brownish fur; there was dryness and soreness of the mouth, rendering swallowing difficult, low muttering delirium, an extremely rapid and weak pulse, and an ill-formed eczematous eruption, as it is termed, about the face and lower extremities. He continued to sink during the following day, and died on the sixth day from the setting in of the febrile symptoms. As small-pox was prevailing very extensively on shore, and at this very time several cases had occurred in the Conqueror
, there appears to be little doubt that this was an ill-developed form of that disease.
In the Coquette
the cases of primary fever were of an ephemeral character, and with the exception of one case of the enteric type, the same may be said of those in the Cormorant
, the average duration of each case on the sick-list being abort four days. The single case in the Coromandel
was only two days on the sick-list, and although the average duration of each case in the Encounter
, was about ten days, they appear not to have been of any urgency, as no special reference is made to them.
There were forty-eight cases of primary fever in the Euryalus
, all of which are returned as of the ephemeral type. A large number of these cases, however, occurred at a time when small-pox prevailed very extensively on board, and there appears to be little doubt that they were mere modifications of that disease. The surgeon ( Surgeon David Lloyd Morgan) of the Euryalus
makes the following observations respecting these cases:-
"The majority of these cases (forty) were admitted during the outbreak of small-pox. I had every reason to believe, at the time, that they were caused by the poison of variola. The febrile symptoms which became manifested in them were precisely similar to those of the primary fever of small-pox, and strictly speaking they should be denominated variolous fever. In some of them the predominant symptoms, such as rigors, vomiting, and lumbar pains, were quite as distressing as in the pyrexia preceding the eruption in the confluent cases of small-pox. The average period of these symptoms was three or four days. It was particularly remarked that in some of the cases a florid-looking rash, resembling that of scarlet fever, appeared when the febrile symptoms had subsided. In one case a boy had been suffering severely from rigors, vomiting, great pain in the back, and extreme prostration, when on the fourth day a bright scarlet efflorescence appeared on the face, neck and forearms; immediate relief was the result, and he was discharged after having been four days only on the list. In another, an officer who had been suffering in a similar manner, immediate relief was experienced after the outbreak of a red rash on the back of the hands and on the wrists. No vesicles appeared in his case, and he only remained four days on the sick-list. In these cases the cicatrices of former vaccination were very well marked.
"There were five officers under treatment for these febrile symptoms, followed by the rash alluded to. It varied somewhat in character in two of them; for instance, one, after the febrile symptoms had subsided, was covered over the trunk with a rash closely resembling urticaria; whereas the other broke out in a rash very much like measles, clustered patches of minute papules, only that they were of a brighter red hue. I have myself on three separate occasions, observed these febrile symptoms during epidemics of small-pox, but I cannot recall to mind having observed before, cases of that description which were accompanied by a rash. Probably these are the cases which have been produced as the vaunted results of the use of the so-called specifics which have been so frequently cried up as preventives against the outbreak of the eruption in small-pox.
"The treatment adopted in these cases was simple enough. In fact it may be questioned whether they would not have done equally well without any treatment whatever. The alimentary canal having been previously cleared out by means of calomel and jalap, or calomel and the compound colcynth pill, the citrate of potash in a state of effervescence, sinapisms to the spine and epigastrium, and cooling diluent drinks, were used with advantage."
These cases were all treated on board ship, and the average duration of each on the sick-list was five days. The remarks made in connection with them are very interesting and suggest the advisability, during the prevalence of any eruptive fever on board ship, of dealing with all cases of febrile disease as modifications of the prevailing fever, obscure, it may be, and trivial in themselves, but possibly capable of being communicated to others, and of assuming more decided and virulent symptoms.
There was nothing of a noteworthy character in the cases of primary fever occurring in the Insolent
, or Manilla
. They were of the ephemeral type mostly, the average duration of each case being only from four to five days. In the Severn also, although each case was between ten and eleven days on the sick-list, this was not occasioned so much by the severity of the febrile symptoms as by the debility which followed upon them. The vessel was chiefly employed on the coast of Borneo, and the medical officer (Assistant Surgeon Alexander Murphy) says:-
"The fever of Labuan seldom proves fatal when treatment is commenced early, pyrexia leaving the patient on the fifth or sixth day from the onset of the disease; but the debility induced in that short time is remarkable, and may indeed be considered one of the most important features of the disease. A fever of a few days' duration will not unfrequently require months to restore the patient to his original health."
There were thirty-five cases of primary fever in the Marine Battalion; but little information is to be obtained from the returns from that force, in connection with these cases, further than that each case had an average duration of eleven days on the sick-list, and that many of them occurred at a time when dysentery prevailed in an epidemic and very virulent form in the battalion. Some of then were of an ephemeral character, but the majority were of the continued type. Six were cases of remittent fever.
In the Osprey
, in which there were twenty-one cases of primary fever, they are said to have been very mild, averaging little more than five days each in duration. In most of the cases the disease ensued after a debauch on shore, or after exposure in the sun.
The case of primary fever in the Pearl
and those in the Pelorus
were of a trivial nature.
There were ten cases of primary fever in the Perseus
, five of which were of an ephemeral, and five of the remittent type. Two of the latter proved fatal. In one of these the fever appears to have been of the enteric type. The man was entered on the sick-list with general febrile symptoms accompanied with diarrhoea. The latter symptom was not excessive, and was checked by means of opiates and astringents. He chiefly complained of pain in the head. He appeared, however, to be progressing favourably, when, about a fortnight after being placed on the list, he was attacked with severe pain in the hypogastrium, which rapidly became worse; there was great tenderness on pressure over the abdomen, the legs were drawn up, the breathing became hurried and purely thoracic, and rapidly the face and extremities became cold and clammy. The pulse was weak, hard, and rapid, and the general symptoms those of peritonitis, under which he sank on the third day from their invasion. On post-mortem examination of the body the peritoneum was found highly inflamed, and in the cavity of the abdomen a quantity of liquid faeces was found floating, having escaped through a perforation in the intestine. It is not stated in what portion of the intestine the perforation was situated. The other fatal case of fever that occurred in connection with this vessel was in the person of a warrant officer, who, after much exposure to the sun while refitting ship at Hong Kong, was admitted to the sick-list complaining of great debility and headache. The pulse was quick and weak the, tongue covered with a thick white fur, the skin very hot, the face flushed, and the eyes suffused. Under the treatment to which he was subjected, he improved steadily for the first five or six days, when he had an exacerbation of all his symptoms; he rapidly became very weak, the tongue was dry and brown, there was pungent heat of skin, insomnolency, and disinclination to speak, although be continued perfectly sensible. These symptoms becoming aggravated he was discharged to the hospital, where he died eighteen hours after admission. The Deputy Inspector General (Dr. George Mackay) of the Naval Hospital, in referring to this case, says:-
" . . . The symptoms were more probably wholly due to encephalitis induced by injudicious exposure to the sun, than to the endemic fever of Hong Kong. The patient was sent here eighteen hours before death, in an almost moribund condition. Much obscurity existed as to the nature of the case, but post-mortem examination of the body revealed distinct traces of inflammation in the membranes of the brain. I learnt afterwards that the patient greatly exerted himself in the refitting of his ship, in getting out a disabled foremast, and replacing and refitting a new one, and it was during the excitement of this work, and the passing to and fro in the naval yard, that he was taken ill. When admitted he was very delirious, and in a most prostrate condition; the skin was hot and dry, the pulse rapid, jerking, and feeble, and the tongue dry and covered with sordes. Wine and beef tea were frequently exhibited, but on the following morning coma supervened, and he died during the forenoon. The autopsy revealed congestion of the membranes of the brain, with effusion of milky serum."
The cases of remittent fever in the Perseus
occurred during the Christmas quarter of the year, at which time also this form of fever was prevailing in a virulent epidemic form amongst the troops on shore. The surgeon of the Perseus
(Surgeon J.S Adams) says, with reference to these cases:-
"They attacked us when lying in the harbour of Hong Kong. A great many of the 99th Regiment were also laid up with the same disease. They were quartered opposite the town, at Kowloon, at first in huts, and afterwards they were removed to tents, to be out of the way of the assigned cause. This was the excavation of docks just below their quarters, and the consequently fresh turned up earth or clay. Certainly, after they left the huts, they were much more healthy. The shipping was affected by the same cause, I presume, as I could not trace any other, and the weather was tolerably cool. The disease was very severe in its symptoms, there being severe headache, great restlessness, much anxiety of mind, a capricious state of the bowels, a very rapid, pulse, with a pungently hot skin, yellowness of the face and eyes, and the tongue deeply furred, and red at the tip. In fatal cases typhoid symptoms set in, and it much resembled, in many respects, the yellow remittent of the West Indies. Occasionally leeches were at first applied to the head, and afterwards iced water; aperients and diaphoretics followed, and sometimes a combination of calomel and quinine. In the worst stage, that of collapse, diffusible stimulants were administered."
The Deputy Inspector General of the Naval Hospital likewise remarks:-
"This fever may to a great extent be attributed to extensive excavations recently carried out at Kowloon, where mercantile settlements are about to be made. It has always been most prevalent when the wind was blowing from the Kowloon side, and I have been informed that the officers and men of the 99th Regiment, temporarily stationed there, have suffered very much in the same way and from the same causes. The attacks of fever did not generally last more than three days. They commenced with a feeling of cold, headache, and giddiness, which were soon followed by violent thirst, heat of skin, flushing of the face, redness and suffusion of the eyes, restlessness, and complete loss of appetite. In all those cases in which there was the slightest sore or wound, sloughing action set in, and lasted until the fever subsided; and many of the relapses in dysentery appeared to be induced by an accession of this fever."
There were three cases of primary fever in the Princess Charlotte
, all ephemeral.
There were seventeen cases of primary fever in the Racehorse
, of which one is returned as continued, two as remittent, and fourteen as ephemeral fever. The case of continued fever terminated fatally on the eleventh day. It occurred in the person of an officer who was under treatment for catarrh and sore throat, and almost convalescent, when he was suddenly seized with violent febrile symptoms, which on the following day assumed an exceedingly low form, and resisted every effort to overcome them. On the evening of the fifth day from the febrile accession he suddenly became comatose, and died on the following morning. The body appears not to have been examined, and the details of the case are of a very meagre description. The average duration of each case of remittent fever was twenty-seven days, and of each of the ephemeral cases about seven days. In consequence of the loss of this vessel, the medical records in connection with her are very defective.
There was nothing noteworthy in the cases of primary fever occurring in any of the other vessels of the squadron.
.- The ratio of cases of ague was only one-third of that of the previous year, and only one man was invalided on account of this fever. The Adventure
, the Ringdove
, and the Slaney
were the vessels in which there were the largest number of cases, but there was nothing of a noteworthy character in connection with them.
.- One hundred and fifty cases of small-pox were under treatment in the squadron during the year, of which one was invalided and sixteen proved fatal.
In the Adventure
there was one case of small-pox. It occurred in a boy, who showed good marks of previous vaccination. The disease was contracted at Yokohama, where it was extensively prevalent at the time, and where, according to the surgeon (Surgeon W.H. Adams) of the vessel:-
"The Japanese could be seen daily in the streets, just convalescing from small-pox, and mothers might be met in the streets of Yokohama nursing infants who were suffering from variola in a confluent form."
There were eleven cases of small-pox in the Argus
, two of which proved fatal. The disease first made its appearance when the vessel was at Shanghai, in the persons of two men who had been on shore on forty-eight hours' leave, and who had doubtless slept amongst the Chinese population, amongst whom it was prevalent at the time. These men were at once removed to a hospital on shore, and no other case occurred during the stay of the ship in that port. In march the Argus
proceeded to Yokohama, where several officers of the Euryalus
were in sick quarters on shore suffering from small-pox. An officer of the Argus
, although warned of the risk he ran, imprudently visited the sick quarters, and fourteen days afterwards was attacked with the usual symptoms of the disease. He was at once removed to the shore, where he died on the seventh day. His clothes and bedding were burned, and precautions were taken with regard to the cleanliness and clothing of his attendants before they were allowed to return on board. The surgeon (Surgeon T.B. Purchas) of the Argus
, with reference to this case, says:-
"The disease being very prevalent at this time amongst the Japanese at Yokohama, who were said to be losing from ten to twenty children a day, some vaccine lymph was procured from a civil practitioner, and the whole of the crew were re-vaccinated. Great care was taken in inserting the lymph, but the result was not satisfactory, but few cases presenting an approach to a perfectly formed vesicle. The vaccine employed in the East does not seem, even in children, to afford the protection that it should, most probably from no care having been taken to renew it from the cow. In June, after the ship's company had been granted general leave, two more cases occurred, and were removed immediately to the Euryalus
's sick quarters. One of these died on the ninth day; the other was a very mild case. The man who died bore good marks of vaccination in childhood, and had been re-vaccinated only a month previous to his being attacked. The punctures reddened as usual, on the third day appeared inclined to form good vesicles, and then suddenly died away. Directly he was attacked the cicatrices on the arm became curiously studded with small vesicles. In July an officer was attacked and sent to the Euryalus
's sick quarters. The officers being often on shore, and frequenting Japanese shops and other places, were of course in that way liable to contract the disease. No other case appeared till October, after the return of the ship from the attack on Simonosaki, when the crew were granted leave. In the case which occurred at this time the man was sent to the Military Hospital at Yokohama, and returned to the ship on the 29th of November. On the 10th of December the man who sat next him in his mess was attacked by the disease. I should mention that an officer of the 67th Regiment took passage in the ship from Yokohama to Nagasaki and that after being two days at sea he showed symptoms of small-pox and had a papular eruption. On the arrival of the ship at Nagasaki he was at once removed to the shore. From his case three others resulted; the drummer who acted as his servant, and two young officers of the ship, who would visit him in his quarters, although told not to do so. . . . I think these cases of small-pox tend to show that although its contagion is so sure and certain, the spread of the disease may always be prevented by taking proper precautions."
No reference is made as to previous vaccination in any of these cases, with the exception of the officer and man who died, in both of whom the vaccination cicatrices were well, marked.
There were thirteen cases of small-pox in the Barrosa
. The disease was contracted at Yokohama, and the majority of the cases were of a mild description. No information is given with reference to previous vaccination in any of them, and the same may be said of the single case that occurred in the Bouncer
There were five cases of small-pox in the Conqueror
, and of these one proved fatal.The history of these cases is thus given by the surgeon, (Surgeon D. Saunders) of the vessel:-
"Small-pox made its appearance on board, the first attack taking place in the person of a man who had been on board, and continuously under treatment for dysenteric diarrhoea for the previous eighty-seven days, and who upon no occasion had had any communication with the shore. The second person attacked was likewise under treatment at the time with sprained ankle, and this for the previous fourteen days, nor had he been ashore for some time previously; also the third man attacked had had no communication with the shore for the previous four weeks. The fourth case was in the person of an overgrown boy of seventeen years of age, who possessed little constitutional power, and whose disease promised to be a severe one; this boy had been on shore on leave, seven days previous to his attack. The fifth and last case was in the person of the sick berth attendant, who also had been on shore on leave about the same time as the boy; but I am still at a loss to account for the manner by which the infection was first brought on board, although it may be fair to surmise that the man who first contracted the disease had been rendered more susceptible by being at the time constitutionally impaired by previous long-continued and serious sickness, and it is possible that the infection was brought on board adhering to articles of curiosity purchased in the Japanese part of the town by his own messmates, and by them brought on board, and deposited in some part of the mess to which he belonged; this man had good marks of vaccination. He died on the tenth day of the disease."
Considering the free communication the ship's company held with the shore, where the disease was prevailing to such an extent, the surprise is not so much how the infection was first brought into the ship, as that it did not spread more extensively on board. With the exception of the man who died, no information is given as to whether any of those attacked had been previously vaccinated or not.
Little or no information is given with reference to the two cases of small-pox that occurred in the Coquette
. In one instance the disease appears to have been contracted at Hong Kong, and in the other at Shanghai, but no reference is made to previous vaccination.
There were two cases of small-pox in the Cormorant
, the disease having been contracted in Japan. The surgeon (Surgeon Richard Eustace) of the vessel says:
"We had two cases of small-pox, both of which were of the discrete kind, and occurred in men who had well-marked vaccination cicatrices. . . . The first was that of a petty officer, a special leave man and as he had been very frequently on shore previous to the attack, the exact period of incubation could not be ascertained. The second had been on shore once only, namely, on the 14th of December, and on the 28th of the same month he had an attack of rigors. Small-pox exists in Yokohama, and Japan generally, I believe, from year's end to year's end, but, curiously enough, it becomes more widely spread during the winter, or in cold weather. Whether such extension is attributable to the circumstance of the Japanese paying less attention to the bath during the colder months, or the fact of shutting in their dwellings, which in warmer weather are open; or again, to the necessity of wearing additional garments, which garments are never washed, and which being kept over from one cold season to another, may readily retain the pabulum of the disease; whether any or all of these may account for it, the fact, I believe, has long been noticed that small-pox in Japan becomes more prevalent in the colder months. We date its appearance in the squadron from the close of last January when Her Majesty's ship Vulcan
arrived here with the disease on board; and from the omission of all quarantine regulations at first, and their incompleteness afterwards, the disease was communicated to other ships, and has continued to prevail more or less amongst them till the present time, when it seems to have reached its acme in point of numbers. During this period I attempted re-vaccination on several occasions, but each time unsuccessfully, either from the immunity afforded by the previous vaccination, or the inferior quality of the vaccine lymph used. It is not easy to obtain vaccine lymph, and when obtained its quality is doubtful."
A single mild case of small-pox occurred on board the Coromandel
in the Christmas quarter of the year. The medical officer at that time in charge of the vessel does not say whether the person had been previously vaccinated or not. His predecessor (Assistant Surgeon F.V. Dickins, M.B., SC.B.) although having had no cases of the disease under his charge, makes the following interesting observations on small-pox as it appears amongst the Japanese:-
"During the period of this journal I have had no personal experienceof small-pox; but I have obtained a knowledge of the Japanese language, and have thereby been enabled to gain some information upon the disease as it exists amongst the natives.
"Small-pox (Hōōsōō) is endemic and extremely prevalent. It is very rare indeed to meet a man on whose face there are not some marks of the disease left. A very large proportion die, and a much larger proportion are horribly marked, as a very short walk through the town or country will convince the inquirer. It is so common that it is not considered a great disfigurement, and it seems to be almost as prevalent among the Yakunin even of the higher orders as among the lower classes. Inoculation is practised, but not so extensively as in China. Vaccination is known, but only used to a very limited extent. Japanese doctors are of two classes, one of which learns the Western system of diagnostication and therapeutics from Dutch books; the other adheres to the old system introduced by the Chinese. I prefer the latter class, for the knowledge of the former is purely book knowledge, unfounded on any acquaintance with anatomy, chemistry, or physiology, and they are eminently unpractical, and apt to make strange havoc in their misapplication of the maxims they get from Dutch books, most of which, by the bye, are of ancient date; while the latter are for the most part given to the exhibition of harmless herbs, powdered snakes, &c, which have little bad effect beyond sickening the stomach. The common people say that the danger of small-pox is over after the eighth day. No treatment is adopted beyond wrapping up the patient, placing him in a room from which all draughts and even ingress of air are carefully excluded, and forcing as many eggs down his throat, as his powers or will, will admit of. After the eighth day of the eruption, the man, if alive, is considered cured. Preventive measures against the spread of the disease are adopted, but the people appear to have no dread whatever of contagion except at a certain stage, namely, when the vesicles are markedly depressed. The disease frequently takes on with them a malignant appearance, and of the danger to be apprehended when the pustules do not maturate, or become dark in colour, they are fully aware. Scattered cases occur during the summer months, but it is in October that the disease assumes a more malignant appearance, and from that period to the return of warm weather it is lamentably prevalent. The Japanese say when ’Ka’ (mosquitoes) go out, Hōōsōō (variola) comes in, and vice versa.
"It very frequently attacks the eyes, and, when it does, blindness is almost an inevitable result. Almost every 'Amma,' or blind beggar, of whom I made inquiry as to the cause of his blindness, told me that it was the result of small-pox. The structure of the cornea becomes altered, generally the greater part is rendered quite opaque and somewhat prominent, but sometimes a depression exists, and even a somewhat puckered pit."
There were four cases of small-pox in the Encounter
, all of a mild character, and occurring in persons who had been protected by previous vaccination. The disease was contracted in a district in Hong Kong, where it was prevailing in a very malignant form, all those affected having admitted that they had spent some time, while on leave, in the infected locality.
Nearly one-half of all the cases of small-pox in the squadron occurred in the Euryalus
, in which vessel there were seventy-two cases altogether, six of which proved fatal, and one it was found necessary to invalid. The following interesting and detailed history of this epidemic is by the surgeon of the ship:-
"Nothing worthy of remark transpired in connection with the sanitary condition of the squadron until the 23rd of January, when a case of small-pox made its appearance on board H.M.S. Vulcan
, whish had arrived from Shanghai on the previous day, with a detachment of the 20th Regiment; about 200 rank and file.
"On the 2nd of February the disease appeared among the 20th, but it was difficult to say whether they bought it with them, or contracted it from the Japanese, among whom it then prevailed, since their disembarkation. On the 3rd of February the first case of the complaint appeared on board H.M.S. Euryalus
. An officer was found to be in a highly febrile condition, complaining of rigors and lumbar pain. On the following day confluent papules broke out on the head and neck, which left no doubt as to the nature of the disease. It was conjectured that, as he had not communicated with the Vulcan
, he must have caught the infection from the Japanese. Small-pox is a disease which appears to be equally as prevalent and endemic in Japan as it is in China, and apparently from the same cause, viz., the still common but pernicious practice of inoculation. That dangerous custom is practised among the Japanese even now to a lamentable extent, notwithstanding the existence for years of vaccination establishments under the able superintendence of Dutch medical practitioners, who have been highly instrumental in imparting a practical knowledge of the minor operations of surgery to the Japanese surgeons. The Japanese, who in winter wear a super-abundance of warm clothing, go abroad, the men at least, in summer, comparatively naked. During the latter season the bedding and warm clothing are closely packed and shut up in closets, where they are kept until again required when the cold weather sets in. It is not unlikely that these articles of apparel, &c., may be the means of keeping up a supply of, and preserving the virus of, the different kinds of exanthematous disease which are so commonly endemic in the more densely populated towns of Japan during the colder Station. months.
"Vaccination, however, is practised to a considerable extent at Yeddo, and the neighbouring districts, among the upper classes. At Yokohama I was shown an apparently healthy-looking child with several finely developed vesicles on the left arm, seven or eight days after vaccination, but as the father had been under my treatment some months previously for syphilitic iritis, I did not feel justified in availing myself of that favourable opportunity of procuring vaccine lymph . . . . . . . . . All those persons who had not well-marked (pitted) cicatrices of former vaccination were at once re-vaccinated with lymph procured by the Ganagawa Consul from a vaccine establishment at Yeddo. A healthy lad who recently joined the ship from the Coquette
, and who had no marks showing previous vaccination, was the first selected for the trial of the lymph. Well-developed vesicles appeared in their usual normal manner, from which sufficient lymph was procured as was required, to re-vaccinate the whole of the officers and the majority of the second-class boys in the ship. Notwithstanding that the lymph, as far as I could judge at the time, was good, several of the crew that had apparently been well vaccinated were subsequently attacked by the worst or confluent form of small-pox. I endeavoured to procure a milch cow for the purpose of inoculating her with the small-pox virus, with the view to obtain vaccine lymph pure and fresh, and not deteriorated by transmission from one human being to another, but unfortunately I was not successful. The Chaplain to the Legation at Yokohama kindly placed at my disposal a cow that had a short time previously been a milch cow, but her udder I found to be then dry. The assistant surgeon inoculated the animal in the udder and also in the vulva, but without any results arising therefrom. The epidemic did not last long, however, in the Euryalus
. The last case occurred on the 19th of April.
"There were seventy-two cases altogether of the disease; viz. thirteen officers (two lieutenants, one paymaster, six midshipmen, one assistant paymaster, two masters' assistants, and one boatswain); forty-seven seamen, four boys, two bandsmen, and six marines. There were seventeen confluent cases, of which six (one boatswain and five seamen) died, and one (a marine) was invalided. All had been vaccinated excepting the boatswain, who had not long belonged to the ship, and who had not presented himself for vaccination in accordance with the orders issued both to officers and men, shortly before the outbreak of the disease. As already stated, the first case which appeared in the ship was in the person of a lieutenant, who was taken ill with the primary fever on the 3rd of February; confluent papules appeared on the face on the following day. It was anticipated that no other case would have appeared, when, on the 16th of March, a boy who had been under treatment for an ulcer since the 3rd was taken suddenly ill with rigors, which were soon followed by vomiting, lumbar pain, praecordial oppression, and general prostration. In his case, which was one of discrete small-pox, the eruption appeared on the fourth day. Several officers and men were taken ill in a similar manner, on the evening of the same day, and in a few days the main deck of the ship was crowded with febrile cases, which, immediately on the appearance of papules, were conveyed to the sick quarters on shore.
"The presence of the variolous poison in the blood was manifested during the outbreak of the disease in the Euryalus
, by symptoms which tended to show to what degree the individuals attacked were susceptible to its influence, or, in other words, how far preponderating were the elements requisite for its development in their systems.
"The susceptibility appeared to be comparatively small in cases in which vaccination cicatrices were well marked and foveolated. In these cases the indications of the blood-poisoning were very modified; for example, on the greater number of them, as already stated, the primary fever of variola alone was present, which in several instances was followed by the bright red lobster-like rash referred to previously. Twenty of these cases, however, have been returned under the head of small-pox. In these, umbilicated or centrally depressed vesicles appeared, which instead of being fully matured into pustules, became shrivelled, dried up, and thrown off before the tenth day of the disease, leaving scarcely a vestige behind, excepting perhaps slight discoloration of the skin. The febrile symptoms were remarkably severe in these cases, and usually lasted for four days, and in two of them five days, before the appearance of the papules. The red efflorescence preceded the latter in several of the cases; and in two officers who were covered with patches of that peculiar scarlet rash on the trunk and the upper extremities, only one solitary vesicle, which was depressed in the centre and surrounded by a red areola, appeared, in one case on the face and in the other on the back. The umbilicated vesicle was the test which I adopted in these cases, and which enabled me to draw the line of demarcation between the febriculae and modified small-pox. I need not state that in these cases there was no tumefaction, nor was there secondary fever. The following may be adduced as an example of the cases complicated with the efflorescence, excepting, however, that the fauces were not implicated in any of the other cases. A seaman was admitted on the sick-list on the 20th of March, with heat of skin, rapid pulse, nausea, occasional vomiting, headache, and lumbar pain. These symptoms were ushered in by rigors on the previous evening. Purgatives and saline antimonial medicines were given, and sinapisms were applied to the spine. On the 22nd a rash resembling that of scarlatina appeared on the trunk and upper extremities; the papillae of the tongue were enlarged, prominent, and red (strawberry tongue); the tonsils were swollen, and the fauces generally were red and sore. Papules appeared on the trunk and upper extremities, which in a few days became vesicular. On the 29th the patient was convalescent; the vesicles, which soon became desiccated and thrown off, had disappeared without leaving a trace behind them.
With the exception of two men who were suffering from secondary syphilis at the time, well-pitted vaccination cicatrices existed in all these cases.
"There were thirty-five cases of the discrete, or distinct form of small-pox. All of these passed through the ordinary phases of the disease, viz., primary fever, papules, vesicles, and pustules, intumescence and secondary fever, and scabbing. In several of them the secondary fever, which did not assume an alarming type in any of them, was scarcely appreciable. Two of these cases had had small-pox before, and one of them had well-pitted marks of a former attack of the disease when he presented himself for treatment, and was suffering from the primary pyrexia. The average period of the primary fever in these cases was three days, and, as a rule, the papules first appeared on the face.
"In all these cases the vaccination marks were good, but not equal to the marks in the former cases, who were all of them well marked on both arms, whereas the majority of these were marked on one arm only.
"The confluent cases were, as already stated, seventeen, six of which died and one was invalided.
"In these cases there never was a remission of the febrile symptoms, which had a tendency to assume a low asthenic, and in the most severe of them a typhoid type, complicated in some with congestion of the brain, and in others with congestion of the lungs.
"The following is a brief summary of the cases that terminated fatally:-
"Case 1.- A native of New Zealand. Taken ill on the evening of the 19th of March. Vaccination cicatrices on both arms, but not foveolated. Primary fever complicated with bronchitis. Papules appeared on the 21st. On the 24th the febrile symptoms assumed a typhoid type; lips and teeth covered with sordes; sore throat and profuse salivation; eruption vesicular and confluent. Under the influence of the mistura Vini Gallici of the Pharmacopoeia there was an improvement in the character of the symptoms. On the 28th congestion of the lungs supervened, and the typhoid symptoms became more strongly marked than ever. He died on the 29th at 11 a.m. (The l0th day.)
"Case 2.- Taken ill on the evening of the 24th of March. Vaccination marks indistinct, notwithstanding that he had been vaccinated at Yokohama in this ship last summer, and again shortly before the attack. Papules appeared on the morning of the 28th. On the 29th there were confluent vesicles, which matured into pustules, burst, and scabbed off. On the 8th of April the febrile symptoms, which never had entirely left the patient, assumed a typhoid type, congestion of the lungs followed, and carried him off on the 11th at 1 p.m. (The 18th day.)
"Case 3.- Taken ill on the night of the 28th of March. No vaccination marks; vaccinated a few days previous to the attack. Minute papules seen on the morning of the 31st, on the head and neck, which were highly congested and of a dark livid hue. On the 1st of April the head and neck were covered with confluent vesicles. No subsidence of the febrile symptoms, which on the 2nd became typhoid. The eruption retained the dusky hue, and showed no tendency to maturation. The patient sank in a low typhoid state on the 7th, at 3.40. p.m. (The 10th day.)
"Case 4.- Taken ill on the 1st of April. No vaccination marks. Confluent papules, which were of a dusky hue, discovered by means of a lens on the head, neck, and upper extremities; on the morning of the 3rd typhoid symptoms set in with cerebral congestion; vesicles never arrived at maturation; low muttering delirium soon set in. The patient died in a state of coma on the 11th, at 5.40. a.m. (The 10th day.)
"Case 5.- Admitted on the 10th of April. Vaccinated shortly before the attack; no marks of any previous vaccination; papules on the 11th; confluent vesicles on the 12th; no remission of the febrile symptoms, which assumed a typhoid type on the 17th, accompanied by sore throat and profuse salivation. On the 19th there were symptoms of pulmonary congestion. Died on the, 21st, at 3.35. p.m. (The 11th day.)
"Case 6.- Admitted on the 10th of April. Vaccination marks indistinct; vaccinated last summer at Yokohama in the Euryalus
, and again shortly before the attack. Papules appeared on the 11th; confluent vesicles on the 13th: no tumefaction; pustules badly developed, flattened, and dusky; sore throat and profuse salivation. On the 17th there were alarming symptoms of laryngitis, accompanied by loss of voice and hurried breathing. Died of asphyxia on the 18th, at 8.20. p.m. (The 8th day.)
"The following is a concise summary of the case that was invalided:- Admitted on the 15th of April. Vaccination marks not good. On the 16th there were papules on the trunk and upper extremities; head and neck intensely congested, and throbbing of carotid and temporal arteries; conjunctivae injected. On the 17th confluent vesicles on the face, seen with the lens; occasional delirium and convulsions. On the following day the delirium became permanent, and finally terminated in coma. Under the influence of local depletion, counter-irritation, mercurial inunction, and enemata of brandy and beef tea, there was a return of consciousness on the 22nd, but there were left indications of lesion of the medulla oblongata, viz., defective articulation and difficulty of deglutition, for which he was invalided on the 12th of August.
In all the confluent cases the vaccination marks were ill-defined, and not good. The two cases of secondary syphilis already referred to were the only examples of men indistinctly marked who did not suffer from the confluent form of the disease. I am inclined to believe that the presence of the syphilitic virus in the blood has some modifying influence over that of small-pox, for I have seen cases of small-pox existing with secondary syphilis in unvaccinated Chinamen, all of which have been of the modified form.
.- In the primary fever, which in some cases was of a very severe type, the plan generally adopted was to reduce the temperature of the blood, by means of refrigerant remedial agents. The head was invariably shaved, excepting in the modified cases, which rarely required it. Sinapisms to the spine and epigastrium were found highly beneficial. After a purgative of calomel and jalap, or colocynth, the citrate of potash was given with benefit, in the form of an effervesing draught in the milder cases. Some cases required a mere antiphlogistic plan of treatment, such as saline aperient draughts, to which it was found necessary to add antimonial wine, when the fever, as it frequently was, became complicated with pulmonary congestion. The fever was sometimes remarkably severe in the modified cases; generally mild in the discrete cases; and in the confluent cases, without remitting, it usually assumed a low typhoid type, which required the liberal use of brandy together with ammonia. The tendency to congestion of the brain in some cases, and of the lungs in others, necessitated the employment of local remedial measures, with a view to relieve the distension of the vessels in those organs. When stimulants or liquid nourishment could not be administered by the mouth after setting-in of coma in these cases, frequent injections of brandy and beef tea were found invaluable. Sore throats were very much relieved by the application of a strong solution of nitrate of silver.
"Several means were tried with a view to prevent disfigurement. The most efficacious was the application of a strong solution of nitrate of silver (Argent. Nit. Эij., acid. nit. fort. m. ij., aquae destillat. Эij). In the discrete cases the vesicles were punctured with the point of a needle previously dipped in the solution. In the confluent cases that process was too tedious, consequently the vesicles were painted over with it. It was found necessary that the solution, to be effective, should be applied on the third or fourth day of the eruption, or before the cutis vera became disorganised by suppurative inflammatory action. The result of the application, when used in time, was to prevent a breach of surface of the skin, which was left comparatively smooth, and without the larger depressions, which are the result of a loss of dermal texture, but the minute pits, showing the subdivision of the original vesicles into cells, still remained.”
This very complete history of the outbreak in the Euryalus
is a valuable contribution to the epidemiology of small-pox. While it by no means unsettles a perfect faith in the protective influence of vaccination, it suggests the probability of the protection, in certain cases, being weakened in the course of time, and consequently the importance of establishing compulsory re-vaccination in the public services; it indicates the necessity for a careful regard to the quality of lymph employed in the operation, and it opens a question as to the character of the vaccination cicatrix that may be looked upon as affording the most satisfactory proof of the operation having been effectively performed. The idea that the co-existence of the secondary manifestations of syphilis exerts a modifying influence on the variolous poison is interesting, but upon this point further information is required.
There were eight cases of small-pox in the Leopard
, two of which proved fatal. Six of the cases occurred, in the Lady quarter of the year, at Nagasaki, and two in the Christmas quarter at Yokohama. In both fatal cases the eruption was confluent. One had not been vaccinated, the other had, it is stated, but no mention is made of the character of the cicatrix. With reference to the cases that occurred in the Lady quarter, the surgeon (Surgeon James Lilburne) says:-
"That this disease did not spread further in the ship, may be attributed to the precautions taken to prevent it. The ship's company was composed of young men, mostly under thirty years of age. All had been vaccinated with the exception of two, one of whom was attacked with the disease, and died; the other escaped. On the 30th of January I was fortunate enough to get some vaccine lymph, and with it I commenced vaccinating the ship's company, beginning with the boys. The operation was successful in about two-thirds of the younger members of the ship's company, and about a half of the older."
The beneficial effects of the operation were afterwards shown, he thinks, at Shanghai, where the vessel was stationed at a time when small-pox prevailed epidemically on shore, and where, although the men had abundance of leave, they escaped the disease altogether. Subsequently, however, he adds, "just before leaving Yokohama for Chefoo, two mild cases occurred, one in a man who had been vaccinated on joining the ship; in the other case, vaccination had not been performed since childhood."
There were eight cases of small-pox in the Marine Battalion, all of a modified type. The mild nature of the disease is attributed to the precautionary vaccination which the men had undergone at their several divisions.
In the Osprey
there were three cases of small-pox, all of which were contracted at Yokohama, two in the Midsummer and one in the Christmas quarter of the year. The two former cases were extremely mild, but the latter, which was placed on the sick-list on the 30th of December, assumed a very malignant appearance. There were good vaccination cicatrices in the two first cases, and in the last, the patient, an officer, who subsequently died of the disease, had also, it appears, been vaccinated, but the character of the cicatrix is not stated.
Twelve cases of small-pox occurred in the Pelorus
in the Christmas quarter of the year. As a rule the cases were of a modified character, the men having been vaccinated either in infancy or since entering the service.
A case of modified small-pox occurred in the Racehorse
, in the person of an officer who, it is said, had been successfully vaccinated three weeks previously. The symptoms in the early stage of the disease were those of variola, and the eruption in due course of time made its appearance, but it disappeared again without going on to suppuration.
There were four cases of small-pox in the Ringdove
, all modified by previous vaccination.
It will be perceived, by referring to Table 4, that a death from small-pox appears in connection with the Slaney
. The man was a supernumerary serving at the time on board the Vulcan
, from which vessel he was discharged to the Civil Hospital at Shanghai, on the disease becoming developed. He died there a few days afterwards. No mention is made as to whether he had been previously vaccinated or not.
There were single cases of small-pox in the Scylla
and in the Tartar
. In both instances there had been previous vaccination. In the case of the Tartar
, the person, a warrant officer, presented marks of successful primary vaccination on his arm. On the 1st of April he was re-vaccinated with virus taken from a healthy Japanese child, but the operation was unsuccessful. On the 20th of April he was seized with the premonitory symptoms of variola, and on the morning of the 23rd he was vaccinated again without effect. The surgeon (Dr. George Mason) of the vessel thinks that although the re-vaccination showed no external signs of being successful, it might perhaps have modified the disease, as, although the eruption was confluent on the face and chest and abundant on other parts, the general and constitutional symptoms were very mild during the whole progress of the case.
.- Two cases of this eruptive fever appear in the returns from the Rattler
, and one of them proved fatal. In the Statistical Report of the Health of the Navy for the previous year, notice is taken of six cases of the same disease occurring in this vessel in the month of December, and it is stated that no information was given respecting the outbreak, nor was any reference made to its being prevalent on shore at Nagasaki. In the present instance the two cases are supposed to be a continuation of that outbreak, and the Surgeon (Surgeon Edward M'Sorley), says, with reference to them:-
"The beginning of the year found two of the crew of Her Majesty's Ship Rattler
affected with scarlatina, the disease having been contracted at Nagasaki in the previous month, the ship being at anchor there for nearly seven months. I only heard of one case afloat on board a merchant ship anchored about 200 yards ahead of us, and that proved fatal in four days. From inquiries I made on shore, the disease was unknown among the foreigners of the place, but no doubt it was prevalent amongst the natives; and as leave was given every night, and free intercourse existed between the men and the natives, no doubt the disease was contracted in that way, although those affected, when questioned, denied having seen any one ill with that or small-pox in the houses they visited."
The assumption that scarlatina was prevalent amongst the natives at Nagasaki is not, however, justified by any evidence whatever, and the detailed histories of the cases in the Rattler
lead rather to the conclusion that they were examples of irregular action of the variolous poison, such as is recorded in some of the cases that occurred in the Euryalus
. The history of the fatal case in the present instance is as follows:
". . . . presented himself on the 1st of January 1864, complaining of headache, vomiting, and debility. Pulse 80; states that he felt himself unwell on the previous evening. Tongue clean and moist; there is some redness of the palate. 2nd January. Pulse 68 and full; headache severe; stomach very irritable. 3rd. Scarlatina rash very well developed over chest, abdomen, and lower extremities; eyes suffused; breathing quiet; abdomen tympanitic; severe pain across loins. Ordered a turpentine enema, which gave some relief, and sent to the Civil Hospital on shore at Yokohama. 4th. Pulse 72; passed a very restless night; had eight enemata without relieving the distension of the abdomen, which is very great; both eyes deeply diffused; a dark red eruption has appeared over the abdomen, interspersed with patches of a deep livid colour; tongue very dirty in centre and pale at edges; still complains of the pain across the loins; respiration hurried, and some blood in sputa. Ordered two drops of Croton oil immediately. eleven a.m. One very small motion; difficulty of breathing and bloody sputa increased; extensive congestion of both lungs posteriorly. One p.m. Some relief derived from cupping, but the pulse is very feeble, scarcely felt at the wrist; tympanitis continues; poultices continued, and Croton oil repeated. Two p.m. No alvine evacuation; breathing very hurried; pulse very weak, 72. He gradually sank and expired at 3.43 p.m., being perfectly sensible up to dissolution."
On the same day (the 1st of January) the second case was placed on the sick-list; the patient was a young officer who complained of headache, rigors and pains in the loins and limbs. The face was flushed, and there was a slight rash, the character of which is not stated, over the body. The pulse was 96, and the tongue white. He was at once removed to the Civil Hospital on shore, where the rash almost immediately began to disappear, and on the fifth day he was convalescent. With the exception of the eruption there was no symptom characteristic of scarlatina in any of the cases in this vessel, and as no reference to the existence of that form of fever amongst either natives or foreigners in Japan is made by any officer on the station, while there were numerous examples of irregularity and diversity in the character of eruptions which were unquestionably occasioned by the variolous poison, it may with some confidence be assumed that these so-called cases of scarlatina in the Rattler
were only ill-developed forms of small-pox.
.- A case of measles appeared in the Pearl
immediately after leaving Hong Kong for England. The eruption appears to have been well marked and characteristic, and was accompanied with lachrymation, coryza, catarrh, and all the other symptoms of this form of disease. The man was carefully isolated, and the disease did not spread. There was also a case of measles in the Tartar
, contracted at Yokohama, where, the surgeon says, it was prevalent among the natives on shore. The case is not detailed. It occurred in the person of an officer.
Diseases of the Brain and Nervous System
.- There was a considerable reduction in the ratio of cases coming under this head as compared with the preceding year, and the same may be said of the ratios of invaliding and of death. There was, in fact, only one death from this class of disease during the year, and it was the result of apoplexy induced by intoxication. The subject of it was a private in the Marine battalion serving in Japan, a man of habitually intemperate habits, who was taken to the guard-room at night in a state of intoxication, and died there suddenly on the following morning. On post-mortem examination of the body, it was found that there were no marks of external violence on the body, but his clothes in front, and the palms of the hands were covered with mud, as if he had fallen down helplessly drunk. The face was very livid. There was much congestion of the scalp, meninges, and brain, with serous effusion into the ventricles. The pericardium was diaphanous, but healthy, and the cardiac muscular tissue friable, and much attenuated, without any actual disease in the lining membrane or valves. The stomach was half filled with fluid exhaling a strong, alcoholic odour, in which pieces of boiled potato floated.
Diseases of the Organs of Respiration
.- There was a reduction in the ratio of cases coming under this head, equal to 44.6 per 1,000, and there was also a slight reduction in the ratio of invaliding. The death-rate, however, was increased, the increase being altogether referable to phthisical disease, which caused all the mortality, with the exception of a fatal case of bronchitis in the Marine battalion in Japan.
Diseases of the Heart and Blood-vessels
.- Under this head there was a reduction in the ratio of cases and of invaliding, as compared with the preceding year; but there was no mortality in 1863, while in the present year there were six deaths from organic disease of the heart, and two from aneurism.
A death from disease of the heart occurred in the Acorn at Shanghai, in the person of an officer attached to the gunboat Staunch. He was admitted on board the Acorn on the day of his death, and had successive fits of syncope, in the last of which he died. On post-mortem examination of the body, the heart was found to be enlarged, the walls of its cavities thin, and its texture flabby. The semilunar valves were very thin, and three of the tendinous cords of the mitral valve were observed to be ruptured at their base, or point of insertion into the valvular tissue.
A seaman of the Barrosa
died of disease of the heart, the fatal event being preceded for about thirty-six hours by febrile symptoms. He presented himself in the morning complaining of headache and general malaise; the pulse was accelerated, the tongue coated and creamy, and the bowels irregular. A purge, which acted well, appeared to relieve these symptoms. On the following morning, however, he seemed more uncomfortable; the skin was hot and dry, the pulse 84, weak, and the tongue dry and black. Antimonial diaphoretics, with farinaceous diet, were given him during the day with apparently beneficial effect, when at 7 a.m. he suddenly expired. On post-mortem examination of the body, the pericardium was found to contain about four ounces of serum; the heart was of the average size; the right ventricle was gorged with blood; the left was empty in this respect, but it contained a large atheromatous mass, which extended into the aorta.
Another seaman of this vessel, who had been invalided for disease of the heart, died on board the Centaur
on his passage to England. In this case the disease was complicated with phthisis. No post-mortem examination of the body was made.
A somewhat remarkable case of death, in which postmortem examination revealed disease of the heart, occurred in the person of a non-commissioned officer of the Marine battalion in Japan. The following is the report of the case by the surgeon (Dr. C.K. Ord) of the battalion:-
"He continued his active duties of canteen serjeant till 4 p.m. of the day of his death, when he presented himself with intense headache of twenty-four hours' duration, attributed to exposure to the sun, giddiness, heat of surface, and costive bowels. By 7 p.m. he was much worse, with a failing pulse. At nine, after passing most offensive involuntary stools, becoming insensible, with stertorous breathing, and expectorating a thick dark fluid, he departed this life. The rapidity of his case, and the uncharacteristic symptoms of any particular disease, caused a doubt as to his complaint until the autopsy, next day, showed fatty degeneration and enlargement of the heart, great flabbiness and softening of its muscular tissue, intense inflammation of its lining membrane, extending upwards into the great vessels, with correspondingly extensive pulmonary apoplexy. The brain was healthy."
The report of the assistant surgeon (Assistant Surgeon Angus Robertson) of the battalion is somewhat more minute. He says:-
" . . . presented himself about 2 p.m. with intense headache and vertigo, which he himself attributed to exposure to the sun. The pulse was quick and the tongue furred. When not addressed he was in the stooping posture, holding his head between his hands, and suffering such agony as to be indifferent to surrounding objects. One drachm of the spts. ammoniae aromaticus was administered, and the head kept cool. The symptoms, however, increased in severity, the pulse got smaller, and by 6 p.m. he was unconscious. At 4 p.m. the bowels were relieved by a castor oil enema. At 7 p.m. the pupils were insensible to light, froth surrounded the mouth and nostrils, and at 7 h. 30 m. he died. Post-mortem examination disclosed a fatty condition of the heart, which was large and flabby, and the walls of the ventricles thin. The membranes of the brain were congested, and there was slight effusion into the ventricles. The immediate cause of death was apparently exposure to the sun, acting on the nervous centres, and there reacting on a weak heart."
This is doubtless a correct view of the nature of the case. The man died from the effects of insolation.
A petty officer of the Rattler
died suddenly on board that vessel, at Shanghai. On examination of the body, the heart was found to be extensively hypertrophied, and there were warty excrescences, with atheromatous deposit in the aorta, immediately above the semilunar valves.
A seaman of the Coromandel
died of disease of the heart, in Hong Kong hospital.
A stoker of the Argus
died from the rupture of an aneurism of the aorta, in Haslar Hospital. He had been sent from his own vessel to the hospital at Hong Kong labouring under bronchitis, and invalided from thence as a case of disease of the heart. After death, the true nature of the disease was ascertained to be aneurism of the descending aorta. The aneurismal tumour was of an irregular shape, destitute of a proper investing sac, and had absorbed to a great extent the bodies of the first six dorsal vertebrae, leaving the intervertebral substance untouched. The tumour was gradually working its way posteriorly between the left scapula and the spine. The fourth rib was eaten through, and those immediately above and below were being absorbed.
A petty officer of the Conqueror
, who had generally enjoyed good health, although he had occasionally been under treatment for rheumatism, presented himself, stating that he had spat up a little blood. Immediately afterwards he brought up a little more, and complained of faintness. He was placed in the recumbent posture, breathed with constantly increasing difficulty for a few minutes, and expired. On examining the body after death, on opening the chest a small quantity of serum escaped. The right lung and the heart were observed to occupy their normal position, but the left lung was partly collapsed at its lower part, and the left pleural cavity contained fully three pints of blood. The lung itself was infiltrated at its lower part, and in a less degree at the posterior part of its upper lobe, where there was a small cavity. The right lung and the heart were healthy, but on following the course of the aorta, the sac of a small aneurism, about the size of a hen's egg was found at the commencement of its descending part, containing a clot, and presenting a rather large rent posteriorly. There was no erosion of the vertebrae or ribs and very slight attachments existed between the sac and surrounding parts, except the pleura pulmonalis, to which it was closely adherent.
Diseases of the Alimentary Canal
.- The salutary influence exerted on the squadron by employment in Japan, as compared with the coast of China, was remarked upon in the Statistical Report for 1863. The experience of another year in the same part of the station confirms the favourable impression then made, although in the present year a very extensive epidemic of dysentery occurred, under peculiar circumstances, in the Marine battalion immediately after its disembarkation, and subsequently the disease was communicated to the ship's company of the Conqueror
by men of that force sent on board for treatment. Despite these extensive and virulent epidemics, there is a reduction in the total ratios of the different diseases coming under the above head, as compared with the preceding year. In the ratio of cases, the reduction is equal to 111·2 per 1000 of mean force, in the invaliding rate to 5·8, and in the death-rate to 4·2. The epidemics referred to above increased the number of cases of dysentery to 409, while in 1863 it was only 141. The type of disease, however, in the present year seems to have been much less severe than in the previous one, to judge by the results; for while in 1863, with the comparatively small number of cases, seventy-six men were invalided and twenty-seven died; in 1864, with nearly three times the number of cases, only forty-eight were invalided and thirty-five died.
A stoker of the Argus
died in the hospital at Hong Kong from the effects of inflammation and ulceration of the stomach. He was a man of very dissipated habits, and having broken his leave when his ship went to sea in the month of January, was arrested and sent on board the Euryalus
, where he was attacked with profuse vomiting of blood after drinking a large quantity of raw spirits. On the return of the Argus
he was sent on board, and from thence to the Civil Hospital at Yokohama. While there he suffered from constant vomiting, and pain in the epigastrium, rapidly losing flesh and strength. He vomited blood only on two occasions, and then in but small quantities. Various plans of treatment and of administering food were attempted, but without affording much relief, and no doubt could be entertained that he was suffering from ulceration of the stomach. On the 12th of August he was invalided and forwarded to Hong Kong, and admitted into the hospital there on the 7th of October, where he died eight days after admission. While in hospital he rejected almost everything he swallowed, and could take nothing solid, from the pain it occasioned in the oesophagus and stomach. The post-mortem examination of the body revealed very extensive disorganization of the stomach. The report is to the following effect:-
"Body very much emaciated. On exposing the alimentary canal the stomach was found to be contracted to about the size and shape of an equal length of the duodenum. On laying it open, the greater part of the internal surface was found ulcerated, the ulcers being of a brownish black colour, with large semi-detached sloughs on some of them. The coats of the stomach were thickened from interstitial deposit, but there was no appearance of malignant disease. The contraction appeared to be caused by the healing of previous ulcers. The ulceration extended about three inches above into the oesophagus, but not below the pyloric orifice. The liver was small and hobnailed."
Diarrhoea and Dysentery
.- Four hundred and nine cases of dysentery and seven hundred and twenty-one of diarrhoea were under treatment during the year; and of these, forty-eight cases of dysentery and one of diarrhoea were invalided, and thirty-five of dysentery and one of diarrhoea had a fatal termination. The average duration of each case of dysentery on board ship and in hospital, was about seventeen days and a half; while in 1863, each case was of an average duration of six weeks. The treatment of each case of diarrhoea averaged about nine days.
In the Conqueror
there were fifty-two cases of dysentery and 149 of diarrhoea, and of these five cases of dysentery proved fatal. On the arrival of the Conqueror
on the station, conveying the battalion of marines, she made a stay of twenty-five days at Hong Kong before proceeding to Japan, and during this time, general leave having been given to the ship's company, there was a prevalence of an atonic form of diarrhoea, and this ceasing (to use the words of the surgeon of the vessel), "headaches, backaches, giddiness, and lassitude followed; also severe catarrhs and bronchial affections; and as the sanitary state of the ship up to that time was highly satisfactory, I am disposed to attribute these unfavourable changes to climatic influences operating on constitutions unacclimatised. After this (May), no serious or infectious disease occurred on board till some weeks subsequent to our arrival in Japan. On the 12th of July, twenty-nine cases of dysentery were received on board this ship from the camp of the Royal Marine Light Infantry battalion, where dysentery and diarrhoea prevailed to a great extent; and this disease, as it appeared here, was of a type intermediate between the acute disease of India and an atonic form, approaching probably in its main characteristics more the latter than the former. In a great number of the cases the whole nervous system seemed to be paralysed and rendered prostrate by the virulence of the poison causing the disease. At this time there were on board among the ship's company only a few cases of diarrhoea, some of which, in a slight degree, partook of a dysenteric nature. Eight days subsequent to the arrival on board of these cases, the first case of dysentery presented itself in one of the ship's company, and this in the person of the man who, at the time, was doing the duty of sick-berth attendant He was subsequently invalided. From this time forward till the end of August, dysentery and diarrhoea continued to prevail on board. No case of dysentery presented itself after the 7th of September, but sporadic cases of diarrhoea continued to appear up to the end of the month." The infectious nature of the disease is proved, he thinks, by the fact that dysentery did not make its appearance in the Conqueror
until after the arrival of the men of the Marine battalion.
Three hundred cases of dysentery and diarrhoea, the diseases being grouped together, appear in the returns from the Royal Marine Battalion in Japan, and of these, seven were invalided and sixteen terminated fatally. This alarming and fatal epidemic occurred between the 7th of June and the 26th of August, and the following special report upon it was furnished by the surgeon of the battalion:-
"Nothing could be more satisfactory than the health, spirits, and appearance of the men when disembarked on the 7th of June from the Conqueror
, after a passage from England of five months. Out of a force of 520, fifteen persons only, a proportion of less than three per cent., were inefficient from sickness. Seven of these, principally convalescents from an epidemic influenza, were left on board the ship at their own request until their health was re-established; the other eight marched behind their comrades to the height allotted by the Japanese authorities for our future encampment.
"I drew attention in last quarterly report to the prevalence of diarrhoea among both officers and men, on the passage from Hong Kong, and to its re-appearance in the camp among the latter only. Sporadic cases, which did not excite particular alarm, appeared from the date of disembarkation until the 24th of June. It then became evident that a serious change had taken place, inasmuch as the disease was inclined to assume an epidemic character, and a dangerous dysenteric type. After reaching its height during the ensuing three weeks, between the 25th of June and the 15th of July, it gradually declined.
|Table showing the Number of Attacks and Deaths at different periods
|7th June to 24th June
|25th June to 2nd July
|Week ending 9th July
|Ditto 16th July
|Ditto 23rd July
|Ditto 30th July
|31syt July to 26th August
|Total Re-admissions . . . 10
"The preceding Table shows that 171 separate individuals, ten of whom were re-admitted, suffered more or less severely during the period the battalion was encamped. Eighty-six persons, exactly one-half of all, were attached during the three weeks in question. But not only were the attacks more numerous, and the individual cases more severe, but all those cases which proved fatal commenced and terminated also during this short interval. No death occurred, either among seventeen persons admitted previously or sixty-eight subsequently. The weeks ending July 9th, 16th, and 23rd, furnished most admissions, which then decreased, until August yielded only eight weekly.
"The disease appears to have differed little from its congener in China, as regards symptoms, destruction of health, mortality, and morbid appearances. In less than three months it attacked every third man in the force, while the battalion in North China is stated, in the Report on the Health of the Navy for 1860, page 163, to have suffered to somewhat over every second person, during the twelve months. There was not much difference in the ratio of deaths to attacks, which amounted to 6.4 on the present, and seven per cent. on that occasion. If, in addition to two persons already invalided out of the twenty-nine sent for treatment to the Conqueror
, twenty-four from the camp, and four from that ship, all left in a critical state at Yokohama, on the departure of the squadron for Simonosaki, should, as very probably they will be, unfitted for further service on this station, the loss from invaliding will be greater, as eighteen is to thirteen.
◄Table scrolls horizontally►
|List of eleven Deaths
|Total Deaths in Camp . . . 7
|Total Deaths in Conqueror . . . 4
"Eleven deaths resulted, as per preceding list, between the 3rd of July and the 12th of August; none occurred before or since. They bore the ratio of 1 to 6.4 of attacks, and they number 2 per cent. of the whole force.
"There were some special circumstances bearing on impaired constitution connected with these deaths. No. 1 was reported, I fancy with truth, to have been intemperate for years. Nos. 2 and 11, when attacked with the disease were on the sick-list, the former for consumption, and the latter for abscess of the knee. No. 3, who was constantly under my observation for six months, with a peculiar flabby fissured tongue, and more lately for prolapsus ani, was, I think, predisposed to bowel complaint; he was ill only four days, the shortest period of any. No. 4 was highly strumous, and doubtfully temperate. Nos. 5, 9, and 10 had weak constitutions. No. 6 was always complaining, and oftener ill than well. Nos. 7 and 8 were strong and healthy.
"While one Plymouth Company did not lose a single man, the other in its immediate vicinity lost the greatest number, viz. four. Three out of these four deaths occurred, most inexplicably, in one particular tent. The second Woolwich Company lost the next greatest number. In the aggregate, the different divisions lost very nearly equal numbers. In one case death occurred within four days; in another the interval was prolonged to twenty-two. On an average the fatal result occurred on the eleventh day.
"The disastrous results of this epidemic may be summed up to the present time as amounting to eleven deaths and two invalidings. It remains to be seen how many more shattered constitutions may hereafter succumb, or require removal from the station. I may mention here, that there is every reason to think the disease was infectious; this opinion was also entertained by the surgeon of the Conqueror
. The ships in harbour, so far as I learnt, kept free of it, but some days after the patients of the battalion were received on board the Conqueror
, the crew of that vessel showed similar symptoms and furnished identical cases.
"The disease commenced as diarrhoea, bloody evacuations succeeded, and then symptoms of acute dysentery. There was hardly any real sthenic stage, the type being early and unmistakeably asthenic. It retrograded into diarrhoeal dysentery, which also was marked by debility, slow or little convalescence, and tendency to relapse. Death was generally prognosticated for some days by a peculiar sharpness of the countenance, early emaciation and absorption of all the superficial adipose tissue of the body, and by a characteristic cadaverous odour, as if decomposition were forestalling dissolution itself. Pure blood passed involuntarily; incoherence followed by insensibility; glassy eyes; jactitation, and sometimes continued yelling, foretold its near approach. Sometimes a complete cessation of pain bore to the unfortunate sufferer fallacious hopes of improvement.
"The principal symptoms during life were, dysenteric dejections, pain across the hypogastrium or in the track of the colon, tenesmus, and debility. These were accompanied by a quick, hurried, small, weak pulse, and a tongue little disordered. For a few days, evening exacerbations alternated with morning remissions. In the more severe instances that survived, the dejections continued more or less bloody, with debility, emaciation, and sometimes oedematous feet. The tongue became preternaturally clean, in some instances raw, but more frequently very pale, like the whole surface of the body, translucent, and diminished in size. Pain declined; the pulse ranged from forty-two to seventy-two per minute, continued weak and small, but each stroke was singularly distinct, and measured to a degree. This condition of the pulse was due, I think, to the large amount of opium which it was necessary to continue for weeks after the primary danger was past.
"The calls of the sick, the heat of the weather, the want of any apology even for a dead-house, and other hindering circumstances, permitted only a few post-mortem examinations. These showed the usual appearances of the disease. There was always intense and general inflammation of the great intestine and rectum; sometimes of the small intestine, and clotted patches reached upwards even to the stomach. Thickening, hardening, erosion, ulceration, and a peculiar green verdigris deposit lined the whole extent of the colon.
"The asthenic nature of the disease prohibited any but a stimulant treatment, or the employment of more depressing remedies than calomel combined with opium, to produce ptyalism, constant turpentine fomentations to the abdomen, and strict farinacous diet. Ptyalism was produced with difficulty in the worst cases. Abatement of the urgent symptoms then followed, but I cannot remember that it was induced in any fatal instance. After the urgent symptoms subsided it was still necessary to administer twelve grains of opium daily, in grain pills every two hours. If discontinued, even for a short time, the patients felt the want, and universally and immediately requested its resumption, which was found necessary. Quinine and other tonics seemed to produce more harm than good.
"The urgency of many cases, and the rapidity of those which proved fatal, did not permit any change to be made in that treatment which appeared beneficial, or allowed any new remedies to be tried. I nevertheless did, as particular cases presented themselves, substitute other medicines for calomel and opium. They were occasionally beneficial, but they could not be depended on in graver instances. Ipecacuan, in small doses of two grains, and in more heroic quantities of half a drachm to a drachm, produced no appreciable benefit, but caused considerable gastric irritation. The former was retained only when well guarded by opium, to which drug I am inclined to refer any good effects. Tenesmus, after the first stage, was relieved by an enema of one scruple of nitrate of silver in an ounce of water.
"The disease occurred under the following circumstances:- The site for our camp was allotted by the Japanese authorities, and we were not permitted any option or selection in the matter. It was immediately above and separated by a creek from the foreign settlement of Yokohama, which, though built in a swamp, is not considered unhealthy. It covered about three acres of ground, was irregularly quadrilateral, in close proximity to the sea everywhere except toward the south-west, raised about 200 feet above its level, and encircled by dense wood. The rich alluvial clay sloped gently, dried rapidly after being puddled by heavy rain, and soon hardened under rain and tramping. Two days only before the tents were pitched and occupied, and while soaked by several days' heavy rain, the crops were cut down to make room for our tents. They consisted of wheat, rape, and barley, top-dressed most lavishly with human manure, according to the native ideas of perfection in agriculture. It was in close proximity to fields and paddy swamps, also highly dressed in the same manner, and emitting most offensive odours. Smoke, equally offensive and deleterious, was constantly blown across the camp from a hut immediately below, wherein the Japanese custom of burning the dead body was constantly practised. I recommended the removal of this nuisance, and my application was forwarded to the Government at Yeddo, by the Minister Plenipotentiary. It was not removed when we left.
"Bell-tents brought from England were pitched in lines running east and west, at sufficient distances for streets and ventilation, with their openings to the prevailing southerly winds of summer. Although eleven men belonged to each, they contained on an average seven only at any one time. The men were off guard two out of three nights. Frequently they could not remain in the tents at night for the heat, and torment of mosquitoes, but spent the night in the open air, obtaining but little sleep until the morning. The vicissitudes of climate were extreme. The weather alternated between days of incessant heavy rain with squalls, and days of burning sun. During the latter, the thermometer in my tent, which was one of the coolest, averaged from 85° to 100°, approaching more frequently the higher number; during the rain it fell to 70°. Although some officers found the temperature, I believe correctly, 110°, and although I am not inclined to lay much stress upon the simple height of the thermometer as an exponent of personal discomfort, the heat, nevertheless, must have been very intolerable when there were two or more inmates in a tent. A steamy vapour rose from the exposed soil when strong sun succeeded heavy rain. I have served in countries notoriously damp and rainy, but I never saw such continued torrents of rain, nor did I ever know such dampness, whether this dampness be estimated by personal feeling or instrumental measurement. The wet and dry thermometers seldom differed 3° during the driest part of the finest day, while during rain the atmosphere was constantly charged with 90° per cent. or upwards, of humidity. On the clearest days, a peculiar faint homogeneous milky opacity overspread the otherwise blue and cloudless sky, and this milkiness tinged the sea below. I have meteorologized many parts of the world, but have never observed the like before. Excessive rain fell immediately before and after pitching our tents. Between. the 28th of May, the date of our arrival, and the 5th of August, although there were nine fewer rainy days than in 1863, an average year, ten inches more of rain fell.
"Other agencies, unconnected with soil or climate, were also in operation. They might have been annulled or mitigated, but the class of persons under consideration, if acquainted with their baneful results, are disinclined to remember them in the moment of temptation, and still more averse to practice self-denial. Intemperance ranks first: it was the main and almost the only crime the men committed after disembarkation. Much drunkenness prevailed; many men were brought up from town helplessly intoxicated; and any decrease of this degrading habit appeared to be due to the fright inspired by the epidemic. The cheapness of the native ’Saki,' and the unusually large amount of ready money in their possession, stimulated the inherent partiality of the men for ardent spirits. From various sources then available, each private, I am led to believe, had nearly two shillings a day clear, in addition to free rations. Opportunities too, unsurpassed in any country, were offered for unbridled licentiousness amongst the native women, and there can be little doubt as to their having been fully enjoyed. Though interdicted in the camp, they doubtless also indulged largely in the fruits of the season, principally of the peach and melon classes, notoriously indigestible in themselves, and moreover sold unripe to yield a quicker profit.
"The officers were completely exempt from the disease. Having appeared under the foregoing conditions, it is not surprising that exemption should accompany their abeyance. Besides their superior education and greater powers of self-restraint, the officers were placed in a condition far more favourable to the preservation of health. They occupied single tents, which they immediately boarded at their own expense. One of two young gentlemen who did not employ this precaution found it advisable to floor his tent after two days of bloody flux. This was the only case in an officer, and it was unimportant. They could resort at will to a smoking-hut in addition to a mess marquee, both of which afforded protection from the weather, and particularly from the heat of the sun. The United Service Club in town, and the houses of foreign residents which were open to their visits, afforded innocent amusement and wholesome recreation. From all these privileges the men were debarred, and sought an enjoyment in little else than the most pernicious vices.
"Immediately after disembarkation I recommended that all the tents in the camp should be floored without delay, at the public expense, and I stated my apprehensions of remaining encamped without this precaution. When the disease assumed a graver type, I pointed out the immunity enjoyed by the officers and those few others who had thus provided themselves privately. On the arrival of the head quarters of the 2nd battalion of the 20th Regiment, I suggested that application should be made for the larger cotton double-lined Indian tents, with which they were provided, and the officer commanding that corps supplied them to us. A large hospital marquee was also supplied at the same time, and flooring was purchased by order of the admiral. The comfort of the men was sensibly enhanced by this change. From these tents they went into wooden huts, erected on the same encampment, on the 17th of August, and remained there until re-embarked on the 26th. I have already noticed as hygienic measures, the recommendation of removing the hut for burning the dead, and the interdiction of fruit. On landing, flannel belts for the abdomen were made and worn by the men, on my recommendation.
"Little good could be expected while the conditions enumerated above continued in operation. After heavy rainy squalls, with thunder and lightning, the weather became decidedly cooler on the 21st of August, and improved daily. While hoping that this change and the substitution of huts for tents would conduce to exterminate the disease and promote recovery, we were suddenly ordered to embark in the Conqueror
for active service at Simonosaki.
"The appearance of acute dysentery, so far as I can discover, is a new phase in the medical history of Yokohama. Cases, indeed, are seen here, but always of the chronic variety, and invariably contracted originally in China or elsewhere, Japan being the resort of invalids from various portions of the Chinese and adjacent waters. The medical and lay residents with whom I conversed on the subject expressed their surprise at hearing of its eruption among the men of this battalion. The principal and most extensive practitioner amongst the European population was perfectly unacquainted with it during an experience of four years, and an intelligent and observant American practitioner, who attends the shipping and is most intimately acquainted with the diseases of the natives, from long residence, large practice among them, and knowledge of their language, informed me that, though subject to bowel complaints in summer, they were perfectly free from dysentery, and his experience among foreigners coincided with that of the other medical practitioner.
"The naval squadron, which had been several months in the harbour; detachments, first of the 67th Regiment, and then of the 2nd battalion of the 20th, quartered in the town, also for months; and all who have resided here for longer or shorter periods, or who had lately arrived, were equally exempt, and continued exempt, while we suffered so severely. As marked was the immunity of the head quarters of the 2nd battalion of the 20th Regiment, 600 strong, who arrived after us, and encamped at 500 yards distant. The same immunity prevailed in the detachment of the 67th Regiment, 100 in number, who arrived later than the 20th and encamped between them and us. There were at this time in all 1,700 troops in garrison, including the Marine battalion; but neither in my capacity of senior medical officer of the garrison, nor otherwise, did I hear of any man of the several corps comprising it, except ourselves, having suffered.
"Having stated the complete exemption of the residents, of the squadron, and of the troops, I think it will help to elucidate the causation of this disease by drawing a contrast between, the circumstances in which this battalion and the other corps were placed. It may be remarked, generally, that their condition was far superior to our own. The head quarters of the 20th did not disembark until their huts were ready for their reception, and they occupied them forthwith. Their ground, which previously had been strictly enclosed, and under grass, belonged to the British Consulate, and was given to them for encamping. The site certainly was not extensive, and the huts were closer than was consistent with free ventilation; but they were large, airy, and very lofty. From their construction they afforded extensive cubic space, were an efficient protection from the rain, and, more still, from the heat of the sun, and mechanically guarded their occupants against emanations from the subjacent soil. The men therefore enjoyed more coolness, greater protection, purer air, and better ventilation than those of this battalion, who were crowded together in small bell tents, and lying on the bare ground.
"It was often remarked how impervious these small thin tents were to torrents of rain; but although they afforded shelter from the rain while it was falling above, the ground all round them was flooded, water rushed down the declivity and found its way to their interior. Then commenced a steamy oppressive dampness which was increased by the heated bodies of more than an usual number of men who had no other shelter. On the other hand, while the sun shone strongly, with several heat-emitting bodies crowded together in a close confined space, the men, I consider, would have been less predisposed to contract disease had they been without covering and exposed to the full blaze of that luminary. They would then at least have enjoyed any currents of air which might be in motion; and, on this account, I frequently found the open sun more tolerable than my tent. The thin canvas was no protection from the surrounding heat; and if increments of heat, measured by the rise of the thermometer; be permitted to have any connection with the production of disease, the exposure of this instrument to the full blaze of a midday sun caused a very trifling rise after its removal from under canvas. I never observed a higher indication in the sun than 170°, and I have already stated that in my tent it was generally nearer 100° than 85°. Though it way be difficult to determine whether the excessive heat or the unusual damp experienced in tent life was more detrimental to health, there can be little doubt, I think, that their actual occurrence, and, what is more, their mutual succession, must have tended to predispose very much towards disease.
"The detachment of the 67th were seasoned men, who had endured long and rough service in China, but were provided with proper Indian tents and tressle-beds. On my recommendation, as senior medical officer in garrison, the tents were floored immediately. I held, with the officer commanding the detachment, that it would be far safer and more judicious to encamp forthwith on the rank grass than to remove it and overturn the soil. Like that given to the 20th, this ground was the property of the American Legation, by whom it was lent as a site for all the regimental hospitals, and had been enclosed and under grass.
"In considering all the circumstances attendant on this serious epidemic, the following conclusions, I think, are warranted. From the exemption which prevailed among the whole of the foreigners, in civil and other life, the country must be exonerated from the disease being considered endemic. It must be regarded rather as a local epidemic confined to this battalion, resulting from several conspiring causes. The provision of proper accommodation, by huts or otherwise, previous to disembarkation; the lapse of a longer interval between the removal of the crops and the occupation of the ground; the absence of such detrimental animal manures; and better protection from the heavy rains, and from the heat of the sun above, by thicker tents or huts, and from noxious exhalations and ground-miasma below, by flooring, would probably have mitigated the severity of the epidemic, while the prevalence of more propitious weather than that where the only alternations were confined to excessive damps and unusual heats, would have been highly beneficial."
As a sequel to the foregoing very interesting account of this epidemic, the following observations by the surgeon of the Euryalus
, on the same subject, are of considerable value:-
"Her Majesty's ship Conqueror
, with the battalion of marines, arrived at Yokohama on the 28th of May. Her crew, together with the marines, were reported on her arrival to be suffering very much from 'diarrhoea,' which was said to have been contracted at Hong Kong, where she remained some time refitting, in the month of April.
"On the 8th of June the battalion was disembarked, and encamped on a plateau-shaped hill, about 200 feet above the level of the sea, and on the south side of the settlement. That elevated jet of land is called the 'Bluff,' extending in a direction from west to east towards the bay, where it terminates in precipitous cliffs. Its surface, which is slightly undulating, is composed of a rich loamy soil, highly fertile, and producing a succession of cereal and green crops during the year. At that time buckwheat was the prevailing crop, which was ripe and being cut down by Japanese husbandmen with antique-looking sickles. The tents of the battalion were pitched in a stubble-field apparently healthily situated, for although there were paddy fields in the valleys below, to the north and south, the rising slopes which intervened were thickly covered with trees and dense brushwood, which would act as barriers against the ascent of the malarious poison generated in those marshy localities. Their tents were bell-tents, rather closely arranged, but every man had his waterproof sheet to put under him at night; the floors were also covered with matting. It was remarked soon after the landing, that the men of the battalion indulged to an alarming extent in the intoxicating drink of Japan, viz., saki, an alcoholic liquor extracted by a process of fermentation from rice, and similar in its properties to the notorious samshu of China, which was the predisposing cause of so much mortality among our troops at Canton during the recent campaign, and in Chusan and other places during the old war in that country.
"Dysentery of an asthenic type soon broke out in the battalion. It was conjectured at the time, that the exciting cause of the disease may have emanated from the ground on which they were encamped, but to that hypothesis there are several objections:
"1stly. Although the soil had been manured with human ordure when tilled, deleterious emanations from that source must have long before been expended in the growth of the cereal crop. No unpleasant odours could be detected when the tents were pitched.
"2ndly. The officers did not suffer from the complaint. It is true that most of them had wooden floorings to their tents, after a delay of several days, and at their own expense; but many of them did not incur that expense, and were not better off than the men in that respect, during the whole period of the prevalence of the disease.
"3rdly. The disease broke out afresh among the men after their return from Simonosaki, when comfortably housed in well ventilated wooden huts, which had been built for them during their absence.
"4thly. A detachment of the 67th Regiment, amounting to 260 in strength, were encamped in tents on the same soil, from July to December, without a single case of dysentery having occurred among them.
"5thly. The disease did not appear among the convalescents from small-pox who were hutted on the Bluff; in the immediate neighbourhood, and on the same soil, but at a time when the latter was highly offensive from recent manuring.
"I attributed the immunity of the 67th to acclimatisation, until I was informed by the surgeon of that regiment that there were many recruits among them who had only recently arrived on the station. The 20th Regiment was also hutted on the Bluff, but their quarters were situated on a plot of ground not cultivated, which had been conceded to the British Government by the Japanese, for the purpose of building a Legation on it.
"The dysenteric cases of the battalion, for want of hospital accommodation on shore, were conveyed on board the Conqueror
, and the disease soon manifested itself among the crew of that ship.
"What could have been the real exciting cause of the outbreak of a disease so uncommon in the neighbourhood of Yokohama? For there had been no instance of dysentery among the Japanese troops, who had been occupying guard-houses for several months, built upon the hilly ground, including the Bluff, surrounding the settlement, all of which is cultivated alike, and composed of the same soil. Extended experience in China of malarious diseases induces me to believe that malaria was the exciting cause of disease in this instance. The crew of the Conqueror
, and the marines, whose constitutional powers had been much reduced by confinement and salt provisions during a long and monotonous voyage, must have been highly susceptible, on the arrival of that ship at Hong Kong, to the influences of the malarious poison which was rife in the harbour at that time, and was supposed by the naval and military medical authorities to emanate from the excavations which were then being made for building purposes in the disintegrated granitic rock of Kowloon. Malarious diseases prevailed among the crews of the shipping in that harbour, and among the 99th Regiment, who were encamped at Kowloon. The seamen and marines on board the Conqueror
soon became afflicted with diarrhoea of a very intractable nature, from which they suffered after their arrival in Yokohama, and from what I can gather, in many of them ultimately terminated in the more formidable disease, dysentery.
"Asthenic dysentery in China, if I may be allowed to form an opinion from personal experience, is often very insidious in its course, and evinced by symptoms remarkable for their obscurity; it is invariably preceded by diarrhoea. The latter is a precursor of the former for days, sometimes weeks, and sometimes even for months. The malarious poison appears to lie dormant in the system until what are commonly called predisposing causes, such as riotous and intemperate living, fatigue, wet, exposure to the heat of the sun or to the night air, when the vital force has become depressed after a heavy debauch, superinduce inflammatory action in the mucous lining of the large intestines, and other complications. Indications of these lesions are frequently very indistinct and imperfectly marked, hence the reason that cases of dysentery have been sometimes returned as diarrhoea, even when they have terminated fatally, and a post-mortem examination might have revealed the true nature of the disease."
On a careful review of the whole circumstances connected with this disastrous epidemic, it would appear, that whatever influence may have been exerted by the circumstances under which the men were disembarked, and the soil on which they were encamped, the disease was unquestionably originally contracted at Hong Kong, and that acting with peculiar obstinacy on men whose vital stamina was reduced by the comparative privations of a five months' voyage, it was kindled into activity at Yokohama, and assumed its epidemic character by the unbridled dissipation and debauchery in which the men indulged, and by the exposure to which they subjected themselves during a period of unusual climatic vicissitude. That in some instances infection may have propagated the disease among the men on shore, as it certainly did among the crew of the Conqueror
, is not improbable, but it would not appear that its infectious character could have been very great, or could operate at any great distance, otherwise it must have spread to the other regiments in the immediate vicinity of the marine camp.
There were twenty-two cases of dysentery and thirty-three of diarrhoea in the Ringdove
. The majority of these occurred during the Michaelmas quarter of the year, when the vessel was on her passage to the Cape of Good Hope en route for England, during which time very heavy weather was rncountered, and the decks were continually wet, and from straining so very leaky, that it was impossible to keep the men dry. Each case of dysentery was nearly six weeks under treatment on board ship.
.- Ten cases of cholera occurred in the squadron, and of these seven terminated fatally. Three of these deaths, however, occurred in gunboats not bearing medical officers, and from which no return of cases that can be relied on have been obtained, so that there must at least have been thirteen cases altogether in the force.
There were two cases of choleraic diarrhoea in the Algerine
, at Shanghai, during the Christmas quarter of the year. Very little information is furnished in connection with them, and they do not appear to have been of much importance.
In the Leopard
, also at Shanghai, four cases of cholera occurred during the Midsummer quarter, one of which terminated fatally in the person of an officer who was on the sick-list, under treatment for another complaint, at the time he was attacked with this malignant disease. The attack proved fatal in twelve hours. Cholera was prevailing in Shanghai at the time, and the surgeon of this vessel, who looks upon a deficiency of ozone in the atmosphere as an exciting cause of the disease, says:-
"During the months of July and August, ozone exists in the atmosphere of Shanghai to so slight an extent as not to be detected by the usual tests; in fact, some believe it is entirely absent, excepting after heavy rain with thunder and lighting. It is also generally allowed that in unhealthy situations and during epidemics of cholera, there is a marked absence of this vitalized oxygen. Could not its absence be met by artificial means for its supply? This could not be done on a grand scale to a country, or even to a town, but I think it might be to a ship or an hospital during the prevalence of an epidemic. In Shanghai for the last three years the absence of ozone has been remarked, and during these years cholera has prevailed to a fearful extent, a remission of the attacks being marked after the heavy rains with thunder and lighting; I believe that previous to 1861, Shanghai was considered comparatively healthy, so far at least as regards cholera. The question naturally arises, does the absence of ozone, and the presence of cholera, bear the relation to each other of cause and effect. In this ship on the 30th of May I exposed phosphorus to ignition on the lower deck, before the hammocks were piped down, and also in the ward-room and steerage, and continued to do so daily, for a fortnight excepted, when we had rain with thunder and lighting, when I omitted it. Whether this had anything to do with the fact of few cases occurring and the mildness of the attacks, I am not prepared to say, but I think in future a trial might be made regarding this point."
There was a case of cholera in the Osprey
, at Shanghai, in the Michaelmas quarter, which made a good recovery after being nine days under treatment. It will be perceived, however, on referring to Table 4, that a death from this disease is entered as having occurred in connection with this vessel. This occurred in the person of an officer very subject to attacks of ague, and who, after unusual exposure to the heat of the sun, was attacked with fever which resulted in a condition indicative of disease of the brain. In this condition he was sent to the General Hospital at Shanghai, where his symptoms somewhat improved; ultimately he was invalided, and was just about to leave the hospital, when he was suddenly attacked with cholera, which carried him off in five hours.
There were two cases of cholera in the Perseus
, at Shanghai, in the Michaelmas quarter, both of which proved fatal. They were of an exceedingly virulent type, occurring in one case in the person of a seaman who, contrary to orders, had exposed himself much to the sun, and in the other in a habitual drunkard. The surgeon states that both in these cases, and in the general hospital on shore, the type of disease was very severe, the primary symptoms rarely declaring themselves before collapse primary symptoms on, after which there was no effort to rally.
A case entered as sporadic cholera appears in the returns from the Scylla
. It occurred in the person of an officer at Yokohama, and was the result of a hearty meal of curried prawns, partaken at a late dinner on the evening in which he was attacked. He made a good recovery.
Of the three fatal cases that occurred in the gunboats, two belonged to the Cockchafer, at Shanghai, in both cases death resulting from secondary fever; and the third was in a seaman of the Hardy, in whom the principal symptom was collapse of an extreme nature. The other characteristic symptoms, such as absence of the pulse at the wrists, cold limbs, suppression of urine, and occasional vomiting and purging, were also observed in this case.
Diseases of the Liver
.- Although the ratio of cases, and of invaliding under this head is not one-half of what occurred in 1863, the death-rate is precisely the same.
The were two deaths from abscess of the liver. One of these occurred in the person of a private in the Royal Marine Battalion in Japan. He presented himself, complaining of severe pain in the right hypochondrium and constipation, followed a week afterwards, and to the time of his death, by frequent incoherence, and gastric irritability. At the time of the presumed bursting of the abscess, he became collapsed, with pinched features and failing pulse, and he continued to sink until the following day, when he expired. The symptoms during life were very obscure, but the post-mortem examination of the body showed that a large chronic abscess of the liver, glueing the opposed surface of that organ to the transverse colon, had burst into the abdominal cavity. This man it appears had been invalided three years previously from a ship in China, and the surgeon of the battalion appears to consider that disease of the liver may have commenced then.
The other fatal case occurred in one of the gun-boats, but no details in connection with it have been received.
Diseases of the Genito-Urinary Organs
.- The continued employment of the squadron on the Japanese division of the station, although attended with very beneficial results as respects the more active and fatal forms of disease, had unfortunately the effect of increasing much the ratio of cases under the above head, more particularly these of syphilis. In 1863 the ratio of syphilitic cases was 132·2 per 1,000 of mean force; in the present year it yeas 177·7. The invaliding rate in 1863 occasioned by these cases was 5·5 per 1,000; in 1864 it was 8·7.
A fatal case of uraemic poisoning occurred in a bandsman of the Euryalus
. He was brought to the sick bay of the ship at the morning visit in a state of insensibility. One of his messmates stated that he appeared to have been taken suddenly ill about 2 a.m., his attention being drawn to loud moaning in the next hammock, which was occupied by the patient, whom he found, on further investigation, to be in a state of semi-insensibility, arising, as he thought, from drink, on which account he said nothing about it until the morning, when he found him getting worse. On examination, the pupils were acting sluggishly; the pulse was 100, jerking; there was a slight foaming at the corners of the mouth, restlessness accompanied by loud moaning, and convulsive twitchings of the levatores palpebrarum and orbiculares palpebrarum muscles. During the forenoon stertorous breathing came on, and the pupils became dilated and inert on the approach of light. The stertorous breathing was also accompanied with whiffing. On passing a catheter, in the early part of the evening, the bladder was found to be empty; three hours afterwards a few drops with a highly ammoniacal odour were brought away. The pupil was more sluggish, but slightly susceptible to light. At midnight the bladder contained about an ounce of urine, but at 11 a.m. of the following day it was empty. In the evening there was a marked improvement in his symptoms. The pupils acted more readily at the approach of light, and his attendant stated he had nodded and shaken his head when questioned as to his wishes in regard to drink, which he had once or twice swallowed with difficulty. Two ounces of urine, limpid and free from ammoniacal odour, were removed by catheter. During the night, however, he relapsed into a state of complete coma, and a strong ammoniacal odour was perceived in the breath and in the perspiration. The pulse became weak (140), but regular. He died on the following evening. On post-mortem examination of the body, nothing remarkable in connection with the membranes of the brain could be discovered. The brain-substance was found to be unusually firm and consistent. The ventricles were filled with a sero-sanguineous fluid, and about four ounces of a similar fluid were found in the sub-arachnoid space. There was effusion of serum also in the pleural and pericardial cavities. All the viscera were found healthy, excepting the kidneys, which were very much atrophied and degenerated by sego-cystic disease, apparently of long standing. The right kidney weighed one ounce and six drachms, and the left kidney two ounces and five drachms.
.- Eight hundred and sixty-nine cases of syphilis were under treatment altogether, and of these forty-seven were invalided. The total number of days' sickness on board ship and in hospital from these cases was 31,564, which gives an average duration of 36·3 days to each case. Eighty-six men were daily under treatment for syphilitic disease in the squadron, which is in the ratio of 16 per 1,000 of mean force, being double the ratio of any other class of disease or injury.
The ships that suffered most from this form of disease were the Argus
, the Rattler
, and the Tartar
. There was a large number of cases also in the Marine Battalion in Japan.
There were sixty-five cases of syphilis and thirty-one of gonorrhoea in the Argus
, all contracted in Japan. The surgeon of the vessel says:
"Syphilis has been as troublesome and as virulent this year as last. The large number of cases that have occurred swells the general sickness of the ship to a disproportionate extent. The crew have been examined weekly to detect the disease as soon as possible. In the treatment mercury has always been given when any induration of the sores existed; but, notwithstanding, severe secondary affections have followed in many cases, rendering it necessary to invalid them."
Many of the cases of rheumatism that occurred in this ship were also of syphilitic origin, and proved extremely obstinate and difficult to treat.
In the Barrosa
there were fifty-seven cases of syphilis and seventeen of gonorrhoea, all likewise contracted in Japan; but no information whatever is furnished by the medical officer in connection with them.
There were forty cases of syphilis and twelve of gonorrhoea in the Conqueror
, the surgeon of which vessel says:-
"With reference to syphilis contracted at this place (Japan) the climate appears in the most intense manner to favour, and bring into active life or development some one or other of the baneful secondary results of the poison, as in almost every instance of the disease that occurred on board here, either rheumatism or some form of characteristic cutaneous eruption followed; and it was this evil condition, combined with chronic dysentery, diarrhoea, and their sequelae, that necessitated the invaliding of so many men with the triple view of avoiding from the latter maladies serious visceral disease as a remote consequence of further detention in this climate, shortening loss of service, and sparing expense to the country. Syphilis being in Japan both prevalent and very virulent, a regular system of personal examination of all men who had been on shore on leave was established on board this ship, and although this was regularly and carefully practised, twenty-three cases of primary syphilis were contracted, the majority of which were followed by constitutional symptoms, though every precaution was taken to prevent both the extension of the primary disease, as well as subsequent contamination of the system. With this view iodide of potash and quinine were administered, after the disappearance of the primary disease under the influence of purgatives, saline draughts, cleanliness, low diet, and rest; but in spite of these precautions constitutional symptoms invariably followed. The treatment of this disease has been purely non-mercurial."
Whether the low diet and systematic non-mercurial treatment of the primary disease in this ship had any share in promoting the constitutional symptoms which so invariably followed in each case, may be open to doubt, inasmuch as in other vessels in which the mercurial treatment was adopted, secondary results likewise appeared in a large proportion of cases. Still it may be laid down as a sound axiom in medicine, that it is unphilosophical either dogmatically to adopt or reject any particular remedy in every case of any given disease.
The report (Report.- To the Right Honourable the Lords Commissioners of the Admiralty, and the Right Honourable the Secretary of State for War, p. xvi.) of the Committee recently appointed to inquire into the best mode of treatment of the venereal disease, in this country, with a view to diminish its injurious effects on the men of the army and navy, has the following remarks on the employment of mercury in this disease:-
"In the treatment of the indurated sore mercury is frequently resorted to, the object being to obtain the absorption of the indurated mass beneath it, on the belief that the induration constitutes the disease to be contended with.
"No treatment by mercury, whether moderately or freely administered for this purpose, can give exemption from the liability to constitutional disease. The service rendered by mercury is therefore limited to its influence on the sore and the induration.
"The weight of evidence on this subject preponderates in favour of the advantage of mercurial treatment in postponing or modifying the severity of the constitutional disease. On the other hand, it is contended by a minority of authorities, that mercurial treatment of the hard sore neither prolongs the interval of apparent health, nor modifies the severity of the future disease.
"The balance of these two opinions is rather favourable to the treatment of the primary hard sore by mercury."
And again, with reference to the treatment of the constitutional disease by mercury, the following conclusion of the Committee will be found at page xviii of the same report:
"The opinion of the Committee is unanimous in favour of mercury as the most efficient agent yet known in the treatment of constitutional syphilis.
"Mercury cannot be deemed a specific in the ordinary acceptation of that term, and does not appear to exercise any direct influence on the poison of syphilis, but on the effects of the poison only.
"Opinions are divided as to its power, when administered in the primary affection, to postpone or to mitigate the severity of the symptoms of true syphilis; if mercury possessed the powers of an antidote to the poison of syphilis, it might with reason be employed at any stage before the constitutional symptoms appear. The non-resort to it during the interval between the healing of the sore and the appearance of the constitutional symptoms proves that general opinion deems the action of mercury to be directed against the effects and not against the poison. It is generally admitted that treatment by the agency of mercury is not indispensable to recovery, and that in many cases the disease will die out spontaneously at a longer or shorter interval of time; and again, it is a fact well worthy of remark, that syphilis, in both primary and constitutional forms, may make its appearance in an individual whilst under salivation by mercury.
"Still the advocates of mercurial treatment greatly preponderate amongst the witnesses, and, we believe, in the profession at large; and among them are included many who have tested the value of non-mercurial treatment, and who have returned to the use of the mineral after an impartial investigation into the relative value of each mode of treatment. (See Observations on the Treatment of Syphilis, by Thomas Hose, in Medico-Chirurgical Transactions, vol. viii., and Evidence, Q. 4. 105.)"
The following very interesting observations on syphilis as it appeared on board the Euryalus
, in which ship there were 183 cases of the disease during the year, and six of gonorrhoea, are by the surgeon of the vessel. His observations refer to 201 cases, eighteen of which, however, were entered on the sick-list in the previous year:-
"There were 201 cases of this disease under treatment; 153 were discharged to duty, twenty-four sent to hospital, eleven invalided, and thirteen remaining.
"Of these cases there were eighty-three primary and 118 secondary cases. Many of the latter have been under treatment several times, consequently the number of cases in the return does not give a correct estimate of the number of cases treated. The primary cases which were not followed by a constitutional taint were comparatively few.
"The cases of primary syphilis admitted this year were much reduced in number as compared with last year, when there were 158 cases admitted on the sick-list. I attribute this decrease to the fact that the majority of the crew who were naturally susceptible to the complaint had been already tainted by it. Inspections twice a week, and the local application of the strong nitric acid to abraded surfaces and incipient sores may have had some influence in preventing the spread of the disease. The following were the different varieties of the primary form of the disease as it presented itself on board this ship.
"Independently of simple excoriations, and small circular sores with a greyish surface, and without induration, which never infected the system; there were:-
"1st. The bubo, which could be traced to originate neither from a urethral discharge nor from any kind of sore, and which was followed by the constitutional form of the disease.
"2ndly. There were one or two cases in which the constitutional form of the disease followed a simple urethral discharge.
"3rdly. There were cases of an indurated cicatrix which appeared on the site of a simple abrasion or an excoriated sore, which had healed without attracting the notice of the patient.
"4thly. There were cases of apparently simple sores on the corona, which, after healing without difficulty, would be followed by the exudation of plastic materials on the prepuce, or, as in one case, at the root of the penis, or in the groin itself.
"5thly. There were the true Hunterian sores, shaped like buttons, and with indurated bases. This variety was rare.
"6thly. There were the phagedenic chancres; viz.,a
The phagedenic - chancre without any sloughing; an eroding sore, eating away the glans as a rule. b
The phagedenic chancre, with the white sloughing surface, which was the most common. c
No case of a phagedenic chancre with a black slough was seen in this ship, although I have seen one or two cases at Yokohama.
7thly. The creeping chancre was also common. It usually appeared on the body of the penis in the form of pimples, which passed on to pustules, and then formed into small sores, which coalesced until, in some cases at least, the whole body of the penis, or the greater part of it, became a large sloughy-looking ulcer, which would soon assume a raw, glazed appearance, with a great tendency to spread.
"The secondary manifestations of the disease which came under my notice were the following:- Cutaneous eruptions, such as the erythematous, papular, and pustular. There was not a case of psoriasis, lepra, or rupia.
"There have been cases of phagedenic chancres under treatment, and followed by constitutional symptoms, which prove the fallacy of the doctrine that certain kinds of sores are followed by certain kinds of cutaneous eruption. For instance three phagedenic chancres with a white sloughy surface, have been followed by the erythematous, by the papular, and by the pustular eruptions respectively, but none of them have been followed by the squamous. But I found the rash and other symptoms of blood-poisoning much more intractable after the phagedenic chancre than any of them, except the creeping chancre, which also appeared deeply to infect the system. No rule, however, could be deduced from the cases that came under my notice in Japan, in regard to the nature of the eruption which would follow each variety of chancre respectively. The commonest form of eruption that appeared was the roseolar. The mucous membrane of the mouth was usually implicated at the same time. The papular eruption was also common; the pustular was seen less frequently. In some of these cases the eruption very much resembled the papular and vesicular stage of small-pox. Each crop was invariably ushered in by pyrexia. The joints in some of these cases became sub-acutely inflamed, and distended with fluid. The tissues which were next attacked were the fibrous, more especially in those parts of the body where the bones are near the surface of the shin, such as the great trocanther, the tuberosity of the tibia, the malleoli, the acromion process, and the olecranon. In these instances the ligaments were probably the tissues implicated, or rather the fibrous bands connected with them. The periosteum of the sub-cutaneous surfaces of the tibia and ulnae soon became involved, and in some cases, ultimately, the bones themselves became enlarged and thickened. Iritis was a common affection; in these cases sometimes both eyes were implicated. The cervical glands were also frequently enlarged. Pulmonary congestion was not an unusual complication in some of them. Hemicrania was also a frequent complaint. Syphilitic disease of the testicle followed in several of them; and, as already stated, two men tainted by syphilis were invalided with phthisis, one of whom died.
.- I have now come to the conclusion that this disease cannot be effectually treated without mercury. The remedy must be given judiciously, however. It must not be given if there be any febrile symptoms present, nor when there is any inflammatory action going on in the chancre. I find that by combining the iodide of potassium with Plummer's pill, or the bichloride of mercury, that the general health is not impaired by the drug as it usually is when liven alone. The latter preparations were generally given in the secondary form of the disease. The chancres, except the phagedenic (which were treated by opium in full doses) were treated with iodide of mercury in one-grain doses. I found the iodide of potassium, in scruple doses, and in some cases in half-drachm doses (in case of obstinate syphilitic rheumatism in which the fibrous tissues were involved), invaluable.
"In cases of indolent buboes I found local pressure, by means of a truss, very effective in causing their absorption. The pressure in these cases must be continued to be successful, as interrupted pressure has a tendency to cause hypertrophy."
There were forty-three cases of syphilis and eight of gonorrhoea in the Rattler
, all contracted in Japan. Mercury was employed in Some Cases, and others were treated without it, but under both circumstances secondary symptoms followed in nearly every case.
In the Tartar
there were sixty-six cases of syphilis and five of gonorrhoea. The surgeon remarks, in connection with these cases:-
"Syphilis shows a vast increase in numbers, as will be seen by the following comparison of the years that this ship has been in commission:-
"In 1861 there were 8 cases with 191 days sickness.
"In 1861 there were 9 cases with 299 days sickness.
"In 1861 there were 16 cases with 383 days sickness.
"In 1861 there were 66 cases with 1,643 days sickness.
"The great increase of that disease arises from our visit to Japan, where we arrived on the 17th of November 1863. The men were often on shore at Yokohama, where, as will be seen from the context, syphilis must be present among the Japanese population to a great extent. Application has been made to the authorities to have the diseased women removed from their licensed Government brothel, but without success, as Government derives a large revenue from the place. It has been proposed to place sentries round it, to prevent the men on leave getting into it. Some steps should be taken, as the men's constitutions suffer, and the service becomes crippled by the disease.
"In treating syphilis as met with in Japan, it is necessary in every case to give mercury. Five grains of blue pill, with a quarter of a grain of opium, given twice daily, seems to be as efficient as any other mercurial. The system must, however, be kept under its influence for some time; and if there is any hardness about the sore, or its cicatrix, it must be continued till it has all disappeared. Ten grains of chlorate of potash given internally three times daily, I have found useful in preventing salivation. Strong nitric acid should be applied to the sores in all cases."
There were eighty-six cases of syphilis, and nine of gonorrhoea in the Royal Marine Battalion. Very little information, however, is given in connection with them.
.- The ratio of cases of this disease was about precisely the same as in the previous year. There is a slight increase, however, in the invaliding rate; there was no mortality from this disease. As in the previous year, a large majority of the cases were of syphilitic origin.
.- There was one death from hernia. It occurred in the person of a seaman of the Euryalus
, who was admitted on the sick-list on the 10th of January with symptoms of obstruction of the bowels. He died on the 20th. After death it was discovered that there was an old omental hernia. The omentum was so altered in structure that it could not be recognised until the membrane was traced downwards to the inner abdominal ring, where it presented the appearance of a fibrous band intimately blended with the adjacent structure by old cellular adhesions. Behind that band was found a portion of the ileum incarcerated. A consultation was held during the progress of the case to decide as to the propriety of cutting down on the internal abdominal ring, and exploring, but as the local signs of hernia were entirely wanting, the majority decided against that procedure. The case was complicated by a large tubercular tumour in the left side of the scrotum, which had suppurated. The testicle, which was reduced to about the size of a marble, was discovered behind it.
Wounds and Injuries
.- Thirteen men were killed in action; one man fell down a hatchway, and died from rupture of the bladder; two men sustained fatal fracture of the skull by falling from aloft; and one man died from fracture of the skull, caused by a blow of the main-top-gallant mast.
Four men were drowned by falling overboard; two by falling out of boats; two were drowned when on leave, under what circumstances is not known; one was capsized in a shore boat, and drowned; and three men belonging to gun-boats were drowned, under what circumstances is not stated.
Two deaths occurred in the gun-boats, but no information is given in connection with them.
The total number of deaths from all causes was 131, of which ninety-nine were from disease, and thirty-two from wounds and injuries of various kinds, and drowning. The ratio of mortality was 24·3 per 1,000 of mean force, which is a reduction of 7·5 per 1,000, as compared with the previous year.
.- Two men were invalided for the sequels of fever; one for the sequelae of small-pox; sixteen for diseases of the brain and nervous system, chiefly epilepsy, paralysis, and inanity; thirty-nine for diseases of the respiratory organs, thirty-six of whole were phthisical; sixteen for diseases of the heart and blood-vessels; fifty-two for diseases of the alimentary canal, forty-eight of whom laboured under chronic dysentery; six for diseases of the liver; fifty-eight for diseases of the genito-urinary organs, of whom forty-seven were labouring under syphilitic disease; thirty-seven for rheumatism, mostly of syphilitic origin; one for gout; seven for diseases of the bones and joints; two for diseases of the special senses; five for scrofula, and five for abscess and ulcer; twelve for dyspepsia; two for dropsy; thirteen for the effects of wounds and injuries of various kinds; and nine for hernia. The total number invalided was 283, which is in the ratio of 52·5 per 1,000 of mean force, being a reduction of 11·5 per 1,000, as compared with the previous year.
Cape of Good Hope and East Indies ◄► Table 5