► Royal Navy ► Naval Surgeon Australia ◄► Table 5
Statistical Report of the Health of the Navy - 1864.
IRREGULAR FORCE - 1864
THERE were forty-two vessels in the Irregular Force in 1864, of which, two were iron-clad; one was a line-of-battle ship of the first rate; there were four line-of-battle ships of the second rate; one of the third rate; three frigates of the fourth rate; six of the sixth rate; seven sloops; five gun-vessels; one steam vessel; one stationary Coast Guard ship; four store ships; six troop ships; and one yacht. The mean force, corrected for time, was 4,840; and the total number of cases, of all kinds, placed on the sick-list during the period, was 7,867, which is in the ratio of 1,625·4 per 1,000 of mean force, being a reduction to the extent of 180·1 per 1,000, as compared with the preceding year. The returns from one fourth rate, one sixth rate, all the store-ships, and three of the troop-ships are for the whole twelve months; from the other vessels the periods vary from a few weeks to eleven months.The average number of men sick daily from febrile diseases was between seventeen and eighteen, or in the ratio of 3·3 per 1,000 of mean force. The daily sick rate from diseases of the brain and nervous system, was 0·8; from diseases of the respiratory organs, 7·0; of the heart and blood-vessels, 1·6; of the alimentary canal, 1·8; of the liver, 0·5; of the genito-urinary organs, 18·9, almost altogether from venereal diseases; from rheumatism, 5·3; from diseases of the special senses, 0·8; of the skin and cellular tissue, 15·7; from dyspepsia and debility, 2·0; from dropsy, 0·1; from wounds and injuries of various kinds, 9·1; and from hernia, 0·1. The average number of men daily sick, from all causes, was 263·6, which is in the ratio of 54·4 per 1,000 of mean force, being 18·7 per 1,000 below that of the previous year.
Fevers.- There were 261 cases of primary fever; ten of yellow fever; thirty-two of ague; forty of small-pox; three of measles; and six of scarlatina, under treatment during the year; and of these, four of primary fever, one of yellow fever, and three of small-pox, proved fatal.
The average duration of each case of primary fever, on board ship and in hospital, was between thirteen and fourteen days; of ague, eleven days; of small-pox, fifty-three days; of measles, thirty-seven days; and of scarlatina, fifty-four days.
Continued and Remittent Fever.- The vessels that presented the largest numbers of cases of these fevers, were the Clio, Fawn, Fox, Galatea, Gladiator, and Vulcan; but in one only of these, - viz., the Galatea, did a fatal case occur. There was a fatal case in the Assurance, one in the Bombay, and one in the Racoon.
The fatal case in the Assurance, in which vessel there were altogether only four cases of primary fever, occurred in the person of a petty officer, a man of a debilitated constitution, and prematurely aged. He was placed on the sick-list while the ship was at Aberdeen, with febrile symptoms of an asthenic character. He was discharged to sick quarters on shore, where he died on the twenty-fifth day of the disease. What was the precise type of the fever is not stated.
In the Bombay, in which there were five cases of primary fever, one proved fatal at sea. The person, a seaman, was placed on the sick-list five days after the ship left England, stating that for the three previous days he had suffered from prostration, loss of appetite, and disturbed sleep; at the time of presenting himself he chiefly complained of palpitation of the heart, headache, and rigors. There was some heat of skin. He was at once placed in bed, where, during the first four days, the febrile symptoms steadily increased; there was great heat of skin, thirst, and the pulse ranged from 110 to 120. There was no eruption on the skin, nor was there any abdominal tenderness at any time, nor diarrhoea. About the seventh day the tongue became brown and parched in the centre, and the patient became stupid and oppressed, but could easily he roused to take nourishment and stimulants. These symptoms continued to increase; on the fourteenth day, the tongue was dry, and the teeth were covered with sordes; he was now roused with more difficulty, and passed his urine and evacuations in bed; clonic spasms affected the limbs at times, and a bed sore made its appearance on the lower region of the spine. From this condition the downward progress was very steady, and on the seventeenth day of the disease he died. On the morning of his death the thermometer, in the axilla, stood at 105°; and during the course of the disease, the heat of the body, taken twice daily, ranged from 100° to 105°. No post-mortem examination of the body appears to have been made.
There were twenty-two cases of primary fever in the Clio. Nineteen of these were of an ephemeral character, and three of a typhoid type. In the only example which is given of the latter form of fever, there were no abdominal symptoms, nor any eruption. The patient, however, was reduced to a very low condition, with muttering delirium, subsultus tendinum, and picking at the bed-clothes. He made a good recovery, however. The average duration of each case of ephemeral fever in this vessel was between three and four days, while each typhoid case was on an average forty days on the sick-list.
All the cases of primary fever in the Fawn, and in the Fox were of an ephemeral character.
There were twenty-nine cases of primary fever in the Galatea, of which four are said to have been of a continued type, with an average duration on the sick-list to each case of twelve days; two were of the remittent type, each case averaging twenty-one days treatment; and twenty-three were ephemeral in character, with an average duration of between five and six days. One case of continued fever proved fatal; it was complicated with pneumonia, and on post-mortem examination much effusion into the ventricles of the brain was found. The man died comatose.
There were seventeen cases of primary fever in the Gladiator. One is said to have been of a continued, and the remainder of the remittent type. The latter cases were chiefly referable to service on the West Coast of Africa, and in alluding to them the surgeon (Surgeon W.J. Eames) makes the following observations:-
“Quinine has been issued daily during the time the ship was lying either in the Gambia, or Sierra Leone rivers, and for fourteen days after our departure. The prophylactic properties of quinine admit now, I imagine, of no doubt. I frequently have had evidences of it coming under my own notice on this coast, and in the present instance I may say we enjoyed an almost perfect immunity from endemic fevers, a very few cases only having been under treatment, and those of a mild form. I may remark here upon a very peculiar feature connected with this disease, which, if properly investigated, might perhaps throw some light on the action of that mysterious agency, malaria.
"Ships employed on river service for periods of from one to six weeks, or two months, have remained healthy during the time they were so employed, but immediately on their return to the open sea, endemic fever has made its appearance. This is a fact known to all on the coast, and has happened so often, as to preclude the possibility of its being attributable to mere chance. The first time it was brought under my own notice was in 1860, when the Bloodhound ascended the Niger, and remained for sixteen days. During that time she was in the most unhealthy part of the river, the Delta, yet there was little or no sickness. A week after her return from the river, remittent fever appeared, and with only two exceptions, went through the whole ship’s company. The following year the Espoir was detailed for the same service; she was a much longer time in the river; exactly the same thing occurred to an officer and some men, after she was to all appearances removed from the influence of malaria. This year the Investigator has just returned suffering from a similar epidemic, and upwards of half the complement, which was lent her from the Rattlesnake, are now on their way home in this ship invalided, and I have been told that during her stay in the river, she was particularly healthy, having had only one or two cases of fever on board. In the case of the Bloodhound, quinine was given for fourteen days after her departure, but whether it was persevered in or not in the other vessels I am not prepared to say."
There were ninety-three cases of primary fever in the Vulcan. One of these was of the remittent type, and was forty-six days under treatment; the remainder are said to have been ephemeral, although the average duration of each case was over ten days. Sixty-one of these cases occurred during the Midsummer quarter of the year when the vessel was leaving the coast of China for England. They are said in some instances to have been intermitting, and in others remitting in character, but in all the symptoms were very mild.
In the Racoon in which there were five cases of primary fever, three were continued and two ephemeral. Two of the continued cases were well marked examples of enteric fever, and one of them proved fatal. The disease was contracted at Gibraltar.
Yellow Fever.- During the Michaelmas quarter of the year, when yellow fever was devastating the Island of Bermuda, it was deemed advisable to remove to Halifax as many of the troops, and seamen and marines connected with the dockyard there, as had as yet escaped the epidemic, and on this service the Galatea was on two occasions employed. On both occasions, after leaving the island, yellow fever made its appearance among the passengers, and spread in a few cases from them to the crew of the ship. Ten cases in all occurred amongst the ship's company of the Galatea, and they were of an exceedingly mild character as a rule, no mortality resulting from them. Among the passengers, however, ten of whom were attacked with the fever, it assumed a very fatal form, no fewer than seven having died after being landed at Halifax. These men were for the most part borne on the books of the Terror, and their deaths are included with the others that occurred in connection with that vessel, on the North American and West Indian Station.
One death from yellow fever appears in Table IV., in connection with the Galatea. This occurred in the person of the surgeon (Surgeon J.B. Rickards) of the ship, who, on the death of the deputy inspector general of the naval hospital at Bermuda, having volunteered his services at the hospital during the prevalence of the epidemic, was placed in temporary medical charge of that establishment. He was not long permitted, however, to continue to discharge the responsible and harassing duties to which he had most anxiously and earnestly devoted himself. Within ten days after being landed he was himself stricken down with the disease, which assumed a very virulent form, and, running a rapid course, proved fatal.
Small-pox.- Forty cases of small-pox were under treatment during the year, and, with the exception of the Bombay, into which ship the disease seems to have been imported from Woolwich, and the Vulcan, in which it was contracted at Shanghai, all the vessels refer their cases to exposure at Portsmouth, where the disease prevailed during the whole year. Three cases proved fatal; one in the Orontes, one in the Racoon, and one in the Vulcan; but in none of these is any mention made as to whether the men had been previously vaccinated or not.
Measles and Scarlatina.- Three cases of measles occurred in the Bombay; one of scarlatina in the Espoir, one in the Gladiator, and four in the Trafalgar. In the Bombay, measles appears to have been contracted at Portsmouth. In the Espoir, the case of scarlatina appeared in the person of an officer, shortly after the vessel leaving England. The port at which she fitted out was Plymouth, so that probably the disease was contracted there. In the Gladiator, also, the disease appears to be referable to Plymouth; in the Trafalgar it was contracted at Malta.
Diseases of the Brain and Nervous System.- There is a reduction in the ratio of cases coming under this head, as compared with the preceding year; but both the invaliding and death-rates are higher.
Inflammation of the brain proved fatal to a stoker of the Achilles, who had for some years been subject to a purulent discharge from the right ear. He was placed on the sick-list complaining of headache and general muscular pains. The pain in the head increased, and three days after his entry on the sick-list he became delirious. The pulse was eighty, full; the skin hot and moist. Two days afterwards, when being conveyed to the hospital, comatose symptoms suddenly supervened; first one pupil and then the other became dilated, and he expired. On post-mortem examination of the body the vessels of the pia mater were found congested, and the arachnoid was slightly opalescent on the right side. The dura mater over the petrous portion of the temporal bone on the right side, and just behind the internal auditory meatus, was much thickened, and the bone itself roughened. The posterior cornu of the right lateral ventricle contained some pus, and the brain in its vicinity was softened; but there was no injection of the vessels.
A petty officer of the Bacchante died of general paralysis, the result of inflammation of the spinal cord. He was placed on the sick-list, complaining of pains situated in the muscles of the back, and extending round the thorax. He stated that he had first felt them after coming round Cape Horn, and he attributed them to cold caught then, during stormy weather. The pains became slowly worse, particularly on doing any work, or moving the body so as to bring the muscles into action. On examining him with care the lungs were found to be free from disease; the tongue was clean, the pulse full and regular, the face florid, and general aspect healthy; the bowels were confined, and not easily acted upon. This latter symptom and the muscular pains being the only indications of disease, the case was considered one of muscular rheumatism. Very little change took place in his symptoms for a month after he came under treatment, excepting that the pain on motion appeared to become more severe; but at the end of that time a slight loss of muscular power was observed, and symptoms of spinal irritation became more evident. This was on the 1st of July. On the 7th urine was passed involuntarily in bed, and it was necessary to empty the bladder by means of the catheter. On the 8th, the report by the surgeon (Surgeon Charles Sproule) of the vessel is:-
"Paralysis increasing; general symptoms worse; voided urine and faeces during the night, involuntarily. Loss of power extending from the lower limbs to the arms and muscles of the chest. Sensation of the surface very much diminished. Urine drawn off three times a day." In the evening the stomach became irritable for the first time, and there was slight headache, with intolerance of noise. From this time his condition became steadily worse, and he died on the morning of the 10th, of general paralysis, his intellect and reasoning powers continuing clear and unimpaired to within four hours of his death. The following is the report of the post-mortem examination of the body:-
"Body, muscular and well-proportioned. An incision was made from the neck to the lumbar region, and the muscles sufficiently removed to allow of the arches of the vertebrae being sawn through, and the posterior section of the spinal column removed, exposing the spinal cord to a considerable extent. On cutting through the cord between the dorsal and lumbar regions, about two ounces of serum escaped from within the membrane; and on taking out a section of the cord extending from the cervical to the lower dorsal region, the lower portion presented a healthy appearance, but the upper portion, extending from the sixth cervical to the fourth dorsal vertebra, had a softened and irregular feel when the finger was passed over it. On opening the outer membrane the serous covering was found to be opaque, and presented evident traces of inflammation; the blood-vessels of the cord were turgid and tortuous, presenting a very congested appearance; for about three inches the cord was very much softened, and in two places disintegrated, and presenting; the consistence of thick yellow cream, breaking up or melting as it were between the fingers. Owing to there being no cerebral symptoms present up to the last day or two of life, it was not deemed necessary to open the head."
Only one case of delirium tremens occurred in this force during the year. The subject of it was an officer, and it proved fatal.
Diseases of the Organs of Respiration.- There is a very considerable decrease in the ratio of cases coming under this head as compared with. the preceding year, but the ratio of invaliding is very nearly the same; the death-rate is below that of 1863. Eight men were invalided and three died from inflammatory diseases of these organs, and twenty-four were invalided and four died of phthisis.
Diseases of the Heart and Blood-vessels.- There is a great increase, both in the ratio of cases and of invaliding under this head as compared with the preceding year; the death-rate is, however, the same. There was, in fact, only one death, and that from aneurism of the thoracic aorta. It occurred in the person of a petty officer of the Galatea, and, as so often happens in this formidable disease, was obscured by the symptoms of bronchitis to which it gave rise. He was sent to sick quarters at Halifax, where the more urgent bronchitic symptoms disappeared, although a very troublesome cough with some expectoration remained. He also complained of occasional attacks of dyspnoea of an asthmatic character. The voice was wheezing and croaking, suggesting pressure on the trachea, but no tumour was detected. About three weeks after his admission to sick quarters the expectoration, which had been mucous, became streaked with blood, and the attacks of dyspnoea were more constant and distressing, preventing the patient lying down in bed; there was also a sense of constriction about the upper part of the chest. Three days after this he rose from bed, dressed himself, and was walking across the ward, when he suddenly fell forward on his face and instantly died. On examination of the body the pericardium was found full of partly coagulated blood. In the upper part of the ascending portion of the arch of the aorta a large aneurismal tumour was found, which had burst into the pericardium.
It is stated that the ordinary stethoscopic signs of aneurism were not marked in this case. No bruit was heard, nor was anything abnormal discovered in the sounds of the heart beyond their being muffled in character. The cardiac dulness was, however, increased in area.
Diseases of the Alimentary Canal.- There is a considerable decrease in the ratio of cases under this head, as compared with the previous year; both the invaliding and death-rates are, however, higher.
An officer died in Melville Hospital from the effect of profuse haemorrhage, apparently from the stomach, for unfortunately the friends would not consent to a post-mortem examination of the body. He was admitted into hospital suffering from cachexia, apparently of a syphilitic nature; there was much debility and nervousness, and he complained of ill-defined pain in the limbs; his appetite was defective, and he suffered much from nausea; but the gastric symptoms were not, at any time, very prominent. From the violent nature of the haemorrhage it appears probable that ulceration had opened a large vessel in the stomach.
A seaman of the Defence died from sub-acute peritonitis in sick quarters at Portland. The case was a highly interesting one, from the doubt that arises as to whether the peritonitis was not occasioned by the passage of pus from an inguinal abscess into the abdominal cavity. The condensed history of the case is as follows: he was placed on the sick-list on the 14th of February, complaining of pain in the left groin, and the upper and inner part of the thigh; there was slight enlargement of the inguinal glands. These symptoms appear to have been considered attributable to an irritable condition of the glans penis, arising from the accumulation of sebaceous matter, and the treatment was consequently directed to removing this condition. The inflammation soon subsided, but on the 28th of the month the patient began to complain more and more of deep-seated pain in the upper and inner part of the thigh, and, on comparing the limb with that of the opposite side, there was evidently a fulness of the parts, and pressure occasioned pain. On the 5th of March there was very perceptible bulging of the skin, and the health began to suffer, as indicated by febrile symptoms and gastric derangement. On the 7th of March complaint was made, not only of uneasiness in the swelling situated in the thigh, but also of abdominal pain and diarrhoea; no throb, pulsation, or fluctuation could be felt in the tumour, and there was no pain along the spinal column. On that evening it is reported that he had derived some relief from the application of sinapisms over the abdomen, but that the abdominal pain had returned with equal severity; the pulse was quick, exceedingly small and weak; the skin cold, and the tongue still coated and dry. On the afternoon of the following day he was sent to sick quarters at Portland; there his symptoms steadily increased in severity; there was pain and tenderness in the right iliac region; he lay with the legs drawn up; the abdomen was tympanitic; the pulse 120; there was much vomiting. On the 10th he had passed a good night, and the vomiting had ceased; a small tumour was perceptible four inches below Poupart's ligament. The tympanitis was distressing. On the 18th three ounces of pus were evacuated by the lancet, and the leg was strapped to prevent the re-accumulation of pus. On the 23rd, the discharge from the abscess was very moderate, but he complained of great pain at the inner side of the knee and along the whole length of the leg; there was also some fulness about the hip. On the 4th of April there were night-sweats. On the 9th, about two ounces of pus escaped from the umbilicus; he had felt no pain there previously. It is said that there did not appear to be any communication between that abscess and the one in the thigh, nor with the cavity of the abdomen. On the 12th all discharge from the umbilicus had ceased; there was a little discharge from the thigh; the leg was oedematous. On the 21st some ounces of unhealthy pus were discharged by lancet from an abscess behind the great trochanter; after this he gradually got weaker, but he had no nausea nor abdominal pain. On the 3rd of May there was delirium in the evening, and on the 6th he expired. Unfortunately the post-mortem examination of the body is not minutely detailed; it showed, however, that there had been extensive peritonitis; the bands of lymph contained blood-vessels; the intestines were matted together; pus was found in the cavity of the abdomen, and a communication was found to exist between the abscess of the thigh and the abdominal cavity. The lesions were so extensive, it is stated, that it appeared surprising that life should have lasted so long. No diseased bone could be discovered. The surgeon (Surgeon C.F.A. Courtney) of the Defence, in remarking on this case, says:-
"The case was somewhat obscure and difficult to diagnose. I considered it to be a case of psoas abscess, and thought that a communication existed between the swelling on the thigh and the abdomen. No sign of disease of the vertebral column existed during life, nor was there any discovered after death. The general testimony of the man, and that of his messmates in the ship, was to the effect that he had never been well since he overstrained himself at gunnery exercise about a month before he applied for medical advice."
Diseases of the Genito-Urinary Organs.- There is a trifling reduction in the total ratio of cases of all kinds of disease coming under this head, but happily there is a considerable reduction in the ratio of cases of syphilis. The ratio of syphilitic cases in 1863 was 143·2 per 1,000 of mean force; in the present year it was 127·6. The ships that had the largest number of cases of venereal disease were the Achilles, Bombay, Duncan, Galatea, Himalaya, Princess Royal, and Urgent.
In the Achilles there were forty-three cases of syphilis, and eleven of gonorrhoea. The surgeon (Surgeon G.F.A. Drew) says:-
“The syphilitic diseases were contracted chiefly at Chatham and Plymouth. Forty-three cases appear under this head, thirty-five of which were cases of primary syphilis contracted whilst serving on board the Achilles, the remaining eight cases were of a secondary character. In seven of these the primary disease was contracted before joining the ship, and one, a case of rupia, followed a Hunterian chancre contracted at Chatham. The secondary forms of the disease were, three cases of sore-throat (one man appearing twice), both joined with the disease, and for which they had previously been in hospital. Two cases of rupia; one joined with the secondary disease existing, the other followed a primary sore on board. One case of lichen, one of lepra, one of iritis, all of whom had the primary sore before joining. The cases of chancre that presented an indurated base were treated with blue pill to ptyalism, the others with the iodide of potassium. One case of rupia, as well as the cases of condylomata, yielded readily as soon as the gums were slightly touched. The other cases were treated with iodide of potassium."
Of the other vessels named above, venereal disease was contracted in the Bombay and Princess Royal at Plymouth, and in the remainder at Portsmouth.
Wounds and Injuries.- A man was killed by a topmast fid falling from aloft, fracturing his ribs and lacerating the lungs, and one man sustained such severe injuries by falling into the hold as proved fatal. There were five deaths from fracture of the skull; three of these were occasioned by falling from aloft; one by falling from the main deck into the hold; and one by falling into a dry dock.
Six deaths occurred by drowning. In five instances the men fell overboard accidentally, and in the sixth the man was washed off the jib-boom in a gale of wind. A man was poisoned by drinking solution of chloride of zinc in mistake for some other fluid.
The total number of deaths from all causes was forty, which is in the ratio of 8·2 per 1,000 of mean force, being a slight increase as compared with the previous year. Twenty-six deaths occurred from disease, and fourteen from wounds and injuries of various kinds, and drowning. The death-rate from disease alone was only 5·4 per 1,000.
Invalided.- Seventeen persons were invalided for diseases of the brain and nervous system; thirty-two for diseases of the respiratory organs, twenty-four of these being phthisical; twenty-two for diseases of the heart and blood-vessels; seven for affections of the alimentary canal; sixteen for diseases of the genito-urinary organs; eleven for rheumatism; three for diseases of the bones and joints; seven for diseases of the special senses; nine for diseases of the skin and cellular tissue; four for dyspepsia; one for headache; twelve for wounds and injuries of various kinds, and nine for hernia, making a total of 150, being in the ratio of 30·9 per 1,000 of mean force. The invaliding rate of this force in 1863 was 27·2 per 1,000.
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