► Royal Navy ► Naval Surgeon Mediterranean Station ◄► Table 5
Statistical Report of the Health of the Navy - 1864.
NORTH AMERICA AND WEST INDIES STATION
THE squadron on this station in 1864 comprised thirty vessels, viz.: two second rates; four fourth rates; three sixth rates; thirteen sloops; six gun vessels; one receiving ship; and one floating battery. The mean force corrected for time was 6,040, and the total number of cases of disease and injury under treatment, was 9,082, which is in the ratio of 1,503·6 per 1,000 of force, being nearly 10 per 1,000 below the ratio of cases in the preceding year. The time, included in the returns from the different vessels, varies from between three and four months to a year, about two-thirds of them being for the whole year. Of the ships employed in the ordinary duties of the squadron, those which showed the smallest sick-rates were the Steady, the Liverpool, the Duncan, and the Phaeton, while the highest sick-rates were in the Virago, Plover, Rinaldo, and Pylades. During the greater part of the year the Virago was stationed in the Gulf of Mexico, and while there the ship's company were visited by fever in an epidemic form. It prevailed very extensively, and was attributed by the surgeon of the ship to atmospheric causes. There was nothing of any importance in the returns from the Plover. The Pylades was chiefly employed amongst the West Indian Islands, where the diseases of greatest numerical importance were fevers of a remittent and ephemeral type, diarrhoea, rheumatism, and boils; and the same may be said of the Rinaldo which was similarly stationed.About twenty-nine men, or in the ratio of 4·7 per 1,000 of mean force, were daily under treatment for febrile disease. This is greater by one-half than the ratio of the preceding year. The daily loss of service from eruptive fevers was in the ratio of 0·5 per 1,000; of diseases of the brain and nervous system 0·1; of the organs of respiration 3·6; of the heart and blood-vessels 0·5; of the alimentary canal 2·3; of the liver 0·1; of the genito-urinary organs 7·6, all of which was attributable to venereal disease; rheumatism and diseases of the bones and joints 3·5; the special senses 0.4; of the skin and cellular tissue 15·3, of which 13·6 was attributable to boils, abscesses, and ulcers; dyspepsia and debility, 1·1, and wounds and injuries of various kinds 9·2. The total number daily sick from all forms of disease and injury was 311·8, which is in the ratio of 51·6 per 1,000 of mean force, being an increase, as compared with the previous year, of 6·2.
NORTH AMERICAN AND WEST INDIES STATION
Fevers.- Including the exanthemata, 1,078 cases of fever were under treatment in the squadron, during the twelve months. Of these 821 are returned as continued and remittent fever; seventy as yellow fever; 128 as intermittent fever; fifty-six were cases of small-pox; one of measles and two of scarlatina; four cases of continued and remittent fever, thirty-nine of yellow fever, and four of smallpox terminated fatally.
Continued and Remittent Fever.- The vessels that suffered most from these fevers were the Barracouta, Duncan, Immortalite, Liverpool, Medea, Peterel, Phaeton, Shannon, and Virago.
There were forty-two cases of primary fever in the Barracouta, and the duration. of each case on the sick-list averaged a little over ten days. The surgeon (Surgeon Geo. Newton) of the ship says with reference to this form of fever:-
“It principally attacked ordinary seamen; the petty officers and able seamen rarely suffered. It generally commenced after any unusual exposure to the sun in those whose constitutions were debilitated by copious perspiration, disturbed rest and other causes common in the hot humid climate of the West Indies, and who after passing a restless night rose in the morning unrefreshed, tired and languid, low-spirited, morose, and incapable of directing attention to any subject. At this stage a saline purgative often stopped the further progress of the affection without rendering it necessary to place the person on the sick-list. Frequently, however, it proceeded to headache with pains in the back and limbs and general debility. In some the first symptom was a rigor of short duration, followed by feelings of nausea and languor, loss of appetite, headache, hot, dry, and harsh skin, foul tongue, and abdominal pains. The treatment consisted in the administration of purgatives and saline diaphoretics, and occasionally during convalescence it was necessary to have recourse to tonics."
With the exception of two cases, all the febrile attacks occurred in the Midsummer and Michaelmas quarters of the year, when the vessel was employed in the West Indies.
There were sixty-six cases of primary fever in the Duncan, sixty-two of which were of an ephemeral character; and sixty of these occurred in the Midsummer quarter of the year, when the vessel was cruizing amongst the West Indian Islands. The duration of each case of ephemeral fever on the sick-list was about five days; that of each of the other four cases which are returned as being of the remittent type, was twenty-eight days. No special remarks are made with reference to these cases, but it may be observed that the appearance of the sixty cases of ephemeral fever in the Midsummer quarter, was coincident with a somewhat severe epidemic of small-pox that prevailed amongst the ship's company, and to which reference will be made, hereafter.
There were fifty-nine cases of primary fever in the Immortalite. Fifty-eight of these were ephemeral in their nature, the average duration of each case on the sick-list being under five days. As commonly happens, however, there were a few cases in which convalescence was rather protracted. The only case not of an ephemeral character was fifty-six days under treatment. It was a well-marked example of enteric fever, the abdominal symptoms and the eruption being very characteristic.
In the Liverpool there were thirty-eight cases of primary fever. Of these, thirteen are returned as being of continued, and twenty-five of ephemeral character; but as the average duration en the sick-list of each case of both forms of fever was precisely the same, viz., between four and five days, they may all with propriety be referred to the latter type. There is nothing worthy of note in connection with them.
The returns from the Medea are so imperfect, that but little reliable information is to be obtained from them. From the only one available it would appear that there were eighty-three cases of primary fever under treatment during the year, four of which are classed as remittent, and seventy-nine as bilious remittent fever. The whole of the cases of the latter type occurred during the months of July and August, when they prevailed in an epidemic form on board, the ship during the first portion of the time being at anchor in the harbour of Nassau.
The assistant surgeon (Assistant Surgeon J. Brown) who was in medical charge of the vessel at this time, states that yellow fever was very prevalent on shore, and the mortality occasioned by it was in the proportion of one death to five cases. He remarks :-
"On the 30th of June, the first case of decided bilious remittent fever occurred. It was very slight, and the man was only on the sick-list for three days. Between that date and the 4th of July, four cases occurred, and it was now thought advisable to proceed to sea on a cruise. The number of cases, however, increased rapidly, although every precaution was used . . . . . . Forty-eight cases of this fever were added to the list in the month of July, only one of which ended fatally, although the average deaths on shore were about one in five. The general symptoms of the disease were as follows:- It commenced with great lassitude, the skin was hot and dry, the eyes suffused and yellowish, dull, and languid; there was great pain in the head, especially in the forehead, and in many cases in the eyes, of a lancinating character, and frequently there was a sense of fulness and turgescence in the nose. The pulse ranged from 90 to 112, there was great thirst, the stomach was generally irritable, the matters vomited being very bilious and dark. The bowels were, as a rule, constipated, but in a few rare cases there was diarrhoea. There was great restlessness, with depression of spirits, loss of appetite, and pain on pressure over the epigastrium. As the disease advanced there was delirium in some, the vomiting became more frequent, and debility very great, accompanied with profuse perspiration, the bedclothes being wetted through, and the pulse being scarcely perceptible at the wrist. The average duration of the disease was in slight cases about five or six days. The second class, or those which did not improve with early treatment, from ten to fourteen days; and the worst cases from about three weeks and upwards. After the fever subsided, recovery was usually rapid, and strength speedily regained."
The treatment employed, and which appears to have been attended with much success was, in the early stages, the administration of mercurial purges, and the liberal use of quinine, subsequently support and stimulation were freely had recourse to. The only fatal case occurred in the person of an officer, and is returned as one of yellow fever. He first complained in the evening of 27th of July, the day on which the vessel left Nassau, but his symptoms then were very mild. On the following morning and during the day he was much better, but in the evening an exacerbation occurred, the pulse became quiet, the skin hot and dry, and the eyes injected and slightly yellow. From this time the febrile action appears to have become continued. On the night of the 29th, he was delirious, the eyes were very yellow, and the irritability of the stomach very great. There seems never to have been any suppression of urine, but in the morning of the 31st the vomited matters were black. On the evening of the 1st of August he passed a stool of a black colour, soon after became comatose, and expired. At this time the vessel was on her way to New York, but as cases of fever continued to increase the course was altered for Halifax, where she anchored on the 15th. Twenty-three cases of fever were sent to hospital on her arrival, and five subsequently. They all appear to have done well. It is quite impossible from the defective nature of the returns from this vessel to arrive at any satisfactory conclusion with reference to this epidemic. From the small mortality it occasioned however, it may reasonably be inferred that it was not specific yellow fever, but the ordinary remittent fever of the station varying in severity in different cases. The fatal case however undoubtedly presents all the features of yellow fever.
There were fifty-four cases of primary fever in the Peterel, thirty of which were of an ephemeral, and twenty-four of the remittent type. The average duration of each of the former cases on the sick list was between three and four days, and of the latter about eight days. The surgeon (Dr. W. H. Lloyd) makes the following observation with reference to these cases:-
"During the last two years fever has furnished a large number of cases to our returns. The type has not varied much; remittents of mild form have been frequent, and very often the same individual has suffered from three or four attacks during the year. One of these cases, a seaman, in whom the disease, constantly recurring, indicated a cachectic state of the system, was invalided. The ephemeral cases were in most instances the same disease in a modified form. In one or two cases some congestion of the liver and spleen was noticed, but in general they were free from complication. The bulk of the cases, and the most severe, occurred during the summer, and this when the other ships in the same locality were perfectly free from the disease. My opinion formerly expressed, that this was the result of a predisposition, and the disease consequent on deterioration of stamina in the men, rather than local influence, and requiring change of climate for its removal, appears to have been borne out by the fact, that since we have had the advantage of the cool winter breezes of the Gulf of Mexico, the disease has almost entirely disappeared, though the climatic influences (at Vera Cruz) appear still to be occasionally present."
In the Phaeton there were eighty-six cases of primary fever; eighty of these were of an ephemeral character, and six continued. The average duration on the sick list of each of the former cases was between six and seven days, and of the latter between fourteen and fifteen days. Sixty of the cases of ephemeral fever occurred during the Michaelmas quarter of the year, during which period also diarrhoea was epidemic amongst the ship's company. These affections are attributed to the oppressive nature of the heat experienced at Fortress Monro, in Virginia, where the vessel was for some time stationed. During the same period also five of the cases of continued fever were placed on the sick list. There was nothing to call for special comment in these cases.
There were forty-three cases of primary fever in the Shannon. The average duration of each case on the sick-list was between five and six days. Thirty of the cases are returned as continued fever, two as gastric fever, and eleven as ephemeral fever. The only case of any moment was one of those termed gastric fever, which was thirteen days under treatment. It occurred in the person of a warrant officer, and in its symptoms very much resembled a case of insolation. No mention is made, however, of any unusual exposure to the sun. He was placed on the sick-list at Vera Cruz, with intense headache, nausea, and vomiting. The pulse was small and quick, and the skin cold and covered with a clammy perspiration. The head symptoms were so severe that in the same forenoon he became delirious; but this, under the treatment to which he was subjected, passed off in the afternoon. Cramps of the lower extremities supervened, and he had much pain in the hypogastric and iliac regions. The bowels were freely opened by active purgatives, and cold applications applied to the head. All the more formidable symptoms rapidly disappeared and convalescence was only protracted by debility and some amount of pain at the epigastrum. These, however, ultimately disappeared, and he was discharged to duty. The other case of so-called gastric fever was only five days under treatment.
In the Virago there were 104 cases of primary fever. Ninety-eight of these, returned as continued fever, appeared in an epidemic form, during the months of June and July, when the vessel was stationed off Vera Cruz. The average duration on the sick-list of each of these cases was between nine and ten days, and they, with very few exceptions, exceedingly resembled each other in all their symptoms. A typical case is given, from which it would appear that the earliest symptoms were rigors, headache, numbness of the thighs, pain in the loins, tenderness of the eyeballs, rapid pulse, dryness and heat of skin, and a yellow coated tongue. An emetic usually induced copious bilious vomiting, which was followed by profuse perspiration and much relief. On the following day the symptoms would be much mitigated, but vertigo was frequent, accompanied with pains in the limbs. There would still be some headache, the eyeballs being especially tender, the skin warm, and the pulse a little too rapid. On the third day the limbs would be relieved, the eyes less tender, and the pulse reduced to eighty-five. On the fourth day, the fever had disappeared; the skin was agreeably cool, the pulse natural, the tongue cleaning; and in the case given as an example of the disease, the gums were very slightly tender from the exhibition of calomel, of which two grains, with two grains of quinine, had been prescribed on the second day, and taken four times daily. This was now stopped, and quinine alone given. Soups were also ordered. On the fifth day the patient was better, and placed on an allowance of wine, and from that time he progressed steadily until the ninth or tenth day, when he was usually discharged to duty.
The Surgeon, Surgeon J. T. Gabriel, of the Virago says that the residents on shore recognise the disease as "break-bone"fever, from the universal and severe pains that accompany it. In some cases the accompanying nervous depression was so great that the most powerful men were found shedding tears. As a rule, the cases were uncomplicated, and were generally followed by crops of boils, or the formation of abscesses. There were, however, three exceptions to the rule of absence of complication. In one of these palpitation was associated with the fever, in another herpes, and in the third pleurisy.
The other six cases of fever, not forming part of the above epidemic, were classed as febricula; the average duration of each case was seven days. They were tolerably equally spread over the year.
Yellow Fever.- This fatal form of fever prevailed at Nassau during the summer of 1864, and in the month of June was conveyed from that place to Bermuda, where it committed great ravages amongst the naval, military, and civil population. The history of that epidemic has appeared in various forms, so that, excepting in so far as the naval force on the station was affected by it, only a brief notice of its origin is called for here. In the midst of all the theories which have been put forth to account for its outbreak, and the extraordinary list of diseases which are said to have been prevalent for months previously in Bermuda, and to have afforded convincing proof to some people that an epidemic of yellow fever was imminent, the following facts stand prominently conspicuous. In the month of June yellow fever prevailed in Nassau. A carpenter, working in a shop there, became alarmed on two of his fellow workmen dying of the disease, and, taking passage in a steamer for Bermuda, arrived at St. George's on the 13th of June. He had been suffering from ague, it appears, and had several seizures after landing on the island. On the 25th of June he was seized with fever of a continued type, which proved to be specific yellow fever, of which he died on the 30th. That was the first case of yellow fever in Bermuda, in the epidemic of 1864. The second case occurred in the person of a man who lodged in a house about 200 yards from the one in which the first case died. He was taken ill on the 10th of July, and died on the 17th. The medical officer (Dr. Alexander Crosbie) of the Terror says, with reference to this last case:-
"He (the subject of the second case) went to board in the house of a coloured man living on the road, leading past the house where case No. 1 died. On the 10th of July he was seized. I believe, and it was remarked at the time, that all the earlier cases occurred in the neighbourhood of the two houses in which the first two men died. After the 1st of August the fever assumed an epidemic form, and soon spread to the most distant parts of the island."
It might reasonably be supposed that here, at least, there could be no doubt as to how the epidemic originated, or where the first man contracted the disease, but this is far from being the case. It is objected that the carpenter could not possibly have carried the specific poison of yellow fever with him from Nassau, because he was labouring under ague at the time, and, it is said, "medical experience will declare that it is impossible for two distinct fevers to exist in the system at one time, the one lying dormant, and the other being in a state of activity."(Papers relating to the Origin and Spread of the Yellow Fever in Bermuda, in 1864. Ordered by the House of Commons to be printed, 4th August 1866, p. 9.)
Medical experience, however, declares no such thing; on the contrary, it establishes as indisputable facts the co-existence in the system, of enteric fever and scarlatina; of enteric fever and measles; of enteric fever and diphtheria; of variola and typhus fever; and of variola and scarlatina, as testified by Murchison in his work on Continued Fevers, where he further says, "I have elsewhere collected numerous instances, demonstrating the contemporaneous existence in the system of almost any two of the diseases which are believed to spring from different specific poisons." (A Treatise on the Continued Fevers of Great Britain. By Charles Murchison, M.D., &c., 1862, p. 584.) And if it were necessary to multiply evidence to the same effect, it would be found in the very next sentence of the Report, quoted above, where the following admission is made, "But there is evidence that an intermittent may suddenly change its type to that of yellow fever when the specific epidemic wave, or influence, passes over a district," which is simply another mode of saying that when yellow fever enters a district, persons suffering from ague are liable to be affected by it.
It is said that the essential conditions for the development of yellow fever were peculiarly present in Bermuda at the period of the outbreak of this epidemic, these being geographical position, certain degrees of heat, humidity, and the generally defective sanitary condition of the islands; but the resident medical men affirm, that up to the first appearance of the epidemic, the year 1864 was an ordinary one as regards the general health of the civil population. It is true that some practitioners had more cases than usual of influenza, diarrhoea, and dysentery, but it is said that there was nothing unusual in the nature of the diseases under treatment, and in St. George's, where the epidemic was most virulent, the medical men state that they had no warning whatever of the approach of the pestilence. Geographical position is undoubtedly an element which enters largely into the chances of a locality being visited by yellow fever, but its influence in this respect will be just in proportion to its being more or less remote front the track of vessels coming from infected localities. All conclusions from thermometrical and hygrometrical observations, with reference to the development of specific fevers, are as yet absolutely worthless in a scientific point of view. They are hypothetical and fanciful. If accumulations of every abomination, defective drainage, crowding, squalor and poverty, heat and humidity, and every one of the so-called essential conditions for the development of yellow fever are sought after in their highest degree of perfection, they will be found in many localities where yellow fever has never yet appeared and whatever may have been the sanitary condition of Bermuda in 1864, there can be no question of this fact, that the first person affected with yellow fever in that year, was a man who had just arrived from an infected locality from which he had fled, scared by two of his fellow workmen dying of the disease. It is much to be deplored that in the consideration of this fatal form of fever there should be so much desire to set aside plain facts, and substitute for them crude and untenable theories. In questions of mere ordinary importance, such a proceeding would be simply regretable, as tending to retard their satisfactory solution; but where human life is so fearfully involved, as in the present instance, it proves very disastrous, misleading those who look to the medical profession for instruction and guidance, and hindering the prompt adoption of the only measures capable of arresting the spread of the disease.
Seventy cases of yellow fever appear in the returns from the Terror; many of them occurred in men belonging to gunboats and tenders, whose names were borne on her books, and their sick attended by her medical officer. With reference to the Terror herself, the following remarks are made by the medical officer.
"With the knowledge that yellow fever was prevalent at St. George's, and that it would probably follow its usual route, ample time was given for the adoption of hygienic measures. Every part of the ship was thoroughly cleaned and ventilated, and chloride of zinc was largely used in the bilges, which were thoroughly dried and whitewashed. The decks were less frequently wetted, and deck cloths, wet clothes, or articles retaining moisture of whatever kind were immediately sent on the upper deck to be dried in the upper air; the men were encouraged to be careful in their ablutions, and their bedding was frequently aired. The same precautionary measures were adopted in the gun-boats. If cleanliness, dryness and thoroughly good ventilation could have insured exemptions, it must have done so on the Terror, for they were all complete and admirable. When the fever appeared quinine in three and four grain doses was issued twice a day, in the dockyard with half an allowance of spirits, in the Terror and gun-boats, in simple solution: exposure to the sun was avoided as much as possible; the working hours were abridged, the period of rest at mid-day when the heat was greatest, lengthened, and breakfast served immediately the men got up. An extra allowance of spirits was given to those engaged in the immediate burial of the dead, and the crew of the gun-boats who were always at work had an extra allowance of lime juice in addition. These measures though they may have had an effect in warding off the predisposition to the disease, and though they may have delayed its onset, yet had no protective power once the disease had become thoroughly epidemic, and I seriously question whether the increased expenditure thus caused in extra issues was worthy of recommendation, and the quinine served out, not valuable medicine entirely thrown away. The other plans adopted partially or completely are worthy of the greatest consideration. These were, the removal of the men from the place where the disease appeared among them to a healthier, if possible; the removal of the debilitated and convalescent, and ultimately of the entire number from the epidemic locality; the first, with the seamen of the yard, was a failure; with the gun-boats a partial, and with the Terror's crew (who were removed on shore and put under canvass) a complete success. The most important measure, however, was the entire and speedy removal of the men from the influence of the fever, and this should be done as soon as the disease becomes established."
At Ireland Island where the Terror is stationed the first case of yellow fever occurred, it is stated, in the person of a boy belonging to the commissariat, who resided on board the Tenedos hulk. He had come on the 13th August, apparently in good health, from St. George's where the disease was raging, and although the attack was at first mild he nevertheless died in the morning of the 17th with profuse black vomit, insensible, and screaming violently. On the 17th of August two cases were met with among the artificers of the dockyard; on the 20th there was a case from the Nettle gunboat (at that time in the Harbour of Hamilton), and on the 27th and 28th of August one from the Spitfire and Terror respectively.
"From the 17th of August the fever increased in a rapid and irregular manner until the 19th of September, when it reached its highest point. It continued high as far as the 13th of October, and then continuously diminished to the end of the month. In the beginning of November it rapidly lessened, and as the last case was registered on the 23rd of November, the epidemic may then be said to have ceased. . . . . of the proportion of the entire population of Ireland and Boag Islands attacked I have no means of determining, but I think I am within the limits of the truth when I say that at least one-half suffered. No case came under my notice where one only of a household suffered, but generally there were three or four, and frequently every member of it."
The same medical officer has the following remarks on the disease, and the treatment usually adopted:-
"It would be impossible to include in a formal description a disease presenting such a great variety of symptoms, from the slight febrile disturbance only a short way removed from health, to the deadly suppression of urine and black vomit, shown in the severe cases, and connected by an intermediate series of gradually increasing intensity. Many would not have given the name of yellow fever to the milder cases, in which the characteristic symptoms (yellowness of the integument, &c.), were not exhibited; but I think they ought to be included as such, and for the following reasons, viz., their occurrence along with undoubted yellow fever, peculiarities of symptoms only milder in degree; and the occurrence of cases intermediate in degree and kind between the two. From the experience derived from the late epidemic, I should call the fever a continued one, and although in a few cases the disease resembled bilious remittent, and in a few more remissions, though well marked, were infrequent, the general course of the disease was continuous and unbroken, and only presented exacerbations such as are met with in all varieties of febrile disease. Relapses were numerous, and second attacks common enough. A few of the cases were long and tedious, and resembled typhoid fever more in their course, but the great majority were short, and soon attained their termination either in death or convalescence.
"The attack was generally sudden, but occasionally preceded by a few days' indisposition; seldom accompanied by a confirmed, but often by a slight irregular rigor, with chills and flushing; pains in the limbs were complained of; wandering about the trunk, severe across the loins, with severe frontal headache. Sometimes wandering pains in the limbs, headache, or general malaise, diarrhoea or catarrh formed prodromata.
"The disease once formed, exhibited the usual symptoms of fever in its general meaning. The pulse was excited, beating from 80 to 130 in a minute; the skin was first hot and dry, but in a few hours became covered with profuse perspiration, of a peculiar sour smell, like that of rheumatic fever, which commonly drenched the bedclothes, and frequently dropped on the floor beneath. The tongue was either clean, slightly furred, or covered with a thick fur in the centre, margined by a brownish-yellow streak, outside of which were the edges and tip reddened with white projecting papillae. Anorexia was complete, thirst urgent, and nausea constant or occasional; vomiting common, and seldom wanting; at first of clear mucus, followed by bilious fluid, sometimes in large quantities. There was epigastric pain, and slight tenderness on pressure, but sometimes these symptoms were absent. The bowels were generally confined, but sometimes they were loose, with watery or bilious, or they might be bloody stools. The urine was always scanty, of dark colour or deep yellow, often of clear amber colour, occasionally bloody. The frontal headache severe, sometimes pain only in the occiput and temple; wandering pains in the limbs, across the loins generally severe. The debility was always marked, vertigo frequent, oppression great; and occasionally slight delirium at night. The face was flushed, with suffused, injected conjunctivae as if from intoxication, giving a red ferretty appearance to the eyes. Generally from the fourth to the sixth day, the febrile symptoms began to abate, the pulse frequently falling rapidly from 100 to 60, or even 40 a minute; sometimes more gradually. The skin now became cooler, the febrile oppression, the pains and headache passed away, the thirst diminished, appetite in a manner returned, the urine increased in quantity, the tongue cleaned, and convalescence became established. The sweating had ceased before. Now, although in the majority of cases these were the more common symptoms, yet in many they were liable to be superseded and interrupted by others of graver import or fatal effect. The epigastric tenderness might become increased, the restlessness constant, the pulse small and weak, and the fluids ejected by vomiting changed to a brownish or black colour, either scanty or copious, and death follow in no long time. Or, the urine which had been scanty, might become suppressed, and be soon followed by drowsiness, occasional incoherence, succeeded by wandering, rambling delirium, and finally by coma. Haemorrhage might show itself from every mucous surface, and vibices and petechiae appear under the integument, and the matrices of the nails be purpled by blood. These usually fatal symptoms were generally accompanied by yellowness of the skin, varying in tint from a light yellow or earthy colour, to a dusky brown, and the earlier this symptom appeared, the more fatal the case. The change in colour was usually first observed on the flanks or breast, and soon spread over the entire surface. Though usually a bad symptom, yet many recovered from it, especially when it appeared later. A pustular eruption was met with in a few cases, resembling the eruptions of modified small-pox; and in one instance so great was the resemblance, that two medical officers pronounced it a small-pox eruption. Bullae filled with pus were of more frequent occurrence, and appeared on the third or fourth day of the disease. In a few instances a measly eruption similar to that of dengue was observed. Convalescence was generally slow, and there was a tendency to relapse, and second attacks so long as the slight muscular pains continued. Premature labour and abortion were generally induced by an attack, though women near their full time have passed safely through it.
"The treatment had for its object the imitation, or attempt at imitation of the natural methods of cure in favourable cases. At first the warm bath was used which generally proved soothing, and determined sweating, and this was kept up by covering the patient with blankets, and giving bland luke-warm drinks. This process was kept up for two or three days, and the extra clothing was then cautiously removed. If the bowels were confined two blue pills were ordered, followed by seidlitz powder in four hours. A diaphoretic mixture was usually given, unless contra indicated by vomiting or continued nausea, when it was changed for effervescent draughts. When the skin became cool, and the pulse fell, beef tea and animal soups were given as diet, and in failure of the vital powers alcoholic stimulants. The greatest care was required in allowing solid food in early convalescence. Epigastric pains and tenderness were often relieved by sinapisms. Diarrhoea I never had occasion to check, and I believe it was frequently critical. In suppression of urine, or tendency thereto, diuretic salts, or turpentine in small doses, were used, and stupes of the latter were applied to the loins. Haemorrhage was met by various astringents, as lime water, alum, and gallic acid. I think that alcoholic stimulants were injurious when given early, or when they were not urgently called for. During recovery quinine, and quinine and iron were of great service."
The following account of the disease as it was seen in the Royal Naval Hospital at Bermuda, the mode of treatment adopted there, and. the appearances found on post-mortem examination of the bodies is given by one of the assistant surgeons (Assistant-Surgeon James E. Milne, M.B., M.A.) of the Duncan, who was lent to do duty there during the prevalence of the epidemic:-
"On admission the symptoms were those of the premonitory stage of a continued fever, only occurring in an intensified form. There was the headache, pain in the back and limbs, the strong, quick, full pulse, often on admission as high as 120 and 130, congested conjunctiva, hot dry, parched skin, and the feeling of oppression and weight over the chest and pericardia. It was not an uncommon thing to have this strong, quick, full pulse, next day becoming slow, weak, and compressible, leaving the patient in a great state of exhaustion, from which very often they never recovered. When this condition happened it was always a period of care and anxiety to the medical attendants, and the patient required great watching, and the judicious administration of stimulants. At the outset of the epidemic large doses of calomel and quinine had been administered as a sort of heroic measure, but its administration had failed to satisfy the medical officers that its use should be continued, and afterwards a rational or objective system of treatment was substituted, which the Deputy Inspector General seemed to entertain greater hopes of. The essential point in this treatment consisted in keeping, so far as was possible, the secreting organs in perfect working order, in cautiously and carefully anticipating certain bad symptoms where they were thought likely to happen, and in at once treating these promptly when they occurred, and as circumstances indicated. A great deal seemed to hinge on the proper time far administering the stimulants being seized upon. On admission it was usual to prescribe a warm bath, and then ten grains of blue pill, or sometimes a podophyllin pill, followed by saline refrigerants. Being placed in bed great care was taken at each visit to inspect the state of the skin, and also to ascertain correctly that urine was being freely secreted and passed. An alkaline effervescing mixture was kept on a stand by the patient's bedside, so that when thirst oppressed, a wineglassful or so might be given by the nurse. Lime juice was freely supplied to the inmates, and was always gratefully acknowledged as being an agreeable and refreshing beverage. After the bowels had been freely acted on, a mixture containing liquor ammonia; acetatis, and nitric ether was given so as to counteract any tendency to sluggishness on the part of the skin or kidney. In many cases it was extremely difficult to get the skin to work properly; in some cases impossible, so that the hot wet blanket had to be applied. The success attending this application was in many instances most gratifying, the patient improving rapidly, after the resistance to free action on the part of the skin had been overcome. It must not be forgotten, however, that not unfrequently after a copious perspiration the debility was very, marked, and the weakening tendency existing to such a degree that brandy in repeated doses had to be exhibited. Important as was the regular action of the skin, a much greater danger was apprehended if there appeared the slightest tendency on the part of the kidneys to show that the secretion of urine was being stopped, a symptom which always augured badly, for the patient generally took an unfavourable course, and but rarely improved. The tonics used during recovery were iron, quinine, and the acids, especially the two former, and there can be no doubt whatever that the effects of these were most favourable and satisfactory. Relapses were not of unfrequcnt occurrence, the patient in midst of apparently rapidly returning health, being suddenly seized, and very soon in great danger. With one or two exceptions every nurse had an attack and every medical officer excepting one. Men picked up from the roads at night and received. into hospital were as a rule under the influence of the fever poison in the morning, and every case of a man being drunk at night, and afterwards attacked, proved fatal. A good many such have come under my own observation. It is well worthy of note that the greatest fatality occurred amongst those under 25 years of age, and who were phlegmatic and plethoric.
"Up to the second week of September the Deputy Inspector General had made a post-mortem examination of, I think, every fatal case, and found them all, as a rule, and with but trifling exceptions, to present the same general appearance, but nothing in the pathology that suggested to him any new or more effectual mode of treatment than that, already adopted. The membranes of the brain were often found inflamed, and the vessels of the pia mater and dura mater congested and tinged with blood, the ventricles containing fluid. Blood was often also seen in large clots on the substance of the brain, thus showing extensive extravasation. Other appearances were black vomit in the stomach, the coats of the stomach apparently in a state of inflammation, kidneys congested, bladder empty; sometimes a continuity of inflammation leading from the stomach into the intestine. An abnormal state of the liver was not so constant as those just mentioned. Bile seemed to be distributed freely through the veins. The yellow hue was not in every case diffused all over the surface of the body, but was frequently observed to be distributed in patches, in all cases the colour becoming more and more distinct shortly after death. Sometimes there would not be, during illness, the slightest indication of this yellow tinge, yet in a very short time after the death of the patient it would in a most distinct manner establish itself."
On reference to Table IV. it will be observed that thirty-seven deaths from yellow fever appeared as occurring amongst the cases from the Terror. Many of these, however, occurred in the persons of men attached to the dockyard, but returned on the hospital books as belonging to the Terror.
On the same Table also, two deaths from yellow fever appear as occurring in other ships; one in the Medea has already been referred to in noticing the epidemic of fever that visited that vessel; the other occurred in the person of an officer of the Phaeton, who, while on a visit to the headquarters of General Grant's army, in Virginia, was attacked with ague. The attacks were of an irregular character, the accessions of fever mostly appearing at night. He was placed on the sick-list while the vessel lay at Fortress Monroe, and was under treatment when she sailed for Jamaica. On the voyage the Phaeton came to off Bermuda, to land the mails and despatches; and there, at his urgent solicitation, and in ignorance of the prevalence of yellow fever on shore, this officer was landed, he being in a low and desponding state, and still labouring under intermittent fever. He was landed on the 17th of August, and received into the naval hospital on the following day. On the 22nd symptoms of yellow fever set in, and on the 25th he died. The report of this officer's case while in hospital is to the effect that the symptoms were in some respects different from those in the majority of cases :-
"He had become debilitated by intermittent fever, slept at St. George's one night before reaching the hospital, and at St. George's probably received the virus, which in his state of health soon manifested itself, and appeared to act as a toxic agent of the narcotic class, producing stupor and passive delirium, followed by suppression of urine, uremia, and coma."
The highly infectious nature of yellow fever was abundantly proved in the Bermuda. epidemic of 1864. Six of the medical officers attached to the naval hospital, the dispensary assistant, and the steward and his wife, besides many of the nurses attending upon the sick, were affected with the disease. The Deputy Inspector General (Dr. John Gallagher) who, in the midst of his laborious and unwearied exertions on behalf of those placed under his care, himself fell a victim to the fever, writes: "That the disease is highly infectious has been proved by several of the sick-attendants, who were all volunteers, and previously in good health, being attacked, and in some instances, I regret to say, fatally; and that immunity from the fever is not secured by one attack is also proved, several convalescents having been suddenly seized with vomiting and high pyrexia, in two cases fatally, and three others remaining in a critical condition." And the medical officer (Assistant Surgeon T.G. Wilson) who temporarily succeeded him says: "That the disease is eminently infectious has been proved beyond doubt by this fact, amongst others, that few of those who have been attending on the sick, or in any way brought into communication with them, have escaped. Medical officers, nurses, and washerwomen (the latter coloured) have all suffered severely. Many cases of relapse have occurred, whether owing to imperfect convalescence, or to fresh attacks of the disease, it is impossible to state definitely; but I believe they were owing to the former circumstance."
Intermittent Fever.- There is only a fractional reduction in the ratio of cases of ague, as compared with the preceding year. The largest number of cases appears in the returns from the Rosario, and the disease was attributed to exposure to malarial influences while the vessel lay at Fortress Monroe. With reference to these cases the assistant surgeon (Assistant Surgeon John Mulvany) of the vessel makes the following observations:-
"Although the number of fever cases has been on the whole much less than during the previous year, the diminution has only been in the continued fevers. There has been a large increase in the intermittent and remittent varieties. Latterly the majority of fever cases commence as intermittent, and not unusually merge into the remittent form. When this is the case some of the concomitant symptoms are so peculiar that I may be permitted to mention them; the more so as, having had experience of them in my own person and having carefully observed them in others, I can vouch for their accuracy.
"There is constant increasing pain in the cardiac region, only less intense during the remissions about seven o'clock, p. m., or six o'clock, a. m. The pulse is quick, ranging from 80 to 120; burning heat of the palms of the hands and soles of the feet is never completely absent, and there is great heat of forehead. All these symptoms were aggravated by change of position, sudden noise, or the introduction of food into the stomach.. As the fever passed off, the forehead became gradually cool, the pain in the heart abated and became intermitting; but a violent palpitation came on, usually every third day, as if the fever expelled from the general system selected the heart as its last stronghold, making a demonstration at first on every third day, at a later period every fourth day, and lastly every seventh. Quinine was the only medicine in my experience used with much benefit. But the disease is very liable to recur in a much modified form, however, when a northerly wind blows, or when the patient suffers from irregularity of the stomach or bowels. The burning sensation in the palms of the hands and soles of the feet is the last symptom to disappear."
Eruptive Fevers.- Fifty-six cases of small-pox, two of scarlatina, and one of measles, were under treatment in the squadron squadron. Thirty-eight of the cases of small-pox occurred in one vessel, the disease having been originally introduced into the ship in England.
Small-pox.- There were three cases of small-pox in the Aboukir, the receiving ship permanently stationed at Port Royal, Jamaica; and of these, one proved fatal. The disease was prevailing at Kingston at the time. The two men who recovered had been vaccinated, and they appear to have had the disease in a modified form. No mention is made as to whether the subject of the fatal case had been previously vaccinated; but as he was a black man, the probability is that he had not.
In the Bulldog there was a single case of smallpox. It occurred in the person of a marine, who presented two deep vaccination marks, and who is supposed to have contracted the disease at Kingston, Jamaica, where he slept one night. The case was of the confluent variety, and of great severity. He ultimately recovered, however.
There were three cases of small-pox in the Challenger. The average duration of each case in the sick-list was three weeks. The disease was traced in every instance to direct contagion at Kingston.
In Table 4, a fatal case of small-pox appears in connection with this ship. The subject of it was a petty officer who had been invalided for lupus-non-exedens, and who, on his arrival in England, was sent to Haslar Hospital, where he was seized with small-pox, where he died. He presented marks of primary vaccination; but the disease, notwithstanding, assumed a virulent confluent form.
In the Duncan there were thirty-eight cases of small-pox, one of which proved fatal. In this number are not included three cases, one of which occurred in England during the fitting out of the vessel, and two on the outward passage. As it was from these cases, however, that the epidemic doubtless had its origin, it will be necessary to refer briefly to them here. Small-pox was prevailing on shore at Portsmouth in the early part of 1864, and on the 30th of January the first case occurred amongst the ship's company of the Duncan, in the person of a seaman, who was at once discharged to hospital. The case was an exceedingly mild one, with an entire absence of febrile symptoms. The next case occurred on the 17th of February, eleven days after leaving, England. It also was very mild, and he was discharged to duty in eight days. The third case presented itself on the 22nd of February; it was more urgent in its character. The man was discharged to duty on the 11th of March. On that day a seaman presented himself, complaining of much pain in the back, which he stated was occasioned by a severe fall he had sustained on the previous day. There being no other symptom present than the pain in the back, which was naturally considered to be consequent upon the accident; he was treated at first for contusion, and on account of the severe pain from which he suffered, and his inability to walk, placed in a hammock in the sick bay. Very soon, however, decided febrile symptoms began to show themselves, and ultimately a well-marked and somewhat severe case of smallpox was the result. The pustules particularly on the face became confluent, and for the first fortnight the symptoms were urgent. He recovered, however, and was discharged to duty on the 28th of April. From the 11th of March, the day on which this man was placed on the sick list until the 9th of April, no other case of small-pox presented itself, so that hopes were beginning to be entertained that the disease would not spread further. On that day, however, a petty officer was entered on the sick list with the premonitory febrile symptoms, which culminated in a severe outbreak of the confluent form of the disease, and on the 27th of the same month the fatal case occurred in the person of a serjeant of marines, who presented the marks of early vaccination. From that date, the ship then being at sea, the disease assumed an epidemic form amongst the ship's company, and spread rapidly until the arrival of the vessel at Port Royal, when all the cases were landed at the naval hospital. One of the assistant surgeons, (Assistant Surgeon J. G. Milne, M.B., M.A.) of the ship says, with reference to the spread of the disease:-
"Patients, instead of coming in as before, at considerable intervals, now, during the first ten or eleven days of the month (May) presented themselves in twos, threes, and not unfrequently fours; and the presenting symptoms varied much in the different cases. In many, and I think these were most numerous, the local pains were very severe, and were generally accompanied by pretty sharp febrile disturbance; whilst some, on coming for advice, complained of none of the usual febrile symptoms at all, only showing the well defined pustules, and saying they had boils coming out on them. In these latter cases, it is to be remarked, that at no time during their illness did a numerous crop of pustules come out; and their cases, generally considered, did not indicate that there was much deviation from the ordinary course of their usual health. At the same time, however, these were confined and isolated from the healthy portion of the crew, the same as the others. A large screen was erected, occupying a great portion of the port side of the main deck, and within this, those who were seized were immediately placed. Suspicious looking cases were narrowly watched, and confined separately, until the true nature of their ailment was made out, when, if it were found to be variola, they were immediately conveyed to the screen in the place before mentioned. On one occasion we had a general inspection of all the officers and men in the ship, with a view to pick out any cases that were, or might seem suspicious; and at divisions, morning and afternoon, there was a medical scrutiny of all the men on the respective decks. By these means, not a few were detected, and thus became subject to treatment at an earlier stage than they otherwise would have been. There were some cases, indeed, shortly after the outbreak, in which they did not come for medical relief so soon as they might have, their only reason being, that they thought the headache, hot skin, and even in some cases the pustules, would wear away. Of all the cases, from first to last, there was but one death. Amongst the measures adopted for the prevention of the disease, I should have mentioned that we resorted to vaccination to such of those as showed no marks of having been vaccinated, and to many others who had previously had that operation performed on them. A remarkable immunity from this disease seems to have been enjoyed by the officers, only two of whom were attacked. They were treated in a screen abaft the main one. Fortunately for us at this time, when the disease was just about its worst, we arrived at Port Royal Harbour, Jamaica, when all the patients. both officers and men, were, without delay, removed to the Naval Hospital, there to enjoy the superior advantages in treatment which a hospital in many respects affords, compared with a ship. After the removal of the cases, sanitary and preventive measures still continued to be used in the ship. The fatal case alluded to was that of a serjeant of marines, who was admitted on the sick-list on the 27th of April, with the usual symptoms attendant on the commencement of variola, but in an intensified form. The eyes were much suffused, and the frontal headache very severe, but the most distressing symptom was the great pain experienced in the back. The eruption made its appearance in due form, and at the wonted time, and was the most confluent we had seen. The symptoms, at first highly inflammatory, soon passed into the typhoid type, the pustules being visible in great numbers on the tongue, fauces, and pharynx. Wine here was given early, with carbonate of ammonia and chlorate of potass, but in spite of everything he never rallied, sinking until he died."
The surgeon (Surgeon J. Little) of the Duncan says, "This was a case of malignant small-pox, and one of the worst I have ever seen; previous to death decomposition had set in at the lower extremities, and both of the legs were disorganised." During the ship's stay at Port Royal, three cases of the disease occurred, which were at once removed to the hospital, after which the epidemic ceased. On the 22nd of May twenty-five of the small-pox cases that had been sent to hospital returned to the ship cured, and were discharged to duty, and on the 23rd the vessel left for Havannah, en route for Bermuda and Halifax. No fresh cases occurred after the ship left Port Royal.
What proportion of the men attacked with the disease on this occasion had been vaccinated in early life, it is impossible to say, as no information on that important point is given by any of the medical officers. It appears, however, that after the disease appeared on board, eighty-four men were vaccinated who had no marks of previous vaccination on their arms, and that several of these were subsequently attacked with small-pox in an exceedingly mild form. Of the whole number of cases fifteen were of the confluent type, and the remainder of a modified character.
There was a single case of small-pox in the Liverpool, and as the ship was at sea at the time, and the man consequently had to be treated on board, it is fortunate that the disease did not spread. Great care was taken in the isolation of the man, anal to that circumstance as well as to the fact that the crew had been re-vaccinated since their arrival in the tropics, this good fortune is, probably with justice, attributed. The patient had a well-marked vaccine cicatrix on his arm. The disease was contracted at Kingston, Jamaica, where it was prevailing on shore.
There were two cases of small-pox in the Phaeton. They were very modified in form, and both patients presented marks of early vaccination. The disease was contracted at Kingston.
Two cases of small-pox are entered on the tables as having occurred on board the Rosario. One of these, however, is stated to have been a case of varicella. It occurred in the person of a midshipman, while the ship lay at Fortress Monroe. in Virginia, small-pox being then very prevalent on shore amongst the Americans. The other case was one of modified small-pox. It occurred in the person of a stoker who had been on shore at Kingston, on leave, while the disease was prevalent there. He was admitted to the sick-list seventeen days after exposure to contagion. The constitutional disturbance was very slight, but no mention is made as to whether he had been previously vaccinated or not.
A case of modified small-pox occurred in the Royalist. The subject of it had been on shore at Kingston on leave on the 19th of April, the disease being very prevalent there at the time, and on the 7th of May the premonitory symptoms made their appearance. He had been vaccinated.
There were five cases of small-pox in the Shannon. The disease was contracted at Kingston, the ship's company having been granted leave there at a time when it was prevailing on shore in an epidemic form. In four of the cases the cicatrix of early vaccination was more or less distinctly marked; but in the fifth the man had not been protected either naturally or artificially, and in that instance the disease proved fatal.
Scarlatina.- Two entries under this head appear in the returns from the Greyhound. Both, however, refer to one person who appears to have contracted the disease while on leave at Baltimore. He was placed on the sick-list while the ship was lying at Fortress Monroe, and was discharged to Norfolk Hospital, Virginia, where he remained on the ship leaving for Bermuda. He rejoined the vessel after being discharged from the hospital, and appears to have caught cold in the interval, the result of which was to induce symptoms of the sequelae of scarlatina for which he was again placed on the sick-list, and at once sent to the naval hospital at Bermuda.
Measles.- There is only one entry under this head, and the case appears rather to have been one of roseola. It occurred in a boy of the Virago, who presented himself with feverish symptoms, and a florid eruption upon the face, arms, legs, and trunk. Co-existing with it was a slight eruption of urticaria.
Diseases of the Brain and Nervous System.- The ratio of cases coming under this head is almost precisely the same as in the preceding year, but the invaliding and death-rates are much increased.
A death from abscess of the brain occurred in a man of the Challenger. The disease was the result of a severe accident sustained on the 26th of March, when he was struck over the outer angle of the right orbit by a leading block, the lashing of which had carried away. The result of the injury was a compound and comminuted fracture of the frontal bone, extending into the right orbit. The haemorrhage was very great, and particles of bone, and of brain matter were removed from the wound, and from the front of his dress. The vessels were compressed over the right temporal bone, and the wound covered by wet lint, the edges being kept together by a bandage. He was placed in a cot, and as perfect quiet as possible was observed throughout the ship. This treatment was continued without a single unfavourable symptom arising. The bowels were kept relaxed by castor oil, and the diet was light and nourishing. On the 4th of April his state was such that he was able to walk about the main deck; the wound was nearly healed, but although able to see fingers held up before the right eye, and to tell their number, it was feared that vision in the eye would be lost. In this condition he was discharged to the naval hospital at Jamaica, where active inflammation ending in sloughing of the cornea and iris took place, with escape of the humour and collapse of the globe of the eye. The wound over the frontal bone healed quickly, but he complained for some time of pain, often very severe in that part of the head. This, however, after a time subsided entirely, and he was invalided and sent on the 27th of May to the receiving ship, to await a passage to England. He was re-admitted to the hospital a few days afterwards, the pain in the head having returned, and he continued in the same condition until the 5th of June, when coma suddenly supervened, and death took place in a few minutes. On examination of the body after death. the body was found to be spare, and there was a cicatrix over the right orbit. On turning down the scalp, a fracture corresponding to the cicatrix was seen extending from the inner angle of the orbit. to the frontal eminence, and outwards to the squamous portion of the temporal bone, a part of which of about the size of a shilling was depressed. A portion of the orbital process of the malar bone was broken off and loose. On removing the calvarium, the vessels of the, membranes were more turgid on the right side than on the left. The brain substance was soft and easily broken down. On cutting into it, a large abscess containing from an ounce and a-half to two ounces of pus, was found in the anterior lobe of the right hemisphere, close to, but not communicating with the lateral ventricle. The right ventricle contained a larder quantity of fluid than usual. When the brain was removed, it was found that the depressed portion of bone had a few sharp spiculae projecting from it, which in one part wounded the dura mater slightly. All the bones of the head were unusually thin; in one or two situations not much thicker than note paper.
There were four deaths from apoplexy. Of these one occurred in the Cordelia, one in the Duncan, one in the Nile, and one in the Rinaldo.
The fatal case in the Cordelia occurred in the person of an officer, of a full corpulent habit of body, and short necked, who had been exposed to a very high temperature for some time in the engine-room. On being relieved from his watch, he went to his cabin, and lay down on his bed, where he was found shortly afterwards unconscious, with stertorous breathings, full and strong pulse, slow and embarrassed breathing, and contracted pupils. Despite every effort, he expired very shortly after being seen. No post-mortem examination of the body appears to have been made.
The subject of the fatal attack in the Duncan was a seaman who had been placed in the sick-list with very mild febrile symptoms. He appeared to be doing very well, when he suddenly became insensible, and on the medical officer being called to him, was found to be in a heavy stupor, perfectly unconscious, the respiration being slow and laboured, with puffing of the lips in expiration. The pupils were dilated and insensible to light, the pulse natural. He did not rally at all but died in an hour-and-a-half after being attacked. On examination of the body after death, the vessels of the brain were found to be very turgid, and the right cerebral hemisphere was highly conjested, the vascularity giving it a pinkish hue.
A petty officer of the Nile fell down in the street in an apopletic fit. He was at once conveyed to the naval hospital, when he was found to be paralysed on the right side. He subsequently became unconscious, with contracted pupil. He lingered until the following day, when he died. The postmortem examination of the body revealed no lesion to account either for this seizure or the phenomena accompanying it. The scalp, brain, and membranes were found to be normal as to vascularity, and no effusion could be detected either at the base or in the ventricles of the brain, nor any extravasation in its substance.
The fatal case in the Rinaldo was in the person of a stoker who while fighting with another man, had received several severe blows in the epigastrium, and had been tightly hugged round the neck, when on being loosed he suddenly fell to the deck insensible, gasped once or twice and expired. The report drawn up by the medical officers on the post-mortem examination of the body, made four hours after death, was to the effect that a large effusion of blood had been found in each side of the brain, sufficient to cause death; that there was no other external or internal injury; that the general aspects of the body were those of a healthy man; and that in their opinion death did not result from the direct application of violence but from excitement and great exertion, producing rupture of the blood vessels of the brain.
There were nine cases of delirium tremens in the squadron, one of which proved fatal. Two of the subjects of the disease were ward-room officers; two were petty officers; three marines; one a bandsman; and the rating of one person is unknown.
Diseases of the Organs of Respiration.- There is a considerable decrease in the ratio of cases coming under this head as compared with the previous year. There is also a reduction in the ratio of invaliding, but in the death rate the decrease is only fractional. As in the preceding year the mortality was almost entirely attributable to phthisis.
There were twenty-five cases of inflammatory disease of these organs in the Duncan, eighteen of which were bronchitis, four pleuritis, and three pneumonia. The surgeon attributes the large average of lung affections chiefly to the men being exposed while fitting out during a severe winter. There were also seventeen cases of cynanche and fifty-eight of catarrh in this vessel during the year.
In the Liverpool there were sixty-six cases of catarrh, the majority of which occurred during the Christmas quarter of the year, when the vessel was on her passage to England. There was nothing in the general character of those cases to call for comment. One case of bronchitis, five of pleuritis, and seventeen of cynanche were also under treatment in the Liverpool.
The total number of cases of inflammatory disease of the respiratory organs placed on the sick-list during the twelve months was eighty-one, and the total days sickness on board ship and in hospital occasioned by them 2,114, which gives an average of twenty-six days treatment to each case; the average loss of service from each case of catarrh was six, and of cynanche nearly seven days.
Diseases of the Heart and Blood-vessels.- There is a slight increase in the ratio of these cases as compared with the previous year, and the invaliding rate is also slightly increased, but the ratio of mortality is precisely the same.
A marine of the Duncan died from rupture of an aneurism of the abdominal aorta. When serving in a previous ship he had fallen on deck and struck the lower part of his back, suffering a good deal of pain from the injury at the time, but not sufficient to prevent him doing duty subsequently however, when at head quarters after his return from furlough the pain increased to such a degree as to prevent him standing upright. In this condition he was sent to Haslar hospital where he was under treatment for several weeks, ultimately recovering so far as to permit of his embarkation in the Duncan. While on board that vessel he was frequently under treatment for what was looked upon as rheumatism, and he was ultimately invalided from the temporary hospital at Halifax for disease of the sacrum, and discharged to the Barracouta for a passage to England. The report of the surgeon of the Barracouta on the arrival of the man on board that vessel is as follows:-
"The invalid is of a lymphatic temperament and scrofulous diathesis, and appears to have lost flesh, the integuments being loose and the muscles flabby. He is weak and unable to stand, and has lost weight. He can lie on his back, abdomen, or side equally well, according to inclination. The expression of his countenance is haggard from much suffering, the face pale, the eyes sunken, and he feels depressed in spirits. The malformation of the sacrum exhibits an inclination forward of the lumbar region, and a protrusion backwards of the sacrum. Great tenderness exists; any movement of the legs or pressure brings on spasms which last for a few minutes, and acute pain, which is relieved by resting in one position; he has the power of movement, but it is attended with great suffering; he has no appetite; the tongue is foul; at present no irritability of the stomach exists; the bowels are often constipated, and he passes restless and sleepless nights."
He was received on board the Barracouta on the 19th of October, and for several days thereafter his condition did not appear to alter much, excepting that irritability of the stomach returned. On the 28th he had passed a quiet night, but pain returned in the morning, and he had a fainting fit. On the following morning he had another fainting fit, and about an hour afterwards, on sitting upright, he suddenly fell forwards and died. The following is the report of the autopsy:-
"Post-mortem examination took place five hours after death. Weather very stormy; blowing a gale of wind, drizzling rain, sea running high, thermometer 50°. The countenance had a calm expression, eyes sunken. The external peculiarities were, a striking protrusion of the sacral vertebrae, and flattening of the nates; the limbs were well formed without much loss of muscular development. No want of symmetry between the two sides of the body. The marks on the surface were arms and chest tattooed; scars of former wounds on inner side of right thigh, and between shoulders; marks of blisters over stomach and sacrum. The body was apparently well nourished, the only emaciation being about the gluteal region; the muscles, however, were loose and flabby.
"The posterior part of the sacrum was first examined, and showed a lateral displacement, there being a deviation laterally to the extent of three-eighths of an inch between the last lumbar, and the first sacral spinous processes; the lumbar vertebra; had also an incurvature. There was no disease of the bones, nor of the adjacent textures."
"On opening the thorax the right lung was found healthy, but light coloured, the left had numerous adhesions between the upper lobe and the pleura, with extensive serous effusion into the pleural cavity; the lung was crepitant, and had a healthy mottled appearance. The pericardium contained a large quantity of serum; the heart was natural, but had much fat on the surface. The cavity of the abdomen, especially in the left side, was filled with a large clot of blood, which adhered to the surfaces of the stomach, liver, spleen, and left kidney; it was of a firm consistence, and dark colour. The viscera were all in a normal condition, with the exception of an enlargement of the left kidney, which, however, on section, presented no abnormal appearance. On removing the viscera, a large, round, ruptured, aneurismal sac was discovered on the left side of the abdominal aorta, about three inches below the diaphragm, in such a position as to have pressed on the stomach, solar plexus, and bowels."
No mention is made of the appearances presented by the bodies of the lumbar vetebrae.
Diseases of the Alimentary Canal.- There is a reduction to the extent of 27·6 per 1,000 in the ratio of cases occurring under this head as compared with the preceding year. The ratio of cases of dysentery is only one-half of that of 1863. The ratio of invaliding, however, is somewhat higher, and the reduction in the death-rate is very small.
There was a fatal case of gastritis in the Peterel. It occurred in the person of an officer of very intemperate habits, who had been repeatedly under treatment for sharp attacks of gastric derangement, generally following extra indulgence, and marked by constant vomiting, anorexia, epigastric tenderness, and a great and altogether disproportionate amount of depression. Under the use of creosote and counter irritation, with stimuli cautiously given, and subsequently tonic treatment, he made fair recoveries. On the 8th of September he was placed under arrest for drunkenness, and this appears to have preyed on his mind, and produced great bodily and mental depression. On the evening of the 22nd of September he was reported to be unwell, and on being visited by the medical officer, was found to be very weak and emaciated, and in a state of most apathetic indifference to his condition. It appeared that he had taken no food worth mentioning since the 8th, and that for the previous few days everything taken had been rejected. The pulse was 92, soft, and intermitting once in about every forty beats. Although often urged, he had obstinately refused to apply for medical advice. He appeared to be slowly improving under the treatment to which he was subjected until the 26th of September, when vomiting returned accompanied with flatulence, and distressing eructations, and he ejected a quantity of dark grumous fluid. He slept a little during the afternoon after a large dose of morphia, and felt much better, but about four p.m. he suddenly fell into a state of deep collapse; from this he was roused by rapidly administered stimuli, but the fit recurred and he expired the same night. The above history and the following report of the postmortem examination of the body is from the surgeon of the vessel. "Autopsy six hours after death. Body: Extremities and fauces emaciated, but a thick layer of fat in the brain and abdominal parieties. Head not examined. Thorax: lungs healthy. The muscular tissue of the heart was pale and flabby, the valves and cavities were of normal appearance, but a very unusual amount of fat was found deposited over its whole external surface, especially about the base. Abdomen: The mucous membrane of the stomach generally was thickened and soft, and along the curvatures, red and vascular with extensive ecchymoses. About the lesser curvature ulceration appeared commencing. The liver was larger than the average, smooth and tawny coloured, and apparently fatty. The gall bladder was much distended. The intestines were healthy, and there was a good deal of fat in the mesentery. Both kidneys were about double the average size, their cortical structure pale, the tufts congested. The pelvis of the left kidney was much distended with urine, and contained about half a drachm of coarse gravel (oxalates). There was a small extravasation of blood in the right suprarenal capsule. The bladder was normal."
There were three cases of dysentery and thirty-nine of diarrhoea in the Liverpool. One of the dysenteric cases was of great severity. The patient first complained shortly after leaving Havana, having a day or two previously eaten a large quantity of rotten fruit. The stools, which from the first were muco-sanguineous, continued day after day unaltered in character, until at length debility was so great that he lost all power over the sphincter ani, and dark muco-sanguineous fluid ran constantly from him in bed. He became very much prostrated, and was for some days troubled with hiccup. Medicine appeared to have no effect whatever on the disease. Nourishment and wine were freely administered throughout. Hydrocyanic acid checked the hiccup, and after being for some time in a very precarious state he began to improve, the first favourable symptoms being a desire to get out to stool, and some returning ability to retain the discharge, the change in which was first to matters of a bilious, and then of a feculent character. Convalescence was rapid, and not checked by any tendency to relapse, or in the disease to become chronic.
There were two cases of dysentery and eighty-six of diarrhoea in the Phaeton. Sixty-one of the cases of diarrhoea occurred during the Michaelmas quarter of the year when the vessel was at Fortress Monroe, They co-existed with a large number of cases of ephemeral fever, and both affections were in all probability dependent upon the high rate of temperature which prevailed at the time, the thermometer on the lower deck being for days at 90° and upwards. The surgeon (Dr. John T. Caddy) of the Phaeton says:-
"In the treatment of the diarrhoea cases, I considered there as nature's efforts at elimination, and gave freely ammonia and chlorate of potash, with laudanum. In some cases of diarrhoea there was nausea and vomiting, profuse perspiration, quickened pulse, headache, and abdominal pain. In such cases the citrate of ammonia taken in a state of effervescence was found useful in allaying the irritability of stomach; wine and arrowroot were given, and a lemonade with the chlorate and nitrate of potass to relieve thirst. Sinapisms were also applied to the abdomen. The bowels being quieted and capable of bearing tonics, the treatment of the debility succeeding diarrhoea did not materially differ from the management of the convalescence from fever. These diarrhoea cases some times take on a dysenteric character. With the advent of dysenteric symptoms I gave in small and frequently repeated doses, grey powder, camphor, Dover's powder, trisnitrate of bismuth, and occasionally turpentine. A farinaceous dietary with a little wine, and rice water to relieve the thirst, were ordered. With the active symptoms checked Dover's powder with bismuth proved useful. The bowels quieted, the treatment of debility was often benefited by the mineral acids, with cod liver oil and morphia at night."
Two deaths from dysentery occurred, one in the person of a marine, and the second in a warrant officer attached to the Terror. In the former instance the disease was complicated with hepatic abscess. The man died in hospital to which he had been admitted after being about a fortnight under treatment. Before admission the stools contained blood and pus, but in hospital no pus was observed and blood only in a few of the stools first passed. There was slight general tenderness and pain of abdomen, but not specially referred to the hepatic region. The pulse ranged from 80 to 90. Under treatment by dilute sulphuric acid and the application of sinapisms and turpentine epithems to the abdomen, he appeared to improve, the abdominal tenderness subsiding, and the purging decreasing in frequency. On a sudden, however, symptoms of collapse with much abdominal pain set in, and he died on the following day. On post-mortem examination of the body a large abscess was discovered on each lobe of the liver; that in the right lobe had burst into the peritoneum, producing inflammation of that membrane and death. No ulceration of the intestines or other lesion was found.
1n the case of the warrant officer the disease supervened during convalescence from yellow fever. He was progressing favourably when slight symptoms of dysenteric diarrhoea set in with griping. These speedily assumed a very acute character; the stools were very frequent, muco-sanguineous, and accompanied with much tenesmus and griping. Loss of control over the sphincter ensued, large sloughs of mucous membrane were passed from the bowels, and he ultimately sunk exhausted.
The fatal case of dysentery in the Vesuvius occurred in the person of a marine who had served much in tropical climates, and had suffered from dysentery and ague in India. The dysenteric symptoms were being much subdued, when ascites and anasarca of the lower extremities set in, and these ultimately carried him off in Haslar Hospital, to which he had been sent on the arrival of the ship in England.
There were twenty cases of dysentery, and 662 of diarrhoea under treatment, in the squadron, throughout the year; each case of the former disease being on an average thirty-five days, and of the latter, between five and six days under treatment on board ship and in hospital.
Disease of the Liver.- There is a trifling reduction in the ratio of cases of diseases of the liver, as compared with the preceding year, and there was no loss to the service, by invaliding, from them. Two deaths, however, occurred under this head. One of these was in the person of an officer of the Buzzard, of intemperate habits, who had suffered from climatic disease in China, where he had served, chiefly in gun-boats, for upwards of four years. He was placed on the sick-list, at New Orleans, complaining of general debility, which he had felt gradually increasing for some months previously. There was loss of appetite, slight morning cough, wandering pains over the limbs, occasional vomiting, and a general feeling of coldness. He stated, that he had observed a wasting of the lower extremities lately. He rapidly became worse, oedema of the lower extremities set in, and he appeared to be sinking when he was discharged to the naval hospital at Bermuda. On admission there, the following report of his condition was made by the Deputy Inspector General (Dr. W.R.G. Smart).
"Patient much emaciated and very weak, in a state of extreme exhaustion; face pallid; sub-jaundiced; leucocythemic; hepatic hardness, and fulness extend low; no tenseness; no fluctuation; pulse 120, quick and feeble; feet oedematous; surface cold; frequent twitchings of features; eyes vigilant; pupils dilated; manner anxious; coherent when spoken to, but vacillating when not roused; urine loaded with brick-dust deposits, lithates." No improvement whatever took place in his symptoms, exhaustion increased, he became semi-comatose, and died on the seventh day after his admission into hospital. The following appearances were found on post mortem examination of the body. " Body attenuated, in rigor mortis; muscles of thorax and abdomen wasted, and apparently converted into adipose matter. On opening the abdominal cavity, a large quantity of gas escaped. Peritoneum of healthy appearance, but dry, without even a serous halitus. Omenta, mesentery, and appendices epiploicae loaded with fat. Kidneys imbedded in the same material.
"Liver enormously enlarged, weighing eight pounds and a quarter. Specific gravity increased; edges and angles rounded off; surface glossy; substance pale, waxy, and firm on pressure. On cutting into it, several oil globules adhered to the knife, and others exuded from the sides of the incision. Very little blood escaped, and the sides of the interlobular veins seemed to be in contact, no gaping orifices being observable. The gall-bladder was distended with pale bile. The kidneys were normal; the spleen slightly enlarged and friable. The stomach and intestines distended with dark fluid, ingesta, which had not undergone much change. The heart was small, with an adipose coating under the serous lac; the muscular fibres pale and easily broken down; the walls thin; the valves healthy. The lungs were healthy. The cranial cavity was not examined."
The other death occurred in the person of a stoker of the Steady, who laboured under cirrhosis of the liver, accompanied with ascites. Two gallons and a-half of fluid were removed from the abdominal cavity after death.
Diseases of the Genito-Urinary Organs.- There was a slight increase in the ratio of cases coming under this head, as compared with the preceding year; but the loss to the service by invaliding; occasioned by them was much less. Unfortunately, the increase of ratio is occasioned chiefly by the greater prevalence of syphilis on the station, and this has been of a progressive nature since 1859. In that year the ratio of cases of syphilis was 20·8 per 1,000 of mean force; in 1860, it was 31·1; in 1861, 35·8; in 1862, 36·3; in 1863, 48·5; and this year it was 52·4. The total number of cases of syphilis under treatment was 317, and the number of days' sickness on board ship and in hospital, occasioned by them, 13,002, which gives an average of forty-one days, or, as nearly as may be, six weeks' treatment to each case, a most serious loss to the public service. There is no reason why this should be so. Most of the disease is contracted in our own possessions, chiefly at Halifax and Kingston, Jamaica, where there ought not to be any difficulty in establishing such a system of surveillance of prostitution as would check the progress of this foul and destructive form of disease. The surgeon of the Peterel says:-
"Nearly all the venereal cases were contracted at Port Royal or Kingston. These places, until lately almost free from disease, have now a rapidly augmenting amount, and a bad form of syphilis is commonly met with. When the well known, almost promiscuous relation of the sexes carried on in Port Royal, is considered, its future, as a hot-bed of infection, may well. be looked forward to with apprehension. With a population entirely dependent on the naval and military, this growing evil might, I think, be checked by legislative means."
Rheumatism.-There was an increase of about 5 per 1,000 in the ratio of cases of this disease, as compared with the preceding year; and there was also a slight increase in the ratio of invaliding. The death-rate, however, was precisely the same as in 1863. The total number of cases under treatment was 487, and the total days' sickness on board ship and in hospital, occasioned by them, 7,238, which gives an average of nearly fifteen days' treatment to each case.
Wounds and Injuries.- Four men sustained fatal fracture of the skull by falling from aloft, and an officer had his skull fatally fractured by a heavy block striking it. A man was killed by being jammed between the metal yoke of the rudder and the ship's stern. General paralysis and death were occasioned in one instance by a man falling into the hold, and sustaining severe injury of the spine; and one man, who was killed by falling from aloft, sustained compound fracture of the bones of the face, and other severe injuries.
Two men were drowned by falling off the dockyard quay, at Bermuda; and one was drowned while bathing there. One man was capsized in a canoe, and drowned; one was drowned in Halifax harbour, and another at the same place, in assisting to get the Vesuvius off the patent slip. Two men were drowned in attempting to swim from their ship, and two men fell overboard and were drowned. A wardroom steward was drowned, but under what circumstances is not stated. In one fatal case the cause of death has not been ascertained.
The total number of deaths from wounds and injuries of various kinds and from drowning was twenty, and from disease seventy-seven, making a total of ninety-six deaths from all causes, which is in the ratio of 15.8 per 1000 of mean force, and therefore rather more than double the death-rate of the preceding year. The increase is altogether occasioned by the epidemic of yellow fever at Bermuda, more than one-half of the deaths from disease being from that cause alone.
Invalided.- Six men were invalided for the sequelae of fever; eighteen for diseases of the brain and nervous system, two-thirds of these being epileptic subjects; thirty-three for diseases of the respiratory organs, of whom twenty-five were labouring under pulmonary consumption; twelve for functional and organic diseases of the heart and blood-vessels; eight for diseases of the alimentary canal; eleven for diseases of the genito-urinary organs; twelve for rheumatism; six for diseases of the bones and joints; sixteen for diseases of the skin and cellular tissue, eleven of these being cases of obstinate ulcer; six for dyspepsia; fourteen for wounds and injuries of various kinds; and three for hernia; making a total of 150, or in the ratio of 24·7 per 1,000 of mean force, which is a little below the ratio of invaliding of the previous year.
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