► Royal Navy ► Naval Surgeon South East Coast of America ◄► Table 5
Statistical Report of the Health of the Navy - 1864.
PACIFIC STATION
THE squadron on this station consisted of twelve vessels, of which five were frigates, five were sloops, and two were store ships permanently stationed, one at Valparaiso, the other at Callao. Three of the frigates were of the fourth rate, one of the fifth, and one of the sixth. Besides this force there was a detachment of marines on the island of San Juan. With one exception the returns from all the vessels are for the whole year. The mean force corrected for time was 2420, and the total number of cases entered on the sick-list 3638, which in the ratio of 1503·3 per 1000 of mean force, being a considerable increase as compared with the preceding year.The daily loss of service from fevers was in the ratio of 2·9 per 1000: from diseases of the organs of respiration, 4·4; from disease of the heart and blood-vessels, 0·9; of the alimentary canal, 2·0; of the liver, 0·2; of the genito-urinary organ, altogether of venereal origin 7·9; from rheumatism and diseases of the bones and joints, 5·1; from diseases of the special senses, 0·4; from diseases of the skin and cellular tissue, 12·4, of which ten were occasioned by boils, abscesses, and ulcers; from dyspepsia and debility, 1·9; and from wounds and injuries, 6·0; making a daily loss of service equal to about 115·2 men, or in the ratio of 47·6 per 1000 of mean force, which is slightly below the sick-rate of the previous year.
PACIFIC STATION
Fevers.- One hundred and fifty-four cases of primary fever were under treatment in the squadron during the year, of which three terminated fatally. The total number of days' sickness from these cases was 1791, so that each case was, on an average, between eleven and twelve days under treatment.
There were twenty-one cases of primary fever in the Alert, but eighteen of these were of a very ephemeral nature, the average duration of each on the sick-list being only two days.
The surgeon (Surgeon F.W. Davis) makes the following remarks with reference to the employment of quinine in these cases:-
"In connection with the cases registered as ephemeral and remittent fevers, I have to remark that the distinctions between them are not specific, the differences existing less in the cases than in the mind of the observer, who often cannot say where one form ends and the other begins. In studying the natural history of disease, our best attempts at classification are arbitrary and imperfect. I continue to place the highest confidence in the treatment of these fevers by quinine. In 1854 I gave quinine in two-grain doses every morning to the crew of H.M.S. Minx, when employed up the lagoon and rivers of Lagos in West Africa. The men had very heavy work, were often on shore, and indulged freely in drinking and excesses of other kinds. Of the forty-seven men that made up the Minx's complement forty-three were seized with fever. There were only two deaths, and I was disposed to attribute the small mortality to the previous use of quinine. In the Niger expedition, under Dr. Baikie, in 1856-7-8, of which I was medical officer, we had no severe case of fever among the naval men; occasional attacks of intermittent fever were not uncommon, but they were always cut short by the quinine after the usual preliminary treatment which common sense dictates. The only deaths during that time were among those in the employment of a private firm, who did not take quinine as a prophylactic, and who were not under my care. Before that, in the Philomel, Scourge, and Hecla, in the coast of Africa, and since then in the Spiteful in the West Indies, I have seen enough to convince the most sceptical of the value of quinine in the treatment of fevers, intermitting, remitting, and yellow . . . . . I think the addition of sulphuric acid to quinine is a mistake. The disulphate is more apt to disagree with the stomach than the simple sulphate is, and bad wine is not a good menstruum for the exhibition of any drug. Sulphate of quinine stirred up in a glass of water, with perhaps a little lime juice squeezed into it, will rarely cause nausea, while quinine with sulphuric acid will cause nausea, if not vomiting, in all cases where the stomach is irritable, i.e. in nearly every case of fever."
Of the three cases not of an ephemeral character, one was of the remittent type, one was a low form of continued fever complicated with glandular swellings, and one was a case of enteric fever contracted at Valparaiso, where it is stated the disease prevailed on shore. The man had "slept on shore, and in all probability imbibed the poison in the dirty, ill-drained, and foul-smelling tenements of the ’maintop,’ a part of Valparaiso where sailors most resort."
There were three cases of primary fever in the Bacchante, and the average duration of each on the sick-list was sixteen days. No further information in connection with. them is given in the returns from this ship.
There were twenty-two cases of primary fever in the Cameleon, ten of which were of an ephemeral character, and twelve of the remittent type. The average duration of each of the former cases on the sick-list was between three and four, and of the latter between five and six days. The surgeon (Dr. Alex. Fisher) of the Cameleon says that the cases of remittent fever were of considerable severity, although only so few days on the sick-list:-
"They were characterised by vertigo, headache, nausea, chills (rather than rigors), and Pyrexia; the tongue was generally clean, and reddish towards the edges. These symptoms were accompanied with some bilious derangement and great debility, the whole indicating much depression of nervous power. The bowels were commonly inclined to be loose, although sometimes the opposite was the case. These cases chiefly occurred when we were on the passage down the coast of Mexico and Central America, when we were exposed to great heat and moisture."
In the Charybdis, which was employed during nearly the whole year on the coasts of Mexico and Central America, there were twenty-four cases of primary fever. The average duration of each case on the sick-list was about nine days. Although not of a serious character, they left the patients in a very low and depressed state for some time.
The cases of primary fever in the Columbine were of little or no importance, being quite of an ephemeral nature.
There were sixty-four cases of primary fever in the Leander, several of which were of great severity, and two proved fatal. More than one-half of these cases occurred during the Christmas quarter of the year, when the fever assumed an epidemic character. They were chiefly of the remittent type, but several of them presented decided enteric symptoms. The average duration of each case on the sick-list was nearly eighteen days. The surgeon (Surgeon W.H. Clarke) of the Leander makes the following remarks on some of these cases:-
"Towards the close of the year, remittent fevers assumed an alarming position. Sporadic cases of fever the ship's company have always been subject to. In almost every acute febrile disease or severe catarrh, as also in many trivial cases of diarrhoea, the powers of nutrition were very low indeed, and it was surprising to observe the listless manner in which the men, when convalescent, moved about. Strong, active-minded, and well-conducted men all complained of weakness and debility; and though desirous of getting back to their duties on deck, such was the extent of asthenia, that for a long time they were wholly unable for it, requiring a goodly supply of wine and liberal diet, with mineral tonics, to restore healthy and vigorous blood to the system. During the first six months of this report only eight cases of continued fever were under treatment as fresh entries, requiring over 400 days' care on the sicklist. This arose from the period of convalescence being so very protracted. The climate at this time was peculiarly depressing to these patients, being hot during midday and generally damp and heavy in the mornings and evenings. . . . In the last three months of the year the total number of cases of fever was forty-seven, requiring a little over 600 days' treatment, the average duration of each case being fourteen days, being in marked contrast with those of the former period. Thirty-six of these are classed as remittent fever, nearly all of them having distinct remissions in the afternoon, to be again subject to an accession of heat of skin, headache (in some cases torpor), increased thirst, and vascular action in the evening. This onset of fever assumed an epidemic form on board, about the middle of November. No assignable cause could be discovered for it in the ship herself. From the 14th, when it broke out in a virulent concentrated form, to the 23rd of the month, twenty-five cases appeared, and four of febrile catarrh. A few days prior to this the atmosphere became hazy, very damp, and cold, the adjoining island of San Lorenzo being nearly hidden from sight, with the thick, misty fog or cloud surrounding it. Where the ship lay at anchor we were well to windward of Callao and the swamps surrounding it. Ahead of us lay the hulks and vessels of the Steam Navigation Company, and on the shingle beach to windward of us all, was the Company's station for factory, coal-store, dock, and victualling yards, all around this being a high, barren, and dry shingle beach with no deposit nor drain near it for over half a mile, and even then to leeward of us all. About the same time that this fever broke out with us, influenza and diarrhoea appeared at the factory and amongst the crews of the mail company's vessels, and on the 20th of November they had five cases of severe bilious remittent fever. Was the exciting cause of this so sudden and severe mischief local, atmospheric, or due to land miasma? The River Rimac and the neighbouring rivulets were largely increasing, owing to the increased temperature of approaching summer melting the snow on the Cordillera range. The dead animals lying about in the hitherto dry valley and plains adjoining the sea border, covered with the decayed vegetable matter of the past year, were now well supplied with moisture, and decomposition had set in. The water supplied by pipes to the town and shipping, hitherto bright and clear, became turbid and whitish in appearance. In Callao and Lima, influenza in a severe form, cynanche, neuralgia, and intermittent fever, became much more prevalent than usual. Believing that we were exposed to a vitiated stratum of atmosphere, a change to sea was recommended, and on the 19th we weighed, and stood out under steam, and having obtained an offing, gave up steaming, and sailed. The immediate effect of getting into the trade wind was most gratifying; not only were the daily admissions to the sick-list at once checked, but those attacked as rapidly and markedly improved, and the whole ship's company became enlivened and cheered." . . . . "Nearly all the cases were suddenly struck down, attacked either with vomiting or purging, violent headache, sweating, and depression; in others vascular excitement, as shown in the flushed face, suffused eye, rapid pulse, and alarmed manner, would almost simulate drunkenness; but next day the loaded tongue, anorexia, restlessness, headache, and depression appeared. The treatment consisted in the exhibition of calomel at first, with saline purgatives and diaphoretic mixtures; but the quinine was early and largely resorted to, the local symptoms affecting the head, stomach, and bowels were carefully watched and treated as they arose; beef-tea, fresh soups, wine, and brandy were generally used, and as the tongue cleaned and remained moist under their use, they were the more steadily persevered in. The fifth or seventh day was generally critical; debility during convalescence was very marked, and in some it assumed a serious character, and for a long time retarded the return of the patient to duty."
Two deaths from fever occurred in this vessel some time prior to the outbreak of the epidemic. In both these were marked enteric symptoms, and in one petechiae appeared on the chest and arms. Both cases occurred while the vessel was lying at Callao.
In the Nereus, permanently stationed at Valparaiso, there were three cases of fever, the average duration of each case on the sick-list being about fourteen days. No remarks appear in the returns from the vessel with reference to these cases; but the medical officer (Assistant Surgeon W.D. Dillon) states, that on shore, typhoid fever had assumed an epidemic form, and had occasioned some mortality. He further adds:-
"Typhus fever of a very mild type, called "Chefalonga" by the natives, has been very common. Few spots appear, but the debility comes on very rapidly, and in several cases that I have seen, the patients have lain for days, and sometimes weeks, in almost an unconscious state, answering rightly, however, to all questions put to them in a loud voice; there is seldom delirium or muttering. If seen in time, and properly treated, it is rarely fatal. There is seldom a marked crisis, and when sweating occurs, the symptoms are perhaps slightly aggravated. The duration of the disease is from fifteen to twenty days. In the rural districts the treatment adopted succeeds very well. An emetic is given at first, and immediately sinking sets in, an admirable tonic infusion of a plant called "Canchilagua," a bitter, and slight diaphoretic."
There were six cases of primary fever in the Shearwater, one of which proved fatal in hospital at Valparaiso. In that instance the disease, as classed by the medical officer (Surgeon E.H. Evans) of the vessel as one of pure typhus. He says: "Delirium in all its stages set in, and the debility was extreme. The morbilliform spots were well marked, and the total absence of bowel irritation distinguished it from typhoid. This was one of the most fatal cases of typhus witnessed, the patient being, so to speak, ’knocked down’ at once, and killed by the virulence of the poison." The other cases appear to have been of an ephemeral character.
There was only one case of primary fever in the Tribune. It was of the remittent type, and mild in character. The patient was eleven days under treatment.
Eruptive Fevers.- The only entry under this head was a single case of roseola, which appears in the returns from the Alert, and was doubtless sympathetic of irritation caused by the use of copaiba in the treatment of gonorrhoea. The rash disappeared on the third day.
Diseases of the Brain and Nervous System.- There is a slight increase in the ratio of cases under this head, as compared with the preceding year, but there is a trifling decrease in the ratios of invaliding and mortality.
There were five cases of delirium tremens in the squadron, one of which occurred in the person of an officer; one in a petty officer; one in a seaman; and two in bandsmen. In the case of the seaman, the disease proved fatal. He was of exceedingly intemperate habits and broken-down constitution; and having broken his leave for a week, at Valparaiso, returned on board, labouring under the usual symptoms of a prolonged debauch. These speedily assumed the character of delirium tremens, the delirium being of the most violent character, and terminating in convulsions and death.
Diseases of the Organs of Respiration.- The ratio of cases under this head is lower than obtained in the preceding year. The invaliding rate is higher, however, and the death-rate more than double that of 1863. Two-thirds of the mortality, however, was from phthisis, and as remarked on a former occasion, with reference to that form of disease on this station, the death-rate will be much influenced by the opportunities that may be afforded of removing those labouring under it before it has advanced to such a stage as to render removal impossible or unadvisable.
There were forty cases altogether of inflammatory disease of these organs; twenty-three appear as cases of bronchitis, eleven pleuritis, and six pneumonia.
There were twenty cases of inflammatory disease of the lungs in the Sutlej; of these, thirteen were cases of bronchitis, five of pleuritis, and two of pneumonia. Each bronchitic case was, on an average, about nine days under treatment; each pleuritic case between eleven and twelve days; and each case of pneumonia about twenty-three days.
There was a fatal case of broncho-pneumonia in the person of an officer of the Devastation, who had long suffered from symptoms indicative of advanced disease of the liver, and it is stated, had a slight tendency to ascites. He was discharged to the Naval Hospital at Esquimault, where he was suddenly seized with pneumonic symptoms, under which he sank in a few days. No examination of the body was made after death, but it is conjectured that abscess of the liver, passing through the diaphragm and acting upon the pulmonary structure, was the immediate cause of the disease.
A fatal case of pleuritis appears in the returns of the Leander: it occurred in the person of a petty officer, and the symptoms, as detailed, are certainly more those of thoracic aneurism than of disease of the pleura. The patient, a very pale and emaciated man, had been on shore at a cricket match, where he appears to have over-exerted himself; on his presenting himself for treatment, he complained of severe lancinating pain in the back and chest, accompanied with hurried breathing and great anxiety of countenance; the pulse was rapid, the skin cool, and he had no cough. Under the treatment to which he was subjected, he was somewhat relieved during the evening. On the following day, however, he had a violent paroxysm of pain, which was only relieved by the exhibition of chlorodyne. Next day he expressed himself better, but in the evening was attacked with a sudden fit of dyspnoea, accompanied with a faltering pulse and other symptoms of sinking; again he experienced relief from the measures adopted, and that night he lay quiet, the breathing was much better, and the skin cool; about three o’clock of the following morning, however, he was seized with a sudden rigor, and turning over in his cot, he brought up a large quantity of arterial blood, and in a few minutes expired.
The following report of the appearances found on postmortem examination of the body, are by the surgeon. of the ship:-
"Autopsy, eight hours after death. Body greatly emaciated. On the chest being opened, there were found the remains of extensive old adhesions of the right pleura, both posteriorly and inferiorly. The left lung was highly engorged with blood, in fact solidified. The heart was enlarged and fatty; the pericardium natural; the trachea and large bronchi were filled up with clots of dark blood; the liver enlarged and very soft; gall-bladder healthy; the cardiac portion of the stomach slightly congested; the other abdominal viscera healthy. The ruptured vessel could not be detected."
It is to be regretted that a more careful examination was not made in this case, as it would doubtless have revealed the true nature of the disease.
A marine of the Shearwater died of bronchitis in the hospital at Valparaiso; and a seaman of the Sutlej died of pneumonia. In the latter instance the disease ran an unusually rapid course, but otherwise there was nothing peculiar in these cases.
Catarrhal affections were very prevalent in the Leander in the Lady, Midsummer, and Christmas quarters of the year. The average duration of each case on the sick-list was about six days and a half; a few were of considerable severity, and in one or two instances they were followed by phthisical symptoms, for which the patients were subsequently invalided. There was no epidemic catarrh in any vessel of the squadron. In most instances the disease presented the ordinary features of a common cold, and was attributable to exposure to atmospheric vicissitudes.
Diseases of the Heart and Blood-vessels.- There is a considerable increase in the ratio of cases admitted under this head as compared with the preceding year, which is almost altogether referable to the excess of haemorrhoidal and varicose diseases of the veins. The ratios of invaliding and mortality differ only fractionally from those of 1863.
A fatal case of pericarditis, uncomplicated with any rheumatic affection, occurred in a seaman of the Leander, and was attributed to exposure to wet and cold. The symptoms from the first were of a very unfavourable nature, and he died of the disease on the ninth day. On post-mortem examination of the body, the pericardium was found to be distended with nearly two quarts of amber-coloured serous fluid and its surface coated with lymph, presenting a honeycomb appearance.
A death from ulceration and rupture of the pulmonary artery, or one of the pulmonary veins, took place in the person of a petty officer of the Sutlej. He was a very powerful man, had never been ailing, and was of steady, sober habits. He was on leave at Esquimault, and after walking about a mile from the ship stopped with some of his companions at a public-house, where they remained sitting for about two hours, when he rose suddenly exclaiming that he felt ill, and soon after fell to the ground. He retained his senses, and for a few minutes was able to answer questions. He was at once taken up, and being conveyed to a carriage was driven hastily towards the ship. Before reaching the boat, however, life was extinct. On post-mortem examination of the body "a large quantity of blood was found in the mediastinum, which had escaped from a small perforation in a pulmonary vessel, seemingly the result of circumscribed ulceration. Not the least trace of violence was anywhere perceptible, and the heart and large vessels, excepting that just mentioned, were perfectly healthy. The brain and the thoracic and abdominal viscera were also healthy."
Diseases of the Alimentary Canal.- Although there is a decided increase in the ratio of cases under this head, as compared with the preceding year, the increase is fortunately attributable to the greater prevalence of the less formidable varieties of disease, viz., diarrhoea and colic. The ratio of invaliding is consequently less, and there was no mortality.
A stoker of the Cameleon was invalided for chronic gastritis. He had been much subject to rheumatic affections, and while on the sick-list for an attack of that nature he was seized with nausea, and pain in the left hypochondrium. The countenance was anxious, the breathing slightly hurried, the bowels confined, and the tongue furred, yellow. The pain was described as being of a "burning" character, increased even on slight pressure, and on eating. The appetite was deficient, and the irritability of stomach so great that nothing could be retained. Little or no amendment resulted from the variety of treatment to which he was subjected, although occasionally he derived much temporary relief. The inability to retain food, however, soon induced great weakness and emaciation, which were accompanied with tendency to syncope and hysterical attacks. Under these circumstances he was invalided and sent home, there being no prospect of his improving on the station. Referring to the cases of diarrhoea that occurred in this ship, the surgeon remarks: "The principal period for the appearance of these cases was from May until August, that is, the period from the ship's arrival in the hot climate, off the coast of the ’Tierra Caliente,’ until the men got acclimatized or accustomed to the heat. All might have been classed as diarrhoea, but in those entered as hepatic derangement, the affection of the liver was one of the most prominent symptoms, and it was from the overwork thrown on that organ that they arose, as might be expected in such a sudden change of climate. These were characterised by headache, bilious vomiting, yellowness of the tongue, pain in the epigastrium and right hypochondrium, in addition to the diarrhoea, which was sometimes most severe." A single case of dysentery occurred in this ship in an old subject of the disease.
Four cases of dysentery and four of diarrhoea appear in the return from the Shearwater. The average duration of each case of dysentery on the sick-list. was fourteen days, that of diarrhoea only three. Two of the dysenteric attacks occurred in one man, a confirmed drunkard.
Diseases of the Liver.- The ratio of cases under this head is double that of the previous year. This, however, is altogether attributable to the entry of a number of cases as "hepatic derangement" in the returns from the Cameleon. They have been already alluded to in connection with diseases of the alimentary canal, and seem to have been cases of what is ordinarily termed bilious diarrhoea. One man only was invalided for disease of the liver, and there was no death.
Diseases of the Genito-Urinary Organs.- The ratios, both of cases and of invaliding, are very nearly the same as in the preceding year. During the present year there is a fractional decrease in the former and a fractional increase in the latter.
The vessels which suffered most from venereal diseases were the Alert, Leander, Shearwater, and Sutlej. Most of the disease was contracted, as heretofore, at Valparaiso, but much of that in the Sutlej made its appearance after general leave at Esquimault, Vancouver's Island. With reference to this class of diseases, the surgeon of the Sutlej remarks:-
"Venereal complaints were again by far the most numerous; at least the greatest loss of service resulted from these disorders.
Under the heads syphilis, gonorrhoea, and orchitis, there occurred 1513 days’ sickness, nearly one-fourth of all the sickness for the year; but even that did not comprehend all the mischief caused by the venereal virus, for several other diseases, such as phthisis, rheumatism, and glandular swellings, were excited, protracted, or complicated by syphilis. Its ramifications indeed are so numerous, that the more closely it is investigated, the more difficult it appears to determine the limits of the venereal poison; and I am persuaded that it would not be too much to assert that one-third of the loss of service from all complaints during the year was due, directly or indirectly, to the syphilitic virus. Unfortunately this poison is not confined to one locality; . . . . . whether amidst the bustle of commerce in Valparaiso, the seductive indolence of Tahitian sensuality, or the semi-nude savages inhabiting the primeval forests of Vancouver, the loathsome disease is propagated with the same sad uniformity."
The surgeon (Dr. Robert Irvine) of the Tribune states that "when at Valparaiso, the French and Spanish ships of war were literally crippled from syphilis;" and the surgeon of the Leander, speaking of the same locality, says:
“Prostitution exists here to a very great degree, and especially amongst the half-caste portion of the inhabitants. No system of registration exists, nor any police surveillance, and as a consequence, in those parts of the town frequented by marines and seamen, both of the Royal Navy and merchant service of all nations, these unfortunate women congregate, and are diseased to an alarming extent. As there is no surveillance, so there is no hospital accommodation for them, and the result is that they ply their trade and spread the poison as long as nature does not cause them to succumb; hence syphilis and gonorrhoea, with all their sequelae and train of manifold evils, have full sway here."
This officer bears testimony to the freedom from venereal diseases enjoyed by ships' companies stationed at Callao. Referring to the Leander, and to the amount of disease contracted at Valparaiso, he says:-
"Now to this is contrasted the long stay the vessel made at Callao, viz., eight months, where special and privileged leave was given weekly, and general leave once, and yet only three cases of primary syphilis occurred, and these were traced to women who had arrived in Callao from Chili. At Callao there is no law, municipal or otherwise, to control or regulate the females so exposing themselves, but there is at Lima a species of native Lock Hospital, where they are admitted and healed when affected with disease."
The medical officer (Assistant Surgeon H.A. Close) of the Naiad store-ship permanently stationed in the Bay of Callao says, with reference to this subject:-
"Venereal disease is, as a rule, but rarely seen in Callao or Lima. I know not how to account for its absence. The natives are certainly not noted either for cleanliness or morality, and as there is frequent and rapid communication with Valparaiso (where the disease is always raging) it seems strange that Callao should remain exempt. Lately a few cases of syphilis have made their appearance, both on shore and among the shipping. It is most probable that they were brought from Valparaiso by a Chilian frigate which was sent, together with a regiment of volunteers, to assist the Peruvians against the Spaniards. The almost entire absence of venereal disease at Callao is worth notice, as it would be a great, advantage to ships newly arriving on the station if they proceeded there at once, and it would only prolong the voyage six or seven days. At present all ships call first at Valparaiso, the men are given leave, and the consequence is that numbers contract syphilis, and are thus not only rendered incapable of present duty, but lay the foundation of various affections, which in very many cases lead to their being invalided."
There can be no question of the value of such facts as these, considering the important bearing they have upon the selection of the most eligible localities for granting general leave to ships' companies on this station.
Rheumatism.- The unenviable notoriety which this station had maintained for this form of disease seemed likely to be affected by the returns for 1863, when the ratio of cases under treatment was not only lower than that of the year preceding it, but lower than any of the previous seven years. During the present year, however, the station has returned to its normal condition, the ratio of cases being 109·5 per 1000 of mean force, which is 29·4 per 1000 in excess of the previous year and 4 per 1000 above the average of the station taken for a period of nine years. The total number of cases under treatment was 265, and the total number of days’ sickness from them on board ship and in hospital was 4,114, which gives an average duration to each case of between fifteen and sixteen days. The rate of invaliding also is more than double that of the preceding year.
There was a large number of cases of this disease in the Sutlej, respecting which the medical officer says:
"Rheumatism and diseases of the joints were of frequent occurrence; a large proportion of sickness was due to these complaints, and cases of a protracted and lingering nature were common. The station indeed is notorious for the frequency and obstinacy of the rheumatic attacks, and my short experience only corroborates its bad repute. Many of the cases, however, were obviously complicated with a syphilitic taint, and in other cases, where this condition was repudiated by the sufferer, there was still broad ground for suspicion."
In the Leander also, which had the largest number of cases of rheumatism, many of them are stated to have been of syphilitic origin, and this may be said of some of the cases that occurred in every ship of the squadron. This cause alone, however, by no means accounts for the frequency of rheumatism on the Pacific Station; although it may indicate the most common form in which constitutional syphilis is likely to be developed in that climate. Almost every medical officer on this station, who makes any observation at all upon rheumatism, remarks upon the effect of the climate as the exciting cause of the disease. The surgeon of the Cameleon says:-
"Rheumatism stands second in the number of days' sickness during the year. Of the cases entered, one-half were in the first quarter, and owed their origin to similar causes as the cases of catarrh. The well-known tendency of the climate of the Pacific to originate and aggravate cases of a rheumatic character made the treatment of the cases tedious, and two required to be invalided."
And the medical officer of the Devastation remarks:-
"This disease is one of the greatest troubles on the Pacific coast. It rarely takes the acute form, but principally attacks the lumbar and sciatic nerves, and is very obstinate in its character."
A considerable number of the cases in the Devastation occurred while the vessel was cruising off the coast of Mexico, and are attributed to exposure to the sun and wet, while the men were employed on boat duty.
Entozoa.- There was a considerable increase in the ratio of cases under treatment for different forms of intestinal worms, as compared with the preceding year. Almost all the cases, however, that are tabulated occurred in the Alert, and concerning them the surgeon remarks:-
"The number of cases of worms observed during the year was twelve, ten of cestoid and two of nematoid worms. In every instance but one the patients had been in the habit of eating raw pork, or uncooked sausages, and in the one exceptional case the man said that, whatever he might have done before, he was quite certain he had not eaten any uncooked pork for twelve months. The oil, or aetherial extract of the male fern, invariably caused the expulsion of the tape-worm, sometimes complete, but mostly in fragments. After one or two doses of the male fern the cure was completed by the tincture of the muriate of iron, in infusion of quassia. To the men suffering from lumbrici, turpentine was given with good effect."
Several of the men affected with tape-worm in this vessel had previously suffered from it while serving on the Mediterranean Station.
Wounds and Injuries.- Three men fell from aloft, sustaining fatal fracture of the skull. In one of these cases the man fell overboard into a boat that lay alongside, striking his head against the gunwale.
There were seven deaths from drowning. One of these was occasioned by the swamping of a punt in a river, one was found drowned in the harbour of Esquimault, and five fell overboard.
A petty officer on detached service committed suicide by shooting himself through the head while labouring under delirium tremens. There were thirty-two deaths altogether, which is in the ratio of 13·2 per 1,000 of mean force, being an increase of 3·6 per 1,000, as compared with the previous year. This is altogether owing to the greater proportion of deaths from phthisis.
Invalided.- Five men were invalided for ague; five for diseases of the brain and nervous system; nineteen for diseases of the organs of respiration, of whom fifteen were labouring under phthisis; twelve for diseases of the heart and blood-vessels; one for organic disease of the stomach; one for disease of the liver; twelve for diseases of the genito-urinary organs, almost all of which were of venereal origin; fifteen for rheumatism; two for diseases of the bones and joints; one for disease of the special senses; one for ulcer; three for different forms of dyspepsia; five for wounds and injuries of various kinds; and six for hernia; making a total of eighty-eight, or in the ratio of 36·3 per 1,000 of mean force, which is an increase of 4·1, as compared with the previous year.
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