► Royal Navy ► Naval Surgeon North America and West Indies ◄► Table 5
Statistical Report of the Health of the Navy - 1864.
SOUTH EAST COAST OF AMERICA STATION
THE mean force on this station was 1,370 men. The squadron comprised eleven vessels, of which three were frigates of the third, fourth, and sixth rates respectively; three were sloops; there was one steam vessel; three gunboats, and a receiving ship permanently stationed at Rio de Janeiro. There was also a small detachment of marines at the Falkland Islands. The total number of cases of disease and injury placed on the sick-list was 2,425, of which thirty-four were invalided, and 115 died, This great mortality, however, is almost altogether attributable to the loss by fire of the Bombay, when one officer and ninety men were drowned. The ratio of cases was 1,770 per 1,000 of mean force, being an increase of 31·31 per 1,000 as compared with the preceding year.The daily loss of service from fever was in the ratio of 2·1 per 1,000; from diseases of the brain and nervous system ·4; of the organs of respiration 5·5; of the heart and blood-vessels ·3; of the alimentary canal 5·5; of the genito-urinary organs 6·2; from rheumatism 4·6; from diseases of the bones and joints ·7; of the special senses 0·3; of the skin and cellular tissue 16·0; from dyspepsia and debility 2·1; and from wounds and injuries of various kinds 14; making a total ratio of 55·9 per 1,000 of mean force, which is equal to the daily loss of service of seventy-seven men, and only slightly exceeds the daily loss of the previous year.
SOUTH EAST COAST OF AMERICA STATION
Fevers.- Seventy-four cases of primary fever were under treatment, of which four had a fatal termination. Two-thirds of these cases occurred on board the Forte.
There were only two cases of primary fever in the Alecto, and of these one terminated fatally. In this instance the fever was of the enteric type. The man presented himself two days after the vessel had sailed from Monte Video, suffering from what appeared to be ordinary catarrhal symptoms, which he attributed to having got some days previously while on shore, and not being able to shift his clothing until he returned on hoard in the evening. The catarrhal symptoms soon subsided, but diarrhoea set in with general febrile disturbance, and tenderness on pressure, over the abdomen. The diarrhoea became very frequent, the pulse was 104, small and weak; the tongue appeared quite clean and moist, but was smooth and glazed, there was irritability of stomach, the sleep was disturbed, and there was occasional wandering delirium. He was very much in this condition when the vessel arrived at Rio Janeiro, when he was at once transferred to the Egmont for treatment. When received on board that vessel he was feverish, the pulse was 108, the tongue red, shrunken, and marked with two streaks of whitish brown fur. There was slight pain on pressure in the iliac region; the bowels were loose, the stools being of a yellow-ochry colour; there was no headache, and the pupils were natural. For some days there was a good deal of wandering muttering delirium, and on the fourth day after admission miliary vesicles and rose coloured spots appeared on the abdomen. The purging, however, gradually diminished in severity, the iliac tenderness disappeared, and all the more unfavourable symptoms gradually subsided, so that about three weeks after joining the Egmont he was considered convalescent, and was able to walk about the sick bay during the greater part of the day. He had been in this favourable condition for about a week when he had a relapse, and he began to complain of general debility, lumbar pain, and slight headache. This occurred on the 1st of July. The report of the surgeon (Dr. G.W. Willes) of the Egmont continues:-
"On the 3rd of July he had an increase of fever with diarrhoea, which complication was relieved by the 7th of July, on the night of which date, though he had been under a supporting plan of treatment for twenty-eight days, he had a slight epistaxis. On the 8th he had a return of the bleeding in the evening, but not to such an extent as to cause alarm, and was ordered a mixture containing the tincture of the perchloride of iron. On the 9th the febrile symptoms had not abated, his pulse was eighty, and he had no local pains He was directed to continue the iron mixture, in addition to quinine, nourishing diet, and a liberal allowance of stimulants. At eight p.m. epistaxis returned, and was arrested at ten by plugging the anterior nares, other methods having failed. On the 10th at seven a.m., the haemorrhage from the nose returned, and the posterior nares were plugged, iced water applied to the face, and a liberal supply of iced punch, porter, wine, and beef tea, was ordered. Petechiae were also this day observed on the loins, face, and back of the neck; his pulse was 100, and feeble; there was no diarrhoea, the skin was hot, and the tongue dry, but not brown. Eight p.m.; oozing has gone on all day, the blood not having sufficient plastic material to form a clot. July 11th; oozing has gone on all night; a large ecchymosis has appeared in the integuments around the left nipple, and another on the shoulder; petechiae are also to be seen on the tongue and soft palate. July 12th; oozing from nares continues, and an ecchymosis has appeared on the left shin; pulse 100; urine not bloody. July 13th; oozing appeared to have stopped; slept during the first and middle watches last night; passed one copious dark watery stool this morning; no blood in his urine; pulse ninety-eight and weak; skin dry, but not, so hot as yesterday; intellect clear. Eight p. m.; a little oozing again; has passed two copious watery stools; pulse eighty; getting deaf; and beginning to decline nourishment. Twelve p.m.; pulse eighty, and very feeble; clammy perspiration on forehead; will hardly swallow. July 14th; two a.m., pulse seventy-two, and very feeble; extremities cold and clammy; will not swallow; sunk gradually and expired at 2. 55 a.m.
This exceedingly interesting case is an illustration of a very rare complication of enteric fever. Mr. Murchison (A Treatise on the Continued Fevers of Great Britain, p. 474.), in his work on continued fevers, states that he only remembers to have seen petechiae twice in that disease, but that Trousseau has recorded a case in which there were extensive vibices. It certainly does seem extraordinary that, as incidentally notified by the surgeon of the Egmont so violent an attack of purpura should have occurred in a person so long under a most liberal supporting and stimulating treatment.
There were seven cases of primary fever in the Bombay, all of an ephemeral character, the average duration of each case on the sick-list, being only between three and four days.
In the Curlew, in which there was only one case, and the Egmont in which there were three, of primary fever, the type was ephemeral. In the latter vessel the attacks are referred to insolation, and to suddenly checked perspiration.
There were forty-seven cases of primary fever in the Forte, two of which proved fatal. Both these cases were of an exceedingly low type, with early and persistent sensorial disturbance; but in neither case does there appear to have been any eruption either of a rose or mulberry colour. In one there was diarrhoea in the early stage of the disease; and subsequently, after his discharge to the Egmont, on board which vessel he died, when lying in a state of stupor, he frequently placed his hand on the right iliac region, as if there was some uneasiness there, but the features did not indicate pain when the part was pressed on. The other fatal case occurred in a man whose constitution was completely undermined by intemperance. From the very first the nervous system was seriously involved. On admission his gait was unsteady, his utterance indistinct, and there was great general prostration. On the third day after admission to the sick list, he was as wandering and incoherent in his speech - appeared to have great difficulty in collecting his thoughts when spoken to - answered questions very slowly, and was occasionally muttering to himself. He then became violently delirious and required the constant supervision of two attendants. This stage passed off and was followed by low delirium, picking at the bed clothes, subsultus tendinum, and involuntary discharge of urine and faeces in bed. On the sixth day after being placed on the list, a remission of his symptoms took place, subsultus disappeared, he ceased to pick at the bed clothes, appeared to recognise those around him, and made attempts to speak. He asked for, and used the bed pan and urinal, and drank freely whatever was offered him. During the day he took some nourishment; his features nevertheless assumed a peculiar cadaverous appearance. He slept tolerably well that night, and enjoyed apparently some natural sleep, spoke to his messmates in a rational manner, took some chicken broth in the middle watch, and voluntarily obeyed the calls of nature. On the morning of the 7th day however there was a return of all the more urgent symptoms. He became delirious and unconscious, constantly striving to get out of bed, and continually muttering to himself. From this condition he never rallied; coma set in early in the morning of the eighth day, and shortly afterwards he expired. It is to be regretted that no post-mortem examination was made in either case. One presents very much the history of a case of enteric fever, the other that of remittent fever. No information whatever is given in reference to the other cases of fever that appears in the returns from the Forte, but the total days' sickness on board ship occasioned by them, gave an average duration of ten days to each case.
There were five cases of primary fever in the Satellite, all being of an exceedingly mild character; two of them were discharged to hospital for prudential reasons, but they also proved to be of trivial importance. The same may be said of the cases that occurred in the Spider and Stromboli.
There were six cases of primary fever in the Triton, two of which were evidently of the enteric type, one of them proving fatal. In that instance the disease, as not uncommonly happens, was very insidious in its approach, and was entered on the sick list as a case of diarrhoea. The patient, a seaman, had been labouring under looseness of the bowels for some time before he came under treatment, but thought so little of it, that he had gone on general leave with the rest of the ship's company, and indulged in a prolonged debauch. About the eleventh day the case assumed a serious appearance, and was discharged to the civil hospital at Monte Video, where it terminated fatally three days afterwards; unfortunately no post mortem examination of the body was made.
Eruptive Fevers.- There was a single case of varicella in the Curlew. It occurred in the person of a boy, who was at once removed to the engine room and isolated as much as possible from the ship's company. He was only six days on the sick list. The vessel was in the River Plate at the time, and small-pox was prevalent in Monte Video.
In the Satellite there were two cases of small-pox. They occurred after general leave given at Monte Video. In both the marks of vaccination were present. One ran a very mild course, the other was more severe. Both cases were discharged to the civil hospital at Monte Video.
A single case of measles occurred in the person of a young officer of the Egmont. The source from whence the disease was contracted could not be satisfactorily traced. He was at once discharged to sick quarters on shore to prevent any risk of the disease spreading in the vessel. The symptoms were mild, and he rejoined the ship at the expiration of twelve days.
Diseases of the Brain and Nervous System.- A petty officer of the Spider while in the act of dressing in the morning, fell heavily forwards on the deck, and when taken up was found to be insensible. He was seen immediately by the medical officer of the ship, and was then unconscious, and insensible to external impressions, the pupils were dilated and not affected by light; there was no stertor nor frothing at the mouth. He died within two hours of the seizure. On post-mortem examination of the body the membranes of the brain were found highly vascular, and the surface of the brain itself much congested. On cutting into the brain numerous small clots were visible throughout the entire mass, and the lateral ventricles were almost filled with sanguineous fluid, each containing a large clot. The heart, a little fatty externally, was otherwise healthy. He was of spare habit, with a rather short neck, and some years previously had suffered from sun stroke in China; up to the moment of the attack he seemed in perfect health.
The medical officer (Assistant Surgeon N.T. Conolly) of the Doterel makes the following interesting observations on the frequency of traumatic tetanus in the river Plate.
"The worst feature in the climate, however, is the prevalence of tetanus, trismus, lock jaw, or whatever it may be called, after wounds, whether clean cut or contused, whether arising from the knife of the surgeon, or the lance of the soldier. This affection is more likely to supervene during the heat of summer, and for this reason surgeons do not like to operate during the months of December and January. The garrison of Paysandu having been left without surgical assistance, it fell to the lot of the surgeons of those neutral vessels of war then present to render the wounded what assistance they could. Many cases of this disease occurred, and all those I saw terminated fatally, and that, with one exception, within forty-eight hours. In the exceptional case, which lasted about eight days, the result was the same as in the others. In confirmation of the greater liability of wounds of the extremities to be followed by this affection, I may state that those cases which came under my notice, were all wounds of those parts. The old theory of Baron Larrey here too met a refutation, in that the very first case that occurred at the Hospital Militar, followed amputation of the leg, below the knee joint, for a bullet wound in the neighbourhood of the ankle. The wounds were principally bullet ones, and but a small percentage of them recovered. Those penetrating the chest were almost all attended by a fatal issue, for if the wound of itself were not sufficient to accomplish this result, it was ably assisted by the absence of all nursing, or comforts for the patient, for these could not be expected where even the commonest necessaries of life were wanting. It may be worth mentioning that the tetanus of this country is very much milder, though an equally fatal affection, with that of England. It does not generally assume those forms under which it is usually classified by authors, such as emprosthotonos, opisthotonos, &c.; nor are the spasms very severe, or of long duration. The teeth are firmly set, and the muscles which spasmodically act are those of the wounded part or side, whilst the rest of the body is voluntarily fixed, to resist pain."
Diseases of the Organs of Respiration.- The ratio of cases coming under this head is more than double that of the preceding year; this is entirely attributable to the greater prevalence of catarrhal affections and sore throat, which in several of the vessels assumed an epidemic form.
A petty officer of the Stromboli, died on board the Egmont of chronic bronchitis; he was a worn-out man, who had long laboured under the disease which ultimately carried him off; he was subject to severe paroxysms of orthopnoea, and in one of these he died. Post-mortem examination of the body showed old and extensive pleuritic adhesions: the bronchial tubes gorged with viscid secretion; fatty degeneration. of the heart, with dilated auricles, and warty vegetations on the semilunar valves.
Influenza was epidemic in the Satellite, at Monte Video, in the Lady quarter of the year; in the Forte, at Rio de Janeiro, very extensively in the Midsummer quarter, and in the Stromboli, at Rio de Janeiro in the Michaelmas quarter. The majority of the cases were of a mild character, but some were rather severe. The surgeon (Surgeon J.S. Crawford) of the Forte says:-
"Between the 24th and 30th of June, while at anchor in Rio Harbour, nearly every one on board was attacked with catarrhal fever. Some cases were severe, but the majority were of a mild nature. The weather was warm and very wet at the time. Sore throat was also prevalent. The impossibility of keeping the men's clothes dry may account for this outbreak. No other ship in the harbour, however, suffered in the same way."
The surgeon (Surgeon Robert Creighton) of the Satellite says:-
"During the month of February, when at anchor at Monte Video, several damp foggy days, rendering the air for the season rather chilly, occurred, and seemed to be the exciting cause of a mild epidemic of catarrhal influenza which appeared. A great many of the crew were affected with simple coryza, although quite able to continue at duty; but frontal headache with lassitude and pain in the back placed about twenty men on the sick-list. Simple warmth, with seclusion from draughts, some pectoral medicines, and Dover's powder at bed time, restored them all in a few days."
And with reference to the outbreak in the Stromboli, the surgeon (Surgeon E.T. Mortimer) of that vessel remarks:-
"During the months of May and June the crew were healthy, but in July an epidemic of influenza appeared on board. Between the 8th and 14th twenty-six cases were admitted on the sick-list. The men were on leave on the 5th and 6th of the month, and I have been told that influenza prevailed on shore at that time. In addition to those entered on the sick-list several others were attached, but in so mild a form that they did not apply for treatment. The average time the men were on the sick-list was about four and a half days."
Diseases of the Heart and Blood-vessels.- A leading stoker of the Forte died from the rupture of an aneurism of the thoracic aorta; he had been apparently in the most perfect health, and talking, cheerfully to his fellow stokers, while in the act of hanging a pair of trousers on a line higher than himself', when he suddenly experienced a sensation in his throat, which made him cough; after coughing two or three times, he brought up a little blood, and this was almost immediately followed by a profuse flow of florid blood, which gushed from his mouth; he fell down senseless, and in a few minutes expired. On post-mortem examination of the body, nothing remarkable was to be seen in the appearance of the superficial vessels of the neck and chest; the joints and muscles of the limbs were rigid; the lungs were healthy; the heart natural in size, and the valves and various openings normal. An aneurismal tumour of about the size of the clenched fist was found at the commencement of the descending aorta, so firmly adherent to the back part of the upper lobe of the left lung and to the front of the spine, that the sac was torn in trying to detach it. When the sac was exposed to view, it was found to be intimately adherent to the lung, into which it had burst, and its other wall was formed by the denuded bodies of two dorsal vertebrae. The sac contained coagulated blood and fibrine; the part of the lung to which the sac was attached presented a cup-like depression.
This man was never known to complain of his chest, although he often complained of rheumatic pains in his back and shoulders, which he invariably attributed to exposure and cold. He exerted himself as much as the other men in the engine-room; there was nothing peculiar in his appearance; he was six feet two inches in height, and latterly of a spare habit of body.
Diseases of the Alimentary Canal.- There is an increase in the ratio of cases coming under this head as compared with the preceding year, to the extent of 83.2 per 1,000 of mean force; this is altogether attributable to the greater prevalence of diarrhoea in some ships of the squadron. The ratio of cases of dysentery is only about one-third of that of 1863.
A fatal case of gastritis appears in the returns from the Forte: it occurred in the person of the ship's barber, who for about a fortnight previously, had been drinking very hard, and four or five days before he was taken ill, being new year's day, had taken raw spirits to great excess. He was brought to the sick bay late at night in a state of collapse, complaining of violent burning pain in the epigastrium. and tenderness on pressure. He was pale and nearly pulseless, the surface was cold and clammy, the countenance anxious, and indicative of great suffering. The tongue was clean, thirst urgent, but whatever was swallowed was at once rejected. Despite every effort to induce reaction, not the slightest effect was produced; mustard did not act on the skin, and heat did not warm the parts it was applied to. The pulse became weaker and weaker; the powers of life sank gradually, and on the following night about a pint of dirty coloured fluid was suddenly discharged from the mouth and nostrils, and he died calmly. About two hours before death, all pain ceased, and hiccup set in, the surface being covered with a cold clammy perspiration, and for the first time the intellect became clouded. No post-mortem examination was made of the body.
The total number of cases of diarrhoea under treatment during the year, was 343, and the total days' sickness occasioned by them on board ship and in hospital, 2,588, which gives an average of 7·5 days' treatment to each case. Although this would argue some amount of severity in a large proportion of the cases, nothing of a noteworthy character is to be met with in those recorded, and in general the causes to which they are attributed, are dietetic errors, variations of temperature, and impure water. With reference to the prevalence of these affections in the squadron in the River Plate, the following observations of the surgeon of the Satellite may be noticed:-
"It was not until the ship went to the outer roads at Buenos Ayres that cases of diarrhoea assumed their wonted frequency, and their sudden appearance there is rather remarkable. The summer season had not set in, and there was no fruit in use, so that it is difficult to assign to them any other origin than drinking the water from alongside the ship, the more so as it was generally supposed that since using water from another and new source at Monte Video, where these affections so much prevail, they had become very much less numerous, and were in fact altogether disappearing. For a long time the water in use in all the ships had been collected up the river, wherever it was found fresh - a doubtful and uncertain method at all times, but latterly it has been obtained from a supposed spring at the head of the Bay of Monte Video, recommended by the senior officer of the Italian ships. There, where the land rises gently from the sandy beach, in the winter season, a very small stream or rivulet flows, but I believe wells have been sunk at a distance from the sea, into which most likely the sea water, already mostly brackish river water percolates, and so is rendered pure. A stratum of rocks underlies the sand and soil where the water is procured, which gives it the character of a spring, but I incline to the opinion already stated, that simple percolation through a sufficient extent of ground is most likely its source. At all events it seems better than the river water, and, to the naked eye, is free from the discoloured and suspended impurities which made the old water conspicuous to the eye and unpalatable to the taste. But no matter what water is used a certain number of cases of diarrhoea will always be encountered in the river during the autumnal season when fruit is abundant, and the heat oppressive."
The surgeon of the Egmont, speaking of diarrhoea at Rio de Janeiro, says
"Thirty-nine cases of diarrhoea have been treated and discharged to duty. Of these eight occurred in the month of March and appeared due to a sudden fall in the temperature of the atmosphere about the middle of the month, when the midday temperature fell from 84° to 75° and continued at that point for eleven days, when it rose again to 81°. No satisfactory proofs could be obtained that eating undigestible food, or unripe fruit was the exciting cause of these cases. Thirteen more occurred between the 18th and 28th of June, and seemed fairly attributable to the damp and foggy weather which prevailed during that period. The remainder did not occur in groups, but were distributed over the different months of the year. All these cases were what is usually termed, diarrhoea of irritation; some of them no doubt had their origin in errors of diet, or indulgence in intoxicating liquors on shore, but the majority seemed clearly referable to sudden changes in weather and temperature. The treatment consisted in confining the patients to bed, and evacuating the alimentary canal by means of a mild laxative, as castor oil or rhubarb; and when this object had been effected full doses of compound ipecacuan powder were exhibited at intervals of four or six hours, and a farinaceous diet adhered to. In those cases where the diarrhoea continued after griping and tenesmus had ceased, the tongue being clean, and the frequent discharges from the bowels appearing to depend on a want of tone in the intestine, the tincture of perchloride of iron in infusion of quassia was prescribed with advantage."
Diseases of the Genito-Urinary Organs.- There was an increase in the ratio of cases coming under this head as compared with the preceding year, altogether owing to the greater prevalence of venereal affections. Fortunately, however, this station, as has on previous occasions been remarked, is tolerably exempt from these diseases, and many of the cases that are seen in the hospitals on shore even, are in foreigners who have brought the disease from other localities. Sixty-two cases of syphilis were under treatment during the year, but many of these were secondary manifestations of the disease. The total number of days' sickness occasioned by them was 2,013, which gives an average duration to each case of between thirty-two and thirty-three days. Of six cases that occurred in the Egmont, one occurred in the constitutional form in a boy, who, it is stated, had probably inherited the disease from his parents, as there was reason to believe that he had never suffered from any primary form of the disease, at all events, on board that vessel; and another case of a similar character likewise occurred in an older boy, who might have been exposed to contagion, but who had not been laid up with any primary sore, or glandular affection. The medical officer (Assistant Surgeon George Bolster) of the Triton makes the following observations on the syphilitic poison:-
"The ship's company have this year also been very exempt from syphilitic disease, the total number of cases of all kinds being thirteen, and of these only one was an example of true syphilis. There is, however, a good deal to be seen in the hospitals on shore, and from the observations I have made, I have been led to believe strongly in the duality of the syphilitic virus, and to think with Diday of Lyons, and Bumstead of America, that the poison which produces the true chancre, goes on invariably to infect the constitution; that it is useless to use escharotics for the purpose of preventing the constitutional taint as the disease has already become constitutional, coincident with the appearance of the chancre; that mercury properly administered is the remedy on which most dependence can be placed during the primary and secondary stages; and that iodide of potassium is especially useful in the tertiary one. But that, however fully and carefully mercury may have been given during the first stage, its effect is not so much to prevent as to modify the subsequent general symptoms; that the true syphilitic bubo very rarely supurates; and that the old idea of identifying this disease with the local one now called chancroid, and accounting for the marked distinction between them on the ground that certain constitutions have a resisting power which subdues the virus in its bud, while others less vigorous fail to do so, and allow it to develop itself until it ultimately affects the constitution, is not in accordance with the results of recent investigations. It is, however, a matter for congratulation, that the doubts which have so long obscured this very formidable and common disease, are now clearing off."
Wounds and Injuries.- A man was killed by falling from aloft, and in his descent swept another from off the rigging, who was also killed. In the former case there were numerous fractures of the extremities, but death appears to have been occasioned by some internal injury; and in the latter there was fracture with dislocation of the lower cervical vertebra. A man sustained an extensive and fatal fracture of the skull, by falling from aloft; and a man in a state of intoxication fell from his hammock and sustained a concussion of the spine, which subsequently proved fatal in hospital.
Three men fell overboard and were drowned; one man while attempting to desert was drowned by the capsizing of the boat; an officer and a man were drowned by the upsetting of a boat, in attempting to go off to a wreck; two officers and a mess-servant were drowned in the harbour of Rio de Janeiro, by the capsizing of a boat in a heavy squall; and ninety men, and one officer, were drowned on the occasion of the loss of the Bombay, by fire. The total number of deaths was 114, ten of which were from diseases of various kinds, and 104 from wounds and injuries, and drowning. The total death-rate was 83·2 per 1,000 of mean force, but 66·4 of this is contributed by the Bombay alone. The ratio of mortality from disease only, was 7·2 per 1.000, which is an increase of 2·1, as compared with the preceding year.
Invalided.- Five men were invalided for diseases of the brain and nervous system; five for phthisis; three for diseases of the alimentary canal; six for diseases of the genito-urinary organs; one for rheumatism; one for diseases of the bones and joints; two for affections of the special senses; five for diseases of the skin and cellular tissue; one for dyspepsia; four for wounds and injuries; and one for hernia; making a total of thirty-four, which is in the ratio of 24·8 per 1,000 of mean force, being somewhat below the invaliding rate of the preceding year.
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