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► Royal Navy ► Naval Surgeon Irregular Force ◄► Ships and Stations

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Statistical Report of the Health of the Navy - 1864.

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TOTAL FORCE

THE Total Force in the service afloat in 1864 was 53,000 men; and the total number of cases of disease and injury placed on the sick-list was 72,138, being in the ratio of 1374 per 1,000 of mean force, and 80·3 per 1,000 below the ratio of cases of the previous year. In estimating the ratio of cases, the Total Force is computed at 52,500, an allowance of 500 men being made for the gun-boats on the China Station, from which, on account of there being no medical officers attached to them, no reliable returns were obtained. In estimating the invaliding and death rates, however, the full force is taken. The total number invalided was 1881, or in the ratio of 35·4 per 1,000 of mean force, being a fractional increase as compared with the preceding year. Of the whole number invalided, 1,675 were for various forms of disease, and 206 for wounds and injuries of different kinds. There were 742 deaths, which is in the ratio of 14 per 1,000 of mean force, being an increase of 2·7 per 1,000 as compared with the previous year. The number of deaths from disease was 461, and from wounds, injuries, and drowning 281; the former being in the ratio of 8·6 per 1,000, and the latter of 5·3. The ratio of mortality from disease is greater than that of the previous year by 1 per 1,000.

The number of cases of disease and injury per man on the Home Station was 1·0; on the Mediterranean Station, 1·3; North America and the West Indies, 1·5; South East Coast of America, 1·7; Pacific, 1·5; West Coast of Africa, 2·0; Cape of Good Hope and East Indies, 1·6; China, 1·6; Australia, 1·3; and in the Irregular Force, 1·6; making an average of 1·3 per man for the Total Force, which is below the average of the preceding year.

The smallest sick-rate was on the Mediterranean Station, and the highest on the China Station. The ratio per 1,000 of mean force of men sick daily on the Home Station was 47·4; on the Mediterranean, 45; North America and West Indies, 51·6; South East Coast of America, 55·9; Pacific, 47·6; West Coast of Africa, 65·3; Cape of Good Hope and East Indies, 66·6; China, 72·8; Australia, 50·5; and in the Irregular Force 70·5; making the mean sick-rate of the Total Force 54·0 per 1,000. In 1863 it was 54·3. The stations on which the sick-rate exceeded that of the previous year were the Home Station, to a trifling extent; North America and the West Indies, where yellow fever in one locality was epidemic; the West Coast of Africa; and the Australian Station. The difference between the sick-rate of the West Coast of Africa, and the Cape of Good Hope and East Indian Station is only 1·3 per 1,000; this, as has been previously observed, arises from the peculiar nature of the service in the Mozambique Channel assimilating the latter station very much to the former. On the China Station the advantage of making Japan the head quarters of the squadron continues to be exemplified by a decreasing sick-rate. Could the Japanese authorities by induced to adopt a system of surveillance of prostitution, which they have more power, perhaps, than any other nation of enforcing, there can be little doubt that the sick-rate on this station would be comparatively small.

As compared with the previous year there was an increase in the ratio of invaliding on the Home, Pacific, West Coast of Africa, and Cape of Good Hope and East Indian Stations, and in the Irregular Force. The increase, however, was comparatively trifling excepting on the West Coast of Africa, and the Cape of Good Hope and East Indian Station, on the former of which it was to the extent of 12 per 1,000 of mean force, and on the latter of 14·9 per 1,000. The ratio of invaliding on these two stations was precisely the same, and the cause of increase in each probably alike, viz. the increased length of time the vessels had been on the station, as referred to in the observations on the invaliding on the West Coast of Africa, in the Total Force for 1863. The ratio of invaliding on the Home Station was 32·3 per 1,000 of mean force; on the Mediterranean Station 36·7; North America and the West Indies, 24·5; the South East Coast of America, 24·8; the Pacific, 36·3; the West Coast of Africa, 53·4; Cape of Good Hope and East Indies, 53·4; China 52·5; Australian, 20·6; and in the Irregular Force, 30·9. The total number invalided was 1,881, which is in the ratio of 35.4 per 1,000 of mean force; an increase, as compared with the previous year, of 0·3 per 1,000.

There is an increase in the ratio of mortality of 2·7 per 1,000 as compared with the previous year. Of this amount 1·7 per 1,000 is contributed by the loss of the Bombay on the River Plate, when one officer and ninety men were drowned; and 0·7 by the deaths which occurred in connection with the epidemic of yellow fever at Bermuda. The death-rate on the Home Station from disease was 6·1 per 1,000 of mean force, and from violence, l·7; on the Mediterranean Station from disease 4·9, and from violence, 2·8; North America and the West Indies, from disease, 12·3, from violence, 3·4; South East Coast of America, from disease, 7·3, from violence, 83·2, an altogether exceptional ratio; the Pacific Station, from disease, 9·8, from violence, 4·4; West Coast of Africa, from disease, 14·3, from violence, 5·5; Cape of Good Hope and East Indies, from disease, 13·8, from violence, 5·6; China, from disease, 18·3, from violence, 5·9; Australia, from disease, 9·4, from violence, 16·3; and in the Irregular Force, from disease, 5·4, and from violence, 2·8. The total number of deaths was 742, being in the ratio of 14 per 1,000 of mean force. The death-rate in 1863 was 11·3 per 1,000.

The stations on which there was an increase in the death rate, as compared with the previous year, were the Home Station, North America and the West Indies, the South East Coast of America, the Pacific, Cape of Good Hope and East Indies, and in the Irregular Force. On the Home Station the increase was merely fractional. On the North America and West Indies Station the increase was to the extent of 8·1 per 1,000, 6·4 of which was attributable to yellow fever. On the South East Coast of America the increase was to the extent of 68·7 per 1,000, referable, as before stated, to the loss of the Bombay. On the Pacific Station the death-rate was increased 3·6 per 1,000: on the Cape of Good Hope and East India Station 3·2; and in the Irregular Force 0·4.

In the Mediterranean there was, on the other hand, a reduction in the death-rate to the extent of 1·7 per 1,000; on the West Coast of Africa of 2·5; on the China Station of 7·5; and on the Australian Station of 2·3. It will thus be apparent that the year 1864 bears a favourable comparison with 1863 in respect to its death-rate, inasmuch as the increase which it shows must be altogether looked upon as belonging to the class of casualties, being mostly, indeed, confined to two ships, the Bombay, in the River Plate, and the Terror, at Bermuda.

The following table shows the ratio per 1,000 of mean force of all cases of disease and injury placed on the sick-list, and of mortality from the various classes of disease on the different stations.


Fevers.- Three thousand two hundred and sixteen cases of fever of a continued or remittent type were placed on the sick-list during the year, which is in the ratio of 61·2 per 1,000 of mean force, being below that of the preceding year. Thirty-eight persons were invalided for the sequelae of these fevers, and forty-seven died, the former being in the ratio of 0·7 per 1,000, and the latter of 0·8, both of which, and particularly the death-rate, are greater than those of the previous year. As usual, the West Coast of Africa much exceeds all the other stations, both in the ratio of cases and of mortality, from these diseases; next to it ranks North America and the West Indies, on which there was a large amount of primary fever in the squadron stationed in the Gulf of Mexico. It was mostly of an ephemeral character, however, and the death-rate on this station occasioned by it is consequently amongst the smallest. On the South East Coast of America, although the ratio of cases of primary fever was not much more than one-half that of the preceding year, the death-rate was more than twice as great, and nearly the same observations apply to the Pacific Station. There were also fewer cases and more mortality on the West Coast of Africa, and the Cape of Good Hope and East Indies commands.

Yellow fever added 0·7 per 1,000 of mean force to the total death-rate for this year. The disease, so far as the naval service was concerned, was almost exclusively confined to one ship, a floating battery permanently stationed at Bermuda, and it occurred during the period of the severe epidemic that devastated that island.

Ague was much less prevalent on the West Coast of Africa, the Cape of Good Hope and East Indies, and on the China station, than during the preceding year. It occasioned no mortality.

Eruptive Fevers.- There was a considerable increase in the ratio of cases coming under this head, as compared with the preceding year. This almost altogether arises from the greater prevalence of small-pox on the Home and China stations. In 1863, 121 cases of small-pox were placed on the sick-list, while in 1864 the number was 462. Of these, 199 cases occurred on the Home Station, and 150 in China. On the Home Station the disease prevailed at all the seaports, but chiefly at Portsmouth, while on the China Station it was very prevalent in Japan. The death-rate from smallpox was three times that of the previous year. Scarlatina was much less prevalent, there having been only fifty-two cases under treatment, against 186 in 1863. In the present year one-half of the cases occurred on the Home Station.

Diseases of the Brain and Nervous System.- There was an increase in the ratio of cases coming under this head, as compared with the previous year, but the death-rate was precisely the same as had obtained in the two previous years. The ratio of invaliding was fractionally increased. There were eleven deaths from various forms of disease of the brain; nine from apoplexy; three from paralysis; three from insanity; ten from delirium tremens; and one from coup de soleil. The highest ratio of cases under this head was on the Mediterranean Station, the lowest in the Irregular Force.

Diseases of the Organs of Respiration.- There is a reduction in the ratio of cases coming under this head, as compared with the previous year, equal to 18·2 per 1,000 of mean force; there is also a reduction in the invaliding rate, but the death-rate is fractionally increased. Although the ratio of cases is considerably less than in 1863, the daily loss of service resulting from them is not proportionately reduced. In the previous year the ratio per 1,000 of men sick daily, from all forms of disease of the respiratory organs, was 5·8; in 1864 it was 5·3. As heretofore, the highest ratio of cases of phthisis was on the Mediterranean Station. Compared with the previous year, the only stations in which there was an increase in the ratio of all classes of disease coming under this head were the South-east Coast of America, and the West Coast of Africa, and in both localities the increase was mainly due to the prevalence of catarrhal affections.

Diseases of the Heart and Blood-vessels.- There is an increase in the various ratios under this head, as compared with the preceding year, the increase being greatest in the ratios of cases and of mortality. In the invaliding rate the increase is only 0·1. Four hundred and sixty-two cases of disease of the heart were placed under treatment, and of these 155 were invalided and thirty-six died. There were ten cases of aneurism, and ten deaths. Four men were invalided for haemorrhoidal disease, and twenty-six for varicose veins.

Diseases of the Alimentary Canal.- There was a decrease in the total ratio of cases, invaliding, and mortality, under this head, as compared with the preceding year; and in the ratio of cases the decrease on some of the stations was considerable. On the Mediterranean Station it was equal to 43·5 per 1,000 of mean force; on the North American and West Indian Station, 27·6; Cape of Good Hope and East Indies, 35·1; China, 111·1; and in the Irregular Force, to 14·1. The stations on which there was an increase were the Home Station, to the extent of 5·8 per 1,000; South-east Coast of America, 83·2; Pacific, 20·8; West Coast of Africa, 23·5; and the Australian Station, 18·1. Although the ratio of cases of dysentery was 5·4 per 1,000 in excess of the previous year, the death-rate resulting from them was only increased by 0·1. On the China Station, in 1863, only 141 cases of dysentery altogether were placed on the sick-list, of which twenty-seven died, while in 1864 there were 409 cases, of which thirty-six died. Three hundred of these cases and sixteen deaths are referable to the epidemic which prevailed in the marine brigade in Japan, but for which the number of dysenteric cases in the total force would have been smaller than in 1863. The death-rate is reduced on the Home, Mediterranean, North American and West Indies, South-east Coast of America, China, and Australian Stations. On the China Station the reduction is to the extent of 4·3 per 1,000 of mean force.

Diseases of the Liver and Spleen.- There was an increase in the ratio of cases and of mortality under this head, as compared with the preceding year, but the invaliding rate was lower. One hundred and sixty-seven cases of disease of the liver, mostly inflammatory, were placed on the sick-list, and of these, twenty-five were invalided and eleven proved fatal.

Diseases of the Genito-Urinary Organs.- The following Table shows that there was a decrease of syphilitic disease on the Home, Pacific and Australian Stations, and in the Irregular Force. The greatest increase was on the China Station, where it exceeded the previous year by 45·5 per 1,000 of mean force, and was altogether attributable to the squadron being stationed in Japanese waters. The decrease on the Pacific Station may be considered due to the fact of the vessels of the squadron having been less frequently at Valparaiso than in the preceding year. In the Home ports although the Contagious Diseases Act was in operation during part of this year, the trifling reduction in the ratio of venereal disease cannot in all probability be attributed to its action, there having been a decrease in the ratio of cases of syphilis in 1863, although the Act was not then framed, as compared with the year preceding it. Four thousand three hundred and eighty five cases of syphilis were under treatment during the Total Force. year, of which, 101 were invalided, and one died. The daily loss of service from this loathsome and destructive disease was equal to 460 men, the complement of a large frigate; and the total days' sickness on board ship and in hospital, from all the cases, gave an average duration of 38·3 days to each case.

Stations.	Syphilis.		Gonorrhoea.
	1863	1864	1863	1864
Home	104·2	96·6	32·4	25·7
Mediterranean	29·1	35·3	14·9	10·2
North America and West Indies	48·5	52·4	13·0	15·8
Brazils	38·6	45·2	18·9	22·6
Pacific	54·6	48·7	22·6	19·4
West Coast of Africa	18·6	22·9	16·5	22·3
Cape of Good Hope and East Indies	60·0	63·7	27·4	23·2
China	132·2	177·7	57·3	37·2
Australia	22·4	17·2	8·6	6·8
Irregular Force	143·2	127·6	31·4	29·1

Rheumatism.- There was a very considerable increase in the ratio of cases of this disease as compared with the preceding year, and the invaliding rate was also higher. The mortality, however, was not so great. The following Table shows that the highest ratio was on the West Coast of Africa, and the lowest on the Home Station:-

Stations.	Rheumatism.
	1863	1864
Home	57·5	66·8
Mediterranean	95·6	82·3
North America and West Indies	75·4	80·6
Brazils	71·5	126·2
Pacific	80·1	109·5
West Coast of Africa	103·1	129·8
Cape of Good Hope and East Indies	113·3	96·9
China	96·8	96·7
Australia	89·6	105·1
Irregular Force	110·4	109·5

There was a great reduction in the ratio of cases on the Cape of Good Hope and East Indies Station, in great measure dependent probably on the vessels of the squadron not being so much employed in malarious localities. In the Statistical Report on the Health of the Navy for the year 1862, it was observed that since the duties of this station had become more assimilated to those of the West Coast of Africa, in consequence of the endeavours that were being made to suppress the slave trade carried on by the Arabs in the Mozambique channel, malarial fevers had become very prevalent, and that there had been a corresponding increase in the number of cases of rheumatism, and it was suggested that these two forms of disease were dependent on the same cause. The following Table shows the ratios per 1,000 of mean force of cases of continued and remittent fever, intermittent fever, and rheumatism, on the Cape Station for nine years, where it will be observed how the ratio of cases of the latter disease rise with the increase in the ratio of malarial fevers.

Year	Ratio of Cases of Continued and Remittent Fevers	Ratio of Cases of Intermittent Fevers	Ratio of Cases of Rheumatism
1856	15·7	9·0	67·4
1857	37·7	7·6	70·7
1858	86·9	7·9	67·6
1859	49·1	17·2	60·0
1860	80·9	11·4	66·2
1861	122·3	37·8	115·4
1862	210·1	154·2	121·1
1863	105·1	76·2	113·3
1864	76·3	28·6	96·9

The total number of cases of rheumatism under treatment during the year was 4,478, of which 221 were invalided, and three died. The total number of days' sickness from these cases, on board ship and in hospital, was 79,268, which gives an average duration of 17·7 days to each case. The average number of men sick daily from this disease was 217.

Diseases of the Special Senses.- There was a decrease in the ratio of cases under this head as compared with the previous year, to the extent of nearly one-half. Thirty-three men were invalided for affections of the eyes, and twenty-seven for deafness.

Diseases of the Skin and Cellular Tissue.- As heretofore the greatest daily loss of service from these diseases was from abscesses and ulcers. For the former affections including boils, 317·7 men were, on an average, daily under treatment, and for the latter 268·4. There were four deaths from erysipelas, three from abscess, and one from ulcer. Two men were invalided for erysipelas; twenty-three for different forms of scrofulous disease; one for sympathetic bubo; twenty-seven for boils and abscesses; seventy-seven for ulcer, and five for skin diseases.

Average Number Sick Daily.- The average number of men daily under treatment for different forms of fever, including the exanthemata, was 175·8; from diseases of the brain and nervous system, 38·1; from diseases of the respiratory organs, 292·5; of the heart and blood vessels, 49·7: of the alimentary canal, 137·5; of the liver and spleen, 16·9; of the genito-urinary organs, chiefly venereal, 608·8; from rheumatism, 217·1; from gout, 2·3; from diseases of the bones and joints, 23·4; from diseases of the special senses, 38·5; from diseases of the skin and cellular tissue, 743·6; from dyspepsia and debility, 75·0; from diseases not classed, 17·8; and from wounds and injuries of various kinds, 426·7. The total number of men daily under treatment for diseases and injuries of various kinds was 2865·4, which is in the ratio of 54·0 per 1,000 of mean force, being almost precisely the same ratio as in 1863.

The following table shows the ratio per 1,000 of mean force of cases placed on the sick-list, of invaliding, and of mortality, on the different stations during the year.

Stations	Ratio per 1,000 of Force of Cases placed on the Sick List.	Ratio per 1,000 of Force Invalided.	Ratio per 1,000 of Force Dead.
Home	1,0718·2	32·3	7·8
Mediterranean	1,362·4	36·7	7·8
North America and West Indies	1,503·6	24·6	15·8 or 16
Brazils	1,770·0	24·8	83·9 or 83·2
Pacific	1,503·3	36·3	13·2
West Coast of Africa	2,003·7	53·4	19·8
Cape of Good Hope and East Indies	1,622·5	53·4	19·4
China	1,681·3	52·5	24·3
Australia	1,386·1	20·6	25·8
Irregular Force	1,625·4	30·9	8·2

Summary.- The total force in 1864 was 53,000, and the total number of men sick daily was 2,865·4, being in the ratio of 54·0 per 1,000 of mean force. In 1863 the ratio was 54·3.

There were 72,138 cases of disease and injury under treatment, being in the ratio of 1,374·0 per 1,000, which is a decrease compared with the previous year equal to 80·3 per 1,000. Each case was, on an average, about fourteen-and-a-half days under treatment, and the total days' sickness divided amongst the total force gave an average of 19·7 days' sickness to each man.

The total number invalided was 1,881, being in the ratio of 35·4 per 1,000, which is an increase of 0·3 per 1,000 as compared with the previous year. The total number of deaths was 742, or in the ratio of 14 per 1,000, being an increase compared with the preceding year of 2·7 per 1,000. Of this increase 1·7 was occasioned by the catastrophe which occurred in the loss of the Bombay in the River Plate, and 0·7 by the mortality in connection with one ship permanently stationed at Bermuda during the epidemic of yellow fever which prevailed there. Deducting deaths by violence only the ratio of mortality was 9·0 per 1,000 of mean force.

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