► Royal Navy ► Naval Surgeon Pacific ◄► Table 5
Statistical Report of the Health of the Navy - 1864.
WEST COAST OF AFRICA STATION
THE squadron on the West Coast of Africa in 1864 comprised nineteen vessels; viz., two frigates of the sixth-rate, two steam-vessels, one sloop, eleven gun-vessels, one gunboat, and two storeships. The time included in the different returns varies from three months to twelve, sixteen of the vessels being on the station during the whole year. The mean force corrected for time was 1,610, and the total number of cases of disease and injury placed on the sick-list was 3,226, being in the ratio of 2003·7 per 1,000 of mean force, which is a slight increase, as compared with the preceding year. The average ratio of cases during the preceding eight years was 1968 per 1,000. Of the vessels that were during the whole year upon the station, those showing the largest ratio of cases were the Speedwell, the Archer, and the Handy; while the smallest were the Zebra, the Rattlesnake, and the Snipe. The ratio of cases in the Maeander was small, but she was exceptionally circumstanced, being permanently stationed at Ascension.The daily loss of service from fevers was equal to eighteen men, or in the ratio of 11·3 per 1,000 of mean force, a decrease to the extent of 2·5 per 1,000, as compared with the preceding year; from diseases of the brain and nervous system the ratio was 0·5; of the respiratory organs, 3·6; of the heart and blood-vessels, 1·1; of the alimentary canal, 4·6; of the liver, 0·5; of the genito-urinary organs, 5·0; from rheumatism, 5·0; from diseases of the bones and joints, 1·4; from diseases of the special senses, 0·6; of the skin and cellular tissue, 16·4, almost all referable to boils, abscesses, and ulcers; from diseases not classed, 4·9; and from wounds and injuries of various kinds, 8·7. The total daily loss of service from all causes was equal to 105 men, which is in the ratio of 65·3 per 1,000 of mean force, being somewhat in excess of the preceding year.
WEST COAST OF AFRICA STATION
Fevers.- There were 425 cases of fever of a continued or remittent type under treatment during the year, and 108 cases of ague. The ratio of cases of the former class of fever was 100 per 1,000 below that of the preceding year, and of the latter 43·8 per 1,000. The ratio of invaliding and mortality from them was, however, in excess of 1863. The total number of days' sickness on board ship and in hospital, from the continued and remittent types, was 5,618, which gives an average of about thirteen days' treatment to each case, the average duration of each case of ague being under ten days.
There were ten cases of primary fever in the Antelope, the majority of which occurred during the month of December, when the vessel was lying at French Popo, off which she had been at anchor for nearly five months. There was nothing in any of the cases to call for comment.
In the Archer there were fifty cases of primary fever, one of which proved fatal. Ten of these cases occurred during the month of May, and, with reference to them, the following observations are made by the medical officer (Acting Assistant Surgeon C.H. Ward) in charge:
"The fever broke out about twelve days after our leaving Sierra Leone. It occurred in all cases amongst those who had had occasion to go on shore. Some were of a slight character, so far as the febrile symptoms were concerned; but the majority suffered severely from great prostration, both corporeal and mental, and all were followed by a very tedious convalescence. The fever has been of the common continued type, but I have observed occasional exacerbations at night. In one case it was of a remittent character. Vomiting does not form a symptom of the fever, as I have yet witnessed it; but pains in the head and limbs are always complained of. The skin is usually tinged yellow, from the functions of the liver being for a time arrested or prevented. I have also observed, that during convalescence the fever has, in two cases, assumed the remittent character, whereas, as I have previously said, they were of the continued type. Sudamina and in some cases boils have occurred, these being sufficiently general to form a symptom, so to speak, of the severity of the fever,- a point worthy, I think, of remark."
It was at this time that the only fatal case of fever occurred in this ship, and in that instance the patient was progressing favourably when he imprudently exposed himself in some way, inducing a return of the febrile symptoms, with a great degree of depression, from which he never rallied. The type of fever was remittent. A large number of the remaining cases in this vessel were of an ephemeral character, but some were very severe and tedious, convalescence being retarded by relapses of irregular paroxysms; the fever, in fact, assuming an irregular intermittent type, accompanied with vertigo and neuralgic pains affecting the head. These pains and febrile symptoms would continue for a few days, and then subside. All the cases of ephemeral fever occurred in men who had not left the ship, and were attributable to insolation, dietetic errors, and the like causes.
There were fifteen cases of primary fever in the Dart. Of these nine were of an ephemeral character, and the remainder remittent. The average duration of each of the former cases was between three and four days, and of the latter about three weeks. The majority of the remittent cases were attributable to river service.
In the Griffon there were sixty cases of primary fever, more than one-half of which occurred during the Michaelmas quarter of the year, when the fever assumed an epidemic character on board, consequent on service in the River Congo. On two occasions, indeed, the crew of this vessel were severely visited by epidemics of fever in that river during the year, and on each occasion the disease was promptly checked by at once proceeding to sea. The ship had been upwards of three years on the station, and both officers and men were much debilitated by climatic influences, and very prone to febrile disease.
There were ten cases of primary fever in the Handy, two of which proved fatal. This vessel is permanently stationed in the Lagos lagoon, and has only a very small complement of Europeans, usually from ten to fourteen. During the period of this report the crew had been comparatively healthy, which is considered to have been mainly attributable to the system adopted of sending so many of them occasionally out to sea in a cruiser, for a change. One of the fatal cases occurred in an officer, who was attacked with what is termed bilious remittent fever, not, however, of a severe type. Unfortunately it appears that he obstinately refused to take medicine of any description, and he at length became so debilitated that he was ordered to England for the preservation of his life. He rapidly sank, however, and died before the arrival of the mail packet. The other fatal case is also stated to have been one of bilious remittent fever, and was of an extremely urgent character from the first. Two days after being taken ill vomiting set in, and continued persistent until his death, which took place on the fourth day of the disease.
The vomited matters in this and the former case were of a dark or brownish black colour, as frequently occurs in severe cases of this form of fever, and has so often led to its being confounded with yellow fever. The surgeon (Surgeon Henry Eales) of the Handy, says that at the time the officer died:-
"Bilious fever was raging on shore, where out of forty-two Europeans, twelve died in six weeks. From the accounts given of yellow fever, I am of opinion that three of the cases on shore were of that description; however, as I have never visited the West Indies or other places where this disease makes its appearance, it is possible I may be mistaken. In all the three cases death took place within thirty-six hours of the appearance of the disease; there existed intense prostration from the commencement, deep yellow skin, and at last black vomit. Although the crew of the Handy have been comparatively healthy, the crews of the merchant vessels in the Lagoon have at times suffered severely. One brig with eight men lost six of the number in five weeks, while several others lost many of their crews after being towed over the bar. It not unfrequently happens that a ship will discharge and take in cargo in the Lagoon without there being much sickness on board, and leave without having any one on the sick-list, yet a few days after her departure all hands are down with intermittent fever. The large amount of sickness in the merchant ships is easily accounted for by exposure to the sun, improper food, and excess of drink, added to habitual filthiness, all of which it is impossible to prevent, notwithstanding the stringent regulations which the health officer has imposed."
There were eighty-five cases of primary fever in the Investigator, sixty-eight of which occurred during the Christmas quarter of the year. This vessel, which was chiefly employed in the Lagos lagoon, had been despatched on an expedition up the river Niger, to convey an officer to the confluence of the Lukoje for the purpose of relieving the resident agent there. In performing this duty every precaution was taken to preserve the health of the ship's company, and the medical officer (Assistant Surgeon R.J. Sweetnam) who had been in a previous Niger expedition, and had observed the remarkably depressing effect of the climate in the river, says, "I considered it advisable to recommend that each man (white) should have one pint of the best porter daily, in addition to his allowance of grog, and at seven o'clock p.m., when the days' work was done, four grains of quinine in one ounce of sherry. Cleanliness and ventilation were particularly attended to, and any exposure to the weather was completely obviated by the use of good awnings."
The expedition having been fifty-one days in the river Niger, returned to Lagos on the 26th of October, without the loss of a single man. There the Investigator remained until the 12th of November, when she was ordered into the Bights to cruise. The change from the lagoon to the sea-air rapidly affected the officers and men. Day after day cases of climatic fever presented themselves of a low type, increasing in, numbers until the early part of December, when it appeared to have reached its climax, there being at that time five officers and seventeen men on the sick-list, out of a complement of six officers and twenty men; all of whom were in a very weak and desponding condition. Towards the end of December the health of the ship's company gradually improved, but as most of them had been three years on the coast of Africa, and their constitutions in consequence much impaired, they were brought before a board of survey, the result of which was that thirteen of them were invalided, and sent home to England. The experience of the medical officer of this vessel, with reference to the tendency of fever to make its appearance in ships shortly after their leaving the rivers and proceeding to sea, appears to be confirmatory of that previously given by the surgeon of the Handy. He says, speaking of this epidemic of fever,-
"I have remarked on every occasion since, that, when the ship leaves the lagoons, and puts out to sea, climatic fever makes its appearance, generally on the third day. One would think ague the more likely of the two to occur, but strange to say under these circumstances that form of fever happens very rarely, which may, I think, be accounted for by the fact that the temperature of the atmosphere outside is from 4° to 6° higher than that inside, and much less moist. This I believe to be owing to the position of Lagos, which is situated on low-lying ground surrounded on all sides by mangrove swamps and shallow lagoons, the hot-beds of those pestilential malaria so deadly to Europeans."
There was only one case of primary fever in the Jaseur, and that of an ephemeral type. This singular immunity from febrile disease, considering that the vessel was for some days in the rivers Cameroon, Brass and Bonny, is attributed by the medical officer (Dr. T.D. Allison) to the prophylactic influence of quinine. He says:
"Every precaution was taken to keep the ship's decks clean and dry, and any of the men, on exposure to wet and rain, had always to shift into dry clothing. Quinine was issued to each white person in four grain doses (suspended in a quarter of a gill of rum, and three quarters of a gill of water) once daily after evening quarters, and continued for one week after our return from the rivers. I recommended the rum as a vehicle for the quinine, and I found the mixture was generally much relished, though in a few instances the first dose was ejected. I consider the happy immunity from fever the Jaseur enjoyed during her stay in the rivers, was due to the prophylactic administration of quinine, combined with the other sanitary arrangements adopted on board."
It certainly speaks well for this ship that, although she was during the whole twelve months on the station, only one case of ephemeral fever, and one case of ague, appear on her returns.
There were twenty cases of primary fever in the Lee, the total days' sickness on board ship occasioned by them giving an average of nearly three weeks' duration to each case. This might indicate that they were of some severity, but it appears that the prolonged treatment was less owing to the severity of the febrile symptoms than to the tedious convalescence which is so frequent a consequence of this form of fever. But very little information, however, of any kind is to be obtained from the returns from this vessel.
In the Mullet which had little or no river service during the year, there were seventeen cases of primary fever, all of which were of a more or less ephemeral character, the average duration of each case on the sick-list being between four and five days.
There were thirty-six cases of primary fever in the Pandora, thirteen of which are said to have been of the continued, eighteen of the remittent, and five of the ephemeral type. The duration of each case of continued fever on the sick-list on board ship was about twenty-seven days; of the remittent form about nine days, and of the ephemeral fever between five and six days. Almost all these cases are attributed to exposure at Bathurst in the river Gambia. A few cases occurred after boat service in the rivers between the Isles de Los and Cape Verga, when the boats' crews were much exposed to heavy rains. More sickness would doubtless have resulted from this exposure, but for the careful administration of quinine to the men while so employed, and for fourteen days after their return to the ship.
There were twelve cases of primary fever, all of an ephemeral nature, in the Philomel. This vessel was chiefly employed cruizing between Jackin and Cape Coast. None of her men were on shore during the period for which the returns are sent in from this ship, and her officers had very few opportunities of landing. All boat service was performed by the Kroomen.
In the Ranger there were sixteen cases of primary fever, of which one is said to have been continued, five remittent, and ten ephemeral. The case of continued fever was ninety-one days on the sick-list, recovery being retarded by numerous relapses; each case of remittent fever was on an average sixteen days under treatment, and the average duration of the ephemeral cases was between six and seven days. The case of continued fever was very complicated in its character, and of much severity. It occurred in the person of an officer who had been engaged for seven days in an open boat keeping watch off Porto Seguro. Two days after his return to the ship he began to complain of headache, great depression, and nausea. The nausea and vomiting continued to be very urgent for the first three days, leaving him much prostrated. This condition was succeeded by much epigastric uneasiness, which was relieved after somewhat profuse purging of very dark offensive matters. A distinct remission now occurred in his symptoms, which was followed by intense headache, and this again was relieved by a violent attack of epistaxis. The bleeding, however, reduced him very much; his look became unsteady and anxious, and his voice sank to a whisper. He now complained of much pain and tightness across the upper part of the abdomen; there was a slight return of headache, but no epistaxis. He did not sleep apparently, but lay in a drowsy state, starting up on the slightest noise. The respirations were hurried, the pulse 115. The knees were drawn up towards the abdomen; the urine was scanty and high coloured, with a copious lateritious deposit. The abdominal pain, which continued to increase, was again relieved by copious purging, which was productive of increased prostration, so that stimulants required to be freely used. He became restless and watchful. Morphia was now administered with temporary relief, but this seems to have induced obstinate constipation of the bowels, and consequent return of abdominal pain, requiring for their removal the free use of purgatives. Vomiting of dark grumous fluid now took place, which reduced him still further. This was followed by a return of epistaxis, the bleeding continuing for about twenty minutes, and his condition became most critical. There was severe hypogastric pain, the knees were drawn up upon the abdomen, and the voice was scarcely andible. The hypogastric pain was just overcome, when acute pain in the perinaeum set in, which increased, and was accompanied with redness and swelling of the parts. After some days of much suffering and great prostration, which were only relieved by the constant use of opiates and stimulants, fluctuation was perceived in the swelling, and on an incision being made into it, exit was given to a large quantity of fetid, ill-conditioned pus. The operation was followed by immediate relief, and from that time the patient made sensible progress towards recovery. Convalescence was retarded by occasional attacks of spasmodic pains in the bowels, and by rheumatic pains in the lower extremities and across the loins, but he made a good recovery, and was ultimately discharged to duty.
There were sixteen cases of primary fever in the Rattlesnake, one of which proved fatal. The majority of them seem to have been of little importance, the average treatment of each case only occupying about six days. The fatal case occurred in the person of a seaman who appears to have been lent to the Investigator, in which vessel he contracted fever, which, becoming complicated with bronchitis, proved fatal while he was on his passage in the Wye to Ascension.
There were seventeen cases of primary fever in the Snipe all of which were of an ephemeral character, the average duration of each case on the sick-list being under four days.
In the Sparrow there were eighteen cases of primary fever, and the average duration of each case on the sick-list was a little over fourteen days. This would indicate a tolerably severe type of fever, but it appears that only two of the cases were of much importance. The medical officer (Assistant Surgeon George St. A. Campbell) says:-
"There were eighteen cases of remittent fever under treatment during the year, but of these only two call for special mention. One, was in the person of a stoker, who had not been on shore since coming on the station. Nevertheless he contracted the disease in a most virulent form. The ship went a short distance up the Congo on the evening of the 10th of February, remaining in the river only about an hour. This man, who was at work in the stokehold (the ship being under steam), came on deck to cool himself, and of course was in the state most favourable for the absorption of the malarious poison. He could not have been more than ten or twelve minutes on deck, and yet he imbibed enough of the poison to give him a severe attack of fever. The other case was that of an officer who was upset in the surf while landing at Jellah Coffee. He remained but a short time in his wet clothes, as he had the good sense to take them off and get them dried as soon as possible. He suffered, however, severely from fever, the head symptoms being particularly violent. This was his third attack . . . . Every precautionary and prophylactic measure was taken that my knowledge or prudence could suggest to keep the men free from fever, and I am happy to say with very encouraging results. Boats when away cruising were always supplied with quinine."
There were only four cases of primary fever in the Speedwell and of these three occurred in the persons of officers, and the fourth in a mess servant, whose duties would necessitate his having frequent communication with the shore. In one case the officer had just returned from a boat expedition; in the second case the fever set in after a few days' stay on shore; in the third case, the officer had not been out of the ship nor been exposed in any way; and in the fourth case, that of the mess steward, the disease was contracted at Sierra Leone, where he had been in the habit of landing to procure supplies for the mess, and on several occasions passed the night on shore. The average duration of each of these cases was about eighteen days.
There were ten cases of primary fever in the Wye, none of which appear to have been of any severity. The average duration of each case upon the sick-list was about six days. The crew of this vessel enjoyed a large measure of good health, a circumstance doubtless attributable to the service on which she was employed, which, in the conveyance of stores and supernumeraries to the squadron on different parts of the coast, kept her constantly moving about at sea.
In the Zebra there were twenty-eight cases of primary fever, eight of these being of the remittent type and twenty ephemeral. The average duration of each case of the former disease was between ten and eleven days, and of the latter three or four. Three of the remittent cases proved fatal, two of these being in the persons of the medical officers of the ship. In consequence of these deaths, the medical returns from this vessel are so deficient that but little information is to be obtained from them; but it would appear that, with the exception of those that proved fatal, none of the cases were of any severity.
Intermittent Fever.- One hundred and eight cases of ague were under treatment during the year, and the total days' sickness on board ship and in hospital occasioned by them was 1,027, which gives an average of 9·4 days' treatment to each case. The vessel in which the largest number of cases appeared was the Griffon, in which there were thirty-nine. She had been long on the station, and the crew, both officers and men, were in consequence in a very debilitated condition.
Eruptive Fevers.- Two cases of small-pox of a mild character occurred in the persons of two Kroomen of the Zebra. The disease had been contracted at Fernando Po, where it was epidemic amongst the native population. These men were carefully isolated from the ship's company, and happily the disease did not spread.
Diseases of the Brain and Nervous System.- There is a very large increase in the ratio of cases coming under this head, as compared with the previous year, but there is a reduction in the ratio of invaliding. There were two deaths, however, from these diseases, while there was none in 1863. There were three cases of delirium tremens in the squadron, all occurring in the persons of ward-room officers. One of these proved fatal, death being apparently occasioned by rupture of a blood-vessel during a violent paroxysm of delirium.
Diseases of the Respiratory Organs.- There is an increase in the ratio of cases of these diseases as compared with the preceding year, which is altogether dependent on the greater prevalence of catarrhal cases in the squadron. Both the invaliding and death rates were much less than in 1863. The only fatal cases were one of pneumonia in a stoker of the Archer, and one of phthisis in an African, a native of Sierra Leone, employed as mess servant in the Jaseur.
Diseases of the Heart and Blood-vessels.- Five men were invalided for affections under this head. Four of these suffered from palpitation of the heart to such a degree as to unfit them for active service, although no signs of organic disease could be detected.
A fatal case of aneurism of the thoracic aorta occurred in the person of a petty officer of the Rattlesnake, who had been invalided from the station for asthma. He died in Plymouth hospital, and post-mortem examination of the body revealed emphysema of the upper lobes of both lungs, and old pneumonic consolidation of the inferior part of both lower lobes. The arch of the aorta was dilated into an aneurism of considerable size.
Diseases of the Alimentary Canal.- There is a very considerable increase in all the ratios coming under this head as compared with the preceding year.
Three cases of local inflammation of this canal occurred in the Archer, one of which resulted in perforation of the stomach, and death. In this instance the patient, a boy, had frequently suffered from fever in rather a severe form, and on the occasion of the fatal seizure presented himself complaining of rigors and general malaise. The skin was hot, the pulse full, and the tongue covered with a white fur. The treatment to which he was subjected seemed to have overcome these symptoms, and on the second day after being placed on the sick-list he felt so well that he requested to be allowed to go to his duty. As he was a delicate lad, however, this was not permitted, and on that same afternoon he was suddenly attacked by intense pain in the epigastrium, followed in a few minutes by symptoms of incipient peritonitis. In this condition he was removed to hospital, where he arrived in a moribund state, and died a few hours afterwards. On postmortem examination of the body, a large ulcer was found to have completely perforated the stomach at its cardiac extremity. The spleen was of immense size and very friable, and there were some ulcerated patches in the small intestine.
The other two cases of local inflammation are entered under the head of Colonitis, and occurred to one person, an officer, who was ultimately invalided. The symptoms commenced with acute pain in the caecum, extending gradually across the abdomen, and finally settling in the hypogastrium, and accompanied with incessant diarrhoea, which at length assumed a dysenteric character, large quantities of glairy mucus being passed frown the bowels.
A case of gastritis appears in the returns from the Handy, but as it was only four days under treatment; and no remarks are made upon it, it was probably of a trivial character.
The same observations apply to a case of enteritis in the Investigator, the duration of which was only five days.
A fatal case of enteritis occurred in the person of an officer of the Jaseur, who appears to have led an irregular life. The earlier symptoms were those of aggravated dyspepsia, evidenced by great irritability of stomach, and much prostration. He had restless nights, and although his more urgent symptoms were subdued, and he had recovered sufficiently to be enabled to be out of bed for a short time, he continued to get progressively weaker. Eight days after being placed on the sick-list pain in the abdomen set in. This rapidly increased, he became restless and delirious, the pain was increased on pressure, and he lay with his thighs drawn up and fixed on the abdomen. The abdomen became extended, and the pain assumed a violent paroxysmal character. No relief seemed to be derived from any treatment; the surface of the body became cold and clammy, he was only partially sensible, the pulse was gone from the wrist, the pupils were contracted, he gradually became weaker, and ultimately comatose for some time before death. The post-mortem examination of the body is to the following effect:-
"Autopsy: twenty-two hours after death. Body. That of a well formed person, stiff and rigid. No external marks were observed. Head. On removing the scalp no blood was observed, but on taking the calvarium off a large quantity of bloody serum escaped; the cerebral membranes were much congested, and also the brain itself, which was of a large size, and of unusually firm consistence. Both ventricles contained a large quantity of sero-sanguineous fluid; the chloroid plexus of the left side was much congested, and firmly adherent to the surrounding textures, and loaded with small particles of white fatty-looking substance. Thorax. Covered in with a layer of adipose tissue of about one inch in thickness. There were no pleural adhesions, and the lung substance appeared healthy, although much congested, especially posteriorly. The heart was small, soft, pale, and flabby, and contained no blood. The valves were attenuated. Abdomen. Much distended, muscles generally pale and flattened; the peritoneum loaded with fat. The liver was enormously enlarged, its substance pale, and presenting the appearance of fatty degeneration throughout its entire structure. The spleen and pancreas were congested. Both kidneys were much enlarged, softened in structure, and had generally a pale fatty appearance throughout. The stomach appeared healthy, and contained a small quantity of partially digested substance. The small intestines presented the appearance of acute inflammation throughout, with deposits of white lymph-life patches. No ulcers were observed."
A case of enteritis of eight days' duration appears in the returns from the Lee, and one of gastritis in the Philomel. In the latter instance the attack is referred to eating fish, which, it is stated, whenever they are procured in the Bights, are liable to occasion irritation of the stomach and bowels.
Diarrhoea and Dysentery.- There were fifty-two cases of diarrhoea, and one of dysentery in the Archer, the majority of which occurred during the Lady quarter of the year. In the commencement of that quarter, the vessel was stationed in the River Congo, and although no particular form of disease existed on board there, a great many of the officers, and most of the men, were suffering from, apparently, great debility, not severe enough to necessitate their being placed on the sick-list, but in the loss of appetite, listlessness, and indifference to surrounding objects, accompanied by a pale, sallow state of the skin, and either torpidity or relaxation of the bowels, sufficiently well marked to indicate the depressing character of the climate. On the 16th of January the ship proceeded to St. Paul's de Loando, where she arrived on the 20th, and remained until the 10th of February, when it was found necessary, on account of the increasing number of sick, to proceed to Ascension. For a short time after leaving the Congo while at sea, and during the first portion of her stay St. Paul's, the crew appeared to improve slightly, but colic and diarrhoea then became epidemic on board, so that sometimes as many as thirty would, in the course of the day, apply for medicine for the relief of their symptoms. The surgeon (Surgeon Owen J. Llewellyn) says:-
"What could have caused the general tendency to intestinal irritation, I cannot explain. The drinking water was blamed by the crew as its cause, but I tested it, and found it perfectly pure, the water being condensed on board, and no trace of saline matter detectable in it. Perhaps the fresh meat might have had something to do with it, especially at St. Paul's de Loando, where, through some mistake on the part of the beef contractor, no fresh beef was procurable for some days, and then the animals were driven at a furious rate for several miles, killed directly on their arrival, and the meat sent on board, and possibly the imperfectly oxygenated blood may have rendered the meat poisonous, as everyone that partook of it suffered either from colic or diarrhoea. I did not ascertain this fact for some days after the attacks commenced, and my attention was directed to it by the deep red hue of the flesh, almost purple in some cases, which indicated it. I remonstrated with the beef contractor, and the practice was discontinued, but the diarrhoea did not cease. Quantities of fish, for which St. Paul's de Loando is renowned, were also caught and eaten, but they did not produce any more disease, as I had at first feared they would."
The cases that occurred in the Archer subsequent to this outbreak were of a trivial character, occasioned chiefly by dietetic errors, by over-indulgence in unripe fruit, occasionally eating stale fish, and, it is said, by the drinking water brought off from the shore, which was often impure, especially that obtained from the River Bengo, at St. Paul's de Loando, after the rainy season commenced.
There were eleven cases of diarrhoea in the Dart. A great many cases of colic and diarrhoea occurred between the 5th and 9th of February, when the vessel was in the harbour of St. Paul's de Loando. They are said to have been caused by eating fish cooked in palm oil, which were purchased from the bumboats. The cases were characterised by the sudden supervention of severe griping pain in the abdomen, with vomiting and, when there was diarrhoea, profuse watery and acrid stools. In two instances no urine was secreted for twenty-four hours, in the others it was highly acid, and of a peculiar deep brown colour. The tongue at first was dry and furred; there was much thirst; the circulation was normal. Oleaginous laxatives were given to clear away offending matters, combined with laudanum, to ease pain and quiet the bowels, and under this treatment the majority speedily recovered, so that it was only necessary to place four of these cases on the sick-list, the two in whom the urine was suppressed being included, and for whom, in addition to the above treatment, hot fomentations were applied to the hypogastric and lumbar regions, and copious diluent drinks administered, with alkaline diuretics. On a subsequent visit of the vessel to St. Paul's, the purchase of cooked fish was prohibited, and no bowel complaints occurred.
The total days' sickness from the cases of diarrhoea that occurred in the Dart was eighty-one, which gives an average of between seven and eight days' treatment to each case. This, however, gives an exaggerated view of the character of most of the cases, which were, in fact, of very short duration, being only from three to four days under treatment, and is entirely occasioned by the severe and protracted nature of one case, occurring during the Christmas quarter of the year, in which the bowels for a long time continued very irritable, and the debility induced was very considerable and very little influenced by treatment, the subject of the attack, a marine, being forty days on the sick-list.
There was only one case of diarrhoea in the Handy, but the surgeon of that vessel, who also held the appointment of Colonial surgeon at Lagos, has the following observations on dysentery as it appeared among the white population of that place, which may be considered as a continuation of the remarks made by him on the same subject in the previous year, and quoted in the Statistical Report for 1863.
"We are called on to treat many cases of dysentery, although this disease is much less common at Lagos, among the white inhabitants, than on other parts of the coast. When treatment is commenced early, I have not experienced much difficulty in subduing the disease, unless the subject be a drunkard, in which case he is tolerably certain to be carried off in a period varying from five days to two weeks. I find the chief difficulty exists, not so much in the treatment of the disease in its first stage, as in the after-treatment, when, although the stools have no admixture of blood or mucus, the body is debilitated, the bowels irritable, and the appetite large and vitiated, with a constant craving for the most indigestible food. The treatment under these circumstances becomes difficult, and the patients require constant watching. On the coast of Africa one-half of them die during this period from want of proper nursing. Should a relapse occur at this time, the chances of recovery are but slight, and for some weeks there is danger of a relapse, caused either by improper food or drink, too much exercise, a febrile attack, or allowing the bowels to become constipated. When, however, relapse does occur, we often find that those medicines which were of avail before, are now useless or even hurtful. Stimulants are absolutely necessary to combat the disposition to syncope, and narcotics to give sleep and allay nervous irritability.
"My usual treatment has been, in the first place, to administer an aperient draught composed of three drachms of castor oil, one drachm of tincture of rhubarb, and half a drachm of tincture of opium. This frequently increases the quantity and frequency of stools for a time. After two hours I apply a strong mustard poultice across the stomach, keeping it on for fully half an hour. I then give a pill composed of three grains of ipecacuan and a quarter of a grain of opium every two hours. If, after the third pill, the results do not equal my expectations, I administer one scruple of ipecacuan, two grains of opium, and two grains of tannic acid, the usual effect of which is to cause profuse diaphoresis, and sleep for about two hours; soon after the patient wakes he has another stool, generally pretty natural, but accompanied with a little mucus. Rice, nearly cold, with rice-water for drink, form the only diet. The ipecacuan pills are now given every three or four hours and continued for three or four days, by which time the stools are generally natural. It is now, in my opinion, that the greatest difficulty occurs in the treatment of these cases. Considering the short duration of the disease, the system is greatly prostrated, the appetite is vitiated and great, and the bowels are inclined to constipation.
"For the rice diet, I now substitute arrowroot with port wine, and soup in small quantities and frequently given. Every morning I give the whites of three eggs beaten up, and find it exert a most soothing influence on the intestinal canal for some hours. The tendency to constipation is met by two grains of compound rhubarb pill with one grain of ipecacuan being given every night and morning. The administration of tonics requires the greatest caution, as they are very liable to cause abdominal pains, and if then persevered in, to bring on diarrhoea. In the event of the patient getting over the attack, it is highly desirable that he be removed from the neighbourhood for a time, as should he be attacked with fever of the bilious type, it is pretty sure to be complicated with dysenteric symptoms, and to have a fatal termination.
"I believe it quite possible for a person to sustain twenty attacks of fever during the year, without his constitution being seriously permanently affected; but one severe attack of dysentery renders the system liable to its recurrence for a very long time, when debilitated by exposure, improper food, or an attack of fever."
There were three cases of dysentery and two of diarrhoea in the Investigator. One of the dysenteric cases proved fatal. It occurred in the person of a boy who had only recently recovered from a severe attack of the same disease, and had, in defiance of all injunctions to the contrary, eaten to excess of different kinds of fruit. The immediate cause of death was profuse haemorrhage from the bowels, ulceration having apparently laid open a vessel. The blood was of a purely arterial character, and was not accompanied with any faecal matters.
The other dysenteric attacks occurred in one person, a Krooman.
There were eight cases of diarrhoea, and one of dysentery in the Jaseur. In the latter instance the disease occurred in the person of an officer, who had served for a number of years on the China Station, where he had suffered much from dysentery, and been operated on for fistula in ano. The disease assumed the chronic form, and as he presented symptoms of incipient phthisis, he was sent to hospital. The eight cases of diarrhoea were very amenable to treatment; they were chiefly caused by dietetic errors.
Dysentery proved fatal to a stoker of the Lee, who had been for several months in Ascension Hospital, suffering from debility following fever. He was seized with dysentery while in hospital, and was sent up the mountain for change of air. In a few clays, however, the disease assumed an aggravated form, and carried him off. There were five cases of diarrhoea and one of dysentery in this vessel. The average duration of each case of diarrhoea was four days, that of dysentery six.
Two deaths from dysentery occurred in the persons of marines, borne on the books of the Maeander, for service on the Island of Ascension. In one case the immediate cause of death appears to have been profuse haemorrhage from the bowels; and in the other the disease was complicated with abscess of the liver. In the proper complement of this vessel there were only six cases of diarrhoea, the average duration of each case on the sick-list being five days.
In the Mullet there were four cases of dysenteric diarrhoea, and seventeen of simple diarrhoea. The average duration of each of the former cases was nineteen days, of the latter about four days. The dysenteric cases were attributed to errors in diet, acting on persons already predisposed to disease by exposure on a malarious coast; and the cases of diarrhoea to errors of diet, and sudden changes in diet, as when fresh provisions were substituted for salt.
The cases of diarrhoea in the Rattlesnake, of which there were thirty-two, were of trivial importance; each case was, on an average, five days under treatment.
Two cases of dysentery and eleven of diarrhoea appear in the returns from the Snipe. In one of the former cases, the man, a seaman, had been on boat service, and the evening before returning on board had jumped out of the boat and swum on shore, where he remained in his wet clothes, and also partook of some bad spirit and unwholesome food. For a few days the symptoms were of a somewhat acute character, but he ultimately did well, and was discharged to duty. The other dysenteric case was an exceedingly mild one.
There were eleven cases of dysentery and twenty of diarrhoea in the Speedwell. The dysenteric cases appear to have been of a very protracted character, as the average duration of each on the sick-list was between thirty-three and thirty-four days. Three of the attacks occurred in one person. One case had a fatal termination. This happened in the person of a marine, who, after being thirty-four days on the sick-list of the Speedwell, was discharged to the Wye, for a passage to Ascension Hospital. Although the urgency of his symptoms appeared to abate in that vessel, he did not rally, but sank exhausted two days after being taken on board. The duration of each case of diarrhoea averaged between five and six days.
Diseases of the Liver.- There was a considerable increase in the ratio of cases coming under this head as compared with the previous year, and this increase extended to the invaliding and death rates.
Death from acute inflammation of the liver occurred in the person of a Krooboy of the Handy who having gone on shore on leave, was brought on board four days afterwards in a semi-comatose condition, with the conjunctivae deeply jaundiced, and with pain on pressure over the region of the liver, which organ was found to be much enlarged. He became very sulky and taciturn, as frequently happens with this race of people when ill, and obstinately refused all food and medicine. Frequent hiccough with vomiting set in, and he sank two days after being brought on board. There was no examination of the body, apparently.
A non-commissioned officer, and a private of marines, borne in the Maeander's books for service at Ascension, died of abscess of the liver, which in both instances burst into the cavity of the peritoneum.
Rheumatism.- There was a very considerable increase in the ratio of rheumatic cases as compared with 1863, although that year was much in excess of the one preceding it. There was only a fractional increase, however, of loss to the public service by invaliding occasioned by it. The vessels in which there were the largest number of cases were the Archer and the Speedwell.
Diseases not classed.- A case of Guinea-worm occurred in a petty officer of the Rattlesnake, and was fifteen days under treatment. No details are given in connection with it. The following remarks, however, by the surgeon of the Handy on the native method of dealing with this entozoon may be considered interesting:
"Guinea-worm, proverbially uncommon among the Krooboys, is common among the natives, especially among those from the interior. The Houssa irregular troops, for example, are occasionally stationed for some weeks in villages situated along the edge of the rivers. Soon after their return to head quarters very many of them are laid up with dracunculus, and as the native method of treatment equals my own, I rarely interfere with them. They first apply for some days, or it may be weeks, a poultice of emollient herbs, until a soft prominence indicates the presence of the worm; they then pass under the skin and worm a very thin piece of bamboo, then carefully divide the integument and expose the worm, around which they fasten a piece of cotton, and make it fast round the limb. The poultice is now discarded, the part kept moist with palm oil, and kept cool by means of wet plantain leaves. Daily the thread is tied further up the limb, and usually the worm is thus brought away in about twelve days."
As an interesting contribution to the geographical distribution of leprosy, it may not be out of place here to introduce the observations of the same medical officer on the varieties of the disease that are met with at Lagos:-
"Another disease not uncommon here is leprosy, of two varieties. In one the indurated integument beneath the heel and great toe becomes thickened and cribriform with an immense number of minute dry holes. After a time a thin colourless fluid exudes from these openings, and soon after this a deep ulcer, with elevated edges and very large granulations, forms. This sore spreads until the ankle joint becomes implicated; swelling takes place, with induration, and small fistulous openings form. The constitution now participates; great emaciation supervenes, with anorexia and sleepless nights; very little pain, however, is complained of. The period at which this disease ends varies considerably, from two to ten years being about the ranges. Occasionally, but very rarely, nature effects a cure, the toes ulcerate off, and the stump heals. As a rule, however, the disease again breaks out, either in the same or the other foot.
"I have experimented in the some of these cases, and am under the conviction that in one a cure was effected by attacking the disease early with nitric acid, then poulticing, and administering tonics and alternatives. The man on whom I thus experimented is now quite well, and working at the French factory. In no other instance have I succeeded in making a favourable impression on the disease, and in a few, I am pretty sure, I accelerated the catastrophe.
"In the other form alluded to, the constitutional symptoms are often the first to appear; general debility comes on, with anorexia, and wasting of the body. The inferior extremities then become numb, the toes become particularly thin, giving them the appearance of being elongated; then a constriction takes place, exactly as though a piece of small cord had been tied tightly round the first phalanx of one toe; no ulceration takes place, but the constriction increases until integument alone is left, and the top of the toe soon drops off; there is no ulceration and no haemorrhage. As soon as the distal extremity of each toe is gone, the disease attacks the other foot, but it is worthy of remark, that it very rarely attacks both extremities at the same time. While the outward manifestation of the disease is progressing, the constitution becomes weaker, the body is reduced almost to a skeleton, very little pain is complained of, and one day the patient is 'found dead.'"
Wounds and Injuries.- A warrant officer sustained fatal fracture of the skull, by falling down the main hatchway into the hold of the ship, and a man had his skull fatally fractured by falling from aloft.
One man was drowned by being upset in a canoe while going off to his ship in a state of intoxication; a man was drowned while on detached boat service, but how the accident occurred is not stated; a cook while going on shore for fresh provisions was upset in the surf and drowned; and a man was washed out of a boat by the surf and drowned. A man on detached boat service, while carelessly sitting on the gunwale, fell overboard, and being carried away by the current was drowned before assistance could be rendered him. An African was drowned at Ascension, but under what circumstances is not stated.
A man was suffocated by the impaction of a piece of beef in his larynx. The accident appears to have happened while vomiting, after a heavy debauch. There were twenty-three deaths altogether, from diseases of various kinds, and nine from wounds and injuries and drowning, being in the ratio of 19·8 per 1,000 of mean force, which is a reduction of 2·5 per 1,000 as compared with the preceding year. The death-rate from disease alone was 14·2 per 1,000; in 1863 it was 14·6.
Invalided.- Twenty-seven men were invalided for the sequelae of fever; four for diseases of the brain and nervous system; six for diseases of the respiratory organs; five for diseases of the heart and blood-vessels; eight for diseases of the alimentary canal, seven of these being for dysentery; six for disease of the liver; five for diseases of the genito-urinary organs; six for rheumatism; four for diseases of the bones and joints; one for deafness; eleven for dyspepsia and debility; and three for wounds and injuries of various kinds; making a total of eighty-six, being in the ratio of 53.4 per 1,000 of mean force, which is an increase, as compared with the preceding year, of 12.0 per 1,000.
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