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ON THE HISTORY OF FEVER IN THE ROYAL NAVY.
182
HISTORY OF FEVER IN THE ROYAL NAVY. BY SIR WILLIAM SMART, K.C.B., R.N. THE author gave a sketch of the sanitary history of the navy up to the present time, exemplified by the greater or less prevalence of fevers at various periods, showing how much that class of diseases was answerable for the failure of numerous expeditions, and the cause of incalculable sufferings and loss of life. From 1585, when Drake lost 75C out of 2300 men by yellow fever in the West Indies, and again in 1594, when Drake and Hawkins fell victims there, up to 1794, when Sir John Jervis and Sir Charles Grey reduced the French islands, probably not less than 100,000 men were sacrificed by yellow and remittent fevers alone on that single station. On the home station, from the Thames to Gibraltar, from the days of Howard and Drake to the end of the Seven Years’ War with France and Spain, not less probably than 150,000 men were lost by typhus. The former were from tropical endemic malaria, and the latter from contagion received from the gaols on shore, and disseminated from ship to ship, and dispersed around the coast towns at which the sick were landed ; but it soon died out when carried to tropical climates, whilst the West Indian fevers were never brought to England. In each there was an essential cause-in the former the product of vegetable, and in the latter of animal decomposition--much aggravated in its intensity iu ships by overcrowding, foul atmosphere, defective nutrition, and inattention to cleanliness of person and of locality. From French naval history it is learnt that from the same causes their fleets suffered, at the same period, For example, in 1757 a even more terribly than our own. large fleet infected with typhus left Brest for the protection of Louisburg, and returned to it in 203 days totally disabled by typhus, by which the town was infected grievously through five months, with a loss of above ] 0,000 lives, in. cluding five physicians, 150 surgeons, and 200 priest, which far exceeds anything in our own annals from a similar cause. Two years later the fleet under Sir E. Hughes which defeated that of Admiral Conflens was at sea six months before the battle took place, and yet on the day of it there were only twenty-four sick out of 14,000 men, owing to their having been kept well supplied with fresh meat and vegetables. In fact, whenever, before or after that event, fever and flux committed ravage, there was always the scorbutic diathesis undermining the general stamina of the men. The first and second voyages of Captain Cook-1768 to 1773-afford a contrast : in the first, with scorbutic diathesis, 35’7 per cent. of the crew died of tropical fevers with flux in four months; but in the second, only one man died of disease in three years, under sanitary and antiscorbutic precautions. These are facts typical of the period. From that time, however, there was much less of fever, as before the next naval war, 1778 to 1782, the sources of fevers were cleansed by improved management of the gaols, and by improvements in the ventilation and the cleanliness of ships, but the causations of scurvy remained unmitigated, notwithstanding the experience of Hawkes’ fleet. In 1759-60 the admissions to Haslar for fever were 393 and for scurvy 119 per 1000 of all admissions; but in 1782 there were 329 and 112 respectively, showing a larger proportional abatement of fever than of scurvy ; and in 1780 the Channel fleet, after a ten weeks’ cruise, returned with 2400 men sick of scurvy, proving that the causes of scurvy were as rife as ever, while the causes of fever were less so. From that period, however, there was a considerable abatement progressive in both ; but at no period was it so marked as immediately after the mutiny in 1797, which was followed by great reforms in the quantity and quality of the seaman’s rations and pay. In proof of this, the datafrom thesame source show that in 1796 the admissions were in the ratios of 257 per 1000 for fever and 745 for scurvy, and that in 1799 they haddeclined to 200 and to 20 per 1000 respectively, being a rapidity never beforeexperieuced. and that, too, in In the last century, and that very late in war time. it, scurvy disappeared initsepidemic epidemic typhushas been unseen since, ou account of reforms that have acted preventively, as soon as the propriety of them has been reeogrdeed. Superior meansofventilation have been invented;
type,and
1
Abstract of
a
paper read at
a
meeting of
ships and of persons has been enforced ; while overcrowding, by reason of employing larger ships in propor. tion to the crews, has been lessened ; iron tanks have been cleanliness of
ON THE
the
Epidemiological Society
substituted for wooden casks for water; and a very pro. gressive improvement in the food, in quality and in variety, as regards both fresh meat and vegetables, has taken place wherever possible. Cinchona was given until supplanted by quinine as a preventive of fever; lime-juice, as a preventive of scurvy; and more frequent intercourse on shore has pro. duced cheerfulness amongst the seamen ; while the half pint of spirits allowed daily in the last century, encouraging if not legalising drunken habits, has been abolished save on emergencies, and sobriety is no longer the rare virtue it was formerly in the navy; and, finally, the employment of iron instead of wood in naval construction, and the use of steam as a motor power, render long detention at sea un. necessary-all these changes have combined to make the navy as healthy as life on shore. The last century was, in a medical sense, devoid of experimental spirit in the navy, while such cannot be said of it since the dawn of the present century, when medical officers first began to obtain a reco. gnised position in its ships and service. The latest hospital statistics, from 1869 to 1877 inclusive, yield, at Haslar and Plymouth, 51,584 total admissions, with 2539 for fevers of all types, and no scurvy, being less than 50 per 1000, showing a decline of 150 cases per 1000 ’since 1799 ; and of mortality from 70’5 to 60in each 1000 cases of fever, exhibiting the extent of mitigation as regards febrile forms of disease in the present century. It is to be lamented, for the good of the service, that hospital returns ceased in 1877 to be published, thus precluding useful and encouraging comparisons in future.
LUMBAR COLECTOMY. BY CLELAND
LAMMIMAN, F.R.C.S. ENG.
THE operation called lumbar colectomy seems likely, in the advance of abdominal surgery, to become a generally adopted one, and as since its introduction it has only been performed on one or two occasions, the following notes of a case upon which I have recently operated may prove of some value to any who are purposing to pursue this method of relief in cases where the position of the stricture can be
settled any
as lying in either the upper part of the sigmoid or in part of the splenic flexure of the colon.
I first saw Mrs. -, with Dr. Ivers of Tonbridge, on Feb. 2nd (Friday), when the following history was given :On the previous Sunday she failed to effect her usual morning evacuation, and towards the evening bad some amount of distress, when vomiting came on. Dr. Ivers had given several doses of purgative medicine without effect, and had succeeded in passing 0’1’ieirrie’s tube into the bowel (its whole length apparently). She had taken only fluid food in small quantities with opium. There was no history of cancer. Physical examination.-A well.nourished woman of fiftyfour years, dark, somewhat sallow, and inclined to obesity. Abdomen not tender, but filled with flatus, which could be perceived rolling the intestine over and over with loud No tumour could be detected; no hernia. No noises. evidence of anything wrong in rectum. She informed us that upon several occasions, which had increased in frequency lately, she had had great pain in her abdomen, with constipation and vomiting, once or twice with jaundice. Concluding that we were dealing with an occlusion of the intestine, we resolved once more to give a competent purgative, hoping that the case might yet turn out to be fsecal impaction. This produced in an hour or two some very suspicious-looking vomit. In the meantime, we introduced O’Beirne’s tube into the rectum, and apparently into the sigmoid flexure, as the whole tube, save an inch or two, was passed in ; but when we injected gruel, we found that not more than half a pint was retained, the rest flowing out as it was injected. Now, as at the operation the stricture was found in the upper part of the sigmoid flexure, it is plain that the tube must have turned upon itself. There was during this period and up to the time of operation no fever. After the stercora’eous vomit had appeared, we used no food, save ice in small quantities, by the mouth, using by the rectum thejuice of raw meat
HISTORY OF FEVER IN THE ROYAL NAVY. BY SIR WILLIAM SMART, K.C.B., R.N. THE author gave a sketch of the sanitary history of the navy up to the present time, exemplified by the greater or less prevalence of fevers at various periods, showing how much that class of diseases was answerable for the failure of numerous expeditions, and the cause of incalculable sufferings and loss of life. From 1585, when Drake lost 75C out of 2300 men by yellow fever in the West Indies, and again in 1594, when Drake and Hawkins fell victims there, up to 1794, when Sir John Jervis and Sir Charles Grey reduced the French islands, probably not less than 100,000 men were sacrificed by yellow and remittent fevers alone on that single station. On the home station, from the Thames to Gibraltar, from the days of Howard and Drake to the end of the Seven Years’ War with France and Spain, not less probably than 150,000 men were lost by typhus. The former were from tropical endemic malaria, and the latter from contagion received from the gaols on shore, and disseminated from ship to ship, and dispersed around the coast towns at which the sick were landed ; but it soon died out when carried to tropical climates, whilst the West Indian fevers were never brought to England. In each there was an essential cause-in the former the product of vegetable, and in the latter of animal decomposition--much aggravated in its intensity iu ships by overcrowding, foul atmosphere, defective nutrition, and inattention to cleanliness of person and of locality. From French naval history it is learnt that from the same causes their fleets suffered, at the same period, For example, in 1757 a even more terribly than our own. large fleet infected with typhus left Brest for the protection of Louisburg, and returned to it in 203 days totally disabled by typhus, by which the town was infected grievously through five months, with a loss of above ] 0,000 lives, in. cluding five physicians, 150 surgeons, and 200 priest, which far exceeds anything in our own annals from a similar cause. Two years later the fleet under Sir E. Hughes which defeated that of Admiral Conflens was at sea six months before the battle took place, and yet on the day of it there were only twenty-four sick out of 14,000 men, owing to their having been kept well supplied with fresh meat and vegetables. In fact, whenever, before or after that event, fever and flux committed ravage, there was always the scorbutic diathesis undermining the general stamina of the men. The first and second voyages of Captain Cook-1768 to 1773-afford a contrast : in the first, with scorbutic diathesis, 35’7 per cent. of the crew died of tropical fevers with flux in four months; but in the second, only one man died of disease in three years, under sanitary and antiscorbutic precautions. These are facts typical of the period. From that time, however, there was much less of fever, as before the next naval war, 1778 to 1782, the sources of fevers were cleansed by improved management of the gaols, and by improvements in the ventilation and the cleanliness of ships, but the causations of scurvy remained unmitigated, notwithstanding the experience of Hawkes’ fleet. In 1759-60 the admissions to Haslar for fever were 393 and for scurvy 119 per 1000 of all admissions; but in 1782 there were 329 and 112 respectively, showing a larger proportional abatement of fever than of scurvy ; and in 1780 the Channel fleet, after a ten weeks’ cruise, returned with 2400 men sick of scurvy, proving that the causes of scurvy were as rife as ever, while the causes of fever were less so. From that period, however, there was a considerable abatement progressive in both ; but at no period was it so marked as immediately after the mutiny in 1797, which was followed by great reforms in the quantity and quality of the seaman’s rations and pay. In proof of this, the datafrom thesame source show that in 1796 the admissions were in the ratios of 257 per 1000 for fever and 745 for scurvy, and that in 1799 they haddeclined to 200 and to 20 per 1000 respectively, being a rapidity never beforeexperieuced. and that, too, in In the last century, and that very late in war time. it, scurvy disappeared initsepidemic epidemic typhushas been unseen since, ou account of reforms that have acted preventively, as soon as the propriety of them has been reeogrdeed. Superior meansofventilation have been invented;
type,and
1
Abstract of
a
paper read at
a
meeting of
ships and of persons has been enforced ; while overcrowding, by reason of employing larger ships in propor. tion to the crews, has been lessened ; iron tanks have been cleanliness of
ON THE
the
Epidemiological Society
substituted for wooden casks for water; and a very pro. gressive improvement in the food, in quality and in variety, as regards both fresh meat and vegetables, has taken place wherever possible. Cinchona was given until supplanted by quinine as a preventive of fever; lime-juice, as a preventive of scurvy; and more frequent intercourse on shore has pro. duced cheerfulness amongst the seamen ; while the half pint of spirits allowed daily in the last century, encouraging if not legalising drunken habits, has been abolished save on emergencies, and sobriety is no longer the rare virtue it was formerly in the navy; and, finally, the employment of iron instead of wood in naval construction, and the use of steam as a motor power, render long detention at sea un. necessary-all these changes have combined to make the navy as healthy as life on shore. The last century was, in a medical sense, devoid of experimental spirit in the navy, while such cannot be said of it since the dawn of the present century, when medical officers first began to obtain a reco. gnised position in its ships and service. The latest hospital statistics, from 1869 to 1877 inclusive, yield, at Haslar and Plymouth, 51,584 total admissions, with 2539 for fevers of all types, and no scurvy, being less than 50 per 1000, showing a decline of 150 cases per 1000 ’since 1799 ; and of mortality from 70’5 to 60in each 1000 cases of fever, exhibiting the extent of mitigation as regards febrile forms of disease in the present century. It is to be lamented, for the good of the service, that hospital returns ceased in 1877 to be published, thus precluding useful and encouraging comparisons in future.
LUMBAR COLECTOMY. BY CLELAND
LAMMIMAN, F.R.C.S. ENG.
THE operation called lumbar colectomy seems likely, in the advance of abdominal surgery, to become a generally adopted one, and as since its introduction it has only been performed on one or two occasions, the following notes of a case upon which I have recently operated may prove of some value to any who are purposing to pursue this method of relief in cases where the position of the stricture can be
settled any
as lying in either the upper part of the sigmoid or in part of the splenic flexure of the colon.
I first saw Mrs. -, with Dr. Ivers of Tonbridge, on Feb. 2nd (Friday), when the following history was given :On the previous Sunday she failed to effect her usual morning evacuation, and towards the evening bad some amount of distress, when vomiting came on. Dr. Ivers had given several doses of purgative medicine without effect, and had succeeded in passing 0’1’ieirrie’s tube into the bowel (its whole length apparently). She had taken only fluid food in small quantities with opium. There was no history of cancer. Physical examination.-A well.nourished woman of fiftyfour years, dark, somewhat sallow, and inclined to obesity. Abdomen not tender, but filled with flatus, which could be perceived rolling the intestine over and over with loud No tumour could be detected; no hernia. No noises. evidence of anything wrong in rectum. She informed us that upon several occasions, which had increased in frequency lately, she had had great pain in her abdomen, with constipation and vomiting, once or twice with jaundice. Concluding that we were dealing with an occlusion of the intestine, we resolved once more to give a competent purgative, hoping that the case might yet turn out to be fsecal impaction. This produced in an hour or two some very suspicious-looking vomit. In the meantime, we introduced O’Beirne’s tube into the rectum, and apparently into the sigmoid flexure, as the whole tube, save an inch or two, was passed in ; but when we injected gruel, we found that not more than half a pint was retained, the rest flowing out as it was injected. Now, as at the operation the stricture was found in the upper part of the sigmoid flexure, it is plain that the tube must have turned upon itself. There was during this period and up to the time of operation no fever. After the stercora’eous vomit had appeared, we used no food, save ice in small quantities, by the mouth, using by the rectum thejuice of raw meat