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MEDICAL E S S A YS:

COMPILED FROM REPORTS

BUREAU OF MEDICINE AND SURGERY,

MEDICAL OFFICERS OF THE U. S. NAVY.

Published by order of the Navy Department.

WASHINGTON:

GOVERNMENT PRINTING OFFICE,
1873-

ill

Navy Department,
Bureau of Medicine and Surgery,

Washington, December 20, 1872.
The files of this Bureau having been found to contain numerous
reports of cases interesting to the profession at large, and instructive
to medical officers of the Navy in particular, Medical Inspector
Albert L. Gihon has been detailed to select and collate them.
As it is proposed to continue these publications, it is hoped that
medical officers will be encouraged to report all cases of interest
occurring to themselves, or observed at home or abroad.

James C. Palmer,
Surgeon-General, U. S. Navy.

Digitized by the Internet Archive

in 2011 with funding from

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CONTENTS.

Page.
Practical Suggestions in Naval Hygiene. By Albert Leary Gihon, A. M., M. D.,

Medical Inspector, United States Navy, Member Naval Medical Board 1-151

Resection of Head of Femur for Gunshot Wound. By W. E. Taylor, M. D.,

Surgeon, United States Navy , 153

An account of the Yellow Fever which appeared in December, 1866, and prevailed

on board the United States Store and Hospital Ship Jamestown, at Panama.

By Delavan Bloodgood, A. M., M. D., Surgeon, United States Navy, Surgeon

of the Fleet, Asiatic Station 171

An account of the Yellow Fever which appeared on board the United States

Ship Saratoga in June, 1869. By Lewis S. Pilcher, M. D., Passed Assistant

Surgeon, United States Navy 205

Sanitary condition of the United States Asiatic Squadron during the period of two

years, from April 1, 1868, to March 31, 1870. By Robert T. Maccoun, M. D.,

Medical Inspector, United States Navy, Surgeon of the Fleet, Asiatic Station.. 223
On Diabetes. By James McClelland, M. D., Medical Director, United States

Navy 233

Reports upon certain English Hospitals. By Edward Shippen, M. D., Medical

Inspector, United States Navy, Surgeon of the Fleet, European Station 249

Schedules of Examinations at Netley 2S7

Reports upon the Hospitals, Charitable Institutions, and Peculiar Diseases of Peru.

By John M. Browne, M. D., Medical Inspector, United S*tates Navy, Surgeon

of the Fleet, Pacific Station 299

Experiments and Observations in Naval Hygiene. By Edward D. Payne,

M . D . , Surgeon, United States Navy 323

PRACTICAL SUGGESTIONS

NAVAL HYGIENE

ALBERT LEARY GIHON, A. M., M. D.,

MEDICAL INSPECTOR, U. S. NAVY, MEMBER OF THE NAVAL MEDICAL BOARD.

James C. Palmer, Esq., M. D.,

Surgeon- General, United States Navy,

Chief of Bureau of Medicine and Surgery,

Navy Department :

Sir : The flattering reception which has been accorded to these
suggestions by officers of long experience and high authority, and
which has induced you to direct me to prepare them for the third
time for publication, demands my most grateful acknowledgment.
While expressing my appreciation of their approval, I beg you to
permit me to record my sense of obligation to yourself, for the
encouragement I have received from you, in my effort to direct
attention to the urgent need of sanitary reforms in the adminis-
tration of the naval service.

Very respectfully, your obedient servant,

Albert Leary Gihon, M. D.,

Medical Inspector, U. S. Navy.
Washington, March i, 1873.

NAVAL HYGIENE.

THE PROVINCE OF NAVAL HYGIENE.

Notwithstanding the general knowledge of the fact that the
better mode of relieving human flesh of the ills to which it is
heir is to prevent them, very little is done toward lessening the
amount of physical suffering among mankind. Not only are
individuals improvident of health, but public communities neg-
lect precautions that would avert many attacks of disease ; and
even governments, having control of armies and navies, are
unmindful of preventive measures which would diminish the
expense and promote the efficiency of these bodies.

It ought to be unnecessary to urge the importance of naval
hygiene. If it be so requisite to study what to do and what to
leave undone on shore, where everything demanded for the
healthy maintenance of the body is in abundance, how much
more strictly ought the laws of health to be observed on board
ship, where human beings are crowded together in violation of
all these laws, breathing a scanty supply of air vitiated by the
retention of their own excretions, subsisting upon an unwhole-
some diet, their sleep always interrupted, and their minds contin-
ually disquieted by passions called into operation by the unnat-
ural circumstances of their lives. Yet no sanitary code has ever
been promulgated in our own service, nor, until recent years, has
it been attempted elsewhere. The young medical officer is with-
out a guide. As much confused by the manners of those around
him as by the maze of rigging overhead, he credits whatever he
is told and accepts, "it is the custom of the service," as palliating
whatever appears barbarous and unnatural.

NAVAL HYGIENE.

The same cause that has retarded the influence of civil
hygiene has prevented the institution of sanitary regulations for
the Navy. The real character and mission of the physician have
not been recognized. He is regarded solelv as a medicine-man,
and there is a general rebellion against his authority when he
prescribes to the well what they shall eat and drink, how they
shall live, dress, and sleep, how their houses should be built, their
lands tilled, and their food cooked. The public mind does not
rise to the comprehension of the extent of province of our great
profession. The scientific medical man is at most regarded as an
"allopath," a sectarian amid globulistic and rational homoeo-
paths, Thomsonians, and Swedish-movement curers.

The naval surgeon has had his domain still further retrenched.
Despite the radical changes which time has effected in the service,
traditional jealousies and want of confidence have been perpetuated,
and there are still many who, through a fear lest the medical officer
transcend his position, are deaf to his warnings. Over the country
are distributed the victims of this system, and many a grave has
been untimely filled through inattention to sanitary recommenda-
tions. Every national vessel arriving at our naval sea-ports brings
a number of invalid men and officers: the business of the naval
hospitals is disproportionate to the size of the naval establishment;
and this sacrifice of life and money will continue " until physicians
have the place in the councils of military commanders that is due
to science. The health history of the late wars in Europe is demon-
strative in proof of the important fact that military life has been
sacrificed in an enormous proportion to ignorance — that is, to the
unwillingness of commanders to be advised on subjects which
they could not themselves be supposed to know." — (Robert
Jackson.) "From the neglect of the precautions specified,
thousands of lives have been sacrificed which might otherwise
have been preserved. The care of the health of the troops
should certainly be one of the first duties of a military commander.
Unless his men are in good physical condition they can be of no
service to him in carrying out the ends he may have in view, but

NAVAL HYGIENE.

are a hinderance to him and a burden to themselves. And yet
how often it happens that those in command are heedless of the
warnings and inattentive to the advice given by their medical
officers." — (Hammond.) " It is urgently necessary that the
influence of enlightened medical opinion be more and more felt
in the administration of the Navy in all matters relating to
health, for costly blunders still continue to be committed in the
construction and arrangement of our ships of war, which
seriously injure the efficiency of the crew, and which might be
easily effected if every ship were thoroughly examined by a sani-
tary officer before she was commissioned. One of our iron-clads,
the Royal Oak, was. found to be a most unhealthy vessel from
first going to sea, and thrice had she to be inspected by a sani-
tary board before her high sick-rate was reduced. And this is
but one of many similar instances that might be adduced." —
(Medico-Chirurgical Review.)

The naval authorities of Great Britain and France have already
acted toward the establishment of sanitary codes. The medical
officers of our own service, therefore, would be delinquent in de-
laying longer to obtain the sanction of the Department to their
recommendations, and that indorsement of authority which will
secure their observance. In this let us disclaim any purpose of
interference with any other corps. It cannot be too often re-
peated that the function of the physician on board ship is to assist
the executive authorities by maintaining the personnel of the
Navy in its state of utmost physical efficiency ; not to augment,
but diminish sick-lists and empty sick-bays and hospitals. When a
vessel with a complement of one hundred and fifty men has a
daily sick-list of ten or fifteen, something is wrong. Both com-
manding and medical officers should be mutually interested in
discovering and remedying that wrong, and it is often possible
that the latter, through misjudged kindness, the imposition of
malingerers, or an unpardonable feeling of spite, is as responsible
as the former, whose unwise harshness, laxity of discipline, or
neglected hygiene has disabled his vessel. Let us hope, therefore,

NAVAL HYGIENE.

that henceforth both commanding and medical officers, with a
more perfect confidence in each other's professional integrity,
will not hesitate to confer amicably on all questions concerning
the hygiene of the ships and stations on which they serve.
Cheerfully recognizing our obligations of obedience to the com-
manding officer and constituted authorities, we ought to have no
desire to do anything that is foreign to our calling as physicians.
The sacred character of our profession bestows such honorabe
and enviable distinction and dignity upon its followers, that we
need not seek to encroach upon the functions of others. We,
therefore, demand that our motives in making these suggestions
may be no' longer impugned; but that our efforts to accomplish
the legitimate objects of our vocation may be generously assisted
by the other corps, that our common aim, the honor and efficiency
of the service, may be attained.

THE EXAMINATION OF RECRUITS.

The province of naval hygiene begins at the recruiting-office.
To banish disease from shipboard as effectually as possible, it is
as necessary to guard against its admission within the bodies of
the officers and men themselves as to prevent its development
among them, just as the attempt to extirpate the syphilis of the
public prostitutes of large cities is fruitless so long as men who
are themselves affected are allowed access to them. Hence the
importance of carefully guarding this avenue of disease. With
the medical corps rests the entire responsibility of selecting the
personnel of the Navy. The various grades of officers are ex-
amined prior to appointment by special medical boards, while
the medical officer of the rendezvous is charged with the exami-
nation of all applicants for the subordinate positions of shipped
and enlisted men in the Navy and Marine Corps, and with the
rejection of all who are unfit for these branches of the service,
whether on account of existing acute or chronic disease or de-
formity, or constitutional taint, infirmity, predisposition, or inherit-
ance, physical or mental. Could this duty be always performed
with rigid exactness, sick-lists would consist only of acute mala-
dies and injuries; but, unfortunately, all the cachexias are repre-
sented on our medical returns. Many of these latent seeds of
disease are hidden beyond the ken of the most acute observer ;
still there is reason to complain of the superficial manner in which
these examinations are often conducted. It is not unusual for a
man discharged with a certificate of ordinary disability from a
naval hospital to re-appear at that hospital within a few weeks,

NAVAL HYGIENE.

either from the receiving-ship or from some vessel to which he
had been transferred and found unfit for duty. A second dis-
charge has been followed by reshipment at another station. Most
of these cases wait until their arrival at a foreign port, and then
present themselves with chronic and incurable maladies, for which
they have to be invalided, and sent, at great expense, to a naval
hospital in the United States, perhaps the very one they had left.
Dr. Ruschenberger " sent a man home from on board of the United
States ship Falmouth, at Rio de Janeiro, who twice imposed him-
self upon the recruiting officers with a fistula in perineo of several
years' standing, for which he has been unsuccessfully treated at
several civil hospitals." There are men who have passed years
in the service in this way, without having ever completed a cruise.
Haemorrhois, prolapsus ani, fistulas, reducible hernia, stricture of
the urethra, functional cardiac diseases, syphilis, and chronic
rheumatism are the complaints which are most frequently thus al-
ternately concealed and reported. It is not presumed that all
such cases can be exposed at the rendezvous, but greater care
and minuteness of examination would reveal many of them, and
the establishment of dynamometric tests would discover the
greater number, as well as convalescents from exhausting diseases.
Thus, it would have prevented the shipment of a man with
chronic luxation of the head of the humerus, whom I have en-
countered three or four times in the service, and who, while able
to perform the usual movements of the shoulder-joint, could not
accomplish violent circumduction without displacing the bone.
Dr. Magruder, of the Iroquois, when fitting at the Philadelphia
navy-yard for a cruise in the East Indies, informed me that he
had to transfer to the hospital, with phthisis pulmonalis, a recruit
whom he found to have been surveyed and discharged from the
service only eight months prior to his reshipment ; and stated
that there were two other cases of incipient phthisis and one of the
developed disease already on his list, although the ship had been
but a few days in commission. A few years ago, a man who had
recently shipped was discharged from the New York Naval

NAVAL HYGIENE.

Hospital with double inguinal hernia, which he confessed to have
had five years; and among a list of forty-seven cases of pulmo-
nary tubercle then in the hospital, (i860,) twenty-three had been
in the service but a few weeks, and in most of these there was
not a doubt that the early stages of the disease, or the tendency
to its development, were positively indicated at the time of ship-
ment by local physical signs or by evidences of constitutional
impairment. Chronic rheumatism and subluxations are more
difficult of detection, but even these can seldom perfectly dissem-
ble all the abnormal actions of their articulations.

As a further check to the admission of disqualified men into the
service, it is necessary to particularize descriptive lists, to specify
and locate exactly every ineffaceable mark, scar, or peculiarity of
the individual, and to describe, more fully and accurately than is
now done, the general appearance and development of each person.
This complete descriptive list should accompany the man through-
out his connection with the service ; when transferred from one
vessel to another ; when invalided and sent to a naval hospital ;
when discharged from that hospital, whether on certificate of
ordinary disability or to duty • when discharged from the service,
whether with ordinary or honorable discharge ; and it should
appear on all certificates of disability, death, or pension. In all
cases of discharge for permanent disability from incurable affec-
tions or injuries, it should be filed at the Navy Department for
reference when suspicion is entertained that such a man has re-
shipped, and as evidence against him, if this have been done, on
his trial for the fraud he had perpetrated upon the Government.
Men should also be instructed to preserve these lists carefully as
conclusive and requisite for their identification. A recent instance
within my own knowledge illustrates the necessity for minuteness
and exactness in descriptive lists. Jeremiah Griffin presented
himself at a rendezvous to ship as coal-heaver, and was refused
by the recruiting-officer on the ground that he had already shipped
and had failed to repair on board the receiving-ship. This he
denied, and reference to the surgeon's register, although estab-

8 NAVAL HYGIENE.

lishing the prior shipment of Jeremiah Griffin, coal-heaver, of the
same height, age, and nationality as the applicant, exhibited in
the column of remarks, " defective teeth," while the man then
offering had a perfect set. Incompleteness of descriptive lists
subjects the Government to fraudulent claims. John Smith, boat-
swain's mate, shipped and presented an honorable discharge on
which he claimed three months' extra pay. He was well marked
by the loss of a portion of a finger, but no mention was made
upon the discharge which he presented, of the deformity, which
had existed a long time. A seaman recently died, at the Naval
Hospital at Philadelphia, with erosion of the entire penis, who had
suffered amputation of a third of the organ, ten or twelve years
before, at a civil hospital at Adelaide, Australia; yet, as Dr. Rusch-
enberger remarks in his report of the case, " there was no profes-
sional testimony as to the condition of the penil stump at the time
of his last enlistment in the Navy." The sale and transfer of hon-
orable discharges is readily "carried on when descriptive lists are
merely filled up with " eyes dark, hair dark, complexion dark,
marks none," or "eyes light, hair light, complexion light, mark
on arm ; " and, furthermore, the interests of the man himself are
often jeopardized by his name not being spelled in conformity
with the original shipment, or by carelessness in transcribing the
meager items of description. The records of the Bureau of Med-
icine and Surgery contain the following names, which are all in-
tended to represent one individual : Charles Jacks, Charles Zerks,
Clans Zeike, Clane Ezekiel, and Ezekiel Claue. I have known
Houghton, after only two years in the service, to return as Hortom
Bacquiel as Boquil, Tuer as Ture, and Koulousi as Gulachi and
afterward as Galusha ; transformations which originated, perhaps,
on board the receiving-ship, where some careless or uneducated
clerk, in making out the roll of the crew to be transferred to a
sea-going vessel, spelled by sound, or as well as he knew how. the
names as they were read to him, and committed an error which
may appear under a second mutation of form on the honorable
discharge, filled up in a similar manner by another equally heed-

NAVAL HYGIENE.

less clerk. Even should the man present himself for reshipment
at the same rendezvous where he originally passed, the very med-
ical officer who wrote the first descriptive list must perpetuate the
error on the second to secure the sailor his three months' bounty,
since its payment will be refused unless the reshipment agrees in
name exactly with that on the face of the discharge. Instances
of this are numerous. One related to m£ by Surgeon Kitchen
occurred in January of this year, (187 1.) A very worthy and
intelligent petty-officer, named Charles L. Anthony, having re-
fused to sign his name on reshipment Charles T. Anthony, as it
had been erroneously entered on the books of the ship to which
he had previously been attached and thus copied upon his hon-
orable discharge, was, in consequence, refused the payment of the
bounty to which his long and faithful service entitled him. In
my own experience, Peter Woppel, as an honorable discharge
styled him, though he protested that he was baptized Vaupel, and
so wrote it in a legible hand, had to remain a Woppel until an-
other blunderer might convert him into a Wobble or something
else ; his claim for admission into the Naval Asylum, after twenty
years' service, consequently being invalidated under the rule re-
quiring that service to be under the same name, or great difficulty
being occasioned in the adjustment of any pension claim in his
favor. As it devolves upon the medical officer to fill up the blank
descriptive list with the name, nationality, etc., of the recruit, it
behooves him, for the sake of being exact, to cross-examine closely
the answers that are made on these points. Many men, who pro-
fess to have been born in New York, Boston, or Philadelphia, will,
when asked the precise place of birth, mention Cherry, North, or
Penn streets, localities not remarkable for the fecundity of the fe-
males who dwell there. This is done through a fear lest only
natives of the country will be accepted, or in the belief that it
will insure them more favorable consideration ; but when assured
on these points, they frankly admit that they are of foreign birth-
Confusion often arises from the number of identical names on
board ship. I have seen a John Smith 12th. The most of these

NAVAL HYGIENE.

are simply "purser's names," and a little coaxing and argument
will usually induce the man to acknowledge his proper name, and
in other cases will reveal a middle name, which is seldom tendered
unless asked for. Foreigners should be required to spell their
names in their native languages, since it will often happen that a
man maybe designated Louis Blanc or Johann Schmidt, who would
otherwise have become a numerical Lewis White or John Smith.
Not unfrequently common English names are spelled incorrectly by
-the examiner himself. Since writing the above, I was in a rendezvous
where I observed a young assistant surgeon enter the name of a
-•recruit without asking the orthography, and to my inquiry how
he knew that to be the proper spelling, he replied, "Oh! I judge
so." Thus Thomson is given a p, Emory an e, and Fraley an i,
merely as the indolent or indifferent examiner may judge proper.
However acute he may be in other respects, no exercise of judg-
ment will enlighten him whether Riley or Reilley, Dixon or Dick-
son, Wallis or Wallace, Fife or FyfTe, Sheppard or Shepherd, Diehl
or Deal, Bailey, Bayley, or Baillie is correct. All this care on the
part of the medical officer, however, will be thrown away unless
the Government exacts a rigid adherence to the original returns
of the rendezvous in spelling and every other particular, by every
person whose duty it is to transcribe those returns. How readily
•could the applicant for re-enlistment, or the chronic invalid, who,
-~as soon as sent on board ship and required to do duty, repairs to
the sick-bay with a sprained back, a stricture of the urethra, or a
rheumatic joint, be identified, if his descriptive list were filled up in
some such manner as follows : John Henry Smith, seaman ; native
of Galway, Ireland; age, when shipped, 26^- years; height,

5 feet 6*4, inches; figure, slender; hair, brown and curly; com-
plexion, florid ; face, square; forehead, low ; nose, sharp; mouth,
small ; teeth, perfect ; eyes, dark chestnut and sunken ; broad cicatrix
of scald on left shin ; anchor on right hand; etc. All this involves
a little more labor, but it is labor that the Government has a right
to demand of its officers. The subject is so important that I
have been induced to dwell upon it at some length. Every act

NAVAL HYGIENE. II

of duty, however trivial, should be well done, and professional
pride should deter every officer, whatever his rank, from affixing
his signature to a subordinate's work until he has satisfied himself
that it has been performed entirely free from mistake. The fol-
lowing series of errors in the descriptive list of the crew of a single
vessel, (the St. Louis,) effectually illustrates the magnitude of the
•evil sought to be corrected :

Isaac J. Borden, age 39; instead of Isaac G. Borden, age 31.

Petrie Martin, age 29; instead of Pierre Martin, age 40.

William Evene, native of Hartford, Connecticut; instead of
William Evans, native of Maryland.

William J. Heme, native of Maine; instead of William J.
Hearne, native of Canada.

Alfred McDonald ; instead of Alexander McDonald.

Randall McVerrish ; instead of Ranald McVerrish.

William Sims ; instead of William Synis.

Alexander Gorman ; instead of Alexander 0: Gorman.

James Nolen ; instead of James Noidean.

George McGoyn ; instead of George McGoyne.

Christian Allvord ; instead of Chrisiop Allvorden.

Frederick Linderman ; instead of Frederick Lendman.

William Channer ; instead of William Charmerin.

Daniel Callihan, native of Rhode Island ; instead of Daniel
Callaghan, native of New York.

Cornelias Callighan ; instead of Cornelius Callaghan.

Peter Durgan ; instead of Peter Dugan.

Monroe Durgan ; instead of Monroe Durgin.

John Custice ; instead of John Curtice.

Charles J. Conlogue; instead of Charles J. Conologue.

Andorous Dodge ; instead of Andorus Dodge.

Agustus McEwen ; instead of Angus McEwen.
• Benjamin A. McClain; instead of Benjamin A. McClane.

Charles H. Smith, age 25, native of Denmark; instead of
Charles H. Smith, age 22, native of Providence, Rhode Island.

John Kelly, native of Brooklyn ; instead of John Kelly, native
of Philadelphia,

12 NAVAL HYGIENE.

John Brown, native of Ireland; instead of John Brown, native
of Boston.

Henry Johnson, native of Russia; instead of Henry Johnson,
native of Prussia.

George Brown, native of Nova Scotia; instead of George
Brown, native of New Hope, Pemisylvania.

John Williams, native of S'weden ; instead of John Williams,
native of Pennsylvania.

Andrew Anderson, native of Philadelphia; instead of Andrew
Anderson, native of Norway.

Patrick Fardy, native of Maine ; instead of Patrick Fardy, na-
tive of Irela?id.

George D. Vanness, native of New York; instead of George
D. Vanness, native of New Jersey.

Samuel Wood, native of Russia; instead of Samuel Wood,
native of Maine.

John Butler, native of Boston, Massachusetts; instead of John
Butler, native of Edgartown, Massachusetts.

Jacob K. WToodbury, native of Boston, Massachusetts; instead
of Jacob K. Woodbury, native of Beverly, Massachusetts.

George W. Martin, native of Maine ; instead of George W.
Martin, native of Lynn, Massachusetts.

John E. Woodbury, age 35; instead of John E. Woodbury,
age 21.

Yet blunders gross as these are still committed. While pre-
paring my monthly return of men examined for enlistment during
July, 1872, at the Philadelphia rendezvous, with which I was then
temporarily connected, I was induced to compare it with the re-
cruiting officer's list, and was surprised to find that a man de-
scribed as John J. Harrison on the surgeon's roll, was represented
on the other simply as James Harrison. Referring to the origi-
nal certificate of physical capacity, (Form Q,) it was evident that
part only of the man's full name, John James, had been retained
by the careless clerk who prepared the records of the office.
•During the same month Private Ketterer was recruited as Ket-

NAVAL HYGIENE. 1 3

tereer and described as Ketteerer, although he had legibly signed
his name without any double e whatever. A still more flagrant
case occurred a month later. I had sent in the descriptive list of
Hermann Philipp Spengler, and in five minutes received an enlist-
ment paper from the clerk for my indorsement filed up with the
name of Hermann Phillip Spangler.

No physical examination can be thoroughly and deliberately
conducted in the five or ten minutes which, I have reason to
believe, are the average time devoted to this purpose, particu-
larly by young officers. More than thirty years ago, Surgeon
Ruschenberger, prefacing the American edition of an essay by
Deputy Inspector-General Marshall on the " Enlisting, Discharg-
ing, and Pensioning of Soldiers," declared that "the inspection
of recruits, both for the Army and Navy, involving, as it does,
the consideration of the interests of the Government and of in-
dividuals, which are often conflicting, is perhaps the most im-
portant and difficult duty which the surgeon is called upon to
perform. Men who, through vice, dissipation, or misfortune,
find it difficult to obtain a livelihood from private patronage, are
very apt to seek employment in the Army or Navy, often with
the sole view of obtaining medical attendance, and ultimately an
asylum for pension; and even when the greatest caution and
circumspection are observed, some unworthy and inefficient
individuals gain admission into the service. Nor is this very
surprising, when we consider that, prompted by their interests,
recruits resort to every means within their knowledge to deceive
the inspecting officer, whose examination is generally limited for
each recruit to ten or fifteen minutes, a period much too short to
ascertain the qualities of a horse, in which the most astute and
wary jockey may be deceived."

Paragraph 166 of the Regulations for the Government of the
Navy requires a muster of the officers and crew, at which the
executive officer, surgeon, and paymaster shall be present,
whenever a ship shall be put into commission, "for the purpose
of verifying the descriptive lists, of ascertaining that the name

14 NAVAL HYGIENE.

of every man is correctly registered, and that every one has the
exact uniform dress prescribed by regulations," at which muster
any discrepancy in the descriptive lists, or error in the transfer
roll, shall then be corrected. But if the objects of this regula-
tion are not very generally ignored, except as regards the inspec-
tion of uniforms, the examination of the descriptive lists is cer-
tainly never conducted in the critical spirit intended, nor is such
possible at a general muster ; and even when errors are discovered
paymasters very strenuously object to the alteration of the entries
in their books. The three officers indicated should sit as a board,
and deliberately and carefully examine every individual of the
crew singly with regard to the spelling of his name, his age,
nativity, and correspondence with the other items of the descrip-
tive lists.

The points to be particularly noted by the examining medical
officer at the rendezvous are —

i. Name — in full, middle, if any, and in his native language.

2. Nativity — specifying town or other locality.

3. Age — in years and months at time of shipment.

4. Height— in feet and fractions of inches,

5. Circumference of thorax — immediately below the nipples,
and apex of scapula, after full inspiration and prolonged expira-
tion.

6. General development and figure — slender, robust, corpulent,
muscular, stooping, etc.

7. Intelligence — good, bright, ordinary, obtuse, etc.

8. Face — oval, square, high-cheeked, freckled, pock-marked,
smooth, bearded, etc.

9. Forehead — high, low, receding, prominent, etc.

10. Complexion — pale, fair, florid, dusky, tawny, swarthy, quad-
roon, mulatto, negro, etc.

11. Eyes — light or dark blue, gray, hazel; bicolored, prominent,
sunken, etc.

12. Hair — light or dark chestnut, brown, auburn, sandy, red.
flaxen, gray, black; thin, bald, straight, curly, wool, etc.

NAVAL HYGIENE. I 5

13. Nose — large, small, aquiline, pug, flat, sharp, bent, etc.

14. Mouth — small, large, thick or thin lipped, etc.

15. Teeth — perfect, irregular, deficiencies, etc.

1 6. Distinguishing marks — smoothness or hirsuteness of sur-
face, prominence of pomum adami, peculiarities of ensiform car-
tilage, hollowness of sternum, prominence, rotundity, or flatness
of abdomen, unusual size or smallness of penis, scrotum, or testes,
hollowness or prominence of anal region, bow-legs, knock-knees,
splay-feet, largeness of hands, feet, or joints, besides every abnor-
mal feature not inconsistent with perfect bodily vigor, such as
nsevi materni, discolorations, cicatrices, outgrowths, varicose veins/
deficiencies, etc.

The certificate of the applicant that he is "not subject to
fits," etc., (Form Q,) which precedes the physical examination,
is usually signed without hesitancy and without regard to fact..
Cases of epilepsy, stricture of the urethra, hamiorrhois, chronic,
rheumatism, old injuries, congenital and inherited affections, pre-
sent themselves on the sick-list of every vessel in commission,
encumber sick-bays, and materially interfere with the health and
the comfort both of the well and of those who have become sick
in the performance of duty. If the certificate of exemption from
these complaints were required to be in the form of an oath, and
its fraudulent signer were subjected to court-martial and punish-
ment as a perjurer, these cases would soon become infrequent.

In this connection I desire to propose a system of physical ex-
aminations, which may assist the younger medical officers who
have had little or no experience in such duty. It must be borne
in mind, however, as Dr. Fallon, of the Belgian army, has well ob-
served : "That rules and regulations on this subject, however
carefully they may have been devised, and however minutely they
may enter into detail, are but very imperfect guides. They fur-
nish an outline, it is true, of the track which requires to be fol-
lowed, but they do not enable us to escape many mistakes into
which we may fall." The Prussian regulations for the medical
examination of recruits, after reminding the surgeon that it is one

1 6 NAVAL HYGIENE.

of the most difficult and responsible of the duties he has to per-
form, add: "It is impossible to frame specific rules for the exam-
ination of recruits so as to obviate every difficulty. In a great
variety of cases the decision must depend on the discretion and
experience of the inspecting medical officer." Hence the impro-
priety of ordering newly-appointed officers to rendezvous, or of
intrusting the physical examination of recruits and applicants for
survey and pension to the assistant surgeons on board vessels to
which their seniors are attached or in squadrons, since officers of
experience are guided in a great degree by their knowledge of
the duties and habits of sailors, the deceptions they are accus-
tomed to practice, and the requirements of the service. The rou-
tine of examination, which I here propose, and no single detail of
which should ever be omitted, will, I believe, indicate to the med-
ical examiner every important point to which his attention should
be directed.

i. The examiner must satisfy himself of the sobriety and clean-
liness of the applicant. It is proper to require a bath before ex-
amination,* for the better exposure of syphilides, etc. ; and the
least evidence of the narcotic effect of alcohol upon the eye, face,
or heart should decide the medical officer to decline proceeding
any further at that time.

2. The applicant having then made oath or affirmation of his
freedom from any disability of which he is himself cognizant, let
him stand erect before the examiner in a broad light, and perfectly
nude, with chin elevated, heels together, and arms hanging ex-
tended, and let him slowly turn so as to present his front, rear,
and sides in succession. This inspection will satisfy the examiner
of the unfitness of the applicant should he have an attenuated

* Captain George Henry Preble, the commanding officer of the naval ren-
dezvous at Boston, Massachusetts, which is located, as all such establishments
should be, within the precincts of the navy-yard, has recently added two large
bath-rooms to the rendezvous, where unclean men can bathe before examina-
tion, without expense to themselves, delay to the examiner, or risk of the loss
of the recruit to the Government.

NAVAL HYGIENE.

or crooked form, cutaneous or other external disease, glandular
swellings and other evidences of the strumous cachexia, excessive
development of fat, softness of muscular tissue, oedema, deformi-
ties, tumors, extensive cicatrices, nodes,varicosities, etc. Evidences
of medical treatment, particularly when recent, in the shape of
leech-bites, discolorations from blisters, seton, issue, or scarifica-
tor marks, or cicatrices of operations, in connection with marked
diathesis, are valuable suggestions of liability to disease.

3. The general appearance being satisfactory, the next point
to be determined is the existence of venereal disease. I particu-
larly advise a careful inspection of the internal epitrochlear spaces
and posterior cervical region for indurated lymphatic glandulse,
as positively indicative of the existence of a syphilitic taint. The
penis should be scrutinized in its entire length, the prepuce re-
tracted, the glans and orifice carefully inspected, the urethra com-
pressed, and the man required to cough to eject purulent matter.
Most men affected with gonorrhoea or gleet wash out the urethra
by urinating immediately before entering the examining-room; so
that when there is any reason to suspect this disease, it is well to
look at the urethra again after all the other examination has been
completed. The flexion of the glans upon the dorsum, and firm
pressure near the bulb, generally occasion so much pain that the
man winces and exposes himself, even when there is no discharge
discernible. The scrotum should be carefully examined for vari-
cocele, cirsocele, orchitis, and the other diseases of these parts.
Any permanent abnormal condition, singularity of development?
retention of testis, induration of globus minor and vas deferens,
etc., should be noted on the descriptive list. Notwithstanding the
large proportion of sailors affected with stricture of the urethra, it
is scarcely possible to guard against their shipment except by
requiring them to certify on oath to its non-existence, and by
punishing them by sentence of court-martial on the subsequent
exposure of the deception practiced. Few Americans could be
persuaded, like the French, to submit to the introduction of a
bougie ; and it would be almost as repugnant to require them to
urinate in the presence of the examiner.
2

1 8 NAVAL HYGIENE.

4. Direct the applicant to stoop over, touching his toes with
his fingers, the knees stiffened, and in a straight line with the legs,
the feet apart, and the nates exposed to a strong light. Separate
the latter widely, and inspect carefully to discover haem'orrhois,
prolapsus, fistulas of the anus and perinaeum, etc. The latter
diseases very often escape observation, and, when overlooked,
constitute the grounds for so many applications for survey. I
remember one man who had been operated upon for fistula ani
at two hospitals, reported himself on my sick-list on board the
Preble, was again the subject of operation, transferred to a third
hospital, and discharged from the service. A few months later I
again encountered him an inmate of that same hospital.

5. While the man is still stooping, make forcible pressure on
each of the spinous processes of the vertebrae, to discover spinal
affections, and over the renal regions for evidences of tenderness.

6. Cause him to rise and face the examiner : to present both the
dorsal and palmer surfaces of each hand ; to flex and extend every
finger; to grasp with the thumb and forefinger and with the whole
hand ; to flex and extend the wrists and fore-arms; to pronate and
supinate the hands; to perform all the motions of the shoulder-joints,
especially violent circumduction ; to extend the arms at right angles
from the body, and from that position touch the shoulders with
the fingers ; to elevate the hands above the head, palm to palm, then
back to back, and, while standing thus, examine the axillae and
groins for enlarged lymphatics, and the latter regions closely for
fistulous openings, hernias, and relaxation of the inguinal parietes
predisposing to ruptures, compelling the recruit to bend forward,
cough and strain repeatedly and violently. Inspect the abdomen
for umbilical hernia, and for enlargement of the liver and spleen.
Next cause him to evert and invert the feet ; to stand on the
heels and then on tip-toe, coming down on the heel quickly and
heavily, and lifting the toes from the floor; to bend each thigh
alternately high up on the abdomen, and while standing on one
leg to hop with each foot; to squat low down by bending both
knees and thighs, and to rise quickly from this position; to per-

NAVAL HYGIENE.

form all the motions of the hip-joints; to walk backward and for-
ward slowly and at double-quick; and thus to exercise every
articulation of the body in all its movements.

7. Examine the thorax by percussion and auscultation, espe-
cially in the infraclavicular and cardiac regions, at the same time
observing the radial pulse; cross the arms upon the chest, placing
each hand upon the opposite shoulder, and, inclining the body
forward, examine the posterior regions of the thorax. Observe
the movements of the chest during prolonged inspiration and ex-
piration, recording its extreme dimensions by measurement with
a tape in a horizontal direction immediately below the nipples.
In this connection, the indications of the expiratory and inspira-
tory power afforded by the haemadynamometer would be valua-
ble. Observe the effects of violent exercise upon the pulse and
respiration.

8. Examine the scalp for cicatrices, depressions, tinea, etc.; di-
rect the head to be bent forward and backward, and to be rotated
upon the neck ; observe the motions of the lower jaw. Examine
the ears for polypi, disease of the membrana tympani, etc. Test
the hearing by asking questions in an undertone, at a distance,
each ear being alternately closed by an assistant. Examine the
eyelids and eyes, closing and opening them to observe the mo-
tions of the iris. Test the eye-sight by requiring the applicant
to read test-types, or to distinguish articles of various sizes and col-
ors at proper distances, using each eye alternately. Note the
absence of cilia, corneal opacities, redness of tarsal edges, ob-
struction of the puncta, etc. Throw back the head and inspect
the nostrils for polypi, ozaena, etc. Examine the teeth, noting
great defects. Absence of all the teeth of one jaw, or of all the
molars, is sufficient reason for rejection, since imperfect mastica-
tion, especially when the man is restricted to the regular sea-
ration, is very apt to cause dyspepsia and its consequences.
Note if the cutting edges of the central incisors are excavated in-
ternally, believed, on good grounds, to be indicative of congenital
syphilis. Depress the tongue and examine the fauces for hyper-

NAVAL HYGIENE.

trophied tonsils, syphilitic ulceration, mucous patches, etc. De-
cided stammering or difficult enunciation are sufficient reasons
for rejection.

9. Ascertain whether he has been vaccinated, or presents satis-
factory evidence of having had variola.

10. Discover by adroit questioning with what diseases he has
been affected, and of what his parents or near relatives have died.
This part of the examination is important, as it enables the med-
ical officer to discover the fatuity or imbecility of the applicant.
Many officers probably remember a man named Benjamin Sea-
man, who has several times appeared in the service as an ordinary
seaman. He was utterly inefficient on board ship, and was twice
sent to naval hospitals. Any careful observer ought to have been
satisfied, after a few minutes' conversation, that this man was of
very feeble intellect. Unprincipled persons sometimes attempt
to impose weak-minded boys upon the service to rid themselves
of their care. I was witness to two such attempts, in the year
i860, at the naval rendezvous at New York, by ministers of re-
ligion, one of them an officer of a charitable orphan asylum.

At the risk of the accusation of imposing unnecessary labor
upon the examiner, and of making the inspection needlessly tedi-
ous to the subject, I urgently advise the establishment of dynamo-
metric tests for ascertaining the absolute and relative strength of
the individuals presenting themselves for shipment, as furnishing
important data for determining their ability to perform the labor
and endure the fatigues of a nautical career. I do not recom-
mended this, however, for the object proposed by the French hy-
gienists — the stationing of the crew according to the indications
of the dynamometer. Thus, Keraudren, writing on this subject,
states, " Other things being equal, we consider those sailors who
are endowed with great manual strength as the most proper to be
stationed in the tops; we know what a prehensile power topmen
require to gather up or reef a sail which is blown about or dis-
tended by the wind. Those men, on the contrary, who possess a
considerable renal (lumbar) strength should be assigned to the

NAVAL HYGIENE.

battery, and particularly to the working of guns of heavy caliber."
No complex apparatus will be required for the purpose I suggest.
It is desirable to ascertain and record the hoisting, hauling, and
lifting power of the individual. The number of pounds which he
can lift a certain distance, or the height to which he can elevate
a certain weight by pulling steadily on a rope led through a
block overhead, will give the first ; by hauling on a rope led hori-
zontally through a block fastened at the level of the waist, the
second will be ascertained ; while the third may, of course, be ob-
tained by attaching as many weights to a bar or ring as can be
lifted the same distance in the ordinary way. These very simple
contrivances may be extemporized on board any vessel, and may
readily be introduced into the examining-room of the rendezvous.
The numbers obtained are not to be entered on the descriptive
list, but should be recorded on the medical officer's register for
statistical purposes, along with those indicated by the haemadyna-
mometer, should its use also be authorized.

THE RECEIVING-SHIP.

The receiving-ship is the nursery of the man-of-war's man.
First impressions are enduring, and the sailor will be permanently
influenced by the examples he sees around him on entering the
service. The receiving-ship should be a disciplined man-of-war.
The recruit, with his civilian clothes, should cast off his civilian
habits, and witness, at the very outset, the spectacle of order,
cleanliness, and discipline, to which he will be subjected during
his whole naval career.

When the recruit leaves the rendezvous, he is furnished with a
descriptive list and a due-bill for the authorized advance; but, in-
stead of at once repairing on board, he returns to his boarding-
house, indulges in a last debauch, and is finally carried off to the
receiving-ship by his landlord. He is required to present himself
clean, sober, and, until recently, outfitted. He is now allowed to
obtain his clothing from the paymaster of the receiving-ship, but
it is a matter of regret that this is not made compulsory.* The fur-
nishing of the outfit constitutes a large part of the business of board-
ing-house keepers, and of a class of persons who have shops
attached to or adjoining the rendezvous, and who seize upon such
of the recruits, usually boys, landsmen, and merchant-men, as
they can persuade to patronize them.

■^ * Commodore Reynolds, Chief of the Bureau of Equipment and Recruiting,
has issued, (January, 1873,) an order prohibiting the payment for the outfit of
clothing out of the advance money.

NAVAL HYGIENE. 23

The recruiting-office ought undoubtedly to be either on board
the receiving-ship, or within the precincts of the navy-yard,* and
the agency of the landlord entirely ignored by the Government.
The vast majority of men now received in the naval service are
picked up by the "landshark" as soon as they are paid off from a
cruise, supplied with rum, board, and money for prostitutes as
long as he sees fit, and then carried by him to the rendezvous,
where he receives their descriptive lists and the due-bills for their
two or three months' advance, and whence he takes them back to
his tavern, indulges them in a farewell spree, outfits them with
worthless clothing, and then transfers them to the receiving-ship.
If any of them have had honorable discharges, he increases his
bill proportionally, and likewise receives the three months' extra
pay to which that discharge entitles them. The descriptive list
and due-bill ought in every instance to be delivered only to the
recruit himself, who should be informed that he must obtain his
outfit on board the receiving-ship, unless he is in possession of
clothing from paymaster's stores. He ought to be required to
proceed at once to the receiving-ship; and when this is not done,
the medical officer of the rendezvous should inform him that he
has to be re-examined, and that he must wash his body, dress
cleanly, and have his hair cut short before reporting himself on
board. After the second examination by the surgeon of the re-
ceiving-ship, which is preliminary and requisite to his acceptance,
and which is absolutely necessary not only for detecting recent
venereal affections, but for discovering anything that may have
escaped the first examiner, he should he required to bathe
thoroughly, using warm water and soap, under the supervision of

* This has been the case for some time at all the naval stations, and is still
so, except at New York, where the rendezvous is about being established as
a matter of experiment in the same building with the office of the United
States commissioner for enlisting seamen for the merchant service. All the
latter are now required by law to be obtained from this office, where they are
paid off at the expiration of their periods of enlistment, and where a reading-
room, savings-bank, etc., are established, completely removing them from the
influences of the landlords, whose intermediacy is no longer permitted.

24 NAVAL HYGIENE.

the master-at-arms, in a part of the vessel especially assigned for
that purpose, and be provided with the outfit of clothing indicated
elsewhere. His former clothing should be returned to his family
or disposed of for his benefit. From this time he should be re-
garded as the child of the Government, and should be cared for
by the officers who represent that Government. He should be
taught the necessity of obedience, the certainty of punishment for
misdoing, and of reward for meritorious conduct, and he should
be assured that the arm of authority by which he is chastised is
also powerful to defend him from imposition and injustice. There
is a class of persons who have filled certain petty-officers' positions
on board receiving-ships for years, and who, like the sutlers at the
various marine barracks, take advantage of their stations to extort
money from new men on various pretenses, or make loans to them
at exorbitant rates of interest. Some of these persons have ac-
quired large fortunes by their nefarious trade, which they adroitly
conceal from the officers of the vessel, who are continually chang-
ing and do not become familiar with or are indifferent to their ex-
tortions. Every transaction of this kind should be strictly pro-
hibited by law, and every infraction of the law severely punished:
a monthly allowance of pay, conditional upon good behavior, re-
moving the excuse for obtaining money in this wTay. This is
not ground foreign to hygiene. The moral health of a crewT is as
necessary to discipline and efficiency as the normal condition of
their bodies. The superiority of the modern over the old-time
sailor, as an intelligent, thinking man, is evident to the unpreju-
diced, and the late war demonstrated that he wras no less zealous,
brave, and competent than his ruder predecessors, who made a
naval reputation for their country. It is the province of hygiene
to correct all errors and abuses whatsoever which enfeeble the
body, obtund the mind, or degrade the moral nature of the sailor.
The purpose of its suggestions is to diminish sick-lists, empty
brigs, and banish from the berth-deck the filth, obscenity, and
profanity, of the existence of which only those are ignorant who
never visit it except when it is prepared for inspection.

NAVAL HYGIENE. 25

The sanitary regulations applicable to receiving-ships are the
same as those I shall recommend to be adopted on board cruis-
ing vessels. They do not, therefore, need any special discussion
in this place.

Before being drafted to a sea-going vessel, every man should
be inspected by the executive officer as to the completeness of
his outfit of clothing, and by the medical officer as to his health
and cleanliness. The executive and medical officers of the sea-
going vessel should also carefully inspect them as they come on
board. Under the present system, men are sent away usually
scantily clothed, sometimes in ill-health, and generally unclean
in their bodies. I have known vessels to receive their crews in
the winter season, a majority of the men being without mat-
tresses, blankets, under-clothing, stockings, jackets, or overcoats,
and many of them infested with vermin, with which they were
compelled to suffer several weeks, the intensely cold weather
rendering it impossible to cleanse their bodies. It is not uncom-
mon to clear off the sick-list of the receiving-ship by sending its
most troublesome habitues away with a draft, and when these men
have to make a passage in a dispatch-boat or tug, to some
distant navy-yard, they are frequently exposed for several days
to the rigors of our coast, always insufficiently clad, and forced
to sleep about the decks, without bedding, wherever they can
find a place. Such men invariably report for treatm ent as soon
as they get on board the vessel to which they are ordered.
Many others, who were well when they started, contract severe
acute diseases, which disable them when their services are most
required, and often entail permanent organic changes, for which
they have to be invalided sooner or later during the cruise. The
medical journal has usually to be opened as soon as the ensign
is hoisted and the vessel put in commission, and the apothecary
is at work compounding prescriptions before the cook has lighted
his fire at the galley. The transfer of a case of parotitis from the
sick-bay of the receiving-ship to that of the Tennessee, a trans-
fer effected without the consent of the medical officers, resulted

26 NAVAL HYGIENE.

in the illness from that disease of more than seventy of the crew
of the latter vessel. Every man-of-war should begin her cruise
under the most favorable circumstances possible, and hygiene
exacts nothing so important as that every man shall be in good
health and provided with all the clothing he may need. The
necessity for the vessel remaining a few days at the navy-yard
after going into commission is apparent, that omissions may be
supplied and provision made for every possible contingency, but
it is no less important for the Government to provide a proper
transport, with adequate berthing accommodations, for drafts of
men sent from one naval station to another.

NAVY-YARD S

There is a medical officer attached to every navy-yard, whose
special and almost only recognized duty is to attend the sick
among the officers and marine guard, and to examine applicants
for enlistment in the Marine Corps. His more important func-
tions should pertain to the sanitary considerations involved in the
construction and proper preservation of the home of the sailor —
questions similar to those within the province of civil health-
officers. If it be important to require architects to consider
hygienic principles in the construction of dwelling-houses, it is
of no less consequence to insist that ship-builders shall have
regard to the healthfulness and comfort of the structures in which
so many thousand men have to pass so large a portion of their
lives. In claiming for the medical corps this professional interest
in the building of vessels, and the care of those in ordinary, no
interference is sought with the customary routine of dock-yard
duty. The recommendations of the medical officer are of gen-
eral applicability, and would be better embodied in stringent
regulations of the Department than left to the suggestion of
individual officers. The medical officer of the navy -yard is,
doubtless, the proper person to supervise the observance of these
regulations, and call attention to their neglect by subordinates.

The objects it is urged upon the Department to enforce by reg-
ulation are —

i. To preserve vessels in ordinary and those building as dry
as possible.

2. To keep them perfectly clean.

2 8 NAVAL HYGIENE.

3. To provide the most perfect means for their ventilation.

4. To provide the most perfect means for the admission of
light into their interior.

Dampness, dirt, foul air, and darkness are the direst enemies
with which the sailor has to battle when afloat. They can never
be wholly routed and conquered, but they may be subdued
and rendered comparatively harmless. Leagued together, they
slaughter more than all the adversary's powder and shot. The'
most accomplished ordnance officer has no more subtle and pow-
erful ally, in the work of bringing death to his country's foes, than
the poor hygiene of his opponents. Sir Gilbert Blane attributed
the failure of the British arms during our war of Independence
to the deficiency of numbers, and want of strength and energy of
the men from excessive sickness and mortality, and declared that
if the same death-rate in their navy had continued during the
French revolutionary war seamen would no longer have been
procurable, and their famous victories have never been achieved ;
so that, says Prefessor Guy, "it was not the seamenship and fight-
ing qualities of our sailors alone that carried us triumphantly
through that terrible contest, but a reduced mortality, due to the
sanitary discoveries and reforms, which first recruited our popu-
lation by saving lives in infancy and childhood, and then cut off
from our forces, by sea and land, the destructive supplies of jail-
fever, scurvy, dysentery, and small-pox." Therefore, while, in-
ventive talent is being strained to meet the exigencies of an
exceptional state of war, let something be done to stay the mur-
derers who are dealing out death as well in times of peace as in
those of conflict.

It is not expected that ships can ever be made as comfortable
and healthful as homes on land. The creatures that swim the
sea and those that roam over the earth each have their habits.
The carpeted and mirrored steamship, like the painted harridan,
^is pretty only in spots. Her foul and unclean parts are only
masked by the local splendor. The attempt at reform need not,
however, be stopped because absolute perfection is impossible.

NAVAL HYGIENIC. 29

Humanity demands that all should be done that may. The float-
ing hells of the past century, and the rude, strange race who lived
and died upon their ocean home, who spoke a language unintel-
ligible to shore folk, and were ignorant of the customs of the
land world, have become historical. Sailors are men, and ships
the habitations of men, but there are still filth and depravity and
sickness where there might be cleanliness and decency and
health. The medical corps is laboring to this end — not to over-
turn for the sake of overturning, as has been unkindly and unjustly
insinuated.

The first great fact which should be impressed on all naval
constructors, sailing officers, and dock-yard officials, is the neces-
sity of keeping a vessel as dry as possible, not only when in com-
mission and in ordinary, but even when on the stocks. The wood
of which a vessel is composed is a dead organic substance, sub-
ject to molecular decay, which is accelerated by heat and moist-
ure. The temperature is to a certain extent beyond our control,
but it is not altogether out of our power to maintain a certain
degree of dryness, which will not only retard this decomposition,
but diminish one of the causes of that humidity on board ships
which I shall presently show to be so prejudicial to the health of
the crew. All vessels should be built under cover, in dry seasons
of the year, of old and seasoned timber, and the operations of
building should be conducted slowly, so that a circulation of air
may take place between all parts of the frame. When timber
has been allowed to soak in salt water for purposes of preserva-
tion, it should be thoroughly dried before being used in the con-
struction of vessels. Green wood, from the amount of contained
sap and the softness of its tissues, is more readily decomposed
than old hard timber in which the wood-cells are compact, and
vessels constructed of it are notoriously unhealthy. Fonssagrives,
whose excellent work on naval hygiene is the most complete that
has ever been published, narrates two instances in point: "We
are indebted to M. Delalun, capitaine de vaisseau, for the two fol-
lowing facts, demonstrating the influence of the mode of construe-

30 NAVAL HYGIENE.

tion of vessels upon their salubrity. At Navarino the crews of
our vessels were properly subsisted and were spared by the scurvy.
The vessel of Admiral de Rigny alone, although it had fresh
meat twice oftener than the others, was decimated by this affec-
tion. There were about eighty men constantly on the sick-list.
The fact was explained by the humidity of the wood which wras
used in this vessel and by the rapidity of its construction. The
improvised squadron of Antwerp (181 2-13) had been built of
wood felled while in sap. At the end of eight years all these
vessels were out of service, and there was not one of them that
could be repaired. The ship L'Hector, among others, wras so
rotten that she could not even be used as a hulk. She was con-
stantly full of scorbutic cases." The histories of our own "ninety-
day gun-boats" and " double-enders " illustrate the same fact.

Vessels in ordinary should be immediately housed over.
When fitting out for sea, it should be the especial duty of the
watchman or ship-keeper to carefully close all hatches and ports
in wet weather, and open them in dry. It is not unusual when a
vessel is in the hands of the navy-yard employes to find her
lower decks flooded with water or piled up with snow, even when
her crew is hourly expected on board. Large painted awnings
or tarpaulins should be provided and so arranged as to be quickly
spread on the occurrence of rain or snow.

No vessel can be made absolutely impervious to water. It
finds entrance by a thousand channels, by opening seams, by
worm-holes, by leakage from tanks and casks, by the condensa-
tion of the aqueous vapor in the atmosphere. Great care should,
therefore, be taken in ship-building that it be allowed to run
down freely into the limbers, and find access, without obstruc-
tion forward or aft, to the pump-well, whence it can be daily
removed. Medical Director Joseph Wilson, in his work on
naval hygiene, calls attention to a very common defect in
^pumps, which are too short to reach to the bottom of the well,
and thus discharge all the accumulated water. I translate the
following instance quoted by Fonssagrives from a thesis on dys-

NAVAL HYGIENE. 3 I

entery by M. Collas, a surgeon in. the French navy, illustrating
the danger that may result from any obstruction to the discharge
of this bilge-water : " The corvette La Triomphante was anchored
at Nouka Hyva, at a point where there were no marshes. There
was not a single case of dysentery on shore. Soon afterward
this disease commenced to rage on board. The agitation of the
vessel, first by a gale of wind and then by getting aground, soon
caused new cases to appear. The hold was examined, and under
the store-room a pool of stagnant water was found which could
not run into the pump-well, the vessel being down by the head
from the anchors on the bow. The place was carefully cleaned,
and the epidemic disappeared."

It would be supposed to be impossible to make complaint of
the uncleanliness of newly built vessels, but it is a fact that there
are few which do not carry with them from the stocks as great a
source, of disease as the foulness accumulated by a whole ship's
company during a cruise. There is a general neglect, inexcusa-
ble and criminal because it does not involve much trouble, to
remove the chips and other remains of building-materials, which
collect on the floor of the vessel and are planked up under the
ceiling, where they remain year after year, decomposing under
the influence of confined and heated air and the admixture of
fresh and salt water constantly in the limbers. The report of the
Portsmouth Relief Association upon the origin of the yellow
fever which prevailed at Norfolk and Portsmouth, Virginia, in
the year 1855, relates an instance of frightful extent of illness
traceable to this cause ; and an illustration quite as conclusive
was furnished by the United States ship Macedonian during her
cruise on the north coast of South America. The fact was com-
municated to me by her first lieutenant. Numerous cases of
fever having occurred on board this vessel, it was remarked
by her surgeon, now Medical Director Grier, that the men
attacked were chiefly those who slept in the forward part of the
vessel. A local cause was suggested and discovered by scuttling
the fore peak. As soon as an opening was made, a noisome

32 NAVAL HYGIENE.

effluvium arose, and a candle introduced into the peak was in-
stantly extinguished. Both sides were scuttled, wind-sails were
let down, and, after the place was sufficiently ventilated to allow
men to descend into it with safety, was cleaned out. More than
fifty bucketfuls of putrescent vegetable matter and several hogs-
heads of foul discolored water were removed. From this time
the disease disappeared. A letter in the London Times, Septem-
ber 18, 1861, from Halifax, where Her Britannic Majesty's ship
Jason then was, states that " she is a new vessel, built of green
wood; her bilges cannot be kept sweet; the officers have tried
all means to do so without success. This is considered the prin-
cipal cause of her being so unhealthy. The stench is abomi-
nable, particularly in the after part of the ship and in the officers'
cabin, and the Jason is not the only sickly ship in which such a
nuisance has existed."

Naval constructors will, doubtless, admit that when planning
vessels the very last subject, if ever, in their thoughts is hygiene.
They aim at buoyancy, speed, strength, lightness of draught, but
never salubrity. The means of ventilating a ship in commission
will be hereafter referred to, but the constructor has it in his
power to make those means much more efficacious than they can be
under the present system of internal arrangements. There should
be no such thing as a solid bulkhead in the inhabited part of a
vessel. Some of our finest ships have their berth-decks ruined by
being divided into four or five close compartments by as many
complete transverse bulk-heads. Every partition, those separat-
ing private appartments as well as those marking the larger sub-
divisions of ward-room, steerage, warrant officers' steerage, sick-
bay, etc., should be latticed or gratinged above and below. This
can always be done without any sacrifice of strength. The cabin
and ward-room bulk-heads and doors usually have Venetian
blinds or perpendicular bars in their upper part, but the lower
panels should also be permeable to air, and all other bulk-heads,
whether of store-rooms, lockers, sail-room, shell-room, etc., should
be arranged in the same way. Every place should be accessible

NAVAL HYGIENE. , -,

to air, which should circulate freely forward and aft on every deck
of the vessel. The furniture of officers' rooms is not only anti-
quated and inelegant, but such as unnecessarily diminishes the
cubic air-space of the rooms. Cumbersome and unwieldy bu-
reaus, bunks, and wash-stands are taken out and restored, cruise
after cruise, without change or improvement. Instead of the huge
box-like wash-stand, a neat iron upright, with rings for basin and
pitcher, sockets for mug and soap-block, and hooks for towels,
might be devised to occupy one-fourth the space. The bureau'
could be made of much lighter materials, and the bunk would be
far more confortable if constructed on the principle of the French
swinging cradles. A neat style of clothes-locker might be con-
trived of wire which would be cleaner, more commodious and
more ornamental than the great wooden boxes and drawers that
are now never opened nor closed without difficulty. These
changes would furnish space for a much larger amount of respir-
able air, and if, in addition, all the bulk-heads were latticed
though only for a few inches at the top and bottom, the officers''
room would not be such an inclosure of confined and heated air,
from which the occupant escapes on deck in the morning with
nausea, dyspnoea, and headache, and to which he returns with
loathing at the dampness and foul smell he encounters.

The apertures for the admission of light are necessarily few
These are the gun-ports, air-ports, and hatchways. Sometimes
deck-lights of very thick glass are introduced in the ward-room
and cabins, and might, with great propriety and no risk, be dis-
tributed forward over the berth-deck.

These improvements are all feasible in old as in new vessels
Naval constructors would, undoubtedly, cheerfully exercise their
skill m the furtherance of these hygienic objects if the matter were
brought officially to their notice. Some of these gentlemen, with
a laudable desire to contribute to the comfort of officers, have in-
troduced the novelty of bathing-tubs, and I am, therefore, sure
they would be no less disposed to devise improvements conducive
to the health of those who have to inhabit the floating houses thev
put together. J

3

HUMIDITY.

The great danger the sailor encounters is water. Not the
mighty deep he traverses, on whose wide waste he is but an indis-
tinguishable speck, and from whose depths he is only separated
by a few inches of plank. It is not the water without his vessel
that imperils his life so much as that within it — that which saturates
his clothes and bedding, fills the air he breathes, and, creeping in
wherever that air can enter, permeates the very tissue of the wood
of which his ship is built. This is his enemy ; terrible because
unseen, powerful because denied, depreciated and therefore un-
resisted. Fewer lives are lost by shipwreck than by the operations
of this subtle agent. Man's skill has mastered the fury of the
ocean. He is able to oppose its storms and currents, and go
upon its surface as he lists ; but he makes no attempt to combat
this insidious slayer.

The daily variations in the hygrometric constitution of the at-
mosphere do not amount to more than a few grains in weight per
cubic foot. Air is saturated at 5 2° F. by 1.42 per cent, of its
volume of aqueous vapor, in weight about four and a half grains
to the cubic foot. As the temperature rises it becomes able to
retain a larger quantity of vapor in solution, being saturated at
770 F. by three per cent, or 9.8 grains, while at the freezing-point
it holds only a fraction over two grains, or less than one per cent,
of its volume. Ordinarily, it seldom contains more than two or
three grains, or from thirty to fifty per cent, of the quantity of
water in the state of vapor required to completely saturate it.
The fluctuations in humidity, which the rheumatic invalid appre-

NAVAL HYGIENE. 35

dates so sensitively, sometimes correspond to a change of weight
of less than a single grain. The marine atmosphere normally
contains a larger amount of aqueous vapor than the terrestrial, and
on board ship the proportion is further increased by the exhala-
tion of fluid from the surface of the bodies of the men confined
upon it, and very greatly by that from the lungs in the act of ex-
piration, twenty-five to forty ounces of water being discharged
daily by each individual in this way. The evaporation from a
wet deck supplies water enough to the atmosphere to raise it to
its point of saturation ; and when this is repeated without regard
to temperature and season, all those evils result which are attrib-
uted by the scientific to the prolonged influence of moisture and
heat, and which have conferred upon the climate of the west
coast of Africa its notorious unhealthfulness ; and as far as my
own observation has extended, it has generally escaped attention
that these two morbific influences usually act in conjunction. Ac-
cording to Tyndall the aqueous vapor of the atmosphere absorbs
solar heat radiations with rapidity, and the greater the amount of
vapor and the more humid the atmosphere the greater will be the
amount of heat absorbed, and consequently the smaller will be
the excess of sun temperature over that of the shade. Hence, a
ship, the atmosphere of which is always kept near the point of
saturation by being frequently deluged with water, will have the
temperature of its shaded parts raised almost to the height of those
exposed to the unshielded sun. In temperate climates the usual
average yearly excess of sun over shade is twenty degrees, and in
the tropics it is three times as much. It is evident, therefore, that
the beneficial effect of spreading awnings is very much diminished
and the temperature of the lower decks greatly augmented, if the
ship is kept damp; and this is not inconsistent with the fact that
the occasional sprinkling of a dry heated uncovered spar-deck
momentarily reduces the temperature through evaporation.

Since, then, such minute differences in the amount of aqueous
vapor in the atmosphere disturb the harmonious action of the
functions of the human body, how urgently necessary are those

$6 NAVAL HYGIENE.

measures of precaution which are insisted on by medical men !
There is but one opinion on this subject among naval surgeons
all over the world. "Humidity," says Pringle, "is one of the
most frequent causes of the derangement of health;" and Fons-
sagrives, the greatest authority on naval hygiene, uses this lan-
guage: "The practice of medicine on board ship confirms the
truth of this assertion : Whenever a vessel may be said to be
very damp, it may be said to be an unhealthy vessel. All the
authors who have written on the diseases of seamen, Rouppe,
Lind, Poisonnier-Desperieres, Keraudren, Raoul, etc., are unani-
mous in attributing a very great importance to this etiological
influence. The latter, after having, in his report on the cruise of
the Caraibe, analyzed the causes of the production of scurvy on
board different vessels, and discussed all other influences, as
nourishment, sojourn in port or at sea, different stations, etc.,
finally attributed this formidable affection to the persistence of
humidity. All are of one accord on the insalubrity of an atmos-
phere saturated with water, in which the cutaneous depuration
greatly flags, and respiration is performed with difficulty."

English testimony is quite as decisive. Captain John Mc-
Neill Boyd, of the royal navy, candidly admits that "the objec-
tions to wet decks are supported by the medical officers, with
such a weight of evidence that they cannot be gainsaid, and if
the mate of a deck does not think the health of the crew a matter
of indifference, he may so arrange the process of cleaning as to
prove that dry decks are not incompatible with health;" and in
the Life of Coliingwood, it is stated that "his flag-ship, with a
crew of eight hundred men, was on one occasion more than a
year and a half without going into port, and never had more than
six on her sick-list. This result was occasioned by his system of
arrangement and his attention to dryness, ventilation, etc., but
above all by the contented spirit of the sailors, who loved their
commander as their protector and friend, well assured that at his
hands they would receive justice and kindness, and that of their
comforts he was more jealous than his own."

NAVAL HYGIENE. 37

The unanimity of our own medical corps in this matter, in-
stead of attracting that attention and consideration it deserves from
commanding and executive officers, is too often regarded as a
mere perverse contrariety of opinion, having no other object
than a mean and petty attempt to interfere with the routine of
the ship; and this ungenerous belief will probably continue until
the principles of hygiene are better understood by the officers of
the other corps. The consequences of ignorance on this point
were remarkably and conclusively demonstrated on board the
Coast-Survey schooner Varina, during the autumn of i860, while
anchored off the navy-yard at Brooklyn. The officers of this
little vessel, desirous of emulating the customs of their huger
men-of-war neighbors, scrubbed their decks every day without
regard to weather. Numbers of her crew soon became ill with
bronchial, pulmonary, and rheumatic affections, and at one time
nearly a third of them had been sent to the hospital. As soon
as the fact was represented to Captain (afterward Admiral) Foote,
then executive officer of the yard, he ordered the wetting of the
decks to be discontinued, from which time her sick-list rapidly
diminished. Since the first issue of these suggestions, I have
been favored by officers of experience, both line and medical,
with numerous instances corroborating these views. A prominent
case, related to me by Medical Director Maxwell, was that of
the Powhatan, a vessel formerly remarkably healthy, which was
anchored during the rainy season at Kow-luen, opposite Hong-
Kong, and soon became totally ineffective from an enormous
sick-list of pneumonia, dysentery, and fever. Agreeably to his
recommendations, the ship went to sea with every furnace
lighted and every port and hatch kept open until she was thor-
oughly dried, with the immediate abatement of the miasmatic
affections which had decimated the crew. Admiral Boggs in-
forms me that he, of all the naval officers commanding the mail-
steamers to Aspinwall, escaped illness by having his cabin heated
every evening; and he narrates a conclusive instance of the
prophylactic influence of heat from his experience on the coast

38 NAVAL HYGIENE.

of Africa, when compelled to pass a couple of days on shore
below Monrovia, he and all but two of his men remained with
impunity by sheltering themselves at night in a hut in which a
large fire was kept burning, while these two who slept outside
succumbed to the prevailing fever.

A ship must be kept dry to be healthy; her crew must be
healthful to be efficient. To promote this efficiency is alike the
duty of medical officers as of commanders and lieutenants. But
she must be kept clean, it is replied; cleanliness is likewise essen-
tial to health. The daily wetting of the decks, however, is not
evidence of cleanliness, but of dirt. That is an ill-managed ves-
sel which becomes so quickly foul. A well-arranged ship and
well-conducted crew do not accumulate dirt. When the weather
or sea necessitates the eating of meals below, not a crumb should
be spilled from a mess-cloth. The cooks at the galley should be
required to remove grease as they let it fall. Tarpaulins should
be spread whenever the hold is broken out. The cleaning of
mess-things, blacking of boots, brushing of clothes, and every
other operation that can occasion dirt, should be done in the
open air. The unclean berth-deck is so only because of the in-
attention or incapacity of the mate or other officer whose duty it
is to take care of it.

Berth-decks and covered gun-decks do not require to be wet-
ted oftener than once, or, at most, twice a month. They should
then be cleaned thoroughly, and not upon any stated day, but
when the weather is such as will justify it. A dry, clear, sunny
day, after a prevalence of fine weather, is the most proper for the
purpose. It should always be selected and indicated by the com-
mander himself, who should solicit and be guided by the advice
of the medical officer. On these days all other exercises should
be suspended. Every man, except the cooks and such others as
are engaged in the work, should be sent on deck with his bag
and ditty-box, and should be compelled to remain there until the
deck is thoroughly dried. Hot water should be supplied for the
purpose from the galley, and the greatest care should be taken

NAVAL HYGIENE. 39

not to use it in such quantities as to overflow the coamings of the
hatches into the hold. After scraping and scrubbing as much as
is necessary, the greatest expedition should be made in removing
the unclean water by swabs and squilgees, and then drying-stoves
should be lighted and kept swinging until the decks are com-
pletely dried, when they should be thoroughly coated with shellac.
The common form of drying-stove is objectionable, because not
provided with cover and pipe for discharging, through the ports
or hatchways, the products of the combustion of the charcoal,
an arrangement which should only be omitted when the vessel is
rolling too much to allow its use. The hatchways should, all the
while, have been wholly uncovered, wind-sails let down to the
deck, ventilators worked, and, when possible, air-ports opened.
In this way a lower deck may be properly cleaned with the least
detriment to the health of the ship's company.

When a prevalence of wet weather causes the decks to become
damp, they should be scraped and drying-stoves should be fre-
quently lighted. No other process of cleaning should ever be
tolerated. A practice prevails on board some vessels, which can-
not be too strongly reprobated, of going over the berth-deck every
morning with a wet swab, for what purpose it is difficult to under-
stand except it be to maintain an appearance of having observed
the ancient custom of daily scrubbing, the decadence of which
some officers class with the abolition of the cat, as among the
causes of the degeneracy of the Navy.

The flying berth-decks of small vessels should be scrubbed and
dried in the open air, as should also the hatch-covers, ladders, and
gratings of all other vessels which are wetted on any other than
the day for the general cleaning of the lower decks.

It is singular that while there is such difficulty in keeping water
which finds an entrance from natural causes out of a vessel, there
should be such a universal habit of deluging it above and below,
and thus superadding an artificial and unnecessary cause of hu-
midity. There is a general custom of wetting or "holy-stoning"
the spar-deck every morning, which has been handed down from

4° NAVAL HYGIENE.

the past century, with other observances that are equally incon-
sistent with the intelligence of this age. It is very proper to do
this when the crew have soiled the deck with soap-suds by wash-
ing clothes and scrubbing hammocks, and these occasions occur
so frequently that there is no necessity for wetting it at other times,
except after some special unclean work, as weighing anchor, coal-
ing, provisioning, etc.

Small vessels are habitually wet when under way. This can be
partially obviated by greater care in fitting bucklers to the hawse-
holes, and by calking the bridle-ports.

In wet weather the officer of the deck should always promptly
cause the boom-cover to be hauled out at sea, and the awnings
to be spread and housed when in port, rather than cover the
hatchways with tarpaulins.

In this connection I have to suggest a protection against get-
ting wet, which, to the disgrace of the educated officers of the
present day, has not been already generally instituted — a hood
for the head. Men are compelled to visit this place and sit ex-
posed to no matter how heavy a rain or intense a sun. This is
one of the most potent sources of disease on board ship. A
man gets out of his warm hammock at night, and returns to it
with his clothes drenched with water. His blankets and mat-
tress become wet, and in vessels where bedding is aired but
once in two or three months, they remain damp and foul all that
time. On board small vessels without sick-bays and water-
closets for the sick, invalids often refuse to use the close-stool in
the vicinity of their shipmates' messes, and watch an opportu-
nity to elude the vigilance of the nurses and steal on deck. Very
many cases of disease, mild in their incipiency, have been aggra-
vated by this cruel exposure. Nothing can be easier than to
provide a properly fitted tarpaulin or canvas cover for the head,
which would not only defend from the rain, but from the spray
^continually breaking over the bows at sea. Even if unsightly,
though it need not be so, a sacrifice of appearance is a small evil
that will be productive of so much good. So many comforts

NAVAL HYGIENE. 4 1

have of late been instituted in cabins and ward-rooms that it
were only generous to extend a semblance of them to the berth-
deck and forecastle, where the customs of civilized life may be
imitated without greater risk of effeminacy in the one case than
the other.

Another cause of humidity on board ship is provisioning, wood-
ing or coaling in bad weather. Unless absolutely necessary,
these operations should be conducted only on dry days. No wet
or green wood, wet or unclean casks, or wet coal should ever be
allowed below the spar-deck. All coal and wood should have
been kept under cover before being taken on board, and the latter
should also have been deprived of its bark and baked. The
hoops of all casks should also be barked, and the casks carefully
swept prior to being sent below. It would be an additional safe-
guard to whitewash them, and this could be repeated whenever
the hold is broken out. In this way the hold and spirit-room
may ke kept perfectly clean and dry.

It is a matter of controversy whether water should ever be
purposely admitted into a vessel. It is manifestly improper when
it is made a daily habit for the theoretical purpose of " keeping
the vessel sweet," and the only occasion when it is allowable is
when bilge-water has formed, and the bilges are so constructed
that they cannot be cleaned in any other way. In this case the
bilge-water should be pumped out, and fresh water admitted into the
pump-well by a hose from the stop-cock in the ship's side, but not
to exceed in amount the depth ascertained by the first sounding
of the well. This should then be discharged, a second supply of
water admitted and pumped out, and this operation should be re-
peated until the discharge from the pump-well is free from smell.
On board some vessels a very reprehensible practice exists of open-
ing the magazine-cock and flooding the spirit-room and hold.
Such vessels will always be troubled with bilge-water, which forms
the more rapidly as these wettings are frequent. Experiments
are now being made with an automatic bilge-pump of very simple
construction, which proposes to prevent any accumulation of water

42 NAVAL HYGIENE.

in the bilges, and the reports of its effectiveness, on board vessels
in which it has been introduced, are so satisfactory that it will
probably be generally adopted.

I would also urge the necessity of requiring hygrometric obser-
vations by the medical officers of every vessel in commission,
with a careful particularization of the attendant circumstances, so
as to establish on an indisputable basis of fact the propositions
here advanced. These observations should be the duty of the
assistant surgeon, and not be delegated to nurses or apothecaries,
who would perform it in the same superficial manner as the quar-
termasters, who record the temperatures indicated by the dry and
" wet-bob " thermometer. The points to be determined are the
degree of relative humidity and the absolute weight of aqueous
vapor in a cubic foot or litre of air. It is desirable that every
medical officer, on duty on shore or afloat, should be required to
make a detailed annual sanitary report,* embracing not only
a summary of these and other meteorological observations, but
precise information on all the subjects that relate to the preserva-
tion of the health of the Navy, and which are certainly as important
as the records of the failures to effect this object, as shown by the
quarterly reports of sick and expenditure of medicines and medi-
cal stores necessary for their treatment.

* Surgeon-General Palmer, in the forthcoming revised volume of Instructions
for Medical Officers of the Navy of the United States, requires such a
sanitary report from the senior medical officer of every vessel and shore-
station.

VENTILATION

It is scarcely possible on board ship to supply every man with
the thousand cubic feet of space for air which physiologists
declare to be the minimum that can be safely assigned, except
when extraordinary provisions are in operation for its renewal.
Probably no single-decked vessel in the service supplies one-third
of that amount. The best authorities agree that a healthy man
requires a supply of twenty cubic feet of fresh air every minute.
Hammond states that thirty to forty are desirable, and Professor
Donkin places the minimum at three thousand cubic feet per
hour. According to Martin, "the constant movements going on
in the atmosphere prove that the amount of change which
nature has provided for healthy existence is unlimited. The test
of ventilation in a sick-ward is the comparative freshness or purity
of the air. The interesting experiment of Lariboisiere appears
to prove that about four thousand cubic feet per hour are required
to insure this." The amount of air which passes through the
lungs is variously estimated at from three hundred to four hun-
pred and eighty cubic feet, four per cent, of which, at the ordi-
nary rate of respiration, is carbon di-oxide, (carbonic acid-gas,)
that is, one hundred times as much as normally exists in the
atmosphere, while the proportion is largely increased when the
latter is moist; consequently, wrere there no renewal of air by ven-
tilation on board ship, one day would suffice to make its atmos-
phere irrespirable, since, according to Lankester, over six parts
in ten thousand in a breathing atmosphere are adverse to comfort
and obnoxious to health. The rapidity with which air is deterio-

44 NAVAL HYGIENE.

rated by respiration may be understood by imagining a room
seven feet in size in each of its dimensions, and having nearly the
cubic capacity of three hundred and fifty feet, which, containing
normally about one gallon of carbon di-oxide, will, at the end of
ten hours, all apertures being closed, have this amount raised to
ninety-two and a half gallons by the respiration of a single adult
man, showing that every particle of that air had passed through
his lungs. This, however, is not the only noxious element acquired
by air in apartments which are defectively ventilated. Every
act of expiration discharges a large amount of aqueous vapor,
raising its quantity, according to Dr. Craig, of the United States
Army, from one to seventeen grains in a cubic foot ; elevates the
general temperature of the air, and thus increases its absorbent
power for vapors; and further, adds a variable amount of organic
matters, the presence of which is distinctly enough indicated,
even to the unprofessional observer who leans over the fore or
main hatch toward the end of the first watch, by the heavy mawk-
ish odor, which appeals to the sense of taste as well as to that
of smell. According to Gavarret, air thus vitiated is unfit for
respiration, and may lead to serious accidents, not on account of
the carbon di-oxide (carbonic acid gas) it contains, but from the
mere presence of the putrid exhalations of the body, since organic
matter in stagnant air, as that of berth-decks, putrifies as rapidly
as that in stagnant water. Fonssagrives believes " that air may
yet supply the chemical needs of respiration in a place crowded
with men, when from the organic miasms which impregnate it, it
has already become a deleterious agent," and thus quotes Piorry :
'•'That which is the most dangerous in the vitiated air of con-
fined habitations we do not know ; chemistry does not inform us
of it; but our senses, more delicate than chemistry, demonstrate
to us, in an evident manner, the presence of deleterious putrid
matters in the air in which man has long resided." Nor is respi-
ration the only human process which empoisons the air. The
whole cutaneous surface imperceptibly, but ceaselessly, contributes
a determinate amount of aqueous vapor, carbon di-oxide, and

NAVAL HYGIENE.

45

organic emanations. Furthermore, to produce these nocuous ele-
ments, which are thus poured into the atmosphere, each adult on
board ship, according to Dumas, completely disoxygenates twenty
gallons of air every hour, requiring the hourly addition of more
than a hundred gallons to simply restore its equilibrium, disturbed
by this cause alone, without taking into account that necessary to
wash away or dilute the morbific vapors and gases which have
been added. Finally, the decomposition of provisions and ship's
stores, especially coal, and that resulting from the admixture in the
hold of fresh and salt water with the leakage of brine, molasses,
vinegar, etc., all operate to deteriorate the atmosphere of the
ship, not merely by the addition of the gaseous products of this
decomposition, but, as in the case of the crew, by the direct
removal of the oxygen, on which the fitness for respiration of the
atmosphere depends. The problem of ventilation, therefore, is
one of the most interesting and important that can occupy the
naval hygienist.

The greater number of our national vessels are overcrowded
with men. Few can berth their whole complement. With ham-
mock-hooks only fourteen inches apart, less than the breadth of
a man's shoulders, with numbers swinging under the top-gallant-
forecastle, many of our single-decked vessels, when both watches
are below, as in port, still have a dozen or more men who are
compelled to billet themselves on deck, behind mess-chests, or
wherever else they can stow themselves away. Frequently ves-
sels are sent home from distant stations cumbered with men whose
terms of service have expired, with prisoners, and, with manifest
impropriety, the accumulated chronic invalids of the squadron.
The ship-fever of emigrant packets, and the typhus, not uncom-
mon on board men-of-war twenty years ago, and notably virulent
among the transports employed during the Crimean war, were due to
overcrowding. Fonssagrives narrates the case, among others, of the
corvette La Fortune, which, having been employed in transporting
Turkish troops, had two-thirds of her crew prostrated by this dis-
ease, of whom half were lost, and was obliged to land the rest at

46 NAVAL HYGIENE.

Messina. Even when the ill effects of overcrowding are not so
disastrous and manifest, they are not compensated by any ad-
vantage whatsoever. The effective number of the crew is reduced
by a sick-list of from fifteen to twenty-five a day, and the invalids,
who require to be returned to the United States, ultimately bring
down the complement of men to the capacity of the vessel. All
this additional expense, as well as the discomfort which a large
sick-list necessarily occasions to the well, might be obviated by a
reduction of the ship's company at the outset. As the small
gun-boats and iron-clads are the worst circumstanced in every
sanitary respect, and besides being officered by young and inex-
perienced men are, in consequence of their lightness of draught,
often required to cruise up narrow rivers and in unhealthy locali-
ties, they present, relatively, the largest number of disabled men,
and thus have their effectiveness seriously impaired; hence, while
especial care should be taken to provide for the proper ventilation,
cleanliness, etc., of this class of vessels, it is desirable to limit their
complements of men and officers to the smallest numbers abso-
lutely necessary to work them, introducing every possible labor-
saving appliance known to the nautical art, and dispensing with
superfluous attendants by diminishing the number of officers'
messes; and furthermore to change their crews annually by trans-
ferring them to the larger vessels of the squadron.

Too little attention is paid to the subject of ventilation by
officers of the Navy. I have heard them express incredulity
when told there was danger from battening down hatches two
or three days continuously, and I have seen a boy confined for
some trifling offense six hours at a time for several successive
days in a narrow " sweat-box," with only a few perforations at the
top of the door, and none at the bottom or sides, and where,
after sinking from fatigue below the level of the holes, he had to
breathe an atmosphere as fraught with danger to his life as that of
the most dreaded plague-ridden spot on earth.

The neglect to provide proper means of ventilation has been
often attended with rapidly fatal consequences. The case of the

NAVAL HYGIENE. 47

Black Hole of Calcutta, where one hundred and twenty-three
persons out of one hundred and forty-six died after one night's
confinement in a room eighteen feet square, provided with only
two small windows, is familiar to every reader. Of three hun-
dred Austrian prisoners confined in one room after the battle of
Austerlitz, two hundred and sixty died; and Carpenter narrates
an equally horrible catastrophe which occurred afloat: " On the
night of the ist December, 1848, the deck passengers on board
the Irish steamer Londonderry were ordered below by the captain
on account of the stormy character of the weather, and although
they were crowded into a cabin far too small for their accommo-
dation, the hatches were closed down upon them, and the conse-
quence was that out of one hundred and fifty individuals, no fewer
than seventy were suffocated before the morning." Instances of
less severity used to be of common occurrence on board men-of-war.
On one occasion, nine or ten prisoners were confined in the main
hold of a single-deck sloop-of-war and half of the hatch closed over
them. At the end of four hours one of the men was taken out
asphyxiated, and resuscitated with difficulty. The occupants of
" sweat-boxes" have often been found almost lifeless or have fallen
out insensible as the doors were opened. Dr. Billings, of the United
States Army, in his report on barracks and hospitals, published in
Circular No. 4, from the Surgeon General's Office, refers to in-
stances of exhaustion and insensibility from confinement in
" sweat-boxes," as experimental evidence in determining the min-
imum amount of air on which life can be supported. In the same
able report, he fixes the proper allowance of fresh air for soldiers
in barracks at two thousand cubic feet per hour for each man.
It is useless to expect to violate with impunity the immutable laws
of our existence, and therefore, so long as the circumstances of
our nature require the inspiration of oxygen into the lungs and
the ingestion of food in the stomach, it will be just as impossible
to compel sailors to do without the one and be healthy, as to
abstain from the other and live. Statistical inquiries on mortality
prove beyond a doubt that of all the causes of death which

48 NAVAL HYGIENE.

usually are in action, impurity of the air is the most important.
Guy states, in his recently published lectures on public health, as
the results of a laborious inquiry into the health of letter-press
printers, and of others following in-door occupations, " that out of
thirty-six thousand deaths a year in England and Wales, which I
attributed to pure pulmonary consumption, five thousand might
be saved by increased space and improved ventilation in shops,
work-shops, and factories; that among men doing the same work
under the same roof, the liability to consumption was determined
by the space ; and that this might be narrowed to a point at which
men would die as fast as by some contagious malady, so that
here, as in Italy, consumption might seem to pass from one person
to another." According to Dr. Parkes, the extraordinary amount
of consumption which prevails among the men of the royal and
merchant navies, and which in some men-of-war has amounted to
a veritable epidemic, is in all probability attributable to faulty
ventilation. I have remarked the same excess of tubercular dis-
ease of the lungs in our own naval service, and injustice has
undoubtedly been done in many cases of phthisis pulmonalis
which were certified " not to have occurred in the line of duty,"
but. assumed to have had a remote inherited origin, when the
disease was in fact directly attributable to the unwholesome and
humid air they were compelled to respire, for the researches of
Bowditch and Buchannan show that, independently of mere
impurity of the atmosphere, there is a decided relation of cause
and effect between dampness and consumption. The nosological
heading " phthisis," on the quarterly report of sick, often repre-
sents only advanced cases of the disease, and not all of these,
many being carelessly recorded as bronchitis chronica, while a
very large proportion of incipient pulmonary tubercle is simply
classed as bronchitis acuta or catarrhus. Constitutional predis-
position assuredly existed in some of these, but the majority
might have escaped the devlopment of the disease had they
'lived under proper hygienic conditions, especially with regard to
a sufficient supply of pure air.

NAVAL"HY<;iENK.

49

Notwithstanding the importance of this matter of ventilation,
few officers trouble themselves about it further than to order
the wind-sails set when the weather is fine. These are certainly
among the most important ventilating apparatus we possess,
but they are seldom set in wet, cold, or very windy weather,
although a larger proportion of the crew is below at these times,
when the hatchways are also usually partly covered up. On
many of these occasions they could be kept hoisted without
inconvenience. They ought not to be lowered at every fresh
breeze or rain-squall. A fire-tub placed under the foot of the
wind-sail and watched would prevent the deck from becoming-
flooded with water, and in cold weather the men had better
protect themselves by extra clothing than keep warm by confin-
ing and corrupting the atmosphere; for though the human odor
is not perceptible when the temperature is low, the air is still
loaded with organic matter, and disoxygenation and the exhala-
tion of carbon di-oxide go on as at other times. Steamships are
now generally heated by coils of steam-pipes, and if proper
apertures are provided for the discharge of the heated and access
of fresh air, they become excellent aids to ventilation. Wind-
sails, of which there cannot be too many, require to be carefully
watched while set. They should always be accurately trimmed
to the wind, kept free from bends, and fastened down not more
than a foot from the deck, never triced up by a lanyard to the
beams. When the latter is done, those men who sleep exposed to
the currents of air through them are apt to contract catarrhal affec-
tions. The bottom piece, sometimes added for ornament, should
always be removed, a hoop taking its place, and large fenes-
trated openings being made in the sides of the wind-sail above
the hoop. They should be hoisted however light the air, even
in calms, when all the fore and aft sails should be set with their
sheets hauled as flat as they can be got, not merely to assist in
steadying the vessel, but to create a movement in the atmos-
phere through the rolling of the ship. In narrow rivers and'
inlets, ships at anchor should be sprung to the wind whenever
4

NAVAL HYGIENE

feasible, the broadside of the vessel with its numerous apertures
affording a very much greater surface for the admission of air
than the bows, and the wind-sails not operating to becalm each
other as when the wind is right ahead. On some stations, as
Japan, this is a subject of stringent regulation on board the
British men-of-war. A scuttle admitting a wind-sail or ventilator
should always open into the sick-bay and yeoman's store-room,
the latter the worst ventilated apartment in the vessel, its atmos-
phere being rendered still more impure by one or two lights kept
constantly burning. When it is absolutely necessary to cover
them, light iron gratings over all the hatchways are better than
the ordinary heavy wooden covers or gratings, being more easily
cleaned, and allowing larger apertures for the admission of air.
When sailing-vessels are under way with courses and spencers
set, powerful currents of air are directed downward through the
open hatches. In steamers this is, in a measure, compensated for
by the upward current induced by the elevation of the tempera-
ture of the engine-room atmosphere ; but during the long anchor-
ages in port, and especially during calm weather, when wind-sails
are of little service, the galley-fire, should it be located on the
berth-deck, is the only means for exciting motion in the stratum
of air below the level of the lowest line of air-ports. Two or
more large iron ventilating pipes or funnels, like those com-
municating with the fire-room on board passenger steamers and
steam-vessels, in the Navy, should open on the berth-deck. In
severe gales it is occasionally necessary to batten down all the
hatches, closing every aperture by which air or water can enter,
except a small scuttle in the main and steerage hatches, and at
other times this has been done as a mere measure of precaution.
In such cases the atmosphere soon becomes unfit for respiration,
and much suffering is occasioned and danger incurred by the sick,
and those whose duties confine them below. Much of this
inconvenience, as well as that experienced from covering the
hatches and skylights during the long rainy seasons of so many
of the stations of our naval vessels, would be obviated bv venti-

NAVAL HYcMKNK.

5

lating-funnels, projecting six or eight feet above the spar-deck
and fitted with movable cowls, carefully adjusted to the wind.
When the hatches are battened down, both watches should be
kept on deck, and the watch off duty allowed to sleep on the
poop or other convenient dry place. The officers should also be
required to remain in the open air, and the bed-ridden sick be
removed to the spar-deck cabin, or to some equally sheltered and
ventilated place when there is no such apartment.

Nor is this all that can be done toward ventilating a vessel. It
is not merely sufficient to provide for the admission of fresh air,
but that which is impure should be removed. It is discreditable
to the mechanical ingenuity of our country that so few attempts
have been made to devise machines which can effect this double
purpose. On board steamers the problem would seem to be very
easy of solution, air being propelled through a system of pipes
traversing the vessel, and even kept in motion by punkahs or fans
operated by the machinery when under way, or by a donkey-
engine when at anchor. The officers of the French navy have
taken the lead in this matter, commanding as well as medical
officers having interested themselves in it. The apparatus of
Captain Brindejonc and that of M. Peyre, though both of small
size, are fully able to accomplish the objects proposed. The
principle of the first is the same as that of the ordinary rotary fan
ventilator, recently placed on board some of our vessels, a number
of fans being made to revolve by means of a crank, in a cylinder,
from which canvas»tubes lead above and below for the admission
and discharge of air. Though occupying but a small space and
employing the labor of only one or two men a few hours every
day, it is able to effectually supply every part of the vessel with
fresh air. I have been attached to but one vessel in the Navy
which has been provided with this apparatus, and even on board
this ship, notwithstanding my repeated recommendations, it was
only put in operation on two or three occasions, and then prin-
cipally as a punishment for black -listers. Certainly, as a system
of punishment, it is better to employ men at this work than, as

52 NAVAL HYGIENE.

may be daily seen, at polishing round-shot, scraping, painting.
and rescraping iron stanchions, walking up and down the deck
carrying heavy loads, or sitting idly in the brig with their hands
and legs ironed, rejoicing in their exemption from labor. Simple
as is this apparatus in its construction, it is necessary to pay atten-
tion to the freedom of the tubes from bends and to the direction
in which they are led, while to produce a current of sufficient
velocity, that is, one moving at least two feet per minute, the
cranks should be turned with considerable rapidity. If two appa-
ratus are put in operation at the same time, as is desirable, one
should be used forward and the other aft, the one discharging air
from below, while the other forces it from above, reversing the
direction of the currents every hour. The same principle involved
in the automatic bilge-pump, to which I have elsewhere referred,
has been applied in the construction of an apparatus for venti-
lation, a column of water acted upon by the rolling of the vessel
being substituted for the mercurial column in the bilge-pump ;
and I learn from Rear-Admiral Boggs that he has introduced
this ventilating-pump on board some of the light-ships, and that
the escape-air issues in sufficient force to operate a fog-horn.

A captain in the French navy has devised a system of stowage
known as the "Arrimage Lugeol," by which the flour, salt, pro-
visions, bean-lockers, rigging, and every other substance in the
hold subject to decomposition, are surrounded by aeriferous
canals. By wind-sails or ventilators introduced into these pas-
sages, currents of pure dry air may be districted through every
part of the vessel, thus not only contributing to the health of the
crew, but also to the preservation of the provisions and other de-
structible stores. Such vessels are less apt to be overrun by
roaches and other vermin, which are active sources of offensive-
ness. As our own vessels are constructed, all that can be done is
to open the spirit-room, holds, sail-room, etc., every few days in
pleasant weather, lower wind-sails into them, and at other times
renew their atmosphere by the fan ventilators. The superior
means of cleansing and ventilating the decks, holds, bilges, in-

NAVAL HYGIENE. 53

terspaces of the ribs, and those under the engine-rooms, which
have been introduced into the British service, are advanced im-
provements, from which Dr. Smart declares "high results may
be reckoned, and as these means are perfected, so we may calcu-
late on a reduced rate of sickness and a diminished mortality
from yellow and remittent fevers, dysentery, and broncho-pneu-
monia, to which may be assigned three-fourths of the present large
amount of phthisis."

The private mess-stores of officers contribute greatly to vitiate
the air of the lower decks. The ward-room and other pantries, and
the various store-rooms on the berth-deck and orlop contain eggs,
fresh meats, and vegetables, which decompose rapidly and become
very offensive. These rooms should all be accessible to air,
through numerous openings in the bulk-heads, and they should
also be opened and ventilated several times a week. I have
already suggested the desirability of latticing all the bulk-heads
on the berth and gun decks to permit the free circulation of air
forward and aft.

It proper attention is paid to these points, there will seldom be
occasion for the employment of chemical disinfectants. Dryness,
cleanliness, and ventilation are the most powerful disinfecting
means. The holds, spirit-room, and store-rooms for provisions
should be whitewashed every month, as well as all casks which
are stowed below, and whenever these are broken out for the pur-
pose of taking an inventory or for cleaning the hold, they should
be swept and re-whitewashed. Whitewash should also be used
on the berth-deck beams and bulk-heads instead of paint. By
absorbing carbon di-oxide, it assists in purifying the air. Lead
nitrate, chlorinated lime and soda, carbolic acid, etc., are never
more than aids to proper ventilation. They can never be carried
in bulk sufficient to be, serviceable alone, and, besides, their effects
.are only temporary.

LIGHT

Light is a powerful vital stimulant. Removed from its influ-
ence, both plants and animals lose color, strength, and firmness of
tissue. " Of all the elements which play a high part in the ma-
terial universe, the light which emanates from the sun is certainly
the most remarkable, whether we view it in its sanitary or scien-
tific relations. It is, to speak metaphorically, the very life-blood
of nature, without which everything material would fade and per-
ish. Man in his most perfect type is doubtless to be found in the
regions of the globe where the solar influences of light, heat, and
chemical rays are so nicely balanced. Under the scorching heat
of the tropics man cannot call into exercise his highest powers.
The calorific rays are all-powerful there, and lassitude of body
and immaturity of mind are its necessary results ; while, in the
darkness of the polar regions, the distinctive characters of our
species almost disappear in the absence of those solar influences
which are so powerful in the organic world." — (Sir J. Ranald
Martin.) According to Dr. Edwards, the proper development of
the body depends upon its free exposure to sunlight, absence of
which he considers one of the external causes of those deficiencies
of form seen in children affected with scrofula. The feeble, puny,
and deformed offspring of those people who habitually live under-
ground in cellars, caves, and mines, and, in a less degree, of the
dwellers in dark lanes and alleys, and of the inhabitants of the
frigid zone, is due to the deprivation of light as well as to unclean-
liness, starvation, and defective ventilation.

The greater part of the crew of the man-of-war has sufficient cm-

NAVAL HYGIENE. 55

ployment in the open air, but there are numerous individuals on
board ship, whose special duties confine them below all day, who
exhibit the pallid exsanguious appearance, the effect of habitually
remaining in the dim twilight of the lower decks. All such per-
sons should be permitted, or, if necessary, compelled, to go on deck
and expose themselves to the sunlight every day. Recovery from
disease is accelerated by the beneficial influence of this agent.
The occupant of a bright and consequently cheerful sick-cham-
ber will leave it sooner and have less the aspect of an invalid
than one who lies in continual shade behind heavy draperies in a.
gloomy apartment. So the sick and convalescent on board ship
will improve more rapidly if kept on deck as much as possible,
those unable to walk being placed in chairs or cots under the top-
gallant forecastle, the break of the poop, or quarter-deck awning.

All the lower decks will be better illuminated by thick plates of
glass set in the deck overhead. The only objection that can be
opposed to them is that they are apt to leak, but this can easily
be remedied by a renewal of the setting.

Artificial light is more injurious than beneficial. Every lamp
and candle is an active consumer of oxygen, and therefore con-
tributes to vitiate the air. Hammond's experiment shows that a
single good sperm candle, burning at the rate of 135 grains an
hour, will produce 9,504 grains (nearly 69 gallons or 11.6 cubic
feet) of carbon di-oxide in twenty-four hours; and as many candles
burn faster and produce more carbonic acid gas, it is within the
bounds of fact to say that a candle, while burning, in the main
causes as great a deterioration of the atmosphere as an adult per-
son breathing in it during a similar length of time. Hence the
minimum number of lights absolutely necessary should be placed
on the berth-deck, and these always under open hatchways, that
the upward current of the heated gaseous products of their com-
bustion may assist the ventilation of the deck. Those officers who
confine themselves to their rooms not only experience the per-
nicious effects of breathing an impure atmosphere, but have their
sight impaired by the flickering blaze constantly near their eyes.

56 NAVAL HYGIENE.

Deck-lights of thick glass over their apartments would often en-
able them to dispense with the use of candles.

Another advantage attending the employment of whitewash on
the berth-deck, besides its effect in purifying the air, is that it multi-
plies the light admitted by the ports and hatchways. All the furni-
ture of officers' apartments and of the ward-room and steerages
should be painted white, the otherwise unpleasant uniformity being
relieved by a little gilded molding or ornamental decoration with
bright colors. On the spar-deck an excess of white or metal
bright-work is objectionable, and should give place to light-blues,
greens, or yellows, or to the natural color of the wood.

CLOTHING.

Every man in the Navy should be required to possess the fol-
lowing articles of clothing:

One water-proof cap.

One water-proof pea-jacket.

One pair of blue cloth trousers.

Two pairs of blue satinet trousers.

Three blue flannel overshirts.

Four blue flannel undershirts.

Four blue flannel drawers.

Three white sheeting frocks.

Three pairs of white duck trousers.

One blue flannel jumper.

Four pairs of woolen socks.

One pair of boots.

One pair of shoes.

One straw hat.

One black silk neckerchief.

One mattress.

Two blankets.

Of which there should be supplied to the recruit, as an outfit,
the pea-jacket, cap, neckerchief, shoes, mattress, and blankets,
one pair of cloth and one of satinet trousers, a flannel overshirt,
two undershirts, two pairs of drawers, and two of socks. Al-
though only these things may be required at the outset, it is
indispensable that the remainder be obtained as soon thereafter
as possible, that the proper changes may be made in the event

NAVAL HYGIENE.

of getting wet. The British admiralty, with a view of lessening
the indebtedness which men have to incur on entering the service,
has authorized the gratuitous presentation to certain recruits of a
blue cloth jacket and pair of trousers, a blue serge frock, a white
duck frock and trousers, a black silk neckerchief, and a pair of
shoes.

Many sailors prefer to buy the materials from the paymaster
and make their own clothing, being able to fit themselves better
and to sew them together more neatly and enduringly. This
affords occupation for the crew, and should, if only on that
account, be encouraged. One of the most interesting spectacles
presented on board a man-of-war is that of groups of men seated
on their ditty-boxes between the guns busily sewing.

I have restricted the number of white clothes because they
are seldom worn, on board some vessels never, and ought to be
abolished. Their chief use is as a Sunday morning mustering-
dress in the tropics, but in recent years the whim of the execu-
tive officer of the flag-ship, or, in its absence, of the vessel,
determines whether the dress shall be white shirts and pants,
blue shirts and white pants, white shirts and blue pants, or blue
shirts and pants, apparently more for the sake of variety than
anything else, straw hats and blue caps, with or without white
covers, extending the number of permutations. The absurdity
of requiring a man to clothe his legs in flannel and his arms in
white duck to-day, while to-morrow he is blue above and white
below, ought to be evident to even the non-professional, as it is
to the old quartermaster whose "rheumatiz" is made to shift
from his shoulders to his loins and back again; but I have
known ships on board which the daily dress-signal followed the
card as regularly as the paymaster's stewards did in issuing the
appropriate ration for the day. Whether white is or is not worn,
under no circumstances, in no climate, ought the sailor to omit
wearing flannel next the skin. This is a hygienic measure of the
utmost importance, and should invariably be insisted upon. The
flannel abdominal belt has been recommended as a substitute.

NAVAL HYGIENE. 59

but it is difficult to keep in position, and while doubtless of great
benefit where dysentery is apt to occur, does not offer the same
protection against pulmonary complaints and malarial diseases
as the complete flannel suit. The single argument in favor of
white is that it absorbs and transmits less solar heat, and is there-
fore cooler than blue; but if worn for this reason, the whole suit
should be white and made of flannel, for the additional woolen
under-clothing will more than counterbalance the advantage of
the light-colored outside garment. The white dress as now worn
is a useless expense and an unnecessary addition to the bag, and
boys and landsmen will elude observation and wear no other
clothing on account of the discomfort and annoyance occasioned
by the thick heavy undergarments now served to them, which may
be obviated, as shown by Surgeon E. D. Payne, United States
Navy, who has recently performed some interesting experiments,
testing the hygienic value of certain articles of sailors' clothes, by
supplying for use, in warm climates, a quality less heavy in texture
and lighter in color. In very hot weather both flannel under and
overshirts may be left off, and a neat light flannel jumper substi-
tuted. The narrow leathern strap, or belt, often worn around the
waist, should be interdicted, on account of its interference with
the circulation; the pantaloons and drawers being supported by
buckles or lacings. If caps are worn in the tropics, they should
be covered with white,* but a light straw hat is the proper article
of head-gear. The weight of the coarse sennit hat made on board
ship is objectionable. If men are sent aloft or exposed to the sun
on deck in the tropics, they should be advised to put wet handker-
chiefs or cloths inside their hats, and allow a flap like an army
havelock to fall over the neck. Dr. Payne has shown the very

* The Secretary of the Navy has issued the following regulation, dated Feb-
ruary 7, 1873:

" Hereafter, whenever it is considered conducive to comfort or health, white
caps of the regulation pattern, or white linen cap-covers, may or shall be
worn by officers on shipboard within the tropics, or elsewhere in very hot
weather, with the permission or by the direction, as the case may be, of the
commanding officer ot the vessel or station."

6o NAVAL HYGIENE.

considerable elevation of temperature above that of the outside
air, under the cap now worn. He has also called attention to
the power of absorbing water from a damp deck possessed by the
soles of the shoes with which men-of-war's men are now supplied.

Neatness and cleanliness of dress are always to be inculcated.
Clothing should be kept in order. The custom of allowing men
to have their bags on deck once a week, usually on Saturday,
should be universal, and departed from only in emergencies.
Clothes-lockers have been proposed as substitutes for bags, but
the change is not desirable. The latter are more convenient,
protect the clothes better from dampness, and can be taken on
deck, and their contents exposed to the sun and air. They pre-
vent the accumulation of dirt unavoidable in lockers, and a not
less important advantage is that they do not encroach so much
on the air-space of the vessel. Their removal on deck, when
the berth-deck is cleaned, allows the access of air to their racks.
Ditty-boxes or bags are conveniences which every man should
be permitted, preferably the former, since they can be arranged
not only for sewing-articles, shaving-utensils, trinkets, and writing-
materials, but may also serve as desks and stools. It would be
well for the Government to supply them of uniform size, num-
bered with the bags. When not in use, they should be carefully
stowed away in racks assigned for them.

The sailor can easily be taught habits of order and regulaiity.
In a well-disciplined man-of-war the whole crew soon acquires
them. If a berth-deck is always dry and clean, every bag and
ditty-box in its place, the master-at-arms will have very little
trouble with the men themselves. A few lazy, worthless fellows,
however, if allowed to go unchecked, will inconvenience and
confuse all the rest. The berth-deck is the man's home ; his bag
and ditty-box are to him what the privacy of the officer's room
is to the latter, and it is, therefore, proper that he should enjoy
as much comfort there as is possible under the peculiar circum-
stances of his life.

Under-clothing should be frequently changed. This does not
require argument, yet it is a matter to which not the slightest

NAVAL HYGIENE. 6 1

attention is paid in the service. The officers' servants, landsmen,
and many of the foreigners in the crew are habitually unclean,
both in person and dress, and require careful supervision. Few
of them provide themselves with proper outfits except by com-
pulsion. They will keep a clean mustering suit, which they re-
move immediately after inspection, and a few clean articles in
their bags to satisfy the quarterly examination of their contents,
and will wear the same pair of drawers and socks for months.
One of the most important duties of division officers is to attend
to their men being properly provided with clothing, and it is
equally important that, at every morning inspection at quarters,
they should ascertain whether they are cleanly clad. It will soon
be evident which men are habitually clean and neat, and which
will require examination. Sufficiently frequent opportunities
should be allowed for washing and drying clothes. At sea, un-
less the weather is very bad, this maybe done daily; in port,
twice a week. New navy-blue flannel requires frequent washing
before the color ceases to come out, and men's skins and blan-
kets are usually dyed an intense blue for several weeks when this
is not done.

I have already insisted upon the necessity of keeping a vessel
dry, and have indicated the means by which this object may be
attained. I have omitted until this place to refer to the subject of
damp clothing. There are officers who believe that it will
make men delicate to insist that they shall remove their wet
clothes, and point to the impunity with which some continue
in them for days. Where there is one such exception, there are
many who succumb, sooner or later, and appear at the sick-bay.
The French Departeme?it de la Marine has not considered this
matter unworthy of its interference. The ordonnance of August
15, 1 85 1, prescribes that the watch officers shall see that the men
do' not keep on their wet clothes when their watch is over, and
that they shall enter on the log all such accidental changes of
dress. In bad weather, when the watch is piped down, and at
all times when boats' crews return wet, let them be compelled to
remove their wet clothes and deposit them in fire-tubs. The

6 2 NAVAL HYGIENE

provision of outfit which I have recommended will allow three
changes. Should the rain continue, and no occasion offer for
drying the wet clothes, let each man remove his damp outershirt
and trousers on turning in, and hang them on his hammock-hooks,
to be resumed when he returns on deck. Men should not be
allowed to expose themselves needlessly. Every one should be
provided with a water-proof overcoat, and if the weather is not
cold, be required to remove shoes and stockings. If too cold to
go barefoot, boots should be worn. Similar precautions about
wet feet should be exacted while washing decks. Few old
sailors keep on their shoes when at this work, but landsmen and
merchant sailors shipped for the first time, too lazy to take them
off, will not do so unless compelled.

Numerous attempts have been made to devise a material for
water-proof clothing which will not only exclude water but pro-
tect from cold, and not be so cumbrous as to interfere with the
agility of movement required especially aloft, nor too bulky for
compact storage. The seamless overcoats formerly issued were
popular when first introduced, but they easily soiled, became hard
and stiff, and split in the folds. The ordinary pilot-cloth pea-
jacket is comfortable in cold weather, but is heavy when wetted
and not easily dried. The favorite weather-clothing with sailors
themselves are the old-fashioned oil-skins, the familiar signs of
seamen's outfitting establishments on the water-front of all mari-
time cities, but they only imperfectly answer their purpose..
Lieutenant George C. Reiter, United States Navy, in a letter to
me, dated March 3, 1873, calls attention to the fact that men
are never properly protected from rain, etc., by any of the tarpaulin
clothing now in use in our Navy. He says: 'T have never found
any water-proof clothing at all serviceable except that made in
England. The best we have is the ' Cape Ann ' coat and over-
alls, but after they have been stowed away for a short time, as they
must be on a man-of-war, it requires a powerful man to pull them
apart, and afterward they are not good for much." He advises
the manufacture by the Government of tarpaulin jackets and over-
alls, of three sizes, to be furnished as part of the outfit, and recom-

NAVAL HYGIENE. 63

mends, after a satisfactory personal experience of two years, the
application of a paint-, the invention of a sailmaker at Deal, England,
which will render them perfectly water-proof and yet leave them
so flexible that they can be folded up and stowed compactly
without injury. The same result promises to be better achieved
by the process of the " Porous Water-Proofing Company of Penn-
sylvania," which proposes to make textile fabrics of wool or cotton,
leather, paper, etc., water-repellent, mildew-proof, and absolutely
moth-proof. Medical Director Bache, United States Navy,
reports to the Secretary of the Navy, that in the case of cloth
treated by this process and made up into clothing, "the water-
proofing power was very manifest ; long exposure to driving
rain did not wet the material through," and that a pair of partly-
worn thick winter shoes of calfskin similarly treated, "was found
to be more soft and pliable than before treatment, and to be per-
fectly water-proof after long exposure in actual wear in mud and
melting snow." Commander Braine, United States Navy, bears
similar testimony to its efficacy in increasing the strength of flax
and cotton canvas, and rendering them water-repellent, and
Major General Upton, United States Army, states that four tents
treated by this process and used by the cadets during their encamp-
ment at West Point in a season of heavy rain, "were white and
apparently sustained no damage," while all others were badly mil-
dewed, and had entirely lost the appearance of being new.

A board of Army quartermasters appointed to investigate the
process of Cowles & Co. has reported that "the evidence is abund-
ant, continuous, clear, and positive that the prepared goods
withstand the action of moths, are in a measure water-repellent,
and resist mildew far longer than the unprepared," and was of
the opinion that "the process should be continued so long as a
better and cheaper does not offer." The Secretary of the War
concurred in these views and recommendations, and directed them
to be carried into effect. It is probable, however, that while this
process will be found effecient as protective against moths, it is
inferior to the other in water-repelling power, and therefore less
serviceable for the Navv.

PERSONAL CLEANLINESS

Occasionally a man notoriously filthy is ordered to be scrubbed
in the head, or the negro servants are inspected during the morning-
watch by the master-of-arms ; but beyond this, I have never wit-
nessed nor heard of any inquiry by officers into the bodily con-
dition of the crew. If a man's cutlass is bright and his overshirt
clean, the inspecting officer is satisfied, although his axillae, groins,
and perinseum may be abominably dirty and verminous, his
under-garments unclean and unchanged for weeks, and his bed-
ding disgustingly foul and offensive. Even when some one with
sensitive nostrils has obtained an order for the daily inspection of
the ward-room boys, they are only compelled to strip to the waist,
and if the collars of their shirts and wristbands are not very much
soiled, they are pronounced clean, although their genitals, but-
tocks, and thighs have not been touched with water during the
whole cruise. I have known officers' servants to come under
treatment at the sick-bay, and to be discovered to have worn the
same pair of drawers, night and day, for months.

It is not altogether the fault of the men that this is so. The
human beast requires to be taught to be cleanly. Physicians know
that sordid bodies, as well as sordid minds, are found even among
the possessors of wealth and the occupants of prominent stations
in society. Bring the rude, illiterate sailor, therefore, on board ship,
still reeking with the foulness of the slums whence the land-shark
has beguiled him, compel him to live, eat, and sleep uncleanly,
deprive him of every semblance of personal comfort, never appeal
to his reason or intelligence, but teach him that he is nothing but a

NAVAL HYGIENE. 65

slave or beast of burden — what result may be expected? Seamen
are naturally careless. Left to themselves, they will neglect them-
selves. Some few men-of-war's men are exceptions, but the great
majority of patients admitted into the naval hospitals from before
the mast are shamefully unclean. Always the first, and sometimes
the only prescription they require is a warm bath and clean shift of
clothing. What physician would ever think of attempting to
accomplish a diaphoretic effect upon the begrimed, callous, hide-
like cuticle of most sailors, until he has dissolved off as much as
possible of it with warm water and soap, or borax ? Yet I have
heard officers frequently joke about the appearance of these dirt-
encased fellows, and laughingly describe them as " veritable old
shell-backs," or as " covered with barnacles."

Ninety per cent, of the men presenting themselves at the naval
rendezvous are filthy in person, and every medical officer should
refuse to examine them in such a condition ; and even after pass-
ing them he should direct them to bathe again before reporting
on board the receiving-ship, otherwise they will remain dirty, will
be transferred to some sea-going vessel in the same state, vermin
on their bodies and in their hair, and they will continue so until
they are discharged or become sick, and are sent to a naval hos-
pital and subjected to a compulsory bath.

When swimming is possible or allowed, usually about twenty
or thirty of the crew avail themselves of it as a diversion, but
months sometimes intervene between these opportunities. The
customary usual time for washing is during the morning watch, after
the decks are " holy-stoned." Some of the men strip to the waist
and wash their necks, arms, breasts, axillae, and feet, but the greater
number do not. Scarcely any ever cleanse their thighs, groins,
or buttocks. Officers of divisions are responsible for the unclean
condition of their men. They should require them to present
themselves at the morning inspection, not only with clean outer-
apparel, but with clean under-clothing and clean skins. They
can perform this duty without any abasement of dignity. It
is less disagreeable for the division officer to make this in-

66 NAVAL HYGIENE.

spection than for the medical officer to conduct an examination
of a patient who has fistula ani, or to labor by the hour to
dilate his strictured urethra. Many duties are unpleasant, but
the object in view should reconcile us to their performance. Very
properly, in ports where prostitutes are subject to examination, no
man is allowed access to them until the medical officers are satis-
fied of his own exemption from venereal disease, and no greater
outrage is committed upon the man's modesty when he is required
to satisfy the officer of his division that he is clean in person.
False modesty cloaks both vice and dirt, and the man who makes
the loudest outcry about outraged sensibilities will be found to
have the strongest reasons for avoiding exposure. Habitually
clean men will be very soon discovered and relieved from exam-
ination ; others will be shamed into an attention to their persons
that they had never been taught at home nor seen practiced else-
where ; while the incorrigibly foul will be isolated and cleansed
by force. It is not proposed that the men at quarters shall
unbutton their pantaloons and submit to a close scrutiny of even-
square inch of their surfaces every day ; but their spare under-
clothing should be frequently and carefully inspected. Provision
should be made to allow general ablution by every man on board,
and the' divisional officer should satisfy himself in as private and
delicate a manner as possible that this has actually and thoroughly
been done. No man should be allowed to remain, as is often
the case, for weeks with his skm of a deep-blue color from the
dye-stuff of his rarely-washed new flannel shirt and drawers, and,
in tropical climates, daily general ablution should be exacted of
every member of the crew. If objection is made to the con-
struction of a proper permanent bathing apparatus, a large fire-
tub may be placed under the top-gallant forecastle, or in the
manger, or in some other convenient situation, and surrounded
by a screen, or the head-pump may be screened at certain times
in the day and devoted to this purpose. In vessels where con-
"clensed water can be obtained in quantities, this should be used
in preference to salt-water. Every man should be required to

NAVAL HYGIENE. 67

possess one or more towels, which should appear among the pay-
master's stores, and facilities should be afforded every day for
drying them. If a "sweat-rag," as the little piece of sheeting is
termed, which some men use, is now seen flying anywhere to dry,
it is immediately ordered down, even while the spans of the
quarter-boats are fluttering with officers' towels. When the
clothes-lines are not up, the men usually spread their " sweat-rags "
upon their shoulders and back, and dry them there.

The hair, beard, and teeth are all neglected on board ship.
It would be a difficult matter to compel old sailors to cleanse
their teeth, but all the boys should be obliged to purchase tooth-
brushes, and to use them regularly.

Firemen and coal-heavers should be compelled to bathe every
day, when the vessel is steaming, but not immediately after quit-
ting their stations. Cardiac diseases, pulmonary affections, acute
inflammations, etc., are common among this class from their
imprudent exposure to cool draughts, and from washing with
cold water while their bodies are heated. The engineer on
duty should attend personally to the disposition of men who
come off watch, and not allow them to throw themselves under
the ventilators, nor to bathe until a proper time has elapsed.

FOOD

No objection can be urged against the quantity of food fur-
nished by the Government, nor, if inspectors continue to do
their duty as faithfully as at present, to its quality. That enough
is supplied by the ration is evidenced by the amount thrown
overboard by the cooks, and by the fact that there are few messes
which do not commute one or more of their rations. The Gov-
ernment authorizes this to the extent of two rations for every ten
men. It is idle to speculate upon the amount of carbon, oxygen,
hydrogen, and nitrogen required to supply the waste of the body,
and to endeavor to arrive, by chemical analysis, at the precise
number of grains a man should be given to eat. The molecular
waste of tissue depends upon climate, physical exertion, and
health ; but the naval ration undoubtedly supplies the maximum
under any circumstances. The robust appearance of an Ameri-
can man-of-war's crew attests this fact, as do the zest and excla-
mations of surprise and delight with which foreign sailors partake
of it when invited. In the French navy each man receives less
than half a pound (214 grammes) of meat a day, and only 3.3
pounds (1,500 grammes) of animal food (beef, bacon, and cheese)
and 16.5 pounds (7.5 kilogrammes) of. vegetable substances
(beans, peas, and rice) a week. In the American service each
man gets every week from six and a half pounds of the former
(beef, pork, and preserved meats) at sea, to eight and three-
-quarters pounds of fresh meat in port, and eleven of vegetables,
(beans, rice, flour, dried fruit, desiccated potatoes, and mixed
vegetables,) with a liberal allowance of sugar, molasses, vinegar,

NAVAL HYGIENE. 69

and pickles. This ration has been instituted sufficiently long for
its effects upon the health on long cruises to be manifested.
That the former ration was not exactly what the human body
required for its healthy maintenance was evident from the disturb-
ances occasioned by its persistent use ; but on two days on which
salt beef and rice were then served out, preserved meats and
vegetables are now substituted. The change leaves scarcely any
other improvements to be suggested, except a more frequent
issue of preserved beef or other meat in lieu of salt, an increase
in the allowance of coffee and butter, and a further extension of
variety in vegetables by the occasional substitution of peaches,
sauer-kraut, and cranberries for dried apples. With these excep-
tions it is probably the best that can be devised, for temperate
climates at least, to meet all the requirements of economy of
space, capability of resisting decomposition, palatability and ali-
mentariness, until experiments now being made with the object
of preserving fresh meat by the abstraction of its moisture, allow
the total abolition of salt meat as an article of diet. Dr. Alex-
ander Rattray, surgeon Royal Navy, in an admirable report
published by the admiralty, in their annual volume on the health
of the British navy, has called attention to the injurious conse-
quences of the use of salted meat, which he correctly styles an
unnatural form of food, and which he recommends to be almost
entirely displaced by preserved meat. Commanding officers
should eagerly embrace every occasion of going into port or of
speaking vessels at sea to obtain supplies of fresh meat and suc-
culent vegetables. One pound and a quarter of fresh or three-
quarters of a pound of preserved meat, which should not always
be beef, may be substituted for a pound of salt ; one pound of
soft bread or of flour for the daily allowance of ship-biscuit ; and
fresh vegetables not to exceed in value the dried. When the
stay in port is prolonged beyond a fortnight, salt food may be
issued twice a week. Dr. Rattray has proposed a radical change
in the British naval dietary, arranging it for temperate and tropi-
cal climates, for harbor and for sea. One prolific source of the

70 NAVAL HYGIENE.

disease in the Navy, or notoriously unhealthy tropical stations, is
the neglect to adapt the diet, dress, and labor to the necessities
of the climate. Englishmen have been performing a great
physiological experiment for many years in every quarter of the
globe in their extensive colonial dependencies. Carrying their
national customs wherever they have immigrated, they have
dressed, eaten, slept, and generally lived as they were accus-
tomed in their own foggy island, with results that are now matters
of scientific history. The red-coated, leather neck-cased, over-
laden soldier is not so often seen marching under a mid-day
Indian sun : but despite all lessons, the wealthy Englishman, male
and female, dines at seven off as many courses, drinks beer and
brandy and soda, and goes home with "liver." The" Japan
Weekly Mail, of Yokohama, for August 12, 187 1, refers to a
recent instance of culpable violation of sanitary laws by military
authorities, for which the medical officers were in no way respon-
sible, in the following terms :

The old story again ! The weary old story of life sacrificed, but sacrificed
for nothing — to appease no gods ; to propitiate no demon ; to gain no laurels ;
to chastise no enemy ; to procure no benefit ; to afford no example ; to inspire
no devotion. Any moderately sensible judge of human affairs might have
dreaded some such a catastrophe as has overtaken the Tenth Regiment and
the newly-landed battalion of marines, which has arrived to relieve it. The
regiment is moved in marching order in the heavy clothes which a tropical
climate converts into shirts of Xessus, with knapsacks, arms, and full para-
phernalia. They may have been moved on empty stomachs, but what with
parade, the march to the quay, and the time required for getting on board,
they are for three hours exposed to the sun before they get food or arrive under
the shelter of an awning. Meanwhile the plague has begun. The full-blooded-
men are smitten with heat-apoplexy, and the wonder is that more do not suc-
cumb to the enemy. Three good men fell victims to that march — men who
had been long in the regiment, and who might have lived to feel the pride of
belonging to it. On the same day the marines, who have replaced them, come
under the same fatal influences. Three were struck down. One is dead,
others are in a dangerous state, and their recovery doubtful. Now it is clear
that coddling soldiers is absurd, but you caimot inure men to a hot sun by
exposing them to its deadly rays. You may gradually acclimatize them, and
after all this you must handle them in the sun as in the presence of an enemy

NAVAL HYGIENE. 7 I

whom you may, with certain precautions, defy, but whom you cannot conquer.
You must avoid him to the uttermost. In Avar it may be necessary to face
him ; in peace it can hardly be so. The whole question is one of manage-
ment and administration. The regiment was incontestably in good order;
but why was it moved in August, with the thermometer at ninety, and the
ominous typhoon-fly hovering about ?

It is a physiological impossibility for the sailor at Singapore, Bata-
via, Hong-Kong, or Maranham to eat the same kind and quantity
of food as at Kittery or Boston, where he shipped, and remain
healthy and efficient. Messes in the tropics should, therefore, be
allowed, advised, and encouraged to commute parts of the ration
of meat for vegetables, especially rice, at sea, and for fruits and fresh
vegetables when in port. Most messes stop one or more entire
rations and draw their value in money, either to pay their several
cooks, which should be prevented by not allowing " steady " cooks,
or to create a fund for the purchase of potatoes, turnips, onions, or
other vegetables as sea-stores, which should be encouraged, and
conveniences afforded by the authorities of the ship for their
storage in the boats, under the boom-cover, or elsewhere on the
spar-deck. They enter into the composition of the morning
" scouse," which is the favourite dish of the sailor, and they are
better antiscorbutics than anything in the dispensary. When one
has been a month at sea a roasted "spud" (potato) is relished
with an avidity that only a man starved of his natural aliment can
experience, and a plentiful supply of this vegetable will render
unnecessary any large provision of lime or lemon-juice, or any
other medicinal antidote to scurvy. It is commonly but errone-
ously believed that this disease has disappeared from the Navy.
Medical Director Wilson, in his Naval Hygiene, relates two
instances, during his experience, of the development of the scor-
butic tendency on shipboard, the first occurring on the frigate
Savannah, on her return from California during the Mexican war,
and the second on board one of the vessels of the Japan expedi-
tion during her passage from New York to the Straits of Sunda.
I have also had to treat the disease, the first time while attached
to the sloop-of-war Levant, which, as in Dr. Wilson's second
instance, was making a passage from New York to China via the

NAVAL HYGIENE.

Straits of Sunda, and again on board the Idaho in 1868, while e?i
route for Japan by way of the Ombay passage. Short stoppages
were made in both cases at Rio de Janeiro and at Cape Town,
but the crews were not allowed liberty on shore, and conse-
quently did not experience that indescribable but marked benefit
which undoubtedly results from simple contact with the earth, the
deprivation of which may be ranked with the want of fresh veg-
etable food as one of the efficient causes of the disease. The
passage of the Levant was stormy, the men were exposed to con-
tinued rain and cold, their labor was arduous, and almost even-
article of the ration was badly spoiled. After a delay of only
two days at Anjer, the ship resumed her course to Hong-Kong,
where she arrived on the one hundred and eighty-third day from
Xew York, a passage greatly exceeded by the Idaho, which did
not anchor at Nagasaki until the two hundredth day. In neither
of these cases did the disease manifest itself by those terrible
symptoms formerly supposed to be essentially diagnostic. There
were few individuals who sought to be excused from duty, but
the general condition of the whole crew was below par; they
performed their duties listlessly and slowly, and were cursed for
being morose and lazy; they lost strength and appetite; their
bodies were covered with mottled discolorations ; their gums were
tender and bled easily, causing those who chewed to attribute it
to the tobacco, for which they lost taste ; scratches, wounds, and
bruises healed slowly or not at all ; and men, often of the finest
normal physique, succumbed readily to trifling causes of disease.
Large numbers were subsequently invalided, whose disabilities
really began at this time, and the actual money loss to the Gov-
ernment was far greater than would have been the expense caused
by a few days' longer sojourn in port. Sporadic cases of scurvy
appeared the current month, (November, 187 1,) on board of sev-
eral of the Russian escort squadron during their wet and stormy
passage from Madeira to New York, though it was not protracted
much beyond a month. A further delay at sea would have cer-
tainly been followed by serious consequences.

In foreign ports, bumboats attend all vessels whose crews are

NAVAL HYGIENE. 73

permitted to draw any portion of their pay. A small allowance
of money, conditional upon good behavior, should always be
made for this purpose, since the men have no other way of obtain-
ing the fruits of the countries they may visit, and which in tropical
climates ought to enter largely into their diet. Excessive indul-
gence, however, particularly on first joining a station, must be
carefully guarded against. In some bumboats, which should
always be inspected by the medical officer that no unripe fruit
nor other improper articles may be offered for sale, boiled eggs,
broiled chickens, fried fish, steaks, etc., are prepared, which the
sailor, cloyed with the unvarying boil of the coppers, relishes
exceedingly, and which it is highly proper he should be permitted
to enjoy. A watchful and comprehensive hygiene neglects no
occasion of catering to the native instincts of the body, in viola-
tion of which the seaman lives, and of recalling the customs of
civilized life, from which he is unnaturally severed.

Besides vegetables, eggs, properly packed, might be allowed to
be purchased by the several messes as sea-stores. They can
easily be fried before the galley is given up to the officers' cooks,
and they make a palatable morning meal. The practice of carry-
ing live-stock to sea is of doubtful propriety. It encumbers the
decks, diminishes the air-space, impoverishes the atmosphere,
creates filth, and becomes diseased, while it benefits a very small
proportion of the persons on board. Fowls are more easily kept
clean and healthy than other live food, but their flesh is not supe-
rior in flavor or nutrient properties, nor better relished even by
the sick, than that properly canned. This is especially true of the
poor emaciated sheep and calves, which are sometimes killed for
food after six or eight weeks' fright and torture on board a rolling
ship. An exception may be made in the case of the large green
turtle, which, whenever obtainable, should be taken to sea to be
made into soup for the whole ship's company.

It seems to escape officers of the Navy that the cooking of the
sailor's food has anything to do with its nutritive value or palat-
ability. The ship's cook is appointed without any special ques-

74 NAVAL HYGIENE.

tioning as to his ability to perform his duties, which, however, are
of the simplest character. Everything given the sailor is boiled
in the coppers, except in port, when some of the mess-cooks, by
arrangement with the cabin or ward-room cooks, succeed in get-
ting a piece of meat or a fowl roasted. The craving of the sailor
for change is shown by the popularity of the scouses, which some
commanding officers are thoughtful enough to encourage by
allowing the range an extra supply of wood. Our galleys are not
very commendable exhibitions of American inventive talent. It
is certainly not impossible to contrive an apparatus possessing
facilities for roasting meat and baking bread. In this matter, as
in every other within the province of hygiene, the French are far
in advance of all other nations. The "cuisine distillatoire" of
Peyer and Rocher combines an oven for baking with an appa-
ratus for distilling fresh water from salt, the coppers being at the
same time heated by the steam, which is in process of condensa-
tion into fresh water. Freshly-baked bread, when properly made,
ought to be substituted for biscuit whenever possible.

It is the duty of the officer of the deck to inspect the dinner
prior to the serving out at seven bells in the forenoon watch.
As now conducted this inspection is a mere form. The ship's
cooks brings a mess-pan to the mast containing the choicest piece
of meat from the coppers, which the officer of the watch inspects
by cutting off a slice or two as a lunch. This duty should be
performed by some other officer, perferably one of the medical
corps, and the inspection should extend to all the messes and to
all the food at every meal. The fresh soups are sometimes so
badly made, the vegetables not being half cooked nor the meat
properly boiled, that it is common for sailors to attribute to them
all their digestive irregularities in port; yet some cooks are so
expert in making these soups that officers find them very palata-
ble as their own noonday meal. At sea the same complaint is
^general with regard to bean-soup. Sometimes this is due to the
inferior quality of the beans, occasionally to the hardness of the
water, but most frequently to the neglect to soak them properly

NAVAL HYGIENE. 75

(a whole day being sometimes necessary) in cold water and to
boil them sufficiently long. Cooks often have the water in the
coppers boiling before they add the meat for the soup, ignorant
of the fact that the flavor and nutritious qualities of the latter
depend upon the extraction of the soluble principles of the meat,
which only takes place when it is put in cold water and that
slowly heated. On "duff" days, it is very proper to boil the
water before the beef is added, since it is thereby prevented from
yielding all its nutrient qualities to the water and is consequently
more tender, juicy, and palatable. The "harness-cask," in
which the meat is thrown after it has been issued by the pay-
master's subordinates, and where it remains until ready to go into
the coppers, is often imperfectly cleansed and allowed to become
dirty from the accumulation of stale brine. It should be care-
fully and thoroughly washed after every using, and the master-at-
arms should be required to inspect it daily with the coppers and
all the cooking-utensils at the galley and the mess-things of the
berth-deck cooks.

The tea and coffee especially require examination into the
method of their preparation. Frequently they are such abomin-
able mixtures that even the men refuse them, while there is no
part of their ration of which they are more fond, none which is
of greater importance to their well-being, nor any which is so
easily prepared. Tea-water should be issued to the mess-cooks
boiling, not more than ten minutes before the hour for the meal,
and the mess-kettle should be kept tightly covered until the bev-
erage is served out. Properly, coffee should be made by the ship's
cook at the galley, and only issued a few minutes before break-
fast is piped. As nutritive properties are of more importance to
the sailor than delicacy of flavor and aroma, which he probably
would not appreciate, it would be well to preserve a portion of
the tea-leaves and coffee-grounds from each meal for addition to
the ration of the following.

The usefulness of tea, coffee, and alcohol in the form of wine,
beer, or whisky, as food-stimuli or accessory food, has been satis-

76 NAVAL HYGIENE.

factorily established by Anstie, Lankester, and others. An old
writer, whose wisdom has never been questioned, epitomizes in
Ecclesiasticus, chap, xxxix, v. 26, with a scientific precision to
which the learning of twenty centuries has but little to add :
k'The principal things for the whole use of man's life are
water, fire, iron, and salt, flour of wheat, honey, milk, and the
blood of the grape, and oil and clothing;" adding significantly in
v. 27, "All these things are for good to the godly; so to the sin-
ners they are turned into evil." The frightful consequences of
intemperate indulgence in alcoholic liquors have resulted in the
abolition of the spirit portion of the ration. If the substitution
of a pint of beer or a half a pint of wine for the gill of spirits,
which the Department used to authorize, could be effected,
there is no doubt of the propriety and benefit of its issue.
The objectionable feature of the old service of grog was
that it was drank undiluted and. upon an empty stomach. The
moral argument that it engendered and fostered a fondness for
intoxicating liquors applied only to boys and a few landsmen,
most sailors, firemen, and marines having already acquired the
taste and habit before entering the service. It is doubtful whether
even three years of enforced total abstinence could destroy the
appetite in the confirmed inebriate. In such cases the land-shark
and prostitute can nullify in half an hour the resolutions of years.
There are few medical officers in the Navy whose experience
cannot furnish instances of officers of rank and education who
have repeatedly violated the most solemn pledges and oaths to
abstain from rum-drinking. Liberty on shore is so frequent, and the
license allowed drunkenness on such occasions, through the
neglect to punish its habitual occurrence, so general, that the
mere abolition of the grog ration has, probably, accomplished
little toward the checking of intemperance on board ship. Even
under the old system, the opportunity to commute the grog for
money to be spent in the bumboat or on shore was extensively
embraced. On board a sloop-of-war having a complement of
one hundred and sixty men, I have known only forty to drink

NAVAL HYGIENE. 77

their grog. Nevertheless, many excellent seamen have, undoubt-
edly, been deterred from shipping in the Navy in consequence of
the commutation of the grog, and I am well satisfied that the ma-
jority of such men were not injured by the regular consumption
of the moderate quantity of spirits they received. Fortunately,
tea, coffee, and tobacco, to a large extent, accomplish the same
results as alcohol. Under their use the sailor better endures
fatigue and the vicissitudes of climate, is more cheerful in
mind, is better nourished, and in tropical regions experiences
less desire to eat an excess of meat. Gasparin long ago called
attention to the fact that the Belgian miners performed their
arduous toil and maintained their robustness and health with a
diet notoriously scant, in consequence of the daily use of coffee ;
and Anstie has adduced numerous instances " where the support
of the organism, in the absence of ordinary food, by stimulants,
(that is, agents which, by their direct action, tend to rectify some
deficient or too redundant material action or tendency,) is one of
the most remarkable phenomena which can be offered to the
attention of the physiologist." Von Tschudi relates that an
Indian, sixty-two years of age, worked for him (at excavation)
for five days and nights consecutively without any ordinary food
at all, and with a very short allowance of sleep, and yet, at the
end of that time, was fresh enough to undergo a long journey,
simply because he was supported by the coca, which he chewed
from time to time. He declares that the moderate eaters of coca
are long-lived men, and that they perform extremely hard labor,
upon a very little food, as miners, soldiers, etc., and he mentions
the fact that the custom of coca-chewing is of immemorial an-
tiquity in Peru; and Anstie adds: "Next, perhaps, to coca, in
its power of replacing ordinary food, we must reckon tobacco,
and next to tobacco in efficacy as a supplementary food, and far
surpassing it in its effectiveness under certain circumstances, is
alcohol." I do not desire to advocate the re-issue of a daily
ration of grog. Provision, however, should be made for its
proper use in emergencies, as when the crew are exposed to a

J 8 NAVAL HYGIENE.

long continuance of bad weather, and especially when the rolling
of the vessel prevents the lighting of the galley-fire and the
preparation of coffee or tea, when they have been more than thirty
days at sea and begin to manifest the consequent ill-effects of the
salt ration, or when they are subjected to intense mental or
physical effort, as in time of shipwreck, fire, or action. There is
no doubt that under such circumstances tobacco-chewers and
smokers find a mental and physical sustenance for which other
men instinctively and painfully crave; and we need not hesitate
to refuse to join the pseudo-moral crusade which would deprive
the sailor of the solace and support of his pipe and quid, when
so learned a therapeutist as Pereira declares, " I am not acquainted
with any well-ascertained ill-effects resulting from the habitual
practice of smoking." A similar observation is made by Dr.
Christison ; and Hammond, whose carefully conducted experi-
ments upon himself have conclusively established the physiolog-
ical effects of these agents, states, " I have no hesitation in ex-
pressing my opinion that, in the great majority of cases, the mod-
erate use of alcohol and tobacco is calculated to exert a benefi-
cial effect upon the organism. This use, like that of every other
good thing which we have, must be guided by wisdom. To
transgress the laws of our being in the employment of these sub-
stances leads just as surely to punishment as the violation of any
other sanitary or physiological law. Like everything else capa-
ble of producing great good, alcohol can also cause great harm.
Our object should be to secure the one and provide against the
other. I am decidedly of the opinion that tobacco is beneficial
to those who, like soldiers, have a great deal of mental and bod-
ily fatigue to undergo. But these remarks apply only to the mod-
erate use. When employed to excess, there is no doubt that it
predisposes to neuralgia, vertigo, indigestion, and other affections
of the nervous, circulatory, and digestive organs." Dr. Gray,
writing on the medical aspect of the tobacco question, states that
" tobacco should by used as supplementary to food, not as a sub-
stitute for it. The season, therefore, for healthv smoking is after

NAVAL HYGIENE. 79

a meal. Against moderate smoking, by a healthy person who
enjoys it, not a single argument of any weight has yet been ad-
vanced." For those who are debarred from using tobacco and
alcohol, an extra issue of coffee on turning out, and occasionally
during the night watches, will supply the demand of the system
when it is improperly or insufficiently nourished.

Though comparatively little fault can be found with the com-
ponent parts of the ration, the same is not true of the arrangement
of meals. The usual hour for breakfast is 8 o'clock ; for din-
ner, at noon; and for supper, 4 o'clock. By this system men
eat three times within eight hours, and fast all the rest of the day.
The objections to it are evident. Economy of fuel is no excuse
for a practice that is so contrary to the simplest teachings of hy-
giene and common sense. It is far more easy to provide a larger
quantity of wood and coal before setting out than to teach a man's
stomach to regulate its functions according to the arbitrary dic-
tum of his "superior officer." After the supper, the sailor gets
nothing to eat for sixteen hours, although his most arduous duties
frequently occur within that period, and although the craving for
food is manifest even in officers, who eat their last meal so much
later, and yet universally require the caterers of their messes to
provide them a lunch before going on deck during the night and
morning watches. At sea the labors of the night are probably
more frequently laborious than those of the day ; while in port
the vessel may have been brought to anchor or gotten under way,
and in the morning hammocks have to be scrubbed, clothes
washed, and decks "holy-stoned;" and all this with an empty
stomach. In hot climates, both men and officers always feel list-
less and indisposed for exertion in the morning, when a slight
repast would give them the energy to perform their duties prop-
erly. Hammond advises that " soldiers should always be fed
before they are sent to drills, parades, or other labor," and Mac-
leod declares that he has little doubt that, if the precaution had
been taken to supply the troops in the Crimea every morning with
hot coffee, much of their mortality might have been avoided. I

So NAVAL HYGIENE.

therefore recommend that every man maybe served a cup of cof-
fee and piece of bread immediately after turning out, and that
breakfast be eaten at 7 o'clock, dinner at noon, and supper at 6
o'clock, the dinner-hour of many cabin and ward-room messes.
In port all hands turn out at daylight, and should then have
their bread and hot coffee ; at sea, the morning watch comes on
deck at 4 o'clock, and should be allowed coffee as soon as it can
be made. The other watch is called with "all hands" at 7
o'clock, the hour I propose for breakfast. To give them time to
lash and stow their hammocks, wash, and dress before breakfast,
they should be called at ten or fifteen minutes before 7, in which
quarter of an hour they will be able to do all they are required.
The range should be given up to the berth-deck cooks to make
scouses until fifteen minutes before 7 o'clock, which is early
enough for the officers' cooks to begin their breakfast. In bad
weather, unless the ship rolls too heavily for safety, or when the
work is very arduous, fire should be kept in the galley and hot
coffee served out to the middle and morning watches. It is get-
ting to be the custom to light the galley-fire in the morning watch,
to make the officer of the deck his cup of coffee, when the ship's
and officer's cooks take advantage of the opportunity to prepare
coffee, which they retail to such men as are able or willing to
pay their charges ; but this is done surreptitiously, at an expense
to the men which they cannot always afford, and in the cases of the
officers' cooks at the cost of the officers, whose private stores supply
the materials used. To prevent this fraud and to enable every one of
the crew to be benefited by the procedure, the Government should
make it a regular daily issue ;* or, if objection is urged to the in-
creased cost of the ration, such a charge should be determined upon
by the paymaster as will purchase the coffee required. I have
known instances of ships' cooks who have amassed several thousand
dollars during a cruise, by irregular sales, principally of coffee.

* The naval appropriation bill, approved May 23, 1872, provides, "That
an additional ration of tea or coffee and sugar shall be hereafter allowed to
each seaman, to be provided at his first ' turning out.' "

NAVAL HYGIENE. 8 1

An improvement should be made in the furniture of the messes.
Everything is repulsive about the sailor's mess-cloth, where each
man is using his fingers and the jack-knife with which he may-
have been scraping masts or cleaning tar-buckets. A few cheap,
strong knives and forks, block-tin plates, cups, etc., might be
included among the paymaster's small stores. The British sailor
receives his mess-utensils from the government gratis. In large
ships, tables and camp-stools are provided for the men, and
might appropriately be made a part of the outfit of every vessel,
care being taken to stow them, when not in use, so as not to en-
croach on the air-space of the berth-deck.

The medical officers should frequently visit the messes and
inquire into everything relating to their subsistence. This duty
is especially enjoined upon the surgeon by paragraph 534 of the
Regulations for the Government of the United States Navy for
1870, and which, so far as the medical officer is concerned in his
character of physician, is the most important in the book. Hence
I quote it, and urge upon the young assistant surgeon the neces-
sity of pondering seriously upon the grave responsibilities it de-
volves upon him :

He (the surgeon) shall inspect the provisions -for the crew, and report to
the commanding officer when he may discover any that are unsound. He
will also cause the purity of the water to be tested before it is received into
the tanks, and he will make known to the commanding officer any want of
care or cleanliness in the preparation of food for the crew, or any instance of
personal neglect with regard to it, of which he may be cognizant. He will
also make known to the commanding officer everything which may come to
his knowledge as conducive to, or as militating against, the general health and
comfort of the ship's company.

Although these sanitary functions are manifestly among the
legitimate duties of the physician, the Navy Department, in these
instructions, very properly directs particular attention to them,
and every medical officer should be held strictly accountable for
the consequences of any violation of a proper hygiene which he
may have neglected to investigate and report.
6

POTABLE WATER.

Physiologists estimate that the daily loss of fluid by cutaneous
and pulmonary exhalation is from one and three-quarters to five
pounds; that of the thirty or forty ounces of urine excreted only
two to seven per cent, are solid; and that seventy-five per cent, of
the faecal discharge of the twenty-four hours, which averages
from four to six ounces, is water — a total loss of fluid every day
of from three and a half to seven and a half pounds. The cus-
tomary allowance of water on ship-board is one gallon a day for
each person, of which half is given to the ship's cook for the
coppers, and the balance put into the scuttle-butt for drinking.
This allowance is sufficient under ordinary circumstances, but
during hot weather the water is all drank up in the forenoon, and
the landsmen and boys, who have been less employed than the
rest of the crew, usually drink a disproportionate share. While,
therefore, the issue of water should never be less than a gallon a
day in temperate latitudes, this amount should be largely increased
whenever the crew are exposed to unusual fatigue or to prolonged
heat. The listless, careless way in which the men go through
their exercises in tropical climates is as much due to the stint of
water as to the direct depressing effect of heat. According 'to
Parkes, "the supply of water becomes a matter of the most
urgent necessity when men are undergoing great muscular efforts,
as it is absolutely impossible that these efforts can be continued
without it. If we reflect on the immense loss of water by the
skin and lungs which attends any great physical exertion, we
shall see that to make up for this loss is imperative ; and it is

NAVAL HYGIENE. 8$

very important that this loss should be made up continually by
small quantities of water being constantly taken, and not by any
large amount at any one time."

An article which enters so intimately into the composition of
the animal economy, which permeates every tissue, and forms
the basis of the various circulating media, which has so much to
do with the reparation of the body and the normal performance
of its function^, should be as free as possible from nocuous quali-
ties. The terrible mortality of the old-time vessels was due as
much to the excess of saline and the presence of putrescent mat-
ters in their water as to the neglect of any other of the measures
which hygiene demonstrates to be indispensable to health. To
this effect Pereira quotes a report of the British secretary of state
for the home department: "The beneficial effects derived from
care as to the qualities of water is now proved in the navy, where
fatal dysentery formerly prevailed to an immense extent in con-
sequence of the impure and putrid state of the supplies." Though
a certain amount of saline constituents is essential to good pota-
ble water, a very slight excess of any one salt will occasion grave
disturbance of health. Carpenter relates an instance where seri-
ous detriment to the health of a neighborhood was occasioned by
using the water of a well containing only five grains of saline
matters to the pint. According to Christison one two-thousandth
of its weight of saline ingredients (thirty-five grains in the impe-
rial gallon) renders water unfit for domestic purposes. French
writers have incontestably shown that the intestinal disorders,
which were common among the inmates of certain hospitals and
prisons of Paris, were directly traceable to the use of well-waters
containing calcium and magnesium sulphates. Parkes refers to
the prevalence of diarrhoea on the Cape frontier stations, under
his own observations, from the use of brackish water; the dele-
terious effects of our western river waters on non-residents are
widely known ; and there is no doubt that malignant cholera is
principally, if not exclusively, as Dr. Snow taught, transmitted
through the medium of drinking-water.

84 NAVAL HYGIENE.

So much, then, depending on the character of the water, it
should never be received on board ship for drinking and culinary
purposes until it has been submitted to the medical officers, faith-
fully and carefully examined by them, and pronounced potable.
Notwithstanding the very serious interests involved, this subject
has not received a tittle of the attention it deserves. Most med-
ical officers, when notified that water is about to be taken on
board, direct their apothecaries to add a piece fof crystalized
nitrate of silver to a tumblerful of the water, and if the precipitate
produced is not a positive cloud filling the tumbler, and the taste
not markedly brackish, consent to pass it. Frequently, this is
the extent of the chemical means they have at hand, but the
careless manner in which even this test is applied renders it prac-
tically useless. The taste of water, on which so much reliance
is ordinarily placed, is a very unsafe guide, since, according to
Parkes, "organic matter, when dissolved, is often quite tasteless;
55 grains of carbonate of soda and 70 of chloride of sodium per
gallon are imperceptible; 10 grains of carbonate of lime give no
taste; 25 grains of sulphate of lime very little;" yet, a potable
water, according to the same authority, should never contain more
than 20 grains of carbonate nor 10 of cloride of sodium, 16 of car-
bonate nor 3 of sulphate of lime, nor 3 of the carbonate and sul-
phate of magnesia.

Water, to be potable, does not require to be chemically pure.
The stomach instinctively loathes water freshly distilled, rain-
water recently fallen, and the water formed by the melting of
ice and snow. The eminent hygienist Guerard describes good
potable water as "limpid, temperate in winter, cool in summer,
inodorous, of an agreeable taste. It should dissolve soap with-
out forming clots ; be fit for cooking dried beans; hold in solution
a proper quantity of air, carbonic acid gas, and mineral substances;
these last not exceeding 0.5 gramme to the litre, (35 grains per
gallon.) Finally, it should be free from organic matters."

The river-waters, from which our principal naval stations are
supplied, contain a far less proportion of saline constituents than

NAVAL HYGIENE. 85

this. According to Professor Barker, " the purest water supplied
to any city in this country is that from Lake Cochituate, which
supplies Boston, which contains but 3.11 grains (solid matter) in
one gallon. The Schuylkill [water (Philadelphia) contains 3.50
grains; Ridgewood, (Brooklyn,) 3.92; the Croton, (New York,)
4.78; Lake Michigan, (Chicago,) 6.68; the water which supplies
Albany, 10.78." European rivers- are seldom so pure. The
Loire, Garonne, and Danube average about 10 grains; the Rhine
12 ; the Rhone 13 ; the Seine, Scheldt, and Thames range from
16 to 30. Fonssagrives restricts the proportion of salts which a
potable water should contain to from 0.10 to 0.20 gramme per
litre, (7 to 14 grains per gallon;) "beyond this the water is hard,
indigestible, and unfit for cooking vegetables." Christison con-
siders a water to be hard which contains one four-thousandth
part, or ijj4 grains of saline matter to the gallon, and says that
that which contains not more than 14 grains will lather with
soap, and may therefore be used for washing. The absolute
amount of saline substances is, however, of less practical import-
ance than the quantity of each particular salt, since a small
amount of calcium sulphate will render a water harder than twice
or thrice as much of alkaline carbonates, and if organic matters
are also present, the reduction of the sulphate will render the
water offensive from the disengagement of hydrogen sulphide.

The saline ingredients of ordinary river-water are principally
the chlorides, sulphates, carbonates, and phosphates of sodium
and calcium, the chloride, bromide, carbonate, and sulphate of
magnesium, the chloride and sulphate of potassium, a little
silica, oxide of iron, and occasionally other metallic salts. Of
these, sodium chloride and calcium carbonate and sulphate form
the largest proportion.

The medical officer of a man-of-war has no need to attempt a
complete analysis of water, for which, indeed, he will have neither
time, place, nor appliances, in conducting his examination as to
its fitness for drinking and culinary purposes, but he should never
give his consent to the reception on board ship of any water

86 NAVAL HYGIENE.

which does not possess the physical properties enumerated by
Guerard, which curdles a standard solution of soap, which decol-
orizes a standard dilute solution of potassium permanganate, and
which gives more than a faint white precipitate, insoluble in nitric
acid, with silver nitrate, barium chloride, and ammonium oxalate.
Most common waters have an alkaline reaction from calcium
carbonate, held in solution by carbon di-oxide, but this gas is
expelled by ebullition, the carbonate is precipitated, and forms the
ordinary lining crust of tea-kettles. " Six grains per gallon of a
lime-salt gives a turbidity with oxalate of ammonia ; sixteen grains
a considerable precipitate; thirty grains a very large precip-
itate." "As only two grains per gallon of carbonate of lime can
remain in solution after boiling, a large precipitate on the subsequent
addition of another portion of the oxalate will show that the
sulphate or chloride of lime is present." " Four grains per gallon
of chloride of sodium give a turbidity with an acidulated solution
of nitrate of silver; ten grains a slight precipitate ; twenty grains
a considerable precipitate." "Sulphates to the amount of one or
even one and a half grains per gallon give no precipitate with
chloride of barium ; at first, or on standing, three grains give a
haze, and after a time a slight precipitate ; above this amount the
precipitate is pretty well marked." — (Parkes.)

Fortunately, there is now very little difficulty in obtaining a
sufficient supply of excellent potable water at the principal resorts
of our naval vessels, to obviate the necessity of watering ship with
impure water — a necessity which, in the case of steamers, of
course, never can exist. In some tropical sea-ports, as Anjer.
where the water is necessarily largely impregnated with vegetable
matter, filtered water may be obtained at a small charge, and I
was once witness of the lamentable consequences of a command-
ing officer's refusal, through a mistaken spirit of economy, to incur
this expense. Parkes quotes as a curious fact from Davis, in ref-
erence to the West Indies, that ships' crews, when ordered to
Tortola, were " invariably seized with fluxes, which were caused
by the water. But the inhabitants, who used tank (rain) water,

NAVAL HYGIENE. 87

were free ; and so well known was this, that when any resident at
Tortola was invited to dinner on board a man-of-war, it was no
unusual thing for him to carry his drinking-water with him."

Should it become necessary to obtain water from unknown
places, the medical officer should always examine its source,
means of transit, preservation, etc. It is manifestly improper to
fill up from stagnant pools, shaded and sluggish streams, marshes,
mineral springs,- etc., nor should any springs or wells ever be com-
pletely exhausted. During the late war I have known whole tanks
rendered unfit for drinking by the final addition of a cask obtained
by the exhaustion of a spring. Rain-water, though largely aerated,
is insipid from deficiency of salts, while melted ice and snow
lack both the necessary gaseous and mineral ingredients, and re-
quire the same treatment as distilled water to be potable. Cap-
tain Cook's attempt to water ship from an iceberg resulted dis-
astrously to the health of his crew. Snow itself does not assuage
thirst, and absorbs ammonia in such quantities that its ingestion
is often attended with dangerous and, in several cases of children,
fatal consequences.

Boat expeditions or exploring parties on land may sometimes
be compelled to use only such water as they can get, when the
preferable mode of purifying it will be by filtration through sand
and charcoal. Water containing principally organic matters in
solutionis rapidly purified by means of potassium permanganate.
Calcareous waters, containing the carbonate, may be improved
by the addition of pure lime-water which combines with the
solvent, (C02,) and precipitates it as carbonate, along with the
rest of that salt which it had held in solution. Water containing
calcium sulphate in excess is more objectionable than that hold-
ing an excess of carbonate, for though the addition of bicarbon-
ate of sodium will likewise throw down the lime carbonate, the
sodium sulphate left in solution gives the water a disagreeable
taste and unpleasant laxative qualities. The objection to the
popular French plan of purifying turbid water, entitled " ahmage
de Veau" which simply consisted in the addition of a small

NAVAL HYGIENE.

quantity of alum, was that, while clarifying the water, it merely
converted the lime carbonate into sulphate, which remained in
solution, and rendered the water worse than before. Youatt says
that the horse, "through instinct or experience, will leave the
most transparent and pure (?) water of the well for a river, although
the water may be turbid, and even for the muddiest pool."

A common source of impurity in water brought on board ship
is the leakage of the water-boat, casks, or tanks, in which it is
conveyed from shore. These are frequently old, are seldom or
imperfectly cleansed, not properly calked and lined, or are open
to salt spray or to the swashing of salt-water into the pump- well.
A pint of sea-water contains from three hundred and six to three
hundred and fifteen grains of saline substances, while less than
two grains in that quantity are the most that can be drank any
length of time with entire impunity ; consequently a single gallon
of sea-water will render unfit for drinking more than a hundred
of otherwise pure water. Hence a sample of water should be ex-
amined out of every tank, and several tests should be made, if it
remains alongside of the ship any length of time. Where the
young medical officer is in doubt whether the water examined
falls far enough below the standard to be rejected, let him always
decide against and decline to approve it.

The greater part of the water used on board steamers is distilled
from the sea, and the attention of engineers and constructors has
been directed to the production of an apparatus which shall ac-
complish this in the most satisfactory manner. The disagreeable
empyreumatic odor and flavor usually attending water from this
source, its chemical purity and consequent insipidity, are the prin-
cipal faults which have to be remedied. The first depending on
defective process of distillation, has been gotten rid of as this has
improved. Perroy's apparatus, as modified by Bourel-Ronciere.
in use in the French naval service, is probably the best yet devised :
the steam generated by the boilers of the engine being condensed
by the water of the sea surrounding the vessel, in the midst of a
current of air, by which it is aerated, and deprived of empyreuma

NAVAL HYGIENE.

by filtration through granular animal charcoal. The filter con-
sists of a tinned sheet-iron box, divided internally into four com-
partments, separated by vertical partitions pierced with alternate
holes, so that the water produced traverses successively the entire
mass of charcoal contained in the four compartments, and becomes
immediately potable as it leaves the apparatus. The condenser
is a simple tinned copper tube, placed on the outside of the keel,
about a metre below the water-line, secured firmly to the vessel,
and covered up so as to prevent its injury by the grounding of
the vessel, but not to hinder her steerage-way. After running a
certain distance outside, it enters the ship's side and discharges
the fresh water obtained by the condensation of the steam under
the cooling influence of the sea-water. Cocks at the two extrem-
ities regulate the admission of steam and the discharge of water.
A minute analysis of the waters obtained on board La Circe, where
Bourel-Ronciere performed his experiments with distillatory appa-
ratus, wTas made at the naval medical school at Toulon, by M.
Fontaine, premier pharmacies en chef, and demonstrated that at
the first working of the apparatus they contained sodium chloride
in sensible quantity, a few sulphates, and traces of organic matters ;
but Bourel-Ronciere claims that as the apparatus is worked the
water becomes purer, and the quantity of saline matters is much
diminished, and, after leaving Perroy's filter, it is sufficiently
aerated to be healthy and salubrious. "The problem of the dis-
tillation of sea-water," adds A. Tardieu, from whom I have ob-
tained these facts, "may thus be considered as practically settled."
Fonssagrives proposes to supply the deficiency of saline matter in
distilled water by the addition to every hundred gallons of a mix-
ture containing about half a drachm of sodium chloride, a scruple
of sodium sulphate, six drachms of calcium carbonate, a drachm
and a half of sodium carbonate, and two scruples of magnesium
carbonate, the aggregate amount of salification amounting to 5.4
grains per gallon. Besides the mechanical means for aerating
the water, if the tank is only filled to the extent of two-thirds its
capacity, the motion of the vessel will agitate it sufficiently to

90 % NAVAL HYGIENE.

cause it to dissolve a larger proportion of the gaseous constituents
of the atmosphere. A crystal of green ferrous sulphate will not
produce the characteristic ocherish discoloration unless air is
present. Condensed water should always be cooled before it is
passed into the tanks. When this is neglected, the consequent
elevation of temperature hastens the decomposition of the pro-
visions usually stowed upon the tanks.

Not infrequently water, unobjectionable when brought off or
distilled on board, is seriously impaired after it has been placed
in the tanks. This is the case when the latter have been white-
washed inside, a practice that cannot be too severely condemned.
I sailed from Boston, in the autumn of 1858, on board the Dol-
phin, of which the tanks had been treated in this way, and, with
every other officer and man, I was tormented with burning thirst,
dryness of mouth and fauces, nauseous taste, epigastric heat, etc.,
until we arrived at Buenos Ayres. The tea, coffee, and soups
were also spoiled. Still another cause of the deterioration of
water on board ship is overlooked. It is a very general custom
to fill the tanks as soon as they have been emptied, with sea-
water, either to preserve the trim of the vessel or to prevent cap-
sizing, though on board steamers provided with distilling appara-
tus there can be no possible pretext for using salt-water for this
purpose. With the greatest care it is difficult to remove the ef-
fects of this procedure, and the destruction of the brackishness of
the water by the chemical action of the iron is inconsiderable :
but usually, the only cleansing attempted is to pump out the salt-
water, wash the tanks with a few gallons of fresh, and then re-
plenish them. The tanks of some small vessels will not admit a
boy, and frequently the beams of the berth-deck partly cover the
man-hole openings, so that it is not possible to reach but a small
portion of their surface. The substitution of iron tanks for casks
is one of the greatest improvements hygiene has effected in mod-
-ern naval establishments, and its satisfactory results should secure
attention to other suggestions emanating from this department of
the medical profession. Tanks, however, require considerable

NAVAL HYGIENE. 9 I

care. They should always be thoroughly cleansed when emptied,
scraped, well rinsed with fresh, preferably distilled water, and
waxed before they are refilled. Galvanizing the inside of the
tanks is opened to the objection that it will add another foreign
substance to the water in the shape of a salt of zinc. The scuttle-
butt ought also to be of iron ; it should be cleansed and waxed
every month, and provided with a filtering diaphragm of sand
and charcoal, which must be occasionally removed and renewed.

1 have known vessels on which the scuttle-butt was not disturbed
during the whole cruise.

Instead of the ordinary mess-pot holding nearly a quart, such
as is used for tea and coffee, which is filled and emptied at a
draught, and oftenest by the landsmen, writers, boys, etc., who
require it least, a small tin drinking-cup, of the capacity of a gill,
should be attached by a chain to the faucet of the scuttle-butt,
and allowed to be filled but once at each drinking. This quan-
tity is as much as should be swallowed at any one time, and will
enable the man to get from ten to fifteen full draughts a day.
The sentry on post should be instructed to prevent any particular
set of men from using an undue share. The whole daily allow-
ance should not be pumped into the scuttle-butt at one time, but
at intervals, during the day; thus, if the entire daily amount is
one hundred gallons, let fifty be introduced at 9 a. m., thirty at

2 p. m., and the balance at 8 p. m. The tea and coffee will sup-
ply its place at intermediate times. The addition of oat-meal to
water is customary with engineers and firemen, a smaller quan-
tity thus more effectually relieving thirst. At general quarters,
not only the scuttle-butt should be filled, but the mess-kettles of
the berth-deck cooks, which should be convenient to be passed
on deck by the powder division. Similar provisions for an extra
supply of water should be made whenever any other protracted
or exhausting labor is undertaken.

SLEEP.

The graphic descriptions by reporters of the filth of some of
the unclean and degraded poor of our great cities would find a
parallel on the berth-decks of many of our men-of-war at night.
It is a place that few officers but those of the medical corps ever
visit at that time ; and the close bulkheads of the comparatively
well-ventilated ward-room exclude the foul and stifling odors of
the adjoining apartment. It is impossible to remain many min-
utes among the hammocks without experiencing a. sensation of
suffocation and nausea ; indeed it is only necessary to lean over
the main -hatch, toward the close of the first watch, to recognize
the heavy mawkish odor that arises and betokens the over-crowd-
ing of human beings. That these beings are injuriously affected
by what appeals so forcibly to our senses and excites disgust,
does not admit of question. I have referred incidentally to this
subject of overcrowding when speaking of ventilation, and have
shown the evil of the system which fills vessels with more men
than they can berth, even with hammocks swinging so closely
together that the movement of one man disturbs all those
among whom he is wedged. The berthing capacity of even-
vessel should be determined by a commission of officers, in part
of the medical corps, and should be the guide to the regulation
of the armament, rather than that a certain number of guns
should be put on board and a certain allowance of human muscle,
like that of tackle and breechings, be subordinate thereto. The
ship carrying a small battery, manned by a hundred athletic,
healthy men, will be far more efficient than one bristling with

NAVAL HYGIENE.

93

cannon and encumbered with twenty or thirty daily sick, and
twice as many more enfeebled convalescents.

At sea only one watch sleep below; but all the advantages
derived from the increased breathing-space thus afforded are coun-
terbalanced by a horribly disgusting and abominable practice
which is enforced on board many — probably a majority of vessels
— of compelling the watch that come from deck to turn into the
hammocks of the men who relieve them. Perhaps an officer,
who never visits the berth -deck at night, and whose own bunk is
clean and dry, can thoughtlessly issue such an order and reply to
any remonstrance made that "men must not expect to get all the
comforts of life with eighteen dollars a month ; " but the medical
officer, who is ever mindful of the solemn responsibilities of his
profession, will denounce this practice with every expression of
abhorrence. Fancy the loathing with which a clean man must
regard the compulsion to sleep in the bed of a fellow of unclean
habits, diseased with venereal, affected with cutaneous eruptions
or vermin, whose skin is naturally offensive, or whose blankets
are always wet from incontinence of urine or spermatorrhea, or
the equal repugnance he must experience at having his own clean
bedding soiled by such a beast. There is never the shadow of
necessity to excuse this detestable custom. In pleasant weather
each watch should be compelled to "lash and carry." The unoc-
cupied, hammocks should not be left below, except when they
would get wet by being stowed in the nettings, and then they
should be allowed to remain on their appropriated hooks or be
piled up in some convenient place.

I have already insisted that the watch coming below should
remove their wet clothes before turning in, and that if they have
exhausted the three changes which a proper outfit would allow,
that they should remove their outer shirts and pantaloons, and
hang them on their hammock-hooks. In this way the contents
of the hammock may be kept dry and clean. No wet articles
should ever be stowed either in the hammocks or hammock-net-
tings.

94 NAVAL HYGIENE.

All bedding should be exposed in the rigging to the air and
sun at least once a week, if the weather will permit. The blank-
ets and mattress should be well shaken, and the latter should
be repicked once or twice during the cruise. Hennen, writing
on military hygiene, advises the daily exposure of soldiers' bed-
ding to the sun. I have known vessels in which bedding had not
been opened for this purpose for several months, where there was
no care taken to prevent men turning in wet, and where the gon-
orrhceal, the syphilitic, the eczematous, those incontinent of urine,
and those affected with diarrhoea, slept alternately with the clean
in each other's bedding. Opportunities should be improved of
compelling the men to wash their blankets, one or both at a time,
and their mattress-covers, in fresh water. These articles become
quickly soiled with blue dye-stuff during the first weeks that new
flannel is worn. Although we have often imitated or adhered to
the customs of the British service with questionable profit, I can-
not refrain from expressing a hope that our Government will
adopt the course of the lords commissioners of the British admi-
ralty, who "being desirous that the seamen, on entering, as far
as practicable, may be freed from the necessity of incurring debt,
are pleased to direct that all men and boys, on first joining one
of Her Majesty's ships, shall be supplied with a bed, blanket, and
bed-cover free of charge." As they are the property of the Crown,
and have to be returned, paymasters are interested in having them
kept in good order; and the care taken to this end thus indi-
rectly assist to a result which, with only hygiene recommending
it, would never have been attained.

The greasy black hammock-lashing is a relic of old-time cus-
toms, which should go the way of others of its kind. The neat
white "tie-tie," or stop, does not soil the hammock, lessens the
task of cleaning, and does not break the mattress. Hammocks
are adapted for it with very little trouble, and the bedding may
^Jbe more expeditiously tied up and taken on deck' than when a
lashing has to be adjusted.

In pleasant weather the greater part of the watch on deck

NAVAL HYGIENE. 95

sleep on the spar-deck, wherever they can find places. Unless
the decks are perfectly dry, this should be interdicted. Care
should also be taken that the men never lie down where they will
be exposed to dew or to currents' of air through air -ports and
scupper-holes. A large proportion of the aural diseases which
appear on the medical returns of the service is occasioned in this
way.

The necessary interruptions of the sleep of the sailor affect his
health, but many of the needless discomforts and sources of dis-
ease may be abolished with great benefit to the service, as when
" all hands" are called during the night in consequence of clum-
sily executed maneuvers or to punish a few lazy and inefficient
men.

EXERCISE

Among other " non-naturals" which require attention from the
naval hygienist is want of exercise. The sailor's occupation fur-
nishes occasion enough for physical development, but there is a
numerous class of persons on board vessels of war, intrusted with
special duties, who do not share the open-air labors of the mar-
iner. These are the apothecaries, nurses, yeomen, schoolmasters,
writers, masters-at-arms, ship's corporals, captains of the hold,
permanent berth-deck cooks, officers' stewards, cooks, and ser-
vants, musicians, printers, painters, tailors, etc. They are recog-
nizable at the weekly muster on Sunday by their pallid counte-
nances, faltering gait, and untidy, slovenly dress. They are un-
clean and indolent as a class, are scantily provided with clothing,
and form a large proportion of the sick. The dark and lonely
corners where they abide are the favorite haunts of those guilty
of those secret practices that are so rife on board some men-of-
war. Many yeomen pass the entire day in the store-room, which
sometimes is without a scuttle overhead, or even an auger-hole
in the door, where they breathe a confined and stagnant atmos-
phere, still further impoverished and heated by two or three
constantly burning oil-lamps or candles. The captain of the
hold whiles away his leisure hours in the main hold, where he
keeps his ditty-box, and the regular cooks seldom quit the
vicinity of the galley before night, when the fires are extinguished.
The system of steady berth-deck cooks reduces eight, ten, or
more of the crew, according to the number of messes, to this
etiolated condition, and it ought, therefore, to be discounte-

NAVAL HYGIENE. 97

nanced. Every man, except the higher petty-officers, should be
required to perform the duty of mess-cook or caterer (for the
former term is a misnomer) in rotation, changes being made at
least monthly, and while attending to this duty he should not be
excused from the regular exercises of his division or station, an
alternate performing his mess-work. All others whose special
duties confine them below should be compelled to pass a certain
portion of each day, during the hours of daylight, in the open
air. They should either be attached as supernumeraries to the
regular divisions, or be exercised together at the great guns, at
small-arms, single-sticks, rowing, or going aloft. No conflict of
departments need occur in this if officers of the various corps
are actuated by proper feelings toward each o<"her and toward
the service. It is not presumed that the surgeon will be deprived
of the services of the apothecary or nurses whenever these may
be required ; nor that the paymaster will have to subordinate the
business of his department to his writer's exercise; nor that the
captain of the hold will have to neglect his work to play at top-
man or loader and sponger ; nor that the cabin and ward-room

dinners shall become cold or go uncooked, and Mr. 's boy

lay down his razor and leave the lathered chin unshaven when-
ever small-arm men are called away. The special duties for
which these individuals are respectively employed must be at-
tended to in preference to everything else ; but then the officer
who directs or controls this special duty should not throw obsta-
cles in the way of exercise, however distasteful it may be to the
subordinate, by requiring untimely and unnecessary services, but
prompted by a desire to promote the general interests, should
cheerfully co-operate to this end.

The multiplicity of officers' messes crowds our naval vessels
with a superfluous number of ineffective, worthless, and trouble-
some individuals, who eminently deserve the designation " idlers."
A flag-ship may have a separate mess for the admiral or commo-
dore, one for the commanding officer, (and I have heard another
advocated for the fleet-captain,) one for the ward-room, (and for
7

98 NAVAL HYGIENE.

a while there were two of these,) one for the starboard and an-
other for the port steerage, and one for the warrant-officers ; each
with its own steward, cook, and servants; each occupying the
galley, which consequently becomes a theater of confusion and
contention ; each encroaching on the air-space of the ship by its
independent store-rooms and pantries, and deteriorating its at-
mosphere by its accumulation of destructible stores, often in
widely apart localities. I have known a brig-of-war so small
that officers and men elbowed each other on deck, on board
which the show of class distinctions was still kept up by four offi-
cers' messes. I am aware that the time has not yet arrived for
expecting any reform in this matter, though more than one com-
manding officer has agreed with me that there is no good reason
why a general officers' mess, presided over by the captain, should
not be established, as in the Army, where the colonel sits at the
head of the regimental mess-table. The ship is the analogue of
the regiment or battalion, and experience has demonstrated that
where military officers dine en masse their demeanor is no less
gentlemanly and dignified, and their polite and friendly inter-
course no more subversive of discipline than in the Navy, where
inferiority of position is unremittingly indicated by the relative
coarseness of the table-cloth, the number of the viands, the im-
pudence of the steward, and the behavior of the mess-mates. On
the contrary, many arguments may be adduced in favor of the
former practice. The expense of entertaining foreign officials is
wholly defrayed from our own officers' personal means : and when
this is on a large scale, falls chiefly upon those of the ward-room.
Many of our commanders have dined with foreign regimental
messes, in company with cornets as well colonels, without
abasement of their own dignity, and visiting admirals and gen-
erals would doubtless feed with equal complacency in the pres-
ence of midshipmen, masters, and assistant surgeons. The ob-
jection of the inability of the junior officers to bear an equal share
of such expenses could be overcome, first, by the Government pro-
viding an outfit of table and kitchen furniture for every ship, and.

NAVAL HYGIENE. 99

secondly, by its assuming, as in other services, all extra expendi-
tures certified by the commander to have been incurred in the
legitimate entertainment of foreign officials and the necessary re-
turn of civilities received from them • an outlay more than coun-
terbalanced by the saving in wages, subsistence, and sick-care of
the attendants no longer required. The monthly cost to each
individual of maintaining a general officers' mess in superior
style would be actually less than that now expended and wasted
by the inexperienced caterers of many midshipmen's messes.
Furthermore, the young officers of the Navy would, from the
commencement of their career, be beneficially influenced by
the courteous and gentlemanly association and the exemplary
conduct of their seniors. Most steerage-messes, and lately
not only these, are often scenes of unbecoming turmoil and
indecorum. The absence of restraint, which induces even the
younger officers themselves to object to a common mess, is
merely a license for conduct which their parents would not tol-
erate at their own tables, and which would not be permitted in
any gentlemen's club on shore. The general mess, therefore,
would advance the morale of the service, while the hygiene of
the ship would be benefited by the consequent diminution of
the servant class. It is not, of course, proposed to deprive the
commander of his private quarters and offices, where he can reg-
ulate discipline and discuss the weighty affairs of state with for-
eign dignitaries, nor any other officer of the seclusion of his own
apartment ; but the common mess-room would be found an agree-
able place for friendly and unofficial commingling, which would
lead to the re-establishment of those intimacies, once the bond
and pride of the Navy. The absorption of the steerage-messes
would, moreover, allow clerks — commander's and paymaster's — to
be dispensed with. The duties of the former could appropriately
be performed by the midshipmen or ensigns in rotation, whom it
is desirable to have acquire a knowledge of the methods of official
correspondence and Avho ought to be as trusty repositors of State
secrets as the irresponsible parties now appointed. An assistant

NAVAL HYGIENE.

paymaster should be attached to every vessel for clerical duty
and instruction, and the pharmaceutic work of the apothecary,
whom I have elsewhere, assuming the permanence of existing
conditions, advised to be made a steerage officer, would naturally
and properly devolve upon an assistant surgeon. Nor need the
warrant officers stand in the way of this scheme. They are few
in number, inconsistent with the size of the naval establishment,
and in a majority of the vessels of the Navy their duties are
actually and efficiently performed by their mates, who could sup-
ply their places in all, except in the case of the gunner, whose
more important responsibilities ought to pertain to commissioned
officers especially educated and skilled in ordnance. These
mates would partake in that improvement of dress and privilege
which I have asked for the petty [preferably, non-commissioned]
officers, and thus be assimilated to the corresponding grades in
the Army ; while sufficient employment on shore could be found
for the present holders of warrants, many of whom are estimable
gentlemen, far superior to their enforced humble surroundings on
board ship, as was done with the former master's corps, until
their extinction by death or resignation.

CLIMATIC INFLUENCES

The exposures incident to the sailor's life are supposed to fit
him to endure with impunity extremes of temperature or any in-
clemency of season. It is a popular belief that no amount of
soaking in salt water will give one cold, though an old salt who
is not also a chronic rheumatic is a rarity. The carelessness conse-
quent upon these ideas has its result, as shown by statistics, in
shortening the seaman's life. However slow to contract disease
or to be affected by ordinary vicissitudes, the unnatural circum-
stances under which he lives give an unfavorable character to all
his complaints, and maladies of equal severity in their incipiency
are, therefore, more fatal at sea than on shore. The most po-
tent causes of disease in the seaman are not accidental exposure
to cold, occasional getting wet, gluttonous eating of unripe fruit,
not indulgence in unrestrained debauch ; but they are those which
gradually undermine his constitution, and result from the neglect
to adapt his diet, dress, and duty to the hygienic requirements of
the climate in which he lives. Sailors are made up of the same
tissues as princes and gentle folk, and though habit may modify
the effects of natural causes, it cannot altogether nullify them.
Darwin declares that "it is certain that with sailors their manner
of life delays growth," as shown by the great difference between
the statures of soldiers and sailors. It is now very generally
believed that certain races wrere created for certain localities, if
not created in or by them. Acclimation is no longer regarded
as a fact, for such excellent authorities as Johnson and Martin
assert that " residence confers only certain immunities and privi-

102 NAVAL HYGIENE.

leges, and that so far only is there truth in the doctrine of accli-
mation." Even this tolerance, created by a residence of a
year or two in a foreign climate, is at the expense of constitu-
tional vigor. Dr. Bloodgood writes with respect to Panama what
is equally true of many other inter-tropic pest-holes entered by our
national vessels : " Acclimation is impossible ; no one of what-
ever race or country, who becomes a resident of the Isthmus
escapes disease; not even beasts are exempt, and nothing but change
of climate can eradicate the effects of the poisoning from that
malaria." The Government has, therefore, acted wisely in
abandoning the practice of long cruises. Three years are the
most that can be safely passed on any one station notably unlike
the native climate, since, with every attention to hygienic pre-
cautions, there will be such a general loss of constitutional
strength among the crew that they will become ill from slight
causes, and such permanent organic injury will be received by
many officers as well as men as to unfit them for future energetic
duty. A British steam sloop-of-war, cruising on the Caribbean
coast of Central America, in 1859, had had nearly three complete
crews during the five years she had been in commission, and her
commander told me that those officers and men who had re-
mained from the beginning were becoming stultified in mind. A
liberal government like our own has no excuse in the saving of
expense, if there really be any such, to commit the inhumanity
of compelling its men and officers to remain so long from their
families and country. The best American merchant sailors will
not enter the service while they are kept away beyond two years,
and officers are not made better citizens and members of society
if they are exiled until the recollection of home becomes almost
a dream of the past.

Of extreme climates, the cold are more readily borne by our
crews than the hot, being more like the rigorous winters to which
they have been accustomed. The effects of cold, moreover, can
be better guarded against, not only by proper clothing but by the
observance of a strict hygiene, especially in the matter of diet

NAVAL HYGIENE. 103

and ventilation. Raw fat meat, seems to be the appropriate food,
though the scurvy of the frigid zone is not merely the result of
improper alimentation, but of neglect of all the laws of health.
Instinct and appetite guide to what should be eaten, but foul air
and filth are submitted to despite the frightful havoc they assist
in causing. What an intelligent observance of sanitary laws will
accomplish under the most unfavorable circumstances was mark-
edly demonstrated in the Arctic expedition commanded and di-
rected by Dr. Hayes.

The combined influences of protracted exposure to the elevated
temperature, moisture, and organic growth and decay, which
characterize tropical climates, and of an almost universally
neglected hygiene, occasion serious functional disturbances,
which lay the foundation of irreparable structural lesions, the
peculiarities of which are, of course, familiar to the educated
physician. The lungs and kidneys are brought into fuller activ-
ity under a low temperature, while the liver and skin are excited
to greater functional effort under a high one. Zymotic fevers,
diarrhoea, and dysentery are the most intractable of the com-
plaints of the torrid zone, but they are so fully described in the
current medical literature as to render unnecessary any special
reference to their technical history. When the interests of the
service require the visit to or prolonged sojourn in any unhealthy
place, the advice and judgment of the medical officer must be
relied on to provide for the special necessities of the time. The
prophylactic administration of the salts of quinine, the diminu-
tion of the ration of meat and increase of the proportion of vege-
tables, the purchase of fruits, and the issue of spirits or its sub-
stitution by wine, are among those measures that should be left
to his individual discretion. I have only to indicate a few pre-
cautions of universal applicability.

Although the permanent squadron on the west coast of Africa
has been discontinued, vessels of the European fleet occasionally
resort there, and the sanitary regulations of Secretary Preston,
issued January 23, 1850, are still in operation, [vide paragraph

104 NAVAL HYGIENE.

832, Regulations for the Navy, 1870,) and should be enforced on
all other stations, where similar climatic conditions prevail, as in
the East and West Indies, and on the coast of Central America *

1. No officer or man will be permitted to be on shore before sunrise or
after sunset, or to sleep there at night ; this rule to apply not only to the con-
tinental coast but to the Cape de Verde Islands.

2. No United States vessel will ascend or anchor in any of the African
rivers, except upon imperative public service.

3. Boat excursions up rivers, or hunting parties on shore, are forbidden.

4. Vessels, when possible, will anchor at a reasonable distance from shore ;
far enough not to be influenced by the malaria floated off by the land-breeze.

5. Convalescents from fever and other diseases, when condemned by med-
ical survey, are to be sent to the United States with the least possible delay.

6. When the general health of a ship's company shall be reported as im-
paired by cruising upon the southern or equatorial portion of ihe coast, the
earliest possible opportunity will be given them to recruit by transferring the
ship for a time to the Canaries or other windward islands of the station.

7. Boat and shore duty, involving exposure to sun and rain, is to be per-
formed, so far as t':e exigencies of the service will permit, by the Kroomen
employed for that purpose.

8. All possible protection from like exposure is to be afforded to the ship's
company on board ; and the proper clothing and diet of the crew, as well as
the ventilation and care of the decks, will be made a frequent subject for the in-
spection and advice of the medical officers.

9. These regulations are to be considered as permanent, and each com-
manding officer of the squadron, on retiring from the station, will transfer
them to his successor.

The danger of sleeping or remaining on shore after dark in
malarial climates, on account of the greater activity of the mor-
bific cause or the greater susceptibility of its deleterious effects
at that time, is generally understood; while the universally
admitted atmospheric contamination implied in the use of the
word malaria, though its particular character is not known,
points to the prime necessity of keeping as far away from its influ-
ence as possible by avoiding anchorages in narrow streams and
^inlets and to leeward of prevailing winds, and by intervening such a
surface of water as has been practically found to confer immu-
nity, through the surmised absorption of the aerial poison. Ham-

NAVAL HYGIENE. 1 05

mond quotes the following paragraph in point, from Sir Gilbert
Blane : " I have known a hundred yards in a road make a dif-
ference in the health of a ship at anchor, by her being under the
lee of marshes in one situation and not in another," This has
often been remarked in the bay of Rio de Janeiro. Sur-
geon Bloodgood, United States Navy, has shown that it was
the case in the harbor of Panama, when the Jamestown was
so terribly scourged by yellow fever; and I learn from Medical-
Director Beale that the Boxer lay twenty miles up the Congo,
the most unhealthy of the African rivers, without detriment to the
health of the crew, by merely anchoring three miles off shore. In the
British admiralty health reports it is stated that " the Hibernia,
at Malta, during the cholera, was moored within one hundred
yards of the infected districts, and the ship remained throughout
the whole pestilence free from any fatal attack."

The fifth, sixth, and seventh of Secretary Preston's regulations
are so exceedingly important that every infraction of them should
be visited with the severest censure of the Department. Inva-
lids should be sent home without delay ; vessels should tempora-
rily change their cruising-grounds ; and crews should be relieved
as much as possible from duty, especially menial drudgery, in-
volving exposure to sun and rain. Moseley and other writers
on tropical climates advise that all merely laborious work should
be performed by negroes, lascars, coolies, and others inured
to the climate. As the Government authorizes the employ-
ment of Kroomen on the coast of Africa for boat and shore duty,
many vessels of the Asiatic fleet have been provided with Chinese
" fast-boats," manned by natives ; but some commanding officers,
either to save expense, or because they inconsiderately imagine
that " men are shipped for any work, and if they die then-
places can be supplied by others," compel their crews to do
this duty, at all hours of the day, in any weather, and at any sea-
son. The cost of the fast-boat, however, will be many times
defrayed by the saving of health. Admit that only ten men be-
come ill from exposure to the heat of a single tropical summer,

Io6 NAVAL HYGIENE.

would it not have been more profitable to have had those men
well and in efficient condition, than encumbering the deck with
their cots, incommoding their shipmates, and interrupting the
ordinary routine of exercise ? Probably half of them will require
to be invalided and returned to the United States, and the cost
of passage home, the payment of wages for services never per-
formed, and those of the green recruits, who supply the invalids*
places, the subsistence of the latter for months at a naval hospi-
tal, and their subsequent pensioning for the balance of their lives,
would have employed a score of native boats with crews unaf-
fected by the climate, and given to the Government the strength
and spirit of these five men to fight its battles. The other reason
for not employing natives is too inconsistent with the liberal char-
acter of our naval establishment to be for a .moment entertained.
That it is not the theory of the Government is evident from the
general order of January 23, 1850. The seaman is hired for
other purposes than those of pulling pleasure parties of officers
to and from the shore when the thermometer stands above ioo:
F. He has devoted his life to the service of his country, and
stands ready to shed his blood in its cause. The ship's bat-
teries are that country's defenses, and he should be kept in a
condition to man them. Without his strength and bravery, what
will avail all the skill of the navigator, all the science of the
ordnance officer, or all the planning and maneuvering of the
commander?

Besides avoiding the exposure of men by not sending them
out of the vessel at improper hours, they should be protected on
board ship from intense tropical heat both at sea and in port.
Awnings ought always to be kept spread, forward and aft, when the
temperature exceeds 8o° F. They should protect not only the
poop and quarter-deck, but the main-deck, forecastle, and head.
As the awnings in port are usually very high from the deck, the
protection they afford will be insufficient unless curtains are at-
tached. They should be set before the spar-deck is perfectly
dry, if it has been washed, that the slow evaporation may assist

NAVAL HYGIENE. I 07

in keeping down the temperature ; and if the deck becomes dry
and hot during the day. it should be occasionally irrigated.
Painting the hull of a vessel of a light color very materially
affects the temperature of the covered decks. The tops should
be provided with awnings, that those men on duty aloft may find
a shelter when not on the yards nor in the rigging. The lookout
on the topsail-yard should also be screened and relieved every
half-hour, or, in calm weather, at shorter intervals, and, if this is
impossible, should be dispensed with, except when imperatively
necessary for the safety of the ship. Many men are victims to
the routine of keeping lookouts aloft, when it would be sufficient
to have them in the tops or even on deck. The sentries on post
in the gangways should be protected by small awnings or flies,
and they should be frequently relieved. Numerous cases of
coup-de-soleil occur among this class, who are made to parade a
gang-plank two hours at a time, dressed in a closely-buttoned,
uniform, and carrying a heavy musket and accouterments, with-
out any more attempt at shelter than would be afforded in their
own temperate climate. A pensioner on the navy-list, some time
since residing in New York, who is affected with hemiplegia,
consequent upon insolation, was disabled under precisely such cir-
cumstances ; and several other cases which resulted less seriously,
occurred on board the same vessel in the East Indies. When
boats are required to be sent away in the hot part of the day,
their awnings should be spread, and this manifestly applies to
the very largest launch and smallest dinguy, as to those ordina-
rily used.

In very hot weather (above 850 F.) no work nor exercise of
any kind should be performed after 9 a. m. nor before 5 p. m.,
unless absolutely indispensable at that time, and then only under
shelter, and the reasons for such unavoidable work or exercise
should be entered on the log. Tarring rigging, scraping spars,
scrubbing copper, painting ship, divisional exercises, small-arm
drill, etc., at such a time, are inexcusable because perilous. The
dangers that are sought to be avoided are neither imaginary

Io8 NAVAL HYGIENE.

nor exaggerated. I have seen a new fore-topsail bent at n
o'clock on a calm morning, the thermometer indicating 1260 F.
in the sun, and followed by the fatal sickness of the captain of the
top, and the serious illness, within forty-eight hours, of seven of
the men who had been at work upon the yard. The weather
was pleasant all day long, and others concurred with me that the
work could have been as well done early in the morning or late
in the evening. Dr. Maclean, in Reynolds' "System of Medi-
cine," relates several historical instances of insolation occurring
in the field or barracks, among the most striking being the fol-
lowing : " The two wings of Her Majesty's thirteenth regiment
marched, after some very ill-judged exposure and drilling in the
sun, from Nuddea to Berampore, in the midst of the hot weather,
and, as the result of one march, the day closed with a sick-list of
sixty- three, and eighteen deaths in all." " The sixty-eighth regi-
ment, quartered in Fort St. George, Madras, which attended the
funeral of a general officer, and paraded in full-dress at an early
hour in the afternoon, in one of the hottest months in the year,
their tight-fitting coats buttoned up, their leather stocks as stiff
and unyielding as horse-collars round their necks, heavy cross-
belts, so contrived as to interfere with every movement of the
chest, heavy shakoes on their heads, made of black felt, mounted
with brass ornaments, with wide, flat, circular tops, ingeniously
contrived to concentrate the sun's rays on the crown of the head,
and without protection in the way of a depending flap for the
neck; so dressed the men marched several miles. Before the
funeral parade was over the soldiers began to fall senseless; one
died on the spot — two more in less than two hours. Men suf-
fering from insolation in various degrees were brought into hos-
pital all that night and part of next day." " The ninety-eighth
■came from England in the Belleisle, an old 74-gun ship, and suf-
fered from overcrowding. On the 21st of July they took part in
-the attack on Chin-Kiang-Foo. The men were dressed precisely
as those of the sixty-eighth. In this condition they had to take
possession of a steep hill exposed to the fiercest rays of the sun

NAVAL HYGIENE. IO9

shining out of an unclouded sky. A great many were struck
down by the heat, of whom fifteen died." The most recent in-
stance of criminal disregard of sanitary teachings has occurred
since I began writing. The first battalion of the tenth regiment
of British infantry was marched from its camp at Yokohama after
parade on the morning of August 8, 1871, to the French Hatoba,.
where it embarked. The men were heavily armed and accou-
tered, and though exposed to the sun less than three hours, the
thermometer at 920 F., shade temperature, six cases of sun-stroke
occurred, of which three, two sergeants and a private, died.
Three of the marines who relieved them, and who were landed
immediately afterward and marched to the camp they had va-
cated, also succumbed to the heat.

The symptoms of insolation (heat-stroke) often occur among men
not exposed to the direct rays of the sun — in the fire-room of steam-
ers, on board the monitor class of armored vessels, in small, ill-ven-
tilated cells. Dr. Kitchen informed me that while surgeon of the
monitor Dictator it was common for men to be brought to him
for treatment with coma, stertorous respiration, great heat of skin,
full quick pulse, and often convulsions. The cause was mani-
festly enough the exhausting labors of a watch in the fire-room,
where the temperature averaged 1450 F., and where the ventila-
tion was exceedingly defective, air that had been already respired
being repeatedly returned. Maclean states that "insolation has
frequently been observed on board ship, but almost always under
conditions similar to those in barracks — that is, where over-
crowding and impure air are added to the influence of excessive
heat. Insolation is not uncommon on board the mail-steamers
in the Red Sea in the hot months of August and September; it
has been observed that most of the cases occurred while the suf-
ferers were in the horizontal positions in their ill-ventilated cab-
ins," and he quotes the following : "Assuredly," says Dr. Butler,
surgeon of the third cavalry, " those barracks most crowded, least
ventilated, and worst provided with punkahs and other appli-
ances to moderate excessive heat, furnished the greatest number

NAVAL HYGIENE.

of fatal cases." Surgeon Longmore, of the ninteenth regiment,
notes that one-third of his cases and nearly half the deaths oc-
curred in one company of the regiment quartered in the barrack,
which was manifestly the worst conditioned as to ventilation.
and, indeed, in every sanitary requirement. M. Bassier, a sur-
geon in the French navy, reports that the man-of-war brig Le
Lynx, cruising off Cadiz, in the month of August, had eighteen
cases of insolation out of a crew of seventy-eight men. The heat
was excessive (91-950 F.) and much aggravated by calmsj The
ship was overcrowded, offering little space for the berthing of the
crew. M. Boudin quotes the case of the French man-of-war
Duquesne, which, while at Rio de Janeiro, had a hundred cases
of insolation out of a crew of six hundred men. Most of the
men were attacked, not when exposed to the direct heat of the
sun, but at night when in the recumbent position — that is, when
breathing not only a hot and suffocating, but also an impure air.
Other morbid conditions often attend or follow heat-exhaustion.
I have had two marines on my sick-list with abcesses developed
during confinement in "sweat-boxes," in the months of June and
August, in the tropics. In one the collection of pus was located
in front of the neck; the man was comatose, and, on recovering
consciousness, complained of no pain. In the other it was devel-
oped on the upper arm, and was attended with throbbing pain
and greatly increased heat of surface. In both the pulse was
full, hard, and strong, the respiration labored, and the body
drenched with sweat, showing that the heat was as active a cause
of disease as the impoverished air.

After a long and stormy passage through the Indian Ocean,
the Levant arrived at Anjer Roads, in Java, on the 25th of
March, 1856, when the heat was intense. Her crew were enfee-
bled and many of them exhibited evidences of the scorbutic
cachexia, in consequence of the deteriorated and unsuitable char-
acter of their food, which the insufficient daily issue of wood did
not allow to be properly cooked ; of their short allowance of water,
which was impure ; of their confinement on board ship since the

NAVAL HYGIENE.

previous October, when she went into commission ; and of their
unusually arduous labors in the high southern latitudes, where
they were exposed for several weeks to a continuance of cold,
damp, and rainy weather. Notwithstanding their condition they
were laboriously employed, working from daylight until dark for
two days, getting on board wood which was wet and green, and
water, white from organic impurities, and which had run through
a series of dirty wooden troughs into an equally dirty reservoir.
The vessel sailed on the evening of the third day, and within a
few hours that night twenty-four cases of cholera communis were
reported, two of the lieutenants among the number. Few of
these men were ever able afterward to do their duty properly.
As events proved, this was their preparation for a tedious pas-
sage of forty-six days across the China Sea to Hong-Kong, a
distance of only twelve hundred miles, but entirely within the
tropics, (latitude 8° south to 200 north,) at the season of the
change of monsoons, when the high temperature is not moder-
ated by any breeze nor the scorching heat of the tropical sun
scarcely ever shielded by a clouded sky, and when the glassy
surface of the sea reflects and concentrates the heat upon the ship,
whose black sides greedily absorb it. The deck-load of freshly
cut green wood added an unwholesome moisture to the atmos-
phere, and the unfiltered water, with which the tanks had been
filled, preferred for cheapness, soon decomposed and became
offensive and unpalatable. The men had gorged themselves
with oranges, mangosteens, and other fruit during their short stay
at Anjer; but the supply of chickens, vegetables, and fruit which
they brought away with them was soon exhausted, and they were
again fed with the mahogany-like "salt horse," green fat pork,
worm-eaten bread, weeviled beans, and musty rice, which they
had had to eat in the chilly regions of the Southern Ocean. The
paltry interval of three days in ninety-seven had brought no relief
to their jaded and debilitated bodies; but they were occupied
with the still severer labor of working ship for every "cat's-paw"
under the additional morbific influence of a vertical tropical sun.

NAVAL HYGIENE.

Most of the intractable cases of diarrhoea and dysentery, and the
large majority of deaths during the cruise, can be directly traced
to this period. The asthenic habit of constitution, which ren-
dered these complaints fatal, was evidently fixed upon them by
the various concurrent circumstances in operation thus early in
the cruise. After her arrival on the station, this vessel did not.
like the rest of the squadron, employ a Chinese fast-boat, and
the results of this and other violations of hygienic mandates were
plainly shown in a sick-list of thirteen hundred and forty -five cases
during the thirty months of her commission. Nor were the sick-
ness and inefficiency of the crew the only consequences of this
utter disregard of sanitary laws. One of the officers, who in-
spected her at the end of her cruise, told me that she was the
most unclean and ill-conditioned vessel he had ever seen.

Much of the sickness which is attributed to visiting infectious
ports arises from the foul condition of the holds and limbers of
the vessels themselves. Although the fever might not have ap-
peared but for the visit to the port, it is equally true that it would
not have been developed but for the uncleanness of the ship
itself. The decay of the wood of the vessel and of the chips
under the ceiling, the leakage of brine from provision-casks and
of molasses and vinegar from the spirit-room, the drippings of
oil from the machinery of steamers, the sifting of coal-dust from
the bunkers and of ashes from the fire-room, the influx of salt
wTater, its admixture with fresh spilled from the tanks and the
consequent death of the microscopic organisms which inhabit it,
together form a putrescible mass, the malarious emanations from
which pervade the vessel and occasion a general predisposition
to zymotic and paroxysmal febrile affections ; therefore, while so
much attention is being given to the avoidance of unhealthy lo-
calities, let some little be paid to the smouldering pestilential fire
— the artificial marsh over which so many human beings are liv-
ing in fancied security. On this point very valuable testimony
is borne by the annual report of the Health of the Navy, issued
by the British admiralty, for the years 1S65-66: "The Mada-

NAVAL HYGIENE. 113

gascar was long infected with yellow fever at Rio de Janeiro, and
when inspected it was discovered that the sides of the ship and
the lining were in many places decayed, damp, and rotten, and
on lifting the limber boards a quantity of black, offensive mud
was discovered, the smell of which caused nausea, vomiting, and
diarrhoea in several persons present." It is also stated in the
case of the Isis, at Sierra Leone, that " there can be no question
that the existence of the fever poison in that vessel did not
depend on the locality, but on the vessel itself;" the latter even
becoming a focus from which infection spread to other vessels,
since "within six or seven weeks no fewer than twenty-eight
deaths among the crews of two ships-of-war, from this malignant
fever, were clearly due to communication with the Isis ; all these
deaths occurring exclusively among men who had gone on board
that vessel." It is a point of great practical interest in respect to
severe outbreaks of yellow fever on board ship, that "nearly all
the vessels which have been most scourged in late years were
unmistakably unhealthy ships, as evidenced by their larger num-
ber of cases of general sickness, not only during the yellow fever
years, but also in those which preceded or followed them. This
was the case with the Aube, Icarus, Eclair, and the same holds
true of other vessels which have sustained fatal attacks of fever."
The reputation of the Eclair was such that to efface the remem-
brance of the terrible disease the admiralty changed her name to
Rosamond. Undoubtedly, the ultimate universal substitution of
iron for wood in ship-building will be productive of immense
sanitary advantages on account of the freedom from the nocuous
products of the decomposition of the material of the vessel and
of the debris of its construction, and the greater facilities for keep-
ing it clean and admitting air to the interior of its frame-work.
There is no question of the propriety of preventing access to a
vessel of which the crew is affected with malignant, communi-
cable diseases ; neither is there any doubt of the urgent necessity
of removing every individual of that crew without delay to some
healthy and isolated place on shore. The system of quarantine,
however, which proposes to imprison both sick and well upon the

114 NAVAL HYGIENE.

infected vessel until the endemic exhausts itself for lack of new
victims, is a barbarous relic of popular ignorance and supersti-
tion. The sanitary regulations of the United States and Great
Britain are sufficiently liberal, and at the large sea-ports are gen-
erally judiciously interpreted by the health officers; but in Por-
tuguese, and especially in Spanish ports, the most annoying, friv-
olous quarantines are still exacted. I have known a man-of-war
to sail from Philadelphia in midwinter, arrive at Cadiz after a
passage of forty days, and be quarantined for having no bill of
health; another, provided with the proper document, to be
placed under observation because it did not bear the vise of the
Spanish consul; and a third, coming from a port where there
was no such official, to have the same fortune because the law
did not provide for such a contingency. On another occasion I
protested, ineffectually, to the health authorities of Fayal against
the placing in quarantine of a detachment of officers and men
who had gone to rescue a sinking merchantman, one hundred
and fifty days out of port. Occasionally similar annoyances are
experienced in our own country. During the period of my offi-
cial connection with the United States navy-yard near Ports-
mouth, New Hampshire, I had serious trouble with the local
health officers, who refused to consent to the immediate debarka-
tion of the crews of vessels sent north from the Gulf of Mexico,
often with only mild pseudo-yellow fever, though abundant op-
portunities existed for isolating not only the invalids and conva-
lescents, but the unaffected crew and the abandoned vessel. The
various health authorities of New York and the other munici-
palities fronting on the bay have been but lately engaged in dis-
graceful wrangles over their several rights to grant pratique to
vessels from suspected ports. Hence, it would be in the inter-
ests of commerce and humanity if the whole subject of quaran-
tine were placed under the control of sanitary officers appointed
^by the General Government. Assistant Surgeon Harvey E. Brown,
United States Army, in an elaborate report on quarantine on the
Southern and Gulf coasts of the United States, just issued by the
War Department, recommends the assumption of quarantine by

NAVAL HYGIENE.

JI5

the National Government, advising that "the general manage-
ment of affairs should be confided to the Surgeon- General's Bu-
reau, and be under his supervision, aided by such inspectors as
he might consider necessary, who should be detailed from the
officers of the medical corps ; " but the Surgeon-General of the
Army, without indorsing the suggestion, states that even if exist-
ing vacancies in the Army medical corps were filled, "it would be
impossible to furnish officers from it for quarantine duty, without
serious interference with their military duties, and detriment to
the interests of the service." Under these circumstances, the co-
operation of the two services would, perhaps, supply the requisite
number of sanitary inspectors, although the peculiar nature of the
naval medical officer's training, doubtless, especially qualifies him
for dealing with diseases incident to ship-life. Michel Levy and
Fonssagrives, in their respective works on hygiene, have protested
energetically against the useless and ridiculous impositions of the
system of quarantine in vogue, and the medical officers of every
navy are agreed that, no matter what the disease, both sick and
well should be immediately removed from the vessel, which should
be thoroughly cleansed and renovated. The health reports of
the British admiralty state : " Within the last ten or twelve years
cases of yellow fever have, on more than one occasion, been
landed from ships of war in Plymouth and Hasler hospitals with-
out any but good results. The results in Jamaica, in i860, were
eminently satisfactory. The same seems to have been the case
in 1856, the most sickly year, when fever was prevalent on shore
at Port Royal and Kingston." In the numerous instances of
late years where crews, sick and well, have been landed at the
island of Ascension, the disease seems to have speedily much
abated, and in no instance to have extended to the garrison and
other residents, always provided that direct communication with
the infected ship was prevented; and Inspector-General Smart,
Royal Navy, relates striking proofs of the utility of landing the
sick in suitable hospitals at Bermuda.

MORAL INFLUENCES

The sailor of to-day is not the brute of fifty years ago. The
barefooted, abject, illiterate being whose back bore the scars of
the cat is not recognizable in the well-dressed, tidy, manly-look-
ing seaman who receives his letters and papers regularly from
home, and signs his name legibly to the shipping articles. The
many foreign officers and civilians who witnessed the memorable
inquiry into the circumstances attending the loss of the Oneida,
at the British consulate at Yokohama, were impressed with the
intelligent, fearless, and manifestly truthful manner in which the
surviving lookout and helmsman gave their evidence, .and par-
ticularly with the graceful style in which they affixed their names
to the record. While it was once almost unnecessary to inquire
whether a man could write his name, it is now the exception that
" his + mark " appears on the rendezvous returns. The well-filled
condition of the various ship letter-bags, and the general allot-
ment of half-pay, attest the commendable home interest of the
modern sailor. The quiet, dignified old quartermaster, who oft"
duty sits conning his Bible ; the young quarter-gunner reading
stories and travels to a crowd of listeners ; the ambitious ordinary
seaman working out problems from the Bowditch borrowed from
the navigator, are now to be seen on board every vessel of war.

There are some naval officers, generally themselves antiquated,

who insist that the social improvement of the sailor has been at

-the expense of discipline and nautical knowledge ; but there are

others of equal experience, and brighter minds, who candidly

acknowledge the contrary. The abolition of the cat was a nat-

NAVAL HYGIENE.

II7

ural consequence of this moral advancement ; therefore the advo-
cates for its restoration are only attempting to re-inoculate a con-
valescent body with the virus of the disease from which it has
recovered. The necessity of former times, if there ever were such,
has ceased, as witness the testimony of Fonssagrives, whose ex-
haustive work on naval hygiene establishes his authority : "We
do not believe that the sailor of to-day is that of 1790; he has
changed with the public character, and to desire to treat him in
the same manner is to commit a flagrant anachronism. Physical
suffering is, moreover, a bad appeal to make among men who
are neither degraded nor vicious. This punishment excites hate
more often than repentance, and has never reformed any one.
The abolition of flogging, therefore, is a judicious measure. Be-
sides, this punishment, like that of 'keel-hauling,' may be followed
by grave accidents — sometimes mortal; and that alone should
suffice, without any motive of moral propriety, to justify its
abandonment." What is true of the soldier is also true of the
sister profession of arms. " The day when soldiers were regarded
as mere machines has passed away. An intelligent man, who
knows what he is righting for, and who is capable of appreciating
the responsibility that rests upon him, is incomparably a better
soldier than cne who is incapable of such intelligent action." —
(Hammond.) It is not claimed that all sailors are so exemplary;
nor is it expected that all the profane, licentious, and drunken
will ever be transformed into upright, intelligent, well-conducted
individuals. Although the general character has improved, great
numbers are as depraved as they can become by unrestrained
indulgence of their passions. The low haunts of maritime cities
are still crowded, and the man-of-war's man, though distinguisha-
ble by dress and bearing, often lends himself to the general de-
bauchery, and becomes as helpless a victim of the land-shark.

What can be done to correct these evils? Though it be no
more possible to confer on every one the boon of moral health
than to bring their bodies all into a condition of physical eucrasy,
enough good may be achieved to reward all our efforts bounti-

Il8 NAVAL HYGIENE.

fully. Teach the sailor that he is a man, with a man's duties
and capacities. Treat him as such, and require him to act as
such. Develop his mind, which has been subordinate to his
physical instincts, and that mind will do for him what legislative
action or individual beneficence cannot. Ethical hygiene is a
field in which every naval officer, and those of the medical corps
particularly, should not be ashamed to labor.

I would first suggest, for the moral improvement of the sailor,
that every vessel should be furnished with a library — not such as
is now found in the cabin, behind a glass case, but a library to
which every man on board can have access. Exclude sensa-
tional novels, and let it consist of works on natural history, gen-
eral history, historical romance, travel, geography, popular science,
biography and navigation; of encyclopedia, magazines, and school-
books — some rudimentary, and others for advanced students. If
these are not supplied by the Government, as is desirable, they
can always be obtained, without much trouble, by subscription.
They should be placed under the charge of the schoolmaster, or
some other intelligent petty-officer, as the apothecary or pay-
master's writer. Arrangements may readily be made with pub-
lishers to have files of newspapers mailed to vessels on foreign
stations. Many officers considerately send their papers out on
the berth-deck after having perused them. Religious associa-
tions, interested in the moral amelioration of the seaman, occa-
sionally make donations of packages or boxes of books to sea-
going vessels; but these are always so unattractively pious and
devotional that the sailor, with evident disappointment, lays
them aside, after endeavoring to read a page or two, and returns
to his dominoes or checkers, when an interesting tale or travel or
adventure pleasantly told, or an intelligible account of natural
phenomena or scientific facts would have secured his attention,
and contributed as well to his moral as to his mental culture.
Men should be encouraged to write home, and I have, therefore,
advised that ditty-boxes should be allowed in preference to bags,
since not only can writing materials be better preserved in them,

NAVAL HYGIENE.

II9

but they also serve as writing-desks. Some competent person
should be appointed schoolmaster, to instruct not only the boys,
but such others as desire to learn reading, writing, arithmetic,
and geography, and should never be diverted from his legitimate
duties to act as " executive officer's clerk." Commodore C. R.
P. Rogers informs me that on board the Franklin, while under
his command, a reading-room, fitted with tables, and well lighted
at night, was established, where men could read, study, and write,
and where they enjoyed so much real comfort that many volun-
tarily relinquished their turns to go on shore, although the vessel
was cruising in European ports, where dissipation wears its most
attractive garb.

It is not enough, however, to increase the comfort of the sea-
man on board ship, to supply him with reading matter, and to
provide for his instruction. He will not be well if he never leaves
the vessel. Hygiene demands nothing more important, not merely
for their physical well-being, but for their mental and moral
healthfulness, than that the men should be allowed frequent lib-
erty on shore. I have known a whole ship's company, except
the boats' crews, servants, and a few privileged petty-officers, to
be confined eight months on shipboard, without, in all that time,
having once touched foot on land. Is it a matter of wonder,
then, that when liberty was granted for forty-eight hours, at such
long intervals, when old and young, adults and boys, were hur-
ried on shore together, and told if they returned before the expi-
ration of that time, they would forfeit the remainder of their lib-
erty, that in the delirium of finding themselves outside their prison-
walls, they abandoned themselves to unrestrained debauchery ?
Was the spectacle of bruised and bloated countenances, of which
the ship was full for a fortnight after this season, calculated to
improve the younger portion of the crew, or, as often happened
when these youngsters were themselves the most riotous offenders,
did their display, ironed, gagged, and bucked upon the poop, in
the full view of the harbor, convince them of their folly and sin-
fulness ? Dr. Wilson relates an instance which exemplifies the

120 NAVAL HYGIENE.

utter thoughtlessness with which some officers deal with these
matters : " After a ship had been at anchor for several months in a
foreign port, without any of the crew having been permitted to
visit the shore, in a summary court trying a culprit I heard one of
the members express his views by suggesting that the prisoner be
sentenced to the seventh punishment, l deprived of liberty on shore
in a foreign station.'" The mysterious laws of health, psychical
and physical, require that a man should visit the land, walk upon
the earth, breathe its atmosphere, and inhale the odor of its trees
and flowers. Let him see something more of the place to which
he sails than the glimpse he catches through the bridle-port or
over the rail, (for strict discipline does not permit a head to show
above it,) that he may not have to make the mortifying admission
when he returns home that he has never been on shore. Let him
have an incentive to read, study, and inquire about the countries
he visits, and with what interest will he visit them. Make the
visits to the shore no longer a novelty and a recognized occa-
sion for plunging into orgies and dissipation, but an opportunity
for rational enjoyment, instruction, and exercise. That this is
not a visionary's scheme was demonstrated by Commander, after-
wards Admiral, Foote, on board the sloop-of-war Portsmouth,
during her cruise in the China and East India seas in i8$6-sj
and '58, when this system was pursued. Was this a well-disci-
plined ship ? On none in the squadron were there so little need,
and so small a record of punishment. Was she clean and well-
conditioned ? Her executive officer, Lieutenant, the late Com-
modore, Macomb, well deserved the flattering report of the board
of inspection on these points. Was she efficient as a man-of-war ?
The conduct of her officers and men at the attack and capture of
the Barrier Forts, near Canton, is a matter of official record, and
certainly bore comparison with that of a sister-ship on which a
different practice prevailed. Did she maneuver well ? There are
many still in the service who were then on board other vessels, and
who remember the pride they experienced whenever she entered the
crowded harbor of Hong-Kong, threaded her course through the

NAVAL HYGIENE. 121

many sail of every nation there congregated, and anchored, with-
out mishap, wherever her commander desired. Was she a happy
ship ? Those who were fortunate enough to be attached to her
agree that that cruise will be memorable, not only for its general
interest, but for the harmony that pervaded the ship forward and
aft, from the time of going into commission until the flag was
hauled down. I do not desire it understood that this is an iso-
lated case in the practice of our Navy. The book of Regula-
tions for the Government of the Navy, issued in 1870, directs
in paragraph 1429 that "petty-officers and men will be permitted
to visit the shore on suitable occasions when it can be done with-
out injury to the public service ; " but the interpretation of the
terms "suitable occasions" and "injury to the public service"
depends entirely on the will or caprice of the commanding offi-
cer. I believe that those commanders, without exception, who
are pre-eminent for professional skill and broad and liberal views
of their duties and obligations to those under their command,
authorize the granting of frequent leaves of absence to their crews,
though I have had but two opportunities of personally witnessing
the effects of this system on board the men-of-war to which I
have been attached during the eighteen years of my service in
the Navy. These were the brig Dolphin, commanded by the
present Admiral Steedman ; and the sloop-of-war St. Louis, when
under the command of Captain George Henry Preble. Men
seldom look back with any great satisfaction upon the months
they have passed away from home and country on a foreign
cruise; but I think few who were attached to these vessels,
whether as men or officers, do not often recall the happy associa-
tions connected with them. Throughout the many months the
latter ship was anchored in the harbor of Lisbon there was sel-
dom a day that some of the crew were not on shore, and I remem-
ber not only the encomiums their conduct elicited, but on one
occasion, when a disturbance at the circus was attributed to some
of her men, with what promptness the journals of the city con-
tradicted the charge, indicated the young gentlemen who had

122 NAVAL HYGIENE.

actually caused the difficulty, and intimated that these sons of
wealthy and influential citizens might profitably imitate the beha-
vior of the St. Louis sailors, who, of all the crews of the thirty
men-of-war of various nationalities then in port, were welcomed
on shore by the people.

Liberty should not be granted to too many men at one time,
else the half-dozen incorrigibles who are found in every crew will
make it an occasion for revenging private injuries or instigating
disorderly conduct. Let it be understood that every day in port
a single mess will be allowed to go on shore, and that whoever
returns drunk, dirty, disfigured, or with clothes torn or missing,
shall forfeit his right to go when it next comes his turn. Let
such offender, after one deprivation, be again allowed liberty
when his turn arrives a third time, and if again offending be per-
manently deprived the privilege. Let it also be understood that
whoever overstays his leave compels the whole of the next mess
to remain on board until he returns, and there will be few who
will care to encounter the ill-will of their shipmates by so doing,
and whose punishment will not be gladly witnessed by them.
Opportunities for visiting the shore might also be multiplied by
changing boats' crews weekly or semi-monthly, the coxswains
only remaining the same. All hands would thus be able to par-
take of advantages now enjoyed only by a few. The institution
of the system of frequent liberty, besides the sanitary good it
accomplishes, serves to reward the meritorious and punish the
worthless, and operates as a more powerful check to intoxication
than pledges, lectures, or enforced abstinence.

As in many foreign ports efforts are being made to eradicate
venereal disease by subjecting the public women to sanitary
examinations, it is important that similar inspections be required
of men going on shore. Unless very frequent leaves of absence
are granted, men invariably indulge in sexual intercourse, whether
^diseased or not, and those affected with chronic gonorrhoea delib-
erately do so with the object of transferring the disease from
themselves to the woman, a therapeutic effect which Jack has

NAVAL HYGIENE. 1 23

undoubtedly often observed, though he mistakes the rationale of
the cure effected. Similarly well founded is his horror of the
doctor's attempt to prevent the suppuration of his "blue ball;"
for though ignorant of the distinction between chancre and chan-
croid, he knows that a bubo that does not "break" will be followed
by the horrible train of constitutional symptoms. As long as the
sexual impulse exists it will be gratified, and, if not naturally, by
such expedients as can be adopted, and the ingenuity will be
exercised to devise novel modes of excitation. I have never
been attached to a ship in the service on board which manustu-
pration and paederasty were not practiced, the latter, of course,
more rarely than the former. Other officers may deny that they
have heard of them, but I know these vices to be common, and
generally unknown only because uninvestigated or undiscovered.
"It is not to be denied that, however purified and fortified, the
sex -passion,' in a healthy, continent adult, is very powerful ; very
different from the sickly craving of the voluptuary, or the mad,
half-poetical desires of a boy." "How much severer occasional
incontinence makes the necessary struggle to remain continent at
all appears from the sexual distress which widowers or those mar-
ried men to whom access to their wives is forbidden suffer." —
(Acton.) It can, therefore, scarcely be expected that the humble
wearer of blue flannel will excel him in blue broadcloth in that
mastery of his desires which theologians enjoin as necessary to
that purity of heart which is among the promised beatitudes, and
hence the naval hygienist has no other alternative than to recom-
mend frequent liberty on shore as the only practicable means of
preventing the commission of secret sexual vices, though when
these habits are established even this will not serve to eradicate
them, as witness certain cases well known to medical officers in
our own and the British navy among officers of high rank.
Among the causes which formerly operated to enfeeble the sail-
or's constitution and shorten his life, I have no hesitancy in in-
cluding celibacy. Reveille-Parise states that "amid the abun-
dant statistics which have been collected latelv, it has been dem-

124 NAVAL HYGIENE.

onstrated that bachelors live a shorter time than the Benedicts;"
and Dr. Stark, as quoted by Darwin, declares that "bachelorhood
is more destructive to life than the most unwholesome trades, or
than a residence in an unwholesome house or district, where
there has never been the most distant attempt at sanitary improve-
ment." In former days, in our own service, and even now, where
the systems of long enlistment and infrequent leaves of absence
prevail, the man-of-war's man was virtually a celibate. I have
known him return from an absence of three or four years, reship
for another cruise, sometimes on the morrow, often the same
week of his discharge, and thus pass years within the narrow
compass of a ship's hull. Marriage, under such circumstances,
was only a form, and even with officers was little better. A
friend now high on the list, out of the first eleven years of his
married life had not passed a sum-total of eleven months at
home; and another, a British naval officer of rank, told me that
though he had been married twenty-two years, he had lived less
than an aggregate of one with his family. Instances like these
will probably never again occur, at least in our own Navy, since
every officer is by regulation entitled to a period of shore duty
after each full cruise at sea, and sailors who obtain honorable
discharges are also allowed three months' full pay on shore.

As an additional reward for good behavior, a liberal allowance
of money should be made, and withheld from the undeserving,
for the purchase of books, curiosities, or presents for friends at
home. Most men have some dear relative or friend, for whom
they desire to obtain some gift, and any expenditure for such an
object should be sanctioned and encouraged.

There is so little to stimulate the ambition of the sailor on
board a man-of-war that the superior class of native' Americans
are deterred from entering the Navy. In the merchant service
the seaman aspires to become a mate or master, and, if indus-
trious, temperate, and qualified, he succeeds; while in the Navy
he may be twenty years a petty-officer without enjoying any
increase of privilege over the ordinary seaman or landsman of

NAVAL HYGIENE. 1 25

as many days. His duties are more responsible, greater confi-
dence is reposed in him, greater deference paid to his opinion;
but he dresses as he has always done, he squats at the same
mess-cloth, and is as much a prisoner on board ship. The Army
offers opportunities for advancement through the non-commis-
sioned grades to the line of promotion, and all such meritorious
preferments are welcomed to their new station with the cordiality
and public spirit characteristic of this arm of the national defense.
It is a great defect in our naval organization that more distinc-
tion is not made between petty-officers and the rest of the crew.
Their dress should be strikingly distinctive ; they should consti-
tute a totally separate mess; they should be granted greater in-
dulgences, among them that of going on shore three or four at a
time when their duties permit, without reference to the liberty
allowed the other messes. They would then feel that the title
officer was something more than a farce, and less deserving the
adjunct "petty," and the silk-embroidered eagle on the arm
would carry with it more respect than it does now under its fa-
miliar designation of " buzzard." The positions of mates and
warrant-officers should be recruited from this class, and spe-
cial effort should be made to ascertain and report all men quali-
fied for and ambitious of obtaining such situations. The condi-
tion, of the non-commissioned officers of the Marine Corps, who on
shore are treated with the same consideration as the correspond-
ing grades in the Army, is a peculiarly distressing one when they
come on board ship and are subjected to the same restrictions
and exactions as the petty-officers with whom they are there
classed; and many very excellent sergeants have been degraded
and ultimately ruined by the humiliations which they have suf-
fered in consequence of this system. The apothecary and yeo-
man, (the latter an unmeaning title, for which storekeeper should
be substituted,) the one requiring a semi-professional education
in pharmacy and the other intrusted with important pecuniary
responsibilities, and probably also the schoolmaster, when one is
allowed, properly belong to the class of appointed officers with

NAVAL HYGIENE.

the clerks of the commander and paymaster, and should mess
with them in the steerage, unless, as I have advocated in another
place, that apartment, with this entire class of officers should be
dispensed with. Their duties require a far higher order of
ability, for the clerks are only copyists, and their positions
would become attractive to young men in the same genteel sta-
tion in life were they removed from the coarse associations of the
berth-deck. Much of the illicit treatment, especially of venereal
complaints, by which the apothecary, unless closely watched by
the medical officer, will attempt to eke out his inadequate salary,
will be checked by giving this officer a status correspondent to
the nature of his calling, as in the French, Brazilian, and other
foreign navies. A still more important gain will be the getting
rid of the class of imperfectly educated and broken-down drunk-
ards, who now accept the position because their habits keep them
from employment on shore, and of the still worse set of incom-
petents provisionally rated from the deck, who, however carefully
the hospital liquors may be kept under lock by the medical officer,
will steal part of those issued to the sick, or drink or sell the alco-
hol from the spirit-lamp or that from the percolator while making
tinctures, or even the tinctures themselves, and who never com-
pound a pill of calomel or quinine without running the risk of
putting up corrosive sublimate or strychnine, or who add half an
ounce of some potent liquid to a mixture when the prescription
calls for half a drachm. A most shameful instance of criminal in-
competency of subordinates has recently disgraced our service,
when an invalid, who was allowed access to the dispensary, was
fatally poisoned by swallowing a quantity of impure carbolic acid,
which he mistook for his own draught.

The act of Congress establishing honorable discharges and the
institution of honorary badges indicative of every such discharge
have accomplished excellent results. Care should be taken that
"every man entitled to the distinction receives it, and further that
none is issued except in meritorious cases. I have seen an hon-
orable discharge presented at a rendezvous by a man who de-

NAVAL HYGIENE.

127

sired to reship as a seaman, that being the rate he bore on the
discharge, who, when examined, was found unable to send down
a top-gallant-yard or reeve a top-sail buntline, and who finally
admitted that he had not been in a top the whole cruiser but had
been coxswain of the barge and arbitrarily rated seaman. The
presentation of medals of honor, authorized by Congress, for con-
spicuous heroism during the rebellion, should be made a perma-
nent institution. The pride with which Frenchmen display their
little pieces of ribbon, and the emulation excited among English-
men by their Victoria cross and medal, ought to have some par-
allel in the naval service of our own country.

Ennui and home-sickness affect the sailor less than the officer,
but the monotony of his occupation and the protracted confine-
ment on board ship ultimately cause him to become despondent
and indifferent to his duties. Frequent occasions of visiting the
shore and an abundance of reading-matter will do much to dissi-
pate these enervating feelings; but I would suggest, without in-
tending to interfere with the business of any other department,
as a further means of occupying and interesting him, that more
attention be paid on board ship to the minor works of nautical
manufacture. Every one has observed the general interest ex-
cited by the occasional weaving of sword-mats and the crowds
that cluster around the sailmaker's seat, the carpenter's bench,
and the armorer's forge. Would it not be instructive as well as
interesting to multiply these occupations, even though no imme-
diate necessity existed for them ? I do not suggest this, however,
with the object of simply finding work for the crew. Spars,
masts, and coamings have been scraped and painted, rescraped
and repainted, and bright work, introduced whenever possible,
blacked and polished, reblacked and repolished merely for the
sake of keeping the men all the time occupied. Such unneces-
sary and distasteful work makes every one discontented and un-
happy, particularly when accompanied with the announcement
that "there will be no Sundays" on board the ship. The sailor
has a considerable religious element in his character, and, though

128 NAVAL HYGIENE.

restive under long church services, he entertains a respect for
everything sacred. In most vessels of the Navy the Sabbath is
scrupulously observed. Saturdays also are very properly appro-
priated to the crew, that they may take their bags on deck, sew,
arrange, and air their clothing, and examine their little posses-
sions.

The depressing influences of sea life are to be further overcome
by encouraging amusements and diversions. Music has its influ-
ence upon the sailor, as upon the dweller on shore. Witness
how the fife causes him to redouble his exertions at the capstan
when almost exhausted with fatigue. A ship with singers and
instruments on board is always cheerful. The sounds of music,
dancing, and laughter, which are heard toward sundown, indicate
the contented crew, and wherever there are mirth and gayety
there are not apt to be animosity and quarreling. Dominoes,
backgammon, and draughts are also sources of amusement. On
foreign stations many crews endeavor to enliven their time by
organizing theaters, glee-clubs, and negro-minstrel companies,
whose performances are often exceedingly creditable, while con-
siderable ingenuity is displayed in getting up costumes and scen-
ery. At other times they decorate their vessel for fancy balls, in
which they themselves assume the characters ; and I have known
a dinner to be given by one ship's company to another, at which
speeches were made that could not have been excelled by the
officers. Often a little interest, encouragement, and pecuniary

assistance from the officers will lead to undertakings of this kind,
which might not otherwise have been originated. A magic lan-
tern, with a proper set of slides, would be invaluable for the occa-
sional entertainment of the crew, particularly if its exhibitions
were accompanied with explanatory remarks by some of the officers.
Boat-racing, gymnastic feats in the rigging and on deck, swim-
ming, fishing, hauling of the seine, and, when the circumstances
"of the place will permit, athletic games, as base-ball, on shore,
washing clothes there, etc., will afford sport and diversion of in-
calculable benefit to the health of the crew, and contribute to the

NAVAL HYGIENE. I 29

diffusion of a spirit of happiness and contentment among them.
Target-firing, boat-racing, and sailing, and the landing of the
men for company, battalion, and howitzer drill, are not only recrea-
tions but beneficial exercises. Some divisional officers infuse so
much interest in the ordinary exercises of the vessel by the enthu-
siastic, earnest, and vivacious manner in which they impart their
instructions, and by the zeal with which they perform their du-
ties, that their men always work with alacrity and pleasure.

While rewards, honors, and diversions are thus multiplied,
they must not be deprived of their value by inattention to the
necessity of punishing evil-doers. Discipline is the soul of a man-
of-war, and implicit obedience to the constituted authorities is
the prerequisite to discipline. It should be exacted of every man
and officer on board, and the example of submission to superior
authority should be set their crews by commanders and other
officers themselves. Every regulation of the Navy Department,
every order of the honorable Secretary of the Navy, and every
act of Congress should be faithfully and fully obeyed, in the
spirit and according to the letter, else the officer violating them
cannot conscientiously punish those who infringe his rules. Fred-
erick James Brown, M. D., late of the royal navy, in a valuable
little work entitled "Questions and Observations in Hygiene,
recommended to the consideration of naval medical men," thus
answers the question : " Is the general discipline of the ship strict
or lax; and have you noticed, as a consequence of either system,
distinctly referable to such, an increase of the real sickness of the
ship, independently of the number merely on the list ? "

"The answer to be returned to this question will be : I believe
both health and comfort suffer under a lax state of discipline.
And this is my reason for handling subjects which may be con-
sidered beyond my province by many who will read these pages.

"If the commanding officer should permit offenses, even the

slightest, to be committed with impunity, and does not support

the officers serving under him in the execution of their duty, both

the officers and the petty-officers will become remiss and careless,

9

130 NAVAL HYGIENE.

and the men idle, dissipated, insolent, and refractory. Disease is
the consequence of the indolence, filth, drunkenness, and badly-
disposed mental condition of such a crew."

There will be bad men on board all ships, who will interrupt
order and harmony unless they are promptly and effectually
punished. The act of Congress specifying the various allow-
able means of punishment was wisely and humanely framed.
The penalties prescribed are efficacious, affecting the moral na-
ture rather than causing physical suffering which may do perma-
nent injury to the offender's health. The same spirit should ac-
tuate officers in imposing their lesser punishments. He who com-
plains that he cannot manage a ship's company without his in-
struments of torture, only admits his unfitness for his position. A
man of proper mental resources will find abundant means of
bringing shame and mortification to the culprit by the withdrawal
of privileges, the deprivation of spending money, the restriction
of liberty, the imposition of extra duties, particularly those of a
disagreeable kind, etc. The bad are also indirectly but effectu-
ally punished whenever the good are conspicuously rewarded.
Although forbidden by law, recent courts-martial have disclosed
that confinement in " sweat-boxes," or, as they are euphemistic-
ally termed, "the cells," is still inflicted on board ships, at the
risk of the life or jeopardy of the health of the man or boy who
may have been guilty of some trivial offense. Besides its ille-
gality, it is of a class with bucking and gagging; tricing up by
the thumbs, the toes only touchingthe deck ; or lashing on the
inside of the rigging, the bare soles on the rattlins and rope yarns
cutting into the wrists and ankles — barbarities unworthy the
nineteenth century. As drunkenness is the source of most of the
disturbances on board ship, if carefully guarded against there
will never be occasion for gagging a man raving with alcoholic
mania. When such cases do occur, rather than resort to means
.which aggravate the nervous symptoms and may occasion irrep-
arable injury, let them be handed over to the medical officer, who
by a little judicious treatment can soon quiet them. Punishment

NAVAL HYGIENE. 131

is thrown away on men whose brains cannot perforin their func-
tions. When reason and consciousness are restored, it will be ap-
preciated and be of profit. No one thinks of gagging the noisy
victim of delirium tremens, yet it would be a.s rational to do so as
to try to smother the voice of the yelling inebriate. A further good
from this method of treating these cases will be the avoidance of
those scandalous scenes which are so pernicious in their effects upon
discipline, when some half-crazed "liberty-man" defiantly resists
the attempt to confine him, and arouses the whole crew from their
slumbers by the curses and obscene epithets which he couples
with officers' names.

THE SICK-BAY

It is, of course, the paramount duty of the medical officer to
provide for the comfort of the sick. In frigates the forward por
tion of the berth-deck is assigned to the sick-bay. This apart-
ment is always disproportionately small, usually badly ventilated,
imperfectly lighted, sometimes very wet, often foul and offensive
from leakage from the head-pipes, which lead through it, and
disturbed by the noise of the chain-cables in coming to anchor
or getting under way. The Guerriere* and Tennessee are repre-
sentatives of the finest and largest of the vessels of the modern
navy. The former is a first-rate of about 2,500 tons, carrying
twenty-one guns; the latter a second-rate of 2,135 tonsJ w^tn a
battery of twenty-three guns; and both are manned by crews
ranging from three hundred and fifty to five hundred men. The
length of the berth-deck of the Guerriere is 310 feet, its average
breadth 28 feet, and its height between decks 6 feet n inches:
the corresponding measurements of the Tennessee's berth-deck
are 334 feet 4 inches length, 27 feet 9 inches average breadth,
and 7 feet 3 inches height ; yet the sick-bay of the former has a
cubic capacity of only 2,275 fee^ scarcely properly accommodat-
ing three patients: and that of the latter 4,867 feet, not more
than is required by five. Important as is this portion of the ves-
sel, its dimensions are rather a matter of accident or subordinate
tp. other considerations, than regulated by the fitness of its loca-

*No longer on the Navy list, having been badly injured by getting onshore.

NAVAL HYGIENE. 1 33

tion, the numerical size of the crew, the nature of the cruising-
ground, and the probable amount of sickness. Unless the sick-
bay can be removed to its proper site aft, it should be very much
enlarged and made as comfortable as possible. Two or more
air-ports should open into it on either side, and a scuttle or hatch-
way should be cut through the decks overhead for the admission
of a wind-sail from either the spar-deck or, weather permitting,
from the forward gun-deck ports. Several thick glass deck-lights
should also admit light from the gun-deck. The entire bulkhead
of the sick-bay should be made of light gratings, which should
not be furnished with thick woolen curtains, as is commonly
done. This apartment should be as impervious to water as it is
possible to make it, and no pretext should ever sanction the dis-
charge of the men's water-closets through its interior.

In sloops-of-war, brigs, and other single-deck vessels, the mid-
ship portion of the berth-deck is appropriated to the sick. Where
there are midship lockers the mattresses are usually spread on
top of them ; but this is inconvenient if the lockers require to be
frequently opened, and as the hawsers, etc., which are usually
stowed there, can be placed elsewhere, this space should be kept
free from obstruction and devoted exclusively to the sick-bay.

To insist upon the cleanliness of this apartment would be to
impugn the professional qualification of the medical officer, who
on board ship as in the bed-chamber on shore, regards this as a
most important part of the treatment of every case. Everything
should be scrupulously clean about the invalid. The canvas
screen which isolates him, and the cot or hammock in which he
lies, should be of natural whiteness, not soiled by grease and dirt;
his head should rest upon a white-cased pillow, not be propped
up by his boots or pea-jacket; and a comfortable hospital mat-
tress and clean sheets and counterpane should be substituted for
his own rough, soiled blankets. The patent close-stool, now sup-
plied all vessels from the Naval Laboratory, admirably answers
its purpose of preserving the atmosphere of the sick-bay and berth -
deck free from contamination. One or two cots should always

134 NAVAL HYGIENE.

be in readiness for the use of the sick. Even when ill but a few
days, it is a great relief for the sailor, who has been bent like a
bow in his hammock, to lie in a horizontal position, and be able
to stretch himself out at full length. The wooden cot-frame
now in use is a clumsy affair that ought to give way to a light iron
one easily gotten ready for service. The ambulance-cot devised
by Surgeon Gorgas, United States Navy, for the especial purpose
of transporting wounded men, ought to be supplied to every ves-
sel. The cots containing fever invalids and other cases of serious
illness should always be slung on the gun-deck of vessels with
covered batteries, and, when the weather will permit, such patients
should be placed under the top-gallant forecastle of single-deck
sloops.

The medical officer must decide how far the healthy members
of the ship's company are to be inconvenienced by the sick.
Usually the humanity of the sailor and officer prompts them to
sacrifice every selfish interest in behalf of their invalid shipmates,
but occasionally a churlish fellow is met who boasts that he has
never been sick an hour in his life, and only grudgingly assents
to or flatly refuses the requests of the medical officer. If the lat-
ter is known to be zealous, devoted, and self-sacrificing in the
performance of his duties to the sick, he will seldom have any
difficulty in having them properly cared for. I have had charge
of cases of low fever and dangerous operations where the success-
ful issue was largely, if not entirely, due to the assiduous and
intelligent watching of the volunteer nurses. Occasionally an
officer will insist on the blind adherence to routine duty, notwith-
standing the urgent representations of the medical officer of the
risk thereby occasioned to critical cases of sickness. Fortunate
if no harm is done ; but I was a witness some years ago of death
under peculiar distressing circumstances of this nature. A ma-
rine, exhausted by a severe pulmonary haemorrhage on the pre-
vious evening, was lying in a cot on the berth-deck on a Satur-
day morning, the usual day for holy-stoning the deck. Although
the danger of removing the man was fully represented, he was car-

NAVAL HYGIENE.

35

ried on deck and placed under the top-gallant forecastle, the re-
moval being followed within less than ten minutes by a haemor-
rhage which quickly terminated fatally.

Other circumstances the same, food, air, light, and attendance,
I am satisfied that invalids will recover more rapidly on shore
than in the best possibly regulated hospital-ship. The most
extensive experiment of this sort, which had then been made by
our Government, was the Idaho, to the medical charge of which
I was appointed in September, 1867. She was a steamship of
the first rate, from which the machinery had been removed, and
was stationed at Nagasaki, Japan, •" to be used in part as a store
and hospital-ship for the vessels of the Asiatic squadron." Al-
though one of the largest vessels in the Navy, (2638 tons,) she
proved unfit for this double and incongruous purpose. It was
originally contemplated to devote the whole main (berth) deck
to hospital purposes, but the part actually under medical
control for the use of the sick only extended forward from the
main-hatch to the water-closets, an. area containing twenty thou-
sand one hundred and sixty cubic feet of air space, within which
the plan provided for fifty iron bedsteads. I erected, however,
only forty, of which thirty were usually occupied, each invalid
even then having only six hundred and seventy-two cubic feet of
space. This was subsequently further largely intrenched upon
by the erection of prison cells for the criminals of the squadron
on the forward portion of the hospital-deck. Sir J. Ranald Mar-
tin states, in this connection, that " each man should have from
fifteen hundred to two thousand cubic feet of air space ; in very
airy and exposed situations the smaller space will suffice."
Among the most celebrated modern hospital establishments, the
Lincoln Army General Hospital supplied fourteen hundred and
forty-seven cubic feet of air space per man ; the Herbert Military
Hospital at Woolwich furnishes from twelve to fourteen hundred ;
the Blackburn Hospital at Manchester, seventeen hundred and
ninety-four ; the Lariboisiere, at Paris, from seventeen to nineteen
hundred; the Boston Free Hospital, sixteen hundred, and the

136 XAVAL HYGIENE.

Episcopal Hospital at Philadelphia, two thousand, Furthermore,
according to Hammond, a ward containing twelve hundred cubic
feet should have its air completely renewed every hour, being at
the rate of twenty cubic feet per minute, while a supply of thirty
or forty is preferable. The ventilation of the Idaho was alto-
gether insufficient, being effected solely through the ordinary
small round air-ports, high from the deck, and through the hatch-
ways, wind-sails being usually conducted through the latter, but
very often led into the hold beneath the hospital, where an im-
mense quantity of provisions and steamer-coal were stored, of
which the gaseous products of decomposition stained the paint-
work, created noisome bilge-water, and rendered the atmosphere
offensive. Large square ports through the ship's sides would
have supplied a greater abundance of fresh air and mitigated
these evils, but permission to have them cut could not be obtained.
The sick were further inconvenienced by the incessant noises
attending the daily evolutions of a man-of-war, which were reg-
ularly and completely carried on ; by the working of the great
guns and howitzers ; by the exercise of small-arm men and with
broad-swords and single-sticks ; by the tumult and uproar of di-
visional and especially of general quarters ; by the receiving and
discharging of coal and provisions for the squadron which had
no other outlet nor inlet than directly through the hospital ; by
the tramping of men overhead ; by the frequent drum-beats ;
by the shrill whistling and loud bawling of the boatswain's mates ;
by the trumpet-sounded orders of the officer of the deck ; by the
piping of the side when officers came on board or left the ship :
and by the loud clanging of the bell striking half-hours in tones
heard at every bungalow on the neighboring hill-sides. For a
vessel to be as efficient as possible for hospital purposes it must
be absolutely disconnected from every other duty, and even then
it will lack the advantages of the hospital on shore — the quietude,
space, lightness, airiness, the shaded gardens for exercise, and
that indescribable influence of the land itself, to which I have else-
where referred.

NAVAL HYGIENE. 137

When invalids must be treated on board ship, they should be
sent on shore for exercise, under proper surveillance, as soon as
convalescent. They who have this privilege will return to duty
much sooner than those restricted to the ship. I have seen men
slowly lingering weeks and months in a dark, stifling sick-bay in
the bows, hanging in a greasy hammock, wrapped in soiled
blankets without sheets or other pillow than their boots or pan-
taloons, a dull-looking tin pint-pot of cold, nauseous tea or coffee
and a piece of hard-tack, or a black tin pan containing a chunk
of salt meat, stuck on a beam beside them, who were ultimately
invalided and discharged from the service, who, comfortably cir-
cumstanced on a light airy deck, in a clean cot, between white
sheets and properly bathed and fed, would soon have been able
to have been carried on deck in a chair, for an hour's exposure
to the sunshine, then taken on shore by a nurse for daily exercise,
and finally discharged to duty. The medical officer should not
detain a man On the sick-list a day longer than is necessary. His
paramount duty is to maintain the personnel of the vessel in the
most efficient condition, and when this is deranged to restore it
without delay. No man, however, should be returned to duty
until fully able to perform the work required of him, and any phy-
sician who could be guilty of such a violation of professional
trust would justly deserve the contempt of his brethren and the
scorn of all good men.

The practice of indiscriminate invaliding is exceedingly demor-
alizing. Men in order to get away from ships which they dislike
feign sickness, or, when really ill, endeavor to retard their recov-
ery ; and, if discharged from the sick-list, present themselves
again and again at 'the dispensary, seeking to establish such a
reputation for physical inability or worthlessness as will accom-
plish their object of getting surveyed and sent home. There are
not a few officers in the Navy, professing valetudinarians, who
offer themselves as candidates for survey whenever disagreeable,
arduous, or dangerous duty is assigned them, and who, through
the good nature, credulity, or negligence of the medical boards,

138 NAVAL HYGIENE.

generally gain their end. Not the least evil attending the inva-
liding of numbers of a crew is the necessity of shipping other
men on a foreign station to supply their places, and experience
has shown that a very large proportion of such recruits very soon
themselves come under treatment for constitutional diseases which
were undiscoverable, and which they swore did not exist, at the
time of shipment. During the summer of 187 1 I received a letter,
dated at Callao, from the late Dr. John S. Kitchen, the surgeon of the
United States steamship California, en route to join the Pacific
fleet, stating : "We have on board six chronic diarrhoeas and two
epilepsies from the St. Mary's, all enlisted on this coast within
six or eight months. Every one of them acknowledged that he
had the disease before enlisting." Hence, a system of properly
organized temporary hospitals on shore, at the headquarters of
the several stations, will save the Government a large expendi-
ture of money, and an enormous waste of excellent physical ma-
terial. Men, however, who have actually succumbed to climatic
influences, should be sent home, not by "the first public convey-
ance," which may necessitate months of waiting, but by the ear-
liest opportunity, without regard to expense; since the sooner
they are removed from the deleterious climate, the sooner they
will be able to do duty elsewhere.

The proper treatment of malingering, which is especially com-
mon on board ships to which inexperienced medical officers are
attached, should occur to every educated physician.

SANITARY REGULATIONS FOR THE NAVY.

I have epitomized the proposed set of sanitary regulations
which follow from the suggestions briefly tendered in the fore-
going pages, and submit them to my associates in the medical
corps, and to such commanding officers as may be. willing to
apply to them the test of experiment, with a view to the ultimate
institution by the Department, if not of these rules, of others
which may better accomplish the hygienic objects desired.

Dryness, coolness, fresh air, sunshine, cleanliness of body,
clothes, and bedding, good food, pure water, temperance, refresh-
ing sleep, occupation, exercise, cheerfulness, and contentment of
mind are not only the best anti-scorbutics, but anti-dysenteries,
anti-febrifics, and anti-morbifics in every sense. The hygienic
precautions I have suggested receive an indorsement of unques-
tionable value from the following recommendations by Hennen,
which, though intended for soldiers, are based upon those same
general laws of health by which the human body is governed as
well at sea as on land: "The true preventives to disease are
shelter from the heat of the day, and from the dews and cold of
night, avoiding the neighborhood of marshes, allowing men nat-
ural sleep, allowing vegetables in due proportion, a comfortable
breakfast before duty in the morning, the daily exposure of bed-
ding to the sun, the change of clothing after hot and rainy
weather, flannel waistcoats or cotton shirts, frequent bathing,
daily washing of the feet, and the serving out of spirits only in
the evening." "If it be true, as it undoubtedly is," concludes

140 NAVAL HYGIENE.

Guy, in a review of the meliorating influences exerted by sanitary
science upon the British navy, "that by improvements in diet,
water supply and ventilation, in clothing and cleanliness, aided
by superior medical treatment, and especially by vaccination,
and by an improved discipline, tempered by mental culture and
amusement ; if it be that these improvements and reforms have
saved life and prevented sickness to such an extent, that the
effective force of our Navy has been more than doubled, that one
ship, for every purpose of navigation and warfare, is at least
equal to two of the same size and force, that a vessel can now
keep the sea for twice or thrice the time that was possible less
than a century ago; if it be true that, at the old rate of mortality,
all Europe could not have furnished the seamen necessary for
our defense and safety during the great revolutionary war, then
it is a mere waste of words to argue that health, which is the
strength of all who work, is the great source of power to nations
in their peaceful labors as in their warlike struggles." Blane
early in the century attributed the improvement in the health of
the British navy, which even then began to be notable, to the
cessation of impressment, the issue of an anti-scorbutic ration,
the increased encouragement to surgeons, and the better enforce-
ment of medical regulations ; and Inspector General Smart, one
of the most distinguished of European sanitary authorities, further
adds : " Since that era, the prevention of diseases among seamen
has not been neglected ; medical influence has continued its exer-
cise with immense advantage to the sea-service. Peculiar hurts,
wounds, and accidents, from which landsmen are exempt, must
remain forever the special casualties of seamen ; but even these
may be deprived of much of their fatality. Scurvy and typhus
have been banished from our Navy returns ; but there still re-
main, with undue prominence, the reports of yellow fever, syph-
ilis, rheumatism, and phthisis, which are, however, being re-
duced under hygienic measures more nearly to general ratios;
and when that has been effected, the seaman's life, always haz-
ardous, will be acceptable on account of its superior healthi-

NAVAL HYGIENE. 141

ness." If, therefore, commanding officers will listen to and be
influenced by the advice of medical officers, berth-decks and gun-
decks will not be incumbered with cots and hammocks, division
officers will not have to complain that their gun's crews are in-
complete, the efficiency of the vessel will be promoted, and when
emergencies arise, as during the rebellion, when the national
honor has to be vindicated, there will be a strong, stalwart set of
zealous men to fight side by side with their officers, and repay
tenfold those who have had such anxious regard for their health
and comfort. " But an army in hospital," says Sir Ranald Mar-
tin, "as at Walcheren, at Rangoon, and in the Crimea — what
availeth it to the statesman or the commander? It is an incum-
brance— a waste — almost a nullity."

PROPOSED SANITARY REGULATIONS FOR THE NAVY.
I.

The greatest care must be exercised in keeping all parts of the
vessel, especially those below the spar-deck, clean, dry, well
lighted, and thoroughly ventilated.

II.

The berth-deck and covered gun-decks will never be wetted,
except for thorough cleaning, and then only on very dry days,
and not oftener than once a week ; and the operations of clean-
ing and drying will always be conducted as expeditiously as pos-
sible. Those men only engaged in the work will be allowed
upon them, until they are perfectly dry. Hot water will be used,
wind-sails set, ventilators operated, air-ports and gun-ports opened,
when not dangerous, and drying-stoves heated. Mere wet-swab-
bing of the deck will be strictly forbidden at all times, and scrap-
ing resorted to instead. When a continuance of bad weather
keeps the berth-deck wet, drying-stoves will be frequently lighted,
and it will be sanded, as will also be done when any unclean
work is about being undertaken.

I42 NAVAL HYGIENE.

III.

Particular care will be exercised in keeping the hold and spirit-
room dry. They will be thoroughly whitewashed every month,
and be frequently ventilated by the introduction of wind-sails
and ventilators. Whitewash will be used on the beams, bulk-
heads, and ship's sides of the berth-deck in place of paint.

IV.

No casks, boxes, or other articles will be stowed in the hold,
unless clean and dry. No wet coal, nor wet or green wood will
be ever sent below the spar-deck. Dry days will be selected for
provisioning and coaling, unless the urgent necessities of the
service positively forbid delay.

All hatches, gratings, and ladders scrubbed or washed on
other days than those for the general cleaning of the berth-deck,
will be cleaned and dried in the open air.

VI.

Awnings and boom-covers will be promptly spread or housed
on the occurrence of rain. The men will be required to' protect
themselves by water-proof clothing, and will not be permitted to
sleep in wet clothes. The watches, when relieved at night, will
be required to remove their wet clothes, and deposit them in
tubs, provided for their reception, where they will remain until
piped up to dry. Boats' crews, returning wet, will also be re-
quired to change their clothing.

VII.

* Particular care will be exercised in sheltering '-the head" by a
hood in rainy weather, and by an awning when the heat is in-
tense.

NAVAL HYGIENE. 1 43

VIII.

All wet or damp clothing and sails will be exposed to be drie^l
without delay.

IX.

When bilge- water has formed, it is to be entirely discharged,
and if the bilges are not directly accessible for cleaning, but in
this case only, fresh water may be allowed to flow into the vessel.
After the lapse of an hour this is to be again discharged, and
these operations will be repeated until the water is brought up free
from odor, but the quantity of water introduced should never ex-
ceed the minimum indicated by the soundings of the well.

Note. — If the bilges are so foul that this process does not suffice, solution of lead
nitrate, or of impure carbolic acid with ferrous sulphate may be introduced.

X.

Air-ports will be opened and wind-sails set whenever not at-
tended with positive risk, and the latter will be kept carefully
trimmed. All the lowermost parts of the vessel (including sail-
room, yeoman's and officers' store-rooms, etc.) will be frequently
opened for ventilation. Every effort will be made to maintain a
free circulation of air forward and aft on each deck. All bulk-
heads separating apartments or marking subdivisions of the vessel
will be latticed or grated, above and below, when not at the sac-
rifice of strength.

XL

Ventilators will be placed on board every vessel in the Navy,
and will be put in operation every night and morning ; and in
narrow tide-ways vessels will be kept sprung broadside to the
prevailing wind.

XII.

Awnings will be kept spread while the temperature of the at-
mosphere exceeds 8o° F., except after a continuance of rainy
weather or during the operation of cleaning the lower decks.

144 NAVAL HYGIENE.

XIII.

The exposure of the crew to the intense heat of the sun, espe-
cially in tropical climates, will be avoided by the performance of
all labor or exercise not imperatively called for between these
hours, before 9 a. m. or after 5 p. m.

XIV.

Every man will be required to possess sufficient clothing to
change twice if exposed to wet.

XV.

Flannel or woolen garments must be worn next the skin at all
seasons ; and frequent changes of under-clothing and habitual
neatness and cleanliness of dress must be insisted upon.

XVI.

When the weather will permit, at least two wash-days will be
allowed every week.

XVII.

Cleanliness of person will be required of every man. Swim-
ming will be allowed when practicable : if dangerous, a tub will
be placed under the top-gallant forecastle, or the head-pump, or
port-side of the manger, will be screened and used for general
ablution. Any unclean man will be compelled to bathe under
the supervision of the master-at-arms.

XVIII.

^ Firemen and coal-heavers will be afforded especial facilities for
bathing, which, however, will be interdicted immediately after
lea vins; the fire-room.

NAVAL HYGIENE. 1 45

XIX.

Fresh food will be obtained every day, when possible, except
the stay in port be prolonged, in which case it may be issued
four or five times a week. Berth- deck messes will be allowed
to carry potatoes, turnips, onions, etc., as sea-stores.

"V"V

AA.

The crew will breakfast at 7 a. m., dine at noon, and have
supper at 6 p. rri. Hot coffee and biscuit will be issued imme-
diately on turning out. All meals, including tea and coffee, will
be carefully inspected as to character of preparation, and will be
eaten on deck whenever the weather will permit.

XXI.

During a continuance of inclement weather the galley fire will
be kept lighted all night, and hot coffee issued to the wratches.

XXII.

No water for drinking will ever be received on board, nor
that distilled ever be issued, until it has been examined by a

medical officer and pronounced potable, and no condensed water
will ever be passed below into the tanks until properly cooled.

XXIII.

Every man will be required to sleep in his own hammock,
each wTatch to "lash and carry." In bad weather the ham-
mocks of the watch on deck will be kept down on the berth-
deck on their appropriate hooks or in some dry place. No damp
clothing will ever be stowTed in the hammocks or hammock-net-
tings.

XXIV.

All bedding must be shaken and exposed in the rigging on
dry, clear days once a week, if possible.

146 NAVAL HYGIENE.

XXV.

The watch will not be allowed to sleep on deck in rainy
weather, nor exposed to dew and currents of air through ports
and scupper-holes.

XXVI.

The system of stead)'- berth-deck cooks will be discounte-
nanced. The yeoman, master-at-arms, ship's corporal, cap-
tain of the hold, writers, nurses, stewards, cooks, servants, and
all others whose duties confine them below, will be required
to pass a certain portion of each day in the open air during the
hours of daylight. Special exercise at great guns, small-arms,
single-sticks, rowing, and going aloft will be assigned to each of
them.

XXVII.

Amusements, singing, dancing, gymnastic exercises in the rig-
ging, sports on deck, boat-sailing and racing will be encouraged.

XXVIII.

Vessels will avoid notoriously unhealthy ports, rivers, or other
localities, unless upon imperative public service, and in such
places will anchor a sufficient distance from the shore to be
protected from malarious influences; and all boat excursions,
hunting-parties, or visits of men and officers on shore after
sunset or before sunrise, or continuance there all night, will be
^Strictly forbidden; and all boat and shore duty involving expo-
sure to sun and rain will be performed, whenever possible, by
the natives of the countrv.

NAVAL HYGIENE. 1 47

XXIX.

When the general health of a ship's company shall be re-
ported by the medical officers as impaired from anchoring or
cruising in unhealthy localities, the earliest possible opportunity
will be given to recruit, by transferring the vessel to some invig-
orating station, and invalids and convalescents from diseases in-
duced by climatic influences will be sent to the United States
without delay.

XXX.

Medical officers are strictly enjoined to exercise an unceas-
ing vigilance over the sanitary condition of the vessels of the
Navy, and of the officers and men on board them, and to this
end to inquire diligently and report to commanding officers,
or to the Department, everything conducive to, or militating
against, the health, comfort, and efficiency of each ship's com-
nanv.

SANITARY REGULATIONS FOR TRANSPORTS.

The causes that operate to make men-of-war unhealthy exist
in greater force on board of vessels engaged in transporting
troops. There is a greater accumulation of filth from the evac-
uation of the contents of the stomach by the sea-sick and of faeces
and urine by those too lazy or unable to go to the water-closets •
there is a more considerable impoverishment of air by the over-
crowding of men : and the depressing influences of discontent,
disappointment, and home-sickness, operate to a more powerful
degree upon the soldier than the sailor. The steamers that car-
ried three-months' volunteers to Annapolis in April, 1861, arrived,
after only three day's passage from Xew York, in the most filthv
condition imaginable, and, had the weather been hotter, or the
passage a few hours longer, three-fourths of the troops would cer-
tainly have been disabled. As the military surgeons who accom-
pany transports are frequently unused to the special exigencies
of ship life, their labors will, probably, be somewhat facilitated
by the following suggestions :

PROPOSED SANITARY REGULATIONS FOR TRANSPORTS.
I.

A spacious, convenient, light, well-ventilated part of the
vessel should be selected for a sick-bay or hospital, which
should be under the special care of the hospital steward and

NAVAL HYGIENE. 1 49

nurses, and whither all invalids, excepting trifling cases able to
go on deck, should be transferred as soon as reported ill.

II.

Besides the regular attendants upon the sick, two or three
men, not subject to sea-sickness, should be detailed from each
company to act as a sanitary police, who are to be under the im-
mediate control of the medical officers. They should be divided
into three watches and be kept alternately on duty, both night
and day, in the ordinary succession of sea-watches. They should
be required to patrol the sleeping quarters of the men, and be
constantly on the alert to prevent any act of uncleanliness. * Sea-
sick men who vomit or discharge their urine and excrement on
-the deck or in their bunks, should be immediately removed to
the spar-deck, and the excreted matter at once cleared away.
The sea-sick should be compelled to remain on deck all the time
and be placed on mattresses, if too ill to sit up. Compulsory
exercise by being walked between two men and the compulsory
ingestion of hot soup will hasten their recovery.

III.

All hands should be called at daylight, and be compelled
to make up their beds neatly, rolling back the upper blanket to
expose the interior, and then go on deck. The bunks should be
carefully inspected every morning, and all wet blankets and cloth-
ing sent on deck to be dried on clothes-lines.

IV.

Clothing and accouterments should be kept in places assigned
them and not be allowed to encumber the bunks. A certain
hour should be appointed for changing under-clothing, and
access denied to it at ail other times, except in special cases.

150 NAVAL HYGIENE.

V.

The men should be kept on deck all day when possible,
but never be allowed to lie down or sleep on a wet deck.
Awnings should be spread forward and aft in hot or rainy
weather, and the men should be further protected from rain by
water-proof overcoats, which should never be placed in their bunks,
but be hung up on their bunk-posts, or in a place appointed.

VI.

All air-ports should be kept open whenever possible, and wind-
sails should be set all the time and pointed to every change
of wind. In rainy weather tubs should be placed under them to
collect the water. Every transport should be outfitted with ven-
tilators operated by hand or machinery.

VII.

If the troops remain more than a few days on board, their
bedding should be exposed to the sun and air at least once a
week.

VIII.

The men should be required to wash their bodies every morn-
ing, stripping perfectly nude when the weather will permit. If
the transport cannot supply condensed steam for the purpose,
salt-water soap should be provided for the ablution of the body
and for washing clothes.

IX.

If the berth-decks are kept perfectly clean they will not re-
quire to be washed oftener than once a week, and this should
be done only in dry weather and with hot water, which should
be- removed as rapidly as possible by swabs, squillgees, drying
stoves, etc. The beams, bulk-heads, and bunk-posts sould be
whitewashed at the same time.

NAVAL HYGIENE. 151

X.

Hot coffee and biscuit should be issued on turning out.
Breakfast should be served at 7 a. m.; dinner at noon, and supper
at 6 p. m.; and all meals should be eaten on deck, except in very
inclement weather.

XI.

The men should be occupied with their proper military exer-
cises as much as possible, as well as be obliged to assist in work-
ing ship, hoisting ashes, getting up anchor, etc.

^

RESECTION

HEAD OF FEMUR FOR GUNSHOT WOUND.

BY

W. E. TAYLOR, M. D.,

S U R G E O X UNITED STAT E S N A V Y .

RESECTION OF HEAD OF FEMUR FOR GUNSHOT

WOUND.

By W. E. Taylor, Surgeon United State's, Navy.

Naval Hospital, Mare Island, California,

July 12, 1870.

Name — Charles B. Scott.

Grade — Seaman.

Native of Ireland; age, 34 years.

Shipped at San Francisco, May 17, 1869.

Admitted from the United States Steamer Mohican, July 12, 1870.

Diagnosis by hospital ticket — Gunshot wound.

Fred. E, Potter,
Surgeon United States Navy.

■Hospital ticket states : Time and place of occurrence, Teacapan
River, west coast of Mexico, June 17, 1870. Origin: There is
positive evidence that it was in the line of duty, the facts being
as follows, viz :

Was wounded during an attack upon a piratical vessel, in Teacapan River,
west coast of Mexico, June 17, 1870, the ball entering the left natis, midway
between great trochanter of left femur and point of coccyx ; have been unable
to discover its exact locality ; discharge, scanty ; general health, fair ; treat-
ment, water-dressing, and anodynes when required.

On admission, general condition of the patient is decidedly
below par ; appetite is poor ; does not sleep well, and complains
of a great deal of pain in the left hip-joint, upon the least motion.
In consequence of the long sea-voyage, (eleven days,) and his
having been moved about so much, it is not considered advisable
to make an examination of the injury until he shall have become
somewhat rested. To have full diet and milk, and sulph. mor-
phiae at night.

156 RESECTION OF HEAD OF FEMUR.

13///. — Took gr. ss. sulph. morphias last night, but did not rest
well.

i^th. — Rested well last nighty without any morphia, and feels
more refreshed to-day. An examination of the wound was made,
with the following results, viz : Patient is unable to lie upon his
back, but lies upon his right side, with the injured limb semi-
flexed, and resting upon the right leg ; the whole limb is inverted
and rotated inward. On account of this position it is difficult to
get an accurate measurement of the injured limb, but, as far as
can be ascertained, it seems to be about one inch shorter than its
fellow. The motion is very limited, but, with some pain and
difficulty, the left leg and thigh can be moved a short distance
outward. The wound of entrance is small, and situated a little
below the top of the great trochanter, and about two inches pos-
terior to it. The discharge from it is scanty, sanious, and fetid.
Examination with a probe shows that the ball, after entering at
the above-mentioned point, passed inward, forward, and a little
upward. The instrument readily passed for some distance in
this direction, which led directly toward the neck and head of
the bone. After passing between two and three inches, the point
of the probe was arrested against a rough solid body, and then
seemed to pass on in a cavity lined with bone, for a short dis-
tance, when it became finally arrested. From this it would seem
that the neck of the femur had been pretty extensively fractured,
and probably the head also. Nothing was felt that was thought
to be the ball. The porcelain-pointed probe was also used, but
failed to show any lead-marks. Probe was much discolored.
The ball is probably lodged in the head or cotyloid cavity.

From the length of time which has elapsed since the injury, it
is likely that more or less callus has formed, and this, together
with the awkward position of the limb, made the examination
somewhat unsatisfactory. The examination was made without
uskrg any anaesthetic. The joint is not much swollen, but is very
tender to the touch. The patient is in a much better condition
than could be expected after such a serious wound; his appetite

RESECTION OF HEAD OF FEMUR.

57

is improving ; he has no hectic, and sleeps tolerably well; bowels

regular.

1^. — Quiniae sulph., 3i-

Ferri chlor. tinct., ^i.
Glycerin., ^iij.
Ft. sol. — S. Teaspoonful three times a day. To have full diet, milk and
.ale, and sulph. morphias at night, as required.

Wound to be dressed with oakum. Under the circumstances,
some operation will doubtless be required, and it is desirable to
get the patient in as good a condition as possible.

July 2$f/i. — Patient has not improved as much as was antici-
pated, notwithstanding rest, nutritious diet, etc. He complains
of constant pain in the limb, which he is unable to move or allow
to be moved; and as he seems to be slowly failing, and there
being evidently no prospect of recovery if treated on the ex-
pectant plan, the operation of excision of the injured parts was-
dicided upon as giving him the best chance for life, especially as
there was no injury to the large vessels and nerves, and very
little damage to the soft parts. The nature of the case, the
chances of life, and the risks of the operation having been fully
explained to the patient, he cheerfully consented to submit to
any operation that might be considered necessary. Accord-
ingly it was determined to perform the operation to-day. The
following-named medical gentlemen were present, viz : Surgeon
John M. Browne, Assistant Surgeons J. A. Hawke and A. M.
Owen, United States Navy ; and Drs. Weed and Vallijo, of
Vallejo, California. At 1 1 o'clock a. m. the patient was placed
thoroughly under the influence of chloroform by Assistant
Surgeon A. M. Owen. The limb was brought to the straight
position. This was easily accomplished, and during the move-
ment well-marked crepitus was elicited. A straight incision
was then made, commencing about two inches above the great
trochanter, and carried downward over its center and along the
outer side of the thigh for about eight inches. This incision
was carried deeply, and the joint readily- exposed and opened.
The finger being then carried into the joint it was found that

158 RESECTION OF HEAD OF FEMUR.

the neck of the femur was broken entirely across, and numerous
fragments of bone could be felt in the cavity. The thigh was
then well adducted and pushed upward in order to render the
trochanter prominent. The muscular attachments were then
carefully divided close to the bone, which, being well cleared,
was pushed through the wound and sawn off just below the
trochanter minor, with an ordinary amputating saw; after
which the fragments of the neck and head were removed with
the fingers and forceps. The removal of these fragments, some
twelve in number, was easily accomplished. The ball, a conoidal
one, weighing 240 grains, and very much battered, was also
removed along with the fragments of the head, where it had
lodged after causing the fracture. The capsular ligament was
pretty thoroughly removed. No new bone had been formed.
The wound of entrance was not interfered with, as it was so far
removed from the line of. incision. Very little blood was lost —
about four ounces. Two small arteries required securing. The
entire wound was thoroughly syringed with a weak solution of
permanganate of potassa in order to destroy fetor and remove
clots of blood and osseous fragments. After the bleeding had
ceased the wound was partially approximated by four sutures,
about two inches of the central portion being left open for
drainage. Patient was placed in bed, with the limb secured in
the straight position in an ordinary fracture-box, and the wound
dressed with oakum. The patient bore the operation very well,
and promptly rallied from the effects of the chloroform, soon
after which he took gr. ss. sulph. morphise in ^ij of whisky, to be
followed by beef essence, the morphia to be repeated at 3 o'clock
p. m.

Upon examination of the injured bone, after its removal, it was
found that the ball had struck the head of the bone at its junc-
tion with the neck, breaking the latter into three pieces, the line
of fracture being oblique, and extending into and involving the
head. The head of the bone was also extensively comminuted,
seven pieces being removed. In all, eleven good-sized pieces

RESECTION OF HEAD OF FEMUR. 1 59

were removed, exclusive of the upper portion of the shaft. The
ball had lodged nearly in the center of the head. When mounted
the specimen showed quite a large opening at the point of entrance
of the ball, for which no piece of bone could be found, this loss

ANTERIOR AND POSTERIOR VIEWS OF THE FRAGMENTS OF THE HEAD OF THE FEMUR,
AS REPLACED AFTER OPERATION.

of substance being probably due to this portion being pulver-
ized by the ball, and some having escaped with the discharge
prior to the operation, and the remainder being washed out after-
ward. Almost all of the articular cartilage had been removed,
and the remainder was much eroded by the action of the pus.
The round ligament was uninjured, and was attached to one of
the pieces of the head. According to the statement of the patient
and others present at the time of the reception of the wound, the
weapon was fired at a distance of about eighty yards, the patient
being at the time in one of the cutters; and "he was stooping
when struck.

160 RESECTION OF HEAD OF FEMUR.

9 o'clock p. m. — Patient has no pain, but is very nervous and
restless. Pulse 150 per minute. To have gr. ss. sulph. morphiae,
and repeat 12 o'clock. Beef essence, milk and whisky as re-
quired.

26th, 9 o'clock a. m. — Did not sleep well last night. Free from
pain. Still quite nervous. Pulse 120. Tongue coated. Com-
plains of want of sleep. Wound looks well, and is discharging
bloody serum.

PL. — Quinise sulphat., gr. ij.
S. Thrice daily. General diet to consist of beef essence and milk, with
stimulants as required.

9 o'clock p. m. — Condition unchanged. Vomited freely during
the afternoon. Attributed to too much milk.

27///, a. m. — Took gr. i morphias sulphat. during the night, and
rested pretty well, and is more composed this morning. Had bee
essence and one egg for breakfast. No pain. Pulse still frequent.
120, and irritable. Wound looks well and is somewhat swollen
and tender. Discharge more purulent and offensive. In conse-
quence of the bedclothes becoming soiled and offensive the patient
was carefully moved from his bed, and clean sheets, etc., substi-
tuted for those soiled, and when replaced in bed he was turned
toward the right side in order to afford better access to the wound.
Wound was dressed with oakum, moistened with sol. potassae per-
manganat.

28///, a. m. — Patient was quite restless during yesterday after-
noon. Took during the night gr. iss. morphiae sulphat., and rested
pretty well, and this morning is more comfortable, and not quite
so nervous. For breakfast had beef essence and milk toast.
Wound discharging moderately; discharge is more purulent, and
not so offensive. He complains a good deal of excoriation of
the skin about his hips and back, caused by the contact with the dis-
charge, together with free perspiration from the combined effects
^of debility and warm weather. There is also a small bed-sore on
the right hip. The sores are dressed with ung. ox. zinc, and pro-
tected as well as possible with cotton batting, which is to be fre-

RESECTION OF HEAD OF FEMUR. l6l

quently changed. The wound is dressed twice daily, and at each
dressing all the soiled articles are taken away and the pus removed
by gentle pressure, the wound thoroughly sponged with sol. per-
mang. potass, and dressed with oakum. To have Sherry wine
instead of whisky, and grs. iij sulph. quiniae thrice daily. Gen-
eral diet continued.

29M. — Patient was very nervous and restless all the afternoon
of yesterday, and toward evening became delirious, which con-
tinued until 9 o'clock, pulse being 130 and irritable. As he suf-
fered no pain, and insomnia seemed to be the principal trouble,
it was determined to give hydrate of chloral instead of morphia.
Accordingly, at 9 o'clock, gr. xxx of chloral were given in solu-
tion, with directions to repeat in one hour if necessary. In a few
minutes he went to sleep, and when I visited him at 1 1 o'clock
he was still sleeping quietly, and did not awake until 2 o'clock,
after which he slept more or less until morning. Only one dose
was given. This morning he feels much refreshed, looks more
natural, and feels better than at any time since the accident.
Pulse is 100, and pretty good. Wound looks well, and discharges
laudable pus. Dress as usual. Treatment and diet continued.
The good effect of the chloral was very marked ; it seemed to
fulfill the indication, and produced refreshing sleep.

$oth. — Took grs. xxx of chloral at 9 o'clock last night, and
grs. xx at 12 o'clock, and slept until 7 o'clock this morning, get-
ting something like nine hours' refreshing sleep. Bowels not
having been opened since 24th inst., %\. ol. ricini was given this
morning, which operated quite freely. Appetite is good ; pulse
96, and good, and he is not at all nervous. Wound is discharg-
ing pus quite freely. Removed him from bed to-day, and changed
sheets, etc. Dress wound as usual, and repeat chloral at night.

31st. — At 10 o'clock last night took gr. xx of chloral, which
was followed by vomiting; at 12 o'clock gr. x, after which he
slept more or less until morning. He is quiet and cheerful, has
no pain, pulse 96 and fair, tongue clean, and skin in a better con-
dition, although he still perspires a good deal and complains of

62 RESECTION OF HEAD OF FEMUR.

more or less discomfort from the excoriations on his back. Wound
is discharging a moderate amount of laudable pus. All the ner-
vous symptoms have gone, and altogether his general condition
is very favorable. He spends a portion of his time in reading.
Sutures were removed to-day, and there is a partial union of the
wound. Adhesive straps were applied, and the oakum dressing
continued.

August ist. — Patient became restless toward evening of yester-
day. Took grs. xxx of chloral, but did not rest well.

2d — Restless condition returned last night, Took gr. xx of
chloral at 9 o'clock and gr. xx at 12 o'clock, after which he slept
well, and this morning is more cheerful, and says he feels better
than at any time since the operation. Appetite good, tongue
clean, pulse 96. Removed from bed to-day and sheets changed.
Wound discharging very freely. Continue, and to have 3ij cod-
liver oil thrice daily.

3d. — Took gr. xi of chloral last night, and slept well. Condi-
tion about the same as yesterday. Increase quinine to gr. iv
thrice daily, with gtt. xv acid, sulph. arom. To have beef-steak
or mutton-chops for breakfast and dinner.

\tJi. — Took gr. xi of chloral last night in two doses, and slept
several hours. Still improving. Dress wound as usual.

5///. — Took only gr. xxx chloral last night, and slept several
hours. Bowels moved twice to-day naturally. Appetite good
and tongue clean. Wound discharging very freely to-day. Pa-
tient complains of feeling very weak, but there is nothing to in-
dicate any failing. Continue diet, and increase cod-liver oil to
5ss. twice a day,

6th. — Took gr. xxx of chloral, but did not rest well.

yt/i. — Patient was very nervous last night, and for a time par-
tially delirious ; he complained of feeling very drowsy, and was
constantly yawning, but could not sleep. The chloral, in its usual
dose, seems to have lost some of its effect, and, instead of in-
creasing the dose, I determined to combine morphia with it, and
at 9.30 p. m. gave him gr. xxx of chloral, and gr. j^ morph. sulph.

RESECTION OF HEAD OF FEMUR. 1 63

3 o'clock. He then slept very well, and is quite cheerful this
morning. Wound dressed as usual. During the dressing, pus,
mixed with florid blood, was quite freely discharged, the blood
coming probably from the tender granulations. Continue all
treatment.

8t/i. — Doing very well, and says he feels "first-rate." Took
gr. xxx chloral and gr. % morphiae sulph. and slept well. Wound
dressed as usual, discharge moderate, and tinged with blood. He
was removed from bed to-day, and the bedclothes changed.
After being replaced in bed, some extension on the limb was made,
but was not well borne. Is gaining in -flesh, as indicated by his
face.

gt/i. — Took chloral and morphia last night, and slept well. Ap-
petite good, and bowels regular. Discharge from the wound is
small in quantity and laudable.

1 o//^.— Doing well in all respects. Took chloral and morphia
as usual last night.

1 ith.— Slept well last night without any medicine, and feels very
comfortable to-day. Appetite good. Pulse 90, and good. Wound
all healed, except about one inch of the central portion, and a
small opening at the lower end. Discharging a small quantity of

laudable pus.

R. — Quinise sulph., 3ii.
Acid, sulph. arom., 3h-
Aquae, ?iv.
Ft. sol. — S. Teaspoonful ter. die. Substitute ale for Sherry wine, and con-
tinue cod-liver oil and nutritious diet.

\\th. — Since the nth patient has done well. Sleeps some nat-
urally, but takes regularly gr. xx chloral and gr. -^ sulph. mor-
phiae at night, which always insures several hours of good sleep.
Bowels regular. Pulse 90, and good. Wound healed, except
the central portion. Discharge moderate and healthy. Appetite
excellent ; is gaining in flesh. Bedclothes changed to-day. Con-
tinued.

17 th. — Doing well; had slight fever during afternoon of 15th
instant, which lasted a short time, and passed off with moderate

164 RESECTION OF HEAD OF FEMUR.

perspiration. This febrile movement seemed to have been caused
by excitement on account of the death of one of the patients in
the same ward. Skin is much more healthy in its action, and he
does not perspire so much.

21st. — Improving. Wound discharges about two ounces of pus
daily. Appetite excellent ; takes soup, beef-tea, steak, mutton-chop,
and fruit, chloral and morphia at night. Increase cod-liver oil to
?ss. thrice daily. He was removed from bed to-day, and the limb
taken out of the fracture-box, and, all plaster and bandages be-
ing removed, the whole limb was thoroughly bathed with warm
water and soap, and then well rubbed with soap liniment; adhe-
sive strips were then re-applied, the limb replaced in the fracture-
box, and counter-extension being made by means of the ordinary
perineal band, extension was made by turning the screw. This
is to be gradually increased, by means of the screw.

26th. — Appetite has failed somewhat during the past few days,
tongue coated, bad taste in the mouth, and he complains of a
sense of weight and discomfort in the epigastrium. Wound
doing well, but the inguinal glands are enlarged and tender, and
between them and the wound the skin is red and hot. Excoria-
tions nearly healed. Discontinue extension and counter-exten-
sion, and patient is allowed to lie upon the right side for several
hours, the limb remaining in the box, which is turned inwards.
Omit cod-liver oil and quinine.

R. — Mass. Hydrag., gr. vi.
Ext. coloc. comp., gr. iv.
Ft. pil. No. iij. — S. At 9 o'clock p. m., and ?ss. ol. ricini in morning.
Apply tine, iodin. to inflamed skin.

28//Z. — Bowels have been freely opened, and patient is much
better in all respects. Appetite returning, tongue clean, and the
inguinal trouble much improved. He is very cheerful. Bed-
-clothes changed to-day. Hip is much more solid, and bears
handling very well. He is able to move the foot and leg. The
limb was taken out of the fracture-box to-day, and the adhesive
plaster removed, and the leg allowed to rest easily on a pillow for

RESECTION OF HEAD OF FEMUR. 1 65

several hours. After which it was lightly put up in the box, with-
out adhesive plasters, as under the circumstances it is not consid-
ered advisable to make any further attempts at extension for the
present.

R. — Ferri et quinise cit, ^iij.
Glycerin.,
Aquce, aa, ?ii.
Ft. sol. — S. Teaspoonful ter. die, and ?'ss. cod-liver oil, once a day.

2,oth. — Discontinued chloral and morphia last night, as he now
sleeps well without it. The chloral was first given on 29th July,
and since then he has used about two ounces ; it always suited
his case admirably. Vomiting followed its use once, but this may
have been accidental.

September 1st. — Improving; wound discharging moderately;
inguinal trouble gone; bed-sores and excoriations all healed.
Leg is removed from the box, and slight passive motion com-
menced, and then the limb is allowed to rest lightly on a pillow
for several hours, and replaced in the box. Oil-silk removed
from under the hip to-day, as it has a tendency to keep the parts
moist.

\ih. — Discharge diminished, and since the 1st instant has been
thin and serous in its character. While changing his bedclothes
to-day, he was raised to the erect position for a short time, but
soon became faint. Takes f ss. cod-liver oil twice a day. Con-
tinue iron, quinine, and diet.

$th. — Some redness and swelling on the outer side of the thigh,
just below the wound.

14//L — On the 7th instant was able for the first time, with assist-
ance, to leave his bed, and sit for a short time on a chair, the
limb being extended and well supported. Since then he sits up
several hours daily. He is gaining in flesh, his face, chest, arms,
and legs being much better filled out. Wound looks well ; no
purulent discharge at all; the serous discharge continues; its
gross appearance closely resembles synovia, and it probably
comes from remains of the joint tissues. There does not seem to

1 66 RESECTION OF HEAD OF FEMUR.

be any disease of the bone. Wound is sponged daily with tepid
water, and dressed with lint. Appetite good, bowels regular.

i8t/i. — Wound all healed, save two small fistulous openings,
about one inch apart, from which a small quantity of synovial-
looking fluid can be pressed. The whole limb, from the foot to
the groin, was enveloped in a roller bandage, and a spica of the
left groin being made, the foot was slung by a bandage carried
around the neck, and thus supported, and with some assistance,
he walked with crutches the length of the ward, about forty feet,
sat down for a short time, and then returned.

22;/. — With assistance he went down stairs to-day, and sat for a
short time on the porch. Out-door exercise to be continued as
much as possible. Discontinued cod-liver oil, iron, and quinine.
General diet to consist of milk, beef-tea, beef-steak, mutton-chop,
and fruit as needed.

26///. — Came down stairs to-day and walked with crutches for
a short distance outside of the building.

27//Z. — While walking yesterday he, by some means, used the
limb injudiciously, and, to-day, complains of pain in the thigh
upon attempting to walk, but has no pain when in bed. To re-
main quiet for the present.

October ^th. — Still complains of pain in the hip when attempt-
ing to stand or walk. The thigh and leg are cedematous and
hard, having a brawny feel, particularly along the inner and outer
sides of the thigh, at the knee, and along the anterior portion of
the leg. This condition has existed, however, for sdme time. The
foot is not swollen, nor has it been so at any time. General treat-
ment for the swelling to be daily sponged with tepid water and
soap, friction with soap liniment, and occasional bandaging.

6th. — Complains of more or less pain in the hip when walking,
evidently from the swinging about of the leg, for want of proper
support. The foot is somewhat inverted. To-day a piece of stout
iron wire was bent and carried like a stirrup, under the foot, up
along the outer and inner side of the thigh, over the groin, and
reaching almost to the left nipple. This splint was then adapted to

RESECTION OF HEAD OF FEMUR. 1 67

the various curves of the limb, and, when so fashioned, it was
worn outside of the clothes, being held in situ by two or three
strips of bandage. By this means the whole limb was kept quite
steady, and he did not complain of any pain in walking.

iot/i. — Lower fistulous opening has healed. Takes a moderate
amount of out-door exercise daily.

2jih. — During the past ten days there has been some bloody
discharge from the opening, and yesterday the lower fistula, which
had been healed since the ioth instant, opened and discharged a
small quantity of blood and pus. General condition excellent,
and he gets along very well on his crutches, the limb being stead-
ied by means of the wire -splint.

November iot/1. — Steadily improving. Since the 30th ultimo
the fistulous openings have been occasionally injected with solu-
tions of nitrate of silver, carbolic acid, acetate of lead, etc., of va-
rious strengths, in order to bring about healing from the bottom,
but with, apparently, no good effect. The wound has been re-
peatedly examined with a probe ; the instrument passes directly
into the cotyloid cavity, but no diseased bone has been detected.
The discharge doubtless comes from the remains of the old joint,-
and from the granulations.

December %th. — Has walked regularly every day, and can now
walk at least half a mile at a time. The wound is discharging
more freely than usual, and in order to give a better exit to the
pus and expose the parts well, the two openings were united by
an incision of about one inch in length ; the finger was then passed
deeply into the wound, but did not detect any diseased bone ; the
upper end of the shaft of the femur seemed rounded off and well
covered ; the whole of the sinus had a velvet-like feel, and passed
in the direction of the cotyloid cavity, but, owing to the small size
of the sinus, the finger could not be passed quite that far, and the
examination was completed with a probe ; the instrument rested
on the bone, which seemed well covered. The sinus is funnel-
shaped, the neck being toward the acetabulum.

2jt/i. — To-day patient went per steamer to San Francisco in

1 68 RESECTION OF HEAD OF FEMUR.

order to have a plaster cast taken of the pelvis, thigh, and leg
with a view of having a suitable apparatus made for the purpose
of strengthening and supporting the hip, and increasing the length
of the limb. He returned in the evening, having borne the trip,
a distance of more than fifty miles, very well.

January i, 1871. — Doing well; the cedematous condition of
the thigh and leg has entirely disappeared, and the limb is quite
natural in appearance, save, of course, the shortening and some
atrophy of the muscles from long disuse. Patient has discarded
the wire splint, as the limb is now sufficiently firm to retain its
position when he is walking on crutches.

20th. — The apparatus arrived to-day: it consists of Bouvier's
splint, of sole-leather, as used for coxalgia, with the addition of
one external lateral steel splint or brace, jointed at the knee and
ankle, where it is attached to a shoe, with a thick cork sole, in
order to increase the length of the limb, but leaving it one-half
inch shorter than its fellow, this difference in length being con-
sidered necessary to avoid tripping in walking, which might other-
wise happen, in consequence of impaired use of the knee and hip.
The steel splint is so arranged that it can be entirely detached
*rom the thigh-splint and shoe. This was so arranged upon the
supposition that in the course of time he could walk well enough
without the splint, by using only the leather portion of the appa-
ratus and the shoe. The steel splint gives some increased sup-
port, but its main object is to correct and overcome the tendency
to inversion of the limb. It fitted very well, but at first felt very
awkward. The apparatus was substantially and elegantly made
by Messrs. J. H. A. Folkers & Bro., instrument makers and deal-
ers, San Francisco, and cost, complete, $148 currency.

21st. — For two or three days past there have been slight swell-
ing and redness in the cicatrix, left by the bullet, and, to-day, this
opened and discharged a small quantity of pus; it had been
healed for about five months. A probe being passed into this
opening went as far as the acetabulum, and came in contact with
one passed in the wound left by the operation.

RESECTION OF HEAD OF FEMUR. 1 69

2pth. — To-day Scott went to Vallejo and was photographed,
both with and without the apparatus.

February 1st. — Patient is this day transferred to the naval hos-
pital at this station, in charge of Surgeon John M. Browne, Uni-
ted States Navy, the transfer being made on account of the new
hospital being ready for the reception of patients. When trans-
ferred, his general condition is about as follows, viz : General
health excellent, he being, perhaps, the healthiest-looking of all
the patients ; appetite good, sleeps well, and has not taken any
medicine, save an occasional laxative, for four months. The left
buttock is somewhat flattened; there is a small opening about the
center of the line of incision, which discharges a small quantity
of pus. The bullet-wound yet remains open, but shows a ten-
dency to heal. The upper end of the shaft of the femur rests on
the innominate bone, about on a level with the lower margin of
the acetabulum, and the limb is about three and one-half inches
shorter than its fellow. The hip is very firm and strong, and the
whole weight of the body can be borne upon it. The knee is yet
quite stiff, but is slowly improving ; the foot is slightly inverted,
but not so much so as prior to using the apparatus.

He has very good use of the limb, and can move it freely back-
ward and forward and outward, and far enough inward to carry
it across the other leg. He is becoming more accustomed to the
apparatus, and there is no doubt but that in time he will be able
to walk quite well with it without the aid of crutches. At no time
have any abscesses formed in the limb. He has gained about
thirty pounds since the operation of excision.

REMARKS.

This report terminates my official connection with the case; and
inasmuch as the result cannot yet be positively known, it would,
perhaps, be premature to make any comments or draw any con-
clusions. There is one point, however, worthy of mention, viz:
That prior to the operation the patient complained of severe and
constant pain, which ceased immediately upon the removal of the

170 RESECTION OF HEAD OF FEMUR.

injured parts. This relief was so marked that even had the case
terminated fatally, I think operative interference was wan-anted,
with a view to euthanasia.

It will also be noticed that treatment by extension and counter-
extension was abandoned after a trial of a few days, and I feel
quite certain that this particular case did better without it.

The case was admirably suited for the operation of excision; a
better one could not well have been selected.

There was no injury to the vessels or nerves, and none to the
soft parts save the small wround of entrance ; the pelvic walls
were not injured. There were no abscesses, and but little swelling
about the joint. The neck and head of the femur alone bore the
brunt of the injury.

AN ACCOUNT OF THE YELLOW FEVER

APPEARED IN DECEMBER, 1866, AND PREVAILED ON BOARD

THE UNITED STATES SHIP JAMESTOWN, STORE

AND HOSPITAL SHIP AT PANAMA.

DELAVAN BLOODGOOD, A. M., M. D.,

SURGEON UNITED STATES NAVY, SURGEON OF THE FLEET, ASIATIC STATION.

AN ACCOUNT OF THE YELLOW FEVER WHICH AP-
PEARED IN DECEMBER, 1866, AND PREVAILED ON
BOARD THE UNITED STATES SHIP JAMESTOWN,
STORE AND HOSPITAL SHIP AT PANAMA.

By Delavan Bloodgood, A. M., M. D.,

Surgeon United States Navy, Surgeon of the Fleet, Asiatic Station.

On board the United States store and hospital ship Jamestown
in Panama Bay, December 19th, 1866, at midnight, William
McSoley, private marine, was suddenly siezed with "pains in
back," followed by "great thirst and oppression in chest." The
2 1st he was " very weak ; unable to drill." The 2 2d he had " fever
of an ugly character;" "says he feels as he did some years ago
when he had severe typhoid fever;" "heat of skin very great;''
"pulse rapid;" "tongue dry, and red at tip and edges." On
the 24th he was "very much prostrated ; " and the 25th his "pros-
tration continued, with great pains in back." The 26th there
was "great intestinal irritation;" "mind wandering;" "deliri-
ous at night, and attempted to leave his cot." From the last date
McSoley slowly convalesced. This patient had been employed
as sentry at the naval store-house in Panama from the 8th to the
19th of December inclusive. I subsequently learned that irrita-
bility of the stomach was a constant symptom during the first few
days of his illness, and that he had numerous black liquid dejec-
tions.

Charles A. Gicquel, carpenter's mate, was seized during the
night of December 30th with "slight chilliness, followed by fever,
which has continued ever since;" "fullness of head;" "soreness
of limbs." These symptoms were attributed to a debauch on
shore. The 31st his symptoms were regarded as those of "inter,
fever," and the next day, January 1st, 1867, as "remittent fever;
fever recurs at irregular intervals, attended with a good deal of

174 YELLOW FEVER ON BOARD THE JAMESTOWN.

nausea; tongue loaded." January 2d, "Nausea was very dis-
tressing yesterday and last night, and continues to-day in a less
degree." January 3d, "Tongue coated yellow; eyes jaundiced;
stomach so irritable as to reject almost everything ; great thirst,
(the stomach symptoms the result of his debauch, no doubt.)"
January 4th, "Stomach so irritable as to reject all nourishment;
was delirious through the night." One o'clock p. m., "Gicquel
seems to be sinking ; pulse very weak ; passing into insensibility ;
refuses obstinately to allow any medicine to be given him." He
died at half past 9 o'clock that evening, the fifth day from at-
tack.

Marcellus J. Maxwell, sergeant of marines, was admitted on
the sick-list January 10th, having had "successive chills since last
night; pain in the loins more than usually severe." The journal
mentions for following three days, "continuous pain in back,
and soreness of flesh very severe; thirst; tongue coated;" etc.
Maxwell was discharged to duty February 2d. I was afterward
informed by him that he suffered from nausea and vomiting dur-
ing the first few days of his illness, and that in convalescence his
arms and body became yellow.

yanuary 12th. — Edward George Joyce, corporal of marines,
was admitted on the sick-list with "fever of as yet no definite
character." The 13th it was called "intermittent," and he was
reported "convalescent" on the 14th; but 15th and 16th "not so
well;" "fever at night." The 17th there was "return of fever;
tongue very foul." The 19th "int. fever has become con-
tinued;" "tongue red at tip, and coated in middle;" "has
diarrhoea." No further remarks of moment are recorded ex-
cepting that "diarrhoea was arrested," and "bronchial symptoms
had developed," until the 23d, when his condition was accounted
critical from an " unaccountable and exhaustive diarrhoea." Joyce
died at midday on the 24th, and twelfth day from attack. During
the last thirty-six hours of his life, as I learned, vomitings were
frequent, and his corpse turned yellow.

On the 1 8th January, four men who had just been released

YELLOW FEVER ON BOARD THE JAMESTOWN. 1 75

from " the cells" — dark and dank abysses of the orlop-deck —
were admitted and continued on the sick-list five, twenty-three,
twenty-six, and twenty-seven days, respectively. The records of
their " chills," "pains," "great prostration," etc., in connection
with the foregoing and following cases, are worthy of particular
consideration.

January 21st, Bernard Hagan, boatswain's mate, was admitted
with intermittent fever ; the 2 2d he was charged with being drunk,
and was disrated; on the 23d was noted, " has fever and diarrhoea;"
the 24th, "diarrhoea and vomiting;" 25th, "violent retching yes-
terday, with hiccough," and at evening, " vomiting and violent
throwing up mucus and blood." Hagan died at 10 o'clock that
night, having been sick four days.

Edward Hanson, private marine, admitted at the same time
with Hagan, "had pains in back," "debility," " fever," "diarrhoea,"
"hemorrhage from nose and mouth;" but recovered, and was
discharged from the sick-list the eighteenth day after seizure.
This man was associated with McSoley (the case first cited) as
sentry at the store-house on shore.

January 23d, Surgeon Marius Duvall, United States Navy, was
attacked. Passed Assistant Surgeon F. L. DuBois found him
(24th) with "high fever, intermittent type, result of climatic influ-
ences and exposure in walking a long distance over the reef in
the midday heat of a tropical sun;" 25th, there was "persistent
nausea and continued feeling of chilliness;" the 26th, " nausea
continued — pain in scalp and ear;" 27th, the same; 28th, "passed
a wretched night, retching and vomiting; very feeble and pros-
trate; has still eaten nothing; pulse 50;" 29th, "stomach still
irritable, but passed a comfortable night by taking morphia;
relished some champagne; 30th, "conjunctiva quite yellow —
nausea and vomiting;" 31st, " has fever, and is flighty." Feb-
ruary 1st, "depression of spirits;" "his urine has stained his
clothes deep yellow." Dr. Duvall left, per steamer of 1st of
February, for New York, according to recommendation of board
of survey. "In order to prevent the spread of infection the

Ij6 YELLOW FEVER ON BOARD THE JAMESTOWN.

articles used by Dr. Duvall were thrown overboard: the paint
within a bath-tub in which he had urinated was turned com-
pletely black, so abnormal was the condition of his urine."

January 25th, two days after Dr. Duvall's seizure, James Burns,
private marine, and Michael J. Sweeney, landsman, were attacked.
Burns had a "hot but perspiring skin; pain in back; oppression
in breathing; difficulty in swallowing;" 26th, " violent emesis;"
27th, "vomiting continued, with fullness in throat; eyeballs con-
gested;" 28th, the matters vomited were black, and he died the
following day, the fifth of his illness. Sweeney started off with
a " chill," followed by " emesis ;" " pains in head, and conjunctiva
congested;" the 26th, he had " vomiting and epistaxis;" 27th,
" involuntary evacuations in cot; vomitings of blood and black
matter." Death resulted the next day, the fourth after seizure.

Appended to the closing accounts of these two cases is the fol-
lowing : " The congested conjunctiva, severe pains of back and
head, choking sensation in throat, epigastric tenderness on pres-
sure, with nausea, and finally the black-vomit, like coffee-grounds,
render it almost certain that we have the yellow fever among us.
It has lately been in Panama, but had disappeared. At present
the city is very unhealthy'."

Following Burns and Sweeney, Thomas J. Ward, ordinary sea-
man, was attacked the day afterward. He had fever, nausea,
vomiting, prostration, yellowness of skin, etc., but convalesced,
and was discharged February 21st.

The next day after Ward, William Devine, captain of the fore-top,
was seized. Vomiting of bile occurred the second day, of black
matter the third; suppression of urine, insensibility, hiccough,
and yellowness of skin succeeded, and death on the fifth day.

John Dodd, private marine, who had been on the sick-list the
preceding one hundred days with syphilis, chronic rheumatism,
and calculus consecutively, developed, on the 28th of January,
^well-marked symptoms of yellow fever — the chills, the fever, the
nausea and vomiting, yellowness of skin, prostration, etc., but
sustained it all and was discharged to duty March 25.

YELLOW FEVER ON BOARD THE JAMESTOWN. I 77

The next case in succession was that of Dennis Ryan, lands-
man. He had a congestive chill on the evening of January 29th.
The usual severe symptoms supervened— delirium, black vomit,
and death on the 4th of February, having been ill six days.

February 2, John Hasson, captain of main-top, was admitted ;
and the pains, fever, chilliness, nausea, and congested eyes noted.
February 3, there was continuance of fever and nausea, and epis-
taxis; "is well salivated." February 4th, "yellow serum yielded
from a blister over epigastrium ;" " great nausea." February 5th,
he "had convulsions, suppression of urine, vomiting, depression
of spirits." February 6th, "hemorrhage from mouth." Febru-
ary 7th, "hiccough, subsultus tendinum, strabismus," and death
resulted the sixth day.

In the night of February 8th, Mr. John Adams, acting master,
had a chill followed by fever and pains in the head, limbs, and
back. He took about fifteen grains of quinine each day until
the 13th, when it was "suspended on account of headache and
soreness of throat." 14th, his conjunctiva was very yellow.
15'th, the case regarded as quite mild. 16th, "bronchitis super-
vened." 17th and 18th, "improving." 19th, he was "much
troubled with cough and expectoration." 20th, "very severe
bronchitis, with expectoration of greenish mucus and great diffi-
culty in throwing it off his chest; pulse very feeble ; eyes more
yellow; copious watery discharges from bowels." 21, ''breath-
ing very rapid, secretions all operating save biliary." 22d,"had
live copious liquid stools ; respiration loud and rapid ; delirious ;
spat up blood." He died at four o'clock p. m., the thirteenth day,
and his corpse was yellow.

Frederick W. Stevens, private marine, was admitted February
10th, with " intermittent fever," and was given a calomel purgative,
and during the three following days five-grain doses of quinine
ter in die. On the 14th, nausea and the more marked symptoms
of yellow fever presented, and these were duly followed by epis-
taxis, hemorrages, etc., and by death on the morning of Febru-
ary 2 1 st, the eleventh day.

178 YELLOW FEVER ON BOARD THE JAMESTOWN.

Thomas Smith, ordinary seaman, had a chill during the night
of February 17th, which was followed by fever, and in the morn-
ing his eyes were much congested. February 19th, "fever, eye-
balls painful, slept none, bowels and kidneys acting freely." The
next day black-vomit set in, and he died that evening, the third
day after seizure.

Isaiah Marjerison, private marine, was seized before daylight,
February 27th, with the usual chill followed by fever. The sec-
ond morning black-vomit appeared, and next day there followed
delirium, hiccough, and subsultus tendinum, all of which continued
until suspended by death March 2d.

The cases of Paymaster John A. Bates, jr., United States Navy,
and John Braumer, private marine, which developed simulta-
neously with Marjerison's, will be reverted to after the following-
necessary explanations :

Under orders to the Jamestown, I sailed in the mail steamer
from New York February 21st, 1867, reached Panama in the
evening of March 1st, and went off to my duty soon after sun-
rise the next morning in the market-boat. I found fourteen
cases, five of them very critical, on the sick-list, and that twelve
deaths had already resulted from yellow fever. The same disease
was prevailing on shore. Dr. DuBois, whom I superseded as
successor to Dr. Duvall, had on three different occasions "fumi-
gated" the ship, and had advised the commanding officer of the
necessity for the removal of the vessel from that locality. I also
proffered the unheeded advice that the ship should sail immedi-
ately for a cold climate, explaining that such a degree of local
infection existed that there was no hope of the disappearance of
the endemic fever while material remained for it to work upon.
I recommended also that shore- visiting be stopped, that the
prisoners be removed from the cells, and that no one be permit-
ted to sleep on the orlop, or remain there longer than duty re-
quired. It is proper further to remark, in regarding the situation,
that the Jamestown, newly commissioned, sailed from San Fran-
cisco in October, 1866, and reached her station in the middle of

YELLOW FEVER ON BOARD THE JAMESTOWN. 179

November, anchoring in the bay about three miles S. S. E. from
the city of Panama, and about half a mile E. by N. from Fla-
menco, the largest of three precipitous and contiguous islands.
Flamenco is unused excepting as a burial-place, but the other
two, Perico and Llenas, are occupied by the Pacific Mail Steam-
ship Company as depots for stores and coal, and for workshops
and dwellings for the employes. Her arrival was just at the
close of the rainy season, which commences in May, and during
which the miasmatic exhalations are most manifest; when damp-
ness and a greenish mold pervade everything ; iron oxidizes with
wonderful rapidity ; furniture that is only fastened by glue falls to
pieces ; in short, the appearance and idea of disease are constantly
impressed upon one. This period is usually inaugurated by
showers which may last but an hour or two and not recur for
three or four days ; but as the season advances the rain-storms
become intensified, till, deluge-like, they continue from day to
day, accompanied by thunder and lightning such as can only be
experienced in the tropics. The winds, which come mostly in
squalls, are southerly, but they bring no cooling with them, only
heaviness and oppression to the nervous system. Languor, leth-
argy, and loss of appetite are the immediate results, and fevers
and diseases of the digestive apparatus the subsequent. This
season had passed, for from the Jamestown's arrival, November
1 6th, until the end of the quarter and year of 1866, but seven
rainy days were logged. Calms and light variable winds pre-
vailed, and the average daily temperature was (Fahrenheit) 780.2
at 6 o'clock a. 111., 84°.i at noon, 8i°.2 at 6 p. m., and 780.5 at
midnight. The Jamestown had been in port about a month
when the first cases of yellow fever appeared on board. She
was roomy and tidy, and well ventilated excepting her orlop,
where the pestilence first made its manifestation among the
marines and prisoners, who were billeted and kept there, and
where also were the bag-racks for the men ; and as the cloth-
ing and bedding of the first three victims were sold by auction to
the crew, some of the infected articles must have been festering

I So YELLOW FEVER ON BOARD THE JAMESTOWN.

in that locality; which locality will again be called in question.
The complement of officers and men numbered one hundred and
eighteen, of whom four officers and three men had had yellow
fever, and there were fourteen negroes — twenty-one persons in all
who might be regarded as exempt from the danger. The report
of sick for the fourth quarter, 1866, affords evidence of the gen-
eral sanitary tone of the ship's company just previous to the out-
break of the fever. In those three months but thirty-six diseases
had been treated, and of those were febris intermittens, one ;
febris remittens, three; febris continua, one; febris typhoides,
one ; diarrhoea, two ; dysenteria, one ; adynamia, one. The
others were but trifling affections and injuries. McSoley's and
Gicquel's diseases were included in the foregoing enumeration.

Passed Assistant Surgeon DuBois was detached ten days after
I joined the Jamestown. Acting Assistant Surgeon E. T. T.
Marsh, who preceded me on board two days, remained a faithful
and zealous coadjutor to the close of the scene.

To resume the cases of February 27th: Paymaster Bates at
first complained only of a dull headache, and was taciturn and
somnolent. He had no chill, but fever came on at evening and
continued through the night. He took a blue-pill and had a hot
foot-bath at the hour of retiring. During the two following days
he vomited frequently and became greatly prostrated. When I
first arrived on board, March 2d, his mind was clear, and he
brightened up at seeing me, and was much interested in hearing
of friends and in his letters just received, but in less than an
hour he became bewildered, black-vomit was ejected, black
liquid dejections were frequent, and prolonged sighing and hic-
cough set in. The surface of his body was cool. Surrounded
him with bottles of hot water, applied sinapisms over abdomen
and to extremities, and plied him with stimulants. Black-vomit
recurred three times during the day ; after each act gave him, in
'nrucilage, a few drops of chloroform in which an equal weight
of camphor had been dissolved, and again small quantities of
comp. spirits of ether with brandy; ice ad libitum. Throughout

YELLOW FEVER ON BOARD THE JAMESTOWN. l8l

the night he was very restless and partially delirious. Gave him
milk-punch every hour, and the applications of warmth about the
body were not relinquished. March 3d, his hiccough was very
distressing, prolonged, and so loud as to be heard all over the
ship. Remedies which the day before mitigated it then were
unavailing. Black-vomit stools were frequent, and his pulse was
scarcely preceptible at times, but would come up under extra
stimulation. His stomach was quite tolerant to soup and brandy.
Throughout the night delirium and jactitation were unintermitted.
The applications of sinapisms and external heat were kept up,
and stimulants given every twenty minutes. March 4th, observed
about his mouth and alse of nose and on forehead a peculiar
vesicular and pustular eruption ; his body was yellow and sub-
sultus tendinum constant, and he was also muttering in a tremu-
lous manner. At half past 10 o'clock a. m. he became quiet for
a few minutes, looked up consciously, said " Good-by," and died.
He had been sick five days.

Braumer, attacked at the same time with Marjerison and Mr.
Bates, was greatly terrified. The next day, February 28th, he
"had spasms and vomiting," and March 1st was " very low."
When I saw him (morning of March 2d) he was suffering severe
pain in the back, and I ordered dry cups along the spinal
column, milk-punch, and ice ad libitum; flying sinapisms and
bottles of hot water to surround body. March 3d he was
very restless and tremulous ; the treatment was continued as on
day before ; 4th of March he vomited occasionally, and his mind
was wandering. In the afternoon black-vomit appeared, he
became delirious, and the secretion of urine was arrested. On
5th of March hemorrhage from mouth occurred, with soreness
of throat; said that he "would die before sunset." Throughout
the night he was wildly delirious, shouting, singing, and occa-
sionally hiccoughing and ejecting black vomit; the external heat
was kept applied, and stimulants given freely. March 6th he
slept some; stomach was quite tolerant, and be voided a little
bright-yellow urine. March 7th he had rested well during the

152 YELLOW FEVER ON BOARD THE JAMESTOWN.

night; his mind was clear; no nausea; eyes long congested;
urine voided; pulse 48, and feeble; he continued doing well
until the 12th, when, obtaining some salts and senna surrepti-
tiously, he physicked himself prodigiously, but finally recovered
and was discharged to duty.

March 1st, Frederick Dallery, landsman, aged 19, had a chill,
and there followed frontal headache, pain in back and limbs,
suffused and pinkish eyes, which subsequently became yellow, as
did his body ; bowels were constipated, tongue pasty, and pulse
irregular. Nausea and great prostration occurred the second
day, and continued during the two or three following. His
urine was voided involuntarily, staining the blankets yellow.
Treatment: Perspiration produced by hot mustard baths, purga-
tive of calomel followed by oil, hot soups, ice ad libitum (and this
%for all patients); also gave him fifteen grains of quinine after
catharsis. He was discharged to duty the 17th of March.

While waiting on the beach the morning after my arrival I
observed Mr. Charles A. Brown, mate, aged about 23, slowly ad-
vancing along the reef, frequently stopping to rest. He came
up and went on board with me. He had passed the night at a
hotel, where many deaths had but recently occurred, and where,
upon his arrival from San Francisco, five days previously, he had
remained two days before reporting on board the Jamestown.
He had had a chill during the night, and the fever was then full
upon him. As soon as we got on board he took fifteen grains of
calomel, and was put into a hot mustard-bath. But very slight
diaphoresis followed. He was then given quinine fifteen grains,
and the employment of stimulants commenced. He became
greatly prostrated and agitated, firmly convinced that he must
die. On the 3d of March he described a pain "like a cord was
tied tightly around his back-bone." Nausea was constant, but he
retained soup and stimulants. Sinapisms and bottles of hot water
were employed, and he was given Hoffman's anodyne repeatedly.
His. neck first became yellow, and upon it and the face were a few
vesicles, similar to those observed upon Mr. Bates. The secretion

YELLOW FEVER ON BOARD THE JAMESTOWN. 1 83

of urine was arrested, and black vomit set in at i o'clock p. m., thin
and of the "bees-wing" variety, which ran from his mouth as if
it was "pumped " out. The morning following, besides the black
vomiting, black liquid stools were frequent ; delirium and hic-
cough came on, and death succeeded at evening, on the third
day. For thirty hours before death his stomach refused every-
thing offered.

At eight o'clock in the evening of March 5th, Thomas Ander-
son, of the carpenter's gang, who had been working at the bench
on the orlop, was seized with a chill. Fever, general pains, nau-
sea, and the "white" vomiting regularly succeeded that night,
and he slept none. He complained the next morning of a chok-
ing sensation, and nausea lasted over the 6th. His eyes were
quite yellow, and ptyalism resulted from a single purgative of
calomel, followed by oil and quinine. He improved rapidly, and
on the 1 8th, at his earnest solicitation, was discharged to duty,
but the following evening had a relapse, with repetition of all
original symptoms, from which, however, he safely recovered.

March 7th, the next case developed — that of Herman Zimmer-
man, boy, aged 16 years. He was one of the dingey's crew, and
for falling asleep in his boat, and letting her get adrift when off
for marketing on the morning of the 6th, was kept during the rest
of the day pulling at his oars, in the sun, the boat being made
fast to the boom. This did not come to my knowledge till
some time afterward. Distressing nausea and a sense of gastric
distension were first complained of; gave him an emetic of ipecac-
uanha and mustard, and after its operation the nausea ceased.
Hot mustard pediluvia and bottles of hot water were employed
without exciting diaphoresis. He made loud and incessant
complaints of the pains in his head and back, which were
scarcely mitigated by large and repeated doses of compound spirits
of ether and morphia. Bowels were purged by calomel followed
by oil. The second day an abundant vesicular eruption appeared
on the forehead and about the mouth. Stimulants were freely
given. Restlessness, jactitation, and sleeplessness were unre-

184 YELLOW FEVER ON BOARD THE JAMESTQWN.

lieved. On the 10th he became wildly delirious, lay upon his
back, eyes staring, pupils dilated, head rolling from side to side,
wailing incessantly, blood oozing from mouth, evacuations invol-
untary, and these conditions were unchanged until suddenly
arrested by death, the nth of March, the fourth day.

The next case was that of Henry Miller, seaman, a volunteer
nurse, who had been in faithful attendance from the outbreak of
the pestilence. He was seized in the night of the 15th of March
with a chill, and immediately afterward most intense pains in
head and back commenced. Several hot mustard-baths were
required before the establishment of diaphoresis, after which we
commenced giving twenty-grain doses of nitrate of potassa every
third hour, and continued it for two days, with stimulants, p. r. n.;
also took several cut-cups from nucha and along spinal column.
On the third day a vesicular and pustular eruption came out
quite thickly on his face, neck, and arms. Nausea, vomiting,
great prostration, and unfavorable symptoms generally, continued
until the 2 2d, when his convalescence began.

March 16th another case appeared. John Regan, gunners
mate, aged 35, had a chill at n o'clock a. m., and there was
immediate and great prostration, followed by "splitting head-
ache," pains in back and limbs, and his eyes were suffused and
pinkish. Ordered for him the hot mustard-bath and a mercurial
purgative. After he had perspired freely for an hour, commenced
giving him nitrate of potassa fifteen grains, repeated every two
hours, and took a few cut-cups from nucha and back. Black-
vomit appeared on the 18th ; the nitrate of potassa was continued
with stimulants. On the 19th his ejections were white in the
morning, but at evening again black; his conjunctiva yellow, and
an abundant eruption resembling acne came out upon his arms
and thighs. Treatment unchanged. On the 20th his stomach
was too irritable to receive nourishment or medicines, and he
again at evening ejected a large quantity of black-vomit. From
the 21st he convalesced, and was discharged to duty April 1st
with a pretty yellow body.

YELLOW FEVER ON BOARD THE JAMESTOWN. ■ 1 85

Mr. William T. Bull, aged, about 25, paymaster's clerk at the
naval store-house in Panama, died March 23d, after five day's
illness, having had black vomit profusely. He had been attended
by a resident physician, an employe of the railroad company, and
who denominated the disease "bilious intermittent fever," and
denied that yellow fever existed on the isthmus. Mr, Bull was
visited by Dr. Marsh during his illness, and seen by him just be-
fore death, and he recognized the malady as yellow fever, beyond
any question.

At about midnight, March 21st, Harrold Nelson, aged 23 years,
a sturdy seamen, was suddenly attacked. This man had but re-
cently endured five days' confinement in the cells on the orlop-
deck. He had no black vomit, but most of the other prevalent
symptoms, and they were quite severe in degree. He was dis-
charged to duty the twelfth day from seizure, and his treatment
was very similar to Regan's ; nitrate of potassa, after establish-
ment of diaphoresis, being the principal remedy employed.

Charles Thompson, quartermaster, aged 28, and of full habit,
came off watch at noon March 27th, and reported himself "sick."
He seemed stupefied ; skin was hot ; pulse sluggish ; eyes con-
gested; and he "ached. in every part of his body." Put him in
the hot mustard-bath ; gave a calomel purgative ; took four cut-
cups from nucha, and gave him fifteen grains of nitrate of potassa
every two hours. March 28 ; lay upon his back all day like a
stunned animal ; was aroused with difficulty, when he would com-
plain of general pains. Put him again in the hot bath, repeated
the cupping, and continued the administration of nitrate of pot-
assa. 29th he void six ounces of urine, the first since attacked ;
it yielded no albumen. His eyes were yellow; pains unchanged.
Continued the nitrate of potassa, with stimulants occasionally,
and employed external warmth. On the 30th a pustular erup-
tion appeared about his mouth, and on the 31st hemorrhage from
mouth and nose; treatment continued as on the 29th. He
slowly convalesced from April 1st, and was discharged to duty
May 1 st.

1 86 YELLOW FEVER ON BOARD THE JAMESTOWN.

April i st, the commanding officer received from the Secretary
of the Navy an order "to proceed to sea with the Jamestown
without delay, and to proceed as far northward as he might con-
sider necessary for the re-establishment of the health of the ship's
crew," and to bring up at San Francisco. We sailed, in compli-
ance with that order, April 2d, at evening, the fever having then
been endemic on board over three months. Never men more glee-
fully sprang aloft, never clank of windlass sounded more music-
ally than on that occasion. To clear that hated bay, to shut out
the sight of the head-boards which whitened the steep sides of
Flamenco Island, seemed like escape from inevitable doom. In
that reprieve further calamities were unexpected, inconsiderate of
the "ferment" with which we were freighted.

The day before sailing, Charles Hawkins, steerage-steward,
aged 30, and effeminate in appearance, was attacked; he was ex-
cessively prostrated, and there was great nervous oppression.
Black-vomit appeared April 4th, recurred twice on the 6th, once
on the 7th, and again on the 8th, and each ejection was profuse.
He became delirious the 6th, and his mind remained unsettled
until the 9th. A minute pustular eruption spread over his neck,
and oozing of blood from the mouth and nose continued many
days. The surface of his body turned bright yellow after the
eighth day, and convalescence began on the nth. The treat-
ment was commenced by hot mustard-baths and a mercurial
purgative, and during the first ten days gave nitrate of potassa in
ten-grain doses, three or five times per day, as the condition of
his stomach would allow. Milk-punch, egg-nog, brandy, ale, and
wine, wTere given as he fancied, and sinapisms and cups were fre-
quently called into requisition.

Louis Ross, sail-maker's mate, was admitted April nth, pre-
senting the common symptoms and appearances. He stated
that he had been feeling badly for two or three days,, but kept at
work on a sail that was needed. He experienced considerable
difficulty in breathing, and a sense of thoracic distension ; sore-
ness of throat was also complained of, and he vomited frequently

YELLOW FEVER ON BOARD THE JAMESTOWN. 187

the ejections containing mucus and bile. He was treated with
the hot mustard-bath, sinapisms, and external heat ; the nitrate of
potassa was regularly continued with stimulants. The case pro-
gressed favorably without any unusual developments, and was
discharged the thirteenth day.

William Jared, yeoman, aged 21, the next subject, was at-
tacked suddenly and severely in the evening of April 14th; he
was put in the hot mustard-bath, given a mercurial purgative, and
fifteen grains of nitrate of potassa every two hours. During the
night of the 16th he became wildly delirious; surface of his body
and the extremities were cold, and his face and ears leaden-hued.
Took six ounces of blood by cups from nucha, shaved his head,
repeated the bath, applied sinapisms to epigastrium, and con-
tinued the potas. nitr. His mind became clearer the 17th, but
he was very nervous and restless. His eyes and skin were yel-
low, vomitings of white and bilious matter occasionally streaked
with blood occurred, and the prostration was complete. He
recovered, and was discharged the eighteenth day from seizure.

James McBeth, ordinary seaman, aged 19, and very robust,
came down from his watch on deck at 1 o'clock in the morning
of April 13th, having a light chill, which lasted but half an hour.
Gave him two ounces of whisky, twenty grains of calomel, and
turned him in under blankets. In the morning he made but
slight complaint of dizziness and headache ; there was no fever
then nor during the following day; his eyes were clear, appetite
good, and he slept well. R. — Potass, nitr., gr. x., t. d. The 16th
and 17th nothing apparently was required; he wanted to go to
duty, which was permitted on the 18th, but that evening he was
seized with headache and shivering ; his pulse was full, and eyes
suffused and pinkish. He was put into the hot mustard-bath,
and six ounces of blood taken by cups from the nucha. Fever came
on, and continued all night with great thirst, and next day with
nausea; he relished and retained, however, some mutton-soup
and ale. Bowels were opened by calomel, followed by sodae et
potass, tart., 5SS. On the 20th he was greatly prostrated; said

1 88 YELLOW FEVER ON BOARD THE JAMESTOWN.

that he "felt half dead and stunned." More blood was taken
from nuchal region by cups. He vomited at noon and com-
plained of soreness of throat ; his tongue was tremulous, black
in center, and yellow-edged. Gave him one dose of tinct. ferri
chlorid., but it seemed to increase the nausea. Ordered milk-
punch every hour, and flying sinapisms to be employed. On the
21st the headache was intense; skin hot like a "stovepipe:"
mind wandering. Again he was put into the hot mustard-bath,
and two cups cut upon the temples. At midday black vomit ap-
peared, and recurred at evening with hiccough. As his stomach
would no longer retain milk-punch, its administration was con-
tinued by enema; external heat kept up. Delirium set in at
night, and he remained unconscious, with short and labored
breathing, until noon the next day, when he died. Black-vomit
stools were frequent during his last day of life, and the eruption
was abundant on neck and chest, and a few vesicles on the face ;
the body a dirty bronze color; no albumen in urine. Death re-
sulted the fourth day from relapse, and ninth from first ailment.
Accompanying McBeth, when he returned in relapse, was
Alonzo Horton, ship's cook, aged 36, shivering and complaining
of headache and general pains. The surface of his body was
cold, pulse sluggish, eyes brilliant. He was kept a long time in
the hot bath, and afterward surrounded by bottles of hot water
under his blankets, but without exciting diaphoresis. Several
cut-cups were taken from his neck and back without relieving the
pains, which were severest in the lumbar regions. April 19th
bowels purged by calomel ; his tongue had a seared appearance ;
gave nitrate of potassa, twenty grains, every two hours and a half.
The pains in his back being intensified on the 20th, six more cut-
cups were taken from the lumbar regions. White vomiting
occurred at 9 o'clock a. m., black at 2, 4, and 9 p. m., with
severe cramps, particularly in the legs. Suspended medicines on
^account of the nausea, though stimulants were well borne. Cam-
phor and chloroform mixture were given after each act of vom-
iting. April 2 1 st, no urine had been voided since 8 o'clock the

YELLOW FEVER ON BOARD THE JAMESTOWN. 1 89

previous morning ; applied warm fomentations over the bladder,
and resumed the administration of nitrate of potassa, and gave
milk-punch every hour until midday, when black vomit recurred,
precluding their continuance. Toward evening about an ounce
of bright-yellow urine was drawn by the catheter, and later the
same quantity was voided ; no albumen contained. Between 7
and 11 o'clock that evening he had eight copious black-vomit
stools. Milk-punch not being well borne, substituted undiluted
brandy; soon that was ejected, after which it was given by enema
every hour. The temperature of the body continued to diminish.
At two o'clock in the morning of the 2 2d, hiccough, and delirium
of a mirthful character, supervened ; but soon stupor and mut-
terings succeeded, and continued until death, which followed
before daylight, the fourth day. The corpse was completely
bronzed in appearance.

These two cases were the first which had terminated fatally in
forty-two days. We were then twenty days at sea, and in that
time had progressed only seven hundred and fifty miles, and were
still in a lower latitude than the place of departure. When the
weather had been fair it was calm and stifling ; when there was
wind it came as a rain-squall, and ports were closed and hatches
hooded, housing us in noisome vapor. Within a few degrees of
the line, a blood-colored sun overhead, a hot and coppery sky
surrounding,

"Day after day, day after day,
We stuck, nor breath nor motion ;

As idle as a painted ship
Upon a painted ocean.''

But moderately outfitted with luxuries for the sick, those few
nearly exhausted — no ice nor chance for supplies — the prospect
was dismal, and its disheartening effect clearly perceptible upon
the ship's company.

Two days after the burials at sea, George Ellis, ordinary sea-
man, was attacked. The case was quite mild, but in its course
the diagnosis was unequivocally substantiated. He became well
enough for duty the ninth day.

I90 YELLOW FEVER ON BOARD THE JAMESTOWN.

Two. weeks after my arrival on board the Jamestown I had a
pretty sharp attack of fever, lasting three days, and which, though
recorded as febris communis, I flattered myself might have been
yellow fever in mild form. I also assumed security from the cir-
cumstances that after the arrival north of the Dacotah, in Octo-
ber, 1862, with yellow fever on board, which we contracted in the
West Indies, I had a fever of considerable severity, with many
symptoms common to the epidemic; but this 27th of April I was
suddenly stricken down. A feeling of malaise had induced me
to take a blue pill that morning, but at half past 10 o'clock a
chill, preceded by a palpable aura, came upon me with great
suddenness, and lasted three hours in spite of my being twice put
into a hot mustard-bath, bottles of hot water surrounding, and
blankets piled upon me. With sweating, high fever came on,
frontal headache, almost insupportable pain in lumbar region,
cramps in legs, and nausea was constant, with insatiable thirst.
Dr. Marsh gave me, at 2 o'clock p. in., twenty grains of calomel,
and took two cut-cups from nucha; also employed dry-cups along
spinal column and flying sinapisms. Dr. Marsh recorded that my
" eyes were suffused ; tongue foul ; pulse full and hard ; great
prostration. At 4 o'clock, p. m. became delirious. R. — Potas.
nitr., gr. xx, even* three hours. Mind became clearer in even-
ing." The pains were so intolerable down my back, thighs, and
legs that the parts were painted over with tincture of iodine, and
a full anodyne of compound spirits of ether and morphia was admin-
istered. The prostration was so complete that I could neither
rise up nor turn in my berth without assistance. Cathartic oper-
ated twice in the night; urine voided. April 2Sth Dr. Marsh's
record is that I ''passed a very restless night; eyes congested ;
tongue black through center and yellow at edges ; thirst and
nausea unmitigated; pulse slow and feeble ; considerable fever and
headache ; ail these symptoms accompanied by great prostration
^and disinclination for food; taking nitrate of potas.sa. ale. clare ( .
Sauterne, as before." My cognizance of occurrences that day was
much confused. 29th, "fever continued through the day: passed

YELLOW FEVER ON BOARD THE JAMESTOWN. IQI

a very uncomfortable night ;■ expectorates dark matter, [which,
flowing up in my throat without voluntary effort, had a saltish and
oily taste;] treatment as yesterday. In p. m., on account of
severity of pains, was given tine, opii gtt. xl., by enema. Had
eleven black-vomit dejections during day." 30th, " the eruption, as
mentioned in former cases, appeared about mouth and nose ; eyes
yellow and tongue foul; no inclination for food." In the even-
ing was noticed " a great improvement as regards all important
symptoms." The eighth day from attack I resumed my duties,
though much debilitated and without appetite. As sequelae were
oozing of blood from my gums, a continuous headache, and a
protracted diarrhoea. During the first three or four days of my
sickness, though realizing the impropriety and danger, I could
not resist the impulse to throw off the clothing and attempt to
get out of my berth, and I had recourse to various expedients to
divert the attention or send away the attendants that I might
accomplish it; although with the constant dread of exciting vomiting
thereby, I could not restrain myself from large draughts if liquids
were left within my reach ; any, however, that were sweetish were
particularly distasteful. Desirable as it is that the fullest and
most minute observations be given by physicians of unusual dis-
eases they may have survived, I regret, on that account, that dur-
ing the progress of yellow fever in my instance the interest and
attention, so far as consciousness was complete, were most
decidedly personal and very little professional. Dr. Marsh Ae-
clared me to be a most troublesome patient.

Following is Dr. Marsh's record of the case of George Bradley,
corporal of marines, aged 25, and very athletic, who, an hour and a
half after my seizure, had a chill lasting over an hour, during which
he was delirious. Copious perspiration followed after the hot mus-
tard-bath, and his mind became clearer. Pains in head, back,
and legs very severe, also in thorax. White vomiting soon oc-
curred, afterward it was bilious, and at evening dark. Was given
a mercurial purgative, had cut-cups to neck and back, and flying
sinapisms were employed. Throughout the night he was very rest-

192 YELLOW FEVLR ON BOARD THE JAMESTOWN.

less; voided his urine naturally. April 28th eyes suffused; mind
wandering. Repeated cut-cups to nucha, and gave hot soups and
stimulants. No remission of fever, and he again vomited black
matter. 29th eyes yellow; eruption out on forehead and neck.
Appetite good. Black-vomit, with hiccough, set in at half
past 9 o'clock in the morning, and recurred six times during
the day and evening. Was given ether one drachm, after each act,
which afforded temporary assuagement. 30th, five ejections of
black-vomit occurred during the day; hiccough at intervals;
mind clear ; pulse quick and feeble. Milk-punch was given every
hour by enema. Abdomen tympanitic; applied a poultice of
mustard and vinegar, and gave forty drops of tincture of opium
by enema. May 1st, black-vomit and hiccough recurred at 10
o'clock a. m. with great thirst, and he became delirious at 2
o'clock; later he passed a perfectly white clayey stool, and
gulped up a large quantity of black-vomit ; he continued uncon-
scious, with short and labored respiration, until evening, when he
died on the fourth day.

Two and a half hours after my attack, and one after Bradley's,
Mr. Leakin Barnes, acting ensign, was similarly and as suddenly
taken. His chill was prolonged, prostration and pains were ex-
cessive, and the matters vomited were white at first and afterward
streaked with blood. The eruption, which was quite extensive,
appeared the third day. He convalesced favorably. Treatment,
very nearly as described in preceding cases. This officer was an
inveterate smoker, and also a chewer, but after recovering from
this disease his taste for tobacco was entirely lost, nor had it re-
turned when I last saw him, the following year.

April 29th, Charles Brown, ordinary seaman, was seized. He
described his pains as "wicked." The disease progressed rather
mildly ; the diagnosis, however, was fully confirmed, and on the
7th of May he was convalescent.

> William J. Rotham, carpenter's mate, aged ^2, of saturnine
habit, was the next attacked, on the 3d of May. The third day
afterward the secretion of urine was arrested, and black-vomit set

YELLOW FEVER ON BOARD THE JAMESTOWN. 1 93

in witli delirium. He died May 9th, the sixth day. The erup-
tion was present, and petechial on abdomen. No albumen in
urine. Treatment very similar to Bradley's.

Edward Slackford, ordinary seaman, was seized with a severe
chill followed by fever, pains, nausea, etc., at 1 o'clock p. m., and
George Thompson, private marine, at 4 o'clock the 5th of May.
The eyes of both were congested and pinkish; both vomited
white and bilious matter in the evening, and became delirious.
All of their symptoms were very similar, save that Slackford's pros-
tration was the more excessive, and his delirium lasted the longer.
Their nausea and vomiting continued, and at the same instant,
in the evening of the 8th, each ejected about a quart of black
vomit. The eruption appeared on both, and their eyes and skins
were yellow. No albumen was detected in the urine of either.
On the fifth day a favorable change occurred with each, though
both were greatly prostrated, and Slackford wonderfully emaciated.
Thompson was discharged to duty May 2 2d, and Slackford 24th.
Treatment, as hereinbefore particularized — nitrate of potassa, after
diaphoresis was excited, and after purgation and stimulants
p. r. n.

Peter Sullivan, captain of the forecastle, in the evening of the
10th of May, experienced sudden prostration, with frontal head-
ache and pain in back and legs ; his eyes were dull, skin damp,
pulse sluggish, tongue pasty. Soon after he had a chill, suc-
ceeded by fever and vomiting of white and bilious matter, and
the pains in lumbar regions became intensified. The eruption
appeared in due time, and the disease subsided as in regular
course. No trace of albumen in urine. He was discharged the
19th, but in four hours relapsed. By the 24th he was well enough
for duty. The treatment was employed which had almost become
"stock."

Edward Smith,, apothecary, a youth of 19, accompanied me
from New York, accepting his appointment, knowing of the pes-
tilence to be encountered and of the great danger to an unaccli-
mated person suddenly migrating from a northern winter to an
13

194 YELLOW FEVER ON BOARD THE JAMESTOWN.

infected ship in the tropics. With a view to prophylaxis I gave
him two grains of quinine, morning and evening, during the week
after our 'arrival, and pil. hydrarg., gr. v, at intervals of ten or
fourteen days ; also five grains of nitrate of potassa with the qui-
nine. This course was resumed for a few days at a time at irregular
intervals for two months, and stimulants were occasionally given
when his duties were more than usually fatiguing. Regular bathing
was practiced. But, in the evening of May nth, he was seized
with typhus icterodes. We put him into the hot mustard-baih,
and gave pil. hydr., after which high fever came on, and his mind
wandered. White vomiting occurred several times, his thirst was
urgent, and he complained of a burning sensation in his throat.
Flying sinapisms and bottles of hot water about his body excited
but slight diaphoresis. Took three cut-cups from nucha. The
pains were unrelieved, and he slept none; a burning fever continued
all night. Next morning warm saline enemata produced but one
small stool; the mercurial was repeated, and three cut-cups were
taken from his lumbar region; his head was hot, pulse 120,
tongue seared. In the afternoon the hot mustard-bath was re-
peated, inducing diaphoresis and moderating the fever and pains.
Gave him claret and gum-water ad libitum ; also ten grains of nitrate
of potassa every two hours, which was retained, though food ex-
cited vomiting. In the momentary absence of the nurse he got
up, prepared and swallowed about two drachms of citric acid in
six ounces of Tarragona wine. May 13th, 2 o'clock a. m., fever
and delirium increased; skin like a " stove-pipe;" bowels un-
moved; repeated the saline enema without result At 4 o'clock
he became quite unmanageable; two more cups were taken from
nucha and three drachms of potassa? bitartras administered; after
this he slept for a short time, the first since attacked, and his
urine was voided involuntarily. The nausea ceased so that he
ate a little tapioca; he took also milk-punch every hour, and
ten grains of nitrate of potassa every two hours. But soon the de-
lirium increased, and his head rolled from side to side, with pupils
widely dilated. At half past 9 o'clock gave a turpentine enema

YELLOW FEVER ON BOARD THE JAMESTOWN. 1 95

without effect. Abdomen tympanitic ; rubbed it over with cro-
ton-oil and applied a large blister. Three drops of croton-oil
were placed upon his tongue ; but no movement resulting, at 2
o'clock p. m. gave him another turpentine enemax when half an
hour afterward there came away in his cot a large quantity of black
offensive feces, and in the night he had two more involuntary
evacuations, black and very offensive. His delirium became so
violent that we were obliged to anaesthetize him, in which condi-
tion he rested an hour and a half. May 14th, not a very favorable
indication; five ounces of bright-yellow urine were drawn by
catheter ; none had been voided in twenty-four hours ; it con-
tained no albumen. At 5 o'clock p. m. black-vomit appeared,
and recurred repeatedly and profusely in the night. He died
early in the morning, May 15th, the fourth day.

Mr. Robert H. Carey, acting ensign, aged 36, was seized with
chill and pain in head and back just before midnight, May 13th,
and soon after vomited white and bilious matter, and the vomit-
ing was repeated several times before morning. Copious diapho-
resis was induced by covering him with blankets and giving hot
drinks. R. — Pil. hydr., gr. xx. Statim.

14th.— He had high fever, frontal headache, pains down inside
of thighs and legs, great thirst ; his eyes were congested and pink-
ish, tongue white and flabby, pulse full, though not much accel-
erated. Four ounces of blood were taken by cups from his nucha,
and he was given one drachm of nitrate of potassa during the
day. At evening he had three black stools, and was stupid and
somnolent.

i$th. — He had slept all night, and was aroused with difficulty
in the morning, when he complained as on the previous day.
The general appearances were unchanged ; skin and kidneys se-
creting; bowels free.

16th. — Still very somnolent. Eyes and skin yellow ; eyeballs
painful; no appetite ; eruption out on neck and arms. Continued
the nitrate of potassa, but no stimulants were given. He com-
menced convalescing the 17th, and the 2 2d was recovered.

196 YELLOW FEVER ON BOARD THE JAMESTOWN.

Thomas Toner, landsman, aged 20, and slender in habit, was
seized with a chill at half past 2 o'clock p. m., May 15th, and had
the characteristic pains, with constant nausea. His left eye was
merely suffused, while the right was entirely pink. The sight of
the latter had been destroyed some years before, but in health
the appearance of both eyes were similar. Ordered for him the
hot bath, purgative, and nitrate of potassa.

16th. — He had considerable fever, but his pains had diminished
to a sense of general " soreness of flesh." Pulse was feeble and
quick ; appearance of eyes unchanged ; skin moist ; urine voided
naturally. Continued the nitrate of potassa, with stimulants.

On the 17th there commenced a general improvement, and
from that date progressed favorably, and patient was discharged
May 23d. The eruption appeared on neck and chin.

Peter Harmes, ordinary seaman, aged 24, and a stolid Teuton,
was attacked suddenly, and at the same time with Toner. There
were great prostration, prolonged chill, and intense pains. High
fever followed after the bath. Nausea was constant, and fever
with a " stove-pipe skin" continued throughout the night. Gave
him twenty grains of nitrate of potassa every two hours, and took
blood from nucha by cups.

1 6tk. — Bowels purged by calomel given at the first ; no mod-
eration of the fever ; nausea distressing. Continued the nitrate
of potassa.

iyt/i. — Stupor and nervous depression; eyes yellow; tongue
black; neuralgic pain in testes ; nausea unrelieved. No urine
had been voided in forty-eight hours. Drew off by catheter nearly
.a quart, which yielded an abundance of albumen. Continued
the treatment.

19//Z. — A decided improvement commenced and continued. He
was discharged May 27th. The eruption appeared on face and
neck.

William Martin, steerage-cook, aged 22, was attacked before
daylight, 17th of May, and all his symptoms were grave. Em-
ployed the hot mustard-bath, bottles of hot water, and gave purga-

YELLOW FEVER ON BOARD THE JAMESTOWN. 1 97

tive dose of calomel. High fever continued all day with great
thirst, nausea, vomiting, and prostration. He took fifteen grains
of nitrate of potassa every three hours. At evening white vomit-
ing recurred, and the heat of skin and pain in head increased.

i8f/i. — He passed the night very restlessly; stupor had ad-
vanced ; skin yellow and dry, and emitted a musty and offensive
odor ; tongue dirty yellow, and denuded at edges ; pulse excited
and irregular. He was again put into the hot mustard-bath, the
nitrate of potassa continued, with milk-punch ad libitum. He
became delirious at evening, and his urine was albuminous.

19///. — No improvement; eruption thick on face and neck;
medicine and stimulant continued as on preceding day.

20th. — Hemorrhage from mouth and nose occurred, and black
vomit appeared at half past 10 o'clock a. m., and recurred sev-
eral times during the day and evening. Delirium and hiccough
also continued, and convulsions supervened before death, which
resulted early in the morning of May 21st, the fourth day after
his attack and our forty -ninth day at sea, in which time we had
experienced twenty-six days of heavy rain, and the average daily
temperature had been — maximum, 850.7 ; minimum, 8o°.3 F.

Henry Duell, ordinary seaman, was attacked May 19th, early
in the morning, and pretty severely. Treatment was after the rou-
tine of cases, subsequent to leaving Panama. A decided and unu-
sual improvement occurred during his second day of illness,
though the distinctive features of yellow fever were observable.
The favorable change I attributed, in a good measure, to a dim-
inution of ten degrees in temperature.

The last case was developed May 23, in latitude 220 35' north,
longitude 12 6° west. Temperature, maximum, 7 20; minimum,
68°. John Smith, quartermaster, was the subject. He was taken
with a chill, followed by nausea, supraorbital headache, congested
and pinkish eyes, incrusted tongue, severe pains in limbs and lum-
bar region, and fever of moderate character, which was main-
tained without any variation for two days. The fourth day his
eyes and skin became yellow. He was discharged to duty May

J90 YELLOW FEVER ON BOARD THE JAMESTOWN.

28, our fifty-sixth day from Panama. San Francisco was reached
June 7, and our pilot's was the first sail to greet our eyes through-
out that memorable passage of sixty-six days.

Thus succinctly are presented the inception, progress, and ter-
mination of as malignant an outbreak as our service has endured.
Forty-eight cases and twenty-one deaths are enumerated, of which
nineteen had developed before my arrival, and thirteen of them
had fatally terminated ; twenty -nine cases, with eight deaths, sub-
sequently resulted, twenty of which, and six deaths, occurred at
sea. In regarding this summary, it is noticeable that three per-
sons died without having had black-vomit or suppression of urine ;
one who died was ptyalised at an early stage of the disease ; six
recovered after having black-vomit ; three survived in whom the
secretion of urine was arrested ; eight recovered having been de-
lirious ; after hemorrhage from mouth and nose five recovered ;
nine had black-vomit stools, of whom seven died; the urine of
eleven patients was tested for albumen, and it was found but in
two — one of those two patients died. Possessing but a small quan-
tity of nitric acid, and no test-tubes, we were unable to render
fuller statistics in that particular. Had the means for hypodermic
medication been possessed, much more suffering could have been
alleviated than our resources afforded. Should duty again cir-
cumstance me as in the instance recounted, I would hardly em-
ploy a less effectual and prompt cathartic than crcton oil. Mer-
curials were not obviously beneficial. I could not discern any
utility from the administration of quinine, and early discontinued
its employment, though on board the Dacotah, in 1862, its effi-
cacy was very marked ; but before the epidemic in that ship our
crew had suffered severely from malaria, encountered during the
summer up the James River, while co-operating with the Army
in the first peninsular campaign. But those manifestations were
quite different from these of the Jamestown, and were much
milder in type. On the Dacotah we had twenty-five cases, and
not one was lost ; in two only did black- vomit appear, and only
in about half of them were displayed the characteristic discolora-

YELLOW FEVER ON BOARD THE JAMESTOWN. I 99

tions. Beyond the modifications first before suggested, I would
not depart from my line of treatment pursued. Especially effica-
cious seemed the agency of the nitrate of potassa as an elimina-
tor of the specific poison by its diuretic and diaphoretic action,
and not in a single instance did it seem to incite or increase
visceral irritation. The moment for commencing stimulation, and
the extent to which it may be carried, cannot be indicated by any
general rule, and can only be judged by the particular condi-
tions in each individual case.

Some further observations than the few hereinbefore given
respecting topography and meteorology may be relevant and
appropriately introduced here.

The walled city of Panama occupies a small peninsula about
half a mile long by one-quarter in width, extending easterly from
the bases of Mounts Ancon and Gabilan. The walls are crumbling
in many places, and the western line and portion have been pulled
down, and the wide and deep moat filled in for roadway-crossings
in some places, but generally it is only piled and choked up with
deposits of rubbish and filth. Within the city proper is a popu-
lation of from three to four thousand, and nearly the same number
inhabit the arrabal, or collection of miserable abodes, which ex-
tend like excrescences from the walls. Drainage is unknown.
Even the water for drinking and culinary purposes is brought in
on donkeys from a stream by no means taintless, outside the city
limits. Water for the shipping, however, and with which we were
supplied, is obtained from a stream on the island of Toboga, nine
miles away to the southward, and, though reputatively very pure,
is somewhat questionable to those who have observed the laundry
and bathing operations along its coast, as, descending from the
mountain, it lingers in shady and convenient pools. Scavengers
are wanting, too, in Panama, save the buzzards ; and the habits,
persons, and dwellings of the lower orders (most interminably
mixed as to blood), both without and within the walls, are repug-
nant and filthy. Disgusting odors assail the nostril at every
turning, and the visage and demeanor of the denizens in general

200 YELLOW FEVER ON BOARD THE JAMESTOWN.

bear evidence of the perniciousness of their climate and its ener-
vating effect. The tide rises fully twenty-two feet up to the city
walls, but in receding leaves bare long edges of volcanic rock
and coral with sand patches between, which afford lodging-places
for offal and other refuse thrown out. Upon the ramparts, turn-
ing from the charming view of the islands which, under the en-
chantment of varied distances, adorn and diversify a bay next in
celebrity after Naples and Rio, there is afforded a vista even
more attractive — of mountains and gigantic forests, of valleys
and jungles impenetrable, of lagoons within savannas on which
half- wild herds are grazing; and where the foliage is rankest and
flowers most gaudy are hidden the bayous with their slimy
banks; and there, too, beneath the damp shade of the profuse
vegetation which decomposes under the influences of moisture
and a constant summer heat, is the lair of intensest miasm.
The whole Isthmus is its habitat and has been for years, and
undoubtedly will be to the end of time, and from no part or
place has it been or can it be excluded. Acclimation is impos-
sible ; no one, of whatever race or country, who becomes a resi-
dent of the Isthmus escapes disease; not even are beasts exempt,
and nothing but change of climate can eradicate the effects of the
poisoning from that malaria. Intermittent, remittent, bilious,
and congestive fevers and dysenteries are the usual results of the
climatic influences, but under intenser excitation yellow fever ap-
pears. The belief is well grounded that yellow fever never leaves
certain localities which it has once invaded and where the condi-
tions for its existence are constantly maintained. It may seem
dormant for a time, or only sporadically evincing its vitality be-
fore it rouses itself and appears epidemically. I know that it
existed at Panama, at Toboga, and among the shipping of the
bay while I was attached to the frigate Merrimack on the Pacific
station in i857~'59, and that it has played havoc in each of those
^designations several times since. At Aspinwall, when e?i route to
the Jamestown, the late Dr. Kluge (victim at last to the Isthmus
malaria) told me that he had recently treated ten employes of

YELLOW FETER ON BOARD THE JAMESTOWN. 201

the railroad company who had yellow fever, and eight of them
died. And at that time the numerous deaths along the line from
Aspinwall to Panama were exciting special comment, though
they were attributed to bilious, congestive, remittent, and inter-
mittent fevers ; or by two or three or more of such nosological
combinations of terms a nomenclature was provided less oppugned
to lucre than yellow fever, but none the less fatal to human
existence. The evidence of the direct transportation of the yel-
low fever from Panama to the Jamestown is clear and indispu-
table, though for my temerity in maintaining that proposition,
and for intimating that the Isthmus has not par excellence the
most salubrious of climes, I drew upon myself the maledictions
of the two Panamanian newspapers — the organs respectively of
the two great commercial enterprises — in which leaders with
emotional headings established, " The health of Panama," and
vituperated, " The Jamestown's surgeon." Even a fi member of
the Royal College of Surgeons, England," in the employ of a
third commercial organization, under his distinguished sign-man-
ual published and proclaimed the sound sanitary condition of the
Isthmus. The pestilence was conveyed, unquestionably, from
the shore to the ship three miles out of the bay, first, by Mc-
Soley and Hanson, the marines who were on duty at the store-
house in one of the most unhealthy locations in Panama from
December 8th to the 19th, at which last date they were returned on
board with their bags, hammocks, and accouterments ; and that
night of the 19th McSoley was attacked with yellow fever, and
Hanson on the following 21st of January; secondly, by Gicquel,
who hadbeen on shore for several days and nights doing some work
for the commanding officer, and who, December 23d, was brought
on board and confined under the sentry's charge ; one week after-
ward he was attacked with yellow fever and died. The propa-
gation of the pestilence was consummated on the orlop-deck,
where McSoley and Henson stowed their effects and slung their
hammocks; where McSoley remained through his sickness;
where Gicquel was confined, where he worked at the bench, where

202 YELLOW FEVER ON BOARD THE JAMESTOWN.

he was taken sick and remained until the day before his death,
when he was removed to the gun-deck ; where Sergeant Max-
well was sick, and where he and the other marines who had the
fever slept ; where the cells were from which the four patients
were relieved January 18th; where some of the infected clothing
of the first three victims probably was stowed after their deaths,
and its distribution among the ship's company ; where Anderson,
attacked March 5th, worked at the bench; and where afterward
worked Rothman, who died; and where Nelson had been con-
fined for five days just before -his seizure. In other localities the
ferment seemed also to linger; for instance, I succeeded to Dr.
Duvall's room and disease; after Mr. Bates' death Ensign
Barnes occupied the paymaster's room, and had the fever; Mr.
Carey was attacked in the room next to the one in which Mr.
Adams died, and with which there was communication through
the bulk-head ; the officer who took Mr. Adams' room had had
yellow fever, and hence escaped. The attendants upon the sick
suffered to an extent that almost typified contagion. Dr. Duvall
was among the early sufferers (Dr. DuBois, having had the dis-
ease in the Gulf of Mexico, was an exempt almost to a certainty) ;
Miller, the constant nurse up to March 13th, was then stricken
down ; my attack came next in order ; then Edward Smith, the
apothecary, sickened and died; and last Bradley, who was act-
ing apothecary when I arrived with Smith, and who was retained
as nurse and assistant in the dispensary until his fatal sickness.

It is pertinent, in considering the portableness of yellow fever,
to cite the instance of the mail-steamer Golden City, which ar-
rived at Panama March 4th, and the same day an officer of the
Jamestown removed his wife from their lodgings on shore to the
steamer for passage to San Francisco. Each day there was com-
munication between our ship and the steamer, and a quantity of
luggage was transferred from the former to the latter. The
^Golden City sailed on her return trip March 10th, but before
reaching Acapulco the servant that attended the room occupied
by the officer's wife (and by the officer also at Panama) died of

YELLOW FEVER ON BOARD THE JAMESTOWN. 203

yellow fever ; and three other cases and two more deaths re-
sulted before the cold latitudes were reached. It is possible that
the "ferment" was received on board from the shore, but more
probably it was carried from our ship — a question distressing to
the parties who innocently but unwarily were thus concerned in it.
It is to be remembered that the rainy and sickly season ended
before the pestilence broke out on the Jamestown, and that her
stay at Panama was in the dry or healthy period, the climatology
of -which I daily observed and considered; and as evidence of
its general phenomena, I noted that the average daily tempera-
ture during the first quarter of 1867 was (F.) 78°.2 at 6 o'clock
a. m., 84°.2 at noon, 8i°.q at 6 p. m., and 79°.i at midnight.
There was an absence, for the greater part of the time, of north-
erly winds, which are commonly prevalent throughout the dry
season, and rain-showers occurred quite frequently, so that the
unpleasant dampness and moldiness penetrated everywhere —
into books, bedding, clothing, and packages, no matter how
secured. The atmosphere was sultry and stifling, and earth-
quakes, though slight, were not infrequent. In name only was
the season either dry or healthy. At San Francisco I was per-
mitted by the health-officer of the port to examine the sanitary
reports furnished him by the surgeons of the Panama steamers
©n their arrival. I do not remember an exception but that, on
every return voyage, for months from and after December, 1866,
cases of yellow fever, or some exceedingly suspicious diseases,
were returned ; and the same held true at the port of New York.
I have in preservation a formidable list of deaths which resulted
from crossing the Isthmus in the ordinary line of travel during
that year of 1867. An officer on board the United States steamer
Resaca, at Panama, July 1st, 1867, wrote me that "the fever
still continues here ; deaths five per diem just now. One by one
the strangers are picked off. The Panama Mail Steamship Com-
pany's steamer Montana had several cases, and lost two engi-
neers just before leaving here last trip. The Bolivia (Columbian
man-of-war) has it on board, and we have ceased all communica-

204 YELLOW FEVER ON BOARD THE JAMESTOWN.

tion with the shore." Ten days afterward, the commanding
officer of the Resaca reported that " the fever had appeared on
the ship, and that, by advice of the medical officer, he should
leave immediately for a cold climate; that it was very fatal
among foreigners and the troops ashore ; and that the surgeon of
Her Britannic Majesty's steamer Scout had just died of it."
(Nineteen others also died on board the Scout before she reached
Esquimalt, Vancouver's Island, for which port she started at the
instant of the appearance of the yellow fever among her people.)
The Resaca drove northward under full steam, but before gaining
the harbor of San Francisco, sixty-eight of her crew were stricken
down and seventeen corpses hove overboard.

The Jamestown and Resaca were ordered to Sitka for disin-
fection by cold, and I rejoined my ship there in October, about
a month after her arrival ; and the following month I certified that,
in my opinion, any cause sufficient to repropagate yellow fever
within the Jamestown had ceased to exist; that frost or a low-
temperature, when continued a sufficient length of time, will
effectually destroy the "ferment;" and that I considered that a
sufficient length of time had elapsed. The Resaca returned south
in January, and, though she has been employed in the tropics a
good share of the time since, has not had another case of the fever.
We, in the Jamestown, passed the winter in Alaska, and sailed from
Sitka the last of May for Puget Sound, and thence to the Mare
Island navy-yard, where our scarred veteran was dismantled.

The following winter, on returning to the island, I found the
Jamestown refitting for sea; and though during her winter in
the boreal regions she had been thoroughly broken out, cleansed,
dried, and whitewashed three separate and several times, it was
insisted upon as necessary that she should be "steamed," and
accordingly was put through that process. She sailed finally on
her cruise and into the tropics, where she has since been prin-
cipally employed and now is, without having contracted any un-
usual sickness on board.

320 Clermont Avenue, Brooklyn, May, 187 1.

AN ACCOUNT

THE -EPIDEMIC OF YELLOW FEVER WHICH APPEARED ON
BOARD THE UNITED STATES SHIP SARATOGA,

IN JUNE, 1869.

LEWIS S. PILCHER, M. D

PASSED ASSISTANT SURGEON, U. S. N.

AN ACCOUNT OF THE EPIDEMIC OF YELLOW FEVER
WHICH APPEARED ON BOARD THE UNITED STATES
SHIP SARATOGA, IN JUNE, i86g.

By Lewis S. Pilcher, M. D., Passed Assistant Surgeon, U. S. N.

The United States ship Saratoga, third rate, came to anchor
in the harbor of Havana, May 10, 1869, having left New York
on the 2 1 st of April previous. Her complement of officers and
men comprised 17 officers, 105 men, 78 naval apprentices, and
24 marines; in all, 224 souls. She remained at Havana, not
changing from her original anchorage, till the 7th of June fol-
lowing, when, cases of yellow fever having appeared on board
with two deaths, she put to sea. Prior to leaving, a medical
officer was transferred to her from the United States steamer
Penobscot, on account of the death of her own surgeon. She
arrived at Key West, Florida, June 10th, whence she set sail the
following day, June nth, under orders to proceed to Portsmouth,
New Hampshire. Owing to the rapid extension of the disease,
she put into New York, arriving there June 20th. During the
passage from Key West to New York three deaths occurred.
Immediately on arriving at the lower quarantine-station in New
York Bay, the sick, sixteen in number, were transferred to the
hospital-hulk Illinois. Seven new cases reported on the 21st,
and one on the 23d; these, with one exception, were also trans-
ferred to the Illinois.

At noon of the 23d, the United States steamer Frolic was
towed down from the navy-yard, and the entire remaining ship's
company transferred to her. The crew received an entire change
of clothing, but were obliged to take with them their old ham-
mocks, blankets, and mattresses. The officers were allowed to
take their bedding and only the clothes they had on at the time.

208 YELLOW FEVER ON BOARD THE SARATOGA.

The Frolic was anchored near the Illinois, and the officers and
crew of the Saratoga retained on board of her, in quarantine, until
July 7th, but two more cases of fever appearing during that time,
one on the 24th, and one on the 28th of June. They were re-
lieved from quarantine July 7th, and transferred to the receiving-
ship Vermont, at the navy-yard. During the course of the epi-
demic, thirty-seven cases occurred, with seventeen deaths.

In the harbor of Havana, during the spring and early summer
of 1869, at the same time with the Saratoga, were the United
States steamers Albany, Narragansett, and Penobscot. The first
of these, with one or two short intervals, had been there since
November 15, 1868; the two latter had been either in the harbor
of Havana itself, or in neighboring ports of Cuba, since the be-
ginning of March. The Albany and Penobscot were in port
at the time of the outbreak of the epidemic on the Saratoga. Of
these vessels the Saratoga alone, at this time, was visited by the
disease, although later in the season, on both the Albany and the
Narragansett, a few cases occurred, and on the Penobscot, which
left for the north at the same time with the Saratoga, seven cases
reported as remittent fever, none fatal, occurred before reaching
Portsmouth, New Hampshire.

During the summer of 1869, yellow fever was prevalent through-
out the West India Islands, but not to such an extent as to be
considered in any place as epidemic. Out of the seven vessels
constituting our squadron in those waters at the beginning of the
summer, but one escaped its attacks.

During the year there occurred in all throughout the squadron
thirty-one cases of yellow fever,* exclusive of those on the Sara-
toga, with seven deaths, being a percentage of deaths to cases
of .22, or one death in every 4.43 cases.

The Saratoga, first visited, suffered the most, both in number
of cases and in their malignancy, the percentage of deaths in the
jthirty-seven cases being .46, or 1 death in every 2.17 cases.

*La Roche, in his work on yellow fever, vol. i, p. 533, gives statistics of
epidemics on twenty vessels, in tropical regions, gathered from published ac-
counts, which give an average of 1 death to every 3.46 cases.

YELLOW FEVER ON BOARD THE SARATOGA.

209

The following table shows the number of cases of yellow and
remittent fever, respectively, that occurred on each of the vessels
of the West India squadron during the year 1869, as reported :

Vessels.

REMITTENT FEVER.

YELLOW FEVER.

Cases.

Deaths.

Cases.

Deaths.

23

9

1
8

14
8

3

Narragansett

Gettysburg

14

7

Penobscot

37

17

Total

53

68

There can be little doubt but that some cases, which were es-
sentially identical with those reported as yellow fever, but which
did not progress to a fatal termination, and did not manifest the
worst phenomena of that disease, especially at the first appear-
ance of the disease, before its true nature was recognized, were
called and reported as cases of remittent fever. If so, and these
cases could be placed in the proper column, the number of cases
of yellow fever that really occurred in the squadron would be
much increased, while the death-rate, as compared with the cases
in general, would be diminished. However, the figures as re-
ported render sufficiently prominent the exceptional severity of the
disease, as manifested on the Saratoga.

No reason why the disease should have appeared sooner, and
in a more malignant form, on board the Saratoga than on board
her consorts, can be found in the condition of the ship itself;
which, on the contrary, was such as would tend to render it the
least liable to become infected, and which afforded surroundings
the best adapted to the care and favorable progress of such as
should be attacked, should disease make its appearance. She was
roomy and comfortable, well ventilated and lighted, and a model
of neatness and cleanliness throughout. The 7?iorale of the ship's
14

210 YELLOW FEVER ON BOARD THE SARATOGA.

company was excellent, and its general health unusually good.
For six weeks previous to the appearance of the first case of yel-
low fever, there had 'not been a single case of sickness on board,
even of the most trivial character. But though the ship itself
was in this excellent condition, the circumstances in which it was
placed were such as by their combination could not but be potent
agencies in the production of the results in question. These were
the season of the year and the non-acclimation of the ship's com-
pany, and the special evil influences pertaining to the harbor of
Havana, and particularly to that part of it in which the ship was
anchored.

In the latter part of May begins in Havana the so-called un-
healthy season, which extends through the summer and into the
fall, to the last of November, At the very beginning of this season
the Saratoga arrived from the north, with a crew entirely unaccli-
mated, a time when the general climatic influences, at all times
unfavorable to the unacclimated, tended most to the production
of the special diseases incident to them. The harbor of Havana
is a land-locked bay, surrounded on all sides by hills, except at a
point on its northern aspect, where it communicates with the sea
by a narrow channel. Its northeastern boundary is a narrow pen-
insula, less elevated at its junction with the mainland than in the
rest of its course, permitting the prevailing easterly breezes to reach
the harbor. The usual rise and fall of the tide in the harbor is
very slight, while the only communication between the bay and
the sea is narrow and somewhat tortuous ; these conditions cause
the harbor to assimilate in character to a great stagnant pool. The
bay receives the water shed from the surrounding hills, the drain-
ings from the village of Regla, on its southern shore, and the
contents of most of the sewers of the city of Havana. From the
shipping with which it is crowded during the greater part of the
year it receives additional filth. These causes render its water
very foul, and its stagnation favors the putrefaction of the filth
which it contains, which process is hastened and aggravated by
the uniformly high temperature at which the water is kept by the

YELLOW FEVER ON BOARD THE SARATOGA. 2 1 I

conjoined influences of the Gulf Stream and the tropical sun. The
effects of this are somewhat counteracted, during the so-called
healthy or dry season, by the constant sea-breezes prevailing, and
by the dryness of the atmosphere; but during the remainder of
the year, when the sea-breezes fail, and at times are replaced by
debilitating land-breezes, when the atmosphere is saturated with
moisture, an opposite result obtains — the air becomes laden with
the products of decomposition, and a high degree of virulency
favored in their effects. The Saratoga, arriving at the beginning
of this latter season, was anchored on the west side of the harbor,
within a stone's throw of the quay lining the shore, and in close
proximity to the track of a line of ferry-boats. The sea-breeze
could reach her only after passing over the whole bay, becoming
necessarily laden with its exhalations. The constant superficial agi-
tation of the water in the immediate neighborhood of the ship by
the ferry-boats favored, in an eminent degree, the rapid decom-
position of the already putrescent matter contained in it, and the
disengagement of the noxious effluvia resulting. In this position,
without shifting her anchorage, the ship remained from May ioth
to June 7 th, when she put to sea, stricken with yellow fever.
Three cases occurred nearly simultaneously : two on the 2d of
June, those of Surgeon Quinn and Lieutenant Lamberton, and
one on the 3d, that of Private Bowler. No further cases occurred
till June 7th, when two more persons were attacked. Of these
three cases, occurring nearly simultaneously, the habits, circum-
stances, and relations of each differed greatly, agreeing only in
the one point, that they were all equally exposed to the general
evil influences already named, pervading and surrounding the ship.
Her two consorts, the Albany and the Penobscot, were anchored
in another part of the harbor, and both escaped untouched by the
disease at this time, unless the febrile cases, mentioned as having
occurred on the Penobscot, be considered as essentially identical
with those on the Saratoga, though milder in degree. All the
cases that occurred on the Saratoga, thirty-seven in number, are
exhibited in the following general tabulated statement :

212

YELLOW FEYER ON BOARD THE SARATOGA.

u

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2I5

An examination of these cases gives the following

Total number of-

Per cent, of
deaths to
cases.

Officers

Men

Apprentices . -

Marines

Souls on board

Earliest period of death, third day ; latest period of death, tenth
day ; average period of death, fifth day.

Black- vomit occurred in 14 cases; recovery after black-vomit
in 1 case ; epistaxis noted in 5 cases ; recovery after epistaxis in
1 case ; particulars unascertained in 2 cases.

From the time that the ship left Havana until the evening of
the 13th, a space of six days, no new cases occurred. During
this time there was a succession of days of fine weather; a gentle
breeze from the northeast prevailed. All the hatches and air-
ports were kept open. Those already ill progressed favorably,
and the hope was entertained that the disease had been checked.
A new case in the evening of the 13th, and two more the next
morning, re-awakened apprehension. During the afternoon of the
14th the weather experienced a rapid change, becoming cold and
stormy, with rain and wind. This continued through the night
and the next day, necessitating the closing of the hatches, thus ren-
dering the air of the vessel close and bad, while, at the same time,
much necessary exposure to the inclemencies of the weather resulted
to the officers and men. Although the ship made north of Cape
Hatteras on the 15th, and the weather again became fine, with
cool and refreshing breezes, the rapid extension of the disease
dates from that day. Six cases on the 15 th, one on the 16th,
four on the 17th, three on the 18th, two on the 19th, and three
on the 20th, successively appeared. Of these, two died before
reaching New York, while a third, Lieutenant Flagg, expired
just before the ship came to anchor. In many of these cases, in

2l6 YELLOW FEVER ON BOARD THE SARATOGA.

addition to the general influences, acting as predisposing and
efficient causes, it was possible to trace special exciting causes
which determined the attack. Thus, in one case, an officer,
while perspiring freely, became chilled by sitting in a draught of
air; four hours after the fever was fully developed. Another,
returning from the deck with his clothing wet with rain, neglected
to remove it at once, sitting down for some time in his damp gar-
ments; an attack of the disease followed almost immediately.
Another, after the arrival of the ship at Xew York, indulged once
in liquor to intoxication. His debauch left him laboring under
the fever, which resulted in his death. In the last case that oc-
curred, that of the boy Pratt, on the Frolic, five days after the
transfer from the infected vessel, he had lain down to sleep in a
gangway of the vessel, where he became chilled through during
the night. As a result, there followed a typical case of yellow
fever, the stages well defined, and the icterus attending conva-
lescence very marked.

In most of the large number of cases which occurred on
the 2 1 st, seven in all, particular causes of similar nature to those
already given can be traced to which they may be referred. The
large number of cases occurring on that day, and their almost
complete cessation from that time, is somewhat remarkable, and
seems to indicate the utility of the measures for disinfection which
were adopted, and especially to be due to the speedy removal of
the men from the infected ship to one free from such taint. In
the circumstances attending the cases of yellow fever on this ves-
sel, there were none which indicated that the disease was in any
way propagated by contact with the sick, or by exposure to the
emanations or secretions from their bodies. On the contrary,
those who were most about the persons of the sick escaped entirely.

The apothecary and four nurses, all unacclimated and unpro-
tected by a previous attack of the disease, who were with the sick
continually, night and day, and, in some cases, unavoidably re-
ceived upon their persons matters vomited by the dying, were
none of them attacked.

YELLOW FEVER ON BOARD THE SARATOGA. 217

Commander Whiting, who filled his cabin with the sick officers,
and who was constantly among all the sick, encouraging them by
cheerful words and aiding them by his attentions, was one of the
two commissioned officers on board the vessel who alone escaped
the disease.

The medical officer* received from the Penobscot was able to
resist the disease till after the arrival of the vessel at New York,
when, consequent upon exposure for some time to the hot sun in
passing from the Saratoga to the Illinois, and upon unusual exer-
tion in superintending the removal of certain of the sick, and upon
reaction from the mental strain of the preceding two weeks by the
transfer of all care to others, he was attacked, the circumstances
giving no support to any theory of contagiousness in the disease.

This officer was succeeded by Surgeon H. M. Wells, tempora-
rily detached from the New York Naval Hospital, who, trans-
ferred with the rest from the Saratoga to the Frolic, remained
until their release from quarantine. During this time he spent much
of each day on board the hospital-hulk with the sick, being assidu-
ous in his attentions to them, without contracting the disease.
Further, notwithstanding the number of the sick transferred to the
Illinois, not one of the quarantine officials or attendants was
attacked by the disease. In the transfer of the sick special care
was taken to prevent as much as possible any articles from accom-
panying them which might act as fomites.

Upon the arrival of the ship at quarantine active measures were
adopted for disinfection. Carbolic acid was poured down the
pumps, and introduced into the bilge at other points. Carbolated
lime was strewn about the decks, and chlorine gas was liberated
by the common salt mixture throughout the ship, the hatches
being closed. During the summer following the latter measure
was repeated several times, and in the intervals the most thorough
ventilation secured.

Throughout the course of the epidemic, in the cases that oc-

* The medical officer, thus modestly referred to, was the author of this re-
port.— Ed.

2l8

YELLOW FEVER ON BOARD THE SARATOGA.

curred, there was absent any sthenic action, no furious delirium,
no raging heat of the skin, no strong, full arterial pulsations. In
but few cases did any delirium occur, and then it was low and
muttering in its character. The skin from the first, in the major-
ity of cases, was warm and moist, and the pulse, though very
frequent at the outset of the attack in most, yet was always
weak and soft in character. Its variations and characteristics
in the different cases were found to be valueless as an indication
of the intensity or the tendency of the attack.

The following table exhibits its frequency from day to day in ten
cases :

Names.

Pulsations per minute.

Result of case.

Quick

Fitzgerald . .

Riley

Giraud

R. Anderson

Robinson

Diegel

T. Anderson

Carter

Blodgett ....

112
90
IOO
112
96

I30

IO4

72
76

Ida

Recovery.

Death on night of fifth da}T.

Do.
Recovery.

Do.
Death on ninth day.
Recovery.
Death on fifth dajr.
Recovery.
Death on fourth dav.

Complete suppression of urine occurred in no case. In the
majority of cases, even of those terminating fatally, its secretion
remained free. The nearest approach to suppression was in the
case of Surgeon Quinn, the symptoms attending whose death indi-
cated ursemic poisoning. In other cases the urine, though free, was
highly albuminous, a condition which supervened in such of those
cases which were at all prolonged, whether eventuating in death
^or recovery, as were under the observation of the writer. In the
cases which were treated wholly on board the quarantine hospital-
hulk, no examinations of the urine, as to the presence of albumen,

YELLOW FEVER ON BOARD THE SARATOGA. 219

were made. The condition of the bowels presented no features
worthy of note. More or less constipation was present at the outset
of many of the cases, relieved by gentle cathartics in all cases. The
tongue, at the outset, was covered with moist white fur, in some
cases presented a punctated appearance, afterward changing in
its appearance as the disease progressed, either gradually clearing
off, or becoming dry, and brown or black, and in some cases
clearing off rapidly, presenting then a raw appearance, as if en-
tirely denuded of its epithelium. In the three cases which termi-
nated fatally, during the passage from Key West to New York,
death was heralded in each by this latter condition of the
tongue, the denudation beginning first at the edges, on each side,
and thence spreading over the whole tongue. In the last of these
cases, in which life was prolonged to the sixth day, the dorsum
of the tongue became dry, black, and scaly during the last day.

Apparent heat of the head, out of proportion to that of the
body in general, was noticed in every case. This persisted for
some time after all other symptoms ameliorated. Its subsidence
was regarded as an unerring indication of the establishment of
convalescence.

Intense frontal or orbital headache, described as passing from
temple to temple through the eyes, with injection and suffusion
of the conjunctiva, was a constant symptom attending the begin-
ning of an attack. Pain in the back was also usually great. In
one case pain in the calves of the legs was bitterly complained of.
In one case pain was experienced in the left temple, and in the
left side of the body only. Tenderness of the epigastrium and a
peculiar sensation of fullness at that point, especially on deep
inspiration, were usual.

The most prominent and distressing symptom was gastric
irritability. In some cases, despite the careful avoidance of all
irritation, uncontrollable vomiting persisted through the first stage
of the disease. In these, after a short calm, in nearly every in-
stance, the vomiting again recurred, soon presenting the peculiar
appearance termed black vomit.

2 20 YELLOW FEVER ON BOARD THE SARATOGA.

In the greater number of cases, however, after one or two par-
oxysms of vomiting when first seized, though the irritability of
the stomach remained great, it was repressed by the measures
adopted; the slightest indiscretion, however, again provoking vom-
iting. After the period of calm following the subsidence of the
symptoms attending the febrile paroxysm — in many of these latter
also — vomiting then appeared spontaneously, ending in black-
vomit and death. Much thirst was complained of in most of the
cases.

The general measures of treatment adopted on board the Sara-
toga were directed toward supporting the system, and aiding it
in its efforts to eliminate the poison with which it was saturated.
Special symptoms it was endeavored to meet as occasion required.

The treatment as continued on board the hospital-hulk, after the
transfer of the cases thither, was essentially the same. All in-
ternal remedies of a depressing character were avoided; indeed,
the irritability of the stomach universally precluded the adminis-
tration of any internal remedy, even had such been deemed ad-
visable. The most accessible point was the skin, the action of
which it was endeavored to sustain and promote by wrapping the
patient in blankets wrung out in hot water — as a substitute for the
hot bath, which the want of a bath-tub prevented from being
adopted — and by sponging the skin, from time to time, with tepid
water and vinegar. At the earliest possible moment, food and
stimulants were methodically administered according to the con-
dition of the patient.

In the whole course of the epidemic, the most prominent symp-
tom which presented itself was the extreme irritability of the
stomach; the local measures of treatment adopted were chiefly
directed toward this, to prevent its occurrence if possible, and to
lessen its severity when present. A careful avoidance of every
source of irritation, whether medicinal or alimentary, was insisted
upon; counter-irritation by sinapisms to the epigastrium was
effected when occasion seemed to demand; pellets of ice were
allowed to melt in the mouth, for the double purpose of control-

YELLOW FEVER ON BOARD THE SARATOGA. 221

ling gastric irritability and of alleviating thirst; nothing but fluids,
and those in very small quantities often repeated, were adminis-
tered. These were the measures that were found to be most ef-
fectual in preventing and alleviating this symptom. In addition,
various medicaments, as carbolic acid, turpentine, aromatic spirits
of ammonia, the effervescing draught, and others, were used in
most of those cases in which the measures first mentioned did not
prove sufficient, but without decided benefit.

Frontal headache, invariably great, was alleviated by cold ap-
plications to the forehead and temples. Pain in the back, much
complained of, by sinapisms and cuppings.

The importance of avoiding carefully any unusual exposure or
fatigue, or irregularities of diet, or the giving way to excessive
anxiety, and of preserving the general condition of the body in
the most perfect health possible, as prophylactic measures, were
plainly shown by the circumstances which seemed to determine
the attack in many instances, some of which have been men-
tioned.

In a number of instances in which men presented themselves
at once upon the first appearance of those symptoms which usu-
ally marked the onset of the disease, as chills, heat of head, in-
tense frontal headache, and fever, with very frequent pulse and
furred tongue, from fifteen to twenty grains of quinine were given
immediately. In a short time complete relief was experienced,
with no recurrence of the symptoms. Whether this result was a
mere coincidence or an effect cannot be said, yet the impression
grew continually stronger that it was the effect of the quinine ad-
ministered, as although in all cases the result was not so favorable,
yet, in no cases presenting the same symptoms, in which quinine
was not administered at once, as stated, did the disease fail to
continue and to pass through its usual course.

SANITARY CONDITION

UNITED STATES ASIATIC SQUADRON DURING THE PERIOD

OF TWO YEARS, FROM APRIL i, 1868, TO MARCH

31, 1870.

BY

ROBERT T. MACCOUN, M. D.,

MEDICAL INSPECTOR, UNITED STATES NAVY; SURGEON OF THE- FLEET,
ASIATIC STATION.

SANITARY CONDITION OF THE UNITED STATES
ASIATIC SQUADRON DURING THE PERIOD OF TWO
YEARS, FROM APRIL i, 1868, TO MARCH 31, 1870.

By Robert T. Maccoun, M. D.,
Medical Inspector, United States Navy ; Surgeon of the Fleet, Asiatic Station.

The influence of climate on the health and mortality of man in
different portions of the globe is becoming more and more a sub-
ject of interest to scientific as well as practical medicine, now
that we can be whirled around the earth's surface, with compara-
tive comfort, in the short period of ninety days.

Places hitherto remote are now of easy access. Japan was
almost a terra incognita a few years since, and a voyage to China
was thought to be a great undertaking. But now these countries
seem to be brought to our very doors, by means of the Pacific
Railway and the Pacific Mail Company's splendid steamers.
This facility of transit swells the tide of travel, either for busi-
ness or pleasure; hence the influence of this change of locality,
upon those who wander from their homes, is a matter of pecu-
liar interest at the present time.

The limits of the Asiatic squadron extend from the equator to
about 420 of north latitude. Within these lines we have the
whole of the northern tropical and a greater portion of the north-
ern temperate zones. The first of these, styled by Alexander
Keith Johnson the tropical disease realm, is characterized by
great atmospheric heat and humidity; and the prevailing diseases
are dysentery, diarrhoea, cholera, hepatic affections, and malarial
fevers.

That portion of the station north of this, included in the tem-
perate zone, extending along the coast of China, is characterized
i5

226 SANITARY CONDITION OF THE ASIATIC SQUADRON.

by the same diseases during the summer and autumn months,
while in winter, typhus fever, pulmonary affections, and rheuma-
tism prevail. The islands forming the Japanese Empire, having
an exceptional climate, will be considered further on.

The squadron for a greater part of the time was composed of
ten ships, with an average force of fifteen hundred men ; and the
following table will show the classes of disease, sickness, and
mortality during the period indicated :

Table showing the classes of disease and number of admissions and
deaths in the Asiatic squadron for two years, from the ist of
April, 1 8 68, to the 31st of Match, 1870, in a force of fifteen
hundred men.

Class.

a 00

*> OO

2 h I -6

<U £_

< 3

Febrile or miasmatic i 24 374 395

Digestive 6 820 824

Respirator 7 363 268

Circulatory 19 17

Nervous 1 132 131

Integumentary j 4 369 373

Fibrous and osseous 9 287 296

Exhalants and absorbents j j 3 3

Genito-urinary 17 17

Enthetic* ' 12 732 744

Cachexiae 1 45 46

Eye and ear 1 j 58 59

Injuries, accidents i 8 i 474 476

Total 73! 3,693 3<749

* In addition to the above there were over six hundred persons treated for venereal
diseases, -who were not excused from duty.

From the above table the sickness is represented by three thou-
sand six hundred and ninetv-three admissions, and the mortality

SANITARY CONDITION OF THE ASIATIC SQUADRON. 227

by seventeen deaths.* Of the latter, six were from accidents,
one from typhoid fever, two from small-pox, two from dysentery,
two from pulmonary diseases, two from cardiac affections, and
two from diseases of the nervous system. This is a remarkably
small mortality for this station ; especially so as regards intestinal
and malarial fevers. There were eight hundred and twenty ad-
missions for dysentery and diarrhoea, with only two deaths ; yet
a few years ago these diseases were the scourge of the East,
very few of our ships escaping a severe visitation from them dur-
ing some period of the cruise.

It will naturally be asked, Why this great reduction of sick-
ness and mortality in a region hitherto considered so unhealthy ?
The answer is, The adoption of a better system of hygiene, both
afloat and on shore, an ample supply of pure drinking-water, a
better diet for the men, a more enlightened method of medical
treatment, and, finally, the opening of Japan offering facilities
for a change of climate.

Until recently the supply of water on the China coast having
been taken from rivers in the vicinity of filthy towns and cities,
or from streams flowing through rice-fields,f was vitiated by
decayed animal and vegetable matter, and hence the exciting
cause of intestinal affections and malarial fevers. But there is
a great improvement in this respect; at many points we find
abundance of good water at present. This is especially the case
at Hong-Kong, where immense stone reservoirs have been con-
structed, which are filled from pure mountain-streams, affording
an ample supply for every demand.

At Shanghai, also, where the river-water is extremely unwhole-
some, excellent water is now brought from a lake, some miles
above the native city, for the supply of the foreign settlement and
shipping. At other points on the coast, where the water is im-

* Four deaths are reported among those who were invalided home during
the two years.

t In both China and Japan human excrement is carefully preserved and
returned to the soil.

2 25 SANITARY CONDITION OF THE ASIATIC SQUADRON.

pure, the distilling apparatus now attached to all steam-vessels is
called into use; therefore this fruitful cause of disease is obviated.

The allowance of fresh meat and vegetables several times dur-
ing the week, or even daily, if deemed necessary in the hottest
weather, tends to maintain a better condition of the system, and
render it less liable to disease.

Attention to drainage, and an improved method of construct-
ing houses in the English towns and European settlements, have
also greatly improved their sanitary condition ; and our ships
have been greatly benefited by the custom of covering the berth-
deck with shellac, thereby avoiding dampness, as well as by a
greater attention to the cleanliness of the hold and bilges.*

At Hong-Kong, where the range of the thermometer is from
45° to 900 of Fahrenheit, with heavy rain-falls from May to
August, and subject to great changes of temperature during the
winter months, the mortality from fever and dysentery was formerly
excessive. The troops, especially, suffered severely, owing to their
being quartered in poorly constructed frame barracks, and sleeping
upon the ground floor. But since the erection of new buildings,
which are of stone, well ventilated, well drained, with sleeping
apartments raised one story from the ground, they enjoy a com-
parative immunity from disease. In this connection I must men-
tion that venereal diseases are less virulent and much less preva-
lent at this place than formerly, owing to a strict system of registra-
tion and inspection of all public women. The average number
of sick in the English barracks has been reduced one-third by
this measure. We have also reaped the benefit of it ourselves,
or after a liberty of forty-eight hours given to one of the ships
of the squadron, with a crew of nearly five hundred men, only
six cases of chancroid were returned.

The low-lying site of Shanghai, scarcely raised above the level
of the Woosung River, and exposed to marshy exhalations, will

* An improved arrangement of the holds of our ships is greatly needed :
(vide communication No. 6, series 1868, to the Chief of Bureau of Medicine

and Surgery.)

SANITARY CONDITION OF THE ASIATIC SQUADRON. 229

always render it an unhealthy place of residence ; yet even here
there has been a great decrease in sickness and mortality, with
improved drainage, and greater personal care as regards diet
and exposure to the sun during the hot season. Ships obliged to
remain here throughout the summer should take a short trip to
sea every two or three weeks. This is the plan pursued by the
English, who are very careful of the health of their men.

In regard to the treatment of tropical dysentery, once the most
formidable disease in the East, a wonderful change has taken
place. In our day, a disciple of Todd thrills with holy horror as
he reads the general rules recommended by Sir James McGregor
for adoption in the army, during the peninsular war, or those more
recently advised by Sir Ranald Martin. These consist mainly in
calomel and blood-letting, the latter, according to Sir James
McGregor, to be repeated until the stools are free, or nearly
free, from blood. Depletion, either general or local, and the
mercurial treatment advised by Dr. Johnson, are now, happily,
things of the past, at least among the most enlightened practi-
tioners. The object now is to husband the strength of the
patient, however acute may be the symptoms under this depress-
ing disease. Since the adoption of a more conservative treat-
ment, the mortality from dysentery in India has been reduced
from 7.1 per cent, to 1.3 per cent., and the record of the squad-
ron only shows two deaths from that disease in two years.

I come, now, to the islands of the Japanese* Empire. Lying
between the thirtieth and fortieth parallels of north latitude, they
possess one of the most salubrious climates in the world, and are
properly styled the sanitarium of this portion of the East.

At Yokohama, latitude 350 26' north, situated within eighteen
miles of Yeddo, and the headquarters of all the foreign squadrons,
the mean annual temperature is 590 Fahrenheit; minimum, 480 ;
maximum, 920. The most disagreeable feature of the climate is
the heavy rains from April to August. The average rain-fall is

*Ni-pon — ni, sun ; pon, source.

23O SANITARY CONDITION OF THE ASIATIC SQUADRON.

about fifty inches, annually; but during the year 1868-69 — ren~
dered remarkable throughout the world for its meteorological
phenomena — it rose to one hundred and twenty inches. Excel-
lent water, from mountain-streams, can be procured at the prin-
cipal ports of Japan, yet the necessity for a high standard is not
so important as in China, owing to the frequency of intestinal
affections.

Malarial fevers, as far as my observation goes, are rare, even
among the rural population, who dwell amid their damp rice-
fields. The most prevalent diseases are rheumatism, typhus fever,
small-pox, syphilis, ophthalmia, and cutaneous affections.

Typhus fever and small-pox need be feared only during the
cold, damp weather of winter and spring. The Japanese having
no means of heating their houses, shut them up closely in cold
weather, to keep warm. They generally overcrowd them, and
have no appliance for ventilation. This, together with bad drain-
age and defective sewerage, is no doubt the exciting cause of
fever in their cities.

Cutaneous diseases are exceedingly common among them, and
especially scabies, which is of the most inveterate kind, often last-
ing during a life-time. In cases of long standing it becomes
pustular and scaly, and the sufferer presents a disgusting appear-
ance, being sometimes literally covered with sores and scabs.
This is among the poorer classes, however, who rarely, if ever,
change their clothing. The Japanese are described as a cleanly
people, and as far as the use of the bath is concerned this is true.
Bathing-houses are seen all over their cities, filled with bathers of
both sexes, who enjoy, promiscuously, their hot bath. But they
do not change their garments. In fact, they think it very strange
that foreigners find it so necessary. An American physician, who
has resided for many years in the country, told me he was once
traveling in company with a Japanese doctor, who said to him,
>' It must be a great inconvenience to you foreigners to be always
changing your clothes. I have worn these I have on for six
months, and still thev do not smell badlv !J'

SANITARY CONDITION OF THE ASIATIC SQUADRON. 23 1

The most formidable enemy we have to contend with in the
shape of disease is syphilis. This prevails to a frightful extent,
and in its most virulent form. The true chancre is vastly more
common than it is either in Europe or America, and the secondary
manifestations are usually very severe. Gonorrhoea is also very
intractable, and notwithstanding every precaution, epididymitis is
a frequent complication.

Even vice is systematized in Japan. The government not only
sanctions, by license, houses of prostitution, but derives a direct
revenue from this source. A quarter in every town and city of
the empire is inclosed and set apart for purposes of debauchery,
which is covered by no veil of mystery as in other lands.

In the city of Yeddo there is a large district devoted to the
courtesans, called the Yoshi-wara. This is laid out in broad
avenues, planted with pine shade-trees, ornamented with beautiful
gardens, and contains some of the finest buildings in the capital,
next to the daimios' palaces. This region is presided over by a
chief, whose headquarters is the gankiro, a species of casino,
fitted up in splendid style, for the amusement of the higher classes
of the Yoshi-wara, and used for banquets, dancing, concerts, the-
atrical exhibitions, etc. The chief of the gankiro gathers recruits
for his establishments by purchasing young girls from seven to
eight years of age, of indigent parents, who are unable to main-
tain a large family, Their first years are spent in acquiring an
education, the older girls instructing the younger in music, sing-
ing, dancing, embroidery, etc., and many of them become famed
for their accomplishments. When a girl is grown up her master
is ready to part with her if he receives a good offer ; if not, she
remains attached to one of the houses. It is said not to be an
uncommon occurrence for a man to choose a wife* from among
these courtesans. The fact of a girl having been brought up in
that capacity does not operate unfavorably against her in a social
point of view, the fault being charged to her parents, who sold
her in childhood.

*This has been denied by Aime Humbert. ( Vide Japon Illustre, 1870.)

232 SANITARY CONDITION OF THE ASIATIC SQUADRON.

During the past year Admiral Sir Harry Keppel, then com-
manding the English fleet on this station, detailed a naval sur-
geon, with the consent of the Japanese government, to open a
hospital at Yokohama, in the quarter set apart for courtesans,
with the view of instructing native physicians in the use of the
speculum. It is hardly time to witness any striking results from
this humane endeavor to save thoughtless men from the conse-
quences of their own folly, yet, from the aptitude of the Japanese
in adopting everything novel and useful, I think we may safely
look for a great abatement of the evils of syphilis.

In conclusion, I will add that, from the observations of phy-
sicians who have been long resident in Japan, it may now be
safely stated that it possesses one of the most salubrious climates
in the world ; while, on the other hand, all experience proves that
the coast of China is remarkable for its unhealthiness. Yet, even
there, a better acquaintance with the nature of the climate, a
greater personal care, as regards food, clothing, exposure to the
sun, etc., enable foreigners, in a great measure, to combat its dele-
terious influences.

ON DIABETES.

james McClelland, m. d.,

MEDICAL DIRECTOR, UNITED STATES NAVY,

ON DIABETES.

By James McClelland, M. D.,
Medical Director, United States Navy.

Notwithstanding the rapid progress of medical science, the
pathology of diabetes is still involved in obscurity. Even the
seat of the disorder is yet a point of controversy. It is true that
physiology has shed much light upon the phenomena of gly-
cogenesis, that chemistry has explained to us the peculiar nature
of the discharge, and anatomy demonstrated a few morbid
changes, but neither these, nor the labors of Prout, Pavy, Ber-
nard, Schiff, and others, have thrown enough light upon the sub-
ject to lead to a satisfactory conclusion. Among ancient writers,
diabetes mellitus was regarded as a urinary disorder, having its seat
primarily and idiopathically in the kidneys. They likened it to
lientery, from the excessive destruction of tissues, and the rapidity
with which the solids and fluids of the body were hurried forward
to the kidneys; and this view of Galen* was adopted without
much change by Aretaeus and Trallian. The same doctrine was
supported by Ruysch, Dupuytren, Thenard, Henry, and Satterley,
but they associated with the renal mischief some secondary or
sympathetic derangement of the chylifacient viscera. Willis,
Sydendam, Place, Latham, and some others, regarded it as a
" dyscrasy or intemperament of the blood, produced by a morbid
action of the assimilating powers." Nearly a century ago, Dar-
win,f in his ingenious essay, argued that " the disease is dependent
upon a retrograde motion of the lacteals, and is consequently
seated in the lacteal vessels." But this hypothesis, plausible as it

* Galen, De Crisibus, lib. I, cap. xii; De Loc. Affect., lib. vi, cap. iii.
t Darwin, Prize Essay, 1778.

236 ON DIABETES.

was, found few supporters. Even Frank,* who at first accepted
it, gave up the doctrine of a retrograde motion, but still believed
that the disease had its seat in the lymphatic system. And so we
find the stomach, or some of the chylifactive organs, the blood, the
lacteals, and the kidneys, have each in turn been the field for specu-
lation concerning the nature of this disorder. For years the weight
of authority was in favor of some lesion of the digestive organs, and
was doubtless strengthened by Rollo, who fixed the seat of the
disease in the stomach, believing it to consist " in an increased
action and secretion with a vitiation of the gastric fluid, and
probably too active a state of the lacteal absorbents ; while the
kidneys and other parts of the system, as the head and skin, are
only affected secondarily." This hypothesis, which supposes the
blood to be formed imperfectly from the first, and the morbid
change of animal salts for sugar to be the work of the stomach
or its auxiliary organs, was combated by Latham, who believed
the stomach, as well as the kidneys, to be perfectly sound. Some
recent writers regard the liver as the fens et origo mall.' Pavy in-
ferred from experiments made in conjunction with Dr. Owen
Rees, that the morbid condition in diabetes is not the want of
decomposing power in the lungs, nor the overproduction of
sugar in the liver, but in the formation in this organ of glucose,
instead of true hepatic sugar. Andral supposes it is due to an ab-
normal activity in the sugar-forming function produced by hepatic
congestion, and Roberts believes it " consists proximately in some
disturbance of the destiny and functions of the amyloid substance
of the liver." Dr. Bence Jones advances the theory that diabetes
may arise from deficient oxidation of the non-nitrogenous com-
pounds, and Dr. B. H. Coates, of Philadelphia, suggests that it
may be caused by an original defective formation in the organs
of digestion, analogous to dwarfishness, deficiency, or malforma-
tion of the limbs, excessive thinness or obesity. As early as 1692
„Camerariust conceived diabetes to be a nervous affection, and

* Frank, De Cur. Horn. Morb. Epit., torn, v, pp. 54-57.
t Diss, de Diabete Hypochondriacorum Periodico, 1696.

ON DIABETES. 237

looked upon the pains in the loins, and the excessive discharge of
limpid urine, as analogous to symptoms in hysteria. In 1785,
Cull en adopted this view, and classed the disease among the
neuroses; but he does not seem to have been quite satisfied with
his reasons for so doing, for in one of his aphorisms* he says :
"In most cases, the proximate cause is some fault in the assimila-
tory powers, or those employed in converting alimentary matter
into the proper animal fluids." Recent physiological investigations
having somewhat confirmed the views of Camerarius, it is not
unlikely that we shall find diabetes again regarded as a disease of
the nervous system. It is well known that the inhalation of
chloroform, ether, nitrous oxide, and other gases, have been fol-
lowed by the presence of sugar in the urine. Irritation of the
cranial nerves has produced it, and pregnancy, diseases of the
respiratory organs, intemperance in eating and drinking, have
done the same. Reynosa states that he found the urine saccha-
rine after the use of narcotics, quinia, mercury, and other drugs.
But these are cases of incidental glycosuria. Many late writers
seem disposed to regard the disorder as of nervous origin, and
certainly as much can be said in favor of this hypothesis as of
any other. Becquerelf noticed it as the result of cerebral and
spinal lesions. Roberts traced it in several cases to mental emo-
tions. Landouzy saw it brought on by violent grief; and Rayer
mentions a case as coming on after a violent fit of anger. Vari-
ous diseases and injuries of the brain and spinal cord are men-
tioned by Pavy, Fritz, Goolden, Fischer, and others, as exciting-
causes. Roberts, though he believes that the disease "consists
proximately in some disturbance of the destiny and functions of
the amyloid substance of the liver,"! acknowledges that " this
disturbance may be due originally to disease far away from the
liver itself, in some part of the sympathetic chain which controls

* Cullen, Pract. of Phys., Aph. MDXII.

t Brit, and For. Med. Chir. Rev., 1858, p. 199.

t Urinary and Renal Diseases, p. 192.

23S ON DIABETES.

this function." Luys* and Monnerett found serious pathological
changes in the fourth ventricle. Tardieuf records a case in which
the medulla oblongata was found congested ; and Richardson one
in which, after death, an ossific growth was found pressing upon
the pons varolii, and an abscess in the posterior cerebral lobes.
SchirT, Bernard, and Pavy produced diabetes artificially by punc-
turing various parts of the nerve centers and organic nerves, as
the floor of the fourth ventricle, between the origin of the auditory
nerves, at the point of origin of the brachial nerves and the spinal
cord opposite the second dorsal vertebra. The latter experiment
on rats produced permanent glycosuria. In a very able paper
read before the New York Academy of Medicine, February 2,
1 87 1, Dr. Gouverneur M. Smith, of that city, defined diabetes
mellitus to be "a disease of the nervous system, depending either
upon centric or upon eccentric disturbance ; by centric, implying
cerebral lesion; by eccentric, referring to peripheral irritation
transmitted to the brain, and reflected either to the liver or other
parts, inducing the formation of sugar, and likewise generally re-
flected to the kidneys, exciting excessive diureses."§

Of course this definition is not intended to include every form
of glycosuria, but it may serve to explain the etiology of an im-
portant group of cases of which but little is known. I shall now
pass to the dietetic treatment of this disease without pretending
to discuss the various remedies which have been extolled as cura-
tives: for, as might be expected from the diversity of opinion
upon the pathology of diabetes, we find equal inconsistency and
confusion in its therapeusia. Sydenham says : "In hoc effectu.
uti et in omni diabete ex quacunque -pocpaffsi originem ducat, cura-
tive indicationes ad sanguine/u invigorandum corroborandumque, ac-
pariter ad fluxum urinaz prceternaturalem restringendum y"|| — that

* Bulletin de la Soc. de Bibliog., i860.
tGaz. d. Hop., Jan. 11, 1862.
t Ed. Times and Gaz., Feb., 1862.
$ New York Med. Record, March, 1871, p. 26.
Opera Omnia, epist. 1, p. 289.

ON DIABETES. 239

the curative indication must be completely directed toward in-
vigorating and strengthening the blood, as well as restraining the
preternatural flux of urine. And this is about all we can do ; but
to do it effectually, and to restrain and prevent the undue tend-
ency to a production of sugar in the system, our dependence
will have to be upon the materia alimentaria rather than on mate-
ria medica. The necessity for an animalized diet in the manage-
ment of diabetes appears to have been early recognized. Willis
confined his patients chiefly to milk or farinaceous substances,
while Sydenham directed Spanish wine,* and a diet of beef, mut-
ton, and the like, doubtless with the intention of supplying the
deficiency of the animal salts and of counteracting the secretion
of sugar. Not that an exclusive animal diet will entirely prevent
the formation of saccharine matter. The experiments of McGre-
gor and of Griesinger prove the contrary ; but the sugar secreted
under a strictly animal diet is so scanty that the worst effects of
the disorder may be suspended, perhaps cured, if its use be per-
severed in. Unfortunately, however, many patients cannot long
endure it. There seems to be such a natural craving for mixed
food, that, vary it as we will, in time it will become irksome. To
Surgeon-General Rollo we are indebted for reducing to a system
the dietetic plan of Sydenham and of Home. He enforced upon
his patients an entire abstinence from every species of vegetable
matter, limiting them to flesh alone, and under this treatment the
tendency to a secretion of saccharine matter is less than under
any other regimen save that of skimmed milk. The latter has
been recently proposed by Dr. Arthur Scott Donkin, of the Uni-
versity of Durham, though we find a milk diet recommended in
this disease by Dr. Thomas Willis, of Oxford, nearly two centuries
ago. From the earliest times milk has been used as a medicine,
as well as an article of food. Hippocrates, Galen, Celsus, and
Dioscorides agree in considering it wholesome and nutritious, and
of great use in many diseases, though Celsus says it is apt to dis-
order the stomach and to produce headache, hypochondria, and

'Opera, Omnia, epist.

240 ON DIABETES.

flatulence. Its praise was not confined to medical men. Pliny*
mentions the cure of gout by it, in which disease modern authors,
Van Sweiten and others, fully confirm its efficacy. Marcus Teren-
tius Varrof says of it : "Est omnium rerum quas cibi causa capimus
liquentium maxime alibile, et id ovillum,\ inde caprinumj" it is the
most nourishing of all liquid articles which we take for food ; and
this is the case first with that of sheep, and then of goats. Simeon
Seth, Ruffus, and Paul, of iEgina,§ recommend it highly in dysen-
tery and phthisis ; and a host of physicians, from Stephens to
Karell, of St. Petersburg, laud its virtues as a therapeutic agent.
Bouchardat, however, (whose great experience in diabetes is un-
questionable,) doubts its efficacy in this disease, and forbids its
use. Roberts also looks upon it as a doubtful article of food,
though he found one of his diabetic patients improve materially
under its use. One of the greatest advantages of milk is that it is
food not too highly concentrated. For perfect digestion it seems
necessary that the ingesta must be of a specific degree of density,
for if the food be too fluid or too gelatinous the stomach will be
equally impeded in its operations. The interference of a too
highly concentrated aliment with the digestive power may account
for beef extracts and other substances in the highest state of con-
centration proving useless, and in some cases even injurious ; and
may also be the reason why milk is so rapidly beneficial in the
enfeebled digestion of diabetes. In it we have a mixture of solid
and liquid aliment of proper density, which in its dietetic relations
may be considered as intermediate between animal and vegetable
food. It contains albuminous, saccharine, and oleaginous matters,
which, being readily assimilated, quickly supply nutiment to the
exhausted system, without exciting that degree of vascular action
which is produced by most animal substances. The constituents
of skimmed milk are, according to Berzelius :

* Hist. Nat., xxviii, p. 38.

tDe Re Rustica, 11. p. 11.

+ Scaliger's edition De R. R., p. 7, has oviniun.

% Panlus .Egineta, torn. 1, p. 154.

ON DIABETES. 241

Water 928. 75

Casein, with a trace of butter 28. 00

Sugar of milk 35. 00

Hydrochlorate and phosphate of potash 1.95

Lactic acid, acetate of potash, and a trace of lactate of

iron , 6. 00

Earthy phosphates .30

1, 000. 00

In asses' and mares' milk, the proportion of casein is much less,
rarely exceeding one and a half per cent. Hence the value of cows'
and of goats' milk in the treatment of diabetes would seem to
depend upon their superior richness in casein, which is the most
highly azotized of all the nutritive proximate principles. It is at
the expense of this protein compound that the organized tissues
of the body are built up, though we know that for the perfect
formation of all the animal tissues albumen and fatty matter are
essential. To its presence, in a soluble form, may be ascribed the
rapid and great diminution in the quantity of the urine, in from
twenty-four hours to three days, as noticed by Donkin. Phys-
iological experiments prove that under albumen, (and it is said
that all the proteinaceous compounds, albumen, casein, fibrin
vitellin, legumen, and gluten, are probably identical in chemical
constitution,*) the whole quantity of urine is lessened, the urine
becomes more concentrated from the relative increase of solids,
and the amount of urea and uric acid is increased. It is a no-
ticeable fact, however, that under an exclusively albuminous diet,
too long continued, an injurious effect is produced upon the sys-
tem. Hammond proved, by experiment upon himself, that,
under its use, the weight of the body materially declined ; that
the " water, soluble and the whole quantity of inorganic salts of
the serum were diminished, and the solids, albumen and extract-
ive, increased in quantity. In the whole blood there was a dimi-

* Hammond, Physiolog. Mem., p. 85.

242 ON DIABETES.

nution of the water, blood corpuscles, soluble and total amount
of inorganic salts and fat, while there was an augmentation of the
solids, fibrin, albumen, and extractive."* Long ago Magendie
proved that it was impossible to sustain health on any single ali-
mentary substance ; but this does not apply to protein compounds,
for Hammond thinks it "fully proven that before the general
health becomes injured by too long exclusive use of albumen,
that enough of this substance can be assimilated to repair the
waste of tissues and support the respiratory functions. "f This
may be so in the case of a robust experimentalist, and, in many
instances, where the constitution is not shattered, and the digestive
organs weakened, but in diabetes, where the vital powers are gener-
ally at their lowest ebb, skimmed milk — which does not contain
all the substances which enter into the composition of the tissues
of the body — will hardly be found sufficient to sustain life. The
fact is, we can lay down no special dietary for this disorder, as
almost every case must be a law to itself. We know that there
is a natural tendency to asthenia, which must be obviated by a
judicious regimen, but of the necessities in each case the practi-
tioner alone must be the judge. The rule laid down by Dr.
Donkin is that the skimmed-milk diet "must be persevered in,
methodically and exclusively, until convalescence is established." That
method, in its administration, is absolutely necessary to success, '
appears to have been recognized by ancient authors, for Paulus
^Eginetae,! (who copies from RurTus and Oribasius,) says : " He
who drinks milk ought to abstain from all other food until it be
digested and pass downward. It is best, therefore, to drink it in
the morning, newly milked, and to take no food after it, nor any
hard exercise, because this would make it turn acid. But it is
better to walk about gently and rest between, without sleeping."
The italics are mine ; and I would here remark that the time of
its administration is of much consequence. The nutritive and

* Hammond, Physiolog. Mem., p.

t Ibid., p. 104.

t Vol. 1, p. 154, sect, lxxxvii.

ON DIABETES. 243

restorative influence of milk is greater when taken early in the
morning, because the absorbent system at this period is in its-
most active state; besides, a quantity of the fluid can then be
borne without inconvenience, which at any other time would be
followed by the most painful oppression. I must take exception
to that part of the rule which requires the milk to be used "ex-
clusively until convalescence is established." Without a judicious
employment of other dietetics, I fear that many cases (particularly
those of a tuberculous nature) would sink under that general ex-
haustion of the vital powers which it is our object and duty to
avert. Therefore, while acknowledging the remedial value of
skimmed milk in the treatment of diabetes, I am forced to the
conclusion that there are many cases like the following, which
will show the necessity of not depending upon it as an exclusive
diet.

Mrs. A. B., a native of Philadelphia, fifty years of age, of me-
dium height, florid complexion, and nervo-sanguine temperament ;
has never been robust, having suffered from spinal irritation, and
from repeated attacks of gout in the stomach. Ever since 1869
her health has been failing, owing to mental excitement and other
causes; but it was not until the middle of December, 1870, that
a marked change was noticed in her appearance. Most of her
symptoms were then ascribed to change of life, and to a vegeta-
ble diet to which she had exclusively confined herself for one or
two years. About February, 187 1, her emaciation became quite
perceptible, her appetite and thirst were inordinately increased,
and by the middle of March all the symptoms of diabetes were
developed. She was considerably troubled with dyspepsia, head-
ache, nervous tremors, palpitation of the heart, and dimness of
sight. Her bowels were constipated or irregular, and the renal
secretion excessive. Eight to ten pints of pale urine, possessing
the characteristic apple odor, of a specific gravity not below 1040,
were secreted daily. She complained of constant aching pains
in her loins, and in anterior surface of thighs, and of a sense of
sinking, or "falling to pieces," as she expressed it. Her appetite

244

ON DIABETES.

now became voracious, and her thirst intense, her memory more
impaired, and eyesight so defective that she frequently exclaimed,
"I believe I am going blind; I cannot see." These symptoms
were accompanied by fits of despondency, a constant fear of im-
pending evil, and extreme general debility. On testing her urine
by Trommer's, Moore's, and Luton's tests, an abundance of sugar
was discovered. Microscopic examination revealed the presence
of innumerable crystals of oxalate of lime and of epithelium — rather
a rare occurrence — which may account for the intense hypochon-
driasis, pain in the loins, and distressing sense of fatigue in this
case. Having satisfied myself of the nature of her disease, I de-
termined to try the effect of skimmed milk, so highly recom-
mended by Dr. Arthur Scott Donkin, in an article "On a purely
milk diet in diabetes mellitus" &c. (London Lancet, January,
1870.) Accordingly, on Monday, the 20th of March, 1871, I
directed six pints of milk (carefully skimmed and previously
warmed) to be taken in divided doses every three hours, and
prohibited all other food. The result was peculiarly gratifying, as
her hunger and thirst were diminished during the day, and she
felt more comfortable. From this date the accompanying table
will show the daily amount of urine secreted, its specific gravity,
and quantity of solids, so that I shall make but few remarks upon
the progress of the case :

Date.

Quantity,

Specific
gravity.

Solids.

Sugar.

March 20, 1871
March. 21, 1871
March 22, 1871
March 23, 1871
March 24, 1871
March 25, 1871
March 26, 1871
March 27, 1871
March 28, 1871
March 29, 1871

Pis. oz.
6 3

1040
1017
1018

2

14

1020 '

2

5

1030

I

12

1034

2

4

1025 ,

2

3

1028

I

8

1030 i

I

14

1032

Oz. dr. gr.

9 1 53

Grains.
2638
657
96
164
404
320
34o

260

ON DIABETES.

245

Date.

March 30, 1871
March 31, 1871,
April 1, 1871 .

2, 2871 .

3, 1871 .

4, 1871 .,

5, 1871 ■

6, 1871 ..

7, 1871 •■

8, 1871 .,

Quantity

April
April
April
April
April
April
April

April 9, 1871
April 10, 1871
April 11, 1871
April 12, 1871
April 13, 1871
April 14, 1871
April 15, 1871
April 16, 1871
April 17, 1871
April 18, 1871
April 19, 1871
April 20, 1871
April 21, 1871
April 22, 1871
April 23, 1871
April 24, 1871
April 25, 1871
April 26, 1871
April 27, 188 1
April 28, 1871
April 29, 1871
April 30, 1871
May 1, 1871..
May 2, 1871..
May 3, 1871. .
May 4, 1871..
May 5, 1871..

May 6, 1871 i

May 7, 1871 »

May 8, 1871

May 9, 1871 !

Specific
gravity.

1032
1026
1029
1028
1026
1032
1032
1032
1026
1022
1032
1032
1032
1032
1032
1028
1030
1032
1026
1026
1022
1022
1024
1032
1022
1018
1024
1026
1020
1014
1022
1016
1016
1024
1024
1022
1024
1026
1022
1020
1020

Solids-

Sugar.

Oz. dr.

0

38

4

3

5

45

4

42

4

J9

6

25

Grains.
240
278
120

135
115
200
3M
294
297
601
476
45o
377
340
3°9
473
59°
444
3*4
279
420
328
300
64
155
316
101

332
298

23
125
60
39
165
265
220
410
400
606
220
506

246

ON DIABETES.

Date.

_ . ! Specific
Quantlty.| grayity

Solids.

Sugar.

Pis. oz.
May 10, 187

May 11, 1871 3

May 12, 1871 3

May 13, 1871 3

May 14, 1871.

May 15, 1871* 3

May 16, 1871 3

May 17, 1871
May 18, 1871
May 19, 1881
May 20, 1871
May 21, 1871
May 22, 1871

May 23, 1871 2 5

May 24, 1871 2 6

May 25, 1871 3 6

May 26, 1871 2

May 27, 187

May 28, 1871 2 4

May 29, 1871 2 4

May 30, 1871 ! 2 o

May 31, 1871 2 o

1020
1020

1020
1020
1020
1014
1016
1020
1020
1018
1022
1016
1018
1022
1026
1016
1026

io34
1032
1032
1032

IO-?2

0z.dr.g7

Grains.
460
460
356
556
116

4 gr. per oz.

5 gr. per oz.

6 gr. per oz.
4 gr. per oz.
4 gr. per oz.
6 gr. per oz.
4 gr. per oz.

4 gr. per oz.

5 gr. per oz.
S gr. per oz.

4 gr. per oz.

5 gr. per oz.

3 gr. per oz.

4 gr. per oz.
3 gr. per oz.
3 gr. per oz.
3 gr. per oz.

*From the 15th to the 31st of May the quantity of sugar was obtained by making use
of fresh yeast to establish vinous fermentation.

On Tuesday, the 21st March, six pints of milk were adminis-
tered, and the urine was reduced in quantity (in twenty-four
hours) from six pints three ounces, specific gravity, 1040, con-
taining over nine ounces of solids, to four pints thirteen ounces,
specific gravity, 1017, containing two ounces six drachms and
thirty-six grains. During the day she had a slight attack of diar-
rhoea, and expressed distaste for the milk.

March 22a7. — Under the same diet the urine was reduced to
two pints eight ounces; specific gravity, 1018; solids, one ounce
four drachms twenty-six grains. Skin clammy, pulse 98. She
complained of headache, nausea, and debility.

March 23d. — The improvement in the renal secretion contin-
ued, but her strength was rapidly failing. She complained of

ON DIABETES. 247

headache, inability to make the slightest exertion, intense pain in
loins and thighs, nausea, and increased amblyopia.* Pulse 104.
Both hunger and thirst had now completely abated, and the
amount of urine passed in twenty-four hours amounted to but
two pints fourteen ounces; specific gravity, 1020; solids, one ounce
five drachms thirty-four grains.

March 2\th. — Urine secreted, two pints five ounces; specific
gravity, 1030; solids, two ounces two drachms and twenty-four
grains.

March 2$th. — I found my patient so much exhausted that I
scarcely felt justified in pursuing further the exclusive milk diet,
and, after consultation with a medical friend, I decided to give
but fifty ounces of skimmed milk per diem, and to supply addi-
tional nutriment by a suitable proportion of beef-tea. Under this
treatment she became stronger, and expressed herself as "feeling
much better." One pint twelve ounces of urine were secreted;
specific gravity, 1034. Pulse 94.

From the 25th of March to the 1st of April there was a steady
improvement in her symptoms. The renal secretion ranged from
one pint eight ounces to two pints four ounces; specific gravity,
from 1026 to 1034. Her diet was varied occasionally with
poached eggs, mutton, squab, spinach, and Camplin's biscuit.
The oxalates disappeared from the urine under the use of nitro-
hydrochloric acid in infusion of serpentaria, and with them went
many of her distressing symptoms. On the whole, she appeared
more cheerful and less weary ; her eyesight had improved, and
she felt generally more comfortable. On the 29th of March
there was a copious deposit of uric acid. From the 1st to the
7 th of April the urine varied in quantity from one pint eight
ounces to two pints five ounces; specific gravity, from 1026 to
1032.

* It will be seen that the amblyopia did not cease upon the administration of
animal food, (as it did in one of Greisinger's patients,) neither did it follow
the course observed by Lecorche, "\De Damblyopie Diabetiqiie," Gaz. Heb-
dom., Nov., 1 861.

248 ON DIABETES.

April 8th. — Patient caught cold, and felt less well in conse-
quence. She had a night-sweat, and complained of great de-
bility. Urine, three pints nine ounces; specific gravity, 1022.

April 16th. — Her night-sweats returned, but were promptly
checked by sulphate of quinia combined with oxide of zinc.
From this time until the eight of May she continued to improve.
Specific gravity of urine varied from 1018 to 1026.

May 8I/1. — Not so well, and toward evening many of her old
symptoms returned. The quantity of urine was much increased,
though the specific gravity did not rise above 1024. This un-
favorable change was probably brought about by the patient in-
dulging in ice-cream containing corn-starch. As her strength
had now improved sufficiently to justify a return to the exclu-
sively skim-milk diet, I again placed her upon it, directing, as
before, six pints daily, in divided doses ; but on the 13th I was
obliged to give her beef-tea, eggs, &c, as she complained of
being unable to subsist upon the milk alone.

From this time until the conclusion of this report (June 1,
1871) there was a daily improvement of all her symptoms. Her
appetite is now good, her rest sound and natural. She has
gained in flesh, (seven pounds during the period of treatment,)
and though the urine is still glycosuric, the improvement in
her health is so great that she expresses herself as feeling "per-
fectly well."

REPORTS

CERTAIN ENGLISH HOSPITALS,

EDWARD SHIPPEN, M. D.,

MEDICAL INSPECTOR, U. S. N., SURGEON OF THE FLEET, EUROPEAN STATION.

Navy Department,
Office of Medical Inspector-General,

Washington, July 31, 1872.

Sir: The accompanying reports of Fleet-Surgeon Edward
'.Shippen, relative to European hospitals and military medical
schools, made in compliance with official instructions, are respect-
fully referred to the Department.

Its attention is especially invited to the report upon the naval
medical school at Netley. For over forty years the medical
corps of the United States Navy has been making slow but sure
advances toward the elevation of similar corps in the navies of
Europe. The progress has been made in despite of great and
unnatural obstacles. From the appointment (by warrant) of
ignorant apothecaries, native or foreign, as surgeon's mates, or
the intrusion of the incompetent favorites of influential politicians,
the Government, in 1828, protected itself by establishing boards
of examination. These up to the present time, by their increasing
experience and scrutiny of their examination, have largely ad-
vanced the character of the medical corps, and guarded the in-
terests of the naval service and of humanity. It is, however, still
a subject of regret that we are yet behind other nautical powers
in exacting the sufficient evidence of capacity from those to whom
are intrusted the lives of all who commit themselves to the hazards
of naval service. The Department is aware that when I had the
honor to administer the Bureau of Medicine and Surgery, the
Bureau endeavored to continue the progress of the naval medical
corps, and that both verbally and by official communication, it,
with respectful urgency, recommended a higher curriculum, and
that the facilities of our large naval hospitals should be used to

252 ENGLISH HOSPITALS.

train and discipline those young medical officers who had been
found qualified for the service — not the objectionable measure
of a Government education in the professional acquirements,
fitting them for admission to the service, but securing to them,
after they have established a claim of fitness, the higher training
and the military discipline required to make them fully efficient
in their new and special vocation. The report of Fleet-Surgeon
Shippen shows with what care, and how thoroughly, the British
government secures the necessary special instruction for its naval
medical officers, before assigning them to their complicate duties
on board a man-of-war. It is certain that the interests of our
naval service, as well as of science and humanity, will be promoted
by following, even distantly, the distinguished model of naval
medical teaching at Netley.

Very respectfully,

Wm. M. Wood,
Inspector- General Hospitals and Fleets, U. S. N.

Hon. Geo. M. Robeson,

Secretary of the Navy,

Navy Department, Washington, D. C.

ENGLISH HOSPITALS. 253

United States Flag-ship Wabash, (first-rate,)

Southampton, England, J-uly 8, 1872.
Sir: I have to report that circumstances prevented me from
leaving the flag-ship, to carry out certain inspections I was ordered
to make, until a comparatively recent period, when I started in
compliance with an order from Admiral Alden, from which the
following is an extract : '■•' Referring to your letter to me of the
15th ultimo, in regard to carrying out the plan of inspection of
hospitals, etc., (referred to in the instructions from the Inspector-
General of Hospitals, of 2d November, 1871, and in the order of
the Hon. Secretary of the Navy, of 13th November, 1871,) you
are directed to proceed, whenever you are ready, to Switzerland,
to inspect the military medical establishment, particularly at
Berne ; thence to Paris, remaining a sufficient time to obtain
the information you are directed to procure. Thence you will
proceed to England. As your instructions from the Hon. Secretary
of the Navy refer more particularly to the English establishment
in comparison with our own, it is presumed that most of your time
will be passed there, visiting London, Chatham, Greenwich,
Great Yarmouth, and any other places which, from information
received, you may consider inportant."

In consequence of these orders I proceeded to England, via
Switzerland and France, and have now the honor of inclosing
herewith some of the results of my observations, embodied in a
report.

I am, very respectfully, your obedient servant,

Edward Shippen,
Medical Inspector, U. S. JV.
Wm. Maxwell Wood, M. D.,

Medical Inspector- General of Hospitals and Fleets,

Navy Department, Washington, D. C.

REPORTS

UPON

CERTAIN ENGLISH HOSPITALS.

By Edward Shippen, M. D.,

Medical Inspector, U. S. JV., Surgeon of the Fleet, European Station.

Upon reaching Lyons, on my way to Switzerland, I found it
necessary to delay there to obtain a consular certificate, to enable
me to leave France. This was replaced by a regular passport
from our minister in Berne, to enable me to re-enter France. In
the latter case it was indispensable.

During my detention of a day I inquired as to the condition
of the Hotel Dieu, at Lyons, which is one of the oldest and
largest of the civil hospitals of France. It was crowded during the
Franco-German war, and I was informed by our consul (General
Osterhaus) that the mortality within its gloomy, massive old
walls, among both French and Germans, was something perfectly
frightful; and that the death-rate, at any time, is very large. The
French medical authorities resisted every application to get the
wounded put under canvas or in pavilions. General Osterhaus
could give me no more than the result of his own observation,
and he said it was extremely doubtful if any could be had at the
hospital, even had my time permitted a delay for the purpose.
But the general had an extended experience in our own recent
war, and he assured me he had never dreamed of anything like
such mortality. At last he interfered with such success as to
have been instrumental in the parole, or exchange, of a number
of German prisoners. These were sent home in winter weather,

<,$6 ENGLISH HOSPITALS.

their chances being considered so much better than if they had
remained in hospital at Lyons, with almost a certainty of being
carried off by typhus, pyaemia, or hospital gangrene.

The French pretend to recognize the merits of the American
ambulance system, and field treatment generally ; but it is, after
all, in a patronizing, partial way, as, indeed, they are apt to
regard anything which has not its origin in a French brain.

On arriving at Berne, I found that, although Switzerland has
no standing army, every able-bodied young man is liable for
military service at twenty years of age, and is put in the landwehr
at about thirty-five. They are called out for a certain number of
days, in each year, for drill and exercise. There is, however, a
full and complete military staff maintained by the federation, and
a surgeon-general is a member of this staff. He has offices in
the Federal Palace, at Berne, and is allowed a secretary. The
heads of each department are similarly accommodated.

There are several hospitals in Berne, but none devoted exclus-
ively to military purposes. One or two are quite large, but very
antiquated in build, etc. They have the small windows and
double sashes for winter, which are in general use, and are
perhaps below criticism, as compared with some modern hospi-
tals. The splendid natural drainage and airy situation, however,
counteract many of the defects in the buildings themselves, and
I was told that very general success attended surgical operations
within their walls.

On proceeding to Paris, considerable time was occupied in the
formalities necessary to obtain a general permission from the
minister of marine and colonies (through the kind assistance of
Mr. Washburne) to visit the naval hospitals and naval medical
schools of France. There are three of the latter ; one at Roche-
fort, one at Toulon, and one at Brest.

This permission was finally obtained, in the form of a card
with printed permission, signed by the minister's chief of staff, (a
rear-admiral,) and with a place for the autograph of the bearer,
who is identified by this means upon presenting himself. This

ENGLISH HOSPITALS.

57

permission it is absolutely necessary to have, and I can now
avail myself of it at any time that I may find myself in any of
the ports named above.

Passing over to England, at the termination of these formali-
ties, I spend most of my time there, as my instructions demanded.

General Schenck was kind enough to get permission from the
admiralty (which permission was promptly given) for me to see
everything I pleased.

The kindness and politeness of Sir Alexander Armstrong, the
Medical Director-General of the navy, and of Sir Galbraith
Logan, the Director-General, army medical department, were most
gratifying. Both these gentlemen were very prompt in writing to
direct that I should be shown everything at the places under their
control which I might have occasion to visit.

17

ST. THOMAS HOSPITAL.

While waiting in London for the permission alluded to, I vis-
ited St. Thomas Hospital. This is the newest in London, has
an immense endowment, and was opened last year by the Queen,
with great ceremony. Situated upon the Thames embankment,
at Westminster bridge, just opposite the Houses of Parliament,
and having thus the river on one side, with the splendid cause-
way of the embankment and, not far off, on the other side, the
extensive gardens of Lambeth Palace, it occupies an exception-
ally fine position for the heart of London. This hospital consists
of seven blocks, or pavilions, parallel with the river, and connected
by corridors. It has 680 beds, with 1,800 cubic feet of air
space for each bed. I noticed nothing very new in the arrange-
ments. The ventilation and drainage were very good. The wards
were all alike, and had two open fire-places in the middle of each,
with a ventilating shaft around the flue of each one. The win-
dows were plenty and large, going well up to the ceiling. I no-
ticed a want of hard-finish on the wall of the wards, and of such
close joints in the floor and in the angles of the wainscots as is
now considered a sine qua non with us in hospital construction.
I have no doubt trouble will result from vermin and from infec-
tion very probably by-and-by. This seems remarkable in a
building where money was no object, comparatively speaking. The
main bath-rooms are in the basements, and very complete, but I
should suppose that a greater proximity to the wards would ren-
der them more useful. The beds and bedding appeared to me
as not up to the standard of similar institutions in our country.
In the walls, over each bed, were irons and sockets for curtains or

ENGLISH HOSPITALS. 259

testers, but I saw none actually in use. Much useful room is
taken up by the unnecessarily massive architecture of the building,
as was admitted and regretted by the officer who showed me
around. There is the theater or lecture-room for the medical
school of the hospital, entirely distinct and at some distance from
the hospital proper. Near it is the dead-house, and connecting
the latter with the basement of the hospital is an ample subter-
ranean passage. This hospital has an immense out-patient busi-
ness, and the rooms for this purpose, as well as the dispensary,
are very large. The latter seemed very well arranged indeed.
The business offices of the hospital are ample and handsome.
One thing struck me here as well as elsewhere, viz, that they received
all contagious diseases, including small-pox, into one of the pa-
vilions, about 60 feet removed from the next one, and of course
connected by corridors. Some of the non-medical officers of
the hospital and their families had their quarters in the adjoin-
ing pavilion. I was informed that the governors of the institu-
tion prided themselves upon receiving all classes of cases, as a
part of the traditional policy of the hospital, and thence resulted
the reception of small-pox cases. It is quite a good illustration
of the traditional policy and conservatism for which England is
so remarkable. Indeed, I found out afterward that the naval
hospitals had no better arrangements. In our country, and in
most others, municipal or general laws would interfere in such
cases.

Although any one must be impressed by the imposing size and
massive build of St. Thomas Hospital, I must confess that, in
regard to its administration, cleanliness, etc., it did not seem to
me to compare very favorably with similar institutions in our own
country.

THE ROYAL VICTORIA HOSPITAL AT NETLEY.

On the 2d May, 1872, I visited the '-Royal Victoria Hospital
at Netley," the principal hospital of the British army. I was
most kindly and hospitably received by Inspector-General Francis
Wm. Innes, M. D., C. B., who is the senior medical officer and
who ranks with a brigadier-general.

Netley hospital is by this time so well known that any descrip-
tion of it would seem almost superfluous. It may be as well,
however, to make a few general remarks in regard to it, premising
that my principal object in visiting here was to see the medical
school. Its situation is a very fine one, upon a slope of loamy
and gravelly soil, and looking upon Southampton water, with a
climate as fine as any in the south of England. It is a little
below the ruins of the celebrated Netley Abbey, and upon land
formerly belonging to it. It is only a confirmation of the saga-
city of the Netley abbot and his chapter to say that a fairer ex-
posure, or more pleasant situation could hardly be found, whether
for an abbey or a hospital. The natural drainage is exceedingly
good.

Vessels of large draught anchor in Southampton water, and go
above the hospital. A long and handsome pier or jettee was built
when the hospital was founded, with the intention of having the
troop-ships with invalids to come alongside it and land the men
there. But that side of the river shoals so gradually, and the
rise and fall of the tide is so great, that the landing there from
vessels of great size is practically abandoned. The invalids
arriving from abroad are sent around from Portsmouth, either by
smaller steamer or by rail. This must be considered a drawback
to the thoroughly successful working of this really great institution.

ENGLISH HOSPITALS. 26 1

The buildings contained within the government grounds (which
are most ample for any contingency) consist of the hospital proper,
laundries, kitchens, stores, and other offices back of it, and also
the laboratory of the army medical school. There is a row of
buildings for the temporary accommodation of the women and
children of the married invalids sent from abroad, the mess-hall
and quarters for the medical officers, the house of the military
commandant, and that of the principal medical officer ; and finally,
at some distance to the rear, an insane-hospital, quite recently
built.

The hospital proper is an immense building, said (commonly) to
be a quarter of a mile long. It is necessarily an imposing build-
ing, although there is not much in its architecture per se to make
it so. It appears to be well and substantially built, and is not
infrequently visited by the Queen, who laid the corner-stone, and
after whom it is named. I found a little jealousy existing in
other quarters on this account. On two stories wards, having a
capacity of about twelve beds each, open upon the general corri-
dor, which is closed in with glass, and runs along the front of the
building. In the main or central building a few wards are in the
front, with the chapel, etc., in the rear, and all opening upon the
same general corridor. The ground floor is occupied by the
numerous offices, dining-rooms, orderly-rooms and quarters, re-
quired by such an establishment. Great distances have to be trav-
ersed in the ordinary service of the hospital, which is a very great
defect.

The arrangement of the wards and corridors is such that, to
•insure ventilation and to carry on the duties, it would be impos-
sible to cut off any ward, or number of wards, entirely. In case,
therefore, of contagious or infectious diseases occurring, or in case
of the hospital being crowded with wrounded, the corridors would
be nothing more than conductors of disease from one ward to
another. Some form of pavilion would be infinitely preferable.
This was freely admitted in the course of conversation by one of
the principal medical officers. Under the present use to which

262 ENGLISH HOSPITALS.

the hospital is put, as will be explained further on, these consid-
erations do not weigh as they would in time of war or epidemic
disease.

In the center building of the hospital proper are a very large
chapel, an amphitheater for the lectures of the medical class, and
a museum and library; attached to the wards are rooms for
opthalmoscopic, microscopic, and other examinations connected
with the practical service of the wards. But the medical class
have also rooms for chemistry, microscopy, etc., in another build-
ing, to which I shall refer when I come to speak of the medical
school.

In the hospital the service of the wards was wTell done, and
the wards themselves in good order. The water-closets, lined
with enameled slate, were as good as any I ever saw. The neat-
ness of the beds, bedding, and floors, however, was not equal to
that of most naval hospitals, and I could not divest myself, when
in the wards, of the idea of being in a field or camp hospital.
One reason may have been the want of white bed-spreads, and
that the beds not in use had the mattresses and bedding rolled,
as in barrack-rooms, and also that they are now crowded by the
unusual number of invalids, just arrived from abroad, principally
from India. Netley may, after all, be termed a great receiving
and distributing rendezvous for military invalids from all parts of
the w^orld. Large numbers only remain here long enough to
verify their cases, when they are transferred elsewhere, discharged
the service, or pensioned.

The capacity of Netley may be stated at 1,000 beds. On
the day I was there there wrere nine hundred and ninety-seven
patients. This large number was due to recent arrivals from
India, the plan having lately been adopted of sending invalids
from India in the winter for the most part, passing through the
Suez Canal, and arriving in England in the spring. This is better,
of course, than an arrival in winter, and it wras found that the
cases of pneumonia, etc., so common in debilitated men, coming
from warm climates, were much diminished in number from

ENGLISH HOSPITALS. 263

former years. Indeed, there was but one very serious case of
pneumonia in all this crowd of sick men, who had been so sud-
denly transported from a tropical climate to an English spring.
I may mention that there seemed to be an unusual number of
cases of well-defined aortic aneurism among the Indian invalids.
Some two or three of the most remarkable of these I was shown.
I also saw two cases of hepatic abscess, which had opened through
the diaphragm, of which one was apparently doing well, while the
other seemed likely to prove speedily fatal. Dr. Maclean, the
professor of military medicine, who has had great Indian experience,
stated that recovery in such cases was not so rare. The only
cases I ever saw (two in number, in China) were both fatal.
The greater number of the Indian invalids at Netley appeared
to be the subjects of malarial poison, chronic dysentery, debility,
etc.

I will now pass from the main building to the stores, laundries,
kitchens, and other offices, which seemed ample for their purpose.
They are entirely plain and unpretending ; situated immediately
in the rear of the main building, in a well-paved court. They are of
brick ; mostly in two low stories, so as not to impede too much
the circulation of air. The laboratory, etc., for the medical can-
didates, is a part of the same range, which forms three sides of a
quadrangle ; the main building forming the fourth side.

About a quarter of a mile from these buildings, higher up the
slope, and directly in the rear, is the insane-hospital, quite recently
built, or finished. It is in grounds surrounded by a high and
substantial brick wall. A house is about being built, within the
walls, for the medical officer in charge of this department, which
is now permanently established. The insane-hospital is compar-
atively small ; and the building does not seem particularly well
suited, either in plan or details, to its purpose, having been built
by the royal engineers, apparently without consultation with
those who are skilled in such matters. Extensive alterations and
improvements are, consequently, already in progress, rendered
necessary for the comfort and safe-keeping of the unfortunate

264 ENGLISH HOSPITALS.

inmates. The whole system of heating was also undergoing
alteration, at great trouble and expense, after being in use just a
sufficient time to prove that it did not fulfill its purpose.

It was explained to me that a large insane asylum was not so
necessary for the army, owing to what I must characterize as the
very peculiar system adopted in the English army, in dealing with
the insane of that branch of the service — indeed, that this insane
hospital was, at present, like Netley itself, more a place for verifying
and classifying cases than for their permanent retention and treat-
ment. Insane soldiers who become comparatively well are often dis-
charged, especially if they have friends or home to go to. Or,
they are sent to certain civil establishments for the insane, where
they are paid for at the rate of about £\o per annum. Or,
finally, they are discharged, and returned to the parishes to which
they belonged before enlisting, and it appears that these parishes
are bound to receive and take care of them. This explanation
was quite sufficient to show why a small insane establishment
was necessary.

On a lawn, back of the main hospital, was pitched a lot of
tents, which had been made ready in case the accession of
invalids should exceed the capacity of the building, which was
nearly full. I learned afterward that these tents had been put
to an unexpected use (very soon after my visit) in sheltering
some eighteen cases of small-pox landed from one of the troop
ships. Fortunately the disease did not spread. These tents
were of ordinary bell shape, of large size, but, I should think, not
so well suited to the purpose as our hospital wall-tent.

The buildings for the reception of the regimental women and
children, who are here awaiting the convalescence or discharge
of their husbands and fathers, are well removed from the other
buildings, and in a fine airy situation.

The house of the military commandant, near the entrance of
the grounds, is a very neat cottage, of ample size, and the same
may be said of that of the principal medical officer near it.

Among the buildings there only remains to be noticed the mess-

ENGLISH HOSPITALS. 265

hall and quarters for the medical officers and candidates. This
is a handsome building, of ample size, with the mess-hall, ante-
room or drawing-room, kitchens, and other offices on the ground
floor, and the quarters on two floors above. The candidates are
obliged to give a receipt to the barrack-master for their rooms and
the contents, and to make good any willful injury. This gives
them, at once, in a practical way, a sense of responsibility for
government property. The mess seems to be kept up in good
style, and the mess regulations to be good. The whole thing
cannot fail to have an excellent effect in introducing the medical
candidates to this quite important part of military life and cus-
toms; while it conduces very much to their present comfort.
The regular medical staff are members of the mess.

THE MEDICAL SCHOOL AT NETLEY.

As my principal concern, at Netley, was to see the army and
navy medical school, I may now proceed to that. The organi-
zation is as follows, viz :

The governing body, called the senate, consisting of Director
General Sir Galbraith Logan, M. D., K. C. B., army medical
department, president ; Sir James Ranald Martin, C. B., physician
to the council of India ; the professors of the army medical school ;
and the principal medical officer at Netley, (ex officio,) members
of the senate.

This school has a distinct and independent existence, under
the secretary of state for war. It is governed by its senate,
which holds a meeting for the dispatch of business once a month,
or oftener if necessary. Every function pertaining to a senate,
or governing body, is exercised by it, but no act of the senate is
binding until it has received the approval of the secretary of
state for war.

The professorships in the school are as follows : Military Sur-
gery, Deputy Inspector-General T. Longmore, C. B. ; Military
Medicine, Deputy Inspector-General W. C. Maclean, M. D.,
C. B.; Military Hygiene, E. A. Parkes, esq., M. D., F. R. S. ;

266 ENGLISH HOSPITALS.

Pathology, W. Aitken, esq., M. D. These gentlemen are well
known as authors, as well as teachers, and none stand higher in
their respective departments. To them had recently been added
from the royal navy, (on account of the reception of naval candi-
dates for instruction,) for the chair of Naval Hygiene, StaffSurgeon
John Denis Macdonald, M. D., a fellow of the Royal Society.

There are also four assistant professors who are taken from the
army; two being staff surgeons major, one a staff surgeon, and
one a staff assistant surgeon. There is also a secretary, who is a
gentleman of extensive scientific acquirements.

I do not see how I can better illustrate the working of this
excellent institution than by taking the case of a candidate who
is entered there.

In the first place he goes through the competitive examination
(in London or Chelsea) for his position, whether in the army or
navy, just as with us. If found qualified, he is sent to Netley,
instead of going raw into the service, as he would have done a few
years ago — indeed, as they did in the English navy until this
year, when seventeen naval candidates have been received, on
precisely the same footing as the others. Next year the number
will be increased. Arrived at Netley, the candidate assumes his
uniform and goes upon duty. He is still considered on probation.
He has quarters furnished him, and receives five shillings a day,
about enough to defray his necessary expenses, as their mess,
while handsome, is large and well managed. He remains at
Netley four months. Two months are passed in the wards, and
two under special instruction.

Let us take the service in the wards first. Here, under the
supervision and instruction of the staff surgeon in charge of his
division, the candidate has a clinical course, including various
methods of diagnosis, and especially the mode of investigating
the history of diseases, in relation to the previous life and service
of the enlisted man. "The candidate is required to call in the
aid of auscultation, the microscope, etc., and to apply the various
chemical tests for the purposes of exhaustive diagnosis." For

ENGLISH HOSPITALS. 267

this purpose rooms convenient to the wards are provided, and
fitted with appropriated fixtures, and the walls have diagrams, etc.,.
bearing upon the subject to which the room is devoted.

The regulations in regard to recruiting, sick-certificates, etc., are
explained, and the candidates made to examine men for these pur-
poses.

The candidates are put in charge of wards under the supervision
of the staff surgeon of the division. They are held responsible
for the ventilation and general neatness and cleanliness of the-
ward, as well as for the keeping of the different books and papers.
The regulations in regard to prescriptions, diet, etc., are very-
stringent. The candidate is also required to keep a case-book,
in addition to the regular hospital books. This case-book is ex-
amined at the termination of the course of instruction, and marks
are awarded for the manner in which it is kept. The points to*
which the examination of the candidate's case-book is particularly
directed are as follows, viz; professional merit, literary merit,
attention to detail of regulations, and general neatness. The
regulations for the conduct of the candidates are very voluminous,
but appear complete and satisfactory. Candidates on duty in
the wards "are to remain in their wards until 11.30 a. m.. daily..
They may then go to the library, where they must be found until
1 p. m., so as to be within call for any casual duty, unless required
in the laboratory, microscope-room, or opthalmoscopic-room, or
for examination of recruits, or in the lecture theater." In addition
to this they have to perform, in rotation, the duty of orderly
officer.

The candidate commences this duty at 9 a. m. and finishes it
the next day at the same hour. While on duty he must be in
uniform, and must remain in the room appointed for him, unless
called away on duty, when he is to leave a memorandum of
where he is to be found, He visits the wards and dining-rooms
with the orderly-sergeant at each meal-hour; and at 9 p. m.,
to see that all orderlies are present, and all patients in bed. At
meal times he sees that the diet and extra diet are properly cooked

2 68 ENGLISH HOSPITALS.

and served. He asks if there are any complaints, and if there are
any, is to investigate the matter; if the complaint appears just, he
is to see justice done, taking care to state the facts in his report.
At 4.30 p. m. he inspects the meat and bread prepared for issue
for the following day.

During his tour of duty the orderly medical officer is responsible
for the sanitary condition of the wards, and that the patients are
personally clean; that those allowed to be up are properly washed
and dressed; that the wards are well aired; the water-closets, etc.,
clean and without smell; that excreta, poultices, dressings, etc.,
are at once removed ; that no undue noise or irregularities exist ;
also that the nurses are attentive, and carry out instructions.
The orderly officer has charge of instruments and appliances for
any emergency or accident, for which instruments he is held re-
sponsible. He does not leave the hospital for his meals, but is
supplied with them by the mess-man without extra charge. At
the end of his tour of duty the orderly medical officer has to make
a report in a prescribed form, which is really a certificate, over
his signature, that he has performed all his duties. This report
is made to the principal medical officer.

All candidates are required to be present at all post-mortem
examinations, and not to leave before the inspection is over.
One or more of the most remarkable post-mortems form a sub-
ject for examination at the end of the course. The candidate
who had charge of the case in the wards is required to furnish a
complete abstract of it, to be read aloud before the post-mortem
is commenced. He has then to take notes of the post-jnortem ,
and insert them in his case-book, as well as in the necrological
register of the hospital.

It is thus to be seen by this partial sketch of their duties, that the
candidates while serving in the wards have not much leisure time.

Having spent two months in the duties of the wards, the can-
didates pass to the laboratory, etc., while those who have been
at work in the latter relieve those who have been in the wards,
but both still attend the same general lectures.

ENGLISH HOSPITALS. 269

I believe it was the intention, when the school was first estab-
lished, to have the candidates there for six months; but at present,
as I have previously stated, they only remain four months.

No excuse is received for absence from a lecture excepting
duty elsewhere, or leave from competent authority. In all other
cases a certain number of marks are lost, and are deducted at
the close of the session from the total number gained.

LABORATORY.

"The practical work in the laboratory is intended to familiarize
the candidate with the processes he may be called upon to per-
form, in the analysis of drinking-water, air, food, and soils." Can-
didates are obliged to pass a certain time at work in the labora-
tory; but they are permitted to work at other hours, and as late
as 10 p. m., if they please. They are only required to see that
there is no waste of material or gas.

In the microscope-room are carried on, at regular hours, the
study of morbid anatomy and the microscopic examination of
tissues. The number of candidates is so small that in addition
to demonstrating the work for the day by description, plates, the
black-board, or by typical specimens from the museum, the pro-
fessor has the opportunity of passing round and of observing the
progress of each candidate. In this way the advantages of public
instruction and private teaching are combined; and it was quite
pleasant to observe the industry of the pupils and the apparent
good relations between them and their preceptor, the well-known
Doctor Aitken. Each candidate has a space to himself at a long
table, under a good light. He is provided with a microscope,
and other necessary instruments for his exclusive use. He has a
closet, with lock and key, for keeping these instruments, for which
he is responsible, and is required to give a receipt. Candi-
dates are here, as in the laboratory, required to pass a certain
time at work ; a portion of which time is allowed for cleaning up
and putting away the instruments. But they are allowed and
encouraged to return to their work at spare hours. Absence is

270 ENGLISH HOSPITALS.

only permited when actually on the sick-list or with leave from com-
petent authority.

In obtaining leave of absence the application must be made to
the principal medical officer. But the professor in whose division
the candidate is serving, or (if he is serving in the wards) the
staff surgeon of the division, is first to countersign the application.
The approval of the lecturer for the day (if there is a lec-
ture) is also to be obtained. In fact, practically hardly any
leave is had. When given it is generally on Saturday and Sun-
day, and then the candidate, if he has duty, must procure a sub-
stitute. Leave is only granted at other times in cases of the most
urgent necessity.

LIBRARIES.

There are two libraries at Netley, to which the candidates have
access under proper restrictions. The first is the "medical staff
library," which is the property of the officers of the medical depart-
ment of the army, and which is sustained by their entrance fees
and donations. For the use of this library candidates have to
subscribe two shillings a month, besides an entrance fee of ten
shillings. The other library is called the " medical-school library,"
which is the property of the government, and for the use of
which no fee is paid. It is not worth while to enter into the
rules and restrictions applicable to those using the libraries.

MUSEUM.

There is a museum, consisting of a collection of specimens in
natural history and in geology : a large number of specimens of
pathological anatomy, having special reference to the more prev-
alent diseases of military life; a collection of materia medica
and alimentaria, with specimens in their natural and prepared
states. Here, among the alimentaria, are to be found the princi-
pal seeds, grains, and dried and prepared articles of food, from
all parts of the world. There is also a collection of plans and
models of whatever is used in the army for the conveyance, sup-

ENGLISH HOSPITALS. 271

port, or protection of wounded men, with models of tents, hospi-
tals, etc. Indeed, the museum is outgrowing its room very fast,
and a large and interesting collection of heads is necessarily
excluded, and is placed in cases in the passages, an obviously
unfit place in a hospital. Some of these heads are rare, and have
been procured by medical officers serving abroad at the risk of
their lives. The collection of venomous insects, serpents, etc., is
large, and derived from the same source.

The professor of pathology, in his course, not only gives prac-
tical instruction in the preparation for preservation of morbid tis-
sues, but instruction is also given as to the mode of preserving
and sending home from abroad specimens of comparative anatomy
and of natural history.

It would serve no particular purpose to detail the various sub-
jects, and subdivisions thereof, which are treated of by the lec-
turers on military medicine, military surgery, and military hygiene.
Suffice it to say that the course seems to be a thoroughly exhaustive
one.

It would seem impossible for any young man who has passed
the preliminary examination, and who then goes through the
course at Netley, to be otherwise than well prepared for his duties
in whatever part of the world his lot may be cast.

The names of candidates who pass the preliminary examination
are sent to the director-general, and to the professors of the
schools, arranged in the following classes :

1 st. Those who have passed a pre-eminently distinguished
examination, the characters which distinguish the excellence of
each, and their capacity for special service. These are arranged
in order of merit.

2d. Names of those who have passed creditably, arranged in
alphabetical order, giving the topics on which each one has excelled,
or fallen short.

3d. Names of candidates who have passed the minimum ex-
amination, arranged in alphabetical order, with a statement of the
particular branches in which each has been found deficient. This

272 ENGLISH HOSPITALS.

is to enable the professors to carry out their instruction with a
definite aim as regards each class.

As the examination at the end of the Netley course settles the
final position of the candidate in the service, it becomes doubly
his interest to be industrious and well-behaved.

A plan has been initiated of placing upon a marble tablet, in the
hall of the hospital, the name of the candidate of his year who,
in the judgment of the medical board, and of the senate, has most
distinguished himself.

I asked whether any candidates were thrown out, and was told
that it did not occur, as the examination before coming there
secured the very best of the applicants. Then the excellent mess
arrangements, and the being thrown at once into an official posi-
tion and atmosphere, together with constant employment, are
excellent restraints, as well as the best preparation for their gen-
eral duties in the service. Should any candidate render himself
liable in any way, however, either through misbehavior, or idle-
ness or incompetency, he would be permitted quietly to retire or
would be dropped by the senate.

There were several Indians among the candidates. They wore
the same uniform, enjoyed the same privileges, lived at the same
mess, and had the same charge of wards as the others. They
were likely to be placed with native regiments in India, as I
understood, and it was conceded that they deserved great credit
for having successfully competed in a foreign tongue for their
position, and that their acquirements were good. But I fancy
that while all official courtesies would be observed, and no petty
jealousy of their position or success existed, the old prejudice of
race would still hold its sway, and that social intercourse between
these persons and white officers and families would not be very
cordial. This was not stated in so many words, but it was easy
to see that it was so. I state the fact as I found it, because the
time, some think, may come when we may have the same experi-
ment to try, although with a very different race.

As I have before stated there have been this year for the first

ENGLISH HOSPITALS. 273

time, seventeen naval candidates admitted to this school, and a
naval professor appointed. Their course is precisely the same as
the others, except as to the peculiarities of naval hygiene. The
whole number of candidates was between fifty and sixty, but it is
intended to increase the number of naval candidates next year.
The naval candidates wear the naval uniform. It was considered
highly desirable that they should have the advantage of this
admirable course, and they are accordingly received here by the
consent of the war office, the navy bearing the proportionate
share of expense. This is a most advantageous arrangement for
the navy, as so much was already provided and in working order
an immense benefit is derived at a very moderate expense.

Having hastily sketched the main points observed in my most
gratifying visit to Netley, and having omitted much for fear of
greater prolixity, I have respectfully to suggest how easily a some-
what similar institution could be formed for our naval and mili-
tary candidates in connection with that unique establishment the
Army Medical Museum at Washington. It would form a splendid
nucleus for such a school, and all would be interested in adding
to its collections. Washington is now a city of sufficient size to
afford a plentiful supply of subjects for dissection and for opera-
tions on the cadaver, while there should be but little difficulty in
arranging for hospital service and clinical instruction. The ex-
pense would be trifling for the numbers would be small. Plenty
of capable men could be found both in the Army and Navy who
would be happy to take the position of instructors at their ordinary
pay. At any rate it would be perfectly easy to try an experiment
in this connection, which I feel confident would turn out a suc-
cessful one, and a lasting credit to the administration which has
the liberality and foresight to inaugurate it.

Without doubt there are many older medical officers who, from
the want of an earlier practical teaching and experience caused by
the demands of immediate service following upon their entrance,
would be glad to avail themselves of the privileges of instruction
such an establishment would afford.
18

THE ROYAL NAVAL HOSPITAL AT HASLAR.

Haslar is the largest and most important of the naval hospitals
of England, not only on account of its capacity and proximity to
the greatest dock-yard, but because it also supplies bedding,
medical necessaries, and medicines to the service afloat. In ad-
dition to this its laundry washes for the large Indian troop-ships
regularly. It is situated in Gosport, in full view of Spithead, the
Isle of Wight, Portsmouth, and its great naval yard, and is in as
airy a position as can be found in such a flat locality, and very
accessible for boats at high water as well as by an excellent road.
The grounds are extensive, now comprising more than eighty
acres, while the hospital itself (founded in the reign of George II)
is an immense establishment. It consists of a range of substan-
tial double brick buildings, for the most part three stories high,
and extending around three sides of a quadrangle. Upon the
ground floor, within the quadrangle, is an arched cloister, or cor-
ridor, extending completely around the buildings, forming a
sheltered walk and means of communication. On the fourth
side of the quadrangle, in the center, is a chapel facing the main
entrance. In the rear of this is the cemetery, with a substantial
wall and iron fence.

Although this hospital was built so long ago, it was designed
by an architect who was evidently a far-seeing man, of enlarged
views, for the wards are to-day quite comfortable and well ven-
tilated, although perhaps rather wider in proportion to their length,
etc., than modern ideas favor. The ceilings, of course, are not so
high as they would be in a recently constructed hospital. The
wards are so arranged that modern conveniences and improve-
ments have been introduced without very great trouble or ex-

ENGLISH HOSPITALS. 275

pense. The air of comfort and cleanliness, throughout the whole
establishment, was very pleasant, and the good care and kind
treatment received by the patients were manifested by their
bearing toward the medical officers. The beds and bedding of the
men's wards were very neat and nice. In most of the wards a cheerful
open fire was burning in a grate, giving an air of home-like com-
fort and at the same time proving an efficient means of ventilation.

On the day I was there there were four hundred and eighty-
three patients in the hospital, of whom twenty-five were officers
of all ranks. The capacity of Haslar, each ward and room being
filled, is about one thousand. This includes accommodation for
seventy-five officers, many of whom have two rooms, and a few
three. The average of cubic feet of air for each bed in the
hospital is upwards of 1,100 feet. This varies considerably, for
in one large ward it is nearly 1,800 feet, and in some it is only
1,000 feet. The greater number of the wards in ordinary use have
over 1,200 cubic feet to the bed.

Haslar has been much relieved of late years, by the removal to
•Great Yarmouth of the naval insane, who were formerly kept here.
Lately the population has been slightly increased by the reception
of some of the very aged and infirm Greenwich pensioners.
Greenwich hospital itself has lately been diverted for the use of
the naval college, and the pensioners are now allowed to live
where they please, but they can be received into Haslar as
patients. In such case their pensions are stopped and their ex-
penses charged to the " Greenwich Hospital Fund," which is a
very large one.

At the end of one wing of the hospital, and forming a part of
the building itself, is the small-pox ward. This is capable of par-
tial isolation, and has a separate airing- ground for convalescents,
but I must confess my surprise at finding such a ward in the hos-
pital at all. There were several inmates, too, and I managed to
gather that small-pox then existed to some extent in Portsmouth
and its vicinity, and that people employed in the dock-yard
there had recently been obliged to leave work on that account.

276 ENGLISH HOSPITALS.

The cases in Haslar, however, came from vessels in commission,
and principally from those at Spithead.

There is a museum and library in the hospital, both deserving
of more attention than I was able to devote to them. One hun-
dred pounds per annum are devoted to the preservation of the
museum, its increase being principally due to the zeal of the naval
medical officers.

In a very convenient situation, and so arranged as not to occupy
too prominent a position, are a new and extensive laundry, a large
and convenient store-house near it, and other offices. Over the
general store-house are the dispensary and laboratory. From these
supplies are issued, not only to Haslar but also to the navy afloat.
They were at work re-arranging the dispensary, in consequence of
an order lately issued, of which the following is an abstract : " The
lords of the admiralty have issued a stringent code of regulations
for precautions against accidental poisoning on board Her Majesty's
ships and at naval medical establishments. In future all medi-
cines of a poisonous nature are to be put up in bottles or jars of
a dark blue color only, and to bear labels of a yellow color having
the word poison printed in bold letters over the name of the medi-
cine. All medicines of a harmless nature are to be put up in
bottles of white or a pale green glass, or in jars of white ware, and
to be distinguished by labels of a green color. All medicines,
labeled poison are always to be kept under lock and key and
apart from others. No white labels or labels of any other colors
than yellow or green are to be used for medicine bottles or for
dispensing."

Dr. Salmon expressed complete satisfaction with all the offices
of the hospital except the general kitchen, which is in the base-
ment of the main building, and considered defective. There are.
however, a number of diet-kitchens connected with the wards,
which would relieve the general kitchen.

Extensive airing grounds are provided for the convalescent
patients, both officers and men. These grounds are walled, but
have terraces and walks sufficiently elevated to afford an uiiin-

ENGLISH HOSPITALS. 277

terrupted view. The grass and shrubbery are kept in nice order,
and seats and summer-houses provided. There are also extensive
grounds in front of the officers' residences, which are quite commo-
dious. The kitchen gardens of these houses are so arranged that
they do not obtrude upon the view over the lawn, and are ren-
dered more productive by being placed close under the shelter of
these walls.

The alterations, repairs, etc., are carried on at this institution
by an officer who is called the clerk and agent, and who is borne
on the navy list. In cases of any construction, repairs, or altera-
tions being considered necessary, the medical officer in charge
makes out a request for it, the medical director-general receives
and approves it, his recommendation carrying great weight. The
matter is then decided upon at the admiralty, under whose orders
the clerk and agent carries them out. This officer occupies an
excellent house in the grounds.

About three years ago a radical change was made in the gov-
ernment and police of this and other naval hospitals. Previous
to that time they had a military governor, who was charged with
the discipline, police, and guarding of the hospital and its grounds.
This is now dispensed with, and the entire charge in every respect
is vested in the principal medical officer, who attends to all the
details of the government, police, and working of the hospital,
subject only to the admiral in command at Portsmouth.

The principal medical officer consults with the deputy medical
inspectors and staff surgeons in charge of divisions when called
upon to do so, but his duties are for the most part executive and
supervisory. He appears to have no sinecure in conducting so
large an establishment.

I was informed here, and also at the office of the medical direc-
tor-general at Somerset House, that no trouble in discipline, or in
any other way, had resulted from the change alluded to above.
Indeed, that the practical working was acknowledged to be good
even by those who had originally opposed the change.

The police force of the establishment consists of details from

278 ENGLISH HOSPITALS.

the metropolitan police, who wear the regular police uniform.
The strict and intelligent manner in which they performed their
duties was spoken of in the highest terms. The men are selected
by the police inspectors in London from those who have distin-
guished themselves by good behavior. They are generally young
or middle-aged men. This is considered a very desirable place,
and the men are very careful so to conduct themselves as to be
retained here. They have proved so efficient that no change is
desired. The nurses allowed by the admiralty are one to every
seven patients. At present they have about one to nine.

I presume it will be unnecessary to be more prolix concerning
Haslar; I will therefore close with some account of the medical
staff, etc., to enable the Department, and the Bureau, to see the
organization in this respect. I should state that the number of
medical officers for duty is obviously too small, which entails
more constant labor, both professional and clerical, than seems
right and proper. This, however, is only my opinion, as I heard
no complaints on that point. The medical officer in charge is
Inspector- General James Salmon, esq., M. D., who has Sir Gil-
bert Blane's medal, and is honorary physician to the Queen.

There are two deputy inspectors-general, who divided the pro-
fessional supervision in the hospital, one staff-surgeon, and three
assistant surgeons who have all passed for surgeons. There are
also a chaplain and a clerk and agent.

There is a very large number of servants and laborers, amount-
ing to between sixty and seventy, including foreman of laborers,
cooks, butler, carpenter, gas-fitter, barber, postman, washerman,
washerwomen, laborers, scrubbers, and seamstresses.

THE ROYAL HOSPITAL, YARMOUTH, FOR THE
• INSANE OF THE NAVY.

Before leaving England I made a visit to Great Yarmouth to
see the naval insane hospital, of which the medical director-gen-
eral was evidently very proud, and not without reason, as I found
on going through it.

Yarmouth is in a very bleak and raw situation, and about as
far removed from the great centers as it is possible in England
for a place to be. This is to be regretted on several accounts,
the principal of which is that the climate necessitates extra vigi-
lance in regard to pneumonia, etc., with which the insane are so
liable to be affected.

The history of the occupation of the building as an insane
hospital is as follows :

Built early in the present century, when general naval actions
were common, it was in use but a few years when the general
peace took place. The navy, having no present or prospective
use for the buildings, turned them over to the army, by which
they were for a long time occupied as barracks. Finally the army
ceasing to occupy them they reverted to the navy, and, as the
care and treatment of the naval insane in some more systematic
and special way was then attracting the attention of the authori-
ties, it was determined to fit up the buildings in question for
this purpose. This was in 1863.

Deputy Inspector-General William McLeod, esq., M. D.,
royal navy, was ordered to take charge of the establishment in
July, 1866, and he has remained in charge since that time. Dr.
McLeod is so thoroughly capable, so interested in his work, and
now so experienced, that his tenture of office is probably perma-

280 ENGLISH HOSPITALS.

nent, as it is manifest that any change must be undesirable. As-
sociated with him on duty is Staff Surgeon Whicher, who has also
been there for several years. There is also a clerk in charge of
stores, etc., attached to the hospital. These officers occupy very
comfortable residences outside of, but close to, the hospital. Dr.
McLeod has entire charge, and is responsible only to the medical
director-general of the navy and the admiralty, and corresponds
directly with them.

It may be as appropriate a place as any to state that every
patient received here for treatment has to be received upon the
same medical certificates which the act of Parliament requires for
other insane-establishments. These certificates are forwarded to
the medical director-general, who judges from them whether the
person is a fit subject to be received at Yarmouth, and who orders
accordingly.

The buildings comprising the Yarmouth establishment are con-
structed of brick, two stories in height, and built in the form of a
quadrangle. Attached to them are a store-house, kitchen and
bifttery, laundry, and other offices, which are surrounded by walls,
as are also the airing-grounds for the officers and men. Terraces,
however, are so raised from the grounds away from the fences
and walls, that the sense of confinement created by walls is in a
measure done away with. Covered seats and walks are arranged
in these grounds looking south, to allow patients to take the air
with comfort either in very sunny or rainy weather. There are
also convenient drinking-fountains arranged for the use of the
patients.

The quarters of the officers under treatment are in the front of
the quadrangle, mostly on the second floor, and are exceedingly
comfortable and well furnished. There is a dining-room for
convalescents attached. On the floor below is a handsome par-
lor, as well as a room in which, out of hearing, but still in full
sight, the patients may see their friends.

Extreme attention is paid to cleanliness, especially in the bed-
ding. Dr. McLeod had the bedding and bed-clothing turned up

ENGLISH HOSPITALS. 251

for me frequently in both the officers' and men's rooms, and I have
never seen any more admirably clean.

My visit was entirely unannounced, and I saw everything at
an early hour, and without preparation. There seems to be no
limit to the amount of clothing used — every article of wearing-
apparel or bed-linen being changed whenever soiled. There were
some paralytic cases which had been in bed for five years, and
Dr. McLeod assured me he never had bed-sores among them.
This he attributed to complete change of clothing whenever wet
or soiled.

Curtains were provided for the windows, and engravings are
plentifully hung in the passages and day-rooms, both of the offi-
cers and men, and other means of ornament are resorted to to
take off any bare or prison-like air. There were, in many parts of
the establishment, flowers in pots in the window-seats, and jars
and other ornaments for the mantels to make things cheerful.

Dr. McLeod assured me that he never had had assaults com-
mitted with these apparently handy missiles, and no more broken
than would occur in any ordinary establishment. In speaking of
these matters he said that the government was extremely liberal
in carrying out all his suggestions except in regard to matters of
ornament, which he himself regarded as an important feature in
the treatment of the inmates. He began to obtain these things
from the bone and slush sold; and it is wonderful to see how
much he has accomplished.

Large day-wards are provided for the men, where they have
different occupations and amusements, as well as separate dining-
rooms. No patient who is able to be up and dressed is permitted
to be in his dormitory in the day-time. This enables them to
thoroughly ventilate and police the rooms and beds.

There are now there about three hundred men and between
thirty and forty officers, and yet there are a number of spare
rooms for officers, and two complete sets of men's wards vacant.
In the portion of the quadrangle opposite to the entrance and on
the ground-floor are the rooms for patients (other than officers)

ENGLISH HOSPITALS.

who, from disposition to quarrel, etc., require a separate room at
night. Great care is taken in this respect ; one man who is
noisy or quarrelsome, either by day or night, being sometimes suffi-
cient to set off a whole ward, as one hysterical woman will set off
every other one within hearing. These separate rooms open
upon a corridor, and are visited every hour during the night.
The contents of the close-stools provided for each of these rooms,
are emptied as soon as used, no matter how often or at what
hour. The sheets are changed each time they are wet, no matter
how often that accident may occur. There are strong rooms,
but Dr. McLeod said he rarely had occasion to use them. They
were padded in the usual way, and the padding covered with
painted canvas, which was found to be much better than the
" kamptulicon " or any other cloth prepared from caoutchouc, as
when excreta were rubbed upon it it could be washed without dam-
age, while the prepared cloths easily rotted. The same testimony
was borne at Netley. In cases where men were destructive in
their tendencies at night, a bed was made on the floor for them
in a single room, the bedstead and other furniture taken away, and
a nurse put on duty. When an officer became noisy or outra-
geous he was sent during the day to a handsome room large and
nicely furnished, and warmed by hot water pipes. There he was
kept in charge by as many nurses as his condition required. The
effect of these surroundings and of this simple and humane treat-
ment was described as marvelous in most cases. All the rooms
have inside shutters opening half way up, to prevent damage and
to modify the light in certain cases. The epileptics are in a ward
communicating with one in which are the bed-ridden paralytics,
so that one nurse can watch both rooms at night. The nurse
has a small room in the center, between the two, with a light so
arranged that both large rooms are illuminated sufficiently. The
light is high up, behind glass, and can be controlled only from
the nurses' room. There is a window on each side of the nurses'
room, from which every bed in both rooms can be seen. I may
mention that in addition to the watch within doors at night the

ENGLISH HOSPITALS. 283

grounds and offices are regularly patrolled. I will explain else-
where how vigilance is secured on the part of these men.

The water-closets had just been rebuilt, and are now detached
from the buildings sufficiently to allow a space for ventilation by
lattices. They connect with the wards, and are quite as easy of
access as the old ones, which were within the line of wall of the
building itself. There is no possibility of a patient disarranging
anything, or of doing himself any harm in these water-closets, and
they were as entirely free from odor as any I have ever seen.

The bath-rooms had just been re-arranged, and were ample.
A Russian bath was in process of building. Bathing once a week
at least, for both officers and men, is compulsory, and the patients
are at those times more particularly examined for the detection of
vermin, or of any contusions or injuries, or the effects of any in-
jurious practices.

Dr. McLeod has just finished, at an expense of five or six hun-
dred pounds, a set of rooms with a small diet-kitchen attached
to the day-wards for the idiotic and more helpless patients. These
rooms are for two experienced middle-aged female nurses. He is
anxious to try whether these will not be better fitted to take charge
of this unfortunate class of patients. The admiralty cheerfully
consents to supply the means to try the experiment.

To proceed with the buildings : There is a very convenient and
very excellent dispensary with a thoroughly competent apothecary.
I found the expenditure in this department was about the same as
for five hundred men afloat ; at least the cost of drugs is about
that. The proportionate expenditure of cod-liver oil, tonics, etc.,
to that of other classes of medicines is very great.

The buttery, kitchen, etc., were in perfect order. The laundry
was unusually large and complete in consequence of the immense
amount of bed-linen, blankets, and clothing constantly in use.
In fact, the quantity seemed to me to be perfectly enormous.

There is a large store-house in which everything is to be found
which can possibly be needed in such an establishment. It is
under the charge of a disbursing officer, and everything is issued

284 ENGLISH HOSPITALS.

on requisition. There are also a tailor-shop with a hired foreman,
in which all the outer clothing of the patients is made, and rooms
in which repairs are made by females employed for the purpose.
I may mention that almost all the work in the laundry and tailor-
shop is done by patients, and there is a loom at which one of the
patients makes all the cocoa matting used in the establishment.
These people are rewarded by a small portion of tobacco and
sometimes by a little extra bread and cheese and beer. Tobacco
is served out gratis, but in small quantities, to those who are al-
lowed to use it, and is found to be a most valuable incentive to
industry and good conduct.

I should have mentioned that if an officer's friends choose to
clothe him they are permitted to do so, but otherwise they wear
a sack-coat, trousers, and waistcoat of stout blue navy cloth.
The men wear the same, but of coarser material.

Unless officers have families dependent upon them, the most
of their half-pay goes to contribute toward their support, and the
same is the case with men who have pensions.

In regard to the building generally, I may say it is wonderful
how well, by judicious arrangements and alterations, they have
been adapted to their purpose. The forlorn air of a public asy-
lum is avoided, while the safety of the inmates is entirely provided
for. Indeed, there have been but two elopements during the last
five years, and in both cases the men were found in the town the
next day.

I have several times already alluded to the kind and judicious
treatment received by the patients here. I was told that the
cures were quite up to the average, and that the deaths were
about ten per cent., mostly among the paralytic.

I may mention that Dr. M. dissents from the opinion commonly
held in naval circles that insanity is frequently caused by mastur-
bation. On the contrary, he considers it a symptom, and that
it is almost invariably the result of spinal irritation. It is not,
however, either my business or purpose to enter into any purely
medical question in this connection.

ENGLISH HOSPITALS. 285

The system pursued here in regard to the nurses differs entirely
from that of other naval hospitals, and is so important and full of
instruction that I may be excused for dwelling upon it.

Of course it is of the utmost importance to have experienced
men of health, sobriety, strength, and temper. They carry their
lives in their hands almost, and there is scarcely a position in life
requiring more watchfulness and firmness combined with good
temper. These qualities are sufficiently rare, and it requires
greater inducements than the pay offered to ordinary nurses to
secure such men. Dr. McLeod has therefore in his hands the
power of instant discharge of any nurses found indelictu. He told
me he had discharged nineteen nurses the first year he was here —
most of them, as I understood, for rough treatment to patients.

The advantages these nurses have are as follows : Unlike those
in other naval hospitals, they acquire a claim for pension (either
for injury in the line of duty or for length of service) just as if
they served at sea. They have certain fixed hours of duty and
of leave, and can have their families in the town close by. They
are allowed to draw and take home a portion of their ration ; for
instance, they may draw their week's ration of beef in one piece.
Of course for every additional year the attendant remains there
he has a greater interest in retaining his position. In some cases
where men had been discharged for cause, they had made
appeals through friends to the admiralty; but Dr. M. had always
been thoroughly sustained, and his influence thus preserved.

There is one attendant for every eight patients ; but, as I have
stated already, much work is done by harmless patients, much to
their benefit and generally at their own request. For professional
attendance, supervision of attendants, as well as the working of
the institution generally, there are, as I have said before, but two
medical officers employed, which seems too few. Dr. McLeod
told me that he generally went through the wards four times a
day, and he seemed to know the name and the peculiarities of the
case of each individual. It is easily seen that it requires peculiar

',86 ENGLISH HOSPITALS.

interest in and fitness for the work to enable him to carry it on. so
successfully.

The diet of the patients of an insane hospital must, from the
nature of the case, be much more varied in quality and quantity
than in an ordinary hospital. I was shown one man, who,
from disability or unwillingness to perform the act of deglutition,
had been fed by a stomach-tube for weeks. Yet he was up and
dressed, and looked in pretty good condition. Of course such a case
would require great tact and a great variety of liquid aliment to
keep him in tolerable health. Great care is necessary in mincing
meat and vegetables to meet other cases. This is done by simple
machinery, and the whole of the culinary arrangements evinced
unusual care. The meats are of the best quality, and nicely pre-
pared and appetizing. The allowance of meat is only three-fourths
of a pound per man, with three-fourths of a pint of excellent mild
beer. A great deal of barley and rice is used.

The officers who are patients have, generally, a daily allowance
of sound wine, (where it is not contra-indicated,) not as a ration,
but as a sort of standing prescription.

Indeed, there seems to be no difficulty in obtaining anything
that is thought necessary for health and comfort upon simple
recommendation, the admiralty and medical director-general
seeming to have this institution so much and justly at heart.

EXAMINATIONS AT NETLEY.

The following schedules of the examinations of assistant sur-
geons on probation, held at the close of the seasons of 1869 and
1 87 1, of the army medical school at Netley, evidence the high
professional character of the course of instruction at this institution.

ARMY MEDICAL SCHOOL, NETLEY.

Eighteenth session. 1869.

written examination. ($ hours allowed for each subject.)

I. Pathology. (Professor William Aitken, M. D.J Monday,

2d August, 1869.

i . The hydatid echinococcus cysts, the tape-worm (medio-can-
ellata,) and the guinea-worm, being the most frequent of parasitic
diseases among soldiers, give an account of the natural history
of each and all the forms of these parasites, stating the sources
of each, showing how they gain access to the human body as well
as to the bodies of animals, and how they reach the sites in which
they are severally found.

2. Give an account of the lesions in the aorta which seem to
jorecede and to favor the development of thoracic aneurism.

3. Private Andrew Ballantine, one hundred and fourth regi-
ment, aged 36, had completed 15}^ years of service, and was
admitted to Netley from ship-board from India. He had been

288 EXAMINATIONS AT NETLEY.

ioo days on the voyage. He was admitted on the 19th May,
and died on the 12th of June, 1869. His service is as fol-
lows: July, 1854, to November, 1854, in England; from No-
vember, 1854, to June, 1856, at Gibraltar and in the Crimea;
from June, 1856, to February, 1858, in England; afterward in
India. During his service in India he suffered from continued
fever, from gonorrhoea and from diarrhoea. He was finally attacked
by dysentery in January, 1868, and became so debilitated he was
sent home as an invalid to Netley. He improved during the
first part of the voyage home, but after passing the Cape he re-
lapsed, and was landed in a condition of great exhaustion and
emaciation. The discharges from the bowels, during his treat-
ment at Netley, varied from five to ten motions daily. The pulse
was weak, sometimes intermittent, and during the last fortnight of
his life, ranged from 90 to no. The motions, always loose, in-
creased to eight or ten daily, of a brown color, emitting the
characteristic dysentery odor. They were passed without tenes-
mus. He died greatly emaciated and exhausted, the bod v- weight
being only 76 pounds in a man of 69 inches height.

Describe the condition of the following parts :

1. Glands at base of tongue, and the tonsils.

2. Color and consistence of the mucous membrane of the
small gut.

3. Color and condition of the several regions of the great
gut, as to thickness, thinness, or ulceration.

4. Condition of solitary glands.

5. Condition of liver, especially as to capsule and substance.

Write a commentary on the case in relation, especially

1st. To the post-mortem evidences of malaria.

2d. To the results of the dysenteric attack.

3d. As to the post-mortem appearances in the liver.

EXAMINATIONS AT NETLEY. 289

II. Military hygiene. (Dr. E. A. Parkes, F. R. S.J Tuesday
-$(1 August, 1869.

1. What are the points of importance in judging of the purity
of water for drinking ? What diseases are believed to arise from
impure water, and what are the best methods of purification ?

2. What is the standard of purity of air? What are the rea-
sons for such a standard, and for expressing it in terms of carbonic
acid ?

3. What are the conditions of soil which have been supposed
to be favorable to the development or prevalence of phthisis,
typhoid fever and cholera ? What are the conditions of soil sup-
posed to have been instrumental in causing the late outbreak of
fever at the Mauritius ?

4. What are the chief physiological effects of exercise ? What
amount of exercise is demanded from the infantry soldier ? What
is the length of an ordinary march ? What weight does the sol-
dier carry in heavy marching order, and in what manner should
the weight be disposed ? What effects may result from ill-arranged
accouterments and dress ?

III. Military surgery. {Deputy Inspector- General T. Long-
more?) Wednesday, \th August, 1869.

Gunshot Wounds of J-oints.

1. Describe the features which distinguish a gunshot wound of
a joint from an incised or punctured wound of a joint.

2. Describe the surgical steps to be taken in field practice for
the treatment of gunshot wounds, both uncomplicated

. . a. Shoulder-joint.

and complicated wounds of the several loints named &. Eibow-joint

■"■ •> c. vv rist-joint.

in the margin. Explain the motives which determine &' Knee-joint.

° r f. Ankle-joint.

your decision in each case in which you consider the
J9

290 EXAMINATIONS AT NETLEY.

best treatment to be amputation, excision, or the adoption of con-
servative measures.

.(Note. — " Frame your replies respecting the several joints in-
cluded in the question under distinct headings, and in the same
order in which they have been placed in the annexed list.")

Optical examination of the eye.

1. Explain the principles on which the diagnosis of emme-
tropic, myopic, and hypermetropic vision by means of a convex
lens is founded.

2. Describe the process by which the degree of myopia and
hypermetropia may be determined by a convex lens.

(Note. — "Write an example in illustration.")

3. What conditions determine the nearest, and what the most
distant, points of distinct vision of an eye ?

IV. Military medicine. {Deputy Inspector-General IV. C.Mac-
lean.) Wednesday, $t/i August, 1869.

1. Private A. B., regiment, setat 35. Home service, 5

years; foreign service, 8 years; family history, good.

Present state : Is emaciated and has a listless and dispirited
appearance ; complexion muddy ; eyes discolored and expression-
less; lips bloodless.

Muscular system : Wasted, soft, flabby.

Respiratory system : Normal.

Circulating system : Heart's action feeble ; a soft systolic mur-
mur audible in cardiac region in the recumbent position, which
cannot be heard when the patient stands.

Digestive system : Appetite impaired : digestion imperfect ;
prone to diarrhoea from slight causes ; spleen and liver are en-
larged ; the former can be felt and seen to extend into the pelvis.

Urinary system : Urine contains albumen, but no tube casts.

The blood, when examined under the microscope, is deficient
in red corpuscles. The patient, unless warmly clothed, finds it

EXAMINATIONS AT NETLEY. 29 1

difficult to maintain his natural temperature, and is liable to at-
tacks of ague, particularly in wet and cold weather.

Diagnose this case. Give an intelligent commentary on the
symptoms and appearances, adding your prognosis, with reasons
annexed, and lay down a rational plan of treatment.

2. Your attention having been called to pulmonary phthissi as
a disease of armies, you are required to give —

a. The causes which appear to operate in exciting this disease
in military life, including the observed effects of climate, if
any.

b. The form of the disease usually met with in the army.

c. The means of early diagnosis.

d. General principles of rational treatment.

3. Describe, a, the different forms of insolation; b, the sequels
of this affection; c, the treatment, including that of the most
common of its sequels.

Medical candidate

ARMY MEDICAL SCHOOL, ROYAL VICTORIA HOS-
PITAL, NETLEY.

Friday and Saturday, August 6 and 7, 1869.
PRACTICAL EXAMINATION.

1. Medicine, (i hour allowed?)

2. Surgery, (i hour allowed.)

Division , Ward No. .

Make an examination of the case of .

Twenty minutes allowed for the examination. Written notes may be taken.

You are required to write concisely a history of the case, your
diagnosis, prognosis, the probable effects of treatment, and the
influence of the disease (or injury) on the man's fitness for service
as a soldier.

Thirty minutes allowed for this description.

3. Hygiene, (3 hours allowed.)

1. Examination of the sample of water (1) before you.
a. J Physical examination.
b.J Qualitative examination.

c.J Quantitative examination for chlorine, oxygen, total
hardness.

EXAMINATIONS AT NETLEY. 293

Hygiene — Continued.
d.) Determine in sample (n) the total, permanent, and

removable hardness.
c.) Determine in sample (in) (the distillate of yz litre of

water) the amount of free ammonia in grains per gallon.

2. Reading of barometer, with corrections.
Determination of dew point, amount of vapor, elastic force,

etc., by Glaisher's tables.

3. Microscope: state the contents of packet.

4. Pathology.

1. Examine the portions of tissue placed in the dishes. State
of what organ each is a part and describe its morbid condition.

2. Describe the lesions shown in the preparations numbered i, 2,

3, 4-

State what parts are shown in the preparations.

Describe the lesion or lesions which are illustrated, and the
probable stage of the disease to which it corresponds.

3. Determine the magnifying power of any one of the micro-
scopes, and append the scale used.

4. Describe and name generally what you see in the fluid con-
tained in the test-tubes, examined under the highest power.

5. Name each of the preparations placed under the microscopes
on the table.

ARMY MEDICAL SCHOOL, NETLEY.

Examination held at the close of the twenty-second session.

I. Military hygiene. [Doctor E. A. Parkes, F. R. S.) Monday.

July 31, 1 8 7 1 . (3 hours allowed. )

1. What is the usual length of marches; how much ground is
got over per hour ; what weight will the infantry soldier carry on
active service ; and what are the chief conditions during marches
which may affect his health ?

2. What are the chief diseases arising in camps, and what pre-
cautions would you take to keep camps healthy ? What should
be the amount and kind of food on active service ?

3. Give a general statement of the sickness and mortality of
the soldier in India, and state especially what steps you would
take in anticipation of or during an attack of cholera.

4. Give a brief statement of the best known facts on the effect
of a hot climate on natives of a temperate region.

II. Military medicine. (Deputy Inspector- General W. C. Mac-

lean, C. B.) Tuesday, August 1, 187 1. (3 hours allowed.)

1. Under what conditions are typhus and typhoid fever gener-
ated in camrjs ? Give the symptoms of typhus under the follow-
ing heads, and in the following order :

(a) Character of the chill.

(b) When prostration appears.

(c) Describe the exanthem; when it usually appears; the
one which it most resembles ; and the diagnostic signs.

EXAMINATIONS AT NETLEV. 295

(d) The head symptoms and usual condition of mental facul-
ties throughout the disease.

(<?) Chest symptoms.

(/) Abdominal symptoms.

(g) Urine.

(//) Temperature from first, and as usually observed through-
out the disease.

(/) If case terminates favorably, when does the change usually
appear, and in what manner ?

(k) Describe the anatomical lesions, contrasting them with
those of typhoid fever.

(/) The most common sequels of the disease.

(;;/) Give a summary of the most rational treatment.

2. 1. What is the probable source of danger from encamping
on ground lately occupied by a body of men, among
whom cholera has prevailed ?

2. What is the standing order to be observed Avhen cholera
appears in an epidemic form in barracks in India, and
what is the object of this order?

3. What is the object of frequent inspections of men when
cholera prevails?

4. Define exactly what you mean by the term " premoni-
tory diarrhoea" in cholera.

5. At what hour does cholera most usually attack ?

6. What is the difference between the temperature of the
surface, and that in the rectum in the stage of collapse ?

7. What is the period of suppression of urine in very severe
cases?

8. What is the condition of the respiratory functions during
collapse, and what the prognostic value of very rapid
respiration ?

9. Describe the evacuations from the first setting in of the
disease up to the time of convalescence.

10. What is the prognostic value of bloody evacuations in
this disease ?

2 g6 EXAMINATIONS OF NETLEY.

ii. In what condition are the lungs usually found after death,
as regards blood contents and weight ? How does Doctor
George Johnson explain this condition ? State any rea-
sonable objections that have been brought against the
theory.

12. How should you treat premonitory diarrhoea?

13. What should be done with the evacuations of cholera
patients ?

14. What are the objections to the use of opium when the
disease is established ?

15. If urine is long suppressed after re-action appears, what
would you do to aid nature in restoring the secretion ?

III. Military surgery. {Deputy Inspector-General T. longmore,
C. B.) Wednesday, August 2, 187 1. (3 hours allowed.)

Question 1. Give an account of pyaemia as a complication of
gunshot wounds in military hospitals, mentioning in your reply —

a. The classes of wounds which appear to be most liable to

the supervention of pyaemia and the probable explana-
tion of this special liability ;

b. The train of symptoms by which it is usually ushered in,

and accompanied to its termination;

c. The circumstances in campaigning which favor its develop-

ment ;

d. The means of prevention ; and lastly,
e: The treatment.

Question 2. A patient comes before you who is hypermetropic
and presbyopic.

A. Explain the nature of these visual conditions.

B. Describe the steps by which you ascertain the amount of

hypermetropia and presbyopia of the patient.

C. Assume any degrees of hypermetropia and presbyopia

you please and then calculate the focal powers of the
lenses that will correct them.

EXAMINATIONS AT NETLEY. 297

Question 3. Describe the treatment of gunshot wounds of the
head, dividing your reply under the treatment of —

a. Contusions and wounds of the scalp.

b. The same, together with contusion or fracture of the cra-

nium, but without depression of bone.

c. The same, but with depression of bone.

d. Wounds with penetration of the cranium.

IV. Pathology. [Professor William Aitken,M. D.) Thursday,
August 3, 187 1. (3 hours allowed.}

Question 1. What is lardaceous disease? Describe the char-
acter of the lesion, anatomical and chemical. In what textures
and organs, and in what parts of these organs, is the lesion found ?
How is the lesion to be recognized after death with and without
the iodine test-solution ? Give the composition of the iodine test-
solution, and describe the conditions under which lardaceous
disease is brought about.

Question 2. What do you understand by "haematoma?" In
what form and in what part of the body has the lesion been shown
to you ? What is the nature, its usual site, and the circumstances
under which it is to be developed ?

Question 3. Sergeant Thomas Eyles, aged 2,3, after thirteen and
a half years' service was admitted into Netley hospital from India,
after a voyage of forty-six days. He had served in India five years,
and two and a half years in Malta. He is reported to have suf-
fered from gonorrhoea, 40 days; splenitis, 32 days; bronchitis, 20
days; orchitis, 12 days; diarrhoea, rheumatism, and hepatitis.
The duration of illness before admission was 234 days, and was
diagnosed as "ulceration of the stomach."

The points of striking character in the history of the case are,
emaciation excessive ; he could only lie on his back inclined to
the left side, relieved by sitting up in bed and leaning forward.
Breath of very fetid odor. Respiration easy, 20 per minute;

EXAMINATIONS AT NETLEY.

lancinating pain in right side on deep inspiration ; intense bad
taste in the mouth ; appetite gone ; frequent inclination to vomit ;
fixed pain immediately below ensiform cartilage, extending to
the right side over hepatic region j abdomen sunken and tympa-
nitic, and exquisitely tender on pressure. Symptoms were believed
to indicate the stomach as the seat of disease ; others pointed to
the liver ; and the detailed medical history sheet referred to attacks
of dysentery at Nusserabad.

Describe the morbid conditions of the liver, including its dimen-
sions, and the relation of the lesions to the stomach, and also to
the state of the intestines, the conditions of which are required to
be described.

REPORTS

UPON THE

HOSPITALS, CHARITABLEINSTITUTIONS,

PECULIAR DISEASES OF PERU

JOHN M. BROWNE, M. D.,

MEDICAL INSPECTOR, U. S. NAVY, SURGEON OF THE FLEET, PACIFIC STATION.

PERUVIAN HOSPITALS AND CHARITABLE INSTITU-
TIONS.

By the courtesy of Senor Don de la Barrera, director of the
Sociedad de Beneficencia Publica, and under the immediate
guidance of C. S. Rand, esq., whose attention cannot be too grate-
fully acknowledged, Passed-Assistant Surgeons Ver Meulen,
Culbreth, Ayres, and myself, were permitted to inspect the hos-
pitals and charitable institutions at Lima.

The Society of Beneficence has the administration of the hos-
pitals, asylums, cemeteries, "caja de ahorros," or savings-bank,
and the gratuitous schools at Lima; also, the administration of
the various societies of cofradias or confraternities, the manage-
ment of the land and house property of the institution, deriving
its resources from the rents of said property and that of the con-
fraternities, together with a percentage from the national lottery
government subsidies, private donations, inheritance, and intestate
estates. The works actually perfected by the Beneficencia during
the past year amounted to a sum exceeding $165,000.

Our inspection commenced at the Hospital de San Andres, the
only civil hospital for men and boys in the city. Situated in a
densely populated district, without architectural pretension, of
one and two storied adobe buildings, inclosing a front and rear
court, this hospital contains six hundred and fifteen beds, con-
stantly occupied, and yet is insufficient for the requirement, yearly
increasing. Wards of various sizes, insufficiently lighted and badly

302 PERUVIAN HOSPITALS.

ventilated; each dedicated to its patron saint, a large altar with
ornate appointments and surroundings being placed in a semi-
rotunda, from which diverge a few of the principal wards. Floors
of asphaltum ; roof of wood ; painted high walls ; windows small
and far removed from the floor ; unsupplied with baths or water-
closets. Bedsteads of iron ; mattresses of wool ; colored blankets ;
cotton sheeting. Every ward had too many beds, and, in a few,
a greater defect was noticed in the presence of galleries filled with
beds ; fortunately three wards have had their galleries removed,
refashioned, and have gained a better salubrity by increasing the
light and ventilation, but others yet remain. One ward, say 130
feet long by 26 feet wide, deprived of lateral ventilation by its
construction between two others, had upon the floor and in the
galleries one hundred beds, an agglomeration that has too un-
happily assisted in exposing a population in the time of its period-
ical infection. Originally the hospital was constructed for three
hundred and fifty beds, but the continual increase in application
for admission caused other wards to be built whose sites en-
croached upon the garden, and to preserve it these galleries were
erected, and although the number treated at one time amounted
to over seven hundred, the demand continues and probably the
galleries will remain until the new hospital is completed. The
hospital is in the immediate care of Sisters of Charity, certain of
them having the management of the kitchen, laundry, and linen-
room, and as in Chili, the pharmaceutists of the establish-
ment. The dispensary and laboratory, kitchen, and laundry were
well equipped and in good order ; general cleanness fair. Drain-
age ought to be good, the city sewerage, consisting of acequias
or streams of water, covered and uncovered, running through the
streets. A large and tolerably well worked garden, supplied with
fruit and flowers, is in pleasant contrast to other surroundings,
and affords a purity of atmosphere not otherwise attainable. The
interior court-yard contains the chapel ; baptism, profession of
'faith, and marriage being of frequent occurrence. Among the
variety of diseases encountered the most common were phthisis,

PERUVIAN HOSPITALS. 303

dysentery, pneumonia, malarial and typhoid fever, hepatic dis-
ease, rheumatism, scrofula, and syphilis, with the effects of
accidents in the surgical department.

During the year of 187 1 there were subsisted 12,544 sick, at a
cost of nearly $85,000. Of these patients 11,049 were charity,
1,353 paying, and 142 prisoners, of whom 10,046 were discharged,
1,348 died, and 550 remained.

Next the Hospital dc Santa Ana, devoted to the treatment
of women and girls, plain adobe buildings, of one and two stories
in height, originally of cruciform construction, now irregular by
additions from time to time, affording courts, and with a luxuriant
garden, comprises quite a tract, suitably inclosed. Four spacious
lofty walled wards, with fair ventilation and light, and several
smaller wards less high, poorly lighted, and deficient in ventila-
tion. In the center, facing the entrance, the transepts being to
the right and left, is a large and elaborately decorated altar, bear-
ing the statue of the holy patroness, whose rich vestments are
plentifully hung with silver, votive offerings, the grateful acknowl-
edgment of the faithful for benefits received. Asphaltum floors ;
painted walls; wooden roof; windows near to and also in the
roof, and in some of the lesser wards skylights alone ventilate and
light. Bedsteads, cots, and cradles of iron, with frame supporting
and inclosed by white curtains, wool mattresses, white blankets
and bedspreads, cotton sheeting. Principal wards occupied by
women, others by children, and women who have given birth
while under treatment, the only condition upon which infants are
received. No water-closets seen ; baths few and indifferent and
removed from the wards; five hundred beds. General appear-
ance of the main wards attractive ; cleanliness good. Chief dis-
eases noted, phthisis, pneumonia, fevers, dysentery, chronic diar-
rhoea, cardiac disease, brain softening, and diseases peculiar to
women and children. The kitchen, laundry, and linen departments
were spacious and excellent, presided over by Sisters of Charity,
as also the dispensary and laboratory, large apartments thoroughly
and elegantly equipped.

304 PERUVIAN HOSPITALS.

To this hospital, under the charge of the sisters, is attached an
asylum-school for orphaned girls. A new saloon, recently added,
increases the number of girls from fifty, the original maximum
number, to seventy. Instruction in the catechism, common
branches, French language, sewing, embroidery, artificial flowers,
washing, ironing, and cooking, constitute the moral, intellectual,
and domestic education of these orphans, in a manner not to
lose sight of their humble condition and the modest position
they must assume in the world. In this hospital the administra-
tive and economical service intrusted to the sisters is evidently per-
formed with fidelity ; alike the afflicted and the orphans receive
their consoling and useful services.

There were subsisted in the Hospital de Santa Ana during the
year 1771, 8,711 sick, at a cost of nearly $60,000, including the
expenses of the internal school and maintenance of the girls. Of
the patients 7,390 were women, 1,316 children, and 5 prisoners,
of whom 7,637 were discharged, 739 died, and 335 remained.

In close vicinity is the Hospital de San Bartolojne, (military,)
built of adobe, with a two-storied frontage of pleasing architecture ■
other buildings plain, of one or two stories, all arranged to inclose
two quadrangles. Front and sides of first quadrangle afford
apartments, simply furnished, for the officers of the institution and
sick officers, there being for the latter twenty-six beds. Wards
large and small, crowded with beds, five hundred and eighteen in
number, badly lighted and worse ventilated, with roof of wood,
painted walls, and floors of asphaltum, save in a new addition
where wood is substituted. Usual altar and representation of
the patron saint. Bedstead of iron, mattresses of wool, colored
blankets, cotton sheeting. Uncleanliness, vitiated air, gloomi-
ness— an unhappy and unattractive combination. The majority of
the patients were suffering from phthisis, pneumonia, dysentery,
diarrhoea, fevers, typhoid and malarious, syphilis, scrofula, rheum-
atism, and injuries. Kitchen, laundry, and linen-room, well sup-
plied, well kept, spacious ; dispensary and laboratory beautifully
fitted, attractive and worthy of praise. The Sisters of Charity
have immediate management.

PERUVIAN HOSPITALS. 305

For the year 1871 the cost of subsisting 10,329 sick amounted
to $90,000. Of the patients 455 were officers, 9,874 soldiers, of
whom 9, 745 were discharged cured, (434 officers, 9,311 soldiers,)
156 died, (5 officers, 151 soldiers,) 8 soldiers deserted, and 420
remained, (16 officers, 404 soldiers.) The difference in favor of
this hospital, respecting the mortality over the others, has expla-
nation from the fact that in the latter the largest number of cases
possess the greatest severity, while in the military hospital cases
are admitted, however slight may be the indisposition, and fre-
quently the applicant seeks only a rest from the hardships which
enter into the life of the Peruvian soldiery, either real or assumed.

As the other active hospitals and asylums are of less importance
than those described, and have neither in architecture or equip-
ment a superiority, a brief mention of each will suffice.

Hospicio de insanos, {insane asylum.) — During the year 187 1,
363 insane were maintained at a cost of $29,000. Of these 195
were men, and 168 women; 90 were discharged, 28 died, and
245 remained.

Hospicio de Huerfanos Lactantes. — Orphan-asylum for both
sexes not exceeding seven years of age. Five "hundred and five
supported in 1871 at a cost of $32,000. Of these 219 were male,
and 286 female, of whom 163 were discharged, 135 died, and
207 remained.

Hospicio de Huerfanos de la Recoleta. — Orphan -asylum for boys
of all ages. One hundred and sixty-eight supported in 187 1 at a
cost exceeding $27,000, including expense of education in college;
of these 19 were discharged, n died, and 138 remained.

Hospicio de Huerfanos de Santa Cruz. — Orphan-asylum for
girls over seven years of age. One hundred supported in 1871
at a cost of more than $15,000; of these 7 were discharged, 1
died, and 92 remained. A charity-school is attached to this insti-
tution for poor girls of over seven years of age, and an asylum
for children of both sexes from two and a half to seven years ;
also a dispensary. The school during 1871 had 250 girls who

306 PERUVIAN HOSPITALS.

were taught the catechism, sacred history, grammar, reading,
writing, arithmetic, politeness, sewing, weaving, embroidery, and
other manual and domestic labors. To these girls a dinner is
given every Saturday with alms that may be donated by the chari-
table. Gratuitous consultations are held three times a week
in the dispensary, and visits made by three physicians, two paid
by the Beneficencia, and one by the sisters, who assist with food,
clothes, and bedding, the cost of which is defrayed by a monthly
subscription or other extraordinary resources.

Lazareto de la Inmacnlada Conception. — This and other lazar
houses were constructed on account of yellow fever. In 1871
1,105 sick were subsisted at a cost of $11,000; of these patients
there were 1,017 men and && women, of whom 868 were discharged.
150 died, and 87 remained.

Asilo de Mendigos. — This asylum provided for 259 beggars
during 187 1, at an expense of $20,000, 148 men and 111 women,
of whom 45 were discharged, 73 died, and 141 remained.

Hospicio y Colegio de Maternidad. — This lying-in asylum assisted
358 parturients in 187 1, all being gratuitous, except one ; 347 were
discharged, 2 died, and 9 remained.

Hospicio de Santa Rosa 0 Asilo Candanw. — This asylum, founded
under the protection of the patroness of Lima, honored by the
possession of the picture that adorned the old chapel of the
university, was opened in December, 1871, having been erected
by the Beneficencia, agreeably to the provisions of the bequest of
Mr. Candamo. It furnishes a home to 50 girls, orphans, or the
unfortunates, under the direction of the sisters, and is said to be
a true school of domestic arts for the girls of the people.

General cemetery. — Number of burials in niches 3,115 males,
1,820 females, exposed 759, giving a total of 5,694 for the year
1871.

Civil cemetery. — The necessity of a cemetery for depositing the
remains of persons not professing the Catholic religion was gen-
erally recognized as a consequence of the epidemics from which

PERUVIAN HOSPITALS. 307

of late years, Lima has suffered. The Beneficencia made the
government aware of this public necessity, and from it received
authority in 1869 to construct and administer a civil cemetery.
Purchasing a piece of ground, the preparatory works, at an ex-
penditure of $8,000, are already terminated. Estimates for the
future works, including a chapel, amount to $20,000, and the
plans and designs indicate beauty of architecture and solidity.
It is to be desired that the same may have completion at an early
day, thus satisfying one of the most indispensable requirements
of a population that already numbers so many foreigners.

Hospital '" Dos de Mayo" {2d of May.) — The urgent necessity
of a large hospital, constructed after the most approved modern
plans, has long been acknowledged by the Beneficencia, not alone
from the fact that the existing hospital accommodation is entirely
too inadequate for the requirements of an increasing city, but that
in a square, a little more than 300 yards long by 200 broad, are
situated the principal market of the city, and three hospitals that
in the autumn and spring contain ordinarily, in ill-ventilated wards,
1,600 to 1,700 sick. With such incentives the Beneficencia
authorized the first preparatory expenditure for the erection of a
superior and extensive hospital, in July, 1868, and to November,
187 1, had expended thereon the sum of $300,000. The solidity of
the work accomplished corresponds to the importance of the es-
tablishment. This extensive edifice is of one story, save at the
corners of the facade, which are to be ornamented by domes, and
the chapel rising from the center, which is two stories in elevation,
with superimposed dome, supported by pillars and surmounted
by a second dome bearing a cross, the entire architecture being
elaborate and effective. Lower foundations of stone, upper of
brick, and walls of adobes. As the walls are ready for the roof, an
examination, assisted by the architect's plans, enabled a nearly
correct idea to be formed as to its future appearance — a square,
walled by a building that has 600 feet frontage on either side,
within which are separate buildings for wards, etc. This building-
inclosure is divided into a large number of apartments of different

o8 PERUVIAN HOSPITALS.

lengths, but of the invariable width of 23 feet, (except the corner
circular rooms,) and are to be used for the dead-room, anatomical
amphitheater, operating, convalescents', dining, servants', sleeping,
and dining rooms, general kitchen and dependency, laundry,
Jroning and drying rooms, coal, provision, and other store rooms,
,:an d cisterns. The principal and two carriage entrances give ad-
:rrrfes i°n t0 tne first jto/z'tf, which will be beautified by floral gardens .
Arem. "d the patio are rooms of the porter and guard, sleeping
andclrc/wm& rooms of paying patients, reception-room, office and
book-kee Der's room. A covered corridor connects the first with
the princii ia*l patio, and gives communication to five rooms for
the medical officers, four for chaplains, four for the superintendent,
•and three for depositing-rooms, (clothes of patients on admission.)
The principal p, itio in center of the inclosureis quite large, octag-
onal in shape, an d has the chapel in its center, surrounded by
gardens and walks'. Radiating from this patio, and connected with
it by roofed corridors, are six buildings, the future wards. Two
of these buildings are 198 feet long by 72 feet wide, (wards 192
"by 27,) two 185 feet by 72, (wards 180 by 27,) and two 142 by
72. (wards 137 by 27.) Each building is divided longitudinally
into two wards, of which six are for surgical and six for medical
purposes. Each ward at the end farthest removed from the patio
has two nurses' rooms, (sisters,) and communicates by roofed
corridors with two rooms for ward service, and water-closets, uri-
nals, and discharge -receptacles, which have outlet in the aceam'as or
drains of running water. At the extremity of two buildings only
are bath-rooms, eleven baths in each. Between these divergent
buildings, indeed in every part of the inclosure not built upon, will
be flower-gardens, arbors, and walks, and a side door from even-
ward opens directly upon one of these gardens. To the rear of
the chapel, and connected by the covered corridor to the octag-
onzlpatio, is the dispensary, laboratory, library, and parlor, and to
^ the rear of these a square with center garden, surrounded by the
dormitories, parlor, chapel, dining-room, washing-room, kitchen,
laundry, infirmary, linen-room, baths, and water-closets apper-

PERUVIAN HOSPITALS.

3°9

taming to the department of the Sisters of Charity. A plaza in
front will contribute to the salubrity and beauty of the establish-
ment. The chief objection to be raised is in the arrangement of
the wards; having adopted only in part the pavilion plan, the
division by a partition lessens the light and ventilation otherwise
afforded. Again, the ventilation will be somewhat interfered
with by the inclosure-building, which, however, appears essential
in view of the site and surroundings. A greater number of baths,
supplying each ward and private apartment, would be an im-
provement; yet in general plan and arrangement it is so vastly
superior to the hospitals described, that it seems entitled to a
liberal approbation. According to the estimate of the architect
the sum of $272,000 will be required for its completion, which
might occur at the end of the present year if the necessary funds
are available.

The only public hospital at Callao is called the Guadalupe,
being under the administration of the Beneficencia of this city.
Located at the northern extreme of Callao, and at the correspond-
ing terminus of the Alameda, about three-quarters of a mile from
the landing at the muelle, its general plan is quadrangular,
being divided into two unequal parts by a transverse building,
thereby forming two patios, the anterior incomplete on the side
facing the street, inclosed partly by a wall and fine iron fence
which occupies the center of the barrier, and is handsome in
design and workmanship. Entering the gate one is admitted
into a paved court about 100 feet square, two-thirds of which,
inclosed by a neat iron fence, is cultivated as a garden, bearing
a choice variety of plants, arranged in beds regular and fanciful
in figure, and having in the center a fountain playing over iron-
work of appropriate design. The court is surrounded on three
sides by a corridor wide and spacious, with a wooden floor raised
two feet above the ground, from which convenient communication
is had to the several offices of the institution; appearance pleasing
and satisfactory. Passing through a wide door in the center of
the transverse building the inner patio is reached, around which

3IO PERUVIAN HOSPITALS.

the wards are arranged. Largest wards ioo feet long by 50 wide ;
high ceilings ; asphaltum floors ; lighted by side windows and sky-
lights ; deficient in ventilation. Through the middle of each ward
runs an incomplete partition, ten feet high, continuous with the
length of the apartment, except where openings exist, to facilitate
the passing from one division to the other. Each ward contains
about fifty beds closely approximated. Bedsteads of iron, with
frames to support curtains or netting; wool mattresses, scarlet
blankets, cotton sheeting. A small, badly-located room contains
a few ordinary bath-tubs, inadequate for the establishment. Xo
water-closets or discharge-receptacles noticed; general want of
cleanness. One ward is appropriated to females, and was half
filled at the time of inspection. The diseases observed were
usually the result of mal-nutrition, asthenic and pectoral diseases
predominating. There was no apparent classification or arrange-
ment of the patients according to disease, save the surgical cases,
which were in a separate ward. The kitchen is an adjacent and
spacious building, adjoining a butcher's department, and has a
common range and abundance of copper utensils; laundry, of
good size and efficient; dispensary, rather small, but handsomely
and generously equipped ; laboratory, small, clean, neat, and well
furnished with vessels of metal and porcelain. The medicines
are compounded, dispensed, and many of them made by one of
the most intelligent of the sisters, who daily makes up an average
of one hundred prescriptions. The pharmaceutical department
is the most satisfactory of the entire establishment. An operating-
room, lighted from the roof, had a good adjustable table of mod-
ern pattern ; instruments not examined.

At a short distance to the rear of the main edifice are two one-
story buildings, each about 100 feet along by 30 wide, reserved
for contagious and infectious diseases, at present unoccupied.
These quarantine-houses present nothing of import, either in con-
-struction or arrangement.

The Guadalupe Hospital has been in operation six years ; has
four medical officers ; serves alike for civil and military purposes ;

PERUVIAN HOSPITALS. 311

can accommodate 450 sick, average number being 300 ; is imme-
diately directed by twelve Sisters of Charity, principally French.
In plan and general arrangement the hospital is efficient, and is
susceptible of being well ventilated. Considering the actual close-
ness, and in some of the wards the existence of offensive odors, it
is singular that so emphatic a defect should not have a prompt
removal. As before remarked there is a want of proper cleanness,
chiefly observable in the condition of the floors, bedding, and cur-
tains, reminding one of the military hospital at Lima. Another
defect, partaken of by the other hospitals, is that too many patients
are bedded in the same ward, and in the present instance this over-
crowding would seem to have no explanation, unless it be for the
convenience of the attendants. Again, the partitions through the
wards are objectionable, and their presumed utility is not manifest.
These views are sustained in a letter received from Passed Assist-
ant Surgeon Ver Meulen, stationed at Callao, who has made a
thorough inspection of the hospital, and to whom I am indebted
for detailed information.

Attached to, but independent of the hospital, respecting access,
is a girls' school under the care and tuition of two of the sisters.
Two large school-rooms, airy, clean, and well furnished. The
school-books have inscribed the names of 400 scholars, of age
ranging from four to fifteen years. They are taught the essential
elements for a common education, domestic and manual labor.
Daily attendance very irregular, not averaging more than one
hundred.

In the cemetery at Callao there were buried during the year
1871—

In nitches, perpetually 82

In nitches, temporarily 366

In graves 1,122

Total 1, 570

312 PERUVIAN HOSPITALS.

Men 755

Women 264

Children, male _ . 303

Children, female - 248

Total i? 570

Deaths resulted in the majority of cases from fevers, phthisis,
pneumonia, dysentery, dropsy, variola, dentition, wounds, scor-
butus, bronchitis, and apoplexy.

ON VERRUGAS.

During the visit of the flag-ship at Callao, Passed-Assistant
Surgeons Culbreth, Ayres, and myself passed over the built por-
tion of .the Callao, Lima, and Oroya railroad as the guests of Mr.
Cilley, its superintendent. This road, being constructed by Mr.
Henry Meiggs for the Peruvian governmant, will cross the Andes
at an elevation of 16,200 feet, with a summit tunnel of 3,000 feet
in length, and will terminate at Oroya, the head-waters of one of
the tributaries of the Amazon, distant about one hundred and
thirty miles from Callao.

Proceeding by rail for a distance of forty-seven miles along the
left bank of the Rimac River, we reached San Bartolome, the
present terminus, and from thence by horse a few miles farther
on, we witnessed the wonderful engineering that builds a railway
along heights heretofore considered inaccessible. This visit en-
abled an inspection of one of the hospitals of the company, and
gave introduction to two remarkable diseases peculiar to the dis-
trict and comparatively unknown to the profession, an account of
which is the purpose of this communication.

Verrugas, meaning warts, is a disease strictly limited in its
locality, and unobserved until the present except in Peru. Its
district extends from latitude 6° south to 150 south, at an altitude
of from 4,000 to 7,000 feet in the Andean valleys situated on the

314 ON VERRUGAS.

sea-side, while goitre appertains to the valleys of the eastern
declivity, on the side of the Amazon, as at Huanuco. In the
valley of the Rimac River the disease prevails for a distance of
twenty-two miles, including the beautiful but unhappy quebrada
or ravine of Verrugas, sparse in vegetation, picturesque in scenery,
rich in cascades, whose pure and deliciously cool waters have ever
had the popular reputation of being the cause of the singular and
extraordinary disease that gave its name to the quebrada.

The verrugas existed in the time of the Incas, and is proba-
bly the disorder that attacked certain of the Spanish invaders
as mentioned by Prescott in the " Conquest of Peru." Tschudi
mentions it in his memoir of travels, and is said to have furnished
a monograph for a German medical journal. It is alluded to by
Dunglison. Dr. Fasset, a physician at Lima, gave an account of
the disease in a newspaper of that city. Excepting the above
I am not advised that any description has appeared in medical
literature.

The verrugas attacks the native and stranger alike, respects
neither age, sex, nor condition, is uninfluenced by season, and
occurs but once. It would be interesting to know if it would be
susceptible to return again to the person who may have lost the
benefit of acclimation. Mr. Cilley thinks he has found this dis-
ease in the mule and dog.

The Indians attribute the malady to the drinking of the water
of certain springs in the infected localities, some of which are sup-
posed to be more powerful for its production than others. This
belief is entertained by a majority of the natives, but is discarded
by the foreigner, since an analysis of the water shows its remark-
able purity, and many who have not drank the water have had
the disease in its worst form, while others who have partaken
of it freely and for a long period, remain unaffected. The sup-
position that it may be occasioned by the action of certain met-
,als, especially antimony, is equally untenable. Is it due simply
to the miasms that produce the simple intermittent and typho-
malarial fevers of these valleys ? Dr. Fasset regards the affection

ON VERRUGAS. 315

as a particular form of scurvy, which replaces the petechial spots
of the fevers of the Oroya, and considers the circumstance to be
not indifferent for the reason that it appears to weaken the gravity
of the latter disease. As the malignant fevers of the Oroya seem
to have had origin by the breaking of the ground for railroad
purposes, their connection with the verrugas, a disease as old as the
history of the country, is not apparent. It seems to be independ-
ent of the local fevers, for it is manifested without them. It is
inexplicable why it exists only in Peru, and is confined to the de-
clivity of the Andes directed toward the sea, while goitre is lim-
ited to the declivity situated on the side of the Amazon.

The period of incubation is from three weeks to one year; du-
ration, from a few weeks to one or two years. I saw a little girl
three years old who remained two days only in Verrugas que-
brada, then returned to Lima, when the disease made its appear-
ance three weeks after, and though mild in its progress was
emphatic in type. A gentleman in Callao informed me that his
brother passed* one day in Verrugas quebrada, leaving the place
at sunset, and the disease developed itself five months subsequently.
All cases that have appeared in Lima or Callao were persons
who exposed themselves in the habitat of the disease. It is not
contagious, is very dangerous, and requires the greatest precau-
tions. The disease commences with a decided febrile attack,
often mistaken for the access of the local intermittent, and in every
case the paroxysm is accompanied by osteocope, or rheumatic
pains. This fever may be present every day for weeks, but dis-
appears at the period of eruption; until then the pains and
swellings of the bones, and fibrous and muscular systems exist with
greater or less persistency in any part of the body, shifting in
character, and worse at night. When the eruption does not im-
mediately follow the disappearance of the fever, the pains, often
attended with spasmodic contractions of the fingers and toes,
may continue for months, with, in other respects, ordinary health,
suffering at night, with a sense of stiffness and sOreness in the mus-
cles during the day, when comparative comfort is present. The

31 6 OX VERRUGAS.

advent of the eruption is watched for with great interest, as there
is an impression, by no means confined to the illiterate, that the
life of the individual may depend on its appearance : its arrival,
therefore, is a subject of social congratulation. It is thought if
the growths do not appear on the surface they may develop in
any of the internal organs, preferably the lungs, in which case
suffocation is induced by the hemorrhage occasioned.

Succeeding this indefinite period of fever, or its absence, fol-
lows the eruptive stage. The eruption consists of little isolated
points, purplish red, usually acuminated, which delay not in be-
coming red vesicles or tubercular fungoid growths of all dimen-
sions, from the size of a pea to that of a medium-sized orange.
They invade any portion of the surface, having preference for the
head, face, and extremities, especially the palms and soles, also
the eye, nose, and ear, and apparently affect the entire thickness
of the skin. These growths are soft, vascular, and at first have a
uniform surface, but ultimately a scab forms here and there, the
covering becomes attenuated, and the slightest friction excoriates,
and veritable hemorrhages occur. If vesicular, the ordinary hand-
shaking ruptures the vesicles, and bleeding ensues. They are not
painful, may remain for months, and frequently shrink and slough
off, leaving a very slight scar, save in persons of a strumous or
depraved habit, when ulcers are left. Removed by the knife or
scissors the bleeding may be excessive or moderate. Invading
the lungs, intestines, or other internal organs, equivocal symptoms
result, which prognosticate a fatal termination. It sometimes
manifests itself under the skin, in which case the touch reveals
small flattened tumors. At other times are observed little, round-
ish, oblong bodies having the appearance of hypertrophied seba-
ceous glands, which can be detached from the skin, and then have
resemblance to grains of boiled pearl barley.

I was informed that an examination of the blood and erup-
tive growth of a verrugas patient with the microscope revealed
nothing special or original.

Ordinarily the treatment is purely empirical, consisting of a

ON VERRUGAS. 317

tonic and stimulating regimen, as concentrated decoctions of
roasted maize, wine, beer, coffee, and tea. The Indians, reputed
as very successful in the treatment, promote perspiration for fifteen
days by means of vapor-baths in the intent to bring out the erup-
tion, and, when established, danger ceases and recovery ensues.
During these fifteen days the patients are supported by copious
draughts of roasted corn coffee and sweet wine. With the pro-
fession the fever is treated by diaphoretics, warm baths, and quinine,
in the constant endeavor to hasten the eruption. In the absence
of fever, the iodide of potassium, with the infusion of gentian,
is employed for the mitigation of pain and to induce eruption ;
tonics and stimulants in the eruptive stage. The growths are
removed by ligature, the application of caustics, or with better
result by the knife or scissors. The hemorrhage is always con-
trolled by the liquid persulphate of iron.

By present mail I forward a package containing a verrugas
growth taken from the temple of a boy nine years of age. The
specimen was presented by Doctor Arias, surgeon in charge of
Esperanza Hospital.

ON OROYA FEVER

In my communication No. 20 I noticed a disease, popularly
termed the " Verrugas" limited to certain districts and altitudes
of Peru, and which, though existing in the period of the Incas,
had only been made prominent by the construction of the Callao,
Lima, and Oroya Railroad through one of said districts.

The building of this railway, in a portion of its course, has
most unhappily been attended by a prevalence of a pestilential
fever, direful in effect, which seems to have had creation by some
act incident to the construction of the road, as it has been con-
fined to the line of grading, and had no previous existence, and,
as an indication of its origin, it is commonly called the " Oroya
fever." Commencing at La Chosica, 33 miles from Callao, at
an elevation of 2,800 feet, its locality extends along the course
of the road through the valley of the Rimac River, for about 22
miles, to the elevation of 6,500 feet. In the same locality pre-
vail the verrugas and simple intermittent fevers, diseases suffi-
ciently distinctive in symptoms and type from the one under
notice to discredit the theory of a common origin.

Dr. Fasset, of Lima, in an article written for one of the news-
papers of that city, is of the opinion that the so-called " Oroya
fever" is but an aggravated form of the pernicious paludal inter-
mittent fever that is common to marshy localities, or where rice
is cultivated, and particularly in the deep, hot, and humid valleys
of the Sierra. He considers this paludal fever to result equally
from an alliance with what he terms the ''atmospheric intermit-

ON OROYA FEVER. 319

tent element" with the "toxical miasmatic principle" of the
marshes, and that in the localities where it reigns yellow and
typhus fevers never have existed, and cannot. He says: "This
principle (the cause of pernicious paludal intermittent fever) not
being contagious, they are forcibly banished to their marshy local-
ities, and exclude entirely from their latitudes yellow fever and
typhus, and do not undergo any other metamorphosis than that
of masked fevers." Certain it is that the atmosphere circulates
badly in the humid gorges of the Sierra, impregnating itself easily
with the marshy miasms proceeding from the decomposition of a
scanty vegetation, under the influence of solar heat during the
day, while the cold commences as soon as the sun disappears
behind the mountains and permits vapors to condense in these
valleys, a circumstance which cannot make otherwise than a per-
ceptible impression upon their inhabitants, and predisposes to
fever. ■ The work upon the road in many places, by the ground
being broken up, has occasioned the emanation of a fetid odor,
more offensive than that of sulphureted hydrogen. It may be
that this telluric miasm, acting upon a system previously im-
pressed with the miasma of the ordinary intermittent, may de-
velop a highly malignant fever.

This fever attacks by preference the whites, the mongrel, and
especially foreigners. Acclimated persons offer a moderate re-
sistance, but negroes, Chinese, and Indians are most exempt,
although the latter are peculiarly liable to yellow fever. It sub-
jects to a second attack, does not preserve from yellow fever, nor
does the latter grant immunity from it. Happily it is limited to
its region, for its toxical principle, being non-contagious, is not
ambulant. It is sufficient only to remove to a short distance to
be withdrawn from its influence. Departing from Lima, the rail-
road follows the left bank of the Rimac, and until it reaches La
Chosica the workmen are only subject to the simple intermittent;
from thence, where the verrugas waters commence, they are ex-
posed to this pestilential fever up to the point where begins the
cold climate of the Sierra.

320 ON OROYA FEVER.

The ''Oroya fever" is inconsistent in symptoms, no single
case, or even a majority of cases, being typical. As it differently
presents itself it assumes the character of typhus, pernicious re-
mittent, and yellow fevers. It intermits, or may be continuous.
In a conversation with Doctors Crow and Ward, in the service
of the railroad company, I learned that each case was peculiar,
being no guide for that which might follow. They very frankly
confessed that the disease so readily assumed a variety of form,
was so varied in its attack, intensity, duration, and so unin-
fluenced, or but slightly benefited, by any treatment thus far em-
ployed, that it was a mystery, save its lamentable frequence and
fearful destruction. These gentlemen regard the disease as a
typho-malarial fever, which opinion appears correct, judging from
the cases presented for observation.

Death may occur in 24 hours from the attack, though the du-
ration of the disease usually is several days, and in some cases
prolonged into weeks. Doctor Rush, an American physician in
the company's service, died in thirty-six hours from the first in-
vasion, apparently in ordinary health until the moment of the
attack. In certain cases a slight attack is followed by a seeming
convalescence, the patient goes out, a relapse ensues, and he
dies suddenly. It is the rival of yellow fever, equally formidable,
and, though differing in many of the symptoms, the result is
nearly the same. It has been observed that if the access be-
longs to the quotidian type, it is favorable if it delays, and, on
the contrary, it is unfavorable if it anticipates when of the tertian
variety.

In the commencement the symptoms are usually the same.
Intense cold, accompanied by severe pain in the head, loins, and
limbs, succeeded by febrile movement, varying in intensity, with
continuance of headache, pain in loins, etc. This stage is fol-
lowed by an intermission, remission, or the severity of the fever
may subside into a feverish condition which has continuance, or
the paroxysm may be succeeded by copious sweats, affording no
exemption from other paroxysms. The intermissions and remis-

ON OROYA FEVER. 32 I

sions are exceedingly regular, or after a single one the fever may
become continuous. Prostration, relaxation of the muscles, and
anaemia are often sudden, and followed by aphony.

Early in the fever nausea and vomiting usually occur, the mat-
ter at first being yellowish and greenish in color, then brown,
then resembling coffee-grounds, and finally melanic. There are
severe pains in the region of the spleen, liver, and stomach; no
tympanites when unattended with peritonitis, but contraction of
the abdominal walls toward dorsal spine, in some cases iliac ten-
derness, with absence of gurgling sound. The bowels are gen-
erally constipated, therein differing from the grave cases of the
pernicious paludal intermittent of the country, when diarrhoea,
often bloody, supervenes. Intelligence may be good or a mani-
acal delirium at the outset. Petechial spots occasionally found,
urine brown, as in yellow fever, but not often suppressed, except
with peritoneal complication. Tongue presents a gray coating
or greenish yellow at first, but becomes red and raspatory. Sordes
not frequent, gums bloody, breath tainted. The blood seems
deprived of hematosin and globules. The patients take an icteric
tint like that of yellow fever.

As the disease progresses the ataxic symptoms denoting the
typhoid state are more evident, viz, low delirium, sordes, subsul-
tus tendinum, etc. The comatose or convulsive state frequently
happens, and the last condition appears to be less dreaded, how-
ever violent it may be, than the first, except a nervous trembling
of the limbs and tongue, a bad augury.

I was unable to obtain any satisfactory information as to the
morbid appearance after death, post-mortem examinations having
been very rarely performed. Doctor Fasset asserts, however, that
the pathological alterations produced by yellow fever are perhaps
surpassed by the pernicious paludal intermittent fever, of which
he regards the " Oroya fever " as a variety. He states that these
alterations are constant in the spleen; that the liver experiences
as often alterations in its mass as in its consistence, and even in
its adherences to the peritoneum; that the lungs are frequently
21

32 2 ON OROYA FEVER.

altered; that the muscular system is very relaxed, and that the
heart presents the aspect of a soft or flabby mass. It would cer-
tainly be interesting to know if the abdominal lesions are essen-
tially those characteristic of typhoid fever, or approach them in
any degree.

The obscurity attending this fever has naturally occasioned
the employment of nearly every remedial measure in its treat-
ment; unfortunately, with few exceptions, no marked benefit has
been derived. In the incipiency the hot bath and a mercurial
cathartic are often resorted to, and subsequently the greatest re-
liance is placed on quinine, turpentine, and the mineral acids with
spirits.

I regret that my visit to the infected district was, of necessity,
very brief, and as a consequence the observation on the verru-
gas and Oroya fevers are imperfect and unsatisfactory. I trust
that one or more of the medical officers attached to the south
squadron of this fleet may hare the opportunity and inclination
to thoroughly investigate these extraordinary diseases, and that
they may be pleased to communicate the result of such inquiry
to the Bureau. •

EXPERIMENTS AND OBSERVATIONS
IN NAVAL HYGIENE.

BY

E. D. PAYNE, M. D.

SURGEON, U. S. NAVY.

ON NAVY CAPS.

While at sea, with a clear sky and gentle breeze, the thermom-
eter marking 730 F. in the shade and 8i° F. in the sun, I made
the following experiments :

I had one of the men put on an ordinary blue cloth mustering-
cap, beneath which, on his head, I placed a small thermometer
and had him walk up and down the deck in the sun for ten min-
utes. At the end of that time, the thermometer marked 1040 F.
I then had him put a white linen cover over the cap and again
walk for ten minutes in the sun. The thermometer again marked
104 F. Previous to this, I asked one of the most intelligent men
on board if he thought such covers afforded any protection from
the heat or added in any way to comfort. He said he thought
the cap much more comfortable with the cover on than off, for
use in hot weather, and it kept the head cooler.

From the above experiment it would appear that the white
linen cover over the cap in reality affords no protection, and the
comfort derived from it is simply one of imagination. If the cap
was made of white duck, and no cloth interposed between it and
the head, the difference in the temperature would be great and
the comfort real, as I will show below.

On the same day and under the same conditions, I made the
following experiment : I took a Navy cap for officers which had
eyelet-holes pierced through the top, put the glazed cover over it,
and walked for ten minutes in the sun. At the end of that time
the thermometer under the cap marked 1040 F. I then tried it
for ten minutes without the cover, and the temperature was 930

326 ON NAVY CAPS.

F. Finally I put on a white-duck cap of about the same pattern
as the cloth one, and again walked for ten minutes in the sun.
At the end of that time the temperature was 830 F.

From this experiment it would appear, first, that the glazed cover
should not be worn except for protection against storms ; second,
in comparing a cap with an air-chamber and having holes for
ventilation with one (as the ordinary cap for sailors) which sits
close to the head and has no ventilation, the difference in tem-
perature is in favor of the former by 1 1° F. Third, in comparing
a cap made of white duck and having an air-chamber, with a
cloth one which sits close on the head (as the sailors') and is
covered with white linen, the difference is in favor of the former
by 210 F. From which it would appear that caps should be
made of white duck for warm weather, and that blue caps with
white covers, as a substitute, should be discarded.

I regard the cap at present worn by sailors in the Navy as
altogether objectionable. A rim, about one and a half inches
wide, fits the top of the head, immediately surmounting which is
a disk of cloth about ten inches across. There is no air-chamber
to keep the head cool, and the cap is heavy. It does not extend
far enough over the forehead to afford protection, and no peak
protects the eyes ; neither does it extend far enough down the
head behind to give any protection. In fact, it gives no protec-
tion to the head, except to a small circular space on top. As a
matter of comfort, it has none ; and as one of convenience, it is
so easily blown off by the wind, and so often knocked off to go
overboard when aloft, that it might almost be pronounced a nui-
sance. A much better cap was some time ago served out, made
of felt. It elapsed the head better, came farther down on the
brow and behind, and had quite a large air-chamber. But it was
disliked by the men, because, they said, it irritated the skin and
wore the hair off the top of the head. This objection might hold
^as against the material of which it was made, but would not
affect its shape.

If a cap could be made somewhat on the plan of what is

ON NAVY CAPS. 327

known as the Scotch traveling-cap, pointing down over the fore-
head and over the back of the head, and large enough in the top
to afford a good air-chamber, with holes pierced through the top,
and made of good material, I think it would be a great improve-
ment on the one now in use. One of white duck should be made
for hot weather. I think the duck, if of good quality, would
have sufficient stiffness to retain its shape, and would not allow
the transmission of the sun's rays — qualities not obtained if the
cap be made of linen. Or a frame could be made of heavy duck
or very light canvas, and over this could be worn a linen cover
as at present over the blue cap, which would permit a change,
and give an opportunity for always having a clean, white cap.

I suppose it would be a difficult matter to reform even the
present opinion of the men on the general style of their caps,
and the introduction of a peak to the cap would be scouted both
by officers and men; yet it is none the less true that men, who
are exposed to all kinds of weather as much as sailors are, should
have their heads protected from both sun and storm, and their
eyes properly guarded, and that a ventilated chamber to the cap
would be a great comfort.

I have also objections to the cap now in use for officers. The
peak is not large enough nor of the right shape to protect the
eyes; the air-chamber is not large enough for comfort, (especially
when made, as many are, smaller than the regulation pattern;)
and it does not come far enough down on the back of the head
to protect it from the wind and rains. If an officer wears a cap
which sits just on the top of the head, and deprives that portion
of his head of its natural covering by having the hair cut short,
(which is frequently done,) the result in cold and wet weather
must be rheumatism of the scalp, or general catarrh from this
exposure, for I think there is no part of the body more sensitive
to undue exposure, nor one with which the general system more
readily sympathizes, than the back part of the head and neck.
A cap so stiff and cumbersome as the regulation one, having for
its recommendation neither elegance of form nor comfort to the
wearer, is hardly the one for the Navy.

ON NAVY SHOES

Believing that the Government intends that the shoes furnished
to enlisted men in the Navy shall be of good quality, and also
believing that the regulation shoe does not fulfill that intention,
on the 30th day of March, 1871, I drew from the paymaster's
stores of the United States ship Jamestown a pair of what are
called calf-skin shoes, of the style known as Oxford ties. The
fronts were made of calf-skin; the quarters of split leather; the
quarters and the sides of the fronts were lined with deacon-skin :
the soles were one fourth of an inch in thickness, including the
welt, and fastened by stitches five and a half to the inch, rising
above the sole of the shoe.

I put on the shoes and wore them on the open, wet deck after
a rain, trying to avoid places where the water of the deck would
rise above the upper edge of the soles, that I might ascertain
how long it would require to wet my feet by absorption of moist-
ure through the soles and stitches. In half an hour my feet
were wet.

I then ripped the sole from the shoe and cut it open in several
places that I might see to what extent it had become affected
by the water. It was soaked through, and I could wring water
out of it by twisting it between my fingers. The filling between
the inner and outer sole was also saturated, and the insole was
;wet for some distance beside the seams.

The inner surface of the piece of leather which formed the
outer sole had not been shaved or scraped, but presented the

ON NAVY SHOES. 329

original roughness of the leather, and the leather had been neither
pounded nor rolled, aside from what it originally received to con-
vert it into sole leather, to give it hardness and durability. Be-
tween the inner and outer sole was filling, representing a little
more than a quarter of an inch in thickness, a trifle more than
that of the outer sole and welt combined. Its first appearance
was that of leather, but on closer inspection it tore up like paste-
board, and had a large quantity of fine straw mixed with it. I
soaked it in water, and reduced it to a pulp. It then appeared
to be a mixture of leather chips ground fine, with straw-paper
pulp, and glue, mucilage, or other adhesive material. I suppose
a mixture of this kind is first prepared, and before it hardens is
rolled into boards, from which is cut the insoles for these shoes.

In the above description I believe I have given one of a fair
sample of shoes of that description known as calf-skin shoes
served out in the Navy. The facts stated were witnessed by Com-
mander B. Gherardi, Lieutenant-Commander C. L. Huntington,
Lieutenant Asa Walker, and Paymaster G. R. Watkins.

I believe that such shoes answer neither the ends of comfort,
durability, nor economy, and that a shoe which, in its construc-
tion, would cost a trifle more to the man, would be found much
cheaper for him.

In the construction of such a shoe the uppers, fronts, and quar-
ters should be made of calf-skin, and lined with deacon-skin.
Before the outer sole is put on, the leather for it should be first
pounded or rolled, after the rough surface is first shaved off, in
order to harden it, thereby rendering it less easily soaked by
water, and making it much more durable, and the stitches by
which it is attached to the uppers should be counter-sunk, to
prevent being worn off and allowing (the sole to spring from its
place, and should not be less than six and a half to the inch.
The filling, which in reality acts as an inner sole, should be made
of leather instead of chips or paste-board.

UNDER-CLOTHING FOR ENLISTED MEN IN THE NAVY.

The supply of under-clothing for enlisted men in the Navy, as
regards suitableness and quality, is a subject which I believe
worthy of consideration. I also believe that some change from
the universal issue of the quality now in use would be of benefit.

During the late cruise of the Jamestown, in the Pacific, I had
good opportunities for testing the value of such considerations,
and my frequent observation was that a large percentage of the
men who applied for admission to the sick-list were either without
proper under-clothing or neglected to wear it. Their neglect was
usually the result of dislike to the heavy articles served out dur-
ing such periods of our cruise as were passed in the tropics. To
such an extent was this dislike put in practice, by neglecting to
wear such garments, that I made requests to have the men ex-
amined at morning quarters, thereby trying to detect the neglect-
ful and force them to their use. This measure had the desired
effect ; and a good opportunity for comparing it with the one of
allowing the men to follow their own inclinations was found at
Panama, in March, 1871. At that time we were in company
with a ship whose crew was but a little more in numbers than our
own, and, while our sick-list was only from six to ten. hers was
soon above thirty. The explanation was simple : our men wore
under-clothing, and no special care was exercised to compel the
men of the other ship to do so. And it is not surprising that
when men are worked during the day, in such a climate as exists
at that place, that they perspire profusely, and on every opportu-
nity throw themselves down for rest in the coolest spot they can

ON UNDER-CLOTHING. 33 I

find; neither is it surprising that when men are allowed to lie
down on the deck, with no under-shirt on, and the outer one
freely thrown open, with a smart breeze coming under the awning-
apron, (as I have witnessed,) that thirty men, out of a crew of
about two hundred, should soon be down with fever.

So nearly as I could ascertain, the men do not make so much
objection to wearing under-garments as they do wearing, in warm
climates, that which is issued. Men frequently made application
for permission to buy lighter articles on shore, and often took the
responsibility of so doing, and run the risk of punishment, rather
than be forced to wear the heavy articles they would otherwise
be compelled to.

Those which are served out are, I believe, all of one quality,
and made of heavy, dark-blue material, and there is no change
provided for or contemplated in passing from cold to hot climates.
The texture is entirely too heavy for hot weather, and it is ren-
dered still warmer by the dark blue color. The color is further ob-
jectionable from the fact that it allows the garment to be worn to
the condition of filthiness before washing, without being specially
noticed. I think the color is objectionable for this reason alone,
if no other. The very fact that a lighter color readily shows dirt
is a reason in favor of its adoption rather than against it, because
it would then be washed when it became dirty.

The quality which is now in use seems all that could be desired
for cold climates, but I believe it would be a great advantage to
have its place supplied, for use in warm climates, by a quality
which would be both lighter in texture and lighter in color. Then
the men would be found to wear it more regularly, and would at
all times be protected from sudden changes of temperature,

It is objected that uniformity could not be preserved, and that
the men would be careless in their changes, and really suffer more
than they do at present, and that it would be excessively incon-
venient to supply two different articles of clothing for the same
purpose. But I do not think these objections tenable. There
could scarcely be less uniformity than at present exists, when

332 ON UNDER-CLOTHING.

some wear the regulation shirt, some white ones bought on shore,
and some none at all ; and the same care which would be requi-
site to keep under-clothing on the men who receive what is now
served out, would be sufficent to keep them at their proper
changes, and not greater than that which directs changes from
blue over-shirts and pants to white. As for the question of con-
venience and economy, it could scarcely be compared with the
consideration of the inconvenience and expense of having thirty
men out of a ship's company of about two hundred down with
fever, as in the case mentioned above.

ON SOME OF THE DISEASES AND PECULIARITIES OF
THE PACIFIC ISLANDS.

While on an extended cruise through the Pacific Islands in the
United States Ship Jamestown, during the years 1869-70, I
was enabled to observe some of the diseases peculiar to them, the
habits of life of the natives, and note the effect of these on the
population.

The Hawaiian Islands are now recognized as among the civil-
ized countries of the world. A well-organized government and
strict administration of the laws insure safety to the resident, and
an apparently delightful climate invites immigration of those who
see in these islands an important future. Being a connecting
point between the California coast and New Zealand, Australia,
and Fiji, with a monthly line of steamers crowded with freight,
and its importance as a sugar, cotton, and coffee growing country,
the question of climate is one for consideration. The temperature
varies between 750 F. and 850 F., as a general rule, but some-
times falls below the former and rises above the latter ; and the
influence of the atmosphere is so soothing, so soft and mild, that
it induces persons subject to pulmonary complaints and those
needing soothing influences on account of nervous debility to
seek it as a place of either temporary or permanent residence.
Especially is it regarded as a favorable place to visit by those
suffering on account of the fogs and harsh winds of the California
coast. Spoken of as the garden spot of the Pacific, it has much
to attract the eye, in the beauty of some and wildness of other
parts of its scenery; and the bracing influence of sea air is added
to these scenes, as completing the requisites for recuperation and

334 DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS.

attractions for a residence. These combinations are spoken of
with much apparent satisfaction; and to accept the statement
with its full meaning would be to accord all that is claimed on
this account. But while this soothing influence in the atmosphere
may exist, and the beauty of the scene and sea-air be added, there is
to my observation quite a different interpretation to be put on
the desirability of residence for some cases of disease. Instead
of a place to be sought, I think it one to be avoided. Those
who have lived there for three or four years will admit that the
system becomes gradually undermined and enervated by the con-
tinuance of these gentle influences, and that they find it necessary
to go once in a year or two to the California coast for recupera-
tion, or change from one part of tne islands to another. If they
go to California, they get change of scene and air, and come back
re-invigorated ; if to one of the other islands, or to a different part
of the same one, they are benefited, but not in the same degree.
They will also admit that after becoming acclimated, that is, when
the system has become enervated, they find themselves able to
perform only a given amount of work each day ; that by properly
regulating it, they can get through this amount and keep it up ;
but that every extra amount of labor gained and time saved, must
be paid for by a corresponding amount of lassitude and depression
and time lost. Under such influences as these, persons of debili-
tated systems, from whatever cause, would hardly recuperate.
And while I knew of two cases of pulmonary consumption go
steadily on to a fatal termination, I cannot name a person perma-
nently benefited, in any disease, which could be referred to the
climatic influences. Indeed, it seems surprising that the people of
California should seek the islands for benefit of health, when their
own climate affords all that could be desired. The coast line of
fogs and winds extends but about twenty-five or thirty miles
inland, beyond which is an atmosphere at once dry, bracing, and
/SO mild that flowers bloom the year round. I hardly think that
any one who has examined and compared the two climates
would hesitate to recommend that of California. So strongly

DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS. 335

was I impressed with this opinion, that being consulted by a man
suffering from nervous prostration, whom I believe many would
have sent from California to the islands, I recommended him to go
from there to California.

In the Pacific islands the native population differ so much in
complexion and smoothness of skin, that they may almost be said
to be divided into three different classes, those of the southern,
middle, and the northern islands. In the south, represented by
Fiji, New Zealand, and Navigator Islands, (called Papuans, and
generally believed to have gone from Papua,) they are very dark
and have very rough skins. This roughness of the skin is believed
by many to be typical ; and I would believe from my own experi-
ence that what is said may be true, a blind man might distinguish
them by this peculiarity alone. In the middle islands, including
the Society, Marquesas, Gilbert, and Marshall groups, they approach
the lightest shades of complexion and smoothness of skin ; and o^
these, the Marquesans are the lightest, smoothest, and fairest.
The Hawaiians appear to occupy an intermediate position between
the two extremes. They are neither so dark and rough as those
of the southern islands, nor so light and fair as the middle ones.
Why those of the higher latitudes should attain to the highest color
and those of the lower the lightest color, contrary to the general lavv
of races as applied to climatic influences, I am not prepared to state,
and will offer no explanation. That the Hawaiians were originally
North American Indians, the middle groups peopled from the
Malay Islands, and the southern islands from Papua, does not
answer the question; they have too many forms, ceremonies, and
habits in common. One of the first questions to be asked in such
a statement would be, where did the Papuans come from ?

So many different people have been found as the representa-
tives of the lost tribes of Israel, from the North American Indians
to the copper-colored races of the Old World, and so many evi-
dences are brought forward to show that each individual people
has the right to represent them as claimed, that the evidences
in favor of these people may be considered with the rest. It is

336 DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS.

not a new question as applied to them ; it has been talked of for
years by those familiar with them. I have mentioned that they
have forms and ceremonies in common. These are also claimed
as evidences in favor of the Indians. Here is a connecting link
between the two. I have seen a fine representative of the North
American Indian, what might be termed a typical specimen, in
the person of a Fiji chief, and an equally typical Papuan native
of the Gilbert Islands.

The circumstances of common forms and ceremonies and com-
mon peculiarities of race, would indicate a division and wide
diffusion of what was once one people or an intermixture of what
were originally different peoples to form what is now the popula-
tion of Polynesia. These people all have their prophets and tra-
ditionists, who are selected from the young and carefully instructed,
generation by generation, in the traditions of the tribes. A man
who has lived in the Marquesas for more than twenty years has
carefully collected a large number of these traditions and songs,
and very kindly allowed me to make copies of such as I wished.
They comprise accounts of the creation of the world, the deluge,
and many more, so wonderfully in accordance with the biblical
record as to be surprising. And these, he says, he has traced to
come down through one hundred and forty generations. Would
it be likely that a people so closely adhering to traditions would
have none which gave an account of a mixture of races, if such
had taken place ? or would the traditions of separate people, who
each preserved their tenacity, be found to blend harmoniously
in a few generations to represent one race ? I think not. I should
rather think that the fact of common customs, traditions, and
peculiarities of race widely diffused, would indicate an emanation
from a common source. If for one of these peoples it is claimed
these forms and ceremonies entitle them to represent the lost
tribes of Israel, then all are entitled to the same consideration-
-These forms and ceremonies are, circumcision, which is practiced
rigidly all through Polynesia ; the shaving of the head in many
different ways and patterns, though not always for vows ; canni-

DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS. 337

balism, the old sacrificial feast in a state of degeneracy; and hulus
and luous, which, though now indulged on every occasion which
can find excuse for unusual gluttony and lust, was the old gather-
ing of family tribes.

Some of these have been much modified by the influence of
missionaries and the establishment of laws, but the natives cling
to them nevertheless. Even in the Hawaiian Islands, which have
for many years been civilized, the hulus and luous are given in a
bearable manner from distinguished natives to distinguished visit-
ors, and indulged, as occasion offers, in the coarsest manner, in
quiet places, by the lower orders.

Cannibalism is not now thought of in the Hawaiian, Society,
or Navigator Islands, but in the Marquesas, Fiji, and other
groups it is by no means extinct. It is a sacred institution with
them. They believe that when their gods put an enemy in their
hands it would be an insult to deity not to offer him as a sacrifice.
And for this purpose all the instruments and places used in the
horrible rites are held sacred. A gentleman in Marquesas in-
formed me of two instances in those islands within a few years
and though at the time of our visit to Fiji the islands appeared to
be under good rule, and crime was in less percentage than in
large cities of the civilized world, recent events have shown how
readily the natives return to their primitive customs when they
believe the hand of foreign power no longer represses them.

The influence of white men has steadily progressed in the
Southern and Hawaiian Islands; but through Micronesia those
who have sought residence have been of such low character that
they are not only despised by the natives, but treated little better
than slaves.

The population of the Hawaiian Islands now numbers about
60,000, and is said to be rapidly decreasing. Their natural in-
clination to idleness and filth, their ready adoption of all the
vices of the whites, added to their own licentious habits, the large
amount of venereal disease and leprosy, are spoken of as the chief
causes. Drunkenness can hardly be said to be a very efficient
22

338 DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS.

cause at present, however much so it may have been formerly ;
for though the natives are very fond of intoxicating drinks, and,
when they can, indulge in them to the greatest extent, yet the
evils arising from such sources are so well recognized by the gov-
ernment that selling or even giving a native intoxicating drinks
is punished by such heavy fines as to keep the evil in check.
Were it not for these laws, steadily executed, it is believed that
drunkenness might be recognized as one of the principal causes.
The licentiousness of the people is considered one of the causes,
as indeed it would be the curse of any people. So abhorrent to
the sense of civilization is the licentiousness of the whole of
Polynesia, that we are ready to lay untold evils at its door, beside
charging to its account a large proportion of the diseases which
afflict the people. While it may be responsible for a large amount
of disease, I am doubtful if it be the cause of a rapid decrease
among the people of these islands. Among other people it may
act as efficiently or more efficiently than other causes. Let
us apply a test, as far as possible. In the Hawaiian Islands there
are so many causes operating to the same effect that we will leave
them out of the question, or rather try to solve the question with
regard to other groups, and then apply it to Hawaii. Fiji may
also be counted out, for though the natural lasciviousness of the
people is recognized, it cannot be indulged to the extent it might
were it not for the law, for in Fiji adultery is punished by death,
and the girls marry young. But in the Society, Marquesas, Gil-
bert, Marshall, and Caroline Islands the natives indulge their pas-
sions to the fullest extent, and retain their numbers of population,
and this, too, when not more than three children to a marriage are
the rule. Not only that, but so large an amount of disease exists
among them — as syphilis, leprosy, elephantiasis, and ichthyosis,
singly or combined — as to give the impression that the whole
population is diseased. The American consul at Tahiti (a gen-
tleman resident for many years) told me that 95 per cent, of the
population were afflicted with venereal disease ; that a great deal
of it was hereditary, and that there was scarcely a native-born

DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS. 339

child which did not in a few years show evidences of transmitted
syphilis. He also said they generally attained to old age, and
instances of extreme old age were not rare, and that the popula-
tion of the islands remained stationary at about eight or nine
thousand.

In the Marquesas Islands we have a people scarcely, if any,
behind the Society Islands in point of licentiousness. The women
have as many husbands as their fancies dictate, and their husbands
think it no discredit to recommend their qualities and hire them
out to strangers. I was told by the overseer of a plantation that
he had seen one woman, on the occasion of a hulu, receive the
embraces of forty-two men, and had been told by an eye-witness
of another who received one hundred! Such conduct could not
be termed beastly, for beasts would not indulge in it ; it seems
reserved for brutes that are worse than beasts. It can hardly be
credited, yet my informer was a man of responsibility, and did
not otherwise appear given to telling large stories. Yet this
people, so licentious and depraved, was a thriving people in pop-
ulation up to 1864. In that year small-pox was introduced to a
people up to that time free from it, and in a few years reduced
their numbers from twenty to eight or nine thousand; accom-
plishing in a short time what all their lust, and the evils growing
out of it, had previously failed to do. It is not likely they are
more licentious now than they were previous to 1864, yet up to
that time it had not reduced them in point of numbers.

It is the same with the Gilbert, Marshall, and Caroline Islands.
If their increase by birth was rapid there might be a sufficient
number constantly added to the population to compensate for
large losses by deaths from disease and wars; but numerous
children are a rare exception, and from one to three is the rule.
If we apply these facts, can we say that licentiousness is to them
a cause of diminishing the population ? And if in them we recog-
nize the most licentious people on the face of the globe, (a prop-
osition I hardly think can be doubted,) living under influences
generally regarded as tending to shorten life, will it not have an
influence on our opinions as applied to other races ?

34-0 DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS.

The barrenness of the women is recognized as another cause
which tends to reduce the population, by checking the natural
increase. Abortion is also mentioned; indeed, barrenness and
abortion are said to go hand in hand; the one producing the
other in many instances, when the former is not the result of nat-
ural defects. It is asserted, even by medical men, that the native
doctresses, who keep their remedies a secret, are in the habit of
giving a drug which produces not only abortion but barrenness.
Whether this be true or not I am unable to say, but it is generally
believed. It is said that women resort to it from motives of spite
or jealousy toward their husbands. Another method is by me-
chanical means; the subject of it lying flat upon the back while
the doctress kneads the abdomen with her hands or treads it with
her feet, having first thoroughly rubbed it with oil.

The venereal disease is very common through all the Pacific
Islands, though not as much so in Fiji as in others. In the Ha-
waiian, Society, Marshall, Gilbert, and Caroline Islands it is very
common. It is so intimately mixed with leprosy and ichthyosis
that it is sometimes difficult at first sight to determine which is
the disease presented. Indeed, there are those who regard the
leprosy as an aggravated form of syphilis ; and I heard of one
man in Honolulu who offered to take any of the government
patients, called lepers, and cure them on the principles of treat-
ment as applied to syphilis. Whether any such were put in his
hands or not I am unable to say, but presume they were not, for
the minister of the interior, who has general supervision of all
hospitals, is a physician of good abilities, and the staff surgeon of
the king has immediate charge of the leper-hospitals.

So wide-spread was the syphilitic disease supposed to be in the
Pacific Islands, and our men had such ready access to it, that I
expected to have a great deal of it under treatment. In this I
was disappointed. The journal of the Jamestown shows compar-
atively few cases.

I was informed by the American consul at Tahiti that the na-
tive doctors are very successful in the treatment of syphilis, and

DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS. 34 T

he mentioned instances of the constitutional disease which had
resisted the skill of educated men being cured by them. Their
medicines are said to be very powerful, but are kept secret.

Leprosy has been recognized as a disease of Polynesia, and it
presents both forms, the tubercular and anaesthetic. As I have
before stated, there are those who claim that it is an aggravated
form of syphilis, and in some instances they might almost be par-
doned for so doing, where the two are combined. But so accu-
rate are most of the well-pronounced cases to the descriptions of
leprosy, that I think no doubt need be entertained on the subject.

In the Hawaiian Islands the disease is believed by the best
men to be contagious, and the well-pronounced cases are removed
to the leper hospitals. One source of its transmission from person
to person is believed to be by smoking. It is a common practice
for one out of any number gathered together to light a pipe, take
a few puffs himself, and then pass it around. It is believed that
poisonous matter is thus conveyed from a leprous ulcer in the
mouth of one person to a healthy membrane in another, and the
disease propagated. There is also something supposed to exist
in their manner of life which induces it, and their filthy habits,
love of intoxication, sleeping in damp places, may, perhaps, all
combined, give some reason for the opinion. Or there may be
something in the nature of the soil or exhalations, as Wilson
shows, calculated to induce the disease.

It would be unnecessary to go over a typical case and present
it ; the disease is too well described by Wilson to need it. There
is one evidence of it, however, which he does not mention. In the
anaesthetic variety, there is a symptom which precedes anaesthesia.
It is an irresistible and fixed turning inward and upward of the
little fingers. After this comes anaesthesia, then ulceration.
The ulceration generally commences at the extremities of the
fingers or toes, taking one joint after another until the hand or
foot will look as cleanly amputated as if done by the knife of the
surgeon. It generally commences at the extremities, but not
always. I have seen sores which could not be mistaken, occupy-

342 DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS.

ing the insides of the ankles and wrists, deforming the member
before it dropped off, by turning the hand or foot inward and
upward.

It is also believed there is no hope of cure. The disease may
be stationary or latent, but never disappears entirely. The end
may be in two or three years, or it may be much longer. The
surgeon in charge of the leper-hospitals told me he had many
times fair hopes of a cure, but every instance had been disap-
pointed.

Through Micronesia I saw many cases of this disease, but I saw
many more in which there appeared to be a mixed form, in which
the first noticeable feature was a thickened, fissured, rough skin,
which might almost be called alligator-hide, easily recognized
as icthyosis. How this is acquired, they do not know. It comes
on young children, youths, and adults • but it usually commences
on the belly of a child, and gradually spreads until the whole
body is covered. When affected by it alone, they are never sick,
and it interferes in no way with their occupations. It is not con-
tagious, but it is thought transmissible from parent to child. This
form of disease seemed the lot or inheritance of nearly all the
natives of the Gilbert, Marshall, and Caroline groups. A person
once affected by it is never free from it. In the skin of a person
thus affected I believe I have seen the white patch and tubercle
of leprosy, and have seen the ulceration which could not be
doubted. In the Society Islands and the Pomoto group, elephan-
tiasis araburn is common. It attacks not only the legs, but the
breast and scrotum, and is supposed to be contracted by sleeping
on the moist ground. In these islands acute diseases are rare.
and fevers and pulmonary consumption almost unknown.

In the Fiji Islands, the two diseases most feared are dysentery
and theca. The dysentery is generally of a dangerous form, and
frequently fatal. Theca is a muco-purulent ophthalmia, causing
-great pain and frequently destroying the sight of the eye affected.
It is thought to result from the sting of an insect or the lodgment
of a flower-pollen. I had a case presented to my notice. The

DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS. 343

whole conjunctiva of the affected eye was highly inflamed, and
there was considerable discharge, though it had not progressed
to the stage when it becomes muco-purulent. At the point of
highest inflammation there was a minute white spot slightly
raised above the surrounding surface. I saw it early in the attack,
and treated it with a mild solution of acetate of zinc and wine of
opium in water, with the result of its being much better in three
days and well in a week. So dangerous and destructive had this
disease been considered, that the result in this instance was
regarded with astonishment.

Dropsies — general anasarca — the result of diseased livers from
kava drinking, though not common, are not rare. I tapped Tui
Sevuka, while at Fiji, and drew off about four gallons of fluid, much
to his astonishment and much to the gratification of the Rev. Mr.

N- , who pronounced it a good missionary work, as enhancing

the value of the white men in the eyes of the natives. And this
man, who was considered a great warrior, and one of the greatest
enemies of Thakambau, said he would think white men gods if
they did not die.

Kava is prepared from the kava-root, by a process of macera-
tion, and drank in a state of semi-fermentation. Its effect passes
through that of excitement and intoxication to temporary paral-
ysis, which may last two or three days. It is the native drink
through the whole of Polynesia. The Eva plant grows in the
Marquesas Islands; whether elsewhere in Polynesia I do not know.
My attention was called to it by the governor. I at first con-
founded it with kava, but he made a distinct difference. The
stems are about one-fourth of an inch in thickness, corrugated
or rather annulated, pea-green, and grow three or four feet high.
The leaves are oval, a little more than two inches in length, pea-
green on the upper surface, and white and downy beneath. The
fruit is about the size of a small lime, pea-green on the surface,
has a dull white pulp containing two seeds. The seeds are soft
and spongy when fresh, but become shriveled when dry, nearly
round, about half an inch in diameter, and a sixth in thickness.

344 DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS.

They are used as a poison, and produce symptoms similar to
strychnia. The castor-oil plant grows on the banks of the streams
in Fiji.

In habits of dress the natives of the Hawaiian Islands may be
said to be civilized. That of the men is after the European style,
as is also that of the women of the higher orders. The lower
order of women wear a loose dress, which falls from the shoulders
to the feet. This dress for the women is also adopted through
the whole of Polynesia where the missionary influence is felt; and
in some islands of the Marshall and Caroline groups, where the
missionary influence is not felt, it has been adopted at the sugges-
tion of the traders for cocoa-nut oil, who supply not only plain
calico, but fine silk dresses. Besides this robe they adhere to the
native malo (maro) or waist-cloth.

In the southern islands the men wear the tapa, in large folds
about the body, and hanging to the knees. In the Marquesas
they simply wear the malo. In the Gilbert Islands the men wear
a mat tied about the waist, which reaches nearly to the knees,
and the women a petticoat made of fringed bark from the pan-
danus. In the Marshall and Caroline Islands this is reversed.

Tattooing is common through all the groups. It is prohibited,
but not prevented, in the Marquesas. All that one has to do
who wishes to be tattooed is to go from Nukahiva to one of the
other islands or to the mountain, and it is done by one of a pro-
fession.

In food they have great variety, except in meats; and even
where they can be procured they are not sought, as raw fish and
p'oi are preferred. Baked dog is said to be a favorite dish, and is
indulged in at luous. Beside these, bread-fruit, bananas, plan-
tains, and cocoa-nuts are the articles of subsistence.

The question of caste is carried to the nicest points of distinc-
tion among them, and is adhered to scrupulously, or its neglect
punished with great severity.

For reasons which are obvious, when their habits of life are
considered, family names are transmitted from the mother's side.

DISEASES AND PECULIARITIES OF THE PACIFIC ISLANDS. 345

She, being a chiefess, may select whom she pleases for a husband,
without in any way prejudicing her caste, and her offspring will
be of her caste. But if a chief should choose a common woman
for a wife, the children would be plebeian.

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