BIBLIOGRAPHICAL NOTICES.-
Ship Fever, so called: its History, Nature, and best Treatment.
The Fiske Fund Prize Dissertation for 1849. By Henry
Grafton Clark, M. D., Member of the Boston Society for
Medical Improvement. 8vo. pp. 48. With a plate. Boston,
1850.
This essay is the result of observations made by its author, as
visiting physician of the Deer Island Hospital. This establish-
ment being designed for the reception of sick emigrants, afforded
an excellent field for the study of this disease, the prevailing one
among them. It is generated, according to our author, not by the
scarcity or bad quality of their food, but by the bad atmosphere
resulting from overcrowding and filthy habits. He thus describes
a scene he witnessed on one of the emigrant vessels. “ There
were fifty or sixty sick persons in various stages of fever, some
with the dysentery, which sometimes follows as a secondary at-
tack, lying in their berths indiscriminately together, adults and
children, without the least care or attention to cleanliness, and as,
we were assured, they had done during the continuance of the
whole voyage! In another berth were the bodies of two children,
who had died within an hour or two of our arrival; and close by
them, and almost in contact, the feeble mother at whose dry and
withered breast dragged a miserable and squalid infant. Those
who were able, were staggering about with haggard countenances,
whose starting eyes and hollow cheeks showed how narrow an es-
cape they had themselves had from the lonely grave in mid-ocean,
which their associates and their relations had long since found.”
Dr. Clark alludes to many facts to prove the contagious nature
of this fever, and states that in the hospital under his care all the
nurses had been attacked, the physician had died, and the only
remaining assistant physician and apothecary were sick. He be-
lieves also that it may be propagated by chests of clothing. Very
praiseworthy measures were adopted to ensure complete ventila-
tion and cleanliness, after the hospital was placed under the care
of Dr. Clark. The air of the hospital was constantly renewed,
the fever patients in the acute stage were washed every morning,
deodorizing agents employed, and all unnecessary articles of
clothing removed from the wards. Every patient was washed be-
fore admission into the house, and their clothing entirely changed.
The success of these measures was attested by the diminished mor-
tality, and by the subsequent immunity from contagion enjoyed by
the officers, attendants, and visitors to the hospital. Our author
believes that a first attack preserves, as a general rule, from a
second one, an opinion which he grounds upon a personal famili-
arity with nearly two thousand cases. He was guided in the se-
lection of his nurses by a knowledge of the fact. The ordinary
limit of the disease, he says, is fourteen or fifteen days, but two-
thirds of all the deaths occur at a later period. This mortality is
caused by the relapses, or, as they are termed by our author,
secondary diseases, wffiich he classes under two principal forms,
which, though generally distinct, sometimes run into each other.
“ 1. General dropsy, which is often accompanied by swelling
and sloughing, or suppuration of the parotid and other glands, and
occasionally by suffocative oedema of the glottis.
“ 2. A diarrhoea or dysentery, which is usually dependant upon
inflammation and ulceration of the ileum and ccecum and is fre-
quently fatal.”
Three cases are reported -in full, to illustrate the history of the
latter of these secondary affections; and in connexion with this
description, Dr. Clark remarks that it is probable “ that some of
the cases which have been set down as typhoid, (merely on ac-
count of the presence of this symptom during life, unverified by a
post-mortem examination,) were really the sequelae of typhus.”
Also,“ It must then be considered as established, that ulceration
of the small intestines does not take place in the acute form of
typhus; but that the diarrhoea which happens as a sequel to it de-
pends upon ulceration, hypertrophy, or inflammation of the ileum,
ccecum, or colon. Peyer's glands are usually unaffected in any
form of ship fever."
The treatment pursued by the author seems to have been a
highly judicious one. We need hardly cite it, as it contains
nothing particularly new to practitioners. His opinion in refer-
ence to the propriety of venesection, is, that in uncomplicated
cases it is not advisable, and if we understand him rightly, he
seems never to have taken away blood, except by leeches or cups
for the purpose of combating a severe pneumonia or bronchitis.
The chief reliance was placed upon the administration of stimu-
lants, the proper quantity being determined by the effect upon the
pulse. The diet during convalescence was regulated with the
greatest care, as a slight indiscretion was very frequently the
cause of a relapse or brought on the fatal diarrhoea. When the
weather permitted, the patients were allowed to -walk into the open
air as soon as they were able, and improved, in consequence, much
more rapidly than when confined.
We must refer our readers to the original dissertation for the
proof of the conclusions at which the author arrives, viz :
“ Ship fever is identical with the true typhus of Great Britain.
It is not identical with the typhoid fevers of France and New
England, but an entirely distinct disease.
It is most fatal in its secondary forms.
And lastly, that its contagious properties may be greatly con-
trolled, if not destroyed, by suitable sanitary measures.” M. S.