THE
MEDICAL EXAMINEE,
AND
EECORD OF MEDICAL SCIENCE.
NEW SERIES. — NO. C VIII.—D ECEMBER, 1853.
ORIGINAL COMMUNICATIONS.
On the Diseases and Injuries of Seamen. By G. R. B. Horner,
M. D., Surgeon U. S. Navy, Philadelphia.
Diseases of the Respiratory Organs.
Notwithstanding the strict examination of seamen before their
admission on board ship, there are no class of persons who suf-
fer more from the above complaints. This may be ascribed
mainly to their great exposure to every vicissitude of weather,
their often being wet with rain or sea water, neglecting or not
being able to change their clothes, and when chilled not having
it in their power to warm themselves by any artificial means.
When on watch, too, they are very much habituated to lying down
on the decks, and even beneath the sails, reflecting down upon
them the strongest currents of air. Likewise, seamen when sleep-
ing below decks, and the air presses down through the hatches
and into the ports, are very liable to take cold. This, moreover,
affects them from its constant application, and being accompanied
always with more or less dampness, either in the external air, or
in that of their vessels. These likewise shift like the weather,
and so often pass from hot to frigid climates that their crews-
suffer thereby as they would from exposure to vicissitudes of
weather, and when remaining in any fixed place. Owing to these
causes seamen are liable to every species of disease which effects
the lungs, their air-pasages and investing membranes. From
neglect and want of proper medical attendance, many of them are
prone to be severely and chronically diseased ; organic changes
necessarily follow, and cures are more difficult of attainment.
Upon the inspection of the diseases which occurred in three men-
of-war—two frigates and one ship of the line—of which I was
surgeon, I have found that in one of the former 265 cases of ca-
tarrh, alone, took place. In the other frigate there were 106
within 18 months, the period I was on board her ; and in the
Delaware, the ship of the line referred to, which had a crew
of 840 persons, 232 cases occurred, although she spent more than
a year between the tropics before she went to the Mediterranean.
During the entire cruise of two and a half years, 23 of her crew
had phthisis pulmonalis, of whom twelve died; eight on the
Brazil station, and four after she left. But one of the former died
in a merchant vessel before she got clear of the coast, and one
of the latter either at our naval hospital, Port Mahon, or else in
returning home. Of the crew of the United States, the first
frigate referred to, ten had phthisis, of whom eight died, four on
board, and four at the above hospital under charge of another
surgeon than myself ; but in the Savannah, the second frigate,
merely three cases of the disease happened, of which only one
was fatal, that of a supernumerary who came on board of her in
California for treatment. The comparative exemption of her
crew from the disease is ascribed to the great care in selecting
from it, and sending on shore at Boston, before she sailed, all
persons "who were believed to be of unsound constitution. The
great reduction in the number of her crew on her arrival in the
above country, also served to render the number of cases propor-
tionally less, and we must likewise ascribe the small amount of
these and other cases of pulmonic diseases to the avoidance of
wet decks, keeping the vessel continually of moderate temperature
by the use of stoves in her, and the receiving ship, Franklin, to
which the crew were transferred while the Savannah was in the
dry-dock undergoing repairs. But the cold was so intense, the
air so humid, when the wind blew from the north-east and east,
that eleven of them were affected with pleurisy, between the 12th
January and the 4th of March, 1849, the period included within
the time of her arrival off and departure from Boston. No deaths
took place among these cases, and a very small number of other
pulmonic ones, except phthisis, in the above and other vessels
terminated fatally. Among these cases was the one of pneumo-
nia/in the Brandywine, followed by mortification of the lungs,
and another accompanying a violent remittent fever, off the
coast of Syria, and in another frigate. From catarrh no death di-
rectly happened, but one of the fatal cases of phthisis was traced
to it, and one of hypertrophy of the heart in the Delaware which
ended in like manner,two months after the patient contracted a ca-
tarrh in the form of influenza, which attacked the crew in the first
week of September, 1843, while she was at Naples. More than
sixty of them were affected at the same time with the complaint
to such a degree as to be rendered unfit for duty. Many others
were affected moderately and were not taken on the sick list.
What was most remarkable respecting the disease, was, its pre-
valence during warm and fair weather, without any great
change of temperature, Fahrenheit’s thermometer having been at
76°, the day before the influenza appeared; at 73° on the same
day the three first cases were admitted, and only at 71Q upon
the 10th of September, or three days afterwards. The thermome-
ter fell a fraction on the day the disease appeared, and at the
same time the wind blew freshly from off shore, and the Ap-
penines, and raised by its great dryness the hygrometer to a
most extraordinary height. As no rain had recently fallen, a
whitish impalpable dust was blown to the ship, covered her rig-
ging, and caused the sailors to think it was sulphur ejected from
Mouut Vesuvius, although the wind was north-east, and the lat-
ter bore almost south-east. They likewise concluded that the
dust being sulphur must have occasioned the epidemic.
On board the United States the atmospheric phenomena were
different. The air had been damp and chilly, the wind was va-
riable ; the thermometer was at the freezing point the day we
entered the gulf of Smyrna, and snow covered the adjacent moun-
tains. But on the 26th of January, 1837, the day before she
left that port, and three weeks from the former period, the ther-
mometer was at sixty-one degrees. The number and violence of
these cases in this vessel corresponded with the extremes in
temperature. One hundred and twenty-six of the men were af-
fected with catarrh in such a severe form as to have been taken
on the sick list between the seventeenth of January, when the
complaint began to assume an epidemic form, and the 12th of
February, when it ceased to be so, and the vessel arrived at
Port Mahon.
On the 27th of January ninety men, including officers, were
on the list, and almost the whole number had the complaint,
some moderately, others violently, and accompanied with high
fever, acute pains in the head, chest and limbs, and delirium.
Among the latter was an officer liable to hereditary insanity, and
who has been a maniac ever since. His mind had been previously
wavering between sanity and insanity, and lost its balance when
catarrhal fever attacked him. In these cases, as well as
those of the same kind in the Delaware, venesection was em-
ployed : leeches were applied to the temples, cups and blisters
to the chest, when it was much affected ; pectorals, anodynes and
diaphoretics were prescribed ; but in a vast majority of patients
I effected a cure in a few days, often in a single one, by first
giving an ounce of epsom salts and one or two grains of tartar-
emetic in 5viij of water at several doses ; then by administering
a solution of the latter medicine in the dose of an eighth of a grain
in simple water, but generally, as being most palatable and
soothing to the throat, when flavored with sugar, gum arabic and
extract of liquorice. This pectoral was given every hour, or at
intervals of three or four hours, and was aided by some hot herb
tea, as that of catnip, marsh-mallow and horehound. Balm and
eupatorium are also freely used by me in such cases, and for
producing copious perspiration the latter is unrivalled by any of
the other herbs mentioned. To promote the diaphoretic effects
of all of them, the feet were well bathed in hot water; and as
this also produced a revulsive effect from the brain, it composed
this and caused the sick to sleep soundly. The bath, moreover,
helped to relieve coryza, which was often very profuse, from the
inflammation of the mucous membrane of the nostrils being very
intense; but in these cases, the direct application of steam or
hot water to them several times a day was most effectual, from
its inducing a profuse secretion of mucus and disgorging the
capillary vessels. A few grains of super-acetate of lead or sul-
phate of zinc render the hot water still more effectual. The
steam of vinegar or brandy is likewise beneficial, but I prefer
that of water. This, moreover, I have found best to relieve
otitis, which sometimes attends catarrh, and for its cure may be
applied by means of a hot brick wrapped in a damp towel.
Several cases of pleurisy and one of pneumonia occurred in the
United States at the same time with the influenza, and were
cured by copious venesection, cups and blisters to the thorax, and
other remedies enumerated. In the treatment of the last named
affection, the spiritus mindereri and neutral mixture with tartar
emetic dissolved in them, and the nitrous powders containing this
medicine, in the quantity of an eighth of a grain, with one grain
of calomel in each powder, produce a happy effect. The three
first named articles promote sweating and expectoration, open
the bowels and reduce the pulse, while the last named decreases
the plastic property of the blood and causes the absorption of
any effusion which may have occurred in the lungs, or within and
upon their pleural coat and that of the ribs. By observing the
above practice with some variations, none of the above cases of
pleurisy and pneumonia ended fatally, and no others, except two
private ones to which I was called in the last stage, and which
had been unattended by any physician. One was that of a
marble mason, who persisted during a rainy, chilly day in po
lishing one of the columns to the portico of the Naval Asylum
A violent inflammation of the lungs, bladder, and almost every
tissue of his body supervened ; and having been allowed to rage
unchecked, every affected part became so injected with red blood
as to appear to have been done by artificial means. The mucous
coat of the bladder was the most peculiar, from being of a scarlet
hue, covered with dark red spots.
The other case was that of a citizen of the island of Milo,
south of Greece, and to whom I was called during a transitory
visit to the town, in April, 1833, while surgeon to the John Adams.
Although the island contained some thousands of inhabitants,
there was not then a single physician among them. The patient
had therefore received no proper medical attention, was in the
last struggle for existence, and gasping loudly for breath in a
low bed and at the back of a dark room. A crowd of women,
wrapped in white muslin mantles and dresses, stood around the
bed, and holding flaming torches in their hands, were mournfully
looking on at the dying man. He laid, apparently unconscious
of their presence, upon his back, making imperfect inspirations
and expirations; his face was sunken, pallid, cadaverous, his
pulse was rapid and bounding, but sinking. There was not the
least hope of his recovery, yet I prescribed, through an inter-
preter, what seemed calculated to comfort him, and had to
hurry away before the awfully tragic scene had terminated, lest
darkness should overtake me before the landing place and ship
were reached. Her distance from the shore, and this from the
town, prevented me from making any attempt at a post-mortem
examination, and had it been convenient to make one, the friends
of the deceased would probably have refused it. From the symp-
toms, too, the morbid changes, I judge, would have been similar
to those just described, from this man having had the disease also
unchecked. The changes found in the dissection of the seaman,
mentioned as having died of hypertrophy of the heart succeeding
catarrh, were the following: The whole organ was much en-
larged, and especially its left ventricles, the parietes were thick-
ened, the auricular ventricular openings expanded, the chordae
tendinse and columnar carnae elongated and thickened, the aorta
was expanded and gritty, the pericardium contained several
ounces of serum, and the left ventricle was filled with dark blood.
The right lung adhered to the ribs; its bronchia were expanded ;
it contained some tubercles and purulent matter, and within the
pleura were about two pounds of serum. The liver was indu-
rated, of a greyish red color like porphyry, and much engorged.
The gall bladder was small and filled with dark bile ; the pan-
creas indurated and enlarged; the mucous coat of the stomach
congested and somewhat softened.
From these morbid alterations, his age, which was fifty, his
habits as a sailor, and his not having complained before attacked
with catarrh, of any cardiac, or other disorder, to my knowledge,
the following conclusions were drawn : that by long continued in-
dulgence in ardent spirits, the liver, pancreas and stomach had
been affected, and the two first indurated insensibly; that the
circulation of the blood having been partially interrupted, the
heart then commenced to enlarge, and the influenza afterwards
having seized him, that organ, the right lung and pleura became
actively inflamed. This was very clearly indicated by the great
fulness, frequency and strength of his pulse, great dyspnoea,
pain in the chest and other symptoms, which caused me to bleed
him copiously twice within the first three days after he was taken
on the sick list, to bleed him moderately once towards the close
of his life, and to administer the tincture of digitalis, squills,
antimonials, tr. assafoetida, extract of stramomium, and other
anodynes, besides making local applications over the diseased
parts.
In the treatment of phthisis, of the tubercular or other kinds,
the above remedies with a variety of others were employed, but
the result as stated has already shewn that they often failed in
my hands as they have done in those of many more physicians.
Relief was certainly obtained by using these remedies, the pa-
tients were at least made more comfortable, but in all climates
consumption had its full quota of victims, in spite of cod liver oil
and every other specific recommended. But in some cases I was
gratified by success. Two of them were, that of a marine who
had been completely prostrated by phthisis and its accompanying
chronic diarrhoea, and the other that of a seaman just returned
from a cruise in the East Indies ; but his case was not one of
tubercular phthisis, and was thought to have been induced chiefly
by an adhesion of the upper convex surface of the liver to the
diaphragm and inflammation extending from it into the right
lung. An abscess formed in this, a large quantity of thick
whitish pus was discharged day after day, and finally became
so tinged with green, as to permit no doubt that bile was being
effused from the liver through an ulcerated passage extending
through the diaphragm into an adhering portion of the lung.
This patient, John Ward, was and is now, a pensioner in the
Naval Asylum, of which I was surgeon when he was treated.
He was cured chiefly by means of tincture of digitalis, gum
ammoniac and other expectorants, blisters to the chest, tartar
emetic ointment as a dressing, and pills of blue mass. The
other case was cured, at least sufficiently for him to resume
his duties, by the internal use of a solution of sulphate of zinc
and sulphate of morphine, in the proportion of one grain of the
former to | of the latter 3 or 4 times a day in a half ounce of
water, and by injecting the same compound into the rectum to
check the diarrhoea.
While I was at, the Naval Asylum, another uncommon instance
of phthisis occurred in the person of VVm. Williams, a one leg-
ged pensioner, of intemperate habits. He was under treatment
for six months, had taken various pectorals, composed of tine,
of tolu, gum ammoniac, acetate and sulphate of morphine, had
worn a tartar emetic plaster, and for a long period had his wast-
ing frame supported by bitter infusions and quinine mixture.
In the mean while he expectorated a large quantity of pus, and
discharged almost as much from an abscess over the anterior face
of the right ribs. Upon death having occurred, an autopsia was
made to ascertain what connection existed between the internal
and external abscess, and to discover what other morbid changes
existed. Four of the true ribs, the third, fourth, fifth, sixth and
seventh, were found to have formed the base of the external
abscess, and beneath the third and fourth ones was the abscess
in the lung. No direct communication was discovered between
the two abscesses, but it was thought that the trace of it had
been removed by the knife and saw used in dissection. The
cartilages were ossified, and one was separated from its rib by
caries. This was plainly owing to the pulmonic abscess behind
it having had its contents brought into contact with the bone
and cartilage. The external abscess having discharged its fluid
contents through the fistulous orifice which had so long existed,
contained only some cheesy matter. The right lung had a small
quantity of water effused in it, and the left lung had much
contracted in size, was filled with tubercles of a blackish grey
color, adhered closely to the ribs and cartilages, so that the
pleura costalis and pulmonalis were merged into one and undis-
tinguishable, and the lung in its antero-posterior diameter was
merely about one inch and a half in diameter. The liver was
very small and blanched at its lower edge, but the right lobe
was elongated downwards into a flap three inches long, and its
structure otherwise normal.
In conclusion I will state concerning this patient, that he had
an attack of haemoptysis a year before he was treated for phthisis,
and was nine days under my care for the former.
Six other patients at the Asylum besides those spoken of
had phthisis during my last term of service there, and one died
of it there before it was opened for the reception of pensioners,
and while I was assistant to our late distinguished chief of the
bureau of medicine, Dr. Thomas Harris. The latter patient was
a seaman who, while dying, nobly offered, without any request
or persuasion, to let me “ do with his body after death as was
thought fit.” Accordingly it was examined. His lungs were found
filled with tubercles, but the right one, as I have seen in most
dissections, was worst diseased, containing several vomicae, and
being totally disorganized. Of the six other cases three ended
in death, and one within twelve days after it was treated. This case
was an obscure one. The patient was 65 years old ; came on the
list, and was treated for a cough and diarrhoea of great obstinacy,
which seemed the chief cause of death. He was much prostrated,
and in conjunction with an expectorant and opiates taken by
mouth and used as enemata had to be prescribed, pills of sul-
phate of quinine, and an infusion of pulv. cinchonae, Colombo,
ginger and orange peel. For cough, and shortness of breath of an
asthmatic kind, he was also given a tartar emetic plaster to be
worn over the chest. The infusion having appeared to purge,
was combined with laudanum, and xx. drops were taken in each
dose. Opiate enemata were prescribed prorenata, the diarrhoea
having become worse. It was impossible by these or other medi-
cines to sustain him ; the stools became watery, his excretions of
all kinds offensive, and he expectorated some greenish pus ten
days before his decease. Upon examining him, both lungs were
found adhering to the ribs, filled with tubercles, collapsed and
shrivelled. The right lung, however, as expected, was worst, for it
contained many vomicse of small size, and adhered to the ribs by
strong tendinous bands. The small intestines and stomach were
inflamed chronically, and the latter had its mucous coat atro-
phied, of a dark red color, and deprived of its cryptoe and folds.
The liver was blanched and indurated, and had its acini indis-
tinct. But the most unnatural phenomena were the thickening
and softening of the parietes of the heart, and the perfect adhe-
sion of this to the pericardium, no interstice having been left
between them. No instance of this kind had ever before fallen
under my notice, nor has another been since seen.
Another pensioner, named Wilhelm, a foreigner, had long
been gate keeper at the Asylum, and was remarkable for his florid
complexion, slender and agile form. He came on the list with a
slimy diarrhoea and inflamed eyes. His tongue was thickly furred,
his abdomen sore to the touch, and he had had a cough for some
time ; but little notice was taken of it until he had been on the
list for three weeks and expectorated a quantity of glairy, green-
ish mucus. The stethoscope was then applied, and detected a
mucous rattle. His bowels up to that time had attracted chief
attention, and had been restricted by first giving a dose of pulv.
rad. rhei, magnesia and laudanum, and afterwards several sorts
of pills, besides some grains of kino and tine, cinchona compos,
as he had been a free drinker. The pills were of ipecac, and
opium at first, then of these articles and blue mass, and last of
the former, calomel and essence of peppermint. Two days after
his admission he complained of being very weak, and was directed
two doses a day of a quinine mixture and a pill at night. He
likewise was given an infusion of cinchona, Colombo and ginger,
with tincture of opium, a brown mixture for his cough, some
opiate enemata, pills of quinine, opium, and essence of pepper-
mint ; had a Burgundy plaster put on his chest, and a flannel
bandage around his abdomen. Nothing availed ; he died twenty-
five days after taken in charge.
Autopsia.—Two ounces of serum were in the pericardium, the
lungs adhered in every part to the ribs ; when cut into resembled
greyish granite, were filled with tubercles beginning to suppurate,
but the right lung was most diseased. The stomach was dis-
tended with flatus, its mucous coat was deficient, being about the
thickness of brown paper, was softened, and easily scraped off
with a knife handle ; the folds and villi were almost invisible,
and slight inflammation existed in the cardiac orifice. Three
ulcers were seen in the jejunum within a foot of one another,
and completely perforating its coats ; the peritoneal coat of all the
small intestines was inflamed, slightly in most parts, but greatly
in some from the effusion of faeces into the cavity of the perito-
neum. The liver was enlarged, indurated, nearly white, and de-
prived of its acini; the spleen was indurated, but weighed only
about three ounces, was merely two and a half inches long, one
thick, and one and a half broad, and contained no grumous blood,
The bladder was contracted and blanched, its coats were thick-
ened, the left kidney was enlarged, of a light red color, and
nearly as hard as dried beef, and the right kidney, though of
natural size, was of the same consistence.
Such were the effects of disease on this poor old sailor, aggra-
vated by a long-continued abuse of ardent spirits—the greatest
of all curses to his fraternity, and destroying more of them than
become victims to the tempests or the billows of the ocean.