On the Diseases and Injuries of Seamen. By G. R. B, Horner?
M, D., Surgeon U. S. Navy, Philadelphia.
Rubeola, Parotitis, and Tonsillitis.
During my whole term of active service, I have only known
the crew of one vessel to be affected with measles, and that was
the crew of the Delaware, who were infected at Norfolk just
after she fitted out. The disease soon became epidemic, and was
still lingering in her when I joined her three months after it first
appeared. It principally attacked the boys, was accompanied
with ordinary symptoms, fever, soreness of throat and eyes, but
these were sometimes most affected, and remained inflamed for
a long time. Indeed, so much ophthalmia preceded, accompa-
nied and followed the measles, that they seemed to have tainted
the eyes of many persons in a most extraordinary manner. For
though the measles were without exception cured, yet the
ophthalmia was the most obstinate ever met with by me. Some
of the cases were perfectly incurable, the conjunctiva becoming
granulated and chronically inflamed. Local and general deple-
tion, astringent lotions of the greatest reputation, citrine oint-
ment, the nitrate of silver, and all other remedies thought appro-
priate, were tried in vain. Consequently some of these cases
had to be sent on shore before the ship sailed, and others to the
United States after she arrived in Brazil. With the exception
of these cases, I have very rarely failed in subduing ophthalmia
by means of the medicines specified : weak solutions of sup. acet,
of lead, the nitrate of silver, and sulph. of zinc, warm bathing,
cathartics, antimonials, blue mass in moderate quantities, and by
occasionally using leeches and poultices to the eyes, and blisters
on the nape of the neck. Setons also were employed in some
cases of the worst kind with doubtful efficacy, and bathing with
warm water in those of every class, as it was much more soothing
than cold. The former lessens action, relaxes the inflamed parts,
causes a free secretion from the meibomian glands and eyes, ren-
ders them more sensible to the action of cold, or astringent lo-
tions, and thereby indirectly produces a tonic effect. When in-
flammation ran high in the above and like cases, scarification
with a lancet on the inside of the lids was frequently performed.
In some instances, however, it seemed to increase rather than
diminish irritation, either from the great sensitiveness of the
parts, or from an increase of tears having been caused to flow
over the incisions.
For the cure of the measles, the remedies most prescribed were
cooling drinks, seidlitz powders, and other gentle cathartics.
Collyria, alum gargles, and brown mixture were given to the
patients -whose eyes, throats, or respiratory organs were much
affected.
Into two of the ships mentioned another contagious disorder
was introduced—the mumps, or technically speaking, cynanche
parotidea. The first ship infected was the United States, and it
was thought at New York, as she sailed from thence, though the
disease appeared on the seventeenth day afterwards, and when
she was two-thirds across the Atlantic. The period of incuba-
tion, therefore, was nearly three weeks, if not more, unless the
disease originated on board, which is improbable. The first case
was that of a man who had the usual symptoms and was cured
of them, but seized with orchitis twelve days after he was taken
under treatment. Another man had mumps in a reverse manner,
the right testis having been tumefied and inflamed before he had
the parotids sensibly affected, and the jaws made stiff. In a third
case, the submaxillary glands were also enlarged, and as much,
if not more so,- than the parotids. Altogether, twenty cases
happened, and the last one upon the 28th of August, that is
sixty-three days after the appearance of the first case. Most of
them were of a mild kind, but six were attended with orchitis of
one or both testes, and the average cure was effected in seven
and a half days. The youngest patient was seventeen years old,
and the eldest thirty-eight years. Three more persons were
above thirty, and ten were from seventeen to twenty-two years
old. In the Savannah only ten persons had the disease ; the
youngest was a marine drummer of ten years, and the eldest a
seaman of twenty-eight. Most of these cases were also of a mild
character, and all were undoubtedly owing to contamination at
New York, where the ship was when the first took place, though
three did so at Boston, and four others after she sailed thence
for the Pacific. In each vessel the disease seemed to continue
until every person liable to it had been affected, for the last one
in the United States was taken sick in the Archipelago, and the
last patient in the Savannah when she had been at sea twenty-
seven days, and was near Brazil. The average period of cure for
the cases in the latter frigate was short of six days, although
several of them, from the severity of the cold, were accompanied
with tonsillitis.
The ordinary treatment was to give Epsom salts and tartar
emetic in combination, to purge well. Sometimes the castor oil
was given, or an emetic of ipecac, and tartarized antimony, when
the testes were attacked. Afterwards the sick took the spiritus
mindereri, or a solution of the last named medicine, rubbed the
volatile liniment over the parotids, and wore hot linseed poultices
over them. Their diet was low, their drinks cooling when
fever ran high. In two cases this happened to such a degree
as to demand free venesection, and in those where the parotids
and testes were much inflamed leeches were applied. When the
testes were attacked, blisters were occasionally substituted for
volatile liniment to the parotids, and an evaporating lotion of
water, alcohol and sup. acet, of lead were applied to the former
instead of poultices. By the use of the above remedies all the
cases were cured, but one of those in the United States was under
treatment twenty-eight days, from being complicated with catarrh
as well as orchitis. In the cases accompanied with tonsillitis,
gargles had to be used, and I also, agreeably to my practice in
that disease, lanced the tonsils freely. This very much short-
ened the treatment, and relieved the patient of pain and difficult
deglutition, by disgorging the blood vessels and preventing swell-
ing and suppuration. In fact, freely lancing the tonsils does
in a few minutes what may require days or months to accomplish
with medicines. It also prevents the part from remaining indu-
rated and swelled after the inflammation has subsided, and saves
thereby the necessity of excision. Were this practice generally
adopted, in conjunction with appropriate medicines, the above
operation would become almost obsolete. Certain it is, that I
know of no instance of its having been required after I had
treated tonsillitis—and many cases have been seen by me—of
persons who had enlarged tonsils, ascribable to the neglect of in-
cisions into them while inflamed. To make them, a lancet firmly
fixed between the two sides of the handle was most used, but the
blade is apt to turn to the right or left, and is too short to reach
the glands unless the fingers holding the instruments are partly
thrust with it into the mouth. For these reasons, a small straight
scalpel is preferable, and the patient having had the lower jaw
and tongue firmly depressed by means of a spoon handle or
spatula, without being thrust so far back as to cause gagging,
the point of the scalpel should be passed directly through the
projecting portions of the glands. By doing this, a copious flow
of blood will be obtained without danger of puncturing the exter-
nal walls of the fauces and cutting the internal carotid arteries
in their passage to the base of the cranium. Such an accident
could only happen from great carelessness,, awkwardness, or ig-
norance of the anatomy of the parts, and is not more liable to
occur than that of leeches—recommended by some—getting into
the stomach or larynx, either before or after application. These
reptiles likewise are very disgusting and horrifying to many pa-
tients, even when they are externally applied, and few would sub-
mit to their being introduced into their throats. This difficulty
might be obviated by their being used externally, but they would
be less efficient and would have to be applied in larger numbers,
and this wrould be very objectionable where they are scarce and
the patients poor, or the leeches very dear, as at Lima, at ‘which
city they cost a dollar a piece by the hundred. At sea, too, it is
difficult to keep a supply of them ; often they cannot be had for
any price, and for these, if for no other reasons, it is preferable
to employ incisions. But though these possess such efficacy,
they were not relied on alone, were frequently not required, and
always assisted by medicines. The gargles mentioned were used,
likewise some made of the nitrate of potash dissolved in sweetened
water, in the proportion of gi. or gij. to gvij., and others of
Cayenne pepper, molasses, and vinegar, and of like proportion.
In the majority of cases, however, a gargle of 51'j. of powdered
borax, ^i. of honey and 5 viij. of strong sage tea was found tho
most pleasant and useful, and most prescribed. In severe cases
antimonials, and other diaphoretics, eathartics, frictions over the
throat, and hot pediluvia were used. Hot poultices applied ex-
ternally to the affected part after friction with volatile liniment and
turpentine or some other stimulating one, afforded much relief,
and the same benefit maybe derived from filling a small bag with
wood ashes, wetting them with warm ley, and fastening the bag
about the patient’s throat while he is reposing. This is a do-
mestic remedy which I have seen used in country practice, but a
very good one, from its combined fomenting and stimulating pro-
perties, which promote perspiration, and divert irritation from
the fauces to the integuments.