Observations on the Diseases of Seamen

by Sir Gilbert Blane

The natural evacuation, which may with most safety and advantage be solicited and encouraged in this disease, is, that by perspiration; and it is observable, that in those cases for which nature does most, there is a universal warm sweat, which has generally a very offensive smell, and seems to be a salutary effort of the constitution to cure the disease. Where this takes place, little medical assistance is necessary, except to keep it up chiefly by warm dilution; and there is no circumstance in which the judgement of a physician is shewn more than in discerning those cases in which his chief business is to look on, where nature, being equal to the task, ought not to be disturbed by the active and officious interposition of art. We should not, however, aim at producing a profuse sweat, except with a view to effect a remission immediately after the first evacuations. In the course of the disease, it is only necessary to keep up a gentle moisture or softness of the skin.

The head being particularly affected in this sort of fever, the patient is extremely restless and delirious, especially at night; and there is a medicine which has a most pleasing effect in procuring both rest and perspiration. This is a combination of an opiate with an antimonial medicine, which was administered in the evening with great success; and the sudorific effect is rendered more certain by the addition of some saline neutral, especially Spiritus Mindereri[92]. I tried pure opiates in the early stage of this, fever, but found them not to answer; though in the low[93] fevers of England, and in the advanced stages and convalescent state of this fever, they are extremely safe and useful. Pure laudanum is also given by Dr. Lind, at Haslar, with great success in the height of the disease; but in the West Indies there is a greater tendency to acrid excretions, and the effect of pure opium in causing a retention of these, seems to be the cause of its disagreeing in that climate in the first stage of this fever.

It may here be observed, that the addition of a little neutral salt alone will sometimes so qualify the operation of opium, as to prevent its bad effects, such as the increase of febrile heat and delirium, and the stupor and head-ach which, when given alone, it frequently induces the following day. I have generally employed nitre with this intention; but this does not seem so well adapted to this disease as some other neutral salts, as it tends too much to lower the powers of life.

But with a view to perspiration, the Spiritus Mindereri is the most effectual neutral medicine when conjoined with an opiate, and there is not, perhaps, a more safe and pleasing diaphoretic known than a combination of it with syrup of poppies[94]. There is some neutral salt in Dover’s powder, and this has more effect than could be expected from so small a quantity of an inert medicine; for I know from trials of my own, as well as those of others, that ipecacuanha and opium given together, in the proportions prescribed in that powder, will not have the same effect as when joined with the neutral salt. This is an instance of those useful combinations of medicines which can be discovered only by experience, but which every physician ought gladly to adopt in practice upon good testimony and fair trial, though he may not be able to account for their effects, nor to explain their mode of operation.

There is nothing more important than plentiful warm dilution; and the infusion of sauge, or any such light aromatic, is rather more proper than farinaceous decoctions, or any compositions in which there is wine or spirits. Success in this, as well as other diseases, depends on attention to nursing as much as upon medicine; for what would it avail here to administer medicines for promoting perspiration, unless they were assisted with fluids to allay thirst, to dilute the acrimony in the first passages and in the vessels, and to furnish the materials of free perspiration?

But however desirable it may be to procure sweat, this is not to be attempted by close rooms and bed clothes, nor by hot medicines, such as volatile salts, serpentary, spirituous tinctures, or aromatics. These, according to the testimony of Sydenham, tend to increase the heat and delirium, and to produce petechiæ, miliary eruptions, or local inflammations. In the intervals of the anodyne diaphoretic above described, Spiritus Mindereri and small doses of camphor, with proper dilution, may be safely employed to procure a soft skin.

The only other means I shall mention with this view is, the application of warm moisture to the surface of the body, which may be done by soaking the feet and hands in warm water, or by fomenting the feet and legs with stupes[95]. These operations have the effect of bringing on a general relaxation on the skin, thereby taking off febrile agitation and delirium, and inducing sleep. I sometimes, with seeming benefit, ordered cataplasms to be applied to the feet, merely of the emollient kind, without mustard or any other acrid substance, being intended to relax, and not to stimulate.

In the use of pediluvia and fomentations, there is a difference worth attending to between the practice in this fever, and that in the inflammatory fever before described, for they are as hurtful in the latter as they are beneficial in the former. I have observed, in general, that they have a bad effect in all cases where there is sizy blood, particularly where the breast is affected.

Delirium is one of the most constant and alarming symptoms in this disease, and the removing of it depends much upon the attendants as well as the physician. It has been said before, that it depended on a false apprehension of the impressions or natural sensations. When a person, for example, labours under delirium, and is affected with thirst, the minds is either so agitated with other objects, that this sensation is overlooked, or, instead of producing a craving for drink, it excites some other disagreeable emotion in consequence of the disordered state of sensorium. This last seems to be probable from the cessation of delirium, which will take place upon any natural want being satisfied; I have seen a temporary stop put to the patients raving by making him drink, or upon his discharging his urine or feces; for he is then unconscious of thirst and other natural wants, is therefore ignorant of the means of satisfying them; and when he does so, he fancies he is about something else which is the subject of his delirious thoughts. This observation leads to a material practical purpose; for it follows from it, that unremitting attention should be given to the patient’s feelings and all his possible wants, as those natural notices and instinctive cravings which occur in health are now wanting, in consequence of the depraved state of sensation.

Most of the remarks that have hitherto been made apply to the earlier stages of the disease. The principal remedies applicable in the more advanced stages are, blisters, Peruvian bark, opium, and wine.