Observations on the Diseases of Seamen

by Sir Gilbert Blane

In this state of the fever I have also used with advantage the decoction of Peruvian bark and serpentary, as recommended by Sir John Pringle; and when the skin is cold and the circulation is very languid, as is sometimes the case, volatile salts and powder of serpentary may very properly be employed.

But in the advanced state, and in the worst forms of this disease, there is perhaps no medicine superior to wine. This was given either pure, or diluted with water for common drink, and sometimes to the quantity of a quart in twenty-four hours. In delicate people, such as we meet with in private practice, the quantity ought to be less.

There is this caution necessary with regard to the use of wine, that when the fever is gone off, and only extreme debility remains, the free use of it is not safe nor proper; for, in a weak and exhausted state, a person is more apt to be [98]heated and intoxicated by any fermented liquor, than in health, or even in the preternatural and disturbed state of actual disease, such as occurs in this fever.

After the disease is removed, a long state of weakness is apt to succeed, especially in a warm climate. The most proper remedies, then, are bitters, such as decoctions of Peruvian bark, infusions of quassia bark, gentian, or camomile flowers. These answer better than the bark in substance, which is now apt to nauseate and load the stomach, and the patient is apt to take an aversion to this and whatever else he took in a state of sickness. The best strengthening medicines are such as comfort the stomach and create appetite; and we may mention Huxham’s tincture of bark, in small doses, and a moderate use of wine, as the most proper for these purposes. Where colliquative sweats take place, elixir of vitriol is serviceable, and with this intention I have joined it, with evident advantage, to the evening anodyne, which, without such a corrector, tends rather to aggravate this symptom. I have known assafœtida prove a useful stimulus to the stomach at this time, and it may even be used while the fever subsists, especially where the secretions of the fauces are scanty. This medicine is recommended by Sir John Pringle in the same circumstances. But I consider the prudent use of opiates, particularly at bedtime, as the most effectual cordial and strengthening medicine in this convalescent state.

But with regard to the management of the sick at this time, as much depends on diet as medicine. Nothing has been said concerning this in the acute state of fever, because no nourishment is then necessary. In that state there is a loathing of all food, and the powers of digestion and assimilation seem to be then suspended, so that alimentary substances become not only an useless load, but offensive and hurtful by turning acid or putrid. It is likewise evident from fact, as well as reason, that nature, in this situation, does not require sustenance; for we frequently see people labouring under fevers who do well and recover, though they have been entirely without nourishment for a length of time in which the like abstinence in a state of health would have proved fatal. The friends and attendants of the sick, from a prejudice not unnatural, but not considering the difference between health and that state of derangement which takes place in fever, are for ever wishing to supply the patient with nourishment, and every physician meets with trouble in counteracting this officiousness. Nevertheless, when the fever draws out to a considerable length, and the principal symptom is that state of weakness which, in low fevers, runs insensibly into that of convalescence, then it is necessary to pay the utmost attention to nourishment, and nothing tends more to insure and hasten recovery than the assiduous administration of light and nourishing food, the same cautions being observed which have just been mentioned with regard to cordials. One of the greatest hardships of a sea life is the want of those articles of diet that are suitable to a recovering state, and many lives are lost from this circumstance, after the force of the disease has been subdued[99].

With regard to the peculiar form, before described[100], which this fever assumes a few months after ships have been in a hot climate, we found camphor, volatile salts, and serpentary, the best remedies. As there was a remarkable coldness of the skin, I was induced in one case to try the hot bath, and with good effect, from which it seems probable that a short stay in a bath, of a heat from 96° to 100°, so as to have its warming and stimulating, without its relaxing effects, would answer well in fevers of this kind.

2. Of the Bilious Remitting Fever.

This is peculiar to tropical climates, and arises in the same situations in which intermitting fevers arise in temperate and cold climates. It seldom arises at sea, unless where there has been previous exposure on shore, of which some examples have been mentioned in the first part of the work. It may generally be traced to the air of woods or marshes; and in our fleet hardly any men were attacked with it but those who were employed in the duties of wooding and watering.

The most distinguishing symptom is a copious secretion of bile which attends it. Its course, in general, is shorter than that of the fever before described; and though the symptoms are more violent, they are not so equal and steady, owing to the tendency there is to remission. The symptoms are particularly violent at the beginning, in so much that some of the men, after being exposed upon duty to the heat of the sun and the air of marshes and woods, would become frantic, being seized almost instantaneously with delirium resembling madness. This fever, when it arises merely from the effluvia of woods and marshes, has a natural tendency to remit; nay, some fevers at St. Lucia, proceeding from this cause, were of the pure intermitting form from the beginning. But in many of those that arose at Jamaica little or no remission was to be perceived; and it was distinguished from the ship fever by the bilious vomits and stools, more violent delirium, and head-ach, and by being attended with less debility. The greater tendency to the continued form at this time was probably owing to this circumstance, that the men who were exposed to the land air in wooding and watering, were then exposed also to such causes as naturally produce continued fevers, such as infection, the foul air of the French prizes, intemperance, and hard labour. There was in some cases a yellowness of the eye, and even of the whole skin, but without the other symptoms that characterise the yellow fever, properly so called.

In cases that proved fatal, the symptoms, for some time before death, resembled very much those of the fever before described at the same stage. There was either coma or constant delirium, great seeming anguish, the mouth and tongue very dry, or with only a little ropy slime, a black crust on the teeth, picking of the clothes, and involuntary stools.