Observations on the Diseases of Seamen

by Sir Gilbert Blane

Should the patient survive to the end of the second week, the treatment then comes to resemble more and more that of the infectious fever already described. Bark may be given, though there should be no proper remission, and cordials and opiates may be more freely used. Attention to the state of the bowels will still be necessary, since repeated accumulations of bile are apt to occur even in the most advanced stage, and gentle emetics of ipecacuana, as well as laxatives, may be necessary. For the same reason also, greater caution is requisite in the use of pure opiates than in the infectious ship fever before treated of. In order to keep the bowels soluble, it was a very usual practice, and found very useful, to conjoin a few grains of rhubarb with each dose of the bark.

3. Of the Yellow Fever.

The fever last treated of may be said to be peculiar to a hot climate; but the hot seasons of temperate climates produce something resembling it. That now to be described never occurs, so far as I know, except under the influence of tropical heats. Such a fever is indeed known without the tropics; for it is very common in Carolina in the hot season; but there the heat is even greater than that of the West Indies. In order to produce it, there must be, for some length of time, a heat seldom falling below seventy-five degrees on Fahrenheit’s thermometer.

Though it differs from the fever last described, both in its causes and symptoms, it is not meant to say that it is so distinct as to form a separate species of disease, like the measles and small pox. Unless the characters of fevers are strongly marked, it is difficult, and even impossible, to refer them to any particular species; and the different concurrence of causes and constitutions is so various, that great numbers of ambiguous cases occur.

With regard to the cause of the yellow fever, it differs from the bilious remittent in this, that the air of woods and marshes is not necessary to produce it; for it most commonly arose from intemperance or too much exercise in the heat of the sun. It was observable, however, that it was more apt to arise when, besides these causes, men were exposed to unwholesome air, particularly the foul air of ships, whether from infectious effluvia, or proceeding merely from the putrefaction that takes place in neglected holds.

It is also remarkable with regard to it, that it is confined almost entirely to those who are newly come from a cold or temperate climate. The same remark is made by the French, who therefore call it fievre de matelot[101], considering it as peculiarly incident to those who have newly arrived from a long voyage. It would appear also, from what has been formerly mentioned[102] that those men, who have been exposed to that sort of infection that prevails in ships in cold climates are more particularly the subjects of the yellow fever when they arrive in a hot climate. It is farther in proof of the same opinion, that there are medical gentlemen, natives of the West Indies, who have hardly ever seen it, their practice lying at a distance from any sea-port town where strangers usually arrive. Of these strangers, those who are young, fat, and plethoric, are most apt to be attacked; and more of our officers in proportion were seized with it than common men.

It has been said, that it never attacks either the female sex or blacks. This is in general, though not absolutely, true; for I knew a black woman, who acted as nurse to some men ill of this fever at Barbadoes, who died with every symptom of it.

This fever assumes various forms, according to the peculiar constitutions of different men, and other circumstances; but in the following description I shall enumerate the most common appearances:—In general it begins with short alternate chills and flushes of heat, seldom with those rigors which constitute the regular cold fit, and with which most other fevers begin. These are immediately succeeded by violent head-ach, pain in the back, universal debility, sickness, and anguish at the stomach. There is commonly, in the beginning, a good deal of bile on the stomach, which is thrown off by vomiting, either natural or excited by an emetic. Those men who were taken ill of this fever in the Alcide, in the end of the year 1781, had a sore throat in the beginning; but this is not a common symptom.

In the course of this disease there is by no means a free secretion of bile, and least of all in those cases that are most violent, and prove the soonest fatal. In cases that are more protracted, and less desperate, there are frequent accumulations of it, as appears by the vomits and stools[103].

The eye in a few hours takes a yellow tinge, which soon after extends more or less over the face and whole skin. This is a symptom so striking and constant, that it gives name to the disease, though it is not absolutely either peculiar or essential to it. There is something contagious in this symptom, which seems somewhat singular, and difficult to be accounted for. It was observed in the Royal Oak and Alcide to extend to men who were but slightly indisposed; and at the hospital it spread to men in the adjoining beds, without imparting any malignity to their diseases.