Observations on the Diseases of Seamen

by Sir Gilbert Blane

There is something very peculiar in the countenances of those who are seized with it, discernible from the beginning by those who are accustomed to see it. This appearance consists in a yellow or dingy flushing or fullness of the face and neck, particularly about the parotid glands, where the yellow colour of the skin is commonly first perceived. There is also in the eye and muscles of the countenance a remarkable expression of dejection and distress.

One of the most constant and distinguishing symptoms of this fever is an obstinate, unremitting, and painful pervigilium, which is the more tormenting, as the patient is extremely desirous of sleep. It is seldom that even a delirium comes to his relief to make him forget himself for a moment; but he continues broad awake, night and day, with his reason and senses sound, in a state of the most uneasy agitation.

But the most distinguishing symptom, and that which is expressive of the greatest danger, is, an unconquerable irritability in the stomach, which can be brought to bear nothing. An almost incessant retching takes place, which commonly, on the third day, ends in what is called the black vomit, the most hopeless of all the symptoms attending it. When this is examined, the colour is found to be owing to small dark flakes, resembling the grounds of coffee, and seems to be blood which had oozed from the surface of the stomach, a little altered. Indeed pure blood is sometimes thrown up, and we know that the red globules enter the smaller order of vessels, and issue by them; for bleeding at the nose is a common symptom about this time; and some relate that it also escapes by the ears and pores of the skin, which I never saw, but can readily believe it. At the same time, the stools grow black, and the urine is frequently of a very dark colour, which seem to be owing to the same cause. I never remember to have seen any one recover after these symptoms came on.

There seems to be a general error loci of the more tenacious and globular parts of the blood into the smaller order of vessels, to which the yellow colour is in a great measure owing; and when any part of the skin is ever so little pressed upon, a damask red colour remains for some time, the small vessels readily admitting the red globules. It is certain that a yellow colour of the skin may be produced by such an error loci, without any suspicion of the presence of bile. We have an illustration of this in the ecchymosis which follows upon an external contusion. In this case the red part of the blood is mechanically forced either into the smaller order of vessels, or into the cellular membrane, which occasions a livid appearance, and in the course of the recovery the same parts become yellow, probably in consequence of some of the gluten of the blood assuming this colour after the red parts have been removed by absorption or otherwise.

In the worst form of this disease there is all along an uncommonly distressing sensation of universal anguish, particularly about the stomach, where there is a sense of burning heat, which, as the miserable sufferers themselves express it, becomes unspeakable torture.

A sense of weight at the breast, deep and frequent sighing, and a great failure of muscular strength, are dangerous symptoms in all stages of the disease.

Upon the first attack the skin is extremely hot and dry, and the pulse hard and frequent; but the external heat soon becomes very little different from the usual standard of health, and the skin feels soft and moist. There sometimes happens an eruption of small pustules, with white heads, on the trunk of the body, which is a favourable sign; and I have seen a head-ach disappear upon this breaking out. The pulse does not serve as an index of danger; for, after the hurry of the first attack, it becomes very moderate in point of frequency, varying from eighty to a hundred pulsations in a minute, and is natural in point of regularity and strength.

In these circumstances this fever differs from that which was last described; and it also differs from it in being attended with little delirium. I have seen cases in which the senses were not affected from beginning to end; and I never observed that violent and incessant delirium which attends other dangerous fevers.

The state of the fauces is also different from that of most other fevers, for there is no excessive thirst. The tongue is somewhat white and foul; but I do not remember ever to have seen it black and dry.

A want of action in the bowels, and an insensibility to purgative medicines, indicate great danger; and, next to the black slimy stools, one of the most unfavourable symptoms is, when the feces are like white clay, as I have seen in some cases that ran out to the length of a week before they proved fatal. When the black vomit and stools occur, death commonly happens on the third or fourth day. A bilious diarrhœa spontaneously coming on, is a very favourable symptom.