Observations on the Diseases of Seamen

by Sir Gilbert Blane

In more unpromising cases the urine is scanty, and in the last stage of life it becomes of a very dark colour, as was mentioned before. A plentiful secretion of urine is a very favourable circumstance, and seems to be one of nature’s methods of curing the disease; for such cases are observed to terminate well. I remember one case in particular in which several quarts were made daily for several days together, and it was of a very dark saffron colour, but looked green where the surface was in contact with the side of the pot. I inspissated a small quantity of it, and found a large residuum, which was very deliquescent, and seemed to be all saline. In a hot climate the urine does not shew that separation and deposition which denote the crisis of fevers in cold climates, and this is perhaps owing to there being less mucilage and more alkali in the former, on account of the more putrescent state of the fluids. Upon adding a little vinegar to the urine in the case above mentioned, it became turbid like the critical urine of the fevers of Europe.

At the approach of death, cold clammy sweats come on; the pulse continues regular and of a certain degree of strength, but grows gradually slower. I have counted it at forty pulsations in a minute. The patient is frequently sensible to the last moment; nor does the countenance sink into what is called the Hippocratic appearance. In other cases I have seen, at this time, coma, and not infrequently convulsions. Broad livid spots sometimes also appear on the skin. Extreme muscular debility, a great difficulty of deglutition, and a dimness of the eye-sight, are likewise common symptoms in the last scene.

The different stages which lead to dissolution following each other thus rapidly, there is not that gradual failure of the powers of nature that usually give warning of approaching death; but the springs of life run down, as it were, at once, the wretched sufferer expires, and is happily delivered from the most extreme misery of which human nature is capable.

Such is the general train of symptoms in this fever, taken entirely from my own observation; but great varieties occur both in the symptoms and duration, so great indeed, that it is hardly recognisable for the same disease. I shall give specimens of such anomalous cases in two that occurred at Port Royal, on board of the Canada, in July, 1782.

A lieutenant of that ship had been subject, for four days, to fits of retching, without any bilious discharge or pain in the stomach; and, except a white tongue, he had no symptom of fever in that time, nor any thing to prevent him from doing his duty. On the fourth day, when I first saw him, he began to complain of a fixed pain in the pit of the stomach, which was not very violent, and about the same time a yellowness began to appear on the white of the eye. He took a laxative medicine, which had the desired effect, and some volatile spirits, with some drops of thebaic tincture in simple mint water, for the pain in his stomach. He had a good night. Next day the complaint of the stomach was better; but there was great muscular debility. He had several natural stools; and as there seemed little indication but debility, he took nothing that day except an infusion of some bitters and aromatics in wine. As he did not want for appetite, he eat some broth and chicken; and nothing to give any alarm happened this day, except a short qualm, in which he was faint, with a sense of cold, feeling to himself, as he said, as if he should have expired. In the afternoon he began to have black-coloured stools, which was the first symptom that clearly betrayed the nature of the disease. He was then ordered as much Peruvian bark as he could take with red wine, and these his stomach bore. Decoction of bark was also given him in clysters. He had a strong voice, and was quite sensible, but grew weaker and weaker with frequent returns of the qualms, and he expired that evening before ten o’clock.

I have not the least hesitation in ranking this case with the fevers last described, though so many of the usual symptoms were wanting. This gentleman, though of a lively, active disposition, was of a slender make, and of a dingy, doughy complection, and his case gave me the idea of a disease attacking a constitution which, not having powers to struggle with it, is overwhelmed without making resistance[105]. In those robust, plethoric habits, which are most commonly attacked, there is a sufficient degree of strength to excite the violent symptoms before enumerated.

A few days after this gentleman’s death, another officer of the same ship was taken ill with the same sort of fever, and it was also attended with several unusual symptoms. Neither his skin nor eyes were yellow; the skin was hot and dry throughout the disease, and during the three first days there was a diarrhœa, which was neither bilious, putrid, nor mucous, but consisted in watery stools. There were no gripes, nor any local pains whatever; but I never remember to have seen more suffering from that general anguish, particularly about the stomach, which attends this sort of fever. On the third night he began to vomit and purge blood, which soon terminated in that dark-coloured discharge which is a symptom so characteristic and fatal in this disease. He continued sensible till within eight hours of his death, which happened on the fourth night. The pulse was full and pretty strong during the whole course of the disease; but there was all along great debility and frequent sighing, symptoms that ought always to create alarm.

Treatment of the Yellow Fever.

I feel this as the most painful and discouraging part of this work, the yellow fever being one of the most fatal diseases to which the human body is subject, and in which human art is the most unavailing.

It seems hardly to admit of a doubt that there are particular instances of disease, in their own nature, determinedly fatal, that is, in which the animal functions are from the beginning so deranged, that there are no possible means in nature capable of controlling that series of morbid motions which lead to dissolution. Of this kind appear to be the greatest number of cases of the plague, many of the malignant small pox, and some of fevers, particularly of that kind now under consideration. It is extremely difficult to ascertain such cases from observation; and it may be said that the opinion of the existence of them is favourable to ignorance and indolence. But, on the other hand, it may be questioned if more harm is not likely to arise in medicine by being too sanguine and officious, than by a diffidence of art and trusting to the powers of unassisted nature? Were we thoroughly acquainted with the animal œconomy, we should perceive à priori in what instances the seeds of disease would either operate so as necessarily to terminate in death, or when they were within the command of art. But we can derive little or no information from this source, on account of our great ignorance of the secret operations of the living body; so that the only grounds of judging are our observation and experience concerning the usual event of disease, and the effects of remedies. Though these are circumstances attended with great uncertainty and ambiguity, yet I believe it will be admitted as the opinion of the most chaste and experienced observers, that there do really exist diseases whose course cannot be diverted by any means that can be employed. This opinion, I have said, is, in one view, extremely discouraging; yet, to the mind of a feeling and conscientious practitioner, who must often find his best endeavours baffled in many diseases as well as this, and who might be apt to look back and accuse himself of some fault or omission, it affords this satisfaction to his reflections, that the want of success may have been owing to something in the nature of the disease, and not to his want of skill and attention.