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Dr. Bryson observes that
"These returns, modified and improved as from time to time they have been during the last few years, are now, with few exceptions, sent into office in a form so complete, that the labour of constructing the statistical tables, and drawing up any explanatory remarks deemed necessary, has been made comparatively easy." (p. 3.)
But he adds that, notwithstanding the great improvement which has taken place, the returns are still occasionally deficient in the kind of information most essential for inquiry into the origin of endemic or epidemic diseases.
"When an epidemic breaks out in a ship of war, it is no doubt right and proper that the medical officer in charge should give a description of the weather and the hygienic condition of the ship at the time it made its appearance, but it is also of importance that he should distinctly state whether the persons first attacked had or had not been exposed to infection or contagion, or whether they had or had not visited any port, place, or ship during the three weeks immediately preceding the outbreak, because the medical records of the service have been searched in vain to discover an instance in which either choleramorbus or yellow fever made its appearance amongst a ship's company, unless one or more of the men or officers had previously-within at most twenty-one days-been exposed in some house, ship, or locality where the infectious virus which emanates from persons ill of the one or the other of these diseases existed. The spontaneous origin of either malady, far away from an infected locality, is unknown in the naval service; hence the great importance of information respecting the absence or presence of disease on shore, the movements of the ship, or the exposure of her men previous to the eruption of epidemic and infectious diseases, for it is much to be feared that many valuable lives have been lost by vainly endeavouring to extirpate from the holds of ships the exciting cause of diseases which exist only in connexion with the men." (pp. 3-4.) - We proceed to give as full a résumé as our space will admit of the contents of the present report, dwelling chiefly on those parts of it which illustrate general principles or describe peculiar forms of disease. We take the several stations in the order in which we find them.
Home Station.-There were fifty-eight vessels employed on this station, for periods varying from three to twelve months, with a mean force of about 12,445 men. The men were allowed to go on shore much more frequently than on foreign stations, and in consequence of this, the returns show, in the comparative absence of more fatal maladies, a larger proportion of diseases affecting the respiratory and sexual organs. It is a fact which should be more generally known, that syphilitic diseases are more prevalent in this country, especially in the garrison and great seaport towns, than in any other part of the known world, and it will be found in the course of this Report, that a large proportion of the disease prevalent in ships on foreign stations consisted in venereal affections contracted before leaving the home ports. On the home station the evil seems to be on the increase, for the number of cases in 1856 was more than double the average of the preceding fourteen years.
"That a disease so destructive of health and happiness (says Dr. Bryson), which by an acquired constitutional taint may be transmitted to generations yet unborn, should be allowed to go on increasing in our large seaports to an
extent unknown in any other part of the world, is greatly to be deplored, but so long as the municipal authorities of those towns where it is most rife refuse to co-operate with the Government in establishing hospitals for the cure of the degraded creatures that swarm along their pavements, it will be in vain to hope abatement of the evil." (pp. 5--6.)
Of the other maladies which prevailed on this station, there are none of which we need take any particular notice. The number of men daily ineffective through wounds and diseases was in the ratio of about 30 per 1000 of mean force. The lowest ratios were in the stationary or harbour ships, but this was in consequence of the particular nature of the duties of their crews, and the removal of all serious cases to the naval hospitals on shore. In fifteen ships of the line more actively employed than these, the average loss of service was about 3-7, in vessels of the frigate class it was 28.8, and in the smaller vessels 35·5; therefore, supposing the number of men sent to hospital on shore nearly equal in all, it may be inferred that the medium class of vessels were the most healthy. The total number of men invalided was 160, and the total number of deaths 129.
Mediterranean.-There were 63 vessels employed on this command, with a mean force of about 11,090 men. The average of sickness daily in 1000 was, for ships of the line 42, for frigates 43-8, and for the smaller vessels 49.7. The total number invalided was 171, and that of deaths 142. In 4 of the line-of-battle ships in which the loss of service was greatest, the excess was entirely to be ascribed to venereal complaints contracted in the home ports. Among vessels of the frigate class, with crews of 150 men and upwards, there were 4 which had the greatest number of men inefficient from sickness and wounds; this appears to have been owing to the prevalence of phlegmonous inflam-mations, to syphilis contracted by the crew of one of them in England, and to the tardy cicatrization of wounds in all. In four other vessels of this class, in which the loss from sickness was least, there was no phlegmonous disease; so that there appeared to be a superiority in the sanitary condition of some vessels over that of others on the same service and on the same parts of the station. Fever of an adynamic character, which had prevailed in the Hannibal line-ofbattle ship during the preceding year, continued during the present. This ship had remained stationary at Malta between the 1st January and the 13th May; on the 23rd of the latter month she anchored off Karatch, on the Black Sea; from that date until September she was employed between the Crimea and the Bosphorus carrying troops and stores; she then returned to Malta, and in November arrived in England. The persistence of fever in this vessel for two years, through such varieties of geographical position, can only be ascribed to the successive transmission of infection from one set of men to another, for the vessel was kept scrupulously clean, and the crew were clothed, fed, and employed like all other sailors in the fleet. Fever cases of a similar type occurred on board the Royal Albert under nearly the same circumstances of locality and season. As a proof that the fever in these two vessels was not occasioned by climate
or the state of the weather, the Princess Royal lay in harbour at Malta from the beginning of the year until the middle of April; subsequently she entered the Black Sea, touched upon the coast of the Crimea, and returned to Malta in June; yet during the whole time she had only 3 cases of fever against 130 in the Hannibal and 30 in the Royal Albert. Cases of other ships are adduced, leading to similar inferences.
One death took place on this station from rupture of the vena cava inferior about four lines within the pericardium, and another from rupture of the coronary vein. It is stated, in reference to the former case, that the heart and large vessels were free from organic disease, and that the man, up to the time of his death, which of course was sudden, had enjoyed very good health. The only other disease in connexion with the Mediterranean station to which we have to advert is malignant cholera, and this only in relation to the question of contagion. After giving an account of 23 cases which occurred in eleven vessels, Dr. Bryson remarks:
"It thus becomes clearly evident that all the cases of cholera and choleraic diarrhoea that appeared in the fleet during the year were contracted either at Malta or Lisbon, and in almost every instance the first cases in the respective ships were contracted on shore in infected localities, and when the patients returned to their own ships that they communicated the discase, though generally in its milder form, to a considerable number of their shipmates. These facts would, it might be supposed, afford matter for grave reflection to those who still affect to question the infectious nature of Asiatic cholera, and deny the utility or necessity of restricting the communication of the healthy with the sick, as far as may be reasonably practicable." (p. 26.)
West Indies.-There were thirty-seven vessels employed on the North American and West India station, with a mean strength of 7845 men. There were five ships of the line, and in these the loss of service was at a much lower rate than in any other class of vessels, as they were employed chiefly at Halifax and Bermuda, the healthiest parts of the station. The high rate of sickness in one of them, the Orion, was the result of syphilitic disease carried from England, and of ulcerative and febrile diseases contracted off the coast of Central America. The greatest loss of service in any vessel on the station occurred in the Arachne (18 guns, 135 men), owing to the prevalence of boils, small irritable ulcers, and the innumerable complaints which make their appearance in almost every newly-raised ship's company. The loss of service was also great in the Malacca (17 guns, 165 men) from a most destructive eruption of yellow fever, and in the Arrogant (47 guns, 430 men) from remittent fever and ulcer contracted off Grey-town. Most of the vessels which remained for any length of time off Grey-town, or other parts of the coast of Central America, exhibited a high rate of sickness from the prevalence of these two diseases. The greater part of the report relating to this station is occupied with an account of yellow fever as it occurred in different vessels of the squadron. The chief thing which calls for our notice here is the general conclusion arrived at respecting the source of the disease:
"It has already been seen that the fever was introduced into the Malacca and Argus at Port-au-Prince; that these vessels carried it to Port Royal, Jamaica, and that subsequently it broke out in the Termagant and Hermes; but whether the fever in these vessels was an offshoot from the fever in the Malacca, or from some other infectious source at Kingston or Port Royal, there is no means of ascertaining. It is, however, time that the hazardous opinions respecting the non-infectious nature of this malady were more clearly established. If, as was supposed, the fever in each of these vessels had arisen from peculiar states of the weather, from marsh or swamp emanations, or from causes other than a personal poison, it is inconceivable why it did not break out in other vessels lying in the same ports; for, although it is easy to understand how their crews might escape an infectious poison existing only in circumscribed localities, it is not possible to imagine how they could escape from the influence of causes so generally diffused as those called atmospheric, or from marsh malaria." (p. 62.)
It will be observed, throughout this Report, that Dr. Bryson is a staunch contagionist, for which, however, we are not disposed to quarrel with him, being ourselves somewhat ejusdem farinæ.
The total number of deaths from disease on this station was 177, or in the ratio of 22.6 per 1000; and the total number from accidents, suicide, and drowning, 29, or in the ratio of 3-7 per 1000. The total number of men invalided was 185. Deducting the deaths from yellow fever, and those from drowning and external violence, the rate was only 7.8 per 1000 of mean force-a rate so small as to show "that the climate, even of the West Indian division of the station, is by no means so destructive of European life as is generally believed." (p. 74.) East Coast of South America.-There were ten vessels on the Brazilian station, five of which were there during the whole year, and the other five from six to nine months. They were chiefly employed in the suppression of the slave-trade, and had a mean force of about 1200. The total mortality for the year was 18 from disease, and 6 from external injuries and drowning, or 15 of the former and 5 of the latter per 1000 of mean force-a mortality at least one-fourth greater than the average for the fourteen years preceding the introduction of yellow fever into the Brazils. The increased death rate for 1856 is to be attributed entirely to this pestilence, which carried off sixteen of the eighteen men who died of disease, and of whom thirteen belonged to one ship, the Express, the crew of which contracted it at Rio. It thus appears that, setting aside yellow fever, a recent importation into these regions, the total loss from disease was two only, or in the proportion of 4 to 3000 of mean force.
"There was actually not one death from disease which could be called climatorial, so that, were it not for the introduction of two contagious diseases, namely, yellow fever and cholera morbus, this coast would still maintain its character for being one of the most healthy regions for Europeans in the whole world." (p. 92.)
Fever of a peculiar character appeared on board one of the ships of this squadron, the Siren, at Bahia. Yellow fever, which had been very prevalent at that port, had almost entirely disappeared, and the men on the 4th of April had thirty-six hours leave of absence, which was not followed by any increase of sickness. On the 22nd an ex
tensive fire broke out in the town, and the greater number of the men were landed to render assistance, and remained exposed to heavy rain till the following morning. For a few days no illness of any impor tance ensued; but on the 3rd of May there was one case of fever, and another on the 4th. After that the attacks occurred at the rate of two, three, or four per diem, until the 9th of June, when they entirely ceased. At the commencement of this disease all the symptoms were present which usually accompany yellow fever in the same stage. But there were also symptoms which are not commonly met with in yellow fever; thus, epistaxis of an active character occurred from the earliest period. In some cases the patients, while recovering, were seized with a kind of fit, of short duration, attended with partial insensibility, and terminating in syncope; there were painful furunculi, generally on the hands and fingers; herpetic eruptions over the whole surface during convalescence, and in one case purpura, with inflamed, swollen, and spongy gums. Throughout the disease there was no black vomit, and out of 96 cases not one was fatal. If, therefore, the malady was of the nature of true yellow fever, it assumed an unusually mild form.
Whether," says Dr. Bryson, "this fever was the result of exposure and fatigue while on shore at the fire; whether it arose from some peculiar condition of the atmosphere, or from some cause within the ship, will be viewed differently by different individuals. But, as the ship went to sea on the day the first case made its appearance, it is hardly possible to conceive that any abnormal condition of the atmosphere, to which the men might have been exposed on the night of the fire, could have caused those cases which occurred in June, or that any abnormal condition of the atmosphere could have produced the disease in the Siren and not in other vessels in the harbour; nor is it probable that the fever could have arisen from any cause within the ship, as she was clean throughout and well ventilated. The cases which occurred on the 3rd and 4th, and up to the 11th, of June may be ascribed to the exposure on shore on the nights of the 22nd and 23rd of April; but certainly those that occurred subsequently to the 30th of May cannot be ascribed to any malarious influence or personal contagion acting on the men at such a remote period. If this mode of reasoning be admitted, the only other way of accounting for the eruption of the fever, and its continuance for nearly forty days, or until it had attacked nearly every person in the ship, is to suppose that it was contracted on shore at Bahia by one or more of the men, and communicated to others who had not been on shore'; whether or not it had originally been communicable or contagious there are no means of ascertaining." (pp. 88, 89.)
But, surely it might have been ascertained whether any such peculiar form of disease was prevalent on shore when the men were landed, or whether the yellow fever, which had prevailed a short time before, had presented anything unusual in its characters-inquiries which do not appear to have been made, and the absence of which tends to justify Dr. Bryson's remark, quoted at the commencement of this article, respecting the occasional deficiency of the returns in information respecting the origin of epidemics.
Pacific Station.-Fourteen vessels were employed on the West coast of America, and in the Pacific, with a mean force of about 2680 men. The daily average of men, ineffective from wounds and sickness, ranged,