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A Medical Journal 1855-1858

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Title:
A Medical Journal 1855-1858
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Book
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English
Creator:
Daniel, R. P.
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Florida Works Progress Administration
Place of Publication:
Jacksonville, Florida
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Abstract:
“A Medical Journal" is a diary kept by R. P. Daniel, Assistant Surgeon. U. S. N., of the voyage of the (USS San) Jacinto to Japan, 1855-1858. The transcriber corrected the orthography of the original diary - at the request of the owner, Dr. R. P. Daniel, of Jacksonville, Florida, a nephew of the writer.

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University of South Florida
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University of South Florida
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All applicable rights reserved by the source institution and holding location.
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usfldc doi - S62-00015
usfldc handle - s62.15
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SFS0036169:00001


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A MEDICAL JOURNAL 1855-1858 By R. P. Daniel Assistant Surgeon, U. s. N. Copy Prepared By Historical Records Survey Works Progress Administration State Office Jacksonville, Florida 1938

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nA Medical is a diary kept by R. P. Daniel, Assistant Surgeon. U. S. N., of the voyage of the to 1855-1858. The transcriber corrected the orthography of the original diaryat the request of the o wner, Dr. R. P. Daniel, of Florida, a nephew of the writer.

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QOTOBRR 25th, 1855. ll'oday we aailed trom New York for the Eaat Indies. The "San Jacinto goea out as Flagship of the Squadron upon that station. With the exception of a few months spent in the "Gulf, this will be '1113 first cruise, and it is therefore necessary that I should "keep a journal of practice. But I cannot make up msr mind to tu.lfil this instruction literally, and to write simply a copy of, or abstract trom, the medical log of the ship, without noting any data trom which to observe the relation of cause and effect i n the long list of cases with which the book would be filled; and have, consequently, resolved to substitute what may be styled "a medical history of.the cruise" I shall endeavor to mention all ot the principal facts and occurances which can have a bearing upon the subject, and will commence by saying something about the ship and her inmates,. as circumstances, trifling apparently now, may, in the future, exercise an important influence in promoting health or fomenting disease -in terminating our cruise satisfactorily, or otherwise. The san Jacinto" is a sloop-of-war, of some fourteen hundred tons; and carries a compliment of two hundred. and. sixty nenm including sailors, firemen and marines. She has no top gallant totecastle and her bulwarks are very low. Upon the birth deck, the ward room is light, capacious and well ventilated: tbe steerages do well enough: but forward ot this, the engine and fire rooms, together with two side coal bunkers, occupy so large a portion ot the deck that the sleeping accomodations for the men are aeriously interfered with, and it is, indeed, impossible to berth them all. The hawse holes being also on this deck, chain cables, bits be, still farther intrude upon its integrity, and will be especially annoying to the sick who must often lie near t bem. Just forward of the forehatch are two apartments, high enough for a man of medium heighth to stand erect in, and some fourteen by twenty inches in breadth end length: upon two of the sides a number of auger holes are bored tor the purpose of admitting air. These are termed sweat boxes" (very significant term); they are used to contine retactory individuals, and are intended as substitutes, in a measure, for the abolished "oats". The Dispensary is next the forward officers' rooms and just opposite the engine room door; small and poorly fitted up, and, trom its locality, peculiarly liable to the extremes of heat and cold. -l

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is D:_O sick Boy. ship carries about twelve thousand ti ve hundred gallons ot water, and eighteen daya coal. There are two large tilterera on board, inte.nded tor filtering the drinking water tar the men when the ship reaches the East Indies; end each ot the officers' messes has already provided and put in operation smaller ones for t hair own use. The crew were all inspected by one of the medical officers upon being tranatered from the Receiving Ship. Of the whole number, about thirty axe marines, fifty belong to_ t.ba tire department and the remainder and boys. Three seamen were reported unti t to make the cruise: one with an irreducible inguinal hernia; a second with internal pylas which had reduced him very considerably from loss of blood, more than onee; the thi1'd had lost one testicle from disease, and complained of' frequent and severe pain up the groin and lumbar regions of same side: he was also affected with palpitation of the heart which prevented htm going aloft. A survey of these men was applied tor and ordered; but the gentlemen composing the board thought differently trom the medical officers attached to the ship, and the men were consequently not returned. .A similar result attended the etforts of' Mr. Spooner, one of the Assistant Engiileers, to be relieved from going out with us: as be suffers more or le sa constantly when upon duty with praecordial pain and palpitation, with the result or organic disease ot his heart contracted in the Service, it was deemed unadvisable b y Dr. Wood, for him to go upon so long a cruise, an:. d especially in such a climate. All who did not exhibit evident marks ot having success tully undergone the operation, were vaccinated; though in very few instances with the desired result, for the viris sent from the Laboratory proved llOrthless. Commencing with Nowmber, I shall now notice each month separately, giving some general results of meteorological ob servations, extent of sickness and character of diseases upon the list during the month, causes which principally influenced them, and notes of' such cases as mey be of particular interest. November, 1855. The first ten days ar this month, which we passed at sea, were fair, with a pleasant temperature and light breezes. Upon the llth we anchored ott Funchal Madeira. The weather proved tickle here -a-

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our stay: hot suns summer clouds and showers -a heavy blow, and som snow upon the mountain top one morning, presented too many and great atmospheric changes within six days to confirm the ideas that I had previously conceived of the climate of this island, so celebrated for its health-restoring powers. VIe sailed again on the seventeenth. The average daily number of our sick list for this month was a fraction over twel-ve: the minimum four, and maximum twenty. During the first portion of this period, the majority of cases were pulmonary catarrhs and rheumatic affections from exposure while at sea. A few cases of gonorrhoea and syphilis, end, during the last ten or fifteen days, phlegmons and paronychias. CASE 1st. October 22nd. Jno. H. Hanvey APP Boy -Aet. 18 -New York. Pharyngitis -Reported with considerable phlogosis of lining membranae of fauces and pharynxi. Tonsils are also enlarged. Re. magma. Sulph. Zss statim, and argul. nitr. grs. v. Ag. zr -L. Apply with a probang twice or thrice daily. 24th -Better-Purgative acted well Contine Ar. Nitr. 25th Considerable fever last night, and complains of great dryness, with soreness and pain in throat. Re. Infus. Lin. Sem. as a beverage, and remain in his hammock. CoAt. local application. 27th" Improving, though still soDB soreness in fauces. Cont. Liq. Argent. Ni tr. OOth Discharge to duty. CASE 2nd. October 31st. James Hoagland Corpl. 24 Mate Oct. 37 -New Jersey. Since being exposed and wet in gale of 28th inst. complains of' having f'el1; a sharp pain in right side of chest. Unable to take a full inspiration and has f'ullness in head and some excitement of pulse. Re magnes. Sulph. Zi Statim, and to remain between deckS. 5 o'o P. M. Rx. Doven. gr. x. Nov. lat. Is better -Free fever, and respires more treely, though there is still some pain. Repeat doven. Nov. 2nd. About same -To have a sinapism applied over seat of soreness. Nov. 4th. Almost well Still feels the "stitch" upon making a full inspiration. To embrocate with Tinot. Lapon. Camph. morning and evening. Nov. 6th. Discharged to duty. -3-

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NOTember 4th. Jno Merkie Oct. 25 Prussia. Syphilis. Whilat on board the Receiving Ship at Philadelphia, some five or six months since, first discovered a chancre upon his penis. This was treated entirely by local remedies. Three months e.t'ter, whilst on board the "North Carolina" another chancre made its appearance, following by a bubo in the lett groin. The treatment was again entirely local. There were no open sores when he came on board this ahip and he thought he was well. Reported himself', however, some days since with induration and abrasion around orifice of' urethra which has since assumed a state of ulceration. Exhibits at present in addition, an enlarge:o:ent of' subcutaneous glands (lym phatic) of' Deok and several large copper colored blotches and tub ercles upon scalp and legs. Complains of' pain and stiffness of lett Ruce Rx. Argent n1 tr. Fens. to be applied to chancre and dress w1 th soft lint kept wet with water Internally, Rx. Magnes. Sulph. Zi. Ag. Pur. Zi-Liq. L. gtt x v ter in die. 5th. Appears about same. Cont. treat. inereasing dose ot Liq. Potass. Sod. to gtt :a. Diet to be exclusively vegetable. 6th. Sores on penis are looking better, but cervical glands very much enlarged. Cont. water dressing to chancres. Paint enlarged glands with Tincture Iodine and cont. internal remedy. lOth. Is much better in every way. Eruption becoming paler and glands being reduced in size. Rx. Cupr. Sulph. gr i, Ag. zi. L. Chancre to be dressed with lint moistemd with this twice daily. Cont. other treat. 19th. Convalescent. Glandular enlargement almost entirely disappeared. Eruption upon scalp fading. sore upon penis nearly well. Discontinue all treat. except mg. Iod. to enlarged glands. 21st. Discharged to duty. CASE 4th. November lOth. John w Morton. Seam. Oct. 22, Maine. Orchitis Metaatic Has had a swelling in parotid region for some days -not at all serious, and did not report himself. This disappeared suddenly a few hours since, great tenderness and enlargement of' right testicle supervening upon it. To confine himself' strictly to his hammock and keep testicle well with Liq. Plumb acet. Dilut. as a lotion. Internally, Rx. And et. Potass. Tart .gr 11. Ag. zii. Dose zi every hour until emesis is produced. Afterwards, continue in half the quantity. llth. Rather easier. Gont. Tart. Emet. 5 o'clock P. M. Rx. Magnes. Sulph. zas. .. -4-

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12th. is no swelling of moment in gland now. Does not pain in a recumbent posture, but uncomfortable when erect. Stomach considerably deranged from action of antimony. Salts was rejected from stomach inimediately after taking it. Repeat in ssme dose at 12 oc M. today and discontinue Liq. Aul. et Pot. Tart. Cont Lead lotion, rest and low diet. 14th. Much better. Cont. rest. 16th. Still some pain when he walks. To have a suspensory bandage fitted upon him. 18th. Discharged to duty, though directed still to wear truss for some time. November lOth. Richard Robinson Aet. 44 New York. Paronychia -Reported, two or three days since, complaining of dictressingly acute pain in forefinger. There was some swelling about the distal articulation, with heat and ten.sion of the part. An emollient poultice of flaxseed meal was ordered but he has been suffering greatly, and especially prevented from resting at night. This morning an incision one inch in length was made, down to the bone and poultice continued. 18th. T.be relief was great after lancing, discharge of pus became tree, and poultices were continued until the healing process had fairly set in when it was dressed with simple cerate. The ulcer remaining has now cicatrized and he is toclay discharged to duty. There were, about this time a number of other cases, quite similar to this, on board. Tinct. Iodin., Argent. Nitr. ]US., a and boiling water were severally tried as a means of checking, the course ot the affection, but with little or no good effect, and early and free incisions were formed to produce a cure most promptly and with least danger of permanent alteration of the perts. November 27th. HoaglandOe. Mate -Aet. 37 -New Jersey. Poisoning Has been wet more or less for a couple of days, end working down in the bilge, which is very foul. Complains of giddiness, pain and feeling of tightness in head. Nausea and vomiting with bowels constipated -pulse full strong and rapid. Supposed to be su:f'fering from the etfects of sulphure tted hydrogen and other gases encountered below. Rx. Magnes. Sulph. Zi as at once. Pulv. Dove n. gra X hor Somn. -5-

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28th Pulse atill tull and excited tace flushed and complains of pains in chest and limbs Rx. Sod. et Potass. Tart. Zss. at once Repeat in six hours if it does not act treely. 29th -Better Medicine has acted well, and he is tree of fever or pain needs nothing. Dec. 2nd. Complains now only of debility, and pulse is quick and wanting in force Rx. Q.uin. Sulph. grs IV twice daily. 6th -Discharged to duty. DECl!miER 1855. During the first few days of this month, the weather was un wholesome and disagreeable. We were becalmed about the Line. Thermometer ranging from 83 F. to 88, and the atmosphere within one or two degrees of aaturation: little or no wind, and occasion al showers forceing us to cover tl:s hatches. Our ship we.S under sail alone, and ourselves upon three quarts allowance of water. But steam was gotten up at last, and the ship headed for the Island ot Ascension, where we anchored on the 9th. Having tilled up with coal and water, we started two days afterward again, and progressed entirely under canvass until the Cape of Good Hope was made. The remainder of this month was passed in the South Atlantic: The atmosphere pure and temperature delight:f'Ul.. Our sick list exhibited a daily average tor the month, of thirteen, within a small fraction. The lowest for any single day being eight, and greatest seventeen. M any cases of boils and paronychia still presented themselves. C.ASE 7th. October 31st. Je.II2s Spence. Seem. Aet. 26 Born New York. Medium heighth and good developement of chest and muscular system. Reported yesterday complaining of soreness, and occasionally, sharp shooting pains in his chest: also says that he has spit some blood, and also that he has been subject to similar attacks. Has no fever, and physical signs are normal -Rx. Syn. Scill., Tinct. op. Camph. sa Zi. Vin. Ipecac. zii. M. L. 'zss thrice daily Apply dry cups, no. VI over anterior part of chest. Nov. 4th -Thinks he is no better Complains of palpitation of the heart troubling him very frequently. Action of this organ appears normal. His cough is of a spasmodic character, and accompanied by little or no expectoration. Has been ordered to rub croton oil liniment over region of heart. Continue expectorant mixture also. He satisfactorily exhibited, last evening, under force and frequency in the action of the heart. Sleeps little -pain chest -6-

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annoys him, especially when lying down end at night, and the cough continues. Pulse is 80 and rather wanting in strength of impulse. Looks rather thin. Rx. Fen. at Quin. aitr. gr ii thrice daily. lOth. Complains of feeling uncomfortable after taking the above S'Ub'Sti tute Liq. Fer., Iod. gtt V in a wine glass of water twice daily, and continue expectorant pr. n. -14th. Much the SB.lm -Continue internal treatment and open a blister, 21:2 over heart, and keep it open for ten days. From this date until December he remained in much the same condition. Complaining more or less of pain and palpitation of heart, and, towards the latter part of the time, also of dyspeptic sympt0118 He was put upon Tinct. Digital. in dose of gtt X twice daily, with vege table tonics and light nutritious diet. His general appearance continued quite e a good as when first entered upon the sick list, except an absence of v igor which all want who pass most of their time between decks. The chest continuing to exhibit no indication of disease beyond occasional irregular! ty of the heart's action. Dec. Discharged to light duty, and directed to avoid violent ex citement. Since his discharge, the activity he exhibits, and apparent ease with which his duties are performed, have confirmed suspicions previously entertained, of his having greatly exaggerated his symptoms. CASE 8th. December 18th. Jno. Benson Marine -Aet. 24 Born Ireland. Rheumatismus. Complains of soreness and pain in all of his limbs more especially about the joints. Some fever and headache. Rx. potass. Iod. gr V ter indiv. 20th. No improvenent in symptoms, and still complains of pains in joints. Continue Potass. 22nd. Increasing dose by one grain de.Uy. 23rd. Ia improving. 24th. Discharged to duty. CASE 9th. December 14th. Jno. A. Wilson App. Boy -Aet. 17 Born New York. Conjunctivitis Has been suffering for a few days with a catarrh of -?-

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the air passages which has no involved the conjunctiva of both eyes, more especially the right one. Mucous membrane of his eyes is much con gested and reddened Secretion diminished and surface dry. Ball very impatient or light. Rx. Meg. SUlph. Zi at once. Locally, use thrice daily a collipium ot Argul. Nitr. Cryet. gr ss to one ounce or pure water. Diet vegetable exclusively, and eyes to be kept well protected f'rom light. loth. No better -cont. Liq. Argent. nitr., and keep a told ot lint cold water constantly applied. 16th. conjunct! va is still thickened and very red Eyes painful upon least expos\ll."e to light -Pulse f'ull and rather quick Rx. Aul. et Potass. Tart. gr i in .Ag. Zss -repeated after three hours Apply a blister to right temple, and dress with Ceral. Resin. 17th. Improving Eyes less painful and less irritable to light. To have dry cups applied to temple Eye wash continued. De c. roth. Discharged to duty J J.NUARY, 18BB We anchored in Simon's Bay, Cape of' Good Hope, upon the 14th of' this month, and were at last relieved from the short allowance or water, luxuriating ourselves, instead, with an abundance of f'resh meats and vegetables, besides peaches, grapes, and other f'ruits. The temperature here was mild and agreeable. The wind, at this season, blows generally trom the northard, and its prevalence is esteemed by the inhabitants as an assurance of health; whilst it continues the atmos phere being remarkably pure and dry. During several days of' our stay, however, we had south, and southwest winds, with clouds and frequent showers. Upon the 28th, we left tor Mauritius. CASE lOth. December 29th. Isaac.Turner, c. A. Guard-Aet. 41-Born in Virginia. Luxatio humeri -Yesterday, while at work upon deck, tell and brought the weight of' his body upon the right elbow, producing a dislocation of the os humeri of same side. The head of the bone could be plainly telt protuding and forwards. Dr. Wood almost immediately reduced it by a little manipulation, without t h e application of' any amount of' force. The man said that he had suf'fered. f'rom the seme acci dent once or twice bef'ore. Ordered to keep arm in sling. J'an. 3rd. li.lisoharged to duty. -s-

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CASE! 11th. J"anuary 4th. Edward Shay Marine ,Aet 22 -Ireland. Prostratio. Has been undergoing punisb.Imnt for several days by being confined in the cell, or "sweat box", from eight to twelve A. M. and trom one to five P.M. each day. Called to see him at noon yesterday, just after being taken out: found pulse quick, irritable and irregular. Slight convulsive spasms, and complaining ot a feeling ot suffocation and severe constriotipn across chest. Was ordered Rx. Pulv. Dover. grs. VI every five hours, and not to be confined again tor the present. 5th. Prostration of nervous energy is stUl considerable -pulse ninety and teeble -Sense of fullness about interior extremity ot sternum, and impulse ot heart is unduly felt at its apex. Rx. Gum. aesaf. grs. V, Pulv. op. gr t in pill thrice daily. Discharged to duty. CASE 12th. Janu!:l"l 9th. James O'Hara -Fireman Aet. 24 -New York. Scorbutus. Complains of general lassitude and debilitygums are dark, tender and frequently bleeding Rx. Pot ass. Bi tart. grs. v. ter vidie, and to have meat biscuit served daily. 12th. Has improved very greatly, and as we shall get into port in a day or two, is discharged to duty. CASE 13th. December 8th. R. L. Patterson Ooalheaver Aet 23 -New York. Reports with an enlargeiiBnt of lymphatic glands in both groins. Has :telt soreness and pain in parts tor two or three days Cause not appreciable, unless it be alternations of heat and cold in and out of coal bunkers. Blisters were ordered to be applied last night, and have acted well -Dress with Mg. Hudn. Dilut, and to remain quiet in his hammock. Deo. 11th. Tumors remain very sore, and indurated blisters have partially healed over Rx. Potass. Iod. grs. V thrice daily in a wine glass fUll of wateruse logically, mg. Iod. rubbed over tumors morning and evening. Swellings appear rather to have increased very sore and some disposition to soften -Discontinue former treatment, and apply emollient poultices, continuing rest in hammock. -9-

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1 an. 2nd. Bubo in lett groin was opened today, and di sche.rged a quantity ot pus. 15th. Right one also lanced, and both discharged :fioeely, with the employment of emollient applications, tor some days. He continued steadily improving until, When ulcers having cicatrized, was discharged to duty. CASE 14th. J' anue.ry 14th. Jno. Cornell -o. Aet. 23 -New York. Excision of tumor a lobulated tatty tumor, quite moveable under the hand, e.nd under the skin and subcutaneous cellular tipur, w.as removed trom hie left side, about the angle of the eighth and ninth ribs. The mass was circular and disc shaped. sone tour inches in die.neter, and two thirds of an inch thick at the centre. The in cision, which was a strait out some five inches in length, was brought together with adhesive strips, e.nd water dressings applied. It heal ed almost entirely, by first intention and, 29th. Was discharged to duty. CASE 15th. January 18th. s. P. Ring Seam. Aet. 25 -Philadelphia. Die.rrhora. Report with gripin? and frequent watery stools. Skin hot and tongue furred. Rx. Tinct. ep. Tinct. Ce.mph. a.a gtt XXX, and continue in halt the dose every third hour until relief is afforded. 19th. No better. Still complains much of abdonen. Rx. Pulv. Rhii Pi, Magnes. Zii at once, and resume treatment of yesterday as soon as this has acted. 20th. Feels more comfortable. No tormina. Stools less frequent. tongue cleaning and appetite returning. Rx. Pulv. op. gr P Spec. gri p every two hours through the day. Je.n. 21st. Discharged to duty. CASE 16th. Ascension, Dec. 12th 1855. Henry Evans -cox -Aet 26 -Born Ireland. Compound Fracture Yesterday afternoon, whilst assisting in bringing off coal to the ship, M.s hand was jai!l!ISd by the windlass of a orane, producing a compound feacture of the second phlanx of the impudicus, together with a laceration of the extremity of the ring finger. The hemorrhage being considerable, the temporary dressings, a pplied on shore, liere not removed until this morning. Dress with a bandage and simple cerate. To have an opiate at night. -10-

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. Dec. 13th. There is still some hemorrhage. Dec. 14th. Wound looks pretty well. Dis posed to heal upon ring finger. Dec. 15th. Complains of more pain in wound Apply emollient poultices. Improved, and, after a few de.ys, adhesive strips were applied to approximate the parts and compress granulations. Jan. 16th. Was discharged to duty. FEBRUARY 1856. We had rather a pleasant run to Mauritius. The weather fair, with Southeest winds and mercury standing below 80, until we approached Port Louis, when we anchored upon the morning of the 15th. The at moe phere here was sultry and loaded with moisture: low, heavy clouds hanging around the highlands, and showers frequent: thermometer standing above 80, and not comprising a range of more than five during our stay, of a week, Bananas, pip.es, mangoes, etc. were plenti fUl and delicious, and all enjoyed a tree indulgence in these fruits. Small pox was reported as prevailing on shore to a considerable extent, but our ship, fortunately, escaped a visitation :trom this loathesome disease. We sailed upon the afternoon of the 21st for Point de Galle, Ceylon. The remainder of the month, we were passing through a tropical ocean; the days with burning suns or heavy clouds, and nights too op pressive :ror refreshing sleep: there was a succession of calm, and the ship was kept steadily under steam. The worlanen in the fire suffered much, and, after the twelth or fourteenth day's steaming, many of the firemen and coal heavers gave out. Most of these complained of want of appetite, great irritability of stomach and obstinate constipation. In several of these, there was complete prostration of nervous energy; and in one case vio lent cramps, affecting the flexor muscles of the limbs, and those of the wall of the abdomen. These men were, of course, in a profuse state of persperation while upon watch, which included eight out of the twenty--four hours; and during this time they drank at least a pint of water every two hours. An ineffectual attempt was made to obviate this excessive ingestion of fluid by acidulating the water with citric acid. The tree use of vinegar and molasses was also suggested, but "the authorities" were fearful lest this extra call upon the casks might reduce them so much as to endanger their more important (?) purpose o:r sup plying a certain number of pints and quarts each week, to the ship's company: permission was therefore refused to have this relief issued. A month or six weeks afterwards, the Chief Engineer, after repeated urging from the Medical officers, ,was induced at last to purchase a quantity of oatmeal, which should haw been provided before we left the United States: Since which latter time the men have suffered -11-

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much less when the ship has been steaming. CA$E 17th. January 27th. Jno. Devlin Coal heaver -Aet. 22 Massa. Delirium Tremans. Complains of headache insomnia exhibits unsteadiness of hands, and tongue when protuded -Pulse is quick and small. He had been on shore, and drinking considerably Rx. Liq. Morph. Sulph. Zi. and repeat in six hours. 28th. Is much the same. Slept scarcely at all last night, and complains of seeing "sights" Has had no motion from bowels for two or three days. Rx. Magnes. Sulph. Zip. -at once -As soon as this acts, Rx. tinct. op Tinot. Camph. Ether. Sulph. aaa gtt XXX 29th. Rested better last night and feels more comfortable this morning, although nervous system has by no means recovered its tone Rx. Pill Assafoetid. noi thrice daily. Feb. 2nd. Is greatly improved, and dischar@ed to duty, as it is the opinion of both parties that "a good sweat" will be of great service in his present condition. CASE l8the Februm 2nd. William Mackin -o. Seam. Aet 39 -Ireland. Colioa Was called to see him last evening. Small and rapid pulse. Skin cool with occasional flushes of heat. Complained of most violent pain in abdomen, with paroxysmal cramps, extending to arms and lower extremities. Abdomen swollen and tympanitic, and occasional vomiting. Is the man affected with ireducible inguinal hernia, and upon whom a survey was called before we sailed. Was ordered Rx. Tinct. opii, Ether Sulph. aa gtt XXX. An hour afterwards, not having been at all relieved, calomel grs. X was ordered, and a large sinapism applied over the abdom. Three hours afterwards, ol. Ricin. Zss. This last was rejected from the stomach. Is quiet just now, but has had no operation upon bowels. To have a turpentine enema at once. The next day he reported himself entirely relieved, complaining only of prostration and soreness in walls of abdomen, and Feb. 4th. Discharged to duty. -12-

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CASE 19th. Feb. 13th. George McGrath Marine -Aet. 22 Ireland. Prostratio. Was called to 'see him about eleven o'clock yesterday morn ing. Had been in the "cell" since eight, A. M. Was almost insensible. Lying in a prostrate position, and pulse thl'eady. B y placing him comfortable, and accessible to a current of trash air, administering Ether and brandy, he slowly recovered, though pulse continued rapid, and he complained of feebleness. Feb. 14th. Discharged to punishm:lnt. CASE 20th. February 17th. Robert Patterson -c. Heav. -Aet. 23 New York. Colica. Complains of most acute pain in the abdom9n, coming on spas modically. Stomach exceedingly irritable, and has vomited several tiiOOso The ship has been under steam for nearly two weeks, and he has suffered much with heat, perspired profusely, and taken water in great quantities. Last evening he we.s ordered Rxo Tinct. op:; Ether: sulph: aa gtt XXX, and a large sinapiam over epigast: Finding no relief after a second dose of the above, he was ordered, Rx. Hyd.r. Ahldo Mit. grs Xv. This has acted and he feels much better. No pain now, but still vomits oc casionally, and thirst is insatiable. Rx. Liq. Potass. Citr. Zss. every three hours. 18th. Convalescent. 19th. Discharged to duty. CASE 21st. February 15th. Thomas Corcoran Coalheaver -Aet. 31 Ireland. Colica. Reported yesterday with abdomen painful and tympanitic. Some vomiting etc. Same causes have been operating as in preceding case. Was ordered a dose of Aloes and Rhubard, which has not yet acted. Rx. Magnas. Sulph. Zio Statim. This not having acted either, in the afternoon, Rx. Hydr. Chld. met. grs XII, Pulv. Jalap: grs XV was prescribed. Has had no relief. Abdomen very tense, and sore to the touch no stool Some Nausea. etc. To have an enema of ol. Terebiuth. Zs s in tepid salt water oj. 17th. The glyster brought away a quantity of foecal matter, with a lumbrious. Was ordered, after this Rx. ol. Terebiuth. zii. ol. Riciu: Zi. Feels much better, complaining only of exhaustion, and soreness in the abdominal muscles. Rx. Infus: Quass: zi tar in die. -1313

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18th, Still complains of belly being sore, and has had no stool since yesterday. Cathart: Comp: now. 20th. Discharged to duty. This men suffers with constipation habitually, and is, not un!requently, necessitated to take some purgative for his relief. CASE 22nd. Febru;arz 15th. Antonio Golll:lz Fireman -Aet. 35 Madeira. Pleuritis. Says he has been suffering, for two or three days, with a sharp, sticking pain running thro ugh from the interior extremity of the sternum to the spinal column. Slight fibrile exci Rx. Ant. et Potass. Tart. gr. t in q. Zaa every three hours until emesi is produced rest in hammock. 17th. Is much the same Antimony has Tomi ted treely. Still finds the pain sharp -pulse quick -slight cough Rx. Magnes Sulph. Zi. Tinct. Colchice. gtt XX in half pint water at once. end repeat in halt quantity after six hours. Apply drJr cups over seat of pain. 19th. Feels easier this morning. Rz. Blue mass. gra. VIII in six hours, 01. Riciu. Zsa. 2oth. Discharged to duty. CASE 23rd. November 30th. Asa Poinsett Carpenter -Aet. 45 -Born Delaware. Rheum.atismuaComplained, last evening, of a sharp pain in lett hip joint. Began to trouble him early in the day, and b evening increased so much that he could not walk. There was no swelling or redness, but the part exceedingly tender upon pressure. Is a man of very irritable nervous temperament, and little control over his emotions. Easily frightened, and prone to exaggerate his symptoms. as ordered a stimulant embrocation to hip, and Rx. Pulv. Dover. gx hor. sour. This morning is no betterRx. Sod. et Potass. Tart. Zii, Tinct. Colchio. gtt XV Apply cups no iii over parts. Dec, lat. Thinks hip is easier, but complains of pain and stiffness in muscles of posterior part of head and neck. Rx. Pulv. Dover G V every four hours, and neck to be well rubbed with !lin. Sapon. Camph. If not better, to have cups no 11i to parts. Rheum tic pains have much diminished, and now asks to have his throat examined, has telt more or less soreness there for some time, and is annoyed with frequent collection of a very viscid, tenacious -14-I

PAGE 18

mews in the fauces. There is considerable redness and congee tion of mucous membrane of posterior and late ra.l. parts or fauces. Rx. Morph. Sulph. gr i. Aoae: Pulv. x111, Sod. Bice.rb:rl, Aq. Ziii M. Do e a tee.spoont'ul as occasion requires when he is annoyed particularly with the throat -also R:x. Potass. Iod. grs V thrice daily. 7th. Since taking Iodide Pota.es: he complains of a very un C'Oiiirortable reeling in throat. Sense of stricture, and teals otten, as if he would choke. Dose ha.e been reduced, but he still suffers from it. Substitute R:x. Tinct. Colchic: Zss, Tinct. Ganiac: Ammodi. ap twice daily, for a short time. 9th. Improving. Resume Pota.ss. Iod. gra lll thrice daily, and discontinue Tinct. Colch. etc. Continued about until, 14th. When he suddenly began complaining of a most violent aDd acute pain 1n the right eye Sight is irritable. Secretion ot tears abundant. Sclerotic coat much c ongested. A small blister to be applied over temple of corresponding aide at once, and c.:Jnt. Treat. 17th. Pain in eye baa diminished somewhat. Hip entirely free of uneasiness, but both knees are stiff, and very weak when the attempt is made to place weight upon them. Hes general cond.i tion is feeble, and nervous excitability great. Discontinue Iod. Pote.ss. and Rx. Infus: gent. Op. Feu: Citr: Zi. Le. Dose e. wine glaaetul thrice daily. 27th. Has continued much the same very little, if any, improvement. Reaume Iod. Potass. grs. V thrice daily, and discontinue Iod. de. also to have a small blister a pplied, and kept open, upon the inner aide of each knee. 30th. Much the same. Complains sometilooa more than at others, but always of more or leas pain and weakness in knees. Occasionally extending to the hip. Upon examination, some tenderness is discoverable over lumbar vertebrae. To have a blister, 4 x 5 applied here, and cont. other treatment .Tan. 2nd. No 1mprovel!l3nt in his condition. To have ointnant Of vera tria rubbed over knees at night. 9th. Saim -For the past two or three days has been taking Quin: Sulph: grs 111 thrice daily, instead of Pote.ss. Iod. which was discontinued. 16th. Since the application of the blister to his spine, ber of small boils in successive crops have been making their appearance. The local annoyance of these has been considerable, but there has been a decided relief of the rheumatic symptoms and another trouble, which he says has more or less annoyed him tor years, viz. hemorrhois, has entirely disappeared. The ship being in port at this time, Simon's Bay, e.G. Hope, he was sent on shore to remain tor a :rew days. -15-

PAGE 19

?5th. Is decidedly better. Stiffness end weak:ness ot joints still considerable, but pains have, almost entirely disappeared. The boils continue coming out wbare the blister was ap plied, and some emollient applications been found necessary. February lat. Discharged to duty. MARCH 1856. This month was exceedill8ly oppreasi ve to u.s: more trom the uniformity than intensity ot the heat, accompanied as it was by those barometric and hydromatrio conditions of the atmosphere otten so diatresaing both to mind and body near the Equator. Upon the 6th we anchored at Point de Galle, and enjoyed a relief trom the fatigues and distress of a fortnight's steaming through a tropical ocean. The cocoanut groves re pleasant to look at: pleasanter to ride through: and moat pleasant in their inexhaustible supplies ot refreshing fruit. The nights were cool enough here to sleep comfortably. We weighed anchor again on the 11th for Pulo Penang: which place, owing to some temporary derangement in the machinery of our vessel, as not reached until the 2lat. Here, as at the last port, the nights were not oppresei ve, although the sun during the day was intensely so. Owing to the necessity of repairing our engines, we remained at Penany some ten days; and the men ere given "Liberty-4' here, tor the first time since leaving the United States. The exposure thus incurred, by most of them, to the combined influences ot sun, rain and samshoo during forty-eight hours, could not but have a prejudicial effect. Pur health, through the month, was fair. No marked prevailing character to the diseases w hich presented themselves, unless the continued develop ment of boils and paronyohias, as well as the not untrequent appearance ot erythematous and papular eruptions, might assign this prominence to irritability of the skin and subcutaneous cellular tissues. C.ASE 24th. January 3ls t. Martin ottle Marine -Aet. 35 Pennsylvania. Phthisis Pulmonalia. small spare man, with contracted chest and poorly developed muscular system, though previous to this time haa enjoyed tair helath. Reported with a catarrh contracted trom ex posure to a violent storm which the ship encountered a night or two since. Considerable cough, expectoration of tenaceous mucus, with some pain in right chest, and alight febrile excitement. Last eventin was ordered -16If:_

PAGE 20

fUlv. Dover. grs. X, end to have a blister a pplied over seat ot pain. Dress blister simply this morning, and Rx. Syr. Scill. Tinct. op. Camp. aa Zi, Viii. Ipecac. Zi1. Dose Zsa thrice daily. Feb. lat. .Appear better Skin moist, and leas soreness in cheat. Continue mixture as yesterday, end Rx. Spt. Ether. Ni tr. Zss every third hour. 2nd. Not so well again. Pulse is rapid and rather teeble, and he 'C"'iple.ins or a sharp pain about root ot right lung. Discontinue nitr. Spta. and Rx. Pulv. op. gr. t, Ipecac. grii every three hours. 3rd. Is throwing ott an abundant yellowish sputa and tree ot tever "tii"iB morning. Cont. treatiiBnt. ?th. Cauplains or having little rest at night from frequent tits OT'Coughing. .Appee.ra to have rever every a.rternoon, and sweats during the night. General debility considerable. Pulse rather rapid. Was ordered acids Sul.ph:Aromat: gtt XV P r. n. and Rx. ol: Morph: Z11 thrice dally. This latter producing gastric derangement and diarrhoea, a small portion ot Paragoric to be com bined tor obviating this. To uae besides mg: ant. et Pot ass. Tart: as a counter-irr1 tant o"Ver cheat. 16th. General appeare.nce and strength have improved, though the cough is aa as ever. 18th. There was a alight hormoptysis night betore last, and again yesterday. .A small dose ot liq. Morph. ee.aily quieted this. 20th. Has again been expectorating bloody sputa. To discontinue the cough mixture which he ha.s been using, and to have Liq. Morph. P. R. N. 25th. Growing worse. Evident indications or disintegrating tubercle Pulse 100, and small as well as irritable. Coughing almost incessantly. Digestive organs much deranged. Complains ot soreness in epigaatr., and vomi ta atter almost every The eodliver oil we.s discontinued, as the probable cause ot this latter trouble, and Rx. Quin. et l!'err. Citr. grs. V twice daily aubati tu ted. To have e. perme.nen t blister over chest. 26th. Oil was resumed by the special order ot Dr. Wood. He oontinued steadily growing worse trom this period. The use ot the oil kept up e. diarrhoea whieh contributed considerably to reduce his strength and permission was finally obtained to discontinue 1 t. Atter this, he was troubled no more with looseness ot the b0119ls. Halt a pint ot ale daily, with the best diet available was given. Towards the latter portion ot his illness, his meals were sent regularly from the wardroom table. Occasional attacks ot hemorrhage, also contributed to -17-

PAGE 21

reduce him. March 12th. Is too feeble to leave bed. Night neats very troublesom Rx. acid Sulph. Arom. gtt X:X P. R. N. 27th. He.s lost a pint and e. he..lf ot blood since midnight. Table salt, Liq. Morph: te.nnt. and e.cet. Rhumb:, were successively uaed without effect tor but the bleecling f1n.ally atopped towards evening. He continued, however, exceedingly prostrated. March 28th. Yesterday, just after he had eaten a little dinner, was again attacked with protuae bleeding, and axpired at ten minutee peat tour oc. P. M. casE 25th. February 8th. wm. Mander Seam. aet. 27 Maine. Paro117oh1e.. Exhibits a very deep seated inflammation of index finger of the lett hand, in and around the distal articulation. Redness and swelling are coll8iderably ditfuaed, and pain is very acute. The application or solid argsnt. Ni tr: was me.de, w1 th tba view ot aborting the progresa ot the disease, but Ull8ucoesstully. Jmollient poultices ot elmbe.rk or flaxseed qal were then applied, e.nd anodynes administered as necessary, to procure sleep. Af'ter lancing, whicili was doDe as soon as the presence ot pus could be dsteoted, the discharge was tree tu.ngus granulations, with sloughing ot the tissues next the bone, ensued. Frequent cauterization, mg. Hydr& oz. Bubr:, and a solution o:t Creosote in water, gtt V to oj, re us d. The periosteum having, however, been destroyed, the distal pbele.na necroaed, and was, attar e. period withdrawn. After thia tbe ulcer healed kindly, and, March 13th. finger. as discharged to duty with a useful, though shortened, .&.RIL, 1856. In the memorandum tor Me.roh, two facta ware omitted whioh should, perhaps, have been IIBntioned. W e lost our first patient during that month, as may be seen in the history ot this case. And we found it necesaary to diatre.te the Hospital Steward whom we had brought out: thus necessitating the education ot a new one Upon the second day ot April we got under weigh, and had a warm run down the river liD Straits of Mal.lacoa. .Anchored at Singapore on the evening of the 4th: where we found U'Opioal fruits, and weather, both in abundance. We remained at this place tour days. Three men, viz, Pater Grey, Fireman; Francis Riley, Ooalheaver; and George McGrath, MariDB; were condemned, by Medical Surwy at Singapore, and transferred to the IIMB.oedonie.n, whicili ship had been waiting some weeks tor our arrival, and sailed tor the United Statea upon the 5th inst. We were five days trom Singapore to the anchorage ott the Mell81ll, Siam, and we experienced warm, calm weather with a perfectly smooth sea, whilst running up the Gult. Lying off the Menam, twelve miles trom the -18-

PAGE 22

eJ:ttranoe to river, and, having the full neap of the Southwest monsoon, tba portion of our ahip'a ccmpany which remained on board while w were at this place enjoyed good health. Diaee.eed of the digeatiT8 apparatus largely predominate: principally diarrhoea, and in moat instances, ee.sUy emenable to treatunt. Tbere were a taw aenre caaea among the marines end othera who were up at Bang Kok. Several ot theee au.t'fered from Cholera Morbus one caae that of John Purcell, a Marine, was extremely 118'vere, 8Dd oe.DI'l near proving fatal. JJ.moat ell, howeTSr, could be traced to en imprudent indulgence in the abundent trui ta of the country. The number of these was very great end of the moat inviting character. Pineapples, Cocoanuts, Bananas, Mangoes, Mangoateena, Lichee Duriana, and a host of the names ot Which I did not learn. Tbe anrage of the sick list tor the month is not large; though at ou tlma the number was almost doubled by an order whi cil was issued, that every 1ndividual to whom was prescribed a dose of medicine, should be plaoed upon the Report tar the day. The absurdity ot this, however, produced its repeal, and that in a very abort CASE 26th. No"Yember 19th. Gre.7-Fireman tat 26 Scotland. Hyp&rt.rophia Cordis. Rather spare, mdium height, and well put up. Seya that he has enjoyed good health up to this tiD:t. Complains of a 4ull, ohing pain in right side ot chest, and extending down um ot same side. Ia unable to take a tull inspiration without incon venience, and coughs occasionally. When at work in the engine room, is often forced to atop end seek support against someth ing. Physical exploration reveals increased impulsion of the heart's action, dullness on ,erousaion extending over a space larger than usual. Upon right aide of chest, and root of neck, propulsion of blood through the large veaaels is very apparent. Ordered to keep as quiet as possible, aTOid all excitement ot mind or body., to be sparing the diet. Rx. Tinct. aoonit: gtt V thrice daily, in a wine glass of water. Laxative pUla as needed to keep bowels open. 22nd. Very much the BaJIB state, To ha,.e a small permanent blister applied oT&r precordial region, and cont. other treatmsnt. 23rd. ACtion ot heart diminished in force, and pulse is rather feeble. Complains of feeling dizzy at times. Reduce doae ot aconit. Tinct. to gtti. 25th. Reporting himself considerably better, was disehareJBd to light duty. To have dry Ctlps applied oTer cheat occasionally. -19-

PAGE 23

27th. Was entered upon List with a slight catarrh, which soon yielded to sedatiw diaphoretics. Exhibited hOW&ver, an enlargement ot lymphatic glands ot lett side ot neck. Also a dark red, papular eruption over body and limbs. Presumed secondary ayphili tic symptoms; and was ordered Rx. Hydr. Protiod: gri thrice daily and to have Ung. Iodin: applied daily to enlarged cervical glands. Jaii. 3rd. Complains ot great debility. Interior extremities are ordere.teous, and eruption appears increasing over them. Appetite poor, and digestive powers very teeble. Discontinue Hydr: Protion: and substitute Rx. Liqs Ferr: gtt V in a wine glass ot water, thrice daily. 4th. No improvement. To add Potass: Bicarb: grs X to each dose ot ie'rr: Iod:, and to bathe lower limbs daily in a solution of Bicarb: Potass: zi to oj ot water. 7th. Not having improved at a.ll under this treatment, was ordered at tiiTs timB to be put upon Potasa: Iod: grs. V thrice daily, increased gradually to grs x. The alkaline lotion to be continued ass op daily and the beet diet can be had. Ship having been at sea tor almost a month. 14th. Rather betterordema ot extremities continues -cervical glands diminishing in size Discontinue all medicine. To have diet treah meat vegetables etc. Jan. 13. Being very much improved in the symptoms mntioned strength returning eta. Was discharged to duty The old symptoms ot heart disease were more or less complained ot, but not particularly treated. Febru9 7th, 1856. Reported increased enlargement and unduration ot lymphatic glands ot neck. Interior extremities somewhat putted, and irregular pains through body and limbs. Complains much ot s.ense ot praecordie.l fullness; increased action ot heart, with occasional sudden paro,cyama of acute pain shooting through his chest and down the right arm. Exhibits considerable tende .rnass upon pressure over lumbar vertebn.e, and in muscular bundles upon either aide. No traces ot albumen discoverable in urine, by heat or nitric acid. Rx. Potass: Iod: grs VI tbrioe daily a small blister over heart, to be kept open tor several days. March 13th. Feeling better, he made an attempt to return to his duty as fireman, but was forced to give up in a little while, and the next day was again taken up on the "List, more to excuse him from work for which he was unequal, than with any expectation of his deriving benefit trom medical treatment. Rest and quiet were ordered. -2o-

PAGE 24

March 26th. Had a most violent attack of engine. pectoris this morning. This ia a, now, not infrequent result any unusual exertion. Tinct. Digital: gtt X was ordered when ever the heart's action was distresr ingly great. Also Rx. In:tus: Gent: Comp: zss thrice dailYo He con tinued much the same, treatnsnt being varied Q.uinia and Iodid& Potasa: untU, AprU 6th. When a JI8.dical Survey having been ordered end held upon him, tlle following report was made. ttpeter Grey -FiremanDisease, Hyper-trophy of heart Origin of disease, in line of duty: duration indefin i te: Oondi tion unti ta him t-or duty." He was therefore transferred to the u.s.s. "Macedonian", which vesael was about to sail for th& United States. CASE, 27th. December 15th, 1855. Francis Riley Ooalheaver A.et. 25 -Ireland. Hypertrophia Cordis -Reported himeelt first at this tiD:B with con stipation fUrred tongue bitter taste in mouth, and want of appet ite. Just trom the shore, where he had been indulging in liquor. J. mercurial cathartic, repeated the next dey, relieved this. January alat. Whilst on shore some days since, and in a state of intoxication, received a se-vere contusion upon the lett side of his head. The ear (external) was much bruised swollen, and very painful. To have an opiated flaxseed meal poultice applied to side of head. There appeared at thie time, as before, eonsiderable biliary derangenent. Eero"-rial pill, by Sulphate of magnesia, and r&pea ted two or three days suocessi vely, restored him trom this derangement and emollient poultices, with lead water dissipated the local intlemation. Feb. 8th. Discharged to duty. March 12th, 1856. Reported at this time with boUs and gastric derangenent. He also exhibits a derangement in the action of his heart. This, he aa;vs, has been troubling him for sometime Percussion ex hibits dullness over a apace much larger than is usual -impulse very strong -sounds obscure rythm nom.al Sons deformity of chest narrowness, end aternum protuding unnaturally -Was ordered Rx, Tinct. Digit. gtt X in a wiDe glass of water thrice daily. Dry cups to be applied frequently over heart. 12nd. Is no better. Complains of inability to sleep and pain in region of heart increased. Discontinue Digi tel is Apply a small permanent blister over region ot heart. 30th. No improvement a slightly varicose condition of lett leg. April 6th. The same treatnent has been continued up to this date. -21-

PAGE 25

his condition is not at ell improved. A Medical survey was ordered and held upon him yesterday: the tollowing is trom. the report, "'Francis Riley Ooalheaver disease, Hypertrophy of heart; origin ot disease, in the line of duty: present condition unfits him tor duty" He was transferred to the u.s.s. "Macedonian", which -vessel sail ed today tor America. CASE 28th. APril 6th. Georse McGrath Marine -Aetat. 22 Ireland. Diaease ot Heart. In December last, was laid up w1 th an attack ot rheumatism. No complication ot heart observed in symptons at this time. A tall spare, and slender man fair complexion. February 13th. Was called to see him about llo' c. A.M. yesterday A t that time confined in sweat box", where he had been since 8o 'c, A.M. Was almost insensible. Pulse scarcely perceptible. Not able to support himself alone. Ordered to be removed iiiJIIedia tely, end, by frequent and copiaua administrations of stimulants, he is slowly recovered, though complaining of great feebleness, weakness in limbs etc. Pulse at this time is rather quick and fUll The next day he was discharsed But complained frequently attar this time of pain and palpitation in heart brought on by any small or by being punished severely which was not unfrequently necessary. Upon examination, his chest was found very contracted and sternum protud-ing (chicken breasted) Impulse of heart habitually too strong and some fullness in this region. Under these circumstances, he was order ed to be surveyed, and the following is from the report of the Survey held in consequence. "George McGrath, Marine Disease of Heart Origion not in line of duty" He was, today, transferred to the w.Macedoniantt. CASE 29th, April 6th. Richard H. Eagan, Seam .Aet. 24, Born Ireland. Gonorrhoea. Four or five days standing -discharge profuse and yellow irritation considerable. Chordee at nights. Rx. Bale: Copaib: Zii, Tinct& op:, Tinct: catech: aa Zi, Aut: et Potass: Tart: grs II Sprt: Ether: Nitr: Zi, Aq menth& Piper: Zii -tt. misl: Dose teaspoontul thrice daily. To have besides, at bed time, when suffering much from chordu, Rx. Tinct: Op: Sprt: Ether. Nitr. aa qtt XX -with low diet and rest, he improved steadily. April 20th. Discharged to duty.

PAGE 26

, CASE 30th. April 4th. Terence McLutin Seem. Aet. 24 -New York. Gonorrhoea. -Reports with a virulent gonorrhoea of some three or four days standing. There is also sympathetic irritation of one of his testicles. Rx. Bals: Copaib. Zii, Tinct. op. Tinct. Catech. Sprt. Ether Nitr. AdZi, aul. et Potass. Tart. Gr ii, Aq. Menth. Pikin Zii. fl. mist: Dose one teaspoonful thrice daily. To confine self to a recumbent position. Apply lead lotion to testicle, and have low diet. April 8th. Testicle n o pain, except when walking. has almost disappeared discharge from urethra stopped. Copaib. Swelling Cont. Mist. 13th. Apparently well. some diarrhoea pres\llmd from medicine and it was therefore ordered to be discontinued. 14th. Discharged to duty. May, 1856. The Jacintow was lying, during this entire month, some twelve or fourteen miles off the mouth of the Menam. The weather was uncom fortable: frequent light showers, alternating with a burning hot sun; winds light and variable: and nights generally oppressive and close. A tolerantly regular and aboundant supply of fresh provisions, such as beef, fowls, sweet potatoes and fruits, were sent off usually once or twice through the week. The only water which it was possible to obtain, came from the Menam itself, being brought off in earthen jars containing some thirty gallons each. It was brackish, and aboundantly charged with animal and vegetable matter. A large portion of that which came alongside was rejec_ted, but we were forced, from necessity, to receive a certain amount; this was, however, used only for cooking purposes. The health of those who remained on board ship continued good. There were, at one time, a few cases of mild Intermittent, and some violent attacks of gastric and inteBtinal disorder, owing solely to personal imprudence, either in eating, or exposure on deck at night: these were, however, soon controlled. Two or three cases of a serious dysenteric character, es well as one of acute articular rheumatism, were developed amongst those who remained some weeks at Bangkok A few cases of syphilis and gonorrhoea were also reported from this portion of the ship's company. CASE 31. April 4th, 1856. Wm. Johnson Cox Aetat. 30 -New Yor k Syphilis. Reported with a small chancre upon the superior of inter-23.. .:..>

PAGE 27

nal told of prepuce. Also a purulent discharge !rom urethra. Argent. Nitr. Fens., with water dressing for the chancre; and Hydr. Protiod. gr 1, thrice daily internally, were prescribed. April 6th. Chancre is much the same -indurated base, and indisposed to heal from urethra less. Thinks gums are slightly aore. Discontinue mercury, and Rx. Potass. Iod. Grs V ter in die. Dress sore with Black Wash. 8th. Condense again with Argent Nitr. and continue treatment. 30th. Was discharged to duty. I do not know the state of the case at t his time, being absent from the ship. May 12th. Reported to me with chancre still open and enlarging. Considerable inflamation around it, and a bubo in right groin. Or dered mercurial frictions over bubo and internally Hydr. Protiod. grss ter in die. Chancre to be dressed with Mg. Hydr. Ox. Rub. 14th. Better. Cont. local treatment alone. M ay 19th. Discharg ed to duty. C hancre healed, and enlargement in groin almost disappeared. CASE" 32. March 28th, 1856. Justin Baker Cox. Aetat. 35 -New York. Eczema. Has had, for some weeks past, an eruption upon palms of both hands, commencing in the centres and spreading outwards in irreg-. ular circles. The central part healing, and forming a red tender looking cuticle. \li orking at the ropes constantly ag gravates the af fection. The scabs and thickened cuticle not allowing the efficient application of remedial Ill3asures, emollient poultices were cr dered to be applied at nights, and during the day an ointment consisting of equal parts of tar and Ci trine Oint. March 31st. The more inflamed points to be touched with Argent. Nitr. Fns., and former treatment continued. Also Rx. Liq. Potass. Arsenit. gtts. iii ter in die. April ?th. Is improving, cont. treat. and reapply caustic He continued improving under this treatment, until, May 30th. V fuen he was discharged to duty at his own request, diseased surfaces all healed, but cuticle quite tender. Was ordered to continue Liq. Potass. arsenit. for a few da ys. May 23rd. Returned eruption again broken out. Probably from too soon using the hands. The same treatrrent, internal, as well as external, was resumed, with strict orders not to use the parts more than necessary. June 30th. Discharged -thoroughly cured. -24-

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CASE 33. 6th. Jno. Leroy Cox -Aet. 56 -New York. Rheumatism. Was at t acked whilst at Bangkok, a few days since, with acute inflammatory rheumatism of right knee joints -with flushed skin, full quick pulse and considerable nervous irritability. He was put upon lemon juice zss thrice daily, and sent down to tile ship by the first opportunity. Is no better. Knee swollen, tender and red -in a semi-flexed position, and not able to use it at all. Some fever. Bowels constipated. Rx. Magnes. Sulph. Zss. Tr. Colchic. gtts XX Cont. Lime juice and use Lin. Terebinth to part. May 8th. No improvement. Sleeps little. Rx. Dover. Pulv. grs V quaq. sext. hor. Potass. Nitr. Zi, Aq. Oj.L. To be drunk through the twenty-four hours Cont. Liniment. 9th. Complains of having passed a very bad night. Is very restless, and has some fever. Some pain in precordial region, and impulse of heart feeble. Rx. Magnes. Sulph. Zss. Li. Colchic. gtti. XX. Liq. Morph. Zss hor. Somn. Cont. other treatment. lOth. Much better. Rested well and is free of fever. Cont. traat. except purg ative. 13th. Almost free of pain. A little about ankle and feels considerable debility. Rx. Quin. gii ter in die. 16th. Pains continue and he complains of great w eakness in parts. Rx. Potass. Iod. grs. v. ter i n die. Unde r this treatment, with the oc casional use of opiates, and mild laxatives, p. r. n., he gradually improved until, May 30th. V fuen he was discharged to duty. Suffered, however, from chronic rheumatism more or less during the remainder of the cruise. -25-

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Our long and tedious stay in the waters of Siam terminated with the close of last month; and we were all rejoiced at getting under way for Hong KOng, early upon the morning of June the first. We had calms or light head winds until within a few miles of our destined port, and did not anchor in Hong Kong harbor until the 12th instant. Our here was selected with a view to getting stores on board most conveniently, and was a peculiarly unfortunate one as regarded health, or comfort. Lying close in under the island of Hong Kong, its high range of hills extending from East to Southwest, cut us off completely from the south, and Southwest breezes which are the health bringing winds of the season: and, at the same time, we were left exposed to the full force of Northeast blows, pregnant with catarrhs and rheumatism. During the latter half of the month there was rain, almost daily; and the sun, when it o ccasionally shone, was most oppressive. The bad water, taken in from the Menem, was used for several days after we arrived in port. The men were considerably exposed after our arrival at H ong Kong, being employed in coaling ship, and filling up with provisions. The sick list began to increase very considerably before the close of the month: principally with cases of Diarrhoea and Gastric derange ment, though there were two or three of Dysentery, and several of P ulmonar y atarrh, An ordinary Seaman, belonging to one o f the boats' crews, and in consequence, often called upon to leave the ship during the hottest part of the day, was attacked with Sun Stroke, and never recovered his health afterwards. The average daily number of sick for the past quarter, ending with this month, has been a fraction over twenty; and for the whole time since we sailed from New York, about fourteen. CASE 34. Gulf of Siam, May 19th, 1 256 James c. Freeman -Apprentice Aet 17 Born New York. Gonorrhoea. Of four days standing. Discharge is moderate in amount, and urinal canal not greatly inflammed. Prepuce is, howev er, considerably swollen. Rx: Magnes: Sulph: Zss stat. internally. Rx. Zinc: Acet: grs. II, Rhumb: Acet: grs. IV, op: Acet: Zss: aq: ZIV. Liq: use carefully as an injection twice daily. Apply water dressing to penis. -lie in Hammock, and diet low. 20th. Local treatrrent continued and ordered Rx. Ant : et Potass: Tart: grs. II,mq. Ziv.s.zss. every t hird hour. 21st. Prepuce has become very swollen. Effusion a ppears to be mor e upon the right side. there is paraphymosis -Much soreness of the parts discharge diminishing -Discontinue injection and have hot fomentations constantly applied to penis. Rx. Magnes: Sulph: Zss every morning, and, after latter acts, Rx. Sprt: Ether: Nitr: Zss every third hour. For so n e da y s swelling remained unabated, though -26-

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the discharge from urethra was very much reduced in quantity. l\1ercurial and Saline purgatives were daily administered. W arm fomentations kept up low diet and strict confinement to Hammock. 25th. Excessive s welling of prepuce is subsiding and between the folds upon one side behind corona gland are two or three superficial ulcers, presumed to be simply a result of the great constriction and distention of the part. Dress these with soft lint coated with mg. hydr: oz: Rubr: -Internally, Rx. op: Acet:xi. Tr. Catech: Zii. S prt: Ether:Nitr:Zss, ol: Terehinth: gtt XX -Acac:Pulv: Sach. aa q. s. Aq. Ziii. ft. mist: -s. Zss thrice daily. Con tinue salts so as to obtain at least one stool in twenty four hours. June 4th. mount of discharge has rather increased, though the soreness and pain, as well as scalding along passage in urinating, have almost entirely disappeared. Zffusion into prepuce is slowly being absorbed. Internally, Rx. Potass:Iod:grs. V thrice daily. Resume injection as formerly prescribed. Continued slowly improving, until, 18th. W hen there was merely a gluty discharge rema1n1ng. Rx. Tannin. grs X. Aq. Zi. use as injection three times daily. June 21st. Discharged to duty. Although there still remained a considerable thickening in told of pxepuce. CASE 35. GUlf of Siam, May 23rd, 1856. Justin Baker, Seaman. Aetat. 35 Born New York. Eczema Chronic. Was under treatment sometime since for an affection of the skin in palms of hands. Presumed cured, but has returned with a reappearance of the disease. More or less of the palms surface of both hands, also involving the bases of some of the fingers has the skin inflamed -healing in the centres, and extending in an irregular circular manner. Along the borders there are collections of sero-purulent matter under the cuticle. Some times froming openings, from which there is a discharge, and the inflamed cutis vera exposed. Or scabs form, thickening, and keeping the parts beneath sore and tender. To have internally, Rxe Potass:Arsenit:Liq:gtt V twice daily. Locally, to have emollient poultices a pplied every night -In the mornings, when the cuticle and scabs have been softened, the following ointment to be applied and kept on through the day-Rx. Arsenit:Iod. grs Vl. Cerat: Simpl:Zss. m. 30th. There having been little improvement, the diseased surfaces were well cauterized today, after having been softened, a s before, by the poultices. This was 11epeated,, o nce or twice -at the same time the former treatment continued. He improved, though slo wly and June 30th. Was discharged to duty-hands quite well. -27 -

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CASE 36. ) At Sea. June 9th, 1856, William Scott. FiremanAeto 25 Born England, Dysenteria. Reported complaining of pain abdomen and constant desire to stool, without being able to pass anything furred tongue, and feels badly-ordered a purgative -This acted, and after there continued frequent small bloody s .tools with tenseness and constant pain -considerable febrile excitement. lOth. Same Rx. Hydr:Chld:Mit:grs IV, Pulv:op:l, repeat in four hours and four hours after last dose, Rx. ol: Ricin:Zss Diet farinaceous -Drink cold tea or rice water. llth. Dysenteric symptoms have moderated, Stools less frequent -of a bilious character. Complains that gums are tender and breath has mercurial factor Right submaxillary gland enlarged Repeated ol. Ricin. Zss. 12th. Is very much better of bowel disease. But salivation has become profuse :Gwns an.d tongue much swollen and inflarood Slight febrile action, probably from ptyalism-Rx. Sprt:vin:Gall:Zi, Creosote:gtt X A q. Xii.M. use frequently as a mouth wash. Diet arrow root -soft boiled rice -beef or chicken broth. 15th. Mouth continues very sore, and inflammation has extended to throat and glands of neck, so that he swallows with difficulty Contin. mouth wash adding to it Potass:Iod:grs V to Zi:Internally, Rx.Potass:Iod:grs V1 twice daily. 17th. Is rather better though still swallows with considerable difficulty Cont.Internal treatment and Rx. Acid. Tannic:grs iii, Gr. Myrrh. Zss. Agi. Zss. m. Use frequently as mouth washDysentery, b y this time, was entirely relieved. Mouth continued improving. Appetite and general health returning. 24th. Q,uinoidin:grs. iii morning and evening. Ordered morning and evening with S od: Biborat:Pulv. to mouth. Discharged to duty. CASE 37, At Sea. June 8th, 1 856. J, o. Bradford. Purser. Aetat. 42. Born Delaware. Dysenteria. Frequent small bloody stools -pain across abdomen. Some fevor tongue furred -Rx. Hydr: Chld: Mit: grs V, Pul v: op: gr 1 -To be taken at once. 9th. Is easier Bowels quieter Repeat Calomel and opium. I"itil. Convalescent. Rx. Pulv: Dover:grs. V Discharged to duty. -28-

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38 .At Sea. June 5th, 1856. Philip Marine Aetat 22 Born Ireland. Gonorrhoea. Of some days standing -Discharge aboundent Rx. Misl: Copaib: Zss. thrice daily. Bonels kept free with Megnes: Sulph: in small doses daily, if necessary. 9th. Complains of suffering with chodee at night. Cont: former treatment and Rx. opii gri hor: somn. 12th. Inflammatory symptoms have subsided, and there remains a moderate muco-purulent discharge-No irritation at night -Rx. xinc: Sulph: grsii, Rhumb: Acet: grs IV, op: Acet: Zi. Aq. Zii L. To use as an injection thrice daily -Retain half a minute and injection be alwa y s followed by cold water thrown up. June 14th. Discharged to duty. July, 1856 Upon the lOth of this month we got under weigh for Japan, having Mr. Consul General Harris on board. But in a very few minutes after the machinery commenced working, the was found to be so seriously out of order that it would be necessary to d ock the ship before she could proceed to sea. In consequence or this, we wer e towed up to Whampoa; some days were occupied in removing coal and other stores; the ship went into dock upon the 19th; and remained there during the remainder of the month The exposure of the men was very considerable, and the result much less unfavorable than could have been anticipated. During our stay at Whampoa there was an almost constant succession of heavy rains, and blows from the and North East; when the sun did, occasionally show itself, it contributed moxe to the production of a steaming heat, than a dry atmosphere The village of Whampoa is built immediately upon the low banks of the river; in the !l'l.idst of an immense alluvial plain; and almost entirely surrounded by rice fields for miles in extent. Fortunately, however, for us, the excessive and unusual amount of water which fell during our stay, kept the low lands all covered, and prevented that generation of miasma which would have occured under different circwnstances. During the first few days, whilst discharging our stores and coals into a couple of hulks hatued alongside, the men, were, most of them, wet every day and for hours together. In dock, we were not only cut off from a free circulation of air, but surrounded b y innumerable sources o f filth. The men were, besides, constantly smuggling liquor on board;,and others, nightly slipping our few and inefficient sentries, and getting on shore. Some individuals were in. a more or -29-

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less complete state of intoxication for several days together. To make the matter worse, "Libertyn was given during the latter pert of the lbime that we were in dock, and the very few who had previously managed to keep sober, yielded, almost without exception, to the mon temptations of a sailor, and returned, after a few days, or even hours, absence, wet, drunk and pe-rhaps diseased. A very large number of cases of catarrhs and diarrhoeas are exhibited in the table as having been entered for treatirent. N one Of the former were of a serious character, and the latter, generally mild. There were not many of Dysentery. Several of Remittent and Intermittent, all easily controlled. CASE Hongkong, June 24th, 1856. R H ).Seam. -Aetat 24-Born Ireland. Mammitis. any known exciting cause, and being quite well otherwise, complained of pain and burning in right side of chest; which upon examination, appeared to proceed from an acute inflamation of gland of that side. Red, swollen, and very tender u p on the least pressure Was ordered to lie in hammock. Keep lint wet with Lead Lotion over part-and, internally, Rx. Zii, Pulv: Rhei Zss. 26th. is not so diffuse, and pain less acute Near the apex of the gland there appears to be an obscure fluctuation -To apply an emollient paul ti ce, and carry arm in sling, as axillary plexus, an d nerves of arm of saroo side are sympathetically affected. The inflamation gradually subsided without any more decided indications of supperation and, July lat. Was discharged to duty. CASE 40. Hongkong, June 22, 1856. Patrick Newcomb Fireman -Aetat 34 Born Ireland. Sclerotitis. eye has been paining for several days, and it is now very acutely painful, as well as irritable to the light or heat. There is congestion of the blood vessels of the ball of the eye, commencing at the outer of the cornea and running back. Complains that his sight is bad. Sees very little with the affected eye. Apply Lead Lotion to eye, and keep well guarded from light. Internally Rx. Pill: Cathart. Camp: No. IV. The next day, being no better, a blister was ordered to be opened upon temple, and dressed With ung: Resin: Lead Lotion continued and Potass: Iod: grs V to be taken internally thrice daily. 2'7 th. No improvement Cont. dressing to blister, end apply three -3o30

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:J.eechea .as near to eye as blister will allow. Rx. Pill: Hydr: noj morning and evening. A Seidli tz Powd.er every monring. \ Julv 8th. A light mercurial course, with mild cathartics occasionallY Locally, solutions of Nitr: gr t, Capi: Sulph: gri and Zinc: Sulph: grss to Zi of water, have been tried. The activity of the inflamation has been arrested -but the sclerotica, especially a portion upon the outer sid.e of the ball, remains congested, and some what thickened. The eye is still impatient of light, and heat, as of the engine room, a ggravates all the symptoms. Rx. Hydr. Protiod: gr in pill thrice daily -To have another blister opened on temple, and dressed with Basilicon. Use Liq: Argent: Nitr: grs V to Zi Of water as a collyrium. 13th. Thinks there is less irritability of sight though remains much the same. Discontinue Mercury as system is affected. Cont. dressing to blister, and apply to eye. Sulph: gri to ounce. congestion moderately Liq: Xinc: 20th. There is still a tendency to thickening of a portion of the conjunctiva covering the inflamed part of the sclerotic coat though the other parts of the organ are sympathizing much less than pre viously. To have the solid sulphate of copper applied daily The diseased surface rapid.ly resumed its normal condition, and, July 30th Discharged to duty. CASE 41. Hongkong, June 14th, 1856. Jno. MoLean Marine Aet 24 Born United States. Conjunctivitis. Has been doing duty as orderly upon spar deck, exposed to a powerful sun and wearing only a cap-Is constitutionally liable to the disease -Conjunctiva of left eye is very much congested. Sight impatient of light and discharge Of tears profuse Cannot bear to have the eye exposed at all -Internally, Rx. Mag: SUlph: Zss. locally Rx. Rhumb: Aoet: grs XII, A q: Ziii. Use as a lotion, To remain upon berth deck. Diet vegetable. 15th, Pain and irritability of organ are rather greater than yester day. Apply a blister and keep open. Rx. Argent: Nitr: grs X Aq: Zi, Apply with a camel's hair pencil daily to the inflamed surface. Continuing occasional small doses of salts, and confining himself to prescribed diet. 22nd. Scarcely any improvement Acuteness of pain has, measurably, disappeared, but great impatience o!' light, and congested state of conjunctival membrane persist. To have six leeches a pplied to temple. Use Liq: Cupr: Sulph: gri to ounce and contin; general treatment. 23rd. Easier Cont. all treatment. -31I

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. 24th. Congestion of membrane remains as great as ever, and impatience to light appears to be increasing again. Apply another blister to temple and Cont: other treatment. 26th. No better -Dress blister with Cerat. Lavinae. Internally, Rx. Hydr: Chld: Mit : grs IV, Pulv: op: grss -repeat in four hours and in four after last dose, Rx. 01: Ricin: Zss -L eeches were ordered in the evening, but would not bite. 27th. Pain and irritability have lessened a gain, but there is considerable opacity over cornea, from congested condition of corneal conjunctival-Rx. Hydr. Chld: Mit : grs II, Pulv : op: grss every hour. Keep blister open. And use as collyrium thriee daily Liq Argent: Nitr: grs V to Zi of water. 29th. About the same. Is able to see scarcely at all from the af fected eye -not much pain, but opacity is rather increased. Is mercurialised. Discontinue internal treatment, and cont. local application two or three times daily. Aug. 3rd. is improving. Congestion diminishing, and sight better Cont. treat. 18th. Discharged to duty. Conjunctiva almost restored to its natural condition. CASE 42 Whampoa, July 21st, 18_5_? Joseph Rider, B. Mate Aet 42 Born England Neuralgia. Of supra-orbital nerve of right eye -Is a man of robust frame and health. Rx. Liq: Morph : Zi. Chloroform gttX at once, and apply a hop poultice to face. Next day being no better, Chloroform Zi, ol: Oliv: Zss: Tr: Opii Z i was ordered to be used as liniment. 24th. No improvement Pain remits Early in mornings almost free of-aggravates towards noon. Apply a blister to temple, and dress surface with Morph: Sulph: At six o'c A M tomorrow Rx. Quin : Sulph : grs IVimproved Quinia was repeated two or three mornings, and, July 31st. Was discharg ed to duty. CASE 43. Hong Kong, July 6th, 1856. James Travis Qr. Master -Aetat 51 Born England Catarrhus. Complains of pain and giddiness in head -fullness in chest Some febrile excitement. T ongue with w hitish fur etc. Rx. Quin: Sulph: grs III, Liq: MOrph: Zi every t hird hour. Diet farinaceous. 8th. Same. Cont. M:ld thrice. lOth. Discharged to duty. -32-

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CASE 44. Eong Kong, July 8th, 1856. John H. Harway Appr. Aetat 21, Born New York. Catarrhus-. Soreness and pain in chest with some cough. Also con sid&rable inflammation about fauces. Rx. Magnes: SUlph: Zss: Ant: et Potass: Tart: gr. t Repeat in four hours, if does not act well. gth. Throot is rnoxe inflammed today, and swallows with difficulty. To have a large sinipism a pplied to throat, and use probang morning and evening with Liq: Argent: Nitr: Grs X to Zi water. Improved rapidly under this treatment, and, July Was discharged to duty. CASE 45. Penang, March 30, 1856. George Ryan Quarter Aet. 28 Born New York. Gonorrhoea. With rheumatism. Reported only of an ecthymatous inflammation of the leg which he hed noticed for some weeks. Was ordered Liq: Ferr: Iodid: Gtt X twice daily for this, and to lie in his hammock. April 9th. Is almost entirely relieved of inflammati o n of l eg, but now reports a gonorrho&al discharg e of some days continuance Profuse purulent disoharge with heat and soreness or parts, with ChordeeRx. Copaib: Zii, A utmon: et Potass: Tart: gr i, Tr: Kramer: zii. Acct. Op: zi Gum: Arabic: Z IV-ft. mist. L. zii thrice d.aily. 11th. Wasattacked during the last night with violent cramping pains across epigastro. Bowels constipated. A sinapiam was applied over abdomen. Opium, Ether and chloroform administered without much relief An ounce of Castor Oil was ordered this morning. 12th. Bowels not being moved during day yesterday and pain across epigastro persisting, last evening was ordered Calomel grs x. This has purged well -Pain is :removed to left lumbar region and still continues very acute. Gonorrhoeal discharge remains about the same -Mixture has been discontinued. 13th. Is scarcely able to move in hammock this -Appears to be an affection of lumbar plexus of left side -Pain extends down back of thigh along sciatic -To have cups no. VI applied over lum bar spine and resume Mist : Copaib: as before. ]21st. No improvement in symptoms Still confined to hammock. charge from urethra is free -but inflammation has diminished, end chordee is not so troublesome. Rx. Liq: Ferr: Iod: gtt XV thrice daily. Rx. Zinc: Sulp h: grs ii -A q. Z i L. Use as injection to -33-

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twice daily. Discontinue mistura. 27th. Sane. Rx. Potass. Iod. gre VI thrice daily end Capr. Sulph. gr as to Zi of water as injection. July 12th. Up to this time the symptoms persisted obstinately, in spite every remedy which could be tried. Repeated blisters and cups, wet and dry. Morphia internally and ove r .blistered surfaces. Vertria Quinia and other tonics Gauio -Potase: Iod: etc. were all tried without any material benefit to rheumatic affection. He complained constantly of more or less pain in left lumbar region, involving the posterior part of thigh and leg and occasionally extending to the right side -Appetite was good -but being confined to his hammock, suffered with dyspeptic symptoms and general debility The Gonorrhoeal discharge entirely disappeared after using the injection for a short time. At this time (July 12th) a dozen leeches to be applied over spinous processes of last dorsal, and three superior lumbar vertebrae, which exhibit tenderness upon pleasure over themAnd to be repeated for three or four days successively. Cont: Potass: Iod. 21st. Reports himself very much better Scarcely any pain and can walk tolerably The ship being in dock at l hampoa, he is ordered to go on shore morning and evening, to take exercise -He gained strength rapidly, and, July 28th. Was discharged to duty-quite well. CASE 46. Hong Kollg. June 28, 1856. Henry Wells Marine -Aetat 23 -Born United States. Vertigo. Reported this morning at six o'clock bein g suddenly attacked while on post with giddiness and feeling of faintness. Sickness at stomach and profuse perspiration. Had Ether: Sulph: gtt XX at once, a and is somewhat relieved now. Rx. Pill: Cath: Comp: N o IV The next day he appeared pretty well during forenoon, but, towards evening, was seized with another attack, similar to, but not so violent as, the first. Was ordered, RX. Aut. e t Potass: Tart: grs II. A.q: Z L. s. Zss every third hour. 30th. Complains of a little uneasiness in head Slight. July lat. Discharg ed to duty. CASE 4?. Hong Kong. June 28, 1856. Thomas Tightman. -Lds. -Aet. 21 Born New York.

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Prostratio. Last evening, the weather being quite warm, he was or to be confined in the "sweat box" fa!' remaining on shore after sundown -Is one of the Ward Room boys A young negro of rather delicate constitution -After being confined some two hours I was called in haste, and found that he had fainted-Fresh air-cold waternervous stimulant etc. were made use of, but he was very slow in recovering consciousness -Is suffering with great prostration this morning -Pulse feeble, head giddy, disposition to lie down Pain in head upon left side -Rx. Magnes: Sulph: Zs s and repeat in six hours, if first does not aot. 29th. Still complains of feeling weak. General debility, and an uncomfortable sensation about stomach. No appetite. Rx., Tr. Zinc. gtt XXX, Liq: Quin: Sulph; zii (grs. ii) morning and evening. July lat. Discharged to duty. CASE 48. Hong Kong, June 28, 1856. Richard Graham. -o. Seam. Aetat, 26 Born New York. Diarrhoea. Been suffering for two or three days. Had six o r eight watery stools during last night. Whitish tongue -thirst -want of appetit&, and some fever. Rx. Acid: Nitr: Zi, Tr. op: gtt XL Aq: Camph. X VIII L. Zss every three hours -Diet arrow root o r rice. 29th. Is no better -Tongue more fowl -pain in abdomen severe d'Ischarges small but frequent Rx. Pulv: op. grss every 3rd hour -Diet seme. 30th. Is still suffering as before -Rx. opii grss Tannin. grs. V every two hours -July 2nd. M uch improved -Diarrhoea almost checked. Cont. Medicine as needed. 3rd. Discharged to duty. AUGUST, 1 856 Much to our relief, the necessary repairs having been completed, upon Saturday, the 2nd of this month t he ship was hauled out of dock, and upon the following M onday, we commenced taking in our stores, coals, etc. as rapidly as possible. The effect of the miasmatic influences b y w hich we had been surrounded, began now to exhibit itself, and a very considerable number of cases of intermittent reported. -35-

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All, however, were soon controlled by a mild treatment; simple purgat :i,ves, followed by quinia generally checking them after the s ,econd or third paroxysm. Q,ui te a large number o.r venereal cases also presented themselves. Upon Tuesday, the 12th, we once more started from Hong Kong for Japan, with Harris and Suite on board: and, with better success than attened our first attempt, arrived safely in the harbor of Simoda upon the 21st.-Although the weather continued unfavorable during the first few days of our passage, so soon as we were well clear of the coast of Chin a a favorable change began to take place; and as we approached the Islands of Japan, the atmosphere becan:e drier and mare elastic. During the last ten days, the weather, was delightful; a deep blue sky atmosphere dry-temperature comfortably cool, and baroiii3ter above thirty once more. This change was serviceable, as well as pleasant, to all. Our invalids recruited rapidly, and many who had felt more or less unwell were soon restored to perfect health. With the exception of a few cases of Remittent and Intermittent Fever, the seeds of which were obtained whilst we were lying in the Canton River, the sick list, at the close of this month, cont&ned only chronic cases. Lieut. Bryant was invalided and detached from the ship, just before we left Hong Kong last. He had been suffering, and incapacitat e d from the p e rformance of his duty for some time previous, with chronic catarrh, and,. probably, incipient phthisis. CASE 49. Hong Kong, July 6, 1856. Charles Johnson -Boatswain Aet. 50 -Born N. s Diarrhoea. Was exp osed to very hot sun yesterday, while on duty. Complains now of frequent watery discharges from bowels, with great prostration etc Ni tr. Acid. Mixt. Z i was ordered every hour, as needed. 8th. Frequency and profusion of watery stools rather increased. Pulse is quick and feeble. T ongue with a long whitish fur and entire absence of appetite. Rx. Tr: op: Camph: Tr: Catech: aa zii e v ery 2nd hour.-Diet rice Drink cold tea. lOth. No better S ymptoms becoming dysenteric More tormina and tendency to straining at stool. Blue mass Plumb: Acet: and opium Calomel, Ipecac, and opium in v ery small doses, and Q,uinoidin, were successively tried without good results. The disease had a n intermittent character Would remain quiet for some hours, and then the profuse watery discharges recommence. Finally, he was ordered Rx. acid: Sulph: Arom: gtt X M c Murrie's -36-

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:j!:lizir, gtt XX, in a wine glass of water, repeated every four hours, or leas often, if he imp .roved. This had the effect of checking the disease of bowels, although recovery from the prostratio n caused by 1 t was very slow. Aug. 4th. Discharged to duty. CASE 50. W hampoa, A ug 5, 1856. Francis Sullivan -Master at arms -Aet. 44 -Ireland. Poisoned. Complains of a most distressing pain across forehead. Unable to sleep, and general d erangement of nervous system Pulse rapid and rlant of appetite, and some nausea Result of exposing himself several times, last night to gases accumulated below decks in smoking the ship rats Several coal (wood) fires were burning, and, towards tbe 1a st, Sulphur thrown over them. Rx. Liq:Morph:zi repeated as necessary. 6th. Not feeling much better Tongue quite furred -To have a blue pill, and in hours, a Seidlitz, p o wder. 8th. Pain in head still persists, and action of heart is strong his general habit is delicate, and nervous temperamant highly developed. Rx.Ti: C onchon: Camp: Zim Fufus: Quass: Zii, Ether: Sulph: Cont:zii, Liq: Morph:Zss -m. Dose Zss thrice daily. Aug. lOth. M uch improved Discharged to duty. CASE 51. V fuampoa, Aug. 8, 1856. Silas Owens .App boy Aet. 19 Born New York. Gonorrhoea. A slight purulent discharge of three or four days standing. Nor much ardor urinas -First attack of disease. Rx. Argn. Nitr:grs. X Aq. Z i -L. Inject with carefully twice daily Throwing up cold water e ach tim afterwards -Low diet. lOth. No i m provement -Injection appars to have little effect Use three times daily ll.th. Discharg e is rather increased more soreness, and tendenc y to chordee. Discontinue injection and use, Rx. Copaib: Zi. Ant:et Pot: Tart: gr I. T:Kre.n:er: zii. Tr. op. Camph. Zss. Mucilag : Acac: Z Vi. ft. mist: Lument: Vis Q uaq: die Zss. -21st. Discharged to duty Well -except a slight uracoid discharg e -37

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in morning Cont. med. for a day or two. \ CASE 52. Whampoa, Aug. 7 1856. James H. Martin, o. Seam: Aet 23; Born United States. Gonorrhoea. Of four or five days standing. Discharge moderate. Rx. Argent. : Nitr: grs v. Aq: Use as injection twice daily Syringe out after with cold water -Diet low. lOth. Complains tinue injection. reduced, then to of much burning and pain with bloody urine DisconFlaxseed tea ad lib. until inflammatory symp toms are have Mist. Copaib: Camp: Zss. thrice daily / 16th. Much Cont. treat. (probably ttmuch better") 19th. Discharged to duty. Tlw use of the injection in these two cases was attended to by myself, end most carefully. CASE 53. Whampoa, Aug. 2nd, 1856. Jo4n Cornell 0. Seam: Aet. 22 Born United States. Gonorrhoea. Few days standing Discharge free -To use Mist: Copaib: Gomp: Zss thrice daily. Has some diarrhoea Rx. Tannin grs. VIII every hour until relieved. Discharge is moJre profuse -Cont. Mist: adding Tr. op. Gtt X to each dose. Use injection of Argent. Nitr. grs V to ounce. Improved daily. Aug 14th. Discharged to duty. CASE 54. At Sea. Aug. 18, 1856. Charles H. Ashe. -o. S eam. -Aet. 34 -Connecticut. Syphilis. Exhibits a chancre upon inner fold of prepuce, near coronaMedium size -supperation ... Has been dressing for s cme days with Liq: Crpr: (copr) Sulph:-Rx. Hydr: Chld: Mit: grss ter in die. end dress ulcer with soft wet lint. Frequently renewed. 2oth. Ulcer exhibits little disposition to heal Base is indurated. Apply solid nitr: Argent. Cont. water dress: and general treatment. -38-

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Sore looks more healthy -Discontinue Calomel Repeat cauatic at once, and continue water dressing. Continued healing kindly, from this time with a little stimulation occasionally. Aug. 29th. Discharged to duty. CASE 55. Whampoa, Aug. 7, 1856. A. Desilva. -Lds. -Aet. 19 Born Madeira. Dysenteria. Hot, d.ry skin -pulse q_uick and hard Tongue fUrred Stools small, freq_uent, and marked with blood -Last evening was ordered ol. Ricini Zss -This has acted, but tenesmus and other symptoms continue. Rx. Cal. grs ii, Pulv:op: grss Q,uaq. seeund:no v: during day -8th. Rather worse small bloody stools Tormina and teneamus fever, E continue Cal: and opium every two hours -Diet Rice -Drink tea. 9th. Much better -Free of fever -belly easy Stools less frequent Dark bilious characte r Cont: Med: every third hour -Diet Sa.IIB lOth. Convelscent -No medicine Chicken broth. 12th. Discharged to duty. SEPTEMBER, 1856. During the first half of Sept:ember our daily number of patients continued lar@e; but from the same causes mentioned in the swnmary for August: viz.. the influence of malaria while we were lying in the Canton River. The cases of fever were principally Tertian Intermittent; and easily controlled. Scarcely ever continuing to resist remedies beyond the third paroxysm. In many, no other medicine than the Sulphate of Quinia was needed to effect a cure. Q.uinoidin, was experimented with in a number of the. cases, but it was found to be much less certain and reliable than the former. There are several cases of Diarrhoea treated at this time, also. In almost every one of these, more or less fullness and soreness in the right hy p ochondrium were complained of; there being exhibited at the same time, very light colored stools and yellowness of skin and conjunctiva. With these, mercurials in moderate q_uanti ty, appeared essential to the cure. Leaving Simoda upon the 4th instant, w e had a pleasant run over to the Coast of China, and anchored off the mouth of the Yang Tse-Kiang upon the lOth. -39-

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A ,ll regretted leaving the salubrious climate of the Japanese Islands, and a month or two longer there would have been very beneficial to the health of the invalids, as well as have confirmed that of the well. Upon our first arrival at Shanghai which is situated upon the w oosung River, a tributary of the Yangtse, we experienced several days of very disagreeable weather: damp, cool and bracing; the wind blowing pretty steadily from the north and east. These frequent changes of the temperature and moisture of the atmosphere, very naturally gave us several cases of Rheumatism. The only water procurable at Shanghai is taken from the river: directly alongside the vessel. This stream, flowing through an immense alluvial plain, and acting as the recepticle of the accumulated filth of the Chinese City of Shanghai, which is above the anchorage of the foreign shipping, is loaded with vegetable and animal matters; and, unless carefully obtained at low water, also brackish. This is the water used universally, by foreigners and natives on shore at this place; and they consider that it possesses no injurious properties; at least after having been purified b y a small portion of solution of alum. Many of us suffered at first with severe colics and cholera morbus; though possibly this result was o wing to our making use of too large an amount of alum in clarifying it. CASE 56. Whampoa, Aug. 4, John Mulholland-Fireman-Aet., 33-Born Ireland. Ulceraof leg-Reports with an ecthymatous eruption upon right leg and foot Some of the pustules exhibit a disposition to ulcerate General health is fair. Rx. Liq:Iodin: Comp:gtt Vl ter in die. Pustules that are open to be dressed with Ung. Hydr:ox: Rubr: to lie in his hammock. Most of the sores scabbed over and healed within a few days One, however, near the internal malleolus, spread to the size of a sixpence, and assumed an unhealthy appearance and indolent character. A flat, dark base, without any ap pearance of granulation -Various applications were successively tried -Liq: Rhumb:Subacetat: Goulard's Cerate: Emollient poultices; water dressing; Solution Sulph: copper: Argent: nitrat: -fused and solid; Ung: Hydr: ox: Rubr :were all used. The Iodine being continued the while.-24th. Ulcer is still indisposed to heal, though not enlarging its diameter. To have opium grss with each dose of Liq: Fer.(?) Iod: and dress with Hydr. ox. Rub. ung:-40 -

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26th. Is improving Cont. Treat. \ 30th. Ulcer filling rapidly Cont. Sept. 4th. Discharged to duty. CASE 57. At Sea, September 6, 1856. Wm. Scott -Fireman -Aetat. 24 Born England. Constipatio. Violent headache and great torpidity of bowels. Ship has been under steam for some two or three days -Rx. Pill: Cather. Comp' No. IV. These not acting, in evening was ordered M a gnes. Sulph: Zss.-7th. Has had but one small stool, and complains of a constant pain across sacral region. Rx. Jalap: Pulv: grs X. Potass: Bitart: Zss. 8th. Medicine has acted freely and feels greatly relieved Discharg ed to duty. CASE 58. At Sea, Sept. 7, 1856. Thos. At w ood -Fireman -Aetat. 34 Born Ireland. Constipatio. Obstinate torpidness of bowels-with nausea and vomiting Headache etc. Rx. Infus: Senn: Comp : XVI. 8th. No action on bowels yet. Rx. Hydr: Chld: Nitr: Pulv: Jalap: aa grs VIII. This, however operated but slightly, and the next day he was ordered M a gnes: Sulph: Zss. lOth. Discharged to duty. CASE 59. Simoda, Aug. 31, 1856. William Ludlow Lands Aetat. 2 0 New J ersey. Febris Intermittent. Reported yesterday, complaining of want of ap petite, headache and general malaise. Was ordered a purgative but feels no better. Tong ue is foul, and other symptoms a ggravated. Rx. Hydr: Chld: Nitr: grs. X. -In six hours aft er, Infus: S enn: c omp: Zii, repeated ev e r y second hour until it acts. -41-

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Sept. lat. Last evening had a severe chill, and still has feve r this morning, though it has remitted -To have Q,uin: Sulph: grs III every two hours through the day. 2nd. Is worse Pulse full and bounding Skin hot and dry -Tongue heavy fur with red ed@eS Rx. Sprt: Ether: Nitr: Zss ev ery second hour. Towards evening, fever remitted -pulse less hard and frequent and skin somewhat moist, and succeeding day was much better. 4th. Febrile has returned. Pulse is hard, but not so full as in former p aroxysm. Edge s of tongu e very zed N o disposition for food -To have Liq: Potass: Citrat: Zss every third hour-Next day was very much better -No fever, and tongue clearing Rx. Q.uin. Sulph: grs IV every third hour. 6th. No return of fever Cont: Quin: as yesterday. 9th. Had sorre fever last night a gain.Probably owing to i m p r udence in diet and constipation Uas ordered Pill: Cat hart: Comp: no. IV. lOth. Is still complaining of feeling badly, and tongu e is furred. Rx. Calomel. grs. X Pulv. Jalap. grs. Xii. And, after purgative has acted, c ont. Q,uinia grs III twice daily. 12th. Is again constipated. Rx. P. Rhei, Aloes aa grs. X 15th. Only suffering from debility Cont: Q,uinia. Sept. 20th. Discharged to duty. CASE 60. W hampoa, July 31, 1 856. Charles Nichols -Aetat. 32 Scotland. Syphilis. Exhibits a chancre upon inner fold of p r epuce. Touch w ith Argent. Nitr: Fus: Dres s with Black Wash. Internally, Rx. Calo mel. gr I ter in die. Aug. 8th. Ulcer has spread considerably around corona, althoug h it presents a rather less unhealthy appearance. Has been cauterized occasionally, with dressing, alternately, of Black lash, and water dressing. Gums are a little tender. Continue all treatment. 16th. No improvement. Some contraction of prepuce and ulcer not healing -Discontinue use mercurial -Inject und e r prepuce with a solution of Ar@ent: Ni tr: grs X to Zi of water Wate r dressing Bowels to be kept free with saline laxatives. 23rd. Ulcers remain stationary Not disposed to heal. Cont. dress ing and Liq: Argent: Nitr: Rx. Hydr: Chld: Corros: grs II. Aq: z IV. L. Dose Zss twice daily until h e is thoroughly mercuralized. -42I' .:-,;.

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27th. Mouth is quite sore. Discontinue mercurial. Dress ulcers with nitric Acid Lotion. 29th. Rx. Tannic' Acid: grs X Sprt: Vin: Gall: Zss. Aq. Zii -m use frequently as a gargle. Dress ulcers with aromatic wine. Sept. 3rd. Mouth is exceedingly sore. Buccal membrane swollen and peels. Salivary secretion excessive Rx. Sprt. Vin: Gall: Zi Creosote gtt. V, Aq. Z IV. m. use as gargle. Chancres are healingCent: Dressing. Not able to masticate ship's foodTo stop ration and be subsisted upon soft, nutritious food. 12th. Mouth quite well. Chancres are inclined to become stationary Bowels constipated-Rx. S enn: Comp: Zi every two hours until it operates. Afterwards, Hydr: Chlorid: Corros: gr. 1/8 thrice daily Black Wash locally. 14th. Disease much imp roved -Discontinue Mercury, and use mouth w ash again, as gums are tender. 16th. Improving. 19th. Discharged to duty. CASE 61. Simoda, Sept. 2nd, 1856. Thos. M cClusky -o. Seam. Aet 20 Born Ireland. Bubo. Reports with an inguinal swelling of left side. Has not been exposed to the possibility of syphilitic contagion on s hore for some weeks. Probably from cold Swelling is large and diffused pain across hypogastr -To use Ung: Iodin: and lie in his hammock. To have a laxative occ asionally. 9th. Swelling has rather increased, though pain and soreness less. Rx. Ung. Hydr: z .i, Ant: et Potass: Tart: si Iodin: grs X -m.-To be rubbed in night and morning. with this: and Liq: Iod: Comp: internally he improved, and, Sept. 28th. Was discharged to .duty. Swelling almost resolved. -43-

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9CTOBJ!R, 1856. We were in the oosung River during this entire month. The weather was cool, uncom:f'ortably so during a part of the time, but c hangeable, as is always more or less the case at t his season. Our sick list diminished considerably in numbers: and at the close of the month, there were few except chronic cases. Most of the accessions were diarr hoeas and dysenteries. The only one among these of any urgency, was in the person of an old roam belonging to the "Levant", who had been condemned b y Medical Survey for chronic rheumatism. The "L" left for Hong Kong a day or two before the vessel, in which t his man, as well as several other invalids, were to have taken passage, sailed, and he was, in consequence, temporarily transferred on board the San Jacinto. No notice o:r the case was sent b y the M e dical officers under whose charg e he had been; but we foun d him greatly prostrated from at attack of diarrhoea, and his condition such as rendered it very imprudent for him to be sent to the United States at that time, unless und e r the care or a physician. The consequence was that we had him thrown upon our hands for several months: as it was long before another opportunity offered to send him home. w e were particularly annoyed about this time with a cutaneous disease which first made its appearance on boerd the ship s hortly after we arrived in Chinese Waters. This is a sort of eczematous affection, confining itself, in most cases, to the groins or axillae, and varying in duration from a few day s to months. Almost all Europeans or A.nErioans who visit China suffer with this troublesome inflammation of the skin. The vulgar impression is, that it comes thr ough the washed clothes and it is thence called Washerman's Itch't: there is no evidence, how.ever, of its contagiousness, and the cause is either in the food or climate -or both. It is annoying, and under certain circumstances, t h e itching positively painful. A solution of Corros. Sublimat. gr I, V Cupr. Sulphat. grs II to Z i Of water usually checked it, where frequently applied with a sponge. Occasionally Liq. Potass. Arsenit., or Potass. Iod., internally, were needed so to aid the local treatment. CASE 62. At Sea, Sept., 11th, 1856. Hugh M cEver Marine -Aetat. 31 -New York. Gonorrhoea and Syphilis. Reported with a muco purulent discharge from urethra, and two or three tender pimples upon prepuce. Was ordered Mistr: Copaib: Zss twice daily, and Rx. Blue mass grs v. Op: Pulv: grss morning and evening. 14th. There is some tenderness of gums. Discharge about same -induration about bases of pimples is extending so as to involve all the extremity of prepuce. Continue pills once daily. Mixtr. as before. -44-

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16th. Induration having involved entire circumference of prepuce. phymosis has resulted T o b e syringed out daily unde r foreskin with warm water and soap, as gonorrhoeal discharg e collects underneath. 17th. Some ulcerations h ave ocured around orifice of prepuce. To be dressed with Bl:i ck Wash. Mouth has becom e a ffected considerably b y m ercury.Discontinue, and Cont. Mistur: Copaib: 20th. Ung: Hydr: Ox: Rubr: was substituted for Black iash, and, 27th. Discharge from urethra b-eing still considerable the introduction daily of a NOC (1) bougie with an ointment o f S i m p: Cerat: Rino, and zinc. Sulph. was substituted fox the mixture. The ulcers are rather improved, but p h ymosis continues, and attempts at r etraction ope n t h e former and cause hemorrhage. Continue the Black Wash. Octob e r 1, 185 6 Two or three of the ulcers around extremity of prepuce appear enlarging There is also soreness and induration of the froenum Discharg e f rom urethra has become very small Continue dressing etc. to ulcers -Discontinue bougie Rx. Porass: Iod: grs VI morning and evening -4th. N o i m provement in loca l symptoms -Gums are spongy and easily bleed. Rx. Liq: Ferr: Iod: gtt VI twice daily, and continue local treatnent. This treatment was continued, with scarcely eny in symptoms, up to, 15th. When, Argent. Nitr: Lus: was a pplied to ulcers, and repeated next day. 19th. They look healthier. Cont. black wash. 23rd. Ulcers nearly healed. Cont. same. 28th. Discharged to duty. Gonorrhoea entirely cured -Ulcers healed. Phymosis remains, though in a less degree. To continue c autious retraction daily. CASE 63. Whampoa, Aug. 4, 1858. Yeh Aman -Lds. Aetat 1? Born China. Syphilis. Reported with a indurated chancre upon the outer fold of prepuce. Also a bubo in left groinCauterize sore with solid nitrate of silver -mercurial frictions to inguinal s welling mornin g and evening -6th. N o im p xovement in ulcer -cont. former treatment and Rx. Hydr: Pro iod: grss thrice daily in pill -9th. Ulcer appears larger, and base remains indurated B ubo enlarging, -45-

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and softening Apply an emollient poultice to latter, and dress chancre .with Yellow Wash Continue internal treatliBnt. 12th. Slightly mercuralized. Cont. med. twice daily. 14th. Sore looks very unhealthy Discontinue mercury, as is salivated, Dress ulcer with vin. Aromat and continue poultice to swelling -16th. Ulcer looks greatly improved. Mouth quite sore -Cont. treatment and Rx. Tannin grs Vo Tr. Myrrh: Aq: Pur: aa Zi -Use as a mouth wash. 20th. ImprovingCont. all treatment, except mouth wash -24th. Ulcer appears stationary again. Rx. Cupr. Sulph. gri, Aq: Pur: Zi-L.-Apply to chancre morning and eveningCont. other treat:-31st. A small puncture was made in bubo from which considerable pus was dischargedChancre almost healed-Cont. poultice, end dressing to sore. / September 3rd. Bubo was laid open more fully last evening, as pus appeared burrowing considerably below first opening There was a free discharge of thin sanious pus, and the ulcer formed looks dark and sloughy Apply water dressing to this, and vin: Aromat: to sore on penis -Internally, Rx. Liq: Iodin: Comp: gttii thrice daily. -8th. Chancre on penis has cicatized -Ulcer in groin looks better Cont. water dressing and internal trt. 15th. Ulcer in groin still looks very unhealthy dark, deep and flabby, with no disposition to granulate or contract moves about too much. To be confined strictly to cot Rx. Liq: Cupi: Sulph: griss to Zi of water Apply to ulcer groin morning and evening, end cont: water dressing -Also internal treatment -18th. Same -continue local treatment and internally, Rx. Liq: Ferr: Iodid: gtt twi c e daily 19th. Still no disposition to granulate -Cauterize with Argent: Nitr: Fus X and cont water dressings -Add Pulviosa: gr! to each dose of Liq: Ferr: Iod:-22nd. Is improving --From this time the ulcer asswmed a more healthy look -throwing out fluid granulations, general health good. -The above treatment was continued, varying occasionally as indicated. October 18th. Discharged to duty-Ulcer almost cicatized. --46-

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CASE 64. Shanghae, October 22nd 1856. John Purcell. Marine Aetat. 22 Bor n Irel and -Dysenteria Chronic I s a tal l and slender man, of delicate con stitution was upon the list very frequently from the time ship left home Sufferi n g f rom S P ermatorrhoea, and various derangements of urinary, dig estive, and nervous systems, c onsequent upon this -In latter p a r t o f April last, whi l e at BangKok he had a most violent a ttack o f C h o l era Morbus w a s almost pula-less at on e tin:e H e r ecovered f rcm t his. Returning on board ship June l at. he cont i nued doing duty until July lat. Some three weeks after we had arrived at Hon g Kong he reported with frequent water y ye l low stools -griping severe Tongue furred b row n some f ebril e excit ement -Thirsty. After a purge o f oil an d l a udanum, he was ordered lead and opium every hour until t h e d isch arges were c hecked -He was temporarily relieved -but t he disease r eturne d The pains across his abdo men and while at stool w ere gre atly c omplained of, and symptoms of more acute inflammatory action pxesented themselves Tongue a n d smooth end clammy -much thirst and nausea -Pulse quick and f eeble There appears, also, a great aggravation of palpi t a t i on o f the heart, to which he has been more or l ess liable for some time p astmin e r a l tonics and stringents, with Port wine daily, and sane preparation of opium as required, were tried T h ere being no improvemen t small doses of Calomel with opium and afterward, astringents -with counte r irritation, were tried Enemata of starch and Laudanum after stools After t he acute symptoms had disappeared, and there was no long er m uc h f e b r ile reaction, he very slowly improved, though freq uently liab l e to severe attack s of pain, with larg e watery stools, m i xe d with blo od, and much tenesmus The t o ngu e at one tim e would b e almost olean, and then, whitish and clammy, or coated with a l on g dirty fur Compla i ned much of pain palpitation of heart an d also o f soreness and bleeding from a hoemorrhoidal tumor, which appeare d to have resulted from the straining at stoolMineral and vege table tonics, with opiates as necessary, counterirritation to the cheat end abdomen, and sweet oil with cold baths for the h o emmorrhois, constituted the treatment. Aug 17th. He was discharged to duty v ery m uch b etter, but not actually well. Sept. 22nd Returned on the List, with another acute attack Frequent-bloody-pain-furred tongue, and some fever, -the pyles also, have no w become a permanent -calomel, Ipicac end o p ium, in small doses repeated eve r y 2nd or 3rd hour. Lead and opium, first eve r y two hours, and afterwards t w o or three times d aily, were given-alternating with Nitric, or Sulphuric Acids, combined with opiates S taTc h enemata and an -47-

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qpium suppository in the more chronic stage Sinapiema, and bl1 ters kept open for several days, were all employed. Diet at first, simply and afterwards more nutritious, with animal food -The inflammatory symptoms were considerable Red and angry tongue -parched mouth -thirst severe pains in abdomen, especially upon left side Bloody stools with much strain ing -After the first ten days, these were not so marked, and tho principal uneasiness appeared to be local, confined to t he low-er part of rectum and -He became very m uch reduced 1n strength and flesh, both of which were regained very slowly -and then but partially -----------He continued an invalid, lUf1'er ing more or less from the chronic dysentery, until the followine March, when, an opportunity presenting itself, he well aa ar.voral others, were sent hone. I do not know the final i ssue of thU cae CASE 65. Shanghae Sept. 28th, 1856. Jno. Ii/Iulholland Fireman -27 -Ire land. Dysenteria. Reported yesterday with tormina and tenesmus, fre quent small bloody stools, tongue slightly furred, and nit' febrile excitement. Was ordered Rx Rhumb: Acetat: e 11 Pulv: opii gri repeated in two or three hours ai'terwarrle Is no better this morning-Rx. Ce.lom: gre iii, Pulv: O p : "-"I' S i11, Ipecac: grs ix m Dive. (?) incheut: no vi One aeco d hour -Diet soft rice -Drink cold tea -2nd. Discharge still continues frequent b t are b:lic .a, t'1:99 and without any blood no fever-Rx '1st: Acid: S ph : ;.r rr..et; zi every two hours until diarrhoea is October, 4th. Discharged to duty. Cb.SE 66. Shanghae, Sept. 29th, 1856 Silas Owen Lands -Aetat -1 8 7o::-k. Diarrhoea Frequent, paini'ul, weteTJ atoo l.e fever-Rx. Rhumb : Acet: g;rs ii Pul7: Opii gri .7 .. .... Diet, soft rice. 3 0th. Discharges have been a disposition to stool, remeins feels badly generally P.z 0 : ?ic : Zt; ?!...!. .., r; :Z:t to resume p owders of lead and O :;Jium :t ;a-f'"-... o f purgative-Cont. far -42-

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Qct. 2nd. Convelescent -belly easy and quiet Complains merely of debility Rx. quinoidin grs iii morning and evening -Discharged to duty. CASE 67. Hong Kong July 5th 1856. B. F. Isherwood Chf. 35 -New York. Dysenteria Was upon the list a few days during last month with a slight attack of this disease -except which, he has enjoyed excellent health since the ship has been out -Although he suffered very severely from the disease during a cruise in the West Indies some three or four years ago. Complains no w of severe pain across bellyStools are frequent, copious, fluid and mixed with blood Tongue quite covered with a long, dirtywhi re fur -Considerable febrile exciteiiEnt, thirst great. Has been very imprudent in his diet s i nce last attack Rx. Hydr: Chld: Nitr: gr iii Pulv: Dover: gra V every sixth hour-Diet farinaceous, and drink -Gum water or cold tea. 7th. Is better Bowels quiet -no pain -pulse rather weak end soft -Discontinue mercury -Cont. strict diet and rest -To have a small quantity o f Port wine daily, if he can bear it. 8th.!. Convelescing Cont. Diet Re -13th. Had improved much, and was out, but has probably been imprudent-Two or three very copious and painful stools within last few hours. To have Rx. Bismuth: Sub. Nitr: gra iii, Pulv: Opii grss. morning and evening. 15th. Becoming worse -large fluid evacuations have continued steadily, and have prostrated him much. Pulse is small, quick and hard. Skin dry and he.rsh Tongue with bJ.own fUr edges of an angry red Frequent. nausea and vomits occasionally. To have a large s i napism over epigastr, and internally Hopis Nitric Acid Mixture Z i every three hours -No nutriment or drink except rice water in small quantities at a time -During the night he g rew woxse -frequency of stools increasing, and other symptoms remai'ning sruw enemata of starch and Laudanum were administered after each stool and Rx. acid: Sulph:Aroll18. t: gttx. <'lixir: opii zss -repeated if necessary. 16th. Is quiet this morning and easy Cont. above every six hours, P. R N. and enemata after stools i f frequent or painful Diet Rice gruel -The next day was v ery much better, but, 19th. Not so well -Two or three very copious stools in last twenty four hours, with tormina a nd tenesmus Tongue coated with a long dirty brown fUr. Rx. Acid:Sulph:Arom: gtt lX. Tr. Pinchon; Comp:Aq:Camph: aa Zii -m. Dose Zssa thrice daily -To have a -49-

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blister (5x6) over abdomen dressed with Cerat. Resin. -Cont. J Enemata, pr.n. -21st. Less uneasiness about rectum, and tongue is clearing Cont. Treat.22nd. Improving Recomnl3nded a change of air, and left the ship last even ,ing (she is in dock) for that purpose T o go to Macao, where there is sea air and a cooler temperature August 11th. Joined ship at Hong Kong again today -Has continued much the same during his absence From two, to three or four, painful and copious stools every twenty four hours -Is quite emaciatedappears impossible to curb his appetite within the bounds of a proper diet; either in quantity or quality. Has been upon a moderate use of Port wine or ale with his food. 13th. Complains of being more unwel l than usual -Rx. Acid: Sulph: Aromat: Zss, Liq: M orph: Zii aq: Camphor: ziij -Dose Zss thrice daily. 14th. Same-Cont. internal treatment, and have lin: ol: Tigle: rubbed over descending colon until an eruption results. l?th. Same Cont: treat: and to have vin. Rubr : zii daily. 19th. Is no better Pains in abdomen more acute and constant, and three or four discharges in the twenty four hou.rs Same character as formerly described. Tongue always covered with the same long, dirty brown, fur Skin dry and harsh to the touch. Rx. Argent: Nitr: Crystl: gr ,i thrice daily in pill-The use of Tart. emetic ointment to be substituted for Lin: ol: Tigl: which had no effect. 22nd. Same -To have an opium suppository when invitation of funda.ment is great Cant: other treat: Sept. 3rd. M uch the same -Is obliged to 20 or 30 drops tr: opii: every night to obtain rest Has been carefully dieting-food principally farinaceous, with a small portion of light animal nutriment. Discontinue Argenta: Ni tr: Tongue retains long brown fur in center, but edges have become raw. Skin still very harsh and inactiveRx. Rhumb: acet: grs Ij, Pulv: op: grss thrice daily -Tr. op: p.r.n. Lin: Terebinth; over abdoroon. 4th. Rather better Oont. Treat: 15th. Is improving greatly Not more than one stool in twenty fOUr hours more consistant -no pain Tongue clear Skin assuming a healthier appearance Weathe r is cool and drz Continue Lead and Opium once daily -50-

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18th. Improving rapidly Cont. friction alone 30th. Has a huge appetite, which he appears to gratify with impunityOct. 5th. Discharged to duty. He had a relapse a month or two after this, and was on shore at Hong Kong from the middle of November until January '57 -Returned on board quite well and in good flesh Remained well--Suffered with occasional relapses until we were west of the Cape of Good Hope, upon our return home, since which time the disease has entirely left him. Nov. 1856. Upon the third of this month we left Woosung, for Hong Kong, our sick list at this time was small, and the health of the ships company good. Arriving at Hong Kong upon the 8th, we remained there only long enough to fill up the coals and other stores; ran over to Maca o and anchored for some three or four hours, and proceeded thence to Whampoa, where we arrived on the morning of the 12 inst. While at Hong Kong, one of our -riremen, a stout robust man of some thirty o:r age, was found in his hammock, a short time after having come off watch in the fire room, in a state of insensability: breathing slow and labored, and pulsations of heart and arteries scarcely perceptible. Nothing that we were able to make use of had any effect, and he expired in a couple of hours. He had complained more than once within the last few months, o f oppression and pain in his left side, I cannot but regret that in this, as in several other cases which occurred subsequently, it was not convenient to make a post mortem examination. There are many serious obstacles to conducting autopsies on board a crowded ship, especially when of such a character as those required for diseases of the alimentary canal. This reason did not apply so much in the particular case we had at this time, but we were kept in a continuous bustle and hurry in consequence of the Commo dore's desire to @St up the Canton River as soon as possible. During the remainder o f November the ship remained at Whampoa, although a majority o:f' the officers and men were at the Barrier Forts during the latter half of the month. At t his place they were exposed, as well to all the vicissitudes of weather, as to excitement, irregularities and excesses both of mind and body The weather during this period, proved delightful, and ren dered the consequences of such exposure much less serious than might have occurred und e r less favorable circumstances. {e h.l;!.d one case of Typhoid Fever which proved fatal. The man from his own account, had suffered from a severe attack of Chagres fever some two o r three years previously, and had never -51-

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thoroughly regained his former health. Our sick list was small, except at the close of the month, when, from the causes above stated, it was considerably increased. Catarrhs, Dysentery and Rheumatism-upon the morning of th9 16 inst, .rl;dward Mullen, coxwain of the 4th cutter, was killed by a J;all from one of the Barrier Forts. His head and one arm were entirely torn off -He was heaving a lead in the bows of the boat when struck. Upon the 2lat, Je.ID9s Hoagland, Carpenter's Mate, was killed by a shot from one of the Forts, whilst rowing asho:re in the Launch The ball, a thirty two poundsr, passing antero posterior ly through the e.bdamen. Wm. IfJS.c Rin, Seaman, was killed by the same shot; the ball tearing off the posterior portion of the pelois, and expos ing the contents of the abdomen -He lived for half an hour Alfred 'l'urner, O oxwain, had his left thigh torn o1'f by the same shot. He expired a couple of hoUTS afterwards, be-fore he could be operated upon. The cause of death appeared to be nervous shock. The loss of blood was slight, as a tourni-quet was applied almost imrre:diately. There were also sane six or seven men and boys wounded at the Se.liE time: all by splinters, and but slightly. We had two severe cases of burns in consequence of the premature explosion of a gun in one of the forts. These did well however. CASE Shangnae, Oct. 18th, 1856. James McGreevy Seaman -Aetat 34 -Ireland. Dysenteria Complains of feeling hot and dry, with frequent disposition to g o to stoo l -passes very little -Rx.Pulv: Dover: grs V. Hydr: Chld: Mit: grss every third hour -Diet bread and tea or rice vrink cold tea. 19th. Pulse is full, hard and 90 Skin dry-Tongue brownish a nd slimy, with a mercurial odor, Complains of griping and straining at stool -evacuations are frequent, small, and principally blood and mucus, Dover : Powder: grs Vi. e v ery third hour, Diet arrowroot or rice and drink same -In the evening, the symptoms becoming rather aggravatedm and discharges m ore frequent, a large sinap ism was applied over abdoiD9n, and p owders of Plumbi acet: grs IJ, op: Pub : grss every two hours, substituted for the Dover and also a suppository of opium grsis to allay invi ta-t ion about fundament. -2oth. Rather easier Cont p owders and diet -21st. Is much better -Free of fever, and bowels quiet, Mouth -52-

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sore from mercury Cont. diet, end h ave mouth wash for mouth, of Brandy, C reosote and water -vid. pres. 22nd. Continued comfortable until this morning, w hen there was some pain in abdomen again, and t w o o r thre e dark bilious stoolsRx. Pulv:op: grs iii, Ipecac. grs. Viii m. div. in cheul. no Vl one every second hour-Diet same Improved, bu t 24th. Again complained of pain in belly, an d had several small evacuations, foecal matter and mucus no fever. ol: Ricin: Zss. Tr: op: gtt XXV Powders o p ium and Ipecac to be continued after this acts Diet Mutton or chicken broth, with e ggs, toast and tea. 26th. Improving T ongue almost clean no fever no pain -Three or four loose evacuations in twenty four hours Rx. Morph: Zss., Acid: Sulph:Aromat:gtt Viii, Camp h: Ziss thrice daily Convalesced rapidly from this, time and, November 2nd. Was discharged to duty S'han gh ae 0 c to ber 212 1 8 56. John LearingOrdin. S eam, Aet 24-Born United States -Febris Typhoides -Reported yesterday complaining of "feeling badlY' without an y decided symptom.s except a slight febtile excitement-was ordered Ether: Nitr:aa Z i every two hours -This morning has some what more fever tongue furred and bowels torpid -Rx. Hydr: Chld: 1lit:grs V Pulv: Jalap: grs Viii, and Quin: Sulph: grs V thrice as soon as purgative has acted. 22nd. Medicine acted but slightly Complains of pain in his abdomen -fever about same Rx. Blue mass: grs X and a Seidlitz Powder tomorrow morning -Is not confined to his ha.rrnnock Diet farinaceous, although there is no appetite -25th. The Calomel and jalap again r e p eated t his morning, as his bowels have been but partially cle aned out -26th. Is decidedly worse Pulse is 90 Skin harsh and dry Pains in forehead and spine -Brain dull -urine hig h colored and scanty end complains of inability to r etai n it Tongue brownish with edges dark red-Bowels rather loose -Rx.Pill:Hydr:grs X at once Lemonade ad lib -In the evening Pulv: Rhei grs Xii: Magnes: Zii Next mornin g pulse being slo wer an d softer with cutaneous surface, was ordered Quin:grs IV ev ery three hours-31st Again an exerbation of symptoms -more obtuseness of intellect -Pulse small and Skin dry and harsh, Rx. Potass: ,Citr: Zss, Pulv: Rhei grs V every t w o hours --53-

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Nov. 1st. There is a decided pain in right hypoehondr: ag gravat ed upon pressure Other symptoms much the same A pply a blister over right side of abdomen, and cont. Q.uin. and neutral mixture combined every third hour. lOth. Has continued much in the same condition -Last two or three days has some diarrhoea; for which he was ordered Rhumb; Acet: grs II, opii grss every third hour p.r.n. 11th. Skin is hot and dry -Pulse 95 and small Complains of pain in head, and mind is wandering, except when attention is roused. Some subsultus tenderness Some bleeding from the nose Rx.Sprt: vin: Gall: zii, in an ounce of water every hours Rx uampho;r_:Dl" Tr: Myrr!}: gtt xx:, Liq: Morph: Ziij, Gum: alae: Sacch: aa Zii., Aq: Z ii -Ft. Emulsio Dose Zss every thi I'd hour. -12th. Passed a very restless night D elirium more violent Subsultus greater Tongue raw, red and Cont. emulsion of Camphor, adding ol: Terebinth, gtt X to each dose -increase the quantity of Brandy by one third. 13th. Worse -Low muttering delirium though sensible for the moment when aroused Tongue is drier -Characteristic eruption is apparant over abdomen Was ordered a purgative enema last night Cont. Emulsion, adding : M c Munn's Elixir gtt XV to each dose Brandy and wine whey -14th. Blisters were applied to of legs last night Slept at intervals through night -Is still delirious, though more rational when attention is roused Pulse 110 to 115 and more thready A little moisture about skin, though tongu e and mouth are very dry and dark red -Thirst constan t Brandy Zss every t w o hours, and continue other treatment -Beef tea Body to be frequently sponged with hot water and alcohol -16th. Skin is moist and there is more softness of pulse 110 -Is sleeping quietly Tongue dry and blackish There being some symptoms of pectoral con gestion, a blister was ap plied, and has been dressed During this day there was s o much Epistaxis as to reQuire the anterior naves to be plugged with lint soaked in a saturated solution o f alum -l?th. Skin more natural Pulse not so re. pid -abdomen hot and much pain u p on pressure ov e r colon more diarrhoea -other symptoms same Cont. all treat.-18th. Pulse very small and quick -not able to protrude his Complains of oppression in chest, abdomen tympanitic -Blisters indisposed to heal Still passes his urin well .-Stimu lants and 01. Terebinth : with chicken or beef t e a all continued -54--

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19th. Is in almost a comatose state Slips down in his bed Tongue covered with a dry brown Has been heaving through night, Camphor. grs IIJ, Animon: Carle: grs IJ every hour with brandy & Rx. 01: Terebinth:, Bals: Copaib: aa Zss Dose gtt X every two hours. Bed sores came on -with colliquative sweats -insensibility and, Nov. 21st. Died about llo'c P.M. CASE ?0. Shanghae, October 13th, 1856. Thomas McClusky -o. Seam Aetat 20 -Born Ireland Syphilitic Rheumatism Was under treati!l3nt in J"uly last for Gonorrhoea-the attack was a mild one, and be recovered in a couple of weeks-In.the latter part of August he reported with a small chancre. A bubo was the consequence -This supperated and was lancedHe was treated mercury to slight salivation, and recovered in a month Complains now of pains in arms and legs, moxe especially about the ankles, which are stiff and swollen, Aggrava tion of symptoms at night -Rx.Liq: Iodin: Camp: gtt Vi ter in die -27th. Continue s in much the same state. Ankles are especially stiff and weak, and moves about with difficultyCont. Iodine as before, and to use hot salt foot bath nightly -31st. Complains of a constant soreness, with gnawin g pains, in tibias -Ankles are in the same state; and there is some pain in the side-Discontinue former treatment, and Rx, Tr: Ammon: Zss ter in die Nov. 1st. Swelling now extends up both legs along tibias Com bine Liq: Ten: gtt Vi with each dose of Ginniao. 5th. Remains much the same complaining more particularly of pain the insertion of the tendo Achillis Rx. Potass: Iodid: grs Viij thrice daily, and use Liniment. ?th. Is improving Continue treatment lOth. Better Reduce the dose of Potass: Iodid, by three grains, as there is a papulous eruption upon skin, probably Iodon ism 16th Discharged to duty Note! This case, as well as several others of the same char acter, resisted all remedies, so long as we were at Shangae, but recovered rapidly, as soon as we came down the coast. -55-

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PASE 71. At Sea. Sept. 9th, 1856. Thomas Gilmore -o. Seam -Aetat. 23 -Ireland Syphilis Was received upon the List, Aug. 6th, with a small chancre upon prepuce, and a purulent discharge from the urethraThe sore healed with local treatment alone, and the discharge, under the employment of mild purgatives and Mistru: Copaib: diminished; and, upon the 20th, he to duty with merely a slight gluty discharge which gave little inconvenience. Today he returns, complaining that the discharge has become copious, and purulent. Prepuce is much swollen inflamed, and a lymphatic in either groin is indurated and sore. An in jection of X to ounce of water was ordered, but owing to the inflamed Of the parts. lOth. 1listura Copaibo Zss thrice daily ordered insteado 13th. Last evening had a slight Epileptic Convulsion: two or three of which he has had within the last twelve months Complains that urethra. is very sore, and prepuce greatly swollen .. Apply Leeches no XX to preneoum(?) Penis to be kept wrapped in lint wetted with Lead Lotion -Rx. Antimon et Potass: Tart. gr 1/8 every two hours until it vomits Remain strictly in hammock. 15th. Thinks that he is rather better Rx. Sprt. Ether: Nitros: Zss evei"J fourth hour during day, and continue local treatment. 18th. Soreness and swelling of prepuce has very much diminished, but the discharge, with ardor urinal ect, still remains the same. Rx. Pulv: Rino Zi. Zinc: Sulph: grs X: Morph; Sulph: gri Adep: Zss-m -To be carefully introduced into the urethra upon a small sized bougie smeared with it, twice daily. 20th. Reports the pain and discharge from urethra is very much lessened. Bubo in left groin enlarging: Apply Ung: Iodin: and cont. medica ted bougie. 29th. Gonorrhoeal discharge has entirely stopp ed There still remains some ardor urinae, and the stream does not i'low so freely as is natura1. Complains of soreness and neuralgic pains about the scalp. Rx. Liq: Morph. Zi. Chloroform gtt iv, and repeat once or twice p.r.n. 30th. Last night was not able to sleep from severity of pain in scalp. Apply a blister to nape of neck, and dress with Basilicon -Cont.Morphia and Chloroform. -56-

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Oct. 2nd Pain was relieved but has returned -appears of an intermittent character Keep blister open, and in evening before hour o f return of pain, Rx. S u1pho grs IV. Oct. 5th. No relief was obtained from Rx. Liq. Morph. Zi, Chloroform gtt Viii at seven o'c P M 6th. M uch better -7th. Reapply blister, and repeat Morphia ect -8th. Same -Appl y 12 leeches to f orehead and keep blister open -12th. Pain in head has almost entirely disappeare d Some days since, a crop of pimples made their appearance over the body These have now increased, and have a coppery hue -Rx. Potass. Iodid. grs V thrice daily -13th. Eruption has become v ery general Cont Treatment. 15th. Intermittent pains in head are entirely relieved. Cont. Potass. Iod. -19th. Discolorations of surface disappearing and small tubercles, size of a split pea, showing thems elves There is some contraction o f urethral passage, and a slight gluty discharge has its appearance. Cont Potass. Iodid., and introduce a "no vi Bougie" daily 22nd. nearly gone -no discharge from urethra Continue all treatment. 30th. Still improving Cont treat. N ovember lst. Complains of pains in tibias, especially after night sets in-Increase dose of Potass. Iod. by one g -rain. 4th. There is no amelioration of painsRx. Tr. Capsic., Tr Camph. equal parts-Use as a liniment, and cont. internal treatments. 13th. Feels pretty well, and is discharg ed to duty. ----This man continues to suffer from frequent attacks of and the intervals between the epileptic convulsions g rew l ess. S o that, as may be seen in the record of that month in March 1857 he was cond emned by Medical SUrvey, and sent to the United States. In the record for December of this year, a farthe r history o f this case, especially as regards the epilepsy, will be found. -5?-

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DJJ;CEMBER 1856. We had, during this month, an almost uninterrupted succession of beautiful days. The atmosphere pure, and cool enough to be quite bracing. Our health, under these circumstances, would have been excellent, had it not been for the unusual exposure to which most of our officers and men were subjected not only in the operation of the Forts, but also in doing boat service at nights. Catarrhs and B owel affections presented themselves in considerable numbers, as well as several cases of Fever: the latter, however, quite managable. Dec. 4th. s P Kook died of acute dysentery, after an illness of s cme five or six weeks. He did not belong to the service, and had been taken on board the "Portsmouth" as an act of charity. When the latter went up to the Barriers, he was transferred to the nsan Jacinto,n being at that tine in a very low condition. Upon the same day, Joseph Gibbings, a Bos'n's Mate whilst assisting in blowing up the Forts; was instantly killed by the premature explosion of a mine. Two other men were killed, and several wounded, by the same catastrophe: They, however, belonged to the ships of the squadron. Upon Christmas morning we left Whampo a for Hong Kong, and arrived at the latter place early the next day. Three men were condemned by Medical Survey upon the 29th, and all of them recommended to be sent home. One, Andrew Hudson Seaman, was an old man who had been complaining most of the cruise, suffering with incontinence urine and senile debility. The second, John Purcele, was condemned as being affected with chronic dysentery he had been suffering with the disease since July last, and was a young men of little constitutional stamina, having been frequently under our medical care previous to that t Had suffered more o r less constantly from spermatorrhoea. The third, Thomas Gilmore, Seaman, was a case of epilepsy. He first had a convulsion in the early part of June last, and has had three or four, with progressively decreasing intervals, since. CASE ?2. Whampoa, December 1st, 1856. James Me Grath Marine -Ae tat 31 Ireland. Fractura Cost:-Sent down from Forts yest'day complained Of a sharp pain in right side of chest, in a circumscribed spot over bend or seventh rib -Respiration short and diaphragmatic Has a slight hacking cough. Reports that while getting over the -58-

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J3hip' s side into one of the boats; in one of assaul.ting parties* he fell, striking the boat upon this part. Was ordered a bandage Arm in a sling Rest Liq. Morph. zr p.r.n. Dec. 7th. Discharged to duty. CASE 73. Whampoa, Dec. 4th, 1856. Jno. Gart -Fireman, Aetat 27 -New York Dysenteria-Reported last evening with frequent small and painful stools-tongue furred and considerable febrile excitement -was ordered Rx.Hydr.Chld. Mit grs Viii, and four hours after 01. Ricin. Zss. tr. Opii gtts XX -is easier this morning -but has had no natural stool Small, slimy evacuations continue -Repeat oil & Laud. Statim. 5th. M uch better no fever -Belly easy Tongre clearing -Rx. Q.uin. Sulph. grs. lV, Liq. Morph. Z i every fourth hour during the day Dec. 7th. Discharged to duty. CASE ?4. W hampoa, December 7th, 1856. J. w M arbJe s -Fireman Aetat 23 Ohio -Icterus Has been complaining for some days of feeling unwell Want of appetite -indigestion -Fullness and pains in abdomeneyes suffused, and yellow Rx. Blue grs. Viii-repeat in evening adding Quinia grs iii -(?) 8th. Same Cont. Treat. Feels better Skin and Sclerotic have assumed a darker yellow hue, no nausea now_ urine is very weak Rx. Hydr. Chld. Mix. g r t every second hour -11th.. Is improvingCont treat -14th. Not much change since last date Rx. Tarax. ext. Z i (?) in solution thrice daily -16th. Has improved, though there is still some jaundice hue, as wel l as tendency to dyspeptic symptoms Blue Mass grs V at bedtime and cont. Ext. Tarax. 59-

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day was ordered Quinia grs ii twice daily, and, Dec 20th. Discharged to duty. CASE '75. V lhampoa, Nov 25th, 18 56 Thomas Robinson -o. Seaman 23 Contusio One of the men who was in the launch, when she was struck by the round shot upon the 21st inst. P..e appeared to have been injured by a splinter; which striking him across the thighs and over the pubis, produced a severe contusion of these parts, causing besides greats ozeness and irritation of the bladder and of both testicles These latter are much swollen and exceedingly tender, preventing him from walking at all. Tartar Emetic and Liq. Potass. Ci trar. in doses re'peated so as to produce nausea and decided reduction of vascular action Lead Lotion locally -absolute rest and low diet were ordered. After a few days he had improved so as to be able to walk withou t pain, though there remaired enlargement and induration of testicles Ung. Iod. Dilut. was ordered December 15th. Discharged to duty. CASE '76. Whampoa, November 22nd, 185 6 Alexander Mcintosh-c Fore C'stle. Ambustio Was brought down from Forts yst'dy severely burned, in of the premature explosion of a gun which he was assisting to fire-Both hands and,forearms were very severely injured, and his face considerably scorched -the eyes have suffered especially-The parts were dressed with soft lint saturated with a mixture of Linseed oil and Lime water. Nov. 23rd. Last evening had quite a severe chill, was ordered Rx. T. op. gtts XXX and Sprt. vin. Gall. ZI. Pulse is now rapid and hard Burns very painful and inflamed. Continue opiate as needed and dressings to burns Some congestion of the lungs occurred, and cups were o:rdered tn side -with oil Ricin. Z i 27th. Burns of face have almost healed, being superficial -but those upon forearms are supperating Apply poultices and Rx. Quinia grs iii twice daily grs ii 30th. Dress ulcers upon arms with Hydr. Ung. 01. Rubr. D e cember 16th. Ulcers have all healed, except one or two small points. -60-

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: . 25th. Discharged to Duty Some tendency to muscular contraction, will yield to exercise of parts. CASE 77. Vfuampoa, December lOth. 1856. JOseph FoTler. Seam -Aetat 27 -New York Subluxatio and Contusion -This morning, whilst ascending the flagstaff of the Consul at Canton, for the purpose of rearranging the halliards, he fell to the ground i'rom a height of some t :b.irty five teet, lighting upon his feet, Was somewhat under the influence of drink at the time, which accounts for his falling. He complains of great soreness and pain about left sacioiliac junction and in thigh of same side which h e cannot move, and keeps partially drawn over other limb. Can neither stand or sito All the motions o.f the hip joint are, h owever, perfect. Rx Elixir Opii gtts lX zepeated as needed to procure rest -Low diet. Dec. 15th. Is becoming much mo:re comfortable C an lie in certain positions now without pain, Opiates are no longer needed -He proved rapidly, and was soon moving about upon a crutch, with a Burgundy plaster across loins Jan. 3rd. Discharged to light duty. CASE 78. Thomas Gilmore -Aetat 24 -Ireland This was a man of rather below the medium stature, Stout and hardy, apparently, at the commencement of the cruise, a quiet man and industrious enough. Drank when he had an oppor tunity to do so. In June or July of 1 856 was called to see him in tta fit Found him lying upon deck, having fallen from his hammock, .with well symptoms of an epiliptic convulsion. Insensible -eyeballs set, and pupils contracted-breathing heavy foaming at the mouth -etc. He recovered after a few moments, complained of giddiness and headache, with soreness of the muscles, for a day or two, and then appeared quite well. Denied ever having had a similar attack before this one no cause discovered -He had a second attack in some two or three months from the time of the one above mentioned; and perhaps as many as three more, until the time at which he was removed from the.shipvarious remedial means were tried, without any beneficial result. Cups and leeches to the spine and head; blisters and other counter-irritants; internally Potass; Iod. and nitrate of Silve the latter he took :for two months before leaving the "S J 0 tr,,. d t 0 d 1 an ac 1n o an con 1nue t, I believe, after he was transferred to the "Levant"--61-

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Towards the latter of the tiroo, his eyes had a pecular s _tare about them, and he complained of more or less headache and vertigo alroost constantly. He also had more than a singLe fit when the attack came on. Dec. 27th. 1856. A Medical SUrvey was called upon the case and he was condemned as unfit for the Service, and recommended to be sent to the United States and discharged. I have omitted to mention that, subsequent to the first attack of epilepsy, he contracted a combined Syphilis and G onnorhoea -the latter held on as a gluty discharge for a long while -H e had constitutional syphilis, with sore throat, eruption, etc. In the early of March he was transferred to the "Levant, conveyed to and thence sent to the United States, with a number of other invalids; in a merchant vessel -llfhether there was any return o f t he epilepsy after he left the ttSan Jacinto,'t I do not kno w In April of 1858, the Clipper ship "Benefactor arrived at H ong Kong from New York, and my patient (quondam) came aboard of us to see his 'old friends. Persons who c an13 out in the 11Benefactor't informed me he was a hard working man, and had enjoyed g ood health during the voyage. I did not have an opportunity of seeing him myself. I do not think he was a malingerer.(?) CASE 79. Whampoa, Nov. 28th, 1856. Thos. Thompson. Qr. Aet 52 New York. Dysenteria Sent down from Forts -last afternoon, complaining of nausea -tormina and tenesmus Stools small and frequent and mixed with mucus Heada che and slight fever. Was ordered at once Rx. 01. Ricin. Zi Tr. op. gtt XX. This has acted, and he feels easier -still some fever -Rx Quin. grs Hi Liq. l1orph. Zievery fourth hour -Diet Simple Dover -grs X hor. Som. 29th. Rested comfortably, but does not feel so well t his orning. Pulse quick and hard Dizzy Nausea and chilliness -Thinks he has had a chill for three sucessive morning -Cont. Quinia and Liq. Morphia three times daily, and at six :. tomorrow Quini grs Vl 30th, Convelescent, Continue tonic. Dec. lst. Discharged to Duty. CASE so. Whampoa, Nov. 29th, 1856. A. J. Gilmore Corp: Marine 22. -New Hamps hire. Dysenterra Sent down from Forts yesterday, complaining of -62-

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tormina and tenesmu s -frequent t hin stools nausea etc. much general d ebility WE.S ordered ol: Ricin l i o pii gtts :XX at onc e This has acted, and he f e els easi e r since -Rx. acid: Sulph . rom. gtts VIII. Tr. Opii g t t s X Qui n : oulph. grsii, Aq. Camph., .Aq. S impl. aa i e v e r y t hird hour. Diet f arinaceou s 30th. Same Cont. treat. Dec. 1st. Being no bette r last a f t ernoo n 'iTes ordered, R x opn Pul v grss. Ipecac. griss e v e r y se c ond hour. He still r emains with f r equent mucoid ev cuations, fUl r e d t o n gue a n d some fever, Rx Blue I,';ass. grs IV Quinn ..:>ulph. grs IV e v e r y f o urth h our. C o n t uiet. 2nd. Continue Blu e l uass t. Q,uinni a t:b.ro ugh t : is __ orning -and then r e surne t he m i xtin of _.:..rom .:>ulp h t.cid. 4th. :ras u c h bet r e r :i.::ed. c on t inued only thre e times snd ecem b e r 5th. Discharge d to Duty c I!; 81. i, harnpoa, Kov. 29 t h1 1 8ve. Charles T h o mpson 23 Boston. Diarrhoe a C&ae d ovm from Forts complai ning of great pain in a b d omen \7i th freq_uent small stool s Tongue coated Pulse full and q_uick s k i n hot i'Tr.. s orde r e d last evening Blue M a s s grs VI o pii Fulv. g ri. I s rathe r easier n on -Rx. Cal. g r 1/3 o p ; I p e c a c., aa rss. e v ery second hour' i e t farina c eous. 30th. H a s i m proved -stools are l e s s frequent have a more consistent and bilious cha r acte r Cont. all trea t Dec 2nd. a whitis h cha r e c t er, Op. gri I s not s o Tiell h a s r :ore pain and frequent sto ols -tongue Disease s e e m s t o hav e a s sum3d an intermittent thoug h th. re is n o f ever now. x Q.uin. grs iii, q_uaq. q_uat. h r he i m rroved rap i d l y en e c 5th ..as d ischar g e d t o uty. CAS:Z 8 2 V 1 ham poa, 1Jo v 2 th 1 8 56 Bartlett G i b ney, Hea v -26 -I r e l and DysenteriaCame d o w n f rom I1' o r t s ves'd' comp l ain ing of. violent torm i n a a nd str ini n g a t stool f r eq_uentl 1ithout e f ectin n u c h more t han a li ttlo b l o o d J slime Tongue is furr e d t irst greatsome febri l e v XCi t etHent -Rx. 1. Ricini l ..... iss Tr. pii; gtts :cv s t atim. 3 0 t h I s no be tter tene s m u s v ery annoying s t o l s frequent a11d s all tongu a mor e furred and feve r persists Rx. Ca l c,r 1/3 opii; I a c a c a a grss a v r y two D i e t farinaceous -63-

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lst. Still no improvement in any of symptoms -Rx. Caloll)3l grs IV, Dover grs V -In four hours, Rx.Ol, Ricin Zss Tr. Opii V-2nd. Has no fever -Stool s are less painful and frequent and of a bilious character -Rx. Dover. grs V Quin. Sulph. grs iii every fourth hour. 3rd. Last afternoon, whilst exposed by sleeping upon deck, had a violent chill -Febrile reaction was considerable, and all of the dysenteric sym toms were aggravated Was ordered Dover grs Xll-This mornin g is free of fever and feels much better again-Cont. former treatlll3nt every fourth hour. Dec. 5th. Was convalescent yesterday-but has had a slight attack of diarrhoea during night-Easy now-Cont. Dover & Combining Opium grs i with each dose, if returns. Dec. 6th. Discharged to Duty -J A.."NUARY, 185'1. With the exception of a couple of trips of a few hours each, one around the Island of H ong Kong, and the other to Macao and back, our ship was at anchor in the harbor of Hong K ong during this entire month. The pleasant temperature, blue skies and pure of the last month continued throughout t his The accession to our sick List were confined principally to those who were suffering from the consequence exposure during D e cember; or of such as were subjected to a continuance of the same causes of disease; for our boats were nightly employed in rowing guard about the harbor-We gave "Liberty" at the commencemmt of the month, and, of course had our usual number of contributions in the way of contusions and venereal affections, One or two of our most serious old cases were sent to a hospital which had been temporarily established in Hong Kong for the purpose of xelieving the ships of the squadron of same of the sick and wounded consequent upon our operations in the Canton River. About the middle of the month, an in tense excitement was created by an atterapt upon the rart of the Chinese, to destroy the foreign population of Hong Kong, by mixing a poison with the fresh bread. Most fortunately for us, our ship patronized another bakery than t h e one through which the mischief was done, and we therefore, entirely escaped-The ''Levant" was more unlucky, and had several of her officers and c r ew, attacked with the pecu lar symptoms, and of the patients at the hos pital; there were several very seriously ill from this cause. The symptoms made their appearance in upon thirty minutes to two hours, after having eaten the bread Cramps in stomach and limbs -nausea and vomiting, sometimes to an extreme degree-purging, though less frequently -thirstredness of tongue and fauces-eyes blood shot-intense cephalagia anxiety and nervous tremors. The stomach recovered its tone very slowly, and in some instances remained in an enfeebled condition for months after. Although hundreds were affected with these symptoms, I heard of but one death immed iately consequent upon the ingestion of the poison:several have had their organs p ermanently impaired, however not only from the result of analysis made immediately after the occurrence of the poisoni a but from the careful application of the most delicate tests made, Arsenio in some form seems to have been th b t e su s ance employed, -64-

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qASE 83. December 22nd. 1856. Jno. Brown -O' seaman -Aet. 24 -Ireland -Vertigo -This man has been upon the "list'9 several times since last June, when he was laid up with a serious attack of Insolatio, for "giddiness, and pain in his head''. At first 1 t was only occasionally that he suffered, but of late the trouble has become more or less constant, and much aggravated upon any exertion of body or excitement of mind -carries the head stiffly as though he were fearful of moving it in any direction. There is not much positive pain -principally a giddiness and "roaring" in the head -Pulse 65, and rather wanting in fullness. Skin cool Some diarrhoea occasionallyIs a quiet, industrious man, not addicted to any known bad habits, and bears a good character on board ship. He sometimes complains of' dyspeptic symptoms, these may have been owing to the medicines given, or to the inactive life below decks which the condition of his brain required him to leadfor anything which acted forcibly upon the external senses, aggravated the affection -various remedies were tried at different times, but without any good results Tbnics, as QUaasio, preparation of iron, etc -Alteratives, as Iodide Potass., mercury in minute doses etc. -narcotics, as opium and veratria, nervous stimulants and anti spasmodica, as Hoffman's anodyne, assafoetida -Revulsivea and counter irritations, with pergatives, blisters, repeatedly applied to the temples and nape of neck, and a seson at one time in the arm -This cnndi tion continuing to grow worse, so that he was entirely incapacitated from doing anything, a Medical Survey was held upon him in December, and he was condemned as untit for service -Jan. 13th. Was transferred to the Hospital on shore and in the early part of March he was placed on board the "Levant" with a number of other invalids to be conveyed to Manila and thence to the United states. He suf'f'ered from an attack of Small Pox upon the voyage, but reached the states after some months. Whether improved in his condition I do not know, FEBRUARY, 1857. Except an absence of some seventy four hours to Macao, we passed this month, like the preceeding, at anchor in the harbor of Hong Kong. Although not so uniformly fine as during the month of January, the weather was still agreeable, and during the greater portion of the time, free from clouds and dampness. Our ship was healthy; the number of admissions to the 1ist few, and of various diseases. Perhaps a large number of cases of Intermittent recidivations of former attacks, than any other. An opportunity presented itself at this time for sending Invalids -65-

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hoir, and it v1as made available, not only for those who had been con demned in December but for some three or four a dditional cases of chi'Ol.'t disease. One of these, Lieut. s . Carte r 1 1as condemned as having chronic D ysentery, which would probably p ersist as long as he rema ined subjected to the clirnatic influences of the India Station: he also a strong proclivity to phthisis. Jno. H oward Seaman was cond emned for "secondary s yphilis" a ffection ap peared to be principally of the nervous centre s : insomnia, and often most excruciating pains in t h e head sometimes evan affecting the mind ; and resisting obstinately, all that was tried for his relief. He had be e n affected nith primary syphilis som e months before. Jno. Brown was condemned for chronic affection of the nervous centres, with p ains, vertigo and partial paralysis: the cause, in this instance, was a coup de soleil;.received in the Harbor o f Hong Kong J.n June lest. He was employed at the time rowing a boat in the hot sun, without awning CASE 84. January 26th, 185 7 Jno. R owe -c of F Castle Aet 40 =ngland -A robust man who has enjoyed excellent health, excep t the present affliction, wi t h w h i ch he has reported onc e or twice before -complains of pain and soreness in the left half of scalp becoming more towards night -There is no swelling o r discolor tion of the integuments oYa r the parts, nor is the pain a ggravated by The left eye is quite congested, and irritated b y a strong light -Thinks that h i s first a t tack was brought o n by exposure t he 1. 0 operation e t the Barrier Forts. Morph S ulph. gJ.' repeated in three hours, was ordered 27th. Being rather worse t han bette r a small blister was o .:rdere d to be applied to the templ e and dressed with an ointment consisting o f Morph Sulph. gr i to Z i and Q,uin. Sulph. grs. IV repeated two or three times daily, during the mornings at which period of the twenty four h ours he suffers least. This treatment persevered in for a few d a ys, combined with the avoidance of work and exci telll8nt afforded relief an d February 5th, He was discharged t o Duty CASE 85 January 20t h 1 85? Nicholas Dillon C Heaver -Aet 24 Ireland Syphilis -Reported with three chancres one upon the froenum and t he other s upon the inner fold of the prepuce. Has had them several days and has been treating them himself wi t h a solution of Sulphate of C opperThey and d o not appear unhealthy-Rx. Pill Hydr grs IVm, Pulv. Opll grss morning and evenin g Dress sores with Bl k Wash -ac 66-

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23rd. Mouth a little tender -Ulcers not improved -discontinue mer CurialApply .Argent Nitr. fus. to ulcers and dress with Black ;ashThe psyalism becarr:e severe, so that the usual wash of Creosote, Brandy and water, was oxderedThe sores did not alter for the better, however, and seemed rather disposed to enlarge -Feb. 6th. Has quite recovered from effects of mercurial, end disease showing no tendency to improvement, was ordered Rx. Hydr, Chld., Corros. g r 1/16 ter in die -after meals Fox.mer treatment, varied with Ung. Hydr 01. Rubr to ulcers -9th. Ulcers have rather increased in size, s howing no disposition to heal -Discontinue mercury Rx. Liq. Iod. Comp gtts X twice daily -Cauterize ulcers with Argent N i tr. Fus and use water dressing -vary with Black \"lash. 15th. The ulcer prep uce is healing one upon glaus ap pears to be kept in a state o:f irritation from erections Cont treat .and at night to have Pulv. Opii gri with a cold hip bath. 17th. Was again placed upon Hydr. Corros. Chld. gr 1/8 ter in die -This was continued for a few days and then discontinued, to be resumed once or twice afterwards, at intervals-Argent Nitrate-Blac k '.'!ash Lig. cupi. Sulph. and astringent Lotions wer e suqessively used u pon -The one on prepuce healed rapidly, whilst that upon the glaus was v ery slow in cicatrizing, evidently from frequent distention of the organ. The mercury did not appear to have any influence in pro moting the cure. Mar. 23rd. Discharged t o ligh t dutyexcept a min ute point upon glaus, which soon, entirely healed up. MARCH 185'7, This month was also passed by us in the Harbor o f H ong Kong W e were absent for a couple of days, at on e time, searching for a missing boat with its crew, from an Ameri c a n Ship w hich had been wre c ked upon the Prates S hoal. W e were unsuccessful in our search, but the sea air and novelty n o doubt exercized a favorable mnfluence upon the h ealth of the ship's com pany The weather continued p leasant until. the close of the month when the first indications of the approaching change of m onsoon: ) egan to exhibit thems elves in clouds, and most of t h ose -6'7-

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admitted upon the were affected with local diseases of suffered in consequence of their own imprudence. All of our invalids who had been condemned in December and February, as well as the old case we received from the "Levant" whilst in Shanghae last fall, were sent over to Manila in the early part of this month, to be thence conveyed to the United States During their passage to the former port in the "Levant", small Pox made its appearance on board this ship, and Brown, having contracted the disease, was not able in consequence to accompany the rest home from Manila. He recovered from the attack, however, and a passage was subsequently obtained for him in a M erchantman from Shanghi. April, 1857. This month is so barren of or change of any sort, that my summary must be exceeding l y Where March left us, riding at our anchor, there May found us. The Southern M onsoon fairly set in, and showers became the rule of weather; a blue sky the exception. The health of the crew continued very fair: the increase during the last few days of the month being due to a "Liberty" which the men were allowed at thi s time. It has been a source of unceasing S!ll1>rise to me that some other than the old system of giving liberty to men-of-wars men has not been adopted. Independently of those higher considerations which should actuate the conduct of every man to his fellows, and especially when placed in a position so nowerful for the promotion of moral good, or the reverse, it strike s m e that the desire fQr efficiency, in the Naval sense of the word, would prompt those in authority to alter the present system: The life of a sailor is, under its most favorable aspects, trying and wearing enough to the moral, as well as physical, constitution of a man. But when hundreds of individuals, brought by the very degradation of their moral natures to the position in w hich they are found, are crowded together within these wooden walls for month after month, without even the shortest interval of relaxation, it is not surprising that, whilst cut off from amusement or grat:ification from without, those ungovernable passions which have mastered him so long, should terop t t he sailor to misdeme.anors and crimes more degrading' and more sinful than those which would result, from the same nature, with a reasonable amount of freedom. And, when, und e r these circumstances, he is allowed a few hours on shore, 1 t is not at all surprising thathe should give so unbridled a rein to passion and as to debase him, often below the beastliest beast, and to bring upon his calling that stigma of degradation which the world evar attaches to the name of a sailor. When circumstances do not, unavoidably prevent it, men should be given liberty oftener than is now done: say once in every two months. But they should not be sent on shore in large as is now the case, one third or one half, of a large ship's com pany being allowed to go together. A better plan would be to let -68-

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them go by Messes Say two or three Messes of a dozen each, every day or two and constant rotation might be kept up, in this manner, so long as the vessel was in port. All, however, should not be allowed to partake of this privilege equally. Those who overstayed their time, or misbehaved whilst on shore, could be kept back when their next turn came around -or as often as might be deemed proper. This would give an incentive to correct conduct, much more persuasive to the sailor than any abstract principle of morality. It would be found I think, also, that under this system, the madness to get ashore would wear away, that many would soon tire of availing themselves of the privelge and be quite indifferent when their turn came around. May, 1857. Again we have been in port during the intire month -our position, close in under the island of Hong Kong, being one which cut us off, almost entirely, from the prevailing winds of this season, we moved over upon the opposite side of the harbor, next the mainland, and found the change both agreeable and salubrious. The English residents of Hong Kong appreciate this change during the summer months so highly, that they have hulks in which many of them reside at this season, and the Ward Hospital, which is an old line-of-battle ship anchored well out from under cover of the land, so as to get the benefit of the South West Monsoon, is considered preferable to the Military Hos pital which is on shore -It blew pretty heavily shortly after we went over, and the Captain, being a little fearful of a shore which was rather close under our lea, ordered steam to be gotten up, and this was kept on for some hours. I mention this fact, because I consider it not without beneficial effect to have the foul and stagnant air below, driven out by this means. We had several serious cases of Pysenteria as well as Remittent Fever during this month; as also, a good many cases of Syphilis: and one of Suicidal Mania. A Portuguese whom we had picked up at Maderia, and who had been more or less an invalid for several months, attempted to cut his throat whilst at the hospital. He succeeded only in making a moderate gash,.without wounding any important parts, and the wound healed without much difficulty. This condition, except in the healing of the wound, did not improve. He suffered, more or less constantly from the Diarrhoea for which he had been under treatment previous to the appearance of the mental disease; and the latter did not disappear.--For the after history of this case, see summary for the months, of this year, during which the ship was at Shanghae. -69-

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i .TUN 11 TO OCTOBt:;;R 1 85 7 H CLUSIVE Upon the 15th o f June the "San J acinto11 left Hong Kong for Shang hae at which latter place she remai ned nearly five months, and did no t return to H until the middle of N ov e ber. The summary of meterological observations end sick given above Tias abstracted b y me from the nLog" and edical Journal, after he r return. The notice of deaths etc. that occurred during her abse nc e will b e made in the remarks for Kovember During this p eriod I was myself living in Hong Kong, having been left in charge o f the temporary Hospit a l which had been established at the latt e r p l a ce -ot having instruments, I kep t no record o f the weather etc. during the months I lived on shore. The number o f patients under my char@9 was not amounting at a n y one time to more t han fourt een or fifteen. T he majority o f t h ese were cases of Dys enteria a nd D i arrh oea, though I also had seve ral of chronic Rheumatis two or three of Scrofula, on e o f Ulc e r o f Cornea e nd one of Erys ipelas -besides several of wounds and injuries. Of tha cases of Dysen t e r y thre e diedtwo c hronic and the third an acute case develope d at the Hospital, i n the p erson o f the Serg:;ant of the Marine Guard whi c h had been left \ 7 i t h m e for police duty; of the remainder, a ortion were invali ded and s ent home, and the rest returned to duty on board their resp ective ships. But, so far as my knowle g e of the i r after history extends, I f eel warranted in asserting that t h ere was n o t a single entire and permanent cure. And I may add t hat I have n eve r kno'Vn an instance of recovery froiu Chronic upon t his tation, as l o ng as the individual remained exposed to the climate in which the disease had originated. One case of acute also t erminated f t llythe patient was a stout f l orid young m an a seaman from the 11Levant11 He h ad been suffering for several day s before bein g brought to t h H os pital with the usual of inflammatory R heumatism; th disease exhibiting itself locally in one kn e e specially. Three or four day s aft e r c oming under my cha rge the pain in the kne e suddenly subsided, and almost entirel y disap pear e d ; small and irregular ulse, feeble and f l u ttering action of heert, w i t 1 increased dullness of percussion over precordial region, oppres sed b r eathin g ana p i n c h -ed anxious counte nanc e c omin g on at t h e same time. He g rew r a pidly worse and died in fiftJ e i gh t hours after, evidently from inflemmation of membranes o f the heart. The case of phlegmonous Ersupe las was int e r esti n from one o r two p e culiar results. Th e patient was a S eaman f rom the n1, 1innesota11, a quiet yo un g Swede h o was believed t o have enjoyed goo d health, both of mind and bod., whilst on board ship, up to t he eriod of the attack lmost the whole of t h e ri h t arm -79-

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t?Jld become involved in the diseas e S-T'ld there was profuse suppera tion, as well as extensive sloughing both o f the skin and subcutaneous cellular tissu e s This man exhibited symptoms of cerebral disturbance from the first day that he came under my charge he had already been sick some weeks and by the time that his arm was fully h ealed h e was so decidely insane that he was condemned b y Jiedical Survey as mentall y unsound, and s ent to United States The only case in t he Hospita l at t he time t his man 'i/aS brought there, of a n open wound 11es the man Melvin who injured a t the Barrier Forts, and whose case will b e gi yen at length. The ward was large and well ventilated and at JBast fifty feet intervened between the beds of these t v w The Marine was moving about on crutc he s and rna, have been to the bedside of the man with once or tTiice. The former contracted the disease in three or four day s after the admission o f t he ]at ter, and suffered seve r ely: t he skin o f the whole thigh and leg t aking on en erythem a tous i n flammation extending from t h e fistulous orifice u p on t he outer side o f the t h j.gh as a radiating centre The inflammation did not become phlegruninous i n his case howev e r I a ppend two or t h r e e cases from those whi c h were under my charge in t ne Hospital. r OVN\il3E.R 185 7 Upo n the 1 5 t h of l 'ovember, just five months a f t e r he r de parture from Hon g Kong the ''San Jacinto" again made her appearance and anchored off the Hosp i tal' he had suffered severely during her a b s ence, and sickness and death had weakened her crew The summe r in no1th srn China had p r oved v ery dry and ho t a nd B o wel Disea s e s prevailed extensively on board at one time. T h e immense alluvial plains around Shanghae, and impure water of the river, had no t b een without their influenc e too, in producing mi asmatic diseas e F o u r men had died during he r absence: three from D y s entery and one from c h ronic Diarrh o e a The latter Manual Olivera, a Bandsman, was t he Sa.t!B individual who atter p ted to commit suicide t he spring previous. These four added to the two cases from the ship w ho died at the Hospita l make a total of six deaths within a spac e o f six months a l most one in forty of the entire ship' s compl emen t Our ship was anchore'd at Hong K on g during all of t h i s month. We had little rain, and t he range of the t he r m ornente r be tVl(:Jen 6 2 and 79 will show that the temperature was a most pleasant one. T h e principal a ccession s to our List during the mon t h were cases o f G onorrhoea nd yphilis, consequent a "Liberty". Upo n t he 31st we r e c eived s e v eral patients from our t ern_ cra r y on shor e it being broken u p at t his tim e by 71 -

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order of the CorJander in Chief. ':le lost on e case during the month: an old quartermaster wh o had been suffering with D iarrhoea and gen e r a l Dropsy sinc e the shi p w s at Shanghae. .Thilst on shore in this condition he indu l ged considerably in drink; a f t .,.rwards was to a chilling wind in st nding his night watc h : had a violent chill: Jas soon take n with symptoms o f pul monary hemorrhag e and expired in a very few hours. In the earl y part of Decem ber the 11Levant" saiJe d for home. Besides a c onsiderabJe numb e r of invalids of her own crew, s even from the "Portsmouth" amon g them :Melvin, the r arine with the compound fracture of the t h igh, were transferred to bar for conveyance to the United States. T h e 11Minne s ota'' also sent several. As t he impression prevailed a t tJlat time that the "San Jacinto would leave f o r the sam e destination in a v e r y short tim e afte r t he "Levant", nore o f the invalids from our ship were transferred to the latter vessel; wit h the exception o f one old man suffering wi t h chronic diarrhoea, who was allo wed t o go at his own urgent request, ( 'r he cases for the latter pi'irt o f the Cruise I he.v e not been able to c op y into t he J ournal yet. R F. Daniel.) JANUARY, 1 8 5 8 .Almost the who l e month of January was as disag r e eaple as unwholesome. Cloudy-bleak, ith frequent rains -kept us in a c onstant state of discomfort, and, v e r y naturally, produced quite an e pidemic of catarrhs. There were also several case s of Intermitt::Jnt, almost without exc e ption, in individuals who had previously suff ered with the same disease whilst t he ship was at hanghae last slli:liiler and fall. here were scarc e an.: new case s of B owel disease: t hose u pon the List bein g mostly c hronic. U had s evera l admissions o f primary S philis as w ell as two o r three of secondary. This disease was a much more troublesome as well as s erious ; affection t o treat et t his stag e o f t h e C r uise during the first twelve o r e i ghteen months, Uhancres are more indis.osed t o reul, and more apt t o a ssQme a pha gedenic charact r Larg e and ugly occasionally result from bubo now whi c h was never the case until latel y -Constitutional svmptoms also mak8 their appearance more frequently. I c a n only attribute t h i s unfavorabl e chang e in the char acte r of the disease to t hose causes w h i c h have o pe rs.ted to lower t he standard o f health in the Crew Diet, confi nement, foul air, mel arious influences a n d c o ntinued exposure t o damp and rain may b e enum e r ated among the s e Producing dera n nent, and i mper fectness in t h e digc:sti ve organs and assi milative pro cesses: this, together with the absorptio n of Mala rice bri ngin g about anaemic action. T h e climate i s p eculiarl y f avorable t o t he de v elopmen t -72-

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9 f rheumatic af'f ctions also, and this ma;y have had som.ethin to do with the nw n b o r o f men who had been trea ted for Primary Syphilis complaining of Rheumatic symptoms Those who suffered in this way, howe v 1, were, alm ost without exception, amon g suc h as had been treated with mercury, eithe r for a former attack of Syphilis, or for some other disease. The result of my e xperi ence has been, tha t the average period required for curing Syphilis with t he non-mercurial treatment is considerably long 3 r than when that mi neral is but secondary sympt oms are less a p t to supervene. v hat I mea n by non-mercurial-treatru::nt in the primary diseas0 is, cauteries and c o olin g dressings loca llyperhaps a few leeche s with gentle laxative s and anodyn e s a s occasion r e quires. I shall endeavor, at the c lose to c ollect togethe r all t he casa s o f syphilis treated during the cruise to which I may add a comparative exhibit o f the different modes of treatment and t heir results. Upon the 2 8th Francis :Garrett or (Ganetty ) die d aft;;-:r a protracted illness. -He was a man o f sorre t hirt y or t h i rty five years of age. He had suffered with bowe l d isease for several months, and especially Vihilst the ship vras at uhan ghae. Last fall he became dropsical, and the diarrhoea was checked at once. The effusion slowl y accwnulated and befo:re he cUed of the oppr9 ssion of his lung s and heart fro m this cause g a v e him extreme suff ering T h e urine was h i g h l y albuminous in t h i s case. T h e charge of the Medical Department o f the shi p devolved u p on rns at t he close of this montr.., b y the departure of the Fleet Surgeon, D r ,ood, for t he United S tates, i n co mpany uith C orum. Jrmstrong The latte r transferred the command of the q u adran to Com. J Tatnall, who iril.rooa.iately h oisted h i s broad pennant on board the 1 1 'an Jacinto". F:::BROARY, 1858 The Hospita l having been temporarily reeste.blished at Hong Kon g b y order of Com. Tatnall, some five or s i x o f our r0.ost s erious cases of D:sentery and chronic R h e umatism were transferred to it. We were about to g o . to sea, and t heir discomforts and priv tio n s on board ship would have been g reatly increase d by suc h a c hang e .We left Hong K on g u pon t he 7th for 1\:le..nila, where we anchored u pon the morning of the 11th, after a pJe asant run of som e thin g o ve r three days This c hange from the cold dmp f o g s and gloomy s kies so prevalent along the Coast o f China at this season, to the -73-

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balmy air and bri ght sky o f Luzon w a s most delightful, as we'll as beneficial to all o f us. T he revailing breezes from Zast and North East, c ame directly across from the broad Pacific, and moderated t h e rays o f a sun that otherw i s e m ight have been o ppressive. Th e ric hne s s and v ariety o f natural sce ne r y -the people -the amus e m e nts a n d above all, the civilizationc o m b i n e d to r ander t his change most beneficial to us, a s w ell morally as ph, :sically. I have neg lected to mention, i n a previous o f this Journal, that wbilst our ship is lying in any of the Chinese Ports w e usually employed a Fast Boat -In othe r words, a Chinese p a ssenger b oat was hired for the use o f t he 'hips, s erving to convey officers to and from shore, g o on messag B s and do man y other thing s to save our own men from bein g exp osed, W hilst at Ivlanila, Vl8 were de prived o f t bis convenienc e and had t o use our o w n b oats in 60ing on shore. As w e were l y ing some two or thre e from the landing our crew were a t tim e s conside r ably exp osed to the sun; but they were protected, as much as p o ssible, b y a wnings a n o suffer e d no ill 'Jhilst he r e duri n g t h e latter part o f the m on t h t he men were allowed ,Lib erty T h ere was c o 1parativel y f ew iD1111ediate a ccessions to the list from t his cause. 0 T e had, ho r 1eve r one despe r te case o f pulmonar:v apoplexy and pneumonia, in an old hard Drinking Sailor 'l'h, a t A ."
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Upon the 17th we left Kong for Shanghae, and came t o an !=ffiChor off the latter p l ace u pon t h e 26 t h a f t o r a most uncom fortable and boistarous passage. 'I'h e strong :Forth :Cast mons o o n forcing'u s t o g o u p outside of Formosa. The c onsequence of all this was an supp l y o f C atarrhs, Intermittent Fever and R h eumatism After we had been at sea under steam for seve r a l days, as under such circurnstances, a numb e r of fire rn.en and coal heavers re,.orted wit h gastri c irritation and o b stinate t he cause being the and frequent d raughts ofwater taken into t he stomach and t he profuse actio n of the cutaneous surface. Our list Tias also increased, whil we were in Hong T on g b y the r erurn on board of t hose patients whom w e had sent to the B.ospite.l previous t o our for Manil a The C aru.r:odore had ordered the Hos p ital t o b e again broken up and the sic k were being returned to their respective s h i p s O n e of those we left, Patrick runty liarine, affected vvi t h c hronic dysentery, had died during our a bsence, There was one most p e c ular and distressing c a s e at the Hospital, which, from its nature and condition coul d no t be taken on board s hip, except under the most urgent nece ssit y This was a lad b y the narre of Wentworth who had been left at the Hospital b y the f Portsmouthtt when she wen t ov o r to and there transferred b her to. t he b ooks of t he "San Jacinto" when the 11P11 sailed for t he United otat e s This boy c arre out to China in the clipper s h i p C hiloe", during the sum_mer o f 57 ; and s h ipped on board the "Portsmou th11 in October last. When he wa s taken sick I c a nno t f ind out, and know nothing of his c ondition prior to the time whe n he was sent t o the Hos pita l A t that time, Dr. who was in charge on shore, re ports that the boy had com p l ete paralysis o f bo t h inferior ex tremiti e s with od ema of the paralized parts, and inv o luntary discharge o f t he faece s and urine. 'fte r he had been in the Hospital a s_wrt time, mortification and s loughi n g o f t he nat e s and heels took place and at t his time, the m iddle of l\ larc h was making its appearanc e in two or three points along t he thighs and legs, .A Survey was held u pon the case, and its condition a s well a s the imp r actability o f taking such a patient on board the "San Jacintott, strongl y represented to the C ommodore. He ordered that the boy should b e placed in ea.man s Hospital at Hong Kong ( a Civil Institution) The case was at t his time looked upon a s perfe c t l y h o pe less, and i t was not believed he co uld hold out much longer. --F o r t he issue o f t his case, see June of t his year. -75-

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APRIL, 1858. T h e r a p i d c hanges, first from the climate of M anila t o t he chilling d ampn ess of Hon::, Kong and s hortly a f t e r w ards to t h e s earching rawness of earl y s pring i n Northern China, very naturally exercised a n injurious influence u pon t he health o r our ship's company T h e chan ge s were f elt most sensibly by those w h o had lost treir vigor, and beco m e e.en e mic fro m rep e ated attack s of B owel Diseas e o rFever. h euro.e.tism also exhibite d itself in sev eral, principally in individual s who had suffer e d from yphilis V e had s carce l y a f air day whilst at S hanghae and were all most agr eeab l y disap pointed to leave t here u pon t he 6 t h of the month; not for the Guif of Pitchile as we h a d gloomily anticipated but for Hong K on g t here to a wait our r elief T h e f i e l d s along t he banks of t h e river below h a n ghae a s v1e passed down were b e ginni n g to look green, and t h e fruit trees wer e in full but, a t tl::e sarn.e tirn:3, t he air was so t houghly dam p t he.t one was kept c onsta ntly chil1ed. stopped near the "Minnesota11 for a n hom or t w o and received t h r e e Invalids w ho h ad b e e n informally c o n dem n e d and were s ent on board t h e t'San Jacinto" t o b e conveye d to t h e United S t a t e s N o inf'ormc..tion for guidance o r notice o f any k ind to t he medical o f'ficers of our s h i p were received f rom the .. on o f the "IVI" It w a s not until t h e men had been on bo ard an hour or two, tha t I wa s aware o f t his acce ssion t o our Sick List, and the ver"J7 t:J.eagre and accou..llt whi c h I h a ve been able to obtain o f their previous symptoms as \'IElll as treatment, was srotten from the patients t hemselve s ne of t he m was a Fire man who had rec eived an injury t o h i s h e a d from a p i e c e of w ood which fel l t hroug h t he R oom hatch There o n l y a slig h t and im perfectly mar e d cicatrix r emaining u p o n t h e s c alp; he app eared dull a nd sim p l e : p artial pa r a l ysis of face u pon t h e sid e o p posite to that o n whi c h t h e inju r y h a d been r e ceived: b owels c o n s tantly torpid: sle eps a g r e a t d ee.l: a n d has imperfect use o f t he inferior extremities Another w a n a c oal he aver, sufferin g with Chroni"c heumatism and l a r g e n o de s upon both tibias. He s a y s that he h a d dyphilis some four year s a go, and VJ.-s tNated with m ercury for it. T h e t hird w a s a eaman laboring under chronic ysentery. He was much r e d u c e d ; very f eeble a n d required ill1ID9d i a t e a ttention. iJe f ound t h e 11eathe r a t H on g Kong quite sumrn.erlike a n d ( p a g e t orn out h ere) -76-

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1-IA.Y, 1858. was a happy month for us; after having passed two years u._po n the Statio n and subjected, i n a pe culiar manner t_o all the injurious influences of the climate, we were at last permitted to turn our backs upo n China and Chinese, and commenc e the long, long voy a ge which,if happil y t erminated, woul d bring us to our country and homes once more Upon the 1st o f the month the G e rmantown" arrived at Vfhe.mpo a and the Commodore, leaving the latte r at t h a t p l a ce returned in the ltSa n Jacinto". to H on g K ong Anothe r contribution to our already numerous list o f sick was made by the "Gtt -before we parted from her. One was an old seaman with chronic Rheumatism: pro bab l y not his first a ttack s e c ond was an o Seam., suffering wi t h P t hisis Pulmonalis: cou gh emanation and soft ening. The t hird was an apprentice boy who appeared to be afflicted wit h some nervou s disorder, He s eemed v ery aenemic; somewhat emaciated pa l pita t i on s upon any exertion; frequently slight v ertig o and tightness across p r ecordial region, which every week or ten d a s become greatly aggravted, and bring on a paro xy s m of p a i n and spasm, quick and f eeble pulse, hurried respiration a n d cool moist s kin: t his condition lasting for fifteen or twenty minutes, and r elieved for the time by sti mulan t s T h e bowels are obstinately. and persistently torpid. There are n o proofs o f vicious habits, but I strongly suS pct them After having impatiently waited at Hong Kong t hrough another fortnight of such disagreeable weather as alway s att e nd s the c hange of monsoon we wer e at las t upon the 12th o f the month, gladden e d by the s i.ght of the P owhatan. T h e ne cessary chan ge s and arrangements having been completed as soon as p ossibl e upon the afternoon of the 14th we bade a final adieu to H on g K orig an d f airly started upon our home: our destination being Batavia. Before leaving ho?ev e r w e recei ved s ome further contributions t o our already crowded H ospit a l Fou r men, c ondemned for being un f _it f o r fartbsr duty -u p on the Station, were turned ov e r to us from the 11P o w hate.n" T h e first o f these, l:ITichol, was a fireman affected with chronic Inflamm ation of t h e live r : his case i s more fully reported in Jul y for t his year T he e econd case ruvier, was a Bpatswai n s Iv1a t e afflicted with a curious aff ection o f the tarsal bon e s o f the right foo t ; togethe r with a supious inflammation o f t he contiguous cutaneous surfac e Th ere were be sides, in this individual, decided scorbutic symptoms This case will be found in August for t his year. 'l'h e third, Chand ler, a : Marine, a ppeared to be suffering with a neure.l gic affection of the head, tog-ether with sanE cerebral irritatj_ o n He had suffered with an attack o f Insolatice a short time p revious a further notic e o f this case will be found i 1 June for t h i s year. The fourtr h a Corporal of Marines, was mere l y c ond emned from a -77-

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distortion of the meta -tarsophalangpd j oint of the great toe, which might incapacitate him from performing some of the active duties his p o s ition,. He did duty while on our ship. W e were also necessitated, by orde r of the Commodore, to t ake on board the bo y -,rentworth, with paraplegia, who had been b equeathed to us b y the "Portsmouth" before our departure for t..lle United States. M uch to the surprise of all, he had linred on, and was now, upon t h e whole in a rathe r more comfort able condition than when first s ent to t h e Seaman's Hospital: Tho essentially there was no improveF.ent, and no h ope existed of his ultimate recovery T he Commodore dete rmined ho v ever, that he could not longer put the Government to any extra expense with the boy and as we were ab out to s ail for the United States and the boy 1 s name was u pon t h e boo ks o f our s hip, we were obliged to take him on board Under the most favorable circumsta nce as it could not have been expected he co uld linger more t han t w o or tlLT'8e months: and when subjected to the inconveniences, deprivations and exposure s which wera unavoidable on board a ship, and especially upon one with s u c h arran gements as ours, my own convictio n t hat a few d ay s -or w ee k s at most -would bring the case to a fata l issue, were fully verified: as may b e seen i n t he sBstch of it -in June, I have neg l ected to mention that the Commodore seemed seriousl y b e n t at on e time, upon s ending our ship h ome b y the w a y o f I.:uska t But representations o f the v e r y injurious effects w hich this route would hav e upon the Sanitary con dition of our ship having b een m a d e to him the idea was a b andone d 1:.fe had a p l easant an d rapid run d o w n tJ:1.e China Sea and anc hored in Batavia R oads upon the evening of the 2 4th. Five days were p a s s ed v e r y agreeably at t his port, and, he.vin g filled up with Coal and filtered wat e r a s well a s taken on board such fresh provisions as could be obtained, we left upon the afternoon of the 2 9th, and in twenty four h ours after, wer e past the Straits of S unda and fairly away acros s the Indian Ocean for the C ape. Our sick List w a s larg e during the whol e month, but incre ased e a c h time a day or t w o a f t e r getting to Sea. These a dditions w e r e principally cases of Fever or Chronic R heumatism and in such as ha d previously s u f fered fro m these affections whilst on the Station. W e i t healthy at Batavia, thou gh of co urse, it was necess to guard as much a s practicable a gainst being exposed to the direct rays of S o tropical a S un JUNE 185 8 Sailing, as we were, during almost this entire month across the breadth of the Indian Ocean and in Latitude s which afforded Steady Trade wind, and a greea b l a temp erature; the days @enerally -'78-

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-clear and pleasant, and the nights cool; with no steaming or annoying work for the men; one might have presumed that the health of our ship's company would, a t all events, ha v e improved, if it did not become positively z; o od under the circum stances! But indepe nd ently of two deaths which occurred from special and not general causes, we had a larg e Sick List and a greater number o f erious cases under t reatment in t h i s month than ever before during the cruise. Tis true our invalid passengers h e l ped to make out tre long list, but the above fact will h old good without including them at all. A large proportion of the admission s were Intermittent and Remittant Fevers, almost withou t exce ption, in the same individual s who had suff ered previouslyfro m t hese aff e c t i ons : and I repeat the o bservation which was made in the summary for the last month that I h ave no t i ced, upon the ship's first going to Sea end especially after having been in port for some time -that these affections are v ery apt to return u p on the sufferers in this way. There were also several cases of Bowel Disease admitted. I noticed a dec i ded a ggravation of symptoms in many of the old case s of this disease which were under treatm::m t : in a l most all, the Live r a ppeared more or less involved, and in some p rominently so T h i s was also the case in t h e individuals admitted u pon the list as t 1Dyspepsia": and t w o or three cases of decided Hepatic in flanmation presented themselves F ood end water, c hange of air and temp erature probably all contributed towar ds bringing abo u t this state of things. One of the deaths was the boy W entworth, affected with paraplegia, a n d t he other, was a Case of Dilirium Tremen s complicated with Insolatio Both exe detailed below The Captain, in h i s desire to expedite our home wards as muc h as poss i ble, and avoid the necessity of making a p ort oftener than p o ssible ordered that one of our coppe r b o i lers (holding some thirteen t housand gallons) should be filled with fresh water before we left Batavia -'I'he inner surface of the boile r was so coated with Sea S alts which had been deposited u p o n its surfac e that no injurious cons equences could have r e sulted from corrosion of the met a l but, aft e r a day or two of motion at sea, the mter became so foul fran soluble matter contained in t he boiler, such as ve getable dep osits f rom river water, and dung thrown in to calk the s eams that the water becaw2 useless and was pumped overboard. Upon the 2 9th we anchored at S imon s Bay, Cape of G o o d and f elt qui t e ready t o avail ourselves o f t he o p p ortunity to eat fresh foo d end walk u p o n the land for a few days his bein g t h e i r col6. a 3a son we found it r a ther u lplet:santl cool t o us who had been so l on g a ccusto ed t o the Tropics. 79 -

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J.ULY, 1858 .If the number of sick during June was unusually large, this exhibits a still farther increase; end the continued aug mentation of our sick list during its first thra e fourths, almost t empted m e to believe t hat no change of air would give health to our worn people. During the last few days of the month, ho,,vever there was a c hange in t he prospect. New case s stopped reporting, and the old ones exhibited a decided disposition to im prove: except, indeed a few of the old invalids, who just managed to keen from getting much worse -and that was aJ.l Dyspepsi. a in the broadest and most comprehensive signification of the word, would have embraced four out of five of all the cases we had been called upon to treat, since we had beencaJ.Jed upon to treat, since leaving the Straits of S u.nda ''ihether owing to the fact of being compelled to live altoge ther upon salt provisions, after having had the digestive organs impaired in China, or that the rapid change from a warm moist climate t o tha t w hich VJas comparatively co}.d, had a tendenc'y to produc congestion, with diminished secre.tion in the liver, I know not-probably a combination of both these causesA t all events, this organ appeared to suffe r prominate l y Inability to assimilate. properly a ny kind of ailment ----torpidity o f' the bowels -or diarrhoea with thin chalky stools -pain and fullness, with some enlarge ment frequently, of the :).iv e r -and the wa.11t of vigor or energy to mind or body were some of the chief s ympt oms in these cases -severa l o f our erew who were amongst t ho strongest and healthiest up to this time, and who had enjoye d at JB ast moderate health while upon the .Station, were affected i n t his way. We rernaire d at S imon 1 s Town some nine or t e n day s and did not start upon our h omeward route again until the afternoon o f the ninth. Our men were allowed "Liberty" whilst we were at t his p lace, and I 'had considerable satisfaction in the reflection, that i n all probability it wa s the last scene o f this kind I should hav e to e n counter, a t J.s ast f' or some time to come Several contusions, and a case of f r actio n of t he Radius were the immediate consequences. :ve arrived at S t F..elene upon the 20th and remai.n9 d forty eight hours. Just before leav. n g the latter p l a c e I discovered a case o f Varioloid on board, in one of our Fireman. re had been complaining of.fever for two or three day s but as he had been affected with Intermittent previously, and such cases YJere so common at this time, I p aid no particular attention to him, until, upon the morning of the 22nd, I discovered a w ell marked crop o f pimple s ov e r head, face and upper extremities, '.Which 89-

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:(rom appearances and the history of the case, there was little doubt of being modified Variola The man had been over to Cape 'rown whilst upon liberty, and had slept in a house where they had had small pox .About ten days after this he had b3 en taken with a chill -fever -violent pain in back c o n gestion of eyes etc, and, upon the third day after, exhibited a papulous eruption upon bead and face end extending to the limbs-with, at the same time, of the fever. He was a German and had beert v accinated. in .i'..Urope when a child As w e had ob tained "Patique 11 at St. Helena with this disease actually_ on board; (though ourselves not aware of the fact), we got to sea as soon as possible. Having no vaccine virus except some which had been broug h t outwith us from the United 'tates, and was worthless, I suggested we might touc h at Ascension, which was scarcely out of our direct route homeward and endeavor to o btain some This v7B did, but were not successful in procuring any mat t e r and had no reasonable alternative but to take our chance for the run of thirty or thirty five days, which was between us and r Tew York, without any protection of this sort a gainst t .e s p r ead of the disease. The man had been immediately r er oved t o t h e Spar Deck, and his cot in the Launch, some feet abov e the leve l of the deck. Two men who had unmistakabl e signs o f having had bmall pox were detailed to wait upon him, end cut off from the rest of the ship, a s much as possible. .l).s soo n as we got into t he warm weather near the line Catarrhs became v ery pre valent. A UGUST 1858. The c alculations for this month are only made fro m the first tvrenty day s although we did not ge t in until the 24th. In t he hurry and bustle of our a:rriv a l and t he events connected wit h getting clear of the ship, I negl ecte d to fill u p m y tables to a late r date. 'fe had pleasant v 1eather most of t he t iine Found it somewhat warm i n steaming across the tropical calms but soon experienced a d elightful c hange i n the N Trades. T h i s continued until we were within a f e,, hundred mile s of New York, when the winds and weather bet:"nle more variable and t he morning we ran up 1\ew York Ba . : The wind was out froUJ. the north west en d it was ; _quit e cool e n o u gh so as to make an overcoat p l eas t Our sick list dtminished considerably during the Jast ten days or t\'iO w e eks. This w e s in a great measure owing to th3 cool and bracing atmosphere, and the near prospect of home, fre edom from the long endured restraints of s hip life, and amusernen ts on sho r e a l l J:T educing a real improvement in the re alth of the Crew : and r:a rtly too p erhaps, from the fear of being sent to the Hos pital upon the arrival o f the ship at her destination. -81,'/

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Our case o f Varioloid recovered, after a moderately severe o f t he disease; and V'lS were so blest \'li t h care and atten t ion upon our part, t o escape without having it to extend farther and, e.s no other cases made their a ppearance, we were enabled to avo i d being quarantined at New York. a considerable amount o f catarrhal affections, whic h still continued to report during t he first o f the month, there were s c a r c e l y any new cases of disease Not one of iarrhoea or Dysentery is reporte d altho u g h we s till had a good num b e r of old ones upon our hands and s me o f them dishearteningl y ob stinate. Of course, our sick remaining upon hand were cleared off t o the Hospita l as soo n as p ossible afte r our arrival. ',7 e sent e ight een invalids to the Na v e l Hospital, including a l l of those who came as passen09rs from the othe r Ships. Two or thre e o f these latter were quite well and had been upon duty f o r so!Jl3 weeks previous to our arrival: ever a l of our ovm men who really n eeded medical attention, preferred taking their discharge to being sent to the Hospita l T hare wa s one singular case amon g those discharged, an o ea man a n Irishman of' tvventy four or t wen t y five years of age, a v ery quiet man, who d LU'in g the firs t portion of the cruise, had been an industrious and healthy man, and s carcely eve r at the Sick Bay. Of late h owev e r he had been upon the list al.rnost all the time and wa s a most u nsatisfactor y case to treat. Com p laired o f various dyspeptic symptoms end d iarrhoea. 3 eemed often suspicious up o n being examined too close l y and moped a bout the ship withOut havin g muc h to do with t h e other !i en. I found, upon conversing with h i m o ne day, that r.e c onsidered h i m self very ill used, and that h e had been imp osed upon by both office r s and. men in the shi p H i s appearance and demeanor sugge sted that he might hav e been a ddicted to se l f abuse, but the manner in which he denied my accus tion almost made me discard the o pinion. Tl l o or three days before we got into York I was c alled out ha.stily a 'bou t eleven o 1 clocl{ in the morning to see him, a nc1 folmd he had a kn i f and deliberate l y cho pped off the f ourth finger of t he right hand at tll.e s econd joint. He gave no reason for t his, but appeared grateful for my attention in dressing it. refused to g o t o t he H o s pital, and as his t i m e had expired some t w o or three month s previousl y and there was no lega l proof o f his being unsound in h i s mind, we were compelled to let him g o : though I am v ery r:m c h j_nclined to be lieve he was partiall y insane. Upo n t he second day aft e r sending the sic k t o the Hospita l the men were permitted to leave the s h i p and the officers detached. 8 2 -

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90NCLUSION. Thus: after an absence from the United C>tates of thirty .four months, and after having been in almost thirty five, our Cruise in the "San Jacinto" was terminated. The tables above are in t ended to convey s o m e general idea of the amount and proportion of sickness and deaths which occurred on board; e.s well as the amount of some of the most common diseases, with the months in which they -.rere severally least prevalent, or .the r everse. The figures a ttached to "Daily Sick" will more a ccurately give an idea of the progressive increase in the average size of our sick list during the latter ::art of the Cruise than will the 11N umber o f Sick" or admissions to the List, in t h e list above. For .although t h e number of new cases taken Lmder treat men t during the second and third years d o e s not appear to have been so large as during the first; yet the g reat e r l e n g t h of tirre re quired for the treatment of many acute cases, togethe r v.rith the numb e r of chronic cases that accumulated upon our hands during the latter part of our stay in China, render the a gg regate number of daily prescriptions for 58 far g r eater than that eithe r for 56 or '?. It must be recollected, in comparing the different years, that the first c ontains tw elve months within a few days; the second full twelve months; and the t hird not quite eleven. During the first year, also, the shi p w & s at sea almost half of the time: during the second not more than fifteen or t wen t y days ; and during the third nearl y four month s Of the deaths b y disease, one was a case of Phthisis f Pulmonalia: on e Typh o li \ _Feve r : s even Dysentery and Diarrhoea: t w o congestions oi' the lung s : and one Dropsy. T h e p .ro portion of sickness and deaths from disease was g reater amon g the Marire s than in any other class o f the crew Of tho se condemned b y .:Jurvey, five wer e s ailors; t h r e e Fir G men ; three lv.arines ; and one a Lieutenant. Of t he deaths from accidents, one was by drowning ; and five killed at the Barri e r F orts. T h e c alculation o f percentage of d eatb.s to C.hips Co 1pany is based upon the latte r to be 2 5 5 i hich was about the avera@O numbe r T h e term B owel ff'ectionsn in the second tabl e is intended to include Diarrh oea, Dysentery and Cholera Morbus, The numb e r of simpl e Diarrhoeas l a r g e l y p redominated, but t hose which assumed a Dys enteric char acte r were, b far, the more serious; and most o f the deaths, as ;Jel l as chronic cases were of t his latter clas s Unless thE: d isease could be controlle d -83-

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within the first five or six weeks, it almost invLriabl y terminate d eithe r in death, or i n a c hronic c on dition which b a ffle d our every effort to produce a e rmanent cure. The t e rm "Caterrht1 as used here, is also a l oo s e one and coversall Bronc hial Infla.rowation s vrhich did not have decided Pneumonic or l euristic s y mptoms Tr.Jse a p pear lik e the B o w e l affections, to have been more prevalent during t he w arm damp season, than in the wint e r 1N i asmatic Fe vers" c omprehend Remittents and Intermittents many, partic u larly of the latter, are returns o f the disease in the same individuals. 'I'he origin of t h ese case s can, in ost instances, be traced to t he periods during which the ship was lying either in the Canton R iver or at S he.nghae Ve had of fevers, besides theset two cases of Typhoid, one o f Congestive and several o f Irritative. The 11Rhe umfl.tisms" were principally o f the subacute er Chronic f orms In four out o f five o f these, t he individuals had p reviousl y been afflicted with dyphilis. O f the cases of "Sy philis, 11 about one tenth were secondary or tertiary This disee.se in its primary form, was much more menagable during the first part of the Cruise were apt toassume an obstinate, ugly character, bub oes n o t so easily resolved, and when s upperatin g liab l e to de generate into sloughing sores, v ery difficult and tediou s to mana g e V e bad only two cases of contag i ous disease (independent of venereal a ffections) duri ng the Cruise: t h e one o f Psora, 8!l.d tre othe r of Varioloid The latte r was contracted at the C ape of G ood H ope upon our return to the United 5tates, and the particulars are given for July o f 1858 Upo n the who l e the latter mQnths of -u turnn appear to h ave been those during whi c h t h e h ealth of our ship was best: and the greatest amount o f sickness occurred during the summer months. This is v ery easily a ccounted for, esp e cially in a climat e lik e that o:f hina, where the conditions o f the atm o s ph e r e during t h e North East, and South ":'iest lVIonsoons, are de cidedl y d ifferent; the other is provocative of sickness end ill malih to the foreign population at all events. 84-