Yellow Fever in O'Brian's "The Commodore"

[damned_colonial]

I just read "Fever 1793" last week which is about Yellow Fever, and then this week I'm reading Patrick O'Brian's "The Commodore", part of the Aubrey-Maturin series, in which Stephen himself (the ship's surgeon) gets yellow fever from wandering around a river on an island off the west coast of Africa. (He thinks the cause is miasmata, incidentally, but of course it's spread by mosquitoes.)

Here's the scene from the book. Note the quotations which, knowing O'Brian, are from some period medical manual.



Two more cups did produce a laboured paragraph or two, but this was nothing like the happy spontaneous flow that had been running through his head the day before. A modest ball of coca-leaves (he was husbanding his store) scarcely helped his prose but after a while it did prompt him to go to his looking-glass and put out his tongue. Alas, it was scarlet, as he had half suspected; and his eyes, though bright, had a ferrety look round the edges, while his lips might have been rouged. He felt his pulse: quick and full. He took his bodily temperature with Fahrenheit's thermometer: a little above a hundred, scarcely more than the surrounding air. He reflected for a while and then went below, where he found Mr Smith rolling pills in the dispensary. 'Mr Smith,' he said, 'in Bridgetown I make no doubt you saw many cases of the yellow fever.'

'Oh yes, sir,' said Smith. 'It was our chief killer. The young officers looked to it for promotion. They called it the black vomit, or sometimes yellow jack.'

'Would you say that there was a facies febris markedly typical of the disease?'

'Yes indeed, sir: more so than in almost any other.'

'Then be so good as to come with me when you have finished that board of pills, till I bring you to a good light.'

No light could have been better than the open gun-port by which they stood, nor could any young medical man have been more convincing than Mr Smith. After he had looked at Stephen with the closest, most objective attention he quite naturally assumed the physician's liberty, raising his eyelids, desiring him to open his mouth, taking his carotid pulse, and asking the relevant personal questions. At length, looking very grave, he said 'With all the reserves due to my fallibility and relative inexperience, sir, I should say that with one exception you have all the characteristics of a patient in the first stadium of the yellow fever; but I pray I may be mistaken.'

'Thank you for your candour, Mr Smith: what is the exception?'

'The visible anxiety and the strongly-felt oppression about the praecordia, which has never been absent in any of the cases I have seen, and which, in Barbados, is held to be most significant.'

'Perhaps you have never examined a patient fortified by coca, that stoical plant,' said Stephen inwardly, and aloud 'In spite of that absence, Mr Smith, we will treat the indisposition as a case of nascent yellow fever, and I shall dose myself accordingly. Have we any calumba root left?'

'I doubt it, sir.'

'Then the radix serpentariae Virginianae will answer very well. I shall also take a large quantity of bark. And should the disease declare itself, Mr Smith, I formally direct that there should be no bleeding in this case, and no purging whatsoever: there is no plethora. As much warm water just tinged with coffee may be exhibited - as much as possible without gross discomfort. And sponging, mere sponging - no foolish affusion - would be beneficial at the height of the feverish stadium. Do you undertake to follow my direction, William Smith?'

'Yes, sir.' He was about to add something, but thought better of it.

'Otherwise, a dim light with what quiet a man-of-war at sea can provide, and my pouch of coca-leaves beside me is all I wish. In spite of the estimable Dr Lind and several others I do not believe the yellow fever to be infectious. But rather than distress my shipmates I shall live in my cabin on the orlop for the time being. The little booth is in moderately good order, but I should be obliged if you would have it swept to some extent - not swabbed and flogged more or less dry, but swept: for the great shining brown West African cockroach, though interesting as an individual, grows tiresome in large numbers; and I fear they are already breeding with us.'

'Very well, sir. I shall come back as soon as the cabin is ready and aired.'

Left to himself Stephen made his slow way to the empty wardroom and sat there beside the rudder-head, gazing astern; for though this deck was denied a stern-gallery it did possess a noble breadth of windows directly overhanging the white turmoil of the Bellona's wake - nothing more hypnotic, and for a while his mind sank into a familiar dreamy vagueness before returning to distinct sequential thought.

The yellow jack was indeed a killer: it was difficult to fix upon any satisfactory figure, though he had heard well authenticated accounts of a mortality amounting to eighty in a hundred. As for material affairs, he had made what Mr Lawrence described as a cast-iron will' before leaving England, with some very solid gentlemen as trustees to look after Diana, Brigid, Clarissa and the others: while as for the less tangible side, his experience as a physician had shown him that all other things being equal patients who gave in, either from terror or pain or a want of spirit, want of appetite for life, did not survive, whereas those with an urgent desire to live without the loss of so much as an hour - those with an enchanting daughter, an ample fortune, a collection of almost certainly unknown phanerogams. . . 'What is it?' he cried.

'Commodore's compliments, sir,' said a red-haired youngster, so young that he was still shedding teeth, 'and would be happy to see the Doctor at his leisure.'

'My duty to the Commodore,' replied Stephen mechanically, 'and shall wait upon him directly.' He sat on for a few minutes and then stood up, dusted himself, straightened his wig and neckcloth and slowly climbed the ladder to the quarterdeck and so aft, his knees feeling strangely weak.

'There you are, Stephen,' cried Jack, while Tom Pullings leapt to his feet and set him a chair, 'how good of you to come so soon. Tom and I wanted you to look over this statement of our proceedings since arriving on the station. Perhaps you could throw in some elegant turns of phrase. Mr Adams writes a capital hand, but he is no better than we are, at your elegant turn of phrase.'

'It is only a rough draft, Doctor,' said Tom.

Stephen read for a while. 'What do you mean by expediently?' he asked.'. . . proceeded as expediently as possible.'

'Why, as fast as ever we could sail,' said one; and 'Like expedition, you know,' said the other. 'With the greatest expedition.'

'If you do not like as fast as ever we could sail. . .' began Stephen.

'No,' said Tom. 'As fast as ever we could sail is low.'

'Then put with the utmost celerity,' said Stephen.

'Celerity. There's a word for you,' said Tom, smiling. 'How do you spell it, sir?' A pause. 'How do you. . . are you feeling quite well, sir?'

Startled, they both looked at him with great concern as he sat there gasping. Jack pulled the bell-line and to the answering Grimble he said 'Pass the word for the surgeon's mate. Tell Killick to ready cot, nightshirt, chamber-pot.'

Both assistant-surgeons reported within the minute, Killick only seconds later, and in the ensuing contention the faint Stephen, weak in body and will, was overwhelmed by kindly insistence. 'Infection be damned,' said the Commodore. 'I had a touch of the yellow jack in Jamaica when I was a boy: I was salted. Besides, it ain't infectious.'

'Doctor, you do look wholly pale,' said Tom Pullings. 'Fresh air is what you need, not the stink of bilge in the orlop.'

He was overwhelmed; and after a certain amount of activity and carefully moderated noise he found himself in his familiar cot, under the shaded poop skylight, with a jug of lukewarm water tinted with coffee in reach, and his coca-leaves. His fever was mounting: his pulse was firm and rapid, his breathing fast: a grateful waft of sea-air passed over his face: he settled himself to the coming trial.

The first Stadium: the opening day of the disease, the kindest, sees much dozing, though in spite of the moderately elevated animal heat the sensation of chill returns. At this time the tongue is moist, rough. The skin moist, with an often profuse sweating.

'Pray, Mr Smith, give me a brief account of the three stadia of this malady, and their separate events. And it would be as well if Mr Macaulay were to listen and to observe the symptoms as you name them,' said Stephen.

'Well, sir, this is the second day of the first stadium, and we may expect a diminution of the animal heat - increasing restlessness and jactitation. We shall find the urine cloudy, troubled, probably bloody - dark, in any event. And although the muscular pains and heavy sweats of yesterday diminish, the patient grows increasingly despondent.'

'It is very well, very valuable, that the patient should be told this. For, gentlemen, you are to consider that if he knows his sadness to be as who should say mechanical, a mere part of the disease, common to all sufferers from it, and not the reasoned outcome of the working of his own mind, still less the onset of melancholia or even the result of guilt, he is very much better armed against its attack.'

'Yes, sir,' said Smith. 'Pray show me your tongue. Exactly so. This is the second day, and the middle is brown. Should you like me to hold your shaving-glass, sir?'

'If you please.'

'Tomorrow the roughness and ill colour will abate. But I regret to say that tomorrow, the third day of the first stadium, will also see heavy vomiting and great weakness.'

The weakness is already strongly marked. Pray set the wineglass to my lips: I can scarcely raise it, much less keep it steady A party of seamen employed in setting up the foretopmast shrouds, loosened by the onset of the dry season, saw their midshipman reach out for a backstay and slide down on deck, presumably to go to the head. They relaxed, and one of the simpler hands, returning still again to the gossip of the ship, said 'So the Doctor would not let us go ashore for fear of the fever: and it's him has got the yellow jack, oh ha, ha, ha! He wouldn't let us go, and now he's got it himself: God love us.'

'You had better not tell that to Barret Bonden,' said another, 'or he'll serve you out like he served Dick Roe, as is laughing the other side of his face now. What face he has left.'

The second stadium: pulse weak and declining, but no fever, indeed, the bodily heat is less than the ordinary degree of warmth. Extreme restlessness and yellow suffusion of the eyes and person. Black vomit. Still greater despondency: prostration: delirium. This stadium lasts an indeterminate number of days before either ceasing entirely or merging with the third.

It was through this prostration and this delirium - a moderate delirium, apparently checked by the coca-leaves and nearer to a waking dream than to the raving of high fever - that Stephen was continuously aware of Jack, a comforting presence, moving quietly about the room, talking now and then in a low voice, giving him a drink, holding him up to be sick, and that in one of his many lucid intervals he heard a hand on the poop say 'Don't you breathe anywhere near the skylight, mate: surgeon lies just below, and the air that comes off of him is mortal. There is a tree in Java, which if you sleep under it, you wake up dead. This is much the same.'

'Killick says it ain't catching.'

'If it ain't catching why does the poor bugger take in the victuals at a run, holding his breath with a piece of charcoal in his mouth and then rush out, daubing his face with vinegar and Gregory's cordial, pale and trembling? Not catching, my arse. I seen ward after ward of them die in Kingston, till the very land-crabs was sick and tired of eating them up.'

The third stadium: pulse, though soft, becomes exceedingly small and unequal: the heat about the praecordia increases much, respiration becomes difficult with frequent sighs: the patient grows yet more anxious, and extremely restless: sweat flows from the face, neck and breast: deglutination becomes difficult, subsultus tendinum comes on, the patient picks the nap of his bedclothes. Coma may last eight, ten or twelve hours before death.

And then on another day - but how many between? - he heard the voices loud and clear, dreamlike clear: 'Loblolly-boy helped them to sponge him: says he had never seen a body so yellow: like a guinea all over, with purple spots. The doctors say if he don't look up in a couple of days they will put him over the side come Sunday, when church is rigged.'

Sunday came and went with no funeral, and on Tuesday Smith and Macaulay came and said 'Sir, we are now convinced you have avoided the third stadium. Your pulse, though still faint, is a delight to feel, so regular and true; your excrements a pleasure to inspect. The inner loss of blood has been negligible since Friday, and already your strength is returning: you can almost raise a half-filled glass; your voice reaches the sterngallery. It will be a long, long, very long while before you can roam the forest again, yet even so we feel that now we may properly congratulate you and give you joy of your recovery.'

'Give you joy, sir, give you joy of your recovery,' said Macaulay, and both gently shook his hand.

Comments

[al_zorra]

I remember reading those passages.

Yellow Jack was more responsible than anything else, except, perhaps, Toussaint, for the defeat of both the Napoleonic and Brit forces to restore San Domingue - Haiti to colonial and slave status.

It wiped out Memphis, U.S.A.

It devastated New Orleans every summer, see B. Hambley's Fever Season -- which then so weakened the populace it was easily prey to other equally lethal epidemics. Malaria was endemic to NO, as it was to all of the Gulf and the lower Atlantic coast as well. It wasn't only the heat that sent those in the Southern states who could afford the annual migration to the mountains and elsewhere every summer.

As we see from other novels published, such as Charles Brockden Brown's Arthur Mervyn; or Memoirs of the Year 1793 these Yellow Jack epidemics were not confined to the South either.

What frightens me (recall, I've lived in New Orleans and am very familiar with the Gulf from both sides of it, and Tulane was the first facility to seriously research tropical diseases and how to fight them -- see the Sinclair Lewis novel, Arrowsmith) is we're beginning to see the signs of these conditions return in these parts of the world due to the state of the health care racketeers and other criminals who hold this nation hostage. They have no interest in public health, but epidemics don't much pay attention to your rank either.